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.

Post-graduate surgical training in Nigeria: The trainees' perspective.

BACKGROUND: Quality surgical training is crucial to meeting manpower needs and creating a vibrant healthcare delivery. Feedback from trainees provides insight to understanding training challenges and needs to improve the programme. The objective of this study was to determine the challenges faced by surgical trainees and their perception of their training in Nigeria. MATERIALS AND METHODS: A questionnaire survey of trainees in 16 academic surgical training centres in Nigeria between September and December 2012. RESULTS: Of 235 respondents, 227 were males (96.6%) and 8 females (3.4%) with mean age of 33.9 years. A significant proportion (62.3%) of the respondents believed that the volume and diversities of surgical cases managed during their training were sufficient; however, 53.9% were less satisfied with their operative experience. Majority (71.8%) of the respondents felt "supported" by their trainers but they also believed that the training was skewed towards service provision. They were not actively involved in research due to lack of funds in 77.7%, lack of time/motivation in 15.8%, indifference in 11.8% and poor knowledge of research methods in 9.2%. Inadequate training facilities (50.7%), poor welfare (67.2%), inadequate sponsorship (65.9%) and poor remuneration (88.3%) were identified among their challenges. On the whole, majority (62.3%) believed that their training would adequately prepare them to function independently. CONCLUSION: Surgical residents in Nigeria face a variety of challenges. Based on our findings, a training that tracks and keeps trend with global changes through a higher investment in surgical training, improved facilities and residents' well-being from both the teaching authorities and government will more likely improve the quality of training.

Awareness and breast cancer risk factors: perception and screening practices among females in a tertiary institution in Southwest Nigeria.

AIMS AND OBJECTIVES: this study is aimed at assessing the practices of breast cancer screening and risk perception of women of reproductive age group in a tertiary institution in Osun state. SUBJECTS AND METHODS: It was a descriptive cross sectional study carried out at the Federal polytechnic, Ede. A total of 393 eligible respondents recruited using a stratified random sampling technique, were interviewed using semi-structured questionnaire after obtaining a verbal consent from them. RESULTS: About two thirds (67.9%) of those who had heard of breast cancer knew that there were screening methods available. Of these 91.6% knew breast self examination, 93.2% knew clinical breast examination and only a third 32.8% knew mammography as a screening method. About half of respondents who were aware of breast cancer practice breast self examination. Only 28 (7.6%) of the respondents had ever visited any clinic for breast cancer screening, and 85.7% (24) of the visit was for clinical breast examination while mammography was rarely done (14.3%). Eighty one per cent of those who were aware of breast cancer believed that screening had a role to play. CONCLUSION: The study shows that though awareness of breast cancer among respondents was good, the practice of breast cancer screening was poor among the respondents and even worse with screening with mammography. A major recommendation is that initiatives to reduce morbidity and mortality due to breast cancer among young females in the southwest Nigeria should include education on risk factors, early signs and methods of screening for breast cancer.

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.

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

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.

Mirizzi syndrome caused by a bile pseudocyst.

BACKGROUND: Mirizzi syndrome caused by bile pseudo cyst presents diagnostic and management challenges to the surgeon. OBJECTIVE: To emphasize to clinicians the need to always recognize and correct associated liver derangements before surgery so as to prevent the usual accompanying high morbidity/mortality associated with Mirizzi syndrome. CASE REPORT: We report an unusual and previously unreported pathology of post-cholecystectomy Mirizzi syndrome in a 35 year old female who developed a bile pseudo-cyst and which may possibly qualify for Mirizzi syndrome type 5--highlighting the need for maximum pre, -intra, and post-operative challenges for improved prognosis. The patient was lost from reactionary haemorrhage due to limited facilities. CONCLUSION: There is a crying need in developing countries to have Critical Care centers and for Clinicians to recognize the necessity for adequate pre, intra and post-operative care of these high risk patients.

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.