Adult Kidney Cancer in Mauritania: Clinical and Therapeutic Aspects

Introduction: since its creation, our urology department has taken care of tumor pathologies in particular kidney cancer in adults;our goal is to study the clinical and therapeutic epidemiological profiles of adult kidney cancer in Mauritania. Materials and Methods: We carried out a retrospective study over a period of six years, from January 1, 2012 to December 31, 2017, including all cases of adult kidney cancer registered in the urology-andrology departments of the Cheikh Zayed Hospital and Pathological Anatomy of the National Hospital of Nouakchott (Mauritania). Results: we collected 50 cases of kidney cancer. The average annual incidence was 8.3 cases. The average age of the patients was 52.98 years with extremes of 18 and 84 years. There was a female predominance (52%) or 29 women for 21 men. Lumbar pain was the most frequent clinical expression, more than half of the patients had symptoms over a period of at least 12 months before the first consultation. The left kidney was the most frequently affected. The right localization was demonstrated in 23 patients, the extension assessment was made with thoraco-abdomino-pelvic CT in 40 patients. Twelve patients had a tumor localized in the kidney. The extension assessment had made it possible to objectify the existence of metastases in 17 of our patients (37%). The preferred locations of these metastases were pulmonary and hepatic. Surgical intervention was performed in 44 patients (88%), of whom 36 underwent radical nephrectomy (72%), and two patients underwent partial nephrectomy (4.5%). Surgical abstention was decided from the outset in 6 patients (13.6%). None of our patients had received treatment with anti-angiogenics. The histological type most observed in our patients was renal cell carcinoma, observed in 34 patients, or 77.72%. At the time of the study, more than a third of the patients had died. The mortality rate in our series had reached 24%. A specific survival rate could not be assessed due to lack of information in the files and significant numbers of patients lost to follow-up at the time of the study. Conclusion: adult kidney cancer in Mauritania is characterized by its low incidence, its occurrence in a relatively young population, its female predominance, its often late diagnosis at locally advanced and metastatic stages, and the treatment is the most often surgical.

PREDICTION OF THE THERAPEUTIC EFFECTIVENESS OF NEW DRUGS FROM CLINICAL PHARMACOLOGY STUDIES

The development of new drugs for therapeutic purposes has become very expensive and time-consuming in American and European countries.It is estimated that on the average 50 to 100 million dollars and 10 or more years from the time of patenting are required to make a new drug available for general prescription. Every new drug needs to be charac-

Therapeutic potentials of fasudil in liver fibrosis

Fasudil has the potential to prevent liver fibrosis by activating natural killer cells and inhibiting the proliferation of hepatic stellate cells.Fasudil may be a promising clinical therapeutic drug for the prevention and treatment of liver fibrosis.

Patients’time in therapeutic range on warfarin among atrial fibrillation patients in Warfarin Medication Therapy Adherence Clinic

BACKGROUND The quality of warfarin therapy can be determined by the time in the therapeutic range(TTR)of international normalized ratio(INR).The estimated minimum TTR needed to achieve a benefit from warfarin therapy is≥60%.AIM To determine TTR and the predictors of poor TTR among atrial fibrillation patients who receive warfarin therapy.METHODS A retrospective observational study was conducted at a cardiology referral center in Selangor,Malaysia.A total of 420 patients with atrial fibrillation and under follow-up at the pharmacist led Warfarin Medication Therapeutic Adherence Clinic between January 2014 and December 2018 were included.Patients’clinical data,information related to warfarin therapy,and INR readings were traced through electronic Hospital Information system.A data collection form was used for data collection.The percentage of days when INR was within range was calculated using the Rosendaal method.The poor INR control category was defined as a TTR<60%.Predictors for poor TTR were further determined by using logistic regression.RESULTS A total of 420 patients[54.0%male;mean age 65.7(10.9)years]were included.The calculated mean and median TTR were 60.6%±20.6%and 64%(interquartile range 48%-75%),respectively.Of the included patients,57.6%(n=242)were in the good control category and 42.4%(n=178)were in the poor control category.The annual calculated mean TTR between the year 2014 and 2018 ranged from 59.7%and 67.3%.A high HAS-BLED score of≥3 was associated with poor TTR(adjusted odds ratio,2.525;95%confidence interval:1.6-3.9,P<0.001).CONCLUSION In our population,a high HAS-BLED score was associated with poor TTR.This could provide an important insight when initiating an oral anticoagulant for these patients.Patients with a high HAS-BLED score may obtain less benefit from warfarin therapy and should be considered for other available oral anticoagulants for maximum benefit.

Comparison of the clinical features and therapeutics of COVID-19 in cardio-cerebrovascular disease(CCVD)and non-CCVD patients

Cardio-cerebrovascular disease(CCVD)is a major comorbidity of coronavirus disease 2019(COVID-19).However,the clinical characteristics and outcomes remain unclear.In this study,102 cases of COVID-19 from January 22,2020 to March 26,2020 in Xixi Hospital of Hangzhou were included.Twenty cases had pre-existing CCVD.Results showed that compared with non-CCVD patients,those with CCVD are more likely to develop severe disease(15%versus 1%),and the proportion of pneumonia severity index grade IV was significantly higher(25%versus 3.6%).Computed tomography images demonstrated that the proportion of multiple lobe lesion involvement was significantly higher in the CCVD group than in the non-CCVD group(90%versus 63.4%).Compared with non-CCVD group,the levels of C-reactive protein,fibrinogen,D-dimer,and serum amyloid-A were higher,whereas the total protein and arterial partial Pa02 were lower in the CCVD group.Although no statistical difference was observed in the outcomes between groups,CCVD patients received more intensive comprehensive treatment to improve COVID-19 symptoms compared with non-CCVD patients.Integrated Chinese and Western medicine treatments have certain advantages in controlling the severe conversion rate and mortality of COVID-19.In addition,given that COVID-19 patients are usually related to coagulation disorders and thrombosis risk,the application of Chinese medicine in promoting blood circulation and removing stasis should be strengthened.

Benin Goitre in the General Surgery Department at Teaching Hospital Gabriel Touré

Introduction: Goitre is an increase in the volume of the thyroid gland. Goiters may be congenital or acquired, diffuse or nodular, functional or non-functional, benign or malignant. Purpose: The objectives of this work were to study and determine the frequency of benign goitre in the general surgery department of CHU Gabriel Touré, and to study epidemiological, clinical and therapeutic aspects. Patients and Method: This was a retrospective and prospective study conducted in the general surgery department of CHU Gabriel Touré, from January 1999 to December 2019. Included in the study were all patients with benign goiter confirmed in histology, hospitalized and treated in the service. Patients with thyroid malignant tumours, strumite, thyroid tract cyst, cervical abscess and neck trauma were not retained. Socio-demographic, clinical, para-clinical, therapeutic and post-operative aspects were the study parameters. Word processing and tables were done with Microsoft Word and Excel 2016 software. Data analysis was performed with Epi info7 software, the statistical test used was the Khi2 test and a value of P < 0.05 was considered statistically significant. Results: A total of 253 patient files were collected. Thyroidectomy represented 5.02% (253/5036) of surgical procedures. The average age was 42.5 years with a standard deviation of 15.6 and extremes of 13.9 and 76 years. The sex ratio was 8.7 in favour of the female sex. Anterior cervical swelling was the most common reason for consultation with 90.0% (230/253). There were 118/253 cases of euthyroid goiter (46.6%), 132/253 cases of hyperthyroid goiter (52.2%) and 3/253 cases of Basedow’s disease (1.2%). Histology revealed (178/253) cases of micro and macro follicular colloid adenoma (70.3%), (27/253) cases of micro and macro follicular vesicular adenoma (10.7%) and (48/253) cases of micro and macro vesicular hyperplasia. The most performed surgical techniques were subtotal thyroidectomy with a rate of 138/253 (54.5%) isthmo-lobectomy with a rate of 102/253 (40.3%), lobectomy with a rate of 11/253 (4.3%) and isthmectomy 1/253 (0.4%). One-month follow-up was marked by 4 cases of surgical site infection (1.6%), 2 cases of transient hypocalcemia (0.8%). One-year follow-up was simple in 98.4% of cases, we noted 4 cases of keloid. The average length of hospitalization was 3.31 ± 0.1 days. Conclusion: Goiter surgery is relatively common in the general surgery department of CHU Gabriel Touré. Good preparation and better post-operative monitoring could help minimize post-operative complications.