Dapsone-induced drug reaction with eosinophilia and systemic symptoms (DRESS): the role of the primary care physician

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but severe adverse drug reaction with debilitating morbidity and high mortality. The interest of this presentation is to report a case of dress and the role of the healthcare coordinator (family physician) in early diagnosis, prompt treatment and coordination of care. We report a case of a 32-year-old male who was wrongly commenced on Dapsone for seizure disorder from a primary health centre. He presented two months later with a month history of severe dry cough, pleurisy, intermittent breathlessness and high-grade fever. He had a generalized pruritic rash with erythema and desquamation. There was marked oedema of the face and feet with generalized lymphadenopathy. He was jaundiced with tender hepatomegaly. He had dark coloured urine and a trace of proteinuria but normal renal function. There was marked leukocytosis (35*109/l) with eosinophilia (36%). His chest X-ray and viral screen for HBV, HCV and HIV were all negative. The multiple systemic presentations warranted a multidisciplinary review, and a final diagnosis of DRESS was made. His symptoms began to resolve within two days of withdrawal of the offending drug and commencement of oral corticosteroid with supportive care for his symptoms. At six weeks, there was a complete resolution of clinical features, and his laboratory parameters had returned to the baseline. Diagnosis of DRESS can be challenging, and a high index of suspicion is required. The multidisciplinary coordination of care by the first line physicians can also not be overemphasized for good outcomes

Prediction of difficult laryngoscopy in a homogenous population: The role of height

Background: Airway problem is a leading cause of anaesthesia related mortality. This prospective study was conducted to determine the role of the patient’s height on difficult laryngoscopy.Patients and Methods: Two hundred and seventy eight consecutive patients of Akwa Ibom State origin undergoing general anaesthesia were studied. Demographic characteristics, thyromental distance (TMD) and ratio of height to thyromental height (RHTMD) were obtained. Laryngoscopic views were graded according to the Cormack and Lehane (CL) classification. The patients were divided into two groups namely: Difficult Visualisation of the Larynx (DVL) and Easy Visualisation of the Larynx (EVL), multiple logistic regression was done to determine independent predictors of DVL.Results: Difficult laryngoscopy occurred in 28 (10.1%) patients. The mean height of patients in DVL and EVL groups were 163.9± 6.2 and 161.5± 7.2 respectively, p= 0.081. Multiple logistic regression analysis showed that height was not a predictor of difficult laryngoscopy.Conclusion: The patient’s height has no role in the prediction of difficult laryngoscopy.Keywords: Prediction, Difficult laryngoscopy, Homogenous population, Heigh

Antigonadotrophic Effect of Spondias Mombin Leaf Extract In Male Wistar Rats

Spondias mombin is a fructiferous tree used for medicinal purposes and is relied on for its contraceptive and abortifacient properties. The aim is study is to investigate the effect of Spondias mombin leaf’s aqueous extract on the anterior pituitary cells and hormones. 30 mature male Wistar rats (180- 200g) were obtained and divided equally into three groups 1, 2 and 3. Group 1 served as control and received vehicle. Groups 2 and 3 were treated with 400mgkg-1 and 800mgkg-1 of the leaf extract through oral gavage for 28 days. The animals were anaesthetized by chloroform and sacrificed on the 29th day.  Blood was obtained from the hearts of the animals and skull was opened to excise the pituitary gland. Testicular and accessory glandular weights were taken. Regression of gonadotropin cells was observed in the experimental groups compared to the control. Hormonal assay showed significantly reduced levels (p<0.05) of FSH, LH and T in experimental groups. Significant (p<0.05) changes were recorded in weights of testis, epididymis and prostate gland with no changes in the weight of seminal vesicle. We conclude that aqueous leaf extract of Spondias mombin may cause regression of the anterior pituitary cells with decrease in serum levels of FSH, LH and T which supports its use as an herbal contraceptive. Keywords: Antigonadotrophic, FSH, LH, Spondias mombin, Regression

Cancer incidence in Nigeria: a report from population-based cancer registries.

INTRODUCTION: Cancer has become a major source of morbidity and mortality globally. Despite the threat that cancer poses to public health in sub-Saharan Africa (SSA), few countries in this region have data on cancer incidence. In this paper, we present estimates of cancer incidence in Nigeria based on data from 2 population-based cancer registries (PBCR) that are part of the Nigerian national cancer registry program. MATERIALS AND METHODS: We analyzed data from 2 population based cancer registries in Nigeria, the Ibadan Population Based Cancer Registry (IBCR) and the Abuja Population Based Cancer Registry (ABCR) covering a 2 year period 2009-2010. Data are reported by registry, gender and in age groups. We present data on the age specific incidence rates of all invasive cancers and report age standardized rates of the most common cancers stratified by gender in both registries. RESULTS: The age standardized incidence rate for all invasive cancers from the IBCR was 66.4 per 100000 men and 130.6 per 100000 women. In ABCR it was 58.3 per 100000 for men and 138.6 per 100000 for women. A total of 3393 cancer cases were reported by the IBCR. Of these cases, 34% (1155) were seen among males and 66% (2238) in females. In Abuja over the same period, 1128 invasive cancers were reported. 33.6% (389) of these cases were in males and 66.4% (768) in females. Mean age of diagnosis of all cancers in men for Ibadan and Abuja were 51.1 and 49.9 years respectively. For women, mean age of diagnosis of all cancers in Ibadan and Abuja were 49.1 and 45.4 respectively. Breast and cervical cancer were the commonest cancers among women and prostate cancer the most common among men. Breast cancer age standardized incidence rate (ASR) at the IBCR was 52.0 per 100000 in IBCR and 64.6 per 100000 in ABCR. Cervical cancer ASR at the IBCR was 36.0 per 100000 and 30.3 per 100000 at the ABCR. The observed differences in incidence rates of breast, cervical and prostate cancer between Ibadan and Abuja, were not statistically significant. CONCLUSION: Cancer incidence data from two population based cancer registries in Nigeria suggests substantial increase in incidence of breast cancer in recent times. This paper highlights the need for high quality regional cancer registries in Nigeria and other SSA countries

Cancers Attributable to Alcohol Consumption in Nigeria: 2012–2014

IntroductionAlcohol consumption has been identified as a risk factor for many cancers but less attention has been paid to the fraction of those cancers that are attributable to alcohol consumption. In this study, we evaluated the incidence and population attributable fraction (PAF) of cancers associated with alcohol consumption in Nigeria.MethodsWe obtained data on incidence of cancers from two population-based cancer registries (PBCRs) in Nigeria and identified cancer sites for which there is strong evidence of an association with alcohol consumption based on the International Agency for Research on Cancer Monograph 100E. We computed the PAF for each cancer site by age and sex, using prevalence and relative risk estimates from previous studies.ResultsBetween 2012 and 2014 study period, the PBCRs reported 4,336 cancer cases of which 1,627 occurred in males, and 2,709 occurred in females. Of these, a total of 1,808 cancer cases, 339 in males and 1,469 in females, were associated with alcohol intake. The age standardized incidence rate (ASR) of alcohol associated cancers was 77.3 per 100,000. Only 4.3% (186/4,336) of all cancer cases or 10.3% (186/1,808) of alcohol associated cancers were attributable to alcohol consumption. Some 42.5% (79/186) of these cancers occurred in males while 57.5% (107/186) occurred in females. The ASR of cancers attributable to alcohol in this population was 7.2 per 100,000. The commonest cancers attributable to alcohol consumption were cancers of the oral cavity and pharynx in men and cancer of the breast in women.ConclusionOur study shows that 4.3% of incident cancers in Nigeria can be prevented by avoiding alcohol consumption. While the incidence of cancers associated with alcohol intake is high, the proportion attributable to alcohol consumption is much lower suggesting that the number of cancers that may be prevented by eliminating alcohol intake in this population is relatively low

Comparative analysis of the nutritional, biochemical and hematological parameters of pregnant women attending the University of Abuja Teaching Hospital, Nigeria

BACKGROUND: Despite the efforts to encourage the intake of nutritional supplements during antenatal periods, there are still many cases of anemia and protein-energy malnutrition during pregnancy. Hence, this study determined the incidence of anemia, protein-energy malnutrition, and associated risk factors among pregnant women in Abuja, Nigeria. MATERIALS AND METHODS: This hospital-based, case-control study involved randomly selected 176 pregnant and non-pregnant women attending the University of Abuja Teaching Hospital (UATH), Gwagwalada, Nigeria. Hemoglobin and hematocrit measurements were used to determine anemia incidence, while plasma protein, zinc levels and body mass index (BMI) were used to determine energy index status. Complete blood counts were analyzed using 5 parts-automatic hemo-analyzer, while plasma protein and zinc were analyzed using calorimetric method. Anemia and protein-energy malnutrition were defined using the World Health Organization (WHO) cut-off values. RESULTS: The mean age of participants was 28.75 ± 5.22 years. Out of 176 participants, 7 (4%) were malnourished while 25% of the participants were anemic. Anemia was significantly associated with participants’ occupation (p = 0.002), parity (p<0.001) and gestational age (p<0.001). Most hematological indices, plasma globulin, albumin, protein, and zinc levels were significantly different (p<0.001) among non-pregnant and pregnant women of the first, second and third trimesters. CONCLUSION: The incidence of anemia and malnutrition was high among study participants. There is a need for improved nutritional intervention, increased awareness and strengthening of health systems in the area of maternal health in Nigeria