Gastric malignancies and associated pre-malignant lesions in a teaching hospital in South West Nigeria

The histologic types of gastric malignancies and other associated histopathological indices in gastric biopsies received at the Department of Morbid Anatomy and Forensic Medicine, Obafemi AwolowoUniversity Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria were determined. The study was retrospective and it involved collecting all slides on all available cases of gastric biopsies over a periodof ten years and reviewing them to screen for gastric malignancies and associated pathologies of the stomach. Out of 107 cases of gastric malignancies reviewed, 102 (95.3%) were carcinomas, 3 (2.8%)were sarcomas and 2 (1.9%) cases were lymphomas. Of 102 cases of carcinomas, 36 (35.3%) were tubular adenocarcinomas, 14 (13.7%) cases were papillary adenocarcinomas, 22 (21.6%) cases weremucinous adenocarcinomas, 9 (8.8%) cases were signet carcinomas, and 21 (20.6%) were poorly differentiated adenocarcinomas. One hundred and two (95.33%) cases of gastric malignancies were inthe pyloric antrum, 3 (2.80%) were in the gastric cardia, and 1 case each (0.93%) in the corpus and fundus. Sixty-four (60%) of cases showed moderate to numerous Helicobacter pylori. Mild chronicgastritis was seen in 11 (10%) cases, moderate chronic gastritis was seen in 75 (70%) of cases, and severe chronic gastritis was seen in 16 (15%) cases. Five (5%) cases were indeterminate. Mild glandularatrophy was seen in 5 (5%) cases, 32 cases (30%) showed moderate glandular atrophy, 1 (1%) case of severe glandular atrophy was seen. Intestinal metaplasia was seen in 17 cases (16%). Peptic ulcerdisease was not seen in any of the cases

Quality of primary care physicians’ communication of diabetes self-management during medical encounters with persons with diabetes mellitus in a resource-poor country

Background: Most of the Nigerian studies on the determinants of diabetes self-management have focused on patient-related factors. There is no previous local study that examined the quality of diabetes self- management education provided by primary care physicians to people with diabetes mellitus.Methods: A descriptive cross-sectional study was conducted among 105 primary care physicians during a workshop. The quality of diabetes self-management education provided by the physicians was assessed using a self-designed scale of 39 Likert questions derived from American  Association of Diabetes Educators seven domains of diabetes self-management. Cronbach’s reliability coefficient of each domain/subscale was ≥ 0.7. The data was analysed using the independent sample t-test and one-way ANOVA.Results: Over half of the physicians provided ‘inadequate quality’ diabetes self-management education in all the domains. Physicians had the highest mean score in the ‘taking medication’ domain (4.35 ± 0.59). The mean scores in the ‘problemsolving domain’ (3.63 ± 0.74) and the ‘being active domain’ (3.57 ± 0.71) were low. The quality of diabetes self-managementeducation provided by the physicians was not associated with any of the physician characteristics.Conclusion: The quality of physicians’ communication of diabetes self-management was suboptimal in this study. The majority of the adequately communicated diabetes self-management behaviours were risk factors reduction related and disease-centred. Thus, training of primary care physicians on diabetes self-management education is recommended because of the key role these physicians play in diabetes management in resource-poor countries.Keywords: diabetes self-management, patient–physician communication, primary care physicians, resource-poor countries, Nigeri

Making a case for community screening services: findings from a medical outreach in Ibadan, Nigeria

Background: Currently, population based medical check up is yet to be explored as a veritable tool for assessing the burden of on-communicable diseases in Nigeria. Objectives: This study aimed to assess the prevalence of selected lifestyle related diseases during a free medical rally in an urban community. Methods: General medical examinations of all participants at a free medical rally in a middle class community in Ibadan, Oyo State was conducted. Body Mass Index (BMI), blood pressure and random blood sugar measurements were done using standardised instruments. BMI classification for children was done using the CDC guidelines for males and females aged 2-20 years. Results: Of the 302 participants examined, 33.1% were males and 32.1% were less than 18 years. Of those aged 2 to 20 years, 22.9% were underweight, while 5.2% were overweight/ obese. In adults 3.6% were underweight and 43.2% were overweight/ obese. Adults were significantly more likely to be overweight/obese (P<0.001). Prevalence of high blood pressure was 29.3% and 9.4% of adults had elevated random blood glucose levels. A higher proportion of obese people (P=0.259), males (P= 0.327) and those older than 40 years (P<0.001) had elevated blood pressure. A weak correlation (spearman rho= 0.3) was found between blood pressure and BMI (P<0.001) and also between BMI and blood sugar level (spearman rho= 0.2) P=0.05. Conclusion: There is a need for greater emphasis on community based screening programmes to aid early diagnosis and treatment of non communicable diseases in the country

The contribution of alcohol to chronic liver disease in patients from South-West Nigeria

Objective: This study aimed at determining the level and type of alcohol consumed by patients diagnosed with chronic liver disease (CLD) and, hence, the extent to which alcohol may have contributed to the development of the condition.Study Design: Patients with diagnosis ofCLDwere consecutively recruited and a structured questionnaire was administered on each of them. Diagnosis of CLD was made based on liver histology and/or typical clinical and laboratory features.Alcohol consumption was considered significant if a patient took 50g/day for 10 years.Results: A total of 145 patients were studied consisting of 102 males and 43 females. Their ages ranged from 20- 80 years with a mean of 46.8 ± 15.7 years. Fifty-one (35.2%) patients, all males, drank significant alcoholwhile consumption was not significant in 43 (29.6%) patients. Alcohol was not consumed at all by 51 (35.2%) patients made up of 18 males (35.3%) and 33 females (64.7%). Beer was the commonest form of alcohol consumed (70.2%) followed by palm wine (50%) and locally-brewed gin (20.2%).The diagnoses made were liver cirrhosis [LC] (60, 41.38%), chronic hepatitis [CH] (54, 37.20%), hepatocellular carcinoma [HCC] (23, 15.86%), alcoholic liver disease [ALD] (6, 4.14%) and non-alcoholicfatty liver disease [NAFLD] (2, 1.38%). The liver disease spectrum did not differ between the patients who drank significant alcohol and those who did not. However, the proportion of LC/HCC cases increased relativetoCHwith increasing age and consumption of alcohol.Conclusions: The proportion of CLD directly attributable to alcohol (i.e. ALD) is low among the patients studied. However, the burden of LC andHCCis directly related to age and the amount of alcohol consumed andthe determinants of alcohol abuse are gender and affluence

Histological and biochemical effects of Arteethertm on the liver of wistar rats

ArteetherTM is among the recent drugs that are used to combat chloroquine-resistant malarial parasites. This study examined the effects of arteetherTM on enzyme biomarkers of the liver, serum protein concentrations, and liver morphology. Twenty (20) adult albino Wistar rats weighing 200 – 250 g were randomly divided into four groups (A, B, C and D) of five animals each, and used in this study. Group A rats were given intramuscular (i. m.) arteetherTM (3 mg/kg b. w.) daily for 3 days.Group B rats received i. m. arteetherTM (6 mg/kg b. w.) daily for 3 days. Group C rats were given i. m. arteetherTM (3 mg/kg b. w.) daily for 3 days. The same dose was repeated at two-weekly intervals for 4 further weeks, while group D rats which received normal saline (0.9 % w/ v, 3 ml/kg b.w.), served as controls. At the end of the experiment, the body weights of the animals were determined and recorded. Serum levels of alanine  transaminase (ALT), aspartate transaminase (ASP), alkaline phosphatase(ALP), total protein (TP) and albumin were assayed, and histological studies were performed. Results obtained show no significant difference (P<0.05) in liver enzymes (ALT, ASP, ALP). TP and albumin were significantly reduced in group C rats. Histological studies revealed no cyto-architectural changes. It is concluded that at therapeutic doses, arteetherTM is well tolerated in Wistar rats. .Key Words: ArteetherTM; Malaria; Liver enzymes; Serum protein concentrations; Morphology; Wistar rat

Determinant of Agroforestry Practices among Small Holder Farmers in Oyo State Nigeria

The multiplicity of agroforestry practices demand the choice of appropriate methods that will give the rural farmers an excellent result. Thus, this study analysed the factors determining the choice of agroforestry practices among small holder farmers in Oyo State, Nigeria. Primary data was obtained using multi-stage sampling technique. Structured questionnaire was administered to 250 selected small holder farmers to elicit relevant information and 211 was retrieved and used for this study. The findings revealed that most 55% of the farmers chose agrisilvicutural system while 33.2% and 11.8% of the farmers chose agrosilvopastoral and silvopastoral systems respectively. Most of the farmers were males 89.1%, with average age of 47years indicating they were relatively young with basic formal education. The average farm size of 3.34ha indicated that the study covered small holder farmers. The multinomial logit result showed that factors such as educational level, meeting attendance, type of labour used, household assets significantly determined the choice of agroforestry practices adopted by the farmers. The study therefore recommends the implementation of policies that promote more enlightenment on the benefits of agroforestry to both the educated and non-educated farmers to facilitate quick adoption, provision of incentives to farmers that attend meetings regularly and making available improved agroforestry methods and practices to enhance wider suitability of agroforestry practices

Community knowledge, attitude and practice of childhood immunization in Southwest Nigeria: Data from a Paediatric Association of Nigeria town hall meeting

Background: Vaccine preventable diseases account for 22% of under-five deaths in Nigeria and poor knowledge and attitude have been responsible for non-vaccination of children. This study aimed to assess the knowledge,attitude and practice of childhood immunization among community members in Ile-Ife.Methods: Quantitative data (using an interviewer-administered questionnaire) was collected from a convenience sample of 36 adultresidents who attended a town hall meeting with the PaediatricAssociation of Nigeria. Two focus group discussions were also conductedamong sub-samples of male and female respondents.Results: The mean age of respondents was 43.2 ± 11.9 years with amale to female ratio of 1:0.7. Most had secondary education (63.9%)and had children (91.7%). Most of the respondents understood whatimmunization was and knew the benefits but were unaware of severalof the specific types of immunization. There were erroneous beliefs about the contraindications for immunization and mothers were entrusted with the sole responsibility of getting children immunized. Although most of therespondents had immunized their children, they identified laziness ofmothers, negative attitude of health workers and logistics problemsat facilities as barriers to patronage of immunization services.Conclusion: This study identified knowledge gaps and negative attitudestowards childhood immunization. We therefore recommend a community-wide health education intervention with emphasis on substantial male involvement in immunizations and improvement inimmunization service delivery.Key words: Community, knowledge, attitude, childhood immunization

Modified Alvarado Scoring System as a diagnostic tool for Acute Appendicitis at Bugando Medical Centre, Mwanza, Tanzania

<p>Abstract</p> <p>Background</p> <p>Decision-making in patients with acute appendicitis poses a diagnostic challenge worldwide, despite much advancement in abdominal surgery. The Modified Alvarado Scoring System (MASS) has been reported to be a cheap and quick diagnostic tool in patients with acute appendicitis. However, differences in diagnostic accuracy have been observed if the scores were applied to various populations and clinical settings. The purpose of this study was to evaluate the diagnostic value of Modified Alvarado Scoring System in patients with acute appendicitis in our setting.</p> <p>Methods</p> <p>A cross-sectional study involving all patients suspected to have acute appendicitis at Bugando Medical Centre over a six-month period between November 2008 and April 2009 was conducted. All patients who met the inclusion criteria were consecutively enrolled in the study. They were evaluated on admission using the MASS to determine whether they had acute appendicitis or not. All patients underwent appendicectomy according to the hospital protocol. The decision to operate was the prerogative of the surgeon or surgical resident based on overall clinical judgment and not the MASS. The diagnosis was confirmed by histopathological examination. Data was collected using a pre-tested coded questionnaire and analyzed using SPSS statistical computer software.</p> <p>Results</p> <p>A total number of 127 patients were studied. Their ages ranged from eight to 76 years (mean 29.64 ± 12.97). There were 37 (29.1%) males and 90 (70.9%) females (M: F = 1:2.4). All patients in this study underwent appendicectomy. The perforation rate was 9.4%. Histopathological examination confirmed appendicitis in 85 patients (66.9%) and the remaining 42 patients had normal appendix giving a negative appendicectomy rate of 33.1% (26.8% for males and 38.3% for females). The sensitivity and specificity of MASS in this study were 94.1% (males 95.8% and females 88.3%) and 90.4% (males 92.9% and females 89.7%) respectively. The Positive Predictive Value and Negative Predictive Value were 95.2% (males 95.5% and females 90.6%) and 88.4% (males 89.3% and females 80.1%) respectively. The accuracy of MASS was 92.9% (males 91.5% and females 87.6%).</p> <p>Conclusion</p> <p>The study shows that use of MASS in patients suspected to have acute appendicitis provides a high degree of diagnostic accuracy and can be employed at Bugando Medical Centre to improve the diagnostic accuracy of acute appendicitis and subsequently reduces negative appendicectomy and complication rates. However, additional investigations may be required to confirm the diagnosis in case of atypical presentation.</p

Consistent patterns of common species across tropical tree communities

Trees structure the Earth’s most biodiverse ecosystem, tropical forests. The vast number of tree species presents a formidable challenge to understanding these forests, including their response to environmental change, as very little is known about most tropical tree species. A focus on the common species may circumvent this challenge. Here we investigate abundance patterns of common tree species using inventory data on 1,003,805 trees with trunk diameters of at least 10 cm across 1,568 locations1,2,3,4,5,6 in closed-canopy, structurally intact old-growth tropical forests in Africa, Amazonia and Southeast Asia. We estimate that 2.2%, 2.2% and 2.3% of species comprise 50% of the tropical trees in these regions, respectively. Extrapolating across all closed-canopy tropical forests, we estimate that just 1,053 species comprise half of Earth’s 800 billion tropical trees with trunk diameters of at least 10 cm. Despite differing biogeographic, climatic and anthropogenic histories7, we find notably consistent patterns of common species and species abundance distributions across the continents. This suggests that fundamental mechanisms of tree community assembly may apply to all tropical forests. Resampling analyses show that the most common species are likely to belong to a manageable list of known species, enabling targeted efforts to understand their ecology. Although they do not detract from the importance of rare species, our results open new opportunities to understand the world’s most diverse forests, including modelling their response to environmental change, by focusing on the common species that constitute the majority of their trees

Consistent patterns of common species across tropical tree communities

Trees structure the Earth's most biodiverse ecosystem, tropical forests. The vast number of tree species presents a formidable challenge to understanding these forests, including their response to environmental change, as very little is known about most tropical tree species. A focus on the common species may circumvent this challenge. Here we investigate abundance patterns of common tree species using inventory data on 1,003,805 trees with trunk diameters of at least 10 cm across 1,568 locations1-6 in closed-canopy, structurally intact old-growth tropical forests in Africa, Amazonia and Southeast Asia. We estimate that 2.2%, 2.2% and 2.3% of species comprise 50% of the tropical trees in these regions, respectively. Extrapolating across all closed-canopy tropical forests, we estimate that just 1,053 species comprise half of Earth's 800 billion tropical trees with trunk diameters of at least 10 cm. Despite differing biogeographic, climatic and anthropogenic histories7, we find notably consistent patterns of common species and species abundance distributions across the continents. This suggests that fundamental mechanisms of tree community assembly may apply to all tropical forests. Resampling analyses show that the most common species are likely to belong to a manageable list of known species, enabling targeted efforts to understand their ecology. Although they do not detract from the importance of rare species, our results open new opportunities to understand the world's most diverse forests, including modelling their response to environmental change, by focusing on the common species that constitute the majority of their trees