Case Report: Locally advanced skin cancer in an albino, a treatment dilemma

We report on a 27 year old albino woman, who was admitted on the 20th May 2010 to our facility at Queen Elizabeth Central Hospital with a left-sided pre-auricular ulcerating mass suspected to be originating from the skin.The mass developed three weeks prior to admission and was progressively growing in size

Neoadjuvant chemotherapy in Albinos with locally advanced skin cancer at a Blantyre Hospital: - Case Series

Albinism in Africa remains a public health concern with increasing numbers of advanced skin cancer in this population at presentation. There are challenges with availability of Radiotherapy (RT) units in Africa which is an important modality for controlling loco-regional disease alone or in combination with surgery. Proposed chemotherapy  regimens have not been well validated through Randomized Controlled Trials thus posing difficulties for standard of care for units that do not have access to functional RT facilities. Malawi is one such country without radiotherapy.Case summarySeven patients with locally advanced skin cancer were seen in the adult oncology unit at Queen Elizabeth Central Hospital in Blantyre (QECH), Malawi between 2010 and 2013. QECH is one of the teaching hospitals in the country. All were subjected to neo-adjuvant chemotherapy. The primary treatment aim was cyto-reduction followed by surgery whilst the secondary outcome was general symptom control. Three patients achieved complete responses of which two underwent resection and a pectoralis major myocutaneous flap. One had a near complete response and threeshowed partial responses.ConclusionNeo-adjuvant chemotherapy may be a possible

Case Report: Down-staging locally advanced head and neck cancer in an HIV infected patient in a limited resource setting

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Case Report: Treatment of metastatic germ cell tumor in a newly diagnised HIV infected man: use of BEP chemotherapy.

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Soil Phosphate Solubilising Bacteria of the Okavango Floodplains, Botswana

Phosphorus although abundant is among the most limiting macro plant nutrients in some soils. Deficiencies are often seen as purpling of leaves due to unavailability of PO4 in soil solution. In soil solution PO4 solubility is pH dependent; at pH \u3c 6, it is often bound to Fe or Al, while at pH \u3e 7 it forms insoluble complexes with Ca, Mg, K or Na making it unavailable to plants (Brady 2002). Soil organic P requires mineralisation then solubilisation by the enzyme phosphatase before being available. Botswana soils due to the low rainfall (\u3c 450 mm/yr) are characterised by high pH and salt pans scattered all over the semi-arid and arid landscape. Cultivation of most of these soils often results in P deficient crops (Leuschner and Manthe 1996). However, in grassland areas of the Okavango, very few grasses show P deficiency. Studies from other areas indicate that some grasses habour PO4 solubilizing bacteria in their rhizosphere that help them in their P sequencing quest (Duponnois et al. 2005). This study was set up to study the PO4 solubilising bacteria of the Okavango Delta at Seronga. The study also looked at possible mechanisms of solubilisation employed by the bacteria. In the long run, the study will also attempt to use these bacteria on locally grown staple cereal, sorghum (Sorghum vulgare)

Biopsy case mix and diagnostic yield at a Malawian central hospital

Cancer is a major disease burden worldwide resulting in high morbidity and mortality. It is the leading cause of mortality in developed countries and is one of the three leading causes of death for adults in developing countries. Pathological examination of tissue biopsies with histological confirmation of a correct cancer diagnosis is central to cancer care. Without an accurate and specific pathologic diagnosis, effective treatment cannot be planned or delivered. In addition, there are marked geographical variations in incidence of cancer overall, and of the specific cancers seen. Much of the published literature on cancer incidence in developing countries reflects gross estimates and may not reflect reality. Performing baseline studies to understand these distributions lays the groundwork for further research in this area of cancer epidemiology. Our current study surveys and ranks cancer diagnoses by individual anatomical site at Queen Elizabeth Central Hospital (QECH) which is the largest teaching and referral hospital in Malawi. A retrospective study was conducted reviewing available pathology reports over a period of one full year from January 2010 to December 2010 for biopsies from patients suspected clinically of having cancer. There were 544 biopsies of suspected cancer, taken from 96 anatomical sites. The oesophagus was the most common biopsied site followed by breast, bladder, bone, prostate, bowel, and cervical lymph node. Malignancies were found in biopsies of the oesophagus biopsies (squamous cell carcinoma, 65.1%; adenocarcinoma, 11.6%), breast (57.5%), bladder (squamous cell carcinoma, 53.1%) and stomach (37.6%). Our study demonstrates that the yield of biopsy for clinically suspected malignancy was greater than 50% for the 11 most common sites and provides a current survey of cancer types by site present in the population reporting to our hospital

Cadmium Sorption by Moringa stenopetala and Moringa oleifera seed Powders: Batch, Time, Temperature, pH and Adsorption Isotherm Studies”.

There is a widespread recognition that the presence of heavy metals such as cadmium in water is hazardous to the environment and human health and their discharge into surface waters is of great concern world wide. The use of natural coagulants such as Moringa for heavy metal removal from water replacing expensive imported synthetic coagulants is particularly appropriate for agro-based developing countries such as Malawi. This study was aimed at investigating the potential of Moringa stenopetala and Moringa oleifera in the removal of cadmium(II) ions from water. The potential of M. stenopetala for cadmium removal was investigated by means of jar test beakers. With an initial cadmium concentration of 7 mg/l, M. stenopetala seed powder, at a dose of 2.50 g/100 ml, reduced the concentration of cadmium by 53.8%. Comparison of removal capacities between M. stenopetala and M. oleifera indicated that M. stenopetala was more effective than M. oleifera in removing cadmium from water (p < 0.05). Increasing initial cadmium concentration, agitation time and ionic strength reduced cadmium removal. Equilibrium sorption was attained at pH 5 where maximum cadmium removals were 82.7 and 70.7% using M. stenopetala and M. oleifera respectively. There was a reduction in cadmium removal between 0 to 60°C for M. stenopetala and 0 -40°C for M. oleifera before increasing with subsequent temperature increases. It was also shown that cadmium sorption at 30°C and pH 3 for the M. oleifera could best be modelled by the Freundlich isotherm whereas the Langmuir model is slightly better than the Freundlich isotherm in the case of the M. Stenopetala. The energies of adsorption from Dubinin-Radushkevich models have indicated that cadmium removal using both powders is based on physisorption. The results indicate that M. stenopetala and M. oleifera have potential in cadmium remediation of polluted waters

Incidence of HIV-positive admission and inpatient mortality in Malawi (2012-2019).

OBJECTIVE: To investigate trends in population incidence of HIV-positive hospital admission and risk of in-hospital death among adults living with HIV between 2012 and 2019 in Blantyre, Malawi. DESIGN: Population cohort study using an existing electronic health information system ('SPINE') at Queen Elizabeth Central Hospital and Blantyre census data. METHODS: We used multiple imputation and negative binomial regression to estimate population age-specific and sex-specific admission rates over time. We used a log-binomial model to investigate trends in risk of in-hospital death. RESULTS: Of 32 814 adult medical admissions during Q4 2012--Q3 2019, HIV status was recorded for 75.6%. HIV-positive admissions decreased substantially between 2012 and 2019. After imputation for missing data, HIV-positive admissions were highest in Q3 2013 (173 per 100 000 adult Blantyre residents) and lowest in Q3 2019 (53 per 100 000 residents). An estimated 10 818 fewer than expected people with HIV (PWH) [95% confidence interval (CI) 10 068-11 568] were admitted during 2012-2019 compared with the counterfactual situation where admission rates stayed the same throughout this period. Absolute reductions were greatest for women aged 25-34 years (2264 fewer HIV-positive admissions, 95% CI 2002-2526). In-hospital mortality for PWH was 23.5%, with no significant change over time in any age-sex group, and no association with antiretroviral therapy (ART) use at admission. CONCLUSION: Rates of admission for adult PWH decreased substantially, likely because of large increases in community provision of HIV diagnosis, treatment and care. However, HIV-positive in-hospital deaths remain unacceptably high, despite improvements in ART coverage. A concerted research and implementation agenda is urgently needed to reduce inpatient deaths among PWH

Soil Microbial Biomass Carbon, Nitrogen and Sulphur as Affected By Different Land Uses in Seronga, Okavango Delta, Botswana

Aim: The Okavango Delta at Seronga is fragmented into different land uses ranging from grasslands to woodland (Ximenia and mopane), often punctuated with cropped and fallow fields. The influence of land uses on surface (A1 horizon) soil physico-characteristics, nitrogen, sulphur, carbon, microbial population and biomass were studied to understand soil variability in order to devise conservation strategies for the area. Methodology: Total soil nitrogen (N) was analysed using a Leco N analyser, total carbon and sulphur by CS800 Carbon–Sulphur analyser. NH4+-N, NO3- and NO2- were extracted with KCl and determined using the indophenol blue method and by Griess-Ilosvay colorimetric method respectively. Microbial populations were determined by plate count method. Biomass carbon and flush of nitrogen were determined by fumigation and re- inoculation technique. Results: All the soils had a high sand content (> 85 %). Total soil N was generally very low, 0.017% in grasslands closest to the channel, 0.013% in cropped fields, 0.007% in fallow and lowest in woodlands (0.002%). Grasslands showed higher NH4+-N indicating low nitrification potential. Even if mopane woodlands had low total N, they had higher NH4+-N (0.067 ppm) and low NO2- compared to other land uses, this could be attributed to their inherent nitrification inhibition ability. No NO3--N was detected in these soils, probably due to the low nitrification ability and high leaching capacity of sandy soils. Microbial biomass C and population were highest in the grasslands and cultivated soils, while the woodlands had lower levels. Conclusion: Seronga soils have very low N, with the least in the woodlands furthest from floodplains. Grasslands closest to the channel basin had significantly higher total N, C and microbial biomass C but low S as opposed to the woodlands further from the channel. Cultivated areas had increased N and C levels and microbial biomass C compared to the woodland probably due to incorporation of crop residues and animal manure. The paucity of nitrifiers and undetectable NO3--N indicate a low nitrification potential and a high leaching ability of the soils. Fallowing of fields resulted in a decline in nutrient status