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Publications


2014

Odhiambo, AO, Kiarie GW, Ngugi MP, JOSHI MD.  2014.  Serum Vitamin D Profile In Black African Men with Prostate Cancer at Tertiary Referral Facility in Sub-Saharan Africa. IOSR Journal of Dental and Medical Sciences . 13(4):60-64. Abstract

Background: Considerable epidemiological, in vitro, in vivo and clinical data support an association between vitamin D deficiency and prostate cancer risk and outcome. Few studies have examined t his association in African men with p rostate cancer. The vitamin D status in pat ients with prostate cancer in Kenya is unknown. This study aimed to determine the profile of vitamin D levels in patients with prostate cancer and to correlate this to patient and disease characteristics. Methods: H ospital - based cross - sectional study that evaluated black African men with incident or 3 - month prevalent histologically confirmed prostate cance r seeking ambulatory care at KNH . M edical history was obtained by direct interview and the information recorded in questionnaires. Treatment history , pre - diagnostic serum PSA and Gleason score were abstracted from patient records. Every participant had their anthropometric measurements taken and plasma samples drawn for 25 - hydroxyvitamin D (25 - VD) concentrations using the LIAISON® 25 - OH automated chem iluminescent immunoassay method . The relationship between age, body mass index, pre - diagnostic serum PSA and Gleason score on vitamin D status was evaluated using bivariate and multivariate analysis. Results: 162 black African men were evaluated. The mean 25 - VD was 19.15 ng/ml and 144 (88. 9 %) men had vitamin D deficiency (25 - VD < 30ng/ml). 29 (17.9%) were severely deficient (25 - VD < 10ng/ml), 115 (71%) were moderately deficie nt (10 - < 30 ng /ml) and 18 (11.1%) were normal ( 30 - 100ng/ml). Gleason scores > 7 (OR 2.9 ; 95% CI 1.5 - 5.5 , p = 0.001) and serum PSA ≥ 50ng/ml (OR 2.2 ; 95% CI 1.7 - 5.1 , p = 0.014) were associated with vitamin D deficiency (25 - VD < 20ng/ml) whereas age and BMI were not. Adjusted for age, BMI and serum PSA l evels, having Gleason scores > 7 was independently associated with vitamin D deficiency (OR 2.5 ; 95% CI 1.2 – 4.9 , p = 0.01). Conclusion: Vitamin D deficiency is very common in black African men with prostate cancer, p articularly in those with higher Gleason scores.

2013

Othieno-Abinya, NA, Riyat MS, Omollo R, Kiarie GW.  2013.  Differences in response to imatinib between gastrointestinal stromal tumours involving the liver and tumours that do not: experience from Nairobi. African Journal of Cancer. 5(2):79-83. Abstract

Introduction

More than 60% of gastrointestinal stromal tumours (GISTs) arise from the stomach and about 20% from the small intestine. About 95% of GISTs express kit receptor tyrosine kinase (CD117), which is used for purposes of diagnosis and targeted treatment. However, kit expression alone is not specific for GIST, nor does it necessarily imply that signalling through the kit kinase is the driving oncogenic event. Poor prognostic features of GIST include involvement of the liver and other bulky sites of disease.
Patients and methods

We carried out a retrospective analysis of patients with CD117-positive leiomyosarcomas arising in the abdomen and treated through the Glivec International Patient Assistance Program (GIPAP) Clinic at the Nairobi Hospital between 7th November 2005 and 22nd November 2011.
Results

In total 54 patients were included. Males were 36 (66.7%) and females 18 (33.3%). The age range was 25–86 years and the median age 50 years. The stomach was involved primarily in 22 of 47 cases evaluable (46.8%). The liver was primarily involved in 3 (6.4%) and liver metastases in 7 (14.9%) cases. None of 8 patients (0%) with evaluable liver involvement regressed or stabilized on treatment for at least 6 months compared with 10 of 14 (71.4%) from the stomach, 7 of 7 (100%) from the small bowel, and 7 of 13 (53.8%) with mesenteric/omental involvement. These differences were statistically significant (P<0.001).
Conclusion

Apparent lack of response by tumours involving the liver could suggest that the kit, or by extrapolation PDGFR-alpha overexpression, may not be the factors activating kit or PDGFR-alpha targets in this subset of patients, or they could be of exon 9 mutation predominantly. Mutational analysis studies may shed more light in this issue.

2011

Othieno-Abinya, NA, Kiarie GW, Mlombe Y, Wanzala P.  2011.  Neutrophil dynamics and death in postchemotherapy septic neutropenia . Journal of Clinical Oncology. 27(15):175-179. Abstract

Background: Mortality rates from septic neutropenia vary between studies, ranging from 7% to 30%. We observed the mortality rate for patients hospitalized for postchemotherapy septic neutropenia was 28.6% in one of our studies. Many deaths appeared to have occurred at the time of neutrophil recovery. We attributed this to immune reconstitution inflammatory syndrome akin to what is seen in HIV/AIDS. Methods: Records of patients who died during hospitalization with septic neutropenia. Results: Twenty one patients, 14 males (67%) and 7 females (33%) were included, age range 14–67 years. Six (28.6%) had World Health Organization (WHO) grade 0 neutropenia at the time of death, none had grade 1, one (4.8%) had grade 2, one (4.8%) grade 3, and 14 (67%) had grade 4. The last absolute neutrophil count (ANC) at death ranged between 0.005 and 6.3 x 109/litre. Ten patients (47.6%) died during neutrophil upswing and 11 (52.4%) during neutrophil decline. Thirteen patients (61.9%) also had grade 4 thrombocytopenia but no death was attributed to bleeding. Five of 18 (27.8%) had WHO grade 3 renal function impairment, and six (33.3%) had grade 2 impairment. The main cause for renal function disturbance was hypotension that was usually sudden and unexplained. There was no correlation between ANC and renal function impairment (p > 0.5). Conclusions: Death from septic neutropenia could not be attributed to neutrophil dynamics and by extension immune reconstitution from this study. Neutropenia grade 4 still stood out as a major predictor of death. Larger prospective studies are required to address this issue.

2009

Othieno-Abinya, NA, Kiarie GW, Abwao HO, Mlombe YB, Omollo R.  2009.  Outcome of poor prognostic phenotype non-Hodgkin’s lymphoma treatment in relation to human immunodeficiency virus serostatus. African Journal of Cancer. 1(4):200-206. Abstract

Background

The risk of developing aggressive phenotype non-Hodgkin’s lymphomas is high among HIV infected individuals and is associated with worse prognosis than among non-HIV infected ones. Effective antiretroviral therapy has more recently been reported to greatly improve outcome among these patients. A retrospective review of treatment outcome for aggressive and highly aggressive phenotype non-Hodgkin’s lymphoma patients was carried out.

The objective was to compare outcome of treatment for poor prognosis subtypes of non-Hodgkin’s lymphomas in relation to HIV-serostatus. The setting was Hurlingham Oncology clinic, a private oncology clinic in Nairobi, Kenya. The main study endpoints were complete remission rate and overall survival.
Results

Thirty-two patients (42.7%) were HIV-positive, 32 (42.7%) were HIV-negative and 11 (14.7%) had HIV serostatus undetermined. Seven (21.9%) of HIV positive patients achieved complete remission compared with 24 (75%) of HIV negative ones. This difference was highly significant (P < 0.0001). Five (15.6%) of HIV-positive patients died during first-line treatment compared with none of the HIV-negative counterparts. The difference again was highly significant (P < 0.0001). The median survival time was 19 months among HIV-negative patients and 6 months among positive cases.
Conclusion

Complete remission rate among HIV-negative patients in this series was the same as reported from well established centres, but the rate among HIV-positive patients was lower than expected. Patients with HIV infection were more likely to die from toxicity during induction and had inferior survival compared with HIV-negative cases.

Kiarie, J.W, Othieno Abinya, N. A, Riyat MS.  2009.  The GLIVEC international patient assistance programme: the Nairobi experience.. East African Medical Journal. 86(12):106-107. Abstract

Glivec is a drug used in the treatment of chronic myeloid leukaemia (CML) and gastrointestinal stromal tumours (GISI). It is an expensive drug which would be out of reach for most patients in Kenya. Norvatis Pharmaceutical together with Axios International a healthcare management company and Max Foundation have made it possible for patients in developing countries to get access to the drug at no cost. Patients meet the cost of the confirmatory test and are recruited into the programme to receive the drug at no cost. A total of 201 patients are in the programme in Nairobi, mainly drawn from Kenyatta National Hospital the major referral hospital in Kenya. The age range is nine years to 75 years with a mean age of 39.5 years. Males make up 56.5% while females are 43.5%. CML are 173 (86%) while GIST patients are 28 (13.9%). Most of the CML cases are referred in the chronic stable phase (87.8%) and 85.7% have been on hydroxyurea as the initial treatment. Compliance rates are approximately 80%.

2004

Kiarie, GW.  2004.  A Study To Determine The Prevalence Of Familial Clustering Of Cancer In Two Tertiary Care Hospitals In Nairobi. Abstract

Familial clustering of cancer has been documented in the Western World. Familial
cancer syndromes have been described..' Genetic testing has demonstrated family
member positive for certain genes are at risk of these familial cancers.
No studies have been done in Africa to look into this and familial clustering is still
anecdotal. Evidence of familial clustering of cancer will lead to identification of
susceptibility genes in our setup, counseling affected individuals and instituting targeted
surveillance for early diagnosis and prophylaxis. Early diagnosis of cancer saves cost
and there is a reduction in mortality and morbidity .

2002

Othieno-Abinya, NA, Nyabola LO, Kiarie GW, Ndege R, Maina JM.  2002.  Chronic myeloid leukaemia at the Kenyatta National Hospital, Nairobi.. East African Medical Journal. 79(11):593-597. Abstract

OBJECTIVE:

To determine the clinical and haematological factors associated with treatment and outcome of chronic myeloid leukaemia (CML) at Kenyatta National Hospital.
DESIGN:

Retrospective survey of patients treated for chronic myeloid leukaemia.
SETTING:

Kenyatta National hospital, Nairobi, Kenya, between April 1990 and August 2000.
SUBJECTS:

Patients with chronic myeloid leukaemia.
RESULTS:

One hundred and four patients, 55 males and 49 females, age range 10-72 years with a median age of 35 years. Treatment with busulphan getting less popular in favour of hydroxyurea. Median follow-up 20 months with none of the clinical and haematological parameters impacting significantly on duration of follow-up.
CONCLUSION:

CML occurs at a younger age-group in Kenya, and none of the clinical or haematological parameters appears to impact on follow-up duration.

Othieno-Abinya, NA, Nyabola LO, Kiarie GW, Ndege R, Maina MD.  2002.  Chronic myeloid leukaemia at the Kenyatta National Hospital, Nairobi.. East African Medical Journal. 79(11):593-597. Abstract

To determine the clinical and haematological factors associated with treatment and outcome of chronic myeloid leukaemia (CML) at Kenyatta National Hospital.
Retrospective survey of patients treated for chronic myeloid leukaemia.
Kenyatta National hospital, Nairobi, Kenya, between April 1990 and August 2000.
Patients with chronic myeloid leukaemia.
One hundred and four patients, 55 males and 49 females, age range 10-72 years with a median age of 35 years. Treatment with busulphan getting less popular in favour of hydroxyurea. Median follow-up 20 months with none of the clinical and haematological parameters impacting significantly on duration of follow-up.
CML occurs at a younger age-group in Kenya, and none of the clinical or haematological parameters appears to impact on follow-up duration.

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