Prognostic Impact of Alpha Fetoprotein at Diagnosis on Overall Survival of Single Small Hepatocellular Carcinomas.

BACKGROUND: Alpha-fetoprotein (AFP) is a serum tumor marker used in the past for surveillance and screening of hepatocellular carcinoma (HCC) in patients with cirrhosis. Its prognostic value is still debated in the literature. The aim of this study was to evaluate the prognostic impact of the AFP rate at diagnosis on the overall survival of patients with a small HCC (<3cm) in patients with cirrhosis. PATIENTS AND METHODS: Among the 122 patients diagnosed with HCC during the study period, 49 patients had a small HCC at diagnosis, including 40,8% (N 20) patients with a negative AFP (group I) and 59,18% (N 29) with an AFP >10 ng / ml (group II). Both groups of patients were comparable for age and WHO status (World Health Organization). Patient survival was assessed by the Kaplan-Meier method. The survival at 5 years was 35.7% in group 1 vs 12.3% in group 2. The AFP level was identified as an independent prognostic factor of survival. CONCLUSION: Alpha-fetoprotein serum positivity seems to have prognostic value in patients with single small HCC.

Gastric Adenocarcinoma in a Moroccan Population: First Report on Survival Data.

BACKGROUND: Although its incidence has decreased over the last 20 years, gastric adenocarcinoma remains frequent (1,033,701 new cases worldwide per year, Globocan 2018). Its prognosis is still poor, with overall survival rates of 10 to 25% despite improvement in surgical and perioperative treatment. In Morocco, we do not have data on survival and predictors of mortality in our population, the present study aims to describe the epidemiological and clinicopathological features of gastric adenocarcinoma and the survival rate. MATERIALS AND METHODS: We retrospectively reviewed data files of 265 patients with histological diagnosis of gastric adenocarcinoma between January 2007 and June 2017. Survival was estimated by the Kaplan Meier method and prognostic factors in multivariate analysis (Cox model). RESULTS: The mean age of our population was 54.48 ±15.53 with a sex ratio M/F of 1.76. Clinical symptomatology dominated by epigastralgia episodes in two-thirds of the cases and deterioration of the general state in most cases (61.7%). Proximal localization accounted for 17.4%. According to histological classification, poorly differentiated adenocarcinoma was the most common histological type (51.7%). Metastatic or locally advanced tumors accounted for 92% of cases. Only 11% of patients received curative resection. The 5-year survival was 6%. Multivariate analysis revealed three prognostic factors: vascular invasion, advanced stage and differentiation. DISCUSSION: The high mortality of gastric adenocarcinoma in our Moroccan series is probably explained by the late stage at diagnosis. Symptoms are nonspecific and endoscopy is usually performed for advanced symptoms such as anemia, bleeding or weight loss. The main identified prognostic factors in gastric adenocarcinoma are tumor subtype (Linitic forms), stage at diagnosis, vascular and lymph nodes invasion and general performance status which correlates to available data in the literature. Besides, the age distribution of GC in our series showed that the proportion of affected young adult is high (30.6%) compared to data from developed countries varying between 6 and 15%. This age distribution can be explained by the Westernization of diet, the increase of obesity in our population and more exposure to alcohol and tobacco. CONCLUSION: Overall cancer survival in our population does not exceed 7%, a rate that remains low compared to studies published in the occidental literature. Recommendations have to be elaborated to make a strategy for screening and early diagnosis of gastric adenocarcinoma to improve the survival rate.

Epidemiology of viral hepatitis in the Maghreb.

INTRODUCTION: Viral hepatitis represents a serious public health problem in the world especially in the Maghreb where the prevalence of the 5 viruses A, B, C, D, and E remains high and varies from one Maghreb country to another, there is few published studies on these infections in our Maghreb countries. METHOD OF STUDY: Our work is a review of the literature about prevalence, the most common mode of transmission, and the most exposed population for these viruses in the Maghreb countries through published studies between 2011 and 2017. RESULT: It has been found that the Maghreb countries are endemic for the five viruses with variable prevalence from one country to another, with sometimes heterogeneous data in the same country. For hepatitis B, Mauritania is the Maghreb country most affected by this infection unlike the rest of the Maghreb countries which are moderately endemic for this virus, the lowest prevalence of VHB was noted in Morocco, the genotype the most common is the D for the majority of Maghreb countries, and the precore mutant profile is also the most common. For hepatitis C the prevalence of infection does not vary much from one Maghreb country to another, but it remains slightly higher in Mauritania. The population most exposed to the virus C in the five countries is hemodialysis patients. The most common genotype in all Maghreb countries is genotype 1 except for Libya, where genotype 4 remains the most common probably related to its borders with Egypt. For hepatitis D, Mauritania is the only Maghreb country with a high endemicity for the virus. Tunisia has the lowest prevalence for hepatitis A and E compared to the rest of the Maghreb countries, all of which are endemic for these two viruses with fecal-oral transmission. CONCLUSION: The management of these viral hepatitis is costly for the health economy and to reduce their prevalence, prevention measures must be followed like vaccination and improving hygiene conditions.

HLA-B27 rats develop osteopaenia through increased bone resorption without any change in bone formation.

Osteopaenia is a common complication of inflammatory bowel diseases (IBD). However, the mechanisms of bone loss are still the subject of debate. The aims of this study were to investigate bone loss in HLA-B27 transgenic rats, a spontaneous model of colitis and to compare the results provided by the usual markers of bone remodelling and by direct measurement of bone protein synthesis. Systemic inflammation was evaluated in HLA-B27 rats and control rats from 18 to 27 months of age. Then bone mineral density, femoral failure load, biochemical markers of bone remodelling and protein synthesis in tibial epiphysis were measured. Bone mineral density was lower in HLA-B27 rats than in controls. Plasma osteocalcin, a marker of bone formation, and fractional protein synthesis rate in tibial epiphysis did not differ between the two groups of rats. In contrast, urinary excretion of deoxypyridinoline, a marker of bone resorption, was significantly increased in HLA-B27 rats. The present results indicate that bone fragility occurs in HLA-B27 rats and mainly results from an increase in bone resorption. Systemic inflammation may be the major cause of the disruption in bone remodelling homeostasis observed in this experimental model of human IBD.