Radiological comparison of tumour burden of lymphoma in HIV positive and HIV negative patients

Introduction: Patients with Human Immunodeficiency Virus (HIV) are known to exhibit atypical pattern of lymphoma on imaging. There is paucity of literature on differences in tumour volume or burden of disease amongst HIV positive patients compared with HIV negative patients and how this correlates with clinicopathological parameters of aggressiveness and effects on prognosis. Objective: The purpose of this study was to evaluate the tumour burden of non-Hodgkin’s lymphoma in HIV positive patients compared with HIV negative and how this correlates with the clinicopathological parameters of aggressiveness and the overall clinical outcome. Methods: This was a retrospective analytical cross-sectional study. All patients diagnosed with non-Hodgkin lymphoma from January 2011 to June 2021 were identified. These were then stratified into those with HIV and those without HIV and the tumour burden and site of disease on CT imaging calculated using the Lugano classification for lesion measurement. The international prognostic score, the histological type and Ki-67 index were recorded. Continuous variables were analyzed using the Kruskal Wallis test while the categorical variables were analyzed using the Fischer’s Exact test. Logistic regression was performed to assess if HIV is independently associated with clinical outcome after controlling for extranodal disease. Results: Out of the 92 patients with non-Hodgkin lymphoma, 47 were HIV positive while 45 were HIV negative with a median age of 45 years. The median sum of product diameters used to measure the tumour burden was 102.6 [51.7, 173.1] with no difference seen in the two groups. The extranodal disease was significantly higher in the HIV positive group (85.1%) while exclusive nodal disease was seen predominantly in the non-HIV group (66.7%) (p value \u3c0.001). Although, there was no difference in the clinical IPI score and Ki-67 between the two groups, when comparing the IPI score with the volume of disease, the patients who had a higher burden of disease had poor prognosis and vice versa but this was only statistically significant for the non-HIV group (p value \u3c0.001). Complete treatment response was higher in the non-HIV group 54.5% compared to 20.9% for the HIV group (p value \u3c0.001). More HIV positive patients succumbed, 37.2% compared to the 4.5% for non-HIV patients (p value \u3c0.001). Conclusion: HIV related lymphoma remains a poorly understood subset of lymphoma. Imaging plays a critical role in staging of the HIV lymphoma. The significant imaging finding in HIV related lymphoma is presence of extranodal disease irrespective of the overall imaging burden. Furthermore, the clinical IPI score and Ki-67 which apply well for HIV-negative patients may not be apply for HIV related lymphoma. Recommendations: We propose a separate clinical prognostication index for HIV related lymphoma that incorporates the stage of the disease and a higher weighting given to presence of extra nodal disease. Further studies are also needed to determine the initiation, type of HAART and the type of chemotherapy regimens and how this relates to occurrence and prognosis of HIV related lymphoma

Variations in branching pattern of external carotid artery in a black Kenyan population

Knowledge of variations in branching of external carotid artery is important to minimise inadvertent injury and confusion in identification during neck and craniofacial surgery and interventional neuroradiology. These variations show ethnic differences. Procedures in head and neck are increasing but data on these variations among black populations are scarce. This study therefore examined the branching pattern of external carotid artery in a black Kenyan population. Two hundred and twenty-four common carotid arteries of 112 black adult Kenyans were exposed by cadaveric dissection at Department of Human Anatomy, University of Nairobi, Kenya. The sternocleidomastoid muscle and body of mandible were removed and the external carotid artery and its branches exposed. The conventional pattern of branching was observed in only 41.1% of cases. The variant patterns observed were trifurcation (26.8)%, bifurcation (17.9%) and quadrifurcation (8.9%). There were 20 (5.3%) cases of early division. Linguofacial trunk was observed in 44.7% cases. Frequency of variant branching pattern of external carotid artery in the population studied is high. Interventional radiologists, vascular, craniofacial and neck surgeons should be aware of these. Preoperative sonographic evaluation of the carotid arterial system is recommended.Keywords: External carotid artery, Variation, Trifurcation, Quadrifurcation, Africa

Young professionals for health development: the Kenyan experience in combating non-communicable diseases

Young individuals (below 35 years) comprise an estimated 60% of the global population. Not only are these individuals currently experiencing chronic, non-communicable diseases (NCDs), either living with or at risk for these conditions, but will also experience the long-term repercussions of the current NCD policy implementations. It is thus imperative that they meaningfully contribute to the global discourse and responses for NCDs at the local level. Here, we profile one example of meaningful engagement: the Young Professionals Chronic Disease Network (YPCDN). The YPCDN is a global online network that provides a platform for young professionals to deliberate new and innovative methods of approaching the NCD challenges facing our societies. We provide a case study of the 2-year experiences of a country chapter (Kenya) of the YPCDN to demonstrate the significance and impact of emerging leaders in addressing the new global health agenda of the 21st century

Endovascular management of a congenital hepatic arterioportal malformation in a low resource setting

Background: Arterioportal malformations, a rare type of vascular malformation, have significant associated morbid- ity and mortality. Management requires a carefully thought out approach by a multidisciplinary team. Low resource settings have an added challenge of limited treatment options and consumables. Case presentation: We report a case of a 14-month-old male with failure to thrive due to a congenital hepatic arte- rioportal fistula. He was successfully treated via an endovascular approach with metallic coil embolization. Conclusion: Hepatoportal fistula, a rare hepatic vascular malformation, has limited treatment options which can further be restricted by overall patient wellness. Minimally invasive endovascular treatment options can offer a high rate of success and reverse the morbidity associated with the disease as was seen with our case

Young professionals for health development: the Kenyan experience in combating non-communicable diseases

Young individuals (below 35 years) comprise an estimated 60% of the global population. Not only are these individuals currently experiencing chronic, non-communicable diseases (NCDs), either living with or at risk for these conditions, but will also experience the long-term repercussions of the current NCD policy implementations. It is thus imperative that they meaningfully contribute to the global discourse and responses for NCDs at the local level. Here, we profile one example of meaningful engagement: the Young Professionals Chronic Disease Network (YPCDN). The YPCDN is a global online network that provides a platform for young professionals to deliberate new and innovative methods of approaching the NCD challenges facing our societies. We provide a case study of the 2-year experiences of a country chapter (Kenya) of the YPCDN to demonstrate the significance and impact of emerging leaders in addressing the new global health agenda of the 21st century