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Kijabe, Kenya

Nthumba P.M.,AIC Kijabe Hospital
World Journal of Surgery | Year: 2010

Background: Cutaneous malignancies are considered rare among Africans. Trauma, its sequelae, and other chronic non-healing wounds are known to predispose to malignant degeneration. Not much is known of the demographics of Marjolin's ulcers in sub-Saharan Africa. Methods: Pathology records on patients suspected to have Marjolin's ulcers submitted to the Pathology Department were extracted from a database of 75,124 specimens. A review of the English literature on Marjolin's ulcers from Nigeria, a sub-Saharan country, was also performed. Results: Of 210 specimens from suspected Marjolin's ulcers, 167 records had a histological diagnosis of malignancy, with a male to female ratio of 1:1.4, and a mean age of 48 years (range: 4-97 years). There were 163 (97.6%) squamous cell carcinomas, 3 (1.8%) sarcomas, and 1 (0.6%) malignant melanoma. Burn scars, chronic ulcers, osteomyelitis, and "other" ulcers constituted 82 (49%), 70 (42%), 9 (5.4%), and 6 (3.6%), respectively. Subjects in six sub-Saharan Marjolin's ulcer studies had a mean age between 36 and 42 years, with a mean latent period 16 years. Conclusions: Marjolin's ulcers in sub-Saharan African have a shorter latent period, and they occur in younger patients. Provision of early stable wound cover is essential for prevention of malignant degeneration of scars, while early appropriate intervention is crucial in the treatment of chronic ulcers. © 2010 Société Internationale de Chirurgie.

Awori J.,University of Michigan | Strahle J.,University of Michigan | Okechi H.,AIC Kijabe Hospital | Davis M.C.,University of Alabama at Birmingham
Journal of Neurosurgery: Pediatrics | Year: 2016

Objective: Pediatric neurosurgery can be highly cost-effective even in the developing world, but delivery of these services is hampered by resource limitations at the levels of both health care infrastructure and individual patients. Few studies have evaluated costs borne by neurosurgical patients in the developing world and their potential implications for efficient and effective delivery of care in this population. Methods: The families of 40 pediatric neurosurgery patients were surveyed in February 2015 at the AIC Kijabe Hospital in Kijabe, Kenya. Costs associated with obtaining inpatient care were assessed. Results: Patient families were charged an average of US $539.44 for neurosurgical services, representing 132% of their annual income. Indirect expenses (transport, food and lodging, lost wages) constituted US $79.37, representing 14.7% of the overall cost and 19.5% of their annual income. Conclusions: Expansion of pediatric neurosurgical services throughout the developing world necessitates increased attention to seemingly insignificant expenses that are absorbed by patients and their families. Even when all direct costs are covered at the institutional or national level, without additional assistance, some patients may be too poor to obtain even "free" neurosurgical care. © 2016 AANS.

Tjong J.,AIC Kijabe Hospital
East African medical journal | Year: 2012

Diagnosis for lower abdominal pain is always challenging clinically and more so inthe setting of rural Africa. Eighteen cases of sonographically-shownipsilateral enlargement and echo alteration of iliopsoas muscle have been compiled in patients with chronic lower abdominal pain. Seventy percent of the cases were treated with antibiotic and 30% with additional anti-inflammatory drug. A telephone interview follow up was done to nine patients, in which eight reported improvement after treatment. One case was biopsied and shown to be myofibrositis of iliopsoas muscle.

Nthumba P.M.,AIC Kijabe Hospital
World Journal of Surgery | Year: 2010

Background: Most reconstructive surgery in Sub-Saharan Africa is provided by numerous noncoordinated individuals and organizations, in multiple short trips, or "surgical blitzes." Because many such groups do not train local surgeons, these communities have become dependent on unsustainable systems. By providing much-needed care to otherwise neglected areas, the blitzes offer an easy solution to what would otherwise be the source of a significant headache to local governments. Methods: The collection of data and other material in this highly ambiguous and fluid field is nearly impossible, as scientific papers on the results of poor surgical treatment, especially in the realm of humanitarian medicine, do not exist: The author has had to rely on personal experience and community interaction to reach the views and conclusions articulated in this article. Results: Although not the rule, blitz surgeries have poorer outcomes than in-hospital procedures, primarily because of inadequate preoperative and postoperative care. Conclusions: Although the value of blitz surgery in meeting some of the surgical needs of otherwise neglected communities is undeniable, the author seeks to provoke a sober reexamination of these efforts vis-à-vis the long-term sustainability of such programs, with the objective of harnessing strengths that would see the evolution of a new reconstructive surgical service tailor-made for Africa-affordable and sustainable yet able to deliver quality surgical care to the remotest villages. Otherwise, these humanitarian efforts' will continue to be 'drops in the ocean, meeting the needs of a few in the community but resulting in no long-term gains. © 2009 Société Internationale de Chirurgie.

Nthumba P.M.,AIC Kijabe Hospital
World Journal of Surgical Oncology | Year: 2010

Background: Due to improved care, more and more children born with spina bifida in rural Kenya are surviving into adulthood. This improved survival has led to significant challenges in their lifestyles, especially the need to ensure pressure ulcer prevention and treatment. Malignant degeneration of pressure ulcers in spina bifida patients is very rare. The author describes the clinical presentation of two pressure ulcer carcinomas that are at variance from classical descriptions.Materials and methods: An internet/Medline/PubMed search of English literature for theories on Marjolin's ulcer evolution and prognostic features of Marjolin's ulcers was performed.A chart review of two young adults with spina bifida who had presented to the author's hospital between 2004 and August 2010 with chronic pressure ulcers found to be Marjolin's ulcers on histo-pathological examination was performed, and the clinical features are reported.Results: The two ulcers appeared clinically benign: one was a deep ulcer, while the other was shallow; both had normal, benign-appearing edges, and a foul smelling discharge. The two ulcers were surrounded by induration and multiple communicating sinuses, with no evidence of chronic osteomyelitis. The internet search revealed a total of nine theories on Marjolin's ulcer development, as well as seven clinical and four histological prognostic features.Discussion: The multifactorial theory, a coalescence of a number of proposed theories, best explains the evolution of Marjolin's ulcers. Poor prognostic features include pressure ulcer carcinomas, lesions and location in the lower limbs/trunks, all present in the two patients making their prognosis dim: this is despite the surgical margins being clear of tumor. Benign appearance, induration and presence of multiple communicating sinuses are features that have not been previously described as presenting features of pressure ulcers carcinomas.Conclusion: There is need for spina bifida patients and their guardians/caretakers to receive a close follow-up throughout life; health education focused on pressure ulcer prevention as well as early treatment of pressure ulcers when they occur, will avert the development of Marjolin's ulcers, and save lives. © 2010 Nthumba; licensee BioMed Central Ltd.

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