Experience establishing tuberculosis laboratory capacity in a developing country setting.

OBJECTIVE: To describe the experience of strengthening laboratory diagnosis of tuberculosis (TB) in a resource-limited country with high TB-HIV (human immunodeficiency virus) and multidrug-resistant TB (MDR-TB) prevalence. METHODS: In the Kingdom of Lesotho, which is confronted with high levels of TB, MDR-TB and HIV prevalence, between 2006 and 2008 a coalition of the Foundation for Innovative New Diagnostics, Partners In Health and the World Health Organization renovated the National TB Reference Laboratory and reinforced microscopy services, streamlined conventional culture and drug susceptibility testing (DST) and introduced modern TB diagnostic methods. FINDINGS: It was feasible to establish a biosafety level three facility for solid culture and DST and an external quality assessment programme for smear microscopy within 4 months, all in 2007. Liquid culture and DST were introduced a month later. Preliminary results were comparable to those found in laboratories in industrialised countries. A year later, line-probe assay for the rapid detection of MDR-TB was introduced. DISCUSSION: Through strong political commitment and collaboration, it is possible to rapidly establish quality assured TB diagnostic capacity, including current methods, in a resource-limited setting. Case detection and management for TB and MDR-TB have been greatly enhanced. From a low baseline, TB culture throughput in the laboratory increased ten-fold and has been sustained. This experience has served as a catalyst to translate policy into practice with new diagnostic technologies. It supports global policy setting to enhance and modernise laboratory work in developing countries.

Reduction mammoplasty: the experience in Ile-Ife, Nigeria.

BACKGROUND: Reduction mammoplasty is a frequently performed aesthetic surgical procedure in the female adolescent and adult Caucasian population. We reviewed the cases of reduction mammoplasty performed at the Obafemi Awolowo University teaching hospital, (OAUTH), Ile-Ife. PATIENTS AND METHODS: A retrospective review of all patients who have had reduction mammoplasty at the OAUTH over a 20 year period was carried out. RESULT: Ten patients requested reduction mammoplasty during the period. Two patients declined surgery while one required, and was treated by chemotherapy. Seven patients had surgery. Outcomes were uniformly satisfactory. CONCLUSION: We conclude that request for reduction mammoplasty in our surgical practice is uncommon. Request for purely cosmetic reasons is even rarer. Most patients had massive breast enlargements with physical symptoms and gross disfigurement with or without an underlying breast disease which was the usual reason for presentation.

Testicular Torsion : a Fifteen Year Review in a Nigerian Teaching Hospital

Aim and Objectives: To determine the prevalent age; presentation; duration of symptoms before intervention; and outcome of management of testicular torsion (TT) in our community. Design: A fifteen-year retrospective study. Setting: University Teaching Hospital. Materials and Method: Records of patients managed for TT; January 1992- Decem- ber 2006; were reviewed. Records of 91 out of 106 patients managed during the period were available for review. The age of patient; presentation; duration of symptoms; predisposing factors; interval between presentation and operation; and outcome of management were extracted and analyzed. Results: Ninety-one patients; mean age 20.1yrs (range 8-34) were reviewed. The average duration of symptoms at presentation was 26.7hrs (range 1.5- 168). The patients were mostly 74(81.3) students. All of them presented with scrotal pain; and 66(72.5) had scrotal swelling (Left: Right=1.8:1). Torsion was partial (180-270o) in 14(15.4); and complete (360o-1440o) in 77(84.6). Intra-scrotal anatomic abnormalities were observed in 77(84.6) patients. Testes were viable in 59(64.8) patients offered bilateral orchidopexy and gangrenous in 32(35.2) that had orchi- dectomy with contralateral orchidopexy. The average duration of hospital stay was 2.8days. Most of the patients 76(83.5) were lost to follow up within 3 weeks postoperative. Conclusion: TT occurs in patients aged 8-34yrs in our immediate community. Presentation is late and most patients 77(84.6) have predisposing congenital abnormalities. There is a need for increase awareness by the general public and the health personnel's of the danger posed by delay in treating TT. Where doubts exist; early scrotal exploration should be the investigation and intervention of choice to prevent irreversible damage to the germ cells

Problem-based learning for tuberculosis and leprosy supervisors.

A problem-based learning programme for tuberculosis and leprosy supervisors is reported from Nigeria. It proved stimulating, motivating and enjoyable, and encouraged independent learning. The quality of their subsequent field work was average to good and showed sustained motivation.

Coexisting malignant melanoma and vitiligo in a Nigerian.

A case of malignant melanoma associated with vitiligo in a middle aged Nigerian is presented. The Association has been well documented in some other parts of the world, but this is the first of its type in the West African subregion. The occurrence of vitiligo in melanoma patients is generally believed to be beneficial, and has been well recognised to presage long time survival for the patient. The course of events in our patient is still being observed.

Cutaneous sarcoidosis and tribal scarifications in West Africa.

Sarcoidosis is quite common in American and West Indian blacks. In America, the incidence in blacks could be up to 10 times higher than in whites. Sarcoidosis is generally believed to be rarer in African blacks and especially along the West African coast from which the American blacks trace their ancestry. The difference in incidence may be due to environmental influences, poor reporting system from inadequate local awareness of the presentation, confusion with tuberculosis, and lack of the Kveim antigen. Diagnosis of sarcoidosis is most commonly made from the pulmonary and skin manifestations. Since the skin manifestation presents readily for observation without the need for costly devices like x-ray machines, the present study focused on and analyzed the seven cases seen in the skin clinic within a period of 2 years (an incidence of 0.85%), showing that the commonest presentation was as scar-sarcoid on longstanding tribal marks. Tribal scarification is common in West Africa, and one should investigate any change in a longstanding scar. This heightened awareness in areas where scarification is or was practiced could end the belief of the rarity of sarcoidosis in the West African subregion.

Sarcoidosis in Africans: 12 cases with histological confirmation from Nigeria.

During a 2 year-period 12 Nigerians with sarcoidosis were diagnosed at the chest and dermatology clinics of the University College Hospital, Ibadan, Nigeria. Intrathoracic involvement was the commonest presentation followed by the skin, lymph nodes and liver. Histological diagnosis was obtained in all cases either from skin biopsy, transbronchial lung biopsy, lymph node or liver biopsy where applicable. This study suggests that sarcoidosis is not as rare as previous literature on the subject portrays.

Lichen planus in tropical Africa.

The pattern of Lichen Planus seen among 95 Nigerians seen over a 3 year period is described. They constituted 5% of all skin cases, with females slightly more affected than males. A younger age group is predominantly affected. In most patients (68%), the lesions are widespread all over the body. Large papules, scaly patches and hypertrophic verrucous lesions in the legs are frequent findings. Patients having lesions in the mouth are few. Seasonal variations of the disease do occur, the peak being during the rainy season, April-September (65%). Pruritus is a constant feature. Lesions do heal with marked residual hyperpigmentation. There is no report so far of the "subtropical" (actinic) Lichen Planus in West Africa. It is suggested that drugs, weather and the hard native sponge may play a role in the causation of the disease in tropical Africa.

Diabetic scleredema-a case report

A case of diabetic scleredema is described. As far as we are aware, this is the first such case to be reported in the West Indian medical literature (AU)