Awareness of Venous thromboembolism among doctors in a Nigerian tertiary centre

Background: Venous thromboembolic (VTE) is a preventable leading cause of morbidity and mortality worldwide and is a cause of sudden death. Awareness of VTE among doctors will reduce the incidence of unexpected deaths in hospitalised patients.Objective: To assess doctors’ awareness of venous thromboembolism in our centre.Design: Cross sectional questionnaire based study.Setting: University of Port Harcourt Teaching Hospital, Nigeria.Subjects: One hundred and twenty four doctors attending a hospital grand-rounds session were recruited.Results: The response rate was 82.7% (124 of 150 questionnaires). Almost half (n=57, 46%) correctly identified VTE, but two (1.6%) did not know what VTE was and 27 (21.8%) stated it to be normal haemostasis. Commonly identified risk factors included: increased body mass index 113 (91.1%), diabetes mellitus 105 (84.7%), pregnancy 105 (84.7%), age 104 (83.9%), and immobility 104 (83.9%). Although clinical features were identified, VTE was acknowledged to be asymptomatic by 62 (50%) responders. About 68 (54.8%) did not know of a VTE risk stratification model and only one (0.8%) had used a model in practice. Responders commonly prescribed anticoagulants for prophylaxis. Although most had come across VTE in practice, 15 (12.1%) had not seen a case of VTE.Conclusion: The knowledge of VTE was average. There was a gap between knowledge and practice for this preventable disorder. Patients in our centre were not routinely risk stratified for VTE. Updating of medical knowledge is encouraged

Prospective Study of Sex Hormone Levels Among Prostate Cancer Patients Attending University of Port Harcourt Teaching Hospital Clinic

Background: Longstanding and diverse body of evidence supports the view that sex steroids play a role in the development of prostate cancer. Epidemiological and demographic studies in humans as well as animalexperiments have sought to determine the independent effect on risk as well as the interrelationship between these hormones. In this study, we investigated the variations in testosterone and oestradiol levels among prostate cancer patients attending UPTH clinics with the objective of determining the role played by sex hormone variations in the development of cancer of prostate in patients attending the University of Port Harcourt Teaching, Port Harcourt.Methods: Newly diagnosed patients with cancer of the prostate attending the Urology clinic of University of Port Harcourt Teaching, Port Harcourt from December 2011 to April 2012 were recruited for the study. Their Prostate Specific Antigen (PSA) testosterone and oestrogens levels were measured using Elisa Kits. Correlation between individual hormone levels in control subjects were assessed by Spearman correlation coefficients (R). Student t-test was used to assess if there was any significant difference between the patients and controls in the level of these hormones. We computed the ratio of oestradiol to testosterone and compared case patients with control subjects by use of t-test at 95% confidence interval. Test cases were also divided into two groups by age to study variations across subgroups.Results: 105 patients recently diagnosed with prostate cancer and 40 normal subjects were analyzed. We observed a negative correlation between testosterone and oestradiol (r = -0.66). Testosterone and oestradiol levels in prostate cancer patients were also significantly different from that of controls. Mean testosterone level in control was 3.2 ng/ml while that of the patients was 4.0 ng /ml. Mean oestradiol level in controls was 32.8 pg/ml while that of the patients was 21.2pg/ml (p < 0.05 in both cases). The ratio of oestradiol to testosterone was also significantly alteredin prostate cancer patients (p < 0.05). The mean levels of hormones and hormone ratios across the two sub-age groups were not substantially different in patients with prostate cancer (p > 0.05).Conclusion: This study indicates that increased levels of testosterone in circulation are associated with risk of prostate cancer. This risk is further associated with low levels of circulating oestradiol. The relative levels or ratio of these hormones are very important in the development of prostate cancer. Age of the patient appear not to be strongly related with these changes after the cancerous state has set in.Key Words: Prostate cancer, oestrogens, testosterone, Prostate Specific Antigen (PSA)

Management of Patients with Advanced Prostate Cancer: Report from the Advanced Prostate Cancer Consensus Conference 2021.

BACKGROUND: Innovations in treatments, imaging, and molecular characterisation in advanced prostate cancer have improved outcomes, but various areas of management still lack high-level evidence to inform clinical practice. The 2021 Advanced Prostate Cancer Consensus Conference (APCCC) addressed some of these questions to supplement guidelines that are based on level 1 evidence. OBJECTIVE: To present the voting results from APCCC 2021. DESIGN, SETTING, AND PARTICIPANTS: The experts identified three major areas of controversy related to management of advanced prostate cancer: newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC), the use of prostate-specific membrane antigen ligands in diagnostics and therapy, and molecular characterisation of tissue and blood. A panel of 86 international prostate cancer experts developed the programme and the consensus questions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The panel voted publicly but anonymously on 107 pre-defined questions, which were developed by both voting and non-voting panel members prior to the conference following a modified Delphi process. RESULTS AND LIMITATIONS: The voting reflected the opinions of panellists and did not incorporate a standard literature review or formal meta-analysis. The answer options for the consensus questions received varying degrees of support from panellists, as reflected in this article and the detailed voting results reported in the Supplementary material. CONCLUSIONS: These voting results from a panel of experts in advanced prostate cancer can help clinicians and patients to navigate controversial areas of management for which high-level evidence is scant. However, diagnostic and treatment decisions should always be individualised according to patient characteristics, such as the extent and location of disease, prior treatment(s), comorbidities, patient preferences, and treatment recommendations, and should also incorporate current and emerging clinical evidence and logistic and economic constraints. Enrolment in clinical trials should be strongly encouraged. Importantly, APCCC 2021 once again identified salient questions that merit evaluation in specifically designed trials. PATIENT SUMMARY: The Advanced Prostate Cancer Consensus Conference is a forum for discussing current diagnosis and treatment options for patients with advanced prostate cancer. An expert panel votes on predefined questions focused on the most clinically relevant areas for treatment of advanced prostate cancer for which there are gaps in knowledge. The voting results provide a practical guide to help clinicians in discussing treatment options with patients as part of shared decision-making

Surgical inpatient mortality in a Nigerian Tertiary Hospital

Background: There is paucity of literatures on audit of mortality in the surgical units of tertiary hospitals in the country. This has made the spectrum of mortality not to been known in some of the centers and therefore, there is a great disparity and dearth in apportioning health care services appropriately.Aim: The determination of the pattern of mortality in a surgical unit helps in planning, provision of quality surgical care and prioritizing of limited resources in developing countries.Methods: This is a retrospective study of all patients who died during admission into surgical wards of our hospital between 2007 and 2012. Data on demography and events leading to death were collected and analyzed from all surgical wards, the emergency unit, surgical outpatients, and theater records.Results: A total of 527 deaths occurred among the 8230 patients admitted during the 6‑year period giving a mortality rate of 6.4%. Three hundred and forty‑five (65.5%) were male, while 282 (34.5%) were females. The mortality rates in units were as follows: Burn and plastic (23.1%), general surgery (5.5%), neurosurgery (7.9%), urology (6.0%), orthopedics (3.8%), pediatric surgery (3.4%), and cardiothoracic surgery (11.9%). The yearly mortality rate were as follows, respectively: 2007 (7.1%), 2008 (6.0%), 2009 (4.5%), 2010 (6.5%), 2011 (7.2%), and 2012 (7.5%). About 84.6% of the patients died within 1 month on admission. The leading causes of mortality were trauma (41.8%) and cancer (32.4%). Most of the deaths (64.9%) occurred between 20‑ and 70‑year‑old.Conclusion: Trauma and cancer constitute a great deal of health burden in our region. Strong legislation and screenings with timely interventions are required.Keywords: Cancer, surgical mortality, traum

The migrant intrauterine contraceptive device: An uncommon cause of bladder stone

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Spontaneous non-treatment related tumuor lysis syndrome in metastatic testicular tumour

Background: Tumour lysis syndrome (TLS) is a clinical condition characterized by hyperuricaemia, hyperkalaemia and hyperphosphataemia due to rapid release of intracellular contents into blood. The condition is usually seen during chemotherapy for rapidly dividing haemopoietic malignancies such as lymphomas and leukaemia. It is rarely seen in solid tumours, and very seldom occurs spontaneously.Aim: To present a case of spontaneous non- treatment related tumour lysis syndrome (STLS) developing in a patient with advanced testicular tumour.Case report: A 43-year-old patient presented with advanced testicular tumuor. There was delay in giving consent for orchidectomy. He suddenly deteriorated post-operatively while awaiting histology report and was simultaneously being worked up for chemotherapy. Serum analysis was initially normal post-operatively. It became deranged a few days later and  showed hyperuricaemia, hyperkalaemia, acidosis with elevated urea and creatinine. He died before he could get dialysis. Conclusion: TLS may occur spontaneously in rapidly dividing tumour such as testicular tumours. It is important to be wary of this fatal complication when managing patients with tumours that have a short doubling time.Keywords: Yolk sac testicular tumour, Tumour lysis syndrome,  Spontaneous tumour lysis syndrome, Hyperuricaemia, Hyperkalaemia, Hyperphosphataemi

Chronic myeloid leukaemia presenting as priapism

Background: Patients with chronic myeloid leukemia (CML) have diverse modes of clinical presentation. Priapism is a rare clinical presentation of CML. Aim: To report two cases of CML who first presented as priapism at the University of Port Harcourt Teaching Hospital (UPTH).  Case report: Case notes of two  patients who presented to  the Urology Unit of UPTH between December 2008 and October 2011 with priapism and CML were reviewed. Their clinical features, findings on physical examination, results of investigations, treatment modalities and outcome of treatment were documented.  Case 1 was a 60-year-old man who had splenomegaly for two years and six months after splenectomy developed priapism. White cell count at presentation was 360 x 109/L; he was Philadelphia chromosome positive.  Case 2 was a 26-year-old man who presented with priapism.  In the course of evaluation, he was discovered to have a White Blood Cell (WBC) count of 365 x 109/L.   Both cases had surgical intervention to achieve detumescence. Thereafter, they were commenced on chemotherapy.  Both patients developed erectile dysfunction after treatment because of late presentation.Conclusion:  Though rare, CML may present as priapism.   A high index of suspicion will aid diagnosis.  Full haematological work-up should be the standard practice in all patients presenting with priapism.  Surgical intervention is necessary in cases due to myeloproliferative disorders.Keywords: Priapism, Chronic myeloid leukaemia, Hyperleucocytosi

What Experts Think About Prostate Cancer Management During the COVID-19 Pandemic: Report from the Advanced Prostate Cancer Consensus Conference 2021.

Patients with advanced prostate cancer (APC) may be at greater risk for severe illness, hospitalisation, or death from coronavirus disease 2019 (COVID-19) due to male gender, older age, potential immunosuppressive treatments, or comorbidities. Thus, the optimal management of APC patients during the COVID-19 pandemic is complex. In October 2021, during the Advanced Prostate Cancer Consensus Conference (APCCC) 2021, the 73 voting members of the panel members discussed and voted on 13 questions on this topic that could help clinicians make treatment choices during the pandemic. There was a consensus for full COVID-19 vaccination and booster injection in APC patients. Furthermore, the voting results indicate that the expert's treatment recommendations are influenced by the vaccination status: the COVID-19 pandemic altered management of APC patients for 70% of the panellists before the vaccination was available but only for 25% of panellists for fully vaccinated patients. Most experts (71%) were less likely to use docetaxel and abiraterone in unvaccinated patients with metastatic hormone-sensitive prostate cancer. For fully vaccinated patients with high-risk localised prostate cancer, there was a consensus (77%) to follow the usual treatment schedule, whereas in unvaccinated patients, 55% of the panel members voted for deferring radiation therapy. Finally, there was a strong consensus for the use of telemedicine for monitoring APC patients. PATIENT SUMMARY: In the Advanced Prostate Cancer Consensus Conference 2021, the panellists reached a consensus regarding the recommendation of the COVID-19 vaccine in prostate cancer patients and use of telemedicine for monitoring these patients