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Lamprecht CB, Kashuv T, Lucke-Wold B. Understanding metastatic patterns in gastric cancer: Insights from lymph node distribution and pathology. World J Gastrointest Oncol 2025; 17:103709. [DOI: 10.4251/wjgo.v17.i4.103709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Revised: 01/26/2025] [Accepted: 02/17/2025] [Indexed: 03/25/2025] Open
Abstract
Gastric cancer (GC) represents a significant global health burden due to its high morbidity and mortality. Specific behaviors of GC sub-types, distinct dissemination patterns, and associated risk-factors remain poorly understood. This editorial highlights several key prognostic factors, including pathological staging and vascular invasion, that impact GC. It examines a recent study’s investigation of differential metastatic lymph nodes distribution and survival in upper and lower GC sub-types, focusing on histological characterization, pathophysiology, usage of neoadjuvant chemotherapy, and additional predictive determinants. We assess the statistical robustness and clinical applicability of the findings, underscoring the importance of treating GC as a heterogeneous disease and emphasizing how tailored surgical approaches informed by lymph node distribution can optimize tumor detection while minimizing unnecessary interventions. The study’s large cohort, multi-center design, and strict inclusion criteria strengthen its validity in guiding surgical planning and risk-stratification. However, integrating genetic and molecular data is critical for refining models and broadening applicability. Additionally, recurrence-metrics and infection-related factors, such as Helicobacter pylori and Epstein-Barr virus, absent in the original study, remain vital for directing future research. By bridging metastatic patterns with prospective methodologies and inclusion of diverse populations, this editorial provides a framework for advancing early detection and personalized GC care.
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Affiliation(s)
- Chris B Lamprecht
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL 32608, United States
| | - Tyler Kashuv
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL 32608, United States
| | - Brandon Lucke-Wold
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL 32608, United States
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Cui Z, Wang J, Diao J, Xi L, Pan Y. Knowledge mapping of childhood infectious mononucleosis: a bibliometric analysis for the twenty-first century. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2025; 44:43. [PMID: 39962592 PMCID: PMC11834496 DOI: 10.1186/s41043-025-00781-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Accepted: 02/02/2025] [Indexed: 02/20/2025]
Abstract
BACKGROUND The incidence of infectious mononucleosis (IM) has increased in recent years, particularly in the pediatric population, and there are currently no specific drugs available, posing a threat to the lives and health of children worldwide. Although some results have been published, there is a lack of systematic review and summarization of current research. METHODS Based on screening criteria, literature on IM in children from 2000 to 2023 was retrieved from the Web of Science Core Collection. The included literature's indicators (country, institution, journal, author, keywords, and references) were analyzed and visualized using Citespace, VOSviewer software, and the Bibliometrix program package. RESULTS A total of 538 eligible publications were included in this study. The number of publications has been on an upward trend during this century, with great potential for future growth. The countries with the most publications are the USA and China, and Capital Medical University is the most contributing institution. Hjalgrim, Henrik and Cohen, Jeffrey, I are among the field's most influential authors and co-cited authors. Among the major journals, the JOURNAL OF MEDICAL VIROLOGY had the highest output and the JOURNAL OF INFECTIOUS DISEASES was the most frequently cited. The reference with the highest outbreak intensity was Ramagopalan, SV, LANCET NEUROLOGY, 2010. Through in-depth analysis of the keywords, we conclude that the characteristics of diagnosis and assessment of IM, the association of IM with other diseases, and interventions for IM are the current hot topics of research in the field and that the pathogenesis of IM due to EBV is a cutting-edge topic in the field. This study also analyzes the reasons for geographical research differences and proposes a new "increasing quantity-improving quality-integrating" cooperation model. CONCLUSION This study's hotspots and frontiers reflect the current status and trends in pediatric IM, and these findings provide important insights to guide future research and optimize therapeutic strategies. In the future, there is a need to strengthen international collaboration and cooperation, conduct RCTs with large sample sizes, and promote the development of new drugs in mechanism research.
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Affiliation(s)
- Zhengjiu Cui
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jinjuan Wang
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Juanjuan Diao
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Leiming Xi
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
| | - Yueli Pan
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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Flynn TG, Paredes Olortegui M, Garcia Bardales PF, Schiaffino F, Pinedo Vasquez TN, Shapiama López WV, Peñataro Yori P, Ramal Asayag CJ, Meza Sánchez GR, Colston JM, Kosek MN. Epstein-Barr Virus in the RIVERA Case-Control Study of Acute Febrile Illness: Acute Mononucleosis Nearly Absent as an Etiology in the Peruvian Amazon. Am J Trop Med Hyg 2025; 112:200-207. [PMID: 39531721 PMCID: PMC11720789 DOI: 10.4269/ajtmh.24-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 08/26/2024] [Indexed: 11/16/2024] Open
Abstract
Large diagnostic panels allow for pathogens with high or low likelihood of causing attributable illness to be tested simultaneously. Infectious mononucleosis (IM) due to primary infection with Epstein-Barr virus (EBV) is a common cause of acute febrile illness (AFI) in case series from high-income countries, though its contribution to AFI in tropical low-income settings is unclear. As part of a case-control study using multiplex quantitative polymerase chain reaction (qPCR) diagnostics, we set out to determine if primary EBV infection was an underrecognized cause of AFI in the Peruvian Amazon. Presence of EBV DNA in whole-blood samples was equally prevalent among febrile cases and afebrile controls (34.6% [247/714] versus 35.7% [248/695]) and was not correlated with classic IM symptoms. Given the clear lack of clinical significance of the whole-blood PCR results, additional testing was pursued to ascertain the true prevalence of IM among cases of AFI in this population. The presence of EBV DNA in plasma, a marker of active EBV-related processes, was detected in 7% (5/68). Anti-EBNA-1 IgG, a late marker of prior infection, was tested via ELISA and detected in 4/5 of the plasma-positive patients, thereby excluding an acute primary EBV infection in all but one patient. Infectious mononucleosis due to primary infection with EBV was not an important etiology of AFI in the Peruvian Amazon, despite high rates of initial test positivity.
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Affiliation(s)
- Thomas G. Flynn
- Division of Infectious Diseases and International Health, School of Medicine, University of Virginia, Charlottesville, Virginia
| | | | | | - Francesca Schiaffino
- Division of Infectious Diseases and International Health, School of Medicine, University of Virginia, Charlottesville, Virginia
- Faculty of Veterinary Medicine, Universidad Peruana Cayetano Heredia, San Martín de Porres, Perú
| | | | | | - Pablo Peñataro Yori
- Division of Infectious Diseases and International Health, School of Medicine, University of Virginia, Charlottesville, Virginia
- Asociación Benéfica Prisma, Investigaciones Biomédicas, Iquitos, Perú
| | | | | | - Josh M. Colston
- Division of Infectious Diseases and International Health, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Margaret N. Kosek
- Division of Infectious Diseases and International Health, School of Medicine, University of Virginia, Charlottesville, Virginia
- Asociación Benéfica Prisma, Investigaciones Biomédicas, Iquitos, Perú
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Wainaina M, Wasonga J, Cook EAJ. Epidemiology of human and animal leptospirosis in Kenya: A systematic review and meta-analysis of disease occurrence, serogroup diversity and risk factors. PLoS Negl Trop Dis 2024; 18:e0012527. [PMID: 39331677 PMCID: PMC11463743 DOI: 10.1371/journal.pntd.0012527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 10/09/2024] [Accepted: 09/10/2024] [Indexed: 09/29/2024] Open
Abstract
BACKGROUND Leptospirosis is a priority zoonotic disease in Kenya, but an in-depth review of its presence in humans, animals and the environment is lacking. Therefore, we conducted this systematic review and meta-analysis to understand the epidemiological situation to date. METHODOLOGY We searched for literature in African journals online, AGRIS, Embase, the Leptospira WOAH reference laboratory library, ProMED-mail, PubMed, Scopus, Web of Science, and the institutional repositories of 33 academic institutions and included 66 publications on leptospirosis in Kenya which spanned from 1951 to 2022. The review was registered on the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY). FINDINGS Most investigations were done in rural and urban areas in western, southern, central, and coastal areas in Kenya and the largely pastoral eastern and northern areas were under-represented. A wide host range of domestic animals and wildlife was revealed, and occupational exposure was an important risk factor for humans. The microscopic agglutination test (MAT) was the most frequent test, particularly common in studies conducted during the 1980s and 1990s. However, varying MAT panels and cut-off titres were observed. The overall seroprevalence in cattle was 28.2% (95% confidence intervals [CI]: 12.0-53.0; heterogeneity: I2 = 96.7%, τ2 = 1.4), and 11.0% in goats (95% CI: 5.4-21.2; heterogeneity: I2 = 78.8%, τ2 = 0.4). Molecular tests were seldom used to determine species and illustrate strain diversity. There was a lack of awareness of leptospirosis among farmers and health practitioners. CONCLUSION The widespread presence of leptospires and inadequate diagnostic capacity demonstrate that leptospirosis is a common but underreported disease in Kenya. Raising awareness and boosting the country's diagnostic capacity is crucial to timely detection and disease control.
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Affiliation(s)
- Martin Wainaina
- Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Joseph Wasonga
- Animal and Human Health Department, International Livestock Research Institute, Nairobi, Kenya
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Grundy BS, Parikh H, Jacob S, Banura P, Moore CC, Liu J, Houpt ER. Pathogen Detection Using Metagenomic Next-Generation Sequencing of Plasma Samples from Patients with Sepsis in Uganda. Microbiol Spectr 2023; 11:e0431222. [PMID: 36625651 PMCID: PMC9927450 DOI: 10.1128/spectrum.04312-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Metagenomic sequencing is a promising new method for pathogen detection. We aimed to detect pathogens from archived plasma using metagenomic sequencing in a previously well-characterized cohort of 254 predominantly HIV-infected patients with sepsis in Uganda. We used Illumina sequencing and the Chan Zuckerberg ID metagenomics platform to sequence and identify pathogens. On average, each plasma sample yielded 3,404,737 ± 2,201,997 reads (mean ± standard deviation), of which 220,032 ± 416,691 (6.3% ± 8.6%) were identified as nonhuman reads. Using a background model filter, 414 genus-specific pathogen identifications were found in the 254 samples. Nineteen pathogens were previously detected positive by quantitative PCR (qPCR), compared to sequencing, which demonstrated 30.2% sensitivity and 99.5% specificity. Sensitivity was higher for viral pathogens than nonviral pathogens (37% versus 5%). For example, HIV viremia was detected in 69% of samples using qPCR, and sequencing revealed 70% sensitivity and 92% specificity. There were 75 genus-specific potential pathogens identified by sequencing in this cohort, including hepatitis B and Epstein-Barr virus (EBV), among several others. qPCR showed a prevalence of hepatitis B and EBV viremia of 17% and 45%, respectively. In-hospital mortality was associated with a lower qPCR threshold cycle value for EBV (adjusted odds ratio, 0.85; P < .001) but not for hepatitis B or HIV. In conclusion, a broad range of potential pathogens were identified by metagenomic sequencing in patients with sepsis in Uganda. Unexpectedly high rates of hepatitis B and EBV viremia were found. Whether these viral infections in HIV patients with sepsis are clinically important requires further study. IMPORTANCE The use of next-generation sequencing (NGS) in blood samples is an emerging technology for clinical microbiology labs. In this work, we performed NGS on plasma samples from a well-characterized cohort, where all samples had been previously tested by PCR for 43 pathogens. Therefore, we could compare sequencing performance against that of PCR and identify clinical correlates. A broad range of potential pathogens were identified by metagenomic sequencing in patients with sepsis in Uganda, particularly viruses, which we confirmed by PCR. In addition to HIV viremia, unexpectedly high rates of hepatitis B and EBV viremia were found, which may have important clinical implications.
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Affiliation(s)
- Brian S. Grundy
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Hardik Parikh
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Shevin Jacob
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Patrick Banura
- Ministry of Health, National Disease Control Department, Kampala, Uganda
| | - Chris C. Moore
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Jie Liu
- School of Public Health, Qingdao University, Qingdao, China
| | - Eric R. Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
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Dhodapkar R, M M, Thangavelu K, Sivaradjy M, Veerappan K, Gunalan A. Epstein-Barr Virus: An Infrequent Pathogen of Acute Undifferentiated Febrile Illness From a Tertiary Care Hospital in Southern India. Cureus 2021; 13:e18207. [PMID: 34722023 PMCID: PMC8544617 DOI: 10.7759/cureus.18207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/26/2022] Open
Abstract
Context: Acute undifferentiated febrile illness (AUFI) is characterized by a sudden onset of raised body temperature and is a common cause of hospital admission though not recognized as a disease state by the World Health Organization. Epstein-Barr virus (EBV) is reported to account for a significant occurrence of AUFI cases. Aim: To know the role of EBV infection as a cause of acute undifferentiated febrile illness (AUFI). Settings and design: We have used the combination of EBV serological assays to establish the role of the Epstein-Barr virus as the cause of acute undifferentiated febrile illness. Methods and material: A total of 721 suspected cases of acute undifferentiated febrile illness which were tested negative for other common causes of acute febrile illness were selected for the study. Serum samples collected from these cases were tested for the presence of the EBV viral capsid antigen (VCA) IgM antibody. All positive serum samples were tested for the presence of EBV Epstein-Barr nuclear antigen (EBNA) IgG. Statistical analysis used: Statistical analysis was performed with the help of Microsoft Excel software (Microsoft Corporation, Redmond, USA). Results: Out of 721 suspected AUFI cases tested for EBV VCA IgM antibodies, 117 samples were positive and 604 were negative. All these 117 samples were tested for EBV EBNA IgG antibodies in which 88 were positive and 29 were negative. In our study, we found that around 4% (positive for VCA IgM and negative for EBNA IgG) of AUFI cases can be attributed to primary acute EBV infection. Conclusions: EBV infection should be considered particularly in AUFI cases of less than five years of age even in those who do not meet the typical presentation of fever, lymphadenopathy and sore throat. Our study should help to raise awareness regarding the possibility of EBV infection particularly in AUFI cases. A high index of suspicion and timely diagnosis will definitely help clinicians to avoid a battery of investigations and misuse of antibiotics in cases of AUFI.
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Affiliation(s)
- Rahul Dhodapkar
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Mugunthan M
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Kalpana Thangavelu
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Monika Sivaradjy
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Kowsalya Veerappan
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Anitha Gunalan
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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Nyataya J, Maraka M, Lemtudo A, Masakhwe C, Mutai B, Njaanake K, Estambale BB, Nyakoe N, Siangla J, Waitumbi JN. Serological Evidence of Yersiniosis, Tick-Borne Encephalitis, West Nile, Hepatitis E, Crimean-Congo Hemorrhagic Fever, Lyme Borreliosis, and Brucellosis in Febrile Patients Presenting at Diverse Hospitals in Kenya. Vector Borne Zoonotic Dis 2020; 20:348-357. [PMID: 31928511 DOI: 10.1089/vbz.2019.2484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Data on pathogen prevalence is crucial for informing exposure and disease risk. We evaluated serological evidence of tick-borne encephalitis (TBE), West Nile (WN), Hepatitis E virus (HEV), Crimean-Congo Hemorrhagic Fever (CCHF), Yersiniosis, Lyme Disease (LD), and brucellosis in 1033 patients presenting with acute febrile illness at 9 health care facilities from diverse ecological zones of Kenya: arid and semiarid (Garissa District Hospital, Lodwar District Hospital, Marigat District Hospital, Gilgil District Hospital), Lake Victoria basin (Kisumu District Hospital, Alupe District Hospital, Kombewa Sub-County Hospital), Kisii highland (Kisii District Hospital), and coastal (Malindi District Hospital). Epidemiological information of the patients such as geography, age, gender, and keeping animals were analyzed as potential risk factors. Of the 1033 samples, 619 (59.9%) were seropositive to at least one pathogen by IgM (current exposure), IgG/IgM (recent exposure), and IgG (past exposure). Collective seroprevalence for current, recent, and past to the pathogens was 9.4%, 5.1%, and 21.1% for LD; 3.6%, 0.5%, and 12.4% for WN; 0.9%, 0.5%, and 16.9% for HEV; 5.8%, 1.3%, and 3.9% for brucellosis; 5.7%, 0.2%, and 2.3% for yersiniosis; 1.7%, 0%, and 6.2% for TBE; and 0.4%, 0%, and 1.9% for CCHF. Brucellosis risk was higher in patients recruited at Garissa District Hospital (odds ratio [OR] = 3.41), HEV (OR = 2.45) and CCHF (OR = 5.46) in Lodwar District Hospital, LD in Alupe District Hospital (OR = 5.73), Kombewa Sub-district hospital (OR = 8.17), and Malindi District hospital (OR = 3.3). Exposure to LD was highest in the younger age group, whereas yersiniosis did not vary with age. Age was a significant risk for WN, brucellosis, CCHF, TBE, and HEV and in those aged >14 years there was an increased risk to WN (OR = 2.30, p < 0.0001), brucellosis (OR = 1.84, p = 0.005), CCHF (OR = 4.35, p = 0.001), TBE (OR = 2.78, p < 0.0001), and HEV (OR = 1.94, p = 0.0001). We conclude that LD is pervasive and constitutes a significant health burden to the study population, whereas yersiniosis and CCHF are not significant threats. Going forward, community-based studies will be needed to capture the true seroprevalence rates and the associated risk factors.
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Affiliation(s)
- Josphat Nyataya
- Medical Research Directorate-Africa/Kenya Medical Research Institute, Basic Science Laboratory, Kisumu, Kenya
| | - Moureen Maraka
- Medical Research Directorate-Africa/Kenya Medical Research Institute, Basic Science Laboratory, Kisumu, Kenya
| | - Allan Lemtudo
- Medical Research Directorate-Africa/Kenya Medical Research Institute, Basic Science Laboratory, Kisumu, Kenya
| | - Clement Masakhwe
- Medical Research Directorate-Africa/Kenya Medical Research Institute, Basic Science Laboratory, Kisumu, Kenya
| | - Beth Mutai
- Medical Research Directorate-Africa/Kenya Medical Research Institute, Basic Science Laboratory, Kisumu, Kenya
| | - Kariuki Njaanake
- Department of Medical Microbiology, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Benson B Estambale
- Division of Research, Innovation and Outreach, Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
| | - Nancy Nyakoe
- Department of Biochemistry, Cell and Molecular Biology, West African Center for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
| | - Joram Siangla
- Medical Research Directorate-Africa/Kenya Medical Research Institute, Basic Science Laboratory, Kisumu, Kenya
| | - John Njenga Waitumbi
- Medical Research Directorate-Africa/Kenya Medical Research Institute, Basic Science Laboratory, Kisumu, Kenya
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Opanga L, Mulaku MN, Opanga SA, Godman B, Kurdi A. Adverse effects of chemotherapy and their management in Pediatric patients with Non-Hodgkin's Lymphoma in Kenya: A descriptive, situation analysis study. Expert Rev Anticancer Ther 2019; 19:423-430. [PMID: 31023089 DOI: 10.1080/14737140.2019.1606717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Chemotherapy-related side effects and their management in patients with Non-Hodgkin's Lymphoma (NHL) are not well defined in developing countries, including Kenya. This needs addressing considering the high number of patients with cancer in these countries. Consequently, we sought to determine the common side effects of chemotherapy used to treat NHL in pediatric patients and its implications. METHODS Observational study conducted at the Kenyatta National Hospital in patients aged ≤15 years. Some data was collected by reviewing patients' records admitted to the pediatric oncology ward, December 2016 to May 2017; and additional data was collected retrospectively (review of patients' records with NHL, January-2014 to May-2017). Data were analyzed descriptively. RESULTS Overall, out of the identified NHL patients (n = 85), 93% (n = 79) had chemotherapy-related side effects. The majority of patients suffered from side effects were managed; apart from 23% to 24% of the documented anemia and hypersensitivity, respectively. CONCLUSIONS Whilst the majority of the reported side-effects were being managed, the lack of management of some side effects raises real concerns since this indicates either failure to manage or failure to document their management in patients' records, both of which should be addressed appropriately to improve future care.
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Affiliation(s)
- Linda Opanga
- a Department of Pharmacology and Pharmacognosy, School of Pharmacy , University of Nairobi , Nairobi , Kenya
| | - Mercy N Mulaku
- a Department of Pharmacology and Pharmacognosy, School of Pharmacy , University of Nairobi , Nairobi , Kenya
| | - Sylvia A Opanga
- b Department of Pharmaceutics and Pharmacy Practice, Division of Clinical Pharmacy, School of Pharmacy , University of Nairobi , Nairobi , Kenya
| | - Brian Godman
- c Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde , Glasgow , UK.,d Division of Clinical Pharmacology , Karolinska Institute , Stockholm , Sweden.,e School of Pharmacy , Sefako Makgatho Health Sciences University , Garankuwa , South Africa
| | - Amanj Kurdi
- c Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde , Glasgow , UK.,f Department of Pharmacology , College of Pharmacy, Hawler Medical University , Erbil , Iraq
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