Haematological Diseases in the Tropics

Thachil, Jecko; Owusu‐Ofori, Shirley; Bates, Imelda

doi:10.1016/b978-0-7020-5101-2.00066-2

Cited by 17 publications

(15 citation statements)

References 331 publications

(334 reference statements)

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“…The diagnosis and treatment delays could be attributed to the inability of healthcare workers to recognize AML, as AML presents quite similarly as other common diseases in sub‐Saharan Africa (e.g., malaria, human immunodeficiency virus, iron deficiency anemia). 39 There could also be inadequate training on childhood cancer in the training schools. Also, the poor clinical status patients present with and how quickly the parents give consent for diagnostic procedures and treatment may have contributed to the poor survival.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of pediatric acute myeloid leukemia treatment in Western Kenya

et al. 2021

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Background Pediatric acute myeloid leukemia (AML) is a challenging disease to treat in low‐ and middle‐income countries (LMICs). Literature suggests that survival in LMICs is poorer compared with survival in high‐income countries (HICs). Aims This study evaluates the outcomes of Kenyan children with AML and the impact of sociodemographic and clinical characteristics on outcome. Methods and Results A retrospective medical records study was performed at Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya, between January 2010 and December 2018. Sociodemographic and clinical characteristics, and treatment outcomes were evaluated. Chemotherapy included two “3 + 7” induction courses with doxorubicin and cytarabine and two “3 + 5” consolidation courses with etoposide and cytarabine. Supportive care included antimicrobial prophylaxis with cotrimoxazole and fluconazole, and blood products, if available. Seventy‐three children with AML were included. The median duration of symptoms before admission at MTRH was 1 month. The median time from admission at MTRH to diagnosis was 6 days and to the start of AML treatment 16 days. Out of the 55 children who were started on chemotherapy, 18 (33%) achieved complete remission, of whom 10 (56%) relapsed. The abandonment rate was 22% and the early death rate was 46%. The 2‐year probabilities of event‐free survival and overall survival were 4% and 7%, respectively. None of the sociodemographic and clinical characteristics were significantly associated with outcome. Conclusion Survival of Kenyan children with AML is dismal and considerably lower compared with survival in HICs. Strategies to improve survival should be put in place including better supportive care, optimization of the treatment protocol, and reduction of the abandonment rate and time lag to diagnosis with sooner start of treatment.

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Section: Discussionmentioning

confidence: 99%

“…*39 There could also be inadequate training on childhood cancer in the training schools. Also, the poor clinical status patients present with and how quickly the parents give consent for diagnostic procedures and treatment may have contributed to the poor survival.…”

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confidence: 99%

Outcomes of pediatric acute myeloid leukemia treatment in Western Kenya

et al. 2021

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“…Underlying sources of immunosuppression are also summarized in Table S2 . Primary immunodeficiency diseases 20 and hematologic diseases 21 were present in nine patients (69.23%) and three patients (23.08%), respectively, and one patient (7.69%) had no apparent immune disorder.…”

Section: Resultsmentioning

confidence: 99%

Bacteremia tuberculosis among HIV‐negative children in China

Chu

Shi

Dong

et al. 2022

Pediatric Investigation

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Importance: Bacteremia tuberculosis (TB) is a severe form of extrapulmonary TB. Studies assessing bacteremia TB in children are limited, especially for HIV-negative children. Objective: To explore the detailed clinical features of the bacteremia TB in children under 18 years of age. Methods: We reviewed the clinical records of the patients retrospectively and collected the strains isolated from their blood cultures. We used mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) to characterize the bacterial genotypes and alamarBlue to determine their drug susceptibility profiles. Polymerase chain reactions and DNA sequencing were used to identify drug-resistant mutations. Results: There were 13 pediatric bacteremia TB patients, 10 of whom were diagnosed with Bacillus Calmette-Guérin (BCG) bacteremia TB. Thirteen patients aged from 0.30 to 11.58 years were enrolled, of whom 76.92% were boys. All had fevers before hospitalization, and 76.92% had respiratory symptoms. All had received BCG vaccinations, and 46.15% had adverse post-vaccination reactions. Compared with Mycobacterium tuberculosis, BCG bacteremia was more likely to appear in younger children. Patients with BCG bacteremia had primary immunodeficiency diseases, and lower CD4, IgA, and IgE levels. Interpretation: Bacteremia TB was rapidly fatal in a large proportion of the immunodeficient children. Because classic findings may not be diagnostically specific, a high level of clinical suspicion is required, especially for patients with certain types of immunosuppression. Studies are needed to develop rapid diagnostic tests and to determine the value of empirical therapy in childhood bacteremia TB.

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“…The dominance of the SCD-SS phenotype in the population matches several reports ( Bardakdjian-Michau et al, 2009 ; de Castro Lobo et al, 2014 ; Fernandes et al, 2015 ; Asare et al, 2018 ; Isa et al, 2020 ). It is known that the prevalence of Hb S is high in Africa ( Thachil et al, 2013 ) and specifically in countries below the equator in sub-Saharan Africa ( Grosse et al, 2011 ). In our registry, the proportion of SCD-SS is higher by about 10% compared with data from the newborn screening program in Kumasi reported in 2005 ( Ohene-Frempong et al, 2008 ) and subsequently in unpublished data in 2020.…”

Section: Discussionmentioning

confidence: 99%

Establishing a Sickle Cell Disease Registry in Africa: Experience From the Sickle Pan-African Research Consortium, Kumasi-Ghana

et al. 2022

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Sickle cell disease (SCD) is the most common clinically significant hemoglobinopathy, characterized by painful episodes, anemia, high risk of infection, and other acute and chronic complications. In Africa, where the disease is most prevalent, large longitudinal data on patients and their outcomes are lacking. This article describes the experiences of the Kumasi Center for SCD at the Komfo Anokye Teaching Hospital (KCSCD-KATH), a Sickle Pan-African Research Consortium (SPARCO) site and a SickleInAfrica Consortium member, in establishing a SCD registry for the evaluation of the outcomes of patients. It also provides a report of a preliminary analysis of the data. The process of developing the registry database involved comprehensive review of the center’s SCD patient medical records, incorporating data elements developed by the SickleInAfrica Consortium and obtaining ethical clearance from the local Institutional Review Board. From December 2017 to March 2020, 3,148 SCD patients were enrolled into the SCD registry. Enrollment was during the SCD outpatient clinic visits or through home visits. A significant proportion of the patients was from the newborn screening cohort (50.3%) and was males (52.9%). SCD-SS, SCD-SC, and Sβ +thalassemia were seen in 67.2, 32.5, and 0.3% patients, respectively. The majority of the patients were in a steady state at enrollment; however, some were enrolled after discharge for an acute illness admission. The top two clinical diagnoses for SCD-SS patients were sickle cell painful events and acute anemia secondary to hyperhemolysis with incidence rates of 141.86 per 10,000 person months of observation (PMO) and 32.74 per 10,000 PMO, respectively. In SCD-SC patients, the top two diagnoses were sickle cell painful events and avascular necrosis with incidence rates of 203.09 per 10,000 PMO and 21.19 per 10,000 PMO, respectively. The SPARCO Kumasi site has developed skills and infrastructure to design, manage, and analyze data in the SCD registry. The newborn screening program and alternative recruitment methods such as radio announcement and home visits for defaulting patients were the key steps taken in enrolling patients into the registry. The registry will provide longitudinal data that will help improve knowledge of SCD in Ghana and Africa through research.

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Haematological Diseases in the Tropics

Cited by 17 publications

References 331 publications

Outcomes of pediatric acute myeloid leukemia treatment in Western Kenya

Outcomes of pediatric acute myeloid leukemia treatment in Western Kenya

Bacteremia tuberculosis among HIV‐negative children in China

Establishing a Sickle Cell Disease Registry in Africa: Experience From the Sickle Pan-African Research Consortium, Kumasi-Ghana

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