Does a Structured Data Collection Form Improve The Accuracy of Diagnosis of Acute Abdomen in an Urban Private Hospital?

Background: Accuracy of initial assessment of acute abdominal pain (AAP) is confounded by subjectivity and multiple etiologies for similar presentation. Standardized forms may harmonize the initial assessment, improve accuracy of diagnosis and enhance outcomes.Objectives: To determine the extent to which use of a structured data collection form (SDCF) affected the diagnostic accuracy of AAP.Methodology: A before and after study carried out from October 2011 to March 2012 of patients aged 13 years and older presenting with AAP in the emergency department (ED) of Aga Khan University Hospital, Nairobi (AKUH,N). Patients clerked by ED physicians using conventional history taking and examination between October and December 2011 were compared to a second group clerked after the introduction and use of a SDCF (January – March 2012) for proportion of correct diagnosis at initial encounter. This influence of age, gender and disease type on the impact of the form was evaluated as was the impact of the introduction of the structured forms on time to ED disposition, hospital stay, number and cost of investigations. Data were compiled in MS-Excel spreadsheets and analyzed using SPSS v16. P value of <0.05 was significantResults: 125 participants were included, 60 in Period 1 and 65 in Period 2. The overall mean age for males was 28 and 34 for females. Patients with surgical abdominal conditions were 21% and 49% for medical conditions. The diagnostic accuracy was 58% and 43% before and after the introduction of the SDCF respectively (p=0.088). For surgical patients, diagnostic accuracy was 77% before and 31% after the introduction of the form (p=0.018).Conclusions: The structured form did not improve the accuracy of diagnosing the causes of acute abdomen. It had a negative impact on the surgical diagnoses

A Profile of Female Breast Cancer Patients in a Kenyan Urban Private Hospital

BackgroundBreast cancer shows differences between the Afro- American and Western population. We present data from our centre, analyze the age variation, parity and compare it to Kenyan data from a public hospital and worldwide data. We designed a study to evaluate important characteristics of a mixed socio-demographic population of female breast cancer patients who are referred from monthly breast clinics or seek care at a private hospital and compare it to similar characteristics in the western population.MethodsThis was a retrospective study of two hundred and sixty patient case records with a diagnosis of breast cancer. Patient charts were retrieved and assessed for age, stage and parity profiling and this was compared to western data by search through medical databases (Pubmed and Uptodate Ver 19.3.)ResultsThe highest proportion of cases was in the 45-49 year range (15%). 136 records were retrieved with data on parity and staging. Of all patients, 26% had a parity of three while 16% of the cases were nulliparous. Of the patients, 124 had data on staging; 67.5% had late disease at the time of presentation. Of those under 50 years, 31% had early disease. Patients over 50 made up 34% of the women.ConclusionAga Khan University Hospital sees a different age profile at time of diagnosis from that seen in the Western population which is mainly postmenopausal. Despite our population being affluent, urban and with access to information and healthcare facilities, there is still significant number presenting with late disease

Addressing the challenges of practicing breast cytology in a tertiary teaching hospital in Kenya

Objectives: To assess diagnostic accuracy of breast cytology through histological correlation and identify reasons for diagnostic pitfalls. Methods: A total of 2700 cases were reported in cytology during the study period of 14 months, of which 1100 (40%) were from breast lesions. Only 96 (9%) cases had histological follow up in the form of core biopsy, lumpectomy and/or mastectomy. The cases in which cytology diagnosis did not match with histology diagnosis were reviewed by two pathologists and reasons for the diagnostic pitfalls in cytology were recorded. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of cytology were calculated. Results: Seventy cases (73%) had no cytohistologic discrepancy, three cases were reported as unsatisfactory while 23(24%) showed discrepancy with histology. Interpretation errors occurred in 16 cases in 3 categories (benign C2, atypical C3 and suspicious C4). There were 2 false negatives (C2) and 14 false positives (C3 and C4). Majority (58%, 8 out of 14) of the errors in the false positive groups were due to the poor quality of smears received from our satellite centres. Misclassification of subtypes within benign and malignant categories occurred in 2 cases each due to overlapping features. Sampling errors occurred in three cases due to inherent nature of the lesion. Sensitivity of our FNA was 91%, Specificity was 79%, Positive predictive value (PPV) 59% and negative predictive value (NPV) was 96%. Conclusions: There was no major discrepancy to influence the management or prognosis significantly. Minor discrepancies resulted due to sampling and interpretation errors. Poor quality smear emerged as a major cause of interpretation errors. This calls for corrective measures to be applied for both sample providers and pathologists

Sentinel Lymph Node Biopsy Pathology and 2-Year Postsurgical Recurrence of Breast Cancer in Kenyan Women

Purpose: The goal of this study was to describe the pathologic findings and early follow-up experience of patients who underwent a sentinel lymph node biopsy (SLNB) at Aga Khan University Hospital (AKUH) between 2008 and 2017. Patients and Methods: We performed a retrospective analysis of women with breast cancer who underwent an SLNB at AKUH between 2008 and 2017. The SLNB was performed on patients with stage I and stage II breast cancer, and identification of the sentinel lymph node was made by radioactive tracer, blue dye, or both, per availability and surgeon preference. Demographic, surgical, and pathologic data, including immunohistochemistry of the surgical sample for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2, were abstracted from the patient records. Follow-up data were available for a subset of patients. Results: Between 2008 and 2017, six surgeons performed SLNBs on 138 women, 129 of whom had complete records and were included in the study. Thirty-one of 129 (24%) had a positive SLNB, including 10 of 73 (14%) with stage I and 21 of 56 (38%) with stage II disease. Seventy-eight patients (60%) received systemic adjuvant chemotherapy and 79 (62%) received radiation therapy, and of the 102 patients who were estrogen receptor positive, 86 (85%) received endocrine therapy. Seventy-nine patients were observed for \u3e 2 years, and, of these, four (5.1%) had a regional recurrence. Conclusion: The SLNB positivity rates were similar to those of high-income country (HIC) cohorts. However, preliminary data suggest that recurrence rates are elevated at AKUH as compared with those of HIC cohorts, perhaps because of a lower use of radiotherapy and chemotherapy at AKUH compared with HIC cohorts or because of differences in the characteristics of the primary tumor in patients at AKUH as compared with those in HICs

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

Primary duodenal cancer: case report

No Abstract. East African Medical Journal Vol. 84 (6) 2007: pp. 296-29

Perforated Meckel’s diverticulitis presenting as a mesenteric abscess: Case report

Only 2% of patients with Meckel’s diverticulae (MD) will manifest clinical problems. Diverticulitis occurs in approximately 10-20% of patients with symptomatic MD and more often in the elderly population. We report a case of Meckels diverticulitis presenting with perforation and mesenteric abscess in a young African man. The authors present information on diagnostic pitfalls and advise a lower threshold for consideration of MD as a differential diagnosis of acute right iliac fossa pain especially when the CT scan denotes a normal appendix in a male patient

Descriptive case series of patients presenting with cancer of the prostate and their management at Kenyatta National Hospital, Nairobi

No Abstract. East African Medical Journal Vol. 84 (9S) 2007: pp. S31-S3