A review of 640 Oral squamous cell carcinoma cases in Nigeria

Oral squamous cell carcinoma (OSCC) is the most prevalent malignant neoplasm in the oral cavity and accounts for 70% to 90% of all oral malignant neoplasms. The aim of this study was to examine the demographic distribution of OSCC in five Tertiary Health centres in Nigeria. All cases diagnosed as OSCC during the period from 1970 -2014 were retrieved from the records of five teaching hospitals in Nigeria. Hematoxylin and eosin stained histological slides of all cases that had a diagnosis of OSCC were reviewed for confirmation and inclusion. Data from all the centers was collated at the University College Hospital, Ibadan by 2 researchers. The data was entered into and analyzed with the SPSS for Windows (version 20.0; SPSS Inc. Chicago, IL). Simple descriptive and comparative analyses were done, with the test of statistical significance set at p ? 0.05. A total of 640 cases of OSCC were seen out of 1560 oral malignant neoplasms representing 41% of all the oral malignancies seen. The mean age of occurence of OSCC was 55.5 (±17.0) years and a peak age incidence in the sixth and seventh decades of life. OSCC occurred more in males (60.9%) than females (39.1%) with a male: female ratio of 1.6:1. The well differentiated OSCC with 309 (48.3%) cases, was the most common grade, while the moderately differentiated and poorly differentiated OSCC accounted for 232 (36.2%) and 92 (14.4%) cases respectively. This study showed that OSCC is more common in males, most commonly seen in the 60-69 age group and the commonest site of occurrence was the mandibular mucosa. The well differentiated OSCC was the most common histology sub-type

Assessment of Tumor markers, C-reactive Protein, Cortisol and Total Plasma Peroxides Levels in Uterine Leiomyoma Patients

Objective: The pathophysiology of uterine leiomyoma is yet to be fully understood. This study determined the status of cortisol, C-reactive protein, total plasma peroxide and selected tumor markers in uterine leiomyoma patients. Materials and Methods: Forty-eight individuals (aged 25-45 years) with uterine leiomyoma (nodules=1-4; size=5-120mm) were recruited for this study. Forty apparently age-matched normal individuals without uterine leiomyoma served as controls. The patients and controls were selected after confirmation of the status of uterine leiomyoma by ultrasound imaging technique. The plasma levels of total plasma peroxides(TPP), cortisol, carcino-embryonic antigen(CEA), alpha fetoprotein (AFP), carbohydrate antigen 125(CA125) and C-reactive protein(CRP) were determined in them using spectrophotometry, enzyme linked immunosorbent assay and single radial immunodiffusion (Maccini) methods respectively. Results: The result shows significantly higher levels of TPP (p0.05) changes in the plasma levels of cortisol, CEA and AFP in the leiomyoma patients when compared with the controls. Significant (r=0.521, p=0.03) correlation existed between the number of myoma nodules and the levels of CRP in the leiomyoma patients. The size of the nodules correlated significantly (r=0.47, p=0.04) with the plasma levels of TPP. Conclusion: Elevated levels of CRP and TPP could indicate oxidative stress and inflammatory response in uterine leiomyoma patients. The induced inflammation and oxidative stress may increase with increase in number and size of the myoma nodules respectively. Higher level of CA125 could be a feature of uterine leiomyoma

A geographical analysis of ethnic distribution of jaw ameloblastoma in Nigerians

Introduction: Ameloblastoma is the most common odontogenic tumour in Nigeria. A definite geographic variation has been observed in the frequency of odontogenic tumors from different parts of the world. However, there is no study on the regional variations in Nigeria. Hence, this study was designed to document the ethnic and geographical distribution of jaw ameloblastoma in Nigeria.Methods: Archival data on ameloblastoma from 10 health facilities were obtained. Global Moran’s I detected geographic clustering in its distribution while Local Getis Ord indicated the location of ameloblastoma clusters. Chi-square tested associations between variables at 0.05 level of significance.Results: A total of 1,246 ameloblastoma cases were recorded in Nigeria. Besides substantial state variations, a South-North gradient was noticed in its distribution. Significant positive spatial autocorrelation was observed in the three major groups while ameloblas- toma hotspots were found in the SouthWestern and Northwestern Nigeria. The Igbos had a higher prevalence of ameloblastoma outside their home region than within.Conclusion: The study hypothesized that the geographical distribution of ameloblastoma in Nigeria is the result of all or one of the following:  the country’s tropical climate, migration patterns and health seeking behavior. Hopefully, these claims should lead to further enquiry on the underlying causes.Keywords: Ameloblastoma, ethnicity, spatial analysis, Nigeria

A geographical analysis of ethnic distribution of jaw ameloblastoma in Nigerians

Introduction: Ameloblastoma is the most common odontogenic tumour in Nigeria. A definite geographic variation has been observed in the frequency of odontogenic tumors from different parts of the world. However, there is no study on the regional variations in Nigeria. Hence, this study was designed to document the ethnic and geographical distribution of jaw ameloblastoma in Nigeria. Methods: Archival data on ameloblastoma from 10 health facilities were obtained. Global Moran\u2019s I detected geographic clustering in its distribution while Local Getis Ord indicated the location of ameloblastoma clusters. Chi-square tested associations between variables at 0.05 level of significance. Results: A total of 1,246 ameloblastoma cases were recorded in Nigeria. Besides substantial state variations, a South-North gradient was noticed in its distribution. Significant positive spatial autocorrelation was observed in the three major groups while ameloblastoma hotspots were found in the SouthWestern and Northwestern Nigeria. The Igbos had a higher prevalence of ameloblastoma outside their home region than within. Conclusion: The study hypothesized that the geographical distribution of ameloblastoma in Nigeria is the result of all or one of the following: the country\u2019s tropical climate, migration patterns and health seeking behavior. Hopefully, these claims should lead to further enquiry on the underlying causes. DOI: https://dx.doi.org/10.4314/ahs.v19i1.44 Cite as: Adisa AO, Osayomi T, Effiom OA, Kolude B, Lawal AO, Soyele OO, et al. A geographical analysis of ethnic distribution of jaw ameloblastoma in Nigerians. Afri Health Sci. 2019;19(1). 1677-1686. https://dx.doi.org/10.4314/ ahs. v19i1.4

Performance evaluation of concrete made with sands from selected locations in Osun State, Nigeria

It is common practice among most local contractors in Nigeria to produce concrete with any available sand, disregarding its attendant effect on concrete performance. Sands obtained from popular quarries in Osun State, Nigeria were investigated to determine their suitability for concrete production. The sands were labelled A, B, C, D and E. Physical and chemical properties as well as grading characteristics of the sand samples were determined using standard procedures. Impurities in the sands were equally evaluated. Strength and water demand of the concrete produced from these sands were also examined. The results showed that all the sands contained high silica with traces of alumina in almost the same quantity except Sand E that had relatively low silica but higher alumina. Particle size distribution of the sands indicated that Sand A had more fine particles with fineness modulus of 1.95 while sand D was coarser (2.79) and other sands (B, C and E) were within the range of 2.7 and 2.6. The specific gravities of the sands fell in the range of 2.5–2.7 except Sand A, which was 2.2. The strength of the concrete made from each of the sands equally differed significantly, with Sand E having the highest strength (23.5 N/mm2). Water absorption results indicated that Sands A and C may pose durability challenges due to higher water absorption compared to other sands. The study concluded that the selected sands had influence on the performance of concrete and it was recommended that all except Sand A, could be used for specific construction application. Keywords: Compressive strength, Aggregates, Organic matter, Particle size distribution, Water deman

Biological profile of ameloblastoma and its location in the jaw in 1246 Nigerians

OBJECTIVES: Ameloblastoma is a benign, slow-growing, locally invasive epithelial tumor of odontogenic origin, with unlimited growth capacity and a strong tendency to recur. This multicentric study analyzed ameloblastoma diagnosed in Nigeria among different ethnic groups. STUDY DESIGN: This retrospective study included ameloblastoma cases diagnosed from 1964 to 2017 at 10 hospitals or medical centers in Nigeria. Age, sex, tribe, and location of the ameloblastoma in the jaw were analyzed. Associations between variables were tested by using χ2 and Fisher's exact test. RESULTS: A total of 1246 ameloblastoma cases were recorded (mean patient age 32.51 ± 14.54 years; range 4-86 years; male-to-female ratio 1.2:1). Approximately 60% of ameloblastoma cases occurred in young adults (age range 18-40 years). Ninety-eight lesions were located in the maxilla and 1103 in the mandible; the posterior mandible was the most common site (31.3% on the right and 26.5% on the left, respectively), followed by the anterior (26.0%) mandible. No significant differences were noted in the distribution of ameloblastoma within the tribes with respect to age (P = .92) and sex (P = .71). CONCLUSIONS: The mandible is a common site of ameloblastoma in patients in Nigeria, and in most cases, it occurs in young adults. Early presentation, diagnosis, and treatment are important to reduce postoperative disfigurement and morbidity.status: publishe

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit