Default from neoadjuvant chemotherapy in premenopausal female breast cancer patients: What is to blame?

Background: Breast cancer is the most frequent cancer among women in most parts of the world including Nigeria. Neoadjuvant chemotherapy has been demonstrated to be a helpful strategy in the context of locally advanced breast cancer.Aims: The purpose of this study was to investigate some factors that may contribute to low rate of acceptance and adherence to neoadjuvant chemotherapy.Materials and Methods: A 1-year prospective study of premenopausal women with locally advanced breast cancer recommended for neoadjuvant chemotherapy from June 2009 to May 2010.Results: Forty-four patients gave consent to be part of the study. The ages ranged from 26 to 51 years with a mean age of 42.1 years ± 7.7 years. Only 31 patients completed the four courses of NAC. Seventeen (38.6%) patients dropped out of treatment, before, during or after completing NAC. Ten of these defaulted due to inadequate funds to procure chemotherapy, three patients because they insisted on immediate mastectomy, and four of these patients refused surgery when they achieved complete clinical response, probably due to fear of mastectomy which is common among women in our environment. Twenty patients had dose deferment.Conclusion: Lack of funds to procure chemotherapy and refusal of additional modality of treatment are the two major factors responsible for default of NAC and its goal in patients with LABC

Breast Lumps in NAUTH, Nnewi :A 5 year Review

Background Breast lump is the most common reason for presenting to breast clinics. It is a source of great anxiety to a female when it is discovered. Objective This study aims at a clinico-pathologic review of breast lump as a presenting complaint. Material and Methods A 5-year retrospective analysis of 550 patients presenting with a complaint of breast lump to the breast clinic of NnamdiAzikiwe University TeachingHospital (NAUTH) Nnewi, fromJanuary 2004 December 2008. Results Breast lump was the presenting complaint in 550(82.8%) of 664 patients presenting to the breast clinic. The lump was painless in 458 (83.3%), associated with pain and breast ulcer in 59(10.7%) and 33(6.0%) patients respectively. Females constitute 548(99.6%) with only 2(0.4%) males. There was no palpable lump in 23 patients (4.2%) on clinical examination and only 54 patients (9.7%) ad >1 lump. The clinical diagnosis were breast cancer in 260 patients (47.3%), fibroadenoma in 175 (31.8%), fibrocystic changes in 67 (12.2%) patients. The others were different types of benign diseases. Histopathology report was available in 294 patients with 161(54.8%), 56(19.0%) and 46(15.6%) patients diagnosed respectively as having invasive cancer, fibroadenoma, and fibrocystic changes. Conclusion Our study shows that breast lump was the most common presenting complaint with most patients not presenting early. Fewer lumps are discovered by breast self examination. The finding that breast cancer was slightly more common than benign breast lesions is at variance with most studies probably due to proliferation in our environment of private owned hospitals by general practitioners where most of the benign lesions are probably managed. But the finding of fibroadenoma as the most common of the benign lesions is similar to that reported by other researchers in Nigeria and other parts of theworld.KeyWords: breast lump, Nnewi,Revie

Neoadjuvant chemotherapy for locally advanced pre menopausal breast cancer in Nigeria women: Early experience

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Knowledge of risk factors, beliefs and practices of female healthcare professionals towards breast cancer in a tertiary institution in Lagos, Nigeria

<p>Abstract</p> <p>Background</p> <p>Breast cancer is the leading female malignancy in Nigeria. Screening for early detection has led to reduction in mortality from the disease. It is known that attitudes of physicians and motivation by community nurses influence uptake of screening methods by women. This study aims to investigate knowledge of breast cancer risk factors, beliefs about treatment and practice of screening methods among a cohort of female healthcare professionals in Lagos, Nigeria.</p> <p>Methods</p> <p>A cross-sectional study was conducted using a self-administered questionnaire to assess the knowledge of breast cancer risk factors, beliefs about treatment and practice of screening methods among 207 female doctors, nurses and other healthcare professionals working in a university teaching hospital in Lagos, Nigeria. Stratified random sampling method was employed. Chi square test, analysis of variance and Mantel-Haenszel test were performed in data analysis using SPSS v10.0 and Epi Info version 6 statistical packages.</p> <p>Results</p> <p>Female doctors obtained a mean knowledge score of 74% and were the only professional group that had satisfactory knowledge of risk factors. Majority (86%) believed that early breast cancer is curable while half of participants believed that prayer can make breast cancer disappear from the affected breast. Eighty three percent practice breast self-examination (BSE) once a month and only 8% have ever had a mammogram. Age, knowledge of risk factors, profession and beliefs were not significantly associated with rate of BSE in this study.</p> <p>Conclusion</p> <p>Results from this study suggest the need for continuing medical education programmes aimed at improving knowledge of breast cancer among female healthcare providers other than doctors.</p

Medical Education in Nigeria: Status and travails of medical publications

It is generally accepted that the level of healthcare delivery in a society is directly related to the amount of research and dissemination of research information. Journals are a veritable tool in driving research and in continuing medical education..Fundamental tenet of academia is an obligation to disseminate acquired knowledgeJournal publications rank very high in the hierarchy of sources for decisions on healthcare funding, research endeavours and patient carePrevious studies have alluded to the underdeveloped CME and poor reading culture among Nigerian doctors. A review of the role of Nigerian medical publications in world literature shows a level probably similar to our Health status indices with poor per capita contribution to world knowledge. Only 9 journals published within Nigeria are in PUBMED with 8 having 2010 articles. Of the 45 Medical journals listed in AJOL from Nigeria only 12 have any articles in 2010. A review of causes implicated the following poor funding, poor infrastructure, poor distribution systems, poor institutional support and sharp author and editorial practices. Remedial factors highlighted included institutional commitment to philosophy of research and publications, institutional review boards and measures to eliminate common author-associated fraudulent practices likeplagiarism, duplicate publication, salami slicing and others. Editor / reviewer/ author training programs should be instituted. The use of current technology like etBLAST, Cross-Ref, Plagiarism checker, Google scholar and others to check widespread author sharp practices are recommended.Keyword: medical education, medical publications, Nigeria

Acute intestinal obstruction in Nnewi Nigeria: a five-year review

Background: Acute intestinal obstruction is still one of the commonest causes of acute abdomen in the country and the patterns and causes have kept changing over time within various parts of the country. We undertook this study to determine data on presentation and management in our environment as well as highlight these changing patterns. Methods: A retrospective study of all patients managed for acute intestinal obstruction from 1993 to 1997. Results: Seventy-six patients fulfilled the inclusion criteria; 51 males and 25 females. Peak age incidence was in the first decade of life while the major complaint was abdominal pain. Commonest clinical finding was abdominal tenderness. Seventy-five (98.68%) had surgery and 42(55.26^) had resection. The commonest causes were; strangulated hernia (18) intussusception (18) and adhesion (15). The commonest postoperative complication was burst abdomen (4%) and mortality was (9.2%). Conclusion: High clinical acumen, aggressive resuscitation and prompt surgical intervention are the key to achieving good results in both pediatric and adult acute intestinal, obstruction. Key words: Intestinal obstruction Nig. J. of Surgical Research Vol.4(3-4) 2002: 107-11

Childhood Acute Appenditis In Nnewi Nigeria

Background: a retrospective study to establish how common acute appendicitis is in the peadiatric age in our environment as well as establish justification if any for incidental appedicectomy in children in our environment Patients and Methods Retrospective study of patients aged 15 years and below who had appendicetomy in a 6 years period Information from the surgical wards and theatres were to trace the case note. The following were extracted and analyzed bio data, mode of presentation: grade of operating surgeon, operative as well as histological findings Results There were 28 appendicectomies out 1248 surgical operation performed in patient 15 years and below. There were 14 males and 14 females. Commonest mode of presentation was abdominal pain which was present in all the patient. The youngest was aged 8 years Thirteen (2 grossly inflamed; 5 moderately inflamed and 6 mildly inflamed) were sent for histology and 5 ( 2 grossly inflamed ; 3 moderately inflamed ) were confirmed as being pathologic acute appendicitis Conclusion Acute appendicitis is not common in the paediatric age group in our environment and far more negative appendicectomies are performed A scoring system for acute appendicitis in children in our environment is hereby advocated to reduce the incidence of negative appendectomy. Key Words: Acute, appendicitis, children Nigerian Journal of Clinical Practice Vol.7(1) 2004: 11-1

Carcinoma Of The Gallbladder At The Nnamdi Azikiwe University Teaching Hospital – A 5-Year Retrospective Study

Background: Carcinoma of the gallbladder is often missed because of the low index of suspicion.Aims and Objectives: To review the incidence, pattern and outcome of carcinoma of the gallbladder in our center and to highlight the need for early diagnosis. Design: Retrospective survey of all cases of carcinoma of the gallbladder.Setting: Nnamdi Azikiwe University Teaching Hospital serving rural, semi-urban and urban communities.Patients and Methods: Patients who had histologically confirmed carcinoma in the general surgical units of the Nnamdi Azikiwe University Teaching Hospital over a 5-year period were reviewed and, from their case notes, the following information on sex, age, mode of presentation, time of diagnosis, stage of disease, treatment given and outcome were extracted.Results: Twenty-one cases of gallbladder carcinoma were seen out of a total of 692 cases of different types of cancers seen in the general surgical units, giving an incidence of 3.04%. Six were males and 15 were females, age ranged between 39 and 72 years, a mean of 55; with the peak age in the 7th decade of life. Eleven patients (5.24%) presented with features of chronic cholecystitis and had cholecystectomy. Ten patients presented with obstructive jaundice in a stage too advanced for any form of palliative surgical treatment The outcome was good in patients who presented with features of cholecystitis but who turned out to be cases of early carcinoma of the gallbladder because after five years of follow-up, none of them has shown any features of recurrence. There was no mortality in this group and the patients have remained in good health. However, the prognosis was poor in those patients who presented with obstructive jaundice. They remained very ill, with worsening general condition. They were discharged home on request of their relations and were lost to follow-up. Conclusions: Carcinoma of the gallbladder may present as cholecystitis. It is advisable for clinicians to have this in mind before, during and after cholecystectomy. Early presentation to hospital by patients would avert delay and improve early diagnosis, early treatment, and better outcome.Key Words: Carcinoma, gallbladder, NigeriaNigerian Journal of Clinical Practice Vol 8(1) 2005: 10-1

A Review Of In-Hospital Surgical Mortality At The Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria

Aims and Objectives: A retrospective study to determine In-hospital surgical mortality rate, gender and age distribution of cases and operations associated with In-hospital surgical mortality at the Nnamdi Azikiwe University Teaching Hospital, Nnewi. Patients and Methods: Data was collected from the theatre operation registers, ward registers and case notes of all patients who were admitted into the surgical wards including those who died within 30 days of admission. From the 1st of January 2000 to 31st December 2003. Results: Two thousand, Nine hundred and ninety two (2,992) patients were admitted into the surgical wards under the care of surgeons within the period of study and there were 249 deaths giving an In-hospital surgical mortality rate of 8.3%. Only 124 cases notes could be retrieved from the records dept. (50%). Ninety-seven (78.2%) of these patients were males and 27(21.8%) were females giving a (male: female ratio of 3.6:1). The age of the patients ranged from less than 1yr to 95yrs. Forty three (34.7%) patients were operated upon while 81 (65.35) patients did not have any form of operative intervention because the patients presented late and were in poor clinical states. The ratio of those who were operated upon to those who were not operated upon was 1:1.9. Conclusion: In-hospital surgical mortality of 8.3% in our centre is the same as that for low volume hospitals (LVHS) in developed countries. Also, from this study, In-hospital surgical mortality was not operation related since more deaths occurred in patients who were not operated because of late presentation, hence aggressive enlightenment campaigns aimed at encouraging people to report early to hospital may help to reduce the rate of In-hospital surgical mortality in our centre. Keywords: In-hospital, surgical mortality, operation related.Tropical Journal of Medical Research Vol. 11 (2) 2007: pp. 26-3

Primary papillary transitional cell carcinoma of the breast: A case report

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