Diagnosis and management of brain tumors at Jos university teaching hospital, Nigeria

(East African Medical Journal: 2001 78(3): 148-151

Comparative analysis of urethral catheterization versus suprapubic cytostomy in management of neurogenic bladder in spinal injured patients

No Abstract Nigerian Journal of Medicine Vol. 16 (4) 2007: pp. 318-32

Mortality and Morbidity Following Repair for Lumbosacral Myelomeningoceles

A retrospective study of 220 infants with myelomeningoceles was carried out to evaluate the results of management by non-operative (NO) and Delayed Surgical Closure (DSC). One hundred and twenty infants were managed by NO versus 100 for DSC during a 14-year period. There was an increase in the number of infants with patchy sensory loss from 15% at admission to 25% at 3 months post admission in NO versus an increase from 19% to 60 % for DSC. Similar figures for faecal incontinence for NO were 50% to 55% versus 52% to 68% for DSC. Hospital mortality for NO was 33% versus 6% for DSC. Wound infection occurred in NO in 46% versus 10% for DSC. At 2 years in NO, there were no survivors versus 52 surviving children in DSC. This study suggests treatment by DSC compared to NO was more effective in decreasing the mortality and morbidity associated with management of lumbo-sacral myelomeningoceles (Nig J Surg Res 2000; 2:139-143) KEY WORDS: Myelomeningoceles, delayed surgical closure, mortality, morbidit

Survival Following Resection for Soft Tissue Sarcomas

A retrospective study was carried out at the Jos University Teaching Hospital in order to determine the mean survival time (MST) at 10 years for 60 patients with histologically confirmed soft tissue sarcomas at different sites. There were 42 males to 18 females with a mean age of presentation of (28 ± SD 2) years. Forty-six per cent were predominantly high grade extremity lesions, 32 per cent were predominantly low grade trunk lesions and 12 per cent were high/intermediate grade sarcomas of the head and neck. Forty per cent were in stage T3, N0, M0, G3, 33 per cent T2, N0, M0, G1, and 8 per cent were in T2, N0, M0, G2 stage. Local resection was performed in 48 per cent, amputation in 35 per cent and craniectomy/ laparatomy plus resection in 7 per cent respectively. All patients with low grade sarcomas were still alive and free of disease (AFD) at a maximum period of 10 years. For intermediate grade lesions, Kaposi's sarcoma carried the lowest mean survival time (MST) of 1 year, fibroblastic fibrosarcoma 2 years and undifferentiated sarcoma 3 years. The average MST for all high grade lesions was 2 years. Upper extremity lesions carried the worst prognosis with a MST of 1½ years, head, neck, retroperitoneal, abdominal wall sarcoma 2 years and visceral and lower extremity sarcomas 3 years respectively. It was concluded that MST was probably more related to histological grade than site of lesions. Key words: Soft tissue sarcoma, resection, survival Résumé Une étude rétrospective a été effectuée à l'Hôpital Universitaire de Jos pour déterminer le Temps de Survie Moyenne (TSM) au cours de 10 ans, de 60 malades avec des sarcomes tissulaires mous déjà confirmés histologiquement, et localisés à différents emplacements du corps. L'étude a porté sur 42 hommes et 18 femmes âges en moyenne de 28 ±2 ans qui avait présenté des symptômes lors du diagnostic médical. Quarante-six pour cent (46%) des lésions étaient au stade grave, et principalement localisées sur des membres inférieurs et supérieurs, tandis que 32% se situaient au niveau du tronc et elles étaient d'importance relativement moindre. Enfin 12% des lésions étaient des affections de catégories de moyenne à grave et elles étaient localisées sur la tête et le cou. Quarante pour cent (40%) de cas étaient au stade T3, N0, M0, G3; 33 % - au stade T2, N0, M0, G1, et 8% - au stade T2, N0, M0, G2. L'incision locale a été pratiquée dans 48% de cas, l'amputation dans 35%, et la craniotomie / laparotomie suivie d'incision en 7% de cas, respectivement. Tous les malades avec des sarcomes mineurs étaient encore vivants et sans signes de la maladie pour une période maximale de 10 ans. Un TMS d'une année était enregistré pour des lésions de catégorie moyenne de sarcome de Kaposi. Les fibrosarcomes fibroblastiques donnaient lieu à une survie de 2 ans tandis que les sarcomes d'origine imprécise donnaient lieu à 3 ans de survie. Le temps moyen de survie pour toutes les lésions graves était de 2 ans. Les lésions des membres supérieurs donnaient lieu à de pires pronostics avec un TMS de 1½ ans. Aussi une survie de 3 ans était enregistrée chez les personnes avec des lésions situées sur la tête, le cou, de même que dans le cas des sarcomes des parois rétropéritonéale et abdominale, Un temps de survie de 3 ans a été observé pour les malades avec des sarcomes viscéraux et ceux des membres inférieures. Une conclusion donc se dégage de cette étude que le temps moyen de survie est probablement plus lié à la catégorie histologique que l'emplacement des lésions. Mots clés: sarcome mou de tissu, incision, survie (Discovery and Innovation: 2002 14 (3-4): 215-220

Examining characteristics, knowledge and regulatory practices of specialized drug shops in Sub-Saharan Africa: a systematic review of the literature.

BACKGROUND: Specialized drug shops such as pharmacies and drug shops are increasingly becoming important sources of treatment. However, knowledge on their regulatory performance is scarce. We set out to systematically review literature on the characteristics, knowledge and practices of specialized drug shops in Sub-Saharan Africa. METHODS: We searched PubMed, EMBASE, WEB of Science, CAB Abstracts, PsycINFO and websites for organizations that support medicine policies and usage. We also conducted open searches using Google Scholar, and searched manually through references of retrieved articles. Our search included studies of all designs that described characteristics, knowledge and practices of specialized drug shops. Information was abstracted on authors, publication year, country and location, study design, sample size, outcomes investigated, and primary findings using a uniform checklist. Finally, we conducted a structured narrative synthesis of the main findings. RESULTS: We obtained 61 studies, mostly from Eastern Africa, majority of which were conducted between 2006 and 2011. Outcome measures were heterogeneous and included knowledge, characteristics, and dispensing and regulatory practices. Shop location and client demand were found to strongly influence dispensing practices. Whereas shops located in urban and affluent areas were more likely to provide correct treatments, those in rural areas provided credit facilities more readily. However, the latter also charged higher prices for medicines. A vast majority of shops simply sold whatever medicines clients requested, with little history taking and counseling. Most shops also stocked popular medicines at the expense of policy recommended treatments. Treatment policies were poorly communicated overall, which partly explained why staff had poor knowledge on key aspects of treatment such as medicine dosage and side effects. Overall, very little is known on the link between regulatory enforcement and practices of specialized drug shops. CONCLUSIONS: Evidence suggests that characteristics and practices of specialized drug shops differ across rural and urban locations, and that these providers are highly responsive to client demand. However, there is a dearth in knowledge on how regulatory enforcement influences their characteristics and practices, and what strategies can be employed to strengthen the governance of the retail pharmaceutical sector