Bio

Prof. Mwanda

Address/Contacts:

P.   O. Box 19676, Nairobi.

 

Official:   P. O. Box 19676, Nairobi, Kenya

Telephones;

Cell   +254705849623 / +254733714386,  -

Office:   University office 2738414 or KNH 2726300 Ext. 43661/654/586

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Publications


2013

OW, M, KA B, GK K, er CS G.  2013.  Antiphospholipid antibodies in patients with venous thrombosis at Kenyatta National Hospital. Afr J Rheumatol . 2013(1(2): ):52-56.
Stoute, JA, Aluoch JR, Gondi SMO, Odera MM, Estambale BBA, Otieno W.  2013.  Sickle Cell Trait (HbAS) is Associated with Increased Expression of Erythrocyte Complement Regulatory Proteins CR1 and CD55 Levels in Children. Abstractbenson_b._a._estambale.pdfAbstractAbstract

Erythrocyte complement regulatory proteins, complement receptor 1 (CR1) and decay accelerating factor (CD55) protect red blood cells (RBCs) from complement mediated damage by controlling complement activation cascade and potentially protect RBCs from complement mediated damage that may occur when immune complexes are formed following malaria infection. Given the important role of RBCs in regulation of complement activation, we considered the competence of sickle cell trait RBCs in these functions. Methods: Children (age 0-192 months; n=116) were enrolled in a nested case controlled study conducted in Kombewa Division, Kisumu west District between October and December 2004. Based on hemoglobin (Hb) type, children were stratified into those with HbAS (n=47) and HbAA (n=69). The 47 HbAS individuals were matched to the 69 HbAA individuals of similar age (± 2 months or ± 24 months for those below or more than 192 months, respectively) at a ratio of 1:1 or 1:2. Circulating CR1 levels and CD levels were quantified using a FACScan cytometer under normal and reduced oxygen saturation. Results: The mean CR1 copy numbers per RBC was comparable in the two groups. However, between the ages of 49-192 months, the mean CR1 copy numbers per erythrocyte was significantly higher in children who had HbAS compared to those with HbAA (P=0.0332). The mean CD55 levels were comparable between the two groups but after deoxygenation, the mean CD levels in RBCs of individuals with HbAS was significantly higher than in the HbAA (P=0.011). Conclusion: The mean CR1 and CD55 copy numbers per RBC were comparable between the two groups under normal and reduced oxygen saturation. Beyond the age of 49 months, the CR1 copy numbers was higher in the HbAS compared to HbAA and this was also true for CD55 levels under deoxygenated conditions. Taken together, these results demonstrate that in the younger age groups, the protection afforded by HbAS against severe manifestations of malaria may be due to other factors other than complement regulatory proteins but beyond the age of 49 months, this protection may be partly due to the high CR1 copy numbers in the HbAS individuals.

2012

O., MW.  2012.  Sporadic Burkitt’s Lymphoma. . : Philadelphia: Springer / CM: Current Medicine Group, LLC, 2012.

2011

2010

2009

and D. G Njeru, W. O Mwanda, KNGWEC.  2009.  Prevalence of Cytomegalovirus Antibodies in Blood. Review Article MEDICOM. 2009(8, 12):58–68.abstract_-_prevalence_of_cytomegalovirus_antibodies_in_blood_donors.pdf
Leucci E, Onnis A, CDFIACCMMGFG.  2009.  ‘ B cell. Int J Cancer.. 15(126):1316-1326.b-cell_differentiation_in_ebv-positive_burkitt_lymphoma_is.pdf

2007

Kanduma, EG, Mukuri JC, Mwanda OW.  2007.  Survey of Hanganutziu and Deicher (HD) Antibody in Cancer Patients Attending Kenyatta National Hospital. Abstractsurvey_of_hanganutziu-_--.pdf

The sensitivity of HD antibody in cancer diagnosis/prognosis could be improved by detection of Immune Complex (IC) dissociated antibody. Combined evaluation of native HD and Immune Complex (IC) dissociated antibody was carried out. Presence and titre of these antibodies in cancer patients was investigated in serum samples obtained from 420 patients with various types of tumors. Results were compared with those of 246 age and sex-matched controls. The serum samples were analysed for hemagglutination antibodies by hemagglutination (HA) test and the antibodies quantified by ELISA. Dissociation was achieved by treating the samples with Glycine Hydrochloride (pH 1.8), then neutralised by Tris-HCl (pH 7.4). Mean HA titre was 16.8 in controls and 67.4 in patients (p<0.001). Patients aged between 26-35 years had the highest mean titre of 75.9 (p=0.397) while controls of the same age had the highest mean titres of 19.9 (p=0.043). Carcinomas had a mean titre of 81 compared to 54 for sarcoma and 52 for lymphoma (p=0.117) among histological types. Female patients had a titre of 75.2 compared to 55.7 of males (p<0.05) while the difference by gender in controls was 15.1 for males and 19.3 for females (p=0.199). The mean level of native HD antibody was -0.011 in controls compared to 0.004 in patients (p=0.03). The levels were significantly high in carcinoma (p=0.017) compared to sarcoma and carcinoma type of malignancy. There was no association between HD antibody levels and age. Mean levels were higher in females than males in both study groups (p=0.628) (p=0.601). IC dissociated antibody mean level was -0.06 in the control group compared to 0.014 in test cases (p=0.000). Levels were independent of gender (p=0.984) while they were highest in sarcoma type compared to other types of tumors that were negative for the antibodies (p=0.413). Both native and antigen-bound HD antibodies are significantly increased in cancer disease.

Mwanda, OW, Mukuria JC, Kanduma EG.  2007.  Total Sialic acid (TSA) and Hanganutziu and Deicher (HD) antibody in malignant and healthy sera. Abstract

To determine the levels of both TSA and HD antibody in sera of patients with various malignancies and evaluate their potential role as diagnostic and/ or prognostic markers. DESIGN: Laboratory based analysis. SETTINGS: Kenyatta National Hospital, Kenya Medical Research Institute and the Department of Biochemistry, University of Nairobi. SUBJECTS: A total of 909 serum samples, 420 from cancer patients recruited at Kenyatta National Hospital and 509 from normal blood donors recruited at Nairobi Hospital. RESULTS: The mean age for the patients and controls was 36 and 37 years respectively. Carcinoma patients constituted 54%, sarcoma 12.1%, lymphoma 16.4% and 17.4% had other types of tumours. The mean TSA in patients was 0.86 mg/ml +/- 0.026 compared to 0.82 mg/ml +/- 0.014 in controls. The TSA level was significantly higher in patients compared to controls (Student's t-test p = 0.031 at 0.05 confidence level). The TSA increased with age in both study groups. In patient sera, both gender gave the same mean of 0.83 mg/ml while it was 0.82 mg/ml and 0.83 mg/ml in control females and in males respectively. Sarcomas had the highest amount of 0.93 mg/ml but there was no significant statistical variation between tumour types (p = 0.076). The HD antibody mean readings were 0.004 in pathologic sera compared to 0.011 in controls. The values were significantly elevated in patients (p = 0.03) with females giving a higher value for both study groups (p = 0.628). HD antibody readings was significantly higher in carcinomas (p = 0.017) compared to those of sarcomas and lymphomas. There was no association between antibody readings and age of patient (p = 0.601). CONCLUSION: Both TSA and HD antibody values were significantly elevated in patients compared to clinically healthy controls and while TSA levels increased with age and was independent of gender, HD antibody levels were independent of age, gender and also tumour type. The study demonstrates that although TSA is normally elevated in malignancy, most of the sialic acid shed is of N-acetyl type as some patients do not express HD antibody directed to the N-glycolyl sialic acid. The reason why some tumours would express Neu5Gc at any one time needs further evaluation.

Rainey JJ, Mwanda WO, WMAMWMLRPR.  2007.  Spartial distribution of Burkitt’s. Trop Med Int Health. 8(12):936-43..spatial_distribution_of_burkitts_lymphoma_in_kenya_and.pdf

2006

OTIENO, PROFMWANDAWALTER.  2006.  Orem J, Otieno MW, Remick SC.Challenges and opportunities for treatment and research of AIDS-related malignancies in Africa.Curr Opin Oncol. 2006 Sep;18(5):479-86. Review.PMID: 16894296 [PubMed - indexed for MEDLINE]. Curr Opin Oncol. 2006 Sep;18(5):479-86.. : MBA Abstract

PURPOSE OF REVIEW: Following our review of AIDS-associated cancer in developing nations in 2004, we sought to update recent publications and review data on the challenges and opportunities for the treatment and research of AIDS malignancies in Africa. RECENT FINDINGS: It is apparent that the burden of AIDS-related malignancies and other virus-associated tumors is significant and increasing in Africa. Several recent studies report findings on conjunctival squamous cell carcinoma and there is a report that Hodgkin's disease, a non-AIDS-defining neoplasm, is increasing in incidence. International collaborative partnerships dedicated to AIDS malignancies in developing countries are feasible and invaluable for clinical strategies to address this aspect of the pandemic. A departure point is the ongoing work of the East Africa - Case Western Reserve University Collaboration in AIDS malignancies. SUMMARY: The burden of neoplastic complications of HIV infection and endemic virus-associated tumors are assuming increasing significance in Africa. There is a need to develop nonmyelotoxic therapies and approaches that are hypothesis-driven and pathogenesis-based. The scarcity and shortages in this region demand that our scientific and therapeutic strategies are both suitable and pragmatic for testing in this setting. It is also imperative that African investigators lead us in this important endeavor.

2005

Mwanda, O W; Fu, CWRP; R; C;.  2005.  Kaposi's sarcoma in patients with and without human immunodeficiency virus infection, in a tertiary referral centre in Kenya. Abstract

Mwanda OW1, Fu P, Collea R, Whalen C, Remick SC.
Author information
Abstract
The clinical features of Kaposi's sarcoma (KS), in patients with and without HIV infection, were investigated in a tertiary referral centre in Kenya between 1997 and 1999. Although 186 cases were identified prospectively, the data analysis was restricted to the 91 (49%) cases who had pathological confirmation of Kaposi's sarcoma and documented HIV serostatus. Among these 91 subjects (58% of whom were male), the age-group holding the largest number of KS cases was that of individuals aged 31-40 years; most of the paediatric cases were aged 6-10 years. The ratio of HIV-seropositives to HIV-seronegatives was 8.5:1 for the adult cases and 0.9:1 for the paediatric. Of the signs and symptoms of Kaposi's sarcoma seen at presentation, only peripheral lympadenopathy was found to be significantly associated with underlying HIV infection (P = 0.05). The median survival was 104 days. It is apparent that, as the HIV epidemic advances in regions of the world with endemic KS, the clinical presentation and natural history of the endemic KS are blending with those of the epidemic or AIDS-associated disease, leading to a reduction in the mean age of the cases and a nearly identical incidence in men and women. In regions of the world where patients have ready access to such chemotherapy, the impact of treatment with highly active antiretroviral drugs on the incidence and natural history of KS has been dramatic. It will be important to monitor the clinico-pathological features of KS in the developing world, as more active antiretroviral regimens become available in clinical practice there.

Mwanda, OW.  2005.  Aflatoxicosis: health implications. AbstractWebsite

Author:

Mwanda OW

Source:

East African Medical Journal. 2005 Jun; 273-274.

Abstract:

Aflatoxicosis remains unrecognised by medical professional experts till several people are involved yet the global scale would show that approximately 4-5 billion people living in developing countries are chronically exposed to unacceptable aflatoxin levels. There is also no comprehensive data set from which to evaluate the exact extent and severity of biological exposure and direct measurements(1). Aflatoxin is a common contaminant of food particularly the staple diets of many developing countries. The toxin is produced by a fungal action during food production, harvest, storage and processing. The most affected are grains, rice, maize/corn; others are cassava, nuts, peanuts, chilies and spices. The toxins are produced as secondary metabolites by Aspergillus flavus, and Aspergillus parasiticus fungi when the temperatures are between 24°C and 35°C and the moisture content exceeds 7% to 10%. These conditions are prevalent in geographical latitudes between 40° N and 40° S of the equator.

OTIENO, PROFMWANDAWALTER.  2005.  Orem J, Otieno MW, Banura C, Katongole-Mbidde E, Johnson JL, Ayers L, Ghannoum M, Fu P, Feigal EG, Black J, Whalen C, Lederman M, Remick SC.Capacity building for the clinical investigation of AIDS malignancy in East Africa.. Fogarty AIDS International Training and Research Program, Case School of Medicine, Case Western Reserve University, Cleveland, OH, USA.. : MBA Abstract

PURPOSE: To build capacity in the resource-poor setting to support the clinical investigation and treatment of AIDS-related malignancies in a region of the world hardest hit by the AIDS pandemic. METHODS: An initial MEDLINE database search for international collaborative partnerships dedicated to AIDS malignancies in developing countries failed to identify any leads. This search prompted us to report progress on our collaboration in this aspect of the epidemic. Building on the formal Uganda-Case Western Reserve University (Case) Research Collaboration dating back to 1987, established NIH-supported centers of research excellence at Case, and expanding activities in Kenya, scientific and training initiatives, research capital amongst our institutions are emerging to sustain a international research enterprise focused on AIDS and other viral-related malignancies. RESULTS: A platform of clinical research trials with pragmatic design has been developed to further enhance clinical care and sustain training initiatives with partners in East Africa and the United States. An oral chemotherapy feasibility trial in AIDS lymphoma is near completion; a second lymphoma trial of byrostatin and vincristine is anticipated and a feasibility trial of indinavir for endemic Kaposi's sarcoma is planned. CONCLUSIONS: In the absence of published reports of evolving international partnerships dedicated to AIDS malignancy in resource constrained settings, we feel it important for such progress on similar or related international collaborative pursuits to be published. The success of this effort is realized by the long-term international commitment of the collaborating investigators and institutions to sustain this effort in keeping with ethical and NIH standards for the conduct of research; the provision of formal training of investigators and research personnel on clinical problems our East African partners are faced with in practice and the development of pragmatic clinical trials and therapeutic intervention to facilitate technology transfer and enhance clinical practice.

PMID: 15829373 [PubMed - indexed for MEDLINE]

OTIENO, PROFMWANDAWALTER.  2005.  R. Rochford, G. Feuer, J. Orem, C. Banura, E. Katongole-Mbidde, W. O. Mwanda, A. Moorman, W. J. Harrington, S. C. Remick. Strategies to overcome myelotoxic therapy for the treatment of Burkitt's and AIDS-related Non-Hodgkin's lymphoma. EAMJ, 2005; 82 (9):. East Afr Med J. 2005 Sep;82(9 Suppl):S155-60.. : MBA Abstract

Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY 13210, USA. BACKGROUND: Strategies to circumvent or lessen the myelotoxicity associated with combination chemotherapy may improve the overall outcome of the management of patients particularly in resource poor settings. OBJECTIVES: To develop effective non-myelotoxic therapies for Burkitt's Lymphoma (BL) and AIDS-related non-Hodgkin's lymphoma. DATA SOURCES: Publications, original and review articles, conference abstracts searched mainly on Pubmed indexed for medline. DATA EXTRACTION: A systematic review of the clinical problem of combination chemotherapy. Identification of clinical strategies that circumvent or lessen the myelotoxicity of combination cytotoxic chemotherapy. Length of survival, lack of clinically significant (> grade 3) myelosuppression and weight loss were used as markers of myelotoxicity. DATA SYNTHESIS: Review of published experience with some of these strategies including dose-modification of multi-agent chemotherapy; rationale for targeted therapies, and the preclinical development of a mouse model exploring the role of metronomic scheduling substantiate pragmatism and feasibility of these approaches. CONCLUSION: Myelotoxic death rates using multi-agent induction chemotherapy approach 25% for endemic Burkitt's lymphoma and range between 20% to 60% for AIDS-related malignancy. This is mostly explained by the paucity of supportive care compounded by wasting and inanition attributable to advanced cancer and HIV infection making patients more susceptible to myelosuppressive side effects of cytotoxic chemotherapy. Investigations and alternative approaches that lessen or circumvent myelotoxicity of traditional cytotoxic chemotherapy for the management of Burkitt's lymphoma and AIDS-related non-Hodgkin's lymphoma in the resource-constrained setting are warranted. Pertinent pre-clinical and clinical data are emerging to support the need for abrograting the myelosuppressive effects of traditional cytotoxic chemotherapy. This can be achieved by developing targeted anti-viral and other strategies, such as the use of bryostatin 1 and vincristine, and by developing a preclinical mouse model to frame the clinical rationale for a pilot trial of metronomic therapy for the treatment of Burkitt's and AIDS-related lymphoma. Implementation of these investigational approaches must be encouraged as viable anti-cancer therapeutic strategies particularly in the resource-constrained settings.

OTIENO, PROFMWANDAWALTER.  2005.  J. Orem, P. Fu, A. Ness, W.O. Mwanda, S. C. Remick. Oral combination chemotherapy in the treatment of AIDS-associated Hodgkin's disease. EAMJ, 2005; 82 (9): S144-S150.. East Afr Med J. 2005 Sep;82(9 Suppl):S144-9.. : MBA Abstract

{ Uganda Cancer Institute, Mulago Hospital and the Makerere University School of Medicine, Kampala, Uganda. OBJECTIVES: To determine the effectiveness of an oral combination chemotherapy regimen administered to patients with AIDS-associated Hodgkin's disease. DESIGN: Prospective, pilot phase II clinical trial. SETTING: Consecutive patient recruitment occurred at two medical centers in the United States: Albany Medical Center, Albany, New York, where patients were recruited prior to December 31, 1996 (pre-HAART era); and University Hospitals of Cleveland, Cleveland, Ohio, where patients were recruited after January 1, 1997 (HAART era). INTERVENTION: Oral chemotherapy consisted of lomustine (100 mg/m2 day I for cycle one and odd cycles thereafter); etoposide (200 mg/m2 days 1 through 3); and cyclophosphamide and procarbazine (each 100 mg/m2 days 22 through 31). Cycles were repeated every six weeks. Colony-stimulating factor support (G-CSF in all instances) was allowed. MAIN OUTCOME MEASURES: Clinical demographic variables, peripheral blood counts, serum chemistries, CD4 lymphocyte count, histopathological subtype of Hodgkin's disease were identified for all patients, who were staged according to Ann Arbor criteria. DATA ANALYSIS: Common Toxicity Criteria were utilized to assess safety; response was assessed using ECOG criteria; and survival was analyzed by Kaplan-Meier methods and difference of survival between pre-HAART and HARART era was compared using log-rank test. RESULTS: Eleven patients (six in pre-HAART era), all but one male, with a median age of 36 years, excellent performance status and advanced International Prognostic Score were treated. Myelosuppression was the major side effect and there were minimal other grade 3 or greater toxicity all of which were promptly reversible. An overall objective response rate of 82% (with 18% complete responses) and median survival duration of 24 months (range 2.5 +/- 68) were observed. Survival was markedly improved in patients treated in the HAART era (median not reached versus 7.25 months

OTIENO, PROFMWANDAWALTER.  2005.  W.O. Mwanda, J. Orem, S. C. Remick, R. Rochford, C. Whalen, M. L. Wilson. Clinical characteristics of Burkitt's lymphoma from three regions in Kenya . EAMJ, 2005; 82 (9): S135-S143.. East Afr Med J. 2005 Sep;82(9 Suppl):S135-43.. : MBA Abstract

Department of Haematology and Blood Transfusion, Kenyatta National Hospital and the University of Nairobi College of Health Sciences, Kenya. OBJECTIVES: To describe the clinical characteristics of Burkitt's lymphoma (BL) from three regions in Kenya at different altitudes with a view towards understanding the contribution of local environmental factors. DESIGN: Prospective cross-sectional study. SETTING: Kenyatta National Hospital and seven provincial hospitals in Kenya. METHOD: Histologically proven cases of Burkitt's lymphoma in patients less than 16 years of age were clinically examined and investigated. MAIN OUTCOME MEASURES: For every case the following parameters were documented: chief complaint(s); physical examination, specifically pallor, jaundice, oedema, lymphadenopathy, presence of masses, splenomegaly and hepatomegaly. Reports of evaluation of chest radiograph, abdominal ultrasound/scan, bone marrow aspiration, cerebral spinal fluid cytology, liver and kidney function tests, urinalysis, stool occult blood and full blood count results. Stage of disease was assigned A, B, C or D. Cases of BL from three provinces of Kenya with diverse geographical features were analysed: Central, Coast, and Western. RESULTS: This study documented 471 BL cases distributed as follows: Central 61 (males 39 and 22 females), M:F ratio 1.8:1; Coast 169 (111 males and 58 females), M:F ratio 1.9:1; and Western 241 (140 males and 101 females), M:F ratio 1.4:1. The major presenting complaints were: abdominal swelling–Central 36%, Coast 4% and Western 26%; swelling on the face–Central 31%, Coast 81% and Western 64%; and proptosis–Central 3%, Coast 1% and Western 9%. The mean duration of these complaints in weeks were Central 6.9, Coast 6.08, and Western 5.05. The initial physical finding was a tumour mass in 39%, 72% and 54% of cases for Central, Coast and Western respectively. Tumour stage at diagnosis was: stage A–Central 21%, Coast 43% and Western 34%; stage B–Central 10%, Coast 5% and Western 10%; stage C–Central 41%, Coast 34% and Western 30%; and stage D–Central 28%, Coast 17% and Western 26%. For the age and sex matched cases the results show that commonly involved sites were: abdomen–Central 35%, Coast 9% and Western 14%; jaw (mandible)–Central 24%, Coast 22% and Western 31%; maxilla–Central 6%, Coast 24% and Western 11%; and lymph nodes–Central 10%, Coast 4% and Western 8%. The disease stage was A–Central 33%, Coast 44% and Western 36%; stage B–Central 11%, Coast 10% and Western 27%; stage C–Central 39%, Coast 34% and Western 27%; and stage D–Central 21%, Coast 13% and Western 37%. CONCLUSION: This study shows that clinical features of childhood BL vary with geographical region. The variations are documented in proportion of jaw, maxilla, abdominal and lymph nodal sites involvement. The differences observed are potentially due to the local environmental factors within these provinces. BL cases from Western province had features, intermediate between endemic and sporadic. Coastal province BL cases were similar to endemic BL, while BL cases from Central province resembled more or less sporadic BL subtypes. Strategies to explain and investigate the local environmental factors associated with the observed differences may certainly contribute towards improved understanding and clinical management of BL.

OTIENO, PROFMWANDAWALTER.  2005.  O.W. Mwanda, C. F. Otieno, E. Omonge. Acute Aflataoxicosis: Case Report. EAMJ, 2005; 82:320-324.. EAMJ, 2005; 82:320-324.. : MBA Abstract

D. M. Ndetei, D. M. Kathuku, O. W. Mwanda. Research proposal: Psychological aspects of the paediatric cancer patients in Kenyatta National Hospital . 2005

OTIENO, PROFMWANDAWALTER.  2005.  W.O. Mwanda, C. Whalen, S. C. Remick. Burkitt's lymphoma and emerging therapeutic strategies for EBV and AIDS-associated lymphoproliferative diseases in East Africa . EAMJ, 2005; 82 (9): S133-S134.. East Afr Med J. 2005 Sep;82(9 Suppl):S133-4.. : MBA Abstract

Department of Haematology and Blood Transfusion, College of Health Sciences, University of Nairobi, Kenya. PMID: 16619688 [PubMed - indexed for MEDLINE]

OTIENO, PROFMWANDAWALTER.  2005.  Otieno MW, Fu P, Collea R, Whalen C and Remick SC. Kaposi's sarcoma in patients with and without human immunodeficiency virus infection in a tertiary referral center in Kenya . Ann Trop Med Parasitol, 2005; 99 (1): 81-91. Ann Trop Med Parasitol, 2005; 99 (1): 81-91. : MBA Abstract

D. M. Ndetei, D. M. Kathuku, O. W. Mwanda. Research proposal: Psychological aspects of the paediatric cancer patients in Kenyatta National Hospital . 2005

OTIENO, PROFMWANDAWALTER.  2005.  Psychological aspects of the paediatric cancer patients. Curr Opin Oncol. 2006 Sep;18(5):479-86.. : MBA AbstractWebsite

D. M. Ndetei, D. M. Kathuku, O. W. Mwanda. Research proposal: Psychological aspects of the paediatric cancer patients in Kenyatta National Hospital . 2005

2004

KHALFAN, DRABDALLAHFATMAH, OTIENO PROFMWANDAWALTER.  2004.  Quality of-life in male cancer patients at Kenyatta National Hospital, Nairobi. East Afr Med J. 2004 Jul;81(7):341-7.. East Afr Med J. 2004 Jul;81(7):341-7.. : MBA Abstract

BACKGROUND: The quality of life of cancer patients is likely to be influenced by psychological reactions of the cancer patients yet there are no documented issues related to quality of life in cancer patients in Kenyan hospitals. OBJECTIVE: To investigate issues which affect the quality of life in male cancer patients. DESIGN: Prospective cross sectional study. SETTING: Kenyatta National Hospital, Nairobi, Kenya. METHODS AND SUBJECTS: Cancer patients above 12 years of age were interviewed during the course of their stay in the hospital, specifically to gather information on; semi structured questions and a modified Beck's 24 item depression inventory with a view to solicit for their reaction on issues which pertains to quality of life. MAIN OUTCOME MEASURES: Age group, level of education, tribe, geographical place (province) of birth, chief complains, main concerns, views on doctors, contact with psychiatrist and psychologist, the anatomic site of cancer, treatment given and responses on modified Beck's depression inventory. RESULTS: Forty two patients were studied, their age range 13-72 years, mean 43.2 and peak 13-26 years. Forty seven per cent of cases had no formal education. The cancers were gastrointestinal tract 33%, blood and lymphoid tissue (26%), bone and muscle (11.9%), skin (9.4%) and genitourinary tract (4.8%). Treatment given was chemotherapy, radiotherapy and surgery. Ninety three per cent were unable to cope. Chief complaints were pain, inability to work, feeling miserable and concerns were families, health and work retardation. Modified Beck's depression score was 20%, with major issues being; work retardation, insomnia, weight loss, and anorexia. Most affected were, age group 27-35 years (and least 13-26 years), uneducated, living in Nairobi (city), having carcinomas, treatment with combined surgery and radiotherapy. Low education level and residence in Nairobi coped poorly. Radiation therapy group appeared to cope better than other modalities. CONCLUSION: The issues affecting the quality of life of male cancer patients stated were pain, inability to work, poor coping with cancer and psychological reactions of work retardation, insomnia, weight loss, fatigability and depression. Gambling, suicidal ideas and social withdrawal were minimal. Other concerns were families, health and work.

OTIENO, PROFMWANDAWALTER.  2004.  Orem J, Otieno MW, Remick SC. AIDS-associated cancer in developing nations. Current Opinion in Oncology 6:468-476; 2004.. MEDICOM, 2004; 19, 1: 13-18.. : MBA Abstract

PURPOSE OF REVIEW: With the emergence of the highly active antiretroviral therapy era, it is apparent that the incidence of Kaposi sarcoma, in particular, and lymphoma in patients with AIDS is declining, especially in regions of the world where these regimens are routinely available. The burden of HIV infection and AIDS is greatest in the developing world, and no doubt neoplastic complications are increasingly encountered. The purpose of this review is to highlight recent developments of this aspect of the AIDS epidemic in the developing world. RECENT FINDINGS: It was readily apparent that the incidence of Kaposi sarcoma sharply increased after the onset of the AIDS epidemic in developing countries. By the end of the second decade of the epidemic, non-Hodgkin lymphoma is increasing in incidence and the natural history of Burkitt lymphoma is evolving in the backdrop of HIV infection as well. Cervical cancer is the most common cancer in women in many developing countries, yet the true impact of HIV infection on the development of this neoplasm is not fully understood. Squamous cell carcinoma of the conjunctiva appears to be a unique AIDS-associated neoplasm that is encountered in sub-Saharan Africa as well. Finally, although the epidemiologic and clinicopathologic features for many AIDS-associated neoplasms are well characterized in developing regions of the world, there is a paucity of data on the therapeutic approach to these tumors in this setting. SUMMARY: It is apparent that as the AIDS pandemic proceeds, the burden of neoplastic diseases is increasing in developing nations. Current therapeutic approaches are not well documented. Pragmatic prevention and therapeutic interventions suitable for the resource-constrained setting are clearly needed.

OTIENO, PROFMWANDAWALTER.  2004.  Dr. Obondo A., Dr. Mwanda O. W. Aspects Of Psychological Issues Of Adult Cancer Patients, Review Article. MEDICOM, 2004; 19, 1: 13-18.. MEDICOM, 2004; 19, 1: 13-18.. : MBA Abstract

PURPOSE: To build capacity in the resource-poor setting to support the clinical investigation and treatment of AIDS-related malignancies in a region of the world hardest hit by the AIDS pandemic. METHODS: An initial MEDLINE database search for international collaborative partnerships dedicated to AIDS malignancies in developing countries failed to identify any leads. This search prompted us to report progress on our collaboration in this aspect of the epidemic. Building on the formal Uganda-Case Western Reserve University (Case) Research Collaboration dating back to 1987, established NIH-supported centers of research excellence at Case, and expanding activities in Kenya, scientific and training initiatives, research capital amongst our institutions are emerging to sustain a international research enterprise focused on AIDS and other viral-related malignancies. RESULTS: A platform of clinical research trials with pragmatic design has been developed to further enhance clinical care and sustain training initiatives with partners in East Africa and the United States. An oral chemotherapy feasibility trial in AIDS lymphoma is near completion; a second lymphoma trial of byrostatin and vincristine is anticipated and a feasibility trial of indinavir for endemic Kaposi's sarcoma is planned. CONCLUSIONS: In the absence of published reports of evolving international partnerships dedicated to AIDS malignancy in resource constrained settings, we feel it important for such progress on similar or related international collaborative pursuits to be published. The success of this effort is realized by the long-term international commitment of the collaborating investigators and institutions to sustain this effort in keeping with ethical and NIH standards for the conduct of research; the provision of formal training of investigators and research personnel on clinical problems our East African partners are faced with in practice and the development of pragmatic clinical trials and therapeutic intervention to facilitate technology transfer and enhance clinical practice.

PMID: 15829373 [PubMed - indexed for MEDLINE]

OTIENO, PROFMWANDAWALTER.  2004.  Mwanda O. W , Rochford Rosemary, Jenetter Rainey, Mark L Wilson. Challenges (in the epidemiological and clinical aspects) of Burkitt's lymphoma in Kenya : linking evidence and experience. EAMJ, 2004; 81: S111-116.. EAMJ, 2004; 81: S104-110.. : MBA Abstract

PURPOSE: To build capacity in the resource-poor setting to support the clinical investigation and treatment of AIDS-related malignancies in a region of the world hardest hit by the AIDS pandemic. METHODS: An initial MEDLINE database search for international collaborative partnerships dedicated to AIDS malignancies in developing countries failed to identify any leads. This search prompted us to report progress on our collaboration in this aspect of the epidemic. Building on the formal Uganda-Case Western Reserve University (Case) Research Collaboration dating back to 1987, established NIH-supported centers of research excellence at Case, and expanding activities in Kenya, scientific and training initiatives, research capital amongst our institutions are emerging to sustain a international research enterprise focused on AIDS and other viral-related malignancies. RESULTS: A platform of clinical research trials with pragmatic design has been developed to further enhance clinical care and sustain training initiatives with partners in East Africa and the United States. An oral chemotherapy feasibility trial in AIDS lymphoma is near completion; a second lymphoma trial of byrostatin and vincristine is anticipated and a feasibility trial of indinavir for endemic Kaposi's sarcoma is planned. CONCLUSIONS: In the absence of published reports of evolving international partnerships dedicated to AIDS malignancy in resource constrained settings, we feel it important for such progress on similar or related international collaborative pursuits to be published. The success of this effort is realized by the long-term international commitment of the collaborating investigators and institutions to sustain this effort in keeping with ethical and NIH standards for the conduct of research; the provision of formal training of investigators and research personnel on clinical problems our East African partners are faced with in practice and the development of pragmatic clinical trials and therapeutic intervention to facilitate technology transfer and enhance clinical practice.

PMID: 15829373 [PubMed - indexed for MEDLINE]

OTIENO, PROFMWANDAWALTER.  2004.  Aywak A.A., Mwanda W.O., Adamali N.E. The Radiological Features of Burkitt's Lymphoma. EAMJ, 2004; 81: S104-110.. EAMJ, 2004; 81: S104-110.. : MBA Abstract

PURPOSE: To build capacity in the resource-poor setting to support the clinical investigation and treatment of AIDS-related malignancies in a region of the world hardest hit by the AIDS pandemic. METHODS: An initial MEDLINE database search for international collaborative partnerships dedicated to AIDS malignancies in developing countries failed to identify any leads. This search prompted us to report progress on our collaboration in this aspect of the epidemic. Building on the formal Uganda-Case Western Reserve University (Case) Research Collaboration dating back to 1987, established NIH-supported centers of research excellence at Case, and expanding activities in Kenya, scientific and training initiatives, research capital amongst our institutions are emerging to sustain a international research enterprise focused on AIDS and other viral-related malignancies. RESULTS: A platform of clinical research trials with pragmatic design has been developed to further enhance clinical care and sustain training initiatives with partners in East Africa and the United States. An oral chemotherapy feasibility trial in AIDS lymphoma is near completion; a second lymphoma trial of byrostatin and vincristine is anticipated and a feasibility trial of indinavir for endemic Kaposi's sarcoma is planned. CONCLUSIONS: In the absence of published reports of evolving international partnerships dedicated to AIDS malignancy in resource constrained settings, we feel it important for such progress on similar or related international collaborative pursuits to be published. The success of this effort is realized by the long-term international commitment of the collaborating investigators and institutions to sustain this effort in keeping with ethical and NIH standards for the conduct of research; the provision of formal training of investigators and research personnel on clinical problems our East African partners are faced with in practice and the development of pragmatic clinical trials and therapeutic intervention to facilitate technology transfer and enhance clinical practice.

PMID: 15829373 [PubMed - indexed for MEDLINE]

OTIENO, PROFMWANDAWALTER.  2004.  Mwanda O.W. The Clinical Characteristics of Burkitt's Lymphoma seen in Kenyan Patients. EAMJ, 2004; 81: S78-89.. EAMJ, 2004; 81: S78-89.. : MBA Abstract

PURPOSE: To build capacity in the resource-poor setting to support the clinical investigation and treatment of AIDS-related malignancies in a region of the world hardest hit by the AIDS pandemic. METHODS: An initial MEDLINE database search for international collaborative partnerships dedicated to AIDS malignancies in developing countries failed to identify any leads. This search prompted us to report progress on our collaboration in this aspect of the epidemic. Building on the formal Uganda-Case Western Reserve University (Case) Research Collaboration dating back to 1987, established NIH-supported centers of research excellence at Case, and expanding activities in Kenya, scientific and training initiatives, research capital amongst our institutions are emerging to sustain a international research enterprise focused on AIDS and other viral-related malignancies. RESULTS: A platform of clinical research trials with pragmatic design has been developed to further enhance clinical care and sustain training initiatives with partners in East Africa and the United States. An oral chemotherapy feasibility trial in AIDS lymphoma is near completion; a second lymphoma trial of byrostatin and vincristine is anticipated and a feasibility trial of indinavir for endemic Kaposi's sarcoma is planned. CONCLUSIONS: In the absence of published reports of evolving international partnerships dedicated to AIDS malignancy in resource constrained settings, we feel it important for such progress on similar or related international collaborative pursuits to be published. The success of this effort is realized by the long-term international commitment of the collaborating investigators and institutions to sustain this effort in keeping with ethical and NIH standards for the conduct of research; the provision of formal training of investigators and research personnel on clinical problems our East African partners are faced with in practice and the development of pragmatic clinical trials and therapeutic intervention to facilitate technology transfer and enhance clinical practice.

PMID: 15829373 [PubMed - indexed for MEDLINE]

OTIENO, PROFMWANDAWALTER.  2004.  Mwanda WO, Christopher W, Scot CR, Lederman M, Orem J, Banura C. Anatomical sites predilections of Non-Hodgkin's Lymphoma in Human Immunodeficiency Virus infection: A Report on 54 cases. EAMJ, 2004; 81: S90-96.. A Report on 54 cases. EAMJ, 2004; 81: S90-96.. : MBA Abstract

PURPOSE: To build capacity in the resource-poor setting to support the clinical investigation and treatment of AIDS-related malignancies in a region of the world hardest hit by the AIDS pandemic. METHODS: An initial MEDLINE database search for international collaborative partnerships dedicated to AIDS malignancies in developing countries failed to identify any leads. This search prompted us to report progress on our collaboration in this aspect of the epidemic. Building on the formal Uganda-Case Western Reserve University (Case) Research Collaboration dating back to 1987, established NIH-supported centers of research excellence at Case, and expanding activities in Kenya, scientific and training initiatives, research capital amongst our institutions are emerging to sustain a international research enterprise focused on AIDS and other viral-related malignancies. RESULTS: A platform of clinical research trials with pragmatic design has been developed to further enhance clinical care and sustain training initiatives with partners in East Africa and the United States. An oral chemotherapy feasibility trial in AIDS lymphoma is near completion; a second lymphoma trial of byrostatin and vincristine is anticipated and a feasibility trial of indinavir for endemic Kaposi's sarcoma is planned. CONCLUSIONS: In the absence of published reports of evolving international partnerships dedicated to AIDS malignancy in resource constrained settings, we feel it important for such progress on similar or related international collaborative pursuits to be published. The success of this effort is realized by the long-term international commitment of the collaborating investigators and institutions to sustain this effort in keeping with ethical and NIH standards for the conduct of research; the provision of formal training of investigators and research personnel on clinical problems our East African partners are faced with in practice and the development of pragmatic clinical trials and therapeutic intervention to facilitate technology transfer and enhance clinical practice.

PMID: 15829373 [PubMed - indexed for MEDLINE]

OTIENO, PROFMWANDAWALTER.  2004.  W. O. Mwanda. Aspects of Epidemiological and Clinical Features of Patients with Central Nervous System (CNS) Burkitt's Lymphoma (BL) in Kenya . EAMJ, 2004; 81: S97-103.. EAMJ, 2004; 81: S97-103.. : MBA Abstract

PURPOSE: To build capacity in the resource-poor setting to support the clinical investigation and treatment of AIDS-related malignancies in a region of the world hardest hit by the AIDS pandemic. METHODS: An initial MEDLINE database search for international collaborative partnerships dedicated to AIDS malignancies in developing countries failed to identify any leads. This search prompted us to report progress on our collaboration in this aspect of the epidemic. Building on the formal Uganda-Case Western Reserve University (Case) Research Collaboration dating back to 1987, established NIH-supported centers of research excellence at Case, and expanding activities in Kenya, scientific and training initiatives, research capital amongst our institutions are emerging to sustain a international research enterprise focused on AIDS and other viral-related malignancies. RESULTS: A platform of clinical research trials with pragmatic design has been developed to further enhance clinical care and sustain training initiatives with partners in East Africa and the United States. An oral chemotherapy feasibility trial in AIDS lymphoma is near completion; a second lymphoma trial of byrostatin and vincristine is anticipated and a feasibility trial of indinavir for endemic Kaposi's sarcoma is planned. CONCLUSIONS: In the absence of published reports of evolving international partnerships dedicated to AIDS malignancy in resource constrained settings, we feel it important for such progress on similar or related international collaborative pursuits to be published. The success of this effort is realized by the long-term international commitment of the collaborating investigators and institutions to sustain this effort in keeping with ethical and NIH standards for the conduct of research; the provision of formal training of investigators and research personnel on clinical problems our East African partners are faced with in practice and the development of pragmatic clinical trials and therapeutic intervention to facilitate technology transfer and enhance clinical practice.

PMID: 15829373 [PubMed - indexed for MEDLINE]

OTIENO, PROFMWANDAWALTER.  2004.  Mwanda O. W. Burkitt's Lymphoma; The Initial defining Characteristics. EAMJ, 2004;81:S63-67.. EAMJ, 2004;81:S63-67.. : MBA Abstract

PURPOSE: To build capacity in the resource-poor setting to support the clinical investigation and treatment of AIDS-related malignancies in a region of the world hardest hit by the AIDS pandemic. METHODS: An initial MEDLINE database search for international collaborative partnerships dedicated to AIDS malignancies in developing countries failed to identify any leads. This search prompted us to report progress on our collaboration in this aspect of the epidemic. Building on the formal Uganda-Case Western Reserve University (Case) Research Collaboration dating back to 1987, established NIH-supported centers of research excellence at Case, and expanding activities in Kenya, scientific and training initiatives, research capital amongst our institutions are emerging to sustain a international research enterprise focused on AIDS and other viral-related malignancies. RESULTS: A platform of clinical research trials with pragmatic design has been developed to further enhance clinical care and sustain training initiatives with partners in East Africa and the United States. An oral chemotherapy feasibility trial in AIDS lymphoma is near completion; a second lymphoma trial of byrostatin and vincristine is anticipated and a feasibility trial of indinavir for endemic Kaposi's sarcoma is planned. CONCLUSIONS: In the absence of published reports of evolving international partnerships dedicated to AIDS malignancy in resource constrained settings, we feel it important for such progress on similar or related international collaborative pursuits to be published. The success of this effort is realized by the long-term international commitment of the collaborating investigators and institutions to sustain this effort in keeping with ethical and NIH standards for the conduct of research; the provision of formal training of investigators and research personnel on clinical problems our East African partners are faced with in practice and the development of pragmatic clinical trials and therapeutic intervention to facilitate technology transfer and enhance clinical practice.

PMID: 15829373 [PubMed - indexed for MEDLINE]

OTIENO, PROFMWANDAWALTER.  2004.  Mwanda OW, Rosemary Rochford, Ann M Moormann, Adam Macneil, Christopher Whalen, Mark L Wilson. Burkitt's Lymphoma in Kenya : Geographical, Age, Gender and Ethnic distribution. EAMJ, 2004; 81: S68-77. EAMJ, 2004; 81: S68-77. : MBA Abstract

PURPOSE: To build capacity in the resource-poor setting to support the clinical investigation and treatment of AIDS-related malignancies in a region of the world hardest hit by the AIDS pandemic. METHODS: An initial MEDLINE database search for international collaborative partnerships dedicated to AIDS malignancies in developing countries failed to identify any leads. This search prompted us to report progress on our collaboration in this aspect of the epidemic. Building on the formal Uganda-Case Western Reserve University (Case) Research Collaboration dating back to 1987, established NIH-supported centers of research excellence at Case, and expanding activities in Kenya, scientific and training initiatives, research capital amongst our institutions are emerging to sustain a international research enterprise focused on AIDS and other viral-related malignancies. RESULTS: A platform of clinical research trials with pragmatic design has been developed to further enhance clinical care and sustain training initiatives with partners in East Africa and the United States. An oral chemotherapy feasibility trial in AIDS lymphoma is near completion; a second lymphoma trial of byrostatin and vincristine is anticipated and a feasibility trial of indinavir for endemic Kaposi's sarcoma is planned. CONCLUSIONS: In the absence of published reports of evolving international partnerships dedicated to AIDS malignancy in resource constrained settings, we feel it important for such progress on similar or related international collaborative pursuits to be published. The success of this effort is realized by the long-term international commitment of the collaborating investigators and institutions to sustain this effort in keeping with ethical and NIH standards for the conduct of research; the provision of formal training of investigators and research personnel on clinical problems our East African partners are faced with in practice and the development of pragmatic clinical trials and therapeutic intervention to facilitate technology transfer and enhance clinical practice.

PMID: 15829373 [PubMed - indexed for MEDLINE]

OTIENO, PROFMWANDAWALTER.  2004.  Mwanda O. W. Burkitt's Lymphoma in Kenya : views from the 20th Century, Introduction. EAMJ, 2004; 81:S61-62.. EAMJ, 2004; 81:S61-62.. : MBA Abstract

PURPOSE: To build capacity in the resource-poor setting to support the clinical investigation and treatment of AIDS-related malignancies in a region of the world hardest hit by the AIDS pandemic. METHODS: An initial MEDLINE database search for international collaborative partnerships dedicated to AIDS malignancies in developing countries failed to identify any leads. This search prompted us to report progress on our collaboration in this aspect of the epidemic. Building on the formal Uganda-Case Western Reserve University (Case) Research Collaboration dating back to 1987, established NIH-supported centers of research excellence at Case, and expanding activities in Kenya, scientific and training initiatives, research capital amongst our institutions are emerging to sustain a international research enterprise focused on AIDS and other viral-related malignancies. RESULTS: A platform of clinical research trials with pragmatic design has been developed to further enhance clinical care and sustain training initiatives with partners in East Africa and the United States. An oral chemotherapy feasibility trial in AIDS lymphoma is near completion; a second lymphoma trial of byrostatin and vincristine is anticipated and a feasibility trial of indinavir for endemic Kaposi's sarcoma is planned. CONCLUSIONS: In the absence of published reports of evolving international partnerships dedicated to AIDS malignancy in resource constrained settings, we feel it important for such progress on similar or related international collaborative pursuits to be published. The success of this effort is realized by the long-term international commitment of the collaborating investigators and institutions to sustain this effort in keeping with ethical and NIH standards for the conduct of research; the provision of formal training of investigators and research personnel on clinical problems our East African partners are faced with in practice and the development of pragmatic clinical trials and therapeutic intervention to facilitate technology transfer and enhance clinical practice.

PMID: 15829373 [PubMed - indexed for MEDLINE]

OTIENO, PROFMWANDAWALTER.  2004.  Mwanda W.O., Abdallah F.K., Obondo A., Musau F. Quality Of Life: Aspects To Look For In Male Cancer Patients At A Referral Hospital In Kenya . EAMJ 2004; 81: 341-347.. EAMJ 2004; 81: 341-347.. : MBA Abstract

PURPOSE: To build capacity in the resource-poor setting to support the clinical investigation and treatment of AIDS-related malignancies in a region of the world hardest hit by the AIDS pandemic. METHODS: An initial MEDLINE database search for international collaborative partnerships dedicated to AIDS malignancies in developing countries failed to identify any leads. This search prompted us to report progress on our collaboration in this aspect of the epidemic. Building on the formal Uganda-Case Western Reserve University (Case) Research Collaboration dating back to 1987, established NIH-supported centers of research excellence at Case, and expanding activities in Kenya, scientific and training initiatives, research capital amongst our institutions are emerging to sustain a international research enterprise focused on AIDS and other viral-related malignancies. RESULTS: A platform of clinical research trials with pragmatic design has been developed to further enhance clinical care and sustain training initiatives with partners in East Africa and the United States. An oral chemotherapy feasibility trial in AIDS lymphoma is near completion; a second lymphoma trial of byrostatin and vincristine is anticipated and a feasibility trial of indinavir for endemic Kaposi's sarcoma is planned. CONCLUSIONS: In the absence of published reports of evolving international partnerships dedicated to AIDS malignancy in resource constrained settings, we feel it important for such progress on similar or related international collaborative pursuits to be published. The success of this effort is realized by the long-term international commitment of the collaborating investigators and institutions to sustain this effort in keeping with ethical and NIH standards for the conduct of research; the provision of formal training of investigators and research personnel on clinical problems our East African partners are faced with in practice and the development of pragmatic clinical trials and therapeutic intervention to facilitate technology transfer and enhance clinical practice.

PMID: 15829373 [PubMed - indexed for MEDLINE]

OTIENO, PROFMWANDAWALTER.  2004.  Mwanda O.W., Otieno C. F., Abdalla F. K., Transfusion Haemosiderosis Inspite Of Regular Use Of Desferrioxamine - Case Report. EAMJ 2004; 81:326-328.. Fogarty AIDS International Training and Research Program, Case School of Medicine, Case Western Reserve University, Cleveland, OH, USA.. : MBA Abstract

PURPOSE: To build capacity in the resource-poor setting to support the clinical investigation and treatment of AIDS-related malignancies in a region of the world hardest hit by the AIDS pandemic. METHODS: An initial MEDLINE database search for international collaborative partnerships dedicated to AIDS malignancies in developing countries failed to identify any leads. This search prompted us to report progress on our collaboration in this aspect of the epidemic. Building on the formal Uganda-Case Western Reserve University (Case) Research Collaboration dating back to 1987, established NIH-supported centers of research excellence at Case, and expanding activities in Kenya, scientific and training initiatives, research capital amongst our institutions are emerging to sustain a international research enterprise focused on AIDS and other viral-related malignancies. RESULTS: A platform of clinical research trials with pragmatic design has been developed to further enhance clinical care and sustain training initiatives with partners in East Africa and the United States. An oral chemotherapy feasibility trial in AIDS lymphoma is near completion; a second lymphoma trial of byrostatin and vincristine is anticipated and a feasibility trial of indinavir for endemic Kaposi's sarcoma is planned. CONCLUSIONS: In the absence of published reports of evolving international partnerships dedicated to AIDS malignancy in resource constrained settings, we feel it important for such progress on similar or related international collaborative pursuits to be published. The success of this effort is realized by the long-term international commitment of the collaborating investigators and institutions to sustain this effort in keeping with ethical and NIH standards for the conduct of research; the provision of formal training of investigators and research personnel on clinical problems our East African partners are faced with in practice and the development of pragmatic clinical trials and therapeutic intervention to facilitate technology transfer and enhance clinical practice.

PMID: 15829373 [PubMed - indexed for MEDLINE]

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