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Article ; Online: The future of lymphoma diagnosis, prognosis, and treatment monitoring in countries with limited access to pathology services.

Chamba, Clara / Mawalla, William

2023 Volume 60, Issue 4, Page(s) 215–219

Abstract: The world is moving towards precision medicine for cancer. This movement goes hand in hand with the development of newer advanced technologies for early, precise diagnosis of cancer and personalized treatment plans with fewer adverse effects for the ... ...

Abstract	The world is moving towards precision medicine for cancer. This movement goes hand in hand with the development of newer advanced technologies for early, precise diagnosis of cancer and personalized treatment plans with fewer adverse effects for the patient. Liquid biopsy is one such advancement. At the same time, it has the advantage of minimal invasion and avoids serial invasive biopsies. In countries with limited access to pathology services, such as sub-Saharan Africa, liquid biopsy may provide an opportunity for early detection and prognostication of lymphoma. We discuss the current diagnostic modalities for lymphoma, highlighting the existing challenges with tissue biopsy, and how feasible it is for countries with limited pathology resources to leverage advancements made in the clinical application of liquid biopsy to improve lymphoma care.
MeSH term(s)	Humans ; Lymphoma/diagnosis ; Lymphoma/therapy ; Neoplasms ; Prognosis ; Liquid Biopsy ; Precision Medicine
Language	English
Publishing date	2023-08-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	206923-4
ISSN	1532-8686 ; 0037-1963
ISSN (online)	1532-8686
ISSN	0037-1963
DOI	10.1053/j.seminhematol.2023.07.004
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Article ; Online: Clinical application of circulating cell-free lymphoma DNA for fast and precise diagnosis of Burkitt lymphoma: Precision medicine for sub-Saharan Africa.

Chamba, Clara / Mbulaiteye, Sam M / Balandya, Emmanuel / Schuh, Anna

Cambridge prisms. Precision medicine

2023 Volume 1, Page(s) e13

Abstract: Burkitt lymphoma (BL) has a cure rate of around 95% when treated with chemo-immunotherapy that is standard of care in high-income countries (Minard-Colin et al., 2020, ...

Abstract	Burkitt lymphoma (BL) has a cure rate of around 95% when treated with chemo-immunotherapy that is standard of care in high-income countries (Minard-Colin et al., 2020,
Language	English
Publishing date	2023-01-13
Publishing country	England
Document type	Journal Article ; Review
ISSN	2752-6143
ISSN (online)	2752-6143
DOI	10.1017/pcm.2023.1
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Article ; Online: Clinical application of circulating cell-free lymphoma DNA for fast and precise diagnosis of Burkitt lymphoma

Clara Chamba / Sam M. Mbulaiteye / Emmanuel Balandya / Anna Schuh

Cambridge Prisms: Precision Medicine, Vol

Precision medicine for sub-Saharan Africa

2023 Volume 1

Abstract: Burkitt lymphoma (BL) has a cure rate of around 95% when treated with chemo-immunotherapy that is standard of care in high-income countries (Minard-Colin et al., 2020, New England Journal of Medicine 382, 2207–2219), but currently, more than 50% of ... ...

Abstract	Burkitt lymphoma (BL) has a cure rate of around 95% when treated with chemo-immunotherapy that is standard of care in high-income countries (Minard-Colin et al., 2020, New England Journal of Medicine 382, 2207–2219), but currently, more than 50% of children and young adults with endemic BL (Epstein Barr virus driven BL) in sub-Saharan Africa (SSA) do not survive. Treatment for BL is largely free of charge, but there is limited access to reliable diagnostic services leading to significant delays and misdiagnoses. Innovations in histopathology such as whole slide imaging and the use of novel diagnostic approaches, in particular using circulating cell-free viral and/or lymphoma DNA (liquid biopsy), could increase access to timely and reliable diagnosis and improve outcomes in SSA.
Keywords	liquid biopsy ; Internal medicine ; RC31-1245 ; Therapeutics. Pharmacology ; RM1-950
Subject code	610
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Cambridge University Press
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Treatment delays in children and young adults with lymphoma: a report from an East Africa lymphoma cohort study.

Mawalla, William Frank / Morrell, Liz / Chirande, Lulu / Achola, Caroline / Mwamtemi, Hadija / Sandi, Godlove / Mahawi, Salama / Kahakwa, Atukuzwe / Ntemi, Paul / Hadija, Nabalende / Mkwizu, Elifuraha / Chamba, Clara / Vavoulis, Dimitris / Schuh, Anna

Blood advances

2023 Volume 7, Issue 17, Page(s) 4962–4965

MeSH term(s)	Humans ; Child ; Young Adult ; Cohort Studies ; Time-to-Treatment ; Lymphoma/diagnosis ; Lymphoma/epidemiology ; Lymphoma/therapy ; Africa, Eastern/epidemiology
Language	English
Publishing date	2023-09-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2915908-8
ISSN	2473-9537 ; 2473-9529
ISSN (online)	2473-9537
ISSN	2473-9529
DOI	10.1182/bloodadvances.2022009398
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Article ; Online: Molecular response to imatinib in patients with chronic myeloid leukemia in Tanzania.

Nasser, Ahlam / Hussein, Ally / Chamba, Clara / Yonazi, Mbonea / Mushi, Rosemary / Schuh, Anna / Luzzatto, Lucio

Blood advances

2021 Volume 5, Issue 5, Page(s) 1403–1411

Abstract: Imatinib is the mainstay of treatment of patients with chronic myeloid leukemia (CML) in Tanzania. Monitoring molecular response to therapy by real-time polymerase chain reaction at defined milestones is necessary for early detection of treatment failure. ...

Abstract	Imatinib is the mainstay of treatment of patients with chronic myeloid leukemia (CML) in Tanzania. Monitoring molecular response to therapy by real-time polymerase chain reaction at defined milestones is necessary for early detection of treatment failure. However, this assay is not routinely performed in Tanzania; therefore, the depth of molecular response among patients with CML is not known. A total of 158 patients with previously diagnosed CML who received imatinib treatment were recruited from January 2019 and followed up through October 2020 at Ocean Road Cancer Institute. Information was obtained at the time of diagnosis and follow-up. Blood samples were collected in EDTA tubes to measure the BCR/ABL ratio on the Gene Xpert system for molecular response determination. The median age of the 158 adult patients was 45 years (range, 18-86). By reference to established treatment milestones, only 37 (23.4%) achieved optimal molecular response. Signs of advanced-stage disease, in particular the need for red cell transfusions before diagnosis (adjusted odds ratio [AOR], 3.4; 95% CI, 1.32-9.17) and cytopenias (AOR, 2.26; 95% CI, 1.03-4.96) necessitating drug interruptions were statistically validated predictors of treatment failure on multivariate, multinomial logistic regression. Patient survival at the 22-month follow-up was lowest, with 78.6% (95% CI, 69.4-85.4) in the failure-to-respond category and highest in patients achieving optimal response 97.0% (95% CI, 80.9-99.6). In summary, the majority of patients with CML treated with imatinib in Tanzania do not obtain deep molecular response. This outcome can be attributed to late diagnosis, the development of cytopenias requiring multiple drug interruptions, and poor adherence to treatment.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents/therapeutic use ; Benzamides/therapeutic use ; Humans ; Imatinib Mesylate/therapeutic use ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics ; Middle Aged ; Piperazines ; Pyrimidines/therapeutic use ; Tanzania/epidemiology ; Treatment Outcome ; Young Adult
Chemical Substances	Antineoplastic Agents ; Benzamides ; Piperazines ; Pyrimidines ; Imatinib Mesylate (8A1O1M485B)
Language	English
Publishing date	2021-03-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2915908-8
ISSN	2473-9537 ; 2473-9529
ISSN (online)	2473-9537
ISSN	2473-9529
DOI	10.1182/bloodadvances.2020002973
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Article ; Online: Potential of point of care tests for newborn screening for sickle cell disease: Evaluation of HemotypeSC™ and sickle SCAN® in Tanzania.

Christopher, Heavenlight / Josephat, Emmanuel / Kaywanga, Frida / Saul, Sephord / Mshana, Irene / Kunambi, Peter / Nasser, Ahlam / Chamba, Clara / Makani, Julie / Nkya, Siana

International journal of laboratory hematology

2022 Volume 44, Issue 5, Page(s) 959–965

Abstract: Background: Sickle cell disease (SCD) is an important cause of <5 mortality. In Tanzania, it is estimated up to 11 000 children are born with SCD annually, making this the fifth country with the highest SCD annual births worldwide. The biggest challenge ...

Abstract	Background: Sickle cell disease (SCD) is an important cause of <5 mortality. In Tanzania, it is estimated up to 11 000 children are born with SCD annually, making this the fifth country with the highest SCD annual births worldwide. The biggest challenge of expanding the service of newborn screening for SCD as the national health intervention in Tanzania is due to the high cost of the currently used assays and lack of rapid screening methods. Therefore, in this study, we assessed the diagnostic accuracy of point-of-care tests for SCD diagnosis in newborns. Aim: To evaluate the sensitivity and specificity of HemotypeSC™ and sickle SCAN® in diagnosing SCD in newborns. Methods: Diagnostic accuracy of HemotypeSC™ and sickle SCAN® were evaluated in comparison to isoelectric focusing as a confirmatory method. Results: A total of 706 newborns were enrolled in the study. The sensitivity and specificity of HemotypeSC in detecting Hb SS, Hb AS and Hb AA phonotypes was 100%. The sensitivity and specificity of sickle SCAN® in detecting Hb SS, Hb AS and Hb AA phenotypes were 100%, 97% and 100% respectively. Conclusion: Both POC tests displayed high accuracy in detecting SCD, we believe the introduction of either of these tests in health facilities will help in the early detection and management of SCD. In addition, the margin of cost per test is relatively affordable (1.4$ per test for HemotypeSC™ and 4.75$ for sickle SCAN®).
MeSH term(s)	Anemia, Sickle Cell/diagnosis ; Anemia, Sickle Cell/epidemiology ; Humans ; Infant, Newborn ; Neonatal Screening/methods ; Point-of-Care Testing ; Sensitivity and Specificity ; Tanzania/epidemiology
Language	English
Publishing date	2022-07-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2268590-X
ISSN	1751-553X ; 1751-5521 ; 0141-9854
ISSN (online)	1751-553X
ISSN	1751-5521 ; 0141-9854
DOI	10.1111/ijlh.13929
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Article ; Online: A protocol to clinically evaluate liquid biopsies as a tool to speed up diagnosis of children and young adults with aggressive infection-related lymphoma in East Africa "(AI-REAL)".

Legason, Ismail D / Ogwang, Martin D / Chamba, Clara / Mkwizu, Elifuraha / El Mouden, Claire / Mwinula, Hadija / Chirande, Lulu / Schuh, Anna / Chiwanga, Faraja

BMC cancer

2022 Volume 22, Issue 1, Page(s) 484

Abstract: Background: The capacity for invasive tissue biopsies followed by histopathology diagnosis in sub-Saharan Africa is severely limited. Consequently, many cancer patients are diagnosed late and outcomes are poor. Here, we propose to evaluate circulating ... ...

Abstract	Background: The capacity for invasive tissue biopsies followed by histopathology diagnosis in sub-Saharan Africa is severely limited. Consequently, many cancer patients are diagnosed late and outcomes are poor. Here, we propose to evaluate circulating tumour (ct) DNA analysis ("liquid biopsy"), a less invasive and faster approach to diagnose endemic EBV-driven lymphomas (EBVL) in East Africa. Methods: We will evaluate the clinical utility of an already validated ctDNA test prospectively in a head-to-head comparison against histopathology. The primary endpoint is the time from presentation to the specialist centre to a final diagnosis of EBV- Lymphoma. Secondary endpoints include the sensitivity and specificity of liquid biopsy and health economic benefits over histopathology. One hundred forty-six patients will be recruited over 18 months. Patients will be eligible if they are 3-30 years of age and have provided written consent or assent as per IRB guidelines. Tissue and venous blood samples will be processed as per established protocols. Clinical data will be captured securely and in real-time into a REDCap database. The time from presentation to diagnosis will be documented. The sensitivity and specificity of the methods can be estimated within 5% error margin with 95% confidence level using 73 cases and 73 controls. Health-economic assessment will include micro-costing of ctDNA test and histopathology. All results will be reviewed in a multidisciplinary tumour board. Discussion: The study evaluates the clinical utility of ctDNA in improving the speed of diagnostic pathways for EBVL in sub-Saharan Africa. Our results would provide proof-of-principle that ctDNA can be used as a diagnostic tool in areas without access to regular pathology, that transfer of the tool is feasible, and that it leads to an earlier and faster diagnosis. The potential clinical and economic impact of this proposal is thus significant. If successful, this study will provide appropriate, and cost-effective diagnostic tools that will promote earlier diagnosis of EBVL and potentially other cancers in countries with restricted healthcare resources. Trial registration: Pan African Clinical Trials Registry: PACTR202204822312651 , registered on 14th-April-2022.
MeSH term(s)	Africa, Eastern ; Biomarkers, Tumor/genetics ; Child ; Circulating Tumor DNA ; Herpesvirus 4, Human/genetics ; Humans ; Liquid Biopsy/methods ; Lymphoma, Non-Hodgkin ; Neoplasms/diagnosis ; Young Adult
Chemical Substances	Biomarkers, Tumor ; Circulating Tumor DNA
Language	English
Publishing date	2022-05-02
Publishing country	England
Document type	Journal Article
ZDB-ID	2041352-X
ISSN	1471-2407 ; 1471-2407
ISSN (online)	1471-2407
ISSN	1471-2407
DOI	10.1186/s12885-022-09553-w
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Article: Anaemia in the Hospitalized Elderly in Tanzania: Prevalence, Severity, and Micronutrient Deficiency Status.

Chamba, Clara / Nasser, Ahlam / Mawalla, William F / Masamu, Upendo / Budodi Lubuva, Neema / Tebuka, Erius / Magesa, Pius

Anemia

2021 Volume 2021, Page(s) 9523836

Abstract: Introduction: Anaemia is a common problem in sub-Saharan Africa. While most literature has focused on children, women of childbearing age, and pregnant women, data for the elderly population are relatively scarce. Anaemia exhorts negative consequences ... ...

Abstract	Introduction: Anaemia is a common problem in sub-Saharan Africa. While most literature has focused on children, women of childbearing age, and pregnant women, data for the elderly population are relatively scarce. Anaemia exhorts negative consequences to functional ability of elderly patients, both physically and cognitively. The purpose of this study was to determine the prevalence of anaemia, severity, and micronutrient deficiency status in the elderly hospitalized patients in Tanzania. Methods: A total of 156 hospitalized adults aged 60 years and above were enrolled in this study. A structured questionnaire was used to capture sociodemographic and clinical characteristics. Blood samples were collected, and a complete blood count, serum cobalamin, serum ferritin, and serum folate levels were measured to assess anaemia and micronutrient deficiency status in all participants who had anaemia. Results: The prevalence of anaemia was 79.5% (124/156) with severe anaemia in 33.9% (42/124) of participants, moderate anaemia in 42.7% (53/124) of participants, and 23.4% (29/124) of all participants had mild anaemia. Micronutrient deficiency was found in 14.5% (18/124) of all participants with anaemia. Combined deficiency (either iron and vitamin B12 deficiency or iron and folate deficiency) was the most common micronutrient deficiency anaemia with a frequency of 33.3% (6/18), followed by isolated iron and folate deficiencies at equal frequency of 27.8% (5/18) and vitamin B12 deficiency at 11.1% (2/18). Conclusion: The prevalence of anaemia in the hospitalized elderly population is high warranting public health attention and mostly present in moderate and severe forms. Micro-nutrient deficiency anaemia is common in this age group and is mostly due to combined micronutrient deficiency.
Language	English
Publishing date	2021-02-26
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	2595393-X
ISSN	2090-1275 ; 2090-1267
ISSN (online)	2090-1275
ISSN	2090-1267
DOI	10.1155/2021/9523836
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Article ; Online: Haematopoietic stem cell transplantation in Tanzania.

Mtenga, Janeth / Orf, Kate / Zheng, Jiexin / Chamba, Clara / Chuwa, Harrison / Luoga, Frederick / Malangahe, Stella W / Iversen, Per Ole / Makani, Julie

British journal of haematology

2020 Volume 192, Issue 1, Page(s) 17–21

MeSH term(s)	Anemia, Sickle Cell/therapy ; Delivery of Health Care/economics ; Hematopoietic Stem Cell Transplantation/economics ; Hematopoietic Stem Cell Transplantation/methods ; Humans ; Tanzania ; Tissue Donors/supply & distribution
Language	English
Publishing date	2020-09-25
Publishing country	England
Document type	Journal Article
ZDB-ID	80077-6
ISSN	1365-2141 ; 0007-1048
ISSN (online)	1365-2141
ISSN	0007-1048
DOI	10.1111/bjh.17106
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Article: Genomics of fetal haemoglobin: a targeted approach for reticulocyte transcriptome study.

Nkya, Siana / Kaywanga, Frida / Nzunda, Collin / Karim, Salmaan / Solomon, David / Saukiwa, Emmanuel / Christopher, Heavenlight / Ngowi, Doreen / Johansen, Julieth / Urio, Florence / Mgaya, Josephine / Chamba, Clara / Hashim, Fadya / Ambroise, Emmanuela / Acquah, Solomon Ofori / Makani, Julie

Research square

2023

Abstract: Background: Fetal haemoglobin (HbF) remains a major sickle cell disease modifier. The mechanism of HbF synthesis has been studied for several decades with the intention of increasing interventions for sickle cell disease (SCD), including drugs. However, ...

Abstract	Background: Fetal haemoglobin (HbF) remains a major sickle cell disease modifier. The mechanism of HbF synthesis has been studied for several decades with the intention of increasing interventions for sickle cell disease (SCD), including drugs. However, the complex mechanism of HbF synthesis is influenced by multiple genetic factors interacting with environmental factors. In order to capture useful genetic information, especially with limited resources, one has to carefully design the study. This includes choosing the relevant participants, the correct phenotyping, the choice of samples, and the right genomic assays. This paper describes the approach undertaken as part of preparations for a reticulocyte transcriptome study intended to discover genes associated with HbF decline in newborns in Tanzania. Results: Of the 152 newborns enrolled in the larger study, 40 babies were selected for the reticulocyte transcriptome study based on their HbF levels at birth and later stage of life. Of these, 30 individuals were included under the category of high HbF levels ranging from 72.6-90% and the remaining 10 under the category of low HbF levels ranging from 5.9 - 10.3%. The reticulocyte enrichment recovery purity ranged from 85% - 97%. The total RNA concentrations obtained were >250 ng total RNA, with the average purity of 1.9 (A 260/280) respectively. The total concentration obtained was sufficient for the transcriptome and other downstream assays. Conclusion: We have documented important steps and factors to consider in identifying the relevant participants and required laboratory sample processes prior to the final stage, which involves total reticulocyte RNA sequencing.
Language	English
Publishing date	2023-06-30
Publishing country	United States
Document type	Preprint
DOI	10.21203/rs.3.rs-3061395/v1
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