Correlation between receptor status and presence of axillary lymph node metastasis in breast cancer in Kenya

Background: Breast cancer survival is linked to early detection, and timely and appropriate treatment. Survival depends on the stage and biological behaviour of the tumour. It is unclear how different molecular subtypes impact on axillary node involvement.Objective: This study sought to determine the correlation between hormonal receptor status with axillary nodal status in breast carcinoma.Methodology: A cross sectional study was carried out at Kenyatta National Hospital surgical wards and histopathology laboratory. Patients with a histological diagnosis of breast cancer, scheduled to undergo a modified radical mastectomy, were recruited. Data collected included age at diagnosis, parity, menopausal status, clinical examination findings, stage of the disease clinically and pathologically, and hormonal receptor status. Data were analyzed using SPSS version 21.0.Results: We enrolled 79 women with invasive breast carcinoma. Mean age was 48(SD=14.5) years. Most (48.1%) presented with stage III tumour. Most tumours (58.2%) were luminal A. Correlation between molecular type and nodal involvement was not significant. Luminal B was significantly present in those above 50 years (p=0.011).Conclusion: The most common molecular type of breast cancer was luminal A, but luminal B disease which was prevalent in women more than 50 years old was the only molecular subtype that had a positive correlation with axillary nodal status.Keywords: Breast cancer, Axillary lymph nodes, Molecular subtypes, Hormonal receptor status, HER-2 statu

Establishing the College of Pathologists of East, Central and Southern Africa – The Regional East Central and Southern Africa College of Pathology

Issues: The scarcity of pathologists in sub-Saharan Africa is a well established fact that is attributable to few training programmes in the region; this is further compounded by the lack of harmonised curricula, training and exams within and without member countries. Description of the intervention: Through the Association of Pathologists of East, Central and Southern Africa, the College of Pathologists of East, Central and Southern Africa (COPECSA) was formed with the clear-cut goal of establishing a regional and internationally recognised college to support and inform good quality medical and laboratory practice by promoting leadership, mentorship and excellence in the safe practice of pathology through training, exams, accreditation, advocacy and professional development for health. Lessons learnt: Since its inception in 2010, COPECSA has conferred fellowships to 120 practising pathologists in the East, Central and Southern Africa in partnership with international organisations; the college has been awarded five competitive grants and conducted several quality improvement workshops. Recommendations: This paper describes the journey that COPECSA has made towards standardising the practice and training of pathology in the East Central and Southern Africa region

Placental villous changes among hypertensive and normotensive pregnant women at Kenyatta National Hospital

Background: Hypertensive pregnancy disease is a major cause of maternal morbidity and mortality in Africa and is one of the major causes of maternal deaths in Kenyan public health facilities. Previous studies have not demonstrated chorionic villous histological changes specifically observed in chronic hypertension in pregnancy and gestational hypertension. No studies have been done in Kenya to demonstrate variations in chorionic villous histomorphology in normotensive and hypertensive pregnant women. Determining the difference between villous histomorphological findings among the hypertensive pregnancy disease clinical groups (pre-eclampsia eclampsia, chronic hypertensive disease and gestational hypertension) may provide insight onto whether the different groups have a common pathological end point; an altered villous histomorphology. Established associations between placental villous histopathology and clinical variables such as maternal blood pressure status will also help sensitize clinicians on the need for histology examination of placentae. Objective: To determine placental villous changes among hypertensive and normotensive pregnant women who delivered at Kenyatta National Hospital. Design: Laboratory based retrospective cross-sectional analytical study. Methods: The study was carried out at the University of Nairobi (UoN) Histopathology Laboratory. Archived placental tissue blocks (n=143) obtained from hypertensive pregnant women and their normotensive counterparts who delivered at Kenyatta National Hospital between July and December 2015 were processed and analyzed. Results: Placentae from women with hypertensive pregnancy disease at Kenyatta National Hospital had significantly higher rates of accelerated villous maturity, distal villous hypoplasia, stromal fibrosis, decidual arteriopathy, villous infarction and an increased area (\u3e25%) of intervillous fibrin deposition (p\u3c0.01). The pre-eclampsia-eclampsia clinical group had placentae characterized by lesions associated with placental ischemia supporting evidence that placental hypoperfusion could be characteristic of pre-eclampsia-eclampsia rather than gestational hypertension. Recommendation: Sensitization of clinicians in Kenyatta National Hospital on clinical utility and need for placental histopathological examination in hypertensive pregnancy disease and related clinical scenarios

HIV-associated mortality in the era of antiretroviral therapy scale-up – Nairobi, Kenya, 2015

<div><p>Background</p><p>Declines in HIV prevalence and increases in antiretroviral treatment coverage have been documented in Kenya, but population-level mortality associated with HIV has not been directly measured. In urban areas where a majority of deaths pass through mortuaries, mortuary-based studies have the potential to contribute to our understanding of excess mortality among HIV-infected persons. We used results from a cross-sectional mortuary-based HIV surveillance study to estimate the association between HIV and mortality for Nairobi, the capital city of Kenya.</p><p>Methods and findings</p><p>HIV seropositivity in cadavers measured at the two largest mortuaries in Nairobi was used to estimate HIV prevalence in adult deaths. Model-based estimates of the HIV-infected and uninfected population for Nairobi were used to calculate a standardized mortality ratio and population-attributable fraction for mortality among the infected versus uninfected population. Monte Carlo simulation was used to assess sensitivity to epidemiological assumptions. When standardized to the age and sex distribution of expected deaths, the estimated HIV positivity among adult deaths aged 15 years and above in Nairobi was 20.9% (95% CI 17.7–24.6%). The standardized mortality ratio of deaths among HIV-infected versus uninfected adults was 4.35 (95% CI 3.67–5.15), while the risk difference was 0.016 (95% CI 0.013–0.019). The HIV population attributable mortality fraction was 0.161 (95% CI 0.131–0.190). Sensitivity analyses demonstrated robustness of results.</p><p>Conclusions</p><p>Although 73.6% of adult PLHIV receive antiretrovirals in Nairobi, their risk of death is four-fold greater than in the uninfected, while 16.1% of all adult deaths in the city can be attributed to HIV infection. In order to further reduce HIV-associated mortality, high-burden countries may need to reach very high levels of diagnosis, treatment coverage, retention in care, and viral suppression.</p></div

Percent HIV positivity among cadavers at City and KNH mortuaries, Nairobi 2015.

<p>Percent HIV positivity among cadavers at City and KNH mortuaries, Nairobi 2015.</p

Annualized and coverage-adjusted surveillance deaths, Nairobi 2015.

<p>Annualized and coverage-adjusted surveillance deaths, Nairobi 2015.</p

Risk difference (RD), standardized mortality rate (SMR) and population attributable fraction (PAF) due to HIV, Nairobi 2015.

<p>Risk difference (RD), standardized mortality rate (SMR) and population attributable fraction (PAF) due to HIV, Nairobi 2015.</p