Prevalence and Pattern of Stimulants Use among Long-distance Truck Drivers in a Truck Part in Kaduna State, Nigeria

Background: Stimulant use is recognized as an important factor in road safety worldwide, and concerns are growing over the incidence of road traffic accidents among drivers who drive under the influence of stimulants. Yearly, more than 1.25 million people lose their lives as a result of road traffic accidents, many of which are associated with stimulant use. Aim: The study aimed to assess the prevalence, pattern, and factors associated with stimulant use among long‑distance truck drivers in a truck part in Kaduna State, Nigeria. Methods: A cross‑sectional study was conducted in a truck park in Marraraban Jos in Kaduna State. A structured, interviewer‑administered  questionnaire was used to obtain data. A total of 152 respondents were interviewed. Data were analyzed using SPSS version 20. Chi‑square and  Fisher’s exact tests were used to identify the relationship between categorical variables with a level of significance at P < 0.05. Results: A total of 152 respondents participated in the study with a mean age of 33 ± 5 years. The prevalence of stimulant use was 64.5%. Only 92  (60.7%) drivers reported using stimulants on rare occasions. Years of driving experience was found to be associated with stimulant use (P = 0.031).  Other sociodemographic variables were shown not to be significantly related to stimulant use. Conclusion: The prevalence of stimulant use was found to be high among the drivers, with less experienced drivers more likely to use stimulants.  Efforts on improving road safety should include reducing stimulant use, especially among the younger less experienced drivers. Keywords: Jos, long‑distance drivers, Nigeria, stimulant

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown