Endomyocardial fibrosis: is it a systemic disease?

Background: Patients with endomyocardial fibrosis (EMF) characteristically present with gross ascites and absent or minimal pedal oedema. This has long puzzled clinicians, especially since this clinical picture remains the same regardless of whether there is left, right or biventricular ventricular heart failure. The development of ascites, therefore, may not be directly and solely related to changes in the heart, but to local changes in the peritoneum. In order to investigate this possibility we performed peritoneal biopsies on 28 EMF patients.Methods: Successful peritoneal biopsies were performed on 28 EMF patients and 11 age-matched healthy controls who had died in road accidents.Results: All 28 patients (100%) showed complete or partial peritoneal fibrosis. Twenty Six (93%) had additional signs of chronic peritonitis characterised mainly by lymphocytes (92%) eosinophils (27%) and plasma cells (23%). Neutrophils were not seen. Vascularisation was common (87%) with an increase in capillaries and granulation tissue. Other components were Russel bodies (50%), deposits of fibrin (50%) and haemosiderin pigment (32%). Only two samples showed fibrosis without signs of inflammation. None of the controls showed any of these changes.Conclusion: Peritoneal fibrosis was found in all and peritonitis in most of our EMF patients. This suggests that pathology of EMF is not confined to the heart but also involves the peritoneum. This local peritoneal inflammation may explain why marked ascites is often present with little or no peripheral oedema, and why conventional heart failure treatment is of limited value.Keywords: peritoneal-fibrosis, endomyocardial-fibrosis, ascites, histology, echocardiograph

Drivers of advanced stage at breast cancer diagnosis in the multicountry African breast cancer - disparities in outcomes (ABC-DO) study.

Breast cancer (BC) survival rates in sub-Saharan Africa (SSA) are low in part due to advanced stage at diagnosis. As one component of a study of the entire journey of SSA women with BC, we aimed to identify shared and setting-specific drivers of advanced stage BC. Women newly diagnosed in the multicountry African Breast Cancer-Disparities in Outcomes (ABC-DO) study completed a baseline interview and their stage information was extracted from medical records. Ordinal logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for advanced stage (I, II, III, IV) in relation to individual woman-level, referral and biological factors. A total of 1795 women were included from Nigeria, Uganda, Zambia, and the multiracial populations of Namibia and South Africa, 1091 of whom (61%) were stage III/IV. Stage was lower in women with greater BC knowledge (OR 0.77 (95% CI: 0.70, 0.85) per point on a 6 point scale). More advanced stage was associated with being black (4.00 (2.79, 5.74)), having attended <secondary education (1.75 (1.42, 2.16)), having never heard of BC (1.64 (1.31, 2.06)), an unskilled job (1.77 (1.43, 2.20)) and pregnancy in the past 3 years (30% of ≤45 year olds) (1.63 (1.15, 2.31)), and were mediated through delays to diagnosis: symptom duration of ≥ 1 year (OR 2.47 (1.93, 3.15)). These findings provide further evidence that late-stage BC in SSA is largely attributed to modifiable factors and strategies to improve BC education and awareness in women and the health system should be intensified

Endomyocardial fibrosis: is it a systemic disease?

Background: Patients with endomyocardial fibrosis (EMF) characteristically present with gross ascites and absent or minimal pedal oedema. This has long puzzled clinicians, especially since this clinical picture remains the same regardless of whether there is left, right or biventricular ventricular heart failure. The development of ascites, therefore, may not be directly and solely related to changes in the heart, but to local changes in the peritoneum. In order to investigate this possibility we performed peritoneal biopsies on 28 EMF patients. Methods: Successful peritoneal biopsies were performed on 28 EMF patients and 11 age-matched healthy controls who had died in road accidents. Results: All 28 patients (100%) showed complete or partial peritoneal fibrosis. Twenty Six (93%) had additional signs of chronic peritonitis characterised mainly by lymphocytes (92%) eosinophils (27%) and plasma cells (23%). Neutrophils were not seen. Vascularisation was common (87%) with an increase in capillaries and granulation tissue. Other components were Russel bodies (50%), deposits of fibrin (50%) and haemosiderin pigment (32%). Only two samples showed fibrosis without signs of inflammation. None of the controls showed any of these changes. Conclusion: Peritoneal fibrosis was found in all and peritonitis in most of our EMF patients. This suggests that pathology of EMF is not confined to the heart but also involves the peritoneum. This local peritoneal inflammation may explain why marked ascites is often present with little or no peripheral oedema, and why conventional heart failure treatment is of limited value