Browsing by Author "Grewal, R."

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    Electrophoresis test prevalence, requesting patterns, yield and related bone marrow biopsy findings at a South African tertiary hospital : a 5-year retrospective audit
    (Health and Medical Publishing Group, 2017) Naidoo, N.; Erasmus, R. T.; Grewal, R.; Zemlin, A. E.
    Background. Studies of electrophoresis testing (serum protein electrophoresis (SPE), urine protein electrophoresis (UPE), immunofixation electrophoresis (IFE)) in a South African (SA) pathology laboratory setting are limited. Objectives. To evaluate the prevalence, testing pattern and yield of electrophoresis tests performed over a 5-year period in a tertiary academic laboratory and to relate these findings to bone marrow biopsy findings in a few selected cases. Methods. This was a retrospective audit of all SPE, UPE and IFE tests performed on new and follow-up adult patients (aged ≥18 years) from 2010 to 2015, using data from the Tygerberg Academic Hospital (Cape Town, SA) National Health Laboratory Service hospital information system database. A subgroup analysis of all patients with negative serum (SIFE) and/or urine immunofixation (UIFE) tests who had concurrent bone marrow biopsies close to the time of IFE testing was also performed. Results. A total of 5 086 SPE tests were performed (44.3% were follow-up tests, and of these patients 13.8% had SIFE tests); 1 299 UPE tests were performed (23.3% were follow-up tests, and of these patients 33.6% had UIFE tests). The mean ages of patients who had SIFE and UIFE tests were 59 years (standard deviation (SD) 14.2) and 60 years (SD 15), respectively. The female-to-male ratio was 1.1:1 for both SIFE and UIFE. The negative test yields for SIFE and UIFE were 31.3% and 52.1%, respectively. Bone marrow biopsy findings for patients with negative SIFE tests identified 8 out of the 20 biopsies (40.0%) as positive for myeloma. Conclusion. This audit provides baseline data on the prevalence of test requests, their source and the yield of electrophoresis testing in our laboratory. An increasing trend in SIFE and UIFE was evident.
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    Impact of the HIV epidemic and Anti-Retroviral Treatment policy on lymphoma incidence and subtypes seen in the Western Cape of South Africa, 2002-2009: Preliminary findings of the Tygerberg Lymphoma Study Group
    (2011) Abayomi, E. A.; Somers, A.; Grewal, R.; Sissolak, G.; Bassa, F.; Maartens, D.; Jacobs, P.; Stefan, C.; Ayers, L. W.
    The Tygerberg Lymphoma Study Group was constituted in 2007 to quantify the impact of HIV on the pattern and burden of lymphoma cases in the Western Cape of South Africa which currently has an HIV prevalence of 15%. South Africa has had an Anti-Retroviral Treatment (ART) policy and a roll-out plan since 2004 attaining 31% effective coverage in 2009. This study is designed to qualify and establish the impact of HIV epidemic and the ARV roll-out treatment program on the incidence of HIV Related Lymphoma (HRL). Early data document that despite the ART roll out, cases of HRL are increasing in this geographical location, now accounting for 37% of all lymphomas seen in 2009 which is an increase from 5% in 2002. This is in contrast to trends seen in developed environments following the introduction of ART. Also noted are the emergence of subtypes not previously seen in this location such as Burkitt and plasmablastic lymphomas. Burkitt lymphoma is now the commonest HRL seen in this population followed by diffuse large B-cell lymphoma subtypes. The reasons for this observed increase in HRL are not ascribable to improved diagnostic capacity as the tertiary institute in which these diagnoses are made has had significant expertise in this regard for over a decade. We ascribe this paradoxical finding to an ART treatment environment that is ineffective for a diversity of reasons, paramount of which are poor coverage, late commencement of ART and incomplete viral suppression. © 2011.
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    Incidence of Hodgkin lymphoma in HIV-positive and HIV-negative patients at a tertiary hospital in South Africa (2005 - 2016) and comparison with other African countries
    (Health & Medical Publishing Group, 2018-06-26) Naidoo, N.; Abayomi, A.; Locketz, C.; Musaigwa, F.; Grewal, R.
    Background. Hodgkin lymphoma (HL) is the most common non-AIDS-defining cancer in HIV-positive patients. Studies on South African (SA) populations have described the prevalence as 7 - 17% of all lymphomas, 8 - 27% of head and neck lymphomas, 9% of lymph node biopsies and 4% of HIV-related malignancies. Objectives. To describe the incidence of HL at our centre between 2005 and 2016 by year, gender, HIV status, histological subclassification and bone marrow involvement, and compare these findings with similar SA and African studies. Methods. This was a retrospective study of all incident HL cases diagnosed in the Department of Pathology, National Health Laboratory Service, Tygerberg Academic Hospital, Cape Town. Follow-up, relapsed and referral cases were excluded. A positive diagnosis of HL was confirmed by either lymph node or bone marrow biopsy and was based on morphological and immunohistochemical findings in accordance with the World Health Organization classification. Results. There were 303 incident cases of HL diagnosed. The incidence increased from 2005 to 2011, with a spike in cases in 2008 and a subsequent decline overall after 2011. The highest proportion of cases was in the 25 - 49-year-old age category (51.1%). There were 77 HIV-positive patients (25.4%), of whom 53 (68.8%) had CD4+ counts <500 cells/µL. In keeping with other African studies, the main subtypes were nodular sclerosis HL (49.8%) and mixed-cellularity HL (23.1%). Bone marrow biopsy following lymph node diagnosis of HL confirmed involvement in 23.7% of patients. Conclusions. Absolute numbers of cases of HL at our centre have increased since the roll-out of antiretroviral therapy (ART) to the public sector. The recent change in policy to make ART available to all HIV-positive patients independent of CD4+ count suggests that patients will survive longer and are therefore at increased risk of developing HL. We anticipate that numbers of HL cases will increase or remain high in the coming years, and we need to prepare for this.
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    V - Vitamins B12 and Folate - Part II - Diagnosis and treatment
    (The Specialist Forum, 2011) Van Wyk, J.; Grewal, R.; Wood, L.; Abayomi, E. A.; Jacobs, P.