Treatment outcomes of esophageal cancer in Eastern Africa: protocol of a multi-center, prospective, observational, open cohort study

Background

Esophageal squamous cell carcinoma (ESCC) is a major cause of cancer morbidity and mortality in Eastern Africa. The majority of patients with ESCC in Eastern Africa present with advanced disease at the time of diagnosis. Several palliative interventions for ESCC are currently in use within the region, including chemotherapy, radiation therapy with and without chemotherapy, and esophageal stenting with self-expandable metallic stents; however, the comparative effectiveness of these interventions in a low resource setting has yet to be examined.

Methods

This prospective, observational, multi-center, open cohort study aims to describe the therapeutic landscape of ESCC in Eastern Africa and investigate the outcomes of different treatment strategies within the region. The 4.5-year study will recruit at a total of six sites in Kenya, Malawi and Tanzania (Ocean Road Cancer Institute and Muhimbili National Hospital in Dar es Salaam, Tanzania; Kilimanjaro Christian Medical Center in Moshi, Tanzania; Tenwek Hospital in Bomet, Kenya; Moi Teaching and Referral Hospital in Eldoret, Kenya; and Kamuzu Central Hospital in Lilongwe, Malawi). Treatment outcomes that will be evaluated include overall survival, quality of life (QOL) and safety. All patients (≥18 years old) who present to participating sites with a histopathologically-confirmed or presumptive clinical diagnosis of ESCC based on endoscopy or barium swallow will be recruited to participate. Key clinical and treatment-related data including standardized QOL metrics will be collected at study enrollment, 1 month following treatment, 3 months following treatment, and thereafter at 3-month intervals until death. Vital status and QOL data will be collected through mobile phone outreach.

Discussion

This study will be the first study to prospectively compare ESCC treatment strategies in Eastern Africa, and the first to investigate QOL benefits associated with different treatments in sub-Saharan Africa. Findings from this study will help define optimal management strategies for ESCC in Eastern Africa and other resource-limited settings and will serve as a benchmark for future research.

Trial registration

This study was retrospectively registered with the ClinicalTrials.gov database on December 15, 2021, NCT05177393.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-09124-5.

Alcohol-Related Liver Disease Is Rarely Detected at Early Stages Compared With Liver Diseases of Other Etiologies Worldwide

BACKGROUND & AIMS

Despite recent advances in treatment of viral hepatitis, liver-related mortality is high, possibly owing to the large burden of advanced alcohol-related liver disease (ALD). We investigated whether patients with ALD are initially seen at later stages of disease development than patients with hepatitis C virus (HCV) infection or other etiologies.

METHODS

We performed a cross-sectional study of 3453 consecutive patients with either early or advanced liver disease (1699 patients with early and 1754 with advanced liver disease) seen at 17 tertiary care liver or gastrointestinal units worldwide, from August 2015 through March 2017. We collected anthropometric, etiology, and clinical information, as well as and model for end-stage liver disease scores. We used unconditional logistic regression to estimate the odds ratios for evaluation at late stages of the disease progression.

RESULTS

Of the patients analyzed, 81% had 1 etiology of liver disease and 17% had 2 etiologies of liver disease. Of patients seen at early stages for a single etiology, 31% had HCV infection, 21% had hepatitis B virus infection, and 17% had nonalcoholic fatty liver disease, whereas only 3.8% had ALD. In contrast, 29% of patients seen for advanced disease had ALD. Patients with ALD were more likely to be seen at specialized centers, with advanced-stage disease, compared with patients with HCV-associated liver disease (odds ratio, 14.1; 95% CI, 10.5-18.9; P < .001). Of patients with 2 etiologies of liver disease, excess alcohol use was associated with 50% of cases. These patients had significantly more visits to health care providers, with more advanced disease, compared with patients without excess alcohol use. The mean model for end-stage liver disease score for patients with advanced ALD (score, 16) was higher than for patients with advanced liver disease not associated with excess alcohol use (score, 13) (P < .01).

CONCLUSIONS

In a cross-sectional analysis of patients with liver disease worldwide, we found that patients with ALD are seen with more advanced-stage disease than patients with HCV-associated liver disease. Of patients with 2 etiologies of liver disease, excess alcohol use was associated with 50% of cases. Early detection and referral programs are needed for patients with ALD worldwide.

Open abdomen management and outcomes: two case reports from western Kenya and a review of literature from Africa

The open abdomen (OA) is clinically indicated for attenuating the effects of select intra-abdominal insults that may lead to high intra-abdominal pressure with fascial closure. Despite the high incidence of conditions warranting OA in Africa, there are few reports on its use and outcomes. A retrospective chart review was performed for two patients managed with an OA at the Moi Teaching and Referral Hospital. For comparison, a literature review on related studies from Africa was performed. One patient had an anastomotic leak, while the other had a perforated gastric ulcer. A Bogotá bag was used for temporary abdominal content containment. There was no mortality in our series and fascial closure was achieved in one patient. Upon review of studies from Africa, overall mortality stood at 44%, while 25% of surviving patients underwent fascial closure. The use of OA in Africa is associated with high mortality and low rates of fascial closure. Our limited experience shows this technique is a viable treatment option in an attempt to bridge a patient to abdominal closure during critical illness.

Bilateral versus unilateral mandibular block anesthesia in a pediatric population

PURPOSE

This prospective study aimed to evaluate unilateral versus bilateral mandibular nerve block anesthesia with regard to post-operative soft tissue trauma and other complications in a pediatric population.

METHODS

A total of 320 patients age 2 to 18 years were appointed for routine operative treatment. There were no age, gender, behavior, or general health exclusions. Oral and written post-operative instructions were given to parents, as well as a survey preview. A phone survey was conducted after treatment to determine a number of variables, including soft tissue trauma.

RESULTS

A total of 13% of all patients experienced post-operative soft tissue trauma. By age group, trauma frequency was 18% (< 4 yrs.), 16% (4-7 yrs.), 13% (8-11 yrs.) and 7% (> 12 yrs.). Comparing unilateral versus bilateral subjects as to trauma revealed that in the < 4 age group trauma was higher for the unilateral subjects (35% vs. 5%, P < .02). Non-significant trends showed increased trauma in unilateral groups at ages 8-11 and > 12 years.

CONCLUSION

This study represents the first documentation of post-anesthetic soft tissue trauma prevalence in a pediatric population. The results reveal no contraindication to the use of bilateral mandibular block anesthesia.

Caries prediction and indicators using a pediatric risk assessment teaching tool

The goals of this study were to determine both predictability and risk indicators in a young pediatric population seen in a dental school clinic using a Caries Risk Assessment teaching tool. Assigned risk categories and factors for 140 patients were analyzed for relationships with future caries development using Logistic Regression (p < 0.01) and Chi-square analysis (p < 0.05). Among the group developing caries, variables and disease were analyzed using ANOVA Independent Samples Test (p < 0.05). Assigned-risk categories were significantly predictive with odds ratios (OR) of Moderate- and High-risk developing new caries being 5.41 and 28.64 respectively when compared with Low-risk. Significant risk indicators were diet, oral hygiene and the presence of caries and decalcifications. The risk assessment tool used in this study predicted future caries development. Through this method of assessment, caries risk indicators in the population studied were determined to be diet, oral hygiene and past caries experience.

In vitro enamel effects of a resin-modified glass ionomer: fluoride uptake and resistance to demineralization

PURPOSE

The purpose of this study was to determine the in vitro effects of a resin-modified glass-ionomer restorative material on human enamel.

METHODS

Enamel specimens were restored with Photac-Fil, a resin-modified glass ionomer; Ketac-Fil, an autopolymerizing glass ionomer and silver amalgam. The samples were pH cycled and then subjected to an artificial caries challenge. Specimens were evaluated by fluoride microdrill biopsy and quantitative microradiography at 1, 2, and 3 mm from restorations. Data on fluoride content, lesion depth, and mineral content were analyzed by one-way ANOVA, Student's t test, Neuman-Keuls procedure (multiple [pairwise] comparison), and Pearson's product-moment correlation tests.

RESULTS

There were significant differences in fluoride uptake, lesion depth, and mineral density between groups. Significant correlational relationships were also determined.

CONCLUSION

This study demonstrates that Photac-Fil and Ketac-Fil prevent in-vitro demineralization of enamel and suggests different mechanisms of action for each material.

Preparation and beliefs of graduates of a predoctoral infant oral health clinical program

PURPOSE

The aim of this study is to evaluate the effects of a predoctoral clinical educational program on preparation and beliefs of participants related to infant oral health.

METHODS

Questionnaires were constructed and mailed out to four classes of past dental students, two of which had attended the program.

RESULTS

Significant differences were detected between groups regarding their feelings of preparation for examination procedures in children younger than 36 months and their beliefs regarding appropriate age of the initial dental visit.

Equilibrium vapour pressure of mercury from dental amalgam under loading conditions

Earlier studies have failed to establish a consensus on the amount of mercury vapour released from dental amalgam restorations. The purpose of this study was to accurately and quantitatively measure the equilibrium mercury vapour pressure from dental amalgam. The vapour pressure was measured using a quartz crystal microbalance as a function of the load from 0-5.4 MPa. Auger spectra were collected of the as-formed and argon ion sputter cleaned dental amalgam surface. For the as-formed surface the mercury vapour density is zero with no load and increases to 0.6 microg m(-3) at 5.4 M Pa. Following cleaning the mercury, vapour density increased to a maximum value of 15 microg m(-3). The Auger spectra of the as-formed surfaces were dominated by features associated with carbon and oxygen. These spectral results in concert with the mercury vapour density measurements indicate that the oxide film on the as-formed surfaces inhibited the release of mercury vapour. The results of this experiment provide an upper limit for the amount of mercury vapour released by dental amalgams. Under conditions simulating the oral cavity this value would be reduced by oxides that form on the surface of dental amalgam restorations.

Comparative in vitro microradiographic effects of resin-modified and autopolymerizing glass ionomers on demineralization of primary and permanent enamel

The purpose of this study was to compare in vitro effects of resin-modified and autopolymerizing glass ionomer restorative materials on demineralization of primary and permanent human enamel. Thirty primary and permanent enamel specimens measuring approximately 3 x 4 x 4 mm were sectioned and plano-paralleled before random placement of materials: Photac-Fil, a resin-modified glass ionomer; Ketac-Fil, an autopolymerizing glass ionomer; and Tytin, a silver amalgam. After incubation for twenty-four hours, the samples were pH cycled for eight hours at pH 5.0 and sixteen hours at pH 7.2 for a total of two weeks, all at 37 degrees C. The specimens were then subjected to an artificial caries challenge at pH 5.0 for 196 hours. The specimens were embeded in Epon 812 and incubated at 55 degrees C for thirty-six hours. Microsections were produced from each sample and subjected to microradiography and quantitative microdensitometry. Data on lesion depth and mineral content were analyzed by Two Way ANOVA and Student Newman-Keuls Pairwise Multiple Comparison tests. There were significant differences in lesion depth and mineral content between groups (p < 0.05) and between permanent and primary enamel. This study demonstrates that Photac-Fil and Ketac-Fil prevent in vitro demineralization at varying levels in primary and permanent enamel.

Epidermolysis bullosa: case report of appropriate classification of subtype because of an early dental exam

Epidermolysis bullosa is a unique group of disorders that have blister formation as the common feature. Although there are many variants of this disorder, the subtypes are classified into three groups based upon the level of tissue separation that occurs after mechanical trauma is sustained by the skin. Specific subtypes of EB may have substantial involvement of extracutaneous areas such as the oral cavity and dentition. This case report demonstrates the importance of a dental examination at an early age in order to facilitate the correct subtyping of EB. For the very young patient, correct classification of the subtype of EB may be very important in identifying the severity of clinical features associated with the disorder, and with this information the patient and family may become better aware of potential complications of the disorder such as the dental defects described in this report.

Equilibrium vapor pressure of mercury from dental amalgam in vitro

OBJECTIVES

The purpose of this study was to acquire reliable quantitative data on mercury vapor pressure above the surface of dental amalgam samples in both the as-formed and the abraded state.

METHODS

The equilibrium vapor pressure of mercury from dental amalgam was obtained using residual gas analysis in conjunction with a quartz crystal microbalance. The measurements were performed under ultrahigh-vacuum conditions.

RESULTS

Using the residual gas analyzer, the average mercury vapor pressures measured from the as-formed and abraded dental amalgam surfaces were 8 x 10(-7) and 1.7 x 10(-4) Pa, respectively. The corresponding vapor densities are: 6 x 10(-2) micrograms/m3 and 14 micrograms/m3. The average mercury vapor pressures measured from the as-formed and abraded dental amalgam surfaces using the quartz crystal microbalance were: 2.4 x 10(-6) and 1.0 x 10(-4) Pa, respectively. The corresponding vapor densities are: 0.2 microgram/m3 and 8 micrograms/m3.

SIGNIFICANCE

This project provides a measurement of the equilibrium vapor pressure of mercury from as-formed and abraded amalgam surfaces. By definition, the equilibrium vapor pressure provides the maximum density of mercury which can be present in the environment above the amalgam. The vapor density of mercury within the oral cavity must be less than this value due to the dynamic nature of the system.

In vitro comparative fluoride release, and weight and volume change in light-curing and self-curing glass ionomer materials

The purpose of this study was to evaluate and compare in vitro fluoride release from and weight and volume changes of Photac-Fil, a light-curing polymaleinate restorative glass ionomer, with Ketac-Fil, a self-curing glass ionomer, and Ketac-Silver, a metal reinforced glass ionomer. Five discs of each material, measuring 2 mm height and 5 mm diameter, were suspended in separate vials of distilled water and laboratory artificial saliva. Fluoride release into the solutions was measured using a calibrated fluoride-sensitive ion meter initially at 24 hr and then weekly from 1 to 9 weeks. These results were evaluated statistically using repeated measures analysis of variance. Volumes and weights were recorded at the start and end of the experiment and analyzed using the paired t-test. Photac-Fil released similar amounts of fluoride to Ketac-Silver, but significantly less than Ketac-Fil in distilled water (P < or = 0.05). In artificial saliva, Photac-Fil released similar amounts to Ketac-Fil, but significantly more than Ketac-Silver (P < or = 0.05). Photac-Fil volume increased in distilled water and artificial saliva (P < or = 0.05) as did Ketac-Fil and Ketac-Silver in artificial saliva (P < or = 0.05). The only material that demonstrated significant net weight increase was Ketac-Silver in artificial saliva (P < or = 0.05). In summary, differences in fluoride release between these three glass ionomer materials varied as a function of the media in which they were stored. Whereas Ketac-Fil exhibited significantly greater fluoride release than the other materials in distilled water, in artificial saliva Ketac-Fil and Photac-Fil exhibited comparable fluoride release. Dimensional change, as evaluated by volume and weight differences, was also affected by storage media.

Home-use tooth bleaching agents: an in vitro study on quantitative effects on enamel, dentin, and cementum

Studies on home-use bleaching agents containing carbamide or hydrogen peroxide demonstrate minimal topographic alteration and insignificant organic change to tooth material. This in vitro study evaluated the effects of a three-step commercial home-use bleaching agent on extracted human incisors over time. Each tooth was digitized by baseline and sequential profilometry and analyzed using computer software. Statistically significant volume loss was evident in cementum and dentin after simulations of 4 and 8 weeks of use.

Parental child abuse and neglect from a paediatric dental clinic: two case reports

A seven and twelve-year old boy and girl presented to the paediatric dental clinic seeking dental treatment. The boy had dental neglect with fearful and uncooperative behaviour; while the girl was defiant and had disruptive behaviour. The behaviour of the two children was extreme, and this helped the clinician to question child abuse. Both children were abused by close relatives and were both neglected by the parents. The conflicting history from the guardians about the behaviour of both children and the extreme behaviour patterns made the clinician suspect child abuse. There was a marked change of behaviour when these minors were accompanied by their respective parents for the dental treatment. Child abuse requires a multidisciplinary approach to detect, diagnose and protect the minor. In this instance the parents were made aware of the possibilities of child abuse. Fortunately, they recognised the problems and therefore came to the assistance of the children whose behaviour transformed and were able to undergo dental treatment without any difficulties.