Pattern of Bone Metastasis in Breast Cancer Patients at a Radiotherapy Facility in Lagos.

Aim: To determine the pattern of bone metastasis in breast cancer patients. Study Design: Retrospective case series Place and Duration of Study: Data were collected at Eko Hospital radiotherapy facility, Lagos, Nigeria, between years 2006 and 2011. Methodology: A total of 67 patients with a histologically confirmed diagnosis of breast cancer from 2006 to 2011 treated at a radiotherapy facility were analysed to describe the pattern of bone metastasis. Radiological imaging included chest X-ray, X-rays of the bone, bone scan, and Computed Tomography scan (CT scan). Result: Of the 67 eligible breast cancer patients, one is male and 66 are female. The average age of the patients was 46 years old, ranging from 28 to 77 year old. Among the 67 patients who received radiotherapy, 58 (87%) have bone metastases. The most common sites of bone metastases are spine (61%), pelvis (22%), and long bones (22%). Among the 32 patients without metastasis at presentation, the median duration from diagnosis to onset of symptoms of bone metastasis was 16.5 months, ranging from 5 to 38 months. Thirty-one patients had osteoblastic lesions, 24 patients had osteolytic lesions, and 2 patients had mixed osteolytic and osteoblastic lesions. Conclusion: Bone metastasis remains common and incurable. Early recognition and better description of bone relapse patterns of metastatic breast disease will allow rapid administration of effective palliative treatment.

Effects of pyrimethamine-sulphadoxine, chloroquine plus chlorpheniramine, and amodiaquine plus pyrimethamine-sulphadoxine on gametocytes during and after treatment of acute, uncomplicated malaria in children

The effects of pyrimethamine-sulphadoxine (PS), chloroquine plus chlorpheniramine, a H1 receptor antagonist that reverses chloroquine resistance in Plasmodium falciparum in vitro and in vivo (CQCP), and amodiaquine plus pyrimethamine-sulphadoxine (AQPS) on gametocyte production were evaluated in 157 children with acute, symptomatic, uncomplicated falciparum malaria who were treated with these drugs. PS was significantly less effective than CQCP or AQPS at clearing asexual parasitaemia or other symptoms of malaria. Gametocyte carriage on days 3, 7, and 14 were significantly higher in those treated with PS. The ratio of the density (per æl blood) of peripheral young gametocyte (PYG), that is, < stage III to peripheral mature gametocyte (PMG), that is, stage IV and V, an index of continuing generation of gametocytes, rose to 1 by day 7 of treatment in those treated with PS, but remained consistently below 1 in the other treatment groups. PYG-PMG density ratio increased significantly from day 0-14 in those treated with PS and CQCP (chi2 = 76, P = 0.000001 and chi2 = 42.2, P = 0.00001, respectively) but decreased significantly in those treated with AQPS (chi2 = 53.2, P = 0.000001). Both PS-sensitive and -resistant infections generated PYG (18 of 29 vs 13 of 20, chi2 = 0.04, P = 0.93) but PYG was present only in those with resistant response to CQCP. Combination of PS with amodiaquine (AQ), that is, (AQPS) resulted in less production of PYG, but in this setting, PYG was not indicative of response to AQPS. These data indicate that PS enhanced production or release of young gametocytes when used alone, but generated less young gametocytes when used in combination with AQ. PYG may be used as an indicator of response to CQCP but not PS or PS-based combination drugs.

Effects of antifolates - co-trimoxazole and pyrimethamine-sulfadoxine - on gametocytes in children with acute, symptomatic, uncomplicated, Plasmodium falciparum malaria

Antimalarial drugs including the antifolate, pyrimethamine-sulfadoxine (PS), can modulate the prevalence and intensities of gametocytaemia following treatment of acute malaria infections. They may also directly influence the transmission and spread of drug insensitivity. Little is known of the effects of co-trimoxazole (Co-T), another antifolate antimalarial, on gametocytes in children with acute malaria infections. We compared the effects of Co-T and PS on the prevalence and intensities of gametocytaemia and gametocyte sex ratios in 102 children aged 0.5-12 years presenting with acute and uncomplicated falciparum malaria. Compared to pre-treatment, both drugs significantly increased gametocyte carriage post-initiation of treatment. However, gametocyte carriage was significantly lower on day 14 in those treated with Co-T than PS. Significant increase in gametocytaemia with time occurred in PS - but not Co-T-treated children. Kaplan-Meier survival curve of the cumulative probability of remaining gametocyte-free in children who were agametocytaemic at enrolment showed that by day 7 of follow up, children treated with PS had a significantly higher propensity to have developed gametocytes than in Co-T-treated children (Log-rank statistic 5.35, df = 1, P = 0.02). Gametocyte sex ratio changes were similar following treatment with both drugs. PS and Co-T treatment of acute malaria infections in children from this endemic area is associated with significant increases in prevalence and intensities of gametocytaemia but these effects are more marked in those treated with PS than Co-T.

Profile of chloroquine - induced pruritus in Nigerian children resident in Ibadan, Nigeria

Chloroquine is still the first-line drug in the treatment of malaria in Nigeria and West- Africa sub-region. A major drawback to the use of chloroquine is pruritus. We studied a total of 175 children aged 1­15 years with a view to assessing some factors that may influence chloroquine induced pruritus and the possible impact on therapy with this drug. The mean age was 5.2+4.0 and there were 87 females and 88 males. Chloroquine-induced pruritus was found in 43/175 (24.6%). All the subjects experienced the itching within 24 hours of ingestion of the drug and median duration of the itching was 2 days. Majority of those who itched still used chloroquine to treat malaria for various reasons. There was positive family history in 34/43 (79%) of those who itched and 57/132 (43%) of those who did not itch to chloroquine. Those who had chloroquine-induced pruritus were relatively older (mean age 6.90+3.68 years versus 4.64+4.00; p< 0.05) and mean age onset of chloroquine-induced pruritus was positively associated with mean age of the children r = 0.91; 95% confidence limits: 0.71< r < 0.91. We concluded that chloroquine-induced pruritus in this group of children evolved with increasing age and was associated with positive family history

Parental piroxicam arthralgia and musculoskeletal conditions of acute malarial [sic] : an open randomised comparison with oral acetylsalicylic acid and paracetamol

An open comparative trial of the toleration and safety of piroxicam; paracetamol and acetylsalicylic acid was conducted in 115 out patients with acute plasmodium falciparum malaria. Patients of both sexes received a single dose of sulfadoxine or pyrimethamine as anti-malarial therapy. Study participants were subsquently randomized to receive standard oral doses of paracetamol; acetylsalicylic; or injectable piroxicam; followed by oral doses of piroxicam; for management of fever; arthralgia and headache associated with acute malaria