Outcomes of World Health Organization–defined Severe Respiratory Distress without Shock in Adults in Sub-Saharan Africa

Sepsis is the leading cause of global mortality and is most often attributed to lower respiratory tract infections and subsequent acute respiratory distress syndrome (ARDS) (1). The greatest burden of sepsis rests on sub-Saharan Africa, where lower respiratory tract infections account for approximately 390,000 adult deaths each year (2). However, patients from sub-Saharan Africa are underrepresented in sepsis and ARDS research (3). ARDS is difficult to diagnose in low-income countries because it requires often unavailable imaging, mechanical ventilation to set positive end-expiratory pressure and deliver a reliable fraction of inspired oxygen, and arterial blood gases to identify hypoxemia (4). To mitigate this gap, the World Health Organization (WHO) pragmatically defined severe respiratory distress without shock (SRD) in adults as oxygen saturation of less than 90% or a respiratory rate of more than 30 breaths per minute, and a systolic blood pressure over 90 mm Hg in the setting of infection and in the absence of clinical cardiac failure (5). The natural history of SRD has not been fully described; accordingly, we aimed to evaluate the prevalence, characteristics, and outcomes of SRD in hospitalized patients in sub-Saharan Africa

Expression of Oestrogen and progesterone receptors, Ki-67,p53 and bcl-2 proteins, cathepsin D, urokinase plasminogen activator and urokinase plasminogen activator-receptors in carcinomas of the female breast in an African population

(East African Medical Journal: 2001 78(7): 360-365

EXPRESSION OF OESTROGEN AND PROGESTERONE RECEPI ORS, Ki-67, p53 AND BCL-2 PROTEINS, CATHEPSIN D, UROKINASE PLASMINOGEN ACT1 VATOR AND UROKINASE PLASMINOGEN ACTIVATOR-RECEPTORS IN CARCINOMAS OF THE FEMALE BREAST IN AN AFRICAN POPULATION

Objective: To determine the expression of oestrogen (ER) and proj ;esterone receptor (PgR),Ki-67, p53, bcl-2 proteins and the proteolytic enzymes cathe~lsin D (CD), urokinaseplasminogenactivator (uPA) and its receptor (uPA-R) in primary carcinomas of the breastfrom indigenous Tanzanian female patients by immunohistochenristry.Design: i'rospective cross-sectional study.Setting: Muhimbili Medical Centre, Dar es Salaam, Tanzania.Subjects: Sixty patients admited between 1995 and 1997.Results: Markers were found to be expressed as follows: ER (3: .3%), PgR (18.3%), p53(30%), bcl-2 (43.5%) and the median proliferation rate of Ki-67 was 15%. Proportion oftumours positive for ER, PgR and bcl-2 initially decreased to 12 nonths disease duration,after which it increased. The observed proliferation rate approaches that reported indeveloped countries. p53 expression did not influence the prolife ration rate nor did bcl-2expression. ER, PgR and bcl-2 were strongly co-expressed. CD was wedominantly expressedin stromal macrophages than in cancer cells.Conclusion: The low expression of ER and PgR and their strong co-expression with bcl-2might negatively influence response to hormonal therapy. The influence of bcl-2 on tumourresponse to anti-cancer therapy in patients with long disease duration requires urgentclarification. Determination of CD in stromal macrophages rathe~ than in cancer cells mayhave greatel- prognostic significance in patients of this region

Toxoplasma encephalitis in HIV: case report

(East African Medical Journal: 2001 78(5): 275-276

Receptor-defined subtypes of breast cancer in indigenous populations in Africa: a systematic review and meta-analysis.

BACKGROUND: Breast cancer is the most common female cancer in Africa. Receptor-defined subtypes are a major determinant of treatment options and disease outcomes but there is considerable uncertainty regarding the frequency of poor prognosis estrogen receptor (ER) negative subtypes in Africa. We systematically reviewed publications reporting on the frequency of breast cancer receptor-defined subtypes in indigenous populations in Africa. METHODS AND FINDINGS: Medline, Embase, and Global Health were searched for studies published between 1st January 1980 and 15th April 2014. Reported proportions of ER positive (ER+), progesterone receptor positive (PR+), and human epidermal growth factor receptor-2 positive (HER2+) disease were extracted and 95% CI calculated. Random effects meta-analyses were used to pool estimates. Fifty-four studies from North Africa (n=12,284 women with breast cancer) and 26 from sub-Saharan Africa (n=4,737) were eligible. There was marked between-study heterogeneity in the ER+ estimates in both regions (I2>90%), with the majority reporting proportions between 0.40 and 0.80 in North Africa and between 0.20 and 0.70 in sub-Saharan Africa. Similarly, large between-study heterogeneity was observed for PR+ and HER2+ estimates (I2>80%, in all instances). Meta-regression analyses showed that the proportion of ER+ disease was 10% (4%-17%) lower for studies based on archived tumor blocks rather than prospectively collected specimens, and 9% (2%-17%) lower for those with ≥ 40% versus those with <40% grade 3 tumors. For prospectively collected samples, the pooled proportions for ER+ and triple negative tumors were 0.59 (0.56-0.62) and 0.21 (0.17-0.25), respectively, regardless of region. Limitations of the study include the lack of standardized procedures across the various studies; the low methodological quality of many studies in terms of the representativeness of their case series and the quality of the procedures for collection, fixation, and receptor testing; and the possibility that women with breast cancer may have contributed to more than one study. CONCLUSIONS: The published data from the more appropriate prospectively measured specimens are consistent with the majority of breast cancers in Africa being ER+. As no single subtype dominates in the continent availability of receptor testing should be a priority, especially for young women with early stage disease where appropriate receptor-specific treatment modalities offer the greatest potential for reducing years of life lost. Please see later in the article for the Editors' Summary