Medical Specialties Commons^™

Low Sensitivity Of The Carehpv™ Assay For Detection Of Oncogenic Human Papillomavirus In Cervical Samples From Hiv-Infected And Hiv-Uninfected Kenyan Women, Titus Maina, Aaron Ermel, A. Moormann, Susan Cu-Uvin, Elkanah Omenge, Philip Tonui, K Chelimo, B Rosen, Peter Itsura, K. Muthoka

Obstetrics and Gynaecology, East Africa

Background: Human papillomavirus (HPV) infection causes cervical cancer (CC), a common malignancy among Kenyan women. New CC screening methods rely on oncogenic HPV (“highrisk”, or HR-HPV) detection, but most have not been evaluated in swabs from Kenyan women.

Methods: HPV typing was performed on 155 cervical swabs from Kenyan women using the Roche Linear Array® (LA) and careHPV™ (careHPV) assays. Detection of 14 oncogenic HPV types in careHPV assay was compared to LA results.

Results: Compared to LA, sensitivity and specifi city of careHPV assay was 53.0% and 80.9%, respectively. The sensitivity and specifi city of careHPV …

Breast Cancer Recurrence Rate In Patients Treated For Early Breast Cancer, Cecilia Munguti

Master of Medicine in General Surgery

Background: Breast cancer, the leading cause of cancer in Kenya among women, has a prevalence of 57.1 per 100,000 women and an annual mortality of 3.7 per 100,000. Early breast cancer is curable, but has a residual risk of recurrence of 10.4% in the first 5 years. Fifty percent of the recurrences occur after the first 5 years after diagnosis. Recurrent breast cancer is associated with poorer prognosis and higher mortality rates. Objectives: The primary objective was to determine the breast cancer recurrence rates for women managed for DCIS and early breast cancer at Aga Khan University Hospital. Secondary objectives …

The Quality Of Life Of Patients With Early Breast Cancer And Their Partners One Year After Breast Conserving Surgery Versus Modified Radical Mastectomy: A Single Centre Five Year Review, Senoga Andrew

Master of Medicine in General Surgery

Background: Breast cancer accounts for the highest incidence rate (40.3/100000) and fourth highest mortality rate (17.8/100000) among cancers in Kenya. Forty percent of breast cancer cases in Kenya are early breast cancer and this is will increase with scaled up awareness campaigns and screening. Breast conserving surgery (BCS) followed by radiotherapy (BCT) and modified radical mastectomy (MRM) are the commonest forms of surgical techniques utilized in treatment of early breast cancer with similar overall survival and recurrence rates. These treatments impact variably on the quality of life of the patients and their spouses who are their immediate emotional and social …

Prevalence And Factors Associated To Incidental Prostate Carcinoma Among Patients Undergoing Turp For Benign Prostatic Enlargement., Isaac Herman Mawalla

Master of Medicine in General Surgery

Background: Prostate carcinoma carries higher morbidity and mortality when diagnosed late. Prostate cancer screening is paramount, however, there are no specific clinical signs for early-stage prostate cancer. As an independent variable, prostate-specific antigen is an established predictor of cancer. Incidental prostate cancer is detected by histological examination of resected biopsy tissue that had been previously diagnosed as benign. In the current PSA-use era the prevalence of incidental prostate cancer ranges from 1.4 to 13%. The prevalence in Tanzania as published by Gunda et al was 21.71%. This is alarmingly high. However, in his study, patients with high prostate-specific antigens were …

Perceptions Of Surgeons On Surgical Antibiotic Prophylaxis Use At Aga Khan Hospital, Dar Es Salaam., Elizabeth Elibariki Mmari

Master of Medicine in General Surgery

Introduction: Surgical site infections are a major cause of morbidity and mortality among operated patients. The use of antibiotic prophylaxis in prevention and reduction of incidence of surgical site infection is widespread. 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 medications 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 …

Referral Patterns Affecting Age At Orchidopexy For Undescended Testis At A Tertiary Hospital In Nairobi., Muthua Ken Njoroge

Master of Medicine in General Surgery

BACKGROUND: Undescended Testis is the most common urological congenital anomaly with significant burden of disease especially in our local context. Management relies on early diagnosis, in the perinatal period, and prompt referral to an appropriate surgical unit. Spontaneous descent, while possible, doesn’t occur beyond 6 months and thus surveillance should not proceed beyond this age. Current guidelines recommend surveillance up to 6 months, referral by 9 months and, most importantly, orchidopexy by 1 year of age. Despite these clear guidelines, achieving them has proven difficult globally with low rates of orchidopexy by 1 year. The most common cited cause has …

A Review Of The Influence Of Fathers On Children's Eating Behaviours And Dietary Intake, Stephanie Rahill, Aileen Kennedy, John Kearney

Articles

The role of fathers in child rearing has changed in recent years due to an increase in maternal employment. Despite this, the majority of research has focused on maternal influences and behaviours in relation to child feeding. Therefore, the aims of the narrative review were: 1) to examine the role and responsibility of fathers in child feeding and the factors associated with paternal responsibility in child feeding; 2) to establish how paternal modelling, paternal diets, and paternal feeding practices relate to children's eating behaviours and dietary intake; and 3) to explore the role of maternal perceptions on paternal feeding roles, …

Effect Of Unmaskes On Delivering Difficult News Among Residents, Karishma Sharma

Master of Medicine in Internal Medicine

Background: Effective delivery of difficult news to patients and family has been shown to improve the physician-patient relationship, quality of care, and overall patient satisfaction. However, delivery of difficult news (DDN) remains a challenging task for even the most experienced providers. Little has been studied about delivery of difficult news by resident physicians in the sub-Saharan setting. We developed a 4-minute, easily accessible, graphic video using the mnemonic UNMASKES to help improve delivery of difficult news by resident physicians at our institution and their patients. Objective: To determine the impact of a short training video called UNMASKES in helping resident …

Occult Hepatitis B Virus Infection In A Cohort Of Hiv Infected Antiretroviral Therapy Naïve Adults, Adil Suleiman Salyani

Master of Medicine in Internal Medicine

Background: Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are endemic to sub-Saharan Africa (SSA) with co-infection being common. Infection with HIV is a risk factor for occult hepatitis B virus infection (OBI), defined as presence of HBV deoxyribonucleic acid (DNA) in the absence of hepatitis B surface antigen (HBsAg). Occult hepatitis B virus infection is further classified based on HBV DNA level as true (/mL) or false (≥200 IU/mL). Presence of OBI is associated with development of liver cirrhosis and hepatocellular carcinoma (HCC). Objectives: The primary outcome was to determine the prevalence of OBI in anti-retroviral therapy (ART) …

Utility Of Glasgow-Blatchford Scoring System In Identification Of Low Risk Patients With Upper Gastrointestinal Bleeding In Emergency Departments In Dar Es Salaam Hospitals, Tanzania, Selestin D. Mpiri

Master of Medicine in Internal Medicine

Background: Acute upper gastrointestinal bleeding (UGIB) remains a common cause of visits to the Emergency Department (ED). To stratify the risk of complications, rebleeding, need for clinical intervention, or death, several clinical scores are in use. Glasgow-Blatchford Score (GBS) is an excellent risk assessment tool and has shown to accurately identify patients with a low risk of death or requiring intervention. In urban Tanzania, there is a lack of standardized protocol and a well-validated risk assessment tool for analyzing patients presenting with UGIB symptoms. Good performance of GBS score and its use will help to reduce unnecessary emergency endoscopies and …

Discordance Between Breast Imaging And Histopathology Findings After Ultrasound Guided Core Needle Biopsy, Margaret Mutinda Mwania

Master of Medicine in Imaging and Diagnostic Radiology

Introduction: Breast cancer is the most prevalent cancer among women worldwide with an estimated global incidence of 11.6%. According to the GLOBOCAN factsheet, in 2018 breast cancer incidence in Kenya was 40.3 per 100,000. Early detection and diagnosis of breast cancer has been shown to reduce mortality and increase years of life gained. Breast lesion diagnosis is heavily based on imaging and pathology and typically findings are reported independent of one another. Correlation of imaging findings and pathology after biopsy is found to be of critical importance in detecting possible sampling error, concordance versus discordance, recommend appropriate management and thus …

Von Willebrand Disease Among Women Of African Descent Attending The Aga Khan University Hospital Nairobi, With Menorrhagia, Angela Nabutilu Munoko

Master of Medicine in Clinical Pathology

Introduction: Von Willebrand Disease (VWD) is the most common heritable bleeding disorder with equal prevalence reported across the races. Women are more likely to present with excessive bleeding due to menstruation and child bearing. Studies have found that 5-24% of women presenting with menorrhagia have VWD. Women of African descent are under-represented in studies carried out on Von Willebrand disease and lower prevalence has been reported in this population. VWD has variable penetrance and racial differences in genetic mutations may influence presentation and disease severity. It was predicted that the standardization of the study conditions (case definition of menorrhagia, use …

Dynamic Conformal Arcs For Lung Stereotactic Body Radiation Therapy: A Comparison With Volumetric-Modulated Arc Therapy., Rasmus Bokrantz, Minna Wedenberg, Peter Sandwall

Oncology Articles

This study constitutes a feasibility assessment of dynamic conformal arc (DCA) therapy as an alternative to volumetric-modulated arc therapy (VMAT) for stereotactic body radiation therapy (SBRT) of lung cancer. The rationale for DCA is lower geometric complexity and hence reduced risk for interplay errors induced by respiratory motion. Forward planned DCA and inverse planned DCA based on segment-weight optimization were compared to VMAT for single arc treatments of five lung patients. Analysis of dose-volume histograms and clinical goal fulfillment revealed that DCA can generate satisfactory and near equivalent dosimetric quality to VMAT, except for complex tumor geometries. Segment-weight optimized DCA …

Gynecologic Large Cell Neuroendocrine Carcinoma: A Review, Grant Burkeen, Aman Chauhan, Rohitashva Agrawal, Riva Raiker, Jill M. Kolesar, Lowell B. Anthony, B. Mark Evers, Susanne Arnold

Internal Medicine Faculty Publications

Large cell neuroendocrine carcinomas (LCNEC) are rare, aggressive high-grade neuroendocrine neoplasms within the neuroendocrine cell lineage spectrum. This manuscript provides a detailed review of published literature on LCNEC of gynecological origin. We performed a PubMed search for material available on gynecologic LCNEC. We analyzed 104 unique cases of gynecologic LCNECs, of which 45 were cervical primary, 45 were ovarian, 13 were uterine, and 1 was vaginal. A total of 45 cases of cervical LCNEC were identified with a median age of 36 years. Median overall survival was 16 months. We identified 45 ovarian LCNEC cases in the published literature with …

The Write Stuff - Winter 2020 (Vol. 17, No. 1), Research Medical Library

Write Stuff 2020

• Best practices for sharing confidential materials outside MD Anderson
• 11th edition of the AMA Manual of Style to be published this month
• MD Anderson’s policies on disclosure of foreign relationships
• New NIH grant application instructions and forms coming in spring 2020
• Cabell’s Blacklist
• Unusual terms used in scientific writing and publishing: Hybrid journal and mirror journal

Long Term Health Related Quality Of Life Following Uterine Fibroid Embolization At Aga Khan University Hospital, Nairobi, Michael Muthoka Kioko

Master of Medicine in Obstetrics and Gynecology

Background: Uterine Fibroid Embolization (UFE) is one of the effective options available for treatment of symptomatic uterine fibroids with documented improvement in the quality of life and reduction in symptoms. Most of the studies have demonstrated an improvement in the quality of life over a short to intermediate period. We carried out this study to assess the long-term quality of life following uterine fibroid embolization in a predominantly black population. There are no identified studies locally or in Africa addressing this issue whereas studies done elsewhere indicate a probable increased fibroid disease burden among black women. Objectives: Our objectives in …

Timing And Factors That Contribute To The Decision Making Process On The Mode Of Delivery After One Previous Casearean Section., Sylvia Nyanyu Mruttu

Master of Medicine in Obstetrics and Gynecology

Background: The rates of caesarean sections have continued to rise despite public and professional concern. This has continually increased the proportion of the obstetric population with a history of previous caesarean delivery. These women may be offered either elective repeat caesarean section (ERCS) or planned vaginal birth after caesarean delivery (VBAC). This study aimed to identify the timing, level of knowledge and factors that influence the decision-making. Objectives: The primary objective was to elicit the factors that contribute to women to choose VBAC or ERCS. The secondary objectives were to determine the timing of this decision, measure the level of …

The Burden Of Urinary Incontinence Among African Diabetic And Non-Diabetic Women Seeking Care At The Aga Khan University Hospital, Nairobi, Martin Kimemia Mbuthia

Master of Medicine in Obstetrics and Gynecology

Introduction: Female urinary incontinence is a common and chronic condition with devastating psychosocial effects. It can occur at any age and is specifically more common in older women. It has a prevalence of up to 55% depending on the age-group and the target population studied. About 9% of adults globally have diabetes and a greater number live in LMICs. Diabetes is twice as prevalent in blacks and three to four times higher in South-Asian populations compared to Caucasian populations. In women with Type 2 DM, urinary incontinence is 30% to 70% more common than among women with normal glucose levels. …

The Association Of Maternal Sociodemographic Factors With Stress In Pregnancy, Maheshwari Andhavarapu

Master of Medicine in Obstetrics and Gynecology

Introduction: Antenatal stress has been linked to maternal morbidity and preterm birth (PTB). One of the pathophysiological processes leading to PTB is thought to be via activation of the hypothalamus-pituitary-adrenal axis resulting in cortisol production. Hair cortisol has recently been shown to be a stress marker in the pregnant and non-pregnant population. Some determinants of hair cortisol have also been studied but more research is needed in this area, especially in pregnancy. Understanding the risk factors of antenatal stress may guide institution of preventative or screening measures to reduce the risk of adverse birth outcomes. As the effect of stress …

Cyto-Histological Correlation Of Thyroid Cytology And Associated Adverse Surgical Outcomes At Aga Khan University Hospital, Nairobi., Moses Barasa

Master of Medicine in General Surgery

Background: Solitary thyroid nodules are commonly encountered endocrine disorders in surgical practice. Fine Needle Aspiration Cytology (FNAC) is a minimally invasive, accurate and cost-effective diagnostic tool that provides basis for surgical decisions-making in thyroid lesions management. Thus, it’s imperative that such a test should have high diagnostic accuracy in order to avoid under or over-treatment arising from false negative or positive results respectively. Studies from the African region, compared to the developed world have reported higher thyroid cyto-histologic discrepancy. Objective: To determine the diagnostic accuracy and adverse surgical outcome of discrepant thyroid cytology. Methods: Retrospective cross-sectional analytical study conducted at …

Local Anaesthetic Wound Infusion Versus Thoracic Epidural Analgesia For Post-Operative Pain Control Following Elective Laparotomy: A Randomised Controlled Trial, Daniel Gathege Mwangi

Master of Medicine in General Surgery

Background: Post-operative pain control is an important pillar in enhanced recovery after surgery. There is a paucity of data that compares efficacy of pain control between continuous local anaesthetic wound infusion and thoracic epidural analgesia in elective laparotomy patients Objective: To evaluate pain control between continuous local anaesthetic wound infusion and thoracic epidural analgesia in elective laparotomy patients. Design: A randomised, single-blind, controlled clinical trial. Setting: Aga Khan University Hospital, Nairobi, Kenya. Population: Patients undergoing elective laparotomy. Methods: Thirty eight patients scheduled for elective laparotomy were randomized into two equal groups to receive either continuous local anaesthetic wound infusion or …

Two Months Of Global Health In Maseru, Lesotho, Rachel Hildebrand

Posters

Describes her experience working with infants and children at the Center of Excellence and Adolescents at Queen Mamohato Memorial Hospital in Maseru, Lesotho.

Global Health Immersive Elective In The Philippines, Lisa Godfrey

Posters

Describes her experiences working at Fabella Memorial NICU and the Philippines General Hospital.

Hpv Immunization Intervention Application In Rural Arkansas, Randi M. Wright

Doctor of Nursing Practice Projects

HPV (Human Papillomavirus) is the most common sexually transmitted infection (STI) contracted with over 33,000 cases of cancer attributable to the virus in the United States. The socioeconomical impact of HPV can be combatted with the HPV vaccine which is almost 100 percent successful in preventing infection. A strong provider recommendation is the most effective way to increase HPV vaccination. A private clinic in Arkansas with a total of 13 employees were provided HPV vaccination education. A survey was provided to evaluate knowledge on the topic prior to the presentation. An intervention bundle including 9 changes to vaccination procedures was …

Phenology Of Cupressaceae Urban Infrastructure Related To Its Pollen Content And Meteorological Variables, A. Monroy-Colín, J. M. Maya-Manzano, I. Silva-Palacios, R. Tormo-Molina, R. Pecero-Casimiro, Á. Gonzalo-Garijo, S. Fernández-Rodríguez

Articles

Cupressaceae pollen is one of the major airborne allergens of the Mediterranean region and in other regions around the world. Pollen production of these species causes considerable allergic problems during winter, being this type of pollen the most abundant in this period of the year. This work aims to relate phenology, meteorology and airborne pollen records in these species. Aerobiological sampling was carried out in Badajoz (SW Spain) from 2016 to 2018 using Hirst-type volumetric sampler. Pollination phenology was studied in 50 specimens, ten of Cupressus macrocarpa, ten of Cupressus arizonica, 15 of Cupressus sempervirens and 15 of …

Hysplit As An Environmental Impact Assessment Tool To Study The Data Discrepancies Between Olea Europaea Airborne Pollen Records And Its Phenology In Sw Spain, Alejandro Monroy-Colín, J. M. Maya-Manzano, Rafael Tormo-Molina, Raúl Pecero-Casimiro, María Ángeles Gonzalo-Garijo, Santiago Fernández-Rodríguez

Articles

The olive tree (Olea europaea) is a native evergreen tree in the Mediterranean region, being one of the most important causes of seasonal respiratory allergies in Mediterranean countries. This work aims to relate flowering phenology, source tree distribution, meteorology, and airborne pollen records for this species and to analyse the possible arrival of air masses from distant areas during days when differences between the phenological and pollen peaks. Aerobiological sampling was carried out in Badajoz (SW Spain) for 4 years (2016–2019) using a Hirst volumetric sampler. Trees were geolocalized in the city and surrounding areas. The pollination phenology of 15 …

Improving Access To Hepatitis C Treatment For Uninsured Patients In Southeast Georgia, Bonzo K. Reddick, Marianna O'Ree

Journal of the Georgia Public Health Association

Background: In this brief report, we discuss enhancing access to hepatitis C treatment for uninsured patients in Southeast Georgia.

Methods: Through our screening program for hepatitis C virus (HCV) infections in a local safety net emergency department, the Comprehensive AIDS Resources Emergency (CARE) Initiative studied the rates of linkage to care for newly diagnosed patients with HCV and sought ways to improve linkage to care for those who did not have health insurance.

Results: Our multidisciplinary team partnered with a local federally qualified health center (FQHC) and a wholesale laboratory service to offer affordable care options, thus increasing the percent …

Assessing The Temporality Of Adverse Effects Of Vaccines In The Nicu, Julia Tonnessen, Pedro Urday, Md

Phase 1

Introduction: Premature infants have an increased risk of contracting vaccine-preventable diseases and experience worse outcomes. Evidence supports keeping them on a regular vaccination schedule, but it is often delayed, partly because preterm infants have an increased incidence of cardiorespiratory events compared to term infants. The aim of our study was to determine if immunizations in the NICU contribute to an increased number of adverse events.

Methods: This was a retrospective, single-center, observational study with the target population infants born at less than 32 weeks gestation at Thomas Jefferson University Hospital who received the two-month vaccination series in the NICU. The …

The Financial And Psychosocial Impact Of Medicinal Cannabis, Andrew Lee, Chris Ahmed, Amanda Campbell, Gregory Garber, Msw, Lcsw, Neil D. Palmisiano, Md, Brooke Worster, Md

Phase 1

Introduction: The use of medicinal cannabis for symptom management in cancer patients is a growing area of clinical interest. Past studies have demonstrated cannabis’s potential as an antiemetic and analgesic, but there is still much research to be done on its clinical efficacy. Our study hypothesizes that cancer patients using medicinal cannabis experience subjective improvements in pain, chemotherapy-induced nausea and vomiting (CINV), and quality of life (QOL) that justify related out-of-pocket costs.

Methods: Cancer patients are surveyed by phone three to six months after certification for access to medicinal cannabis. The survey assesses patient-reported changes in pain, CINV, QOL, and …

Ageism In Consent? In A Decision-Making Capable Geriatric Orthopaedic Trauma Patient Population, Does Increased Age Impact Who Physicians Consent For Surgical Fixation?, Madeline M. Mcgovern, Michael F. Mctague, Mph, Marilyn Heng, Md, Mph, Frcsc

Phase 1

Introduction: Persistent misconceptions of frailty and dementia in geriatric patients impact physician-patient communication and leave patients vulnerable to disempowerment. Our study examines the consenting process in an orthogeriatric trauma patient population to determine if there is a relationship between increased age at presentation and utilization of health care proxies (HCPs) for surgical procedure consent.

Methods: We retrospectively reviewed medical records of patients aged 65 and older admitted for an operative fracture between 2013 and 2016. Patients were considered decision-making capable if there was absence of history of cognitive impairment prior to surgical consent and if the patients screened negative in …