Spontaneous rupture: An uncommon complication of ventral hernia

BACKGROUND: Literature is scarce about spontaneous rupture of hernia because spontaneous rupture of here is uncommon (1). Reported cases are complications of incisional hernias, recurrent inguinal hernia, and umbilical hernias. It is potentially life threatening (1) because the ensuing entrapment and tension on bowel mesentery may lead to vasovagal shock or  strangulation.In addition to systemic problems and increased intra-abdominal pressure that lead to the herniation, the spontaneous rupture and evisceration is usually preceded by other factors such as inflammation that weaken the hernia covering (1, 2).We a report a case of spontaneous rupture of an incisional ventral hernia referred to the University of Ilorin teaching hospital.KEYWORDS: spontaneous, rupture, incisional, hernia, pathogenesi

Determination of haptoglobin, hemoglobin genotypes and malaria incidence in Nigerian breast cancer patients

Breast cancer is the second leading cause of cancer morbidity and mortality globally. Cancer chemotherapy commonly result in hemolysis, which impacts patient overall health. There is a need to determine genetic factors associated with hemolysis in breast cancer patients. Haptoglobin (Hp), a polymorphic protein plays important role in hemoglobin clearance and disease predisposition, but has been reported to have no prognostic factor in breast cancer. However, understanding selection pressure that drives certain gene mutations in specific populations and how it confers protection or susceptibility to diseases is crucial. In Nigeria, breast cancer, malaria infection and sickle cell disease are prevalent and associated with hemolysis, but little is known of their association in breast cancer patients. This study aims to determine relationship between haptoglobin, hemoglobin genotypes and submicroscopic malaria co‐morbidity in clinically diagnosed breast cancer and healthy Nigerian women. DNA was extracted from blood using standard methods. Haptoglobin 2 and hemoglobin genotypes were detected by RFLP‐PCR, while Plasmodium falciparum infection was detected by primer specific amplification of plasmodium cytochrome oxidase III gene (cox III) in 75 clinically diagnosed breast cancer (BC) and 287 healthy women (control; HC). Proportions were determined and compared in the two groups and test of association was carried out with significance level set at P <0.05. In BC groups, 3 (4.1%) of 72 Hp 2‐2 phenotypes was detected compared to a significantly higher occurrence of 48 (16.7%) of 287 in HC group (p <0.05). Conversely, malaria infection was detected in 68 (94.4%) BC versus 255 (88.9%) in HC group. A similar proportion had Hp deletions (2 in BC and 8 in HC group). There was a low prevalence of hemoglobin S genotype in the entire population and relative risk for Hp 2‐2 polymorphism in hemoglobin genotypes was not significantly different. In conclusion, this study reports in breast cancer and healthy women an inverse correlation of haptoglobin (Hp2‐2) genotype with malaria incidence in southwest Nigeria. The results imply a possible protection against hemolysis and can play significant role in determining choice of cancer therapy for good patient treatment outcomes

How Effective is the Treatment of Locally Advanced and Metastatic Breast Cancer in Developing Centres?: A Retrospective Review

BACKGROUND: The use of chemotherapy in advanced metastatic breast cancer remains a subject of controversy. The thought of MicKinnon et al (early 1950s) that the course of breast cancer was unaffected by chemotherapy has been refuted by results of treatment in the developed countries. The poor result of treatment in developing centres still compares with prechemotherapy era. Consequently, The McKinnon’s thought may still lurk. We compared the survival of chemotherapy treated with chemotherapy untreated cancer of breast patients.METHOD: Records of breast cancer patients who presented and died between January 2010 and May  2014 were reviewed. The primary outcome was overall survival. Records of patients that received  chemotherapy with or without other tumor directed specific therapy were compared with records of patients who did not receive any tumor directed therapy.RESULT: Thirty-one patients received chemotherapy while 25 patients did not. All were females, more than 90% were of the patients had advanced or metastatic disease. Treatments were not biologically  directed and treatment plans were largely compromised and suboptimal. The overall mean survival was  19.2 ±9.2 months, and the median duration was 17.5 months(range 6-44months). The overall survival  was not statistically different between the two groups (p= 0.230, unequal variance assumed). The  objective of using neoadjuvant chemotherapy for fungating lesions was not achieved.CONCLUSION: In advanced and metastatic breast cancer, outcomes of patients who receive  suboptimal regimen of cytotoxic chemotherapy do not differ from chemotherapy untreated patients.KEYWORDS: breast cancer, suboptimal treatment, untreated, chemotherap

A Clinicopathological Review of Colonic Polyps in a Tertiary Hospital in North Central Nigeria

Background: Colorectal polyps, especially adenomas, are known as precursors of colorectal carcinomas. This study was aimed at determining the prevalence and histopathologic characteristics of colonic polyps among Nigerians that underwent colonoscopy at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. The authors also determined the polyp detection rate and adenoma detection rate. Materials and Methods: This was a hospital-based cross-sectional study of all colonoscopy examinations performed at the University of Ilorin Teaching Hospital, Ilorin from March 2013 to September 2017. The endoscopy register was reviewed, and patients’ biodata, indications for colonoscopy and colonoscopic findings were recorded on a proforma. The histopathologic reports of the polyps were also retrieved and their diagnosis confirmed. Results: A total of 289 patients had colonoscopy carried out on them. The age of the patients ranged from 14 to 90 years with a mean ±SD of 57.0 ± 15.3 years and a median age of 58 years. There were 178 (61.6%) males and 111 (38.4%) females giving a M:F ratio of 1.6:1. The indications for colonoscopy were rectalbleeding 124 (42.9%); suspected colorectal cancer 67 (23.2%); abdominal pain 22 (7.6%); chronic diarrhea 18 (6.2%); surveillance colonoscopy 12 (4.2%); constipation 11 (3.8%); change in bowel habit 9 (3.1%); occult bleeding 6 (2.1%); others 20 (6.9%). Endoscopic findings were normal findings 89 (30.8%); hemorrhoids 88 (30.4%); colonic polyps 50 (17.3%); diverticulosis 34 (11.8%); rectal cancer 29 (10.0%); colon cancer 24 (8.3%); colitis 19 (6.6%); others 13 (4.5%). The findings were not mutually exclusive. The diagnostic yield was 69.2%. The overall polyp detection rate was 17.3%. Of the 50 patients with polyps, 33 (66.0%) were males (p = 0.481). Theadenoma detection rate was 4.8%. Conclusion: The authors conclude that their observed polyp detection rate is consistent with the estimated rates for Africa. Rectal bleeding and adenomatous polyps were the commonest presentation and histopathologic finding, respectively

Translation and psychometric assessment of the mastectomy module of the BREAST-Q questionnaire for use in Nigeria

Background: The majority of non-metastatic breast cancer patients in sub-Saharan Africa are recommended to have mastectomy. The impact of mastectomy on a predominantly young African patient population requires evaluation. The BREAST-Q is a validated patient-reported outcome measure of quality-of-life following breast surgery that has been translated into 30 languages-none in Africa. This study aimed to translate and assess the psychometric properties of the mastectomy module of the BREAST-Q for use in Nigeria. Methods: The BREAST-Q mastectomy module was translated from English to Yoruba and its psychometric properties assessed using best practice guidelines. Translation was performed in 4 steps: forward translation (x2), back translation, back translation review, and cognitive interviews with post-mastectomy patients. The translated BREAST-Q instrument was administered to post-mastectomy patients (n = 21) alongside the EORTC-QLQ BR23 to evaluate construct validity. Test-retest reliability was evaluated using intraclass correlation coefficients (ICC); surveys were re-administered 4 weeks apart. Results: The translation process identified English phrases not amenable to direct translation, including “emotionally healthy” and descriptions of pain (“nagging,” “throbbing,” “sharp”). Translations were amended to reflect local context and question intent. During cognitive interviews, patients provided suggestions to simplify complex phrases, e.g. “discomfort in your breast area.”. Internal consistency within scales was over 0.70 for psychosocial wellbeing (α = 0.84–0.87), sexual wellbeing (α = 0.98–0.99), physical wellbeing in chest (α = 0.84–0.86), and satisfaction with care (α = 0.89–0.93). ICC for test-retest reliability was moderate (0.46–0.63). Conclusions: The Yoruba version of the BREAST-Q mastectomy module presents a unique opportunity to adequately capture the experiences of Nigerian women post mastectomy. This instrument is being used in a pilot study of Nigerian patients to identify targets for intervention to improve the patient experience and compliance with breast cancer surgery

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Bilateral Breast Cancer: Experience in a Poor Resource Black African Setting

Background: Breast cancer is the most common malignancy in women in Nigeria. Women previously treated for ipsilateral breast cancer have increased risk of developing contalateral breast cancer (CBC), the chance of which increases with longer period of survival and is associated with worse prognosis. Reports from Nigeria are few on this. The aim of this study was to assess the prevalence, predisposition, presentation, and outcome of management of bilateral breast cancer (BBC) in a population, South-western Nigeria. Methods: A review of bio-data of all patients with BBC seen in LTH, Osogbo, Nigeria between 2001 and 2008 was done. Age, parity, age at menarche and first child birth, family history, duration of symptoms, tumour characteristics and exposure to cigarette, oral contraceptive pills (O.C Pills) and outcome of treatment were also assessed. Results: BBC constituted 4.6% of the 256 breast cancer patients. Eight (73%) were metachronous and 91% were infiltrating ductal carcinoma. Patients’ mean age, mean age at menarche and first child birth were 39, 14.5+3 and 22.5yrs respectively. Mean parity was 3.5 child birth, 91% were premenopausal and all have menstruated for 12-31yrs. None had positive family history while only 1 and 3 had insignificant exposure to cigarette and O.C pills respectively. The mean interval between the 2 onsets was 18mths (0-68mths). 91% of all tumours were advance, while 81% of the first tumours were on the right. Mean duration before presentation for the first and second tumours were 261 and 111 days respectively. One patient has survived for 2 years thus far. Conclusion: The incidence of BBC was 4.26%. Most patients were young and premenopausal with mostly infiltrating ductal carcinoma (NOS) and presenting with late stage disease, hence poor prognosis. Aggressive follow-up of patients with ipsilateral cancer will aid early detection of CBC

A Clinicopathological Review of Colonic Polyps in A Tertiary Hospital in North Central Nigeria

Background: Colorectal polyps, especially adenomas, are known as precursors of colorectal carcinomas. This study was aimed at determining the prevalence and histopathologic characteristics of colonic polyps among Nigerians that underwent colonoscopy at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. The authors also determined the polyp detection rate and adenoma detection rate. Materials and Methods: This was a hospital-based cross-sectional study of all colonoscopy examinations performed at the University of Ilorin Teaching Hospital, Ilorin from March 2013 to September 2017. The endoscopy register was reviewed, and patients' biodata, indications for colonoscopy and colonoscopic findings were recorded on a proforma. The histopathologic reports of the polyps were also retrieved and their diagnosis confirmed. Results: A total of 289 patients had colonoscopy carried out on them. The age of the patients ranged from 14 to 90 years with a mean ±SD of 57.0 ± 15.3 years and a median age of 58 years. There were 178 (61.6%) males and 111 (38.4%) females giving a M:F ratio of 1.6:1. The indications for colonoscopy were rectalbleeding 124 (42.9%); suspected colorectal cancer 67 (23.2%); abdominal pain 22 (7.6%); chronic diarrhea 18 (6.2%); surveillance colonoscopy 12 (4.2%); constipation 11 (3.8%); change in bowel habit 9 (3.1%); occult bleeding 6 (2.1%); others 20 (6.9%). Endoscopic findings were normal findings 89 (30.8%); hemorrhoids 88 (30.4%); colonic polyps 50 (17.3%); diverticulosis 34 (11.8%); rectal cancer 29 (10.0%); colon cancer 24 (8.3%); colitis 19 (6.6%); others 13 (4.5%). The findings were not mutually exclusive. The diagnostic yield was 69.2%. The overall polyp detection rate was 17.3%. Of the 50 patients with polyps, 33 (66.0%) were males (p = 0.481). Theadenoma detection rate was 4.8%. Conclusion: The authors conclude that their observed polyp detection rate is consistent with the estimated rates for Africa. Rectal bleeding and adenomatous polyps were the commonest presentation and histopathologic finding, respectively