L. M. D. Yusufu

The mobile phone as a tool in improving cancer care in Nigeria.

Objective: The use of mobile phone as a tool for improving cancer care in a low resource setting.

Pattern of Presentation and Survival of Breast Cancer in a Teaching Hospital in North Western Nigeria

OBJECTIVES Developing countries are experiencing demographic and epidemiologic transition and the prevalence of non-communicable diseases especially cancers which is on the increase. Breast cancer is the most common and lethal malignancy in developing countries with varying presentation. This study aims to determine the pattern of presentation and survival of breast cancer patients in North Western Nigeria. METHODS A five-year retrospective review of breast cancer records from 2001-2005 was conducted. Relevant information was retrieved and analyzed using statistical package for social science software. Manchester stage III and IV were classified as advance disease. Survival analysis was carried out with survival defined as the time between the date of commencement of treatment and the date of last follow-up or death. RESULTS Most of the patients were in the 4th and 5th decades 58 (57.4%) with a mean age of 44.5±13 years. Majority of the patients were females 99 (96.1%). One of the four males had invasive lobular carcinoma while the others presented with invasive ductal carcinoma 3 (75.0%). Most of the patients were premenopausal 62 (62.6%) and were presented late with advanced breast cancer disease 64 (62.1%). The left breast was more affected 64 (62.1%), and the upper outer quadrant was mostly involved 48 (60.7%), followed by the areola, 43(41.7%) either singly or in combination. Invasive ductal carcinoma was detected in 85 (82.5%) cases and was the predominant histological finding. Survival rate beyond 30 months was observed in 24.5% of cases and 100% for advanced and early breast cancer respectively, (p=0.0001). The overall survival rate beyond 36 months was 70.4% and postmenopausal patients (70.6%) had better survival beyond 36 months than premenopausal (68.5%) patients (p=0.05). CONCLUSION The overall survival rate was low and patients with early breast cancer had better survival than those with advanced disease. Majority of the patients were young premenopausal women with advanced breast cancer.

Psychosocial effects of mastectomy on married African women in Northwestern Nigeria.

Objectives: Few studies have examined the psychosocial impact of breast cancer and its treatment on African women who come from a poverty‐stricken, uneducated background in a developing country. The purpose of this study was to describe the specific psychosocial effects of breast cancer on married African women in order to help physicians educate and counsel future women and their families in Northwestern Nigeria.

Pattern of postoperative pain management among adult surgical patients in a low-resource setting.

Objective Postoperative pain is one of the most common complications of surgery. The pattern of management varies between centers. The current study aimed to study the prescription pattern and the common drugs used in the management of postoperative pain in adult surgical patients at Ahmadu Bello University Teaching Hospital (ABUTH; Zaria, Nigeria). Methods Following ethical approval, a prospective observational study of consecutive adult patients who had surgery at the ABUTH Zaria was performed from January to December 2005. The data were entered into a proforma and analyzed using the Minitab statistical package. Results One hundred and thirty-eight patients were included in the study. The age range was 17 to 80 years, with a mean age of 41 years. One hundred and thirty-two (95.7%) of the prescriptions were written solely by the surgeon or surgical resident; passive suggestions were given by the anesthetists for only six patients (4.3%). Intermittent intramuscular injections of opioids/opiates were prescribed for 126 patients (91.3%), while nine patients (6.5%) received intermittent intramuscular injections with non-steroidal anti-inflammatory drugs. Oral paracetamol was prescribed for six patients (4.3%), while three patients (2.1%) received no postoperative analgesic. Moderate pain was recorded in 48 patients (34.8%), and 90 patients (65.2%) had mild pain 8 hours after their operation before subsequent doses of analgesics were given. More females (81 patients [58.7%]), than males (42 patients [29.7%]) suffered moderate to severe pain. The reported side effects were nausea (reported by 32.6% of patients), dry mouth (21.7%), vomiting (13.0%), and urinary retention (6.5%), with 32.6% of patients experiencing no side effects. The three patients who received no analgesics experienced vomiting as a side effect. Despite the high incidence of pain and other side effects, 108 patients (78.2%) still reported that the methods of postoperative pain management were satisfactory. Conclusion Despite recent advances and the development of more effective techniques for postoperative pain control, a high proportion of patients still experience moderate to severe postoperative pain. Intermittent intramuscular injection of analgesic medication remains the mainstay of postoperative pain management at the ABUTH Zaria. Anesthetists should be more involved in postoperative analgesia prescriptions and should include other forms of multimodal pain management in their regimens. With proper application of current knowledge and training, postoperative pain management can be improved.

Injuries from cow gore in adults among Fulani

A retrospective study of 32 patients managed for cow gore injuries. The abdomen was involved in 16 (50%) patients, scrotum in six (18.9%), neck in three (9.3%) and other sites in seven (22.8%). All injuries were penetrating in nature and laparotomy was done on 17 (53%) patients.

Herniated gravid uterus: clinical course and result of treatment.

Herniated gravid uterus in an incisional hernia of the anterior abdominal wall is relatively rare. A 30-year-old house wife presented with a six month gravid uterus that had herniated through an incisional hernia of the anterior abdominal wall. She had non-operative management till term, when she then had elective lower caesarian section. Physiotherapy of the anterior abdominal wall muscles to improve their tone was done. She subsequently had keels repair of the hernia. Aggressive physiotherapy of the anterior abdominal wall muscles followed by keels repair may be an alternative surgical technique in patients with a moderate defect of incisional hernia.

Pyomyositis in adults: a 12 year review.

From January 1988 to December 1999, 43 adults with pyomyositis were managed at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Staphylococcus aureus was the most commonly cultured organism (92.5%). All the 41 patients responded well to incision and adequate drainage, antibiotics and partial thickness skin grafting in 10 patients (23.2%). Two patients (4.65%) died from septicaemia, while being resuscitated.

Residency training program: Perceptions of residents

BACKGROUND There is a phobia among doctors for the residency training program, since the establishment of the program over 30 years ago. The reason for establishing the program was mainly to provide the much-needed specialists in medicine. OBJECTIVES To ascertain the perception of the residency training program among residents. MATERIALS AND METHODS Structured questionnaires were administered to residents at 3 training institutions in Nigeria. RESULTS One hundred nineteen (85.5%) questionnaires were returned out of 140. The ages of respondents ranged from 27 to 42 years, the median age being 30 years. There were 110 males and 9 females. One hundred six (89.1%) were junior residents. Ninety (75.6%) were sponsored by the training institutions. Seventy-four (62.25%) felt their consultants were contributing just 50% or less to their training. Sixty-two (52.2%) of the respondents had attended a revision course, conference or seminar within the last 6 months. Majority of the residents would want better remuneration, up-front payment of examination and revision fees, more teaching by the consultants and less emphasis on the provision of services as ways of improving the program. CONCLUSION Majority of the residents are sponsored by the training institutions.

Nasogastric tube obstruction by Ascaris lumbricoides.

A man aged 60 presented with fever. burning micturition. and retention of urine of I day duration. Physical examination revealed firm. enlarged prostate. The patient was clinically diagnosed as a case of retention of urine due to benign prostatic hyperplasia. Retention was relieved by urethral catheterization with Foley catheter. Six days later. the patient was scheduled for suprapubic transvesical prostatectomy. On opening the bladder. no intravesical enlargement of prostate was detected. A finger was inserted in the prostatic urethra through the internal urinary meatus. As soon as attempt was made to break the anterior commissure. pus presented with a gush. With gentle probing laterally. the loculi were broken and more pus was evacuated. In total. about 10 cm) of pus was evacuated. The pus was sent for culture. The bladder was irrigated with saline. A 28F size tube drain was inserted for suprapubic drainage of bladder. and the bladder was closed in layers. The abdominal wall was closed in the usual manner. The patient received ciprofloxacin for 2 weeks. The pus and urine grew no organism on culture. Smear examination did not reveal acid-fast bacilli. The tube draining the bladder was removed on the eighth postoperative day. The patient resumed normal micturition per urethra. Postoperatively. digital rectal examination revealed a marked decrease in size of the prostate.

Penetrating abdominal injuries in a developing country

the first sample was collected had convalescent serum tested for Parvo-virus serology in another reference laboratory, and this was negative. Water samples were collected from the nursery on three occasions spread over 20 days. The sample collected from the pantry of the nursery was unsatisfactory showing gross contamination with Pseudomonas and Coliform organisms. Sample from two other areas of the hospital were found to be excellent.