Epidemiology and clinicopathological pattern of endometrial carcinoma in Lagos tertiary Hospitals, South-West Nigeria.

Endometrial cancer has become a global health challenge because of its rising morbidity. Understanding the epidemiology and clinicopathological review of this disease may not only aid with treatment but also further the development of prevention strategies. Objectives: To review the epidemiology and clinicopathological pattern of endometrial cancer in 2 Lagos Tertiary Hospitals between January 1997 to December 2016. Methodology: This is a retrospective study conducted at the oncology clinics of Lagos University Teaching Hospital (LUTH) and Lagos State University Teaching Hospital (LASUTH). Patients' sociodemographic variables, disease characteristics and clinical features were retrieved and analyzed using the statistical package for social sciences (SPSS) version 23.0. Results: This 20-year review revealed 162 cases. There was an increasing trend in the incidence with the highest number of cases seen in 2016 (26 patients). The age ranges from 31 to 90years with a mean of 61.0 + 10. 6years. The most common histology was endometrioid adenocarcinoma with 98(60.5%). Eighty-four (51.9%) patients presented with stage III disease, 46 (28.4%) with stage IV. All the patients presented with bleeding per vaginum, 73(45%) presented with low backache and vaginal discharge seen in 46(28.4%) patients. Conclusion: There was an increasing incidence over the years. More than three quarters presented with stage III or IV diseases. This suggests the need for a high index of suspicion for endometrial cancer especially in women with bleeding per vaginum

The ‘evil arrow’ myths and misconceptions of cancer at Lagos University Teaching Hospital, Nigeria

Background: Myths and misconceptions have significant impact on the presentation and management of cancers globally. One such example includes ‘evil arrow’ myths. There is limited knowledge regarding the role of misconceptions in late presentation for management in developing countries. The percentage increase in cancers in many African countries is higher than that in developed countries. Evil arrow is the seeming attack of the enemy in a supernatural version as a result of wizardry. Aim: To evaluate the relationship of common myths and misconceptions among cancer patients, their treatment and delay of presentation to the hospital. Setting: The study was undertaken in a tertiary health facility in a cosmopolitan tropical state. Method: This is a randomised observational survey study carried out among patients and their relatives referred to the Radiotherapy Clinic of the Lagos University Teaching Hospital for treatment (a lower-income mixed metropolitan setting). A self-administered questionnaire was used. Patient consent was obtained. Data were analysed with Epi Info 2002 software and the results were presented using frequency tables and charts. Results: About 57 were patients (67%) and 28 were patients’ relatives (33%). The age distribution of participants showed 31–40 years (31.8%; 27) as the highest number, while 11–20 years (1.2%; 1) was the lowest number. A slight female preponderance of 58.8% (50) was observed. High incidence of those with the opinion that cause of cancer is unknown represented 63% (54). Over 65% of patients presented with advanced disease. The reasons for late presentation to the hospital included lack of funds in 23.5% of patients (20). Conclusion: Lack of funds, myths and misconception are main reasons why patients presented late to hospital. There is a need to emphasise debunking innumerable myths and misconceptions associated with cancer

Delayed referral and treatment of paediatric cancer in Nigeria: Time to stop blaming the victim

Background: Caregiver delay in presentation has been cited as a major contributor to poor prognosis of paediatric cancers in low-middle income countries like Nigeria. This study explored the time duration between onset of symptoms and presentation to healthcare facilities, diagnosis, and referral for specialist care. Methods: Data were compiled from caregivers of newly registered children at a teaching hospital in Nigeria. Sociodemographic and clinical history of the child were taken. Type of cancer, date of diagnosis, centre where the diagnosis was made, treatment start date, and duration of symptoms until treatment were elicited from consenting caregivers and documented. Results: Acute lymphoblastic leukaemia was the most prevalent cancer type among the patients. The mean time from first symptom to presentation was 15 weeks and from presentation at any health care facility to specialist referral and diagnosis was 38 and 39 weeks, respectively. Time from diagnosis to treatment was a mean of 8 weeks (range: 1 to 27 weeks) Conclusion: Delayed presentation has become a commonly cited factor for poor cancer outcomes in Nigeria and may often inaccurately assign blame to the patient/caregivers. The results of this study point to delayed detection, delayed diagnosis and delayed referral for specialist care, as more accurate contributors to late-stage presentation and consequently worse outcomes of paediatric cancers in Nigeria. Strengthening of community and primary level healthcare professionals’ understanding of paediatric cancers, establishment of simple detection algorithms and national implementation of efficient referral protocols will potentially reduce delays in specialist attention and improve outcomes

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Childhood cancer in Nigeria: The effect of a handbook in the experiences of caregivers

Background: Parents of children diagnosed with cancer are handed a frightening diagnosis, with attendant emotional, social, and financial challenges. They often have many questions that remain unanswered by busy doctors and nurses, who are themselves overwhelmed by the challenges of caring for cancer patients in resource-constrained circumstances. The objective of this study is to evaluate the impact of a childhood cancer handbook on the experience of caregivers of children diagnosed with paediatric cancer in Nigeria.Methodology: A series of focus group discussions involving caregivers of children with histologically diagnosed cancer were held. A childhood cancer handbook was given to each participant to read. Data was collected four weeks later and analysed using qualitative content analysis.Results: In general, 91.7% of focus group participants reported that they found the handbook useful and having it at diagnosis would have significantly increased their level of information and made dealing with the diagnosis more tolerable. However, many of the participants reported that while the book completely catered to their informational and emotional needs, it did not adequately address certain practical needs such as paying for cancer treatment.Conclusion: Many Nigerian families go through the entire paediatric cancer journey, feeling like they are stumbling in the dark. No dedicated information resource on paediatric cancer exists in Nigeria. The provision of a detailed handbook at diagnosis may reduce the psychological and emotional toll of a cancer diagnosis on parents and family of a child diagnosed with cancer

Cultural Characteristics and Antibiotic Susceptibility Pattern of Helicobacter pylori Isolated from Dyspepsia Patients

Helicobacter pylori consist in a helical shaped Gram-negative bacterium, approximately 3 micrometers long with a diameter of approximately 0.5 micrometers. It has 4-6 flagella. It is microaerophilic and tests positive for oxidase, catalase and urease. With its flagella, the bacterium moves through the stomach lumen and drills into the mucus gel layer of the stomach. In humans, H. pylori have been associated with peptic ulcers, chronic gastritis, duodenitis and stomach cancer. It is widely believed that in the absence of treatment, H. pylori infection, once established in its gastric niche, persists for life. The aim of this research is to study the cultural characteristics and antibiotic susceptibility pattern of H. pylori strains isolated from southwest Nigeria. The cultural characteristics and antibiotic susceptibility pattern of Helicobacter pylori strains isolated from gastric mucosal antral biopsy specimens collected from 43 of 52 dyspepsia patients in the University College Hospital Ibadan, Oyo State, Nigeria, were determined using standard microbiological methods for Helicobacter pylori isolation. The 43 isolates were subjected to 23 different antibiotics and each of the antibiotics demonstrated a variable degree of activity against the isolates. Among the antibiotics to which the organism was most susceptible are: ofloxacin (30 μg) 100% activity, ciprofloxacin (5 μg) 97.67% activity, gentamicin (120 μg) 95.35 activity, amikacin (30 μg), kanamycin (30 μg) and chloramphenicol (30 μg) each 90.70% activity, clarithromycin (15 μg) 93.02, while the less active antibiotics are: augmentin (30 μg) 23.26% active, amoxycillin (25 μg) and metronidazole (50 μg) each 27.91% active and clindamycin (2 mg) 30.23% active. From the result of the antibiotic susceptibility pattern of the strains of the organism, 95.35% of the total isolates are multi drug resistant. Resistance was developed to, among others, augmentin (30 μg), amoxycillin (25 μg), metronidazole (50 μg) and clindamycin (2 mg)

Examining Cancer Patients' Perceptions of the Impact of COVID-19 on Teleoncology: Findings From 15 Nigerian Outpatient Cancer Clinics

PURPOSETo examine cancer patients' perspectives on the impact of COVID-19 on teleoncology in Nigeria.METHODSData from a multicenter survey conducted at 15 outpatient clinics to 1,097 patients with cancer from April and July 2020 were analyzed. The study outcome was telemedicine, defined as patients who reported their routine follow-up visits were converted to virtual visits because of COVID-19 (coded yes/no). Covariates included patient age, ethnicity, marital status, income, cancer treatment, service disruption, and cancer diagnosis/type. Stata/SE.v.17 (StataCorp, College Station, TX) was used to perform chi-square and logistic regression analyses. P values ≤ .05 were considered statistically significant.RESULTSThe majority of the 1,097 patients with cancer were female (65.7%) and age 55 years and older (35.0%). Because of COVID-19, 12.6% of patients' routine follow-ups were converted to virtual visits. More patients who canceled/postponed surgery (17.7% v 7.5%; P ≤ .001), radiotherapy (16.9% v 5.3%; P ≤ .001), and chemotherapy (22.8% v 8.5%; P ≤ .001), injection chemotherapy (20.6% v 8.7%; P ≤ .001) and those who reported being seen less by their doctor/nurse (60.3% v 11.4%; P ≤ .001) reported more follow-up conversions to virtual visits. In multivariate analyses, patients seen less by their doctors/nurses were 14.3 times more likely to have their routine follow-ups converted to virtual visits than those who did not (odds ratio, 14.33; 95% CI, 8.36 to 24.58).CONCLUSIONCOVID-19 caused many patients with cancer in Nigeria to convert visits to a virtual format. These conversions were more common in patients whose surgery, radiotherapy, chemotherapy, and injection chemotherapy treatments were canceled or postponed. Our findings suggest how COVID-19 affects cancer treatment services and the importance of collecting teleoncological care data in Nigeria