Urinary bladder metastasis from breast cancer: a rare cause of hematuria

Breast cancer is the most common cancer in women globally as well as in Kenya. The most common sites of metastases reported include the bones, liver and lung. Metastasis to the urinary bladder is relatively uncommon with only a few case reports in literature. It can therefore be easily overlooked as a cause of hematuria in these patients. We describe a rare case of a patient with breast cancer who presented with urinary bladder metastasis as a late complication of her illness

Utility of liver biopsy in HIV-infected patients presenting with febrile illnesses and inconclusive evaluation

Objectives: To determine the utility of liver biopsy in providing a diagnosis in HIVinfected patients presenting with febrile illnesses and inconclusive initial investigative work up. Design: A retrospective descriptive study. Setting: The Aga Khan University Hospital, Nairobi. Subjects: Twelve in-patients with HIV disease who underwent liver biopsy following inconclusive initial investigative work up for febrile illnesses between January and December 2007. Results: Seven out of 12 patients had granulomatous hepatitis reported on histology with characteristic tuberculous epitheloid granulomas all having stainable acid-alcohol fast bacilli on Ziehl-Nielsen (ZN) stain. The mean alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) levels in these seven patients were 260U/L and 304U/L respectively, while the mean aspartate aminotransferase (SGOT) and alanine aminotransferase (SGPT) were 106U/L and 72U/L respectively. Conclusion: Disseminated tuberculosis is still among the most common causes of unexplained pyrexia in our HIV- infected cohort and a liver biopsy, performed earlier in the investigative work up of unexplained fever in the HIV-infected patient, would be a useful adjunct in providing a diagnosis

HIV Prevalence and Characteristics Among Patients With AIDS-Defining and Non–AIDS-Defining Cancers in a Tertiary Hospital in Kenya

Purpose: Antiretroviral therapy (ART) has resulted in a higher life expectancy of persons living with HIV. This has led to an aging population at risk for both non–AIDS-defining cancers (NADCs) and AIDS-defining cancers (ADCs). HIV testing among patients with cancer in Kenya is not routinely performed, making its prevalence undefined. The aim of our study was to determine the prevalence of HIV and the spectrum of malignancies among HIV-positive and HIV-negative patients with cancer attending a tertiary hospital in Nairobi, Kenya. Materials and Methods: We conducted a cross-sectional study between February 2021 and September 2021. Patients with a histologic cancer diagnosis were enrolled. Demographic data and HIV- and cancer-related clinical variables were obtained. HIV pretest counseling and consent were done, and testing was performed using a fourth-generation assay. Positive results were confirmed using a third-generation assay. Results: We enrolled 301 patients with cancer; 67.8% (204 of 301) were female; the mean age was 50.7 ± 12.5 years. From our cohort, 10.6% (95% CI, 7.4 to 14.7, n = 32 of 301) of patients were HIV-positive with the prevalence of a new HIV diagnosis of 0.7% (n = 2 of 301). Of the HIV-positive patients, 59.4% (19 of 32) had a NADC. The commonest NADC was breast cancer (18.8%; 6 of 32), whereas non-Hodgkin lymphoma (18.8%; 6 of 32) and cervical cancer (18.8%; 6 of 32) were the most prevalent ADCs among HIV-positive patients. Conclusion: The prevalence of HIV infection among patients with cancer was twice the Kenya national HIV prevalence. NADCs comprised a larger percentage of the cancer burden. Universal opt-out HIV testing of patients attending for cancer care regardless of cancer type may facilitate early recognition of HIV-infected patients and aid in appropriate selection of ART and cancer therapies and preventive strategies

Baseline blood count levels increase odds of cytopenia among CML patients in Kenya: a case control study

Background: Imatinib is the gold standard for the treatment of all phases of Philadelphia positive Chronic Myeloid Leukemia (CML). During treatment, patients may develop cytopenia. We aimed to study the baseline characteristics and factors associated with cytopenia at a Nairobi Hospital. Methods: This was a retrospective case-control study of patients aged ≥18 years on follow-up at the Glivec Inter‑ national Patient Access Program (GIPAP) clinic from 2007 to 2015. The cases consisted of CML patients on imatinib who developed cytopenia. The controls were CML patients on imatinib who did not develop cytopenia. Baseline socio – demographic, clinical, hematologic, and molecular data were retrieved from patients’ fles. Chi square or fshers’ exact tests were used to analyze for diferences between cytopenia and no cytopenia. Binary logistic regressions were employed to identify relationships. Univariate and multivariate analyses were done to identify independent predictors of cytopenia. Odds ratios (OR) were presented including the 95% confdence intervals and respective p values. Results: A total of 201 patients were studied consisting of ninety-four (94) patients with cytopenia and 107 with no cytopenia. Among the entire population, males were 52, and 42% were aged 36–50 years. Sex, age, marital status, occupation and education level were similar between the cytopenia and no cytopenia groups. Among the 201 patients, 70% had symptoms for \u3e12months before diagnosis, 78.6% had B symptoms at baseline, 80% had a moderate splenomegaly at baseline. Among patients with cytopenia, 40 and 37.4% developed cytopenia within 3months and 3–6months respectively after imatinib initiation. Baseline neutrophilia, neutropenia, anaemia, thrombocytosis, thrombocytopenia was found in 68, 11, 11, 23.5 and 11% respectively. Baseline hemoglobin, neutrophil and platelet level were signifcantly difer‑ ent between the cytopenia and the no cytopenia group. On univariable analysis, baseline anemia with hb\u3c7.9g/ dL (p =0.002), neutropenia (p =0.001), neutrophilia \u3e100,000/mm3 (p =0.002) and thrombocytopenia (p =0.001) increased the odds of developing cytopenia. On multivariable analysis, baseline anaemia (p value \u3c0.002), neutrope‑ nia (p value \u3c0.001), thrombocytopenia (p value, \u3c0.001) and thrombocytosis (p value, 0.033) increased the odds of developing cytopenia. Conclusion: Odds of cytopenia were higher in presence of baseline cytopenia and thrombocytosis. Clinicians should have a high index of suspicion for these patients

Cytopenia among CML Patients on Imatinib in Kenya: Types, Grades, and Time Course

Background: Imatinib mesylate is the gold standard for the treatment of all phases of Philadelphia-positive chronic myeloid leukemia. Patients on imatinib treatment may develop cytopenia due to drug toxicity. This study aimed to determine the types, grades, and time course of cytopenia in CML patients on imatinib at a Nairobi hospital. Methods: This was a cross-sectional descriptive study of adult patients aged ≥18 years followed up at the Glivec International Patient Access Program (GIPAP) clinic from 2007 to 2015. Patients who developed cytopenia within 12 months of initiating imatinib were eligible. Clinical and hematologic data were retrieved from the patients’ charts and entered into a study proforma. Measures of central tendency such as mean, median, mode, standard deviation, and variance were used for analysis. Results: Sixty three percent (63.6%) of the 94 patients developed a monocytopenia, with anemia seen in 34%, neutropenia in 27.6%, and thrombocytopenia in 8% of the 94 patients. Anemia plus neutropenia was the most common bicytopenia at 12.7%. Pancytopenia was seen in only 5 of the 94 patients. Most of the cytopenia was grades 2 and 3. Anemia was present at baseline while neutropenia and thrombocytopenia developed within 12 months of imatinib initiation. Anemia resolved during the first 12 months of therapy while neutropenia and thrombocytopenia resolved within 24–36 months of treatment. Conclusion: Monocytopenia, especially anemia, was the most common type of cytopenia. The cytopenia was predominantly grade 2, developed in majority of the patients within 6 months after imatinib initiation, and had resolved by 24–36 months after imatinib initiation

Breast cancer risk factors in relation to molecular subtypes in breast cancer patients from Kenya

Background Few studies have investigated risk factor heterogeneity by molecular subtypes in indigenous African populations where prevalence of traditional breast cancer (BC) risk factors, genetic background, and environmental exposures show marked differences compared to European ancestry populations. Methods We conducted a case-only analysis of 838 pathologically confirmed BC cases recruited from 5 groups of public, faith-based, and private institutions across Kenya between March 2012 to May 2015. Centralized pathology review and immunohistochemistry (IHC) for key markers (ER, PR, HER2, EGFR, CK5-6, and Ki67) was performed to define subtypes. Risk factor data was collected at time of diagnosis through a questionnaire. Multivariable polytomous logistic regression models were used to determine associations between BC risk factors and tumor molecular subtypes, adjusted for clinical characteristics and risk factors. Results The median age at menarche and first pregnancy were 14 and 21 years, median number of children was 3, and breastfeeding duration was 62 months per child. Distribution of molecular subtypes for luminal A, luminal B, HER2-enriched, and triple negative (TN) breast cancers was 34.8%, 35.8%, 10.7%, and 18.6%, respectively. After adjusting for covariates, compared to patients with ER-positive tumors, ER-negative patients were more likely to have higher parity (OR = 2.03, 95% CI = (1.11, 3.72), p = 0.021, comparing ≥ 5 to ≤ 2 children). Compared to patients with luminal A tumors, luminal B patients were more likely to have lower parity (OR = 0.45, 95% CI = 0.23, 0.87, p = 0.018, comparing ≥ 5 to ≤ 2 children); HER2-enriched patients were less likely to be obese (OR = 0.36, 95% CI = 0.16, 0.81, p = 0.013) or older age at menopause (OR = 0.38, 95% CI = 0.15, 0.997, p = 0.049). Body mass index (BMI), either overall or by menopausal status, did not vary significantly by ER status. Overall, cumulative or average breastfeeding duration did not vary significantly across subtypes. Conclusions In Kenya, we found associations between parity-related risk factors and ER status consistent with observations in European ancestry populations, but differing associations with BMI and breastfeeding. Inclusion of diverse populations in cancer etiology studies is needed to develop population and subtype-specific risk prediction/prevention strategies

Risk of contrast induced nephropathy in HIV patients receiving radiographic contrast at three Aga Khan Hospitals

Aim: To study the influence of HIV infection on the development of contrast induced nephropathy in patients receiving radio contrast material Design: Prospective cohort study Patients and setting:One hundred and twenty five (125) HIV positive patients and one hundred and fifty five (155) HIV negative patients selected from in and out patient departments of the Aga Khan University Hospital, Nairobi and Aga Khan Hospitals in Mombasa and Kisumu, were evaluated for the study between August 2008 and August 2009. Methodology: Eligible patients undergoing radiological evaluation requiring the use of radio contrast material were consecutively recruited for the study after which their HIV status was determined. A serum creatinine was determined before and 48 hours after administration of radio contrast material. The percentage change between the two values was calculated for each patient. Analysis was then performed to determine the relative risk of development of Contrast Induced Nephropathy for the HIV positive arm in relation to the HIV negative arm Results: The incidence of contrast induced nephropathy was 12% in the HIV positive group and 14.2% in the HIV negative group (p=0.59) resulting in a non significant relative risk of 0.85 (95 % C.I: 0.458, 1.560). Conclusions: Our findings indicate that HIV infection does not significantly influence the development of contrast induced nephropathy

Pregabalin for Treatment of Docetaxel-Related Hand-Foot Syndrome

Hand-foot syndrome (HFS), also known as palmar-plantar erythrodysesthesia, is a painful, often debilitating condition related to the use of various chemotherapies. HFS usually presents with erythema, edema, and a burning sensation of the palmoplantar surfaces. The pathophysiology of HFS is not fully understood, and hence treatment options can often be challenging. We describe the case of patient with HFS due to docetaxel use, presenting with extreme hand and feet pain resulting in inability to walk. Use of pregabalin resulted in significant improvement in his symptoms, including his ability to bear weight and walk, with limited side effects

Clinical characteristics and outcomes of atrial fibrillation and flutter at the Aga Khan University Hospital, Nairobi

Introduction: Scant data exist on the epidemiology and clinical characteristics of atrial fibrillation in Kenya. Traditionally, atrial fibrillation (AF) in sub-Saharan Africa is as a result of rheumatic valve disease. However, with the economic transition in sub-Saharan Africa, risk factors and associated complications of this arrhythmia are likely to change. Methods: A retrospective observational survey was carried out between January 2008 and December 2010. Patients with a discharge diagnosis of either atrial fibrillation or flutter were included for analysis. The data-collection tool included clinical presentation, risk factors and management strategy. Follow-up data were obtained from the patients\u27 medical records six months after the index presentation. Results: One hundred and sixty-two patients were recruited (mean age 67 ± 17 years, males 56%). The distribution was paroxysmal (40%), persistent (20%) and permanent AF (40%). Associated co-morbidities included hypertension (68%), heart failure (38%) diabetes mellitus (33%) and valvular abnormalities (12%). One-third presented with palpitations, dizziness or syncope and 15% with a thromboembolic complication as the index AF presentation. Ratecontrol strategies were administered to 78% of the patients, with beta-blockers and digoxin more commonly prescribed. Seventy-seven per cent had a CHA2DS2VASC score ≥ 2, but one-quarter did not receive any form of oral anticoagulation. At the six-month follow up, 6% had died and 12% had been re-admitted at least once. Of the high-stroke risk patients on anticoagulation, just over one-half were adequately anticoagulated. Conclusion: Hypertension and diabetes mellitus, not rheumatic valve disease were the more common co-morbidities. Stroke risk stratification and prevention needs to be emphasised and appropriately managed