Hand Tumours in Lagos, Nigeria: A Clinicopathologic Study

Background: Hand tumours occur infrequently and are commonly benign, however when malignant they could be life threatening. This study was aimed at determining the prevalence, demographics, the clinical presentations and treatment outcome of hand tumours among patients attending the hand service of the Lagos University Teaching Hospital.Methods: We studied the clinical and pathological records of a 124  consecutive hand tumours that presented at hand clinic of the Lagos University Teaching Hospital(LUTH) between June 2003 and June 2013 .Results: A total of 124 patients were seen of which 98 had excision biopsies . The male to female sex ratio was 1: 1.3. The mean age at presentation was 32.7 years sd ± 8.44 years. An overwhelming majority (94.9%) had their procedures done under local/regional anaesthesia. Two patients died and three of the tumours recurred during the follow up period. The commonest histopathological diagnoses included ganglion cyst, giant cell tumor of the tendon sheath and pyogenic granuloma constituting 23.8%. 15.7% and 6.7% of the cases seen respectively.Conclusion: Hand tumours in Lagos tend to affect young adults with a slight female preponderance. Majority of the tumours were benign. Primary hand malignancy was uncommon and mortality was low. Nearly all (97%) of the surgically treated patients returned to their premorbid occupation.Key words: Hand tumours, biopsy, soft tissue

A cadaveric study of first dorsal extensor compartment in Africans: Clinical implications

While several reports have been made regarding the anatomic variations in the first dorsal extensor compartment, very few have emanated from Africa.  This study looked at this compartment with respect to variations in the superficial branch of the radial nerve and the enclosed tendons. The first dorsal  extensor compartment of the hand was studied in 32 formalin preserved adult African cadavers. The superficial branch of the radial nerve emerged from  underneath the brachioradialis 8.4cm(sd±2.2cm) proximal to the radial styloid and branched 6.2cm (sd ±1.5cm) proximal to it as well. This nerve along  with the cephalic vein or its tributary transversed part of the compartment in all the hands. A double Extensor pollicis longus was found in one hand.  Septations were observed in 31.3 %(n=10) of the hands. Abductor pollicis longus tendon was fused in three hands, and had more than one slip in 94% of  the hands. A single extensor pollicis brevis tendon was found all dissected hands. Clinical implications of these findings are highlighted in this work.&nbsp

Effects of telephonic SMS reminders influence on adherence to scheduled medication pick up appointments among adults on antiretrovirals at the Swakopmund State Hospital ART clinic Namibia

Magister Public Health - MPHBackground: Adherence of patients on antiretroviral therapy to lifelong treatment is a major challenge within the public health system in Namibia. Missed appointments have been shown to contribute to poor clinical outcomes and treatment failure, which may necessitate switching to more expensive antiretroviral regimens. In resource limited settings monitoring of appointments for antiretroviral medication pick up is a documented and feasible method for assessing minimum levels of adherence to antiretroviral medication. Aim: This study was aimed at evaluating the effects of telephonic short message service reminders influence on adherence to scheduled antiretroviral medication pick up appointments. It was also aimed at evaluating how socio-demographic parameters might moderate the effectiveness of short message service reminders. Study design: A randomized double blind controlled study design was employed. Methodology: Stable patients attending the ART clinic were recruited and randomly assigned to either an intervention or control group, until the sample size of 398 was reached in the two arms of the study. The study populations were adult patients’ ≥ 18 years who have been enrolled on treatment for ≥ 3months. The intervention group received an unasked for single short message service reminder, sent 48 hours before their scheduled appointments and continued with standard care, while the control group received standard care without any reminder. The study participants were blinded to their study group. Also, research assistants involved in collecting baseline and outcome data were blinded to study participants study group. Baseline data was collected through a structured questionnaire. Study participants were followed up for four consecutive scheduled ARV pick up appointments. The following outcome data were collected at each follow up visit; number of days late after scheduled appointment, adherence measured by pill count and 3 days self-report recall of adherence. Main results: The pre-intervention survey revealed that only 60% of the study participants were willing to be reminded of their medication pick up appointment. Overall, the SMS reminder improved adherence to medication pick up appointments by 1.6 times as compared to no reminder and also reduced the risk of missing medication pick appointments by 22% as compared to no SMS reminder. Study participants that received a reminder were also two times more likely to achieve optimal adherence to their medication, compared to those who received no reminder. The SMS reminder improved adherence to antiretroviral medication by 11% in this study, while the mean difference in the number of days late to collect antiretroviral medication was significantly reduced by about 4 days by the intervention. Participants that are employed were more likely to adhere to antiretroviral medications as compared to the unemployed. Ironically participants that were on ART for less than one year and those that had treatment supporters reminding them of their medication appointments were significantly less likely to honour their medication pick up appointments. Conclusion: Being employed was significantly associated with attaining optimal adherence to antiretroviral medication. There were no other significant associations between the patients socio- economic and demographic characteristics and adherence to scheduled medication pick up appointments, or to adherence to medication. Recommendations: The Ministry of Health and Social Services should consider rolling out SMS reminders to ART sites with similar settings as Swakopmund State Hospital ART Clinic. Patients that are willing to receive the reminder should be targeted in the scaling up of the roll out. Late and missed medication pick up appointments could be used as an easy proxy measurement for assessing adherence to ART

Awareness and practice of breast screening and its impact on early detection and presentation among breast cancer patients attending a clinic in Lagos, Nigeria

Background: Breast cancer is  the most common malignancy among females in Nigeria. The concept of breast screening (BS) is that it would result in presentation at earlier stages. We evaluated the impact of BS on early detection and presentation of breast cancer and determined the aspects BS need improvement.Patients and Methods: All patients with a diagnosis of malignant breast lump attending clinics at a tertiary hospital in Nigeria were recruited into the study over a 2‑year period. Self‑administered questionnaires were given to patients. Data collected were demographics, knowledge about BS, practice of BS, the motivation to practice BS and the source of information on BS.Results: Of 218 patients seen, 147 (67.4%) patients presented at the surgical outpatient clinic and 71 (32.6%) at the radiotherapy clinic, with age 48.01 ± 0.80 years. A total of 156 (71.6%) were aware of BS, while 62 (28.4%) were not aware. A logistic regression analysis showed that only the level of formal education predicted awareness of BS, P = 0.001 Nagelkerke’s R2 = 0.126. Awareness of BS was mainly from electronic media 87 (55.7%). There was no significant difference in the ages of those aware and practicing BS 48.03 ± 1.05 years, and those not practicing BS 46.32 ± 1.94 years, P = 0.446. There was no significant difference in presentation for those practicing BS 7.41 ± 1.30 months, and those not practicing BS 11.38 ± 2.91 months, P = 0.175, with 64% practicing BS presenting late, while 77% not practicing BS presenting late, χ2 = 2.432, P = 0.488. A logistic regression analysis did not show any demographic or clinical parameters as predictive P = 0.225 Nagelkerke’s R2 = 0.126.Conclusion: The high level of awareness and practice of BS was not translated into the presentation with early breast cancer.Key words: Breast screening, mammography, physician clinical examination, self‑breast examinatio

Severe idiosyncratic drug reaction (Lyells syndrome) after ingesting dihydroartemisinin

Lyells syndrome also called Toxic epidermal necrolysis is the extreme formof idiosyncratic drug reaction that is called Steven Johnsons Syndrome. The condition results in an extensive loss of the skin with mucous membrane involvement. Lyells syndrome has been induced by many agents. The commonest agent in the literature being sulphonamides. However, in our search of the medical literature there was no report of dihydroarthemisinin as a cause ofLyells syndrome.We report three patients seen at two tertiary health institutionswith Lyells syndrome after treatment formalaria with dihydroarthemisinin. This resulted from administration of dihydroarthemisinin with chloroquine in twopatients and dihydroarthemisinin withAmodiaquine in one patient. The first patientwas a seven year old child who developed90%cutaneous involvement and died fromhemorrhagic shock.The secondwas a 28 old female that developed a 76% body surface involvement and died from septicemia. The third patient was a pregnant 37year old woman that developed 52% body involvement and died from septic shock. In these patients the earliest symptomswere not recognized and therewas considerable delay before referral. In view of the recent WHO recommendation of Arthemisinin Combination Treatment (ACT) for malaria, we expect more cases of Steven Johnson Syndrome and Lyells syndrome from ACT treatment. The aim of this report is to raise the awareness of clinicians to this potentially fatal complication

Consumption of psychotropic medicines at a referral hospital in Namibia: findings and implications

Setting: In Namibia, the burden of mental illnesses is estimated at 25.6% and is expected to double by 2025. Few studies in sub-Saharan Africa estimate the consumption rates of psychotropic medicines as a proxy of irrational use. Aim: The consumption rate of psychotropic medicines at a referral hospital was determined. Method: A hospital-based retrospective medicine utilization analysis of Facility Electronic Stock Card (FESC) psychotropic medication was conducted at Intermediate Hospital Katutura over a 7 year period, 2011-2017. Data on consumption and expenditure on psychotropic medicines were abstracted from FESC and analysed using descriptive statistics in SPSS v22. The main outcomes were consumption rates, daily Defined Dose, (DDD) and/or expenditure. Results: Of the 580 351,4 DDD of psychotropic medicines consumed, 84% were anti-psychotics, 9.2% anti-depressants and 6.8% anxiolytics. Anti-psychotics (48.8%) and anxiolytics (47.9%) had the highest consumption by cost relative to antidepressants (3.3%). The most consumed antidepressants were imipramine (62%) by DDD and fluoxetine (55.8%) by cost. The most consumed anti-psychotics were chlorpromazine (74.6%) by DDD and haloperidol (68.4%) by cost respectively. Diazepam (79.4%) and hydroxyzine (94.2%) were most consumed sedative-hypnotics by DDD and cost respectively. Conclusion: The consumption of new psychotropics contributes to higher costs. There is need for cost-effectiveness analysis of new versus conventional psychotropics to optimize treatment, outcomes and costs

Self-Assessment of Final Year Medical Students’ Proficiency at Basic Procedures

BACKGROUND: Procedural tasks are important in patient management, with varying degrees of proficiency expected at different levels of medical training. Little has been done in this region to assess the medical students’ proficiency at performing basic procedures.AIM: The aim of this study is to determine their self-assessed proficiency, degree of participation in performing these procedures and the use of skill-lab training.MATERIALS AND METHODS: The study is questionnaire-based, amongst final year medical students of University of Lagos, Nigeria.RESULTS: One hundred and forty students participated in the study.  A significant number (82{58.6%}) self-reported level of proficiency for venepuncture was above average or excellent; for IV line placement it was  a little less than half (65{46.4%}) and for urethral catheterisation 44 (31.7%); however it was quite low for the other procedures. Many students self-reported high level of participation for venepuncture (83{59.2%}); sixty one (43.6%) for IV line placement and 30 (21.7%) for urethral catheterization. The correlations between self-assessed levels of proficiency and participation were significant for all procedures. There was no exposure to the use of mannequins.CONCLUSION: Self-reported proficiency is lacking for basic procedures in a significant proportion of students with a low level of participation

Anatomic Variations in the Palmar Cutaneous Branch of the Median Nerve Among Adults in Lagos, Nigeria

Dysesthesias due to palmar cutaneous branch of median nerve injuries infrequently follow carpal tunnel release surgeries.Objective: To determine the course of palmar cutaneous branch of the median nerve in wrist of adult Nigerians, identify the common variations, determine its relations to the palmaris longus (PL) in the region of the distal wrist crease. And on these basis, suggest a safe incision for carpal tunnel surgery in Nigerians. Materials and Methods: Detailed anatomic dissection of the palmar cutaneous branch of the median nerve was carried out with the aid of a loupe magnification on 40 Nigerian cadaver wrists. The origin, course in the distal forearm, wrist and proximal palm was traced. Measurements of the distances between the radial and ulnar branches of the nerve and the PL were made. The distance between origin of the nerve and the distal wrist crease was measured as well. The common branching pattern of the nerve was noted. Results: The palmar cutaneous branch of the median nerve was present in all dissected wrists. The mean distance of the radial branch to PL was 0.81 cm (SD ± 0.3 cm), while the ulnar branch was 0.3 cm (SD ± 0.1 cm). from same structure. The mean distance from the origin to the distal wrist crease is 4.5 cm (SD ± 2.1 cm). We noted the terminal distal branching pattern of the nerve to be highly variable. Conclusion: The Palmar cutaneous branch of the median nerve is safe with an incision made at least 0.5 cm ulnar to the PL in carpal tunnel surgeries in Nigerians.Keywords: Carpal tunnel surgery, median nerve, palmar cutaneous branc

Early Experiences with Microvascular Free Tissue Transfer in Lagos, Nigeria

Objectives: Microvascular free tissue transfer within our subregion is fraught with considerable challenges. We aim to highlight our experiences gained with our first fifteen cases of microvascular free tissue transfer at the Lagos University Teaching Hospital. We believe our report will be useful to colleagues embarking on such reconstructions in similar settings. Materials and Methods: The clinical records of the first 15 cases of free flaps done at our center were reviewed. The indications for surgery, choice of flap, recipient vessels, duration of surgery and complications were noted. Results: Fifteen cases were done, 10 flaps survived, ten defects occurred following trauma while remaining five followed cancer resections. Anterolateral thigh and radial forearm flaps were the most common flap used. The mean duration of surgeries was 7.1 hours SD ± 1.10 hours. Our take back rate was 13.3%, with a salvage rate of 50%. Three flaps failed on account venous congestion while remaining two failed due to arterial occlusion.Conclusion: 66.67% free flap success rate recorded reflect our early experiences in our institution. We believe meticulous planning, careful vessel selection, close flap monitoring as well as improved infrastructural support can lead to much better success rates in microvascular reconstruction in our country.Keywords: Experiences, free, tissue, transfe

Early out come of day surgery for inguinal hernia in Sub-urban general Hospital in Lagos, Nigeria

No Abstract.Nigerian Medical Journal Vol. 46 (2) 2005: pp. 33-3