Unusual presentation of fibroadenoma in the pelvic region - A case report.

INTRODUCTION AND IMPORTANCE: Ectopic breast tissue (EBT) may occur anywhere along the milk line, which extends bilaterally from the axilla to the groin. EBT can undergo the same physiologic and pathologic changes seen in normal breast tissues. The most common reported pathologies are carcinoma, inflammatory changes and fibroadenoma. CASE PRESENTATION: A painless slow growing swelling on the mons pubis of a young lady which was initially thought to be a lipoma but pathology showed it was ectopic breast tissue is reported. CLINICAL DISCUSSION: During normal development, mammary ridges form breasts in the pectoral region and their remainder regresses. Failure of regression of the remaining portions of the mammary ridges can lead to ectopic breast tissue development with (polythelia) or without (polymastia) a nipple-areolar complex. Ectopic breast tissue can occur anywhere along the mammary ridge but is most commonly found in the axilla; findings anywhere else outside of the axilla are rare. CONCLUSION: A high index of suspicion of ectopic breast tissue is required for swellings over the anatomic distribution of the embryologic milk line particularly if these swellings respond to hormonal changes in puberty, pregnancy and lactation.

Bacterial and Antibiotic Sensitivity Pattern in Secondary Peritonitis.

Background: Peritonitis is inflammation of the peritoneum usually as a result of a localized or generalized infection. Secondary peritonitis which is the most common type follows an infective process in a visceral organ. The role of peritoneal cultures and use of antibiotics effective against culture results remain controversial. Objectives: This study was conducted to determine the bacterial and antibiotic sensitivity pattern in patients with secondary peritonitis. It also compared the use of empirical antibiotics and culture-sensitive antibiotics with outcomes of patients with secondary peritonitis. Materials and Methods: A prospective randomized clinical study was conducted. Five millilitres of peritoneal fluid was sampled intra-operatively, and microscopy, culture, and sensitivity testing was performed in patients with secondary peritonitis. The patients, randomized into two groups, had antibiotics administered for 7 days. The first group had empirical antibiotics throughout (Ceftriaxone + Metronidazole), whereas the second group had empirical antibiotics (Ceftriaxone + Metronidazole) for the first 2 days and antibiotics according to the sensitivity report for the remaining 5 days. The post-hoc analysis was also done on a third group, who, even though were randomized to either groups, had no growth on culture of peritoneal fluid. Results: The commonest pathogens identified from the peritoneal culture of the participants were Escherichia coli, Klebsiella pneumonia, Anaerococcus group, and Bacteroides fragilis. Complications including mortality were significantly higher in those who received empirical antibiotics than those who received culture-sensitive antibiotics. Conclusion: The outcome of antibiotics administration in patients with secondary peritonitis with a positive culture was better in those who received culture-sensitive antibiotics than those who received empirical antibiotics.

Plasma Zinc Levels in Patients with Chronic Leg Ulcers at University College Hospital, Ibadan, Nigeria.

BACKGROUND: Chronic leg ulcers are defects in the skin below the level of knee persisting for more than six weeks and shows no tendency to heal after three or more months. Zinc is a necessary component of several DNA & RNA polymerases and transferases essential for cell proliferation. Zinc deficiency is known to retard wound healing by preventing cellular mitosis and disturbance of fibroblast function and collagen synthesis. This study compares zinc levels in patients with chronic leg ulcers with apparently healthy individuals. METHODS: Five milliliters of venous blood samples was taken from twelve patients with chronic leg ulcers. Five milliliters of venous blood samples was also taken from a control group, who do not have chronic leg ulcers, but are matched with the cases in age (± 5 yr), sex, socioeconomic status and body mass index (± 3 kg/m2). Plasma zinc levels was determined by atomic absorption spectrophotometry. Principal exposure include the socio-demographic characteristics of patients, duration of symptoms before presentation, signs of ulcer-site, number, size, depth, base, edge, presence of discharge, enlarged lymph nodes and local neurovascular integrity. The outcome variables include plasma levels of biochemical markers measured -Zinc, serum albumin, total protein. RESULTS: The plasma zinc levels was significantly lower (P<0.01) in patients with chronic leg ulcer (92.808±16.689 µg/dl) as compared with control subjects (109.413 ± 9.304 µg/dl). There was no statistical difference in albumin and protein levels in both groups. CONCLUSION: Patients with chronic leg ulcers have significantly lower plasma zinc levels than apparently healthy individuals.

Cancer ecosystem assessment in West Africa: health systems gaps to prevent and control cancers in three countries: Ghana, Nigeria and Senegal.

INTRODUCTION: Sub-Saharan Africa is experiencing a rapid epidemiological transition with the increasing incidence of Non-Communicable Diseases (NCD). Among these, cancer is one of the main causes of death in adults. This is a public health problem whose burden is unknown due to lack of statistical data. In addition, the already overburdened health systems are experiencing enormous constraints to address the problem with the double challenge of communicable and NCDs. METHODS: The purpose of this evaluation was to assess the capacity and needs of health systems to prevent and control cancer. A cross-sectional study, using both quantitative and qualitative methods, was conducted between April 2017 and February 2018 in target countries, through in-depth interviews with key actors, direct observations and documents review. The WHO framework for health system strengthening with the 6 pillars was used for the gaps analysis. RESULTS: Little priority is given to the fight against cancer because of low political commitment. Programs´ resources are very limited and there is a poor coordination of the actions. Human resources are insufficient, and most of them are concentrated in the capital city. This limits access to care with a late consultation of patients. Diagnosis and treatment services are expensive and generally paid by households. Finally, the unavailability of reliable data at national level hinders the decision-based evidence. CONCLUSION: There is an urgent need to create strong partnerships at national and regional levels to (i) Advocate for a strong political commitment; (ii) Strengthen the coordination of actions and create more synergy among stakeholders; (iii) Improve the quality and quantity of human resources; (iv) Extend universal health coverage to cancer and improve program funding; and (v) Set up cancer registries at national level.