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Patterns of Relapse Related to High Expression of Ki-67 After Neoadjuvant Chemotherapy in Triple Negative Breast Cancer
Gines Hernandez-Cortes,
Javier Hornedo,
Raquel Murillo,
Ricardo Sainz De La Cuesta,
Lucia Gonzalez-Cortijo
Issue:
Volume 9, Issue 5, September 2021
Pages:
139-144
Received:
3 August 2021
Accepted:
17 August 2021
Published:
4 September 2021
Abstract: Introduction: Triple negative breast cancer (TNBC) has been classically considered a high-risk subtype. Early TNBC is usually managed with neoadjuvant chemotherapy (NAC). Residual disease after NAC is generally considered a surrogate marker for event free survival in these patients. The aim of this study was to explore the relationship between high Ki-67 expression in residual disease after NAC and disease relapse. Material and methods: This is a retrospective study of 121 patients diagnosed with TNBC, treated with neoadjuvant chemotherapy in our institution between 2008 and 2018. Clinical features, systemic and surgical therapy and pathological response were analyzed. Ki-67 expression was performed in the post-NAC surgical specimens when a pathological complete response (pCR) was not achieved. Results were correlated with number and type of relapse, and survival. Results: Eighty-one patients (67%) achieved a pCR with a median Ki-67 expression in the residual tumor of 22.5%. Thirteen patients (10.7%) relapsed and all of them belonged to the non-pCR group. In the non-relapse group, the median Ki-67 in the residual tumor was 10% compared to 40% found in the relapse group. (P=0.025). Median Ki-67 post NAC was 70% in those patients who developed a central nervous disease (CNS) relapse, 40% if was a nodal or bone recurrence and 28% if it was a visceral relapse. CNS recurrence was significantly associated with higher Ki-67 levels post NAC (P=0.010). Conclusions: Our results suggest that high expression levels of Ki-67 post-NAC could define different patterns of relapse in TNBC patients treated with NAC.
Abstract: Introduction: Triple negative breast cancer (TNBC) has been classically considered a high-risk subtype. Early TNBC is usually managed with neoadjuvant chemotherapy (NAC). Residual disease after NAC is generally considered a surrogate marker for event free survival in these patients. The aim of this study was to explore the relationship between high...
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Epidemiological and Clinical Profiles of Maternal Deaths in Cotonou
Aboubakar Moufalilou,
Obossou Achille Awade,
Ogoudjobi Mathieu,
Lokossou Symphorose,
Dangbemey Patrice,
Tshabu-Aguemon Christiane,
Tonato-Bagnan Angeline,
Denakpo Lewis Justin
Issue:
Volume 9, Issue 5, September 2021
Pages:
145-149
Received:
24 August 2021
Accepted:
8 September 2021
Published:
23 September 2021
Abstract: Introduction: Due to its high frequency, maternal mortality remains a major public health problem, especially in developing countries. Therefore, it is important to establish the epidemiological and clinical profiles of women who died in order to adapt the means to fight maternal mortality. The objective was to study maternal deaths in three university associated hospitals in Benin from 2015 to 2020. Materials and methods: This was a descriptive cross-sectional and retrospective study. Were included women who died during pregnancy or within the 42 days after delivery from January 2015 to September 2020 in the maternity units of National and University Associated Hospital-Hubert Koutoukou Maga (CNHU-HKM), University Associated Hospital of Mother and Child (CHU-MEL) and Army training hospital- University-associated hospital (HIA-CHU). Results: In total, 575 cases of maternal deaths were recorded and the majority at the maternity unit of CNHU-HKM (79.30%). The average age was 29.1 (±6.5) years with extremes of 14 and 45 years. The majority of death was observed in women aged 25 to 29 years. The deceased women were most often pauciparous (33.57%), referred (78.96%), admitted in poor general condition (58.43%) and were in the postpartum period (80.17%) at the time of death. The main causes of maternal death were: haemorrhage (32.87%), hypertensive disorders during pregnancy (22.22%), infections (8.35%) and abortion (5.74%). Conclusion: Maternal mortality remains high in our health facilities. It mainly affects populations with modest socio-economic conditions. The reduction of maternal mortality requires an improvement in the socio-economic conditions of the population, in the technical platform and in the referral modalities.
Abstract: Introduction: Due to its high frequency, maternal mortality remains a major public health problem, especially in developing countries. Therefore, it is important to establish the epidemiological and clinical profiles of women who died in order to adapt the means to fight maternal mortality. The objective was to study maternal deaths in three univer...
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Serious Obstetrical Complications Admitted in an Intensive Care Unit in Benin
Aboubakar Moufalilou,
Akodjenou Joseph,
Tognifode Véronique Medesse,
Dangbemey Patrice,
Zounma Mawuwè Caleb,
Tonato-Bagnan Angeline,
Zoumenou Eugene
Issue:
Volume 9, Issue 5, September 2021
Pages:
150-154
Received:
24 August 2021
Accepted:
8 September 2021
Published:
23 September 2021
Abstract: Introduction: Most complications in pregnancy, delivery or post natal period are managed by obstetricians. However, some are admitted to intensive care units (ICU), for ressucitation. The aim of this study was to describe the epidemiological and clinical profils of patients admitted in the intensive care unit for serious obstetrical complications at the University Associated Hospital of Mother and Child (CHU-MEL). Materials and Methods: This was a descriptive cross-sectional study with prospective data collection from October 1 to from October 1 to December 31, 2019. Were included pregnant and women delivered and within 42 days of the postpartum period admitted to the intensive unit care and presenting one of the criteria of severe maternal morbidity as defined by the EPIMOMS study. The analysis of the data was done with the STATA software. Results: The proportion of admissions to the intensive care unit was 15.44%. The patients were young (mean age 27 years), educated (76.19%), primigravida (39.05%), primiparous (38.1%) and without any particular history (85.71%). Most of them were referred from the peripheral health centers. The main reasons were complications of hypertension during pregnancy (53.33%), bleeding complications (42.86%) and infectious complications (7.62%). The most used products were antibiotics (92.38%), analgesics (89.52%), uterotonics (82.66%), anticoagulants (75.24%), magnesium sulfate (51.43%). Conclusion: Serious obstetrical complications are frequent. Their management needs an ICU well equipped especially in reference hospital. It is important that the references respect the norms to avoid that the patients arrive in a critical state.
Abstract: Introduction: Most complications in pregnancy, delivery or post natal period are managed by obstetricians. However, some are admitted to intensive care units (ICU), for ressucitation. The aim of this study was to describe the epidemiological and clinical profils of patients admitted in the intensive care unit for serious obstetrical complications a...
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Trends and Associated Factors of Maternal Mortality in Zambia: Analysis of Routinely Collected Data (2015-April 2019)
Nedah Chikonde Musonda,
Mumbi Chola,
Patrick Kaonga,
Samson Shumba,
Choolwe Jacobs
Issue:
Volume 9, Issue 5, September 2021
Pages:
155-161
Received:
30 July 2021
Accepted:
19 August 2021
Published:
30 September 2021
Abstract: Introduction: Reduction of maternal mortality is a global priority. Based on one of Sustainable Development Goal target, Zambia aims to improve maternal health and one of the top priorities is to reduce maternal mortality ratio (MMR) to less 70 per 100,000 live births by 2030. Tracking progress towards set targets remains critical to guide policy and program implementation. This study aimed at assessing the trends and associated factors of maternal mortality in Zambia from April 2015 to April 2019. Methods: Data on maternal deaths was collected from the maternal surveillance database from April 2015-April 2019 from the 9 provinces of Zambia. Data was aggregated and coded in excel then merged. Incident rate ratios were reported using Zero Truncated Poisson (ZTP) regression. All analysis was done in 2021 using STATA version 14.2. Results: A total of 1,461 maternal deaths were reviewed. The trends of maternal deaths in the four-year period have not been consistently high or low but steadily following an upward trend with no significant downward trend. A multivariable ZTP model showed that women in Luapula (IRR 0.21 95% CI; 0.07-0.58), Western (IRR 0.44 95% CI; 0.24-0.81) and Lusaka (IRR 0.07 95% CI; 0.001-0.51) provinces had a reduced IRR of maternal deaths compared to women in Central province (P<0.05). The findings also showed that the age group 20-29 and 30 – 39 years had an increased IRR of maternal death compared to the age group less than 20 years (p<0.05). Sepsis, (aIRR 0.14 95% CI; 0.3-0.57), Hypertensive disorders (aIRR 0.20 95% CI; 0.07-0.61) and indirect causes (aIRR 0.22 95% CI; 0.08-0.63) in the study had a reduced IRR compared to women who had abortions (P<0.05). However, women who had live births controlling for other variables had an increased IRR (aIRR 4.75 95% CI; 1.56-14.43) compared to those who had abortions (P<0.05). There was no sufficient evidence to suggest HIV was associated with maternal deaths (P=0.24). Conclusion: The findings in this study shows that, in Zambia, maternal deaths over the years have not had a significant decline, thus provides evidence for re-strategizing, planning, policy formulation and implementation for reproductive health programmes to reduce maternal deaths in Zambia.
Abstract: Introduction: Reduction of maternal mortality is a global priority. Based on one of Sustainable Development Goal target, Zambia aims to improve maternal health and one of the top priorities is to reduce maternal mortality ratio (MMR) to less 70 per 100,000 live births by 2030. Tracking progress towards set targets remains critical to guide policy a...
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PPROM at 15 Weeks of Gestation: A Story of Hope
Aziz Rodolphe,
Halimeh Rawad,
Feghali Joe
Issue:
Volume 9, Issue 5, September 2021
Pages:
162-166
Received:
18 August 2021
Accepted:
7 September 2021
Published:
30 September 2021
Abstract: Spontaneous preterm premature rupture of membranes that occurs before 20 weeks of gestation is a rare complication that is usually followed by miscarriage. There are various risk factors, including infection, inflammation, trauma, and it can sometimes be idiopathic. If PPROM happens as early as 15 weeks of gestation, termination of the pregnancy is usually the method of choice. Several risks affect the fetus and the mother if the mother decides to continue her pregnancy. The fetal musculoskeletal, gastrointestinal, respiratory, and nervous systems are mainly affected, and fetal death occurs in most cases. In patients who decide to take the risk and continue their pregnancy, conservative management with antibiotics and monitoring is usually required. The end result is either chorioamnionitis or spontaneous expulsion. This case presents a rare outcome of pregnancy after spontaneous preterm premature rupture of membranes at 15 weeks of gestation and delivery of a healthy living baby at term. The management of this case throughout pregnancy will be presented along with a literature review.
Abstract: Spontaneous preterm premature rupture of membranes that occurs before 20 weeks of gestation is a rare complication that is usually followed by miscarriage. There are various risk factors, including infection, inflammation, trauma, and it can sometimes be idiopathic. If PPROM happens as early as 15 weeks of gestation, termination of the pregnancy is...
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Pregnancy in a Woman with a Congenital Type of Nemaline Myopathy
Binder Tomáš,
Gerych Pavel,
Škola Josef,
Beneš Jan,
Alwail Abdulhamid,
Stádníková Milena,
Hitka Patrik,
Laštůvková Jana
Issue:
Volume 9, Issue 5, September 2021
Pages:
167-171
Received:
25 August 2021
Accepted:
15 September 2021
Published:
12 October 2021
Abstract: Introduction: Congenital nemaline myopathy is a genetically heterogeneous disease caused by gene defects in a number of genes: nebulin (2q21-22) alpha-tropomysin (1q21-23), alpha-actin (1q42) and others. Nemaline myopathy can be inherited as an autosomal recessive or dominant trait. Case report: We present a case of the first pregnancy in a woman with a congenital type of nemaline myopathy, with a severe pulmonary involvement, in the Czech Republic. Course of pregnancy: The woman got spontaneously pregnant less than two months after a respiratory failure, when she had to be tracheostomized, remained dependent on portable ventilator support. The patient strictly refused artificial abortion recommended to her. Until the 22nd gestational week she was stabilized in terms of ventilation and received health care at home. Subsequently, she was repeatedly admitted to the hospital for lung infection to ICU of the Department of Intensive Care. The fetus was developing proportionately, without signs of muscle hypotonia, but after the 23rd g.w. was diagnosed with slightly progressive polyhydramnios. Childbirth: It was decided to schedule termination of the pregnancy by a caesarean section for the 30th g.w., during the interval of the patient´s relatively satisfactory clinical respiratory and mental stabilization. A boy was born (1120g) and was transferred to the NICU. The newborn required artificial pulmonary ventilation, from the 3rd day he was extubated, with intermittent use of nasal CPAP until the 9th day. Results: The baby prospered, tolerated food and showed no signs of muscle hypotonia. A postoperative course of the mother went without any complications. On the 8th postoperative day she was discharged from the hospital, ventilator-dependent and with tracheostomy in place. Conclusion: Pregnancy in women with a congenital type of nemaline myopathy with a severe lung involvement is a challenge for physicians. Based on the course of pregnancy it is necessary to decide when its termination will be safe for both the mother and the fetus. The care of the patient requires a multidisciplinary approach.
Abstract: Introduction: Congenital nemaline myopathy is a genetically heterogeneous disease caused by gene defects in a number of genes: nebulin (2q21-22) alpha-tropomysin (1q21-23), alpha-actin (1q42) and others. Nemaline myopathy can be inherited as an autosomal recessive or dominant trait. Case report: We present a case of the first pregnancy in a woman w...
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Immediate Essential Care for New-borns in the Six Hospitals of Conakry: Knowledge and Practices of Providers
Soumah Aboubacar Fode Momo,
Keita Massa,
Conte Ibrahima,
Camara Soriba Naby,
Diallo Abdourahamane,
Leino Watanasse,
Balde Ibrahima Sory,
Sy Telly
Issue:
Volume 9, Issue 5, September 2021
Pages:
172-177
Received:
4 September 2021
Accepted:
29 September 2021
Published:
15 October 2021
Abstract: The aim of this work was to analyze the organization and execution of immediate essential care for newborns in referral hospitals in Conakry. Immediate essential newborn care is a key component for a maternity hospital. lower risk, but often overlooked by health providers. Methodology: This was a descriptive and analytical cross-sectional study carried out through an observation of the practices of immediate care for newborns and the individual interview of providers in six referral hospitals in urban areas of Conakry, from April 1 to June 30, 2020. We have carried out an exhaustive recruitment of all providers working in the delivery room and meeting the inclusion criteria. We used the checklist, the written questionnaire for individual interviews and the provider observation grid. Provider knowledge and practice was observed during immediate neonatal care. The independent variables were socio-demographic factors and personal and institutional factors. Statistical comparisons were made using the chi-square test. the differences were considered significant for p<0.05. Results: In this study 69 providers agreed to participate in the study, with a response rate of 100%, the largest proportion 61/69 (88.4%) were midwives, In terms of knowledge: 56, 5% of providers cited all the equipment and consumables to be prepared at the time of childbirth, 94.2% on thermal protection, 82.6% on the components of immediate newborn care, In terms of skills: 84.1% of our providers recognized newborns needing resuscitation and 15.9% were competent on this procedure, skin-to-skin contact was achieved in 68.1%. On the other hand, thermal protection is statistically linked to knowledge of the normal temperature of the newborn p=0.015. For the prevention of infection, there is a significant relationship with the training of providers p=0.001. Conclusion: Globally, newborn care providers have gaps in the knowledge and practice of the immediate care they offer newborns, this situation can only be improved by close monitoring of providers.
Abstract: The aim of this work was to analyze the organization and execution of immediate essential care for newborns in referral hospitals in Conakry. Immediate essential newborn care is a key component for a maternity hospital. lower risk, but often overlooked by health providers. Methodology: This was a descriptive and analytical cross-sectional study car...
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Analysis of Determinants of Late First Antenatal Care (ANC) Booking in Kasenengwa District, Eastern Province, Zambia: A Cross-Sectional Study
Siamondole Mike Wachata,
Godfrey Lingenda,
Eustarckio Kazonga
Issue:
Volume 9, Issue 5, September 2021
Pages:
178-188
Received:
15 September 2021
Accepted:
11 October 2021
Published:
30 October 2021
Abstract: Antenatal care (ANC) is an important public health screening tool to promote better outcomes in pregnant women and their unborn children. Women who book for ANC early enjoy the benefits of early detection of any probable condition which can affect the pregnant woman or her fetus. The objective of the study was to analyse determinants of late First ANC booking among pregnant women in Kasenegwa district in the Eastern Province of Zambia. The study design was a cross-sectional focusing on first ANC women, which used a multi-stage sampling design to sample the health facilities included in the study. Purposive and simple random sampling methods were used to come up with the sample size of 225 pregnant women. Logistic regression was used to analyse the data using Statistical Package for Social Sciences (SPSS) Version 20. The prevalence of late ANC booking was 53% (107/118) in the study area. The binary logistic regression analysis revealed that maternal age (OR=1.7 p-value=<0.0001), Marital status (OR=7.6, 95% CI=2.801-21.020, p-value=<0.0001), Education (OR=6.9, p-value=0.030), Knowledge on the need to book early for ANC despite any noticeable complications (OR=7.964, 95% CI=2.308-27.486, p-value=0.001), decision making to book for ANC (OR=.111, 95%CI=.059-.208, p-value=.000), maternal gravida (OR=1.47, p-value=0.012), Parity (OR=1.65 p-value=0.024), unplanned pregnancy (OR=2.1, 95% CI=6.385-71.406 p-value=<0.0001), and staff attitude (OR=1.973, 95% CI=1.730-2.249, p-value=0.006) were found to be significant determinants. From the results, it can be deduced that Late ANC booking is high in Kasenengwa District and factors associated with this problem are maternal age, maternal marital status, maternal gravida/parity, spouse/husband nonsupport and pregnancy uncertainty.
Abstract: Antenatal care (ANC) is an important public health screening tool to promote better outcomes in pregnant women and their unborn children. Women who book for ANC early enjoy the benefits of early detection of any probable condition which can affect the pregnant woman or her fetus. The objective of the study was to analyse determinants of late First ...
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