Meeting the challenge of hematologic malignancies in sub-Saharan Africa

Gopal, Satish; Wood, William A.; Lee, Stephanie J.; Shea, Thomas C.; Naresh, Kikkeri N.; Kazembe, Peter N.; Casper, Corey; Hesseling, Peter; Mitsuyasu, Ronald T.

doi:10.1182/blood-2012-02-387092

Cited by 93 publications

(109 citation statements)

References 81 publications

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“…22.2% of the patients in current study presented with elevated T3, T4 hormones, but studies by Felemban et al, showed only 3.3% cases, and study done in USA reported 10% cases. The reason is unknown.…”

Section: Discussioncontrasting

confidence: 39%

“…Hence there were no complications reported in our study. Although preliminary results are promising, a great limitation to the study is incomplete information, commonly encountered in clinical care and program evaluation in similar settings 20,21,22 . Both incomplete information and incomplete documentation affect appropriate risk stratification, a challenge in GTN management that has been noted in cancer centers in lowresource settings 23 .…”

Section: Discussionmentioning

confidence: 99%

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Incidence and clinical outcome of Gestational Trophoblastic diseases in a tertiary care hospital

2017

Int. J. Curr. Res. Med. Sci.

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Introduction: Gestational trophoblastic disease (GTD) consists of group of disorders having pathology of abnormal trophoblastic proliferation ranging from hydatidiform mole to gestational trophoblastic neoplasia. Based on differences in morphology, histopathology, karyotype and clinical features, hydatidiform mole can be categorized into partial and complete moles. Molar pregnancy incidence varies across countries. The incidence of molar pregnancy in Asia is 1:100-300, choriocarcinoma 1:1000-2000 of live born children. Aim: To determine the incidence, clinical outcome and management of women with gestational trophoblastic disease (GTD) at tertiary care hospital during a study period of 6 months. Materials and Methods: This is an observational descriptive study conducted over a period of 6 months. In our study, total 18 cases were diagnosed with GTD, based on ultrasound, biochemical and histological examination. Results: During study period, total patients delivered were 3610, out of which 18 cases had GTD. The overall incidence of GTD was 1/200 pregnancies, including cases of partial mole, complete mole, choriocarcinoma, and invasive mole. Highest incidence was found in extremes of age. 77.7% of cases presented in the first trimester, while 22.3% of cases presented in the second trimester. 77.7% of cases were complete mole, 11.1% were partial mole, and 11.1% were diagnosed as gestational trophoblastic neoplasm. Majority of cases (94.4%) presented with vaginal bleeding; pregnancy induced hypertension and preeclampsia was present in 16.6% of cases, 66.6% had abdominal cramps, 44.4% presented with signs of dehydration due to hyperemesis gravidarum, 22.2% had hyperthyroidism. Ultrasound was diagnostic in 95% cases, while histopathological examination was diagnostic in 100% of the cases. The incidence of GTDs in our hospital (1 in 200) is comparable to the incidence in Middle East and Far Eastern countries. Conclusion: In our study, we found a high incidence of GTD in primigravidas. Most patients who had been diagnosed with GTD on USG were in first trimester.

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Section: Discussioncontrasting

confidence: 39%

Section: Discussionmentioning

confidence: 99%

Incidence and clinical outcome of Gestational Trophoblastic diseases in a tertiary care hospital

2017

Int. J. Curr. Res. Med. Sci.

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“…However these figures are based on sparse adult cancer registries. HL is most likely to develop during the first months of antiretroviral therapy and with moderate CD4 lymphopenia (Gopal et al, 2012).…”

Section: Hiv and Hlmentioning

confidence: 99%

Haematological cancers in African children: progress and challenges

et al. 2017

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SummaryCancer is increasingly important in low and middle-income settings where infectious diseases are declining. Childhood cancers treated in well-resourced centres have excellent outcomes with more than 80% survival. This success is not reflected in low-income settings where challenges involve every step on the care pathway. Access to diagnosis, delayed presentation, advanced disease, co-morbidities and underlying malnutrition make treatment difficult. Treatments are costly for impoverished families. Yet, the common haematological malignancies (Burkitt lymphoma, Hodgkin lymphoma, non Hodgkin lymphoma) are relatively easy to diagnose and, when managed with simple chemotherapy protocols, give limited but good results. As funding becomes available for cancer research we must ensure that the care and cure of these children is top of the agenda. There is already evidence of improved outcomes in middle-income countries. For others there is a long journey ahead.

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“…Development of evidence-based guidelines oriented specifically for LMICs will be an important step towards improving the health care systems in these countries. Even though these 'local' guidelines may recommend use of strategies different from those used in HICs, they will be aimed at achieving the best standard of care that is practicable in LMICs (Anderson et al, 2006;Gopal et al, 2012).…”

Section: Applicability Of Guidelines To Lmicsmentioning

confidence: 99%

Guidelines in lower‐middle income countries

2017

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Summary Guidelines include recommendations intended to optimize patient care; used appropriately, they make healthcare consistent and efficient. In most lower‐middle income countries (LMICs), there is a paucity of well‐designed guidelines; as a result, healthcare workers depend on guidelines developed in Higher Income Countries (HICs). However, local guidelines are more likely to be implemented because they are applicable to the specific environment; and consider factors such as availability of resources, specialized skills and local culture. If guidelines developed in HICs are to be implemented in LMICs, developers need to incorporate local experts in their development. Involvement of local stakeholders may improve the rates of implementation by identifying and removing barriers to implementation in LMICs. Another option is to encourage local experts to adapt them for use in LMICs; these guidelines may recommend strategies different from those used in HICs, but will be aimed at achieving the best practicable standard of care. Infrastructural deficits in LMICs could be improved by learning from and building on the successful response to the human immunodeficiency virus/acquired immunodeficiency syndrome pandemic through interactions between HICs and LMICs. Similarly, collaborations between postgraduate medical colleges in both HICs and LMICs may help specialist doctors training in LMICs develop skills required for guideline development and implementation.

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Meeting the challenge of hematologic malignancies in sub-Saharan Africa

Cited by 93 publications

References 81 publications

Incidence and clinical outcome of Gestational Trophoblastic diseases in a tertiary care hospital

Incidence and clinical outcome of Gestational Trophoblastic diseases in a tertiary care hospital

Haematological cancers in African children: progress and challenges

Guidelines in lower‐middle income countries

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