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Neuroblastoma: Incidental Craniocerebral Metastasis - A Case Report
Get PDFNeuroblastoma has been attributed the term “the great imitator” due to its varied spectrum of presentations. Although neuroblastoma is a common childhood malignancy, which frequently metastasizes, involvement of the Central nervous system is rarely reported in the literature. It commonly metastasizes to the base of the skull and orbits late in the disease. Early detection and aggressive treatment of this complication may allow some patients to live longer than they would have otherwise
Using in-Hospital Mortality as an Indicator of Quality Care and Hospital Performance
Get PDFIn-hospital mortality (MIH) is used as a performance indicator and quality healthcare in hospitals. However, the majority of deaths resulted from an inevitable disease process (severity of cases and/or co-morbidity), and not medical errors or changes in the quality of care. This work aims to make a distribution of deaths in the Regional Hospital of Eastern, Al Farabi hospital and to highlight that more studies on the MIH are required consistently with detailed clinical data at admission. The MIH showed its limitation as a health care indicator. The overall rate of in-hospital deaths within the Al Farabi hospital has averaged 2.4%, with 8.4% in the emergency unit, 28% in the intensive care unit, 22% Neonatology unit, 1.6% in the pediatric unit. The MIH may depend, firstly, on the condition of patients before hospitalization and secondly, on the conditions of their transfer from one institution to another that supports them as a last resort. Al Farabi hospital supports patients transferred from the provinces of the eastern region. Thus, 6% of patients who died in 2014 come from Berkane, 2% from Nador, 2% from Bouarfa, 4% from Taourirt, and 2% from Jerrada. One might question the procedures and the conditions of such transfers. In conclusion, the overall MIH measured from routine data does not allow proper comparison between hospitals or the assessment of the quality of care and patient safety in the hospital. To do so, we should ideally have detailed clinical data on admission (e.g. type of admission, age of patient, sex, comorbidity, ...). The MIH is however an important indicator to consider as a tool to detect potential problems related to admission procedures and to suspect an area of "non-quality" in healthcare. The MIH is interesting for the patient and for the hospital because it serves the improvement of quality healthcare
Immediate Reactions to Monoclonal Antibodies in Clinical Hematology
Get PDFMonoclonal antibodies (MoAbs) have been widely used in clinical hematology. As foreign macro-molecules, they can cause infusional reactions during the administration or within 24 hours after the infusion, which encompass a spectrum of mechanisms. Although most of these reactions are non-allergic, are often indistinguishable from true allergic reactions mediated by IgE immunoglobulins. The diagnosis is often challenging and relies mainly on clinical criteria. They occur during the first doses, soon after the initiation of treatment. The symptoms are usually well controlled by the immediate drug discontinuation or reduction of the infusion rate. The management remains largely supportive, consisting of oxygen, intravenous fluids, bronchodilators, antihistamines and steroids. Most of MoAb protocols recommend premedication with steroids and antihistamines and gradually escalating infusion rates. Increased medical and nursing vigilance is required and resuscitative equipment should always be readily available. These events affect patients' quality of life, leading to treatment delay or discontinuation and series of tests. The decision to rechallenge the treatment depends on severity grading, clinical parameters and treatment goals. This article provides an update of MoAbs used in clinical hematology. It summarizes the pathophysiology, the diagnostic approach, the preventive measures and treatment of MoAb-related reactions
Unusual Tufted Hair Folliculitis
Get PDFTufted hair folliculitis was first described by Smith and Sanderson in 1978. This is a rare progressive pattern of scarring alopecia that affects the scalp. The cause of this disorder is unknown. Staphylococcal organisms are frequently found in the lesion, although their role in the pathogenesis is still unclear. No widely accepted treatment regimen exists. Tufted hair folliculitis in locations other than the scalp, and bilaterally on the cheeks, is an unusual presentation
Intramuscular Benign Lipoma of the Biceps Brachii Muscle - A Case Report
Get PDFIntramuscular lipoma is an uncommon mesenchymal neoplasm that characteristically infiltrates adjacent tissues and tends to recur after excision. Only a few publications referring to the upper extremities location have been reported. We report a case of an intramuscular lipoma of the biceps brachii muscle studied with MRI. Complete excision was performed without recurrence
Breast Cancer Molecular Subtypes Among Moroccan Women
No full textIntroduction: Breast cancer remains despite therapeutic progress, the leading cause of death by cancer among women. It represents a group of very heterogeneous clinical, histopathological and molecular diseases. Molecular heterogeneity has been demonstrated by genomic analysis, even for similar histology cancers. Four subgroups of breast carcinomas are distinguished: Luminal A, Luminal B, HER2 overexpression, and Basal-like. The Immuno-histo-chemical analysis uses ip (estrogen receptors) RE, the PR (progesterone receptors), the ((Human Epidermal Growth Factor Receptor-2), the Ki67 (proliferation marker) HER2, CK5/6) has shown a subdivision into subgroups similar to those found by genomic analysis. These subgroups are different from the point of view of clinical course and response to adjuvant treatment.Objectives: The aim of this work is to study the molecular profile of breast cancers by immunostaining on Moroccan series to a classification with a prognostic value allowing a treatment tailored to each group of patients. Furthermore, the molecular subgroups were correlated to other clinical and histological factors.Material and methods: It is a prospective study of the laboratory of Anatomy and Pathologic cytology of the children's Hospital, the service I of the maternity hospital in Rabat, and in cooperation with the United Nations Centre of pathological anatomy. To do this, 88 cases of breast cancer together were diagnosed between January 1, 2010, and December 31, 2014, taking a period of five years. All tissue samples made a subject study of Immuno-histo-chemistry with the following markers: RE, PR, HER2, and Ki67. Only negative triple cases (HR and HER2 negative) benefited from an additional marking with CK5/6 and EGFR to set the basal profile.Results: Series of 88 cases of mammary carcinomas observed on operating parts, ranged in age between 28 and 84 years old, with an average of 51 ± 12, 8. Carcinoma infiltrating non-specific (DOCTORS) was the most frequent (87.5%). Ranks histo-prognostic Scarff Bloom and Richardson (SBR) 2 and 3 respectively accounted for 45.5 and 51.1% of cases and only 2, 3% of the DOCTORS were grade 1. Luminal B (53.4%) was under the most common molecular group, followed by Luminal A (23.9%), HER2 + (15.9%), and triple-negative (6.8%). The correlation of molecular type of tumors with different prognostic factors showed only one significant connection with the SBR grade
Multiple Myeloma Revealed by a Sphenoid Plasmocytoma: Case Report and Literature Review
No full textPlasma cell neoplasms can manifest as solitary or multiple plasmacytomas and may be associated with or progressing to multiple myeloma (MM). Cranial and intracranial plasmacytomas revealing multiple myeloma are very rare and only a few cases are reported in the literature.We report the case of a sphenoid plasmacytoma that revealed multiple myeloma in a 56-year-old woman with 3 months history of temporal headache and diplopia. Magnetic resonance imaging (MRI) and computed tomography (CT) showed a sphenoid mass. An endoscopic sphenoidal biopsy was performed and the histopathological exams showed a plasmacytoma with positive staining for CD138. Further biological studies confirmed the diagnosis of multiple myeloma with a monoclonal gamma peak of immunoglobulin (Ig) A. The patient started systemic chemotherapy and received decompressive radiation therapy on the sphenoidal sinus. She remained in remission for 8 months and died from renal dysfunction. Although the sphenoid plasmacytoma is a very rare presentation of multiple myeloma it should be considered for effective patient management and prognosis improvement
Importance of Therapeutic Drug Monitoring in the Treatment of Active Tuberculosis - A Retrospective Study of 4 Cases
Get PDFBackground: In the treatment of active tuberculosis, therapeutic drug monitoring (TDM) is used to optimize dosing that maximizes therapeutic benefit while minimizing toxicity. In Morocco, TDM is not routinely used, yet low levels of anti-TB drugs can be associated with poorer treatment outcomes. Methods: We retrospectively checked our archives for patients with active TB for whom TDM was performed during 2014. Medical records were reviewed to abstract demographic, clinical, radiographic, and microbiological data including time until smear and culture conversion. Then, we looked for cases with delays in TB conversion.Results: In total, 24 patients were identified, for whom TDM was performed, they all had low serum drug levels. Among them, 4 patients showed delayed bacteriological conversion.Conclusions: Our study cases are showing the benefit of serum dosage in the follow-up of the patients showing a delay of sputum examination conversion, both direct and culture, during their evolutions. TDM is potentially useful for the treatment of active TB but is currently underused in Morocco
Three Weekly Irinotecan and Bolus 5-Fluorouracil Combination in the First Line Treatment of Advanced Gastric Cancer - A Single Institution Experience
Get PDFBackground: This study aims to determine the efficacy and toxicity of a non-platinum-based chemotherapy combination using irinotecan associated with bolus 5-FU as first-line treatment in advanced gastric cancer. Materiel and methods: Retrospective analysis of a population of patients treated for metastatic and locally advanced gastric cancer with irinotecan and 5-FU as upfront chemotherapy. Results: Thirteen patients were enrolled. The median age was 56 years. Seven patients were males and six were females. Ten patients had metastatic disease and three patients had locally advanced disease. Patients received a total number of 43 cycles of chemotherapy. The overall response rate was 38,4%, the median time to progression (TTP) was 3 months, and the median overall survival was 4 months. Three patients (23,1%) presented grade 3 /4 neutropenia complicated with an infectious episode with fever in two cases, three patients (23,1%) required blood transfusion for a grade 4 anemia, and one patient (7,6%) was hospitalized for a severe episode of diarrhea. Conclusion: Three weekly irinotecan and bolus 5-FU is an interesting combination as first-line treatment of advanced gastric cancer; designed clinical trials are needed to confirm the activity of this combination
Performance of Quantitative Ultrasound and Six Osteoporosis Risk Indexes in Menopausal Women: Validation and Comparative Evaluation Study
Get PDFBackground: A number of questionnaire-based systems and the use of portable quantitative ultrasound scanners (QUS) have been devised in an attempt to produce a cost-effective method of screening for osteoporosis.Objective: to assess the sensitivity and specificity of different techniques and their ability to act as screening tools in relation to dual-energy X-ray absorptiometry (DXA).Methods: 295 white postmenopausal women aged over 60 were enrolled. Each subject completed a standardized questionnaire that permits the measurement of six osteoporosis indexes and had bone mineral density (BMD) measured using QUS and DXA. Sensitivity and specificity of the different techniques in relation to DXA were plotted as receiver-operating characteristic (ROC) curves at DXA T-score total hip ≤ -2.5 (osteoporosis).Results: BUA sensitivity and specificity values were respectively 76.8% and 51.2% at the total hip. The optimal cut-off T-score for QUS was -2 at the total hip. The osteoporosis self-assessment tool (OST) provided consistently the highest AUC (0.80) among the clinical tools and had the best sensitivity and specificity balance (90.2%-44.5%). OST negative likelihood ratio was 0.22.Conclusion: OST (based only on weight and age) performed slightly better than QUS and other risk questionnaires in predicting low BMD at the total hip