Awareness and Knowledge of Breast Cancer and Breast Examination amongst Undergraduate Students. Mixed Method Approach.

INTRODUCTION: Breast cancer is the most common cause of cancer death amongst women, and the stage at presentation has been found to be an important prognostic index. The study aims to assess breast cancer awareness, including breast cancer education and knowledge of breast self-examination, among undergraduate students with the hope of improving their knowledge of breast cancer. METHODS: The study used the mixed method approach, to evaluate during breast cancer awareness month. All consenting participants completed a pre-test questionnaire before a breast health seminar, after which the post-test questionnaire was filled out. Consenting participants also had clinical breast examinations performed on them. The data were analyzed using IBM SPSS version 24. RESULTS: One hundred and thirteen participants filled out the pre-test questionnaire while 127 participants filled out the post-test. There was a significant change following the seminar. About 87.9% of respondents knew about breast cancer but had poor knowledge of the predisposing factors (11.3%). Most participants (94.3%) knew about self-breast examination (SBE), however, only 46% examined themselves in the past with only 21% aware of the correct timing for SBE. Clinical breast exams were conducted on 80 participants, six (7.5%) breast lumps were found and two had excision biopsies with histopathology diagnosis of fibroadenoma. CONCLUSION: Breast education is important, as knowledge about breast cancer is still low, even among undergraduate students. Continuous breast education should be encouraged.

INTRODUCTION: Le cancer du sein est la cause la plus fréquente de décès par cancer chez les femmes, et le stade de la maladie au moment de la présentation s'est avéré être un indice pronostique important. L'étude vise à évaluer la sensibilisation au cancer du sein, y compris l'éducation au cancer du sein et la connaissance de l'auto-examen des seins, chez les étudiantes de premier cycle, dans l'espoir d'améliorer leurs connaissances sur le cancer du sein. MÉTHODES: L'étude a utilisé une méthode mixte pour évaluer la sensibilisation au cancer du sein pendant le mois de la sensibilisation au cancer du sein. Toutes les participantes consentantes ont rempli un questionnaire de pré-test avant un séminaire sur la santé des seins, après quoi le questionnaire de post-test a été rempli. Les participantes consentantes ont également subi un examen clinique des seins. Les données ont été analysées à l'aide de la version 24 d'IBM SPSS. RÉSULTATS: Cent treize participantes ont rempli le questionnaire du pré-test et 127 celui du post-test. Des changements significatifs ont été observés à la suite du séminaire. Environ 87,9 % des personnes interrogées connaissaient le cancer du sein, mais avaient une faible connaissance des facteurs prédisposants (11,3 %). La plupart des participantes (94,3 %) connaissaient l'auto-examen des seins, mais seulement 46 % d'entre elles s'étaient déjà examinées et 21 % connaissaient le bon moment pour le faire. Des examens cliniques des seins ont été effectués sur 80 participantes, six (7,5 %) masses mammaires ont été trouvées et deux ont subi des biopsies d'excision avec un diagnostic histopathologique de fibroadénome. CONCLUSION: L'éducation mammaire est importante, car les connaissances sur le cancer du sein sont encore faibles, même chez les étudiantes de premier cycle. Il convient d'encourager la formation continue sur le cancer du sein. Mots-clés: Auto-examen des seins, Cancer du sein, Étudiantes de premier cycle, Méthode mixte.

Addressing Unmet Surgical Needs in an Underserved Nigerian Community: Report of a 'Town and Gown' Initiative.

BACKGROUND: Access to quality and timely care prevents unnecessary deaths and morbidity from potentially curable surgical diseases. This study describes the magnitude of unmet surgical needs in a Nigerian community and describes the experiences garnered during a surgical outreach organized by a tertiary institution in an underserved community. METHODS: This is a descriptive study highlighting details of a surgical outreach to a community in south-Western part of Nigeria. The project was based on a collaboration between a University Teaching Hospital (gown) and the community (town). Details of the patients' demographic and disease characteristics as well as barriers to seeking medical care were obtained. The operational workflow, treatment offered, and outcomes are highlighted. Results are presented as descriptive statistics. RESULTS: Over a two-day period, 83 out of 3,056 patients who were screened had surgically treatable conditions (2.7%), predominantly hernias (37, 46.6%), goitres (13, 15.7%) and soft tissue swellings (9, 10.8%). The majority were adults (56, 67.5%) while 27 (32.5%) were in the paediatric age group. The mean duration of symptoms was 8.64 months ± 9.5 months. About half of the patients (46.9%) had never visited a medical facility on account of their index illnesses. Lack of funds was cited by many patients as the main reason for having not presented at a hospital. Sixty-three surgical operations were performed with no peri-operative adverse events. CONCLUSION: Lack of financial access was the major barrier to surgical care in the sampled community. Moving from 'gown to town' helped address a significant proportion of the unmet needs over a relatively short period. Tertiary hospitals can provide surgical oversight to communities within their jurisdiction using this approach.

CONTEXTE: L'accès à des soins de qualité et en temps opportun permet d'éiter les décès et la morbidité inutiles dus à des maladies chirurgicales potentiellement curables. Cette étude décrit l'ampleur des besoins chirurgicaux non satisfaits dans une communauté nigériane et décrit les expériences recueillies au cours d'une action chirurgicale organisée par une institution tertiaire dans une communauté mal desservie. MÉTHODES: Il s'agit d'une étude descriptive mettant en évidence les détails d'une action chirurgicale dans une communauté du sud-ouest du Nigeria. Le projet était basé sur une collaboration entre un hôpital universitaire (ville) et la communauté (ville). Les détails des caractéristiques démographiques et pathologiques des patients ainsi que les obstacles à la recherche de soins médicaux ont été obtenus. Le déroulement des opérations, le traitement proposé et les résultats sont mis en évidence. Les résultats sont présentés sous forme de statistiques descriptives. RÉSULTATS: Sur une période de deux jours, 83 des 3056 patients examinés présentaient des affections pouvant être traitées chirurgicalement (2,7 %), principalement des hernies (37, 46,6 %), des goitres (13, 15,7 %) et des tuméfactions des tissus mous (9, 10,8 %). La majorité des patients étaient des adultes (56, 67,5 %), tandis que 27 (32,5 %) appartenaient au groupe d'âge pédiatrique. La durée moyenne des symptômes était de 8,64 mois ±9,5 mois. Environ la moitié des patients (46,9 %) ne s'étaient jamais rendus dans un établissement médical en raison de leurs maladies index. Le manque de moyens financiers a été cité par de nombreux patients comme la principale raison pour laquelle ils ne s'étaient pas présentés à l'hôpital. Soixante-trois opérations chirurgicales ont été réalisées sans aucun événement indésirable périopératoire. CONCLUSION: Le manque d'accès financier était le principal obstacle aux soins chirurgicaux dans la communauté échantillonnée. Le passage de la ville à l'hôpital a permis de répondre à une proportion importante des besoins non satisfaits sur une période relativement courte. Les hôpitaux tertiaires peuvent fournir une supervision chirurgicale aux communautés de leur juridiction en utilisant cette approche. Mots clés: Chirurgie, Besoins non satisfaits, Nigeria, Communauté mal desservie.

From the Breast to the Finger - A Case Report of Acrometastasis.

BACKGROUND: Acrometastasis is an unusual presentation that is associated with a poor prognosis. SUMMARY OF CASE: We report a case of an advanced breast cancer in a Nigerian woman, with clinical, radiological and histopathological features of lung, brain, and distal phalanx metastases. We report this case to highlight the need to have a high index of suspicion for acrometastasis as well as to emphasize the effect and challenges of managing metastatic breast cancer in a low-income country. CONCLUSION: Breast cancer metastasis to the bones of the hand is a rare condition and associated with poor prognosis.

CONTEXTE: L'acrométastase est une présentation inhabituelle associée à un pronostic défavorable. RÉSUMÉ DU CAS: Nous rapportons le cas d'un cancer du sein avancé chez une femme nigériane, présentant des caractéristiques cliniques, radiologiques et histopathologiques de métastases pulmonaires, cérébrales et de la phalange distale. Nous rapportons ce cas pour souligner la nécessité d'avoir un haut degré de suspicion pour l'acrométastase ainsi que pour souligner les effets et les défis de la prise en charge du cancer du sein métastatique dans un pays à faible revenu. CONCLUSION: La métastase du cancer du sein aux os de la main est une condition rare et associée à un pronostic défavorable. MOTS-CLÉS: Cancer du sein, Métastase, Acrométastase.

Use of commercial mesh for hernia repair in a low resource setting: experience after 500 cases.

BACKGROUND: The use of mesh has revolutionized the management of hernias in many parts of the world. There is, however, limited experience on its use in sub-Saharan Africa. This study describes a single hospital experience after 500 cases of mesh hernia repairs in a sub-Saharan African country. METHODS: We reviewed the records of the first 500 cases of abdominal wall hernia operations performed using commercial mesh since year 2007. Socio-demographic characteristics, hernia type, method of repair and outcome data were analyzed and presented as descriptive statistics. RESULTS: The first 500 cases of mesh hernia repairs were performed between 2007 and 2017 during which a total of 1,175 hernia operations were carried out, mesh repair accounting for 42.5% of the total. There was a progressive rise in the uptake of mesh repairs over time, with mesh repairs overtaking tissue based repairs in the last few years of the review. Inguinal hernia was by far the commonest indication for mesh use (80.4%), followed by incisional hernia (9%). Polypropylene mesh was the most common type of mesh used in about 96.2% of cases. Overall, there were seven recurrences (1.4%) at a mean follow-up period of 15.3 months (1-108 months) CONCLUSION: In spite of resource limitations, the use of mesh for hernia repairs continues to rise and has overtaken tissue-based repairs in a sub-Saharan African setting. Results show good outcomes justifying continued use.

Feasibility study for a randomized clinical trial of bupivacaine, lidocaine with adrenaline, or placebo wound infiltration to reduce postoperative pain after laparoscopic cholecystectomy.

Background: Short-term pain relief can be achieved by local anaesthetic infiltration of port sites at the end of laparoscopic surgery. This study aimed to assess feasibility of performing an RCT to evaluate short-term postoperative analgesia after laparoscopic surgery in Nigeria using two local anaesthetics for port-site infiltration versus saline placebo. Methods: This was a placebo-controlled, patient- and outcome assessor-blinded, external feasibility RCT. Patients undergoing elective laparoscopic cholecystectomy for symptomatic ultrasound-proven gallstones were randomized into three groups: lidocaine with adrenaline (epinephrine), bupivacaine or saline control. The feasibility of recruitment, compliance with randomized treatment allocation, and completion of pain and nausea outcome measures were evaluated. Pain was assessed at 2, 6, 12 and 24 h after surgery using a 0-10-point numerical rating scale (NRS) and a four-point verbal rating scale. Nausea was assessed using NRS at the same time points. Clinical outcomes were assessed only in patients who received the correct randomized treatment allocation. Results: Of 79 patients screened for eligibility, 69 were consented and randomized (23 per group). Overall, compliance with randomized treatment allocation was achieved in 64 patients (93 per cent). All pain and nausea assessments were completed in these 64 patients. On the NRS, most patients had moderate to severe pain at 2 h (39 of 64, 61 per cent), which gradually reduced. Only six patients (9 per cent) had moderate to severe pain at 24 h. Conclusion: Recruitment, compliance with the randomized allocation, and completion of pain outcome measures were satisfactory. This study demonstrates the feasibility of conducting a surgical RCT in a resource-limited setting. Registration number: ISRCTN 17667918 (https://www.isrctn.com).