Genetic landscape of ultra-stable chronic lymphocytic leukemia patients

Background

Chronic lymphocytic leukemia (CLL) has a heterogeneous clinical course. Beside patients requiring immediate treatment, others show an initial indolent phase followed by progression and others do not progress for decades. The latter two subgroups usually display mutated IGHV genes and a favorable FISH profile.

Patients and methods

Patients with absence of disease progression for over 10 years (10-34) from diagnosis were defined as ultra-stable CLL (US-CLL). Forty US-CLL underwent extensive characterization including whole exome sequencing (WES), ultra-deep sequencing and copy number aberration (CNA) analysis to define their unexplored genetic landscape. Microarray analysis, comparing US-CLL with non-US-CLL with similar immunogenetic features (mutated IGHV/favorable FISH), was also carried out to recognize US-CLL at diagnosis.

Results

WES was carried out in 20 US-CLL and 84 non-silent somatic mutations in 78 genes were found. When re-tested in a validation cohort of 20 further US-CLL, no recurrent lesion was identified. No clonal mutations of NOTCH1, BIRC3, SF3B1 and TP53 were found, including ATM and other potential progression driving mutations. CNA analysis identified 31 lesions, none with known poor prognostic impact. No novel recurrent lesion was identified: most cases showed no lesions (38%) or an isolated del(13q) (31%). The expression of 6 genes, selected from a gene expression profile analysis by microarray and quantified by droplet digital PCR on a cohort of 79 CLL (58 US-CLL and 21 non-US-CLL), allowed to build a decision-tree capable of recognizing at diagnosis US-CLL patients.

Conclusions

The genetic landscape of US-CLL is characterized by the absence of known unfavorable driver mutations/CNA and of novel recurrent genetic lesions. Among CLL patients with favorable immunogenetics, a decision-tree based on the expression of 6 genes may identify at diagnosis patients who are likely to maintain an indolent disease for decades.

[Relationship between oral health status of parents and that of their children]

The aim of this study was to evaluate the oral health status of the parents and their children and the relationships between the parents' oral health status and their children one. Subjects comprised 200 parents (mothers and fathers) and 200 of their children selected at the pediatric dental clinic of the children's hospital Albert Royer and the pediatric dental clinic of the Department of Odontology. In both groups, we have evaluated the dental caries prevalence and dental examination was performed using DMFT or DMF teeth for children. To evaluate the oral hygiene habits we used the Silness and Löe index and a questionnaire. We have finally assessed the relationships between the parents' oral health status and their children' oral health. The dental caries prevalence was 63% for the parents with mean DMF teeth of 5.8 and 5.2 SD and for the children it was 94% and the DMF teeth was 5.85 and 4.00 SD. The parents' DMF teeth, their gingival health and their oral hygiene habits were significantly associated to their professional status (ANOVA: p = 0.00 < 0.05). The DMF teeth of the children was associated with those of their parents and to their parents' professional status. The children's oral hygiene habits and their parents' habits were also associated.

Squamous carcinoma of the hypopharynx in children in Sénégal: between disarray and enigma

INTRODUCTION

The squamous carcinoma of the hypopharynx constitutes the first reason of hospitalization in our department. Different studies have been realized about it and showed an epidemiological profile characterized by the young age of the patients and the predominance of female.

OBJECTIVES

To specify the place of the children in hypopharynx cancers. To evaluate the epidemiological criteria and the difficulties in the management.

MATERIALS AND METHODS

Retrospective study of 11 years (1995-2005). Collection of the data concerning the epidemiology, clinical and paraclinical findings, the treatment, and the evolution was carried out at the University Department of Otorhinolaryngology in Dakar (Sénégal).

RESULTS

15 charts of children have been collected. They presented in the majority of the cases, an advanced cancer, with 93% of T3T4. The lesion was localized at the retro-cricoid area in 4 cases, the pyriform sinus in 3 cases, the oesophagus junction in 2 cases, and the posterior wall in 1 case. In 5 cases the lesion was spreading to the totality of the hypopharynx. No case of smoking or alcohol has been noted. The anemia has been noted in 86.7% of the cases. A case of papillomatosis of the mouth and lips has been noted. The treatment was for most of cases as symptomatic, like tracheotomy with or without gastrostomy. The evolution was fatal with 11 deaths (73.33%).

DISCUSSION

Our set is the richest set through the world of hypopharyngeal cancers in children. The Plummer-Vinson syndrome noted in 86.7% of the cases and the viral infection by HPV could play a role in the genesis of this cancer.

CONCLUSION

The cancer of the hypopharynx essentially affects the young women in Sénégal without alcohol or tobacco consumption. It does not save the children, with an awful prognosis, however. So, it is imperative to organize a vast campaign of information of the populations on the bad prognosis of this cancer and to lead a large-scale epidemiological investigation, to get a better understanding of this cancer in our country.

[Treating five cases of Class III skeletal brachygnatia maxilla with the Delaire mask]

Class III skeletal abnormalities are known as sagittal defects and they are recognized by a hollow profile, which is an unesthaetical morphological distorsion often ill--accepted by the patient, a severe disability. Due to the large number of clinical patterns, it is crucial to make an accurate diagnosis. Class Ill skeletal abnormalities involving a maxillary brachygnatia are caused by an insufficient development of the jawbone. Treatment will therefore consist in boosting growth of the lower back section of the jawbone. The external device known as Delaire mask which stimulates growth of the lower back section of the jaw is particularly recommended to achieve this. This piece of research set out to assess the effectiveness of this method based on five of our patients. Outstanding results were obtained, namely alveolar ridge slided forward on the jawbone, improved profile (a cutaneous Class I is obtained), and a disappearance of the occlusion, along with a correction of the inverted backward bite. When adequately prescribed, the use of the Delaire mask, as opposed to corrective surgery, leads to a slow and gradual improvement. Furthermore, results achieved among young children blend into their own natural growth. By resorting to early treatment with the mask, it is possible to avoid falling back on complex surgery, which would almost necessarily be of the orthognatic type among adults.

[The health of the child during eruption of the deciduous teeth]

Teething is a physiological process that may be marked by local regional or general physiopathologies. We have studied these disorders in a sample of 499 children whom we followed from the age of 5 until the age of 30 months. The study consisted in a clinical endobuccal examination. Each month we recorded the order and the eruption date of the tooth or teeth and the disturbances that arise during the process or after, if any. We expose the results of this study in this paper. We collected local and general disturbances during the primary teeth eruption period. We considered that in certain conditions these disturbances could be to the eruption process. Teething is certainly a natural process, however considering its traumatic impact on the young child, we should not reject the aetiology in the justification of the disturbances observed in this process and seek another one which might not be valid.

[Dental cellulitis in children. Realities and perspectives in Senegal]

Cellulitises originated from teeth are frequent in developing countries. Theyare noted as well as in child as in adult. In child, causal tooth may be primary or permanent. In a prospective trial carried at Hôpital d'Enfants Albert Royer CHU-Fann, where we studied the frequency of cellulitises among the children, the main patterns of dental affections and the causal teeth involved and, in the same way, the management and prevention of these diseases in child. We noted that: 56.52% of the cases of cellulitises recorded interest the child of pediatric dentistry age and that 87.5% of the cellulitises cases are due to a primary tooth (primary molar overall) and first permanent molar necrosis. Management and prevention of cellulitises are based on: the respect of the therapeutic protocol, dental hygiene education and systematization of setting of dental caries preventive clinical procedures like SEALANTS and stainless steel crowns as well as in primaryand permanent dentition with as main target the primary molars and the first permanent molar or 6 years age tooth.

[Prevalence of dental agenesis: a radiologic and clinical study in Dakar]

A total of 1007 files were studied with regard to the prevalence of congenitally missing teeth. All patients were radiographed. 4.56% were found to have at least one congenitally missing tooth. The lower second premolar was the most commonly missing tooth in this study (41.66%), followed by the upper lateral incisor (22.2%). The prevalence and the distribution of dental agenesis between male and female was similar.

Oro-dental and craniofacial anomalies in LEOPARD syndrome

'LEOPARD syndrome' is a syndrome affecting many systems or organs. The main anomalies are summarized in the acronym LEOPARD in which each letter corresponds to the damage of a given organ. In the presented case, there are oro-dental and craniofacial anomalies. The relationship between the LEOPARD syndrome and the given anomalies and the possibilities of the management and the follow-up of the diseased are studied. The clinical case presented is a 4-year-old boy with LEOPARD syndrome showing retardation of dental development, delayed development and possible agenesis of permanent teeth, and craniofacial anomalies (osseous hypodevelopment). The bibliographical study shows that LEOPARD syndrome is due to damage of the neural crest cells. Thus, the dental and craniofacial anomalies arise since neural crest cells participate in the formation of the teeth and some craniofacial bones. Therefore, dental and craniofacial anomalies might be expected in some cases of the disease. The therapeutic management of the lesions, and the follow-up of the patient would be done by a multidisciplinary team.

[Chronology and date of eruption of primary teeth in Senegal]

Chronology and eruption dates of primary teeth are parameters of importance in different medical scientific fields. We carried a longitudinal clinical study to determine these parameters in a local Senegalese population. The study interests a sample of 573 Senegalese Negro children of the two sexes and its aims are to situate these parameters formally and in space in on hand, and to be able to justify; in comparison to these parameters, the disturbances which accompany often the phenomenon of dental eruption in the other hand. We have results relating to chronology and eruption date of the 20 primary teeth of each of the children. Our study strengthens data already known but it reveals also other data as well as important. Other studies are however necessary to set a good board of chronology and eruption date of primary teeth in the Senegalese population.

[Complications of injuries to the deciduous teeth. Clinical and radiographic evaluation. Perspectives on management and prevention. Apropos of 4 cases]

The traumatisms of primary teeth have often sequels thereabouts grave on the germs of their successional permanent teeth. They have many causes but they are above all frequent during the child's walking trial. We have carried out a clinical and radiographic study of some cases. The study has ascertained the fact that the diversity of the sequels and their gravity depend on the age of the occurring of the traumatism, the intensity and the direction of the shock. The therapeutic and preventive management of these traumatisms and their possible sequels use a pluridisciplinary protocol based on the strict application of indicated treatments, the clinical and radiographic regular follow up and the adoption of a rigorous preventive attitude by the parents during the target period of walking trial.

The impact of alternative cost recovery schemes on access and equity in Niger

The authors examine accessibility and the sustainability of quality health care in a rural setting under two alternative cost recovery methods, a fee-for-service method and a type of social financing (risk-sharing) strategy based on an annual tax+fee-for-service. Both methods were accompanied by similar interventions aimed at improving the quality of primary health services. Based on pilot tests of cost recovery in the non-hospital sector in Niger, the article presents results from baseline and final survey data, as well as from facility utilization, cost, and revenue data collected in two test districts and a control district. Cost recovery accompanied by quality improvements increases equity and access to health care and the type of cost recovery method used can make a difference. In Niger, higher access for women, children, and the poor resulted from the tax+fee method, than from the pure fee-for-service method. Moreover, revenue generation per capita under the tax+fee method was two times higher than under the fee-for-service method, suggesting that the prospects of sustainability were better under the social financing strategy. However, sustainability under cost recovery and improved quality depends as much on policy measures aimed at cost containment, particularly for drugs, as on specific cost recovery methods.

Increasing the utilization of cost-effective health services through changes in demand

Attaining efficiency in a health care system with a budget constraint involves increasing the utilization of the most cost-effective services. This can be achieved by adjustments to prices, cost curves, or demand curves. In this paper, the potential for demand curve adjustments is examined by selecting two apparently cost-effective services (prenatal care and childhood immunization against tuberculosis), and analyzing the factors explaining their utilization. Data from recent household surveys in Burkina Faso and Niger are used. A multivariate analysis of utilization employs income, price, and taste variables. Utilization is highly sensitive to the distance which must be travelled to the health facility, a price, and taste variables. Utilization is highly sensitive to the distance which must be travelled to the health facility, a price variable. Members of certain ethnic groups tend to use the services less, other things being equal. The importance of demand-side factors like ethnicity points to certain kinds of policy interventions like information, education and communication activities which could increase the utilization of cost-effective services.

Infant and child mortality in two counties of Liberia: results of a survey in 1988 and trends since 1984

A baseline survey of childhood mortality in two counties of Liberia in 1984 found the risk of dying before age 5 to be almost one-third. Three years into the Combatting Childhood Communicable Diseases (CCCD) project, a survey using a pregnancy history questionnaire was conducted in the same clusters to determine if any change in mortality had occurred. Reinterviews were done in a subsample and pregnancies were matched from the two surveys to determine levels of missing events. After adjustment for omission, infant mortality was estimated at 180 per 1000, a 25% decline from the estimated 1984 level. Childhood mortality declined by an estimated 28%. Tabulations of death by reported cause using a verbal autopsy questionnaire showed that the risks of neonatal tetanus and fever associated deaths declined significantly. These reductions might have been a direct result of programme activities which were shown by a marked increase in tetanus toxoid immunization and access to antimalarial drugs in the study area.