Trace elements; copper, zinc and selenium, in breast cancer afflicted female patients in LAUTECH Osogbo, Nigeria.

BACKGROUND: There is an indication of the possibility of the direct or indirect influence of trace element in the development and prevention of malignant diseases, the contribution of the trace elements in the etiology of breast cancer has been under scrutiny. AIMS: The aim of this study was to determine the serum concentration of trace element in serum of female patients with breast cancer in comparison with healthy controls. SETTINGS: Breast Clinic of the Department of Surgery LAUTECH University teaching hospital Osogbo, in south-western Nigeria. MATERIALS AND METHODS: A cross-sectional age matched controlled prospective study wherein the venous blood sample of 30 patients with breast cancer and 30 healthy volunteers as controls were analyzed using atomic absorption spectrophotometry. The collected data were analyzed using statistical package for the social sciences (SPSS Inc) 16. RESULT: The mean serum concentration of the copper, zinc and selenium were 95.3 ± 4.9 ug/dl and 65.2 ± 15 ug/dl, 62.7 ± 15.7 ug/dl and 93.5 ± 7.2 ug/dl, 45.0 ± 4.6 ug/l and 76.4 ± 8.9 ug/l in the two groups respectively. The concentrations of copper and copper-zinc ratio (C/Z) were significantly higher in the cancer bearing group compared to the controls (C/Z 1.6 ± 0.5 against 0.70 ± 0.14 the P < 0.01). The concentration of zinc and selenium in the venous blood of the breast cancer patients showed inverse relationship while that of the control showed a direct relationship (-0.03 against 0.09). In the breast cancer patients the correlation of copper and zinc, copper and selenium and zinc and selenium showed inverse relationships, none of the relationships was statistically significant. CONCLUSION: We found a significant association between the serum concentration of trace elements and breast cancer.

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, post-premedication, 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.

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

Knowledge and practice of breast cancer screening among female nurses and lay women in Osogbo, Nigeria.

BACKGROUND: Breast cancer is the most common cancer among African women. Most researchers have attributed the late presentation to poor knowledge of breast cancer symptoms. OBJECTIVE: This study was designed to evaluate the relationship between knowledge and practice of breast cancer screening in two groups of women with different levels of knowledge of breast carcinoma. METHODS: A cross-sectional study was conducted using self administered questionnaire to assess the knowledge, attitudes and practice of breast cancer and screening programmes among nurses in a university teaching hospital, and women in non health professionals in south-western Nigeria. RESULTS: The mean knowledge score for the nurses was 10.9%±3.6 whereas the mean score for non-health professionals was 3.5%±4.1 (p value < 0.001). In those above the age of 40 years, comprising 141 subjects, 35 nurses and 106 women in non-health professionals, 22.9% and 15% respectively had had a mammogram (p=0.289,1.123). CONCLUSION: Good knowledge does not imply better screening rates in south-western Nigeria.

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

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 (69.56% from LTH). Fifty-two percent were males. It made up 0.94, 1.43, and 1.86% of 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 6% below the age of ten and 1.3% above 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 39.5% of 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 87% are 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.

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

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

Assessment of preventive oral health knowledge and practices among rural and urban mothers in Lagos state.

AIMS AND OBJECTIVES: To evaluate students' performance and its predictors in the preclinical examinations at the College of Health Sciences, Ladoke Akintola University of Technology Ogbomoso Nigeria. MATERIALS AND METHODS: A cross section of students' records admitted into medical programme in 1999/2000 sessions was studied. RESULTS: Younger students performed consistently better than the older ones in all the three subjects taken at the MBBS1. It was also noticed that the male students performed better, a statistically significant mean difference in score was observed in Biochemistry P>0.05. Students with better Ordinary level aggregate grade of (5-15) in the five core subjects at SSCE, consistently had better results in all the subjects taken at MBBS1 examination compared to their counter-part with aggregate SSCE grade of (16-30). Students that were admitted through JAMB performed better in all the three subjects than those that were admitted through pre-degree programme and the transferred students. However, the mean difference was statistically significant P<0.05 in Biochemistry only. CONCLUSION: Better performance at MBBS1 was found in younger age group, those with aggregate grade of (5-15) in SSCE and those admitted through JAMB. Ordinary level requirement irrespective of the mode of admission should not be compromised. Schools that admit students through pre-degree, transfer or direct entry will have to be more conscious of the quality of students they admit and also operate such system with utmost transparency and with a principle of promoting good academic standard.

Male breast cancer in LAUTECH Teaching Hospital Osogbo, South Western Nigeria.

AIM: To assess the prevalence, presentation, treatment and outcome of management of male breast cancer (MBC) in Osogbo, Nigeria. METHODS: A review of all cases of MBC seen at LAUTECH Teaching Hospital Osogbo between January 2004 and December 2006 was done. The age, presenting symptoms and signs, stage, histology, associated co-morbid illnesses, treatment and outcome of care were all retrieved and analysed. RESULTS: Seven (8.86%) out of seventy nine cases of breast cancers seen are males. Ages ranged between 38 and 80 years (mean 60.5 median 65 years). They all presented with advanced lesions after a 6 -36 months delay (mean-11.57 months). All were invasive ductal carcinoma. All the four with significant co-morbid illnesses died of them within one week to seven months. Only one patient had mastectomy. CONCLUSION: MBC constitutes 8.86% of all breast cancer, all presented late with advanced lesions and co-morbid illnesses contributed significantly to mortality.

Predictors of students'performance in the pre-clinical MBBS programme in a Nigerian University.

AIMS AND OBJECTIVES: To evaluate students' performance and its predictors in the preclinical examinations at the College of Health Sciences, Ladoke Akintola University of Technology Ogbomoso, Nigeria. MATERIALS AND METHODS: A cross section of students' records admitted into medical programme in 1999/2000 sessions was studied. RESULTS: Younger students performed consistently better than the older ones in all the three subjects taken at the MBBS1. It was also noticed that the male students performed better, a statistically significant mean difference in score was observed in Biochemistry P<0.05. Students with better Ordinary level aggregate grade of (5-15) in the five core subjects at SSCE, consistently had better results in all the subjects taken at MBBS1 examination compared to their counter-part with aggregate SSCE grade of (16-30). Students that were admitted through JAMB performed better in all the three subjects than those that were admitted through pre-degree programme and the transferred students. However, the mean difference was statistically significant P<0.05 in Biochemistry only. CONCLUSION: Better performance at MBBS1 was found in younger age group, those with aggregate grade of (5-15) in SSCE and those admitted through JAMB ordinary level requirement irrespective of the mode of admission should not be compromised. Schools that admit students through pre-degree, transfer or direct entry will have to be more conscious of the quality of students they admit and also operate such system with utmost transparency and with also operate such system with utmost transparency and with a principle of promoting good academic standard.

Rotational rural surgery for the poor in developing countries.

Radio and television announcements advised patients with surgical problems in the rural areas of Osun State, Nigeria, to report at any of the nine zonal headquarters of the state which were closest to their homes in order to receive free treatment. Over 1000 patients reported and 801 received operations on a rotational basis within nine weeks. We studied 719 of these patients, ages between 4 months and 87 years, who had detailed follow-up records. There were 14 different procedures ranging from a hernia repair to the separation of syndactyly. Complications included postoperative pain, haematoma and late superficial wound infection. We concluded that rotational free surgery can help the poor in the third-world countries to receive treatment that they would otherwise not be able to afford.

Pattern and outcome of emergency surgery in a new Nigerian Teaching Hospital--The LAUTECH Osogbo experience.

AIMS AND OBJECTIVES: To present a 5 years experience on the pattern and outcome of emergency operations in a new teaching hospital. MATERIALS AND METHODS: A retrospective study carried out between April 1998 and March 2003 with appropriate data extracted from the available case notes. RESULTS: Two thousand and seventy operations were performed within the period of study. Seven hundred and twenty six of them were done as emergency. Obstetrics' and Gynaecology cases were 66.6% while 33.4% (including six cases of perforated uterus and gangrenous bowel from unsafe abortion) belong to the general surgery and specialty emergencies. Waiting time, mean of which was 39.5+/-2.7 hours, was unduly prolonged. Mortality was 10.3%. CONCLUSION: The high morbidity and mortality as reflected in this study could be reduced through prompt surgical interventions, education on contraceptive awareness and legistilation against unsafe abortion.

Knowledge, attitudes and practices of the educated and non-educated women to cancer of the breast in semi-urban and rural areas of SouthWest, Nigeria.

OBJECTIVES: That women with cancer of the breast seek medical help late is a common occurrence in developing countries. We decided to see if education and environment play any role in this and in cancer screening. A semi-structured questionnaire was drawn to inquire about knowledge, attitude (beliefs) and practices of women to breast cancer and available cancer screening methods in their environment- particularly Self and Clinical Breast Examination. PATIENTS AND METHODS: The questionnaires, prepared in English and vernacular, were given to women and women relations seen in the surgical clinics and wards of Ladoke Akintola University Teaching Hospital, Osogbo and some primary health centers, for various ailments. Traders in market places and rural communities were included. RESULTS: Analysis was by SPSS, chi-square, percentage frequency and tested at probability level of 0.05. Eight hundred and thirty two respondents were collected. Six hundred and twenty five (72.2%) were from Semi-urban while 207(27.8%) were from the rural regions. The age range was between 15 and 72 years with a mean age of 30.89+/-11.58. The educational level showed that 304(36.4%) had tertiary education. Six hundred and four (72.6%) have previous knowledge of cancer of the breast, 149(17.4%) offered possible aetiological reasons, and 341(41.1%) have some knowledge of associated symptoms. Available screening methods of Self and Clinical breast examination was practised by 393(47.2%) of the respondents. One hundred and fifty five (32.3%) would give consent to mastectomy while as many as 619(74.4%) have deep fear of the disease. CONCLUSION: Despite a relatively high literate level in the study group, knowledge of aetiological causes of breast cancer, including risk factors is abysmally low; so is knowledge and attitude to symptoms. Because of this poor/inadequate knowledge, as well as available screening methods, efforts should be made to upgrade the knowledge of our women through Information, Education and Communication (I.E.C) on cancer of the Breast and the consequences of late presentation.

Generalised Burkitt's lymphoma involving both breasts--a case report.

BACKGROUND: Burkitt's lymphoma is a disease of children age ranging 8-10 years. Lymphoma involving the breast is an unusual clinical entity, which is rarely distinguished preoperatively from other more common forms of breast cancer. The Management differs from the more typical adenocarcinoma of the breast in that the emphasis is on systemic therapy. CASE: We report a 27-year-old pregnant Nigerian civil servant at 28 weeks gestation, who presented with multiple organ swellings including both breasts. She was diagnosed histologically as primary breast Burkitt's lymphoma. She was treated with systemic chemotherapy after spontaneous abortion. She had a recurrence of the lesion in the right breast a month later that was excised. Presently there is no evidence of any mass. CONCLUSION: Compared with breast carcinoma, primary breast lymphoma is a rare disease but should be considered in the differential diagnosis of breast masses.

Cryptorchidism in a local population in Nigeria.

OBJECTIVE: To screen for undescended testis, retractile testis and other anomaly of the external genitalia in randomly selected Nursery/Primary schools in Osogbo, Nigeria. DESIGN: A prospective study involving seven different Nursery/Primary schools with 1615 male pupils ages 2-10 years were screened. SETTING: Five private Nursery/Primary schools and two government owned primary school in Osogbo. METHODOLOGY: Permission was sought from the schools' Headmasters through the proprietors of the private schools, Local inspector of Education of government primary schools, and the ethical committees of the University and the Teaching Hospital Male pupils were examined by three groups made up of a consultant and a resident in each group. RESULTS: A total of 1615 male pupils were examined out of which 40 pupils (2.5%) were found to have undescended testis, five of these (12.5%) had bilateral cryptorchidism. Eighteen had right undescended testis (45.0%) while seventeen (42.5%) presented with left undescended testis. Four pupils had retractile testis two on each side and another four had a co-existing hydrocoele with their undescended testis. CONCLUSION: Prevalence of Cryptorchidism in the age group in this study is significant. There is need to screen male children so that early detection and correction may be effected.

Intestinal obstruction from a forgotten artery forceps: a case report.

A 43-year-old multiparous patient p2+0 all alive who had abdominal hysterectomy secondary to ruptured uterus 2 1/2 years prior to presentation, was seen with acute (surgical) abdomen. An artery forceps was seen on plain abdominal X-ray and subsequent laparotomy revealed gangrenous ileum. The entire length of the ileum was involved, including the ileocecal valve and part of the cecum. The patient had limited right hemicolectomy and anastomosis of the distal part of the jejunum with the proximal section of the transverse colon. The post-operative period was uneventful and she was discharged to outpatient clinic 2 weeks post operatively.

Ureteric injuries following pelvic operations.

BACKGROUND: Iatrogenic injuries to the ureter are hazardous complications of pelvic operations, causing severe morbidity and even mortality. OBJECTIVE: To present our 10 years experience in the management of such ureteric injuries. DESIGN: A retrospective study carried out between January 1990 and December 1999. SETTING: Two busy health institutions, namely Ife State hospital and Wesley Guild Hospital, both of the Obafemi Awolowo University (OAU) Teaching Hospitals Complex, Ile-Ife, Nigeria. RESULTS: The incidence of iatrogenic injury was 0.4%. Ureteral transection was the commonest lesion (58%). Ureteroneocystostomy was performed in 70% of the operated cases. Those diagnosed at the time of injury and treated with end-to-end anastomosis had the best results. CONCLUSION: The proper identification and, when necessary, isolation of the ureter during operations in which there is a risk is crucial in reducing the incidence of ureteral injuries.