Characteristics, management, and outcomes of patients with hepatocellular carcinoma in Africa: a multicountry observational study from the Africa Liver Cancer Consortium.

BACKGROUND: Hepatocellular carcinoma is a leading cause of cancer-related death in Africa, but there is still no comprehensive description of the current status of its epidemiology in Africa. We therefore initiated an African hepatocellular carcinoma consortium aiming to describe the clinical presentation, management, and outcomes of patients with hepatocellular carcinoma in Africa. METHODS: We did a multicentre, multicountry, retrospective observational cohort study, inviting investigators from the African Network for Gastrointestinal and Liver Diseases to participate in the consortium to develop hepatocellular carcinoma research databases and biospecimen repositories. Participating institutions were from Cameroon, Egypt, Ethiopia, Ghana, Ivory Coast, Nigeria, Sudan, Tanzania, and Uganda. Clinical information-demographic characteristics, cause of disease, liver-related blood tests, tumour characteristics, treatments, last follow-up date, and survival status-for patients diagnosed with hepatocellular carcinoma between Aug 1, 2006, and April 1, 2016, were extracted from medical records by participating investigators. Because patients from Egypt showed differences in characteristics compared with patients from the other countries, we divided patients into two groups for analysis; Egypt versus other African countries. We undertook a multifactorial analysis using the Cox proportional hazards model to identify factors affecting survival (assessed from the time of diagnosis to last known follow-up or death). FINDINGS: We obtained information for 2566 patients at 21 tertiary referral centres (two in Egypt, nine in Nigeria, four in Ghana, and one each in the Ivory Coast, Cameroon, Sudan, Ethiopia, Tanzania, and Uganda). 1251 patients were from Egypt and 1315 were from the other African countries (491 from Ghana, 363 from Nigeria, 277 from Ivory Coast, 59 from Cameroon, 51 from Sudan, 33 from Ethiopia, 21 from Tanzania, and 20 from Uganda). The median age at which hepatocellular carcinoma was diagnosed significantly later in Egypt than the other African countries (58 years [IQR 53-63] vs 46 years [36-58]; p<0·0001). Hepatitis C virus was the leading cause of hepatocellular carcinoma in Egypt (1054 [84%] of 1251 patients), and hepatitis B virus was the leading cause in the other African countries (597 [55%] of 1082 patients). Substantially fewer patients received treatment specifically for hepatocellular carcinoma in the other African countries than in Egypt (43 [3%] of 1315 vs 956 [76%] of 1251; p<0·0001). Among patients with survival information (605 [48%] of 1251 in Egypt and 583 [44%] of 1315 in other African countries), median survival was shorter in the other African countries than in Egypt (2·5 months [95% CI 2·0-3·1] vs 10·9 months [9·6-12·0]; p<0·0001). Factors independently associated with poor survival were: being from an African countries other than Egypt (hazard ratio [HR] 1·59 [95% CI 1·13-2·20]; p=0·01), hepatic encephalopathy (2·81 [1·72-4·42]; p=0·0004), diameter of the largest tumour (1·07 per cm increase [1·04-1·11]; p<0·0001), log α-fetoprotein (1·10 per unit increase [1·02-1·20]; p=0·0188), Eastern Cooperative Oncology Group performance status 3-4 (2·92 [2·13-3·93]; p<0·0001) and no treatment (1·79 [1·44-2·22]; p<0·0001). INTERPRETATION: Characteristics of hepatocellular carcinoma differ between Egypt and other African countries. The proportion of patients receiving specific treatment in other African countries was low and their outcomes were extremely poor. Urgent efforts are needed to develop health policy strategies to decrease the burden of hepatocellular carcinoma in Africa. FUNDING: None.

Practice of Hemodialysis in a Resource-Poor Setting in Nigeria: A 2-Year Experience.

BACKGROUND: Hemodialysis (HD) is the main form of renal replacement therapy available in Nigeria. However, this is still largely unaffordable by individuals with resultant poor outcomes. METHODS: This was a retrospective study of all patients with renal failure who had dialysis in the renal unit of Dalhatu Araf Specialist Hospital over the past 2 years. Information retrieved included sex, age, cause of renal failure, human immunodeficiency virus status, hepatitis B surface antigen status, antibodies to hepatitis C virus status, number of sessions, total duration on dialysis (in weeks), use of erythropoietin (EPO), common problems encountered on the dialysis machine, and the outcome of the patient. RESULTS: A total of 68 patients (50% males) were enrolled in the study. The mean age was 41 ± 15 years (17-75), and mean weight in kilograms was 64.3 ± 10.9 (42-87). Acute kidney injury was seen in 18 (26.5%), while 50 (73.5%) had end-stage renal disease (ESRD). Chronic glomerulonephritis was the leading cause of ESRD (46%) with autosomal dominant polycystic kidney disease being the least (2%). The mean packed cell volume at the start of dialysis was 25.7% ± 5.9%. Tunneled necklines were in 11 (16.8%) and femoral catheters were in 48 (70.6%). The median total number of sessions was 4.0 (1-136), while the median duration on dialysis was 1 week (1-48) with both sexes having the same duration on dialysis (P = 0.44). The average frequency of dialysis among those with ESRD was twice weekly. Only 15 (30.0%) of those with ESRD continued dialysis after 3 months. The median survival time for females was 5 weeks while that for the males was 20 weeks (P = 0.108). EPO use was in 12 (17.7%) being 4000 IU once weekly. Cramps complicated the first sessions of dialysis in 27 (39.7%) patients. CONCLUSION: The survival of patients on HD in our environment is poor due largely to poor affordability despite its availability.

Datos vs. comprension? El dilema de la escogencia de un metodo de investigacion / Data vs. understanding? The choice of a research method

La situación de cambios acelerados que se vive a nivel mundial y en todos los ámbitos de la vida y su relación con los cambios que se producen en el ámbito científico, en la manera de concebir la ciencia, de hacerla y legitimada, da el contexto para la presente investigación, la cual representa un intento de aproximación a la discusión epistemológica y a la evaluación de las creencias y actitudes de investigadores en las áreas de Psicología y Educación acerca del uso de métodos cuantitativos y cualitativos en la investigación. La recolección y analisis de la información se realizó siguiendo el procedimiento propuesto en la Teoría de la Acción Razonada (Ajzen y Fishbein, 1975). La muestra estuvo constituida por 148 personas que se desempeñaban como investigadores y/o docentes en diversas universidades del territorio nacional y profesionales afiliados a asociaciones de carácter cientifico relacionadas con el área de estudio. Los resultados obtenidos reflejan que los métodos cuantitativos se relacionan mas a datos, su manejo y procesamiento, mientras que los métodos cualitativos tienen que ver con la realidad, su conocimiento y comprensión. Igualmente se observa la apertura de la discusión epistemológica y el comienzo de la flexibilización de la comunidad cientifica hacia la aceptación de otras prácticas de investigación.