HIV/AIDS among surgical patients in Butare University Teaching Hospital

Background: Despite the increasing number of patients with the human immunodeficiency virus (HIV) infection particularly in Sub-Saharan Africa, surgical experience with these patients remains limited. A prospective review of 165 surgical patients admitted over a period of 3 months from 20th September to 20th December 2006 was undertaken. The main objective of the study was to determine the frequency HIV among these patients and associated surgical conditions.Methods: This 3-months prospective study was undertaken at Butare Teaching Hospital Rwanda over a 3-months period starting from 20th September 2007. A total of 165 patients who after counseling gave an informed consent had their blood collected for HIV screening. Data obtained was analyzed using Epidata and SPSS 11.5. P value was P value equal to 0.05 or less was considered as statistically significant.Results: The patients’ ages ranged from 6 to 86 years with a mean of 35.2 years. The sex ratio M: F was 2.11:1. The HIV seroprevalence was 6.7%. The majority of HIV positive patients were female (54.5%) and the most affected age range was 30-39 years. Only 2 (22.2 %) affected patients were on ARV therapy. Eight of the HIV patients had musculoskeletal sepsis (72.72 %). Associated surgical diseases included infection of osteosynthetic material in, chronic osteomyelitis, Pyomyositis and osteonecrosis of the head of femur associated with pyomyositis.Conclusion: With a prevalence of 6.6%, HIV/AIDS is a real and significant problem in surgical practice and patients with HIV admitted to a surgical department require special consideration if their surgical management is to be effective. Surgeons and other health-care workers who are potentially exposed to blood and body fluids must take appropriate precautions to avoid getting infected with HIV. We found no statistically significant difference in the surgical pathologies between HIV-positive and HIV-negative patients

HIV/AIDS among Surgical Patients in Butare University Teaching Hospital.

Background: Despite the increasing number of patients with the human immunodeficiency virus (HIV) infection particularly in Sub-Saharan Africa, surgical experience with these patients remains limited. A prospective review of 165 surgical patients admitted over a period of 3 months from 20th September to 20th December 2006 was undertaken. The main objective of the study was to determine the frequency HIV among these patients and associated surgical conditions. Methods: This 3-months prospective study was undertaken at Butare Teaching Hospital Rwanda over a 3-months period starting from 20th September 2007. A total of 165 patients who after counseling gave an informed consent had their blood collected for HIV screening. Data obtained was analyzed using Epidata and SPSS 11.5. P value was P value equal to 0.05 or less was considered as statistically significant. Results: The patients’ ages ranged from 6 to 86 years with a mean of 35.2 years. The sex ratio M: F was 2.11:1. The HIV seroprevalence was 6.7%. The majority of HIV positive patients were female (54.5%) and the most affected age range was 30-39 years. Only 2 (22.2 %) affected patients were on ARV therapy. Eight of the HIV patients had musculoskeletal sepsis (72.72 %). Associated surgical diseases included infection of osteosynthetic material in, chronic osteomyelitis, Pyomyositis and osteonecrosis of the head of femur associated with pyomyositis. Conclusion: With a prevalence of 6.6%, HIV/AIDS is a real and significant problem in surgical practice and patients with HIV admitted to a surgical department require special consideration if their surgical management is to be effective. Surgeons and other health-care workers who are potentially exposed to blood and body fluids must take appropriate precautions to avoid getting infected with HIV. We found no statistically significant difference in the surgical pathologies between HIV-positive and HIV-negative patients

Treatment of chronic myeloid leukemia in rural Rwanda: promising early outcomes

Purpose The burden of cancer is rising in low- and middle-income countries, yet cancer treatment requires resources that are often not available in these settings. Although management of chronic myeloid leukemia (CML) has been described in low- and middle-income countries, few programs involve patients treated in rural settings. We describe characteristics and early outcomes of patients treated for CML at rural district hospitals in Rwanda. Methods We conducted a retrospective review of patients with confirmed BCR-ABL–positive CML who were enrolled between July 1, 2009 and June 30, 2014. Types of data included patient demographics, diagnostic work up, treatment, clinical examination, laboratory testing, and death. Results Forty-three patients were included, with a maximum follow-up of 58 months. Of 31 patients who were imatinib-naïve at enrollment, 54.8% were men and the median age at diagnosis was 36.9 years (interquartile range: 29-42 years). Approximately two-thirds of patients (67.7%) were on the national public insurance scheme. The imatinib dose was reduced for 16 patients and discontinued for five. Thirty-two of the 43 patients continued to have normal blood counts at last follow-up. Four patients have died and four are lost to follow-up. Conclusion Our experience indicates that CML can be effectively managed in a resource-constrained rural setting, despite limited availability of on-site diagnostic resources or specialty oncology personnel. The importance of model public-private partnerships as a strategy to bring high-cost, life-saving treatment to people who do not have the ability to pay is also highlighted

Treating nephroblastoma in Rwanda: using International Society of Pediatric Oncology guidelines in a novel oncologic care model

Purpose Success in treating nephroblastoma in high-income countries has been transferred to some resource-constrained settings; multicenter studies report disease-free survival of greater than 70%. However, few reports present care models with rural-based components, care tasks shifted to internists and pediatricians, and data collection structured for monitoring and evaluation. Here, we report clinical outcomes and protocol compliance for patients with nephroblastoma evaluated at Butaro Cancer Center of Excellence in Rwanda. Patients and Methods This retrospective study reports the care of 53 patients evaluated between July 1, 2012, and June 30, 2014. Patients receiving less than half of their chemotherapy at Butaro Cancer Center of Excellence were excluded. Results Of the 53 patients included, 9.4% had stage I, 13.2% had stage II, 24.5% had stage III, 26.4% had stage IV, and 5.7% had stage V disease; the remaining 20.8% had unknown stage disease from inadequate work-up or unavailable surgical report. The incidence of neutropenia increased with treatment progression, and the greatest proportion of delays occurred during the surgical referral phase. At the end of the study period, 32.1% of patients (n = 17) remained alive after treatment; 24.5% (n = 13) remained alive while continuing treatment, including one patient with recurrent disease; 30.2% (n = 16) died; and 13.2% (n = 7) were lost to follow-up. Conclusion Our findings confirm that nephroblastoma can be effectively treated in resource-constrained settings. Using an approach in which chemotherapy is delivered at a rural-based center by nononcologists and data are used for routine evaluation, care can be delivered in safe, novel ways. Protocol modifications to mitigate chemotherapy toxicities and strong communication between the multidisciplinary team members will likely minimize delays and further improve outcomes in similar settings

Gestational trophoblastic neoplasia treatment at the Butaro Cancer Center of Excellence in Rwanda

Purpose Gestational trophoblastic neoplasia (GTN) is a highly treatable disease, most often affecting young women of childbearing age. This study reviewed patients managed for GTN at the Butaro Cancer Center of Excellence (BCCOE) in Rwanda to determine initial program outcomes. Patients and Methods A retrospective medical record review was performed for 35 patients with GTN assessed or treated between May 1, 2012, and November 30, 2014. Stage, risk score, and low or high GTN risk category were based on International Federation of Gynecology and Obstetrics staging and the WHO scoring system and determined by beta human chorionic gonadotropin level, chest x-ray, and ultrasound per protocol guidelines for resource-limited settings. Pathology reports and computed tomography scans were assessed when possible. Treatment was based on a predetermined protocol stratified by risk status. Results Of the 35 patients (mean age, 32 years), 26 (74%) had high-risk and nine (26%) had low-risk disease. Nineteen patients (54%) had undergone dilation and curettage and 11 (31%) had undergone hysterectomy before evaluation at BCCOE. Pathology reports were available in 48% of the molar pregnancy surgical cases. Systemic chemotherapy was initiated in 30 of the initial 35 patients: 13 (43%) received single-agent oral methotrexate, 15 (50%) received EMACO (etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine), and two (7%) received alternate regimens. Of the 13 patients initiating methotrexate, three had their treatment intensified to EMACO. Four patients experienced treatment delays because of medication stockouts. At a median follow-up of 7.8 months, the survival probability for low-risk patients was 1.00; for high-risk patients, it was 0.63. Conclusion This experience demonstrates the feasibility of GTN treatment in rural, resource-limited settings. GTN is a curable disease and can be treated following the BCCOE model of cancer care