Browsing by Author "Hees, Stijn Van"
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Item Challenges Associated with the Roll-out of HCC Surveillance in Sub-Saharan Africa - the Case of Uganda(Journal of Hepatology, 2020) Hees, Stijn Van; Muyindike, Winnie; Erem, Geoffrey; Ocama, Ponsianoo; Seremba, Emmanuel; Apiyo, Paska; Michielsen, Peter; Okwir, Mark; Vanwolleghem, ThomasIn their recent review article, Singal and coworkers describe the challenges associated with surveillance for hepatocellular carcinoma (HCC) and propose interventions to increase the effectiveness of surveillance. We agree with the authors that improved uptake of screening and performance of HCC surveillance should be considered a high priority in Western countries. In sub-Saharan Africa, where HBV infections are the main cause of HCC, surveillance programs are mostly not available. Nonetheless, with an incidence rate of 8.9 cases per 100,000 inhabitants per year, which is likely to be an underestimate, HCC surveillance is a pressing medical need in this part of the world. The recent introduction of country-wide vaccination programs in these countries will likely result in a drop in HCC incidence a few decades from now, but this does not apply to patients that are currently infected. In a recent African cohort of 1,315 hepatocellular tumors, 84% of the tumors were diagnosed at a late, multifocal disease stage with a mean size of 8 ± 4 cm and a median survival of 2.5 months.Given the strong association between early detection and improved survival, these findings highlight the need to set up surveillance programs in sub-Saharan Africa, provided curative treatment options are available.Item Neuropathological Changes in Nakalanga Syndrome—A Case Report(Pathogens, 2021) Hotterbeekx, An; Lammens, Martin; Onzivua, Sylvester; Lukande, Robert; Olwa, Francis; Kumar-Singh, Samir; Hees, Stijn Van; Idro, Richard; Colebunders, RobertNakalanga syndrome is a clinical manifestation of onchocerciasis-associated epilepsy characterized by stunting, delayed or absent secondary sexual development and skeletal deformities, and is often accompanied by epileptic seizures. The pathophysiology of Nakalanga syndrome is unknown. Here, we describe the post-mortem findings of a 17-year-old female who died with Nakalanga syndrome in northern Uganda. Macroscopic and histopathological examination of all major organs (liver, lungs, kidney and heart), including the brain and the pituitary gland, was performed. The suspected cause of death was malaria, and all major organs and pituitary gland appeared normal, except the lungs, which were edematous consistent with the malaria. Neuropathological changes include signs of neuro-inflammation (gliosis and activated microglia), which co-localized with tau-reactive neurofibrillary tangles and threads. The pathology was most abundant in the frontal cortex, thalamic and hypothalamic regions, and mesencephalon. The choroid plexus showed psammoma bodies. These findings indicate accelerated aging, probably due to repeated seizures. The neuropathological findings were similar to other persons who died with onchocerciasis-associated epilepsy. Examination of the pituitary gland did not reveal new information concerning the underlying pathophysiological mechanism of Nakalanga syndrome. Therefore, more post-mortem studies should be performed.