Electrocardiographic Changes during Oesophagogastroscopy

Background: Oesophagogastroduodenoscopy (EGD) should be very safe, but there are many potential hazards,although the rate of serious complications is small. There are so many complications that can arise during this procedure.Most of these complications involve the respiratory or cardiovascular systems, especially in sick or sedated patients.The aim of this study was to determine the various electrocardiographic changes that can occur at different stages of diagnostic EGD and to determine their severity.Materials and Methods: The study is a descriptive one which was carried out at the endoscopy unit of Ladoke Akintola University of Technology Teaching Hospital, (LAUTECH), Osogbo, Osun State. Consecutive patients who were referred for oesophagogastroduodenoscopy (EGD) over a 3-month period and who consented to take part in the study were recruited. The electrodes of a portable electrocardiographic (ECG) machine (model Cardiovit AT_1ECG Machine) were attached to the patients accordingly and remained fixed till the end of the procedure. ECG recordings were done at baseline, postpremedication, during intubation and 5 minutes postprocedure. The results of the study were analyzed using simple descriptive statistical methods such as range, mean and standard deviation for continuous variables, and numbers and percentages for discreet variables.Results: Twenty-six (26) patients were studied, comprising 14 (53.8%) males and 12 (46.2%) females. The mean age of the patients was 47.19 ± 14.42 years. Three (11.5%) patients had tachycardia at the beginning of the procedure, while 13 (50%) patients developed tachycardia postpremedication and during the procedure, whereas 17 (65.4%) patients had tachycardia at the end of the procedure. Only one patient had bradycardia. Various ST-T wave abnormalities were observed at each stage of the procedure. Conduction abnormality was observed in 8 (30.8%), 9 (34.6%), 7 (26.9%) and 5 (19.2%) patients at rest, post-premedication, during the procedure and postprocedure respectively. Premature ventricular complexes (PVC) were observed in 4 (15.4%), 5 (19.2%), 4 (15.4%), and 4 (15.4%) patients at rest, postpremedication,during the procedure and post procedure respectively. Conclusion: This study has shown that, although ECG abnormalities do occur during EGD, these abnormalities are not severe enough to warrant specific interventions or discontinuation of the procedure

Non-Adherence to the Use of Tamoxifen in the First Year by the Breast Cancer Patients in an African Population

Background: Tamoxifen has been in use worldwide in the care of breast cancer over decades.It has been found to significantly reduce disease free survival and also reduce the chance of recurrence. The issue of non-adherence (NA) to its usage has not been reported in the black African setting. The aim of this study was to determine the rate and contributory factors to non adherence rate to tamoxifen during the first year of usage in patients with breast cancer in LAUTECH teaching hospital (LTH) Osogbo ; Nigeria .Methods: One hundred and fourteen patients (108 females and 6 males) were studied during their various first year of tamoxifen usage at LTH Osogbo; South-Western Nigeria between June 2001 and June 2005.The incidence; indications and variables that might contribute to NA e.g. age; sex; disease stage; occupation etc were assessed.Results; indings included NA rate of 24.5(72of which occurred in the first 6 months of usage). Adherence tend to worsen with age and higher disease stage (p=0.154 and 0.146 respectively). Non-adherence was commoner in farmers and traders while unbearable side effects and financial constraints are most common reasons.Conclusion: The 24.5non-adherence rate; though comparable with results from other reports is unacceptably high These patients could not have been receiving full benefits of hormonal treatment; thus adequate counseling and education on benefit and side effects of tamoxifen is strongly advised

Bilateral Breast Cancer: Experience in a Poor Resource Black African Setting

Background: Breast cancer is the most common malignancy in women in Nigeria. Women previously treated for ipsilateral breast cancer have increased risk of developing contalateral breast cancer (CBC); the chance of which increases with longer period of survival and is associated with worse prognosis. Reports from Nigeria are few on this. The aim of this study was to assess the prevalence; predisposition; presentation; and outcome of management of bilateral breast cancer (BBC) in a population; South-western Nigeria.Methods: A review of bio-data of all patients with BBC seen in LTH; Osogbo; Nigeria between 2001 and 2008 was done. Age; parity; age at menarche and first child birth; family history; duration of symptoms; tumour characteristics and exposure to cigarette; oral contraceptive pills (O.C Pills) and outcome of treatment were also assessed.Results: BBC constituted 4.6of the 256 breast cancer patients. Eight (73) were metachronous and 91were infiltrating ductal carcinoma. Patients' mean age; mean age at menarche and first child birth were 39; 14.5+3 and 22.5yrs respectively. Mean parity was 3.5 child birth; 91were premenopausal and all have menstruated for 12-31yrs. None had positive family history while only 1 and 3 had insignificant exposure to cigarette and O.C pills respectively. The mean interval between the 2 onsets was 18mths (0-68mths). 91of all tumours were advance; while 81of the first tumours were on the right. Mean duration before presentation for the first and second tumours were 261 and 111 days respectively. One patient has survived for 2 years thus far.Conclusion: The incidence of BBC was 4.26. Most patients were young and premenopausal with mostly infiltrating ductal carcinoma (NOS) and presenting with late stage disease; hence poor prognosis. Aggressive follow-up of patients with ipsilateral cancer will aid early detection of CBC

Appendicitis: Trends in Incidence; Age; Sex; and Seasonal Variations in South-Western Nigeria

Background : Appendicitis is a common clinical condition worldwide. Differences in incidences; sex; age; and seasonal variations have been reported widely; with paucity of information from Nigeria. Aim : To assess the trends in incidence and pattern of variation with age; sex; and seasons of the year. Materials and Methods : A review of the records of all patients with confirmed appendicitis treated in both the LAUTECH Teaching Hospital (LTH) and the Abake Medical Center (AMC); both situated in Osogbo; Nigeria; between January 2003 and December 2008; was done. LTH was a 320-bed University Hospital (with 100 surgical beds); while AMC was a 20-bed surgical center. The age; sex; and month of admission of all the histologically proven cases of appendicitis were retrieved and treated. Analysis was done using simple percentages; Student t or Chi-square tests; where applicable. Results : A total of 299 out of 321 cases of appendicitis recorded during the observed period were confirmed histologically from both hospitals (69.56from LTH). Fifty-two percent were males. It made up 0.94; 1.43; and 1.86of the total hospital admissions in 2004; 2006; and 2008; respectively. There has been an increasing incidence in both sexes almost in a similar pattern. The overall mean age was 25.79 years (M 25.94 and F 25.43 years) with 6below the age of ten and 1.3above 60 years. The highest incidence in males and females occurred in the second and third decades; respectively. Incidences were higher during the rainy season (April to September) 68; P 0.05); with peaks from June to August; when 39.5of all cases presented. Conclusion : The increasing incidence of appendicitis in both sexes in this region may be due to the change to a Western lifestyle. The age distribution has a similar pattern in both sexes and 87are 40 years or less; although the incidence is marginally higher in males. Higher prevalence of infections and allergens from pollens in the rainy season could contribute to a higher incidence of appendicitis