Browsing by Author "Mohamed, Zainab"

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    Evaluation of prognostic risk factors at diagnosis and treatment outcomes in adult patients with early-stage hodgkin lymphoma in Cape Town, South Africa
    (2024) Dawood, Shakira; Verburgh, Estelle; Mohamed, Zainab
    The National Comprehensive Cancer Network (NCCN) Guidelines are a recognized standard for prognostic staging in Hodgkin Lymphoma (HL). We aimed to determine if the NCCN staging system and its individual risk factors correlated with patient treatment outcomes in early-stage adult classical HL (cHL) patients. This retrospective study included 70 patients diagnosed with and treated for early-stage (stage I and II) cHL from 2010 to 2022, at Groote Schuur Hospital Radiation Oncology and Clinical Haematology Units. NCCN unfavourable risk factors assessed were mediastinal mass ratio, presence of bulky disease, B-symptoms, number of nodal regions involved and erythrocyte sedimentation rate. Patients were divided into early-stage favourable (no unfavourable factors) and early-stage unfavourable (any unfavourable factors). Kaplan-Meier curves and log-rank tests were used to compare treatment outcomes between groups. The median age at diagnosis was 35 years and 50% of the patients were male. Most patients had stage II disease (86%) and were classified as unfavourable (76%). During the study period, 6 patients died (9%) all of whom had stage II unfavourable disease. The 5-year overall survival for the favorable and unfavourable groups was similar (94% vs. 90%, P=0.599). Progression free survival at 5 years was also similar (83% vs. 88%, P=0.984). This study demonstrates excellent 5-year survival outcomes in early-stage cHL patients. These findings are comparable with those in higher income countries and were not affected by HIV status or unfavourable risk factors. This highlights the importance of early diagnosis and treatment while patients still have early-stage disease
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    Relationship of HHV8 serum levels and clinical features of Kaposi's sarcoma among patients in South Africa
    (2023) Tibenderana, Rebecca; Mohamed, Zainab
    Background. Kaposi's sarcoma is an AIDS-defining illness caused by Kaposi's Sarcomaassociated Herpesvirus (KSHV). The level of HIV immune suppression and extent of KSHV DNA determine the development of Kaposi's sarcoma. Common manifestations of Kaposi's sarcoma include skin and mucosa} involvement. lympboedema. and viscera] disease. Objectives. The purpose of this study was to explore the association between KSHV DNA viral load and clinical extent of Kaposi's sarcoma. Methods. This was a cross sectional study involving 100 patients with Kaposi sarcoma who attended Groote Schuur Hospital for treatment. The cohort had previously participated in a study investigating polymorphisms in the KSHV G-protein coupled receptor gene. KSHV viral load was determined by PCR of DNA extracted from peripheral blood mononuclear cells. Demographic and clinical data were collected. and logistic regression was applied to study association of KSHV viral load with the predominant presenting feature in patients with symptomatic KS. Results The cohort was predominantly male (63.16%) with a median age of 37.76 years. Median CD4 count was 235 cells/microlitre (64.0-418.0) and most patients (95.7%) had Tl disease. There was no association between KSHV DNA levels and clinical extent of Kaposi's sarcoma. Relative risk ratio (RRR) of l.006 (95% CI 0.974-1.006) p=0.174. Serum KSHV levels were not associated with outcome of treatment. however, patients who had poor outcomes had elevated KSHV levels. Conclusion. There was no relationship between KSHV viral load and clinical extent of Kaposi's sarcoma in this study. KSHV DNA viral load may be useful in predicting which patients will require aggressive treatment for Kaposi's sarcoma
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    Retrospective study of patients treated for Plasmablastic Lymphoma at Groote Schuur Hospital between 2004 and 2009
    (2014) Chiyapo, Sebathu Phillip; Mohamed, Zainab
    Includes abstract. Includes bibliographical references.
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    The determinants and impact of diagnostic delay in lymphoma in a TB and HIV endemic setting
    (2019-04-25) Antel, Katherine; Levetan, Carly; Mohamed, Zainab; Louw, Vernon J; Oosthuizen, Jenna; Maartens, Gary; Verburgh, Estelle
    Background Little is known about the pathway to diagnosis of lymphoma in Sub-Saharan Africa, despite the increased risk of lymphoma in people living with HIV (PLHIV). The challenges of diagnosis in this setting include diagnostic confusion with extrapulmonary tuberculosis (EPTB), which commonly causes lymphadenopathy in PLHIV. Methods We analysed the time to diagnosis and treatment in patients using predetermined time intervals. Univariate and multivariable analyses were performed to determine the relationship between patient and disease-specific variables with delays to diagnosis. We were particularly interested in the impact of HIV, empiric tuberculosis therapy and fine-needle aspirate for cytology (FNAC) in contributing to delay. Results Patients (n = 163), 29% HIV-infected, waited a median of 4 weeks before seeking medical attention. It took a median of 7 weeks for the diagnosis of lymphoma to be made from the time the patient sought medical attention, termed the healthcare practitioner interval. In multivariable logistic regression analysis, diagnostic delay > 6 weeks was associated with late-stage disease (OR 2.3, 95% CI 1.1–5.2) and Hodgkin lymphoma (HL) (OR 3.0, 95% CI 1.1–8.0). HIV status was not associated with diagnostic delay (OR 0.9, 95% CI 0.3–2.2). The median time to diagnosis was a median of 4 weeks longer for patients on tuberculous (TB) therapy (n = 16, p = 0.28) and patients who underwent an FNAC (n = 63, p = 0.04). Where FNAC was performed, it was diagnostic for lymphoma in only 11%. Diagnostic delay was not associated with overall survival. Conclusions Time-to-diagnosis of lymphoma in South Africa was similar to that reported from high-income countries and shows significant periods of delay between the onset of symptoms to diagnosis and treatment. The longest period of delay was in the health practitioner interval. Education regarding the significance of lymphadenopathy for both patients and health care practitioners and appropriate investigative steps preferably by best-practice algorithms specific to TB-endemic areas are needed to shorten the time-to-diagnosis of lymphoma.