Review: Head and neck squamous cell carcinoma in sub-Saharan Africa

Aim

Review the literature from 1990 to 2013 to determine known anatomic sites, risk factors, treatments, and outcomes of head and neck squamous cell carcinoma (HNSCC) in sub-Saharan Africa.

Methods

Using a systematic search strategy, literature pertaining to HNSCC in sub-Saharan Africa was reviewed and patient demographics, anatomic sites, histology, stage, treatment, and outcomes were abstracted. The contributions of human immunodeficiency virus (HIV), human papillomavirus (HPV) and behavioural risk factors to HNSCC in the region were assessed.

Results

Of the 342 papers identified, 46 were utilized for review, including 8611 patients. In sub-Saharan Africa, the oropharyngeal/oral cavity was found to be the most common site, with 7750 cases (90% of all cases). Few papers distinguished oropharyngeal from oral cavity, making identification of possible HPV-associated oropharyngeal squamous cell carcinoma (SCC) difficult. SCC of the nasopharynx, nasal cavity, or paranasal sinuses was identified in 410 patients (4.8% of all cases). Laryngeal SCC was found in 385 patients (4.5% of all cases), and only 66 patients (0.8% of all cases) with hypopharyngeal SCC were identified. In 862 patients with data available, 43% used tobacco and 42% used alcohol, and reported use varied widely and was more common in laryngeal SCC than that of the oropharyngeal/oral cavity. Toombak and kola nut use was reported to be higher in patients with HNSCC. Several papers reported HIV-positive patients with HNSCC, but it was not possible to determine HNSCC prevalence in HIV-positive compared to negative patients. Reports of treatment and outcomes were rare.

Conclusions

The oropharyngeal/oral cavity was by far the most commonly reported site of HNSCC reported in sub-Saharan Africa. The roles of risk factors in HNSCC incidence in sub-Saharan Africa were difficult to delineate from the available studies, but a majority of patients did not use tobacco and alcohol.     

A Project to Implement Use of 40% Dextrose Gel for Transient Neonatal Hypoglycemia

ObjectiveTo examine the effect of oral dextrose gel and oral feedings on newborns’ blood sugar homeostasis in the first day of life in an effort to decrease transfers to the NICU.DesignEvidence-based practice project.Setting/Local ProblemObstetric service at a large hospital in northeast Ohio with approximately 5,300 births annually. Neonates who experienced hypoglycemia were often transferred to the NICU for management if treatment measures failed, thereby increasing the cost of care and separating mothers from their newborns. During 2018, there were 54 neonates transferred to the NICU for hypoglycemia.ParticipantsPediatricians, neonatologists, neonatal nurse practitioners, clinical nurse specialists, managers, educators, and registered nurses.Intervention/MeasurementsAn interdisciplinary task force created a nurse-driven protocol and associated order set and also created and provided interdisciplinary education to all involved caregivers using a multimodal approach. Neonates’ charts were audited for the time period of April 2019 to April 2020 to evaluate participants’ compliance with the prescribed practice changes.ResultsThe number of neonates who qualified for blood glucose testing per the new protocol totaled 1,369. Of these, 188 (14%) met criteria for and were treated with 40% dextrose gel. Treatment with 40% dextrose gel was unsuccessful for 25 neonates, who were then transferred to the NICU. This is 29 fewer than were transferred in 2018.ConclusionThe use of oral dextrose gel and oral feedings was associated with a decrease in the number of newborns transferred to a higher level of care for treatment of hypoglycemia.     

Steroidogenic gene expression following D-aspartate treatment in frog testis

Previous studies have provided evidence that D-Asp plays a role in steroid-mediated reproductive biology in amphibians, reptiles, birds and mammals. To examine the molecular involvement of D-Asp on steroidogenic pathway regulation, we analysed the expression of StAR, P450 aromatase and 5αRed2 mRNAs in Pelophylax esculentus testis, either in relation to the reproductive cycle or D-Asp treatment. Basal StAR mRNA levels, as well as D-Asp and testosterone concentrations, were higher in reproductive than in post-reproductive frogs. D-Asp treatment increased StAR mRNA expression and immunolocalisation in both the reproductive and post-reproductive periods. In control testis, aromatase mRNA levels were higher in the post-reproductive period, but following D-Asp administration, they increased only in the reproductive period. The level of 5αRed2 mRNA was higher in reproductive frogs than in post-reproductive frogs, and it increased after D-Asp treatment only in the post-reproductive phase. Our results suggest that, in P. esculentus testis, D-Asp increases StAR mRNA in both periods, and P450 aromatase and 5αRed2 mRNAs at different points during the reproductive cycle.