Department of Pharmacology & Toxicology, Moi University School of Medicine
Eldoret, Kenya
Background: Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer globally, accounting for 75-85% of all liver cancer cases with a prevalence of 16 to 32 times higher in developing countries than in developed countries. HCC is an asymptomatic malignancy with a particularly grave prognosis in black Africans. In Kenya HCC is the 13th prevalent cancer in Kenya, and 9th cause of cancer mortality. The cancer burden is greatest in areas where viral Hepatitis B or C prevalence is 8% or more. Surveillance should be tailored to those at risk as it leads to early detection of lesions while they are still amenable to surgery. We describe the clinical profile of patients with chronic liver disease and HCC in a western Kenya multidisciplinary collaborative project. Methods: The HepWek project was carried out in Western Kenya to study risk factors and to improve diagnostic capability and surgical management of HCC. This was a prospective study of patients known to have chronic liver disease or uncharacterized liver lesions requiring further workup. Chronic liver disease was defined either by follow up in the liver clinic or presence of abnormal liver function for more than 6 months. Results: A total of 200 patients were included in the final analysis. The majority were male 110/200 (55%), mean age was 47 (SD 16) years. The commonest etiology for liver disease was Hepatitis B with 90/200 (45%) cases, 30% of the patients (59/200) were diagnosed to have HCC. Risk factors for HCC were older age Odds Ratio (OR) 1.03 (95% CI 1.01 to 1.06), Hepatitis B; OR 2.66 (95% CI 1.28 to 5.51) and liver cirrhosis OR 2.41 (95% CI 1.21 to 4.81). Median alphafetoprotein (AFP) level was 111 (range 1 to 1000) ng/ml in HCC patients and majority of them had albumin bilirubin score of 3 (78%). Most patients (88%), presented with advanced stages of HCC, only 2 patients were amenable to Hepatic resection which they underwent successfully. Thirty-five (74%) out of the 59 patients with HCC died within 1 year. Conclusion: Hepatocellular carcinoma patients in western Kenya present with advanced stage of the disease that is unresectable. Hepatitis B virus infection and cirrhosis from all causes remains the most common risk factor
Background: Substance use is prevalent among people with mental health issues, and patients with psychosis are more likely to use and misuse substances than the general population. Despite extensive research on substance abuse among the general public in Kenya, there is a scarcity of data comparing substance use among people with and without psychosis. This study investigates the association between psychosis and various substances in Kenya.Methods: This study utilized data from the Neuro-GAP Psychosis Case-Control Study between April 2018 and December 2022. The KEMRI-Wellcome Trust Research Programme recruited participants from various sites in Kenya, including Kilifi County, Malindi Sub-County, Port Reitz and Coast General Provincial Hospitals, and Moi Teaching and Referral Hospital, as well as affiliated sites in Webuye, Kapenguria, Kitale, Kapsabet, and Iten Kakamega. The collected data included sociodemographic information, substance use, and clinical diagnosis. We used the summary measures of frequency (percentages) and median (interquartile range) to describe the categorical and continuous data, respectively. We examined the association between categorical variables related to psychosis using the chi-square test. Logistic regression models were used to assess the factors associated with the odds of substance use, considering all relevant sociodemographic variables.Results: We assessed a total of 4,415 cases and 3,940 controls. Except for alcohol consumption (p-value=0.41), all forms of substance use showed statistically significant differences between the case and control groups. Cases had 16% higher odds of using any substance than controls (aOR: 1.16, 95%CI: 1.05-1.28, p=0.005). Moreover, males were 3.95 times more likely to use any substance than females (aOR:3.95; 95%CI: 3.43-4.56). All the categories of living arrangements were protective against substance use.Conclusion: The findings of this study suggest that psychotic illnesses are associated with an increased likelihood of using various substances. These findings are consistent with those of previous studies; however, it is crucial to investigate further the potential for reverse causality between psychosis and substance abuse using genetically informed methods.
Polymyxin B is a reserve antibiotic, but there has been an upsurge in its use due to a rise in multidrug-resistant gram-negative bacteria. However, nephrotoxicity and resistance concerns persist, with global resistance rates reaching 29%. Effectiveness of Polymyxin B (clinical and microbiological response) and the frequency of nephrotoxicity is not well documented in resource limited settings. Research is essential to guide optimization of Polymyxin B therapy and inform the adoption of measures for early detection of kidney injury to prevent damage. This study aimed to assess the effectiveness of Polymyxin B by evaluating clinical and microbiological responses and determining nephrotoxicity incidence using KDIGO criteria in ICU patients at Moi Teaching and Referral Hospital (MTRH). A prospective observational cohort study was conducted at MTRH ICUs between December 2021 and November 2022, on patients treated with Polymyxin B. Data on demographics, comorbidities, Polymyxin B dosage regimens, clinical responses, and microbiological results were collected. Descriptive statistics summarized patient characteristics, while associations between dosage regimens and outcomes were evaluated using Fisher's exact test and multivariate regression, with a p<0.05 considered statistically significant. Forty-four patients with a mean age of 48 years were included; 66% were male, and cerebrovascular disease was the most common comorbidity. All patients had multidrug-resistant gram-negative infections qualifying for Polymyxin B therapy. Most (89%) received monotherapy, with 86% achieving a good clinical response, 7% experiencing treatment failure, and 7% dying. Doses of 20,000–25,000 IU/Kg/day were associated with microbiological eradication and good clinical response (p<0.001), while 15,000 IU/Kg/day was associated with treatment failure. Acute kidney injury occurred in 48% of patients, with 68% developing hypomagnesemia. Polymyxin B at doses of between 20,000-25,000IU/Kg/day should be considered as a starting dose due to the association with good clinical response, with alternate-day monitoring of serum creatinine levels for early detection of nephrotoxicity.