L'autogreffe de cellules souches hématopoïétiques non cryopréservées, un exemple de recherche clinique permettant une plus value en matière de soins: expérience de l'EHU 1er novembre d'Oran / The autographt of non-cryopreserved hematopoietic stem cells , an example of clinical research allowing more value in care: the experience of EHU 1st November of Oran

L'autogreffe de cellules souches hématopoïétiques (CSH) est une technique thérapeutique, permettant d'utiliser les cellules souches du patient afin de contourner l'écueil de l'aplasie sévère post chimiothérapie. Son coût de revient très élevé l'a rendue inaccessible dans de nombreux pays et en particulier en Afrique où on n'en compte que six pays avec 16 centres par rapport à 679 en Europe, ce qui représente un déficit de 98%. En Algérie, la première greffe de cellules a été effectuée en 1998 au niveau du CPMC d'Alger. Le 2ème centre de greffe de CSH a vu le jour en 2009 à l'EHU 1er Novembre d'Oran et est devenu un centre de greffe à vocation nationale. Nous présentons dans ce travail, le cheminement de la mise en place de la procédure de greffe de cellules à Oran, selon les recommandations internationales et leurs adaptations selon les conditions locales de travail.

Knowledge and attitude of medical doctors to kidney donation

Background: Medical practitioners by virtue of their training and exposure are expected to educate and counsel patients and their relatives about kidney donation. Therapeutic strategies for patients with end-stage renal disease are dialysis and kidney transplantation. Hemodialysis is done sub-optimally because it's expensive with resultant poor quality of life and death. Kidney transplantation, although also expensive, offers better quality of life with a major drawback being unavailability of kidney donors. A poor knowledge about kidney donation in itself may partly be responsible for low donation rates. This survey was carried out to assess knowledge and attitude of medical doctors in a tertiary hospital to kidney donation and transplantation. Methods: A cross-sectional descriptive study carried out among medical doctors from the Departments of Surgery, Family Medicine and Internal Medicine, in the University of Benin Teaching Hospital. Knowledge and attitude towards kidney donation and transplantation was assessed using pretested self-administered questionnaires. Results: One hundred and twelve doctors participated in the study with age range being 24 ­55 years, 51(45.5%) of the doctors had a good knowledge of kidney donation and transplantation while 61 (54.5%) had fair knowledge. Sixtynine (61.6%) were willing to donate a kidney with the most common reason being to save lives. Conclusion: Knowledge of kidney donation and transplantation among doctors is relatively good; however same cannot be said for their attitude, with constraints to kidney donation being fear of post-surgical complications and fear of developing kidney disease in the future

Critical appraisals and cultural acceptance of the dead donor rule: A revisit of the contemporary transplantation era

Transplantation remains one of the most rapidly expanding surgical specialties. Harvesting organs plays a crucial step in this highly complex surgical and communication process, and the moment at which vital organs can be donated depends on the declaration of end-of-life. This declaration must be performed by medical practitioners on the basis of clear standardized criteria of death confirmation, within competent local and regional jurisdictions, and with the use of confirmatory tests as indicated to ascertain the irreversibility of end-of-life. The current medically and legally accepted definition of death in most societies challenges the traditional and societal understandings of the process of end-of-life. Significant criticisms and cultural oppositions to transplantation still exist, and there is an ongoing debate about the role and the status of transplantation as surgical and medical sciences continue to evolve. By discussing the social acceptance and common understanding of end-of-life determination, we aim to highlight the current knowledge on transplant ethics with respect to the balance between the need to protect the potential organ donor and the need to donate organs at their utmost viability. No report has been done on social acceptance of transplantation in Rwanda or other Low- and Middle-Income countries (LMIC); though, as emphasis on organ transplantation evolves, we also aim to highlight the need for clear directions towards new transplantation regulations. Technical and non-technical critical arguments and moral acceptance are juxtaposed with the elucidated ethical and deontological principles to support the contemporary concept of the dead donor rule

Calcific uraemic arteriolopathy (calciphylaxis) in patients on renal replacement therapy

Background. Calcific uraemic arteriolopathy (calciphylaxis) is an unusual and potentially fatal condition characterised by small-vessel calcification and ischaemic skin necrosis. It mainly affects patients with end-stage renal disease (ESRD) on haemodialysis, but may rarely occur in the absence of ESRD in conditions such as primary hyperparathyroidism, malignancy, alcoholic liver disease and connective tissue disease.Methods. We reviewed the records of all patients diagnosed with calciphylaxis while on renal replacement therapy at Tygerberg Hospital, Cape Town, South Africa, between 1990 and 2014, to describe its presentation, course and final outcome.Results. Nineteen patients developed calciphylaxis over this period. Their median age was 34 years and 13 (68.4%) were female. Fifteen (78.9%) had received a kidney transplant. All patients had painful skin lesions that rapidly progressed to infarction. Small-vessel calcification was seen on skin biopsy in 13 patients. Twelve patients had hyperparathyroidism. Several of the transplanted patients had been treated for graft rejection in the year preceding the diagnosis. Treatment consisted of good wound care and efforts to normalise serum calcium and phosphate levels. Five patients received an urgent parathyroidectomy. The outcome was fatal in 17 patients, with sepsis being the main cause of death.Conclusions. In our patients, calciphylaxis carried a worse prognosis than previously reported internationally. It should always be considered in the differential diagnosis of painful skin lesions in the dialysis or transplant patient