Cohort event monitoring of patients treated for uncomplicated malaria with artemisinin-based combination therapies in selected hospitals and community pharmacies in Nigeria.

AIMS AND OBJECTIVES: The study was designed with the broad objective of determining the safety profile of artemisinin-based combination therapies amongst Nigerian population. PATIENTS AND METHODS: This was a cohort event monitoring (CEM) programme involving monitoring adverse events (AEs) in malaria patients treated with either artemether-lumefantrine (AL) or artesunate-amodiaquine (AA) in healthcare facilities in Nigeria. The study involved continuous enrolment of patients with malaria and treated with either AL or AA at the various sites until a total cohort of 600 patients were enrolled at each site. Patients were monitored from the onset of therapy, and on days 3 and 7 from the first day of treatment to identify AEs that may occur. RESULTS: A total of 6102 AEs were recorded in 10,259 patients monitored during the programme. Of 4896 patients who received AA, 4233 (86.5%) patients reported at least one AE while 1869 (34.8%) AEs out of 5363 patients who received AL were reported (P = 0.010). The predominant incidence of each specific AE reported in each group among the patients who received AA and AL includes body weakness 30.8%/7.5%, dizziness 10.3%/3.9%, restlessness 5.02/1.12%, vomiting 3.5/1.03% and drowsiness 3.1/1.5% for AA and AL, respectively. There were more AEs among patients with co-morbid conditions and patients in the younger age groups (9-<15 years), P = 0.000. CONCLUSIONS: Various types of AEs were seen and documented during the CEM programme. The findings suggested that the AA/AL monitored during this programme was generally safe and remarkably well tolerated among the Nigerian populations.

Nomadic Fulani communities manage malaria on the move.

As in other public health efforts, the current promotion of insecticide-treated net (ITN) usage and prompt treatment of malaria has left the nomadic populations behind. The hypothesis that nomads can apply the community-directed intervention (CDI) strategy for fever management in children under-5 was tested among nomadic Fulani communities in northeastern Nigeria. Twenty camps selected representatives who were trained to provide artemisinin-based combination therapy and ITNs to their members. Coverage was compared with existing practice in 20 other nomadic Fulani communities. At baseline, none of the camps had ITNs, and antimalarial usage was only 2.7% in intervention camps and 5.8% in comparison camps. The nomads redesigned the negotiated intervention delivery approach to suit their culture. Within 12 months antimalarial usage and appropriate management of malaria in children under-5 reached 88.0% and 81.7%, respectively, and within 24 months they reached 87.9% and 86.1%, respectively, surpassing the Roll Back Malaria target of 80% coverage by 2011. In contrast, usage was <5% in the comparison camps. ITN possession reached 66.7% and 73.2% in the first and second years, respectively, within intervention camps, but was unchanged in comparison camps. However, ITN usage remained low at 21.7% in the second year (P < 0.05). When empowered, nomads will appropriately manage malaria using the CDI approach.

Ensuring the security and privacy of information in mobile health-care communication systems

The sensitivity of health-care information and its accessibility via the Internet and mobile technology systems is a cause for concern in these modern times. The privacy; integrity and confidentiality of a patient's data are key factors to be considered in the transmission of medical information for use by authorised health-care personnel. Mobile communication has enabled medical consultancy; treatment; drug administration and the provision of laboratory results to take place outside the hospital. With the implementation of electronic patient records and the Internet and Intranets; medical information sharing amongst relevant health-care providers was made possible. But the vital issue in this method of information sharing is security: the patient's privacy; as well as the confidentiality and integrity of the health-care information system; should not be compromised. We examine various ways of ensuring the security and privacy of a patient's electronic medical information in order to ensure the integrity and confidentiality of the information

Gastrointestinal stromal tumour of the omentum: a case report.

AIM: The aim of this paper is to present the first published case of a high-risk gastrointestinal stromal tumour (GIST) in Kuwait. CASE PRESENTATION AND INTERVENTION: A thirty-six-year old Egyptian male patient presented with central upper abdominal pain of five-month duration. Clinically, there was an approximately 10 cm x 8 cm diffuse, non-tender, firm mass in the epigastrium. A tumour of the stomach wall was diagnosed. The mass was surgically excised. At laparotomy there was obvious peritoneal dissemination. Histopathological examination revealed a (GIST) of the omentum. Postoperatively the patient was advised to receive imatinib mesylate for a period of one year. CONCLUSION: Despite significant advances in new chemotherapeutic drugs, radical surgery remains the only method offering a chance for long-term survival. Although further data are required to evaluate its use in the adjuvant and neoadjuvant settings, imatinib mesylate currently provides the most effective treatment option in the management of advanced GIST.

Factors predicting failure of labour induction.

Our objective was to identify risk factors for failed labour induction. From January 2001 to December 2005, we conducted a retrospective case-control study in a Nigerian University Hospital. Cases were women who failed to deliver vaginally after labour induction, and therefore had caesarean section. Controls were patients who were similarly induced and achieved vaginal delivery. Univariate followed by Logistic regression analysis were performed. Failed induction occurred in 37.6%. Variables significantly and independently associated with failed induction were cervical effacement < 70% (adjusted odds ratio [OR] 5.12; 95% confidence interval [CI] 2.65-9.90), Bishop's score < 6 (OR 3.47; CI 1.75 - 6.85), nulliparity (OR 3.91; CI 1.92 - 7.99). Prolonged pregnancy independently reduced failure rate (OR 0.44: CI 0.24 - 0.81). These variables can help determine patients that will require early recourse to caesarean delivery in order to avoid prolonged induction-delivery interval.

Follicular variant of papillary thyroid carcinoma -- a cytological study.

The cytological diagnosis of classical papillary carcinoma is easily established based on the characteristic architectural and nuclear features. However, the follicular variant of papillary thyroid carcinoma(FVPTC) poses a diagnostic challenge. In this study we analysed the cytological features of 14 histopathologically proven cases of FVPTC. We inferred that a combination of architectural features such as follicles and syncytial clusters and nuclear features, viz grooves, pseudoinclusions and enlarged nuclei with fine chromatin, were helpful in establishing the diagnosis. It is hence suggested that based on the combination of the aforesaid features a diagnosis of FVPTC be offered whenever it is possible. This helps in patient management, obviating the need for a second surgical intervention.

Fine needle aspiration (FNA) in the management of palpable masses in Ibadan: impact on the cost of care.

Fine needle aspiration cytology is a relatively new technique in the management of palpable lesions in Ibadan. In the University College Hospital (UCH) Ibadan, as in most centres in Nigeria, inadequate facilities, a heavy patient load, financial constraints and an unreliable supply of basic necessities like water, often delay definitive diagnosis and management. In order to alleviate the patient's problems and provide prompt and accurate diagnosis, an FNA Cytology Clinic was set up in the Pathology Department, UCH, Ibadan, managed by the pathology team. This report represents the results of our experience. The cost effectiveness and impact on cost of care are highlighted. FNA costs N250.00 (pounds sterling 2.00), whilst cost of biopsy can vary from N5000.00 to N10000.00 (pounds sterling 35.00 to pounds sterling 70.00). A total of 752 satisfactory smears was reviewed during the 3-year period 1995-97 from various sites including breast (n = 295), lymph node (n = 183) and thyroid (n = 143). Diagnostic accuracy varied with different sites, the accuracy rate for breast, lymph node and thyroid malignancy being approximately 100%, 80% and 93%, respectively.