Pattern of Bladder Cancer at University Teaching Hospital, Lusaka, Zambia in the era of HIV Epidemic

Background: Human Immunodeficiency Virus (HIV) is endemic to Zambia and is associated with changes in the patterns of both AIDS and non- AIDS defining cancers. Bladder cancer is one malignancy that has been noted toincrease in the era of HIV/ AIDS epidemic. This study sought to describe the pattern of cancer of the bladder at UTH in the era of HIV/AIDS epidemic in respect with the epidemiological characteristics, prevalence of HIV infection and the histological types of bladder cancer in patients with cancer of the bladder.Patients and Methods: A prospective cross sectional, hospital based study was performed at the University Teaching Hospital (UTH), Lusaka, Zambia, between November 2009 and November 2010. Patients with bladder cancer who presented to the hospital during this period were recruited and  parameters studied included patients demographics, HIV status and pathology of cancer. Data collected was analyzed using SPSS 17.Results: A total of 53 patients with median age of 57.49 years who had histological confirmed bladder cancer were recruited during this one year period. The male to female ratio was 1.3 to 1. Of the 53 patients, HIV infection was found in six patients (11.3 %). Squamous cell carcinoma was the most common histological type (60.4%) followed by Transitional cell carcinoma (30.2%) and adenocarcinoma was least common type (9.4%).Schistosoma infection was found in 14 patients all had SCC. The study found a statistically significant reduction in the mean age of bladder cancer in HIV infected patients.Conclusions: Squamous cell carcinoma is still the most common histological type of bladder cancer in Zambia and it's strongly associated with schistosomia infection. Haematuria remains to be the most common presenting symptom in bladder cancer patients

Pattern of Bladder Cancer at University Teaching Hospital, Lusaka, Zambia in the era of HIV Epidemic

Background: Human Immunodeficiency Virus (HIV) is endemic to Zambia and is associated with changes in the patterns of both AIDS and non- AIDS defining cancers. Bladder cancer is one malignancy that has been noted to increase in the era of HIV/ AIDS epidemic. This study sought to describe the pattern of cancer of the bladder at UTH in the era of HIV/AIDS epidemic in respect with the epidemiological characteristics, prevalence of HIV infection and the histological types of bladder cancer in patients with cancer of the bladder.Patients and Methods: A prospective cross sectional, hospital based study was performed at the University Teaching Hospital (UTH), Lusaka, Zambia, between November 2009 and November 2010. Patients with bladder cancer who presented to the hospital during this period were recruited and parameters studied included patients demographics, HIV status and pathology of cancer. Data collected was analyzed using SPSS 17.Results: A total of 53 patients with median age of 57.49 years who had histological confirmed bladder cancer were recruited during this one year period. The male to female ratio was 1.3 to 1. Of the 53 patients, HIV infection was found in six patients (11.3 %). Squamous cell carcinoma was the most common histological type (60.4%) followed by Transitional cell carcinoma (30.2%) and adenocarcinoma was least common type (9.4%). Schistosoma infection was found in 14 patients all had SCC. The study found a statistically significant reduction in the mean age of bladder cancer in HIV infected patients.Conclusions: Squamous cell carcinoma is still the most common histological type of bladder cancer in Zambia and it's strongly associated with schistosomia infection. Haematuria remains to be the most common presenting symptom in bladder cancer patients.

Pre-operative bladder irrigation with 1% Povidone iodine in reducing open prostatectomy surgical site infection (SSI) at university teaching hospital, Lusaka

Purpose: The aim of the study is to assess the effectiveness of using preoperative bladder irrigation with 1% povidone iodine in reducing post transvesical prostatectomy surgical site infections. Study design: This was a prospective randomized cohort study with blinding of patients and outcome adjudicator regarding group assignments.Methodology: One hundred and thirty patients were recruited from the waiting list of Urology unit II in the department of surgery during the period between July 2011 to December 2012. The non-probability convenience sampling technique was used. Any consenting patient who presented to the department of surgery for open prostatectomy and fulfills the inclusion criteria was selected. The patients were randomly allocated to each of the two groups. Each group had 65 patients. Patients in the study group had their bladder irrigated with 1% 50cc povidoneiodine which was drained upon opening the bladder followed by enucleating the adenomatous prostate gland. Hemostasis was ensured and a 3 way Foley's catheter inserted via the urethral into the bladder and ballooned appropriately for draining and irrigation. The bladder was sutured in 2 layers using 0 or 1 chromic catgut. In the control group povidone-iodine was not used. Both groups received pre-operative antibiotics 30 minutes before incision and post-operative for 5 days. Pre-operative, intraoperative and post-operative data were collected on a standardized data collection forms. Post-operative irrigation was done for 9 to 12 days after which the catheter was removed as an outpatient. Patients were followed up in the urological clinic at 1 week, 2weeks and at 4 weeks post-operatively to assess whether they had developed surgical site infections according to CDC guidelines. Data was analyzed using SPSS version 16.Results: The patients mean age was 71.1 in the control group and 71.4 in the study group with no statistically significant difference (t=0.318; p=0.75; df=126.89). The overall surgical infection rate was 16.2%. In the control group 15 out of 65 patients (23.1%) developed SSIs. While in the study group 6 out of 65 patients (9.2%) developed SSIs. The difference in the rates of SSI between the two groups was statistically significant (÷²; p<0.05; df=126.89) Escherichia coli was the most predominant organism 13/37 (35%), streptococcus 7/37 (18.9), Citrobacter koseri 5/37 (13.5%), Klebsiella sp 4/37 (10.8%). Escherichia coli, Streptococcus and Citrobacter were sensitive to ciprofloxacin; Pantoea agglomerans was sensitive to ceftazidime while Staphylococcus coagulase was sensitive to imipenem. Enterobacter cloace was resistant to all antibiotics used.Conclusion: The study found that irrigating the bladder with 1% povidone-iodine resulted in significant reduction in post prostatectomy surgical site infection, Escherichia coli as the most common causative organism, reduced morbidity and post-operative hospital stay in the povidone iodine group.Key words: Benign prostatic hyperplasia, transvesical prostatectomy, povidone iodine, surgical site infections

The Pattern of Urological Cancers in Zambia

Objective: To examine the pattern of urological malignancies, particularly cancer of the bladder, seen at the University Teaching Hospital (UTH) in Lusaka and to compare the findings with previous studies on the same parameters done at UTH. Material and Methods: A retrospective study of urological cancers in Zambia was performed, based on histopathology reports of specimens reviewed at the UTH Pathology Laboratory inLusaka, Zambia, between January 1990 and December 2005. The parameters studied were the histological type of the cancer, patient age and trends over a 15-year period. Results: In total, 8829 cancers were diagnosed during the study period, of which 749 (8.5%) were urological malignancies affecting the kidney, bladder, prostate, testis or penis. The maleto- female ratio of the urological cancers was 10.7 to 1. Cancer of the prostate was the most common urological malignancy (54.6%), followed by bladder cancer (21.1%) and penile cancer (18.6%). The histological type of bladder cancer was mainly squamous cell carcinoma (46.2%), transitional cell carcinoma (23.4%) and adenocarcinoma (22.2%); other types (8.2%) included rhabdomyosarcoma, small cell carcinoma and lymphoma. The majority of patients (79%) with bladder cancer were between 56 and 65 years of age. Whereas 20 years ago prostate cancer comprised only 26% of urological malignancies, it accounted for 55% of urological cancersdiagnosed in Zambia between 1990 and 2005. In contrast, cancer of the penis, kidney and testis have shown no change in frequency distribution compared to 20 years ago. Conclusion:Over the last 15 years there has been an increasing proportion of cancer of the prostate and squamous cell carcinoma of the bladder. This is associated with high levels of schistosomiasis, cystitis (some of which is HIV-related) and bladder stones. It may also be due to the extension of urological services and the diagnostic armamentarium (PSA, cystoscopy and histologicaldiagnosis) to indigent rural populations, where the incidence of squamous cell carcinoma is likely to be higher than in affluent urban populations

HIV and male fertility at the University Teaching Hospital Lusaka

Background: There has been anecdotal evidence of a declining male fertility in Zambia over the last 10 years1. This prospective study of men seen in the fertility clinic was designed to look for an association between the increasing HIV infection in the population and male fertility.Methods: This prospective study compared the prevalence of HIV in men with a confirmed diagnosis of infertility seen at the Urology Clinic, to the national HIV prevalence among men of child bearing age. The study was done from October 2006 to October 2007.Results: A total of 34 men were diagnosed with infertility and included in the study. Among these patients 9 were seropositive. This gave an HIV prevalence of 26%. There was a statistically significant difference with the normal population of 13% (p = 0.043).Conclusion: HIV infection is higher in men seeking fertility treatment than in the general population. Further studies are required to determine the precise relationship between HIV and Male Fertility at the University Teaching Hospital Lusaka

How to combine rules and commitment in fostering research integrity?

Research integrity (RI) is crucial for producing research that is trustworthy and of high quality. Rules are important in setting RI standards, improving research practice and fostering responsible research practices. At the same time, rules can lead to increased bureaucracy, which without commensurate increased commitment amongst researchers towards RI is unlikely to lead to more responsible research behavior. In this paper, we explore the question: How can rules and commitment be combined to foster RI? There are three ways that research institutions can govern RI: markets (governing through incentives), hierarchies or bureaucracies (governing through rules), and network processes (governing through commitment and agreement at group level). Based on Habermas’ Theory of Communicative Action, we argue that network processes focusing on consensus, as part of the lifeworld, are necessary to legitimize and support systems, i.e. market and bureaucratic modes of governance. We analyze the institutional response to a serious RI case to illustrate how network processes can create a context in which rules can foster RI. Specifically, we analyze how the Science Committee established at Tilburg University in 2012 has navigated and combined different modes of governance to foster RI. Based on this case analysis, we formulate recommendations to research institutions on how to combine rules and commitment

Nano-risk Science: application of toxicogenomics in an adverse outcome pathway framework for risk assessment of multi-walled carbon nanotubes

BACKGROUND: A diverse class of engineered nanomaterials (ENMs) exhibiting a wide array of physical-chemical properties that are associated with toxicological effects in experimental animals is in commercial use. However, an integrated framework for human health risk assessment (HHRA) of ENMs has yet to be established. Rodent 2-year cancer bioassays, clinical chemistry, and histopathological endpoints are still considered the ‘gold standard’ for detecting substance-induced toxicity in animal models. However, the use of data derived from alternative toxicological tools, such as genome-wide expression profiling and in vitro high-throughput assays, are gaining acceptance by the regulatory community for hazard identification and for understanding the underlying mode-of-action. Here, we conducted a case study to evaluate the application of global gene expression data in deriving pathway-based points of departure (PODs) for multi-walled carbon nanotube (MWCNT)-induced lung fibrosis, a non-cancer endpoint of regulatory importance. METHODS: Gene expression profiles from the lungs of mice exposed to three individual MWCNTs with different physical-chemical properties were used within the framework of an adverse outcome pathway (AOP) for lung fibrosis to identify key biological events linking MWCNT exposure to lung fibrosis. Significantly perturbed pathways were categorized along the key events described in the AOP. Benchmark doses (BMDs) were calculated for each perturbed pathway and were used to derive transcriptional BMDs for each MWCNT. RESULTS: Similar biological pathways were perturbed by the different MWCNT types across the doses and post-exposure time points studied. The pathway BMD values showed a time-dependent trend, with lower BMDs for pathways perturbed at the earlier post-exposure time points (24 h, 3d). The transcriptional BMDs were compared to the apical BMDs derived by the National Institute for Occupational Safety and Health (NIOSH) using alveolar septal thickness and fibrotic lesions endpoints. We found that regardless of the type of MWCNT, the BMD values for pathways associated with fibrosis were 14.0–30.4 μg/mouse, which are comparable to the BMDs derived by NIOSH for MWCNT-induced lung fibrotic lesions (21.0–27.1 μg/mouse). CONCLUSIONS: The results demonstrate that transcriptomic data can be used to as an effective mechanism-based method to derive acceptable levels of exposure to nanomaterials in product development when epidemiological data are unavailable. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12989-016-0125-9) contains supplementary material, which is available to authorized users

(3-Anilino-1-phenyl­imino­thio­ureato)chloridodimethyl­tin(IV)

In the title compound, [Sn(CH3)2(C13H11N4S)Cl], the Sn atom is five-coordinated in a distorted trigonal-bipyramidal geometry, with two methyl groups and one S atom in the equatorial plane, and one N atom and the Cl atom occupying the apical positions

Stability of Immediately Placed and Delayed Implants Using Resonance Frequency Analysis (RFA). A Systematic Review

Objectives: The aim of the present Systematic Review was to compare between immediate and delayed dental implant placement using resonance frequency analysis specifically Implant Stability Quotients (ISQ). Search methods: Search was performed in two databases (PubMed and Cochrane Library) till March 2023. Randomized clinical trials (RCTs) were included and measurements of ISQ at time of placement and time of loading were recorded. We excluded papers discussing bone grafting, orthodontic treatment and implant surface treatment. Results: Results were above ISQ threshold value of 65, with no significant difference between immediate and delayed implants. However, Immediate placement showed shorter treatment time and better esthetic outcome. Conclusion: Implant stability can be achieved with both immediate and delayed implant placement techniques

Concurrent Acquisition of a Single Nucleotide Polymorphism in Diverse Influenza H5N1 Clade 2.2 Sub-clades

Highly pathogenic Influenza A H5N1 was first identified in Guangdong Province in 1996, followed by human cases in Hong Kong in 1997. The number of confirmed human cases now exceeds 300, and the associated Case Fatality Rate exceeds 60%. The genetic diversity of the serotype continues to increase. Four distinct clades or sub-clades have been linked to human cases. The gradual genetic changes identified in the sub-clades have been attributed to copy errors by viral encoded polymerases that lack an editing function, thereby resulting in antigenic drift. We report here the concurrent acquisition of the same polymorphism by multiple, genetically distinct, clade 2.2 sub-clades in Egypt, Russia, and Ghana. These changes are not easily explained by the current theory of “random mutation” through copy error, and are more easily explained by recombination with a common source. This conclusion is supported by additional polymorphisms shared by clade 2.2 isolates in Egypt and Germany