Noria Harir

Use of GeneXpert Mycobacterium tuberculosis /rifampicin for rapid detection of rifampicin resistant Mycobacterium tuberculosis strains of clinically suspected multi-drug resistance tuberculosis cases

BACKGROUND Multi-drug resistance (MDR) TB is defined as tuberculosis (TB) disease caused by a strain of Mycobacterium tuberculosis (MTB) that was resistant to at least isoniazid and rifampicin (RIF). Emerging Multidrug-Resistant TB is one of the major concerns of health policy and rapid detection of M. tuberculosis and detection of RIF resistance in infected patients are essential for disease management. The aim of this study was to evaluate patterns of RIF resistance in cases of sputum positive pulmonary TB by using GeneXpert MTB/RIF and comparing between phenotypic and genotypic testing of RIF resistance in MTB strains of clinically suspected MDR-TB isolated cases in western Algeria. METHODS In this study 50 sputum positive cases of pulmonary TB who were potential MDR suspect were included. Their sputum samples were collected and subjected to sputum smear microscopy, culture and conventional MTB/RIF test followed by GeneXpert MTB/RIF assay. RESULTS Of total 50 cases included in this study, MTB was detected in all patients (100%) by GeneXpert MTB/RIF. However, RIFs resistance was detected in only 21 cases (42%) by GeneXpert MTB/RIF. All RIF resistant strains detected by GeneXpert MTB/RIF were phenotypically confirmed as MDR strains. 42.85% of cases were retreatment failure cases, retreatment cases smear positive at 4 months were 23.82%. While 19.05% of cases were retreatment cases smear positive at diagnosis, and 14.28% patient had history of contact with MDR-TB. Sensitivity, specificity, positive predictive value and negative predictive value of Xpert MTB/RIF to detect RIF resistance in comparison to conventional phenotypic drug susceptibility technique were found equal to the rates of 100%, 100%, 100% and 100%, respectively. CONCLUSIONS GeneXpert MTB/RIF assay is efficient and reliable technique for the rapid diagnostic of TB. Its simplicity, high sensitivity and specificity for RIF resistance detection make this technique a very attractive tool for diagnostic of MTB and RIF resistance in MDR cases.

Delayed diagnosis of pancreatic cancer reported as more common in a population of North African young adults

BACKGROUND Pancreatic cancer is one of the most challenging tumor entities worldwide, characterized as a highly aggressive disease with dismal overall prognosis and an incidence rate equaling mortality rate. OBJECTIVE In order to have an update about pancreatic cancer incidence and evolution in North Africa, we conducted an epidemiological analytical retrospective study at the level of three Algerian regions: Sidi-bel-Abbes, Oran and Tlemcen along the last eight years [2006-2013]. METHODS We performed a retrospective hospital-based study in which we analyzed the records of 160 pancreatic cancer patients registered, evaluated and treated in a Northern African region; at the level of hospital centers of the three western Algerian regions from 2006 to 2013. RESULTS Along the period of study, 160 patients were diagnosed with pancreatic cancer; with a mean age of 66.2 years, and a sex ratio of 1.65; other parameters such as a medical history smoking and alcoholism history, tumor site; histological type as well as the stage of diagnosis were also enrolled in the study. Our statistical analyses reported a very significant correlation between patients who belonged to the age group of 21-40 years and the advanced stage of diagnosis (basing on TNM classification) with P=0.02. CONCLUSIONS Pancreatic cancer is increasingly diagnosed in young adults at an advanced stage in North African regions.

Immunohistochemistry and scoring of Ki-67 proliferative index and p53 expression in gastric B cell lymphoma from Northern African population: a pilot study

BACKGROUND This study aimed to clarify the Ki-67 distribution, p53 expression and their relationship with clinico-pathologic features of gastric B cell lymphoma from Northern African population. METHODS Twenty paraffin blocks of gastric lymphoma were retrieved from the archival materials of Department of Pathology, Central University Hospital of Sidi Bel Abbes (Western Algeria) from 2007 to 2013. Four µm section specimens were stained by immunohistochemical (IHC) technique with Ki-67 and p53 tumor markers. P values <0.05 were considered statistically significant. RESULTS Expression of p53 proteins and the mean proliferative index (PI) were compared between high grade gastric B cell lymphomas (DLBCL) and low grade gastric B cell lymphomas (gastric MALTs). p53 overexpression (P=0.007) and a high proliferation index Ki-67 (P=0.001) were significantly associated with gastric DLBCL. We found also a statistically significant correlation between p53 and Ki-67 (P=0.007) but no obvious relationships were found between Ki-67 PI and p53 expression as well as clinico-pathological features (age, sex, location, macroscopic type). CONCLUSIONS The IHC studies of Ki-67 and p53 expression in gastric B cell lymphoma can help in monitoring of patients at risk, and to give suitable treatment and management of patients.

Immunohistochemical examination of cholecystokinin and gastrin receptors (CCK-2/gastrin-R) expression in normal and exocrine cancerous human pancreatic tissues

OBJECTIVE Evaluating tissue samples of normal and exocrine cancerous human pancreas on the expression of CCK2/gastrin receptor. We performed an immunohistochemical protocol that allows efficient detection of this receptor in formalin-fixed, paraffin-embedded human tissues. METHODS Twenty (20) paraffin blocks of pancreatic tissue sections were collected from the Departments of pathology, Central University Hospital of Sidi-bel-Abbes City (Western Algeria) for the period 2004-2013; ten (10) of them were normal pancreatic samples; and ten (10) cancerous pancreatic sections. The samples were studied using an immunohistochemical protocol for CCK-2/gastrin receptors. RESULTS Our immunohistochemical analysis revealed that CCK-2/gastrin receptors were expressed in both normal and malignant pancreatic cells but with different immunoreactivity levels and different immunostaining intensity i.e., CCK-2/gastrin receptors were highly expressed within the cytoplasmic area of cancerous cells; 40% of the samples had an immunoreactivity (IR) of (+++) and 60% (++++); the immunostaining was as well very intense since we reported a dark brown staining of the malignant cells. However; in normal pancreatic tissues; CCK-2/gastrin receptors IR levels were very low; 80% of the samples had an IR of (+); and 20% had (++) and the immunostaining was less intense; we noted a light brown staining of few normal pancreatic cells. CONCLUSION The gastrointestinal peptides CCK could be very interesting targets for exocrine pancreatic cancer therapies; thus further surveys such as western blotting and RTPCR could indentify CCK-2/gastrin receptors as a helpful biomarker for exocrine pancreatic cancer diagnosis and treatment.

Clinical-pathological features and histological variants of Hodgkin's lymphoma: a study of 526 patients

Context Hodgkins lymphoma is an uncommon disorder with heterogeneous clinical, histological, and epidemiological characteristics. Aims The aim of this study was to describe the epidemiological and histopathological characteristics in patients with Hodgkins lymphoma in Western Algeria. Materials and methods Our retrospective descriptive study was conducted at the Departments of Haematology in Western Algerian hospitals over 11 years (2001–2011). Statistical analysis used SPSS 18.0 was used. Results A total of 526 patients were identified in our study. There were 273 male and 253 female patients, with a male to female ratio of 1.07. The mean age of the patients was 33.33 years (range = 14–89 years), and most of the patients were young adults [20–29 years (38.2%)]. Nodular sclerosis was the most frequent histological type (51%), followed by mixed cellularity (26%); nodular sclerosis was more common among female patients, whereas mixed cellularity was more common among male patients compared with female patients. Staging classification of the disease indicated high frequency of early stage II, with 184 cases (35%). Conclusion Most of the patients were young adults with nodal lymphoma at an early stage of disease and a dominance of nodular sclerosis as the histological type. Further studies are required to determine the factors that play a major role in the etiology of this disease.

Gastrointestinal lymphoma in Western Algeria: pattern of distribution and histological subtypes (retrospective study)

BACKGROUND Primary gastrointestinal (GI) lymphomas (GIL) are uncommon diseases that can involve the whole GI tract. Considerable variation exists in the literature with respect to incidence of the various histological subtypes and sites of involvement. This study was undertaken to establish the anatomic distribution, histological subtypes and sites of GI lymphomas of patients from Western Algeria. METHODS The case records of 58 consecutive patients with GIL diagnosed at the Pathologies Departments of Algerian west region (the Military Hospital of Oran city and the Central University Hospital of Sidi Bel Abbes city) from January 2006 to December 2013 were retrospectively evaluated for epidemiology and histopathology report. All lymphomas were reclassified according to the WHO 2008 classification. RESULTS A total of 58 patients (39 male, 19 female) with mean age of 61 years and a range of 20-89 years were included in this study. Stomach was the most common site involved (70.7%). The commonest histological subtype was mucosa-associated lymphoid tissue (MALT) B cell lymphoma (46.6%), followed by diffuse large B-cell lymphomas (DLBCL) (43.1%).The frequency of Helicobacter pylori (HP) positivity differ between gastric and intestinal location P=0.003 and correlates with the histological type P=0.01. CONCLUSIONS This retrospective study of patients with GI lymphoma from Western Algeria illustrates the pattern of distribution of various common and rare histological subtypes. More studies are necessary to find a potential cause, risk factor or genetic mutation that can explain these specific characteristics of GIL.

CCK-2/Gastrin-R Immunodistribution in a Solid Pseudopapillary Pancreatic Tumor: A Case Report of a 28-Years-Old North African Woman

The presence of a large bulky pancreatic tumour in a young female should raise suspicions of the diagnosis of solid-pseduopapillary tumour of the pancreas.

Maternal and fetal characteristics of premature deliveries in Western

Birth of a baby less than 37 weeks of gestational age is known as preterm birth. The reduction of preterm birth is a demanding proposal since the cause, in many situations; it is hard to get hold off (1). Due to its complex nature, mechanisms underpinning preterm birth are not clearly understood. Causal factors of that include medical conditions of the mother or foetus, genetic influences, environmental exposure, infertility treatments, behavioral and socio-economic factors as well as iatrogenic prematurity (2). The occurrence of complications, and mortality rate, were found to be higher in preterm babies. In fact preterm ones have an increased risk of death in the first year of life (infant mortality), with most of the deaths occurring in the first month of life (neonatal mortality) (3). This is often summarized by contrasting the pattern of preterm births, which comprise 6-10% of all births in Western countries, with that of preterm deaths, which comprise more than two-thirds of all perinatal deaths. Furthermore, among surviving infants, preterm birth is implicated in approximately half of all pediatric neurodevelopmental disabilities, (4-5) including cerebral palsy (6), long-term morbidity, (7,8,4) and high healthcare costs (9, 10). Data on preterm birth rates are not routinely collected in many countries as well as in Algeria, and there were no published findings on maternal and fetal characteristics of premature deliveries in Western Algeria. Therefore, and in order to promote the primary prevention of prematurity in our region, our aim was to determine the possible risk factors which are common causes of preterm deliveries in mothers delivered at the neonatology department of obstetrics and Gynecology Specialized Hospital of Sidi Bel Abbes city (Western Algeria) as well as fetal characteristics of preterm birth babies. Information derived from the study will be used in public enlightenment campaigns on the prevention of preterm birth in Algeria.

HER2 Status in Male Breast Carcinoma: a Single North African Institution Experience of 10 Cases and Review of the Literature

Background: To investigate clinic-pathological characteristics, hormonal receptors and HER2 receptor of male breast cancer.