Knowledge of risk factors, beliefs and practices of female healthcare professionals towards breast cancer, Morocco

le doctors were the only professional group that had satisfactory knowledge of risk factors while the nurses had an unsatisfactory knowledge with a mean score of 43%. A half of participants believed that that herbal therapy can cure breast cancer. 75% practice breast self-examination once a month and only 15% have ever had a mammogram. Age, profession and beliefs were not significantly associated with rate of BSE in this study; however this rate is influenced by knowledge of breast cancer risk factors. CONCLUSION: Results from this study suggest the need for continuing medical education programs aimed at improving knowledge of breast cancer among the nurses

Le traitement chirurgical des adénocarcinomes de la jonction oesogastrique: Expérience marocaine à travers une série de 149 cas

Introduction: L'incidence du cancer de la Jonction oesogastrique (JOG) ne cesse d'augmenter depuis les deux dernières décades aussi bien dans les pays industrialisés que dans les pays en voie de développement notamment le Maroc. Le rapprochement sur le plan étiopathogénique des adénocarcinomes (ADK) du cardia et ceux du bas oesophage reste un sujet de controverse posant le problème du choix thérapeutique chirurgical, notamment l’étendu de la résection. Le but de ce travail est de dresser le profil épidémiologique des patients opérés pour un ADK du cardia et analyser les gestes chirurgicaux réalisés par l’équipe chirurgicale A du centre hospitalier universitaire IBN SINA à Rabat à travers une série de 149 cas. Méthodes: Il s'agit d'une étude rétrospective ayant intéressé les malades opérés pour un ADK de la JOG sur une période de 15 années (1990-2004) en chirurgie A du CHU IBN SINA à Rabat. Résultats: 149 cas d'ADK de la JOG ont été retenus. L'âge moyen était de 55 ans, 76% étaient de sexe masculin avec un sex-ratio de 3/1. Les signes cliniques les plus fréquemment observés sont la dysphagie (70%), les douleurs épigastriques (67%) et le reflux gastro-oesophagien (15.5%). La notion de tabagisme n’a été rapportée que chez 20% des cas et l'oesophage de barret chez 10% des patients. Le type I de Siewert a concerné 65 cas (43.5%), le type II 40 cas (27 %), et le type III 44 cas (29.5%). Dans le type I une oesophagectomie transhiatale a été proposée, alors que les type II et III ont été traité comme un cancer de l'estomac par une gastrectomie totale. Les suites opératoires étaient simples chez 80 % des patients, la mortalité globale était de 8.5%. Conclusion: L’oesophagectomie par voie transhiatale chez les patients fragiles avec un ADK de la JOG de type I permet des résultats carcinologiques satisfaisants avec réduction de la morbidité postopératoire par rapport à la voie transthoracique. La gastrectomie totale est le traitement de choix pour les types III, alors que le débat est toujours ouvert quant à la meilleure stratégie chirurgicale pour la prise en charge des tumeurs de type II.Key words: Cardia, adénocarcinome, Siewert, chirurgie, Maro

Mantle cell lymphoma of the larynx: Primary case report

INTRODUCTION: Primary laryngeal lymphomas are exceedingly rare. Only about a hundred cases have been reported. They consist mainly of non-Hodgkin lymphoma, especially of diffuse large B-cell lymphoma and mucosa-associated lymphoid tissue. We report the first case of a primary laryngeal mantle cell lymphoma. CASE PRESENTATION: We report a case of a primary mantle cell lymphoma of the larynx in a 70-year-old North African non-smoker male. We present a detailed report of his clinical and paraclinical data as well as treatment options. CONCLUSIONS: Mantle cell lymphoma is a very aggressive lymphoma subset associated with poor prognosis. Laryngeal mantle cell lymphoma is exceedingly rare. To the best of our knowledge, this is the first case to ever be reported

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Evolution of Crop Water Productivity in the Nile Delta over Three Decades (1985–2015)

Estimating crop water productivity (CWP) for spatially variable climatic conditions in Egypt is important for the redistribution of crop planting to optimize production per unit of water consumed. The current paper aims to estimate maximum CWP trends under conditions of the Northern Nile Delta over three decades to choose crops that exhibit a higher productivity per unit of water and positive trends in the CWP. The Kafr El Sheikh Governorate was selected to represent the Northern Nile Delta Region, and mean monthly weather data for the period of 1985 to 2015 were collected to calculate standardized reference evapotranspiration and crop water use for a wide array of crops grown in the region using the CROPWAT8.0 model. The CWP was then calculated by dividing crop yield by seasonal water consumption. The CWP data range from 0.69 to 13.79 kg&middot;m&minus;3 for winter field crops, 3.40 to 10.69 kg&middot;m&minus;3 for winter vegetables, 0.29 to 6.04 kg&middot;m&minus;3 for summer field crops, 2.38 to 7.65 kg&middot;m&minus;3 for summer vegetables, 1.00 to 5.38 kg&middot;m&minus;3 for nili season crops (short-season post summer), and 0.66 to 3.35 kg&middot;m&minus;3 for orchards. The crops with the highest CWP values (kg&middot;m&minus;3) over three decades in descending order are: sugar beet (13.79), potato (w2) (10.69), tomato (w) (10.58), eggplant (w) (10.05), potato (w1) (9.98), cucumber (w) (9.81), and cabbage (w) (9.59). There was an increase in CWP of 41% from the first to the second and 22% from the second to the third decade. The CWP increase is attributed to a small decrease in water consumption and to a considerable increase in crop yield. The yield increases are attributed mainly to the planting of higher yielding varieties and/or the application of better agronomic practices

THE IMPACT OF DIFFERENT REGIMENS OF VITAMIN D3 ON GLUCOSE HOMEOSTASIS IN TYPE 2 DIABETIC PATIENTS

Objective: Vitamin D has a role in the regulation of pancreatic β-cell function and insulin sensitivity. Accordingly, Vitamin D deficiency is considered to be a risk factor for the development of type 2 diabetes mellitus (T2DM) and its complications. Therefore, the aim of the study was to assess and compare the effect of different regimens of Vitamin D3 on glucose homeostasis in patients with T2DM. Methods: The study included 80 patients with T2DM taking oral antidiabetic drugs. The patients were randomized to receive antidiabetic drugs alone or with different regimens of Vitamin D3 for 3 months. Vitamin D3-treated patients were supplemented by either daily oral 4000 IU Vitamin D3, weekly oral 50,000 IU Vitamin D3, or a single parenteral dose of 300,000 IU Vitamin D3. In addition to the assessment of patient characteristics, laboratory measurements of serum creatinine, blood urea, total and ionized calcium, serum phosphorus, fasting blood glucose, fasting serum insulin, homeostasis model assessment of insulin resistance, hemoglobin A1c, and 25(OH) Vitamin D levels were measured at the beginning and after 3 months. Results: After 3 months, the increased Vitamin D levels resulting from the daily and weekly oral doses of Vitamin D3 caused a significant decrease in metabolic parameters, whereas the parenteral dose demonstrated a non-significant decrease. Conclusion: Oral daily and weekly doses of Vitamin D3 could improve glucose homeostasis equally in patients with T2DM and better than a single parenteral dose of Vitamin D3

Fgf2 induces resistance to nilotinib through mapk pathway activation in kit mutated melanoma

KIT is a bona fide oncogene in a subset of melanoma and, ex vivo, KIT inhibitors are very efficient at killing KIT-mutant melanoma cell lines. However, KIT-mutant melanoma tumors tend to show a de novo resistance in most cases and a limited duration of response when response is achieved. We performed pharmacodynamic studies on patients with KIT-mutated melanoma treated with nilotinib, which suggested that the FGF2 axis may be a mechanism of resistance in this subset of melanoma. Using several melanoma cell lines, which are dependent on oncogenic KIT, we showed that although KIT inhibition markedly decreased cell viability in melanoma cell lines with distinct KIT mutations, this effect was lessened in the presence of FGF2 due to inhibition of BIM expression by MAPK pathway activation. Addition of a MEK inhibitor reversed the FGF2-driven resistance for all KIT mutants. We confirmed the expression of FGF2 and activation of MEK-ERK in melanoma patients using in situ data from a clinical trial. Therefore, the combined inhibition of KIT with FGFR or MEK may be a next-step effective clinical strategy in KIT-mutant melanoma.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Small cell carcinoma of the urinary bladder: A case report and review of the literature

Small cell carcinoma of the bladder (SCCB) is extremely rare. In this paper, we present a case of metastatic SCCB managed by chemotherapy and we would provide a brief review of the epidemiology, clinical features, diagnosis, pathologic features, staging, treatment, and prognosis of SCCB. A 52-year-old man was admitted with signs and symptoms suggestive of a bladder cancer. Computed tomography of the pelvis and abdomen showed a large tumor at the right bladder wall, measuring 10 cm in diameter, and a multinodular liver disease. Diagnosis of small cell carcinoma was established from the histological study of the transurethral resection of the bladder tumor. The patient received 12 cycles of platinum-based chemotherapy with a good partial response of bladder tumor and liver metastasis. The patient is still alive, 18 months after diagnosis