Profil hématologique des patients VIH/SIDA à l'hôpital régional de Nzérékoré / Hematological profi le of HIV/AIDS patients at the Nzérékoré Regional Hospital

Introduction. Le VIH/SIDA est à l'origine d'un grand nombre de manifestations biologiques à titre de troubles hématologiques graves pouvant atteindre toutes les lignées sanguines. L'objectif de cette étude était de mettre en évidence les anomalies de l'hémogramme chez les PVVIH à Nzérékoré afi n de contribuer à une meilleure prise en charge. Méthodes. Il s'agissait d'une étude prospective de type descriptif à visée analytique d'une durée de 6 mois allant du 25 février au 25 août 2021 sur les PVVIH dans le service de médecine générale de l'Hôpital régional de Nzérékoré. Résultats. Durant notre étude, la prévalence hospitalière du VIH au service de médecine générale de l'hôpital régional de Nzérékoré était de 20,34%. L'âge moyen était de 36,98 ans, le sexe féminin prédominait avec un sex-ratio de 0,74 ; majoritairement mariés (53,33%) et ménagères (41,66%). Les anomalies hématologiques les plus représentées étaient l'anémie (95%) et la lymphopénie (77,5) dont la majorité était au stade III et IV. Conclusion. Le VIH/SIDA reste un problème de santé publique. Son évolution est liée à des anomalies aussi cliniques que biologique imposant un suivi régulier et adéquat

Introduction. HIV/AIDS is the cause of a large number of biological manifestations as serious hematological disorders that can affect all blood lines. The objective of this study was to highlight blood count abnormalities in PLWHA in Nzérékoré in order to contribute to better management. Methods. This was a prospective descriptive study with an analytical aim, lasting 6 months from February 25 to August 25, 2021, on PLHIV in the general medicine department of the Nzérékoré regional hospital.. Results. During our study, the hospital prevalence of HIV in the general medicine department of the regional hospital of Nzérékoré was 20.34%. The average age was 36.98 years, the female sex predominated with a sex ratio of 0.74; the majority were married (53.33%) and housewives (41.66%). The most common hematological abnormalities were anemia (95%) and lymphopenia (77.5), the majority of which were stage III and IV. Conclusion. HIV/AIDS remains a public health problem. Its evolution is linked to both clinical and biological abnormalities requiring regular and adequate follow-up.

Alcohol use and its associated factors among Ethiopian military personnel.

BACKGROUND: Studies indicate that alcohol use is more prevalent in the military and that such use is related to coping mechanisms for stress. Alcohol use could result in health and social problems. However, little is known about alcohol use in Ethiopian military personnel. OBJECTIVE: To assess the level of alcohol use and its associated factors in the Ethiopian military. METHODS: A cross-sectional study including participants from the Ground and Air Forces of the Ethiopian National Defence Forces was conducted from February to June 2021. A representative sample of 502 military personnel from the two forces participated in the study. A structured questionnaire was developed to assess the individual level of alcohol use and its associated factors. The Alcohol Use Disorder Identification Test (AUDIT) was used to identify likely problematic alcohol use (AUDIT score ≥8). Hierarchical multivariable logistic regression models were run to identify associated factors with alcohol consumption. RESULTS: Approximately half of the respondents (49.8%, 95% CI 45.4% to 54.0%) were alcohol drinkers. Of the current alcohol users, 142 (63.1 %) were infrequent users; 60 (26.7 %) were moderate drinkers; and 23 (10.2 %) were heavy drinkers. Based on the AUDIT composite score, 71 (33.0%) of male participants were classified as having a score indicative of hazardous and harmful drinking and possible alcohol dependence behaviours. After adjusting for covariates, alcohol drinking was statistically significantly associated with higher odds of being: male, younger age, part of the Ground Force, smoker and high risk-taker. CONCLUSIONS: This study provides an initial step to addressing patterns of harmful and hazardous alcohol use in the Ethiopian National Defence Forces. Findings indicate the need to integrate alcohol abuse prevention into existing health education and behaviour change efforts of the Ethiopian National Defence Forces.

A neglected source of household air pollution: a preliminary, mixed methods study of purposely produced household smoke in Wollo, Ethiopia.

BACKGROUND: Ill health associated with household air pollution (HAP) is increasingly recognized as a public health problem in sub-Saharan Africa. To date, attempts to reduce HAP have focussed on smoke from cooking fires and have ignored traditional cultural practices which generate purposely produced smoke (PPS). This study aimed to investigate PPS prevalence, reasons for use and safety perceptions. METHODS: The study was conducted in Wollo, Ethiopia, and used a mixed methods approach of quantitative surveys (analysed descriptively) and qualitative interviews with householders and healthcare workers (analysed thematically). RESULTS: PPS use was reported by 99% of survey respondents and it was considered a fundamental part of life. Although reasons for use included housekeeping, culture/religion and well-being, coffee ceremony was most commonly cited (44% of respondents). Both householders and healthcare workers appeared to assume PPS is safe, except for people with certain underlying conditions. Healthcare workers felt the lack of evidence of harm from PPS meant there was no justification for intervention. CONCLUSION: This study, the first in-depth study of PPS, has shown its use to be widespread, with many perceived benefits and thus a very important part of local culture in this sample Ethiopian community. Consequently, any public health interventions aimed at reducing HAP in this setting need to consider PPS.

Sol-Gel Synthesis and Characterization of Coatings of Mg-Al Layered Double Hydroxides.

In this study, new synthetic approaches for the preparation of thin films of Mg-Al layered double hydroxides (LDHs) have been developed. The LDHs were fabricated by reconstruction of mixed-metal oxides (MMOs) in deionized water. The MMOs were obtained by calcination of the precursor gels. Thin films of sol-gel-derived Mg-Al LDHs were deposited on silicon and stainless-steel substrates using the dip-coating technique by a single dipping process, and the deposited film was dried before the new layer was added. Each layer in the preparation of the Mg-Al LDH multilayers was separately annealed at 70 °C or 300 °C in air. Fabricated Mg-Al LDH coatings were characterized by X-ray diffraction (XRD) analysis, scanning electron microscopy (SEM), and atomic force microscopy (AFM). It was discovered that the diffraction lines of Mg3Al LDH thin films are sharper and more intensive in the sample obtained on the silicon substrate, confirming a higher crystallinity of synthesized Mg3Al LDH. However, in both cases the single-phase crystalline Mg-Al LDHs have formed. To enhance the sol-gel processing, the viscosity of the precursor gel was increased by adding polyvinyl alcohol (PVA) solution. The LDH coatings could be used to protect different substrates from corrosion, as catalyst supports, and as drug-delivery systems in medicine.

Hepatitis E virus in patients with acute hepatitis in Cape Town, South Africa, 2011.

BACKGROUND: Early hepatitis E virus (HEV) seroprevalence studies in South Africa (SA) showed seroprevalence rates of 2 - 10%, and suggested waterborne transmission. More recent studies in Cape Town, SA, reported HEV seroprevalence rates of 28% and 26% in outpatients without liver disease and blood donors, respectively. An association was found with eating pork or bacon/ham. Only 3 human cases of hepatitis E in SA have been reported in the literature. OBJECTIVES: To find evidence of HEV infection in hospitalised patients with acute hepatitis and no other identified cause. METHODS: Leftover serum samples were retrieved for patients negative for hepatitis viruses A, B and C, where no other cause of hepatitis was identified. Samples were tested for HEV by polymerase chain reaction (PCR) and IgM and IgG enzyme-linked immunosorbent assay (ELISA). RESULTS: Anti-HEV IgG was detected in 39/132 specimens (29.5%; 95% confidence interval (CI) 22.4 - 37.8), and anti-HEV IgM in 2/125 specimens (1.6%; 95% CI 0.4 - 5.7). No specimen tested positive by PCR. CONCLUSIONS: IgG seroprevalence found in this study was similar to that previously reported in Cape Town. IgM positivity in 2 patients was not confirmed by PCR. Locally, hepatitis E may not be a common cause of clinically apparent hepatitis that requires hospitalisation.

Hepatitis E in pig-derived food products in Cape Town, South Africa, 2014.

BACKGROUND: Hepatitis E virus (HEV) genotypes 3 and 4 are zoonoses, with domestic pigs being the most important reservoir. A high anti- HEV IgG seroprevalence of 26 - 28% has been found in humans in Cape Town, South Africa (SA). Studies in industrialised countries have indicated a high prevalence of HEV in pigs and their associated food products. OBJECTIVES: To determine whether HEV could be found in pig-derived food products in Cape Town. METHODS: Pork-containing food products were purchased from supermarkets and butcheries around the Cape Town metropolitan area. HEV detection by polymerase chain reaction (PCR) was performed, and an amplified viral genome fragment was sequenced from positive samples. Phylogenetic analysis was done on the sequenced fragment. RESULTS: HEV was detected by PCR in 2/144 food samples - both were liver spread samples. One genome fragment sequence was obtained, which was closely related to HEV sequences obtained from humans in Cape Town. CONCLUSIONS: HEV can be found in pork-containing meat products available for sale in Cape Town, suggesting that these products could be a potential source of HEV transmission in our geographical area. Meat of pig origin should be thoroughly cooked before being consumed.

HIV-exposed uninfected compared with unexposed infants show the presence of leucocytes, lower lactoferrin levels and antimicrobial-resistant micro-organisms in the stool.

Background: HIV-exposed uninfected (HEU)-infants have been shown to be particularly vulnerable to infections. In this population, disturbance of the gut micro-environment might increase their susceptibility to enteric diseases and even favour the translocation of bacteria in the bloodstream. Methods: The gastro-intestinal micro-environment was explored in 22 HEU infants and 16 HIV-unexposed (HU) infants aged 6-24 weeks. Faecal leucocytes, firmicutes (gram-positive bacteria) and gracilicutes (gram-negative bacteria) were assessed by cytology. Faecal lactoferrin and sIgA were measured by ELISA. The spectrum of micro-organisms in infants' stool was analysed by culturing. Results: HEU infants were 14 times more likely to have leucocytes in their stool than HU infants (p < 0.005). The lactoferrin level was significantly lower in HEU infants than in HU infants (p = 0.02). Potentially pathogenic bacteria such as Escherichia coli were more prevalent in HEU than in HU infants (64% vs 23.5%). Also, E. coli strains resistant to key antibiotics including co-trimoxazole, ß-lactam (cephalosporins included) and tetraclines were observed in some HEU infants. Conclusion: HEU infants are more likely to present an inflamed digestive tract as highlighted by the presence of leucocytes. In addition, there is a real risk of colonisation of HEU infants' microbiota by resistant micro-organisms.

Hepatitis E virus in patients with acute hepatitis in Cape Town, South Africa, 2011

Background. Early hepatitis E virus (HEV) seroprevalence studies in South Africa (SA) showed seroprevalence rates of 2 - 10%, and suggested waterborne transmission. More recent studies in Cape Town, SA, reported HEV seroprevalence rates of 28% and 26% in outpatients without liver disease and blood donors, respectively. An association was found with eating pork or bacon/ham. Only 3 human cases of hepatitis E in SA have been reported in the literature. Objectives. To find evidence of HEV infection in hospitalised patients with acute hepatitis and no other identified cause. Methods. Leftover serum samples were retrieved for patients negative for hepatitis viruses A, B and C, where no other cause of hepatitis was identified. Samples were tested for HEV by polymerase chain reaction (PCR) and IgM and IgG enzyme-linked immunosorbent assay (ELISA). Results. Anti-HEV IgG was detected in 39/132 specimens (29.5%; 95% confidence interval (CI) 22.4 - 37.8), and anti-HEV IgM in 2/125 specimens (1.6%; 95% CI 0.4 - 5.7). No specimen tested positive by PCR. Conclusions. IgG seroprevalence found in this study was similar to that previously reported in Cape Town. IgM positivity in 2 patients was not confirmed by PCR. Locally, hepatitis E may not be a common cause of clinically apparent hepatitis that requires hospitalisation

N terminal-pro brain natriuretic peptide in fetal umbilical cord meconium-stained amniotic fluid: a prospective case control study.

PURPOSE OF INVESTIGATION: To evaluate the value of N terminal-pro brain natriuretic peptide (NTpBNP) levels in fetuses with meconiumtained amniotic fluid (MSAF). MATERIALS AND METHODS: In this case control study, of 36 fetuses, 19 had MSAF and 17 had normal, as controls. The blood samples were taken from the fetal umbilical cord just after birth to measure NTpBNP levels. RESULTS: Mean NTpBNP values were 1.01 ± 0.49 ng/ml in the patient group and 1.70 ± 0.93 ng/ml in the control group. The difference between the groups was statistically significant (p = 0.01) and power was 78% at 95% confidence interval. CONCLUSION: Serum NTpBNP levels were decreased in the study group. The result suggests that NTpBNP may be a valuable marker for fetuses with MSAF.

Blepharophimosis, Ptosis, and Epicanthus Inversus Syndrome: Expanding the Phenotype.

We present a 3-month-old girl who displayed typical clinical characteristics of blepharophimosis, ptosis, and epicanthus inversus syndrome (BPES). She was referred to our clinic with an initial diagnosis of Down syndrome. Clinical features of elevated follicle stimulating hormone and low estradiol levels in the case were diagnosed as BPES syndrome and were consistent with BPES type 2. To date, there are no cases of BPES with cleft palate and cardiomyopathy, suggesting that these novel findings can be part of this condition.

[Histologic kidney lesions during pure nephrotic syndrome in adults in Conakry]. / Lesions histologiques renales au cours du syndrome nephrotique pur de l'adulte a Conakry.

INTRODUCTION: Nephrotic syndrome represents a significant part of chronic kidney disease in Black Africa. Our work aimed to determine the frequency and type of kidney lesions in an adult carrying pure nephrotic syndrome. PATIENTS AND METHODS: We conducted a prospective and descriptive study (2003-2004), 40 patients were recruited on the basis of the presence of a pure nephrotic syndrome. Proteinuria was plentiful, selective to albumin greater than 3 g/24h, not accompanied by hematuria, or high blood pressure, or kidney failure. Cases of bacterial, parasitic and viral infections (hepatitis B, C, HIV) were excluded. By following contra-indications of renal biopsy, samples were taken under local anesthesia by means of percutaneous lumbar and fixed in two tubes, one containing "Michel's medium" and the other 12% Formalin. These techniques and readings were carried out in the pathological anatomy Laboratories of Nantes (France) and Conakry (Guinea). RESULTS: There were 24 men and 16 women with an average age of 26.2 ± 8 years [range: 20-51]. Clinical symptoms were dominated by weight gain characterized by edema. Proteinuria was between 3-3.5 g/24h in 16 (40%); between 3.6-5 g in 2 cases (5%) and greater than 5 g/24h in 22 cases (55%). The number of glomeruli was on average 11 ± 9 [range: 3-36]; glomerular permeability was on average 10.4 ± 10. Renal impairment was glomerular in 22 cases, tubulointerstitial in 12 cases and vascular in 6 cases. Immunofixation was positive in 30/40 cases for IgA IgG IgM; in 26 cases for C1q C3; in 4 cases for C1q C3 C4; and finally for fibrin in 28 cases. Histological renal lesions were FSGS (40%), MDC (35%), MGN (5%), MPGN (5%) and undetermined (15%). CONCLUSION: A regular practice of renal anatomopathological examination "on the spot" will lead us to carefully assess the causes of kidney failure associated with nephrotic syndrome.

INTRODUCTION: Le syndrome néphrotique représente une part importante d'insuffisance rénale chronique en Afrique noire. Notre travail avait pour but de déterminer la fréquence et le type de lésions histologiques rénales chez un adulte porteur d'un syndrome néphrotique pur. PATIENTS ET MÉTHODES: Au cours d'une étude prospective et descriptive (2003­2004), 40 patients ont été sélectionnés sur la base de la présence d'un syndrome néphrotique pur. La protéinurie était abondante, sélective à l'albumine, supérieure à 3 g/24h, non accompagnée d'hématurie, ni d'hypertension artérielle, ni d'insuffisance rénale. Les cas d'infections bactériennes, parasitaires et virales (hépatites B, C, HIV) ont été volontiers exclus. En respectant les contre indications de la biopsie rénale, les prélèvements ont été effectués sous anesthésie locale, par voie lombaire percutanée, puis fixés dans deux tubes dont un contenait du « liquide de Michel ¼ et l'autre du Formol à 12%. Les techniques et lectures ont été effectuées aux Laboratoires d'anatomie pathologique de Conakry (Guinée) et de Nantes (France). RESULTATS: Il s'agissait de 24 hommes et de 16 femmes âgés en moyenne de 26,2 ± 8 ans [20­51]. La symptomatologie clinique était dominée par une prise de poids marquée par les œdèmes. La protéinurie était comprise entre 3­3,5 g/24h dans 16 cas (40%); entre 3,6­5 g dans 2 cas (5%) et supérieure à 5 g/24h dans 22 cas (55%). Le nombre de glomérules était en moyenne de 11 ± 9 [3­36]; la perméabilité des glomérules était en moyenne de 10,4 ± 10. L'atteinte rénale était glomérulaire dans 22 cas, tubulo-interstitielle dans 12 cas et vasculaire dans 6 cas. L' immunofixation a été positive dans 30 cas /40 pour les IgA IgG IgM; dans 26 cas pour C1q C3; dans 4 cas pour C1q C3 C4; et en fin pour la fibrine dans 28 cas. Les lésions histologiques rénales étaient une HSF (40%), une LGM (35%), une GEM (5%), une GNMP (5%) et indéterminée (15%). CONCLUSION: Une pratique régulière de l'examen anatomo-pathologique rénal «sur place" nous amènerait à apprécier judicieusement les causes d'insuffisance rénale en rapport avec un syndrome néphrotique.

Laparoscopic transperitoneal nephrectomy in non-functioning inflammatory kidneys with or without renal stone.

OBJECTIVE: To compare our laparoscopic simple nephrectomy results in non-functioning inflammatory kidneys with or without renal stones. PATIENTS AND METHODS: Patients, who underwent laparoscopic transperitoneal nephrectomy for non-functioning kidney between June, 2010 and October, 2014 were included to study. Overall, data of 32 patients including 15 patients with renal stone (Group 1) and 17 patients without renal stone (Group 2) were retrospectively reviewed. RESULTS: Mean age was 44.4 ± 18.5 years (10-71) in group 1 and 35.2 ± 21 years (9-77) in group 2. Mean operation time was 95.0±25.9 minutes (70-175) in group 1 and 86.7 ± 15.1 minutes (70-125) in group 2. Mean estimated blood loss was found to be 64.13 ± 26.67 ml (30-120) in group 1 and 58.94 ± 24.24 ml (30-100) in group 2. Both groups had inflammatory findings in pathological analysis. There was no significant difference between groups regarding estimated blood loss, operation time, pre-operative and post-operative hemoglobin values, percent hemoglobin decrease, complications and hospitalization times (p > 0.05). CONCLUSIONS: Non-functioning kidney with or without renal stone could be operated safely with comparable complication rates and success via laparoscopy in experienced hands.

Ankaferd blood stopper in episiotomy repair.

BACKGROUND AND OBJECTIVE: Ankaferd blood stopper (ABS) is a new hemostatic agent that is licensed for external hemorrhages. ABS comprises of a standard mixture of Thymus vulgaris, Glycyrrhiza glabra, Vitis vinifera, Alpinia officinarum, and Urtica dioica which has also been approved in Turkey for the management of bleeding. The authors, aim was to evaluate the efficacy of ABS spray in terms of blood loss during episiotomy repair. MATERIALS AND METHODS: The authors included pregnant women with a term singleton fetus (37-40 wks) in a vertex position, who were at least 18-years-old, had delivered vaginally, and required a mediolateral episiotomy. The patients were randomly assigned to one of the two approaches: 20 (Group 1) to ABS and 20 (Group 2) to isotonic saline solution (0.9% NaCl). The authors applied 4 ml ABS spray solution (1 ml/puff X 4) or isotonic saline solution (0.9% NaCl) (4 ml) topically on a sponge applied on the episiotomy. The sponge was weighed before and after the episiotomy repair to determine the amount of bleeding. Hemoglobin values were also recorded on admission and 12 hours after delivery. RESULTS: Both groups were similar in terms of maternal age, parity, body mass index and gestational age. The sponges weighed heavier in Group 2. Baseline hemoglobin values measured on admission showed no significant differences between the groups. Hemoglobin on the first postpartum day was significantly higher in the ABS group (p < 0.05). The operative time for episiotomy repair for the two groups was also statistically insignificant. No major immediate or delayed complications were observed in either group. CONCLUSION: In this study group, the application of 4 ml of ABS instead of isotonic saline solution lessened bleeding.

Modified Raz operation backed with periurethral roll mesh in female stress urinary incontinence.

OBJECTIVES: With the modifications that we made, the aim is to increase the effectiveness and the success rate of the Raz operation in the treatment of stress urinary incontinence (SUI) and to present a new approach in the treatment by reducing the complication rates. PATIENTS AND METHODS: Between November 2002 and December 2010, the Raz operation that we modified with the changes such as the placement of cystostomy catheter with the Lowsley clamp, vaginal incision of the bilateral oblique, the placement of periurethral roll mesh, the use of a single 0-degree stamey needle instead of a double needle applicator, binding the sutures mutually and on the support of the polypropylene mesh in suprapubic region was performed to 81 female patients with SUI in lithotomy position under the regional anesthesia. RESULTS: We performed the modified Raz operation to 81 female patients with SUI, who had the complaint of urinary incontinence with the effort lasting for about 4.5 years (between 1-16 years) and whose ages were 28-83 years (mean 55.2 years), childbirth numbers were 0-11 (mean 4.8), weights were 60-85 kg (mean 69.3 kg), and 32 of whom (39.5%) were of grade 1, 49 of whom (60.5%) were of grade 2 with the amnesia of SUI, and whose stress test was (+) in the physical examination. While the duration of the operation was 39.8 minutes (20-85 minutes) and the duration of the hospitalization was 2.9 days (2-4 days), the duration of the stay of the patients with the cystostomy catheter was determined to be 4.8 days (3-11 days). We found the rate of our success as 93.8% according to the objective criteria. CONCLUSIONS: With the modifications that we made, we increased the success rate of the Raz operation and reduced the rates of the complication. We believe that the place of our modification method in incontinence surgery becomes more clearly with the comparison of the other anti-incontinence surgery techniques in patient groups with the same characteristics.

Hepatitis E virus genotype 3f in pigs in New Caledonia.

BACKGROUND: Hepatitis E virus (HEV) is highly prevalent in farm pigs worldwide and an increasing body of data from industrialised countries suggests that it is an agent of a porcine zoonosis. METHODS: We used in-house real-time reverse transcription polymerase chain reaction to study HEV infection in 4-26-week-old pigs on a pig farm in New Caledonia, Oceania, for which no data are available. RESULTS: HEV RNA was detected in faeces from 6 of 92 (6.5%) pigs tested and all were 9-16 weeks old. Phylogenetic analysis showed that the HEV open reading frame 1 and 2 sequences recovered in this study formed a single cluster among HEV genotype 3 subtype f. CONCLUSIONS: Our work shows for the first time that pigs are a reservoir for HEV in New Caledonia. Further studies are needed to assess the prevalence and phylogenetic relationships of HEV in pigs and humans in this French overseas collectivity.

[Cerebral thrombophlebitis: parotidectomy complication in a child]. / Thrombophlébite cérébrale: complication d'une parotidectomie chez un enfant.

INTRODUCTION: Onset of cerebral thrombophlebitis following parotidectomy in a child is reported. OBSERVATION: A seven-year-old boy presenting apparently benign tumefaction in the right parotid gland area had undergone a conservative right total parotidectomy. The histological examination of the operative specimen suggested a diffuse neurofibroma as part of a clinical picture of Recklinghausen's neurofibromatosis. The immediate postoperative follow-up was marked by a pyramidal syndrome in the left hemibody, with the CT scan showing thrombophlebitis. After treatment combining an anticoagulant, a vasodilator and an antibiotic, the patient progressed toward partial recovery of left hemibody motor activity. COMMENTS: This cerebral vascular accident is related to the angiodysplasia encountered in Recklinghausen's disease. Anticoagulants initialized rapidly are the only demonstrated therapy to improve the prognosis in this type of complication.

[Maxillofacial metastasis of a cholangiocarcinoma]. / Métastase maxillofaciale d'un cholangiocarcinome.

OBSERVATION: A 64-year-old woman with a history of cholangiocarcinoma, presented with painful cheek-swelling and ulcerated lesion of the lower jaw. There were lytic bone lesions of the mandible. Histological examination revealed cholangiocarcinoma metastasis. Surgery was impossible because of the primitive tumor's extension. The patient then received palliative treatment with radiotherapy - and chemotherapy. She died 13 months after the initial diagnosis. DISCUSSION: Maxillofacial metastasis generally occur in the mandible. Although adenocarcinomas are often observed, cholangiocarcinoma has never been reported as maxillofacial metastasis. The prognosis of cholangiocarcinoma is bad because of a usually late diagnosis.