Use of road asset maintenance planning software in QDMR

Asset Management has over the last decade become the primary focus and objective of any worthwhile road authority. The focus of Road Asset Management is not merely of asset preservation but seeks to maintain the asset at a level, which optimises the returns to the community at large. These aims are achieved by continuously assessing the condition of the road network storing and synthesising the data and subsequently prioritising on the requirement hence providing the optimum treatment at the opportune time. In this background, Main Roads have progressively developed planning software - SCENARIO Millennium to assist their managers in developing maintenance strategies for their road networks. Considerable savings can be generated through timely maintenance and rehabilitation interventions and Main Roads envisage that their newly introduced SCENARIO software will be used as part of the program development process by their regions and districts. This dissertation explores the use of SCENARIO in the Southern District and process of identifying a program for rehabilitation works. This investigation of Scenario application follows a thorough review of the road asset management and the particular aspects of life cycle analysis. The report generally found that emphasis of asset management has in the last decade been fully recognised and embraced in the whole life management of assets. The use of SCENARIO software in the Southern District is yet to be implemented due to several reasons, such as the success in the current practices, staff shortfall and the fact that the software still requires a lot of local development to succeed etc. The report has found that Scenario could in addition to the identification of programmed maintenance requirements be tailored as an effective tool to timely predict the rehabilitation requirements. This involves further engineering analysis of the development of pavement weaknesses. Development of rules and different rehabilitation treatments would be an interesting regime that deserves further attention

Spectrum of imaging findings in AIDSrelated diffuse large B cell lymphoma

Lymphoma in HIV-infected patients is AIDS defining. This is the second most common AIDS defining malignancy after Kaposi’s sarcoma. Development of lymphoma in HIV patients is related to immunosuppression and high viral load. Co-infection with other lymphotrophic viruses especially EBV is also strongly associated with development of lymphoma in HIV patients. Despite advances in HAART therapy, incidence of diffuse large B cell lymphoma in HIV-infected patients remains significantly higher than in the general population. Early diagnosis is challenging due to presence of opportunistic infections and atypical presentation of the lymphoma in this subset of patients. Atypical imaging findings are not unusual, and the diagnosis of lymphoma on imaging is on many occasions unexpected as the patient would ideally be initially investigated for presumed opportunistic infection. Lymphoma treatment approaches in HIV patients are complicated by comorbidity with opportunistic infections and performance status of the patients. Treatment failure and early relapse are also common in AIDS-related lymphoma. This review article highlights the common and unusual multimodality imaging findings in HIV-associated lymphoma

Urinary bladder metastasis from breast cancer: a rare cause of hematuria

Breast cancer is the most common cancer in women globally as well as in Kenya. The most common sites of metastases reported include the bones, liver and lung. Metastasis to the urinary bladder is relatively uncommon with only a few case reports in literature. It can therefore be easily overlooked as a cause of hematuria in these patients. We describe a rare case of a patient with breast cancer who presented with urinary bladder metastasis as a late complication of her illness

A rare case of Biliary Atresia with Biliary Ascites on a (Hepatobiliary Iminodiacetic Acid) HIDA scan

Biliary atresia is one of the most challenging conditions in pediatric surgery even when it is the only finding. Here we present a rare case of biliary atresia complicated with biliary ascites due to ductal perforation identified on a hepatobiliary iminodiacetic acid (HIDA) scan

Thyroid cartilage metastases from prostate cancer on 18F PSMA PET CT: A case series

Prostate cancer metastases to the thyroid cartilage is an extremely rare phenomenon. We report three cases of advanced prostate carcinoma with metastases to the thyroid cartilage identified on 18F prostate-specific membrane antigen-1007 (PSMA-1007) positron emission tomography (PET)/computed tomography (CT). The pathophysiology and possibility for under-reporting are also discussed. Prostate cancer metastases to the larynx should be considered in the differential diagnosis of thyroid cartilage lesions in patients with advanced prostate cancer and is associated with poor prognosis

Elastography in Chronic Liver Diseases

Elastography is useful for diagnosing and grading hepatic fibrosis in patients with chronic liver diseases (CLD). In addition, it may be used as a noninvasive tool for surveillance and prognostication of patients with complications related to CLD. Elastography uses real-time ultrasound to assess for tissue elasticity and is a fast, simple, reproducible, and reliable method for noninvasive liver fibrosis evaluation. Management of chronic liver disease is dependent on the grade of liver fibrosis to ascertain the urgency and choice of treatment and advice on further screening for cirrhosis and hepatocellular carcinoma. This chapter will highlight the role of elastography in the evaluation of chronic liver disease including hepatitis B and C and HIV-related liver disease and nonalcoholic fatty liver disease (NAFLD)

Bone scintigraphy imaging of cardiac amyloidosis

Transthyretin-related cardiac amyloidosis (ATTR) amyloidosis is an aggressive, rapidly progressive, and fatal disease, for which several promising therapies are in development. This condition is frequently underdiagnosed because of the limited specificity of echocardiography and the traditional requirement for histological diagnosis. It is well known that 99mtechnetium-labeled bone scan radiotracers can localize in the myocardial amyloid deposits, but the use of this imaging modality to differentiate between the two subtypes has only lately been revisited. We report a case of a 76-year-old man with a clinical diagnosis of amyloidosis who underwent a bone scan that had features of ATTR amyloidosis. To the best of our knowledge, this is the first case report in Sub-Saharan Africa

High Prevalence of Liver Fibrosis in Patients with Human Immunodeficiency Virus Monoinfection and Human Immunodeficiency Virus Hepatitis-B Co-infection as Assessed by Shear Wave Elastography: Study at a Teaching Hospital in Kenya

Objectives:The aim of this study was to determine the prevalence of liver fibrosis in patients with human immunodeficiency virus (HIV) monoinfection versus those with HIV hepatitis-B virus (HBV) co-infection as assessed with shear wave elastography (SWE) in a tertiary sub-Saharan Africa hospital. Materials and Methods:A total of 105 consecutive patients, 70 with HIV monoinfection and 35 with HIV-HBV co-infection, had liver elastography obtained using SWE to assess for the presence of liver fibrosis the cutoff of which was 5.6 kPa. Assessment of aspartate aminotransferase-to-platelet ratio index (APRI) score (a noninvasive serum biomarker of liver fibrosis) in these patients was also done. Results:The prevalence of liver fibrosis was significantly higher (P \u3c 0.0001) in patients with HIV-HBV co-infection, 25.7%, compared to those with HIV monoinfection, 7.1%. APRI score was greater in patients with HIV-HBV co-infection than those with HIV monoinfection. HIV co-infection with HBV accelerates progression to liver fibrosis. Association of a low cluster of differentiation 4 (CD-4) count with advanced fibrosis supports earlier starting of antiretroviral therapy to prevent rapid progression of liver disease in HIV-positive patients. Conclusion:In view of the high prevalence of liver fibrosis in patients with HIV-HBV co-infection, regular monitoring of the disease progression is recommended

Utility of Multiparametric Magnetic Resonance Imaging as a Predictor of Clinically Significant Prostate Cancer in a Sub-Saharan African Population

Background: Traditionally, the diagnosis of prostate cancer was based on increased prostate-specific antigen level or an abnormal digital rectal examination and confirmed histologically following biopsy. Consequently, a proportion of men without cancer or with clinically insignificant disease undergo unwarranted prostate biopsies and experience resultant complications. Pre-biopsy multiparametric magnetic resonance imaging (MP-MRI) is vital in determining those with clinically significant cancer who need biopsy and those with a negative MRI who can safely avoid unnecessary biopsy. Methods: The diagnostic accuracy of MP-MRI using transrectal ultrasound-guided biopsy as the reference test was established for 133 men who had undergone MRI and biopsy. The MRI images were reviewed and reported by two independent consultant radiologists. Clinically significant cancer was defined as Prostate Imaging Reporting and Data System score ≥3 on multiparametric MRI and Gleason score ≥3 + 4 (grade group ≥2) on histology. Results: MP-MRI of the prostate was found to have 92% sensitivity, 47.8% specificity, 86.8% negative predictive value (NPV) and 62% positive predictive value for the diagnosis of prostate cancer. Conclusion: MP-MRI has a high sensitivity and a high NPV, validating its use in pre-biopsy evaluation of men at risk of prostate cancer to safely avoid unnecessary prostate biopsy and to guide biopsy of suspicious lesions

Supraclavicular nodal metastasis at primary staging of prostate cancer using 18F-PSMA-1007 PET/CT

Background: The most common sites of metastasis in prostate cancer are bone, pelvic and retroperitoneal lymph nodes, liver and lungs. This study aimed to evaluate the prevalence of supraclavicular nodal metastasis in newly diagnosed prostate cancer using 18F-PSMA-1007 PET/CT which has hitherto been understudied. Methods: 18F-PSMA-1007 PET/CT examinations performed at our institution between June 2020 and June 2022 for primary staging of prostate cancer were reviewed to identify supraclavicular nodal metastasis from prostate cancer. Data variables included age, stage of disease, PSA level, Gleason score and ISUP/WHO grade group and how these compare with the presence of supraclavicular nodal metastasis. Results: A total of 240 patients with prostate cancer staged with 18F-PSMA-1007 PET/ CT were analyzed. More than half of the patients presented with stage IVA or IVB disease, 54.1% (n=130/240), and with high or very high-risk disease, 74.6% (n=179/240). The prevalence of supraclavicular nodal metastasis in this cohort was 7.9% (n=19/240). Advanced stage and high-risk groups were strongly associated with the presence of supraclavicular nodal metastasis. Conclusion: There is moderate prevalence of supraclavicular nodal metastasis in patients with intermediate to very high-risk prostate cancer which has likely previously been underdiagnosed with conventional imaging and has been brought to the fore with new-generation imaging such as PSMA PET/CT. It should therefore be an area of consideration during diagnostic work up and follow up of prostate cancer patients. The prognostic signifcance of supraclavicular nodal metastasis in prostate cancer requires further research