Outcome of poor prognostic phenotype non-Hodgkin’s lymphoma treatment in relation to human immunodeficiency virus serostatus

Background

The risk of developing aggressive phenotype non-Hodgkin’s lymphomas is high among HIV infected individuals and is associated with worse prognosis than among non-HIV infected ones. Effective antiretroviral therapy has more recently been reported to greatly improve outcome among these patients. A retrospective review of treatment outcome for aggressive and highly aggressive phenotype non-Hodgkin’s lymphoma patients was carried out. The objective was to compare outcome of treatment for poor prognosis subtypes of non-Hodgkin’s lymphomas in relation to HIV-serostatus. The setting was Hurlingham Oncology clinic, a private oncology clinic in Nairobi, Kenya. The main study endpoints were complete remission rate and overall survival.

Results

Thirty-two patients (42.7%) were HIV-positive, 32 (42.7%) were HIV-negative and 11 (14.7%) had HIV serostatus undetermined. Seven (21.9%) of HIV positive patients achieved complete remission compared with 24 (75%) of HIV negative ones. This difference was highly significant (P < 0.0001). Five (15.6%) of HIV-positive patients died during first-line treatment compared with none of the HIV-negative counterparts. The difference again was highly significant (P < 0.0001). The median survival time was 19 months among HIV-negative patients and 6 months among positive cases.

Conclusion

Complete remission rate among HIV-negative patients in this series was the same as reported from well established centres, but the rate among HIV-positive patients was lower than expected. Patients with HIV infection were more likely to die from toxicity during induction and had inferior survival compared with HIV-negative cases.     

Factors associated with uptake of subdermal contraceptive implants in a young Kenyan population

Background

Subdermal contraceptive implants may be a reasonable option for young women in sub-Saharan Africa; little is known about factors associated with method uptake in this subpopulation.

Study Design

Four hundred women aged 18–24 years who sought short-acting hormonal contraception were offered an opportunity to use an implant instead. Cross-tabulations and logistic regression analysis were used to examine participant characteristics and other factors associated with choosing an implant.

Results

Twenty-four percent of participants chose the implant. Participants with greater than 4 years of contraceptive need were over three times more likely to choose an implant [odds ratio (OR), 3.4; 95% confidence interval (CI), 1.6–6.9]. Women with health concerns over short-acting hormonal methods (OR, 2.2; 95% CI, 1.3–3.6) and those who expressed some difficulty returning to a clinic (OR, 1.9; 95% CI, 1.1–3.1) were about twice as likely to choose an implant. Product attributes such as long-acting protection and convenience were cited reasons for choosing an implant.

Conclusions

The implant appears to be an attractive option for a fairly large proportion of young women in Kenya. Within this age group of implant users, homogeneity of demographic characteristics relative to short-acting users suggests that the product has broad appeal.     

Establishing and sustaining a healthy vaginal environment: analysis of data from a randomized trial of periodic presumptive treatment for vaginal infections

Data from a randomized trial of oral periodic presumptive treatment (PPT) to reduce vaginal infections were analyzed to assess the effect of the intervention on a healthy vaginal environment (normal flora confirmed by Gram stain with no candidiasis or trichomoniasis). The incidence of a healthy vaginal environment was 608 cases per 100 person-years in the intervention arm and 454 cases per 100 person-years in the placebo arm (hazard ratio [HR], 1.36; 95% confidence interval [CI], 1.17-1.58). Sustained vaginal health (healthy vaginal environment for ≥3 consecutive visits) was also more frequent in the intervention arm (HR, 1.69; 95% CI, 1.23-2.33). PPT is effective at establishing and sustaining a healthy vaginal environment.     

Angiographic assessment of atherosclerotic load at the lower extremity in patients with diabetic foot and charcot neuro-arthropathy

Background

The aim of this study was to investigate atherosclerotic load at the lower extremity in patients with diabetic foot and charcot neuro-arthropathy and compare them with patients with diabetic foot without charcot neuro-arthropathy.

Environmental and occupational factors associated with chronic myeloid leukemia: a case-control study

Background

The relationship between chronic myeloid leukemia (CML) and a broad range of exposures to occupational and environmental factors known to cause leukemia in general is limited. CML is by and large incurable and treatment is just palliative and life prolonging, with high case fatality rate, even in the best centers. Furthermore treatment is very expensive. Identification of leukemogenic factors is therefore important if this can lead to simple public health interventions.

Objective

The objective was to determine key environmental and occupational exposure factors that may be associated with CML.

Methods

This was a case-control study involving CML cases enrolled in Glivec International Patient Assistance Program (GIPAP) clinics at the Nairobi Hospital and Aga Khan University Hospital and two control groups for each case, matched for age and sex: a family- and hospital-based control, was carried out. One hundred and eight cases with ageand-gender-matched family- and hospital-based controls were recruited and a standard questionnaire was administered. Individual data on demographics, occupation, environment, and exposures to benzene and farm organochemical products were obtained. Clinical examination was carried out in control subjects. Statistical analysis was done using bivariate and multivariate analysis to look for associations between exposure factors and CML.

Results

The median age at diagnosis of CML cases was 41.32 years with an age range of 8–81 years and a male to female ratio of 1.7:1. Most of our cases were concentrated in or around Nairobi. There was no significant correlation found for exposure to benzene or pesticides. Long duration of exposure to pesticides in the family control group was significantly associated (t-test, P = 0.017) with risk of CML.

Conclusions

Associations between exposures to organic solvents like pesticides and CML were indicated but were not entirely consistent, although no associations with benzene products were found. Nevertheless, for almost all cases of Ph chromosome-positive CML, other explanations must be sought for.     

Condom Use Among Sexually Active Kenyan Female Adolescents at Risk for HIV-1 Infection

High rates of unintended pregnancy and HIV infection occur in sub-Saharan Africa yet few Kenyan studies have defined correlates of condom use in sexually active female adolescents. Female adolescents receiving reproductive health care and aged 15–19 were interviewed. The prevalence of ever-use of condom was 21.4% and 52 (7.3%) subjects were infected with HIV-1. Older age, higher levels of education, ever-use of hormonal contraceptives and higher numbers of sexual partners, non-consensual sex and exchange of sex for favours, were independent correlates of condom use. Condom use should be promoted in this population. Further exploration is needed on the developmental and contextual factors predisposing female adolescents to increased risk of HIV.     

Idiotypic vaccination against human B-cell lymphoma. Rescue of variable region gene sequences from biopsy material for assembly as single-chain Fv personal vaccines

Idiotypic determinants on neoplastic B cells could provide tumor antigens for vaccination of patients with B-cell tumors. Because this approach requires an individual vaccine for each patient, simple methods for obtaining idiotypic antigen are desirable. Using polymerase chain reaction (PCR) with family-based V-gene and J-region primers, the variable region genes of heavy and light chains (VH and VL) of Ig have been obtained from biopsy material from 13 patients with B-cell tumors. In each case, analysis of random clones derived from the PCR product showed repeated, clonally-related sequences, whereas normal lymphoid tissue generated no repeated sequences. In 3/3 cases, the repeated sequences were found to be the same as those in a tumor-derived hybridoma. Mutational patterns in the V-genes differed among the tumors, with follicular lymphoma tending to be more highly mutated. The individual VH and VL sequences have been assembled with a flexible linker sequence to encode single-chain Fv (scFv). The scFv sequences can be cloned into bacterial expression vectors to produce protein, or into vectors suitable for direct vaccination using naked DNA. In a model system, expressed scFv protein retained all idiotypic determinants defined by a panel of five anti-idiotypic monoclonal antibodies (MoAbs). Similarly, expressed scFv proteins from two patients were shown to react with anti-idiotypic antibodies. This approach allows production of potential vaccines from surgical biopsies within 2 to 3 weeks.