The changing pattern of hodgkin lymphoma in adults at Chris Hani Baragwanath academy hospital

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine (Internal Medicine)Hodgkin lymphoma (HL) is a malignancy of lymphoid cells that was first described by Thomas Hodgkin in 1832. It is recognized histologically by the presence of the characteristic Reed Sternberg cells, bathed in a reactive cellular background of inflammatory cells. Hodgkin lymphoma is less common than Non-Hodgkin Lymphoma (NHL) and accounts for approximately 10-20 % of all the lymphomas encountered. It is most often seen in young adults, with a peak frequency in the third decade of life. Hodgkin lymphoma is characterized by the orderly spread of disease from one lymph node group to another (contiguous spread and centripetal distribution) and by the development of systemic symptoms, particularly with advanced stage disease. True extra nodal disease is uncommon. Pathologically, Hodgkin lymphoma is categorized into two groups: Nodular lymphocyte predominant Hodgkin lymphoma which accounts for about 5% and Classical Hodgkin lymphoma which accounts for 95%. Classical Hodgkin lymphoma is further subdivided into four subtypes: Nodular sclerosis classical Hodgkin lymphoma, Mixed cellularity classical Hodgkin lymphoma, Lymphocyte rich classical Hodgkin lymphoma and Lymphocyte depleted classical Hodgkin lymphoma. Once the diagnosis is confirmed on a lymph node or tissue biopsy, a complete work up is done, which includes blood investigations, a bone marrow aspirate and biopsy and appropriate radiological investigations. Following on this, the treatment is individualized and includes both supportive care and specific therapy. The specific initial treatment of Hodgkin lymphoma involves combination chemotherapy and where necessary involved field radiotherapy. Cure is a realistic goal in more than 90% of patients with early stage disease. A delicate balance exists vi between optimal initial treatment and the development of late complications of the disease, mainly related to treatment. The last decade has witnessed the emergence of Hodgkin lymphoma occurring with increasing frequency in association with the Human Immunodeficiency virus (HIV) infection. The relative risk is 10-20 fold higher with HIV seropositivity, compared to the general population. HIV associated Hodgkin lymphoma is generally more aggressive, presents with advanced stage disease, frequent ‘B’ symptoms, less favorable histology, more frequent bone marrow involvement and overall a poorer prognosis compared to Hodgkin lymphoma in HIV seronegative individuals. This study was aimed at exploring and defining the changing pattern of Hodgkin lymphoma at Chris Hani Baragwanath Academic Hospital (CHBAH) from January 2005 to December 2012. Other objectives were to review: (i) the impact of HIV on the clinical pattern of disease and (ii) the different treatment options and the outcome of the patients. Patients and Methods This was a retrospective review of all adult patients with Hodgkin lymphoma seen at the Clinical Hematology Unit, Department of Medicine from January 2005 to December 2012 at CHBAH. Descriptive analysis was conducted through the computation of frequency tables for categorical variables and appropriate measures of central tendency i.e. mean ± SD/median (IQR) for continuous variables. Kaplan Meier survival curves were plotted to determine the survival probability of the patients based on demographic and clinical characteristics. vii Results A total of 150 patients with a confirmed diagnosis were included in the study. Ninety three percent of the patients were of black ethnicity. There were 84 males (56%) and 66 females (44%), with a male to female ratio of 1.27:1. The median age of the patients was 37 years, with a peak frequency in the third and fourth decades of life. HIV seropositivity was noted in 90 patients (60%), with the remaining 60 patients (40%) being seronegative. For the whole group of 150 patients, lymphadenopathy was the most common presenting feature (92.7%). ‘B’ symptoms were present in 74.7% of the patients. Advanced stage disease was noted in 74% of the patients and a performance status of ≥2 was evident in 66.7% of the patients. A comparison of the HIV seropositive and HIV seronegative patients shows that there is a statistically significant difference between the histological subtypes (mixed cellularity with HIV seropositivity and nodular sclerosis with HIV seronegativity), TB association (higher with HIV seropositivity) and more bone marrow involvement with HIV seropositivity. However, the median survival was shorter in HIV seropositive compared to HIV seronegative individuals. Conclusion As compared to the current literature on Hodgkin lymphoma (particularly from the developed world), our study showed a high prevalence of HIV and TB, in association with Hodgkin lymphoma. There is a paradigm shift at our institution, from an early period in the 1980’s with no HIV seropositivity in association with HL, to 50% in the last decade. The association between HIV and HL has an impact on the clinical presentation and outcome of the patients. Therefore, health care workers need to be aware of this emerging and increasing association between HIV and Hodgkin lymphoma.GR201

Birth Outcome and Maternal Risk Factors Associated with Childhood Leukemia in Rwanda: A case - Control Study

BackgroundLeukemia is the most common cancer affecting children and remains the top cause of death among children.ObjectiveThis study aimed at determining birth outcomes and maternal risk factors associated with childhood leukemia in Rwanda.MethodsA case control study was conducted at Butaro Cancer Referral hospital. The sample of 103 cases and 103 controls was recruited using the records for children diagnosed with Acute lymphocytic leukemia (ALL) and Acute myelogenous leukemia (AML) and those who were hospitalized for non-cancer treatment as controls. Semi-structured questionnaire and phone calls were used to gather information. SPSS version 21.0 was used to analyze the data. Logistic regression analysis was used to assess the risk factors.ResultsThe majority (56.8%) of children who participated in the study were aged 10-14 years. Overall 41.3% were born via C-Section. It was revealed that children who had had birth asphyxia had about three (3) times increased risk of childhood leukemia [AoR= 2.47, 95%CI: 1.167-5.262, P=0.018] compared to children that had not experienced birth asphyxia. Children who had suffered Neonatal Jaundice, had five (5) times increased risk of getting leukemia [AOR= 5.05, 95%CI: 1.738-14.664, P=0.003].ConclusionIt is important that public and private stakeholders invest more in childhood oncology researches to enable the health system deliver effective management of the cases more efficiently. Rwanda J Med Health Sci 2022;5(2):158-16

Les bétons autoplaçants renforcés par un fibrage mixte et multi-échelle : de la formulation au comportement mécanique

Hybrid fiber reinforced self-compacting concrete from formulation to mechanical behaviorIn most cases, fiber reinforced self-compacting concrete (FRSCC) contains only one type of fiber. The use of two or more types of fibers in a suitable combination may potentially not only improve the overall properties of self-compacting concrete, but may also result  in performance synergy. The combining of fibers, often called hybridization, is investigated in this paper for a cimentous matrix. Control, single, two fibers hybrid composites were cast using different fiber type steel and polypropylene with  different sizes. Flexural toughness tests were performed and results were extensively analyzed to identify synergy, if any, associated with various fiber combinations. Based on various analysis schemes, the paper identifies fiber combinations that demonstrate maximum synergy in terms of flexural toughness

Congenital knee dislocation: case report

Congenital knee dislocation of knee is a rare condition, with an uncertain incidence in sub-Saharan Africa. The present case report describes the care of a 14 day old female referred to our orthopaedic services with a congenital hyperextended knee deformity. The patient was managed non-operatively with serial manipulation and casting. At 6 months follow up the patient was able to achieve normal passive knee range of motion. The pathophysiology and treatment options of congenital knee dislocations are reviewed

Artisanal fishing in Beira, Central Mozambique

The study focuses on artisanal fishing in Beira, located within the most important fishery area of Mozambique - the Sofala Bank in central Mozambique. The main aim is to establish the degree of compliance with artisanal fishing regulations by artisanal fishermen in light of an increasing concern for the impact of fishing on ecosystems and livelihoods. Qualitative research data was gathered through semi-structured interviews with fishermen, officials from the Department of Fisheries and major stakeholders from the Institute for the Development of Small Scale Fisheries (IDSSF), the National Institute for Fishery Research (NIFR) and the Community Fishing Centres (CFCs). Though a review of the regulations and policies for the management of artisanal fishing in Mozambique indicate that they are well formulated and relevant, there is little to no compliance by the practitioners of artisanal fishing. The data revealed that artisanal fishermen in Beira use types of fishing gear which catches immature and juvenile fish and poses a threat to the health of the marine ecosystems. The most dangerous of these fishing gears are the mosquito net traps (known as “chicocota”) and the beach seine. It is clear that the application and enforcement of the relevant regulations under the right circumstances would lead to better management of the fisheries environment and ensure the sustainability of artisanal fishing.http://www.krepublishers.com02-Journals/JHE/JHE-00-0-000-000-1990-Web/JHE-00-0-000-000-1990-1-Cover.htmam201

RSAT 2011: regulatory sequence analysis tools

RSAT (Regulatory Sequence Analysis Tools) comprises a wide collection of modular tools for the detection of cis-regulatory elements in genome sequences. Thirteen new programs have been added to the 30 described in the 2008 NAR Web Software Issue, including an automated sequence retrieval from EnsEMBL (retrieve-ensembl-seq), two novel motif discovery algorithms (oligo-diff and info-gibbs), a 100-times faster version of matrix-scan enabling the scanning of genome-scale sequence sets, and a series of facilities for random model generation and statistical evaluation (random-genome-fragments, random-motifs, random-sites, implant-sites, sequence-probability, permute-matrix). Our most recent work also focused on motif comparison (compare-matrices) and evaluation of motif quality (matrix-quality) by combining theoretical and empirical measures to assess the predictive capability of position-specific scoring matrices. To process large collections of peak sequences obtained from ChIP-seq or related technologies, RSAT provides a new program (peak-motifs) that combines several efficient motif discovery algorithms to predict transcription factor binding motifs, match them against motif databases and predict their binding sites. Availability (web site, stand-alone programs and SOAP/WSDL (Simple Object Access Protocol/Web Services Description Language) web services): http://rsat.ulb.ac.be/rsat/

A nanobody-based tracer targeting DPP6 for non-invasive imaging of human pancreatic endocrine cells

There are presently no reliable ways to quantify endocrine cell mass (ECM) in vivo, which prevents an accurate understanding of the progressive beta cell loss in diabetes or following islet transplantation. To address this unmet need, we coupled RNA sequencing of human pancreatic islets to a systems biology approach to identify new biomarkers of the endocrine pancreas. Dipeptidyl-Peptidase 6 (DPP6) was identified as a target whose mRNA expression is at least 25-fold higher in human pancreatic islets as compared to surrounding tissues and is not changed by proinflammatory cytokines. At the protein level, DPP6 localizes only in beta and alpha cells within the pancreas. We next generated a high-affinity camelid single-domain antibody (nanobody) targeting human DPP6. The nanobody was radiolabelled and in vivo SPECT/CT imaging and biodistribution studies were performed in immunodeficient mice that were either transplanted with DPP6-expressing Kelly neuroblastoma cells or insulin-producing human EndoC-βH1 cells. The human DPP6-expressing cells were clearly visualized in both models. In conclusion, we have identified a novel beta and alpha cell biomarker and developed a tracer for in vivo imaging of human insulin secreting cells. This provides a useful tool to non-invasively follow up intramuscularly implanted insulin secreting cells

Flexural characteristics of rubberized cement-stabilized crushed aggregate for pavement structure

The purpose of this paper is to investigate the flexural characteristics and to quantitatively study the flexural-induced cracking of reference and rubberized cement stabilized aggregate mixtures. Four volumetric replacement percentages (0%, 15%, 30% and 45%) of 6 mm fraction size were used. This modification was found to affect the material strength detrimentally. However, material toughness was improved and stiffness was reduced. The latter findings were supported by quantitative assessment of the fractured surfaces which revealed more tortuous and rougher cracking as a result of rubber content increasing. This, in turn, may ensure a good load transfer across the cracks after their formation. Overall, using rubber in pavement construction is a sustainable solution that ensures consumption of large quantities of these waste materials. At the same time, it may be considered as a promising method to reduce cracking tendency and sensitivity which may improve shrinkage, thermal and fatigue performance

RSAT: regulatory sequence analysis tools

The regulatory sequence analysis tools (RSAT, http://rsat.ulb.ac.be/rsat/) is a software suite that integrates a wide collection of modular tools for the detection of cis-regulatory elements in genome sequences. The suite includes programs for sequence retrieval, pattern discovery, phylogenetic footprint detection, pattern matching, genome scanning and feature map drawing. Random controls can be performed with random gene selections or by generating random sequences according to a variety of background models (Bernoulli, Markov). Beyond the original word-based pattern-discovery tools (oligo-analysis and dyad-analysis), we recently added a battery of tools for matrix-based detection of cis-acting elements, with some original features (adaptive background models, Markov-chain estimation of P-values) that do not exist in other matrix-based scanning tools. The web server offers an intuitive interface, where each program can be accessed either separately or connected to the other tools. In addition, the tools are now available as web services, enabling their integration in programmatic workflows. Genomes are regularly updated from various genome repositories (NCBI and EnsEMBL) and 682 organisms are currently supported. Since 1998, the tools have been used by several hundreds of researchers from all over the world. Several predictions made with RSAT were validated experimentally and published

Physical and mechanical properties of foamed Portland cement composite containing crumb rubber from worn tires

The management of worn tires is a concern in industrialized countries. The application of crumb rubber as lightweight aggregate in cement based materials is a green alternative for reusing this material. High replacements of natural sand by crumb rubber were studied and an air-entraining agent was employed to ensure a cellular structure in the cement-based composite. The obtained results from tests in fresh state reveal an improvement in workability. The tests conducted on hardened composite show promise for constructive applications where thermal and acoustic properties are required. The minimum requirement of mechanical strength for masonry units was achieved, since compressive strengths varied between 1 and 10 MPa. Finally, potential applications as a construction material have been highlightedEiras Fernández, JN.; Segovia Rueda, F.; Borrachero Rosado, MV.; Monzó Balbuena, JM.; Bonilla Salvador, MM.; Paya Bernabeu, JJ. (2014). Physical and mechanical properties of foamed Portland cement composite containing crumb rubber from worn tires. Materials and Design. 59:550-557. doi:10.1016/j.matdes.2014.03.021S5505575