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Rwezaula S, Yonazi M, Panchal A, Dhoot A, Mathew J, Tony S, Rao S, Muhoka P, Mahfudh S, Budodi N, Kasubi M, Ndobho F, Kakumbula H, Luhulla K, Kapesa L, Tungaraza H, Nyagabona S, Shayo A, Seleki F, Mtenga J, Mwamtemi K, Suko M, Mbughi I, Shirima M, Mkisi A, Ally R, Kyaruzi M, Arola Myaka E, Matiku J, Nyamwaira M, Nair S, Asokan A, kumar G, Badavath R, Swai H, Museru L, Ajaikumar BS, Beda D, Jadhav S. Challenges and Outcomes of the First Stem Cell Transplant Program in Tanzania, East Africa. Adv Hematol 2024; 2024:1937419. [PMID: 38524403 PMCID: PMC10960647 DOI: 10.1155/2024/1937419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/21/2023] [Accepted: 03/05/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Due to the significant resources involved in creating HSCT programs there is a significant disparity in the availability of this treatment modality between the developed and developing countries. This manuscript details the process and the outcomes of the first HSCT program in East Africa which was started at Muhimbili National Hospital (MNH) in Dar-es-Salaam, Tanzania. Materials and Methods Information and data were collected on the processes which had been implemented for starting the HSCT program at MNH. The details of the collaborations, training, infrastructure development, and acquisition of the biomedical equipment, as well as the actual process for HSCT, as well as the outcomes of treatment are described. Observations. The project has been detailed in 4 stages for ease of description: Stage 1: Preparatory work which was performed by the Government of Tanzania, as well as the administrators and clinicians from MNH (July 2017-September 2021). Stage 2: Exploratory gap analysis by the teams from MNH and International Haematology Consortium of HCG Hospital, India (HCG-IHC) in October 2021. Stage 3: Activities for closure of gaps (November 2021). Stage 4: Stem Cell Transplantation Camps (November 2021 to March 2022). 11 peripheral blood stem cell transplants were done in two camps, November 2021 (5 patients), and February 2022 (6 patients). 10 patients underwent autologous peripheral blood stem cell transplantation for multiple myeloma and 1 for lymphoma. The median duration of hospital stay was 19 ± 6 days. The median time for neutrophil engraftment, it was on 8.8 ± 0.8 days, and for platelet engraftment was 9.6 ± 2.4 days. Progression-free survival was 100%, and there was no mortality. Conclusion Commonalities in the socioeconomic challenges in developing countries can be leveraged to create robust HSCT programs in other developing countries.
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Affiliation(s)
| | - Mbonea Yonazi
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Amey Panchal
- Healthcare Global Enterprises Limited, Bangalore, India
| | - Ashish Dhoot
- Healthcare Global Enterprises Limited, Bangalore, India
| | - Jemy Mathew
- Healthcare Global Enterprises Limited, Bangalore, India
| | - Sonu Tony
- Healthcare Global Enterprises Limited, Bangalore, India
| | - Sandeep Rao
- Healthcare Global Enterprises Limited, Bangalore, India
| | - Peter Muhoka
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | - Neema Budodi
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Mabula Kasubi
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Flora Ndobho
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | - Koga Luhulla
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Linda Kapesa
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | | | - Agnes Shayo
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | - Janeth Mtenga
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | - Musa Suko
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Isaac Mbughi
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | - Alfayo Mkisi
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Rahma Ally
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | | | - Johari Matiku
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | - Saranya Nair
- Healthcare Global Enterprises Limited, Bangalore, India
| | | | - Goutham kumar
- Healthcare Global Enterprises Limited, Bangalore, India
| | - Raj Badavath
- Healthcare Global Enterprises Limited, Bangalore, India
| | - Hedwiga Swai
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | | | | | - Sachin Jadhav
- Healthcare Global Enterprises Limited, Bangalore, India
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Mashauri HL. Scurvy: A treatable forgotten fatal differential diagnosis and potential etiology of leukemia and aplastic anemia in pediatric population. Health Sci Rep 2023; 6:e1611. [PMID: 37808934 PMCID: PMC10552072 DOI: 10.1002/hsr2.1611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023] Open
Abstract
Scurvy is a rare nutritional deficiency disease which is less likely to be suspected and it mostly lead to delayed diagnosis. It can present with features which can mislead clinicians to misdiagnose the condition as leukemia or aplastic anemia. This can subject patients to the wrong management which leads to poor outcome and increased preventable morbidity and mortality. Vitamin C deficiency is still prevalent among pediatric population even in the modern days and should no longer be considered as historical condition. Chromosomal fragility has been greatly accounted for the development of leukemia and aplastic anemia secondary to various triggers. The role of vitamin C toward DNA stability, prevention, and control of mutations have been documented. Vitamin C plays a vital role in hematopoiesis by controlling regulation and prevent dysfunction of hematopoietic stem cells. Scurvy deficiency has been a silent growing clinical problem which needs a high index of suspicion for a clinician to pick it. It should be considered as one among potential differential diagnosis of leukemia and aplastic anemia especially in the pediatric population. History of any dietary restriction should be obtained and addressed properly. Serum vitamin C should be among the essential laboratory workout in diagnosis of both leukemia and aplastic anemia. All patients suspected to have such conditions should be screened and supplemented for vitamin C deficiency irrespective of positive confirmatory test results of leukemia or aplastic anemia since the probability of co-occurrence is likely also. Moreover, studies should be conducted to explore the clinical link, if any, between vitamin C deficiency or insufficiency and development of leukemia and aplastic anemia among the pediatric population given its physiological and genomic role in hematopoiesis. Furthermore, the potential pharmacological therapeutic use of vitamin C in treatment of leukemia and aplastic anemia should be determined clinically.
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Affiliation(s)
- Harold L Mashauri
- Department of Pediatrics and Child Health Kilimanjaro Christian Medical University College Moshi Tanzania
- Department of Internal Medicine Kilimanjaro Christian Medical University College Moshi Tanzania
- Department of Epidemiology and Biostatistics Kilimanjaro Christian Medical University College Moshi Tanzania
- Department of Physiology Kilimanjaro Christian Medical University College Moshi Tanzania
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Research on High-Frequency Information-Transmission Method of Smart Grid Based on CNN-LSTM Model. INFORMATION 2022. [DOI: 10.3390/info13080375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In order to solve the problem of the slow transmission rate of high-frequency information in smart grid and improve the efficiency of information transmission, a research method of high-frequency information transmission in smart grids based on the CNN-LSTM model is proposed. It effectively combines the superiority of the CNN algorithm for high-frequency information feature extraction and the learning ability of the LSTM algorithm for global features of high-frequency information. Meanwhile, the client buffer is divided by the VLAN area division method, which avoids the buffer being too large due to line congestion. The intelligent control module is adopted to change the traditional control concept. In addition, the neural network optimization control module is used for intelligent control, which ensures the feedback speed of the control terminal and avoids the problem of increasing the buffer area caused by the feedback time difference. The experimental results show that via the method in this paper, the total efficiency of single-channel transmission reaches 96% and the transmission rate reaches 46 bit/s; the total efficiency of multiplex transmission is 89% and the transmission rate reaches 75 bit/s. It is verified that the method proposed in this paper has a fast transmission rate and high efficiency.
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Hendricks CL, Naidoo A, Thejpal R, Rapiti N, Neethling B, Goga Y, Buldeo S. Childhood aplastic anaemia with paroxysmal nocturnal haemoglobinuria clones: A retrospective single-centre study in South Africa. Afr J Lab Med 2022; 11:1537. [PMID: 35811748 PMCID: PMC9257717 DOI: 10.4102/ajlm.v11i1.1537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/10/2022] [Indexed: 11/01/2022] Open
Abstract
Background: Paroxysmal nocturnal haemoglobinuria (PNH) clones in children are rare but commonly associated with aplastic anaemia (AA) and myelodysplasia.Objective: This study aimed to determine the prevalence of PNH clones in paediatric patients with idiopathic AA, identify differences in clinical and laboratory features and outcomes, and determine the impact of clone size on clinical presentation.Methods: Patients with confirmed idiopathic AA who were tested for PNH between September 2013 and January 2018 at the Inkosi Albert Luthuli Central Hospital, Durban, KwaZulu-Natal, South Africa, were included. PNH clones were detected in neutrophils and monocytes by flow cytometry using fluorescent aerolysin, CD24, CD66b and CD14.Results: Twenty-nine children with AA were identified and 11 were excluded. Ten patients (10/18, 55.6%) had PNH clones ranging from 0.11% to 24%. Compared to the PNH-negative group, these children were older (median: 10 years vs 4 years, p = 0.02) and had significantly lower total white cell counts (median 1.7 × 109/L vs 3.2 × 109/L; p = 0.04). There was no difference in median absolute neutrophil count or haemoglobin concentration. Four patients in each group received immunosuppressive therapy (IST). At six months, all four patients with PNH clones had responded, compared to one in the PNH-negative group.Conclusion: More than half of children with AA had a PNH clone. The size of the clone did not impact clinical severity; however, IST use may positively impact prognosis. We recommend early initiation of IST in patients with AA to avoid delays associated with human leukocyte antigen typing.
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Affiliation(s)
- Candice L Hendricks
- Department of Paediatric Haematology, Faculty of Health Sciences, School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Paediatric Haematology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Ashen Naidoo
- Department of Haematology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Rajendra Thejpal
- Department of Paediatric Haematology, Faculty of Health Sciences, School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Paediatric Haematology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Nadine Rapiti
- Department of Haematology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Beverley Neethling
- Department of Paediatric Haematology, Faculty of Health Sciences, School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Paediatric Haematology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Yasmin Goga
- Department of Paediatric Haematology, Faculty of Health Sciences, School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Paediatric Haematology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Suvarna Buldeo
- Department of Haematology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
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Luzzatto L, Makani J. Treating Rare Diseases in Africa: The Drugs Exist but the Need Is Unmet. Front Pharmacol 2022; 12:770640. [PMID: 35082665 PMCID: PMC8784510 DOI: 10.3389/fphar.2021.770640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/08/2021] [Indexed: 01/18/2023] Open
Abstract
Rare diseases (RD) pose serious challenges in terms of both diagnosis and treatment. Legislation was passed in the US (1983) and in EU (2000) aimed to reverse the previous neglect of RD, by providing incentives for development of “orphan drugs” (OD) for their management. Here we analyse the current situation in Africa with respect to (1) sickle cell disease (SCD), that qualifies as rare in the US and in EU, but is not at all rare in African countries (frequencies up to 1–2%); (2) paroxysmal nocturnal haemoglobinuria (PNH), that is ultra-rare in Africa as everywhere else (estimated <10 per million). SCD can be cured by bone marrow transplantation and recently by gene therapy, but very few African patients have access to these expensive procedures; on the other hand, the disease-ameliorating agent hydroxyurea is not expensive, but still the majority of patients in Africa are not receiving it. For PNH, currently most patients In high income countries are treated with a highly effective OD that costs about $400,000 per year per patient: this is not available in Africa. Thus, the impact of OD legislation has been practically nil in this continent. As members of the medical profession and of the human family, we must aim to remove barriers that are essentially financial: especially since countries with rich economies share a history of having exploited African countries. We call on the Global Fund to supply hydroxyurea for all SCD patients; and we call on companies who produce ODs to donate, for every patient who receives an expensive OD in a high income country, enough of the same drug, at a symbolic price, to treat one patient in Africa.
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Affiliation(s)
- Lucio Luzzatto
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,University of Florence, Florence, Italy
| | - Julie Makani
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
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Iftikhar R, Ahmad P, de Latour R, Dufour C, Risitano A, Chaudhri N, Bazarbachi A, De La Fuente J, Höchsmann B, Osman Ahmed S, Gergis U, Elhaddad A, Halkes C, Albeirouti B, Alotaibi S, Kulasekararaj A, Alzahrani H, Ben Othman T, Cesaro S, Alahmari A, Rihani R, Alshemmari S, Ali Hamidieh A, Bekadja MA, Passweg J, Al-Khabori M, Rasheed W, Bacigalupo A, Chaudhry QUN, Ljungman P, Marsh J, El Fakih R, Aljurf M. Special issues related to the diagnosis and management of acquired aplastic anemia in countries with restricted resources, a report on behalf of the Eastern Mediterranean blood and marrow transplantation (EMBMT) group and severe aplastic anemia working party of the European Society for blood and marrow transplantation (SAAWP of EBMT). Bone Marrow Transplant 2021; 56:2518-2532. [PMID: 34011966 DOI: 10.1038/s41409-021-01332-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/30/2021] [Accepted: 04/26/2021] [Indexed: 11/09/2022]
Abstract
Aplastic anemia is a relatively rare but potentially fatal disorder, with a reported higher incidence in developing countries in comparison to the West. There are significant variations in epidemiological as well as etiological factors of bone marrow failure syndromes in the developing countries in comparison to the developed world. Furthermore, the management of bone marrow failure syndromes in resource constraint settings has significant challenges including delayed diagnosis and referral, limited accessibility to healthcare facilities, treatment modalities as well as limitations related to patients who require allogeneic stem cell transplantation. Here we will provide a review of the available evidence related to specific issues of aplastic anemia in the developing countries and we summarize suggested recommendations from the Eastern Mediterranean blood and bone marrow transplantation (EMBMT) group and the severe aplastic anemia working party of the European Society of blood and marrow transplantation (SAAWP of EBMT) related to the diagnosis and therapeutic options in countries with restricted resources.
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Affiliation(s)
- Raheel Iftikhar
- Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan.
| | - Parvez Ahmad
- Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan
| | | | - Carlo Dufour
- G Gaslini Children Research Hospital, Genova, Italy
| | - Antonio Risitano
- AORN Moscati, Avellino, Italy.,Federico II University, Naples, Italy
| | - Naeem Chaudhri
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ali Bazarbachi
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | - Syed Osman Ahmed
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Usama Gergis
- Sidney Kimmel Cancer Center, Philadelphia, PA, USA
| | - Alaa Elhaddad
- National Cancer Institute, Cairo University, Cairo, Egypt
| | | | - Bassim Albeirouti
- King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | | | | | - Hazzaa Alzahrani
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Tarek Ben Othman
- Center National de Greffe de Moelle Osseuse de Tunis, Tunis, Tunisia
| | - Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Ali Alahmari
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | | | - Amir Ali Hamidieh
- Pediatric Cell Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Walid Rasheed
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | | | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Division of Hematology Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | | | - Riad El Fakih
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Mtenga J, Orf K, Zheng J, Chamba C, Chuwa H, Luoga F, Malangahe SW, Iversen PO, Makani J. Haematopoietic stem cell transplantation in Tanzania. Br J Haematol 2020; 192:17-21. [PMID: 32976624 DOI: 10.1111/bjh.17106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/20/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Janeth Mtenga
- Department of Haematology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kate Orf
- Department of Haematology, University College London Hospital, London, UK
| | - Jiexin Zheng
- Department of Haematology, University College London Hospital, London, UK
| | - Clara Chamba
- Department of Haematology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Harrison Chuwa
- Department of Haematology, Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Frederick Luoga
- Department of Haematology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Programme, Department of Haematology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Per Ole Iversen
- Department of Haematology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Haematology, University of Oslo, Oslo, Norway.,Department of Nutrition, University of Oslo, Oslo, Norway
| | - Julie Makani
- Department of Haematology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Programme, Department of Haematology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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