Management challenges of pancreatic cancer in a resource scarce setting

Background: Of all forms of gastrointestinal malignancy, adenocarcinoma of the pancreas is associated with the worst survival. Management of pancreatic cancer is associated with some challenges. This study is aimed at determining the hospital incidence, sociodemographic characteristics, managements and management\u2019s outcome of carcinoma of pancreas at our hospital. We also discuss the management challenges encountered with these patients. Patients and Methods: We review 96 pancreatic cancer patients seen at Awolowo University Teaching Hospital Complex, Ile \u2013Ife, Nigeria, from July 1989 to July 2007. Results: There were ninety six patients diagnosed with cancer of the pancreas but only 80 patients had histological proof of pancreatic cancer. This account for 2.1% of all malignancies seen and 238/100000 total admissions during the study period. The median age is 55.0. There were 62 (64.6%) male and 34 (35.4%) female with male to female ratio been 2:1. Duration of symptoms in the patients ranges from 4 weeks to 109 weeks. Only three (3.1%) patients have tumor located in a particular anatomical sub site: two head of pancreas and one tail of the pancreas. Other patients had extensive tumor involving the head and body of the pancreas. Two patients had pancreaticoduodenectomy, one had resection of the tumor at the tail of pancreas and 45 patients had triple bypass. Patients with low serum albumin and serum sodium and elevated transaminases at presentation, had poorer prognosis than other patients. Conclusion: We found that pancreatic cancer is not uncommon in our center with male preponderance. Most patients present with advanced condition only amenable to palliative measures. There are signi\ufb01cant challenges in the area of diagnosis, screening, treatment and research

Management challenges of pancreatic cancer in a resource scarce setting

Background: Of all forms of gastrointestinal malignancy, adenocarcinoma of the pancreas is associated with the worst survival. Management of pancreatic cancer is associated with some challenges. This study is aimed at determining the hospital incidence, sociodemographic characteristics, managements and management’s outcome of carcinoma of pancreas at our hospital. We also discuss the management challenges encountered with these patients. Patients and Methods: We review 96 pancreatic cancer patients seen at Awolowo University Teaching Hospital Complex, Ile –Ife, Nigeria, from July 1989 to July 2007. Results: There were ninety six patients diagnosed with cancer of the pancreas but only 80 patients had histological proof of pancreatic cancer. This account for 2.1% of all malignancies seen and 238/100000 total admissions during the study period. The median age is 55.0. There were 62 (64.6%) male and 34 (35.4%) female with male to female ratio been 2:1. Duration of symptoms in the patients ranges from 4 weeks to 109 weeks. Only three (3.1%) patients have tumor located in a particular anatomical sub site: two head of pancreas and one tail of the pancreas. Other patients had extensive tumor involving the head and body of the pancreas. Two patients had pancreaticoduodenectomy, one had resection of the tumor at the tail of pancreas and 45 patients had triple bypass. Patients with low serum albumin and serum sodium and elevated transaminases at presentation, had poorer prognosis than other patients. Conclusion: We found that pancreatic cancer is not uncommon in our center with male preponderance. Most patients present with advanced condition only amenable to palliative measures. There are significant challenges in the area of diagnosis, screening, treatment and research

Characterization of colonizing Staphylococcus aureus isolated from surgical wards' patients in a Nigerian university hospital.

In contrast to developed countries, only limited data on the prevalence, resistance and clonal structure of Staphylococcus aureus are available for African countries. Since S. aureus carriage is a risk factor for postoperative wound infection, patients who had been hospitalized in surgical wards in a Nigerian University Teaching Hospital were screened for S. aureus carriage. All S. aureus isolates were genotyped (spa, agr) and assigned to multilocus sequence types (MLST). Species affiliation, methicillin-resistance, and the possession of pyrogenic toxin superantigens (PTSAg), exfoliative toxins (ETs) and Panton-Valentine Leukocidin (PVL) were analyzed. Of 192 patients screened, the S. aureus carrier rate was 31.8 % (n = 61). Of these isolates, 7 (11.5%) were methicillin-resistant (MRSA). The isolates comprised 24 spa types. The most frequent spa types were t064, t084, t311, and t1931, while the most prevalent MLST clonal complexes were CC5 and CC15. The most frequent PTSAg genes detected were seg/sei (41.0%) followed by seb (29.5%), sea (19.7%), seh (14.7%) and sec (11.5). The difference between the possession of classical and newly described PTSAg genes was not significant (63.9% versus 59.0% respectively; P = 0.602). PVL encoding genes were found in 39.3% isolates. All MRSA isolates were PVL negative, SCCmec types I and VI in MLST CC 5 and CC 30, respectively. Typing of the accessory gene regulator (agr) showed the following distribution: agr group 1 (n = 20), group II (n = 17), group III (n = 14) and group IV (n = 10). Compared to European data, enterotoxin gene seb and PVL-encoding genes were more prevalent in Nigerian methicillin-susceptible S. aureus isolates, which may therefore act as potential reservoir for PVL and PTSAg genes

Developing a Breast Cancer Screening Program in Nigeria: Evaluating Current Practices, Perceptions, and Possible Barriers

Purpose: In low- and middle-income countries like Nigeria, women present with advanced breast cancer at an earlier age. Given the limited resources, development of screening programs that parallel resource capabilities of low- and middle-income countries is imperative. The objective of this study was to evaluate the perceptions, practices, and barriers regarding clinical breast examination (CBE) screening in a low-income community in Nigeria. Materials and Methods: A cross-sectional survey of women age 40 years or older in Ife, Nigeria, using multistaged sampling was performed. Information on sociodemographics, knowledge of breast cancer, screening practices, and willingness to participate in CBE screening was obtained using an interviewer-administered questionnaire. Results: A total of 1,169 women whose ages ranged from 40 to 86 years (mean age, 47.7 years; standard deviation, 8.79 years) were interviewed. The majority of women (94%) knew about breast cancer, whereas 27.5% knew someone who had had breast cancer, the majority of whom (64.5%) had died of the disease. Of the 36% of women who had breast screening recommended to them, only 19.7% had an actual CBE. Of these, only 6% had it in the last year. The majority of women (65.4%) were willing to have regular CBEs and did not care about the sex of the examiner in most instances. Lack of perceived need was the reason cited by women unwilling to participate. Conclusion: The majority of women were aware of breast cancer and knew it as a fatal disease. With the relatively encouraging number of those willing to be examined, a carefully designed CBE program coupled with advocacy to correct uneducated beliefs seems promising

Antibiotic resistance of Helicobacter pylori from patients in Ile-Ife, South-west, Nigeria

Background: Helicobacter pylori has become recognized as a major cause of gastroduodenal diseases in man. Evidence indicates that once acquired, H. pylori persists, usually for life unless eradicated by antimicrobial therapy. Over the past few years, we have accumulated some knowledge of the epidemiology of H. pylori in Ile-Ife, South-West Nigeria. In one collaborative study, we detected H. pylori in 195 (73%) patients referred for endoscopy at Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). Furthermore we have observed a variegated gastric inflammatory response and atrophy including atrophic pangastritis but are yet to demonstrate MALToma in any of our patients. In addition we have demonstrated that dental plaque is a possible source of gastric H. pylori infection and such an endogenous source could account for difficulty in eradication leading to re-infection. Presently, infected patients are treated with standard combination therapy made up of amoxycilin and ciprofloxacin with a proton pump inhibitor /bismuth. Reports however have shown that the incidence of antimicrobial resistance in Helicobacter pylori is a growing problem and which has been linked with failures in treatment and eradication. Given this situation it has become necessary to have information about the susceptibility of isolates to particular antimicrobial agents before the selection of an appropriate treatment regimen. Objectives: More recently, we sought to study antimicrobial susceptibility of locally isolated H. pylori strains. Methods: We subjected 32 isolates to antimicrobial susceptibility testing against seven agents. Results: All the isolates showed multiple acquired antimicrobial resistance as they were all resistant to amoxicillin, clarithromycin, metronidazole, while 29/31, 27/31 showed resistance to rifampicin and tetracycline respectively. Five (15.6%) of these isolates showed resistance to ciprofloxacin. Conclusions: Our findings suggest that H. pylori strains isolated within our study environment have acquired resistance to all the commonly prescribed antibiotics. On the basis of the findings it would be necessary to re-evaluate the eradication treatment regime in our setting. African Health Sciences Vol. 7 (3) 2007: pp. 143-14

Characteristics of nasal and cutaneous <i>S. aureus</i> isolates.

1<p><i>spa</i>, staphylococcal protein A gene; <i>spa</i>CC, <i>spa</i> clonal complex inferred by BURP analysis; n, indicates number of isolates with similar identity for all characteristics tested;</p>2<p>MLST, multilocus sequence typing; CC, clonal complex; ST, sequence type;</p>3<p>PVL, Panton-Valentine leukocidin; pos., positive; neg., negative;</p>4<p>PTSAg/ET gene profile, pyrogenic toxin superantigen gene/exfoliative toxin gene profile; -, no PTSAg/ET gene detected;</p>5<p><i>agr</i>, accessory gene regulator type;</p>6<p>MSSA, methicillin-susceptible <i>S. aureus</i>; MRSA, methicillin-resistant <i>S. aureus</i>;</p>7<p>ND, not done; NT, not type able.</p

Results of testing 61 <i>S. aureus</i> isolates for staphylococcal PTSAg and ET genes by multiplex PCR.

1<p><i>sea</i>, staphylococcal enterotoxin A gene; <i>seb</i>, staphylococcal enterotoxin B gene; <i>sec</i>, staphylococcal enterotoxin C gene; <i>sed</i>, staphylococcal enterotoxin D gene; <i>see</i>, staphylococcal enterotoxin E gene; <i>tst</i>, toxin shock toxin gene; <i>seg-sei</i>, staphylococcal enterotoxin G and staphylococcal enterotoxin I genes; <i>seh</i>, staphylococcal enterotoxin H gene; <i>sej</i>, staphylococcal enterotoxin J gene; <i>eta</i>, exfoliative toxin A gene; <i>etb</i>, exfoliative toxin B gene; <i>etd</i>, exfoliative toxin D gene; <i>luk</i>S-PV and <i>luk</i>F-PV, Panton-Valentine leukocidin genes; <i>hlg</i>, gamma-hemolysin gene.</p

Characteristics of the surgical patient cohort studied.

1<p>Data are no.(%) of participants unless otherwise indicated.</p