Ogbu Ngim

Major dermatologic malignancies encountered in a teaching hospital surgical department in South Nigeria.

AbstractBackground: Dermatologic malignancies are among the most common form of cancer. However, dark-skinned individuals of African descent are said to be far less likely than fair-skinned individuals to develop skin cancer. Significant differences in the pattern of skin malignancy have also been observed in different regions of Africa. Objective:The aim of this study was to evaluate the pattern, site incidence, and outcome of treatment of major histologically diagnosed dermatologic malignancies encountered in a teaching hospital surgical department in South Nigeria. Methods: We evaluated patients with histologic diagnoses of major dermatologic malignancies that presented to the University of Calabar Teaching Hospital, Calabar, Nigeria between January 2000 and December 2004 and compared our findings with the total number of patients diagnosed with malignancies at the same hospital over the same period. This hospital is located in South Nigeria. Results: There were 63 histologically diagnosed dermatologic cancers, comprising 10% of all histologically diagnosed cancers at the University of Calabar Teaching Hospital during the study period. Squamous cell carcinoma (SCC) was the most common (n = 23; 37%), followed by Kaposi sarcoma (KS) [n = 17; 27%]. Other malignancies included basal cell carcinoma (BCC), melanoma, and dermatofibrosarcoma protuberans (DFSP) [n = 5; 8% each]. The peak age varied with the type of cancer but none was found in patients in the first decade of life. The lower limb was the most frequent site of SCC (Marjolin ulcer), KS, and melanoma, while BCC was most common on the head, neck, and upper limb. Excision surgery resulted in healing of all cases of BCC. Some patients with SCC and melanoma presented late for curative surgery. Some African KS tumors were chemo- sensitive. There was a high recurrence rate for DFSP. Conclusion: This study revealed a similar pattern of dermatologic malignancies in South Nigeria compared with other parts of Africa but also some regional differences (e.g. in Kano, melanoma ranked second). The pattern was, however, in sharp contrast to that seen with Caucasian populations, in whom 80% of the lesions are BCC and 20% are SCC. Public education, implementation of preventive strategies, and early presentation of disease would improve outcomes of dermatologic malignancies in Nigeria.

A prospective study of burns trauma in children in the University of Calabar Teaching Hospital, Calabar, south-south Nigeria.

BACKGROUND Burns are among the most devastating injuries seen in the emergency units. The epidemiology varies from one part of the world to another. This communication is a 3-year report of burns in children in an attempt to provide information on the current epidemiology of burns in this centre. METHOD Children admitted into the University of Calabar Teaching Hospital, Calabar with burns were prospectively studied from February 2005 and January 2008. RESULTS There were 56 patients (28 males and 28 females). The ages ranged from 9 days and 14 years (mean 3.5 years) and 19 (73.1%) were preschool children. There were 39 (69.6%) who sustained scald injuries while 17 (30.4%) suffered flame injuries. Twenty-six (46.4%) patients sustained burns with total burn surface area above 10%. CONCLUSION Education of the public on burns prevention based on the factors highlighted, establishment of burns support groups dedicated to publicity on prevention and provision of financial aid would sustain strategies when adopted.

Skin cancers amongst four Nigerian albinos.

Background  Albinism is an established risk factor for skin cancer in black Africans, and high levels of ultraviolet radiation increase the risk of the three major forms of skin cancer.

A Prospective Study of Blunt Abdominal Trauma at the University of Calabar Teaching Hospital, Nigeria.

Background:Blunt abdominal trauma (BAT) usually results from motor vehicle accidents, assaults, and recreational accidents or falls. This communication is a 3-year report of an ongoing study aimed at providing the current BAT prevalence in our center. It is hoped that this would assist in a better design of prevention and emergency trauma response systems to cope with this epidemic.Methods:All of the patients admitted to the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria, from February 2005 to January 2008 were prospectively studied based on a questionnaire. Hemodynamic stability and sonography formed the basis for selecting patients for non-operative management (NOM); others were offered laparotomy.Results:In total, 4,391 emergencies were seen during the study period, of which 1,654 (38%) were due to trauma. Seventy-nine patients with abdominal trauma accounted for 4.8% of trauma cases. Forty-two (53%) patients suffered BAT and their ages ranged from 14 and 56 years (mean 28.4 years), with a male:female ratio of 2.5:1. Road traffic accidents accounted for 13 (87%) and 26 (96%) patients in the NOM and laparotomy groups, respectively. The most commonly injured organ was the spleen in both groups: 8 (50%) and 15 (56%) in the NOM and laparotomy groups, respectively. Fifteen (36%) patients were managed successfully in the NOM group.Conclusion:Trauma was mainly due to road traffic injuries. Hemodynamic stability and ultrasonography effectively selected patients for NOM. The establishment of trauma systems, provision of ancillary diagnostic and monitoring facilities, well-designed roads and traffic infrastructure, and health education on road safety would reduce injury, morbidity, and mortality.

A Prospective Study of Penetrating Abdominal Trauma at the University of Calabar Teaching Hospital, Calabar, Southern Nigeria

Background:Abdominal injuries are on the increase in both developed and developing countries. The frequency of penetrating abdominal trauma (PAT) varies across the globe because it relates to industrialization, the weapons available, and the presence of military conflicts. This study sought to evaluate the current pattern and outcome of managementof PAT in Calabar, which is undergoing rapid urbanization, and with a focus on tourism.Method:Patients admitted to the University of Calabar Teaching Hospital, Calabar with PAT from February 2005 to January 2008 were prospectively studied.Results:Seventy-nine patients presented with abdominal trauma, among which 39 (49%) were PAT. There were 37 males and two females, whose ages ranged from 5 to 54 years (mean 27.8 years). Stab wound (18; 46.1%) was the commonest injury, while gunshot wound (15; 38.5%) ranked second. Others were road traffic accident (two patients), fall, cow horn injury, shrapnel, and criminal abortion (a patient each). The commonest injury was evisceration of the omentum and small intestine, which occurred in 13 (36%) patients. Five (14%) patients suffered small intestinal perforations, while three (8%) had liver, splenic and colonic injuries, respectively. Others were rectal injury (four patients), mesenteric injury and perforated stomach (two patients each), and a patient with diaphragmatic injury. The outcome was fatal in two (5%) patients.Conclusion:Penetrating abdominal trauma is on the increase in Calabar. The pattern of injury revealed areas which, when effectively contained, will lead to an improvement in the safety of our environment.

Pediatric Endoscopy in Calabar, an Emerging Trend - Challenges and Prospects: A Report of Two Cases.

Data on pediatric endoscopy in Nigeria is almost non-existent. This may be due to lack of trained pediatric endoscopist or lack of facilities. Upper gastrointestinal(GI) endoscopy is thegold standard for evaluating upper GI symptoms/diseases. The majority of gastroscopies in Nigeria are done in adults but children also present with symptoms that require it,hence the need to develop pediatric endoscopy in Nigeria. This is a report of two cases done in the only private high definition video endoscopy facility in Calabar (JIL ENDOSCOPY), Nigeria. Two female children aged 10 years and 8 years had gastroscopy for swallowed foreign body (an office pin) and upper GI bleeding respectively. These patients were referred to JIL endoscopy by Pediatricians from the University of Calabar Teaching Hospital,Calabar. Conscious sedation was administered by the same anesthetist in the two cases. In the first patient, no foreign body was seen at gastroscopy while marked duodenitis was found to be responsible for the upper GI bleed in the second child. The choice of anesthesia for pediatric endoscopy has remained a topic of debate in many fora. A lot needs to be done to develop pediatric endoscopy in Nigeria. Keywords: Pediatric endoscopy, anesthetic challenges, Calabar, Nigeria.

Knowledge of hepatitis B virus infection among traders

Introduction: Hepatitis B virus (HBV) is a public health problem in Nigeria, with 13% of its general population having evidence of a previous or current infection. Lack of awareness of HBV, its risk factors, and its consequences are recognized as major deterrents to adopting positive preventive behavior including immunization among HBV high-risk groups. Objective: The objective of this study is to evaluate the knowledge, attitude, and practice (KAP) of HBV infection among traders. Materials and Methods: A structured KAP questionnaire on HBV infection was administered to traders as part of the activities to mark the World Hepatitis Day in 2014. A score was created for the correct answer to 20 questions. Results: A total of 335 traders were interviewed for this study. The mean age was 33.08 ± 13.8 years and the median age was 29 years. There were 165 males and 170 females. Majority of the traders had secondary education (57.1%) and were of the Ibibio and Igbo tribes. Only 10.4% had HBV vaccination. Only 44.2% of the traders reported having any knowledge of HBV. The most common source for the knowledge was television/radio (25%) and hospitals (22%). The median (interquartile range) of the overall KAP score was low (11, 5–16). The score was least in persons aged 35 years and above, but the difference was not statistically significant (P = 0.33). Conclusion: The knowledge of HBV is low among traders in Calabar metropolis. There is need to intensify educational campaigns for the general public.

Pioneering Video Colonoscopy In Calabar, South-South, Nigeria: A Six-Month Prospective Study.

Colonoscopy is the gold standard investigative modality in diseases of the large bowel. However, this service is not readily available in Nigeria as in most developing countries in Africa. In addition, lack of appropriate expertize and high cost of the procedure limits its use in our environment. This is the first report on colonoscopy from this part of Nigeria.The aim of this study was to evaluate the indications, demographic data and endoscopic findings of patients who presented for colonoscopy in JIL Endoscopy, a private endoscopy centre in Calabar,Nigeria. A total of 20 patients had colonoscopy in this centre during the 6-month study period. There were fifteen males and five females with a male to female ratio of 3:1. The age range was 17-78 years with a mean age of 46.3 years. The commonest indication was bleeding per rectum in 16 (80%) patients. The commonest endoscopic finding was hemmorhoids in 9 (45% ) patients followed by colorectal cancer and inflammatory bowel disease with 3 (15% )cases each.

Malignant adnexal tumors: diagnostic and therapeutic challenges in Calabar, Nigeria

challenges in Calabar, Nigeria Adnexal carcinomas of the skin are a rare, highly malignant, and extremely diverse group of neoplasms. They pose a significant diagnostic and therapeutic challenge. Often adnexal tumors are classified together as sweat glands. The apocrine and eccrine glands are two distinct types of glands differing in embryological origin and function. Apocrine glands are derived from pilosebaceous follicles (includes hair follicles and sebaceous glands). The eccrine glands are considered true sweat glands. Sebaceous carcinoma is a rare, aggressive, malignant tumor derived from the adnexal epithelium of sebaceous glands. It may arise in ocular and extraocular sites. Extraocular sebaceous carcinoma is a rare tumor usually found on the head and neck. Eccrine porocarcinoma is a rare tumor of the skin occurring most often in the elderly and affecting more men than women. It may develop from a pre-existing benign poroma. They are destructive lesions with a tendency to local recurrence. We present these cases of malignant adnexal tumor to highlight the rarity of this lesion as well as the diagnostic and therapeutic challenges in our setting. We evaluated the clinical histories and treatment outcomes of patients with a histologic diagnosis of malignant adnexal tumor who presented to the University of Calabar Teaching Hospital, Calabar, Nigeria, during the five year period, (January 2000–December 2004). This was compared with the total number of patients diagnosed with cutaneous malignancies during the same period. Table 1 shows the clinico pathological features and outcomes of management of the three patients with malignant adnexal tumor. Three patients (two female and a male) accounted for 5% of cutaneous malignancies during the period of study. The ages ranged from 36 to 58 years (mean 47 years) with a patient each in the fourth, fifth, and sixth decades. Two lesions involved the scalp and one the vulva. Presentation (time when lesion was first noticed at presentation in the hospital) was late, and the periods ranged from 1 to 2 years. The clinical features were that of huge fungating lesions with raised and everted edges. Two patients had regional lymphadenopathy (Table 1, Nos. 1 and 2). Diagnoses in all the cases were histologic. The diagnosis of sebaceous carcinoma that involved the scalp (occipital) in a male and the vulva was made in two patients (Table 1, Nos. 3 and 1). The third (Table 1, No. 2) had malignant eccrine porocarcinoma; the cells were basaloid, low cuboidal, and envelope areas of keratinous epidermis thereby impacting a feeling of keratinization. There were areas of cyst formation and vascular channels and cells were pleomorphic and mitosis frequent. There were two recurrences in the male patient with sebaceous carcinoma. He was lost to follow-up two months after the last surgery. The other two patients (one each of sebaceous and sweat gland tumor) were lost to follow-up prior to any form of treatment. Malignant adnexal tumor is a rare tumor in our region (incidence 5% of cutaneous malignancies), and other studies attest to rarity of this tumor generally. There were three cases, two patients with sebaceous carcinoma and a patient with malignant eccrine tumor. Extraocular sebaceous carcinoma is a rare tumor usually found on the