Management of Renal Cell Carcinoma- Current Practice in Sub-Saharan Africa

There is a global variation in the incidence of renal masses with the developed nations having a greater incidence. About 80–90% of renal malignancies are renal cell carcinomas (RCC) which account for 2–4% of all cancers. In Africa and the Middle East, the age-standardized incidence for RCC is 1.8–4.8/100,000 for males and 1.2–2.2/100,000 for females. The management of renal cell cancer is challenging. A multidisciplinary approach is effective for diagnosis, staging, and treatment. Guidelines recommend active surveillance, thermal ablation, partial nephrectomy, radical nephrectomy, cytoreductive nephrectomy and immunotherapy as various modalities for various stages of RCC. However, open radical nephrectomy is most widely adopted as an option for treatment at various stages of the disease in sub-Saharan Africa due to its cost-effectiveness, applicability at various stages, and the reduced cost of follow-up. Nevertheless, most patients in the region present with the disease in the advanced stage and despite surgery the prognosis is poor.

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339Laparoscopic radical nephrectomy in renal cell cancer — Technique and oncological follow-up in 170 cases

European Urology Supplements ◽

10.1016/s1569-9056(05)80346-x ◽

2005 ◽

Vol 4 (3) ◽

pp. 87

Author(s):

A. Wille ◽

M. Tüllmann ◽

J. Roigas ◽

S. Deger ◽

S. Loening

Keyword(s):

Renal Cell Cancer ◽

Renal Cell ◽

Radical Nephrectomy ◽

Cell Cancer

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Metastatic Renal Cell Cancer after Laparoscopic Radical Nephrectomy: Long-Term Follow-Up

Journal of Endourology ◽

10.1089/end.2000.14.407 ◽

2000 ◽

Vol 14 (5) ◽

pp. 407-411 ◽

Cited By ~ 78

Author(s):

DONALD D. FENTIE ◽

PETER H. BARRETT ◽

LAWRENCE A. TARANGER

Keyword(s):

Renal Cell Cancer ◽

Renal Cell ◽

Radical Nephrectomy ◽

Cell Cancer ◽

Metastatic Renal Cell Cancer ◽

Laparoscopic Radical Nephrectomy ◽

Long Term Follow Up

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Comparison of laparoscopy and open radical nephrectomy of renal cell cancer

Open Medicine ◽

10.1515/med-2019-0040 ◽

2019 ◽

Vol 14 (1) ◽

pp. 392-397

Author(s):

Dong Wang ◽

Zejun Xiao ◽

Jianzhong Shou ◽

Changling Li ◽

Nianzeng Xing

Keyword(s):

Postoperative Complications ◽

Blood Loss ◽

Hospital Stay ◽

Renal Cell ◽

Radical Nephrectomy ◽

Cell Cancer ◽

Length Of Hospital Stay ◽

Current Evidence ◽

Surgical Time ◽

Open Radical Nephrectomy

AbstractObjectiveThe aim of this study was to summarize the current evidence to evaluate the effects of laparoscopic radical nephrectomy (LRN) and open radical nephrectomy (ORN) in the treatment of renal cell carcinoma.MethodsA comprehensive literature search was performed using PubMed, Embase and Google Scholar to identify all relevant studies. 8 published studies were included in this meta-analysis. We pooled the odds ratios (OR), standardised mean difference (SMD) and conducted heterogeneity, and quality assessment.ResultsThe outcome of treatment effects included surgical blood loss, surgical time, postoperative complications, and post-operative length of hospital stay. Comparing open radical nephrectomy for kidney cancer patients, the pooled SMD of surgical time was 0.47, (95% confidential index CI = [0.09, 0.85]), the pooled SMD of operative blood loss was -68.98, (95% CI = [-99.63, -38.34]), the pooled SMD of post-operative length of hospital stay was -4.32, (95% CI = [-4.62, -4.03]), and the pooled OR of postoperative complications was 0.52, (95% CI = [0.30, 0.91]).ConclusionLRN was found to significantly decrease patients’ blood loss. In addition, LRN offers less post-operative length of hospital stay.

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Comparision of laparoscopic transperitoneal and open radical nephrectomy for treatment of localised renal cell cancer

European Urology Supplements ◽

10.1016/s1569-9056(02)80098-7 ◽

2002 ◽

Vol 1 (1) ◽

pp. 27 ◽

Cited By ~ 2

Author(s):

Christoph Klingler ◽

Mesut Remzi ◽

Jörg Schmidbauer ◽

Günther Janetschek ◽

Michael Marberger

Keyword(s):

Renal Cell Cancer ◽

Renal Cell ◽

Radical Nephrectomy ◽

Cell Cancer ◽

Open Radical Nephrectomy ◽

Laparoscopic Transperitoneal

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Extended Lymphadenectomy during Radical Nephrectomy for Renal Cell Carcinoma. A Prospective Study

Urologia Journal ◽

10.1177/039156039205900613 ◽

1992 ◽

Vol 59 (6) ◽

pp. 51-53

Author(s):

T. Prayer Galetti ◽

M. Dal Bianco ◽

U. Santacatterina ◽

S. Guatelli ◽

L. De Zorzi ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Renal Cell Cancer ◽

Renal Cell ◽

Radical Nephrectomy ◽

Cell Cancer ◽

Extended Lymphadenectomy ◽

Clinical Consideration ◽

Nodal Involvement ◽

A Prospective Study

The role and extension of lymphadenectomy during radical nephrectomy for renal cell cancer still remain a matter of debate. From June 1989 to March 1992, 137 consecutive extended lymphadenectomies were performed in patients undergoing radical nephrectomy for renal cell cancer at the Department of Urology of Padua. Ten patients (7.3%) had a pathologically proved nodal involvement. Only 2 patients had a distant nodal involvement in the absence of metastases to hilar nodes. Both patients with microscopic metastases had massive involvement of hilar nodes. Due to short median follow-up no clinical consideration on survival can be drawn.

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Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis

Infectious Diseases of Poverty ◽

10.1186/s40249-021-00822-7 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Hafte Kahsay Kebede ◽

Lillian Mwanri ◽

Paul Ward ◽

Hailay Abrha Gesesew

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Meta Analysis ◽

Sub Saharan Africa ◽

Hiv Care ◽

Care Services ◽

Validity Assessment ◽

Sub Saharan ◽

Lost To Follow Up

Abstract Background It is known that ‘drop out’ from human immunodeficiency virus (HIV) treatment, the so called lost-to-follow-up (LTFU) occurs to persons enrolled in HIV care services. However, in sub-Saharan Africa (SSA), the risk factors for the LTFU are not well understood. Methods We performed a systematic review and meta-analysis of risk factors for LTFU among adults living with HIV in SSA. A systematic search of literature using identified keywords and index terms was conducted across five databases: MEDLINE, PubMed, CINAHL, Scopus, and Web of Science. We included quantitative studies published in English from 2002 to 2019. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for methodological validity assessment and data extraction. Mantel Haenszel method using Revman-5 software was used for meta-analysis. We demonstrated the meta-analytic measure of association using pooled odds ratio (OR), 95% confidence interval (CI) and heterogeneity using I2 tests. Results Thirty studies met the search criteria and were included in the meta-analysis. Predictors of LTFU were: demographic factors including being: (i) a male (OR = 1.2, 95% CI 1.1–1.3, I2 = 59%), (ii) between 15 and 35 years old (OR = 1.3, 95% CI 1.1–1.3, I2 = 0%), (iii) unmarried (OR = 1.2, 95% CI 1.2–1.3, I2 = 21%), (iv) a rural dweller (OR = 2.01, 95% CI 1.5–2.7, I2 = 40%), (v) unemployed (OR = 1.2, 95% CI 1.04–1.4, I2 = 58%); (vi) diagnosed with behavioral factors including illegal drug use(OR = 13.5, 95% CI 7.2–25.5, I2 = 60%), alcohol drinking (OR = 2.9, 95% CI 1.9–4.4, I2 = 39%), and tobacco smoking (OR = 2.6, 95% CI 1.6–4.3, I2 = 74%); and clinical diagnosis of mental illness (OR = 3.4, 95% CI 2.2–5.2, I2 = 1%), bed ridden or ambulatory functional status (OR = 2.2, 95% CI 1.5–3.1, I2 = 74%), low CD4 count in the last visit (OR = 1.4, 95% CI 1.1–1.9, I2 = 75%), tuberculosis co-infection (OR = 1.2, 95% CI 1.02–1.4, I2 = 66%) and a history of opportunistic infections (OR = 2.5, 95% CI 1.7–2.8, I2 = 75%). Conclusions The current review identifies demographic, behavioral and clinical factors to be determinants of LTFU. We recommend strengthening of HIV care services in SSA targeting the aforementioned group of patients. Trial registration Protocol: the PROSPERO Registration Number is CRD42018114418

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Persistence of mRNA indicative of Plasmodium falciparum ring-stage parasites 42 days after artemisinin and non-artemisinin combination therapy in naturally infected Malians

Malaria Journal ◽

10.1186/s12936-020-03576-z ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Almahamoudou Mahamar ◽

Kjerstin Lanke ◽

Wouter Graumans ◽

Halimatou Diawara ◽

Koualy Sanogo ◽

...

Keyword(s):

Combination Therapy ◽

Artemisinin Combination Therapy ◽

Parasite Prevalence ◽

Sub Saharan Africa ◽

Ring Stage ◽

Qrt Pcr ◽

Sub Saharan ◽

Stage Parasite ◽

Ring Stage Parasite

Abstract Background Malaria control in sub-Saharan Africa relies upon prompt case management with artemisinin-based combination therapy (ACT). Ring-stage parasite mRNA, measured by sbp1 quantitative reverse-transcriptase PCR (qRT-PCR), was previously reported to persist after ACT treatment and hypothesized to reflect temporary arrest of the growth of ring-stage parasites (dormancy) following exposure to artemisinins. Here, the persistence of ring-stage parasitaemia following ACT and non-ACT treatment was examined. Methods Samples were used from naturally infected Malian gametocyte carriers who received dihydroartemisinin–piperaquine (DP) or sulfadoxine–pyrimethamine (SP–AQ) with or without gametocytocidal drugs. Gametocytes and ring-stage parasites were quantified by qRT-PCR during 42 days of follow-up. Results At baseline, 89% (64/73) of participants had measurable ring-stage parasite mRNA. Following treatment, the proportion of ring-stage parasite-positive individuals and estimated densities declined for all four treatment groups. Ring-stage parasite prevalence and density was generally lower in arms that received DP compared to SP–AQ. This finding was most apparent days 1, 2, and 42 of follow-up (p < 0.01). Gametocytocidal drugs did not influence ring-stage parasite persistence. Ring-stage parasite density estimates on days 14 and 28 after initiation of treatment were higher among individuals who subsequently experienced recurrent parasitaemia compared to those who remained free of parasites until day 42 after initiation of treatment (pday 14 = 0.011 and pday 28 = 0.068). No association of ring-stage persistence with gametocyte carriage was observed. Conclusions The current findings of lower ring-stage persistence after ACT without an effect of gametocytocidal partner drugs affirms the use of sbp1 as ring-stage marker. Lower persistence of ring-stage mRNA after ACT treatment suggests the marker may not reflect dormant parasites whilst it was predictive of re-appearance of parasitaemia.

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