Medicine and Health Sciences Commons^™

Quality Indicators In Surgical Oncology: Systematic Review Of Measures Used To Compare Quality Across Hospitals, Megan Mcleod, Kari Leung, C S. Pramesh, Peter Kingham, Miriam Mutebi, Julie Torode, Andre Ilbawi, Jade Chakowa, Richard Sullivan, Ajay Aggarwal

General Surgery, East Africa

Background: Measurement and reporting of quality indicators at the hospital level has been shown to improve outcomes and support patient choice. Although there are many studies validating individual quality indicators, there has been no systematic approach to understanding what quality indicators exist for surgical oncology and no standardization for their use. The aim of this study was to review quality indicators used to assess variation in quality in surgical oncology care across hospitals or regions. It also sought to describe the aims of these studies and what, if any, feedback was offered to the analysed groups.

Methods: A literature search …

The Impact Of Covid-19 Pandemic On Global Neurosurgery Collaborations., Alvan Emeka Ukachukwu, Nancy Abu Bonsrah, Andreas Seas, Zoey Petitt, Romaric Waguia Kouam, Samantha Ramos, Alyssa Edwards, Di Deng, Michael Haglund, Mahmood Qureshi

General Surgery, East Africa

No abstract provided.

The Management And Outcomes Of Hepatocellular Carcinoma In Sub-Saharan Africa: A Systematic Review., Sanju Sobnach, Urda Kotze, Wendy Spearman, Mark Sonderup, Pueya Nashidengo, Chikwendu Ede, Elie Keli, Onesai Chihaka, Luiz Zerbini, Yifan Li, Karan Gandhi

General Surgery, East Africa

Background: Hepatocellular carcinoma (HCC) is a leading cause of mortality in sub-Saharan Africa (SSA). This systematic review aimed to appraise all population-based studies describing the management and outcomes of HCC in SSA.

Methods: A systematic review based on a search in PubMed, PubMed Central, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), AfricaWide and Cochrane up to June 2023 was performed. PRISMA guidelines for systematic reviews were followed. The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration no: CRD42022363955).

Results: Thirty-nine publications from 15 of 48 SSA countries were …

A Rare Case Of Breast Carcinoma Metastasis Into A Meningioma In A 64-Year-Old Female Patient, Edwin Mogere, Miriam Mutebi, Allan Njau, Manel Haj Mansour

General Surgery, East Africa

This report discusses the occurrence of tumor-to-tumor metastasis—an atypical phenomenon in oncology where a secondary malignancy develops within an existing primary tumor. The case of a 64-year-old woman is presented, who, with a history of stage II invasive ductal carcinoma of the breast treated with mastectomy and chemoradiotherapy, developed neurological symptoms indicative of a secondary brain tumor. MRI and subsequent histopathological analysis post-craniotomy confirmed a meningioma with a metastatic breast carcinoma, demonstrating the clinical importance of considering tumor-to-tumor metastasis in similar patient histories.

Phenytoin-Induced Cerebellar Atrophy: A Case For Reversibility Of Neurological Decline., Edwin Mogere, Davis Cheruiyot, Nassiuma Manakhe

General Surgery, East Africa

This case serves as a reminder of the infrequent, yet consequential occurrence of cerebellar degeneration linked to phenytoin usage. Whilst emphasizes the importance of monitoring patients on long-term phenytoin therapy, and it further suggests considering employing bedside imaging tools such as Ultrasound fusion imaging for follow-up of patients at risk of this type of disorder. We present a case study involving a 23-year-old woman who experienced significant neurological impairment resulting in severe cerebellar atrophy while undergoing phenytoin treatment. On cessation of phenytoin, the patient exhibited improvement with enhanced cerebellar function.

Women, Power, And Cancer: A Lancet Commission, Ophira Ginsburg, Verna Vanderpuye, Ann Marie Beddoe, Nirmala Bhoo-Pathy, Freddie Bray, Carlo Caduf, Narjust Florez, Ibtihal Fadhil, Nazik Hammad, Miriam Mutebi

General Surgery, East Africa

Women interact with cancer in complex ways, as healthy individuals participating in cancer prevention and screening activities, as individuals living with and beyond a cancer diagnosis, as caregivers for family members and friends, as patient advocates, as health workers and healthcare professionals, and as cancer researchers and policy makers. The topic of women and cancer spans broad terrain, beyond women’s cancers and the biomedical aspects of any type of cancer that women in all their diversities might experience. It is inclusive of the ways in which sex and gender influence exposures to cancer risk factors, interactions with the cancer health …

Advanced Breast Cancer Care: The Current Situation And Global Disparities, Aruni Ghose, Susannah Stanway, Bhawna Sirohi, Miriam Mutebi, Sarah Adomah

General Surgery, East Africa

Objectives: Advanced breast cancer (ABC) is an incurable disease. The number of people living with ABC has increased globally. Disparities in ABC care exist at both individual and system levels. ABC cases in most low- and middle-income countries (LMICs) are underreported due to a lack of national cancer registries. Harmonized guidelines for resource stratification and capacity building in LMICs are under way.

Data sources: MEDLINE, Cochrane, and Google Scholar databases were used.

Conclusion: To improve ABC outcomes and resolve disparities, more robust health systems or pathways need to be developed across the cancer continuum in addition to social education.

Implications …

Phenytoin-Induced Cerebellar Atrophy: A Case For Reversibility Of Neurological Decline, Edwin Mogere, Davis Cheruiyot, Manakhe Nassiuma

General Surgery, East Africa

This case serves as a reminder of the infrequent, yet consequential occurrence of cerebellar degeneration linked to phenytoin usage. Whilst emphasizes the importance of monitoring patients on long-term phenytoin therapy, and it further suggests considering employing bedside imaging tools such as Ultrasound fusion imaging for follow-up of patients at risk of this type of disorder. We present a case study involving a 23-year-old woman who experienced significant neurological impairment resulting in severe cerebellar atrophy while undergoing phenytoin treatment. On cessation of phenytoin, the patient exhibited improvement with enhanced cerebellar function.

A Review Of The Current State Of Global Surgical Oncology And The Role Of Surgeons Who Treat Cancer: Our Profession’S Imperative To Act Upon A Worldwide Crisis In Evolution, Aaron C. Saunders, Miriam Mutebi, T. Subramanyeshwar Rao

General Surgery, East Africa

Worldwide, the capacity of healthcare systems and physician workforce is woefully inadequate for the surgical treatment of cancer. With major projected increases in the global burden of neoplastic disease, this inadequacy is expected to worsen, and interventions to increase the workforce of surgeons who treat cancer and strengthen the necessary supporting infrastructure, equipment, staffing, financial and information systems are urgently called for to prevent this inadequacy from deepening. These efforts must also occur in the context of broader healthcare systems strengthening and cancer control plans, including prevention, screening, early detection, safe and effective treatment, surveillance, and palliation. The cost of …

Sensitivity Of A Preanaesthesia Screening And Triage Tool In Identifying High-Risk Patients Attending The Preanaesthesia Assessment Clinic In A Tertiary Referral Hospital In Sub-Saharan Africa: A Diagnostic Accuracy Study, Brian Misoi, Vitalis Mung’Ayi, Rajpreet Bal, Shamshudin Mohammedali

General Surgery, East Africa

Objectives: The use of preoperative triage questionnaires is an innovative way to mitigate the shortage of anaesthesiologists and to identify and refer high-risk patients early for evaluation. This study evaluates the diagnostic accuracy of one such questionnaire in identifying high-risk patients in a Sub-Saharan population.

Design: Diagnostic accuracy study

Setting: The study was conducted in a preanaesthesia assessment clinic in a tertiary referral hospital in SubSaharan Africa. Participants The study had a sample size of 128, including all patients above the age of 18 scheduled for elective surgery under any modality of anaesthesia other than local anaesthesia presenting to the …

The Efficacy Of Blended Learning In A Pediatric Spine Deformity Management Program In Sub-Saharan Africa, Alaaeldin Ahmad, Abdallah Abushehab, François Waterkeyn, Beverly Cheserem, Massimo Balsano, Christopher Bonfield, Hamisi Shabani, Juma Magogo, Bryson Mcharo, Costansia Bureta

General Surgery, East Africa

Introduction: Our study assessed the efficacy of blended learning, which combines in-person learning and e-learning, in a pediatric scoliosis training program through an international collaborative effort.

Methods: The course comprised two parts: the online portion, where participants reviewed educational materials for 3 weeks and met with faculty once/week for discussion, and the in-person session, where participants reviewed cases in a team-based approach and came to a consensus on treatment strategy, followed by discussion with an international expert. All participants completed a needs assessment (NA) and clinical quiz at three points: before the course, after the online session, and after the …

Does Mainstream Brca Testing Affect Surgical Decision-Making In Newly-Diagnosed Breast Cancer Patients?, Quratul Ain, Caroline Richardson, Miriam Mutebi, Angela George, Zoe Kemp, Jennifer E. Rusby

General Surgery, East Africa

Background: Germline pathogenic variants mutations) in the BRCA1 and BRCA2 genes cause an increased risk of breast cancer and ovarian cancer. Mainstream cancer genetic testing (MCG) was introduced for breast cancer patients in our unit in 2013. Non-geneticist clinicians have been trained to offer genetic testing during initial treatment planning. We assessed the impact of timely test results on surgical decision-making.

Methods: Women who had undergone mainstream genetic testing for breast cancer between September 2013 and September 2018 were identified from a prospective database. Surgical data were collected retrospectively.

Results: 580 eligible women had mainstream genetic testing. …

Does Mainstream Brca Testing Affect Surgical Decision-Making In Newly-Diagnosed Breast Cancer Patients?, Quratul Ain, Caroline Richardson, Miriam Mutebi, Angela George, Zoe Kemp, Jennifer E. Rusby

General Surgery, East Africa

Background: Germline pathogenic variants mutations) in the BRCA1 and BRCA2 genes cause an increased risk of breast cancer and ovarian cancer. Mainstream cancer genetic testing (MCG) was introduced for breast cancer patients in our unit in 2013. Non-geneticist clinicians have been trained to offer genetic testing during initial treatment planning. We assessed the impact of timely test results on surgical decision-making.

Methods: Women who had undergone mainstream genetic testing for breast cancer between September 2013 and September 2018 were identified from a prospective database. Surgical data were collected retrospectively.

Results: 580 eligible women had mainstream genetic testing. …

Cancer Research Across Africa: A Comparative Bibliometric Analysis, Miriam Mutebi, Grant Lewison, Ajay Aggarwal, Olusegun Isaac Alatise, Christopher Booth, Miska Cira, Surbhi Grover, Ophira Ginsburg, Julie Gralow, Serine Gueye

General Surgery, East Africa

Introduction Research is a critical pillar in national cancer control planning. However, there is a dearth of evidence for countries to implement affordable strategies. The WHO and various Commissions have recommended developing stakeholder-based needs assessments based on objective data to generate evidence to inform national and regional prioritisation of cancer research needs and goals.

Methodology Bibliometric algorithms (macros) were developed and validated to assess cancer research outputs of all 54 African countries over a 12-year period (2009–2020). Subanalysis included collaboration patterns, site and domain-specific focus of research and understanding authorship dynamics by both position and sex. Detailed subanalysis was performed …

Trans-Arterial Therapy For Fibrolamellar Carcinoma: A Case Report And Literature Review, M. M. Bernon, Karan Gandhi, H. Allam, S. Singh, J. Kloppers, E. Jonas

General Surgery, East Africa

Introduction: Fibrolamellar carcinoma (FLC) is a rare pathologically distinct primary liver cancer. Surgical resection is the only treatment associated with prolonged survival. Trans-arterial embolization (TAE), which is a recognised treatment for hepatocellular carcinoma has been used to treat FLC. We present a case and performed a literature review of patients with FLC treated with TAE.

Case presentation: We present a 19-year old female with a large potentially resectable FLC which was initially treated with trans-arterial chemo-embolization (TACE) with drug eluting beads. The TACE was followed by surgical resection. Histology confirmed tumour necrosis related to the previous TACE.

Discussion …

The Kenya Uk Breast Cancer Awareness Week: Curriculum Codesign And Codelivery With Direct And Lived Experience Of Breast Cancer Diagnosis And Management, Bahaty Riogi, Carlo Ross, Miriam Mutebi, Rajiv V. Dave

General Surgery, East Africa

Global health education holds a paradox: the provision of global health degrees focusing on challenges in low-income and middle-income countries has increased in high-income countries, while those in these low-income and middle-income countries lack access to contribute their expertise, creating an ‘information problem’. Breast cancer is a pressing global health priority, which requires curriculum design, implementation, ownership and leadership by those with direct and lived experience of breast cancer.

The Kenya-UK Breast Cancer Awareness Week was conceptualised following the signing of the Memorandum of Understanding between the Kenyan and UK governments launching the Kenya UK Health Alliance. This alliance aims …

A Case Report Of Minimally Invasive Percutaneous Ultrasound Guided Tuberculous Iliopsoas Abscess Drainage In An Immunocompromised Patient, Allyzain Ismail, Neelam Ismail, Athar Ali, Shabbir Adamjee, Ahmed Jusabani, Zainab Fidaali

General Surgery, East Africa

Introduction and importance: Iliopsoas abscess is a collection of pus that presents with nonspecific features with often delays in diagnosis however cause significant morbidity and mortality with Mycobacterium tuberculosis to be considered as causative agent in at risk individuals in tuberculous endemic regions. Management involves drainage and initiation of adequate antibiotics with radiological guided percutaneous approach considered the appropriate initial approach.

Case presentation: 50-year-old immunosuppressed presenting with left iliopsoas abscess who underwent ultrasound guided drainage and placement of pigtail catheter successfully without the need for open surgical drainage. Our experience of interventional radiology for diagnosis of causative agent and treatment …

Authorship Equity And Gender Representation In Global Oncology Publications, Paula Hornstein, Hubert Tuyishime, Miriam Mutebi, Nwamaka Lasebikan, Fidel Rubagumya, Temidayo Fadelu

General Surgery, East Africa

Purpose: Authorship gender disparities persist across academic disciplines, including oncology. However, little is known about global variation in authorship gender distribution.

Methods: This retrospective cross-sectional study describes the distribution of author gender as determined from the first name across variables such as authorship position (first, middle, and last), country region, and country income level. The 608 articles with 5,302 authors included in this analysis were published in the Journal of Clinical Oncology Global Oncology, from its inception in October 2015 through March 2020. Primary outcome measure was author gender on the basis of first name probabilities assessed by …

Extra-Articular Arthroscopic Release Of Lateral Epicondylitis: A Prospective Study, Njalalle Baraza, Mark P. Robinson, Nanda Kumar Sakaleshpura Chandrashekar, Jessica A. Perry, William D. Regan

General Surgery, East Africa

Background: Operative management of lateral epicondylitis can be managed with percutaneous, arthroscopic, or open surgical release. Extraarticular arthroscopic release is a new technique, and no study has compared its outcomes and risk profile.

Methods: A 26-patient cohort was reviewed before and after extraarticular arthroscopic release, which was performed by the senior author. The Mayo Elbow Performance Scores were used as a functional outcome score and obtained via a phone interview. Results were analyzed using a paired t-test with a statistical significance set at P < .05.

Results: Of the 26 patients, 10 were being treated under workers compensation. Preoperative Mayo Elbow Performance …

Prevalence Of Os Acromiale In An Indigenous East African Population: A Computerized Tomography Scan-Based Study, Mordicai Atinga, Njalalle Baraza, Sarah Wambui, Wachira Joseph Thiong’O, Angela Atinga

General Surgery, East Africa

Background: Failure of fusion to any of the acromion physes at maturity may lead to an os acromiale. A radiological review into the prevalence of os acromiale in an indigenous East African population was performed using computer tomography (CT) imaging. The study aimed to demonstrate a lower prevalence of os acromiale in an urban population compared with cadaveric studies.

Methods: This was a cross-sectional study with consecutive sampling. CT scans of both shoulders obtained for non-shoulder pathology were used for the analysis. CT scanning was performed at a tertiary referral hospital from January 2019 to July 2020.

Results …

Hemobilia Secondary To Choledochal Cyst, Stanley Mugambi, S. R. Hussain, Ahmed Laving, Patricia Okiro, Bernadette Muthee

General Surgery, East Africa

Non variceal upper gastrointestinal hemorrhage in children is rare. A 5-year-old presented with hematemesis and melena. Pre-referral imaging and exploratory laparotomy did not reveal the source of bleeding. Hemobilia was detected on endoscopy MRI showed a choledochal cyst. The patient underwent successful resection of the cyst and hepaticojejunostomy.

Perceptions Of Surgeons On Surgical Antibiotic Prophylaxis Use At An Urban Tertiary Hospital In Tanzania, Elizabeth Mmari, Eunice Pallangyo, Authar Ali, Dereck A. Kaale, Isaac Mawalla, Muzdalfat Abeid

General Surgery, East Africa

Background: Surgical Site Infections are a major cause of morbidity and mortality among operated patients. In spite of the accessibility of universal and national guidelines for surgical prophylaxis, recent studies surveying the present routine of prophylaxis have demonstrated overutilization of a wide range antibacterial medication for a single patient. Few studies have shown qualitatively factors influencing this and perceptions of surgeons on surgical antibiotic prophylaxis use. Unfortunately, none of these studies have been done in Tanzania.

Objective: To describe the perceptions of surgeons on surgical antibiotic prophylaxis use at an urban tertiary hospital.

Methods: A qualitative study …

Needs Of Young African Neurosurgeons And Residents: A Cross-Sectional Study, Ulrick S. Kanmounye, Faith C. Robertson, Nqobile S. Thango, Alvin Nah Doe, Nourou Dine Adeniran Bankole, Pape Aicha Ginette, Solomon Ondoma, James A. Balogun, Beverly Cheserem, Mahmood Qureshi

General Surgery, East Africa

Introduction: Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice.

Methods: African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018. The survey link was distributed via social media platforms and through professional society mailing lists. Univariate and bivariate data analyses were run and a P-value < 0.05 was considered to be statistically significant.

Results: 112 respondents from 20 countries participated in this study. 98 (87.5%) were male, 63 (56.3%) were from sub-Saharan Africa, …

3d - Printed Patient Specific Instrumentation In Corrective Osteotomy Of The Femur And Pelvis: A Review Of The Literature, Njalalle Baraza, Chris Chapman, Sima Zakani, Kishore Mulpuri

General Surgery, East Africa

Background: The paediatric patient population has considerable variation in anatomy. The use of Computed Tomography (CT)-based digital models to design three-dimensionally printed patient specific instrumentation (PSI) has recently been applied for correction of deformity in orthopedic surgery. This review sought to determine the existing application of this technology currently in use within paediatric orthopaedics, and assess the potential benefits that this may provide to patients and surgeons.

Methods: A review was performed of MEDLINE, EMBASE, and CENTRAL for published literature, as well as Web of Science and clinicaltrials.gov for grey literature. The search strategy revolved around the research …

Inadvertent Stone Migration During Pneumatic Lithotripsy: Still A Conundrum In The 21st Century, Ali Akbar Zehri, Miten Patel, Philip Adebayo, Authar Ali

General Surgery, East Africa

Currently, an ideal gadget to stop retrograde stone migration remains a holy grail, and the hunt for such a device is still ongoing in the 21st century. The quest for an ideal instrument is driven by the need to reduce cost, minimize ancillary procedure rates, reduce the device's operative time, and improve the stone-free rate. The purpose of the present review is to provide an update on the use of preventive measures that are used to stop retrograde stone migration during pneumatic lithotripsy for ureteric stone management.

Currently, an ideal gadget to stop retrograde stone migration remains a holy grail, …

Innovative Use Of Mhealth And Clinical Technology For Oncology Clinical Trials In Africa, Miriam Mutebi, Rohini Bhatia, Omolola Salako, Fidel Rubagumya, Surbhi Grover, Nazik Hammad

General Surgery, East Africa

Utilization of clinical technology and mobile health (mHealth) is expanding globally. It is important to reflect on how their usage and application could translate in low- and middle-income country (LMIC) settings. With the exponential growth and advancements of mobile and wireless technologies, LMICs are prime to adapt such technologies to potentially democratize and create solutions to health-related challenges. The role of these technologies in oncology clinical trials continues to expand. The lure of mHealth promises disruptive technology that may change the way clinical trials are designed and conducted in many settings. Its applicability in the African context is currently under …

Engaging Patients For Clinical Trials In Africa: Patient-Centered Approaches, Miriam Mutebi, Dicey Scroggins, Virgil Simons, Naomi Ohene Oti, Nazik Hammad

General Surgery, East Africa

Clinical trials in oncology are an emergent field in sub-Saharan Africa. There is a long history of clinical trials in high-income countries (HICs), with increasing attempts to develop patient-centric approaches and to evaluate patient-centered outcomes. The challenge remains as to how these trends could be adopted in low-resource settings and adapted to best fit the different health ecosystems that coexist on the African continent. Models that evaluate patient-related outcomes and measures and that are used in HICs must be modified, adopted, and adapted to suit the diverse populations and the low-resource settings in most of the continent. Patient engagement in …

Retroperitoneal Isolated Enteric Duplication Cyst, Fariha Fazal, Patricia Okiro

General Surgery, East Africa

Enteric duplication cysts are rare congenital malformations of the gastrointestinal tract with an estimated incidence of 1:100,000 live births. Fewer still are isolated enteric duplication cysts (IEDC). Accurate diagnosis and timely excision of IEDCs can help in avoiding possible complications including bleeding from gastric mucosa and malignant transformation later in life. Currently, in the paediatric population, there are twenty reported cases in the literature worldwide. Of these, only three have been described in the retro peritoneum. We present a retroperitoneal IEDC, which was juxtaposed to the inferior vena cava. To the best of our knowledge, this has not been reported …

Establishing Cohorts To Generate The Evidence Base To Reduce The Burden Of Breast Cancer In Sub-Saharan Africa: Results From A Feasibility Study In Kenya, Sujha Subramanian, Robai Gakunga, Madeleine D. Jones, Asaph Kinyanjui, Emily' Ochieng, Nancy Gikaara, Florence Maluni, David Wata, Anne Korir, Miriam Mutebi, Zipporah Ali

General Surgery, East Africa

Purpose: By 2025, Kenya is estimated to experience a two-thirds increase in the incidence of breast cancer. Local research is necessary to generate evidence to inform policy, public health, and medical practice. There have been no longitudinal cohort studies in sub-Saharan Africa of women with and without breast cancer. Our aim is to assess the feasibility of conducting cohort studies in Kenya that consider clinical characteristics, socioeconomic factors, and self-care behaviors.

Methods: We initiated a short-term follow-up cohort study of women with and without a diagnosis of breast cancer with baseline face-to-face data collection and one follow-up interview …

Cyto-Histologic Discordancy In Patients Undergoing Thyroidectomy At Aga Khan University Hospital, Moses Barasa, Abdulkarim Abdallah

General Surgery, East Africa

Fine needle aspiration cytology (FNAC) findings are the basis upon which decision and type surgery is made. Therefore the diagnostic accuracy and utility of FNAC being such an integral tool in management of thyroid lesions must be evaluated for cyto-histologic discrepancy from time to time as a quality assurance measure. The objective was to compare thyroid fine-needle aspiration cytology (FNAC) with final histopathological findings at in patients undergoing thyroidectomy. This was a cross-sectional retrospective study at Aga Khan university hospital, Nairobi. Cyto-histologic discrepancy was found in 19(25%) of cases with false positive and negative rates at 9% and 16%. False …