Relationship between ¹²³l-metaiodobenzylguanidine (¹²³l-MIBG) imaging findings and outcome in patients with neuroblastoma at the Red Cross War Memorial Children's Hospital

Background: In neuroblastoma, the presence of distant metastases is associated with a poor prognosis. Aim: To assess the relationship between the findings on ¹²³I-MIBG scan and outcome in patients with neuroblastoma at the Red Cross War Memorial Children's Hospital (RCWMCH). Methods: A single observer reviewed the ¹²³I-MIBG scans and clinical data of patients who had a histologically confirmed diagnosis of neuroblastoma and a baseline ¹²³I-MIBG scan and at least one follow up scan after chemotherapy cycles 4 or 7 between January 2001 and May 2015. Follow up extended to June 2016. Disease burden was assessed using the Curie scoring (CS) method. Results: Thirty four stage 4 patients were included in the analysis. Twenty nine (85%) were older than 12 months, with a median age at diagnosis of 32.5 months (range 6 - 93 months). 62% of primary tumours were located in the adrenal gland and half were NMYC amplified. Twenty (59%) patients died, 90% of deaths occurring in patients older than 12 months. No deaths were recorded in the 13 months after recruitment ended. The baseline CS did not predict outcome (alive or dead) or duration of survival. Patients with CS >2 (n = 5) on the cycle 4 scan had a median survival of 19.5 months compared with 29 months for those with a score ≤ 2 (n = 17, p = 0.88). Patients with a CS > 2 on the cycle 7 scan (n = 7) had a median survival of 28 months compared with 35 months for those with CS ≤ 2 (n = 14, p = 0.93). There was no relationship between the magnitude of the decrease in CS between the baseline and post cycle 4 or 7 scans and outcome. Conclusion: In these 34 high risk patients, the baseline CS and CS at cycle 4 or cycle 7 were not significantly indicative of survival. This is similar to other studies that did not find the pre-treatment score or the post treatment MIBG scan to be a predictor of outcome

Search Methods for Mobile Manipulator Performance Measurement

Mobile manipulators are a potential solution to the increasing need for additional flexibility and mobility in industrial robotics applications. However, they tend to lack the accuracy and precision achieved by fixed manipulators, especially in scenarios where both the manipulator and the autonomous vehicle move simultaneously. This thesis analyzes the problem of dynamically evaluating the positioning error of mobile manipulators. In particular, it investigates the use of Bayesian methods to predict the position of the end-effector in the presence of uncertainty propagated from the mobile platform. Simulations and real-world experiments are carried out to test the proposed method against a deterministic approach. These experiments are carried out on two mobile manipulators - a proof-of-concept research platform and an industrial mobile manipulator - using ROS and Gazebo. The precision of the mobile manipulator is evaluated through its ability to intercept retroreflective markers using a photoelectric sensor attached to the end-effector. Compared to the deterministic search approach, we observed improved interception capability with comparable search times, thereby enabling the effective performance measurement of the mobile manipulator

Extended-Spectrum-Beta-Lactamase (ESBL) production among Escherichia coli and Klebsiella species in Kumasi, Ghana.

In recent times Enterobacteriaceae including Escherichia coli and Klebsiella spp., isolated in Kumasi at the Komfo Anokye Teaching Hospital (KATH) have shown significant resistance to 2nd and 3rd generation cephalosporins. Microbial resistance to these antimicrobials if due to the production of Extended Spectrum-Beta-Lactamases (ESBLs) may also indicate resistance to the aminoglycosides and other antibiotics. A total of 300 non-selected, non-duplicate isolates were collected and ESBL production was phenotypically determined using the Combined Disc Method. 149 (49.67%) of the isolates were ESBL- producing E. coli (44.37%) or Klebsiella spp. (55.03%). ESBL-producing organisms were more common among in-patients (54.60%) than they were among out-patients (46.27%). Meropenem emerged as the antimicrobial agent of choice for the treatment of serious infections associated with ESBL-producers on the basis of in vitro testing. The high level of ESBL production found in these Enterobacteriaceae with the resultant microbial resistance to the available cephalosporins and other agents may pose difficulties with the choice of therapeutic options for the treatment of severe infections. Efforts to prevent and/or control outbreaks of infections with ESBL-producing organisms must emphasize on the judicious use of all antibiotics. Keywords: Extended Spectrum-Beta-Lactamases (ESBLs), Cephalosporins, Enterobacteriaceae

Hyper-reactive Malarial Splenomegaly (HMS) in a patient with β thalassaemia syndrome

This report describes a case of hyper-reactive malarial splenomegaly in a patient with a thalassaemia syndrome. Increased haemoglobin A2 is valuable for the diagnosis of common forms of β-thalassemia, while haemoglobin F (HbF) helps in diagnosis of the rarer δβ- forms. Thalassemia is characterised by splenomegaly and is common in malaria endemic areas. Hyper-reactive malarial splenomegaly is also a common cause of massive splenomegaly in malaria endemic areas. Splenic enlargement regresses with prolonged antimalarial therapy

Management dilemma of hepatocellular carcinoma in pregnancy: a case report

Hepatocellular carcinoma is rarely associated with pregnancy and when it does there is poor prognosis for both the mother and the baby.There is paucity of evidence for best practice in hepatocellular carcinoma in pregnancy especially in the background of cirrhosis and decompensation. We present a 36 year old gravida 5 para 4 at 27 weeks gestation with hepatocellular carcinoma and main complaint of abdominal pain. She had chronic hepatitis B infection with hepatocellular carcinoma on a cirrhotic background. There were both clinical and laboratory features suggestive of liver decompensation. The pregnancy outcome was a fresh stillbirth with mother alive. This case report highlights the management dilemma of hepatocellular carcinoma in pregnancy on the background of decompensated liver cirrhosis and chronic hepatitis B infection.Pan African Medical Journal 2016; 2

Thyroid scintigraphy in the management of benign thyroid disease

Thyrotoxicosis as a clinical entity has varied aetiologies. Accurate distinction of the underlying aetiology is important to guide therapy. Clinical findings are not always accurate in identifying the underlying aetiology. There is considerable overlap between the various aetiologies when using serum T3/T4 ratio. Although ultrasound is widely available and has reasonable sensitivity, it is operator dependent and misses many cases of early Grave's disease. 99mTc scintigraphy is a simple and accurate modality for assessing the functional status of the thyroid gland and delineating the aetiology of thyrotoxicosis. This paper seeks to inform on the use of thyroid scintigraphy in the management of benign thyroid disorders. Funding: None Keywords: Scintigraphy, thyroid gland, functional imaging, Grave’s disease, Ghan

[123I]-metaiodobenzylguanidine imaging findings and outcome in patients with metastatic neuroblastoma

Background: 123I-Metaiodobenzylguanidine ([123I]mIBG) is the agent of choice to assess for presence of metastases and therapy response in patients with neuroblastoma. Aim: To assess [123I]mIBG scan results and outcome in patients with stage 4 neuroblastoma at our institution. Setting: Red Cross War Memorial Children’s Hospital. Methods: A retrospective review of baseline and follow-up [123I]mIBG scans of patients who presented between January 2001 and May 2015. The clinical follow up extended until October 2019. The association between the baseline and post-induction Curie score (CS) and overall survival (OS) were assessed. Results: Thirty-four patients with stage 4 disease were included. Twenty-two (65%) patients died. The median age at diagnosis for survivors was 15.5 months vs 39 months for those who died (Kruskal Wallis c2 = 4.63, p = 0.03). Neither the baseline CS nor the post-induction CS predict the outcome or duration of survival. The median OS for a baseline CS ≤ 12 and CS 12 was 19 and 26 months, p = 0.13. The median OS for a post-induction CS 2 and CS ≤ 2 was 28 and 26 months, p = 0.66. Conclusion: In this study, baseline, post-induction and reduction in CS did not predict OS in stage 4 neuroblastoma. Factors such as small patient numbers, less intensive treatment regimes, and possible poorly dedifferentiated disease have been identified for this finding. Contribution: In contrast to international studies the Curie score did not predict treatment outcome in the South African setting where the vast majority of patients are treated with OPEC/OJEC OPEC/OJEC (vincristine [O], cisplatin [P], etoposide [E], cyclophosphamide [C] and carboplatin [J]) chemotherapy

Stochastic Search Methods for Mobile Manipulators

Mobile manipulators are a potential solution to the increasing need for additional flexibility and mobility in industrial applications. However, they tend to lack the accuracy and precision achieved by fixed manipulators, especially in scenarios where both the manipulator and the autonomous vehicle move simultaneously. This paper analyzes the problem of dynamically evaluating the positioning error of mobile manipulators. In particular, it investigates the use of Bayesian methods to predict the position of the end-effector in the presence of uncertainty propagated from the mobile platform. The precision of the mobile manipulator is evaluated through its ability to intercept retroreflective markers using a photoelectric sensor attached to the end-effector. Compared to a deterministic search approach, we observed improved robustness with comparable search times, thereby enabling effective calibration of the mobile manipulator

Papillary thyroid cancer recurrence 43 Years following Total Thyroidectomy and radioactive iodine ablation: A case report

Background: Recurrent papillary thyroid carcinoma (PTC) beyond the first two decades of definitive treatment (i.e. total thyroidectomy and radioactive iodine ablation) is a rare occurrence. Case presentation: We present a case of a 71-year old Caucasian female with a distant history of PTC treated with total thyroidectomy and radioactive iodine ablation who experienced recurrence of her disease 43 years following initial diagnosis and definitive treatment. She presented with palpable left-sided neck mass and subsequently underwent a level II, III, neck dissection and adjuvant iodine ablation. This case presents the latest recurrence in papillary thyroid cancer documented to date in the literature. Conclusion: This case exemplifies the need for the head and neck surgeon, radiation oncologist, general practitioner and radiologist to consider new lateral neck mass as late-presenting recurrence of PTC until proven otherwise regardless of low recurrence rates beyond two decades from treatment and low prognostic risk scores

Gastroenterology practice in the COVID-19 era: Ghana Association for the Study of Liver and Digestive Diseases (GASLIDD) position statement

The COVID-19 pandemic has impacted healthcare negatively across the globe. The practice of gastroenterology has been affected especially gastrointestinal (GI) endoscopy which is considered high risk for transmission of the virus. As a community of practitioners there is the need to share information and make evidence-based statements to guide GI practice in Ghana. This GASLIDD position statement based on the growing and rapidly evolving body of knowledge is to provide up to date information on the COVID-19 disease and guidance for the practice of gastroenterology in Ghana and beyond. It is to help the GI community of practice to maintain the highest level of health delivery and safety for our patients, staff, community and GI practitioners