Cervical cancer management in a low resource setting: A 10-year review in a tertiary care hospital in Kenya.

Background: Cervical cancer is one of the leading causes of cancer mortality among women in Kenya due to late presentations, poor access to health care, and limited resources. Across many low- and middle-income countries infrastructure and human resources for cervical cancer management are currently insufficient to meet the high population needs therefore patients are not able to get appropriate treatment. Objective: This study aimed to describe the clinicopathological characteristics and the treatment profiles of cervical cancer cases seen at Moi Teaching and Referral Hospital (MTRH). Methods: This was a retrospective cross-sectional study conducted at MTRH involving the review of the electronic database and medical charts of 1541 patients with a histologically confirmed diagnosis of cervical cancer between January 2012 and December 2021. Results: Of the 1541 cases analyzed, 91% were squamous cell carcinomas, 8% were adenocarcinomas, and 1% were other histological types. Thirty-eight percent of the patients were HIV infected and less than 30% of the women had health insurance. A majority (75%) of the patients presented with advanced-stage disease (stage IIB-IV). Only 13.9% received chemoradiotherapy with curative intent; of which 33.8% received suboptimal treatment. Of the 13% who received surgical treatment, 45.3% required adjuvant therapy, of which only 27.5% received treatment. Over 40% of the women were lost to follow-up. Conclusion: Most of the patients with cervical cancer in Kenya present at advanced stages with only a third receiving the necessary treatment while the majority receive only palliative treatment or supportive care.

Optimal combination of cow and quinoa milk for manufacturing of functional fermented milk with high levels of antioxidant, essential amino acids and probiotics.

The aim of this research was to produce Rayeb milk, a bio-fermented milk product that has important benefits for health and nutrition. The Rayeb milk was divided into five different treatments: T1 from cow milk, T2 from quinoa milk, T3 from a mixture of cow and quinoa milk (50%:50%), T4 from a mixture of cow and quinoa milk (75%:25%), and T5 from a mixture of cow and quinoa milk (25%:75%). As a starting culture, ABT-5 culture was used. The results demonstrated that blending quinoa milk with cow milk increased the total solids, fat, total protein, pH, acetaldehyde, and diacetyl values of the resulting Rayeb milk. Additionally, the total phenolic content, antioxidant activity, minerals, and amino acids-particularly important amino acids-in Rayeb milk with quinoa milk were higher. In Rayeb milk prepared from a cow and quinoa milk mixture, Lactobacillus acidophilus and Bifidobacterium bifidum were highly stimulated. All Rayeb milk samples, particularly those that contained quinoa milk, possessed more bifidobacteria than the recommended count of 106 cfu g-1 for use as a probiotic. Based on the sensory evaluation results, it is possible to manufacture a bio-Rayeb milk acceptable to the consumer and has a high nutritional and health values using a mixture of cow milk and quinoa milk (75%:25% or 50%:50%) and ABT-5 culture.

Household coverage of ivermectin distribution in birnin kudu local government area of Jigawa State, Nigeria.

Purpose: To assess community-directed treatment coverage with Ivermectin (CDTI) in Onchocerciasis-endemic communities in Birnin Kudu local government area (LGA) Jigawa state. Subjects and Methods: This was a community-based multistaged cross-sectional survey based on probability proportional to size. The study involved the administration of a questionnaire on 2021 respondents from 207 households. Also, 30 Community Leaders and Community Directed Distributors (CDDs) were purposively selected for interview from the communities visited. Results: Overall, 2021 respondents from the 2031 sampled population took part in the study giving a response rate of 99.6%. Slightly above half, 1130 (55.9%) were males. The geographic and therapeutic coverage of mass drug administration of Ivermectin achieved in the LGA was 100% and 79.9%, respectively. The key factors affecting coverage includes the unavailability of drugs (48.8%), absenteeism of some of the household members (31%), and inadequate incentives to the CDDs by the government and poor record keeping by the CDDs. Conclusion: This study found that the minimum geographic and therapeutic coverage of Ivermectin distribution was achieved by CDD as recommended by the World Health Organization for the control of onchocerciasis. For this to be sustained and to achieve elimination, there must be an adequate supply of ivermectin, training of CDDs, retraining of CDDs, adequate supervision in record keeping, and health education to the community.

Résumé Objectif: Évaluer la couverture du traitement sous direction communautaire à l'ivermectine (TIDC) dans les communautés endémiques de l'onchocercose de la zone d'administration locale de Birnin Kudu (LGA) dans l'État de Jigawa. Sujets et méthodes: Il s'agissait d'une enquête transversale communautaire à plusieurs degrés basée sur une probabilité proportionnelle à la taille. L'étude a impliqué l'administration d'un questionnaire sur 2021 répondants de 207 ménages. De plus, 30 leaders communautaires et distributeurs dirigés par la communauté (CDD) ont été délibérément sélectionnés pour un entretien dans les communautés visitées. Résultats: Globalement, 2021 répondants sur la population échantillonnée de 2031 ont participé à l'étude, soit un taux de réponse de 99,6 %. Un peu plus de la moitié, 1130 (55,9 %) étaient des hommes. La couverture géographique et thérapeutique de l'administration massive d'ivermectine obtenue dans la LGA était de 100 % et de 79,9 %, respectivement. Les principaux facteurs affectant la couverture comprennent l'indisponibilité des médicaments (48,8%), l'absentéisme de certains membres du ménage (31%), et les incitations inadéquates aux DC par le gouvernement et la mauvaise tenue des dossiers par les DC. Conclusion: Cette étude a révélé que la couverture géographique et thérapeutique minimale de la distribution d'ivermectine était atteinte par le CDD tel que recommandé par l'Organisation mondiale de la santé pour le contrôle de l'onchocercose. Pour que cela soit durable et pour parvenir à l'élimination, il doit y avoir un approvisionnement adéquat en ivermectine, une formation des DC, un recyclage des DC, une supervision adéquate de la tenue des dossiers et une éducation sanitaire de la communauté. Mots-clés: Distributeurs communautaires, TIDC, ivermectine, onchocercose.

Characterization of the Ayran Made with Commercial Probiotic Cultures for Fatty Acids, Cholesterol, Folic Acid Levels, and Anti-Oxidative Potential.

Ayran is a salted drinkable fermented milk food which consumed in many countries around the world. In this study, some chemical parameters were determined to evaluate the healthy properties of ayran prepared using various commercial probiotic cultures. Four treatments of ayran were made from cow's milk and using classic yogurt culture (L. delbrueckii subsp. bulgaricus and Streptococcus thermophilus) [T1], ABT-5 culture (L. acidophilus, Bifidobacterium and S. thermophilus) [T2], exopolysaccharide producing culture (EPS-producing, L. delbrueckii subsp. bulgaricus and S. thermophilus) [T3], and EPS-producing culture + Bifidobacterium animalis subsp. lactis BB12 (mixture culture) [T4]. Treatment 1 had the highest acidity, acetaldehyde, and diacetyl values. Using probiotic [T2] or mixture cultures [T4] reduced saturated fatty acids by 1.97% and increased monounsaturated and polyunsaturated fatty acids of ayran by 4.94 and 5.72%, respectively. Also, the levels of oleic acid (omega-9), linoleic acid (omega-6), and α-linolenic acid (omega-3) increased in ayran produced using probiotic or mixture cultures. Sample T4 was highly richer in the value of antioxidant activity (27.62%) and folic acid (0.1566 mg/100 g) whereas possessed the lowest cholesterol amount (8.983 mg/100 g). Mixture culture (EPS-producing culture + Bifidobacterium animalis subsp. lactis BB12) is a good starter to improve the healthy and nutritional characteristics of bio-ayran.

The future of data management for pediatric cataract.

Cataract is a leading cause of blindness in children worldwide. Blindness can be treated with effective surgery, but in low-resource settings this treatment can be difficult to access. In addition, positive outcomes of the surgery are heavily dependent on comprehensive postoperative care. To date in Nigeria and many other low-resource countries, robust electronic data-management systems that help facility teams to manage their patient data, especially when it comes to tracking children for follow-up visits after surgery, have either yet to be put into place or are in place but have yet to be refined to respond to the specific needs of eye care programs. Sightsavers has worked with multiple state ministries in Nigeria to set up and test a system that responds to those needs.

Neuroprotective effects of Bhilawanol and Anacardic acid during glutamate-induced neurotoxicity.

Bhilawanol (Bh) and anacardic acid (AA) are two lipid-soluble compounds mostly found in the nut of Semecarpus anacardium (SA). This herb has many medicinal properties including enhancing learning and memory, yet its active compounds have not been studied for neuroprotective effects. We investigated the neuroprotective effects of Bh and AA against glutamate induced cell death in the adrenal pheochromocytoma cell line of rats (PC12 cells). Cell viability, toxicity and calcium influx were determined by MTT assay, LDH release assay and Fluo-3 imaging while apoptosis was assayed by caspase-3 and Bcl-2 gene expression. Our results showed that Bh and AA treatments significantly increased cell viability, reduced cell toxicity and calcium influx in PC12 cells in addition to suppressing the reactive oxygen species. Furthermore, AA treatment decreased caspase-3 expression level whereas both Bh and AA enhanced the expression of anti-apoptotic gene Bcl-2 in PC12 cells. Both compounds potently inhibited acetylcholinesterase enzyme (AChE) in a dose and time dependent manner. These findings suggest that the traditional use of SA may be explained on the basis of both Bh and AA showing neuroprotective potential due to their effects on enhancing cell viability, reducing cell toxicity most probably by reducing excessive calcium influx and suppression of ROS as well as by decreasing the expression of proapoptotic caspase 3 gene and increasing the expression of antiapoptotic gene Bcl2. Traditional use in enhancing learning and memory was justified in part by inhibition of AChE.

The prevalence of PI*S and PI*Z SERPINA1 alleles in healthy individuals and COPD patients in Saudi Arabia: A case-control study.

Alpha-1 antitrypsin (AAT) is an acute phase protein produced in hepatocytes. Its deficiency affects the lungs and liver. A case-control study was carried out to determine the prevalence of 2 common deficiency alleles, PI*S and PI*Z, for alpha-1 antitrypsin deficiency (AATD) in both healthy and chronic obstructive pulmmonary disease (COPD)-affected Saudi populations and to clarify the importance of genetic tests in the screening of people at risk for COPD.One thousand blood samples from healthy individuals and 1000 from COPD-affected Saudi individuals were genotyped for the above-mentioned alleles, using real-time polymerase chain reaction (PCR), with the exclusion of any other nationalities. Data were analyzed by determining the allele and genotype frequencies through gene counting and its confidence intervals. The allele frequencies, derived by the Hardy-Weinberg equilibrium method, were analyzed by Pearson Chi-squared tests. The confidence intervals for genotype frequencies were calculated using exploratory software for confidence intervals.Of the 1000 COPD patients included in our study, the prevalence of PI*S and PI*Z was 21.8% and 7.7%, respectively, while within the 1000 normal samples, these alleles occurred in 8.9% of patients for PI*S and 1.6% for PI*Z. The AAT deficiency genotype frequencies (PI*ZZ, PI*SS, and PI*SZ) were 6.5 per 1000 and 87 per 1000 for normal and COPD-affected Saudi individuals.Our results indicated a high prevalence of AATD alleles in the normal Saudi population and an association between AAT deficiency and pulmonary disease development. Additionally, our research confirms the importance of genetic screening to achieve early and accurate diagnosis of AATD.

Genotyping diagnosis of alpha-1 antitrypsin deficiency in Saudi adults with liver cirrhosis.

The acute phase protein alpha-1 antitrypsin (AAT) is mainly produced in liver cells. AAT deficiency affects the lungs and liver. We conducted a case-control study to define a valuable method for the proper diagnosis of alpha-1 antitrypsin deficiency (AATD), as well as the association of liver cirrhosis with AATD in Saudi adults.Blood samples from 300 liver cirrhosis patients and 400 controls were analyzed according to serum AAT concentration, phenotyping, and genotyping. Nephelometry was used for AAT quantification, isoelectric focusing electrophoresis was used for phenotyping detection, and real-time PCR was used for genotyping to determine the Z and S deficiency alleles.This study highlights the accuracy of using genotyping in addition to AAT quantification, since this technique has proven to be successful in the diagnosis of AATD for 100% of our cases. A significant deviation in AAT genotypes frequencies from the Hardy-Weinberg equilibrium in the adult cirrhosis group occurred due to a higher observed frequency than expected for the Pi ZZ homozygous genotype.Pi ZZ in adults may be considered as the risk factor for liver cirrhosis. However, we could not establish this relationship for heterozygous AATD genotypes (such as Pi MZ and Pi SZ).

Pediatric cataract surgery in National Eye Centre Kaduna, Nigeria: outcome and challenges.

PURPOSE: To assess the outcomes of congenital/developmental cataract from a tertiary eye care hospital in Northwest Nigeria. MATERIALS AND METHODS: A retrospective chart review was performed of all patients diagnosed with congenital or developmental cataract who underwent surgery from January 2008 to December 2009. Data were collected on patient demographics, preoperative characteristics, intraoperative complications, and postoperative outcomes as well as complications. RESULTS: A total of 181 eyes of 102 patients underwent surgery. There were 95 (52.5%) right eyes. There were 64 (62.7%) males. The mean age of the patients was 6.88 ± 7.97 years. Fifty-four (51.3%) patients were below 3 years old. Most (62%) patients had congenital cataract with a history of onset within the first year of life [39 (62.9%) patients]. Amblyopia, nystagmus, and strabismus were the most frequent ocular comorbidities accounting for 50.3%, 36.5%, and 35.4% of eyes respectively. The majority (84.3%) of the patients had surgery within 6 months of presentation. All patients underwent manual small incision cataract surgery (MSICS). Seventy-nine (77.5%) patients underwent simultaneous bilateral surgery. Intraocular lens implantation was performed in 83.4% eyes. The most common early and late postoperative complication was, posterior capsular opacity which occurred in 65 eyes of 43 children. In these cases, moderate visual acuity was predominant visual outcome. CONCLUSION: Treatment of pediatric cataract in our setting is complicated by demographic factors which results in late presentation and consequently, late treatment of children. Short-term visual outcome is fair. Data on long term postoperative outcomes could not be acquired due to poor follow-up.

Factors affecting self-reported use of seat belt among commercial vehicle drivers in Gusau metropolis Zamfara State north-western Nigeria.

Optimal and adequate prevention of road traffic injuries in developing countries has been hampered by limitations of knowledge and poor attitude towards use of cost effective safety and preventive measures like the seat belt. The objective of the study was to determine the level of self-reported use of seat belt and the factors affecting it among commercial motor vehicle drivers. The study was cross-sectional descriptive, data was obtained using interviewer-administered, structured and pre-tested questionnaire. Knowledge of seat belt was low, (11%), more than half (55.3%) admitted that use of seat belts prevents ejection of vehicle occupants. Less than half (47%) reported use of seat belt always. Age and educational level were significantly associated with use of seat belts (p < 0.0001), (p = 0.009). There is sub-optimal knowledge of the importance of seat belts coupled with low level of use. Innovative public health education approaches with enforcement could mitigate the low level of use.

Endocarditis prophylaxis in children with congenital heart disease. A parent's awareness.

OBJECTIVE: The aim of this study is to determine the parental knowledge of bacterial endocarditis prophylaxis (BEP). METHODS: Parents of 205 patients attending the Pediatric Cardiology Clinics at King Khalid University Hospital, Riyadh, King Fahad University Hospital, Al-Khobar and Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia from July 1999 to June 2000, were interviewed by a standard questionnaire pertaining to their knowledge of their child's cardiac disease, medications, and BEP. The patients' cardiac lesions and current medications were verified by a review of medical records. Each patient's need for BEP was determined according to American Heart Association recommendations. RESULTS: All parents answered the interview questions. The patients' mean age was 5 years and 8 months with a range of one month to 15 years. One hundred and two (50%) parents were high school graduates. Fifty-two (25%) parents correctly defined endocarditis. Two hundred and one (98%) parents knew the correct name of their child's cardiac condition, and 46/50 (92%) of those on medication knew the names of their child's current medications. Only 113/176 (64%) parents with at risk children were aware of measures to prevent endocarditis. CONCLUSION: While most parents know the name of their child's heart lesion and current medications, parental knowledge of endocarditis and BEP was limited. Intensified education and awareness programs are needed in order to prevent potential major morbidity and mortality for pediatric patients with congenital heart disease.