Metastatic bronchogenic carcinoma to the mandible

A case of a metastasis of adenocarcinoma of the lung to a secondary site in the mandible, in a 53-year-old woman, is presented. The patient complained of trismus, swelling and numbness over the left side of face for 8-weeks. Examination revealed limited left condylar mobility, a firm tender swelling the angle of the mandible and paresthesia of the left inferior alveolar nerve. Computed Tomography revealed an osteolytic lesion in the left angle and ascending ramal region suggestive of a malignant tumor. Her chest radiograph findings were of a diffuse homogenous opacification with ipsilateral pleural effusion pointing to a pneumonic process. Histology features were of moderately differentiated adenocarcinoma. A search for the primary included a bronchial biopsy which revealed, the primary lesion was from the lung. This rare case highlights the difficulty and challenges in making the diagnosis clinicians may encounter in establishing the primary site of metastatic disease. There is need to develop high index of suspicion with regards to metastasis to the Craniofacial and mandibular bones. Multidisciplinary team approach is recommended when dealing with such patients.Keywords: Bronchogenic Carcinoma, Metastasis, Mandibl

Factors Influencing Adoption of Emerging Technology of the Banking Sector of Kenya: A Case Study of Commercial Banks in Meru County

The general objective of this research was to find out the factors influencing adoption of emerging technology in the banking sector among Commercial Banks in Meru town. The objectives were to determine whether banking regulation, Competition, Security concerns, Management and cost   influences adoption of technology in the banking sector. The target population was 22 Branch managers, 22 IT managers and 22 Operational Managers. Research adopted descriptive research design methodology strategy so as to enable researcher to describe the state of affairs as they were. The data was analyzed using both quantitative data and qualitative data whereby, the quantitative data collected was analyzed by the use of descriptive statistics using SPSS version 22. Qualitative data was arranged into topics that were similar and was presented by use of narration and tables. Multiple Linear Regression analysis was used to show the relationship between the independent variables and the dependent variable and to test the hypotheses. Research revealed that there was a significant relationship between banking regulation and adoption of technology but there was no relationship between, security concerns, competitions, cost and management in banking sector. The study recommends banks should regularly respond to issues arising from banking regulations, competitions, security, cost and management on adoption of technology in order for their function to serve its purpose

Role of Feed Processing on Gut Health and Function in Pigs and Poultry: Conundrum of Optimal Particle Size and Hydrothermal Regimens

The aim is to give an overview of available literature data on the role of feed processing on gut health and function with specific focus on particle size and hydrothermal processing. In addition, influence of feed processing on efficacy of exogenous feed enzymes will be discussed. The current feed processing technologies are such that ingredient choices and diet form are refined to improve feed intake and nutrient utilization efficiency. Finer feed particle size enables optimal nutrient utilization and enhances animal performance due to increased surface area allowing better contact with digestive enzymes. Moreover, adequate diminution of feed ingredients is beneficial to feed manufacturing processes such as mixing and hydrothermal treatments including pelleting, extrusion, and expansion. However, emerging trends in consumer and regulatory demands for restriction or cessation of animal production practices such as use of antimicrobial growth promoters are challenging current approaches to feed processing. There is limit as to the fineness of the particle size, as very fine particles negatively affect gut health due to higher incidences of stomach ulceration in pigs and gizzard dysfunction in poultry. Coarse particle size increases stomach and hindgut acidification which may be beneficial in controlling proliferation of enteric pathogens such as salmonella and E. coli. Optimal particle size could be designed in the grinding process using roller or hammer mill. However, since most commercial pigs and poultry diets are subjected to hydrothermal processes, additional reduction of feed particle size is inevitable. The need to achieve high physical quality and to reduce potential levels of feed-borne pathogens such as Salmonella has led to the application of relatively high conditioning temperatures during conventional hydrothermal processes, a practice that does not favor high nutrient utilization and stability of heat sensitive feed additives such as feed enzymes. Therefore, with evolving pig and poultry production practices, the regimens for feed processing will no longer be appreciated only in terms of optimizing nutrients utilization, but also in terms of impact on feed hygienic status, efficacy of feed additives, animal health, and food safety

Clinical Outcomes of Colorectal Cancer in Kenya

Background The incidence of colorectal cancer in Africa is increasing. True data on clinical outcomes of the disease is hampered by follow up challenges. Method Follow up data of 233 patients treated for colorectal cancer between 2005 and 2010 at various Nairobi hospitals were evaluated. The primary outcome was mortality while secondary outcomes included recurrence rates, time to recurrence and the patient, disease and treatment factors associated with mortality and recurrence. Kaplan Meir charts were charted for survival trends. Results Half of the lesions were located in the rectum. There was no relationship between the sub-site location and recurrence and mortality. The mean follow-up period was 15.9 months. Overall recurrency and mortality rates were 37.5% and 29.4% respectively. Most recurrences occurred within one year of surgery. Recurrence was not influenced by age, gender, sub-site, chemotherapy receipt or presence of comorbidity. Factors significantly associated with mortality included the male gender ( p 0.04), presence of co-morbidity (p 0.029), recurrence (p 0.001), curative intent (p 0.01), disease stage (p 0.036) and receipt of chemotherapy ( p< 0.01). Conclusion Follow up of colorectal cancer patients is still challenging. The mortality and recurrence rates are high for the short follow up periods. Further studies are needed to explore the determinants of both survival and recurrences, especially with longer follow ups

Yeast derivatives as a source of bioactive components in animal nutrition: A brief review

With a long history of inclusion within livestock feeding programs, yeast and their respective derivatives are well-understood from a nutritional perspective. Originally used as sources of highly digestible protein in young animal rations in order to offset the use of conventional protein sources such as soybean and fish meal, application strategies have expanded in recent years into non-nutritional uses for all animal categories. For the case of yeast derivatives, product streams coming from the downstream processing of nutritional yeast, the expansion in use cases across species groups has been driven by a greater understanding of the composition of each derivative along with deeper knowledge of mechanistic action of key functional components. From improving feed efficiency, to serving as alternatives to antibiotic growth promoters and supporting intestinal health and immunity while mitigating pathogen shedding, new use cases are driven by a recognition that yeast derivatives contain specific bioactive compounds that possess functional properties. This review will attempt to highlight key bioactive categories within industrially applicable yeast derivatives and provide context regarding identification and characterization and mechanisms of action related to efficacy within a range of experimental models

Maternal valacyclovir and infant cytomegalovirus acquisition: a randomized controlled trial among HIV-infected women.

Background Studies in HIV-1-infected infants and HIV-1-exposed, uninfected infants link early cytomegalovirus (CMV) acquisition with growth delay and cognitive impairment. We investigated maternal valacyclovir to delay infant acquisition of CMV. Methods Pregnant women with HIV-1, HSV-2 and CD4 count >250 cells/µl were randomized at 34 weeks gestation to 500 mg twice-daily valacyclovir or placebo for 12 months. Maternal CMV DNA was measured in plasma at 34 weeks gestation, in cervical secretions at 34 and 38 weeks gestation, and in breast milk at 7 postpartum timepoints; infant CMV DNA was measured in dried blood spots at 8 timepoints including birth. Results Among 148 women, 141 infants were compared in intent-to-treat analyses. Maternal and infant characteristics were similar between study arms. Infant CMV acquisition did not differ between study arms, with 46/70 infants (66%) in placebo arm and 47/71 infants (66%) in the valacyclovir arm acquiring CMV; median time to CMV detection did not differ. CMV DNA was detected in 92% of 542 breast milk specimens with no difference in CMV level between study arms. Change in cervical shedding of CMV DNA between baseline and 38 weeks was 0.40-log greater in the placebo arm than the valacyclovir arm (p = 0.05). Conclusions In this cohort of HIV-1-seropositive mothers, two-thirds of infants acquired CMV by one year. Maternal valacyclovir had no effect on timing of infant CMV acquisition or breast milk CMV viral loads, although it modestly reduced cervical CMV shedding. Maternal prophylaxis to reduce infant CMV acquisition warrants further evaluation in trials with antiviral agents

Predictors of HIV Serostatus Disclosure to Partners among HIV-Positive Pregnant women in Morogoro, Tanzania.

Prevention of mother to child transmission of HIV (PMTCT) has been scaled, to more than 90% of health facilities in Tanzania. Disclosure of HIV results to partners and their participation is encouraged in the program. This study aimed to determine the prevalence, patterns and predictors of HIV sero-status disclosure to partners among HIV positive pregnant women in Morogoro municipality, Tanzania. A cross sectional study was conducted in March to May 2010 among HIV-positive pregnant women who were attending for routine antenatal care in primary health care facilities of the municipality and had been tested for HIV at least one month prior to the study. Questionnaires were used to collect information on possible predictors of HIV disclosure to partners. A total of 250 HIV-positive pregnant women were enrolled. Forty one percent (102) had disclosed their HIV sero-status to their partners. HIV-disclosure to partners was more likely among pregnant women who were < 25 years old [Adjusted odds ratio (AOR) = 2.2; 95% CI: 1.2--4.1], who knew their HIV status before the current pregnancy [AOR = 3.7; 95% CI: 1.7--8.3], and discussed with their partner before testing [AOR = 6.9; 95% CI: 2.4--20.1]. Dependency on the partner for food/rent/school fees, led to lower odds of disclosure to partners [AOR = 0.4; 95% CI: 0.1--0.7]. Nine out of ten women reported to have been counseled on importance of disclosure and partner participation. Six in ten HIV positive pregnant women in this setting had not disclosed their results of the HIV test to their partners. Empowering pregnant women to have an individualized HIV-disclosure plan, strengthening of the HIV provider initiated counseling and testing and addressing economic development, may be some of the strategies in improving HIV disclosure and partner involvement in this setting

Determinants of male involvement in the prevention of mother-to-child transmission of HIV programme in Eastern Uganda: a cross-sectional survey

Background: Mother-to-child transmission of HIV (MTCT) accounts for over 95% of all paediatric HIV infections worldwide. Several studies have shown that male participation in the antenatal care of their spouses together with couple counselling and testing for HIV, increases use of the interventions for HIV prevention. The prevention programme of MTCT (PMTCT) was launched in Uganda in 2000 and Mbale in 2002. Less than 10% of the pregnant women accepted antenatal HIV testing at Mbale Regional Referral Hospital in 2003; couple counselling and testing for HIV was low. Therefore, we conducted the study to determine the level of male involvement and identify its determinants in the PMTCT programme. Methods: A cross-sectional survey of 388 men aged 18 years or more, whose spouses were attending antenatal care at Mbale Regional Referral Hospital, was conducted in Mbale district, Eastern Uganda. A male involvement index was constructed based on 6 questions. The survey was complemented by eight focus group discussions and five in-depth interviews. Results: The respondents had a median age of 32 years (inter-quartile range, IQR: 28-37). The majority (74%) had a low male involvement index and only 5% of men accompanied their spouses to the antenatal clinic. Men who had attained secondary education were more likely to have a high male involvement index (OR: 1.9, 95% CI: 1.1-3.3) than those who had primary or no formal education. The respondents, whose occupation was driver (OR: 0.3, 95% CI: 0.1-0.7) or those who had fear of disclosure of their HIV sero-status results to their spouses (OR: 0.4, 95% CI: 0.2-0.8), were less likely to have a high male involvement index. Barriers to male involvement in the PMTCT programme were related to both the poor health system, to socio-economic factors and to cultural beliefs. Conclusions: Structural and cultural barriers to men's involvement in the PMTCT programme in Mbale district were complex and interrelated. Community sensitization of men about the benefits of antenatal care and PMTCT and improving client-friendliness in the clinics needs to be prioritised in order to improve low male participation and mitigate the effect of socio-economic and cultural factors

Translating global recommendations on HIV and infant feeding to the local context: the development of culturally sensitive counselling tools in the Kilimanjaro Region, Tanzania

BACKGROUND: This paper describes the process used to develop an integrated set of culturally sensitive, evidence-based counselling tools (job aids) by using qualitative participatory research. The aim of the intervention was to contribute to improving infant feeding counselling services for HIV positive women in the Kilimanjaro Region of Tanzania. METHODS: Formative research using a combination of qualitative methods preceded the development of the intervention and mapped existing practices, perceptions and attitudes towards HIV and infant feeding (HIV/IF) among mothers, counsellors and community members. Intervention Mapping (IM) protocol guided the development of the overall intervention strategy. Theories of behaviour change, a review of the international HIV/IF guidelines and formative research findings contributed to the definition of performance and learning objectives. Key communication messages and colourful graphic illustrations related to infant feeding in the context of HIV were then developed and/or adapted from existing generic materials. Draft materials were field tested with intended audiences and subjected to stakeholder technical review. RESULTS: An integrated set of infant feeding counselling tools, referred to as 'job aids', was developed and included brochures on feeding methods that were found to be socially and culturally acceptable, a Question and Answer Guide for counsellors, a counselling card on the risk of transmission of HIV, and an infant feeding toolbox for demonstration. Each brochure describes the steps to ensure safer infant feeding using simple language and images based on local ideas and resources. The brochures are meant to serve as both a reference material during infant feeding counselling in the ongoing prevention of mother to child transmission (pMTCT) of HIV programme and as take home material for the mother. CONCLUSION: The study underscores the importance of formative research and a systematic theory based approach to developing an intervention aimed at improving counselling and changing customary feeding practices. The identification of perceived barriers and facilitators for change contributed to developing the key counselling messages and graphics, reflecting the socio-economic reality, cultural beliefs and norms of mothers and their significant others