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1. Utility of colposcopy for the screening and management of cervical cancer in Africa: a cross-sectional analysis of providers’ training and practices

Author

Fokom Domgue, Joël, Dille, Issimouha, Gnangnon, Freddy, Kapambwe, Sharon, Bouchard, Celine, Mbatani, Nomonde, Gauroy, Elodie, Ambounda, Nathalie Ledaga, Yu, Robert, Sidibe, Fatoumata, Kamgno, Joseph, Traore, Bangaly, Tebeu, Pierre-Marie, Halle-Ekane, Gregory, Diomande, Mohenou Isidore, Dangou, Jean-Marie, Lecuru, Fabrice, Adewole, Isaac, Plante, Marie, Basu, Partha, and Shete, Sanjay

Published
2024
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5. Utility of colposcopy for the screening and management of cervical cancer in Africa: a cross-sectional analysis of providers’ training and practices

Author

Domgue, Joel Fokom, primary, Issimouha, Dille, additional, Gnangnon, Freddy, additional, Kapambwe, Sharon, additional, Bouchard, Celine, additional, Mbatani, Nomonde, additional, Gauroy, Elodie, additional, Ambounda, Nathalie Ledaga, additional, Yu, Robert, additional, Sidibe, Fatoumata, additional, Kamgno, Joseph, additional, Traore, Bangaly, additional, Tebeu, Pierre-Marie, additional, Halle-Ekane, Gregory, additional, Diomande, Mohenou Isidore, additional, Dangou, Jean-Marie, additional, Lecuru, Fabrice, additional, Adewole, Isaac, additional, Plante, Marie, additional, Basu, Partha, additional, and Shete, Sanjay, additional

Published
2024
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6. Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Author

Shalaby, M, Elsheikh, A, Hamed, H, Null, N, Elsheik, A, Sakr, A, Fouad, A, Kassem, A, Elfeki, H, Madbouly, K, Alzahrani, K, Marzouk, K, Ali, M, Helal, M, Elsorogy, M, Farid, M, Di Lorenzo, N, Sileri, P, Wexner, S, Khafagy, W, Adeyeye, A, El-Hussuna, A, Frontali, A, Saklani, A, Lelpo, B, Molena, D, Pandey, D, Karbovnichaya, E, Pata, F, Van Ramshor, G, Gallo, G, Spolverato, G, Pellino, G, Bagaglini, G, Rubio-Perez, I, Negoi, I, Frigerio, I, Juloski, J, Ninkovic, M, Franceschilli, M, Azer, M, Efetov, S, Ippoliti, S, Garoufalia, Z, Fazli, M, Dogjani, A, Cherfa, H, Omar, T, Minoldo, J, Alvarez Gallesio, J, Quesada, M, Bacher, A, Kropshofer, S, Ponholzer, F, Tesik, P, Gehwolf, P, Isci, S, Uranitsch, S, Berchtold, V, Samadov, E, Abualsel, A, Mitul, A, Islam, S, Vanlander, A, Van Praet, C, Van Daele, E, Vanommeslaeghe, H, Stijns, J, Abosi-Appeadu, K, Depuydt, M, Allaeys, M, Yves, V, Colleoni, R, Slavchev, M, Elbahrawy, A, Luc, J, Milford, K, Romic, I, Monti, A, Haydal, A, Klein, M, Ocklind, M, Hadi, S, Alqasaby, A, Elganash, A, Daibes, A, Elsaied, A, Elhattab, A, Lotfy, A, Alnashar, A, Elnour, A, Abdelhalim, A, Abdelhamid, A, Abdellatif, A, Abdelmohsen, A, Abdelrafee, A, Elhawary, A, Zidan, A, Eleshra, A, Elkafoury, A, Ezz, A, Abdelmomen, A, Elkased, A, Fawzy, A, Elkhouly, A, Hemidan, A, Abbas, A, Ismail, A, Attia, A, Farid, A, Elnakash, A, Negida, A, Soliman, A, Taki-Eldin, A, Albadry, A, Sanad, A, Elbatal, A, Elgazar, A, Saleh, A, Fahiem, A, Mohamed, A, Nageeb, A, Elmetwally, A, Alkhalegy, A, El-Wakeel, A, Shemes, A, Fadel, B, Lutfi, B, Ali, D, Abolnasr, K, Gamal, E, Abdallah, E, Ahmed, E, Salem, E, Hamed, E, Elshikh, E, Enad, F, Sarhan, F, Abouelnagah, G, Tagg, G, Atef, G, Shaker, G, Beshir, H, Zakaria, H, Barbary, H, Elgendy, H, Sharaf, H, Elnaghi, H, Elghadban, H, Elzayat, I, Fakhr, I, Sallam, I, Abdelmoneim, I, Elnemr, I, Zewar, K, Elalfy, K, Sabet, K, Mansour, K, Osman, K, Elgaly, M, Shams, M, Abozeid, M, Mohammed, M, Elkatt, M, Samaha, M, Mikhael, M, Khalil, M, Alhendawey, M, Elrefai, M, Gabr, M, Fayed, M, Abdelmaksoud, M, Salem, M, Mohamed Mohamed, M, Nabeeh, M, Elsayed, M, Abdelmonem, M, Eldemery, M, Elmesery, M, Fikry, M, Gharbia, M, Omar, M, Elmoghazy, M, Ghazala, M, Hamed, M, Metwally, M, Arnouse, M, Amen, M, Amary, M, Kandel, M, Abuzeid, M, Rabea, M, Sobh, M, Taman, M, Fathy, M, Moustafa, M, Zuhdy, M, Adel, M, Alaa, M, Alawady, M, Edassy, M, Eldesouki, M, Salim, M, Sanad, M, Khalaf, M, Henes, M, Abdelglil, M, Mohmmed, M, Abdelkhalik, M, Shetiwy, M, Elshazli, M, Hegazy, M, Ahmed, M, Abdelhalim, M, Shahein, M, Sofan, M, Hammad, M, Ahmad, M, Milad, N, Farouk, N, Eldesouky, O, Mohamed, O, Mahadel, O, Gaarour, O, Torky, R, Elhafez, R, Adly, R, Nageeb, R, Hamdi, S, Gamal, S, Emile, S, Regal, S, Abdelrasheed, S, Elzeftawy, S, Khashshan, S, Ashraf, T, Khafagy, T, Nabil, T, Abdelazim, T, Rizk, T, Amr, W, Yousef, Y, Youssef, Y, Castaldi, A, Fiore, A, Hasani, A, Mariani, A, Dagorno, C, Antonio, D, Izzo, G, Addari, G, Mangiameli, G, Rea, L, Pio, L, Paci, M, Andrea, P, De Fatico, G, Elvira, T, Schuldes, A, Rihan, E, Moeslein, G, Lederhuber, H, Botros, I, Jaman, I, Doerner, J, Elseberbihy, J, Sherbiny, K, Ghonim, M, Mikrish, A, Aziz, M, Hatm, M, Archid, R, Gendy, S, Ahmad, S, Charalabopoulos, A, Prodromidou, A, Ioannidis, A, Mpaili, E, Boukorou, G, Papadopoulos, G, Liakakos, T, Styliani, V, Agrawal, A, Jain, A, Rashid, A, Mehraj, A, Brahmachari, S, Lakshmi, H, Vishwakarma, K, Parida, L, Sharma, M, Zaieem, M, Makasarwala, M, Nittala, R, Kumar, S, Vikrantmr, S, Junaid, S, Khuller, S, More, V, Ahmed, A, Alomieri, A, Alhamdany, A, Del, M, Najm, G, Lateef, N, Mcnamara, D, Abdelmageed, M, Majeed, M, Troci, A, Porcu, A, Marano, A, Di Bartolomeo, A, Giani, A, Giardino, A, Canfora, A, Balla, A, Barberis, A, Belli, A, Borasi, A, Manetti, A, Mingoli, A, Morini, A, Maurizi, A, Marra, A, Epifani, A, Iossa, A, Parello, A, Guida, A, Maffioli, A, Scafa, A, Spinelli, A, Matarangolo, A, Picciariello, A, Pirozzi, B, Cirillo, B, Gazia, C, Ratto, C, Foppa, C, Marafante, C, Andrea, C, Tanda, C, Guerci, C, Don, C, Zigiotto, D, Coniglio, D, Sasia, D, Visconti, D, Altomare, D, Guaitoli, E, Botteri, E, Pinotti, E, Martinelli, F, Uggeri, F, Bàmbina, F, Falaschi, F, Costanzo, F, La Torre, F, Milana, F, Abbatini, F, De Lucia, F, Tropeano, F, Colombo, F, Ferrara, F, Litta, F, Carrano, F, Orlando, F, Roscio, F, Selvaggi, F, Giarratano, G, Pagano, G, Lisi, G, Argenio, G, Zancana, G, Cavallaro, G, Frazzetta, G, Mariateresa, G, Sciaudone, G, Vella, I, Siragusa, L, Santurro, L, Ferri, L, Petagna, L, Ferrario, L, Pitoni, L, Pignatelli, M, Angrisani, M, Giugliano, M, Inama, M, Marino, M, Veltri, M, Giuffrida, M, Menna, M, Valente, M, Rottoli, M, Sacchi, M, Uccelli, M, Rho, M, Garino, M, Montuori, M, Campanelli, M, Zese, M, De Falco, N, Cillara, N, Mariani, N, Tamini, N, Adorisio, O, Campennì, P, Venturelli, P, Bernante, P, Sapienza, P, Cianci, P, Marsanic, P, Lapolla, P, Tecchio, P, Familiari, P, Fransvea, P, Bruzzaniti, P, Hassan, R, Pirovano, R, Rimonda, R, Di Saverio, S, Di Carlo, S, Perra, T, Campagnaro, T, Testa, V, Andriola, V, Grappelli, V, Capizzi, V, Chiarella, V, Bellato, V, Yanaga, K, Farouk, M, Uraiqat, A, Almasri, M, Nabwana, A, Siboe, M, W, N, Njoroge, G, Ilkul, J, Obure, R, Palkhi, Y, Alkhayat, A, Ali, A, Malek, A, Abdelsayed, E, Zahra, T, Ayoub, L, Sleilati, F, Aoun, R, Algatanesh, N, Fieturi, N, Ng, J, Díaz, A, Duran, E, Guerrero, J, Jasso, M, Flores, M, Felix, M, Angulo, V, Mejdane, A, Aitali, A, Amal, B, Zentar, A, Bensaad, A, Yacir, E, Jawad, F, Rachid, M, Maliki-Alaoui, M, Ouadii, M, Mohammed, O, Thein, N, Koirala, D, Hilling, D, Pouwels, S, Okunlola, A, Adejumo, A, Akinmade, A, Shittu, A, Oluyomi, A, Abiodun, A, Lawal, B, Odion, C, Popoola, A, Jolayemi, E, Shomoye, E, Wuraola, F, Eke, G, Abiyere, H, Oluwasuyi, I, George, I, Njokanma, I, Aremu, I, Dare, J, Abdur-Rahman, L, Oludara, M, Mohammad, M, Adeoluwa, O, Situ, O, Agbonrofo, P, Kewulere, R, Aliyu, Y, Adebowale, Y, Galala, A, Rao, S, Waleed, A, Inam, A, Shaikh, A, Qureshi, A, Muhammad, A, Kerawala, A, Aslam, M, Mehr, A, Javed, A, Ahmad, F, Majid, H, Ahmed, H, Daudi, I, Akhtar, K, Niaz, K, Anwer, M, Amir, M, Hanif, M, Asif, M, Raza, M, Khokhar, M, Jameel, M, Nasir, M, Shafique, M, Ateeb, M, Nadeem, M, Shah, R, Waqar, S, Shah, S, Waseem, T, Ghafoor, T, Fatima, T, Bashir, U, Gonzales, E, Ruiz, L, Freitas, C, De Sousa, X, Al-Bahrani, A, Portela, C, Elgazar, E, Robles, E, Khan, I, Jarboa, L, Khawar, M, Echevarria, M, Bashah, M, Dawdi, S, Musthafa, S, Ali, S, Ciubotaru, C, Bonci, E, Muresan, M, Bogdan, S, Ioan, T, Zubayraeva, A, Derinov, A, Zakharenko, A, Novikova, A, Bashlachev, A, Kaldarov, A, Stanislav, B, Gorin, D, Puzenko, D, Kazachenko, E, Ashimov, E, Medkova, I, Ignatov, I, Sergeevich, K, Sidorova, L, Kiselev, M, Danilov, M, Aleksandr, O, Rodimov, S, Garmanovs, T, Kitsenko, Y, Valery, N, Japhet, N, Sibiany, A, Saadeldin, A, Abuosba, A, Alawadhi, A, Alharbi, A, Althumali, A, Alghuliga, A, Alotaibi, A, Abduraboh, A, Kateb, A, Sindy, A, Al Eisa, A, Almulhim, A, Aljawhari, A, Abozeid, A, Saad, A, Alqarni, A, Alwan, A, Alwusaibie, A, Bafaraj, A, Eldeeb, A, Tarabay, A, Alhedaithy, A, Almaghrabi, A, Abed, A, Abdullah, A, Semilan, A, Farag, M, Khudhayr, E, Hussain, M, Abbas, G, Alqudaihi, H, Abualnaja, Y, Shaheen, A, Mubarak, A, Ali, B, Alhazmi, B, Hijazi, B, Abdulrahman, C, Oyedepo, C, Alzamel, H, Tairab, E, Alsuwaimel, M, Hejazi, S, Alnoqaidan, E, Alhussien, F, Jallad, F, Khadwardi, F, Alghamdi, F, Haddad, F, Sauri, F, Alafghani, H, Alfalah, H, Gad, H, Aboelmagid, H, Ibrahim, H, Elzayady, H, Sharafeldin, H, Sembawa, H, Alabbas, H, Abbas, H, Elgamal, H, Alawfi, H, Al-Sadery, H, Abdelmotaleb, H, Al Hassn, I, Mudawi, I, Nekhala, I, Elsanhoury, K, Said, K, Albeshri, K, Albahooth, K, Mohammed, K, Asar, K, Osman, L, Alzamanan, M, Alnabarawi, M, Althobaiti, M, Al Naeb, M, Hassan, M, Abdelhamid, M, Alyami, M, Mirza, M, Sayouh, M, Alkhayat, M, Basendowah, M, Ghunaim, M, Alhussaini, M, Khoj, M, Sbaih, M, Saeed, M, Abdelaziz, N, Malibary, N, Abdo, N, Amer, N, Al Turki, N, Durayb, N, Yassin, N, Akeel, N, Larbi, N, Alsallum, O, Suliman, O, Elsherbiny, O, Abusalem, O, Albalawi, I, Abutalib, R, Alarabi, R, Khan, R, Alazzam, S, Alghamdi, S, Alsawat, S, Salim, S, Alshukr, S, Alzahrani, S, Golea, S, Alowairdhi, T, Salman, U, Abusiam, W, Abualkhair, W, Saber, W, Tashkandi, W, Alhazmi, W, Yassine, W, Alshabi, Y, Ibrahim, Y, Shahin, Y, Aljathlany, Y, Alnahas, Y, Alrashidi, Y, Wali, Z, Ndong, A, Ba, M, Faye, P, Arbutina, D, Milic, L, Cuk, V, Hussein, A, Mccaul, J, Bertels, L, Pohl, L, Arnold, M, Mbatani, N, Oosthuizen, P, Rayamajhi, S, Vosloo, S, Jooma, U, Landaluce-Olavarria, A, Vázquez-Melero, A, Marcos, A, Puerto Puerto, A, De La Hermosa, A, Senent-Boza, A, Ugarte-Sierra, B, Montalbán, B, Martin-Perez, B, Gomez, C, Colás-Ruiz, E, Santos, E, Senra, F, Mora-Guzmán, I, Dziakova, J, Díaz, J, Silva, J, Laina, J, Tallon-Aguilar, L, Di Martino, M, Chacón, M, Frasson, M, Calvo, M, Millan, M, Tejedoe, P, Pérez-Bertólez, S, Turrado-Rodríguez, V, Elsanosi, A, Abdalbakheet, D, Salim, O, Youssef, M, Barbon, C, Bouchrika, A, Maghrebi, H, Loukil, I, Yildiz, A, Dursun, A, Gulcu, B, Calik, B, Eral, B, Yeşilyurt, D, Yakar, F, Akin, F, Kilinc, G, Uslu, G, Tuncer, K, Koc, M, Leventoğlu, S, Sokmen, S, Atici, S, Kaya, T, Dere, Ü, Kırmızı, Y, Ssenono, K, Lule, H, Mbiine, R, Hamza, A, Peediyakkal, S, Varma, G, Mussa, H, Al-Masari, H, Shehata, M, Seiam, M, Nimir, N, Khare, R, Rashid, S, Kazim, S, Gondal, Z, Sherif, A, Ghanem, A, Helmy, A, Ibrahim, A, Elshaer, A, Marzouk, A, Tamburrini, A, Parente, A, Light, A, Diamantopoulou, A, Singh, B, Gurung, B, Frauenfelder, C, Leo, C, Raptis, D, Thakrar, D, Madhuri, T, Tsounaki, E, Garreffa, E, Soggiu, F, Stavrou, G, Ng, H, Tabasi, H, Nasef, H, Kostakis, I, Jeffery, J, Warusavitarne, J, Lund, J, Qurashi, K, Sahnan, K, Tong, K, Orecchia, L, Kaur, M, Zaidi, M, Ganau, M, Curtis, N, Bhatt, N, Machairas, N, Zafar, N, Toma, O, Sarmah, P, Bassuni, M, Davies, J, Shawer, S, Lewis, S, Subramanian, S, Nadeem, U, Njau, A, Tohamy, A, Pakula, A, Simioni, A, Jarvis, B, Skandalakis, G, Hesham, H, Isaiah, I, Villwock, J, Martin, L, Kress, M, Sebelik, M, Lathan, S, Towfigh, S, Holubar, S, Demeester, S, Alshehari, M, Ghabisha, S, Abdulatef, S, Al-Kubati, W, Obadiel, Y, Gots, A, Nakazwe, M, Chipaila, J, Mazingi, D, Shalaby, Mostafa, ElSheikh, Ahmed M., Hamed, Hosam, null, null, Elsheik, Ahmed, Sakr, Ahmad, Fouad, Amgad, Kassem, Amr, Elfeki, Hossam, Madbouly, Khaled, Alzahrani, Khalid H., Marzouk, Khalid, Ali, Mahmoud, Helal, Mohamed Alaa Abdelmoez, Elsorogy, Mohamed, Farid, Mohamed, Di Lorenzo, Nicola, Sileri, Pierpaolo, Wexner, Steven, Khafagy, Wael, Adeyeye, Ademola, El-Hussuna, Alaa, Frontali, Alice, Saklani, Avanish, Lelpo, Benedettao, Molena, Daniela, Pandey, Diwakar, Karbovnichaya, Elena, Pata, Francesco, Van Ramshor, Gabrielle H., Gallo, Gaetano, Spolverato, Gaya, Pellino, Gianluca, Bagaglini, Giulia, Rubio-Perez, Ines, Negoi, Ionut, Frigerio, Isabella, Juloski, Jovan, Ninkovic, Marijana, Franceschilli, Marzia, Azer, Mina, Efetov, Sergey, Ippoliti, Simona, Garoufalia, Zoe, Fazli, Mohammad Rafi, Dogjani, Agron, Cherfa, Harieche Abdennour Abderahim, Omar, Tilioua, Minoldo, Javier, Alvarez Gallesio, José Maria, Quesada, Matias, Bacher, Annica, Kropshofer, Stephan, Ponholzer, Florian, Tesik, Philip, Gehwolf, Philipp, Isci, Sevim, Uranitsch, Stefan, Berchtold, Valeria, Samadov, Elgun, Abualsel, Abdulmenem, Mitul, Ashrarur Rahman, Islam, S. M. Nazmul, Vanlander, Aude, Van Praet, Charles, Van Daele, Elke, Vanommeslaeghe, Hanne, Stijns, Jasper, Abosi-Appeadu, Kessewa, Depuydt, Martijn, Allaeys, Mathias, Yves, Van Nieuwenhove, Colleoni, Ramiro, Slavchev, Mihail, Elbahrawy, Aly, Luc, Jessica G. Y., Milford, Karen, Romic, Ivan, Monti, Alessio, Haydal, Ashraf, Klein, Mads Falk, Ocklind, Miranda E. K., Hadi, Sabah Anwar, Alqasaby, Abdallah, Elganash, Abdelazim, Daibes, Adel Goda Hussein, Elsaied, Adham, Elhattab, Ahmad, Lotfy, Ahmad, Alnashar, Ahmed, Elnour, Ahmed Abd Elbaset Elsayed Abu, Abdelhalim, Ahmed, Abdelhamid, Ahmed, Abdellatif, Ahmed, Abdelmohsen, Ahmed, Abdelrafee, Ahmed, Elhawary, Ahmed Adel, Zidan, Ahmed Azmy, Eleshra, Ahmed, Elkafoury, Ahmed, Ezz, Ahmed, Abdelmomen, Ahmed Ezzat Elghrieb, Elkased, Ahmed Farag, Fawzy, Ahmed, Elkhouly, Ahmed G., Hemidan, Ahmed Gamal Abouelfetouh Ibrahim, Abbas, Ahmed Hosam Eldin Hasan, Ismail, Ahmed Mahmoud Ahmed, Attia, Ahmed Mohamed, Farid, Ahmed Mohammed, Elnakash, Ahmed Mostafa, Negida, Ahmed, Soliman, Ahmed, Taki-Eldin, Ahmed, Albadry, Ali Almahdy Ali, Sanad, Aly, Elbatal, Amira Alsayed Abdelhai, Elgazar, Amr, Saleh, Amr, Fahiem, Andrew, Mohamed, Anwar Yahya A., Nageeb, Ashraf, Elmetwally, Ashraf S., Alkhalegy, Ayman, El-Wakeel, Ayman, Shemes, Ayman, Fadel, Bashir A., Lutfi, Basma Waseem, Ali, Doaa, Abolnasr, Khaled Samir, Gamal, Ehab, Abdallah, Emad, Ahmed, Emad Ali, Salem, Eman Abdalla Mohamed, Hamed, Esmael Ali, Elshikh, Essam, Enad, Farazdaq, Sarhan, Fetoh Alaaeldin Fetoh, Abouelnagah, Galal, Tagg, Gamal Hassan El, Atef, Gehad, Shaker, George Samir Habib, Beshir, Hatem, Zakaria, Hazem M., Barbary, Hesham, Elgendy, Hesham, Sharaf, Hesham, Elnaghi, Hisham, Elghadban, Hosam, Elzayat, Ibrahim, Fakhr, Ibrahim, Sallam, Ibrahim, Abdelmoneim, Ibrahim Tharwat Mohamed, Elnemr, Islam, Zewar, Karem Shahin Mohamed, Elalfy, Khaled, Sabet, Khaled, Mansour, Khaled Yousery Ibrahim, Osman, Khalid Abdalla Abdelgadir, Elgaly, Maher Elesawi Kamel, Shams, Maher, Abozeid, Mahmoud, Mohammed, Mahmoud M., Elkatt, Mahmoud Mohamed, Samaha, Mahmoud Yahia, Mikhael, Marolla Maher Eskander, Khalil, Medhat M. H. A., Alhendawey, Moaaz, Elrefai, Mohamad, Gabr, Mohamed A., Fayed, Mohamed Abdelaziz Mohamed Abdalla M, Abdelmaksoud, Mohamed, Salem, Mohamed Abouelmagd, Mohamed Mohamed, Mohamed Adel, Nabeeh, Mohamed Adel, Elsayed, Mohamed Ahmed Abdelhalim Ahmed, Abdelmonem, Mohamed Ahmed, Ali, Mohamed Anwar Abdel Razik, Eldemery, Mohamed, Elmesery, Mohamed, Fikry, Mohamed, Gharbia, Mohamed, Omar, Mohamed I., Elmoghazy, Mohamed Ibrahim, Ghazala, Mohamed Jomma, Hamed, Mohamed Korayem Fattouh, Metwally, Mohamed, Arnouse, Mohamed Mohamed Hamdy, Amen, Mohamed Mohsen, Amary, Mohamed Mokhtar, Kandel, Mohamed Mosaad, Abuzeid, Mohamed Mostafa, Rabea, Mohamed, Sobh, Mohamed Ramadan, Taman, Mohamed, Fathy, Mohammad, Moustafa, Mohammad Montaser Hassan, Zuhdy, Mohammad, Adel, Mohammed, Alaa, Mohammed, Alawady, Mohammed, Edassy, Mohammed El, Mohammed, Mohammed Mustafa Hassan, Eldesouki, Mohammed Nabil, Salim, Mohammed Said Mahmoud, Sanad, Mohammed, Khalaf, Mohsen George, Henes, Mohsen Michael, Abdelglil, Momen, Mohmmed, Mona Mhmoud, Abdelkhalik, Morsi Mohamed Morsi, Shetiwy, Mosab, Elshazli, Mostafa, Hegazy, Mostafa, Ahmed, Mostafa Mahmoud, Abdelhalim, Mostafa Mohammed, Shahein, Mostafa, Sofan, Mostafa, Hammad, Muhammed Alaa Moukhtar, Ahmad, Mustafa, Milad, Nader, Farouk, Nehal, Eldesouky, Omnia, Mohamed, Omnia Y., Mahadel, Osama Abdel Salam, Gaarour, Osama, Torky, Radwan Abdelsabour, Elhafez, Raheem El-Gohary Abd, Adly, Ramy Magdy, Nageeb, Ramy Mikhael, Hamdi, Salah, Gamal, Sameh, Emile, Sameh Hany, Regal, Samer, Abdelrasheed, Sayed, Elzeftawy, Shady Ahmed, Khashshan, Sohib Mohammed Mohammed, Ashraf, Tamer, Khafagy, Tamer, Nabil, Tamer, Abdelazim, Tarek, Rizk, Tarek Taher, Amr, Wesam, Yousef, Yousef Mohamed, Youssef, Youssef Abdel Aziz, Castaldi, Antonio, Fiore, Antonio, Hasani, Ariola, Mariani, Aurora, Dagorno, Claire, Antonio, D'Alessandro, Izzo, Giuliano, Addari, Giulio, Mangiameli, Giuseppe, Rea, Lo Dico, Pio, Luca, Paci, Marco, Andrea, Police, De Fatico, GSerena, Elvira, Tartaglia, Schuldes, Alejandro Daniel Lira, Rihan, Eslam, Moeslein, Gabriela, Lederhuber, Hans, Botros, Ibram, Jaman, Ismail, Doerner, Johannes, Elseberbihy, John Rezk Hanna, Sherbiny, Kareem El, Ghonim, Mostafa, Mikrish, Amir, Aziz, Mina, Hatm, Mohamed, Archid, Rami, Gendy, Samuel Elkess Morcos, Ahmad, Sufian, Charalabopoulos, Alexandros, Prodromidou, Anastasia, Ioannidis, Argyrios, Mpaili, Eustratia, Boukorou, Garyfallia, Papadopoulos, Georgios, Liakakos, Theodore, Styliani, Vasileiadou, Agrawal, Abhishek, Jain, Amita, Rashid, Arshad, Mehraj, Asif, Brahmachari, Swagata, Lakshmi, Harish Neelamraju, Vishwakarma, Kushagra, Parida, Lalit, Sharma, Meenakshi, Zaieem, Mohammad, Makasarwala, Murtaza, Nittala, Rigved, Kumar, Sanjeev, Vikrantmr, Sharma, Junaid, Sheikh, Khuller, Somyaa, More, Vinal, Ahmed, Abeer Abdul Hameed, Alomieri, Adil, Alhamdany, Arkan Shubber, Del, Muslim Ka, Najm, Ghadah, Lateef, Nawras Falah, Mcnamara, Deborah, Abdelmageed, Mohammed Elkassaby, Majeed, Mudassar, Troci, Albert, 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Grace, Abiyere, Henry, Oluwasuyi, Ige, George, Ihediwa, Njokanma, Iloba Gabriel, Aremu, Isiaka, Dare, Julius Kolajo, Abdur-Rahman, Lukman, Ahmad, Misbahu Haruna, Oludara, Mobolaji Adewale, Mohammad, Mohammad Aminu, Adeoluwa, Ojajuni, Situ, Oladele, Agbonrofo, Peter, Kewulere, Raji Taofiq, Aliyu, Yakubu, Adebowale, Yusuf, Galala, Ahmed, Rao, Satish, Waleed, Aasma, Inam, Aatif, Shaikh, Abdul Razaque, Qureshi, Ahmad Uzair, Muhammad, Aneeqah Din, Ahmed, Arooj, Kerawala, Asad Ali, Aslam, Mohammad, Mehr, Asma, Javed, Ayesha, Ahmad, Farooq, Majid, Haroon Javaid, Ahmed, Hassan, Daudi, Irfan, Akhtar, Khalid, Niaz, Khurram, Anwer, Mariyah, Amir, Mohammed, Hanif, Muhammad Amir, Asif, Muhammad, Raza, Muhammad Asif, Khokhar, Muhammad Imran, Jameel, Muhammad Khurram, Nasir, Muhammad, Shafique, Muhammad Salman, Ateeb, Mujammad, Nadeem, Munawar, Shah, Rahmat Ullah, Waqar, Shahzad Hussain, Shah, Shahzad Alam, Waseem, Talat, Ghafoor, Tariq, Fatima, Tauseef, Bashir, Umar, Gonzales, Erick Ivan Huaman, 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Alghuliga, Abdullah, Alotaibi, Abdullah, Abduraboh, Abdullah Fayez, Kateb, Abdullah, Sindy, Abdullah, Al Eisa, Abdulmohsen, Alotaibi, Abdulrahman, Almulhim, Abdulrhman, Aljawhari, Adel Ali, Abozeid, Ahmad Mahmoud, Saad, Ahmad, Alqarni, Ahmed, Alwan, Ahmed, Alwusaibie, Ahmed, Bafaraj, Ahmed, Eldeeb, Ahmed, Tarabay, Ahmed, Mohammed, Mahfoudh, Alhedaithy, Alhanouf, Almaghrabi, Alhassan Hesham, Abed, Ali Ibrahim Eldawy, Abdullah, Alqahtani Ali, Semilan, Anmar, Farag, Mohamed, Khudhayr, Essa, Hussain, Marwah, Abbas, Ghanem, Alqudaihi, Heba, Abualnaja, Yousra, Shaheen, Abelnasser, Mubarak, Ashraf Abdelazeem Mohamed, Ali, Bandar Idrees A., Alhazmi, Barrag, Hijazi, Bilal Ahmed, Abdulrahman, Chadi, Oyedepo, Charles Olajide, Alzamel, Heythem, Tairab, Elsanousi Ibrahim Sabir, Alsuwaimel, Munir A., Hejazi, Soha, Alnoqaidan, Emad, Alhussien, Fade Ahmed, Jallad, Fadi Sami, Khadwardi, Faisal, Alghamdi, Faisal Saleh, Haddad, Feras, Sauri, Fozan, Alafghani, Haitham, Alfalah, Haitham, Gad, Hamada, 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Alaa Abdelmoez, Elsorogy, Mohamed, Farid, Mohamed, Di Lorenzo, Nicola, Sileri, Pierpaolo, Wexner, Steven, Khafagy, Wael, Adeyeye, Ademola, El-Hussuna, Alaa, Frontali, Alice, Saklani, Avanish, Lelpo, Benedettao, Molena, Daniela, Pandey, Diwakar, Karbovnichaya, Elena, Pata, Francesco, Van Ramshor, Gabrielle H., Gallo, Gaetano, Spolverato, Gaya, Pellino, Gianluca, Bagaglini, Giulia, Rubio-Perez, Ines, Negoi, Ionut, Frigerio, Isabella, Juloski, Jovan, Ninkovic, Marijana, Franceschilli, Marzia, Azer, Mina, Efetov, Sergey, Ippoliti, Simona, Garoufalia, Zoe, Fazli, Mohammad Rafi, Dogjani, Agron, Cherfa, Harieche Abdennour Abderahim, Omar, Tilioua, Minoldo, Javier, Alvarez Gallesio, José Maria, Quesada, Matias, Bacher, Annica, Kropshofer, Stephan, Ponholzer, Florian, Tesik, Philip, Gehwolf, Philipp, Isci, Sevim, Uranitsch, Stefan, Berchtold, Valeria, Samadov, Elgun, Abualsel, Abdulmenem, Mitul, Ashrarur Rahman, Islam, S. M. Nazmul, Vanlander, Aude, Van Praet, Charles, Van Daele, Elke, Vanommeslaeghe, Hanne, Stijns, Jasper, Abosi-Appeadu, Kessewa, Depuydt, Martijn, Allaeys, Mathias, Yves, Van Nieuwenhove, Colleoni, Ramiro, Slavchev, Mihail, Elbahrawy, Aly, Luc, Jessica G. Y., Milford, Karen, Romic, Ivan, Monti, Alessio, Haydal, Ashraf, Klein, Mads Falk, Ocklind, Miranda E. K., Hadi, Sabah Anwar, Alqasaby, Abdallah, Elganash, Abdelazim, Daibes, Adel Goda Hussein, Elsaied, Adham, Elhattab, Ahmad, Lotfy, Ahmad, Alnashar, Ahmed, Elnour, Ahmed Abd Elbaset Elsayed Abu, Abdelhalim, Ahmed, Abdelhamid, Ahmed, Abdellatif, Ahmed, Abdelmohsen, Ahmed, Abdelrafee, Ahmed, Elhawary, Ahmed Adel, Zidan, Ahmed Azmy, Eleshra, Ahmed, Elkafoury, Ahmed, Ezz, Ahmed, Abdelmomen, Ahmed Ezzat Elghrieb, Elkased, Ahmed Farag, Fawzy, Ahmed, Elkhouly, Ahmed G., Hemidan, Ahmed Gamal Abouelfetouh Ibrahim, Abbas, Ahmed Hosam Eldin Hasan, Ismail, Ahmed Mahmoud Ahmed, Attia, Ahmed Mohamed, Farid, Ahmed Mohammed, Elnakash, Ahmed Mostafa, Negida, Ahmed, Soliman, Ahmed, Taki-Eldin, Ahmed, Albadry, Ali Almahdy Ali, Sanad, Aly, Elbatal, Amira Alsayed Abdelhai, Elgazar, Amr, Saleh, Amr, Fahiem, Andrew, Mohamed, Anwar Yahya A., Nageeb, Ashraf, Elmetwally, Ashraf S., Alkhalegy, Ayman, El-Wakeel, Ayman, Shemes, Ayman, Fadel, Bashir A., Lutfi, Basma Waseem, Ali, Doaa, Abolnasr, Khaled Samir, Gamal, Ehab, Abdallah, Emad, Ahmed, Emad Ali, Salem, Eman Abdalla Mohamed, Hamed, Esmael Ali, Elshikh, Essam, Enad, Farazdaq, Sarhan, Fetoh Alaaeldin Fetoh, Abouelnagah, Galal, Tagg, Gamal Hassan El, Atef, Gehad, Shaker, George Samir Habib, Beshir, Hatem, Zakaria, Hazem M., Barbary, Hesham, Elgendy, Hesham, Sharaf, Hesham, Elnaghi, Hisham, Elghadban, Hosam, Elzayat, Ibrahim, Fakhr, Ibrahim, Sallam, Ibrahim, Abdelmoneim, Ibrahim Tharwat Mohamed, Elnemr, Islam, Zewar, Karem Shahin Mohamed, Elalfy, Khaled, Sabet, Khaled, Mansour, Khaled Yousery Ibrahim, Osman, Khalid Abdalla Abdelgadir, Elgaly, Maher Elesawi Kamel, Shams, Maher, Abozeid, Mahmoud, Mohammed, Mahmoud M., Elkatt, Mahmoud Mohamed, Samaha, Mahmoud Yahia, Mikhael, Marolla Maher Eskander, Khalil, Medhat M. H. A., Alhendawey, Moaaz, Elrefai, Mohamad, Gabr, Mohamed A., Fayed, Mohamed Abdelaziz Mohamed Abdalla M, Abdelmaksoud, Mohamed, Salem, Mohamed Abouelmagd, Mohamed Mohamed, Mohamed Adel, Nabeeh, Mohamed Adel, Elsayed, Mohamed Ahmed Abdelhalim Ahmed, Abdelmonem, Mohamed Ahmed, Ali, Mohamed Anwar Abdel Razik, Eldemery, Mohamed, Elmesery, Mohamed, Fikry, Mohamed, Gharbia, Mohamed, Omar, Mohamed I., Elmoghazy, Mohamed Ibrahim, Ghazala, Mohamed Jomma, Hamed, Mohamed Korayem Fattouh, Metwally, Mohamed, Arnouse, Mohamed Mohamed Hamdy, Amen, Mohamed Mohsen, Amary, Mohamed Mokhtar, Kandel, Mohamed Mosaad, Abuzeid, Mohamed Mostafa, Rabea, Mohamed, Sobh, Mohamed Ramadan, Taman, Mohamed, Fathy, Mohammad, Moustafa, Mohammad Montaser Hassan, Zuhdy, Mohammad, Adel, Mohammed, Alaa, Mohammed, Alawady, Mohammed, Edassy, Mohammed El, Mohammed, Mohammed Mustafa Hassan, Eldesouki, Mohammed Nabil, Salim, Mohammed Said Mahmoud, Sanad, Mohammed, Khalaf, Mohsen George, Henes, Mohsen Michael, Abdelglil, Momen, Mohmmed, Mona Mhmoud, Abdelkhalik, Morsi Mohamed Morsi, Shetiwy, Mosab, Elshazli, Mostafa, Hegazy, Mostafa, Ahmed, Mostafa Mahmoud, Abdelhalim, Mostafa Mohammed, Shahein, Mostafa, Sofan, Mostafa, Hammad, Muhammed Alaa Moukhtar, Ahmad, Mustafa, Milad, Nader, Farouk, Nehal, Eldesouky, Omnia, Mohamed, Omnia Y., Mahadel, Osama Abdel Salam, Gaarour, Osama, Torky, Radwan Abdelsabour, Elhafez, Raheem El-Gohary Abd, Adly, Ramy Magdy, Nageeb, Ramy Mikhael, Hamdi, Salah, Gamal, Sameh, Emile, Sameh Hany, Regal, Samer, Abdelrasheed, Sayed, Elzeftawy, Shady Ahmed, Khashshan, Sohib Mohammed Mohammed, Ashraf, Tamer, Khafagy, Tamer, Nabil, Tamer, Abdelazim, Tarek, Rizk, Tarek Taher, Amr, Wesam, Yousef, Yousef Mohamed, Youssef, Youssef Abdel Aziz, Castaldi, Antonio, Fiore, Antonio, Hasani, Ariola, Mariani, Aurora, Dagorno, Claire, Antonio, D'Alessandro, Izzo, Giuliano, Addari, Giulio, Mangiameli, Giuseppe, Rea, Lo Dico, Pio, Luca, Paci, Marco, Andrea, Police, De Fatico, GSerena, Elvira, Tartaglia, Schuldes, Alejandro Daniel Lira, Rihan, Eslam, Moeslein, Gabriela, Lederhuber, Hans, Botros, Ibram, Jaman, Ismail, Doerner, Johannes, Elseberbihy, John Rezk Hanna, Sherbiny, Kareem El, Ghonim, Mostafa, Mikrish, Amir, Aziz, Mina, Hatm, Mohamed, Archid, Rami, Gendy, Samuel Elkess Morcos, Ahmad, Sufian, Charalabopoulos, Alexandros, Prodromidou, Anastasia, Ioannidis, Argyrios, Mpaili, Eustratia, Boukorou, Garyfallia, Papadopoulos, Georgios, Liakakos, Theodore, Styliani, Vasileiadou, Agrawal, Abhishek, Jain, Amita, Rashid, Arshad, Mehraj, Asif, Brahmachari, Swagata, Lakshmi, Harish Neelamraju, Vishwakarma, Kushagra, Parida, Lalit, Sharma, Meenakshi, Zaieem, Mohammad, Makasarwala, Murtaza, Nittala, Rigved, Kumar, Sanjeev, Vikrantmr, Sharma, Junaid, Sheikh, Khuller, Somyaa, More, Vinal, Ahmed, Abeer Abdul Hameed, Alomieri, Adil, Alhamdany, Arkan Shubber, Del, Muslim Ka, Najm, Ghadah, Lateef, Nawras Falah, Mcnamara, Deborah, Abdelmageed, Mohammed Elkassaby, Majeed, Mudassar, Troci, Albert, Porcu, Alberto, Marano, Alessandra, Di Bartolomeo, Alessandro, Giani, Alessandro, Giardino, Alessandro, Canfora, Alfonso, Balla, Andrea, Barberis, Andrea, Belli, Andrea, Borasi, Andrea, Manetti, Andrea, Mingoli, Andrea, Morini, Andrea, Maurizi, Angela, Marra, Angelo Alessandro, Epifani, Angelo Gabriele, Iossa, Angelo, Parello, Angelo, Guida, Anna, Maffioli, Anna, Scafa, Anthony Kevin, Spinelli, Antonino, Matarangolo, Antonio, Picciariello, Arcangelo, Pirozzi, Brunella, Cirillo, Bruno, Gazia, Carlo, Ratto, Carlo, Foppa, Caterina, Marafante, Chiara, Andrea, Chierici, Tanda, Cinzia, Guerci, Claudio, Don, Cristine, Zigiotto, Daniele, Coniglio, Denise, Sasia, Diego, Visconti, Diego, Altomare, Donato F., Guaitoli, Eleonora, Botteri, Emanuele, Pinotti, Enrico, Martinelli, Fabio, Uggeri, Fabio, Bàmbina, Fabrizio, Falaschi, Federica, Costanzo, Federico, La Torre, Filippo, Milana, Flavio, Abbatini, Francesca, De Lucia, Francesca, Tropeano, Francesca Paola, Colombo, Francesco, Ferrara, Francesco, Litta, Francesco, Carrano, Francesco Maria, Orlando, Francesco, Roscio, Francesco, Selvaggi, Francesco, Giarratano, Gabriella, Pagano, Gianluca, Lisi, Giorgio, Argenio, Giulio, Zancana, Giuseppa, Cavallaro, Giuseppe, Frazzetta, Giuseppe, Mariateresa, Grasso, Sciaudone, Guido, Vella, Ivan, Siragusa, Leandro, Santurro, Letizia, Ferri, Lorenzo, Petagna, Lorenzo, Ferrario, Luca, Pitoni, Ludovica, Pignatelli, Marcello Filograna, Angrisani, Marco, Giugliano, Marco, Inama, Marco, Marino, Marco V., Veltri, Marco, Giuffrida, Maria Carmela, Menna, Maria Paola, Valente, Marina, Rottoli, Matteo, Sacchi, Matteo, Uccelli, Matteo, Rho, Maurizio, Garino, Mauro, Montuori, Mauro, Campanelli, Michela, Zese, Monica, De Falco, Nadia, Cillara, Nicola, Mariani, Nicolò Maria, Tamini, Nicolò, Adorisio, Ottavio, Campennì, Paola, Venturelli, Paolina, Bernante, Paolo, Sapienza, Paolo, Cianci, Pasquale, Marsanic, Patrizia, Lapolla, Pierfrancesco, Tecchio, Piero, Familiari, Pietro, Fransvea, Pietro, Bruzzaniti, Placido, Hassan, Redan, Pirovano, Riccardo, Rimonda, Roberto, Di Saverio, Salomone, Di Carlo, Sara, Perra, Teresa, Campagnaro, Tommaso, Testa, Valentina, Andriola, Valeria, Grappelli, Virgilio Michael Ambrosi, Capizzi, Vita, Chiarella, Vito, Bellato, Vittoria, Yanaga, Katsuhiko, Farouk, Mohamed, Uraiqat, Ahmad, Almasri, Mahmoud, Nabwana, Ambrose, Siboe, Mark M. W., W, Njoroge P., Njoroge, Githu, Ilkul, Jh., Obure, Ralph Ombati, Palkhi, Yusuf, Alkhayat, Ali, Ali, Ali Sayed, Malek, Amgad Nashaat Abdel, Abdelsayed, Emad Fahim, Zahra, Tarek, Ayoub, Larissa, Sleilati, Fadi, Aoun, Rany, Algatanesh, Nassib, Fieturi, Nura Ahmed, Ng, Jen Siang, Díaz, Andrés Vega, Duran, Erik Efrain Sosa, Guerrero, José Eaazim Flores, Jasso, Manuel Meza, Flores, Manuel SSalas, Felix, Marcos José Serrato, Angulo, Victor Manuel Pinto, Mejdane, Abdelhadi, Aitali, Abdelmounaim, Amal, Benzakour, Zentar, Aziz, Bensaad, Ahmed, Yacir, El Alami, Jawad, Fassi Fihri Mohamed, Rachid, Mohamed Ghassane, Maliki-Alaoui, Mohamed, Ouadii, Mouaqit, Mohammed, Ouazni, Thein, Nyan, Koirala, Dinesh Prasad, Hilling, Denise, Pouwels, Sjaak, Okunlola, Abiodun Idowu, Adejumo, Adeyinka, Akinmade, Akinola, Shittu, Asimiyu Adekunle, Oluyomi, Ayodele Samuel, Abiodun, Azeez Lateef, Lawal, Bashir, Odion, Clement, Popoola, Ademola, Jolayemi, Edward, Shomoye, El-Zaki, Wuraola, Funmilola Olanike, Eke, Grace, Abiyere, Henry, Oluwasuyi, Ige, George, Ihediwa, Njokanma, Iloba Gabriel, Aremu, Isiaka, Dare, Julius Kolajo, Abdur-Rahman, Lukman, Ahmad, Misbahu Haruna, Oludara, Mobolaji Adewale, Mohammad, Mohammad Aminu, Adeoluwa, Ojajuni, Situ, Oladele, Agbonrofo, Peter, Kewulere, Raji Taofiq, Aliyu, Yakubu, Adebowale, Yusuf, Galala, Ahmed, Rao, Satish, Waleed, Aasma, Inam, Aatif, Shaikh, Abdul Razaque, Qureshi, Ahmad Uzair, Muhammad, Aneeqah Din, Ahmed, Arooj, Kerawala, Asad Ali, Aslam, Mohammad, Mehr, Asma, Javed, Ayesha, Ahmad, Farooq, Majid, Haroon Javaid, Ahmed, Hassan, Daudi, Irfan, Akhtar, Khalid, Niaz, Khurram, Anwer, Mariyah, Amir, Mohammed, Hanif, Muhammad Amir, Asif, Muhammad, Raza, Muhammad Asif, Khokhar, Muhammad Imran, Jameel, Muhammad Khurram, Nasir, Muhammad, Shafique, Muhammad Salman, Ateeb, Mujammad, Nadeem, Munawar, Shah, Rahmat Ullah, Waqar, Shahzad Hussain, Shah, Shahzad Alam, Waseem, Talat, Ghafoor, Tariq, Fatima, Tauseef, Bashir, Umar, Gonzales, Erick Ivan Huaman, Ruiz, Luis Angel Garcia, Freitas, Carla, De Sousa, Xavier, Al-Bahrani, Ahmed, Portela, Carlos Antonio Sanchez, Elgazar, Elsayed Aly, Robles, Eloy Morasen, Khan, Irfan Jan, Jarboa, Lutfi, Khawar, Mahwish, Echevarria, Miguel Jose Pinto, Bashah, Moataz M., Dawdi, Salahaldeen, Musthafa, Shameel, Ali, Syed Muhammad, Ciubotaru, Cezar, Bonci, Eduard-Alexandru, Muresan, Mihai-Stefan, Bogdan, Stoica, Ioan, Tanase, Zubayraeva, Albina, Derinov, Aleksandr, Zakharenko, Alexander, Novikova, Anastasia, Bashlachev, Andrey, Kaldarov, Ayrat, Stanislav, Berelavichus, Gorin, David, Puzenko, Dmitriy, Kazachenko, Ekaterina, Ashimov, Erkin, Medkova, Iuliia, Ignatov, Ivan, Sergeevich, Kochetkov Viktor, Sidorova, Lyudmila, Kiselev, Michail, Danilov, Michail, Aleksandr, Ogoreltsev, Rodimov, Sergey, Garmanovs, Tatiana, Kitsenko, Yury, Valery, Nekoval, Japhet, Ntezamizero, Sibiany, Abdulrahman, Saadeldin, Abdelhalim, Abuosba, Abdelrahman, Alawadhi, Abdulbari Mohammed, Alharbi, Abdulhamid, Althumali, Abdullah, Alghuliga, Abdullah, Alotaibi, Abdullah, Abduraboh, Abdullah Fayez, Kateb, Abdullah, Sindy, Abdullah, Al Eisa, Abdulmohsen, Alotaibi, Abdulrahman, Almulhim, Abdulrhman, Aljawhari, Adel Ali, Abozeid, Ahmad Mahmoud, Saad, Ahmad, Alqarni, Ahmed, Alwan, Ahmed, Alwusaibie, Ahmed, Bafaraj, Ahmed, Eldeeb, Ahmed, Tarabay, Ahmed, Mohammed, Mahfoudh, Alhedaithy, Alhanouf, Almaghrabi, Alhassan Hesham, Abed, Ali Ibrahim Eldawy, Abdullah, Alqahtani Ali, Semilan, Anmar, Farag, Mohamed, Khudhayr, Essa, Hussain, Marwah, Abbas, Ghanem, Alqudaihi, Heba, Abualnaja, Yousra, Shaheen, Abelnasser, Mubarak, Ashraf Abdelazeem Mohamed, Ali, Bandar Idrees A., Alhazmi, Barrag, Hijazi, Bilal Ahmed, Abdulrahman, Chadi, Oyedepo, Charles Olajide, Alzamel, Heythem, Tairab, Elsanousi Ibrahim Sabir, Alsuwaimel, Munir A., Hejazi, Soha, Alnoqaidan, Emad, Alhussien, Fade Ahmed, Jallad, Fadi Sami, Khadwardi, Faisal, Alghamdi, Faisal Saleh, Haddad, Feras, Sauri, Fozan, Alafghani, Haitham, Alfalah, Haitham, Gad, Hamada, Aboelmagid, Hamdy Haggag Ebrahim, Ibrahim, Hamed, Elzayady, Hany M., Sharafeldin, Hatem Abdelrahman Ahmed, Sembawa, Hatem A., Alabbas, Haytham, Abbas, Hazem, Elgamal, Hesham, Alawfi, Homoud, Al-Sadery, Humood, Abdelmotaleb, Hussien Ali, Al Hassn, Ibrahim, Mudawi, Ishag M., Nekhala, Islam, Elsanhoury, Kareem, Said, Khalid Babieker, Albeshri, Khalid A., Albahooth, Khalid, Mohammed, Khalid Fathelrahman Bakier, Asar, Khalid Mohammad Ibrahim, Osman, Luqman, Alzamanan, Mahdi, Alnabarawi, Mahmoud, Althobaiti, Majid, Elsayed, Mohamed Abdelmoneim, Al Naeb, Mohamed, Hassan, Mohamed Salah Eldin, Abdelhamid, Mohamed Sayed, Alyami, Mohammad, Mirza, Mohammad Amin, Sayouh, Mohammad, Alkhayat, Mohammed Amer, Basendowah, Mohammed, Ghunaim, Mohammed, Alhussaini, Mohammed Khalid, Khoj, Mohammed, Sbaih, Mohammed, Saeed, Muhammad Ahmad, Ali, Muhammad Zulfiqar, Abdelaziz, Nabil Yassin Tammam, Malibary, Nadim, Abdo, Nael, Amer, Nasser Mohammed, Al Turki, Neamat Ahmed Ali, Durayb, Norah, Yassin, Nouf, Akeel, Nouf, Larbi, Noureddine, Alsallum, Ofays, Suliman, Omar AAbu, Elsherbiny, Osama, Abusalem, Osama, Albalawi, Ibrahim Altedlawi, Abutalib, Raid Abdullah, Alarabi, Rayan, Khan, Roaa Ghazi, Alazzam, Saleh, Alghamdi, Saleh, Alsawat, Salem, Salim, Sami, Alshukr, Sarah, Alzahrani, Saud, Golea, Smain, Alowairdhi, Tumadher, Salman, Usama, Abusiam, Wael, Abualkhair, Wael, Saber, Wael, Tashkandi, Wail, Alhazmi, Waleed, Tashkandi, Waleed, Yassine, Wassim Abou, Alshabi, Yaser Ahmad, Ibrahim, Yaser, Shahin, Yasser, Ibrahim, Yassin, Aljathlany, Yousef, Alnahas, Yousef, Alrashidi, Yousef, Wali, Zubair, Ndong, Abdourahmane, Ba, Mamadou, Faye, Papa Mamadou, Arbutina, Dragana, Milic, Ljiljana, Cuk, Vladica, Hussein, Abdinafic Mohamud, Mccaul, Jeannie, Bertels, Laurie, Pohl, Linda, Arnold, Marion, Mbatani, Nomonde, Oosthuizen, Pj, Rayamajhi, Shreya, Vosloo, Susan, Jooma, Uzair, Landaluce-Olavarria, Aitor, Vázquez-Melero, Alba, Marcos, Alberto, Puerto Puerto, Alejandro, De La Hermosa, Alicia Ruiz, Senent-Boza, Ana, Ugarte-Sierra, Bakarne, Montalbán, Beatriz Cros, Martin-Perez, Beatriz, Gomez, Caroina Gonzalez, Colás-Ruiz, Enrique, Santos, Esther Garcia, Senra, Fatima, Mora-Guzmán, Ismael, Dziakova, Jana, Díaz, Jeancarlos J. Trujillo, Silva, Jesús, Laina, Juan Luis Blas, Tallon-Aguilar, Luis, Di Martino, Marcello, Chacón, Mario Franco, Frasson, Matteo, Calvo, Mikel Prieto, Millan, Monica, Tejedoe, Patricia, Pérez-Bertólez, Sonia, Turrado-Rodríguez, Víctor, Elsanosi, Abdelrhman Azhari Mohammed, Abdalbakheet, Duaa, Ahmed, Mohamed, Salim, Omer El Faroug H., Youssef, Mohamed, Barbon, Carlotta, Bouchrika, Amal, Maghrebi, Houcine, Loukil, Issam, Yildiz, Alp, Dursun, Ayberk, Gulcu, Baris, Calik, Bulent, Eral, Burak, Yeşilyurt, Değercan, Yakar, Fatih, Akin, Furkan Atakan, Kilinc, Gizem, Uslu, Gülberk, Tuncer, Korhan, Koc, Mehmet Ali, Leventoğlu, Sezai, Sokmen, Selman, Atici, Semra Demirli, Kaya, Tayfun, Dere, Ümit Akın, Kırmızı, Yasemin, Ssenono, Kavuma Daniel, Lule, Herman, Mbiine, Ronald, Hamza, Ahmed, Ali, Shabeer, Peediyakkal, Saidalavi Padinhare, Varma, Gopala Pillay, Mussa, Haidar Aal, Al-Masari, Hayder Makki, Shehata, Mina, Seiam, Moham, Aziz, Muhammad Akram Abdul, Nimir, Nessrein, Khare, Ritu, Rashid, Shahid, Kazim, Shuiab, Gondal, Zafar, Sherif, Ahmed Elshawadfy, Ghanem, Ahmed, Helmy, Ahmed Hazem I., Ibrahim, Ahmed, Elshaer, Ahmed Mohammed, Marzouk, Ahmed Msm, Tamburrini, Alessandro Paolo, Parente, Alessandro, Light, Alexander, Diamantopoulou, Angela, Singh, Baljit, Gurung, Binay, Frauenfelder, Claire, Leo, Cosimo Alex, Raptis, Dimitri, Thakrar, Dixa, Madhuri, Thumuluru Kavitha, Tsounaki, Efthymia, Garreffa, Emanuele, Soggiu, Fiammetta, Stavrou, George, Ng, Hwei Jene, Tabasi, Hani, Nasef, Hazem, Kostakis, Ioannis D., Jeffery, James, Warusavitarne, Janindra, Lund, Jon, Qurashi, Kamran, Sahnan, Kapil, Tong, Kin Seng, Orecchia, Luca, Kaur, Mandeep, Zaidi, Mariam, Ganau, Mario, Hassan, Mohamed Ali Gad, Curtis, Nathan, Bhatt, Nikita, Machairas, Nikolaos, Zafar, Noman, Toma, Omar, Sarmah, Panchali, Bassuni, Majid, Davies, Justin, Shawer, Sami, Shawer, Sherif, Lewis, Sophia, Subramanian, Sivaraman, Ahmad, Suhaib, Nadeem, Uqba, Njau, Aidan, Tohamy, Aley Eldin, Pakula, Andrea M., Simioni, Andrea, Jarvis, Bennie L., Skandalakis, Georgios P., Hesham, Hosai Todd, Isaiah, Isaac A., Villwock, Jennifer, Martin, Linda W., Kress, Melissa, Sebelik, Merry, Lathan, Sanaz, Towfigh, Shirin, Holubar, Stefan D., Demeester, Steve, Alshehari, Mohammed Mohammed Hasan, Ghabisha, Saif Ali, Abdulatef, Shehab Ahmed Ali, Al-Kubati, Waheeb, Obadiel, Yasser Abdurabo, Gots, Alexander, Nakazwe, Mildred, Chipaila, Jackson, and Mazingi, Dennis

Abstract

BackgroundSARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice.MethodsThis is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure.ResultsNine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout.There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management.ResultsNine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout.There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits

Published
2024

7. HPV vaccination in Africa in the COVID-19 era: a cross-sectional survey of healthcare providers’ knowledge, training, and recommendation practices

Author

Fokom Domgue, Joel, primary, Dille, Issimouha, additional, Kapambwe, Sharon, additional, Yu, Robert, additional, Gnangnon, Freddy, additional, Chinula, Lameck, additional, Murenzi, Gad, additional, Mbatani, Nomonde, additional, Pande, Mala, additional, Sidibe, Fatoumata, additional, Kamgno, Joseph, additional, Traore, Bangaly, additional, Fazazi, Hicham El, additional, Diop, Mamadou, additional, Tebeu, Pierre-Marie, additional, Diomande, Mohenou Isidore, additional, Lecuru, Fabrice, additional, Adewole, Isaac, additional, Plante, Marie, additional, Basu, Partha, additional, Dangou, Jean-Marie, additional, and Shete, Sanjay, additional

Published
2024
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10. HPV vaccination in Africa in the COVID-19 era: a cross-sectional survey of healthcare providers' knowledge, training, and recommendation practices.

Author

Domgue, Joel Fokom, Dille, Issimouha, Kapambwe, Sharon, Yu, Robert, Gnangnon, Freddy, Chinula, Lameck, Murenzi, Gad, Mbatani, Nomonde, Pande, Mala, Sidibe, Fatoumata, Kamgno, Joseph, Traore, Bangaly, El Fazazi, Hicham, Diop, Mamadou, Tebeu, Pierre-Marie, Diomande, Mohenou Isidore, Lecuru, Fabrice, Adewole, Isaac, Plante, Marie, and Basu, Partha

Published
2024
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14. Assessment of the implementation context in preparation for a clinical study of machine-learning algorithms to automate the classification of digital cervical images for cervical cancer screening in resource-constrained settings

Author

Castor, Delivette, primary, Saidu, Rakiya, additional, Boa, Rosalind, additional, Mbatani, Nomonde, additional, Mutsvangwa, Tinashe E. M., additional, Moodley, Jennifer, additional, Denny, Lynette, additional, and Kuhn, Louise, additional

Published
2022
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15. Risk Factors for Coronavirus Disease 2019 (COVID-19) Death in a Population Cohort Study from the Western Cape Province, South Africa

Author

Boulle, Andrew, Davies, Mary-Ann, Hussey, Hannah, Ismail, Muzzammil, Morden, Erna, Vundle, Ziyanda, Zweigenthal, Virginia, Mahomed, Hassan, Paleker, Masudah, Pienaar, David, Tembo, Yamanya, Lawrence, Charlene, Isaacs, Washiefa, Mathema, Hlengani, Allen, Derick, Allie, Taryn, Bam, Jamy-Lee, Buddiga, Kasturi, Dane, Pierre, Heekes, Alexa, Matlapeng, Boitumelo, Mutemaringa, Themba, Muzarabani, Luckmore, Phelanyane, Florence, Pienaar, Rory, Rode, Catherine, Smith, Mariette, Tiffin, Nicki, Zinyakatira, Nesbert, Cragg, Carol, Marais, Frederick, Mudaly, Vanessa, Voget, Jacqueline, Davids, Jody, Roodt, Francois, van Zyl Smit, Nellis, Vermeulen, Alda, Adams, Kevin, Audley, Gordon, Bateman, Kathleen, Beckwith, Peter, Bernon, Marc, Blom, Dirk, Boloko, Linda, Botha, Jean, Boutall, Adam, Burmeister, Sean, Cairncross, Lydia, Calligaro, Gregory, Coccia, Cecilia, Corin, Chadwin, Daroowala, Remy, Dave, Joel A, De Bruyn, Elsa, De Villiers, Martin, Deetlefs, Mimi, Dlamini, Sipho, Du Toit, Thomas, Endres, Wilhelm, Europa, Tarin, Fieggan, Graham, Figaji, Anthony, Frankenfeld, Petro, Gatley, Elizabeth, Gina, Phindile, Govender, Evashan, Grobler, Rochelle, Gule, Manqoba Vusumuzi, Hanekom, Christoff, Held, Michael, Heynes, Alana, Hlatswayo, Sabelo, Hodkinson, Bridget, Holtzhausen, Jeanette, Hoosain, Shakeel, Jacobs, Ashely, Kahn, Miriam, Kahn, Thania, Khamajeet, Arvin, Khan, Joubin, Khan, Riaasat, Khwitshana, Alicia, Knight, Lauren, Kooverjee, Sharita, Krogscheepers, Rene, Kruger, Jean Jacque, Kuhn, Suzanne, Laubscher, Kim, Lazarus, John, Le Roux, Jacque, Lee Jones, Scott, Levin, Dion, Maartens, Gary, Majola, Thina, Manganyi, Rodgers, Marais, David, Marais, Suzaan, Maritz, Francois, Maughan, Deborah, Mazondwa, Simthandile, Mbanga, Luyanda, Mbatani, Nomonde, Mbena, Bulewa, Meintjes, Graeme, Mendelson, Marc, Möller, Ernst, Moore, Allison, Ndebele, Babalwa, Nortje, Marc, Ntusi, Ntobeko, Nyengane, Funeka, Ofoegbu, Chima, Papavarnavas, Nectarios, Peter, Jonny, Pickard, Henri, Pluke, Kent, Raubenheimer, Peter J, Robertson, Gordon, Rozmiarek, Julius, Sayed, A, Scriba, Matthias, Sekhukhune, Hennie, Singh, Prasun, Smith, Elsabe, Soldati, Vuyolwethu, Stek, Cari, van den berg, Robert, van der Merwe, Le Roux, Venter, Pieter, Vermooten, Barbra, Viljoen, Gerrit, Viranna, Santhuri, Vogel, Jonno, Vundla, Nokubonga, Wasserman, Sean, Zitha, Eddy, Lomas-Marais, Vanessa, Lombard, Annie, Stuve, Katrin, Viljoen, Werner, Basson, De Vries, Le Roux, Sue, Linden-Mars, Ethel, Victor, Lizanne, Wates, Mark, Zwanepoel, Elbe, Ebrahim, Nabilah, Lahri, Sa’ad, Mnguni, Ayanda, Crede, Thomas, de Man, Martin, Evans, Katya, Hendrikse, Clint, Naude, Jonathan, Parak, Moosa, Szymanski, Patrick, Van Koningsbruggen, Candice, Abrahams, Riezaah, Allwood, Brian, Botha, Christoffel, Botha, Matthys Henndrik, Broadhurst, Alistair, Claasen, Dirkie, Daniel, Che, Dawood, Riyaadh, du Preez, Marie, Du Toit, Nicolene, Erasmus, Kobie, Koegelenberg, Coenraad F N, Gabriel, Shiraaz, Hugo, Susan, Jardine, Thabiet, Johannes, Clint, Karamchand, Sumanth, Lalla, Usha, Langenegger, Eduard, Louw, Eize, Mashigo, Boitumelo, Mhlana, Nonte, Mnqwazi, Chizama, Moodley, Ashley, Moodley, Desiree, Moolla, Saadiq, Mowlana, Abdurasiet, Nortje, Andre, Olivier, Elzanne, Parker, Arifa, Paulsen, Chané, Prozesky, Hans, Rood, Jacques, Sabela, Tholakele, Schrueder, Neshaad, Sithole, Nokwanda, Sithole, Sthembiso, Taljaard, Jantjie J, Titus, Gideon, Van Der Merwe, Tian, van Schalkwyk, Marije, Vazi, Luthando, Viljoen, Abraham J, Yazied Chothia, Mogamat, Naidoo, Vanessa, Wallis, Lee Alan, Abbass, Mumtaz, Arendse, Juanita, Armien, Rizqa, Bailey, Rochelle, Bello, Muideen, Carelse, Rachel, Forgus, Sheron, Kalawe, Nosi, Kariem, Saadiq, Kotze, Mariska, Lucas, Jonathan, McClaughlin, Juanita, Murie, Kathleen, Najjaar, Leilah, Petersen, Liesel, Porter, James, Shaw, Melanie, Stapar, Dusica, Williams, Michelle, Aldum, Linda, Berkowitz, Natacha, Girran, Raakhee, Lee, Kevin, Naidoo, Lenny, Neumuller, Caroline, Anderson, Kim, Begg, Kerrin, Boerlage, Lisa, Cornell, Morna, de Waal, Renée, Dudley, Lilian, English, René, Euvrard, Jonathan, Groenewald, Pam, Jacob, Nisha, Jaspan, Heather, Kalk, Emma, Levitt, Naomi, Malaba, Thoko, Nyakato, Patience, Patten, Gabriela, Schneider, Helen, Shung King, Maylene, Tsondai, Priscilla, Van Duuren, James, van Schaik, Nienke, Blumberg, Lucille, Cohen, Cheryl, Govender, Nelesh, Jassat, Waasila, Kufa, Tendesayi, McCarthy, Kerrigan, Morris, Lynn, Hsiao, Nei-yuan, Marais, Ruan, Ambler, Jon, Ngwenya, Olina, Osei-Yeboah, Richard, Johnson, Leigh, Kassanjee, Reshma, and Tamuhla, Tsaone

Subjects
sub-Saharan Africa, 0301 basic medicine, Microbiology (medical), Adult, Male, Tuberculosis, antiretroviral, 030106 microbiology, Population, HIV Infections, HIV Infections/complications, Cohort Studies, South Africa, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Major Article, Medicine, Humans, 030212 general & internal medicine, education, Proportional Hazards Models, education.field_of_study, South Africa/epidemiology, business.industry, Proportional hazards model, SARS-CoV-2, Hazard ratio, HIV, Correction, COVID-19, medicine.disease, Confidence interval, AcademicSubjects/MED00290, Infectious Diseases, Standardized mortality ratio, tuberculosis, Attributable risk, business, Viral load, Demography
Abstract

Background Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. Methods We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates. Results Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID-19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1). Conclusions While our findings may overestimate HIV- and tuberculosis-associated COVID-19 mortality risks due to residual confounding, both living with HIV and having current tuberculosis were independently associated with increased COVID-19 mortality. The associations between age, sex, and other comorbidities and COVID-19 mortality were similar to those in other settings.

Published
2021
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19. Molar pregnancy: A fifteen - year experience of a single tertiary institution

Author

Camroodien, Sedick and Mbatani, Nomonde

Subjects
Obstetrics and Gynaecology
Abstract

Background: Gestational trophoblastic disease (GTD) is a group of uncommon conditions associated with pregnancy that arise from abnormal placental trophoblastic tissue following abnormal fertilization (1). Despite its rarity, it is of clinical and epidemiological importance because it affects women in the reproductive age group and is associated with morbidities and may sometimes be fatal (2). Molar pregnancy represents as two entities, complete or partial mole, which are mostly benign and can be distinguished by gross morphology, histopathology and genetic analysis (3). The incidence and etiologic factors contributing to the development of GTD have been difficult to characterize. Problems in accumulating reliable epidemiologic data can be attributed to inconsistencies in case definitions, inability to adequately characterize the population at risk, no centralized databases, lack of well-chosen control groups against which to compare possible risk factors, and rarity of the diseases (4). Several potential risk factors for molar pregnancies have been suggested. These include paternal age, vitamin deficiencies, maternal genetic translocations and environmental toxins. The only clear data relate to the impact of maternal age and the previous occurrence of a prior molar pregnancy (3,5,6). With minimal data from African countries about GTD, there remains a greater need for early recognition, timely referral and prompt and proper treatment of this condition (7). Aim: The aim of this descriptive study was to provide a detailed analysis of all patients diagnosed with molar pregnancy at Groote Schuur hospital (GSH) for the period January 2004 – December 2019. Methodology: This was a retrospective descriptive study of all women who were referred and followed up at the molar clinic at GSH with a confirmed histological diagnosis of molar pregnancy during the period 2004 – 2019. Subjects were identified from the molar clinic register at GSH, and folders retrieved for those meeting the inclusion criteria. Analysis was by simple frequencies and rates using SSPS statistical software. Subgroup analyses was performed by chi squared and t-tests. Results: There were 554 057 deliveries and 235 cases of molar pregnancies during that period, with an incidence of 0.42/1000 deliveries. Women aged 20 – 40 years and multiparous women constituted 78.7% and 59.8% of patients. Most (51.3%) patients were diagnosed in their second trimester. The most common presenting complaint was vaginal bleeding (37.4%), and the commonest complication was hyperthyroidism (16.6%). Twenty-six (11.2%) patients required a blood transfusion. Ten patients (4.2%) required a second evacuation with only 4 patients (1.7%) requiring a hysterectomy due to excessive haemorrhage. Patients with molar pregnancy normalized their HCG at 12 weeks post evacuation. There were 47 cases of persistent disease, of which 42 cases were referred for chemotherapy. The remaining 5 cases did not require chemotherapy as they achieved spontaneous regression after the second evacuation. Suction evacuation was performed in 97.4%. With regards to follow up, 44.3% of patients defaulted post evacuation surveillance and care. Conclusion: As the incidence of molar pregnancy in our centre continues to decline, it is important that we take the necessary steps to improve the follow-up protocols for patients with this condition. Doing so will avoid experiencing loss to follow-up.

Published
2023

20. A retrospective audit of young patients diagnosed with cervical cancer over ten years at Groote Schuur Hospital, Cape Town between 1 January 2003 and 31 December 2012, and their outcome at five-year follow-up compared to women in the prior decade

Author

Govindasamy, Suveshni, Mbatani, Nomonde, and Fakie, Nazia

Subjects
Gynaecological Oncology
Abstract

Background : Cervical cancer is the second commonest gynaecological cancer amongst women worldwide and the leading cause of cancer deaths in developing countries – contributing 83% of new cases and 85% of all deaths annually to the burden of this disease. Information and awareness of this illness in the developing world is still inferior, and mortality is increasing. In the developing world, late presentation, advanced-stage disease and a poorly run screening programme (covering only 55% of the South African population) are all contributing factors to this statistic. Approximately 20% of all South African women in their reproductive age are also HIV positive. With the rising burden of cervical cancer and the emergence of HIV as an influencing comorbidity, South Africa adopted a national cervical screening programme, rolled out in 2000 as well as an HCT (HIV counselling and testing) programme formalised in 2011. With these initiatives now in place, this study examined trends and compared 5-year survival outcomes between two decades for cervical cancer among young women. Methods : The study undertook a retrospective audit of files and information on the pre-existing cervical cancer database, and appropriate data was extracted (HREC REF 344/2011). Survival and disease outcomes at five years, as well as time to recurrence, was assessed, together with other demographics of the study population. Patients included in the study were non-pregnant female patients, aged 40 years and younger at the time of registration with the Groote Schuur Hospital (GSH) Oncology Unit (LE 33). The diagnosis of cervical cancer had to have been confirmed histologically, as either squamous cell carcinoma or adenosquamous carcinoma or adenocarcinoma. Patients must have attended at the LE 33 unit on or from 1 January 1993 until and including 31 December 2012. The two decades were studied and 5-year outcomes from each decade were analysed and reviewed using Kaplan-Meier curves and univariate analyses. The study compared data using Log Rank tests and p-values. Findings : The two decade-groups under study showed no difference in trends of survival regarding age, treatment type and histology. Albeit small numbers, adenocarcinoma was the histology that had the best probability of survival during both decades. There were more patients with early-stage cancer (stage 1 and 2) diagnosed in decade B (2003 – 2012) than A (1993 – 2002). Within this early-stage cervical cancer cohort, there is a trend toward more locally-advanced (stage 2) cancer in the more recent decade. The proportion of patients presenting with stage 1a and 1b cancer with tumours 4 cm and less has halved from decade A to decade B. The proportion of stage 2 cancers presenting with tumours 2 – 4cm in size during decade B has risen almost 3-fold to that of decade A. This suggests a developing trend of presentation of more locally-advanced cancer. During both decades, stage 1 cervical cancers had the best probability of survival, with an improvement in mean survival from decade A (average of 44 months) to decade B (average of 58 months). The trend of stage 2 disease has deteriorated, with a decrease in mean survival (from 48 months in decade A to 21 months in decade B), an increase in cancer-related deaths and a shorter time to relapse. The number of patients presenting with late-stage disease (stages 3 and 4) has declined. HIV positive status played an influential role in tumour size on presentation and probability of 5-year disease-free survival. Young women who were HIV positive also fared less favourably when compared to NP (not positive) women in terms of mean survival. Due to the small sample size and that the majority of patients in decade A were untested, further HIV comparisons were not credible. Interpretation : The study suggests a moving trend towards young patients that are being diagnosed with the more locally-advanced early-stage disease in the more recent decade than ten years prior. HIV status seemingly played an influential comorbid role in patients diagnosed with cervical cancer. Patients with the locallyadvanced disease appear to have worse outcomes in the latter decade. In an attempt to curb this potentially curable disease in this subset of young women, a greater focus on earlier screening interventions, prompt diagnosis and appropriate and timeous treatment of cervical cancer, together with optimisation of comorbidities like HIV are needed.

Published
2020

21. Hygiena Study: audit of women managed with Cone Biopsy at Groote Schuur Hospital from 1st April 2013 to 31st October 2015

Author

Kadwa, Khatija, Denny, Lynette, and Mbatani, Nomonde

Subjects
Obstetrics and Gynaecology
Abstract

INTRODUCTION: Cervical cancer is the second commonest cancer in South Africa and the commonest amongst Black females with a Lifetime Risk (LR) of 1:35. In South Africa the problem has been compounded by the HIV epidemic as well as a lack of resources and infrastructure to offer an adequate screening and treatment programme. Cone biopsies are one of the diagnostic and sometimes therapeutic modalities used to assess and treat cervical precursors and cervical cancer. Unfortunately, cone biopsy of the cervix remains a morbid procedure often performed on young women in the reproductive age group and has resultant complications. OBJECTIVE: To audit the demographics, indications, histology and post cone management and outcome of women requiring cone biopsies of the cervix, at Groote Schuur Hospital Colposcopy Clinic between 1st April 2010 and 31st October 2013. METHODS: A group of women attending the colposcopy clinic, and requiring cone biopsies between 1st April 2010 and 31st October 2013 were identified from a computerized database, known as the Hygiena Database. Women who had an incomplete dataset were excluded. Folder review and review of the National Health Laboratory Services was also conducted. Patient demographics, indications, cone histology and follow up at 4-6 months, 10-12 months and > 12 months were analysed. Age, parity, HIV status, CD4 count, ARV status and cone margin involvement were included in the univariate and multivariate analysis to determine predictors of persistent disease RESULTS: Three hundred and seventy six cone biopsies were performed during the study period, with a mean age of 42.3 years, mean parity of 2. The majority of women [56,7% (213/376)] were HIV positive. The final histology indicated that 65,2% (246/376) of the women had high-grade disease (CIN 2/3 or HSIL) and 12,5% (47/376) had microinvasion. Ectocervical margins were clear in 57,6% (212/368) of cases and endocervical margins were clear in 54,6% (201/368) of specimens. Fifty-one cancers were detected during the study period. In the multivariate analysis age 40-49yrs (RR 1.4, 95% CI 1.01-2.0: p=0,043), ectocervical margin involvement with CIN 2/3 (RR 1.8, 95% CI 1.1-3.0: p-0.017) and endocervical margin involvement with CIN 2/3 (RR 1.5, 95% CI 1.04-2.3; p=0,031) and microinvasion ( RR 2.4, 95% CI 1.4-4.3; p=0.003) were all predictors of persistent disease. CONCLUSION: The use of cone biopsy is a valid diagnostic and sometimes therapeutic procedure at Groote Schuur Hospital with significant detection of high grade disease and cervical cancer. Women aged 40-49 years and positive cone margins are strong predictors of persistent disease. Improved compliance and a reduction in positive margins are two areas that need to be addressed to improve the current treatment programme. Use of cone biopsy as surgical therapy for early stage cancer appears promising but needs further study.

Published
2017

22. Prevalence of gynaecological disease in women with an HMLH1 mutation in the Northern Cape province: Survey of a population with Lynch Syndrome in South Africa

Author

Lerm, Marlize and Mbatani, Nomonde

Subjects
Obstetrics and Gynaecology
Abstract

Objective: Lynch syndrome, previously called hereditary non-polyposis colorectal cancer (HNPCC), is one of the most common hereditary cancer syndromes with an association with gynaecological cancers. Members of affected families have an increased risk for colon cancer as well as extra colonic sites; in particular endometrial and ovarian cancer. A cohort of patients with Lynch syndrome in the Northern Cape, South Africa has been identified and followed up. According to recommendations by the International Collaborative Group on HNPCC (ICGHNPCC); women affected with the gene mutation warrant full gynaecological assessment to exclude endometrial and ovarian cancer. Thus far the recommended screening has not been possible and the apparent prevalence of gynaecological cancer or premalignancies among this high risk group has not been established. The aim of this study was to determine the actual apparent prevalence of gynaecological pathology in this cohort of patients; by way of screening. Methods: Women with a known gene mutation, or close relatives of affected family members, utilising the annual colorectal service in the Northern Cape, who fulfilled the inclusion criteria, were recruited to undergo gynaecological evaluation. The participants had a gynaecological examination which included a Papanicolaou smear, a pelvic ultrasound and endometrial sampling. The resultant data was captured on an Excel spread sheet and a descriptive analysis was done. Results: In total 43 women were recruited, of which 18 were postmenopausal and 25 premenopausal. 35 of these women had a known hMLH1 gene mutation. The eight remaining women had either normal genotyping (n=7) or were awaiting molecular test results (n=1). Only twenty-one of these participants agreed to endometrial sampling, in addition to pelvic ultrasound and gynaecological examination. Histological results were therefore available for the 21 participants. One patient was diagnosed with a grade-2 endometroid adenocarcinoma. No cases of endometrial hyperplasia were found. Thirty pelvic ultrasound scans were performed. Of these, one patient had an enlarged adnexal mass. No cervical premalignancies were diagnosed on cervical smears, with one abnormal smear of atypical cells of unknown significance (ASCUS) diagnosed. Conclusion: The apparent prevalence of gynaecological disease in this study population was lower than expected. We conclude however that this high risk group of women should still undergo regular gynaecological screening which should include history taking and clinical examination. Screening using routine endometrial sampling and pelvic ultrasound in asymptomatic women did not appear to be beneficial.

Published
2016

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