Changing pattern of cancer distribution: experience from a tertiary health institution in Nigeria and review of literature.

Background: Over the years, epidemiological surveys have established that the five leading cancers in Africa (in descending order of prevalence) are cancers of the breast, cervix, prostate, liver, and colorectum.[1] However, a 10-year retrospective review of cases performed at the University of Ilorin Teaching Hospital (UITH) revealed some changes in the cancer incidence pattern in this region. Aims: The aim of the study was to determine the distribution of cancers managed at the UITH, a tertiary health care center in North Central Nigeria, in the past 10 years and create awareness of changing cancer prevalence patterns in this region. Materials and Method: This was a retrospective review of cancer epidemiology at UITH over a period of 10 years. Confirmed cancer cases within this period were extracted from the data in the Department of Anatomic Pathology and the Cancer registry. Descriptive and inferential statistics were applied to obtain rates and proportions for both sexes. Results: There were 2430 confirmed cases of cancer during the study period from January 2011 to December 2020. Out of these cases, 1310 (54%) were seen in females and 1120 (46%) were seen in males. The most common cancer recorded (in total) was prostate cancer, which accounted for 18% of all cases, constituting approximately one in six of all cancer cases. This was followed closely by breast cancer (16.6%). The most commonly diagnosed cancer in males was prostate cancer (four in ten cancer cases in males), whereas in females, it was breast cancer (approximately three in ten cancer cases in females). Cancers of the lungs and liver were rare in both sexes in this study. In children, the most common malignancies were retinoblastoma (38.3%), non-Hodgkin lymphomas (16.8%), and nephroblastoma (12.8%). Conclusion: There is a changing trend in cancer cases with some cancer cases now predominating compared to previous years. This may be because of increased awareness and/or better medical screening and diagnostic techniques.

Hospitalisation for lower respiratory tract infection is associated with an increased incidence of acute myocardial infarction and stroke in tropical Northern Australia.

Acute respiratory infections appear to precipitate vascular events. Acute myocardial infarction (AMI) and stroke are the leading cause of death and disability globally. This study was based on a cohort of patients admitted to Townsville University Hospital between January 2006 and December 2016. Using a self-controlled case series design, we investigated the risk of AMI or ischaemic stroke after an episode of pneumonia. We defined the 'risk interval' as the first 14 days after hospitalisation for pneumonia and the 'control interval' as one year before and one year after the risk interval. Among a population (N = 4557) with a median age of over 70, a total of 128 AMI and 27 stroke cases were identified within 1 year of an episode of pneumonia in this study. Ten and two admissions occurred during the risk interval, while 118 and 25 admissions occurred during the control period. The relative incidence ratios (RIR) of AMI increased after an episode of pneumonia (RIR=4.85, 95% confidence interval (CI) 2.44-9.67). The risk for stroke after the exposure period of 14 days was 4.94 (95% CI 1.12-21.78) considering only the first stroke incidence. The RIR results for AMI and stroke were not altered by adjusting for age, sex or Indigenous status. The risk of AMI and stroke were significantly higher two weeks after an episode of pneumonia.

Is Nigeria really on top of COVID-19? Message from effective reproduction number.

Following the importation of coronavirus disease (COVID-19) into Nigeria on 27 February 2020 and then the outbreak, the question is: How do we anticipate the progression of the ongoing epidemic following all the intervention measures put in place? This kind of question is appropriate for public health responses and it will depend on the early estimates of the key epidemiological parameters of the virus in a defined population.In this study, we combined a likelihood-based method using a Bayesian framework and compartmental model of the epidemic of COVID-19 in Nigeria to estimate the effective reproduction number (R(t)) and basic reproduction number (R0) - this also enables us to estimate the initial daily transmission rate (ß0). We further estimate the reported fraction of symptomatic cases. The models are applied to the NCDC data on COVID-19 symptomatic and death cases from 27 February 2020 and 7 May 2020.In this period, the effective reproduction number is estimated with a minimum value of 0.18 and a maximum value of 2.29. Most importantly, the R(t) is strictly greater than one from 13 April till 7 May 2020. The R0 is estimated to be 2.42 with credible interval: (2.37-2.47). Comparing this with the R(t) shows that control measures are working but not effective enough to keep R(t) below 1. Also, the estimated fraction of reported symptomatic cases is between 10 and 50%.Our analysis has shown evidence that the existing control measures are not enough to end the epidemic and more stringent measures are needed.

Joint spatial time-series epidemiological analysis of malaria and cutaneous leishmaniasis infection.

Malaria and leishmaniasis are among the two most important health problems of many developing countries especially in the Middle East and North Africa. It is common for vector-borne infectious diseases to have similar hotspots which may be attributed to the overlapping ecological distribution of the vector. Hotspot analyses were conducted to simultaneously detect the location of local hotspots and test their statistical significance. Spatial scan statistics were used to detect and test hotspots of malaria and cutaneous leishmaniasis (CL) in Afghanistan in 2009. A multivariate negative binomial model was used to simultaneously assess the effects of environmental variables on malaria and CL. In addition to the dependency between malaria and CL disease counts, spatial and temporal information were also incorporated in the model. Results indicated that malaria and CL incidence peaked at the same periods. Two hotspots were detected for malaria and three for CL. The findings in the current study show an association between the incidence of malaria and CL in the studied areas of Afghanistan. The incidence of CL disease in a given month is linked with the incidence of malaria in the previous month. Co-existence of malaria and CL within the same geographical area was supported by this study, highlighting the presence and effects of environmental variables such as temperature and precipitation. People living in areas with malaria are at increased risk for leishmaniasis infection. Local healthcare authorities should consider the co-infection problem by recommending systematic malaria screening for all CL patients.

A Prospective Study of Spectrum, Risk Factors and Immediate Outcome of Congenital Anomalies in Bida, North Central Nigeria.

BACKGROUND: Congenital disorders are structural, metabolic, behavioral and functional disorders that are present at birth. Their manifestations are protean ranging from mild anomalies to life-threatening conditions. AIM: The objectives of this study were to describe the congenital anomalies in children seen at Federal Medical Center, Bida over a 12 month period, determine possible factors associated with these anomalies; and their short term outcome. SUBJECTS AND METHODS: Children with clinically recognized congenital malformations were recruited consecutively over a 12 month period and socio-demographic, etiologic and other relevant clinical data were obtained. A detailed examination was also performed and abnormalities documented. The data was analyzed using Epi-info version 6 (Atlanta, USA). The Chi-square was used to identify significant differences for categorical variables. Mid-P and Fisher's exact tests were utilized as appropriate. A P < 0.05 was considered to be significant. RESULTS: A total of 46 children with congenital anomalies were seen during the study period, all which were recruited into the study. The hospital based prevalence amongst neonates was 111/1000 neonates. The most common system affected was the digestive system(50.0%) followed by the central nervous system and head and neck anomalies. There was no significant difference in distribution of anomalies amongst the various ethnic groups. About 22% of families were consanguineous, all being first cousins and 8.7% of mothers were greater than 35 years of age. The case fatality rate for congenital malformations was 2.2%, while 60.9% were referred to other hospitals for further care. CONCLUSION: The study has demonstrated a wide variety of congenital anomalies in Bida, North-Central Nigeria with the digestive system anomalies being the most frequent. The findings of this study strengthen the need for empowerment of the institution in appropriate management of these disorders.

Extraocular myositis in a female puppy.

Extraocular myositis (EOM) is not commonly encountered in dogs. It is generally diagnosed based on clinical features of exophthalmos without third eyelid protrusion, pain or vision loss. The traditional treatment of choice is prednisolone. This report describes a case of a mixed-breed puppy with clinical signs consistent with EOM, the use of ascorbic acid as an adjuvant to traditional corticosteroid therapy and rapid resolution of the condition without recurrence. It also shows that prolapse of the third eyelid and ptosis of the lower eyelids are possible signs of EOM during recovery. This is the first report of this sort from Africa and therefore the report is of epidemiological significance.

Epidemiological analysis of spatially misaligned data: a case of highly pathogenic avian influenza virus outbreak in Nigeria.

This research is focused on the epidemiological analysis of the transmission of the highly pathogenic avian influenza (HPAI) H5N1 virus outbreak in Nigeria. The data included 145 outbreaks together with the locations of the infected farms and the date of confirmation of infection. In order to investigate the environmental conditions that favoured the transmission and spread of the virus, weather stations were realigned with the locations of the infected farms. The spatial Kolmogorov-Smirnov test for complete spatial randomness rejects the null hypothesis of constant intensity (P < 0·0001). Preliminary exploratory analysis showed an increase in the incidence of H5N1 virus at farms located at high altitude. Results from the Poisson log-linear conditional intensity function identified temperature (-0·9601) and wind speed (0·6239) as the ecological factors that influence the intensity of transmission of the H5N1 virus. The model also includes distance from the first outbreak (-0·9175) with an Akaike's Information Criterion of -103·87. Our analysis using a point process model showed that geographical heterogeneity, seasonal effects, temperature, wind as well as proximity to the first outbreak are very important components of spread and transmission of HPAI H5N1.

Sickle cell Nephropathy in children seen in an African Hospital - Case Report.

AIMS AND OBJECTIVES: To determine and report the occurrence of overt renal presentations in children with sickle cell disease seen over the last 14 years (1995-2009) at the Emergency Paediatric Unit and Paediatric Ward and followed up at the Paediatric Nephrology clinic of University of Ilorin Teaching Hospital, Ilorin (UITH). PATIENTS AND METHODS: The five cases with overt renal presentations seen during the period were reported and analyzed for age, sex, and renal manifestations. RESULTS: The age range of the children was 9-15years with a mean of 11years. Four of the five patients were females, with one male. Three of the four females presented with features suggestive of nephrotic syndrome (NS) while the other one had gross haematuria which resolved within 24 hours. The only male had enuresis. The NS in one of the patients progressed to end stage renal disease requiring renal replacement therapy. CONCLUSION: Children with sickle cell disease should be screened for renal complications especially from the late first decade of life. This will help in the early detection of renal disorder that could lead to chronic kidney disease. It is also suspected that the severe forms of SCN such as NS may have a predilection for the female gender. A more extensive study is needed to test the veracity of this observation.

Prevalence of snoring and symptoms of sleep disordered breathing among primary school pupils in Ilorin, Nigeria.

BACKGROUND/AIM: Snoring is the production of sound from the upper aero-digestive tract during sleep due to turbulent airflow This study is to determine the prevalence, pattern, night and daytime symptoms of snoring among nursery and primary school pupils in Ilorin, Nigeria due to its public health importance. MATERIALS AND METHODS: This cross sectional survey was carried out among nursery /primary school pupils in Ilorin, Kwara state between April and September, 2010. Ten schools were selected randomly from 100 schools sited within the 3LGAs of Ilorin municipality. Also private and public schools with different parental social economic status were selected. The pupils were selected from nursery 2 to primary 6 in each school using the class registers with the aid of a table of random numbers with 1500 children assessed. The parents/guardians were made to fill the questionnaires and same returned with visitations to the schools twice weekly and reminders sent via phone calls. Data were analyzed using EPIINFO 2002 version 2 software. RESULTS: 1500 questionnaires were given out but 909 were completely filled and returned (response rate of 61%.). There were 598(65.8%) non snorers (NSn) and 311(34.2%) snorers (Sn) at different scales with 153 male snorers to 158 female snorers. The ages of the children ranges from 3 to 16 years (mean ± SD, 8.3 ± 4.8 years. The mean age for the Sn was 8.2 and 8.3 for NSn (range 3-6 years). No statistical difference in age, gender or socio-economic status between Sn and NSn. 598(65.8%) were non snorers (NSn) and 311(34.2%) were snorers (Sn) especially in the age groups 3-6 years, 121(38.9%) and above 6 years of age 101(32.7%) and below 3 years were 89(28%). CONCLUSION: Snoring is an important health problem among the pupils as a significant percentage snores and most of them are between third and sixth year of life.

Millennium development goals-knowledge and attainability as perceived by doctors: a case study.

OBJECTIVE: To audit the knowledge of doctors and evaluate their disposition toward the attainment of the Millennium Development Goals (MDGs). MATERIALS AND METHODS: Semi-structured questionnaires requesting information about knowledge of the acronym "MDGs" were administered on willing doctors at three tertiary health centers: University of Ilorin Teaching Hospital, Federal Medical Centre, Bida, and Federal Medical Centre, Yola. Data were analyzed using frequency tables and simple statistical methods. RESULTS: One hundred and eighty-three doctors participated in the study, comprising 65 (35.5%) from Bida, 18 (9.8%) from Yola, and 100 (54.7%) from Ilorin, with a male to female ratio of 2:1 (P < 0.05). Thirty-nine respondents (21.3%) had no fore kowledge of MDG (P < 0.05). Only 77 (42.1%) of the respondents who had fore knowledge of "MDG" knew the number of goals to be eight (P < 0.05). Among those who had fore knowledge of MDG, only 34 comprising 15 (10.4%, Bida), 1 (0.7%, Yola), and 18 (12.5%, Ilorin) could correctly list a minimum of four of the MDGs (P < 0.05). Only 12 (8.3%) of the respondents believed that the MDGs are very achievable. CONCLUSION: There is an absolute need for more elaborate publicity on the MDGs among doctors as they are key players if attaining the MDGs is to be a reality.

STRUCTURE OF PORPHYRIN TPPS4 AND ITS INTERACTION WITH METAL IONS AS ELUCIDATED BY 1H NMR AND UV-VISIBLE SPECTRA.

Porphyrins are a group of tetrapyrrole pigments. Physical and chemical properties of porphyrins are often related to their compositions and structures. We conducted 1H solution NMR and UV-visible spectral analysis to characterize the structural feature of a water-soluble, synthetic porphyrin i.e. tetrakis (p-sulfonatophenyl) porphyrin, TPPS4, and its interaction with different metal ions in aqueous solutions. The results indicate that tetrapyrrole and tetraphenyl rings in TPPS4 molecule form a co-planar electron conjugation system; transition-metal ions show stronger binding capacity than alkali and alkali-earth metal ions; the relative stabilities of TPPS4-metal ion complexes can be well assessed by NMR and UV-visible spectral data.