Lymphadenitis due to Histoplasmosis capsulatum var. capsulatum : Unawareness or rare occurrence in the Democratic Republic of Congo? Unusual original report with first immunohistochemical phenotyping of the fungus: Lymphadénite à histoplasma capsulatum var capsulatum. Méconnaissance ou rareté en République Démocratique du Congo ? Cas clinique inhabituel avec caractérisation du fungus par immunohistochimie

We have described herein the first lymphadenitis due to Histoplasma capsulatum var capsulatum with molecular characterization of the pathogen. The patient was a 55-year-old female from a remote village of Yabaondo in the former Province Orientale, currently Tshopo Province, Democratic Republic of Congo (DRC) who presented with multiple swollen left neck lymph nodes. She reported weight loss (undefined) but was otherwise healthy, and a presumptive diagnosis of tuberculosis (TB) was postulated. The biopsy specimen yielded plenty yeast cells of H. capsulatum var capsulatum on Hematoxylin-Eosin routine staining. The molecular identity of the fungus was confirmed by immunohistochemistry at the Pasteur Institute of Paris. The rarity of reported cases of H. capsulatum var capsulatum in DRC prompted us to report this unique case to generate awareness and preparedness of this emerging/reemerging neglected tropical fungal infection against outbreaks. H. capsulatum var capsulatum needs to be considered in the work-up of lymphadenopathies in tropical environment. Nous décrivons le premier cas d’une lymphadénite spécifique histoplasmique à Histoplasma capsulatum var capsulatum. Il s’agissait d’une patiente de 55 ans originaire du village Yabaondo dans l’ancienne Province Orientale, actuellement Province de la Tshopo. Son état général était satisfaisant excepté un amaigrissement et la présence de nombreux ganglions cervicaux gauches de taille variable, présumés tuberculeuses (TB). La biopsie a montré un remaniement de l’architecture folliculaire remplacée par une prolifération de gros macrophages bourrés des spores d’H. capsulatum var capsulatum. L’immunohistochimie utilisant un anticorps spécifique maison a été réalisé à l’Institut Pasteur de Paris et a confirmé l’identité moléculaire du microorganisme. La rareté des cas d’histoplasmose à H. capsulatum en RD Congo nous a motivé à rapporter ce cas inédit afin d’attirer l’attention et de contribuer à la préparation de la lutte contre cette entité émergente/reémergente négligée. L’Histoplasmose à H. capsulatum var capsulatum doit être evoquée dans la demarche de diagnostic differentiel d’une lymphadénopathie en milieu tropical

COMPETITION AND LEADER-FOLLOWER INTERACTIONS: PANEL ESTIMATES ON INDONESIAN BANKING

This paper discusses banking competition and leader-follower relationship. Banking competition is investigated using some specification from Monti-Klein model that allows leader-follower (i.e. Stackleberg) relationship, the possibility of Cournot competition and other form of competition. We use monthly observations across 119 banks listed in Indonesia using the standard panel fixed effect methodology to absorb time-invariant unobserved heterogeneity and dynamic panel data to minimize the risks of endogeneity. The estimation suggests the leader-follower relationship among banks exist both on loan and deposit markets. The results are mostly consistent across different groups and on full sample estimates, although are quite different in magnitudes. While leader-follower relationship is dominantly occur in credit market, there are some evidence of simultaneous appearance of both leader-follower and Cournot interactions on the deposit marke

High prevalence of undiagnosed chronic kidney disease among at-risk population in Kinshasa, the Democratic Republic of Congo

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Caractérisation anatomoclinique et immunohistochimique des lymphadénopathies non tumorales à Kinshasa: Anatomoclinical and immunohistochemical caracterisation of non-malignant lymphadenitis in Kinshasa

Context and objective. Non-malignant lymphadenitis are the most prevalent hemopathies in sub-Saharan Africa. We determined the frequency and histological pattern of non-malignant lymphadenitis. Methods. A retrospective study was undertaken within 5 main pathology laboratories in Kinshasa during a 5-year period spanning from 2011 to 2015. Lymph node specimens were stained with hematoxylin eosin and specific antibodies for immunochemistry (IHC). Results. Lymph node specimens constituted about only 3% of all the biopsies done through Kinshasa. Among 413 (64%) non-malignant lymph node specimens analyzed, 52% were from female patients with a male-to-female sex ratio of 0.96. Patient age ranged from 1 to 81 years, with a median of 25 (16-40) years old. The commonest site of biopsy was cervical (67%) followed by inguinal (11%) and axillary (9%). Mycobacterium tuberculosis (54%) was the main cause of non-malignant lymph node enlargement, followed by reactive lymphadenitis (38%) and nodular lymphadenitis with abscess (4%). Some rare cases such as Castelman disease (1.4%) and Rosai-Dorfman (0.2%) diseases were encountered. Of the 20 reactive lymphadenitis specimens analyzed by IHC, 10 were positive for Epstein Barr virus (EBV), 6 for cytomégalovirus (CMV) and 4 for Herpes virus. Conclusion. In Kinshasa, Mycobacterium tuberculosis and reactive type were the main cause of non-malignant lymphadenitis. The reactive viral lymphadenitis was caused by EBV. Immunohistochemistry staining should be performed for any case of reactive lymphadenitis in order to provide the accurate etiology and consequently an appropriate treatment. Contexte et objectif. Les lymphadénopathies non tumorales sont l’une des hémopathies fréquentes en Afrique subsaharienne. La présente étude a pour objectif de décrire le profil histo-pathologique et immunohistochimique des lymphadénopathies non tumorales. Méthodes. Etude rétrospective et descriptive réalisée dans cinq laboratoires d’Anatomie Pathologique de la ville de Kinshasa durant 5 ans. Les paramètres d’intérêt étaient : la fréquence, l’âge, le sexe, le siège du prélèvement, les aspects histopathologiques et immunohistochimiques. Résultats. 413 cas de lymphadénopathies non tumorales ont été recensés soit 3% de toutes les affections de la période d’étude. L’âge médian était de 25 ans et le sexe-ratio Homme / Femme était de 0,96. Les principaux types histologiques étaient les lymphadénites tuberculeuses (54%), les lymphadénites réactionnelles (38%), les lymphadénites nodulaires abcédées (4%), les lymphadénopathies dermatopathiques (3%), la maladie de Castelman (1%) et la maladie de Rosaï Dorfman (0,2%). Le ganglion cervical était le site le plus fréquent (67%). Sur les 20 cas des lymphadénites réactionnelles d’étiologies virales, les lymphadénites à EBV ont représenté 10 cas (50%), les lymphadénites à Herpès virus et CMV ont représenté respectivement 6 cas (30%) et 4 cas (20%). Conclusion. Les lymphadénopathies non tumorales sont fréquentes dans notre milieu. Hormis la tuberculose ganglionnaire qui est la pathologie la plus fréquente, ils existent d’autres types nécessitant l’apport de certaines techniques ancillaires pour rechercher les étiologies précises

Bcl2, Bax and LMP1 Genes Expression in Uterine Leiomyoma Tissue According to Vitamin D Status among Congolese Women

The objective of this paper is to describe genes expression patterns of the anti-apoptotic Bcl2 and pro apoptotic Bax as well as EBV infection marker LMP1 in, leiomyoma tissue according to patients vitamin D status. To investigate the relationship between alterations of genes expression patterns and serum vitamin D levels, samples from 105 women undergoing surgery for uterine leiomyoma in 6 hospitals in Kinshasa from April 1 to October 31, 2014 were obtained for genes expression analysis of Bcl-2, Bax and LMP-1 genes. Genes expression in leiomyomas was measured by immunohistochemistry. Serum vitamin D levels were determined by IRMA. Association between vitamin D status and genes expression was assessed using logistic regression analysis. From 105 women providers of leiomyoma tissues examined, 41 were sufficients in vitamin D, 36 were insufficients and 28 deficients. In uterine leiomyoma tissues obtained Bcl2 was expressed in 96 (91.4%) of samples with low, moderate and high expression observed in 33.3%, 32.4% and 25.7%, respectively. The differences in Bcl2 expression between the three subgroups of vitamin D categories were not statistically significant.As a mirror of Bcl2 expression, Bax protein was not expressed in the majority (n = 95, 90.5%) of samples. Similar to Bcl2, the differences in Bax expression between the three subgroups of vitamin D categories did not reach the level of statistical significance. Of the 105 leiomyoma tissue examined, LMP1 was observed in 30 (28.6%) of samples and showed a tendency towards increased expression with the decline in vitamin D levels; however, the tendency was fairly not statistically significant.In multivariate analysis, predictors of Bcl2 expression were age, parity, and overweight/obesity and insufficiency/deficiency vitamin D; however, the differences observed were not statistically significant. The same predictors were also associated with Bax expression but once again the observed differences were not statistically significant. Vitamin D deficiency, the only predictor significantly associated with LMP1 expression, conferred a 3.9 fold greater risk (aOR 3.9; 95% CI 1.068-14.242; p = 0.039) of expressing LMP1 in leiomyoma tissue.In the present study, Bcl2 gene expression in ULM tissues tended to increase with the decline in vitamin D levels but observed differences were not statistically significant. In contrast, LMP1 gene expression was significantly associated with vitamin D deficiency. In spite of methodological limits, these findings do suggest a role of Vitamin D deficiency in the development and progression of ULM

Néoplasies intraépithéliales du col utérin chez la congolaise à Kinshasa : intérêt des biomarqueurs immunohistochimiques: Intraepithelial neoplasias of the uterine cervix in the Congolese in Kinshasa : interest of immunohistochemical biomarkers

Context and objective. Although cervical cancer remains the second most frequent in women in Africa, immunohistochemical biomarkers for its diagnosis is rarely used in sub-Saharan Africa. The aim of this study was to demonstrate the contribution of biomarkers p16 and Ki-67 in the diagnosis of cervical intraepithelial neoplasia. Methods. This was a retrospective study carried out in five Pathology laboratories in Kinshasa. Biopsy slides were reread and reclassified by at least two independent pathologists in Kinshasa University Hospital based on the nomenclature of Bethesda/WHO. Immunolabelling (p16 and Ki-67) was carried out with external quality control in Europe. Results. A total of 70 cases were included. All 24 cases of high grade intraepithelial neoplasia (CIN2, CIN3 and CIS) were positively marked by p16 and Ki-67 whereas low grade lesions were positively marked for 41 cases of CIN1 and negatively marked for 5 cases (3 of CIN1 and 2 of CP). Certain lesions have been reclassified. Immunohistochemical labeling was significantly associated with the grade of intraepithelial neoplasia for p16 (p = 0.001) and for Ki-67 (p = 0.004). Conclusion.  p16 and Ki-67 are specific and reliable biomarkers for an optimal diagnosis of intraepithelial neoplasia of the cervix. Contexte et objectif.  Bien que le cancer du col utérin soit le deuxième cancer plus fréquent chez la femme en Afrique, le recours aux biomarqueurs immunohistochimiques reste exceptionnel en Afrique subsaharienne. La présente étude avait pour objectif de montrer l’apport des biomarqueurs p16 et Ki-67 dans le diagnostic des néoplasies intra-épithéliales du col utérin. Méthodes. C’était une étude rétrospective réalisée dans cinq laboratoires d’Anatomie Pathologique de Kinshasa. Des lames biopsiques ont été relues et reclassées par au moins deux pathologistes indépendants aux Cliniques Universitaires de Kinshasa en suivant la nomenclature de Bethesda/OMS. L’immunomarquage (p16 et Ki-67) a été réalisé avec un contrôle qualité externe en Europe. Résultats. 70 cas ont été inclus. Les 24 cas des néoplasies intra-épithéliales de haut grade (CIN2, CIN3 et CIS) étaient marquées positivement par p16 et Ki-67 alors que celles de bas grade étaient marquées positivement pour 41 cas de CIN1 et négativement pour 5 cas (3 de CIN1 et 2 de CP). Certaines lésions ont été requalifiées. L’immunomarquage était significativement associé au grade des néoplasies pour la p16 (p=0,001) et pour le Ki-67 (p=0,004). Conclusion. P16 et Ki-67 sont des biomarqueurs spécifiques et efficaces pour un diagnostic optimal des néoplasies intra-épithéliales du col utérin. &nbsp

Capital Flows and Bank Risk-Taking Behavior: Evidence From Indonesia

This paper investigates the impact of capital flows on bank risk-taking behavior. It undertakes two levels of empirical estimations, namely (i) single-country industry-level; and (ii) multi-country industry-level estimations, covering emerging market economies. The results suggest that capital inflows, in the form of portfolio investment, is significant in raising risk-taking behavior. Large banks are less aggressive in their risk-taking behavior vis-à-vis smaller banks. Such impact of portfolio investment on risk-taking behavior is also shown in the multi-country level estimates

HIV-Associated immune complex glomerulonephritis with "lupus-like" features

Renal structural abnormalities in HIV/AIDS infected patients have been infrequently and incompletely reported in patients from sub-Saharan Africa. We report an immune complex glomerulonephritis with "lupus-like" features in a ten-year-old HIV+ boy who was evaluated at the University Hospital of Kinshasa. The light microscopic examination of the renal biopsy displayed a predominantly membranoproliferative glomerulonephritis with prominent focal segmental necrotizing injury, numerous wire-loops, and a spiky membranous nephropathy. In addition, there were prominent tubular injury, microcysts filled with periodic acid-Schiff (PAS) positive casts, edema and an inflammatory infiltrate of the interstitium, features of a classic HIV-associated nephropathy (HIVAN). Electron microscopy revealed large subendothelial, intra-membranous, subepithelial and mesangial deposits. The combination of these findings, while being consistent with lupus nephritis WHO grade IV/V, the tubulointerstitial HIVAN-like changes and the absence of clinical evidence of lupus disease favored an HIV-associated immune complex glomerulonephritis with "lupus-like features"