Amyloid angiopathy of the floor of the mouth: a case report and review of the literature

Amyloidosis is a rare disease characterised by the deposition of insoluble extracellular fibrillar proteins in various tissues of the body. The pattern of manifestation is organ dependent and also on whether the disease is localised or systemic, primary or secondary

Environmental and Life-Style Related Risk Factors for Sinonasal and Nasopharyngeal Malignancies among a Prospective Cohort in Jos, Nigeria

Background. Worldwide evidence indicates that environmental and life-style related factors are associated with increased risk for cancers in the head and neck region. We aim to study the association between these risk factors and cancers in the sinonasal and nasopharyngeal regions in our environment. Methods. Longitudinal prospective cohort study at the Jos University Teaching Hospital, Jos, Nigeria. Risk exposures were classified based on the International Agency for the Research on Cancer (IARC) classification of suspected carcinogens. Associations between variables were analyzed using logistic regression. Results. We studied 44 patients with malignancies in nasopharynx (n= 24; 54.5%) and sinonasal regions (n= 20; 45.5%). Male to female ratio is 1.9:1 and mean age is 45.2 years. Alcohol was the commonest risk factor in males (n= 19; 43.2%) while cooking wood fumes were the commonest in females (n= 14; 31.8%) which was associated with increased risk for malignancies for all sites, showing ten times risk in nasal cancers (OR= 9.67; 95% CI 1.87- 9.88; p= 0.01). Tobacco was associated with elevated risk of malignancies in the nasomaxillary and nasal regions. Other risks were herbicides, pesticides, and chemical fertilizers in farmers. Conclusion. The significant risk exposures in females were cooking wood fumes and alcohol, tobacco, and exposure to agricultural chemicals in males. Life-style modification and environmental changes to ensure clean air in Nigeria are essential to reduce risks

Theatre start and turnover times in a developing country

Background: Enormous amounts of resources are spent to keep the operating suites running and approximately one-third of total hospital budget is devoted to it. Delays in start or turnover times (TOT) lead to needless cancellations of procedures. Our study seeks to evaluate the causes of delay and to proffer some solutions to these identified reasons.Methods: A prospective observational study carried out to collect data of elective procedures using a proforma. The causes of delay in starting surgical procedures and turnover times were assessed and documented.Results: Three hundred and ninety seven elective procedures were evaluated between 2nd January and 31st July, 2018. All scheduled first procedures were delayed and a third (36%) of subsequent procedures was delayed for between 45-60 minutes. One hundred and forty six (27.2%) of procedures delayed were due to prolongation of time for washing of instruments by perioperative nurses after a procedure and cleaning of the theatre suite by attendants before a subsequent case was brought in. Delays due to challenges with central sterile supply department (CSSD) had 16.0% (86). Other causes of delay included delay in porters transporting patients from ward to theatre (15.6%), and collection of anaesthetic drugs from pharmacy/non-availability which accounted for 10.4%Conclusion: Multiple factors are responsible for delays in turnover times in the operating room. The commonest cause was washing of instruments and cleaning of theatre suites; others were challenges with the central sterile supply department (CSSD and delay in obtaining drugs from the theatre pharmacy. A multidisciplinary approach where all parties involved in surgery target these specific areas would help improve efficiency and reduce turnover times. Keywords: Theatre, delays, turnover time, developing countr

The predictive factors of primary head and neck cancer stage at presentation and survival in a developing nation’s tertiary hospital

Background: Stage of head and neck cancers at presentation is a strong determinant of outcomes. Objective: To evaluate predictors of stage of head and neck cancers at presentation and survival in a Nigerian tertiary hospital. Patients and methods: Health records that met the inclusion criteria for head and neck cancers were retrieved using the International Classification of Diseases, 10th revision and analyzed with associations between variables modeled using logistic regression analysis. Results: From a record of 487 head and neck neoplasms, 129 (26.5%) were malignant of which 122 health records met the criteria for analysis consisting of 83 (68.0%) males and 39 (32.0%) females aged 13–85 years (mean = 51 years; standard deviation = ±16 years). Alcohol (odds ratio = 1.99; 95% confidence interval = 1.08–3.69; p = 0.02) and tobacco exposure (odds ratio = 3.07; 95% confidence interval = 1.32–7.16; p = 0.01) were associated with increased odds for advanced tumor stage at presentation. Stage IV cancer (hazard ratio = 1.44; 95% confidence interval = 1.80–2.59), alcohol (hazard ratio = 2.19; 95% confidence interval = 1.18–4.10) and tobacco use (hazard ratio = 3.40; 95% confidence interval = 1.22–8.74) were associated with increased hazards for death. Conclusion: Alcohol, tobacco use and smoke from cooking wood are predictive factors for advanced HNC stage at presentation. Stage IV cancer, alcohol and tobacco use were associated with an increased hazard for death