Integration of Palliative Care Into Comprehensive Cancer Treatment at Moi Teaching and Referral Hospital in Western Kenya

PURPOSE

The prognosis for the majority of patients with cancer in Kenya is poor, with most patients presenting with advanced disease. In addition, many patients are unable to afford the optimal therapies required. Therefore, palliative care is an essential part of comprehensive cancer care. This study reviews the implementation of a palliative care service based at the Moi Teaching and Referral Hospital in Eldoret, Kenya, and describes the current scope and challenges of providing palliative care services in an East African tertiary public referral hospital.

METHODS

This is a review of the palliative care clinical services at the only tertiary public referral hospital in western Kenya from January 2012 through September 2014. Palliative care team members documented each patient's encounter on standardized palliative care assessment forms; data were then entered into the Academic Model Providing Access to Health Care (AMPATH)-Oncology database. Interviews were also conducted to identify current challenges and opportunities for program improvement.

RESULTS

This study documents the implementation of a palliative care service line in Eldoret, Kenya. Barriers to providing optimal palliative cancer care include distance to pharmacies that stock opioids, limited selection of opioid preparations, education of health care workers in palliative care, access to palliative chemoradiation, and limited availability of outpatient and inpatient hospice services.

CONCLUSION

Palliative care services in Eldoret, Kenya, have become a key component of its comprehensive cancer treatment program.

Dynamic expansion of gastric mucosal doublecortin-like kinase 1-expressing cells in response to parietal cell loss is regulated by gastrin

Doublecortin-like kinase 1 (Dclk1) is considered a reliable marker for tuft cells in the gastrointestinal tract. We investigated the dynamic changes of tuft cells associated with mouse models of oxyntic atrophy and metaplasia in the stomach. Increases in the numbers of Dclk1-positive tuft cells were observed in several models of parietal cell loss. However, the expanded population of Dclk1-expressing cells showed a morphologically distinct structure in apical microvilli and acetylated microtubules, which was not seen in the tuft cells present in the normal gastric mucosa. These microvillar sensory cells (MVSCs) showed no evidence of proliferation. The expansion of the MVSCs induced by oxyntic atrophy was reversible after the return of parietal cells. More important, expansion of MVSCs after induced parietal cell loss was not observed in Gast(-/-) mice. Although the Dclk1-expressing cells in the normal gastric mucosa were in part derived from Lrig1-expressing stem cells, the Lrig1-lineaged cells did not produce the expanded Dclk1-expressing cells associated with oxyntic atrophy. These studies indicate that loss of parietal cells leads to the reversible emergence of a novel Dclk1-expressing sensory cell population in the gastric mucosa.

Measuring absorbed dose for i-CAT CBCT examinations in child, adolescent and adult phantoms

OBJECTIVES

Design and construct child and adolescent head phantoms to measure the absorbed doses imparted during dental CBCT and compare with the absorbed dose measured in an adult phantom.

METHODS

A child phantom was developed to represent the smallest patients receiving CBCT, usually for craniofacial developmental concerns, and an adolescent phantom was developed to represent healthy orthodontic patients. Absorbed doses were measured using a thimble ionization chamber for the custom-built child and adolescent phantoms and compared with measurements using a commercially available adult phantom. Imaging was performed with an i-CAT Next Generation (Imaging Sciences International, Hatfield, PA) CBCT using two different fields of view covering the craniofacial complex (130 mm high) or maxilla/mandible (60 mm high).

RESULTS

Measured absorbed doses varied depending on the location of the ionization chamber within the phantoms. For CBCT images obtained using the same protocol for all phantoms, the highest absorbed dose was measured in all locations of the small child phantom. The lowest absorbed dose was measured in the adult phantom.

CONCLUSIONS

Images were obtained with the same protocol for the adult, adolescent and child phantoms. A consistent trend was observed with the highest absorbed dose being measured in the smallest phantom (child), while the lowest absorbed dose was measured in the largest phantom (adult). This study demonstrates the importance of child-sizing the dose by using dedicated paediatric protocols optimized for the imaging task, which is critical as children are more sensitive to harmful effects of radiation and have a longer life-span post-irradiation for radiation-induced symptoms to develop than do adults.

Cell lineage distribution atlas of the human stomach reveals heterogeneous gland populations in the gastric antrum

OBJECTIVE

The glands of the stomach body and antral mucosa contain a complex compendium of cell lineages. In lower mammals, the distribution of oxyntic glands and antral glands define the anatomical regions within the stomach. We examined in detail the distribution of the full range of cell lineages within the human stomach.

DESIGN

We determined the distribution of gastric gland cell lineages with specific immunocytochemical markers in entire stomach specimens from three non-obese organ donors.

RESULTS

The anatomical body and antrum of the human stomach were defined by the presence of ghrelin and gastrin cells, respectively. Concentrations of somatostatin cells were observed in the proximal stomach. Parietal cells were seen in all glands of the body of the stomach as well as in over 50% of antral glands. MIST1 expressing chief cells were predominantly observed in the body although individual glands of the antrum also showed MIST1 expressing chief cells. While classically described antral glands were observed with gastrin cells and deep antral mucous cells without any parietal cells, we also observed a substantial population of mixed type glands containing both parietal cells and G cells throughout the antrum.

CONCLUSIONS

Enteroendocrine cells show distinct patterns of localisation in the human stomach. The existence of antral glands with mixed cell lineages indicates that human antral glands may be functionally chimeric with glands assembled from multiple distinct stem cell populations.