Mode Of Discovery Research Articles

Novel SDH Inhibitors as Antifungal Leads: From Azobenzene Derivatives to the 1,2,4-Oxadiazole Compounds.

Azo-incorporating was reported to be an effective strategy for increasing SDH inhibitory activity but for poor in vivo control effects. Herein, the azo-incorporated compounds were structurally optimized to retain a preferential conformation by replacing the azo bond with their bioisosteres. Interestingly, the 1,2,4-oxadiazole compound D2 displayed a broad fungicidal spectrum as well as fluxapyroxad. More excitedly, compound D2 showed excellent antifungal activities against rice sheath blight disease both in vitro (EC50 = 0.001 μg/mL) and in vivo (EC50 = 1.08 μg/mL, EC95 = 4.67 μg/mL). In addition, an extra π-π interaction was found between the 1,2,4-oxadiazole ring of compound D2 and the phenyl ring of residue D_Y586, which might interpret the enhanced potency of compound D2 against Rhizoctonia solani. Further structural optimizations of the 1,2,4-oxadiazole compounds gave several analogues that made a breakthrough in controlling rice blast disease. These 1,2,4-oxadiazole compounds, derived from azobenzene derivatives, could be antifungal leads especially against R. solani and Magnaporthe grisea, exemplifying an interesting mode of pesticide discovery and providing theoretical guidance for innovation of the SDHI fungicide.

Les surcharges hépatiques en fer

Iron is essential for functioning of cells and of the body as a whole. Perls staining allows the histopathological identification of iron deposits. By classifying hepatic siderosis as parenchymal, mesenchymal or mixed, it may guide the search for its etiology. HFE1 hemochromatosis is the most common siderosis. Its diagnosis is currently based on genetic analysis. Its expressivity being variable and its penetrance incomplete, the demonstration of hepatic siderosis may represent a mode of discovery.

Outcomes at 6 months after isolated or non-isolated surgery for temporal bone cerebrospinal fluid leak in adults: A STROBE analysis

AimThe main aim of this study was to evaluate 6-month closure success in surgery for isolated or non-isolated temporal bone osteomeningeal breach (OMB). Secondary objectives were to analyze complications of closure and correlations between success and breach, treatment and patient data. Material and methodThis was a single-center retrospective observational study of patients who underwent surgery for temporal bone OMB via a middle cranial fossa or transmastoid approach in a French university teaching hospital between 2007 and 2022, with follow-up of at least 6months. Patients with superior semicircular canal dehiscence were excluded. Study data comprised gender, age, body mass index, OMB etiology, mode of discovery, audiometric and radiological data, surgical technique, length of hospital stay and postoperative complications. The primary endpoint was absence of a cerebrospinal fluid leak on MRI at 6months. Fisher's exact test or Chi2 test were used for qualitative data and Student t-test for quantitative data. ResultsThe closure success rate was 87%: 81% (3 recurrences) in the middle cranial fossa group of 16 patients and 93% in the transmastoid group of 14 patients. Postoperative audiometry showed significant improvement (P=0.0016) for air conduction in the middle cranial fossa group. Five patients (17%) operated on via the middle cranial fossa approach and 1 (7%) operated on via the transmastoid approach had postoperative complications. OMB was in the tegmen mastoideum in 8 patients (29%), tegmen tympani in 7 (25%), tegmen antri in 4 (14%), tegmina antri and tympani in 3 (11%), antri and mastoideum in 1 (8%) and in the whole tegmen in 5 (18%). Eleven OMBs were lateral to the superior semicircular canal, 13 medial and 4 on either side. ConclusionThe transmastoid approach is indicated in case of associated middle-ear procedures, patients aged over 75years or OMB lateral to the superior semicircular canal. The middle cranial fossa approach is reserved for OMB located medial to the superior semicircular canal patients under 75years of age without associated ossicular procedures. For patients with OMB medial to the superior semicircular canal who require middle-ear surgery, a combined approach can be used.

Discovery of the Optical and Radio Counterpart to the Fast X-Ray Transient EP 240315a

Fast X-ray Transients (FXTs) are extragalactic bursts of soft X-rays first identified ≳10 yr ago. Since then, nearly 40 events have been discovered, although almost all of these have been recovered from archival Chandra and XMM-Newton data. To date, optical sky surveys and follow-up searches have not revealed any multiwavelength counterparts. The Einstein Probe, launched in 2024 January, has started surveying the sky in the soft X-ray regime (0.5–4 keV) and will rapidly increase the sample of FXTs discovered in real time. Here we report the first discovery of both an optical and radio counterpart to a distant FXT, the fourth source publicly released by the Einstein Probe. We discovered a fast-fading optical transient within the 3′ localization radius of EP 240315a with the all-sky optical survey ATLAS, and our follow-up Gemini spectrum provides a redshift, z = 4.859 ± 0.002. Furthermore, we uncovered a radio counterpart in the S band (3.0 GHz) with the MeerKAT radio interferometer. The optical (rest-frame UV) and radio luminosities indicate that the FXT most likely originates from either a long gamma-ray burst or a relativistic tidal disruption event. This may be a fortuitous early mission detection by the Einstein Probe or may signpost a mode of discovery for high-redshift, high-energy transients through soft X-ray surveys, combined with locating multiwavelength counterparts.

Pituitary Incidentaloma Complicated by Pan Hypopituitarism at the Health Reference Centre of Commune III of the District of Bamako: Case Report

A frequent mode of discovery since the improvement of imaging techniques is the pituitary incidentaloma, defined as the discovery of a pituitary adenoma without clinical signs on a scanner or magnetic resonance imaging (MRI) performed for another reason. We report a case of pituitary macroadenoma complicated by panhypopituitarism, discovered incidentally as part of the macroangiopathic complications of type 2 diabetes at the reference health centre in commune III of the Bamako district. It has poor semiological characteristics but poses a diagnostic problem. In our case, the patient presented with physical asthenia and headaches. On biology, the patient presented with 5 lines of anteropituitary insufficiency. A scan revealed a pituitary adenoma measuring 27x22. Anatomopathological examination of the surgical specimen concluded that it was a pituitary adenoma. The patient received hydrocortisone and thyroid hormones prior to excision. This case highlights the delay in the diagnosis and management of pituitary adenomas.

Epidemiological, Clinical and Therapeutic Aspects of Diabetes Mellitus in the Elderly in the Internal Medicine Department of the University Hospital Center Point G

Introduction: Diabetes mellitus in the elderly is a complex chronic disease and represents a real public health problem. The diabetic elderly person is particularly fragile since they combine the effects of aging and disease. Methodology: This was a descriptive, cross-sectional and analytical study with retrospective data collection extending from January 2007 to December 2021 carried out in the Internal Medicine department of CHU Point G in Bamako (Mali). Data were collected from medical records and entered and analyzed with SPSS 16.0 version 22 software. Results: We report a hospital frequency of 8.94% with an average age of 72.75 ± 7.16 years. A female predominance was observed. The foot wound was the main reason for hospitalization. The most frequent nosological type of diabetes was type 2. The mode of discovery of diabetes mellitus was mainly fortuitous. The mean HbA1c was 10.44±2.79%. Hyperosmolar hyperglycemia syndrome was the most found acute complication while PAD and diabetic neuropathy were the predominant chronic complications. High blood pressure has been frequently associated with diabetes. The treatment of diabetes was mainly based on insulin antidiabetics. Conclusion: The elderly diabetic must be studied as a whole in order to prescribe an appropriate treatment taking into account comorbidities, prevent certain complications and avoid polymedication as much as possible.

Microcytic Anemia Revealing Acromegaly

Acromegaly is a rare endocrinopathy, related to the hyperfunction of the somatotropic axis. We report through this observation an unusual mode of discovery of acromegaly: microcytic anemia. 38-year-old patient, followed for 1 year for microcytic anemia under iron treatment. On clinical examination, the patient presents an anemic syndrome with a frank dysmorphic syndrome evoking acromegaly. The assessment showed a microcytic anemia at 3.8 g/dl for which he received a transfusion of 09 red blood cells. An IGF1 assay and a hypothalamic-pituitary MRI confirmed the diagnosis of acromegaly secondary to a pituitary macro-adenoma measuring 30x25x18mm. Pituitary Function Testing revealed hypogonadotropic hypogonadism, hyperprolactinemia 5 times normal and thyrotropic deficit. The etiological assessment of the anemia revealed several hemorrhagic gastrointestinal angiodysplasia lesions, probably related to his acromegaly. Acromegaly is a classic cause of colonic polyps, but angiodysplasia lesions have not been described in the literature to our knowledge: is it a digestive tropism of acromegaly that continues to grow? Acromegaly is rarely revealed by anemia, the causal link remains to be established.

A Rare Case of Essential Thrombocythemia Revealed by an Acute Coronary Syndrome: Management Difficulties and Therapeutic Challenges

Essential thrombocythemia is a clonal abnormality of the multipotent hematopoietic stem cell and results in an increased number of platelets. Patients are at risk of microvascular thrombosis and hemorrhage. The occurrence of an acute coronary syndrome may be a rare revealing mode of discovery of essential thrombocythemia. We report the case of a 67-year-old patient admitted for management of an acute coronary syndrome with the discovery during his assessment of a thrombocythemia reaching up to 966,000/mm3. in the context of the etiological assessment of the thrombocytosis, the diagnosis of essential thrombocythemia was retained. Acute coronary syndrome occurs in 9.4% of patients with essential thrombocytosis. In patients with ET, there is a vicious cycle in which the marked increase of activated platelets causes vascular endothelial damage, induces the instability of coronary plaque, evokes the rupture or erosion of the plaque, and consequently activates other resting platelet. The diagnosis of ACS in patients with essential thrombocythemia is similar to that of the general population, nevertheless in terms of treatment, Antithrombotic treatment remains a difficult decision to take. It is necessary to balance the risk of thrombosis and hemorrhage. the optimal long-term treatment of acute coronary syndrome is a dual antiplatelet therapy (DAT) with clopidogrel and Aspirin and adding Hydroxyurea to the DAPT makes the treatment optimal.

New GABA-Targeting Therapies for the Treatment of Seizures and Epilepsy: I. Role of GABA as a Modulator of Seizure Activity and Recently Approved Medications Acting on the GABA System.

γ-Aminobutyric acid (GABA) is the most prevalent inhibitory neurotransmitter in the mammalian brain and has been found to play an important role in the pathogenesis or the expression of many neurological diseases, including epilepsy. Although GABA can act on different receptor subtypes, the component of the GABA system that is most critical to modulation of seizure activity is the GABAA-receptor-chloride (Cl-) channel complex, which controls the movement of Cl- ions across the neuronal membrane. In the mature brain, binding of GABA to GABAA receptors evokes a hyperpolarising (anticonvulsant) response, which is mediated by influx of Cl- into the cell driven by its concentration gradient between extracellular and intracellular fluid. However, in the immature brain and under certain pathological conditions, GABA can exert a paradoxical depolarising (proconvulsant) effect as a result of an efflux of chloride from high intracellular to lower extracellular Cl- levels. Extensive preclinical and clinical evidence indicates that alterations in GABAergic inhibition caused by drugs, toxins, gene defects or other disease states (including seizures themselves) play a causative or contributing role in facilitating or maintaning seizure activity. Conversely, enhancement of GABAergic transmission through pharmacological modulation of the GABA system is a major mechanism by which different antiseizure medications exert their therapeutic effect. In this article, we review the pharmacology and function of the GABA system and its perturbation in seizure disorders, and highlight how improved understanding of this system offers opportunities to develop more efficacious and better tolerated antiseizure medications. We also review the available data for the two most recently approved antiseizure medications that act, at least in part, through GABAergic mechanisms, namely cenobamate and ganaxolone. Differences in the mode of drug discovery, pharmacological profile, pharmacokinetic properties, drug-drug interaction potential, and clinical efficacy and tolerability of these agents are discussed.

Dewey, Implementation, and Creating a Democratic Civic University

Dewey, Implementation, and Creating a Democratic Civic University

Epidemiology and Management of Heart Failure in the Medicine Department of Tombouctou Hospital

Introduction: Heart failure is a complex syndrome and very frequently observed and secondary to the outcome of many advanced heart diseases. It is made up of a set of symptoms that reflect the tissue and visceral consequences of heart failure. The objective was to determine the hospital prevalence and to describe the management of heart failure in the medical department of Tombouctou hospital in Mali. Methods: This is a descriptive cross-sectional study with retrospective data collection, carried out over 24 months and involving the analysis of 266 records of patients hospitalized for heart failure. Results: The frequency of heart failure was 17.6% with a female predominance. The average age was 48 years with extremes of 16 and 90 years. Cardiovascular risk factors were dominated by high blood pressure with 38%. Global heart failure was the mode of discovery in 72.2% of cases. The etiologies were dominated by hypertensive dilated cardiomyopathy in 36.8% and peripartum cardiomyopathy in 32% of cases. The majority of our patients benefited from diuretic treatment, i.e. 95.9% frequency; with a favorable evolution in 96.2% of cases. We recorded 10 deaths, i.e. a lethality of 3.7%. We report some difficulties encountered during our security study because Tombouctou is a war zone and the lack of a technical platform for biology such as (BNP or NT-proBNP). Conclusion: Heart failure is a real public health problem. Its prevalence is increasing due to the aging of the population and especially the poor management of arterial hypertension in our context.

RF33 | PSUN01 Clinical Course of Benign Adrenal Cysts: A Single-Center Experience of 90 Patients

Abstract Introduction Benign adrenal cysts (BACs) comprise 1% of adrenal incidentalomas. Scarce data are available to guide hormonal evaluation and management. We aimed to describe the clinical presentation, imaging characteristics and outcomes of patients with BACs. Methods This was a single center retrospective study of patients with histologically or radiologically confirmed BACs evaluated between 1995-2021. Other cystic adrenal lesions (such as cystic pheochromocytoma and adrenocortical cancer) were excluded. Medical records were reviewed for clinical, biochemical, radiological, and surgical information. Subgroup analyses based on surgical versus nonsurgical management was performed. Results BACs were diagnosed in 92 patients (53, 57% women) at a median age of 45 years. Mode of discovery was incidental on imaging in 81 (88%), symptoms of mass effect in 9 (9.8%), and other in 2 (2.2%). Majority (89, 97%) of patients had unilateral cysts (45 right, 44 left) with a median size of 48 mm (range 4-200) at diagnosis. On imaging, most cysts were round/oval (85.4%), homogenous (83.2%) lesions with calcifications (64.0%) and no vascular enhancement (97.7%). During a median follow-up of 65 months (range 7-288), adrenal cysts demonstrated minimal enlargement (median size change 6 mm, median growth rate 2 mm/year).Age of diagnosis, sex, site and initial size of BAC were not associated with an increase in size during follow up. On hormonal evaluation, 10% (5/50 tested) had an abnormal overnight dexamethasone suppression test, and 9.5% (4/42 tested) had an abnormal case detection testing for primary aldosteronism. Adrenalectomy was performed in 46 (51%) patients. Patients treated with adrenalectomy (46, 50%) were younger (36.9 vs 50.8 years, P=0.0009) and had more rapidly enlarging cysts (median growth rate 5.5 vs 0.4 mm/year, P=0.0002). Conclusions BACs are usually incidentally discovered and nonfunctional lesions with excellent prognosis, irrespective of management. On imaging, benign adrenal cysts appear as large, homogenous lesions without vascular enhancement that demonstrate slow growth. Adrenalectomy should be reserved for the minority of patients with abnormal hormonal evaluation or imaging characteristics (heterogenous, vascular enhancement) concerning for an alternate etiology, or those who develop symptoms of mass effect. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Monday, June 13, 2022 12:42 p.m. - 12:47 p.m.

Clinical course and imaging characteristics of benign adrenal cysts: a single-center study of 92 patients.

Benign adrenal cysts are rare lesions of the adrenal glands. Limited data are available to guide management. We aimed to describe the presentation and outcomes of patients with benign adrenal cysts. Retrospective longitudinal cohort study. Consecutive patients with histologically or radiologically confirmed adrenal cysts between 1995 and 2021 were identified. Pheochromocytomas and malignancy were excluded. Benign adrenal cysts were diagnosed in 92 patients (53, 57% women) at a median age of 45 years. Mode of discovery was incidental on imaging in 81 (88%), symptoms of mass effect in 9 (9.8%), and others in 2 (2.2%). Majority (89, 97%) of patients had unilateral cysts (45 right, 44 left) with a median size of 48 mm (range 4-200) at diagnosis. On imaging, most cysts were round/oval (85.4%), homogenous (83.2%) lesions with calcifications (64.0%) and no vascular enhancement (97.7%). During a median follow-up of 65 months (range 7-288), adrenal cysts demonstrated minimal enlargement (median size change 6 mm, median growth rate 2 mm/year). On hormonal evaluation, 10% (5/50 tested) had an abnormal overnight dexamethasone suppression test, and 9.5% (4/42 tested) had an abnormal case detection testing for primary aldosteronism. Patients treated with adrenalectomy (46, 50%) were younger (36.9 years vs 50.8 years, P = 0.0009) and had more rapidly enlarging cysts (median growth rate 5.5 mm/year vs 0.4 mm/year, P = 0.0002). Benign adrenal cysts are usually incidentally discovered, non-functional, homogenous lesions without vascular enhancement that demonstrate minimal growth. Adrenalectomy should be reserved for patients with heterogeneous lesions, abnormal hormonal evaluation, or those with mass effect symptoms.

Genetic Characteristics of Incidental Pheochromocytoma and Paraganglioma.

Pheochromocytomas and paragangliomas (PPGLs) are being increasingly discovered by imaging performed for unrelated conditions. The genetic landscape of incidental PPGLs remains to be elucidated. We aimed to describe the genetic characteristics of PPGLs discovered incidentally in a large PPGL cohort. This retrospective cross-sectional study included 697 patients with pathology confirmed PPGLs, including 283 incidentalomas and 414 nonincidentalomas, at 2 tertiary care centers in China in 2009-2019. Tumor DNA samples were sequenced by next-generation sequencing. Identified genetic mutations were confirmed by Sanger sequencing and tested in 277 available matched blood DNA samples. There was a lower proportion of patients with mutations identified (53% vs 63.3%; P = 0.0067) in incidental than nonincidental PPGLs. In incidental PPGLs, HRAS (11.7%), FGFR1 (11%), and RET (9.2%) were the top 3 mutated genes, whereas HRAS (17.9%), VHL (9.2%), and NF-1 (8.7%) exhibited the highest rate of mutations in nonincidental PPGLs. In incidental pheochromocytomas, the most frequently mutated genes were RET (10.9%), HRAS (10.4%), and VHL (8.6%), while in incidental paragangliomas, FGFR1 (32.8%), HRAS (16.4%), and EPAS1 (9.8%) topped the list. The frequency of NF-1 mutations was significantly lower in incidental than nonincidental pheochromocytomas (4.1% vs 11%; P = 0.0042), while FGFR1 mutations were far more common in incidental than nonincidental paragangliomas (32.8% vs 15.3%; P = 0.0076). More than half of patients with incidental PPGLs had mutations in common susceptibility genes. The search for susceptibility genes should take both the mode of discovery (incidental vs nonincidental) and tumor location (pheochromocytoma vs paraganglioma) into consideration.

Assessment of Insulin Therapy in 281 Children and Adolescents with Type 1 Diabetes in Senegal

Introduction: In Senegal, with the CDIC “Changing Diabetes In children” project, insulin has been made free. The objective of this study was to evaluate the accessibility and modalities of insulin therapy in the management of type 1 diabetes. Methodology: This was a retrospective study including patients followed for type 1 diabetes (T1DM) in hospital between April 2018 and December 2020. Results: 281 patients were included. The mean age was 14.22 years. The mean age at diagnosis was 11.28 years. Ketoacidosis was the main mode of discovery of diabetes at 51.6%. Premix and rapid insulins were most commonly used at 84.7% and 82.9% respectively, most often in combination. The most commonly used treatment regimen was three injections/day in 82.5% of cases. The average daily insulin dose was 0.62 IU/Kg/dr. Of the patients, 219 (78%) were self-monitoring of blood glucose. The average number of blood glucose checks was 1.78 per day. 76 patients (27%) went days without an insulin injection and up to 7 days in 51% of cases. The main reasons were forgetfulness, therapeutic errors and stock-outs. Hypoglycaemia was observed in 14.2%. The average glycated haemoglobin was 10%. Conclusion: Despite the efforts made, there are still challenges to improve access to insulin. The reinforcement of therapeutic education on insulin therapy is essential for a better quality of life of diabetic children and adolescents.

Monocentric experience of primary hyperparathyroidism surgery in Algeria

IntroductionPrimary hyperparathyroidism (PHPT) remains a relatively underdiagnosed disease in developing countries. The aim of this study was to assess the demographic, pathological, biochemical, and surgical characteristics of patients with primary hyperparathyroidism in a university hospital department of otolaryngology in eastern Algeria. Materials and methodWe performed a retrospective analysis of the records of 62 patients operated in our department for primary hyperparathyroidism between January 2002 and December 2013. ResultsThe mean age was 47.7 ± 15 years with a female preponderance (88.7%). The mode of discovery was during a biological assessment for bone syndrome in 42% of cases. The mean calcemia was 2.92 ± 0.6 mmol/L, and the intact serum parathyroid hormone was 867.78 ± 954.50 pmol/L. A total of 54.8% of patients had bilateral neck exploration, and 45.2% had minimally invasive open parathyroidectomy. Postoperative complications were dominated by severe hypocalcemia and hungry bone syndrome. ConclusionThe diagnosis of primary hyperparathyroidism in our country is late, and management is often performed after the appearance of bone and renal complications.

The impact of celebrity influence and national media coverage on users of an alcohol reduction app: a natural experiment

BackgroundSmartphone apps are increasingly used for health-related behaviour change and people discover apps through different sources. However, it is unclear whether users differ by mode of app discovery. Drink Less is an alcohol reduction app that received national media coverage in the UK caused by celebrity influence (a male TV and radio national broadcaster, aged 51). Our aim was to compare users who discovered the app before and after this coverage.MethodsA natural experiment assessing the impact of media coverage of Drink Less on users’ socio-demographic and drinking characteristics, app engagement levels, and extent of alcohol reduction. The study period was from 17th May 2017 to 23rd January 2019, with media coverage starting on 21st August 2018. Users were 18 years or over, based in the UK and interested in drinking less. Interrupted time series analyses using Generalised Additive Mixed Models were conducted for each outcome variable aggregated at the weekly level.ResultsIn 66 weeks prior to the media coverage, 8617 users downloaded the app and 18,959 in 23 weeks afterwards. There was a significant step-level increase in users’ mean age (B = 8.17, p < .001) and a decrease in the percentage of female users (B = -27.71, p < .001), though these effects dissipated non-linearly over time. No effect of media coverage was detected on employment type or on the percentage of at-risk drinkers, though the mean Alcohol Use Disorders Identification Test score was lower after the media coverage (B = -1.43, p = .031). There was a step-level increase in app engagement – number of sessions (B = 3.45, p = .038) and number of days used (B = 2.30, p = .005) – which continued to increase over time following quadratic trends.ConclusionsCelebrity influence leading to national media coverage in the UK of the Drink Less app was associated with more people downloading the app who were male, older and engaged with the app; and did not appear to impact employment inequality.

Monocentric Experience of Primary Hyperparathyroidism Surgery in Algeria

Introduction: Primary hyperparathyroidism (PHPT) remains a relatively underdiagnosed disease in developing countries. Objectives: The aim of this study was to assess the demographic, pathological, biochemical and surgical characteristics of patients with PHPT in a university hospital department of otolaryngology in eastern Algeria. Materials and Method: Retrospective analysis of 62 patient records operated in our department for PHPT between January 2002 and December 2013. Results.- The mean age was 47.7 ± 15 years with a female preponderance (88.7%). The mode of discovery was during a biological assessment for bone syndrome in 42% of cases. The mean calcemia was 2.92±0.6 mmol/L and the intact serum PTH was 867.78±954.50 pmol/L. 54.8% of patients had bilateral neck exploration and 45.2% had minimally invasive open parathyroidectomy. Postoperative complications were dominated by severe hypocalcemia and hungry bone syndrome. Conclusion: The diagnosis of PHPT in our country is late and management is often performed at the stage of complications.

Etiologies of Chronic Renal Failure in Adolescent Patients at the University Hospital of Brazzaville

Objectives: The aim of our work was to identify the etiologies of chronic renal failure in adolescent patients. Patients and Methods: This is a descriptive cross-sectional retrospective study that included adolescents aged 10 to 19 years hospitalized between January 2014 and December 2017 in the department of nephrology at the University Hospital of Brazzaville. The CRF was defined according to the ANAES criteria by an estimated glomerular filtration rate less than 60 ml/min/ 1.73 m2 of body surface. Results: Forty cases of CRF were collected, representing a prevalence of 4.9%. The average age was 16.32 ± 3.64 years and the sex ratio was 3. The most common mode of discovery was edematous syndrome 62.5%. The most common etiology was glomerular nephropathies 60%, hereditary nephropathies 25% and malformative uropathies in 15%. Ten patients (25%) had moderate CFR at admission, 62.5% had severe CRF, 12.5% had terminal CFR and all of them died during the year. Conclusion: Epidemiological data CRF in adolescent patients in developing countries are scarce and limit treatment. Glomerular pathologies represent the most frequent etiology. Early treatment of chronic renal failure in childhood and multidisciplinary collaboration between pediatrician and nephrologist are necessary.

Cushing´s syndrome: high aggressiveness of low-grade tumors

Cushing´s syndrome is caused by prolonged exposition supraphysiological to endogenous or exogenous cortisol. Ectopic production of adrenocorticotropic hormone by lung carcinoid tumors is relatively rare. Most documented cases have been reported individually. This rare neoplasm low grade that may secrete adrenocorticotropin (ACTH) leading to rapid development of hypercortisolism which is the main mode of discovery, can be a real aggressive form. This report shows a high aggressiveness of this endocrine neoplasia, wich was marked on the general, morphological, bone and psychiatric level. The trivialization of clinical signs had caused the delay in diagnosis with irreparable bone consequences.