Waiting Times in Prostate Cancer Diagnosis and Treatment: A Ten-Year Experience in A Nigerian Teaching Hospital.

INTRODUCTION: Prostate cancer is still the leading male cancer and the leading cause of cancer deaths in Nigeria, and other low- and middle-income countries (LMIC) in Sub-Saharan Africa. Early diagnosis is essential to ensuring prompt treatment and reducing morbidity and mortality. Reducing the waiting times for diagnosis and treatment is therefore important. AIMS AND OBJECTIVES: To study prostate cancer management waiting times, to serve as a baseline in improving the quality of cancer care in the Nigerian populace. PATIENTS AND METHODS: This was a ten-year retrospective study of waiting times of all histologically-confirmed prostate cancer patients seen at Alex-Ekwueme Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria. Statistical analysis was done SPSS version 26. A P-value less than 0.05 was considered statistically significant. RESULTS: A total of 189 patients presented with prostate cancer; however, 73 patients with complete data were analysed. The mean age of the patients was 71.48±8.16 years. The median duration of symptoms before presentation was 6 months. The mean total prostate-specific antigen was 82.08±54.9ng/mL. The mean duration between the first visit to the definitive diagnosis was 6.53±11.68 months with a median of 1 month. The median duration from visit to treatment was 3 months with a mean of 9.71±13.4 months. There were no associations between occupation, highest educational level, financial constraints, and the different waiting times studied (P>0.05). CONCLUSION: The waiting times for prostate cancer management were unduly prolonged in this study; patient-related factors did not influence this wait. INTRODUCTION: Le cancer de la prostate est toujours le principal cancer chez les hommes et la principale cause de décès par cancer au Nigéria et dans d'autres pays à revenu faible et intermédiaire (PFR) en Afrique subsaharienne. Un diagnostic précoce est essentiel pour garantir un traitement rapide et réduire la morbidité et la mortalité. Il est donc important de réduire les délais d'attente pour le diagnostic et le traitement. OBJECTIFS: Étudier les délais d'attente dans la prise en charge du cancer de la prostate, afin de servir de référence pour améliorer la qualité des soins contre le cancer dans la population nigériane. PATIENTS ET MÉTHODES: Il s'agit d'une étude rétrospective de dix ans sur les délais d'attente de tous les patients atteints de cancer de la prostate confirmé histologiquement et traités à l'hôpital universitaire fédéral Alex-Ekwueme, à Abakaliki, dans l'État d'Ebonyi, au Nigéria. L'analyse statistique a été réalisée avec la version 26 du logiciel SPSS. Une valeur de P inférieure à 0,05 a été considérée comme statistiquement significative. RÉSULTATS: Un total de 189 patients ont présenté un cancer de la prostate ; cependant, seuls les 73 patients avec des données complètes ont été analysés. L'âge moyen des patients était de 71,48±8,16 ans. La durée médiane des symptômes avant la présentation était de 6 mois. La concentration moyenne d'antigène spécifique de la prostate (PSA) total était de 82,08±54,9 ng/mL. La durée moyenne entre la première visite et le diagnostic définitif était de 6,53±11,68 mois, avec une médiane de 1(1) mois. La durée médiane entre la visite et le traitement était de 3 mois, avec une moyenne de 9,71±13,4 mois. Aucune association n'a été observée entre l'occupation, le plus haut niveau d'éducation, les contraintes financières et les différents délais d'attente étudiés (P>0,05). CONCLUSION: Les délais d'attente pour la prise en charge du cancer de la prostate étaient anormalement prolongés dans cette étude ; les facteurs liés au patient n'ont pas influencé cette attente. MOTS-CLÉS: Cancer de la prostate, Délai d'attente, Délai, Diagnostic, Traitement.

Simple Prostatectomy for Giant Benign Prostatic Hyperplasia in Sub-Saharan Africa: Case Series and Literature Review.

INTRODUCTION: Benign prostatic hyperplasia (BPH) is a common cause of bladder outlet obstruction in men worldwide. African men are known to have larger mean prostate volumes than other races. Giant benign prostatic hyperplasia (GBPH) is defined as prostate size greater than 200 grams. Management of GBPH is associated with several challenges which have been under-reported from the African sub-region. OBJECTIVE: To highlight the peculiarities of clinical presentation, surgical management and outcome of GBPH. PATIENTS AND METHODS: Men with BPH and trans-rectal ultrasound estimated prostate volume > 200 grams who were scheduled for open simple prostatectomy between January and December 2016 in our hospital were prospectively studied. RESULTS: Four patients with GBPH had simple prostatectomy during the period under review. Their ages ranged from 68 to 78 years with a mean age of 73.7 years.Three patients (75.0%) had transvesical prostatectomy while one (25.0%) had retropubic prostatectomy. The enucleated prostate specimen were found to weigh 312.1g, 396.4g, 420.8g and 450.0g respectively with mean weight of 394.8 ±50.2g and mean operation time of 111.7 ±19.7 minutes. They all had blood transfusion post-operatively with mean transfusion of 3±1.5 pints of blood per patient with relatively longer hospital stay (mean 10 days). CONCLUSION: The surgical management of GBPH can be quite challenging. Recalcitrant gross haematuria, chronic urinary retention and renal impairment are possible modes of presentation. Open simple prostatectomy is the best option for treatment in our environment. It is associated with improved quality of life and minimal morbidity in expert hands.

INTRODUCTION: L'hyperplasie bénigne de la prostate (HBP) est une cause fréquente d'obstruction de la vessie chez les hommes du monde entier. Les hommes africains sont connus pour avoir des volumes de prostate moyens plus importants que les autres races. L'hyperplasie bénigne géante de la prostate (GBPH) est définie comme une taille de la prostate supérieure à 200 grammes. La gestion du GBPH est associée à plusieurs défis qui ont été sous-déclarés dans la sous-région africaine. OBJECTIF: Mettre en évidence les particularités de la présentation clinique, de la prise en charge chirurgicale et du résultat de la GBPH. PATIENTS ET MÉTHODES: Les hommes atteints d'HBP et d'une échographie trans-rectale d'un volume prostatique estimé> 200 grammes qui devaient subir une prostatectomie simple ouverte entre janvier et décembre 2016 dans notre hôpital ont été étudiés de manière prospective. RÉSULTATS: Quatre patients atteints de GBPH ont eu une prostatectomie simple au cours de la période sous revue. Leur âge variait de 68 à 78 ans avec un âge moyen de 73,7 ans). Trois patients (75,0%) ont eu une prostatectomie transvésicale et un (25,0%) une prostatectomie rétropubienne. L'échantillon de prostate énucléé pesait respectivement 312,1 g, 396,4 g, 420,8 g et 450,0 g avec un poids moyen de 394,8 ± 50,2 g et une durée opératoire moyenne de 111,7 ±19,7 minutes. Ils ont tous eu une transfusion sanguine postopératoire avec une transfusion moyenne de 3 ± 1,5 pintes de sang par patient avec un séjour à l'hôpital relativement plus long (10 jours en moyenne). CONCLUSION: La prise en charge chirurgicale de la GBPH peut être assez difficile. Une hématurie macroscopique récalcitrante, une rétention urinaire chronique et une insuffisance rénale sont des modes de présentation possibles. La prostatectomie simple ouverte est la meilleure option de traitement dans notre environnement. Elle est associée à une meilleure qualité de vie et à une morbidité minimale entre des mains expertes. MOTS CLÉS: Hyperplasie bénigne géante de la prostate, prostatectomie simple, Afrique subsaharienne.

Data on artificial neural network and response surface methodology analysis of biodiesel production.

The biodiesel production from waste soybean oil (using NaOH and KOH catalysts independently) was investigated in this study. The use of optimization tools (artificial neural network, ANN, and response surface methodology, RSM) for the modelling of the relationship between biodiesel yield and process parameters was carried out. The variables employed in the experimental design of biodiesel yields were methanol-oil mole ratio (6 - 12), catalyst concentration (0.7 - 1.7 wt/wt%), reaction temperature (48 - 62°C) and reaction time (50 - 90 min). Also, the usefulness of both the RSM and ANN tools in the accurate prediction of the regression models were revealed, with values of R-sq being 0.93 and 0.98 for RSM and ANN respectively.

HISTOMORPHOLOGICAL PATTERN OF UROLOGIC MALIGNANCIES IN ILE-IFE, SOUTH-WESTERN NIGERIA.

INTRODUCTION: The last decade witnessed a remarkable rise in the prevalence of several malignant diseases in Nigeria. Whether Urologic malignancies (UM) have followed the same trend remains to be studied. The pattern of UM diagnosed in a Nigerian tertiary hospital is hereby presented. Our aim was to determine the pattern and prevalence of histologically diagnosed UM in Obafemi Awolowo University Teaching Hospitals Complex. Ile-Ife, Nigeria. MATERIALS AND METHODS: A 10-year retrospective review of all patients diagnosed with UM was carried out between January 2005 and December 2014. Data was obtained from the patients' case files and the Ife-Ijesha Cancer registry. Information obtained included demographic characteristics, site of origin and histology. Data was analysed with Statistical package for Social sciences (SPSS) Version 20. RESULTS: A total of 4675 malignancies were histologically confirmed during the study period. UM accounted for 420 (8.9%) of total malignancies. Prostate cancer was the commonest UM with 315 (75%) cases. Others include renal tumours 62(14.8%), bladder tumours 29 (6.9%), testicular tumours 13(3.1%) and scrotal tumour 1(0.2%). UM were commoner in males (348, 88.8%) than females (47, 11.2%) and accounted for 13.8% and 2.18% of all tumours in males and females respectively. CONCLUSION: This study revealed a rising prevalence of UM most especially Prostate and Renal Cancers among other malignancies in Ile-Ife.

Hepatitis B Virus infection and its modes of prevention among clinical students of Obafemi Awolowo University (OAU), Ile-Ife, Nigeria.

BACKGROUND: Hepatitis B is a major global health problem and is a major infectious and occupational hazard for health workers, especially doctors, nurses, dentists and laboratory staff, including those who are under training, because of exposure to patients' body fluids during clinical activities. Clinical students are also at risk of HBV infection during their training in medical school. HBV vaccination status is very low among medical students in Nigeria AIM: This study assessed the knowledge of clinical students of the Obafemi Awolowo University (OAU), Ile-Ife about hepatitis B virus infection and its modes of prevention. METHODS: A descriptive cross-sectional study was conducted among all 594 clinical students of OAU using a pretested, self-administered, semi-structured questionnaire. Data were analysed and summarized using descriptive and inferential statistics (logistic regression). RESULTS: Four hundred and thirty (72.4%) respondents correctly identified four modes of transmission, while 470 (79%) respondents reported vaccination as a mode of prevention of HBV infection. Of all the respondents, 61.6% had ever received Hepatitis B virus vaccine, while only 39.2% of the respondents had received at least three doses of HBV vaccine. At bivariate level, gender (χ2 = 23.685, p < 0.001) and level of study (χ2 = 7.383, p < 0.05) were significantly associated with HBV vaccine uptake. At multivariate level, gender (OR = 2.58, 95% CI = 1.80-3.7 1) and level of study (OR = 1.71, 95% CI =1.14-2.54) remained significantly associated with HBV vaccine uptake. CONCLUSION: The study concluded that clinical students had poor knowledge of safe sexual practices and post-exposure prophylaxis as preventive measures. The uptake of HBV vaccine was also poor. The significant correlates of vaccine uptake were gender and level of study.

Small bowel obstruction following perforation of the uterus at induced abortion.

BACKGROUND: Unsafe abortion is an important contributor to maternal morbidity and mortality. OBJECTIVE: To present a case of small bowel obstruction following perforation of the uterus at induced abortion. METHODS: A 36-year-old woman, presented at a private hospital, with abdominal pain and weight loss. She had full clinical assessment and laboratory investigations which indicated small bowel obstruction following perforation of the uterus at induced abortion, and was commenced on treatment. RESULTS: She was para 5+0. Her main complaints were abdominal and weight loss following induced abortion of a 12- week pregnancy, four months prior to presentation. At presentation the tools (ultrasound scan, plain abdominal radiograph and barium enema) used for diagnoses only suggested some form of intestinal obstruction and were unremarkable. Correct diagnoses indicating small bowel obstruction was only made at laparotomy. An exploratory laparotomy, adhesiolysis, small bowel resection, end to end anastomosis and bowel decompression was done after bowel preparation. CONCLUSION: Laparotomy has an enviable place in bowel injuries secondary to uterine perforation especially when there is a diagnostic dilemma. Nigerian female population requires continuous health education on widespread and effective use of contraception. Physicians need training and retraining on abortion techniques and management of abortion complications.

Disproportionate intraventricular septal hypertrophy in Nigerians with essential hypertension.

It is not clear how frequently hypertrophic cardiomyopathy coexists with essential hypertension or whether chronic hypertension per se, induces hypertrophic cardiomyopathy (hypertensive hypertrophic cardiomyopathy). Eighty-three Nigerians with essential hypertension alone underwent M-mode and 2 dimensional echocardiographic study. Twenty per cent (17 patients) had disproportionate intraventricular septal hypertrophy (septum: posterior wall ratio > or = 1.4). These subgroup tended to be elderly, with average age of 57.7 years, and were predominantly male (70%). Two patients in this subgroup (2.4% of total) additionally had thickened posterior left ventricles and a hyperdynamic left ventricular systolic function (fractional fibre shortening of > or = 45%). This picture is consistent with "hypertensive hypertrophic cardiomyopathy". Routine echocardiography may permit the early identification and thus a closer scrutiny and follow up of essential hypertensive patients with disproportionate septal thickness. The prognostic implications of this requires long term study.

Plasma lipids, lipoproteins, and apolipoproteins in Nigerian diabetes mellitus, essential hypertension, and hypertensive-diabetic patients.

Plasma lipids, lipoproteins, and apolipoproteins were assessed in three groups of Nigerians at increased risk for atherosclerotic heart disease. The three patient groups, diabetes mellitus (n = 15), essential hypertension (n = 12), and hypertensive-diabetes mellitus (n = 11), were compared with age-matched, apparently healthy controls (n = 14). In subjects with diabetes mellitus, triglyceride and its related apolipoproteins CIII and CIII:NonB were significantly higher than controls. High-density lipoprotein cholesterol (HDL-C) was significantly lower; its related ratios, total/HDL-C and low-density lipoprotein cholesterol (LDL-C)/HDL-C were significantly higher than those for controls. Subjects with hypertension and hypertensive-diabetes mellitus had significantly higher values than controls for those lipids and lipid fractions considered atherogenic (total cholesterol, LDL-C, triglyceride, and the total/HDL-C and LDL-C/HDL-C ratios) as well as apolipoproteins B, CIII, and lipoprotein particles Lp(a) and CIII:NonB. Only hypertensive-diabetes mellitus subjects had lower HDL-C levels, while hypertension patients had significantly higher apolipoprotein AI and LpAI concentrations than controls. Subjects with hypertensive-diabetes mellitus had significantly worse lipid, lipoprotein, and apolipoprotein profiles both in terms of increased atherogenic and reduced anti-atherogenic parameters compared with subjects with diabetes mellitus or hypertension only. These studies suggest that Nigerians with diabetes, hypertension, and especially both hypertension and diabetes need to be fully evaluated from a lipid and lipoprotein standpoint, and any abnormalities detected need to be taken into consideration during therapy of this group of high-risk patients.

A cross-sectional study of echocardiographic indices, treadmill exercise capacity and microvascular complications in Nigerian patients with hypertension associated with diabetes mellitus.

Associations between hypertension and cardiovascular complications of diabetes mellitus in Nigerians, were examined in a cross-sectional study. 20 hypertensive-diabetic patients, 16 hypertensive patients, 10 non-hypertensive diabetic patients and 10 age- and sex-matched healthy controls, underwent M-mode and cross-sectional echocardiography, and Bruce-protocol treadmill exercise performance. Left ventricular (LV) mass indices (+/- SD) were significantly higher in hypertensive patients (164 +/- 12gm-2), diabetic (158 +/- 17gm-2) and hypertensive diabetic patients (125 +/- 129gm-2) compared with normal controls (111 +/- 17gm-2) p < 0.01. However, the LV mass index in the hypertensive-diabetic patients was significantly less than in hypertensive (p < 0.05) or normotensive diabetic patients (p < 0.05). Systolic cardiac contractility measured as fractional fibre shortening, was preserved in the hypertensive patients (24 +/- 4%) compared with the healthy controls (23 +/- 4%), but was depressed in diabetic patients (19 +/- 3%) and to a greater extent in the hypertensive-diabetic patients (15 +/- 4% p < 0.01). Treadmill exercise tolerance time was reduced independently in hypertension (309 +/- 73 seconds) or diabetes (321 +/- 119 seconds), p < 0.05, but was further impaired in hypertensive-diabetic patients (289 +/- 110 seconds) p < 0.01 compared to the healthy controls (490 +/- 156 seconds). The patients with hypertension and diabetes had a greater degree of proteinuria (p < 0.001) and a higher frequency of retinopathy (p < 0.001), in comparison to those with hypertension or diabetes alone.