A 10-year retrospective study of lung cancer in Uganda

The FRESHAIR4Life study: Global implementation research on non-communicable disease prevention targeting adolescents' exposure to tobacco and air pollution in disadvantaged populations

The FRESHAIR4Life study aims to reduce the non-communicable disease (NCD) burden by implementing preventive interventions targeting adolescents' exposure to tobacco use and air pollution (AP) worldwide. This paper presents the FRESHAIR4Life methodology and initial rapid review results. The rapid review, using various databases and PubMed, aimed to guide decision-making on risk factor focus, target areas, and populations. It showed variable NCD mortality rates related to tobacco use and AP across the participating countries, with tobacco as the main risk factor in the Kyrgyz Republic, Greece, and Romania, and AP prevailing in Pakistan and Uganda. Adolescent exposure levels, sources, and correlates varied. The study will continue with an in-depth situational analysis to guide the selection, adaptation, and integration of evidence-based interventions into the FRESHAIR4Life prevention package. This package will be implemented, evaluated, assessed for cost-effectiveness, and iteratively refined. The research places a strong emphasis on co-creation, capacity building, and comprehensive communication and dissemination.

Functionalization strategies of metal-organic frameworks for biomedical applications and treatment of emerging pollutants: A review

One of the representative coordination polymers, metal-organic frameworks (MOFs) material, is of hotspot interest in the multi field thanks to their unique structural characteristics and properties. As a novel hierarchical structural class, MOFs show diverse topologies, intrinsic behaviors, flexibility, etc. However, bare MOFs have less desirable biofunction, high humid sensitivity and instability in water, restraining their efficiencies in biomedical and environmental applications. Thus, a structural modification is required to address such drawbacks. Herein, we pinpoint new strategies in the synthesis and functionalization of MOFs to meet demanding requirements in in vitro tests, i.e., antibacterial face masks against corona virus infection and in wound healing and nanocarriers for drug delivery in anticancer. Regarding the treatment of wastewater containing emerging pollutants such as POPs, PFAS, and PPCPs, functionalized MOFs showed excellent performance with high efficiency and selectivity. Challenges in toxicity, vast database of clinical trials for biomedical tests and production cost can be still presented. MOFs-based composites can be, however, a bright candidate for reasonable replacement of traditional nanomaterials in biomedical and wastewater treatment applications.

Ultrasononography in Managing Extrapulmonary Tuberculosis: A Randomized, Controlled, Parallel, Superiority, Open-Label Trial

BACKGROUND

Patients with suspected extrapulmonary tuberculosis are often treated empirically. We hypothesized that extended focused assessment with sonography for human immunodeficiency virus (HIV) and tuberculosis (eFASH), in combination with other tests, would increase the proportion of correctly managed patients with suspected extrapulmonary tuberculosis.

METHODS

This trial in adults with suspected extrapulmonary tuberculosis was performed in a rural and an urban hospital in Tanzania. Participants were randomized 1:1 to intervention or routine care, stratified by site and HIV status. All participants underwent clinical evaluation, chest radiography, and testing with sputum Xpert MTB/RIF and urine Xpert MTB/RIF Ultra assays. The intervention was a management algorithm based on results of eFASH plus microbiology, adenosine deaminase (ADA), and chest radiography. The primary outcome was the proportion of correctly managed patients. The presence of positive microbiological or ADA results defined definite tuberculosis. An independent end-point review committee determined diagnoses of probable or no tuberculosis. We evaluated outcomes using logistic regression models, adjusted for randomization stratification factors.

RESULTS

From September 2018 to October 2020, a total of 1036 patients were screened and 701 were randomized (350 to the intervention and 351 to the control group). Of participants in the intervention group, 251 (72%) had a positive eFASH outcome. In 258 (74%) of the intervention and 227 (65%) of the control participants antituberculosis was initiated treatment at baseline. More intervention participants had definite tuberculosis (n = 124 [35%]), compared with controls (n = 85 [24%]). There was no difference between groups for the primary outcome (intervention group, 266 of 286 [93%]; control group, 245 of 266 [92%]; odds ratio, 1.14 [95% confidence interval: .60-2.16]; P = .68). There were no procedure-associated adverse events.

CONCLUSIONS

eFASH did not change the proportion of correctly managed patients but increased the proportion of those with definite tuberculosis.

CLINICAL TRIALS REGISTRATION

Pan African Registry: PACTR201712002829221.

Assessment of survival outcomes among lung cancer patients at the National and Referral Hospital in Kenya

INTRODUCTION

Lung cancer has a low overall survival rate linked to late diagnosis and metastasis. Unfortunately, comprehensive data within the African continent are limited due to the lack of a registry, low public awareness of lung cancer, financial constraints, and inadequate screening and treatment facilities. In addition, there was a lack of conclusive data in our setting. Therefore, this study aimed to assess survival outcomes among lung cancer patients at Kenyatta National Hospital.

METHODS

A hospital-based retrospective cohort study was performed to examine the survival outcomes of 151 lung cancer patients. All eligible lung cancer patients diagnosed and treated in the facility between January 1, 2018, and December 31, 2020, were included. The patients were retrospectively followed from the date of primary cancer diagnosis until death or the last follow-up period. The Statistical Package for the Social Sciences (SPSS) version 20.0 statistical software was used to enter and analyze the data. Kaplan-Meier survival and Cox regression analysis were employed to determine median survival and predictors of mortality, respectively.

RESULTS

The mean and median follow-time was 18.2 and 17.5 months, respectively. Most (98%) of the patients had non-small cell lung cancer. The 2-year survival rate was 66.7%, with 59.6% of patients having developed distant metastasis during the follow-up, while 25.1% were deceased. The median cancer-specific survival time among the study population was 18.0 ± 3.40 months. Cox regression analyses showed that patients with distant metastasis had five times more risk of dying (AHR: 4.74, 95% CI: 2.1-10.8, p < 0.001) than patients without distant metastasis.

CONCLUSIONS

The overall two-year survival rate of lung cancer patients at the Kenyatta National Hospital was 66.7%, with most patients developed distant metastasis during the follow-up period. Distant metastasis was the only significant predictor of mortality among lung cancer patients in our setting.

HIV-related lung cancer in Uganda: a cohort study

Background

There are few reports on lung cancer among people with HIV (PWH) in Sub-Saharan Africa. In this report, we describe a cohort of PWH and lung cancer at the Uganda Cancer Institute.

Methods

This retrospective cohort of PWH and lung cancer was managed at the Uganda Cancer Institute between 2008 and 2018. Sociodemographic and clinical data were abstracted from the patient charts. The median survival from diagnosis to death, loss-to-follow up or 31st December 2018, was estimated.

Results

There were 18 people with HIV and lung cancer. The median (interquartile range, IQR) age was 49.5 (38.8–56.0) years, 11 (61.1%) were women and 5 (27.8%) were smokers. Of the 18 PWH, 13 (72.2%) were on antiretroviral therapy and the median (IQR) CD4 count (n = 13) was 380 (243.5–595) cells per mm³. Difficulty in breathing (88.9%), chest pain (78.6%, n = 11), cough (76.5%, n = 17) and weight loss (72.2%) were the commonest symptoms while pleural effusions were observed in 12 (66.7%). In this cohort, 8 (44.4%) were presumptively treated for tuberculosis before the diagnosis of lung cancer. Seven (38.9%) had an Eastern Cooperative Oncology Group performance status of 3. Non-small cell lung cancer was the predominant histological type observed in 17 (94.4%) of whom 14 (82.4%) had adenocarcinoma. Majority of PWH had stage IV disease (88.9%). The median (IQR) survival was 3.3 (1.1–13.2) months and all were either dead (72.2%) or lost-to-follow up (27.8%) at five years from diagnosis.

Conclusion

People with HIV and lung cancer in Uganda report low rates of smoking, present with advanced disease and post very poor survival rates. There is need for biomarkers for early detection of lung cancer in HIV.