Management challenges of pancreatic cancer in a resource scarce setting

Background: Of all forms of gastrointestinal malignancy, adenocarcinoma of the pancreas is associated with the worst survival. Management of pancreatic cancer is associated with some challenges. This study is aimed at determining the hospital incidence, sociodemographic characteristics, managements and management\u2019s outcome of carcinoma of pancreas at our hospital. We also discuss the management challenges encountered with these patients. Patients and Methods: We review 96 pancreatic cancer patients seen at Awolowo University Teaching Hospital Complex, Ile \u2013Ife, Nigeria, from July 1989 to July 2007. Results: There were ninety six patients diagnosed with cancer of the pancreas but only 80 patients had histological proof of pancreatic cancer. This account for 2.1% of all malignancies seen and 238/100000 total admissions during the study period. The median age is 55.0. There were 62 (64.6%) male and 34 (35.4%) female with male to female ratio been 2:1. Duration of symptoms in the patients ranges from 4 weeks to 109 weeks. Only three (3.1%) patients have tumor located in a particular anatomical sub site: two head of pancreas and one tail of the pancreas. Other patients had extensive tumor involving the head and body of the pancreas. Two patients had pancreaticoduodenectomy, one had resection of the tumor at the tail of pancreas and 45 patients had triple bypass. Patients with low serum albumin and serum sodium and elevated transaminases at presentation, had poorer prognosis than other patients. Conclusion: We found that pancreatic cancer is not uncommon in our center with male preponderance. Most patients present with advanced condition only amenable to palliative measures. There are signi\ufb01cant challenges in the area of diagnosis, screening, treatment and research

Cancer research across Africa: a comparative bibliometric analysis

Introduction Research is a critical pillar in national cancer control planning. However, there is a dearth of evidence for countries to implement affordable strategies. The WHO and various Commissions have recommended developing stakeholder-based needs assessments based on objective data to generate evidence to inform national and regional prioritisation of cancer research needs and goals. Methodology Bibliometric algorithms (macros) were developed and validated to assess cancer research outputs of all 54 African countries over a 12-year period (2009–2020). Subanalysis included collaboration patterns, site and domain-specific focus of research and understanding authorship dynamics by both position and sex. Detailed subanalysis was performed to understand multiple impact metrics and context relative outputs in comparison with the disease burden as well as the application of a funding thesaurus to determine funding resources. Results African countries in total published 23 679 cancer research papers over the 12-year period (2009–2020) with the fractional African contribution totalling 16 201 papers and the remaining 7478 from authors from out with the continent. The total number of papers increased rapidly with time, with an annual growth rate of 15%. The 49 sub-Saharan African (SSA) countries together published just 5281 papers, of which South Africa’s contribution was 2206 (42% of the SSA total, 14% of all Africa) and Nigeria’s contribution was 997 (19% of the SSA total, 4% of all Africa). Cancer research accounted for 7.9% of all African biomedical research outputs (African research in infectious diseases was 5.1 times than that of cancer research). Research outputs that are proportionally low relative to their burden across Africa are paediatric, cervical, oesophageal and prostate cancer. African research mirrored that of Western countries in terms of its focus on discovery science and pharmaceutical research. The percentages of female researchers in Africa were comparable with those elsewhere, but only in North African and some Anglophone countries. Conclusions There is an imbalance in relevant local research generation on the continent and cancer control efforts. The recommendations articulated in our five-point plan arising from these data are broadly focused on structural changes, for example, overt inclusion of research into national cancer control planning and financial, for example, for countries to spend 10% of a notional 1% gross domestic expenditure on research and development on cancer

Cancer research across Africa: a comparative bibliometric analysis.

INTRODUCTION: Research is a critical pillar in national cancer control planning. However, there is a dearth of evidence for countries to implement affordable strategies. The WHO and various Commissions have recommended developing stakeholder-based needs assessments based on objective data to generate evidence to inform national and regional prioritisation of cancer research needs and goals. METHODOLOGY: Bibliometric algorithms (macros) were developed and validated to assess cancer research outputs of all 54 African countries over a 12-year period (2009-2020). Subanalysis included collaboration patterns, site and domain-specific focus of research and understanding authorship dynamics by both position and sex. Detailed subanalysis was performed to understand multiple impact metrics and context relative outputs in comparison with the disease burden as well as the application of a funding thesaurus to determine funding resources. RESULTS: African countries in total published 23 679 cancer research papers over the 12-year period (2009-2020) with the fractional African contribution totalling 16 201 papers and the remaining 7478 from authors from out with the continent. The total number of papers increased rapidly with time, with an annual growth rate of 15%. The 49 sub-Saharan African (SSA) countries together published just 5281 papers, of which South Africa's contribution was 2206 (42% of the SSA total, 14% of all Africa) and Nigeria's contribution was 997 (19% of the SSA total, 4% of all Africa). Cancer research accounted for 7.9% of all African biomedical research outputs (African research in infectious diseases was 5.1 times than that of cancer research). Research outputs that are proportionally low relative to their burden across Africa are paediatric, cervical, oesophageal and prostate cancer. African research mirrored that of Western countries in terms of its focus on discovery science and pharmaceutical research. The percentages of female researchers in Africa were comparable with those elsewhere, but only in North African and some Anglophone countries. CONCLUSIONS: There is an imbalance in relevant local research generation on the continent and cancer control efforts. The recommendations articulated in our five-point plan arising from these data are broadly focused on structural changes, for example, overt inclusion of research into national cancer control planning and financial, for example, for countries to spend 10% of a notional 1% gross domestic expenditure on research and development on cancer

Management challenges of pancreatic cancer in a resource scarce setting

Background: Of all forms of gastrointestinal malignancy, adenocarcinoma of the pancreas is associated with the worst survival. Management of pancreatic cancer is associated with some challenges. This study is aimed at determining the hospital incidence, sociodemographic characteristics, managements and management’s outcome of carcinoma of pancreas at our hospital. We also discuss the management challenges encountered with these patients. Patients and Methods: We review 96 pancreatic cancer patients seen at Awolowo University Teaching Hospital Complex, Ile –Ife, Nigeria, from July 1989 to July 2007. Results: There were ninety six patients diagnosed with cancer of the pancreas but only 80 patients had histological proof of pancreatic cancer. This account for 2.1% of all malignancies seen and 238/100000 total admissions during the study period. The median age is 55.0. There were 62 (64.6%) male and 34 (35.4%) female with male to female ratio been 2:1. Duration of symptoms in the patients ranges from 4 weeks to 109 weeks. Only three (3.1%) patients have tumor located in a particular anatomical sub site: two head of pancreas and one tail of the pancreas. Other patients had extensive tumor involving the head and body of the pancreas. Two patients had pancreaticoduodenectomy, one had resection of the tumor at the tail of pancreas and 45 patients had triple bypass. Patients with low serum albumin and serum sodium and elevated transaminases at presentation, had poorer prognosis than other patients. Conclusion: We found that pancreatic cancer is not uncommon in our center with male preponderance. Most patients present with advanced condition only amenable to palliative measures. There are significant challenges in the area of diagnosis, screening, treatment and research

Management of Adult Choledochal Cyst Coexisting with Gallbladder Carcinoma: A Case Report and Review of Literature

Choledochal cyst is a relatively rare condition. Even rarer is a choledochal cyst in association with a gallbladder carcinoma. This study reports a rare case of gallbladder carcinoma coexisting with a choledochal cyst in a Nigerian patient. Clinical records of the patient including preoperative evaluation, intraoperative findings, and postoperative care were reviewed. A 38-year-old woman presented with the recurrent right upper abdominal pain of 3 years duration associated with progressive weight loss, anorexia, recurrent vomiting, as well as, low-grade fever with chills and rigors. Physical examination revealed an anicteric woman with tenderness in the right hypochondrium and a positive Murphy's sign. A combination of abdominal ultrasound and computed tomography scan suggested a Type IV choledochal cyst and a distended gallbladder with thickened walls containing a heterogeneous hyperdense mass. Preoperative serum alkaline phosphatase was elevated while endoscopic retrograde cholangiopancreatography was inconclusive. At laparotomy, extrahepatic biliary dilatation and enlarged, the nodular gallbladder was found with a diffusely fibrotic pancreas. Intraoperative cholangiogram confirmed Type IV choledochal cyst. Excision of the common bile duct and radical cholecystectomy was performed, and a Roux-en-Y hepaticojejunostomy. Histopathology confirmed the diagnosis of gallbladder adenocarcinoma. She had adjuvant chemotherapy and is presently on follow-up. No evidence of recurrence after 5 years of follow-up. A high index of suspicion is required to detect a combination of these two rare entities. When detected, both conditions should be surgically addressed at the same sitting, and when combined with adjuvant chemotherapy, may increase the chances of achieving a cure.Keywords: Adult, choledochal cyst, gallbladder cancer, jaundice, surgery, Nigeri

Early Experience with LigaSure Thyroidectomy in a Nigeria Teaching Hospital

Background: The principles of safe and efficient thyroid surgery had been established and the technique has remained the same for over the century without any major significant changes. The introductions of electrosurgical devices constitute a major shift in the technique of thyroid surgery. Objective: We present our early experience with the use of Ligasure vessel sealing system for the procedure of thyroidectomy. Materials and Methods: This was a quasi-experimental study comparing outcome of LigaSure thyroidectomy in a prospective nonrandomized cohort with another retrospective cohort of preintervention clamp-and-tie thyroidectomy. Results: A total of 30 patients with a clinical diagnosis of goiter were recruited into the study. There were two males and 28 females with a mean age of 42.6 years. Diagnosis was simple multinodular goiter 24 (80%), controlled toxic nodular goiter 3 (10%), grave disease 1 (3.3%), and multinodular goiter with retrosternal extension 2 (6.7%). The mean thyroid weight was 121.0 g. The mean duration of surgery was 59 min compared to 128 min for traditional technique (P < 0.01). The mean blood loss of 116 ml was significantly less than 328 ml following the traditional technique (P < 0.01). Mean duration of hospital stay was 1.9 days, compared to 3.55 days in the traditional technique group (P = 0.02). Troubling postoperative complications of change in voice quality occurred in only one patient (3.3%). Conclusion: LigaSure thyroidectomy was found to be easier and faster to carry out with no learning curve and easy to learn and adapt

EVALUATION OF FERMENTED MANGO (Mangifera indica) SEED MEAL IN THE PRACTICAL DIET OF NILE TILAPIA, (Oreochromis niloticus) FINGERLINGS

This study evaluated the use of fermented mango (Mangifera indica) seed meal (FMS) to substitute yellow maize in the practical diet for Nile tilapia, Oreochromis niloticus fingerlings (4.76±0.32 g). Five iso-nitrogeneous (35% crude protein) and approximately iso-energetic (3400 ME Kcal/kg) dietsin which yellow maize was replaced by FMSat 0% (FMS0/Control diet), 25% (FMS25), 50% (FMS50), 75% (FMS75) and 100% (FMS100) levels were formulated. The fish were fed on the diets at 5% body weight for 84 days. Alkaloids were highest (2.32%) among the anti-nutritional factors analyzed in FMS, while oxalate (0.84%) was lowest. Potassium was highest (8.91 mg/g) among the minerals, while copper was lowest (0.01 mg/g). Weight gain, specific growth rate and feed conversion ratio were similar (p>0.05) in fish fed diets FMS0 and FMS50. The fish fed diet FMS0 had the highest protein efficiency ratio (1.88). Protein digestibility decreased (p<0.05) as dietary FMS increased, while carbohydrate digestibility gave an inverse relationship. Results obtained show that FMS could replace yellow maize at 50% level without affecting growth, nutrient utilization and apparent protein digestibility in diets for Nile tilapia fingerlings

Early experience with ligasure thyroidectomy in a Nigeria Teaching Hospital

Background: The principles of safe and efficient thyroid surgery had been established and the technique has remained the same for over the century without any major significant changes. The introductions of electrosurgical devices constitute a major shift in the technique of thyroid surgery. Objective: We present our early experience with the use of LIGASURE vessel sealing system for the procedure of thyroidectomy. Materials and Methods: This was a quasi-experimental study comparing outcome of LigaSure thyroidectomy in a prospective nonrandomized cohort with another retrospective cohort of preintervention clamp-and-tie thyroidectomy. Results: A total of 30 patients with a clinical diagnosis of goiter were recruited into the study. There were two males and 28 females with a mean age of 42.6 years. Diagnosis was simple multinodular goiter 24 (80%), controlled toxic nodular goiter 3 (10%), grave disease 1 (3.3%), and multinodular goiter with retrosternal extension 2 (6.7%). The mean thyroid weight was 121.0 g. The mean duration of surgery was 59 min compared to 128 min for traditional technique (P < 0.01). The mean blood loss of 116 ml was significantly less than 328 ml following the traditional technique (P < 0.01). Mean duration of hospital stay was 1.9 days, compared to 3.55 days in the traditional technique group (P = 0.02). Troubling postoperative complications of change in voice quality occurred in only one patient (3.3%). Conclusion: LigaSure thyroidectomy was found to be easier and faster to carry out with no learning curve and easy to learn and adapt

UPOTREBA SJEMENA FERMENTIRANOG MANGA (Mangifera indica) U HRANIDBI MLAĐI TILAPIJE (Oreochromis niloticus)

This study evaluated the use of fermented mango (Mangifera indica) seed meal (FMS) to substitute yellow maize in the practical diet for Nile tilapia, Oreochromis niloticus fingerlings (4.76±0.32 g). Five iso-nitrogeneous (35% crude protein) and approximately iso-energetic (3400 ME Kcal/kg) dietsin which yellow maize was replaced by FMSat 0% (FMS0/Control diet), 25% (FMS25), 50% (FMS50), 75% (FMS75) and 100% (FMS100) levels were formulated. The fish were fed on the diets at 5% body weight for 84 days. Alkaloids were highest (2.32%) among the anti-nutritional factors analyzed in FMS, while oxalate (0.84%) was lowest. Potassium was highest (8.91 mg/g) among the minerals, while copper was lowest (0.01 mg/g). Weight gain, specific growth rate and feed conversion ratio were similar (p>0.05) in fish fed diets FMS0 and FMS50. The fish fed diet FMS0 had the highest protein efficiency ratio (1.88). Protein digestibility decreased (p0,05). Oblik hranidbe riba FMS0 imao je najveći omjer djelotvornih bjelančevina (1,88). Probavljivost bjelančevina smanjila se povećanjem dijetetskog FMS-a, dok se probavljivost ugljikohidrata povećala. Dobiveni rezultati pokazuju mogućnost zamjene žutog kukuruza sjemenom fermentiranog manga u hrandibi tilapija do 50% bez da taj oblik hranidbe utječe na rast, iskoristivost nutritivnih sastojaka i probavljivost bjelančevina prilikom hranidbe mlađi tilapije

UPOTREBA SJEMENA FERMENTIRANOG MANGA (Mangifera indica) U HRANIDBI MLAĐI TILAPIJE (Oreochromis niloticus)

This study evaluated the use of fermented mango (Mangifera indica) seed meal (FMS) to substitute yellow maize in the practical diet for Nile tilapia, Oreochromis niloticus fingerlings (4.76±0.32 g). Five iso-nitrogeneous (35% crude protein) and approximately iso-energetic (3400 ME Kcal/kg) dietsin which yellow maize was replaced by FMSat 0% (FMS0/Control diet), 25% (FMS25), 50% (FMS50), 75% (FMS75) and 100% (FMS100) levels were formulated. The fish were fed on the diets at 5% body weight for 84 days. Alkaloids were highest (2.32%) among the anti-nutritional factors analyzed in FMS, while oxalate (0.84%) was lowest. Potassium was highest (8.91 mg/g) among the minerals, while copper was lowest (0.01 mg/g). Weight gain, specific growth rate and feed conversion ratio were similar (p>0.05) in fish fed diets FMS0 and FMS50. The fish fed diet FMS0 had the highest protein efficiency ratio (1.88). Protein digestibility decreased (p0,05). Oblik hranidbe riba FMS0 imao je najveći omjer djelotvornih bjelančevina (1,88). Probavljivost bjelančevina smanjila se povećanjem dijetetskog FMS-a, dok se probavljivost ugljikohidrata povećala. Dobiveni rezultati pokazuju mogućnost zamjene žutog kukuruza sjemenom fermentiranog manga u hrandibi tilapija do 50% bez da taj oblik hranidbe utječe na rast, iskoristivost nutritivnih sastojaka i probavljivost bjelančevina prilikom hranidbe mlađi tilapije