ABSTRACT
INTRODUCTION: Oncologic surgical extirpation, the mainstay of loco-regional disease control in breast cancer, is aimed at achieving negative margins and lymph node clearance. Even though axillary lymph nodal metastasis is a critical index of prognostication, establishing the impact of lymph node ratio (LNR) and adequate surgical margins on disease-specific survivorship would be key to achieving longer survival. This study examines the prognostic role of pN (lymph nodes positive for malignancy), LNR and resection margin on breast cancer survival in a tertiary hospital in Ibadan, Nigeria. METHODS: We conducted a longitudinal cohort study of 225 patients with breast carcinoma, documented clinico-pathologic parameters and 5-year follow up outcomes - distant metastasis and survival. Chi-square test and logistic regression analysis were used to evaluate the interaction of resection margin and proportion of metastatic lymph nodes with patients' survival. The receiver operating characteristic curve was plotted to determine the proportion of metastatic lymph nodes which predicted survival. The survival analysis was done using Kaplan-Meier method. RESULTS: Sixty (26.7%) patients of the patients had positive resection margins, with the most common immuno-histochemical type being Lumina A. 110 (49%) patients had more than 10 axillary lymph nodes harvested. The mean age was 48.6 ± 11.8 years. Tumour size (p = 0.018), histological type (p = 0.015), grade (p = 0.006), resection margin (p = 0.023), number of harvested nodes (p < 0.01), number of metastatic nodes (p < 0.001) and loco-regional recurrence (p < 0.01) are associated with survival. The overall 5-year survival was 65.3%. CONCLUSION: Unfavourable survival outcomes following breast cancer treatment is multifactorial, including the challenges faced in the multimodal treatment protocol received by our patients.
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BACKGROUND: Little is known about the competences of residents as clinical teachers in African health care institutions. OBJECTIVE: We evaluated the clinical teaching skills of internal medicine residents from the perspective of medical students in a tertiary teaching institution in Africa. METHODS: We used the augmented Stanford Faculty Development Program Questionnaire, which has evidence of validity and reliability. To avoid a Hawthorne effect, students completed the questionnaire anonymously and confidentially after clinical teaching sessions by residents. A minimum score of 4 on a scale of 1 to 5 was defined a priori as possession of good clinical teaching skills. RESULTS: Sixty-four medical students assessed all 20 internal medicine residents in the Department of Medicine, University of Ibadan. Mean performance scores for the domains ranged from 3.07 to 3.66. Residents performed best in creating a good learning climate and worst in the promotion of understanding and retention. Sex of the resident, duration of residency, and rank had no significant impact (.09 < P < .94) on their teaching skills. CONCLUSIONS: Consistent with other observations in the literature, residents' clinical teaching skills were suboptimal, particularly in their ability to promote understanding and retention. To enhance these skills, we recommend the integration of appropriately tailored programs to teach pedagogic skills programs in residency training.
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BACKGROUND: The prevalence of differentiated thyroid cancer (DTC) is increasing worldwide. Iodine deficiency is a risk factor for follicular thyroid cancer (FTC). We compared DTC subtypes in an iodine-deficient country with a developed country. METHODS: A retrospective review of thyroid cancer at tertiary centers in West Africa and the United States. All patients diagnosed with thyroid cancer from 1980 to 2004 were retrieved from the West African Center's Cancer Registry Database. The study period was divided into two groups: 1980 to 1989 and 1990 to 2004. In the American center, a review of patients undergoing surgery for thyroid cancer from 1997 to 2008 was performed. RESULTS: At the African institution, 322 patients underwent thyroidectomy for cancer from 1980 to 2004. Overall, 31.5% had papillary thyroid cancer (PTC), and 30.3% had FTC. From 1980 to 1989, 27.3% had PTC and 35.8% had FTC. From 1990 to 2004, 35.7% had PTC and 24.8% had FTC. At the American institution, 105 patients underwent surgery for thyroid cancer from 1997 to 2008; 79% had PTC and 7.6% had FTC. CONCLUSIONS: FTC is still common in developing countries, whereas PTC is the predominant subtype in developed countries. Efforts to decrease iodine deficiency may improve outcomes by changing to a less aggressive subtype.
