Histopathologically detected extranodal extension leads to upstaging and treatment escalation in head and neck squamous cell carcinoma. There is considerable variation in the prevalence of histopathologically detected extranodal extension in comparable studies. The Head and Neck Cancer International Group, which includes 23 organisations managing patients with head and neck cancer, identified several challenges in evaluating histopathologically detected extranodal extension. Thus, the Head and Neck Consensus Language for Ease and Reproducibility (HN-CLEAR) and its global stakeholders prioritised developing diagnostic criteria and uniform terminology for histopathologically detected extranodal extension. The histopathologically detected extranodal extension working group established by WHO, International Collaboration on Cancer Reporting, American Joint Committee on Cancer, Union for International Cancer Control, North American Society of Head and Neck Pathology, and American Academy of Oral and Maxillofacial Pathology committees undertook consensus deliberations using scanned whole slides and a PRISMA literature review-based scoping questionnaire. The guidelines were tested by 30 additional pathologists across six continents and strengthened with prescriptive diagnostic criteria and unifying terminology based on the inter-rater concordance analyses. This Review generates practically useful consensus diagnostic recommendations and aligned terminology for addressing the gaps in the histopathologically detected extranodal extension literature. The recommendations can be used globally and cater to all levels of medical resources, practices, and experiences, thus ensuring equitable patient care.
Introduction:Allergic Rhinitis (AR) is an IgE- mediated inflammatory disease of the nasal mucosa. While the diagnosis mainly relies on a typical clinical history and physical examination, the evaluation of eosinophils in nasal smears is considered a direct marker of inflammation and can play a role in the diagnosis and monitoring of treatment response. The aim of this study was to evaluate the levels of nasal eosinophils among patients with AR, and to correlate these levels with disease severity and frequency. Material and methods:This was a descriptive cross-sectional study conducted at a tertiary referral hospital in Kenya from November 2022 to January 2023. Patients were diagnosed with AR using the Score for Allergic Rhinitis (SFAR) questionnaire. A Total Nasal Symptom Score (TNSS) questionnaire was administered to evaluate for nasal symptoms and assign severity scores. The patients were categorized according to the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines into either intermittent or persistent allergic rhinitis groups, and further sub-classified into mild, or moderate-to-severe AR. Nasal smears were collected to quantify eosinophil counts. Results:The study included 73 patients comprising 35 (47.9%) males and 38 (52.1%) females. The median age of the participants was 19 years (Interquartile Range 9-38), with an age range of 5-84 years. Most patients presented with intermittent symptoms (58.9%) and moderate-to-severe disease (61.6%). Pathological levels of eosinophils were found in 15 patients (20.5%). However, there was no statistically significant correlation between the level of nasal eosinophilia and either disease severity (p = 0.23) or symptom frequency (p = 0.80). Conclusion:In this study, nasal eosinophils counts did not correlate with the severity or frequency of AR as defined by the ARIA classification. These findings suggest that while the presence of nasal eosinophilia is useful for confirming the underlying type 2 inflammation in AR, it should not be used as a standalone biomarker to determine disease severity or guide management.
BACKGROUND:There is insufficient data to inform the management of dolutegravir failure, with the WHO and various countries adopting different approaches, underscoring the need for an evidence-based management approach. METHODS:The Ndovu study is a large multi-country cohort, with a nested randomised controlled trial (RCT), enrolling 6,600 people living with HIV (PLWH) with viral load (VL) of ≥1000 copies/ml after at least 6 months of dolutegravir. Participants aged ≥ 1 year, including pregnant women, will be followed up for 12 months with enhanced adherence counselling (EAC) provided monthly. Viral load (VL) testing will be conducted every 3 months and drug resistance testing conducted if VL ≥ 200 copies/ml. Three hundred and sixty-two participants aged ≥15 years and 30 participants aged 3-14 years with major dolutegravir-associated drug resistant mutations (DRMs) will be enrolled into the RCT and randomised to switch to ritonavir boosted darunavir (DRV/r) or continue with dolutegravir with follow-up for 12 months. VL will be measured at 1, 3, 6 and 12 months and tenofovir levels assessed on dried blood spots at month 1 and month 6. The primary outcome of the cohort is the proportion of participants achieving viral load <200 copies/ml by month 12 and the primary endpoint of the RCT is viral load <200copies/ml at 6 months using a modified FDA snap shot algorithm. Secondary endpoints are DRM patterns associated with non-suppression, level of adherence associated with suppression as well as participant and provider experiences of staying on DTG versus switching to DRV/r. The RCT primary efficacy analysis will be conducted on the Intent-to-Treat Exposed (ITT-E) population and will compare the difference in the proportion of participants with viral load <200 copies/ml 6 months after randomisation between the treatment arms stratified by the randomisation stratification factors. This study is registered at ClinicalTrials.gov, NCT06762054 (cohort) and NCT06747507 (RCT) and enrollment into the cohort started in March 2025. CONCLUSION:The Ndovu study will address critical gaps in the management of DTG failure including the emergence, determinants and implications of DTG resistance. Further, it will evaluate the optimal ART regimens to use in the setting of DTG resistance in adults and children.
IntroductionAcross sub-Saharan Africa, there is a growing burden of vascular disease amid a paucity of training opportunities. In Kenya, most vascular care is delivered by cardiothoracic, general and orthopedic surgeons with limited access to specialist vascular training. We aim to build capacity to recognize, assess, and manage patients with foot sepsis and limb- or life-threatening vascular disease through structured fundamentals and advanced vascular skills courses supported by a network of local trainers to ensure long-term sustainability. Methods The inaugural Fundamentals in Vascular Surgery course was held in September 2024, followed in September 2025 by Advanced Skills in Vascular Surgery alongside the second “Fundamentals” course. Structured surveys were administered to participants in both years, with a 1-y follow-up survey distributed to the 2024 cohort to assess application of skills and longer-term impact. Results Fifty-six participants were trained across the three courses, with all courses oversubscribed. Faculty numbers increased through a faculty development scheme alongside new regional trainers from Ethiopia and South Africa. All participants rated the courses as relevant to their practice and would recommend them to colleagues. At 1-y follow-up, all respondents reported improved perceived ability to assess and manage urgent vascular presentations and to perform fasciotomies, minor, and major amputations. 91.7% had referred patients to a vascular surgeon; 33.3% attended the 2025 Advanced course, with the remainder planning to do so in the future. Conclusions The program has demonstrated sustained engagement, faculty growth, and oversubscription, underscoring unmet training needs. In collaboration with Surgical Society of Kenya, College of Surgeons of East, Central and Southern Africa, and Royal College of Surgeons, Edinburgh, these courses show potential to strengthen regional capacity in vascular surgery, with Kenya emerging as a training hub.
