Immunogenicity persistence after four intramuscular triple-dose or standard-dose hepatitis B vaccine in patients receiving methadone maintenance treatment: A 1-year follow-up study in China

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov (NCT03962816).https://clinicaltrials.gov/ct2/show/NCT03962816.

Diabetic ketoacidosis treatment outcomes and associated factors among adult diabetic patients in Ethiopia: A systematic review and meta-analysis

Background

Diabetic ketoacidosis is a severe complication of diabetes that can threaten life and has a considerable effect on healthcare systems, especially in developing nations such as Ethiopia. Although it is clinically significant, comprehensive data on the factors that lead to unsatisfactory treatment outcomes in diabetic ketoacidosis patients in Ethiopia are lacking. This review aims to investigate and evaluate unsatisfactory treatment outcomes and multiple contributing factors related to diabetic ketoacidosis among patients with diabetes in Ethiopia. This review seeks to identify these factors to provide insights that can guide improvements in the management and treatment of diabetic patients.

Methods

Articles documenting unfavorable treatment outcomes and related aspects of diabetic ketoacidosis among Ethiopian diabetes patients were meticulously sought from various databases, including PubMed/MEDLINE, the Cochrane Library, Science Direct, HINARI, Google Scholar, and gray literature. After the data were extracted, they were imported into Stata software version 17 for analysis. The Cochrane Q test and I2 statistic were used to evaluate heterogeneity.

Results

A total of 580 duplicates were eliminated from the initial set of 1578 papers obtained from PubMed (3), Google Scholar (1,550), HINARI (11), Science Direct (13), and the Cochrane Library (1). The pooled prevalence of poor treatment outcomes for diabetic ketoacidosis was 8 %. Key risk factors for poor treatment outcomes included a Glasgow Coma Scale (GCS) score of less than 15 (POR = 3.16; 95 % CI: 1.52-4.80), sepsis (POR = 2.92; 95 % CI: 1.12-4.72), and comorbidities (POR = 3.66; 95 % CI: 1.64-5.68).

Conclusion

The pooled prevalence of poor treatment outcomes of diabetic ketoacidosis in Ethiopia was high. A GCS score of less than 15, sepsis, and comorbidities were identified as significant risk factors for poor treatment outcomes in diabetic ketoacidosis patients. Addressing and minimizing these factors could help reduce the incidence of poor treatment outcomes in diabetic ketoacidosis patients in Ethiopia.

Intraluminal causes of mechanical small bowel obstruction: CT findings and diagnostic approach

Intraluminal causes of small bowel obstruction (SBO) are less common than mural or extrinsic etiologies. This review categorizes intraluminal causes of SBO into four broad categories to provide a diagnostic framework for radiologic interpretation: 1) ingested contents, 2) bowel stasis, 3) inflammatory causes, and 4) neoplasms. Ingested materials can result in SBO when individual or accumulated contents are too large to pass, such as in the case of foreign bodies or bezoars. Bowel stasis causing SBO can be secondary to abnormal bowel function, such as in cystic fibrosis, reduced transit of contents at sites of narrowing such as surgical anastomoses, or the formation of enteroliths in diverticula which may subsequently dislodge and result in luminal obstruction. Inflammatory causes of SBO include strictures or fistulas that allow foreign bodies (such as gallstones) formed outside the bowel to enter the bowel lumen and cause obstruction. Finally, neoplasms can present as endophytic masses that occlude the bowel lumen through a ball-valve mechanism or serve as a lead point for intussusception. Recognizing the imaging features that are suggestive of intraluminal SBO is critical for accurate diagnosis and timely patient care.

Clinical characteristics and outcomes of paediatric acute lymphoblastic leukaemia in a tertiary hospital in Tanzania: a single-centre observational study

BACKGROUND

A wide inequality exists between high- and low-income countries in the outcome of paediatric acute lymphoblastic leukaemia (ALL). At a tertiary-level hospital in Tanzania, multidimensional approaches have been taken to improve cancer care for children. This study aimed to update the outcomes of paediatric ALL at Muhimbili National Hospital (MNH), Tanzania from 2016 to 2020.

METHODS

We performed a retrospective chart review of children who were treated with modified UKALL2003 protocol at MNH from January 1, 2016 to December 31, 2020. We used the Cox proportional hazards model to estimate the effect of each prognostic factor on event-free survival (EFS).

RESULTS

We identified 202 patients who had confirmatory diagnoses of ALL and initiated treatment at MNH. Fifty-two patients (26%, 52/202) died (n = 47) or abandoned treatment (n = 5) before the end of remission induction. The main causes of death during this period were infections and bleeding complications. The median EFS was 9 months and 2-year EFS was 36%. Oedema, non-early rapid responder, and non-remission were associated with short EFS in the multivariable analysis.

CONCLUSIONS

The number of new paediatric ALL admissions at MNH has doubled in the past decade. The prevention of early deaths is critical to improve the long-term survival of paediatric ALL in Tanzania.

The diabetic foot: progress in Sub-Saharan Africa

In Sub-Saharan Africa (SSA), the number of people with diabetes mellitus is increasing along with the number of complications linked to the condition. Among all complications, diabetes-related foot complications (DRFC) have the greatest rates of morbidity and mortality, and their incidence will increase in tandem with it.Over the past two decades, the magnitude of DRFC has underscored the challenges within SSA's healthcare systems, including limited access to diagnostics, specialized healthcare providers, and treatment options. Education and prevention have proven critical in addressing these challenges, as evidenced by programs like 'Step by Step' and 'Train the Foot Healthcare Professional'. These initiatives not only focus on prevention but also equip healthcare providers with skills in identification, diagnosis, treatment, and holistic management of DRFC, significantly reducing severe complications and improving outcomes. The integration of digital health technologies, including telemedicine and mobile health tools, offers innovative solutions for enhancing access to care, particularly in underserved areas. Governments have a pivotal role in recognizing and addressing the burden of DRFC through policy initiatives, surveillance systems, and public health campaigns. Bridging these gaps requires a coordinated approach, leveraging education, technology, and collaboration to build resilient healthcare systems and improve the management of DRFC in SSA.

Stakeholder mapping for a complex and diverse population: methodology for identifying leaders across sub-Saharan Africa

BACKGROUND

Stakeholder-related methodologies for low- and middle-income countries (LMICs) have primarily focused on stakeholder engagement or identification of specific, well-defined populations. Current stakeholder mapping research methods do not provide sufficient sampling processes for defining and implementing a sampling frame for poorly defined populations. In this paper we develop a unique stakeholder mapping methodology and apply it to the Transforming health: The role and impact of women's leadership in the health sector (THRIVE) study, aimed at generating evidence to support investment in women's leadership in global health decision-making in reproductive, maternal, newborn, child, and adolescent health, and nutrition (RMNCAH-N) and immunization across sub-Saharan Africa (SSA). Though current literature has examined challenges women have faced to reach leadership roles, there are no methods for systematically identifying women leaders, and leaders in RMNCAH-N and immunization have not been uniformly well-defined or systematically documented. Consequently, understanding the impact of women's leadership on health and healthcare policies is lacking.

RESULTS

We developed a stakeholder mapping methodology to ensure accurate identification and representation of leaders in RMNCAH-N and immunization in Sub-Saharan Africa who could serve as a "sampling universe" for further investigation into the impact of women leaders. We began by defining what constituted a "leader" and "leader-adjacent" individual. Using a matrix, we refined the target sample of stakeholders and created uniform inclusion criteria. Stakeholder mapping was guided by the following strategic steps for each SSA country: screen government webpages; contact UN/multilateral agencies; conduct a systematic Google and social media search; identify relevant academic and grey literature; contact professional and personal connections in SSA; cross-check leads against a pre-defined matrix of stakeholder levels; and in-country validation. Inputs were collated into a shared Excel sheet. At the end of the stakeholder mapping exercise, we had systematically identified 3,901 leads. On average, 81 stakeholders were identified for each country. Approximately 38% (n = 1353) of the identified individual stakeholders were women.

CONCLUSIONS

This paper's focus on creating a sampling universe of women leaders in RMNCAH-N and immunization in SSA fills a gap in current operational and implementation research. The insights derived from the adaptation and application of this methodology highlight the value of a structured approach to capturing the complexities of stakeholder and leadership dynamics in global health, particularly when applied to systematically map health topics or disciplines that lack databases or public records.

A critical review on In Vivo and Ex Vivo models for the investigation of Helicobacter pylori infection

Helicobacter pylori is a stomach-dwelling bacterium with a crude global prevalence of nearly 45% in adults and 35% in children and adolescents. Chronic H. pylori infection and the resulting inflammation are major causes of gastritis, peptic ulcer disease and gastric cancer. Since its discovery in 1982, various animal models have been proposed to recreate the specific pathophysiological interactions between H. pylori and the human host. These infection models have been instrumental in dissecting the key drivers of H. pylori colonization, persistence and mediators of host immune responses. However, a comprehensive understanding of the molecular triggers for malignant transformation of the gastric mucosa is still lacking. Vaccine development in this area has stalled, as promising candidates identified through animal studies have failed in advanced human clinical trials. Currently, H. pylori eradication is heavily reliant on different antimicrobial agents. As with other bacterial pathogens, the growing antimicrobial resistance in H. pylori remains a major challenge, making eradication therapy increasingly complex and prolonged, over time. Recent drug approvals have mostly been for newer combinations of conventional antibiotics and proton pump inhibitors. Thus, the development of novel treatments and innovative models are crucial for advancing the drug development pipeline. This review encompasses the development and recent advances in animal and non-animal models of H. pylori gastric infection and its applications in investigating novel therapeutics and vaccine candidates.

A scoping review of worldwide guidelines for diagnosis and treatment of Helicobacter pylori infection

BACKGROUND

This study comprehensively analyzes the diagnostic criteria, eradication indications, treatment, and other information in the latest guidelines published by various countries around the world, so that researchers can have a systematic understanding of Helicobacter pylori and further provide a basis for clinical H. pylori diagnosis and treatment.

METHODS

Nine online databases were searched to find the latest version of guidelines for H. pylori worldwide. Two researchers read the included guidelines independently and extracted the eradication indications, diagnostic criteria, and treatment in the guidelines, conducting a summary of them.

RESULTS

A total of 25 guidelines or consensus were included. Among all diagnostic methods for H. pylori infection, the urea breath test is widely recommended as the first choice. A total of 20 guidelines mentioned indications for H. pylori eradication. Among them, the indications with a higher proportion of recommendations were long-term use of non-steroidal anti-inflammatory drugs (including low-dose aspirin) in 90% of patients with peptic ulcer history or active peptic ulcer disease 80%; gastric mucosa-associated lymphoid tissue (MALT) lymphoma 75%. It is worth mentioning that 40% of the guidelines pointed out that, as long as H. pylori infection is confirmed, it should be eradicated. A total of 24 guidelines mentioned treatment for H. pylori. Among them, bismuth quadruple therapy (a combination of a bismuth, two antibiotics, and a proton pump inhibitor (PPI)) was the most recommended first-line therapy. Levofloxacin triple therapy (a combining of a bismuth, an antibiotic, and a PPI) was the most recommended second-line therapy.

CONCLUSION

Current global Helicobacter pylori management guidelines share foundational consensus, yet exhibit regional variations in diagnostic criteria, eradication indications, and therapeutic regimens due to context-specific epidemiological, socioeconomic, and antimicrobial resistance profiles. Clinical practice should prioritize regionally tailored approaches, integrating local guidelines while maintaining awareness of international recommendations to optimize decision-making. Moreover, health authorities responsible for guideline development must ensure timely updates based on dynamic surveillance of local resistance patterns and socioeconomic realities.

Vonoprazan-based therapy versus standard regimen for Helicobacter pylori infection management in Egypt: an open-label randomized controlled trial

As antibiotic resistance continues to rise, the development of novel H. pylori treatment regimens, combined with regular assessment of existing treatment regimens, is imperative. The study evaluates the efficacy, safety, and compliance of vonoprazan dual and triple therapy (VDT and VTT) both consisting of vonoprazan 20 mg twice daily and amoxicillin/clavulanate 875 mg/125 three times daily plus clarithromycin 500 mg twice daily added in VTT versus standard triple therapy (STT), in which vonoprazan 20 mg in VTT is replaced by PPI standard or double dose all for 14 days, along with investigating factors influencing compliance, treatment response, and symptoms severity. By per-protocol analysis, the eradication rates of the STT, VDT, and VTT groups were 70%, 76.2%, and 79.2%, respectively (p = 0.777) indicating suboptimal efficacy of the three treatment regimens. This necessitates the optimization of dosage and frequency of available treatment regimens as well as the development of new regimens with higher eradication rates. Interestingly, the VDT group demonstrated a better safety profile but with no statistically significant difference in cure rate. No difference in compliance with treatment was found between the groups. Gender, frequency of COVID-19 vaccination, height, and BMI were the only factors assessed influencing infection symptoms severity. ClinicalTrial.gov ID identifier: NCT05614934, first posted date (07/11/2022).

Perforated peptic ulcers in children: a systematic review

BACKGROUND

Perforated peptic ulcers (PPU) represent a significant complication of peptic ulcers, associated with high mortality. As no systematic review of the literature on PPU in children currently exists, this study aims to summarize findings from studies focusing on its risk factors, etiology, treatment modalities, and outcomes.

METHODS

A systematic review was conducted following the PRISMA guidelines. A literature search was performed on 24 November 2024, using four electronic databases: Web of Science, Scopus, PubMed, and ScienceDirect. The inclusion criteria were studies published in English, focusing on perforated peptic ulcers in paediatric patients. The exclusion criteria were: studies published in languages other than English; publication formats such as conference abstracts, personal communications, and single case reports; studies focusing on non-perforated peptic ulcers; studies involving participants > 18 years; and studies reporting ulcer perforations outside the stomach or duodenum.

RESULTS

Out of 1963 records identified, 12 studies met the inclusion criteria and were included in the review. A total of 239 children with perforated peptic ulcers were analyzed, with a median age of 11 years (range 3.2-16.5 years). The results indicate that ulcer perforations were more prevalent in males (74.8%). Furthermore, duodenal perforations (73%) were more common than gastric perforations (27%). The most commonly reported symptoms were abdominal pain (n = 175, 73.2%), vomiting (n = 82, 34.3%), peritoneal signs (n = 79, 33%), and fever (n = 38, 15.9%). Subdiaphragmatic free air was detected in 141 patients (58.9%). Of the total number of patients, 207 (86.6%) were treated surgically, while 32 (13.4%) received conservative treatment. Regarding the surgical approach, most patients underwent open surgery (n = 143, 69%) compared to laparoscopic repair (n = 64, 31%). Among the surgical procedures, 114 involved simple sutures, with or without an omental patch. Postoperative complications were reported in 30 children (14.5%). Reoperation was required in 4 patients (1.9%), and mortality was recorded in 9 patients (3.8%).

CONCLUSIONS

PPU was more prevalent in males and predominantly located in the duodenum. Ulcer suturing, with or without an omental patch, was the most commonly utilized treatment modality, demonstrating a relatively low complication rate. Further studies are needed to provide more comprehensive and unbiased evidence on PPU in children.

Etiology and Short-Term Outcomes of Upper Gastrointestinal Bleeding in Patients Presenting at the Emergency Department in a Tertiary Hospital in a Low Resource Setting-A Prospective Cohort Study

Background

Upper gastrointestinal bleeding (UGIB) is one of the most common medical emergencies. Currently, there is a paucity of data on the clinical profile and outcome of UGIB in resource-limited settings.

Objective

We aim to describe the etiology and outcomes of the patients who presented to the Emergency Department (ED) of a tertiary hospital in Ghana with UGIB.

Methods

This was a single-center prospective cohort study involving 195 adults who presented with symptoms of UGIB from May 2022 to April 2023. Relevant baseline demographic and clinical characteristics were obtained. The cause of UGIB was determined as per findings at endoscopy. Patients were followed up for 6 weeks from admission, looking out for rebleeding, need for transfusion, length of hospital stay, and mortality.

Results

There were 145 (74.4%) males and 50 (25.6%) females, and the mean age ± SD was 51.4 ± 17.4 years. The main clinical presentations included melena (87.2%), hematemesis (69.7%) and postural dizziness (73.8%). The commonest findings at endoscopy were esophageal and gastric varices (33.3%), erosive gastritis and duodenitis (27.7%) and peptic ulcers (21.5%). The median length of hospital stay (IQR) was 7 days (5 days). 70.8% required whole blood transfusion with a median (IQR) of 2 units (2 units). The 6-week mortality and rebleeding rates were 17.4% and 7.2%, respectively.

Conclusion

Variceal bleeding was the most common cause of UGIB at the emergency. One out of every fourteen patients that recover from acute UGIB may rebleed within the first six weeks one out of every six patients who present with acute UGIB may die within the succeeding six weeks.

A study protocol to engage religious leaders to reduce blood pressure in Tanzanian communities: A cluster randomized trial

BACKGROUND

Most people with hypertension in Sub-Saharan Africa are unaware of their status. Low perceived need for hypertension screening, low trust in biomedical health care, unhealthy norms for diet and exercise, and prioritization of spiritual over physical health are key barriers to blood pressure (BP) control in Tanzanian communities. We seek to determine whether engaging religious leaders to screen for hypertension and educate communities on cardiovascular health can lead to a sustained community BP reduction.

METHODS

This trial aims to determine the efficacy of an intervention that engages religious leaders to reduce BP in Tanzanian communities. After refinement of the intervention following pilot testing, a hybrid type I randomized control trial will be conducted across 20 rural communities (10 intervention and 10 control communities). The intervention will consist of educational sessions for religious leaders, equipping them to provide community cardiovascular health teachings, and BP screening organized jointly by religious leaders and health care workers. We will measure the reduction in mean community BP and changes in hypertension awareness and treatment, diet, physical activity, body mass index, and waist circumference after one year. Key elements that contribute to the intervention's implementation and effectiveness to strengthen its adoption and broader use during and after the intervention up to 24 months will be evaluated.

DISCUSSION

Community-level barriers to BP control inhibit awareness and treatment of hypertension in Tanzania. Through innovative partnerships with trusted religious leaders, we seek to study an intervention with the potential to reduce BP and improve overall community health.

Female Genital Schistosomiasis (FGS) in a Nonendemic Setting: Retrospective Case-Notes Review of Schistosoma haematobium-Positive FGS Cases at the Hospital for Tropical Diseases, London, With a Pragmatic Clinical Pathway for Nonendemic Settings

Background

Female genital schistosomiasis (FGS), the genital manifestation of S. haematobium infection in women, results in protean gynecological symptoms and longer-term complications. FGS affects an estimated 75% of women with S. haematobium, totaling 56 million women, mainly in Sub-Saharan Africa. With increasing migration, FGS will be encountered more frequently in nonendemic settings. Despite this, evaluation of FGS diagnosis and management and guidelines for these settings are lacking.

Methods

A retrospective case-notes review was undertaken of patients presenting to the Hospital for Tropical Diseases, London, from 1998 to 2018 with S. haematobium ova in terminal urine or on biopsy. Descriptive and outcome variables were collected. Specific FGS variables included documented gynecological symptoms and referrals to sexual health and gynecology specialists. Results informed a clinical pathway aiding diagnosis and management of FGS.

Results

Overall, 186 patients with S. haematobium ova in terminal urine or biopsy were included, 62 (33.3%) of whom were women. Four women had documented gynecological symptoms (4/62, 6.5%). Two symptomatic women were referred to gynecology (2/4, 50%), and 2 were lost to follow-up (2/4, 50%). Gynecological symptoms were not documented for many women, despite proven S. haematobium infection.

Conclusions

Given that 75% of women with S. haematobium infection may have FGS, there is a gap in diagnosis in this nonendemic setting. We developed a clinical pathway to improve diagnosis and management of FGS, including inquiry about gynecological symptoms, followed by targeted referrals to gynecology, sexual health, and urological imaging. By formalizing a pathway, we aim to improve FGS care in this nonendemic setting.

Prevalence and patterns of peptic ulcer disease in Africa: a systematic review and meta-analysis

BACKGROUND

Peptic ulcer disease (PUD) remains a significant yet poorly understood public health issue in Africa, despite its declining prevalence in Western countries. Studies from Africa report a highly variable burden, with the highest prevalence observed in West Africa and the lowest in Southern Africa. However, the overall burden of PUD in Africa, its patterns (duodenal ulcers, gastric ulcers, and coexisting ulcers), and its association with H. pylori infection remain unclear.

OBJECTIVE

This review aims to systematically analyze the pooled prevalence and patterns of PUD in Africa through a systematic review and meta-analysis.

DESIGN

A systematic review and meta-analysis was conducted following the PRISMA checklist. We searched PubMed, Hinari, and Google Scholar, supplemented by Google and Yahoo search engines. Observational studies reporting the prevalence and patterns of PUD among the African population were included. Two independent reviewers extracted data and assessed study quality. Pooled prevalence estimates were calculated using a random-effects model, with heterogeneity assessed via the Cochrane Q test and I2 statistic.

RESULTS

A comprehensive analysis of 58 studies revealed a pooled prevalence of PUD in Africa at 15.2%. The most common ulcer pattern was DU at 10.2%, followed by GU at 5.8%, while 0.6% of cases had both types. Regional variations were observed, with West Africa having the highest prevalence (19%), followed by East Africa (15%), North Africa (12%), and Southern Africa (8%). Among individual countries, Ghana reported the highest prevalence (27%), followed by Ethiopia (19%) and Tanzania (16%). Furthermore, the pooled prevalence of PUD was 14% before 2010 and 15% in 2011 and later. Additionally, 57.1% of patients tested positive for Helicobacter pylori infection, with its prevalence reaching 76.4% among those diagnosed with PUD. Substantial heterogeneity was observed across most analyses, with I2 values exceeding 95% and p-values < 0.001.

CONCLUSION

The analysis revealed a significant burden of PUD in Africa, with DU being more common than GU. Regional disparities were observed, with the highest prevalence in West and East Africa. Over the past two decades, the burden has remained relatively stable, reflecting a concerning trend. H. pylori infection was also frequently diagnosed in individuals undergoing endoscopic examination. However, substantial heterogeneity was noted across studies, highlighting variability in reported prevalence.

Clinico-pathologic profile of skin cancers in oculocutaneous albinism at Universitas Academic Hospital

Background

Oculocutaneous albinism (OCA) is a genetic disorder found worldwide. Skin cancer is a significant risk for people with albinism, particularly in Africa, where it is a major cause of death. Many patients delay seeking medical care until their skin lesions are in advanced stages.

Aim

The aim of this study was to describe the clinico-pathological profile of skin cancers in patients with albinism at their initial presentation to our dermatology outpatient department.

Setting

This study was conducted at the dermatology department of Universitas Academic Hospital, Bloemfontein, South Africa.

Methods

A retrospective descriptive study covering June 2009 to July 2019 was conducted. Only records of oculo-cutaneous albinism patients diagnosed with skin cancer during their initial visit were included.

Results

Eighty-six patients with albinism were recorded, 37% (n = 32) of whom had skin cancer at their first visit. Females (81%) were more affected than males (19%). The majority of skin cancers were squamous cell carcinomas (SCCs) (54%) and basal cell carcinomas (BCCs) (46%). No melanomas were found. Most SCCs were classified as aggressive (80.4%), compared to 30.8% of BCCs.

Conclusion

Almost 40% of OCA patients presented with skin cancer at their initial visit, highlighting the need for strengthening primary healthcare systems' efficiency in ensuring early referrals for OCA patients.

Contribution

Education, socioeconomic support and awareness campaigns are sine qua non actionable factors that could help encourage early medical evaluation for all OCA patients.

Prevalence and factors associated with Helicobacter Pylori infection among patients with dyspeptic symptoms in Tanzania: Experience from temeke regional referral hospital in Dar Es Salaam

INTRODUCTION

Helicobacter pylori is a type of bacteria that infects the stomach lining and can cause various gastrointestinal disorders, such as dyspepsia, gastritis and peptic ulcers. Dyspepsia is a common symptom among patients seeking medical care, and Helicobacter pylori infection is one of the most common causes of dyspepsia.

OBJECTIVE

This study aimed to determine the prevalence and factors associated with Helicobacter pylori infection among patients attending Temeke Regional Referral Hospital (RRH) in Dar es Salaam, Tanzania.

METHODS

A hospital-based cross-sectional study involving dyspeptic patients was conducted between May and June 2023. A Standardized data collection tool was used to collect socio-demographic characteristics and other information such as level of income and source of water. Helicobacter pylori antigen was detected using a stool Helicobacter pylori antigen rapid test according to the manufacturer's instructions. Data analysis was done using STATA 15 computer software.

RESULTS

The study revealed that the prevalence of Helicobacter pylori infection among dyspeptic patients was 43.77%. Also, male sex, occasional hand washing habits and participants who were not sure whether they used treated water for drinking were the factors that were strongly associated with positive Helicobacter pylori infection.

CONCLUSION

Preventive measures and eradication of Helicobacter pylori infection should be considered worthy by public health authorities. More studies have to be emphasized to check the relationship between sex and Helicobacter pylori infection.

Clarithromycin-resistant Helicobacter pylori in Africa: a systematic review and meta-analysis

BACKGROUND

In 2022, approximately 56.5% of adults and 47.1% of children and adolescents were affected by Helicobacter pylori (H. pylori) infection in Africa, and clarithromycin-resistant H. pylori (CRHp) strains have become global priority pathogens. Therefore, this study aimed to conduct the first comprehensive systematic review and meta-analysis of CRHp in Africa.

METHODS

This investigation was conducted according to the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (The PRISMA 2020). Literature search of electronic databases (Google Scholar, African Journals Online, ResearchGate, PubMed, Embase, and Scopus) was performed using keywords "clarithromycin", "Helicobacter pylori", "African country name", "mutation in the 23S rRNA".

RESULTS

Sixty-five studies involving 5,313 H. pylori strains isolated over 26 years (1997-2022) from 23 African countries were included in this study. The samples from which CRHp was isolated included gastric biopsy (60/63; 95%), and stool (4/63; 6%). The pooled prevalence of CRHp in Africa was 27% (95% CI: 22, 33). There was a steady trend in the prevalence of CRHp isolated in Africa over the 26 years (R2 = 0.0001, p = 0.92, slope coefficient of -0.05x). Ten types of 23S rRNA mutations (conferring clarithromycin resistance) were identified, and included mainly A2143G (465 H. pylori strains out of 1178 tested) and A2142G (344 H. pylori strains out of 1027).

CONCLUSION

To enhance the accuracy and validity of surveillance data for H. pylori in Africa, there is an urgent need for implementing standardized microbiological methods for resistance detection. The prevalence of CRHp reported in this study was very similar to the overall global prevalence and there is a need for more representative studies on CRHp in Africa. While waiting for this, the treatment of H. pylori infections must be based on the guidelines of the AHMSG first Lagos consensus.

The first BILGENSA Research Network workshop in Zambia: identifying research priorities, challenges and needs in genital bilharzia in Southern Africa

Female genital schistosomiasis (FGS) and male genital schistosomiasis (MGS) are gender-specific manifestations of urogenital schistosomiasis. Morbidity is a consequence of prolonged inflammation in the human genital tract caused by the entrapped eggs of the waterborne parasite, Schistosoma (S.) haematobium. Both diseases affect the sexual and reproductive health (SRH) of millions of people globally, especially in sub-Sahara Africa (SSA). Awareness and knowledge of these diseases is largely absent among affected communities and healthcare workers in endemic countries. Accurate burden of FGS and MGS disease estimates, single and combined, are absent, mostly due to lack of awareness of both diseases and absence of standardized methods for individual or population-based screening and diagnosis. In addition, there are disparities in country-specific FGS and MGS knowledge, research and implementation approaches, and diagnosis and treatment. There are currently no WHO guidelines to inform practice. The BILGENSA (Genital Bilharzia in Southern Africa) Research Network aimed to create a collaborative multidisciplinary network to advance clinical research of FGS and MGS across Southern African endemic countries. The workshop was held in Lusaka, Zambia over two days in November 2022. Over 150 researchers and stakeholders from different schistosomiasis endemic settings attended. Attendees identified challenges and research priorities around FGS and MGS from their respective countries. Key research themes identified across settings included: 1) To increase the knowledge about the local burden of FGS and MGS; 2) To raise awareness among local communities and healthcare workers; 3) To develop effective and scalable guidelines for disease diagnosis and management; 4) To understand the effect of treatment interventions on disease progression, and 5) To integrate FGS and MGS within other existing sexual and reproductive health (SRH) services. In its first meeting, the BILGENSA Network set forth a common research agenda across S. haematobium endemic countries for the control of FGS and MGS.

Delay Patterns and Associated Factors Among Gastric Cancer Patients Visiting Tertiary Hospital in Ethiopia

BACKGROUND

Gastric cancer ranks sixth in terms of incidence and fifth in terms of mortality in the world. It is also the fifth most frequent cancer in Ethiopia. In developed countries such as Japan, the diagnosis of gastric cancer is made early and has a better prognosis, but in developing countries like Ethiopia, the majority of patients present late in the advanced state. This study assessed delay patterns and associated factors among gastric cancer patients in Tikur Anbessa Specialized Hospital in Ethiopia.

METHODS

A single-center cross-sectional study was conducted on 64 gastric cancer patients on follow-up from February 2021 to March 2023. The main outcome measures are the mean length of total delay, patient delay, diagnosis delay, and treatment delay. SPSS software version 26 and the Mann-Whitney statistical test were used to verify associations between the time intervals of access to treatment and socioeconomic factors, clinical variables, and patient-reported reasons, adopting a 0.05 significance level.

RESULTS

In this study, the mean length of patient delay was 106 (SD = 142) days, the diagnosis delay was 318 (SD = 370) days, and the treatment delay was 43 (SD = 43) days. The average length of the total delay between symptom onset and definitive treatment was 467.4 (SD = 396.3) days. The greater length of patient delay in this study was correlated with lack of awareness (p < 0.001), search for traditional alternatives (p value 0.02), rural residence (p = 0.05), and economic hindrances (p = 0.01), and diagnosis delay was correlated with misdiagnosis (p < 0.001).

CONCLUSION AND RECOMMENDATION

Delays among gastric cancer patients in this study are much greater than those seen in other low-income countries. Patient delay and diagnosis delay have a lion's share in the breakdown of the delays in our setup. Lack of awareness, the search for traditional alternatives, economic hindrances, and misdiagnosis were associated factors for delays. We recommend training primary healthcare providers regarding early signs of gastric cancer and integrating community-based public health interventions to increase awareness of cancer and early health-seeking behaviors. Along with increasing oncologic centers both by numbers and by quality of services.

Ascaris Peritonitis in a Pediatric Patient With Typhoid Fever

Intestinal infestation with ascaris worms is very common worldwide and usually causes minimal or no abdominal symptoms. Severe abdominal complications such as bowel obstruction may occur, but bowel perforation from ascariasis is rare. We present a case of a seven-year-old boy who initially presented with typhoid fever and then developed ascaris peritonitis requiring emergent surgery. We discuss preoperative diagnosis and perioperative management, as well as the purported mechanisms of coinfection with typhoid fever and ascariasis that can lead to small bowel perforation.

Gastric cancer diagnosis and prevention: Detecting precancerous at community level

The problem of gastric cancer (GC) prevention remains relevant for a long time. Various methods of population serological screening of atrophic gastritis and precancerous changes in the gastric mucosa have been created at present. Modern endoscopic and morphological methods of verification of the diagnosis of precancerous diseases and changes in the gastric mucosa have been introduced into the practice of gastroenterologists and oncologists. GC risk stratification systems allow the formation of risk groups that require population screening. Practical hints for population serological screening of atrophic gastritis, endoscopic and morphological verification of precancerous changes and diseases of the stomach recommend using it: When developing state programs for the prevention of stomach cancer; when implementing preventive measures for stomach cancer by doctors of all specialties; the authors also offer the possibility of use by anyone over the age of 40, provided that they seek methodological help from their doctor; in the work of health schools in any medical and preventive institutions. The use of an assessment system of certain risk factor signatures with prognostic value would add significant assistance to preventive measures against GC.

Overcoming antibiotic-resistant Helicobacter pylori infection: Current challenges and emerging approaches

Recent studies have shown a noticeable increase in global Helicobacter pylori (H. pylori) resistance, with clarithromycin resistance surpassing 15% in various areas. However, inadequate epidemiological monitoring, especially in developing countries, and the absence of uniform testing methods lead to discrepancies between regions and a possible underestimation of resistance levels. The complexity of treating H. pylori is driven by its highly dynamic genome, which is prone to frequent mutations contributing to phenotypical resistance. The usual course of action in empirical treatment involves using a combination of various drugs simultaneously, leading to significant resistance selection pressure and potential side effects. The emergence of H. pylori strains resistant to multiple drugs is closely tied to failures in first-line treatment, highlighting the need to prevent further resistance by using optimal initial empirical therapy or regimens guided by antibiotic susceptibility testing, requiring a collection of mixed samples and multiple isolates for accurate assessment. The emergence of new treatments like potassium-competitive acid blockers offers a hopeful approach to decrease antimicrobial usage while still ensuring effectiveness in comparison to traditional therapies with proton pump inhibitors. Additionally, the use of probiotics is under investigation to identify specific strains and formulations that may mitigate therapy-associated adverse effects.

Insights into Functions of Universal Stress Proteins Encoded by Genomes of Gastric Cancer Pathogen Helicobacter pylori and Related Bacteria

The genes that encode the universal stress protein (USP) family domain (pfam00582) aid the survival of bacteria in specific host or habitat-induced stress conditions. Genome sequencing revealed that the genome of Helicobacter pylori, a gastric cancer pathogen, typically contains one USP gene, while related helicobacters have one or two distinct USP genes. However, insights into the functions of Helicobacteraceae (Helicobacter and Wolinella) USP genes are still limited to inferences from large-scale genome sequencing. Thus, we have combined bioinformatics and visual analytics approaches to conduct a more comprehensive data investigation of a set of 1045 universal stress protein sequences encoded in 1014 genomes including 785 Helicobacter pylori genomes. The study generated a representative set of 183 USP sequences consisting of 180 Helicobacter sequences, two Wolinella succinogenes sequences, and a sequence from a related campylobacteria. We used the amino acid residues and positions of the 12 possible functional sites in 1030 sequences to identify 25 functional sites patterns for guiding studies on functional interactions of Helicobacteraceae USPs with ATP and other molecules. Genomic context searches and analysis identified USP genes of gastric and enterohepatic helicobacters that are adjacent or in operons with genes for proteins responsive to DNA-damaging oxidative stress (ATP-dependent proteases: ClpS and ClpA); and DNA uptake proteins (natural competence for transformation proteins: ComB6, ComB7, ComB8, ComB9, ComB10, ComBE, and conjugative transfer signal peptidase TraF). Since transcriptomic evidence indicates that oxidative stress and the presence of virulence-associated genes regulate the transcription of H. pylori USP gene, we recommend further research on Helicobacter USP genes and their neighboring genes in oxidative stress response and virulence of helicobacters. To facilitate the reuse of data and research, we produced interactive analytics resources of a dataset composed of values for variables including phylogeography of H. pylori strains, protein sequence features, and gene neighborhood.

Gender and healthcare leadership: Addressing critical knowledge gaps by explicitly considering the gendered concept of care

This scoping review of gender and healthcare leadership synthesized the barriers and facilitators at multiple levels employing a framework that integrates a specific focus on the concept of care. The 71 sources identified focus predominantly on barriers to women's leadership at the individual and team level and, to a lesser extent, at the organizational and system level. Facilitators tend to be presented as recommended actions than evaluated interventions. Healthcare leadership tends to ignore the gendered context of care elevating leaders who are least likely to provide such care. Where personal caregiving circumstances are considered, they are individualized, reflecting the literature in general. More critical analysis is needed to focus on women's experiences and how their gender can predetermine their success in achieving and being in leadership positions. Healthcare leadership researchers are encouraged to include gender and care-focused analyses and interventions to address the under-representation of women in healthcare leadership.

A roadmap for surgeon leaders in improving gender equity: educational strategies, implementation, and evaluative methods

BACKGROUND

Gender diversity is lacking in the orthopedic workforce, and patient outcomes are known to be negatively affected when gender inequity exists. Following an unpublished needs assessment, we sought to evaluate participants' proposed solutions to gender inequity faced by female orthopedic surgeons in Canada and to translate the range of solutions into a medical education model.

METHODS

Open-text responses from a gender-bias survey of Canadian orthopedic surgeons who identified as women were analyzed qualitatively by 2 experts. The questions covered the domain of changes required to improve the work environment. We used the latter 2 steps of Kern's educational framework as a lens to interpret the data and generate solutions.

RESULTS

A total of 330 eligible surgeons were approached, and 220 (67.0%) completed the survey. Respondents provided more than 14 000 words of text for analysis. Using the themes of the unpublished needs assessment, we defined broad goals and specific objectives, including raising awareness, establishing an equitable playing field, drawing attention to male privilege, developing effective mentorship, eliminating harassment, and unburdening the second shift. We present solutions via educational strategies and evaluative methods based on Kern's framework.

CONCLUSION

We offer a road map for improving gender diversity in orthopedic surgery, based on survey results from Canadian women in orthopedic surgery, analyzed using a gender bias framework and an educational conceptual framework. We hope that this work will improve the surgical profession and patient care.

Gastric Cancer at a Nigerian Tertiary Referral Center: Experiences With Establishing an Institutional Cancer Registry

BACKGROUND

In Nigeria, gastric cancer is the 10th most common and 9th most deadly malignancy. The limited availability of robust data makes further characterizing it challenging. The objective of this study was to assess the presentation, and management of gastric cancer in Nigeria using an institutional cancer registry.

METHODS

We reviewed a prospective database of patients diagnosed with any gastric cancer at a single tertiary referral center over 15 years (2007-2022). Patients with suspected gastric cancer were surveyed for sociodemographics and then added to the institutional gastric cancer registry. Thereafter, periodic chart review and phone call was used to obtain investigation results, and survival data, respectively. Only patients with complete histopathology were included in analysis.

RESULTS

138 patients met inclusion criteria (mean age 55.3 years, 68.8% male). Patients typically presented with weight loss (119, 86.2%) and anorexia (92, 66.7%). Blood work (132, 95.7%) and ultrasound (80, 57.9%) were the most common investigations. Most fully staged patients presented with metastatic disease (39, 90.2%). Patients underwent at least one treatment modality (109, 79.0%), and most 54 (49.5%) underwent both chemotherapy and surgery. Patients undergoing surgery usually had resection of their tumor (58, 67.4%). The median time of follow-up was 45.6 months, and 51.4% (71) of patients were dead at that time point.

CONCLUSION

Our gastric cancer database identified that most patients present with advanced disease and are undergoing at least one treatment modality. The next steps include initiatives to strengthen the quality of registry data, identify high-risk patients, and provide timely treatment.

Time trends in stomach cancer mortality across the BRICS: an age-period-cohort analysis for the GBD 2021

Objectives

Stomach cancer is one of the leading causes of cancer death, and its epidemiologic characteristics are regionally heterogeneous worldwide. The BRICS nations (Brazil, Russian Federation, India, China, and South Africa) have markedly increasing influences on the international stage. We aim to investigate time trends in stomach cancer mortality among the BRICS countries from 1982 to 2021.

Methods

Data for this study were obtained from the Global Burden of Disease (GBD) 2021 public dataset to investigate the deaths, all-age mortality rate, and age-standardized mortality rate (ASMR) of stomach cancer. The age-period-cohort (APC) model was employed to estimate net drift, local drift, age-specific curves, and period (cohort) relative risks, and the Bayesian generalized linear model was employed to evaluate the relationship between food intake and mortality rate.

Results

In 2021, there were approximately 572,000 stomach cancer deaths across the BRICS, accounting for 59.9% of global death. Russian Federation exhibited the most significant reduction in ASMR of stomach cancer among the BRICS. In contrast, China continued to report the highest number of stomach cancer deaths. The risk of mortality associated with stomach cancer exhibited a marked increase with advancing age, both within these countries and at the global level. PUFA, sodium, calcium and trans fat may have an impact on the mortality rate of stomach cancer. Favorable trends in period and birth cohort effects were observed in these five nations over the past decades.

Conclusion

BRICS countries have made varying progress in reducing stomach cancer mortality. Given the diverse environments, it is recommended to progressively develop customized stomach cancer prevention strategies, utilizing available resources. Healthcare services should be extended to all age groups, with a particular emphasis on vulnerable populations.

Declining eradication rates of Helicobacter pylori with standard triple therapy in Addis Ababa, Ethiopia

BACKGROUND

Standard triple therapy is an effective treatment for eradicating Helicobacter pylori infection, but it is encountered with drug resistance. The stool antigen test is a cost-effective and easy-to-perform test to confirm the eradication of H. pylori, 4-8 weeks post-therapy, with 86% sensitivity and 92% specificity.

AIM

To assess the H. pylori eradication rate of standard triple therapy and factors affecting the eradication rate.

METHODS

We conducted a prospective, multicenter follow-up study in Addis Ababa, Ethiopia, at selected healthcare facilities among dyspeptic patients with positive stool H. pylori antigen tests from June 1, 2023 to October 30, 2023 to assess the H. pylori eradication rate. After completing the standard triple therapy, the eradication was confirmed using a stool antigen test 4 weeks later. The data were analyzed using bivariate and multivariate logistic regression methods.

RESULTS

The H. pylori eradication rate was 85.4%. Patients with a previous diagnosis of H. pylori infection, smokers, and local alcohol consumption were associated with a lower H. pylori eradication rate, with adjusted odds ratio (AORs) of 0.159 [95% confidence interval (CI): 0.050-0.511], 0.206 (95%CI: 0.052-0.822), and 0.228 (95%CI: 0.052-0.997), respectively. Patients with complete symptom resolution were 5.383 times more likely to achieve eradication than patients without symptom improvement, AOR = 5.383, 95%CI: 1.74-21.089.

CONCLUSION

H. pylori eradication rate was lower than expected. Post-treatment testing is crucial to confirm eradication and guide further management, such as susceptibility testing.

Seroprevalence and associated factors for hepatitis B and hepatitis C viral infection among patients with diabetes mellitus in Northern Tanzania

BACKGROUND

The coexistence of viral hepatitis with diabetes mellitus (DM) significantly escalates the risk of severe outcomes. This study aimed to determine the seroprevalence and associated factors of hepatitis B (HBV) and hepatitis C (HCV) viral infections among DM patients in northern Tanzania.

MATERIALS AND METHODS

Conducted between February 2023 and May 2023, this hospital-based cross-sectional study enrolled 189 patients with DM from the Diabetic Clinic of Kilimanjaro Christian Medical Centre. A structured questionnaire captured relevant clinical information, and plasma blood sample was assessed for hepatitis B surface antigen and anti-hepatitis C antibody seropositivity. Data analysis employed SPSS v26, and a chi-square test was used to determine the statistical difference of HBV and HCV among patients with DM. Logistic regression was performed to determine factors associated with HBV and HCV.

RESULTS

Among the 189 patients with DM, the seroprevalence of HBV and HCV infections stood at 2.1% and 0.5%, respectively. Males constituted a significant majority (80%) of those affected by viral hepatitis. Furthermore, 60% of affected patients were in non-union relationships (single, widowed, or divorced), and 40% reported multiple sexual partners. However, the study found no significant association between traditional associated factors and viral infection acquisition.

CONCLUSION

The study's findings reveal a relatively low prevalence of HBV and HCV infections among patients with DM compared to the general population, with no significant association among factors. Nonetheless, the results underscore the importance of early screening and vaccination for HBV and HCV in patients with DM. Such efforts are crucial for curbing infection spread and reducing the risk of hepatocellular carcinoma development in this vulnerable population.

Insights Into Non-Alcoholic Fatty Liver Disease and Diabetes Mellitus in Somalia: Prevalence and Risk Factors

Introduction

NAFLD is a rapidly expanding global health issue that is distinguished by the accumulation of hepatic fat that is not associated with alcohol consumption. Parallel to the increase in obesity and type 2 diabetes mellitus (T2DM), its prevalence is also increasing. Amidst a backdrop of limited epidemiological data, Somalia, which is undergoing urbanization and dietary adjustments, is contending with escalating rates of NAFLD. Our study aims to addresses critical voids in local epidemiological data regarding this subject in Somalia.

Methods and Materials

The objective of this retrospective study was to evaluate the prevalence of NAFLD and concomitant risk factors among T2DM patients at the Mogadishu Somalia Turkish Training and Research Hospital. A total of 832 patients diagnosed with T2DM between May 2023 and March 2024 were used to analyze the data. Various variables, such as age, sex, diabetic medications, hypertension, insulin resistance, hyperlipidemia, and NAFLD grade, were obtained from electronic medical records. Statistical analyses were conducted to investigate the associations and predictors of NAFLD using descriptive analysis, logistic regression, and multiple regression.

Results

The study cohort was predominately female (57%), with a mean age of 53.48 years. The most prevalent grades of NAFLD were grade 1 and grade 2, with NAFLD being identified in 53.8% of patients. NAFLD displayed a robust correlation with insulin resistance (OR: 52.04), with hypertension (OR: 20.091) and hyperlipidemia (OR: 2.528) following shortly thereafter. These factors collectively account for 57% of the variance in NAFLD, as indicated by multiple regression analysis (R2 = 0.57, F (6,823) = 184.302, p < 0.001).

Conclusion

This investigation emphasizes the presence of a high prevalence of NAFLD among T2DM patients in Mogadishu, Somalia, 53.8% which is substantially influenced by hypertension, insulin resistance, and hyperlipidemia. In this region, the necessity of targeted healthcare strategies to mitigate metabolic liver diseases is underscored by the results.

Prevalence of hepatitis B virus infection and associated factors among adults intrafamilial household contacts attending antenatal care clinics in the Central Ethiopian region: from pregnant women index cases

BACKGROUND

In Ethiopia, hepatitis B virus infections are prevalent and highly endemic. Additionally, there has been a significant increase in hospital admissions, morbidity, and mortality associated with hepatitis B virus infections. This study aimed to assess the prevalence of hepatitis B virus infection and associated factors among adult intrafamilial household contacts of pregnant women index cases attending antenatal care clinics in the central Ethiopian region.

METHODS

A community-based cross-sectional study was conducted between October 1, 2023, and March 1, 2024. Three hundred eighty-five adult intrafamilial household contacts were randomly selected via lottery methods. A 3 ml venous blood sample was taken from adult intrafamilial household contacts and checked for hepatitis B virus infection through hepatitis B surface antigen. An interviewer-administered questionnaire was used to collect the data. A logistic regression model predicted the relationship between predictor and outcome variables. A p-value of < 0.05 indicated statistical significance.

RESULTS

The overall response rate was 96.1%. Two-thirds of the adults of intrafamilial household contacts (n = 229; 61.9%) were aged between 18 and 28 years, with a mean age of 28 years. The prevalence rate of hepatitis B virus infection among adults of intrafamilial household contacts with pregnant women as the index case was 11.6% (95% CI, 8.6 to 15.1). Being male (AOR: 0.09; 95% CI: 0.03, 0.37) and a duration of stay with the index case of less than six months (AOR: 0.30; 95% CI: 0.11, 0.81) were associated with a reduced risk of hepatitis B virus infection. Meanwhile, large family sizes (≥ 7) (AOR: 4.32; 95% CI: 1.34, 13.98), genital discharge (AOR: 3.14; 95% CI: 1.60, 6.15), engagement in unsafe sex (AOR: 2.37; 95% CI: 1.13, 4.97), and a history of mortality due to hepatitis in the family (AOR: 3.03; 95% CI: 1.09, 8.42) were associated with an increased risk of hepatitis B virus infection.

CONCLUSION

This study found that hepatitis B surface antigen seropositivity among adult intrafamilial household contacts with pregnant women index cases in the central Ethiopia region was high at 11.6%. These findings suggest that interventions to prevent HBV infection should prioritize educational campaigns targeting adult intrafamilial household contacts of HBV-positive index cases, focusing on risk factors associated with HBV transmission, prevention, counselling, testing, and vaccination.

Prevalence and associated factors of diabetic ketoacidosis among patients with diabetes mellitus at the University of Gondar Comprehensive and Specialized Referral Hospital Northwest, Ethiopia

BACKGROUND

Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Diabetic ketoacidosis is one of the life-threatening complications in diabetic individuals with, high morbidity and mortality globally. However, the data related to the prevalence and associated factors of diabetic ketoacidosis are limited in the study setting.

OBJECTIVE

To assess the prevalence of diabetic ketoacidosis and its associated factors among diabetic mellitus patients at the University of Gondar Comprehensive Specialized Hospital.

METHODS

A hospital-based cross-sectional study was conducted from March 1 to September 30, 2021. A total of 405 diabetic patients aged 20 and above were selected using a systematic random sampling technique. A total of 810 blood and urine samples (each 405) were collected using sterile serum separator tubes and urine collection cups, respectively. Sociodemographic and clinical data was collected using a structured questionnaire. Chemical analysis of urine was done using urine reagent strips to determine urine ketone bodies and PH. BECKMAN COULTER DxC700 AU clinical chemistry analyzer instrument was used to determine electrolytes and metabolites. The data was entered using Epi-Data version 4.6 and transferred to SPSS version 25 for analysis. Bivariable and multivariable logistic regression analyses were used to determine the factors associated with the diabetic ketoacidosis. The results were considered statistically significant if the adjusted odds ratio was reported with a 95% confidence interval and a P-value below 0.05.

RESULTS

The overall prevalence of diabetic ketoacidosis among diabetic patients was 35/405 (8.6%, 95% CI: 6.0-11.0%). Of these cases, 25 (71.4%) had type 1 diabetes mellitus, while 10 (28.6%) had type 2 diabetes mellitus. Statistically significant factors associated with diabetic ketoacidosis included being a young adult aged 20-29 years (AOR = 2.262; 95% CI = 1.090-4.758; P = 0.013), unemployment (AOR = 2.578; 95% CI = 1.457-6.113; P = 0.017), the presence of infection (AOR = 2.819; 95% CI = 1.138-8.428; P = 0.024), and being T1DM (AOR = 3.106; 95% CI = 1.150-7.273; P = 0.003).

CONCLUSIONS AND RECOMMENDATIONS

The prevalence of diabetic ketoacidosis among follow-up diabetes patients in this study was high, particularly among those aged 20-29 years, unemployed, or with infections. Increased vigilance, regular monitoring, timely infection management, and comprehensive diabetes education are essential for early detection and prevention of DKA. Social and financial support for unemployed diabetic patients can further enhance access to care and reduce DKA risk.

A scoping review on the impact of women's global leadership: evidence to inform health leadership

INTRODUCTION

The documented benefits of gender parity in leadership are emerging-women leaders have been shown to have a positive impact on maternal and health care policies, strengthen health facilities, and reduce health inequalities. More research is needed, however, to document their impact on global health. We go beyond the well-documented barriers that uphold the lack of gender parity by identifying areas where women leaders are making an impact to inform investment, programming, and policy.

METHODS

We conducted a scoping review of peer-reviewed literature, following Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, to map evidence on the impact of women's leadership in organisations in low- and middle-income countries. As many leadership outcomes are cross-disciplinary, outcomes were explored across sectors with particular attention paid to the relevance of these outcomes for global health.

RESULTS

137 articles were included in the review. Studies found women leaders' positive influence on six areas of impact: (1) financial performance, risk, and stability, (2) innovation, (3) engagement with ethical initiatives, (4) health, (5) organisational culture and climate outcomes, and (6) influence on other women's careers and aspirations. Articles reporting mixed results focused on multiple indicators and still largely pointed to positive results, particularly when modified by other factors including increased education, increased experience, and opportunities to work with other women across the organisation. In all sectors, across leadership roles, and across geographies, women's leadership can produce positive results. Women leaders' success, however, cannot be separated from the contexts in which they work, and unsupportive environments can affect the extent to which women leaders can have an impact.

CONCLUSION

Increased and sustained investment in women's leadership within the health sector can lead to improved outcomes for organisations and their clients. Such investments must not only target individual women, but also seek to foster organisational cultures that promote and retain women leaders and support their independent decision-making.

Mistakes to avoid in the management of abdominal tuberculosis

INTRODUCTION

The diagnosis and management of abdominal tuberculosis, i.e Gastrointestinal Tuberculosis (GITB) and tuberculous peritonitis (TBP) is challenging. Abdominal tuberculosis, presenting usually with abdominal pain, intestinal obstruction, and constitutional symptoms, is typically a paucibacillary condition. The diagnosis hinges on a correct interpretation of clinical, radiological, histological, biochemical, and microbiological findings as also appropriately assessing response to therapy.

AREAS COVERED

The authors review potential missteps that could occur in managing GITB and TBP sourced from published literature and clinical experience. These include avoiding excess use of tests with limited accuracy, understanding limitations of ascitic adenosine deaminase (ADA) and granulomas, avoiding empirical antitubercular therapy (ATT) where possible but also understanding that microbiological tests may not always be positive, and finally not to bank solely on subjective clinical responses but to use objective markers in assessing response to therapy. In addition, diagnosis of predisposing immunosuppressed states, attention to nutrition, appropriate management of sequelae with endoscopic dilatation/surgery, and early surgery when indicated are some of the additional issues discussed.

EXPERT OPINION

In future, a more secure diagnosis banking on the use of better microbiological tools, multiparameter-based models, artificial intelligence-based approaches, and use of advances in -omics-based approaches can improve diagnosis and avoid some missteps.

Oncogenic genodermatoses in paediatric patients with skin of colour: a review

Cutaneous neoplasms are relatively rare in children. Most commonly, skin cancers arise through environmental factors, particularly ultraviolet radiation; thus, age is the most predictive factor in developing cutaneous carcinomas. However, children born with certain genodermatoses are significantly more likely to develop malignancies and must be carefully monitored and treated. Most published data are based mainly on signs and symptoms present in White patients. Therefore, we aim to highlight the cutaneous presentations and relative differences of these genodermatoses among patients with skin of colour, who are underrepresented in medicine. We conducted a literature review of 504 patients presented in 236 published articles. Manuscripts with accessible case reports for children aged ≤ 17 years were included. Patients with skin of colour often present with fewer classical findings and have higher incidences of scarring and dyspigmentation. There is also a higher incidence of consanguinity in affected patients. Providers who are able to recognize nonclassical signs can provide proper management and treatment regimens, potentially bringing outcomes for patients with skin of colour more in line with those of White children.

A Recessive oca2 Mutation Underlies Albinism in Xiphophorus fish

Oculocutaneous albinism (OCA) is a group of genetic disorders characterized by impaired melanin production, leading to reduced pigmentation in the skin, hair, and eyes. Xiphophorus , a genus of small freshwater fish, has been a pivotal model organism in pigmentation disorder research, providing key findings in the genetic pathways governing physiological and pathological pigment cell biology. Leveraging the well-established research framework provided by Xiphophorus , we have identified a spontaneously occurring albinism phenotype in swordtail fish Xiphophorus hellerii . Genetic mapping of albino fish showed that albinism is associated with a recessive mutation in the oca2 gene. This discovery provides a novel opportunity to explore functions of oca2 gene in pigment cell differentiation, pigment synthesis, melanosome assembly and transportation function and amelanotic melanoma development.

HIV retesting uptake and incidence during pregnancy and breastfeeding period among women in sub-Saharan Africa

To prevent and reduce mother-to-child transmission of HIV and maternal morbidity and mortality, the World Health Organization currently requires retesting for HIV during pregnancy and postpartum. This was a systematic review and meta-analysis in which PubMed, Cochrane Library, Embase, and clinicaltrials.gov were searched for articles published between January 2005 and February 2024. Retesting uptake was defined as the number of women who tested for HIV during pregnancy/breastfeeding periods following an initial HIV-negative test during these periods. Using random-effects models, we computed the pooled prevalence of HIV retesting uptake, incidence rates (IRs), and 95% confidence intervals (CIs). A sensitivity analysis was done by excluding studies that tested women during labor and reported 100% retesting uptake. A total of 37 studies with 1,999,621 women were analyzed. Overall, the pooled prevalence of HIV retesting uptake was 89.1% (95%CI, 81.0-95.2). Retesting uptake was significantly higher during breastfeeding compared to pregnancy (93.3% vs. 89.9%; P < 0.001). A sensitivity analysis showed that overall retesting uptake was 73.9% (95%CI, 60.1-83.8). A total of 1302 (0.2%) women acquired HIV. Twenty-two studies reported an IR; the overall pooled IR was 4.3/100 person-year (PY; 95%CI, 3.4-5.2/100 PY). The HIV incidence rate was significantly higher during pregnancy compared to breastfeeding (5.9/100 vs. 3.4/100 PY; P < 0.001). One to three in 10 women in sub-Saharan Africa do not retest for HIV following a negative test during pregnancy or breastfeeding periods. Emphasizing HIV retesting during these periods is critical to eliminate pediatric HIV given that the overall IR is beyond the WHO threshold (3.0/100 PY) for a substantial risk of HIV transmission.

Diabetic ketoacidosis treatment outcomes and its associated factors among adult patients with diabetes mellitus admitted to public hospitals in Nekemte Town, Ethiopia: a cross-sectional study

Background

Diabetic ketoacidosis (DKA) is a serious and acute complication of diabetes mellitus. In Ethiopia, the mortality associated with acute diabetes complications ranges from 9.8% to 12%. Despite this, there is limited information on the clinical outcomes of DKA in our study location. Therefore, this study aimed to assess the magnitude and associated factors of DKA treatment outcomes among adult patients with diabetes admitted to public hospitals in Nekemte Town, Ethiopia.

Objective

To assess the DKA treatment outcomes and their associated factors among adult patients with diabetes admitted to public hospitals in Nekemte Town.

Methods

A 5-year cross-sectional study was conducted using a systematic random sampling technique among 201 patients from 1 July to 31 August 2023. DKA treatment outcomes were assessed at discharge. Pharmacists collected data by reviewing patient charts using Kobo Toolbox software. The data were then exported to SPSS Version 27 for analysis. Both bivariable and multivariable logistic regression analyses were performed. Variables with a P-value < 0.25 in the bivariable logistic regression were entered into the multivariable regression analysis to control for potential confounders. An adjusted odds ratio with a 95% confidence interval was used to identify predictors of treatment outcomes. A P-value < 0.05 was considered significant in the multivariable analysis.

Result

Complete data was available for 201 patients admitted with DKA. The majority, 178 (88.6%), improved and were discharged. Independent predictors of DKA recovery were comorbidities [AOR: 3.45, 95% CI: 1.33, 9.72], admission Glasgow Coma Scale (GCS) score (<8) [AOR: 2.74, 95% CI: 1.02, 7.34], random blood glucose (RBS) (≥ 500) [AOR: 3.07 (95% CI: 1.12, 8.39)], and urine ketones (≥ +3) [AOR: 3.24, 95% CI: 1.18, 8.88].

Conclusion and recommendation

Most of the treated patients with DKA were discharged with improvement. Comorbidity, admission GCS, RBS, and urine ketones were independently associated with DKA recovery. In general, significant consideration should be given to DKA prevention, early detection, and appropriate hospital management.

Community-Based Point-of-Care Screening for Hepatitis B Virus and Hepatocellular Carcinoma in Rural Tanzania

Sub-Saharan Africa has a high burden of hepatitis B virus (HBV) and hepatocellular carcinoma (HCC). The lack of surveillance programs has led to low rates of diagnosis and treatment, particularly in rural areas. We conducted mobile HBV-HCC screening clinics in rural Tanzania between March 2021 and February 2023. After undergoing informed consent, patients completed a questionnaire about HBV. A rapid point-of-care (POC) assay measured HBV surface antigen (HBsAg), and HBsAg-positive patients underwent POC ultrasound to screen for HCC and POC hepatitis C (HCV) antibody testing. The primary outcome was number of HBV diagnoses, and the secondary outcome was prevalence of liver masses in HBsAg-positive individuals. Data were analyzed with descriptive statistics. Five hundred and one patients were screened for HBV; 63% (n = 303) were female with median (interquartile range [IQR]) age of 40 (28-55) years. Only 6% (n = 30) reported being vaccinated against HBV, 92% (n = 453) reported no vaccination, and 2% (n = 12) did not know their vaccination status. Seventy-six percent (n = 340) did not know they should get vaccinated, and 4% (n = 16) reported that vaccination was too expensive. Two percent (n = 11) of patients were positive for HBsAg, with 55% (n = 6) of those being female with median (IQR) age of 36 (34-43) years. None of the HBsAg-positive patients reported being vaccinated against HBV, and all were negative for HCV. On ultrasound, one patient had a liver mass, and another had ascites. We demonstrated that community-based HBV and HCC screening can be implemented in Africa with local partnerships, and this model could be used to promote awareness and improve early detection of disease.

Barriers to orthodox medical care of prostate cancer in Ghana

Traditional medicine is widely used in sub-Saharan Africa, particularly in Ghana, where it is commonly integrated with modern orthodox medicine. This study examines the barriers that delay the pursuit of orthodox medical care for prostate cancer (PCa) in Ghana's Central region, where a blend of traditional and modern orthodox medicine exists. The preference for indigenous traditional medicine often results in late-stage presentations of PCa, adversely affecting patient outcomes. This prospective cross-sectional study was conducted from July to December 2022 at the Cape Coast Teaching Hospital (CCTH) and in four local communities. We investigated why men prefer traditional over orthodox medicine and identified cultural beliefs, attitudes, and gaps in health awareness that contribute to delays in diagnosing and treating PCa. The study involved administering questionnaires, providing education on PCa, and conducting free prostate-specific antigen (PSA) screening. Ethical approval was obtained from the Ethics Research Committee of the Ghana Health Service. A total of 282 patients participated, including 268 men from the communities and 14 diagnosed with PCa at CCTH after initially consulting traditional healers. Of the community-recruited patients who underwent PSA testing, 26% had elevated PSA levels and underwent further diagnostic procedures. Ultimately, nine of 268 community patients were confirmed to have PCa. Most patients (57.4%) had limited education, which correlated with late presentations and various misconceptions about PCa. The study highlights significant cultural and economic barriers that lead to the late-stage presentation of PCa among men in Ghana's Central region. There is a critical need for a culturally sensitive, multi-pronged strategy that enhances public education about the benefits of early diagnosis and fosters collaboration between traditional healers and orthodox healthcare providers to improve prostate cancer outcomes in Ghana.

Pivotal role of Helicobacter pylori virulence genes in pathogenicity and vaccine development

One of the most prevalent human infections is Helicobacter pylori (H. pylori), which affects more than half of the global population. Although H. pylori infections are widespread, only a minority of individuals develop severe gastroduodenal disorders. The global resistance of H. pylori to antibiotics has reached concerning levels, significantly impacting the effectiveness of treatment. Consequently, the development of vaccines targeting virulence factors may present a viable alternative for the treatment and prevention of H. pylori infections. This review aims to provide a comprehensive overview of the current understanding of H. pylori infection, with a particular focus on its virulence factors, pathophysiology, and vaccination strategies. This review discusses various virulence factors associated with H. pylori, such as cytotoxin-associated gene A (cagA), vacuolating cytotoxin gene (vacA), outer membrane proteins (OMPs), neutrophil-activated protein (NAP), urease (ure), and catalase. The development of vaccines based on these virulence characteristics is essential for controlling infection and ensuring long-lasting protection. Various vaccination strategies and formulations have been tested in animal models; however, their effectiveness and reproducibility in humans remain uncertain. Different types of vaccines, including vector-based vaccines, inactivated whole cells, genetically modified protein-based subunits, and multiepitope nucleic acid (DNA) vaccines, have been explored. While some vaccines have demonstrated promising results in murine models, only a limited number have been successfully tested in humans. This article provides a thorough evaluation of recent research on H. pylori virulence genes and vaccination methods, offering valuable insights for future strategies to address this global health challenge.

Management Outcomes of Variceal Bleeding in Northern Tanzania: Insights From a Single-Center Retrospective Analysis

Aims

Due to the expensiveness and unavailability of endoscopy management in Tanzania, the management outcomes of variceal bleeding are unknown. The objective of this study was to assess the management outcomes of patients with variceal bleeding.

Methods

This was a retrospective study conducted between April 2012 and April 2022. The study enrolled all patients diagnosed with variceal bleeding aged 18 years and older. Socio-demographic and clinic characteristics, treatment modalities, and outcomes were collected. Statistical analysis was done using a chi-square test. Multivariable logistic regression was used to determine factors associated with rebleeding and mortality. A p-value of ≤ 0.05 was considered statistically significant.

Results

A total of 534 patients were enrolled based on diagnostic endoscopy findings. Esophageal varices were identified in 88.9% of patients, gastric varices in 0.9%, and 10.1% had both. Conservative treatment was given to 77.5% of patients, and endoscopic treatment was performed in 22.5%: endoscopic variceal ligation (17.6%), endoscopic injection sclerotherapy (4.3%), and both (0.6%). Rebleeding occurred in 40.1%, and factors associated with rebleeding were patients without insurance (p = 0.037), without comorbidities (p = 0.042), with non-communicable diseases (p = 0.039), and with chronic infections (p = 0.035). In-hospital mortality was 8.1%, and factors associated with mortality were a shorter length of stay (p = 0.045), patients without comorbidities (p = 0.041), and grade II esophageal varices (p = 0.043).

Conclusion

This study shows a high rate of variceal bleeding among patients treated conservatively. Mortality and rebleeding rates in our setting remain high, which appears to be due to the expensiveness and unavailability of endoscopic treatment. Available endoscopic interventions will be vital in improving the outcomes of patients with variceal bleeding.

Hepatitis B Care and Treatment in Zanzibar, Tanzania: A Demonstration Project Following 2015 WHO Treatment Guidelines, 2017-2021

Zanzibar, a low-resource semiautonomous region of Tanzania, has an estimated prevalence of hepatitis B virus (HBV) infections of 3.6%. To assess the feasibility of care and treatment, a 5-year hepatitis B demonstration project was implemented in Zanzibar during January 2017-December 2021, following the 2015 WHO HBV care and treatment guidelines. Participants included adults (aged ≥ 18 years) who tested positive for HBV surface antigen and tested negative for HIV and hepatitis C antibody. Participants were examined for clinical signs of liver disease and testing was conducted at baseline to assess treatment eligibility and every 6-12 months thereafter. Tenofovir disoproxil fumarate (TDF) was provided at no cost to treatment-eligible participants. Clinical and laboratory data were analysed to assess improvement in proximal disease outcomes. Among 596 participants enrolled, the median age was 32 years (IQR 26-39) and 365 (61%) were male. Of those enrolled, 268 (45%) returned for ≥ 1 follow-up visit, with a median of 511 days of follow-up. Overall, 58 patients initiated treatment: 15 met treatment criteria based on liver cirrhosis alone; 13 by APRI > 1.5; among those with HBV DNA results, six met criteria based on HBV DNA levels and ALT activity; 24 met ≥ 2 criteria. Significant decreases in ALT activities, APRI scores and HBV DNA levels were observed among those treated. This hepatitis B care and treatment programme was demonstrated to be feasible in a low-resource setting. Despite challenges, testing and linkage to care is critical to decrease the global burden of hepatitis B.

Development and Implementation of a Context-Specific Multi-modal Point-of-Care Ultrasound Curriculum for a Kenyan Family Medicine Residency Program

Access to diagnostic imaging is significantly limited in much of the world, and sub-Saharan Africa is no exception. Clinician-performed point-of-care ultrasound (POCUS) may provide increased access to diagnostic imaging for many patients in low-resource settings, but training in this modality is limited. We describe the development and implementation of a context-specific, multi-modal pilot POCUS curriculum involving hands-on instruction, in-person and online didactics, asynchronous online image review, and quantitative evaluation. The curriculum was specifically designed for family medicine residents at a rural Kenyan training hospital. This evidence-based training curriculum was designed for integration into a residency curriculum to train Kenyan family medicine physicians to achieve competence in POCUS use and develop the local expertise and leadership necessary to reproduce the training at other institutions. The curriculum was designed specifically for this Kenyan context; however, we provide a detailed description of all curricular elements and review the evidence informing those elements in order to facilitate reproduction at other similar institutions and settings to improve access to POCUS training. We trained eight family medicine resident participants, all of whom strongly agreed with the utility of the curriculum and its component parts. All eight trainees met quantitative competency measures by written evaluations, direct observation, structured clinical exams, image review, and overall numbers of POCUS exams. A total of 1029 ultrasound scans were performed by the participants in the first year of implementation, averaging 128 scans per participant. No participant fully completed the required number of 165 scans for each application; however, most participants are continuing to add to their numbers as planned. Many of these scans were performed under direct faculty supervision to allow for real-time assessment and feedback, and the rest were asynchronously reviewed. All participants also passed all five observed standardized clinical evaluations (OSCEs), demonstrating their competency to perform, record, and interpret images in a timely and accurate manner. We describe many of the logistical requirements and challenges we experienced, as well as our methods of adapting to or overcoming them. Our curriculum is an effective means of developing POCUS competence in an African setting. Our data and experience with implementation may help establish or expand POCUS into medical training in other institutions in sub-Saharan Africa, improving access to this vital diagnostic tool.

Comparison of IL-6, IL-10, and TNFα Levels Between PLWHIV With and Without Kaposi Sarcoma and Healthy Controls

INTRODUCTION

Kaposi sarcoma (KS) is an angioproliferative disease caused by human herpesvirus 8 and is mediated by cytokines in an immunodeficient environment. This study aimed to compare IL-6, IL-10, and TNFα levels among patients with AIDS with disseminated KS (DKS), treatment naïve patients living with HIV without DKS, and healthy controls. Secondary outcomes were to compare cytokines levels in patients with DKS and unfavorable outcomes, and an analysis of the behavior of cytokines over time.

METHODS

This cohort study was performed at 2 centers in Mexico City. Three groups were included. Group 1: HIV+ treatment naïve with DKS, group 2: HIV+ treatment naïve without KS, and group 3: HIV negative, healthy controls. Plasmatic IL-6, IL-10, and TNFα levels were measured at baseline and over time in groups 1 and 2.

RESULTS

Seventy-six patients were included: 39 (52%) in group 1, 17 (22%) in group 2, and 20 (26%) in group 3. The median baseline IL-6, IL-10, and TNFα levels were significantly higher in group 1. In group 1, baseline IL-6 was higher in patients who died than in survivors (14.4 vs 5.8 pg/mL P = 0.048). Patients with severe immune reconstitution inflammatory syndrome because of KS had higher IL-6 values than those without it (14.4 vs 5.8 pg/mL P = 0.004). In the repeated measures model in group 1, IL-10 levels were higher in patients who died ( P < 0.001) and developed immune reconstitution inflammatory syndrome-KS ( P = 0.01).

CONCLUSIONS

IL-6, IL-10, and TNF α levels were markedly higher in patients with DKS. IL-6 and IL-10 levels were higher in patients with unfavorable outcomes.

The use of real-world evidence to generate cost analysis of antibiotic susceptibility testing (AST) in patients with Helicobacter pylori treatment failure in Thailand: A large population-based study

Background

H. pylori eradication is effective for gastric cancer prevention. Treatment failure is caused by increased antibiotic resistance. This study aimed to determine eradication rates and perform cost analysis between susceptibility-guided therapy and empirical treatment in patients with H. pylori treatment failure.

Methods

This retrospective cohort study included patients with dyspepsia undergoing gastroscopy at tertiary care center in Thailand from March 2014 to October 2021. Treatment failure was defined as persistent H. pylori infection after ≥1 regimen completion. Early AST was defined as AST performed shortly after first-line treatment failure. Demographic data, AST results, eradication regimens, and medication costs were collected from database and reviewed.

Results

Of 1080 patients with H. pylori infection, 315 had treatment failure (mean age 58.4 years; 44.4 % males). AST of 85 strains demonstrated resistance to levofloxacin (57.6 %), metronidazole (51.8 %), clarithromycin (44.7 %), and amoxicillin (4.7 %). In multivariate analysis, sequential therapy was significantly associated with treatment failure (OR 1.66; 95%CI 1.01-2.74, p = 0.045), whereas vonoprazan-containing therapy was related to treatment success (OR 1.60; 95%CI 1.04-2.48, p = 0.034). Medication nonadherence (OR 37.97; 95%CI 8.97-160.65, p < 0.001) contributed to treatment failure. Susceptibility-guided therapy provided better eradication rate than empirical therapy (97.5% vs. 65.5 %, OR 20.54; 95%CI 4.92-85.81, p < 0.001) in treatment failure group. Twenty-four patients had early AST, while 61 had AST after treatment failures. Most patients with early AST achieved treatment success by second-line eradication. Early AST provided significantly lower total average cost of treatment than group without AST ($368.2 vs. $402.0 per patient, p = 0.034) and AST after treatment failures ($368.2 vs. $752.8 per patient, p < 0.001). Early AST group had the lowest cost of subsequent medication, posttreatment urea breath test, and hospital visits.

Conclusion

Susceptibility-guided therapy provided significantly higher eradication rate than empirical therapy in patients with treatment failure. Early AST might be a cost-effective strategy for H. pylori eradication after failed therapy and can prevent unnecessary antibiotic use in Thailand.

Epidemiological and anatomopathological profile of colorectal cancer in Northern Morocco between 2017 and 2019

BACKGROUND AND STUDY AIMS

Colorectal cancer (CRC) is the third most common type of cancer worldwide and the second leading cause of cancer-related death. CRC represents a major public health problem in many countries, and its incidence is increasing worldwide. In Morocco, CRC is the third most common cancer. However, epidemiological data on CRC in Morocco, especially in the north, are very limited. This study aimed to describe the epidemiological and clinicopathological characteristics of CRC in northern Morocco.

PATIENTS AND METHODS

This retrospective study was conducted at the Ahmed Ben Zayed Al Nahyan Regional Oncology Center of Tangier between April 2017 and December 2019. Data were collected from the medical records of confirmed CRC patients and analyzed using SPSS computer software version 23.

RESULTS

CRC was detected in 142 patients, accounting for 13.0 % of all cancers identified during the study period in the center. The sex ratio (male/female) of all patients was 1.1. The mean age was 58 years, and the most affected group was 60-69 years old (29.0 %). The rectum was the most common anatomical site (44.0 %) compared to the left and right colon. Histologically, adenocarcinomas were the most common type (91.3 %), half of the tumors were moderately differentiated, and only 4.9 % of the patients presented with poorly differentiated tumors. At diagnosis, 83.0 % of patients were already in advanced stages (stage III, or IV), including 40.3 % presenting with metastatic disease. The liver (64.8 %) was the most affected site by metastasis in our series. Relapse was observed in 11.9 % of patients.

CONCLUSION

Our results showed a younger age at diagnosis and a higher incidence of cancer at the rectal site compared to the Western literature, as well as a high frequency of patients who presented with late-stage disease and other characteristics. However, larger multicenter studies are still needed to confirm our results.

Helicobacter pylori Management in Africa: A Survey of Diagnostic, Treatment, and Related Resources

BACKGROUND

Although Helicobacter pylori infection (H. pylori) prevalence in Africa has declined in the last decade, it remains concerningly high. H. pylori is asymptomatic in the majority of patients but is associated with significant morbidity and mortality in 10%-20%.

MATERIALS AND METHODS

We conducted an online survey of 21 African countries, with the link distributed to members of the African Helicobacter Microbiota Study Group. The survey was completed by 562 respondents; the majority were from Nigeria (27.2%), South Africa (18.1%), Tanzania (17.6%), Egypt (16.9%), and Cameroon (14.2%).

RESULTS

The most common reason for H. pylori testing was dyspepsia in 83.9% of the cases. Abnormal findings at gastroscopy (62.3%) and heartburn (61.7%) were also common indications. Stool antigen testing and histological examination of gastric biopsies using Giemsa were the two most used methods for H. pylori testing at 62.3% and 50.3%, respectively. Most respondents reported the use of standard clarithromycin-based triple therapy as first-line treatment for H. pylori infection.

CONCLUSION

This survey has demonstrated the diversity of practice and resource availability within the African continent. Several international guidelines exist on the management of H. pylori, but little data is available in Africa on how this condition is managed in every day clinical practice. There is an urgent need to formulate evidence-based and locally relevant practice guidelines on the African continent. In this context, the African Helicobacter and Microbiota study group was formed to coordinate efforts across the continent on H. pylori research to provide guidance on its management. This paper, therefore, aimed to evaluate the practice of H. pylori diagnostics and management, as well as related resources in representative countries in Africa, to facilitate the development of such guidelines.