45 results on '"Mwanda W"'
Search Results
2. Bacterial contamination in platelet concentrates prepared at Kenya National Blood Transfusion Service (NRBTC)
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Onchaga, M.K., Mbugua, A.M., Maturi, P.M., and Mwanda, W
- Abstract
Background: Contamination of platelets may result from bacterial inoculation into the blood bags. This is due to insufficient disinfection of the venipuncture site.Objective: To determine the prevalence of bacterial contamination in platelet concentrates prepared at Nairobi Regional Blood Transfusion Centre (NRBTC).Study Design: Descriptive cross-sectional study was used.Setting: The study was conducted at Nairobi Regional Blood Transfusion CentreSubject: Nighty one (91) platelet concentrates were selected for the studyResults: The prevalence of bacterial contamination was 12.1% (11/91) with 95 CI [5.4%-18.8%]. Out of the 11 concentrates that were contaminated, Staphylococcus epidermis was isolated from 5 units, staphylococcus aureus from 4 units and pseudomonas paucimobilis from 2 units.Conclusion: The isolates obtained in the donated blood are skin associated organisms and are considered as contaminants related to venepuncture process during the blood donation process. Based on these findings, there is need to review the quality assurance protocol and focus mainly on the venepuncture process.
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- 2018
3. Experiences during 2 years of Twinning Frankfurt-Nairobi: 12 PO 298
- Author
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MIESBACH, W, ABDALLAH, F, BOEHM, M, ASMELASH, G, SCHARRER, I, and MWANDA, W
- Published
- 2006
4. Therapeutic Challenges of AIDS-Related Non-Hodgkinʼs Lymphoma in the United States and East Africa
- Author
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Otieno, Mwanda W., Banura, Cecily, Katongole-Mbidde, Edward, Johnson, John L., Ghannoum, Mahmoud, Dowlati, Afshin, Renne, Rolf, Arts, Eric, Whalen, Christopher, Lederman, Michael M., and Remick, Scot C.
- Published
- 2002
5. [Accepted Manuscript] Exclusive Breastfeeding Is More Common Among HIV-Infected Than HIV-Uninfected Kenyan Mothers at 6 Weeks and 6 Months Postpartum
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Oiye, S., Mwanda, W., Mugambi, M., Filteau, S., and Owino, V.
- Abstract
To compare breastfeeding practices determined by mothers' own recall versus a stable isotope technique (deuterium oxide dilution) among human immunodeficiency virus (HIV)-infected and HIV-uninfected mothers at 6 weeks and 6 months postpartum. Exclusive breastfeeding (EBF) rates were assessed cross-sectionally at 6 weeks and 6 months postpartum among 75 HIV-positive and 68 HIV-negative women attending postnatal care. EBF was derived from maternal 24-hour recall of foods that were fed to the infant and by objective measurement of nonhuman milk-water intake using deuterium oxide (DO) dilution technique. Multivariable logistic analyses were adjusted for infant sex, gravidity, maternal age, marital status, and maternal education. Using recall method, a greater proportion of HIV-infected mothers exclusively breastfed than HIV-uninfected mothers both at 6 weeks postpartum [94.1% versus 76.9%, respectively (adjusted odds ratio [aOR] 7.81; 95% confidence interval [CI] 1.9-31.6, p = 0.004)] and at 6 months postpartum [75% versus 59.7%, respectively (aOR 2.27; 95% CI 1.0-5.3, p = 0.058)]. At 6 weeks postpartum EBF rates from the DO technique were 23.5% and 13.8% for HIV-positive and HIV-negative mothers, respectively (aOR 0.35; 95% CI 0.11-1.04, p = 0.059). At 6 months postpartum, the DO technique determined EBF rates were 43.3% among HIV-positive and 24.2% among HIV-negative mothers, respectively (aOR 2.4; 95% CI 1.0-5.7, p = 0.048). HIV-infected mothers are more likely to exclusively breastfeed compared with HIV-uninfected mothers. In this resource-poor setting, maternal recall overestimates EBF rates as compared with the deuterium oxide dilution technique. Validating EBF recall data using the objective DO technique is highly recommended for accurate tracking toward global targets on breastfeeding practices.
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- 2017
6. Satisfaction with Delivery Services Offered under the Free Maternal Healthcare Policy in Kenyan Public Health Facilities
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Gitobu, C. M., primary, Gichangi, P. B., additional, and Mwanda, W. O., additional
- Published
- 2018
- Full Text
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7. Quality Assessment of Platelet Concentrate Preparations at the Nairobi Regional Blood Transfusion Centre in Kenya
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K., Onchaga Margare, primary, M., Amos Mbugua, additional, Mwamba, Maturi P., additional, and Mwanda, W., additional
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- 2017
- Full Text
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8. Challenges and opportunities for treatment and research of AIDS-related malignancies in Africa
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Scot C. Remick, Jackson Orem, and Mwanda W. Otieno
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Cervical cancer ,Cancer Research ,medicine.medical_specialty ,education.field_of_study ,business.industry ,Public health ,Population ,Developing country ,HIV Infections ,Disease ,medicine.disease ,Oncology ,Acquired immunodeficiency syndrome (AIDS) ,Neoplasms ,Africa ,Epidemiology ,Immunology ,Pandemic ,medicine ,Humans ,Intensive care medicine ,education ,business - Abstract
Purpose of review Following our review of AIDS-associated cancer in developing nations in 2004, we sought to update recent publications and review data on the challenges and opportunities for the treatment and research of AIDS malignancies in Africa. Recent findings It is apparent that the burden of AIDS-related malignancies and other virus-associated tumors is significant and increasing in Africa. Several recent studies report findings on conjunctival squamous cell carcinoma and there is a report that Hodgkin's disease, a non-AIDS-defining neoplasm, is increasing in incidence. International collaborative partnerships dedicated to AIDS malignancies in developing countries are feasible and invaluable for clinical strategies to address this aspect of the pandemic. A departure point is the ongoing work of the East Africa – Case Western Reserve University Collaboration in AIDS malignancies. Summary The burden of neoplastic complications of HIV infection and endemic virus-associated tumors are assuming increasing significance in Africa. There is a need to develop nonmyelotoxic therapies and approaches that are hypothesis-driven and pathogenesis-based. The scarcity and shortages in this region demand that our scientific and therapeutic strategies are both suitable and pragmatic for testing in this setting. It is also imperative that African investigators lead us in this important endeavor.
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- 2006
9. Capacity building for the clinical investigation of AIDS malignancy in East Africa
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Christopher C. Whalen, Scot C. Remick, John L. Johnson, Leona W. Ayers, Cecily Banura, Ellen G Feigal, Mahmoud A. Ghannoum, Pingfu Fu, Edward Katongole-Mbidde, Jackson Orem, Michael M. Lederman, Jodi B Black, and Mwanda W. Otieno
- Subjects
Cancer Research ,medicine.medical_specialty ,Biomedical Research ,International Cooperation ,media_common.quotation_subject ,education ,Alternative medicine ,Developing country ,Acquired immunodeficiency syndrome (AIDS) ,Excellence ,Neoplasms ,Research Support as Topic ,medicine ,Humans ,media_common ,Acquired Immunodeficiency Syndrome ,Clinical Trials as Topic ,Medical education ,business.industry ,Capacity building ,Africa, Eastern ,medicine.disease ,Clinical trial ,Intervention (law) ,Clinical research ,Oncology ,business ,Needs Assessment - Abstract
Purpose: To build capacity in the resource-poor setting to support the clinical investigation and treatment of AIDS-related malignancies in a region of the world hardest hit by the AIDS pandemic. Methods: An initial MEDLINE database search for international collaborative partnerships dedicated to AIDS malignancies in developing countries failed to identify any leads. This search prompted us to report progress on our collaboration in this aspect of the epidemic. Building on the formal Uganda-Case Western Reserve University (Case) Research Collaboration dating back to 1987, established NIH-supported centers of research excellence at Case, and expanding activities in Kenya, scientific and training initiatives, research capital amongst our institutions are emerging to sustain a international research enterprise focused on AIDS and other viral-related malignancies. Results: A platform of clinical research trials with pragmatic design has been developed to further enhance clinical care and sustain training initiatives with partners in East Africa and the United States. An oral chemotherapy feasibility trial in AIDS lymphoma is near completion; a second lymphoma trial of byrostatin and vincristine is anticipated and a feasibility trial of indinavir for endemic Kaposi's sarcoma is planned. Conclusions: In the absence of published reports of evolving international partnerships dedicated to AIDS malignancy in resource constrained settings, we feel it important for such progress on similar or related international collaborative pursuits to be published. The success of this effort is realized by the long-term international commitment of the collaborating investigators and institutions to sustain this effort in keeping with ethical and NIH standards for the conduct of research; the provision of formal training of investigators and research personnel on clinical problems our East African partners are faced with in practice and the development of pragmatic clinical trials and therapeutic intervention to facilitate technology transfer and enhance clinical practice.
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- 2005
10. Adult Burkitt's lymphoma in patients with and without human immunodeficiency virus infection in Kenya
- Author
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Christopher C. Whalen, Mwanda W. Otieno, and Scot C. Remick
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Cancer Research ,medicine.medical_specialty ,biology ,business.industry ,Incidence (epidemiology) ,medicine.disease ,biology.organism_classification ,Lymphoma ,Serology ,Oncology ,Acquired immunodeficiency syndrome (AIDS) ,B symptoms ,Internal medicine ,Epidemiology ,Immunology ,medicine ,Disseminated disease ,medicine.symptom ,business ,Sida - Abstract
Prior to the acquired immunodeficiency syndrome (AIDS) epidemic, one or two cases of adult Burkitt's lymphoma (BL) were seen annually at the Kenyatta National Hospital, the national referral medical center in Nairobi, Kenya. To investigate the influence of human immunodeficiency virus (HIV) infection in adult BL in Kenya, we conducted a national prevalence survey of all patients 16 years of age and older with BL. A systematic review of medical records of all patients diagnosed with BL between 1992 and 1996 was performed. The diagnosis of BL was based and confirmed on review of pathological material from time of original diagnosis. HIV serology was confirmed by enzyme-linked immunosorbent assay (ELISA). Twenty-nine adult patients with BL were identified during the 5-year study period. Of these patients, 17 (59%) were males, 12 (41%) were females, and the median age was 26 years. Nineteen patients (66%) with BL were HIV-seropositive. The proportion of men was similar in HIV-seropositive and -seronegative patients (58% vs 60%). HIV-seropositive BL patients were significantly older than seronegatives (median 35 vs 19.5 years, p < 0.001). HIV-seropositive patients uniformly presented with constitutional or B symptoms and advanced BL accompanied by diffuse lymph node involvement, whereas the clinical presentation of HIV-seronegative patients during this time period was reminiscent of the “typical” endemic pattern of disease with complete sparing of peripheral lymph nodes. The overall survival of HIV-seropositive cases was significantly worse than that of the HIV-seronegative cases; median survival in the HIV-seropositive patients was 15 weeks. There is an approximate 3-fold increase in the incidence of adult BL during the time period of this study, which is attributable to the AIDS epidemic. In this setting, patients often present with disseminated disease, diffuse peripheral lymphadenopathy and fever, the latter two of which heretofore have been commonly associated with non-lymphoproliferative disorders such as Mycobacterium tuberculosis and sexually transmitted diseases in Kenya. These observations warrant inclusion of AIDS-related BL in the differential diagnosis of the adult patient with unexplained fever and lymphadenopathy in Kenya. The corollary is that HIV infection is virtually excluded in an adult patient without peripheral lymphadenopathy and biopsy-proven BL. © 2001 Wiley-Liss, Inc.
- Published
- 2001
11. Retaining nurses at rural stes through distance learning, the University of Nairobi experience
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Kibwage, I.O., primary, Bosire, K., additional, Matiangi, M., additional, Omoni, G., additional, Macharia, J., additional, Njiri, F., additional, Nduati, R., additional, Mwanda, W., additional, Oyugi, J., additional, Gachuno, O., additional, and Kiarie, J., additional
- Published
- 2016
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12. Non-endemic Burkitt’s Lymphoma
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Mwanda W. Otieno
- Subjects
Acquired immunodeficiency syndrome (AIDS) ,medicine ,Crude incidence ,Non endemic ,Standardized rate ,Disease ,Biology ,medicine.disease ,Burkitt's lymphoma ,Pediatric cancer ,Lymphoma ,Demography - Abstract
Until characterization of HIV/AIDS malignancies non-endemic was one of the two categories of Burkitt’s lymphoma. The types vary mainly in the proportions of several characterizing features. In 1904 Albert Cook made observations in a Mohammandan child who had a malignant tumor that appears to be what Denis Burkitt in 1958 and subsequent years by others provided for founding characteristics. The major defining features included a peculiar age distribution, characteristic anatomical distribution and geographical distribution unrelated to genetic factors. Additionally the disease has typical cytogenesis and cytologic, histologic, immunologic, biologic, and clinical features. Non-endemic Burkitt’s is rare and predominantly found in the temperate regions. In Europe, North and South America and Oceanic Age Standardized Rates in most populations are less than 1 per million in many countries. In Asia, the levels are low and vary from country to country while Australian pediatric cancer registry documented Crude Incidence of 1.8.
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- 2012
13. RBL2/P130 NETWORK ABNORMALITIES IN ENDEMIC BURKITT'S LYMPHOMA EXPLORED BY GENE EXPRESSION ANALYSIS
- Author
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Piccaluga, P. P., Falco, G., Leucci, E., Mwanda, W., Lorenzo LEONCINI, and Pileri, S. A.
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- 2008
14. AIDS-associated cancer in developing nations
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Mwanda W. Otieno, Jackson Orem, and Scot C. Remick
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Asia ,Developing country ,Acquired immunodeficiency syndrome (AIDS) ,Neoplasms ,medicine ,Prevalence ,Humans ,In patient ,Intensive care medicine ,Child ,Developing Countries ,Acquired Immunodeficiency Syndrome ,business.industry ,Incidence (epidemiology) ,Infant, Newborn ,virus diseases ,Cancer ,medicine.disease ,Antiretroviral therapy ,Lymphoma ,Oncology ,Child, Preschool ,Immunology ,Africa ,Female ,Sarcoma ,business ,Brazil - Abstract
With the emergence of the highly active antiretroviral therapy era, it is apparent that the incidence of Kaposi sarcoma, in particular, and lymphoma in patients with AIDS is declining, especially in regions of the world where these regimens are routinely available. The burden of HIV infection and AIDS is greatest in the developing world, and no doubt neoplastic complications are increasingly encountered. The purpose of this review is to highlight recent developments of this aspect of the AIDS epidemic in the developing world.It was readily apparent that the incidence of Kaposi sarcoma sharply increased after the onset of the AIDS epidemic in developing countries. By the end of the second decade of the epidemic, non-Hodgkin lymphoma is increasing in incidence and the natural history of Burkitt lymphoma is evolving in the backdrop of HIV infection as well. Cervical cancer is the most common cancer in women in many developing countries, yet the true impact of HIV infection on the development of this neoplasm is not fully understood. Squamous cell carcinoma of the conjunctiva appears to be a unique AIDS-associated neoplasm that is encountered in sub-Saharan Africa as well. Finally, although the epidemiologic and clinicopathologic features for many AIDS-associated neoplasms are well characterized in developing regions of the world, there is a paucity of data on the therapeutic approach to these tumors in this setting.It is apparent that as the AIDS pandemic proceeds, the burden of neoplastic diseases is increasing in developing nations. Current therapeutic approaches are not well documented. Pragmatic prevention and therapeutic interventions suitable for the resource-constrained setting are clearly needed.
- Published
- 2004
15. Therapeutic challenges of AIDS-related non-Hodgkin's lymphoma in the United States and East Africa
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Christopher C. Whalen, Cecily Banura, Michael M. Lederman, Afshin Dowlati, Rolf Renne, Scot C. Remick, Eric J. Arts, Mahmoud A. Ghannoum, Mwanda W. Otieno, John L. Johnson, and Edward Katongole-Mbidde
- Subjects
Cancer Research ,medicine.medical_specialty ,Acquired Immunodeficiency Syndrome ,business.industry ,Anti-HIV Agents ,Lymphoma, Non-Hodgkin ,Disease ,Africa, Eastern ,medicine.disease ,Chemotherapy regimen ,United States ,Non-Hodgkin's lymphoma ,Lymphoma ,Natural history ,Clinical trial ,Survival Rate ,Oncology ,Acquired immunodeficiency syndrome (AIDS) ,Antiretroviral Therapy, Highly Active ,Immunology ,medicine ,Humans ,Viral disease ,Intensive care medicine ,business - Abstract
Non-Hodgkin's lymphoma (NHL) remains the second most common malignant complication in patients with human immunodeficiency virus (HIV) infection. As we enter the third decade of the acquired immunodeficiency syndrome (AIDS) epidemic, it is apparent that the evolution of antiretroviral therapy and the emergence of combination antiviral strategies have greatly affected the natural history of HIV infection and its neoplastic complications. For example, there may be a trend for declining incidence of AIDS-related lymphoma in the United States for the first time. However, in regions of the world where the burden of HIV infection is greatest, such as in East Africa, AIDS-related lymphoma is an increasing cause of morbidity and mortality. Treatment of lymphoma has evolved coincident with improvements in antiretroviral therapy. Infusional chemotherapy regimens may offer advantages over other regimens and schedules, but comparative trials have not been done. Clinical trial data are available on which to develop therapeutic strategies to treat this disease in East Africa where pragmatic approaches are needed. Both the differences in manifestations of HIV infection and the inherent difficulties in administering cytotoxic chemotherapy in this part of the world must be taken into consideration in planning therapeutic strategies. Improved understanding of the pathogenesis of HIV infection and lymphoma will likely yield improved therapeutic interventions as well.
- Published
- 2002
16. B cell differentiation in EBV-positive Burkitt Lymphoma is impaired at post-transcriptional level by miRNA altered expression
- Author
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Leucci, E, Onnis, A, Cocco, M, De Falco, G, Imperatore, F, Antonicelli, G, Costanzo, V, Cerino, G, Mannucci, S, Cantisani, R, Nyagol, J, Mwanda, W, Iriso, R, Owang, M, Schurfeld, K, Bellan, C, Lazzi, S, Leoncini, L, Leucci, E, Onnis, A, Cocco, M, De Falco, G, Imperatore, F, Antonicelli, G, Costanzo, V, Cerino, G, Mannucci, S, Cantisani, R, Nyagol, J, Mwanda, W, Iriso, R, Owang, M, Schurfeld, K, Bellan, C, Lazzi, S, and Leoncini, L
- Abstract
Udgivelsesdato: 2009-Jun-15, Endemic, sporadic and HIV-associated Burkitt lymphoma (BL) all have a B-cell phenotype and a MYC translocation, but a variable association with the Epstein-Barr virus (EBV). However, there is still no satisfactory explanation of how EBV participates in the pathogenesis of BL. A recent investigation suggested that EBV-positive and EBV-negative BL have different cells of origin. In particular, according to immunoglobulin gene mutation analysis, EBV-negative BLs may originate from early centroblasts, whereas EBV-positive BLs appear to arise from postgerminal center B cells or memory B cells. The appearance of a germinal center phenotype in EBV-positive cells might thus derive from a block in B cell differentiation. The exit from the germinal center involves a complex series of events which require the activation of BLIMP-1 and the consequent down-regulation of several target genes.Here, we investigated the expression of specific miRNAs predicted to be involved in B cell differentiation and we found that hsa-miR-127 is differentially expressed between EBV-positive and EBV-negative BLs. In particular, it was strongly up-regulated only in EBV-positive BL samples, whereas EBV-negative cases showed levels of expression similar to normal controls, including microdissected GC cells.In addition, we found evidence that hsa-miR-127 is involved in B cell differentiation process through post transcriptional regulation of BLIMP1 and XBP1. The over-expression of this miRNA may thus represent a key event in the lymphomagenesis of EBV positive BL, by blocking the B cell differentiation process. (c) 2009 UICC.
- Published
- 2009
17. Challenges and opportunities for treatment and research of AIDS-related malignancies in Africa
- Author
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Orem, Jackson, primary, Otieno, Mwanda W, additional, and Remick, Scot C, additional
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- 2006
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18. Dose-modified oral chemotherapy for AIDS-related non-Hodgkin’s lymphoma (AR-NHL) in East Africa
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Mwanda, W. O., primary, Orem, J., additional, Fu, P., additional, Banura, C., additional, Kakembo, J., additional, Ness, A., additional, Johnson, J., additional, Black, J., additional, Katongole-Mbidde, E., additional, and Remick, S., additional
- Published
- 2006
- Full Text
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19. Capacity building for the clinical investigation of AIDS malignancy in East Africa
- Author
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Orem, Jackson, primary, Otieno, Mwanda W., additional, Banura, Cecily, additional, Katongole-Mbidde, Edward, additional, Johnson, John L., additional, Ayers, Leona, additional, Ghannoum, Mahmoud, additional, Fu, Pingfu, additional, Feigal, Ellen G., additional, Black, Jodi, additional, Whalen, Christopher, additional, Lederman, Michael, additional, and Remick, Scot C., additional
- Published
- 2005
- Full Text
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20. AIDS-associated cancer in developing nations
- Author
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Orem, Jackson, primary, Otieno, Mwanda W, additional, and Remick, Scot C, additional
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- 2004
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21. Autologous transfusion in surgical patients at Kenyatta National Hospitals, Nairobi
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Mahoha, G. A. O., primary, Mwanda, W. O., additional, and Afulo, O. K., additional
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- 2001
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22. Adult Burkitt's lymphoma in patients with and without human immunodeficiency virus infection in Kenya
- Author
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Otieno, Mwanda W., primary, Remick, Scot C., additional, and Whalen, Christopher, additional
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- 2001
- Full Text
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23. DNMT over-expression based on microrna modulation in HIV-related aggressive B-cell lymphomas
- Author
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Rogena, E. A., Luzzi, A., Morettini, F., Onnis, A., Mannucci, S., Bellan, C., Mwanda, W., Lorenzo LEONCINI, and Falco, G.
24. EBV-Bart-6-3p induces cell proliferation and escape of immunosurveillance in BL cell lines and primary tumours
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Rogena, E. A., Di Lisio, L., Navari, M., Onnis, A., Martinez, N., Falco, G., Leon, E. A., Montes-Moreno, S., Bellan, C., Piris, M. A., Mwanda, W., and Lorenzo LEONCINI
25. Gene-expression analysis identifies novel RBL2/p130 target genes in endemic Burkitt lymphoma cell lines and primary tumors
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Giulia De Falco, Dido Lenze, Michael Hummel, Pier Paolo Claudio, Cristiana Bellan, Joshua Nyagol, Walter Mwanda, Antonio Giordano, Piero Tosi, Harald Stein, Stefano Pileri, Anna Onnis, Eleonora Leucci, Giovanna Cerino, Pier Paolo Piccaluga, Lorenzo Leoncini, De Falco G, Leucci E, Lenze D, Piccaluga PP, Claudio PP, Onnis A, Cerino G, Nyagol J, Mwanda W, Bellan C, Hummel M, Pileri S, Tosi P, Stein H, Giordano A, and Leoncini L.
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Male ,Tumor suppressor gene ,Adolescent ,Immunology ,Biology ,gep ,medicine.disease_cause ,Biochemistry ,Gene expression ,medicine ,Biomarkers, Tumor ,Tumor Cells, Cultured ,Humans ,pRb2/p130 ,Burkitt lymphoma ,Child ,Cell Proliferation ,Oligonucleotide Array Sequence Analysis ,Regulation of gene expression ,Retinoblastoma-Like Protein p130 ,Cell growth ,Gene Expression Profiling ,Cell Biology ,Hematology ,medicine.disease ,Prognosis ,Burkitt Lymphoma ,Gene expression profiling ,Gene Expression Regulation, Neoplastic ,Child, Preschool ,embryonic structures ,Mutation ,Cancer research ,Female ,biological phenomena, cell phenomena, and immunity ,Carcinogenesis ,BTG1 ,Burkitt's lymphoma - Abstract
Burkitt lymphoma (BL) is a B-cell tumor whose characteristic gene aberration is the translocation t(8;14), which determines c-myc overexpression. Several genetic and epigenetic alterations other than c-myc overexpression have also been described in BL. It has been demonstrated that the RBL2/p130 gene, a member of the retinoblastoma family (pRbs), is mutated in BL cell lines and primary tumors. The aim of this study was to investigate the biologic effect of RBL2/p130 in BL cells and its possible role in lymphomagenesis. Therefore, we reintroduced a functional RBL2/p130 in BL cell lines where this gene was mutated. Our results demonstrated that RBL2/p130-transfected cells regain growth control. This suggests that RBL2/p130 may control the expression of several genes, which may be important for cell growth and viability. Gene-expression analysis revealed a modulation of several genes, including CGRRF1, RGS1, BTG1, TIA1, and PCDHA2, upon RBL2/p130 reintroduction. We then monitored their expression in primary tumors of endemic BL as well, demonstrating that their expression resembled those of the BL cell lines. In conclusion, these data suggest that, as RBL2/p130 modulates the expression of target genes, which are important for cell growth and viability, its inactivation may be relevant for the occurrence of BL.
- Published
- 2007
26. HIV-Infected and HIV-Uninfected Western Kenyan Women Produce Equivalent Amounts of Breast Milk at 6 Wk and 6 Mo Postpartum: A Prospective Cohort Study Using Deuterium Oxide Dose-to-Mother Technique.
- Author
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Oiye S, Mwanda W, Filteau S, and Owino V
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- Infant, Humans, Female, Kenya, Mothers, Prospective Studies, Deuterium Oxide, Breast Feeding, Postpartum Period, Milk, Human, HIV Infections
- Abstract
Background: Regardless of their HIV serostatus, mothers are advised to exclusively breastfeed infants ≤6 mo postpartum. How this guidance impacts breast milk intake among HIV-exposed infants in varied contexts needs to be better understood., Objectives: The objective of this study was to compare breast milk intake of HIV-exposed and HIV-unexposed infants at 6 wk and 6 mo of age, as well as the associated factors., Methods: In a prospective cohort design, which we followed from a western Kenya postnatal clinic, 68 full-term HIV-uninfected infants born to HIV-1-infected mothers (HIV-exposed) and 65 full-term HIV-uninfected infants born to HIV-uninfected mothers were assessed at 6 wk and 6 mo of age. Breast milk intake of infants (51.9% female) weighing 3.0-6.7 kg (at 6 wk of age) was determined using the deuterium oxide dose-to-mother technique. Student t test for independent samples compared the variations in breast milk intake between the 2 groups. Correlation analysis detected the associations between breast milk intake and maternal and infant factors., Results: Daily breast milk intakes by HIV-exposed and HIV-unexposed infants were not significantly different at either 6 wk (721 ± 111 g/d and 719 ± 121 g/d, respectively) or 6 mo (960 ± 121 g/d and 963 ± 107 g/d, respectively) of age. Maternal factors that significantly correlated with infant breast milk intake were FFM at both 6 wk (r = 0.23; P < 0.05) and 6 mo (r = 0.36; P < 0.01) of age and weight at 6 mo postpartum (r = 0.28; P < 0.01). Infant factors that significantly correlated at 6 wk were birth weight (r = 0.27; P < 0.01), present weight (r = 0.47; P < 0.01), length-for-age z-score (r = 0.33; P < 0.01), and weight-for-age (r = 0.42; P > 0.01). At 6 mo, they were infant length-for-age (r = 0.38; P < 0.01), weight-for-length (r = 0.41; P > 0.01), and weight-for-age (r = 0.60; P > 0.01)., Conclusions: Full-term breastfeeding infants born to HIV-1-infected and HIV-1-uninfected women attending standard Kenyan postnatal care clinics ≤6 mo of age in this resource-poor setting consume comparable amounts of breast milk. This trial was registered at clinicaltrials.gov as PACTR201807163544658., (Copyright © 2022 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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27. Selected genes of Human herpesvirus-8 associated Kaposi's sarcoma among patients with Human Immunodeficiency Virus-1 and Acquired Immunodeficiency Disease Syndrome.
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Demba RN, Shaviya N, Aradi SM, and Mwanda W
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- Acquired Immunodeficiency Syndrome complications, Acquired Immunodeficiency Syndrome drug therapy, Acquired Immunodeficiency Syndrome genetics, Adolescent, Adult, Antiretroviral Therapy, Highly Active methods, Cross-Sectional Studies, Female, HIV Infections drug therapy, HIV Infections genetics, HIV-1 isolation & purification, Humans, Immunocompromised Host, Male, Middle Aged, Sarcoma, Kaposi epidemiology, Sarcoma, Kaposi etiology, Young Adult, HIV Infections complications, Sarcoma, Kaposi genetics, Viral Proteins genetics
- Abstract
Introduction: Kaposi's sarcoma (KS) is a kind of cancer that causes flat or raised lesions containing Human herpes virus 8 (HHV8). The KS lesions are common among immunosuppressed HIV patients. Highly Active Antiretroviral (HHART) treats and prevents the development of KS. The objective of this study was to determine the presence of K1 and K15 (predominant alleles) genes in Kaposi's sarcoma-associated herpes virus (KSHV) among immunosuppressed patients due to HIV-1., Methods: This was a cross-sectional descriptive study where consecutive sampling technique was adopted to pick archived tissue blocks from the Thematic Unit of Anatomic Pathology, Department of Human Pathology, College of Health Sciences, University of Nairobi and Department of Laboratory Medicine, Histology Section, Kenyatta National Hospital., Results: Upon staining 81 tissue blocks with H & E, 84% (68/81) were diagnosed as KS and 16% (13/81) as KS-like. The K1 and K15 (P) genes were both detected at 88.9% (72/81) in the tissue blocks, with 95.8% (69/72) detection from KS and 4.2% (3/72) from the KS-like., Conclusion: The K1 and K15 (P) genes of KSHV were present among the immunosuppressed patients with Human Immunodeficiency Virus (HIV)-1. It is important to carry out K1 and K15 (P) genes detection on tissues that are diagnosed as KS or KS-like by histology technique., Competing Interests: The authors declare no competing interests.
- Published
- 2019
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28. Cost and affordability of non-communicable disease screening, diagnosis and treatment in Kenya: Patient payments in the private and public sectors.
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Subramanian S, Gakunga R, Kibachio J, Gathecha G, Edwards P, Ogola E, Yonga G, Busakhala N, Munyoro E, Chakaya J, Ngugi N, Mwangi N, Von Rege D, Wangari LM, Wata D, Makori R, Mwangi J, and Mwanda W
- Subjects
- Disease Management, Humans, Kenya, Financing, Personal economics, Health Care Costs, Noncommunicable Diseases therapy, Private Sector, Public Sector
- Abstract
Introduction: The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries, including Kenya, disproportionately to the rest of the world. Our objective was to quantify patient payments to obtain NCD screening, diagnosis, and treatment services in the public and private sector in Kenya and evaluate patients' ability to pay for the services., Methods and Findings: We collected payment data on cardiovascular diseases, diabetes, breast and cervical cancer, and respiratory diseases from Kenyatta National Hospital, the main tertiary public hospital, and the Kibera South Health Center-a public outpatient facility, and private sector practitioners and hospitals. We developed detailed treatment frameworks for each NCD and used an itemization cost approach to estimate payments. Patient affordability metrics were derived from Kenyan government surveys and national datasets. Results compare public and private costs in U.S. dollars. NCD screening costs ranged from $4 to $36, while diagnostic procedures, particularly for breast and cervical cancer, were substantially more expensive. Annual hypertension medication costs ranged from $26 to $234 and $418 to $987 in public and private facilities, respectively. Stroke admissions ($1,874 versus $16,711) and dialysis for chronic kidney disease ($5,338 versus $11,024) were among the most expensive treatments. Cervical and breast cancer treatment cost for stage III (curative approach) was about $1,500 in public facilities and more than $7,500 in the private facilities. A large proportion of Kenyans aged 15 to 49 years do not have health insurance, which makes NCD services unaffordable for most people given the overall high cost of services relative to income (average household expenditure per adult is $413 per annum)., Conclusions: There is substantial variation in patient costs between the public and private sectors. Most NCD diagnosis and treatment costs, even in the public sector, represent a substantial economic burden that can result in catastrophic expenditures.
- Published
- 2018
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29. Exclusive Breastfeeding Is More Common Among HIV-Infected Than HIV-Uninfected Kenyan Mothers at 6 Weeks and 6 Months Postpartum.
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Oiye S, Mwanda W, Mugambi M, Filteau S, and Owino V
- Subjects
- Adult, Anti-HIV Agents therapeutic use, Cross-Sectional Studies, Deuterium Oxide, Female, HIV Infections drug therapy, HIV Infections transmission, Health Behavior, Health Surveys, Humans, Indicator Dilution Techniques instrumentation, Infant, Infant Nutritional Physiological Phenomena, Infant, Newborn, Kenya, Male, Mental Recall, Milk, Human chemistry, Patient Compliance, Pregnancy, Self Report, Breast Feeding statistics & numerical data, HIV Infections epidemiology, Mothers psychology, Mothers statistics & numerical data, Postpartum Period
- Abstract
Objective: To compare breastfeeding practices determined by mothers' own recall versus a stable isotope technique (deuterium oxide dilution) among human immunodeficiency virus (HIV)-infected and HIV-uninfected mothers at 6 weeks and 6 months postpartum., Methods: Exclusive breastfeeding (EBF) rates were assessed cross-sectionally at 6 weeks and 6 months postpartum among 75 HIV-positive and 68 HIV-negative women attending postnatal care. EBF was derived from maternal 24-hour recall of foods that were fed to the infant and by objective measurement of nonhuman milk-water intake using deuterium oxide (DO) dilution technique., Results: Multivariable logistic analyses were adjusted for infant sex, gravidity, maternal age, marital status, and maternal education. Using recall method, a greater proportion of HIV-infected mothers exclusively breastfed than HIV-uninfected mothers both at 6 weeks postpartum [94.1% versus 76.9%, respectively (adjusted odds ratio [aOR] 7.81; 95% confidence interval [CI] 1.9-31.6, p = 0.004)] and at 6 months postpartum [75% versus 59.7%, respectively (aOR 2.27; 95% CI 1.0-5.3, p = 0.058)]. At 6 weeks postpartum EBF rates from the DO technique were 23.5% and 13.8% for HIV-positive and HIV-negative mothers, respectively (aOR 0.35; 95% CI 0.11-1.04, p = 0.059). At 6 months postpartum, the DO technique determined EBF rates were 43.3% among HIV-positive and 24.2% among HIV-negative mothers, respectively (aOR 2.4; 95% CI 1.0-5.7, p = 0.048)., Conclusions: HIV-infected mothers are more likely to exclusively breastfeed compared with HIV-uninfected mothers. In this resource-poor setting, maternal recall overestimates EBF rates as compared with the deuterium oxide dilution technique. Validating EBF recall data using the objective DO technique is highly recommended for accurate tracking toward global targets on breastfeeding practices.
- Published
- 2017
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30. A Biosecurity Survey in Kenya, November 2014 to February 2015.
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Ndhine EO, Slotved HC, Osoro EM, Olsen KN, Rugutt M, Wanjohi CW, Mwanda W, Kinyagia BM, Steenhard NR, and Hansen JE
- Subjects
- Kenya, Surveys and Questionnaires, Bioterrorism prevention & control, Laboratories, Security Measures organization & administration
- Abstract
A biosecurity survey was performed to gather information on the biosecurity level and laboratory capacity in Kenya for the purpose of providing information outlining relevant components for biosecurity legislation, biosecurity implementation, and enforcement of biosecurity measures in Kenya. This survey is, to the authors' knowledge, the first to be published from an African country. A total of 86 facilities with laboratories covering relevant categories, such as training laboratories, human diagnostic laboratories, veterinary diagnostic laboratories, and research laboratories, were selected to participate in the survey. Each facility was visited by a survey team and staff were asked to answer 29 groups of questions from a questionnaire. The survey showed that Kenyan laboratory facilities contain biological agents of biosecurity concern. The restrictions for these agents were found to be limited for several of the facilities, in that many laboratory facilities and storage units were open for access by either students or staff who had no need of access to the laboratory. The survey showed a great deal of confusion in the terms biosecurity and biosafety and a generally limited biosecurity awareness among laboratory personnel. The survey showed that the security of biological agents of biosecurity concern in many facilities does not meet the international requirements. The authors recommend developing a legal framework in Kenya for effective controls, including national biosecurity regulations, guidelines, and procedures, thereby reducing the risk that a Kenyan laboratory would be the source of a future biological attack.
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- 2016
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31. Mucosal Blood Group Antigen Expression Profiles and HIV Infections: A Study among Female Sex Workers in Kenya.
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Chanzu NM, Mwanda W, Oyugi J, and Anzala O
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- ABO Blood-Group System, Adolescent, Adult, Aged, Cross-Sectional Studies, Female, HIV Infections epidemiology, HIV Infections virology, Humans, Incidence, Kenya, Middle Aged, Phenotype, Vagina immunology, Young Adult, Blood Group Antigens immunology, HIV Infections immunology, Mucous Membrane immunology, Sex Workers
- Abstract
Background: The ABO blood group antigens are carbohydrate moieties expressed on human red blood cells however; these antigens can also be expressed on some other cells particularly the surface of epithelial cells and may be found in mucosal secretions. In many human populations 80% secrete ABO antigens (termed 'secretors') while 20% do not (termed 'non-secretors'). Furthermore, there are disease conditions that are associated with secretor status., Objective: To investigate correlations between secretor status and HIV infection among female sex workers in Nairobi, Kenya., Methodology: This cross-sectional study recruited 280 female sex workers aged 18-65 years from the Pumwani Majengo cohort, Kenya. Blood typing was determined by serological techniques using monoclonal antibodies to the ABO blood group antigens. Secretor phenotyping was determined using anti-H specific lectins specific to salivary, vaginal and cervical blood group H antigen using the agglutination inhibition technique and correlated to individual HIV sero-status. Participants were additionally screened for Bacterial vaginosis, Neisseria gonorrhoea and Trichomonas vaginalis., Results: Out of the 280 participants, 212 (75.7%) were secretors and 68 (24.3%) were non-secretors. The incidence of all infections: HIV, Bacterial vaginosis, Neisseria gonorrhoea and Trichomonas vaginalis was higher among secretors compared to non-secretors. However, this difference was only statistically significant for HIV infection incidence rates: HIV infected secretors (83.7%) versus HIV un-infected secretors (71.8%) (p = 0.029) Based on ABO phenotype stratification, the incidence of HIV infection was higher among blood group A secretors (26/52 = 50%), in comparison to B (12/39 = 33.3%: p = 0.066), AB (3/9 = 33.3%: p = 0.355), and O secretors (36/112 = 32.1%: p = 0.028)., Conclusion: This is the first report to document the variable expression of the ABH blood group antigens profiling secretor and non-secretor phenotypes in the female genital tract among a high-risk population in a Kenyan population. These findings suggest the non-secretor phenotype may confer a certain degree of protection against HIV infection.
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- 2015
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32. Strengthening health systems by integrating health care, medical education, and research: University of Nairobi experience.
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Kiarie JN, Farquhar C, Redfield R, Bosire K, Nduati RW, Mwanda W, M'Imunya JM, and Kibwage I
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- Capacity Building, Humans, Kenya, United States, Biomedical Research organization & administration, Computer-Assisted Instruction, Education, Medical organization & administration, Education, Nursing organization & administration, International Cooperation, Schools, Medical organization & administration, Schools, Nursing organization & administration
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- 2014
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33. Correlation of EGFR, pEGFR and p16INK4 expressions and high risk HPV infection in HIV/AIDS-related squamous cell carcinoma of conjunctiva.
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Mwololo A, Nyagol J, Rogena E, Ochuk W, Kimani M, Onyango N, Pacenti L, Santopietro R, Leoncini L, and Mwanda W
- Abstract
Background: Squamous cell carcinoma of conjunctiva has increased tenfold in the era of HIV/AIDS. The disease pattern has also changed in Africa, affecting young persons, with peak age-specific incidence of 30-39 years, similar to that of Kaposi sarcoma, a well known HIV/AIDS defining neoplasm. In addition, the disease has assumed more aggressive clinical course. The contributing role of exposure to high risk HPV in the development of SCCC is still emerging., Objective: The present study aimed to investigate if immunohistochemical expressions of EGFR, pEGFR and p16, could predict infection with high risk HPV in HIV-related SCCC., Methods: FFPE tissue blocks of fifty-eight cases diagnosed on hematoxylin and eosin with SCCC between 2005-2011, and subsequently confirmed from medical records to be HIV positive at the department of human pathology, UoN/KNH, were used for the study. Immunohistochemistry was performed to assess the expressions of p16INK4A, EGFR and pEGFR. This was followed with semi-nested PCR based detection and sequencing of HPV genotypes. The sequences were compared with the GenBank database, and data analyzed for significant statistical correlations using SPSS 16.0. Ethical approval to conduct the study was obtained from KNH-ERC., Results: Out of the fifty-eight cases of SCCC analyzed, twenty-nine (50%) had well differentiated (grade 1), twenty one (36.2%) moderately differentiated (grade 2) while eight (13.8%) had poorly differentiated (grade 3) tumours. Immunohistochemistry assay was done in all the fifty eight studied cases, of which thirty nine cases (67.2%) were positive for p16INK4A staining, forty eight cases (82.8%) for EGFR and fifty one cases (87.9%) showed positivity for p-EGFR. HPV DNA was detected in 4 out of 40 SCCC cases (10%) in which PCR was performed, with HPV16 being the only HPV sub-type detected. Significant statistical association was found between HPV detection and p16INK4 (p=0.000, at 99% C.I) and EGFR (p=0.028, at 95% C.I) expressions, but not pEGFR. In addition, the expressions of these biomarkers did not show any significant association with tumor grades., Conclusion: This study points to an association of high risk HPV with over expressions of p16INK4A and EGFR proteins in AIDS-associated SCCC.
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- 2014
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34. B-cell differentiation in EBV-positive Burkitt lymphoma is impaired at posttranscriptional level by miRNA-altered expression.
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Leucci E, Onnis A, Cocco M, De Falco G, Imperatore F, Giuseppina A, Costanzo V, Cerino G, Mannucci S, Cantisani R, Nyagol J, Mwanda W, Iriso R, Owang M, Schurfeld K, Bellan C, Lazzi S, and Leoncini L
- Subjects
- Adolescent, Adult, B-Lymphocytes pathology, B-Lymphocytes virology, Blotting, Western, Burkitt Lymphoma metabolism, Burkitt Lymphoma pathology, Cell Line, Tumor, Child, Child, Preschool, DNA-Binding Proteins genetics, DNA-Binding Proteins metabolism, Female, Gene Expression Profiling, Gene Expression Regulation, Neoplastic, Herpesvirus 4, Human growth & development, Humans, Male, Middle Aged, Positive Regulatory Domain I-Binding Factor 1, Regulatory Factor X Transcription Factors, Repressor Proteins genetics, Repressor Proteins metabolism, Reverse Transcriptase Polymerase Chain Reaction, Transcription Factors genetics, Transcription Factors metabolism, X-Box Binding Protein 1, Young Adult, B-Lymphocytes metabolism, Burkitt Lymphoma genetics, Cell Differentiation, MicroRNAs genetics, RNA Processing, Post-Transcriptional
- Abstract
Endemic, sporadic and HIV-associated Burkitt lymphoma (BL) all have a B-cell phenotype and a MYC translocation, but a variable association with the Epstein-Barr virus (EBV). However, there is still no satisfactory explanation of how EBV participates in the pathogenesis of BL. A recent investigation suggested that EBV-positive and EBV-negative BL have different cells of origin. In particular, according to immunoglobulin gene mutation analysis, EBV-negative BLs may originate from early centroblasts, whereas EBV-positive BLs seem to arise from postgerminal center B cells or memory B cells. The appearance of a germinal center phenotype in EBV-positive cells might thus derive from a block in B-cell differentiation. The exit from the germinal center involves a complex series of events, which require the activation of BLIMP-1, and the consequent downregulation of several target genes. Here, we investigated the expression of specific miRNAs predicted to be involved in B-cell differentiation and found that hsa-miR-127 is differentially expressed between EBV-positive and EBV-negative BLs. In particular, it was strongly upregulated only in EBV-positive BL samples, whereas EBV-negative cases showed levels of expression similar to normal controls, including microdissected germinal centers (GC) cells. In addition, we found evidence that hsa-miR-127 is involved in B-cell differentiation process through posttranscriptional regulation of BLIMP1 and XBP1. The overexpression of this miRNA may thus represent a key event in the lymphomagenesis of EBV positive BL, by blocking the B-cell differentiation process.
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- 2010
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35. Prevalence of cytomegalovirus antibodies in blood donors at the National Blood Transfusion Centre, Nairobi.
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Njeru DG, Mwanda WO, Kitonyi GW, and Njagi EC
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- Adolescent, Adult, Cross-Sectional Studies, Cytomegalovirus Infections diagnosis, Female, Humans, Kenya epidemiology, Male, Middle Aged, Prevalence, Young Adult, Antibodies, Viral blood, Blood Donors statistics & numerical data, Cytomegalovirus immunology, Cytomegalovirus Infections epidemiology, Immunoglobulin G blood, Immunoglobulin M blood
- Abstract
Background: Cytomegalovirus (CMV) infection in susceptible patients is associated with serious morbidity and a high mortality. Transmission of cytomegalovirus infection through blood transfusion is markedly reduced by transfusion of CMV seronegative blood products, or by transfusion of leucodepleted blood products., Objective: To determine the prevalence CMV IgG and IgM antibodies among blood donors at the National Blood Transfusion Services (NBTS), Nairobi., Design: Cross-sectional descriptive study., Setting: Four hundred participants were recruited from blood donors at the NBTS and testing was done at the Kenyatta National Hospital (KNH) immunology laboratories and the NBTC., Main Outcome Measures: Social demographic data and the CMV serologic status for the participants was determined and documented as being positive or negative for immunoglobulin G (IgG) and immunoglobulin M (IgM). The age, gender, marital status, education level and geographical area of residence of the participants were documented. Corresponding results of HIV, hepatitis B antigen, hepatitis C antibody from the patients were obtained from the NBTS., Results: Majority of the blood donors recruited were male at 57.9%. Most blood donors were aged 16-20 years (42.5%) and only 17.2% were above 30 years of age. Unmarried blood donors, those with secondary school education and an income between Kshs 5000 (US $67) and KShs 50,000 (US$ 667) monthly were the majority at 78.5%, 54.8% and 66.1% respectively. Sexually active blood donors constituted 60.5% of the donors recruited. Positivity for transfusion transmissible infections (TTI) tested was 1.3%, 0.3%, 2.3% and 1.0% for human immunodeficiency virus (HIV), syphilis, hepatitis B and hepatitis C respectively. Anti- CMV IgG and IgM positivity was 97.0%, (95% CI 96.45-97.53%), and 3.6% (95% CI 1.7-5.2%), respectively. There was no statistical difference between different ages, marital status, salary, individual's sexuality in the prevalence of CMV antibodies. However females had a higher prevalence of CMV antibodies., Conclusion: There is a very high prevalence of cytomegalovirus antibodies among blood donors at the NBTS, with virtually all blood donors having been exposed to the virus. Since the CMV remains latent within leucocytes after infection inspite of the prescence of antibodies in seropositive individuals, leucoreduction of blood products is recommended before transfusion to seronegative susceptible patients. In Kenya, susceptible groups of patients include very low birthweight babies, patients with acquired immune deficiency syndrome (AIDS) due to human immunodeficiency virus infections (HIV) patients, patients on myelosuppressive cancer therapy and recipients of kidney transplants. Further studies are recomended to determine the prevalence of CMV antibodies in these patients in order to establish the magnitude of the demand for CMV safe blood.
- Published
- 2009
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36. Gene-expression analysis identifies novel RBL2/p130 target genes in endemic Burkitt lymphoma cell lines and primary tumors.
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De Falco G, Leucci E, Lenze D, Piccaluga PP, Claudio PP, Onnis A, Cerino G, Nyagol J, Mwanda W, Bellan C, Hummel M, Pileri S, Tosi P, Stein H, Giordano A, and Leoncini L
- Subjects
- Adolescent, Burkitt Lymphoma classification, Burkitt Lymphoma metabolism, Cell Proliferation, Child, Child, Preschool, Female, Humans, Male, Oligonucleotide Array Sequence Analysis, Prognosis, Retinoblastoma-Like Protein p130 metabolism, Tumor Cells, Cultured, Biomarkers, Tumor genetics, Burkitt Lymphoma genetics, Gene Expression Profiling, Gene Expression Regulation, Neoplastic, Mutation genetics, Retinoblastoma-Like Protein p130 genetics
- Abstract
Burkitt lymphoma (BL) is a B-cell tumor whose characteristic gene aberration is the translocation t(8;14), which determines c-myc overexpression. Several genetic and epigenetic alterations other than c-myc overexpression have also been described in BL. It has been demonstrated that the RBL2/p130 gene, a member of the retinoblastoma family (pRbs), is mutated in BL cell lines and primary tumors. The aim of this study was to investigate the biologic effect of RBL2/p130 in BL cells and its possible role in lymphomagenesis. Therefore, we reintroduced a functional RBL2/p130 in BL cell lines where this gene was mutated. Our results demonstrated that RBL2/p130-transfected cells regain growth control. This suggests that RBL2/p130 may control the expression of several genes, which may be important for cell growth and viability. Gene-expression analysis revealed a modulation of several genes, including CGRRF1, RGS1, BTG1, TIA1, and PCDHA2, upon RBL2/p130 reintroduction. We then monitored their expression in primary tumors of endemic BL as well, demonstrating that their expression resembled those of the BL cell lines. In conclusion, these data suggest that, as RBL2/p130 modulates the expression of target genes, which are important for cell growth and viability, its inactivation may be relevant for the occurrence of BL.
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- 2007
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37. Histopathological profile of gastritis in adult patients seen at a referral hospital in Kenya.
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Kalebi A, Rana F, Mwanda W, Lule G, and Hale M
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- Adolescent, Adult, Aged, Aged, 80 and over, Biopsy, Cross-Sectional Studies, Female, Gastritis ethnology, Gastritis microbiology, Helicobacter Infections complications, Helicobacter Infections pathology, Helicobacter pylori pathogenicity, Humans, Kenya, Male, Middle Aged, Prospective Studies, Gastritis pathology
- Abstract
Aim: To conduct a detailed histological study of gastritis in adult patients attending an endoscopy clinic at a Kenyan teaching and referral hospital., Methods: Biopsy specimens from consecutive patients were examined and graded according to the Updated Sydney System for H pylori infection, chronic inflammation, neutrophil activity, glandular atrophy and intestinal metaplasia. Also documented were gastric tissue eosinophil counts and presence of lymphoid follicles., Results: The rate of the graded variables, in the antrum and corpus respectively, were as follows: H pylori infection (91%, 86%), chronic inflammation (98%, 93%), neutrophil activity (91%, 86%), glandular atrophy (57%, 15%) and intestinal metaplasia (11%, 2%). Lymphoid follicles were noted in 11% of cases. Duodenal and gastric ulcers were documented in 32% and 2% respectively. The mean eosinophil count was 5.9 +/- 0.74 eosinophils/HPF and 9.58 +/- 0.93 eosinophils/HPF in the corpus and antrum respectively. Significant association was found between the degree of H pylori colonisation with chronic inflammation, neutrophil activity and antral glandular atrophy. Biopsies from the antrum and corpus showed significant histopathological discordance for all the graded variables. H pylori negative cases were associated with recent antibiotic use., Conclusion: The study reaffirms that H pylori is the chief cause of gastritis in this environment. The majority of patients show a moderate to high degree of inflammation but a low degree of glandular atrophy and intestinal metaplasia. The study shows that inter-relationships between the histological variables in this African population are similar to those found in other populations worldwide including non-African populations.
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- 2007
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38. Strategies to overcome myelotoxic therapy for the treatment of Burkitt's and AIDS-related non-Hodgkin's lymphoma.
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Rochford R, Feuer G, Orem J, Banura C, Katongole-Mbidde E, Mwanda WO, Moormann A, Harrington WJ, and Remick SC
- Subjects
- Antineoplastic Agents adverse effects, Bryostatins, Drug Therapy, Combination, Humans, Macrolides adverse effects, Vincristine adverse effects, Antineoplastic Agents therapeutic use, Burkitt Lymphoma drug therapy, Lymphoma, AIDS-Related drug therapy, Macrolides therapeutic use, Vincristine therapeutic use
- Abstract
Background: Strategies to circumvent or lessen the myelotoxicity associated with combination chemotherapy may improve the overall outcome of the management of patients particularly in resource poor settings., Objectives: To develop effective non-myelotoxic therapies for Burkitt's Lymphoma (BL) and AIDS-related non-Hodgkin's lymphoma., Data Sources: Publications, original and review articles, conference abstracts searched mainly on Pubmed indexed for medline., Data Extraction: A systematic review of the clinical problem of combination chemotherapy. Identification of clinical strategies that circumvent or lessen the myelotoxicity of combination cytotoxic chemotherapy. Length of survival, lack of clinically significant (> grade 3) myelosuppression and weight loss were used as markers of myelotoxicity., Data Synthesis: Review of published experience with some of these strategies including dose-modification of multi-agent chemotherapy; rationale for targeted therapies, and the preclinical development of a mouse model exploring the role of metronomic scheduling substantiate pragmatism and feasibility of these approaches., Conclusion: Myelotoxic death rates using multi-agent induction chemotherapy approach 25% for endemic Burkitt's lymphoma and range between 20% to 60% for AIDS-related malignancy. This is mostly explained by the paucity of supportive care compounded by wasting and inanition attributable to advanced cancer and HIV infection making patients more susceptible to myelosuppressive side effects of cytotoxic chemotherapy. Investigations and alternative approaches that lessen or circumvent myelotoxicity of traditional cytotoxic chemotherapy for the management of Burkitt's lymphoma and AIDS-related non-Hodgkin's lymphoma in the resource-constrained setting are warranted. Pertinent pre-clinical and clinical data are emerging to support the need for abrograting the myelosuppressive effects of traditional cytotoxic chemotherapy. This can be achieved by developing targeted anti-viral and other strategies, such as the use of bryostatin 1 and vincristine, and by developing a preclinical mouse model to frame the clinical rationale for a pilot trial of metronomic therapy for the treatment of Burkitt's and AIDS-related lymphoma. Implementation of these investigational approaches must be encouraged as viable anti-cancer therapeutic strategies particularly in the resource-constrained settings.
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- 2005
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39. Burkitt's lymphoma and emerging therapeutic strategies for EBV and AIDS-associated lymphoproliferative diseases in East Africa.
- Author
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Mwanda WO, Whalen C, and Remick SC
- Subjects
- Africa, Eastern, Burkitt Lymphoma virology, Humans, Lymphoproliferative Disorders virology, AIDS-Related Opportunistic Infections drug therapy, Burkitt Lymphoma drug therapy, Epstein-Barr Virus Infections drug therapy, Herpesvirus 4, Human isolation & purification, Lymphoma, AIDS-Related drug therapy, Lymphoproliferative Disorders drug therapy
- Published
- 2005
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40. Clinical characteristics of Burkitt's lymphoma from three regions in Kenya.
- Author
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Mwanda WO, Orem J, Remick SC, Rochford R, Whalen C, and Wilson ML
- Subjects
- Abdominal Neoplasms diagnosis, Adolescent, Age Distribution, Burkitt Lymphoma diagnosis, Burkitt Lymphoma physiopathology, Child, Child, Preschool, Cross-Sectional Studies, Diagnosis, Differential, Facial Neoplasms diagnosis, Female, Humans, Jaw Neoplasms diagnosis, Kenya epidemiology, Lymph Nodes physiopathology, Male, Maxilla physiopathology, Prospective Studies, Sex Distribution, Tropical Climate, Abdominal Neoplasms epidemiology, Altitude, Burkitt Lymphoma epidemiology, Facial Neoplasms epidemiology, Jaw Neoplasms epidemiology, Topography, Medical
- Abstract
Objectives: To describe the clinical characteristics of Burkitt's lymphoma (BL) from three regions in Kenya at different altitudes with a view towards understanding the contribution of local environmental factors., Design: Prospective cross-sectional study., Setting: Kenyatta National Hospital and seven provincial hospitals in Kenya., Method: Histologically proven cases of Burkitt's lymphoma in patients less than 16 years of age were clinically examined and investigated., Main Outcome Measures: For every case the following parameters were documented: chief complaint(s); physical examination, specifically pallor, jaundice, oedema, lymphadenopathy, presence of masses, splenomegaly and hepatomegaly. Reports of evaluation of chest radiograph, abdominal ultrasound/scan, bone marrow aspiration, cerebral spinal fluid cytology, liver and kidney function tests, urinalysis, stool occult blood and full blood count results. Stage of disease was assigned A, B, C or D. Cases of BL from three provinces of Kenya with diverse geographical features were analysed: Central, Coast, and Western., Results: This study documented 471 BL cases distributed as follows: Central 61 (males 39 and 22 females), M:F ratio 1.8:1; Coast 169 (111 males and 58 females), M:F ratio 1.9:1; and Western 241 (140 males and 101 females), M:F ratio 1.4:1. The major presenting complaints were: abdominal swelling--Central 36%, Coast 4% and Western 26%; swelling on the face--Central 31%, Coast 81% and Western 64%; and proptosis--Central 3%, Coast 1% and Western 9%. The mean duration of these complaints in weeks were Central 6.9, Coast 6.08, and Western 5.05. The initial physical finding was a tumour mass in 39%, 72% and 54% of cases for Central, Coast and Western respectively. Tumour stage at diagnosis was: stage A--Central 21%, Coast 43% and Western 34%; stage B--Central 10%, Coast 5% and Western 10%; stage C--Central 41%, Coast 34% and Western 30%; and stage D--Central 28%, Coast 17% and Western 26%. For the age and sex matched cases the results show that commonly involved sites were: abdomen--Central 35%, Coast 9% and Western 14%; jaw (mandible)--Central 24%, Coast 22% and Western 31%; maxilla--Central 6%, Coast 24% and Western 11%; and lymph nodes--Central 10%, Coast 4% and Western 8%. The disease stage was A--Central 33%, Coast 44% and Western 36%; stage B--Central 11%, Coast 10% and Western 27%; stage C--Central 39%, Coast 34% and Western 27%; and stage D--Central 21%, Coast 13% and Western 37%., Conclusion: This study shows that clinical features of childhood BL vary with geographical region. The variations are documented in proportion of jaw, maxilla, abdominal and lymph nodal sites involvement. The differences observed are potentially due to the local environmental factors within these provinces. BL cases from Western province had features, intermediate between endemic and sporadic. Coastal province BL cases were similar to endemic BL, while BL cases from Central province resembled more or less sporadic BL subtypes. Strategies to explain and investigate the local environmental factors associated with the observed differences may certainly contribute towards improved understanding and clinical management of BL.
- Published
- 2005
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41. Oral combination chemotherapy in the treatment of AIDS-associated Hodgkin's disease.
- Author
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Orem J, Fu P, Ness A, Mwanda WO, and Remick SC
- Subjects
- Adult, Antineoplastic Agents administration & dosage, Antiretroviral Therapy, Highly Active, Cyclophosphamide administration & dosage, Cyclophosphamide adverse effects, Etoposide administration & dosage, Etoposide adverse effects, Female, Hodgkin Disease mortality, Humans, Lomustine administration & dosage, Lomustine adverse effects, Lymphoma, AIDS-Related mortality, Male, Middle Aged, Procarbazine administration & dosage, Procarbazine adverse effects, Survival Analysis, Antineoplastic Combined Chemotherapy Protocols, Hodgkin Disease drug therapy, Lymphoma, AIDS-Related drug therapy
- Abstract
Objectives: To determine the effectiveness of an oral combination chemotherapy regimen administered to patients with AIDS-associated Hodgkin's disease., Design: Prospective, pilot phase II clinical trial., Setting: Consecutive patient recruitment occurred at two medical centers in the United States: Albany Medical Center, Albany, New York, where patients were recruited prior to December 31, 1996 (pre-HAART era); and University Hospitals of Cleveland, Cleveland, Ohio, where patients were recruited after January 1, 1997 (HAART era)., Intervention: Oral chemotherapy consisted of lomustine (100 mg/m2 day I for cycle one and odd cycles thereafter); etoposide (200 mg/m2 days 1 through 3); and cyclophosphamide and procarbazine (each 100 mg/m2 days 22 through 31). Cycles were repeated every six weeks. Colony-stimulating factor support (G-CSF in all instances) was allowed., Main Outcome Measures: Clinical demographic variables, peripheral blood counts, serum chemistries, CD4 lymphocyte count, histopathological subtype of Hodgkin's disease were identified for all patients, who were staged according to Ann Arbor criteria., Data Analysis: Common Toxicity Criteria were utilized to assess safety; response was assessed using ECOG criteria; and survival was analyzed by Kaplan-Meier methods and difference of survival between pre-HAART and HARART era was compared using log-rank test., Results: Eleven patients (six in pre-HAART era), all but one male, with a median age of 36 years, excellent performance status and advanced International Prognostic Score were treated. Myelosuppression was the major side effect and there were minimal other grade 3 or greater toxicity all of which were promptly reversible. An overall objective response rate of 82% (with 18% complete responses) and median survival duration of 24 months (range 2.5 +/- 68) were observed. Survival was markedly improved in patients treated in the HAART era (median not reached versus 7.25 months, p = 0.034)., Conclusions: This feasibility study demonstrates acceptable tolerance and excellent clinical activity of oral combination chemotherapy in patients with AIDS-associated Hodgkin's disease. Improved survival is observed in combination with HAART therapy. Dose-modification of this regimen would be suitable to evaluate in the resource constrained setting and larger confirmatory studies are encouraged.
- Published
- 2005
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42. Quality of-life in male cancer patients at Kenyatta National Hospital, Nairobi.
- Author
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Mwanda WO, Abdallah FK, Obondo A, and Musau FM
- Subjects
- Adolescent, Adult, Aged, Cross-Sectional Studies, Humans, Kenya, Male, Middle Aged, Prospective Studies, Sex Factors, Socioeconomic Factors, Neoplasms psychology, Quality of Life psychology
- Abstract
Background: The quality of life of cancer patients is likely to be influenced by psychological reactions of the cancer patients yet there are no documented issues related to quality of life in cancer patients in Kenyan hospitals., Objective: To investigate issues which affect the quality of life in male cancer patients., Design: Prospective cross sectional study., Setting: Kenyatta National Hospital, Nairobi, Kenya., Methods and Subjects: Cancer patients above 12 years of age were interviewed during the course of their stay in the hospital, specifically to gather information on; semi structured questions and a modified Beck's 24 item depression inventory with a view to solicit for their reaction on issues which pertains to quality of life., Main Outcome Measures: Age group, level of education, tribe, geographical place (province) of birth, chief complains, main concerns, views on doctors, contact with psychiatrist and psychologist, the anatomic site of cancer, treatment given and responses on modified Beck's depression inventory., Results: Forty two patients were studied, their age range 13-72 years, mean 43.2 and peak 13-26 years. Forty seven per cent of cases had no formal education. The cancers were gastrointestinal tract 33%, blood and lymphoid tissue (26%), bone and muscle (11.9%), skin (9.4%) and genitourinary tract (4.8%). Treatment given was chemotherapy, radiotherapy and surgery. Ninety three per cent were unable to cope. Chief complaints were pain, inability to work, feeling miserable and concerns were families, health and work retardation. Modified Beck's depression score was 20%, with major issues being; work retardation, insomnia, weight loss, and anorexia. Most affected were, age group 27-35 years (and least 13-26 years), uneducated, living in Nairobi (city), having carcinomas, treatment with combined surgery and radiotherapy. Low education level and residence in Nairobi coped poorly. Radiation therapy group appeared to cope better than other modalities., Conclusion: The issues affecting the quality of life of male cancer patients stated were pain, inability to work, poor coping with cancer and psychological reactions of work retardation, insomnia, weight loss, fatigability and depression. Gambling, suicidal ideas and social withdrawal were minimal. Other concerns were families, health and work.
- Published
- 2004
- Full Text
- View/download PDF
43. Autologous transfusion in surgical patients at Kenyatta National Hospital, Nairobi.
- Author
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Magoha GA, Mwanda WO, and Afulo OK
- Subjects
- Adolescent, Adult, Age Distribution, Aged, Cross-Sectional Studies, Elective Surgical Procedures, Female, Hemoglobins analysis, Humans, Kenya, Length of Stay, Male, Middle Aged, Preoperative Care, Prospective Studies, Socioeconomic Factors, Blood Transfusion, Autologous methods, Blood Transfusion, Autologous statistics & numerical data
- Abstract
Objective: To identify autotransfusion strategies and their basis in elective surgery patients., Design: A cross sectional prospective study., Setting: General surgery and orthopaedic wards, Kenyatta National Hospital, Nairobi., Subjects: Adult patients of both sexes planned for elective surgery., Main Outcome Measure: Forevery patient, the following were enquired about and documented: age in years, sex, ethnicity, religion, occupation and educational standard. Blood values of haemoglobin, platelet counts, total and differential white cell counts, urea, electrolytes and liver function tests were assayed. Others were the number of units of blood donated before the operation, the type of surgery performed, time taken from diagnosis to performing the operation and whether the blood was transfused preoperatively, intraoperatively and postoperatively., Results: A total of sixty three cases constituting five per cent of all surgical patients admitted during the period of study were evaluated. Of these 53 (84%) were males and ten (16%) females. The age range was 15 to 65 years with a peak at 45-49 years. There were more Christians (90%) than Muslims (10%). In all, 32 (51.6%) had primary school education, 23 (36.5%) secondary school education, seven (11.3%) no formal education and one (1.6%) had attained college level. Employment pattern showed 50% were civil servants, 30% were self employed and 20% were unemployed. The duration of disease ranged from 1-24 weeks with two peaks at two weeks and six weeks. Orthopaedic cases constituted 78.7% and general surgery 21.3%. Preoperative haemoglobin ranged from 13.5-14.2 g/dl. Transfusions were given intraoperatively to 41 (66.1%) and to 12 (33.9%) postoperatively. Mean duration of hospitalisation was 13 days (range 5 to 21 days). 98.4% deposited only one unit while 1.6% deposited four units of blood. Only one patient required additional transfusion from homologous donors., Conclusion: The strategies and basis for autotransfusion have been demonstrated among a majority of adult patients requiring orthopaedic procedures. Major determinants are shown to be baseline blood count profiles and time to operation.
- Published
- 2001
- Full Text
- View/download PDF
44. Granulocytic sarcoma: report of three cases.
- Author
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Mwanda WO and Rajab JA
- Subjects
- Adult, Breast Neoplasms complications, Breast Neoplasms therapy, Child, Preschool, Combined Modality Therapy, Disease Progression, Female, Fever etiology, Humans, Leukemia, Myeloid complications, Leukemia, Myeloid therapy, Male, Middle Aged, Morbidity, Pancreatic Neoplasms complications, Pancreatic Neoplasms therapy, Remission Induction methods, Uterine Cervical Neoplasms complications, Uterine Cervical Neoplasms therapy, Breast Neoplasms pathology, Leukemia, Myelogenous, Chronic, BCR-ABL Positive complications, Leukemia, Myeloid pathology, Leukemia, Myeloid, Acute complications, Pancreatic Neoplasms pathology, Uterine Cervical Neoplasms pathology
- Abstract
Granulocytic sarcoma (GS) is a rare extramedullary solid tumour composed of malignant immature cells of the granulocytic series. It may herald, accompany or signal acute myeloid leukaemia (AML) or chronic granulocytic leukaemia (CGL). GS may also occur in patients with myelodysplastic syndromes (MDS) where it is a sign of imminent disease progression. Three cases of GS are presented; the first one involving the pancreas and preceding AML, the second case affecting uterine cervix in stable phase CGL and the third case is GS of the breast accompanying AML. Any site of the body may be involved by the GS, and morbidity depends on the local organ/tissue affected in addition to the attending primary leukaemia or MDS. Treatment of GS involves surgery, radiotherapy and chemotherapy. The objective of this communication is to enhance awareness in personnel providing health care. Further, early diagnosis and treatment affects overall outcome.
- Published
- 1999
45. Childhood aplastic anaemia in Kenya.
- Author
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Riyat MS, Kasili EG, and Mwanda WO
- Subjects
- Adolescent, Anemia, Aplastic chemically induced, Anemia, Aplastic pathology, Causality, Child, Child, Preschool, Female, Herbicides adverse effects, Humans, Infant, Kenya, Male, Pesticides adverse effects, Prospective Studies, Retrospective Studies, Risk Factors, Anemia, Aplastic epidemiology
- Abstract
Forty two children with aplastic anaemia were seen at Kenyatta National Hospital, Nairobi, over a period of 8 years (1980-1988). These have been analysed with respect to sex, age and area of geographical origin. The overall male:female ratio is 1:1 with a preponderance of Kikuyu patients. Repeated transfusions was the commonest presenting feature and rapid onset was associated with poor prognosis. Exposure to herbicides/pesticides and other agrochemicals is implicated in the aetiopathogenesis of childhood aplastic anaemia in Kenya.
- Published
- 1990
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