Oxidative stress has been found to be implicated in the development of Alzheimer's disease (AD). In this meta-analytic review, we compared tissue levels between AD and non-AD brains of selenium, an important biological trace element well known for its vital role in the brain function. We included 14 studies with 40 observations on selenium concentrations in AD and control brains. The effect size as standardized mean difference (SMD) was generated using review manager 5.3. Random-effects meta-analysis indicated a decrease (SMD = - 0.42) in brain tissue selenium levels in AD as compared to non-AD controls. The subgroup meta-analysis demonstrated that the selenium levels were decreased in the temporal, hippocampal, and cortex regions in AD. The funnel plot with Egger's (p = 0.88) and Begg's tests (p = 0.24) detected no significant publication bias. The results of sensitivity analysis indicated that no single study/observation had significantly influenced the overall outcome. This meta-analysis provides consolidated evidence for a significant decrease of selenium status in AD brains compared to controls. In line with the evidence supporting selenium's antioxidant role and the involvement of oxidative stress in AD development, this meta-analysis supports new therapeutic strategies aimed at brain tissue selenium homeostasis in AD.

Purpose There are no published data from specific regions of sub-Saharan Africa describing the clinical and pathological characteristics and molecular subtypes of invasive breast cancer by ethnic group. The purpose of this study was to investigate these characteristics among the three major ethno-cultural groupings in Kenya. Methods The study included women with pathologically-confirmed breast cancer seen between March 2012 and May 2015 at 11 hospitals throughout Kenya. Socio-demographic, clinical, and reproductive data were collected by questionnaire, and pathology review and immunohistochemistry were performed centrally. Results The 846 cases included 661 Bantus (78.1%), 143 Nilotes (16.9%), 19 Cushites (2.3%), and 23 patients of mixed ethnicity (2.7%). In analyses comparing the two major ethnic groups, Bantus were more educated, more overweight, had an older age at first birth and had a younger age at menopause than Nilotes (p<0.05 for all comparisons). In analyses restricted to definitive surgery specimens, there were no statistically significant differences in tumour characteristics or molecular subtypes, although the Nilote tumours tended to be larger (OR for ≥ 5 cm vs. < 2 cm: 3.86, 95%CI: 0.77, 19.30) and were somewhat more likely to be HER2-enriched (OR for HER2-enriched vs. Luminal A/B: 1.41, 95%CI: 0.79, 2.49). Conclusion This case series showed no significant differences in breast cancer tumour characteristics or molecular subtypes, but significant differences in socio-demographic characteristics and reproductive factors, among the three major ethnic groups in Kenya. We suggest further evaluation of ethnic differences in breast cancer throughout the genetically and culturally diverse populations of sub-Saharan Africa.

We describe our experience and outcome from the workshop, which can be modelled for other resource poor settings.

The syndrome of intracranial venous sinus thrombosis termed as cerebral venous thrombosis is a distinctive cause of cerebrovascular disease in the young. CVT has been diagnosed almost exclusively at autopsy. However, with the advent of modern neuroimaging techniques, the quantum of CVT cases being diagnosed has increased significantly when compared to previous years. The annual incidence is currently estimated to be 3-4 cases for one million people. It accounts for 10% to 20% of the etiology of young stroke in India. 1 CVT is now typically recognized as a disorder with various clinical presentations and usually favorable outcome. Magnetic resonance imaging and magnetic resonance angiography are the best diagnostic methods available for diagnosis of CVT, and heparin is the first line treatment. But as the symptoms, modes of onset, and neuroimaging methods are diverse, the diagnosis of CVT is commonly overlooked. Pathological hallmark of CVT is hemorrhagic infarction. CVT is primarily a disease of a young man, can present in protean ways with a wide spectrum of clinical manifestations. These include headache, altered sensorium, seizures, focal neurological deficits, papilledema and cranial nerve palsies. The commonest dural venous sinuses involved are superior sagittal sinus and transverse sinus. Nearly 20% of cases of CVT are idiopathic in origin. However, in the Asian Studies, infectious puerperium seems to be the commonest cause of CVST. Though stroke due to arterial thrombosis is more common, cerebral venous sinus thrombosis especially in young strokes. The clinical and neurological presentation can be variable, hence there needs to be a high index of suspicion for venous sinus thrombosis in order to diagnose this entity clinically. There is a wide spectrum of underlying causes of this condition. The prognosis is good, especially when the diagnosis is prompt and treatment initiated. The aim of this study is to study the clinical profile of cerebral venous sinus thrombosis, to study the etiology factors of cerebral venous sinus thrombosis, to correlate the severity and clinical presentation with imaging studies to study the outcome at discharge and at follow-up if possible.

An analysis of 322 cases referred to Aga Khan University, Nairobi, revealed 56% estrogen receptor (ER) positive tumors and 35% prevalence of triple-negative breast cancer (TNBC). Findings were retrospective and limited by inability to control pre-analytical variables that could potentially impact results. Methods: As part of an ongoing prospective study assessing prevalence of TNBC in the three major ethnic groups in Kenya, we gathered a multidisciplinary team from 10 collaborating health facilities around Kenya for an educational workshop. The objectives were to assess baseline capabilities and pre-analytic variables at each center, identify gaps and provide hands-on training in order to ensure accuracy and validity of ER/PR/HER2 prevalence data gathered as part of the study. Results: See table. Breast cancer biopsies ranged from one to 20 per month per center. Diagnosis was predominantly by FNA and ER/PR/HER2 was not routinely performed. Buffered formalin fixative and standardized CAP reporting format was employed only at one center. A survey 3 months following the workshop demonstrated increase in diagnostic core biopsiesby 90%, and uniform use of buffered formalin fixative, and adoption of synoptic reporting. 66 prospective cases of breast cancer from the 10 institutions with patients from different ethnic backgrounds have been subsequently collected and IHC data will be presented. Conclusions: Much has been made of the difference in prevalence of TNBC in Africa as compared to North America, yet little attention has been paid to differences in diagnostic methodologies and basic tissue handling techniques that can potentially alter results. Despite limitations of resources, educational workshops make it possible to improve the practice of breast cancer diagnosis, and thereby enable accurate comparative analysis between breast cancers in the developing and the developed world.