Ephata E . Kaaya | Muhimbili University of Health and Allied Sciences (MUHAS) (original) (raw)
Papers by Ephata E . Kaaya
Archives of AIDS Research, 1991
International Journal of Oncology, 1996
The presence of human Kaposi's sarcoma associated herpesvirus-like sequences (KSHV) was e... more The presence of human Kaposi's sarcoma associated herpesvirus-like sequences (KSHV) was examined in different epidemiological variants of Kaposi's sarcoma (KS) and in KS-derived cell cultures by polymerase chain reaction (PCR). KSHV DNA was present in all tumor biopsies of AIDS-associated KS (59 biopsies), endemic KS (26 biopsies; 21 African endemic KS, 5 Greek endemic KS), sporadic/classical KS (28 biopsies) and post-transplant/iatrogenic KS (6 of 7 biopsies). On the contrary, these sequences were only detected rarely in non-involved skin of KS patients (3 positive specimens of 12), in the peripheral blood mononuclear cells of HIV-infected patients (3 positive specimens of 54) and in lymphoma-biopsies (3 positive specimens of 47). Cell cultures derived from KS skin lesions were positive for KSHV DNA only in the first two passages. However, two longer-term positive cultures from a biopsy of a patient affected with sporadic KS and a biopsy of a patient affected with epidemic KS was identified. A strong association of KSHV with KS tissue was observed in all the different epidemiological variants of KS. Long-term positive KS-derived cell cultures will be an important tool to study the herpesvirus-like agent and to investigate its functional role in the initiation and progression of KS.
Tanzania Medical Journal, Apr 29, 2021
Background Majority of children with cancer live in low- and middle-income countries. The data is... more Background Majority of children with cancer live in low- and middle-income countries. The data is scarce on the epidemiology of childhood cancer in these countries. In this study, we enrolled children and adolescents with cancer at the only cancer hospital in Tanzania and determined the epidemiology and HIV infection among this population. Methodology This was a descriptive hospital-based study conducted at Ocean Road Cancer Institute in Dar es salaam, Tanzania. Data were collected for eight months (May to December 2010). Participants were enrolled consecutively as they presented to the hospital. Demographic data, HIV status and clinical diagnosis were determined and recorded. Each patient was followed up until a final diagnosis was reached, and investigations for disease staging were completed. Results One hundred and fifty-one (151) patients were enrolled in the study. Mean age at presentation was 5.8 years (range 3-17years), and 51.7% of participants were males. Sixty-three per cent (63%) of patients had their diagnoses confirmed by histology or cytology. Retinoblastoma was the most common malignancy (29.1%) followed by Nephroblastoma (11.3%), Burkitt lymphoma (10.6%) and Acute Lymphoblastic Leukemias (10.6%). More than half (58.2%) of patients aged three years or younger had Retinoblastoma. Four patients (2.8%) had HIV infection; three of them with Kaposi’s sarcoma and one with Burkitt lymphoma. Conclusion Retinoblastoma was the most typical malignancy followed by Wilms tumour, Burkitt lymphoma and acute lymphoblastic leukaemia. The prevalence of HIV infection was very low among patients with the described malignancies. Key Words: Childhood Malignancies, Tanzania.
International Journal of Cancer, Oct 21, 1993
Simian-immunodeficiency-virus(SIV)-infected cynomolgus monkeys develop B-cell lymphomas in approx... more Simian-immunodeficiency-virus(SIV)-infected cynomolgus monkeys develop B-cell lymphomas in approximately one third of the cases. We have now studied the expression of cynomolgus-Epstein-Barr-virus(cyno-EBV) nuclear antigens in I3 cyno-EBVcarrying SIVsm-associated monkey lymphomas and established cell lines from 3 of these turriors. lmmunoblots of cell tysates were probed with polyrpecific and monospecific reagents directed against human EB-virus EBNAI-6, and against the membrane protein LMP I. An EBNA2-cross-reacting protein was demonstrated in 8 lymphoma tissues (8/ 13) and in the 3 cell linas derived from the tumors. All tumors expressed a polypeptide with 50 to 55 kDa molecular weight, which cross-reacted with some antibodies to EBNAl. Absorption experiments with normal monkey tissue showed that this polypeptide was specific for the cyno-EBV-carrying lymphoma cells. Equivalents of EBNA3-6 and LMPl could not be detected. Immunophenotypicai characterization showed that the monkey lymphomas were similar to human HIV-associated B-cell lymphomas. Malignant B-cell lymphomas in experimentally SIVsm-infected cynomolgus monkeys can be a model for EBV-associated lymphomagenesis in immunodeficiency states.
Academic Medicine, Feb 1, 2012
One of the major needs for medical schools and health systems in less affluent countries is syste... more One of the major needs for medical schools and health systems in less affluent countries is system strengthening through the training and development of faculty, doctors, nurses, and other skilled health care workers. Partnering with medical schools in more affluent countries such as the United States is one potential approach for medical schools in underresourced areas, such as Sub-Saharan Africa. Most commonly, these partnerships have focused on research agendas or limited educational exchanges. In this perspective, the authors present an approach to strengthening collaborative relationships between three medical schools in the United States and four in Sub-Saharan Africa. The approach is explicitly focused on achieving partnerships that enable institutions to improve care. It developed from an initiative to fund partnerships or "collaboratives" that address 10 key learning questions determined to be central to focusing efforts on strengthening education systems and, in turn, improving health in Sub-Saharan Africa. The leaders of the schools involved in these partnerships met multiple times across three years to discuss how their collaboratives could address the ten learning questions including what is the best approach and what are the key ingredients for creating effective, multidimensional collaborations between academic institutions in the North and institutions in Sub-Saharan Africa. Collaboratively, they defined a framework of evidence that can be used for evaluating their current initiatives and, potentially, for structuring future partnerships.
Apmis, Mar 1, 1995
Sections of 18 malaria‐infected placentas were stained with haematoxylin and eosin, periodic acid... more Sections of 18 malaria‐infected placentas were stained with haematoxylin and eosin, periodic acid and methenamine silver, and immunohistochemically with monoclonal antibodies against human common leukocyte antigen, CLA (CD 45), B cells (CD 20, L 26), T cells (CD 45RO, UCHL‐1) and collagen IV. Parasitized erythrocytes accumulated in the maternal villous spaces, with none in the foetal circulation. These were found in association with inflammatory leukocytes and pigments. Fibrinoid necrosis was more prevalent in the heavily infected placentas. Thickening and reduplication of foetal capillary basement membranes, and a decrease in leukocytes, including B and T cells, were seen in the heavily infected placentas. These findings are in keeping with previously reported depression of cellular and humoral immunity in patients with heavy parasitaemia.
Clinical Immunology and Immunopathology, Dec 1, 1992
ABSTRACT
AIDS, Sep 11, 2006
It is still unclear if Kaposi&amp... more It is still unclear if Kaposi's sarcoma (KS) is a monoclonal cell proliferation or a polyclonal, hyperplastic, reactive process. Reports on KS cytogenetics are few and restricted to late stage disease and cell lines. We analysed 27 KS, early and late, AIDS related (AKS) and endemic (EKS) by laser microdissection, global DNA amplification and comparative genomic hybridization (CGH). Loss of Y chromosome was detected in 20/23 male KS, which was the only recurrent chromosomal aberration in all nine male early (patch) KS. Only one patch EKS showed in addition to the Y loss a loss of Xq. Late (nodular) AKS and EKS showed recurrent copy number changes in chromosomes 16, 17, 21, X and Y, as well as other random changes. The loss of chromosome 16, 17 and Y was confirmed by interphase fluorescence in situ hybridization (FISH) on paraffin sections. EKS showed a higher number of chromosomal abnormalities than AKS, indicating that rapid growth of AKS is less dependent on genetic changes than is EKS, possibly because of the immunosuppressed host environment in AKS. Clonal loss of chromosome Y was detected in all early male KS, while additional chromosomal aberrations appeared during development to late KS. This increase in chromosomal abnormalities during tumour growth indicates genetic instability and the selection of survival cell clones establishing late, aggressive sarcoma growth. Our data support the view that KS (in males) develops into a clonal tumour yet initially is a hyperplastic reactive cell proliferation.
Background: Malignant lymphoma (ML) in HIV patients, are second in frequency to Kaposi's sarcoma ... more Background: Malignant lymphoma (ML) in HIV patients, are second in frequency to Kaposi's sarcoma (AKS) as AIDS-defining tumors. In Africa the frequency of AIDS-related lymphoma (ARL) is rare and the findings are controversial. Kaposi's sarcoma (KS) lesions are now causally associated with KSHV/HHV-8 but whether African ARL shows this association is not clear. Method: Cancer registry data was reviewed for retrospective cases. Both retrospective and prospective lymphoma cases were classified according to the revised European-American (REAL) classification. Immunephenotyping was performed on both frozen and fixed paraffin sections. Viral DNA was assessed by polymerase chain reaction (PCR) of formalin fixed or frozen biopsies. In situ hybridization (ISH) was used to determine the presence of EBV encoded RNA (EBER). Objectives: To determine the frequency and type of AIDS and non-AIDS related malignant lymphoma in Tanzania and a possible coassociation with KSHV/HHV-8 and EBV. Results: An overall increasing tendency for ML in Tanzania was observed during 1991-94 and a clear increase from 1993. The tumors were classified as Burkitt's (6), diffuse large cell (10), precursor-B lymphoblastic (1) and Hodgkin's disease (5) from HIV positive and negative patients. Ten (40%) high grade ML and three Hodgkin's lymphoma from HIV patients had HHV-8 DNA. These findings were not related to age, sex or type of lymphoma. There was no association of HHV-8 with the lymphoma cells. Epstein-Barr virus (EBV) was demonstrable in most (13/18; 72%) of the tested tumors and seven (31.8%) had both HHV-8 and EBV. Conclusions: This study suggests an overall increased frequency of ML patients infected with HHV-8 in Tanzania particularly in HIV patients which may result from the well established high HHV-8 prevalence in the general population, but HHV-8 was not associated with ARL pathogenesis as reflected by lack of tumor cell infection. As opposed to EBV, measures targeting HHV-8 for control of ML may therefore not be appropriate.
Advances in Medical Education and Practice
and Allied Sciences (MUHAS) embarked on structured competency-based curricula (CBC) for its progr... more and Allied Sciences (MUHAS) embarked on structured competency-based curricula (CBC) for its programmes. Other health profession training institutions continued with their traditional way of teaching and thus causing variability in the competencies of the graduates. We aimed to analyze the experiences of different stakeholders on the implementation of CBC specifically on biomedical sciences by MUHAS to inform the development of harmonized competency-based curricula in three health professional training institutions in Tanzania. Methods: We adopted an exploratory case study to analyse the implementation of CBC in programmes of Medicine and Nursing involving MUHAS graduates, immediate supervisors at the employment sites, faculty, and continuing students at MUHAS. Kiswahili guides were used to conduct the in-depth interviews (IDIs) and focus group discussions (FGDs). Qualitative content analysis was adopted for analysis. Results: From the 38 IDIs and 15 FGDs, four categories of human resources teaching and learning environment; curriculum content; and support systems emerged. Human resources were attributed to the shortage of an adequate number of faculty and teaching skills variation. The curriculum content category was linked to the redundancy of courses or topics, poor sequencing of some topics or courses, and limited time for teaching some essential courses or topics. Training and practice area mismatch, accommodation to students, teaching space, and library were the sub-categories linked to teaching and learning environment. Lastly, support systems related to teaching methods and opportunities for improving teaching and learning were revealed. Conclusion: The findings of this study highlight the challenges and opportunities for the implementation of CBC. The solutions to the revealed challenges are beyond the training institutions' capacity. The latter call for multi-stakeholder engagement including those from the public and private sectors in health, higher education and finance for common and sustainable solutions.
Tanzania Medical Journal, 2021
Background Majority of children with cancer live in low and middle-income countries (LMIC) where ... more Background Majority of children with cancer live in low and middle-income countries (LMIC) where survival is disproportionately low compared to high-income countries (HIC). Among the challenges of managing childhood cancers in LMIC is late presentation, advanced disease, and the prevalence of severe malnutrition. Advanced disease and severe acute malnutrition are associated with poor treatment outcomes. Methodology This was a descriptive study conducted in Tanzania at Ocean Road Cancer Institute (ORCI) in 2010. Children and adolescents below 18 years were longitudinally enrolled in the study. Pathological diagnosis was made by examination of tissue biopsies, fine needle aspiration (FNAC) or bone marrow aspiration cytology (BMAC). Stage of disease at presentation was determined by physical examination and radiological investigations such as chest x-ray and ultrasonography. World Health Organization (WHO) anthropometric measurement chart was used to interpret measured Mid-upper arm ...
African Journal of Laboratory Medicine, 2020
Pathologists are medical doctors specialising in the study of the cause of disease and how it aff... more Pathologists are medical doctors specialising in the study of the cause of disease and how it affects the body. They study these by examining changes in the cells, tissues, blood and other body fluids. Pathology is, therefore, a wide area of medical practice that encompasses several specialties including, but not restricted to: anatomical and surgical pathology, cytopathology, microbiology, haematology, chemical pathology, forensic pathology, immunopathology, molecular pathology, and genetic pathology. The list keeps expanding with advances in medicine. Pathology is crucial to the practice of medicine and therefore touches every facet thereof. Pathologists guide medical doctors on the right path for treating disease(s) and significantly contribute to research that advances medicine and devises new treatment. In summary, pathologists investigate the potential, presence, cause, severity, and progress of the disease. Additionally, they also contribute to monitoring the effects of treatment on diseases. 1 It has been well established for some time now that there is a scarcity of pathologists in sub-Saharan Africa. 2 This scarcity is compounded by a shortage of training programmes, with only about 80 cellular pathologists being trained each year. 3 In addition, the variable standards of training in pathology have further increased the gap in the delivery of quality pathology and laboratory services. As an example, some training programmes in anatomical pathology suffer from a lack of student exposure to sufficient numbers of cases and case mix 4 due to a paucity of standardised guidelines for competency training. This situation is further exacerbated by the unrealistic expectations placed on newly-qualified pathologists who are posted to large public Issues: The scarcity of pathologists in sub-Saharan Africa is a well established fact that is attributable to few training programmes in the region; this is further compounded by the lack of harmonised curricula, training and exams within and without member countries.
Research article Antibodies to the CD4-binding site of HIV-1 gp120 suppress gp120-specific CD4 T ... more Research article Antibodies to the CD4-binding site of HIV-1 gp120 suppress gp120-specific CD4 T cell response while enhancing antibody response
Note the increase in frequency of NHL and HD between 1997 and 2000.<b>Copyright information... more Note the increase in frequency of NHL and HD between 1997 and 2000.<b>Copyright information:</b>Taken from "Malignant lymphomas (ML) and HIV infection in Tanzania"http://www.jeccr.com/content/27/1/9Journal of Experimental & Clinical Cancer Research : CR 2008;27(1):9-9.Published online 10 Jun 2008PMCID:PMC2438337.
Anti-CD3 (T-cell) antigen immunoperoxidase reactivity in DLBCL; note the brown focal cytoplasmic ... more Anti-CD3 (T-cell) antigen immunoperoxidase reactivity in DLBCL; note the brown focal cytoplasmic reactivity in tumor infiltrating T-lymphocytes [black arrows] while the malignant cells were not reactive [blue arrows] (× 400). Anti-CD68 antigen immunoperoxidase reactivity in DLBCL; note the brown cytoplasmic reactivity in tumor infiltrating macrophages [black arrow] while malignant cells did not stain [blue arrow] (× 400). Anti-Ki-67 (proliferation) antigen immunoperoxidase reactivity in an aggressive lymphoma: note the brown granular nuclear reactivity in proliferating cells [black arrows] including the abnormal mitotic bodies [blue arrows] (× 400).<b>Copyright information:</b>Taken from "Malignant lymphomas (ML) and HIV infection in Tanzania"http://www.jeccr.com/content/27/1/9Journal of Experimental & Clinical Cancer Research : CR 2008;27(1):9-9.Published online 10 Jun 2008PMCID:PMC2438337.
As immediate and crushing as the health burden is for Tanzania and across Africa, health systems ... more As immediate and crushing as the health burden is for Tanzania and across Africa, health systems will not cope better without many more health professionals competent to play leading roles in meeting population needs. Thus, national and international strategies depend fundamen-tally on universities, and on their transfor-mation into modern engines for change and as custodians of quality education. Tanzania suffers an extreme shortage of health workers [1]. A 2006 facility survey undertaken in Tanzania (Mainland and Zanzibar) suggests that about 39 nurses and midwives, between three and four medical doctors, and fewer than one pharmacist or dentist served a population
<b>Copyright information:</b>Taken from "Human herpesvirus-8 (HHV-8) sero-detect... more <b>Copyright information:</b>Taken from "Human herpesvirus-8 (HHV-8) sero-detection and HIV association in Kaposi's sarcoma (KS), non-KS tumors and non-neoplastic conditions"http://www.infectagentscancer.com/content/3/1/10Infectious Agents and Cancer 2008;3():10-10.Published online 30 Jun 2008PMCID:PMC2499990.
Tanzania Journal of Health Research, 2012
In Tanzania, there is paucity of data for monitoring laboratory medicine including haematology. T... more In Tanzania, there is paucity of data for monitoring laboratory medicine including haematology. This therefore calls for audits of practices in haematology and blood transfusion in order to provide appraise practice and devise strategies that would result in improved quality of health care services. This descriptive cross-sectional study which audited laboratory practice in haematology and blood transfusion at Muhimbili National Hospital (MNH) aimed at assessing the pre-analytical stage of laboratory investigations including laboratory request forms and handling specimen processing in the haematology laboratory and assessing the chain from donor selection, blood component processing to administration of blood during transfusion. A national standard checklist was used to audit the laboratory request forms (LRF), phlebotomists’ practices on handling and assessing the from donor selection to administration of blood during transfusion. Both interview and observations were used. A tot...
Tanzania Medical Journal, 1993
Archives of AIDS Research, 1991
International Journal of Oncology, 1996
The presence of human Kaposi's sarcoma associated herpesvirus-like sequences (KSHV) was e... more The presence of human Kaposi's sarcoma associated herpesvirus-like sequences (KSHV) was examined in different epidemiological variants of Kaposi's sarcoma (KS) and in KS-derived cell cultures by polymerase chain reaction (PCR). KSHV DNA was present in all tumor biopsies of AIDS-associated KS (59 biopsies), endemic KS (26 biopsies; 21 African endemic KS, 5 Greek endemic KS), sporadic/classical KS (28 biopsies) and post-transplant/iatrogenic KS (6 of 7 biopsies). On the contrary, these sequences were only detected rarely in non-involved skin of KS patients (3 positive specimens of 12), in the peripheral blood mononuclear cells of HIV-infected patients (3 positive specimens of 54) and in lymphoma-biopsies (3 positive specimens of 47). Cell cultures derived from KS skin lesions were positive for KSHV DNA only in the first two passages. However, two longer-term positive cultures from a biopsy of a patient affected with sporadic KS and a biopsy of a patient affected with epidemic KS was identified. A strong association of KSHV with KS tissue was observed in all the different epidemiological variants of KS. Long-term positive KS-derived cell cultures will be an important tool to study the herpesvirus-like agent and to investigate its functional role in the initiation and progression of KS.
Tanzania Medical Journal, Apr 29, 2021
Background Majority of children with cancer live in low- and middle-income countries. The data is... more Background Majority of children with cancer live in low- and middle-income countries. The data is scarce on the epidemiology of childhood cancer in these countries. In this study, we enrolled children and adolescents with cancer at the only cancer hospital in Tanzania and determined the epidemiology and HIV infection among this population. Methodology This was a descriptive hospital-based study conducted at Ocean Road Cancer Institute in Dar es salaam, Tanzania. Data were collected for eight months (May to December 2010). Participants were enrolled consecutively as they presented to the hospital. Demographic data, HIV status and clinical diagnosis were determined and recorded. Each patient was followed up until a final diagnosis was reached, and investigations for disease staging were completed. Results One hundred and fifty-one (151) patients were enrolled in the study. Mean age at presentation was 5.8 years (range 3-17years), and 51.7% of participants were males. Sixty-three per cent (63%) of patients had their diagnoses confirmed by histology or cytology. Retinoblastoma was the most common malignancy (29.1%) followed by Nephroblastoma (11.3%), Burkitt lymphoma (10.6%) and Acute Lymphoblastic Leukemias (10.6%). More than half (58.2%) of patients aged three years or younger had Retinoblastoma. Four patients (2.8%) had HIV infection; three of them with Kaposi’s sarcoma and one with Burkitt lymphoma. Conclusion Retinoblastoma was the most typical malignancy followed by Wilms tumour, Burkitt lymphoma and acute lymphoblastic leukaemia. The prevalence of HIV infection was very low among patients with the described malignancies. Key Words: Childhood Malignancies, Tanzania.
International Journal of Cancer, Oct 21, 1993
Simian-immunodeficiency-virus(SIV)-infected cynomolgus monkeys develop B-cell lymphomas in approx... more Simian-immunodeficiency-virus(SIV)-infected cynomolgus monkeys develop B-cell lymphomas in approximately one third of the cases. We have now studied the expression of cynomolgus-Epstein-Barr-virus(cyno-EBV) nuclear antigens in I3 cyno-EBVcarrying SIVsm-associated monkey lymphomas and established cell lines from 3 of these turriors. lmmunoblots of cell tysates were probed with polyrpecific and monospecific reagents directed against human EB-virus EBNAI-6, and against the membrane protein LMP I. An EBNA2-cross-reacting protein was demonstrated in 8 lymphoma tissues (8/ 13) and in the 3 cell linas derived from the tumors. All tumors expressed a polypeptide with 50 to 55 kDa molecular weight, which cross-reacted with some antibodies to EBNAl. Absorption experiments with normal monkey tissue showed that this polypeptide was specific for the cyno-EBV-carrying lymphoma cells. Equivalents of EBNA3-6 and LMPl could not be detected. Immunophenotypicai characterization showed that the monkey lymphomas were similar to human HIV-associated B-cell lymphomas. Malignant B-cell lymphomas in experimentally SIVsm-infected cynomolgus monkeys can be a model for EBV-associated lymphomagenesis in immunodeficiency states.
Academic Medicine, Feb 1, 2012
One of the major needs for medical schools and health systems in less affluent countries is syste... more One of the major needs for medical schools and health systems in less affluent countries is system strengthening through the training and development of faculty, doctors, nurses, and other skilled health care workers. Partnering with medical schools in more affluent countries such as the United States is one potential approach for medical schools in underresourced areas, such as Sub-Saharan Africa. Most commonly, these partnerships have focused on research agendas or limited educational exchanges. In this perspective, the authors present an approach to strengthening collaborative relationships between three medical schools in the United States and four in Sub-Saharan Africa. The approach is explicitly focused on achieving partnerships that enable institutions to improve care. It developed from an initiative to fund partnerships or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;collaboratives&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; that address 10 key learning questions determined to be central to focusing efforts on strengthening education systems and, in turn, improving health in Sub-Saharan Africa. The leaders of the schools involved in these partnerships met multiple times across three years to discuss how their collaboratives could address the ten learning questions including what is the best approach and what are the key ingredients for creating effective, multidimensional collaborations between academic institutions in the North and institutions in Sub-Saharan Africa. Collaboratively, they defined a framework of evidence that can be used for evaluating their current initiatives and, potentially, for structuring future partnerships.
Apmis, Mar 1, 1995
Sections of 18 malaria‐infected placentas were stained with haematoxylin and eosin, periodic acid... more Sections of 18 malaria‐infected placentas were stained with haematoxylin and eosin, periodic acid and methenamine silver, and immunohistochemically with monoclonal antibodies against human common leukocyte antigen, CLA (CD 45), B cells (CD 20, L 26), T cells (CD 45RO, UCHL‐1) and collagen IV. Parasitized erythrocytes accumulated in the maternal villous spaces, with none in the foetal circulation. These were found in association with inflammatory leukocytes and pigments. Fibrinoid necrosis was more prevalent in the heavily infected placentas. Thickening and reduplication of foetal capillary basement membranes, and a decrease in leukocytes, including B and T cells, were seen in the heavily infected placentas. These findings are in keeping with previously reported depression of cellular and humoral immunity in patients with heavy parasitaemia.
Clinical Immunology and Immunopathology, Dec 1, 1992
ABSTRACT
AIDS, Sep 11, 2006
It is still unclear if Kaposi&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp... more It is still unclear if Kaposi&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s sarcoma (KS) is a monoclonal cell proliferation or a polyclonal, hyperplastic, reactive process. Reports on KS cytogenetics are few and restricted to late stage disease and cell lines. We analysed 27 KS, early and late, AIDS related (AKS) and endemic (EKS) by laser microdissection, global DNA amplification and comparative genomic hybridization (CGH). Loss of Y chromosome was detected in 20/23 male KS, which was the only recurrent chromosomal aberration in all nine male early (patch) KS. Only one patch EKS showed in addition to the Y loss a loss of Xq. Late (nodular) AKS and EKS showed recurrent copy number changes in chromosomes 16, 17, 21, X and Y, as well as other random changes. The loss of chromosome 16, 17 and Y was confirmed by interphase fluorescence in situ hybridization (FISH) on paraffin sections. EKS showed a higher number of chromosomal abnormalities than AKS, indicating that rapid growth of AKS is less dependent on genetic changes than is EKS, possibly because of the immunosuppressed host environment in AKS. Clonal loss of chromosome Y was detected in all early male KS, while additional chromosomal aberrations appeared during development to late KS. This increase in chromosomal abnormalities during tumour growth indicates genetic instability and the selection of survival cell clones establishing late, aggressive sarcoma growth. Our data support the view that KS (in males) develops into a clonal tumour yet initially is a hyperplastic reactive cell proliferation.
Background: Malignant lymphoma (ML) in HIV patients, are second in frequency to Kaposi's sarcoma ... more Background: Malignant lymphoma (ML) in HIV patients, are second in frequency to Kaposi's sarcoma (AKS) as AIDS-defining tumors. In Africa the frequency of AIDS-related lymphoma (ARL) is rare and the findings are controversial. Kaposi's sarcoma (KS) lesions are now causally associated with KSHV/HHV-8 but whether African ARL shows this association is not clear. Method: Cancer registry data was reviewed for retrospective cases. Both retrospective and prospective lymphoma cases were classified according to the revised European-American (REAL) classification. Immunephenotyping was performed on both frozen and fixed paraffin sections. Viral DNA was assessed by polymerase chain reaction (PCR) of formalin fixed or frozen biopsies. In situ hybridization (ISH) was used to determine the presence of EBV encoded RNA (EBER). Objectives: To determine the frequency and type of AIDS and non-AIDS related malignant lymphoma in Tanzania and a possible coassociation with KSHV/HHV-8 and EBV. Results: An overall increasing tendency for ML in Tanzania was observed during 1991-94 and a clear increase from 1993. The tumors were classified as Burkitt's (6), diffuse large cell (10), precursor-B lymphoblastic (1) and Hodgkin's disease (5) from HIV positive and negative patients. Ten (40%) high grade ML and three Hodgkin's lymphoma from HIV patients had HHV-8 DNA. These findings were not related to age, sex or type of lymphoma. There was no association of HHV-8 with the lymphoma cells. Epstein-Barr virus (EBV) was demonstrable in most (13/18; 72%) of the tested tumors and seven (31.8%) had both HHV-8 and EBV. Conclusions: This study suggests an overall increased frequency of ML patients infected with HHV-8 in Tanzania particularly in HIV patients which may result from the well established high HHV-8 prevalence in the general population, but HHV-8 was not associated with ARL pathogenesis as reflected by lack of tumor cell infection. As opposed to EBV, measures targeting HHV-8 for control of ML may therefore not be appropriate.
Advances in Medical Education and Practice
and Allied Sciences (MUHAS) embarked on structured competency-based curricula (CBC) for its progr... more and Allied Sciences (MUHAS) embarked on structured competency-based curricula (CBC) for its programmes. Other health profession training institutions continued with their traditional way of teaching and thus causing variability in the competencies of the graduates. We aimed to analyze the experiences of different stakeholders on the implementation of CBC specifically on biomedical sciences by MUHAS to inform the development of harmonized competency-based curricula in three health professional training institutions in Tanzania. Methods: We adopted an exploratory case study to analyse the implementation of CBC in programmes of Medicine and Nursing involving MUHAS graduates, immediate supervisors at the employment sites, faculty, and continuing students at MUHAS. Kiswahili guides were used to conduct the in-depth interviews (IDIs) and focus group discussions (FGDs). Qualitative content analysis was adopted for analysis. Results: From the 38 IDIs and 15 FGDs, four categories of human resources teaching and learning environment; curriculum content; and support systems emerged. Human resources were attributed to the shortage of an adequate number of faculty and teaching skills variation. The curriculum content category was linked to the redundancy of courses or topics, poor sequencing of some topics or courses, and limited time for teaching some essential courses or topics. Training and practice area mismatch, accommodation to students, teaching space, and library were the sub-categories linked to teaching and learning environment. Lastly, support systems related to teaching methods and opportunities for improving teaching and learning were revealed. Conclusion: The findings of this study highlight the challenges and opportunities for the implementation of CBC. The solutions to the revealed challenges are beyond the training institutions' capacity. The latter call for multi-stakeholder engagement including those from the public and private sectors in health, higher education and finance for common and sustainable solutions.
Tanzania Medical Journal, 2021
Background Majority of children with cancer live in low and middle-income countries (LMIC) where ... more Background Majority of children with cancer live in low and middle-income countries (LMIC) where survival is disproportionately low compared to high-income countries (HIC). Among the challenges of managing childhood cancers in LMIC is late presentation, advanced disease, and the prevalence of severe malnutrition. Advanced disease and severe acute malnutrition are associated with poor treatment outcomes. Methodology This was a descriptive study conducted in Tanzania at Ocean Road Cancer Institute (ORCI) in 2010. Children and adolescents below 18 years were longitudinally enrolled in the study. Pathological diagnosis was made by examination of tissue biopsies, fine needle aspiration (FNAC) or bone marrow aspiration cytology (BMAC). Stage of disease at presentation was determined by physical examination and radiological investigations such as chest x-ray and ultrasonography. World Health Organization (WHO) anthropometric measurement chart was used to interpret measured Mid-upper arm ...
African Journal of Laboratory Medicine, 2020
Pathologists are medical doctors specialising in the study of the cause of disease and how it aff... more Pathologists are medical doctors specialising in the study of the cause of disease and how it affects the body. They study these by examining changes in the cells, tissues, blood and other body fluids. Pathology is, therefore, a wide area of medical practice that encompasses several specialties including, but not restricted to: anatomical and surgical pathology, cytopathology, microbiology, haematology, chemical pathology, forensic pathology, immunopathology, molecular pathology, and genetic pathology. The list keeps expanding with advances in medicine. Pathology is crucial to the practice of medicine and therefore touches every facet thereof. Pathologists guide medical doctors on the right path for treating disease(s) and significantly contribute to research that advances medicine and devises new treatment. In summary, pathologists investigate the potential, presence, cause, severity, and progress of the disease. Additionally, they also contribute to monitoring the effects of treatment on diseases. 1 It has been well established for some time now that there is a scarcity of pathologists in sub-Saharan Africa. 2 This scarcity is compounded by a shortage of training programmes, with only about 80 cellular pathologists being trained each year. 3 In addition, the variable standards of training in pathology have further increased the gap in the delivery of quality pathology and laboratory services. As an example, some training programmes in anatomical pathology suffer from a lack of student exposure to sufficient numbers of cases and case mix 4 due to a paucity of standardised guidelines for competency training. This situation is further exacerbated by the unrealistic expectations placed on newly-qualified pathologists who are posted to large public Issues: The scarcity of pathologists in sub-Saharan Africa is a well established fact that is attributable to few training programmes in the region; this is further compounded by the lack of harmonised curricula, training and exams within and without member countries.
Research article Antibodies to the CD4-binding site of HIV-1 gp120 suppress gp120-specific CD4 T ... more Research article Antibodies to the CD4-binding site of HIV-1 gp120 suppress gp120-specific CD4 T cell response while enhancing antibody response
Note the increase in frequency of NHL and HD between 1997 and 2000.<b>Copyright information... more Note the increase in frequency of NHL and HD between 1997 and 2000.<b>Copyright information:</b>Taken from "Malignant lymphomas (ML) and HIV infection in Tanzania"http://www.jeccr.com/content/27/1/9Journal of Experimental & Clinical Cancer Research : CR 2008;27(1):9-9.Published online 10 Jun 2008PMCID:PMC2438337.
Anti-CD3 (T-cell) antigen immunoperoxidase reactivity in DLBCL; note the brown focal cytoplasmic ... more Anti-CD3 (T-cell) antigen immunoperoxidase reactivity in DLBCL; note the brown focal cytoplasmic reactivity in tumor infiltrating T-lymphocytes [black arrows] while the malignant cells were not reactive [blue arrows] (× 400). Anti-CD68 antigen immunoperoxidase reactivity in DLBCL; note the brown cytoplasmic reactivity in tumor infiltrating macrophages [black arrow] while malignant cells did not stain [blue arrow] (× 400). Anti-Ki-67 (proliferation) antigen immunoperoxidase reactivity in an aggressive lymphoma: note the brown granular nuclear reactivity in proliferating cells [black arrows] including the abnormal mitotic bodies [blue arrows] (× 400).<b>Copyright information:</b>Taken from "Malignant lymphomas (ML) and HIV infection in Tanzania"http://www.jeccr.com/content/27/1/9Journal of Experimental & Clinical Cancer Research : CR 2008;27(1):9-9.Published online 10 Jun 2008PMCID:PMC2438337.
As immediate and crushing as the health burden is for Tanzania and across Africa, health systems ... more As immediate and crushing as the health burden is for Tanzania and across Africa, health systems will not cope better without many more health professionals competent to play leading roles in meeting population needs. Thus, national and international strategies depend fundamen-tally on universities, and on their transfor-mation into modern engines for change and as custodians of quality education. Tanzania suffers an extreme shortage of health workers [1]. A 2006 facility survey undertaken in Tanzania (Mainland and Zanzibar) suggests that about 39 nurses and midwives, between three and four medical doctors, and fewer than one pharmacist or dentist served a population
<b>Copyright information:</b>Taken from "Human herpesvirus-8 (HHV-8) sero-detect... more <b>Copyright information:</b>Taken from "Human herpesvirus-8 (HHV-8) sero-detection and HIV association in Kaposi's sarcoma (KS), non-KS tumors and non-neoplastic conditions"http://www.infectagentscancer.com/content/3/1/10Infectious Agents and Cancer 2008;3():10-10.Published online 30 Jun 2008PMCID:PMC2499990.
Tanzania Journal of Health Research, 2012
In Tanzania, there is paucity of data for monitoring laboratory medicine including haematology. T... more In Tanzania, there is paucity of data for monitoring laboratory medicine including haematology. This therefore calls for audits of practices in haematology and blood transfusion in order to provide appraise practice and devise strategies that would result in improved quality of health care services. This descriptive cross-sectional study which audited laboratory practice in haematology and blood transfusion at Muhimbili National Hospital (MNH) aimed at assessing the pre-analytical stage of laboratory investigations including laboratory request forms and handling specimen processing in the haematology laboratory and assessing the chain from donor selection, blood component processing to administration of blood during transfusion. A national standard checklist was used to audit the laboratory request forms (LRF), phlebotomists’ practices on handling and assessing the from donor selection to administration of blood during transfusion. Both interview and observations were used. A tot...
Tanzania Medical Journal, 1993