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2017| September-October | Volume 58 | Issue 5
May 29, 2019
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Practice of hemodialysis in a resource-poor setting in Nigeria: A 2-year experience
Esala Ezekiel Abene, Zumnan Mark Gimba, Ruth Nabe Bello, Alidzi Iliya Maga, Emmanuel Idoko Agaba
September-October 2017, 58(5):156-159
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.
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.
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 (
= 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 (
= 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.
The survival of patients on HD in our environment is poor due largely to poor affordability despite its availability.
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Histopathological spectrum of soft-tissue tumors with immunohistochemistry correlation and FNCLCC grading: A North Indian Experience
Hena Paul Singh, Sumit Grover, Bhavna Garg, Neena Sood
September-October 2017, 58(5):149-155
Soft tissue tumors (STT) are mesenchymal neoplasms with a diverse spectrum and overlapping clinical, radiological and histological features. Histopathology and immunohistochemistry (IHC) are essential to make a diagnosis. Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) Sarcoma Group grading system based on tumour differentiation, mitotic rate and necrosis helps in predicting the tumour progression and treatment response.
The goal of this study was to analyze the incidence, histological spectrum and IHC features of STTs and to grade sarcomas according to FNCLCC grading system.
Material and Methods:
This is a four year study conducted in the Department of Pathology of a tertiary care centre from July 2009 to June 2013. All histopathologically diagnosed STTs were evaluated for gross and microscopic appearance. IHC was done wherever needed and clinical correlation was attempted. Sarcomas were graded according to FNCLCC grading system.
Of the total 270 cases studied, benign, intermediate and malignant STTs were 67.0%, 7.0% and 25.9% respectively. Adipocytic, vascular and peripheral nerve sheath tumors (PNST) formed the bulk of overall STTs (34.1%, 18.5% and 11.1% respectively). Sarcomas not otherwise specified were found to be the most common soft-tissue sarcomas followed by smooth muscle sarcomas and tumors with uncertain differentiation (11.5%, 4.1%, and 3.3%, respectively). Benign STTs were seen two decades earlier and were superficial in location as compared to sarcomas. On FNCLCC grading, grade 3 soft tissue sarcomas were slightly higher in number than grade 2 (27 vs 24). On IHC a definitive diagnosis was reached in 33 malignant, all intermediate and nine benign cases.
: The incidence of intermediate and malignant STTs is increasing due to early detection and better diagnosis by ancillary techniques like IHC. FNCLCC grading helps to prognosticate the malignant STTs thus guiding further plan of action while in some tumors like MPNST and Angiosarcoma it has no prognostic significance.
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