PROGRAMMED CELL DEATH LIGAND 1 (PD-L1) EXPRESSION IN TRIPLE NEGATIVE BREAST CANCER CASES IN BENIN CITY.

Background: Triple-negative breast cancers (TNBC) have been particularly challenging to manage due to their lack of intrinsic cellular receptors, with the resultant relatively higher morbidity and mortality. Recently, the programmed cell death 1/programmed cell death ligand 1 (PD-1/PD- L1) immune checkpoint pathway has become the focus of immunotherapy, especially for TNBCs. This study aimed to determine the pattern of expression of PD-L1 in TNBC cases in Benin City. Methods: It was a 3-year retrospective study that involved the PD-L1 immunostaining of the TNBC cases that were diagnosed in the Department of Anatomical Pathology, University of Benin Teaching Hospital, Benin City, from January 1, 2017 to December 31, 2019. Result: Ninety-two cases of TNBC were tested for PD-L1 expression. Thirteen (14.1%) of the TNBC cases were PDL1 positive to varying degrees on tumour and immune cells. Diffuse tumoural PD-L1 staining was seen in 4 (30.8%) of the PD-L1 positive cases. PD-L1 expression was significantly associated with increasing age up to the fifth decade (p =0.030). All the PD-L1 positive TNBC were invasive breast carcinoma of no special type and mostly grade 2 tumours; however, there was no significant association between PD-L1 expression and histological subtype or grade. Conclusion: PD-L1 expression was shown to occur at a relatively low rate among TNBC cases in this environment and was significantly associated with increasing age. This study has shown that 14.1% (1 in 7) of our TNBC patients could benefit from immune checkpoint inhibitor therapy.

First Cases of Sars-cov-2 Reinfection Coinciding with the Covid-19 Second Wave, Benin City, Nigeria.

BACKGROUND: Reinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has important public health implications pertaining to herd immunity and durability of protection from vaccines. A small but growing number of cases have been reported globally but none from Africa. This is due, in part, to adherence to definitions based on genetic sequencing, the capabilities of which are in short supply on the continent. METHODS: Based on epidemiological and clinical parameters, we report the first two cases of SARS-CoV-2 reinfection from a Nigerian tertiary hospital managing coronavirus disease 2019 (COVID-19) patients. RESULT: Two cases of SARS-CoV-2 reinfection were seen in December, 2020 and January, 2021. Both were males associated with a healthcare setting and aged 37 and 38 years respectively. The number of days between the first infection and the second ranged from 160-196 days. Symptoms ranged from mild to moderate and they recovered without sequelae. CONCLUSION: Public health action, including risk communication and reinfection surveillance backed by genomic sequencing, is advocated.

CONTEXTE: La réinfection par le coronavirus 2 du syndrome respiratoire aigu sévère (SRAS-CoV-2) a des implications importantes pour la santé publique en ce qui concerne l'immunité du troupeau et la durabilité de la protection contre les vaccins. Un nombre petit mais croissant de cas a été signalé dans le monde, mais aucun en Afrique. Cela est dû, en partie, au respect des définitions basées sur le séquençage génétique, dont les capacités sont rares sur le continent. MÉTHODES: Sur la base de paramètres épidémiologiques et cliniques, nous rapportons les deux premiers cas de réinfection par le SRAS-CoV-2 d'un hôpital tertiaire nigérian prenant en charge des patients atteints de la maladie à coronavirus 2019 (COVID-19). RÉSULTAT: Deux cas de réinfection par le SRAS-CoV-2 ont été observés en décembre 2020 et janvier 2021. Tous deux étaient des hommes associés à un établissement de soins de santé et âgés respectivement de 37 et 38 ans. Le nombre de jours entre la première infection et la seconde variait de 160 à 196 jours. Les symptômes variaient de légers à modérés et ils se sont rétablis sans séquelles. CONCLUSION: Une action de santé publique, y compris la communication des risques et la surveillance des réinfections appuyées par le séquençage génomique, est préconisée. MOTS CLÉS: COVID-19; SRAS-CoV-2; Réinfection; Nigeria; Pandémie.

Arterial Oxygen Saturation and other Clinical Predictors of Survival in Patients with Covid-19: A Review of Cases in a Tertiary Care Hospital in Nigeria.

BACKGROUND: We assessed clinical parameters in patients confirmed to have COVID-19 in relation to arterial hypoxaemia and survival. METHODOLOGY: This was a retrospective chart review of patients who were confirmed positive for SARS-CoV-2 virus by Real Time-Polymerase Chain Reaction (RT-PCR) testing. Data extracted from patients' case files included patient demographics, presenting symptoms, provisional diagnoses, and outcomes of hospitalisation. Descriptive variables were summarized; proportions were compared using Chi-square tests, and independent predictors of mortality were assessed using multivariate regression analysis. A p-value of < 0.05 was considered as statistically significant. RESULTS: There were a total of 61 patients with positive RT-PCR testing: mean age ± SD (minimum - maximum) was 53.0 ± 18.5 (5 months - 90) years. Persons aged 60 years and above were the largest group (n=24, 39.3%). More than half were male (n=35, 57.4%); about 43% had one morbidity; 41.0% had at least two co-morbidities. The mean (SD) arterial oxygen saturation (SpO2) was 86.9% ± 16.7. Patients who were clinically dyspnoeic at presentation, and who had co-morbidities were significantly more hypoxaemic (p = 0.026 and 0.04, respectively). Significantly more patients who had normal oxygen saturation at presentation survived (p = 0.006). None of these variables was an independent predictor of mortality, however. CONCLUSION: Arterial hypoxaemia was significantly associated with dyspnoea and underlying disease, and normal oxygen saturation at presentation was significantly associated with survival. Hospital managers and clinicians may thus prioritize routine pulse oximetry, supplemental oxygen therapy and management of co-morbidities in the COVID-19 fight.

An Analysis of COVID-19 Patients Receiving Care in a Tertiary Facility in Southern Nigeria.

BACKGROUND: Information pertaining to the clinical characteristics of COVID-19 in sub-Saharan Africa remains sparse. In Nigeria, it is limited to few isolated reports and case series confined to the early phase of the outbreak. The objective of this study is to describe the presenting characteristics, co-morbidities and outcomes of Nigerian patients managed over a 3-month period in a tertiary hospital. METHODS: This was a descriptive cross-sectional study involving the total population of patients with laboratory confirmed diagnosis of COVID-19 in the University of Benin Teaching Hospital, Edo State, Nigeria from March 31 to June 30, 2020. Data was collected using a review of patients' records. Analysis was by IBM SPSS version 25.0. The level of significance was set at p < 0.05. RESULTS: A total of 173 patients with mean age (SD) 50.7± 20.1 years were managed. One hundred and five (60.7%) were males and the commonest age group was 20-39 years (34.7%). The commonest presenting symptoms were fever, cough and malaise found in 103 (71.5%), 101 (70.1%) and 63 (43.8%) patients respectively. Twenty-five (14.5%) patients had severe disease; 60 (34.7%) had underlying medical conditions mostly hypertension and diabetes mellitus. Outcome analyses showed 117 (67.6%) discharges, 45 (26.0%) deaths, 10 (5.8%) discharges against medical advice, and 1 (0.6%) transfer to another facility. Male sex (p=0.044), increasing age (p<0.001), presence of symptoms (p=0.010), presence of co-morbidities (p=0.010) and non-healthcare worker status (p< 0.001) were significantly associated with mortality. CONCLUSION: The first epidemiological and clinical summary of COVID-19 cases in Edo state, Nigeria over a three-month period is presented showing globally recognized patterns of male predilection and higher mortality with increasing age and co-morbidity.

Impact of Sleep Quality on the Health-Related Quality of Life of Patients with Chronic Obstructive Pulmonary Disease.

BACKGROUND: Impaired sleep is reportedly common in chronic obstructive pulmonary disease (COPD) and the impact of quality of sleep on health-related quality of life (HRQL) has been documented. Although factors affecting HRQL have been investigated in various studies, the impact of sleep quality on HRQL has not been previously investigated among patients with COPD in Nigeria. The purpose of this study was to determine the contribution of sleep quality as a factor affecting HRQL. We hypothesized that sleep quality is a determinant of HRQL. METHODOLOGY: Sixty patients with COPD were evaluated. HRQL was assessed using COPD Assessment Test (CAT). Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Lung function was assessed by spirometry, severity of dyspnea by the Modified Medical Research Council (MMRC) scale, and functional exercise capacity by the Six-Minute Walk Test (6MWT). In all the statistical tests, a p value of <0.05 was considered significant. RESULTS: The mean age of the study population was 70±8years. Forty-nine patients (81.7%) had poor quality of sleep (PSQI > 5). The mean CAT score of the study population was 19.40±7.5. Bivariate correlation shows that HRQL reduces with worsening sleep quality (r=0.705, p=<0.001). HRQL was also associated with COPD severity (P = 0.001), severity of dyspnea, exercise capacity and frequency of exacerbation (P = <0.001). Multiple regression analysis showed that quality of sleep was the best independent predictor of HRQL in our patients (p= <0.001). CONCLUSION: Results from this study suggest that health status is generally poor in patients with COPD and quality of sleep is a significant determinant of their HRQL.

Intestinal obstruction secondary to cecal endometriosis.

Endometriosis of the gastrointestinal tract is rare and occurs in <1% of all patients undergoing major gynecological surgeries. Bowel involvement has been reported in 3%-37% of all women of childbearing age with endometriosis. Total obstruction of the gastrointestinal tract occurs in <1% of cases of endometriosis with bowel obstruction. This case report is that of a 42-year-old female who presented with a 6-month history of change in bowel habits in favor of increasing constipation. This was associated with cyclical lower abdominal pains, abdominal swelling, and weight loss. Examination revealed hyperactive bowel sounds with scant fecal matter on rectal examination. An impression of intestinal obstruction was made and she had an emergency laparotomy. Dilated ileum and a hard, constricting cecal mass were found intraoperatively. She had a right hemicolectomy and ileo-transverse anastomosis, with progressive improvement postoperatively. Histology of the resected bowel segment confirmed cecal endometriosis. In conclusion, cecal endometriosis is a rare cause of intestinal obstruction. A high index of suspicion is required for diagnosis, especially if the woman is premenopausal with a history of abdominal pain that worsens with menstrual periods. Outcome is good with appropriate surgical intervention.

Relationship between knowledge and quality of asthma care among physicians in South-West Nigeria.

INTRODUCTION: Adequate knowledge of asthma management and adherence to international guidelines are known to increase the quality of care offered by Physicians. We conducted this study to assess the level of asthma knowledge and quality of care among physicians practicing in Ondo State. METHODS: We conducted a cross sectional survey of 96 physicians from various specialties participating in a continuous professional development (CPD) lecture using adapted questionnaires. RESULT: Respondents ranged in age from 23-62years (42.5±19.4). There were more male (70%). The minority (17%) had additional postgraduate medical qualifications. There was a high distribution of correct answers for individual knowledge questions. The greatest areas of knowledge gaps appeared in diagnostic instruments, asthma severity and drugs. We observed gaps regarding the use of GINA guidelines (6%) and prescribing combined inhaled steroid and long acting bronchodilator for patients who are not controlled on inhaled steroid alone (29%). A large number of the respondents do not confirm the diagnosis of asthma by spirometry (32%). Only 8% of the respondents with high knowledge reported a corresponding high quality of Asthma care. CONCLUSION: We concluded that although physicians in South-West Nigeria appear to have good knowledge, there are areas of gap in the quality of asthma care with regards to standard guideline. There is need for constant training and re-training of physicians in order to keep them up to date with international guidelines. In addition, increase access to diagnostic facilities and adapting international guideline to local realities will help improve standard of Asthma care.

A Preliminary Assessment of the Impact of a Continuing Medical Education Program on the Knowledge of Nigerian Pulmonologists Regarding the Management of Chronic Obstructive Pulmonary Disease.

BACKGROUND: The knowledge ofPulmonologists in Nigeria regarding the management of chronic obstructive pulmonary disease (COPD) is modest and needs to be improved. Continuing Medical education programs have the potential to improve the knowledge of doctors. OBJECTIVES: To determine the impact of attendance at a COPDtraining on the level of knowledge of pulmonologists in Nigeria. METHODS: A Cross-sectional study conducted during the Nigerian Thoracic Society (NTS) annual conference held at Ile-Ife, Nigeria in November 2013. The participants included residents in respiratory medicine and qualified pulmonologists. The study instruments were pre-test and post-test questionnaires which comprised of the same set of questions. The pre-test was administered and retrieved before the start of the COPD symposium and the post-test immediately afterwards. The scores on the pre-test were compared with the scores on the post-test. RESULTS: There were 54pre-test and 46 post-test questionnaires. The maximum obtainable score was 25. The mean score±standard deviation on the pre-test was 13±6 and 17±5 on post-test (t=-3.9, p<0.001) translating to an improvement in knowledge from 52% to 68%. Assessment of airflow limitation using spirometry in the initial evaluation for COPD was correctly selected by 57.4% on pre-test and 65.2% on post-test (p=0.42). The knowledge of tuberculosis and environmental pollution were the least recognized risk factors for COPD and mood/anxiety disorder was the least recognized comorbid condition. CONCLUSION: The level of knowledge of pulmonologists in Nigeria about COPD is modest and participation at a CME program improved their knowledge.

The relation of airway obstruction to asthma, chronic rhinosinusitis and age: results from a population survey of adults.

RATIONALE: There is conflicting evidence on whether patients with asthma experience an accelerated decline in lung function with age. We examined the association between postbronchodilator lung function, asthma, chronic rhinosinusitis (CRS), and atopy with age using a large European sample. METHODS: In 17 centers in 11 European countries, case-control studies were nested within representative cross-sectional surveys of adults aged less than 75 years. Representative samples of participants with asthma, CRS or both and controls were assessed for postbronchodilator ventilatory function, smoking history, atopy, and treatment. Multiple regression was used to assess the interactive effects of age and diagnostic group on decline in postbronchodilator ventilatory function. RESULTS: A total of 3337 participants provided adequate data (778 with asthma, 399 with CRS, 244 with both asthma and CRS and 1916 controls who had neither asthma nor CRS). Participants with asthma had lower FEV1 /FVC (-4.09% (95% CI: -5.02, -3.15, P < 0.001) and a steeper slope of FEV1 /FVC against age (-0.14%/annum [95%CI: -0.19, -0.08]) equivalent to smoking 1-2 packs of cigarettes per day. Those with atopy had a slope equivalent to controls. CONCLUSIONS: People with asthma have a steeper decline in postbronchodilator lung function with age, but neither CRS nor atopy alone were associated with such decline.

Malignant Breast Tumour in a 13-Year Old Girl.

We report a case of primary malignant fibrous histiocytoma of the breast in a 13-year old girl. She has had wide local excision of the tumour and six cycles of adjuvant cytotoxic chemotherapy. Four years after treatment, she was free from local recurrence; however, the presence of distant metastasis could not be assessed because of inadequate imaging investigations.

Association between lung function and dyspnoea and its variation in the multinational Burden of Obstructive Lung Disease (BOLD) study.

BACKGROUND: Dyspnoea is a common symptom of respiratory disease. However, data on its prevalence in general populations and its association with lung function are limited and are mainly from high-income countries. The aims of this study were to estimate the prevalence of dyspnoea across several world regions, and to investigate the association of dyspnoea with lung function. METHODS: Dyspnoea was assessed, and lung function measured in 25,806 adult participants of the multinational Burden of Obstructive Lung Disease study. Dyspnoea was defined as ≥2 on the modified Medical Research Council (mMRC) dyspnoea scale. The prevalence of dyspnoea was estimated for each of the study sites and compared across countries and world regions. Multivariable logistic regression was used to assess the association of dyspnoea with lung function in each site. Results were then pooled using random-effects meta-analysis. RESULTS: The prevalence of dyspnoea varied widely across sites without a clear geographical pattern. The mean prevalence of dyspnoea was 13.7 % (SD=8.2 %), ranging from 0 % in Mysore (India) to 28.8 % in Nampicuan-Talugtug (Philippines). Dyspnoea was strongly associated with both spirometry restriction (FVC

HISTOPATHOLOGICAL EVALUATION OF H. PYLORI ASSOCIATED GASTRIC LESIONS IN BENIN CITY, NIGERIA.

BACKGROUND: Endoscopic biopsy of the gastric mucosa allows early diagnosis, grading, staging and classification of gastric diseases. Helicobacter pylori, has been recognized as a major aetiologic factor for chronic gastritis, benign gastric ulcers and gastric adenocarcinoma and lymphoma. The loco-regional variability in the prevalence of Helicobacter pylori and associated diseases in Nigeria, emphasise the need for evaluation of subsets of a heterogeneous population like ours. OBJECTIVE: To determine the frequency of helicobacter pylori in gastric endoscopic biopsies and document the pathology of gastric lesions commonly associated with Helicobacter pylori infection. DESIGN: Retrospective descriptive study. SETTINGS: University of Benin Teaching Hospital (UBTH), and Biogenics Histopathology Laboratory (a private Histopathology Laboratory), both based in Benin City, Niger Delta region of Nigeria. SUBJECTS: Endoscopic gastric biopsies recorded in the surgical pathology register of the department from 2005-2009 were studied and relevant demographic and clinical information extracted from the registers, original request cards and patient case files. The clinical data and slides processed from paraffin embedded tissue blocks of endoscopic biopsies of gastric lesions seen from year 2005 to 2009 were studied, analyzed and statistically presented. RESULTS: Total number of specimens studied was 142. Chronic gastritis was present in 117(82.39%) specimens; 9(6.34%) were benign gastric ulcers; 3(2.11%) were gastric polyps; and 11(7.75%) were gastric malignancies. Helicobacter pylori, was demonstrated in 55.6% of all specimens. The peak age for Chronic Gastritis and Gastric Cancer is the 6th decade. Amongst patients with chronic gastritis, inflammatory activity was present in 65%; atrophy in 53%; and intestinal metaplasia in 16.6%. All gastric malignancies seen were intestinal type adenocarcinomas. CONCLUSION: The spectrum of lesions diagnosed in gastric endoscopic biopsy specimens in Benin, their frequency and associations are largely comparable to what has been described elsewhere in Nigeria and Africa.

Frequency of distribution of oestrogen and progesterone receptors positivities in breast cancer cases in Benin-City, Nigeria.

AIMS AND OBJECTIVES: The aim of this study is to determine the prevalence of oestrogen and progesterone receptors positivities among histologically diagnosed breast cancer cases at the University of Benin Teaching Hospital, Benin City, Nigeria. MATERIALS AND METHODS: Cases of breast carcinomas in the records of the Department of Histopathology, University of Benin Teaching Hospital, between 2003 and 2007 constitute the materials used for this study. Immunohistochemical staining was done using representative paraffin-embedded blocks (H&E slides assessment) and stained with oestrogen and progesterone antibodies manufactured by Dako Denmark (AS Denmark). RESULTS: A total of 135 cases were studied. The female to male ratio was 44:1 with an overall mean age of 48.3±13 years. Invasive ductal carcinoma, NOS (not otherwise specified) was the most common histological type (81.5%). Eighty per cent of cases were categorised as grades 2 and 3 tumours. The steroid hormone receptor positivity was 17%. Oestrogen and Progesterone receptor positivity were 14.1% and 9.6% respectively. There was a statistically significant association between hormone receptor status and the grade of tumour (?2 = 6.37, df = 2, p = 0.04). CONCLUSION: This study shows a relatively low steroid hormone receptor positivity of breast cancer in Benin. This finding portends a poor prognostic effect and it is consequently recommended that steroid hormone receptor status be determined before hormonal treatment in these patients. There is the need to determine the immunohistochemical patterns of breast cancer in other centres that treat breast cancer patients.

Medicolegal childhood deaths in Benin City, Nigeria.

BACKGROUND: Children under the age of 15 years constitute over 40% of the population in developing countries of the world including Nigeria. Deaths in this age group also contribute over 40% of total mortality in the general population; a significant proportion of these deaths is of medicolegal importance. OBJECTIVE: The purpose of this study was to describe the frequency and pattern of medicolegal deaths during childhood period. METHODS: The study was a retrospective analysis of all autopsies performed in children less than 15 years of age by the Police Pathologist attached to the Police Medical Unit in Benin City between January 1998 and December 2002. We analysed the deaths by age, sex, and circumstance of death. RESULTS: Ninety-four medicolegal deaths occurred in children under 15 years of age during the period under review. Eighty (85.1%) were sudden unnatural deaths (SUDs) while 14(14.9%) were sudden unexpected natural deaths (SUNDs). Causes of SUDs were accidents 72 (90%), homicides seven (8.8%) and suicide one (1.2%). The major causes of SUNDs were infections seven (50%) and haemodynamic disorders three (21.5%). CONCLUSION: Preventable accidental deaths make up most of the medicolegal childhood deaths in our environment. These deaths can be reduced if adequate measures backed up by favourable government policies are put in place.

Histopathological review of solid tumours in neonates at University of Benin Teaching Hospital, Benin City, Nigeria.

A retrospective analysis of solid tumours in children less than 28days old over a 31 year period (1978-2008) was carried out at University of Benin Teaching Hospital (UBTH) to determine the incidence and histological patterns of such tumours. A total of 17 cases were seen during the study period: 16 cases (9 in males and 7 in females) were benign and 1 was malignant and it was recorded in the male gender. Vascular tumours (n=9), granular cell tumours (n=4), teratomas (n=2) and myxofibroma (n=1) were the histological types of benign tumours seen. The only malignant tumour encountered was a rhabdomyosarcoma. Head and neck was the commonest location of the tumours and most cases presented within 2 weeks of birth.

Migrating foreign body in the tracheobronchial tree of childen: report of two cases.

Tracheobronchial foreign bodies (FBs) especially in infants and children can cause respiratory obstruction and can lead to death if intervention is delayed. Two cases of migrating FBs in the tracheobronchial (T-b) tree with fatal outcome are reported: Case 1 was an 11-year-old girl with a ten-week history of episodes of fever, cough, breathlessness and progressive weight loss. No positive history of FB aspiration. She was cachetic and febrile with short attention span, dyspnoeic, a flattened left upper hemithorax, mediastinal shift and evidence of atelectasis. Case 2, a 5-year-old girl with a three-month history of aspiration of a tiny toy. She developed fever, cough and marked weight loss, developed severe respiratory distress three days prior to presentation. She was febrile, had grade II finger clubbing, markedly dyspnoeic, left mediastinal shift, and evidence of left sided atelectasis. X-ray films in Case 1 showed evidence of FB at various locations in the T-b tree, and complete opacification and atelectasis of left hemithorax in Case 2. Planned bronchoscopy could not be done as both patients were adjudged to be too severely ill for the procedure. Both patients died after 9 days and 8 hours of hospital stay, respectively. Postmortem revealed FB in right main bronchus in both patients (tooth and toy, respectively) and evidence of tuberculosis in Case 2. Fatal outcome is attributed to inappropriate healthcare seeking behaviour, lack of medical expertise and material resources in our health facilities.

Immunohistochemical detection of Her-2/neu overexpression in breast carcinoma in Nigerians: a 5-year retrospective study.

OBJECTIVE: To determine the pattern of Her-2/neu status among breast carcinoma in the University of Benin Teaching Hospital, Benin City, Nigeria. MATERIALS AND METHODS: Immunohistochemical staining for Her-2/neu was performed on 10% formalin-fixed, paraffin-embedded primary carcinoma of the breast from 83 patients, between 2003 and 2007 using anti-Her-2/neu rabbit polyclonal antibody (DakoCytomation, CA, USA) and reactivity detected by an avidin-biotin immunoperoxidase method. The clinicopathologic parameters analyzed were patients' age, histological types, and tumor grade. The Her-2/neu Dako scoring system was used. RESULTS: During the 5-year period, 83 histologically confirmed cases of invasive breast carcinoma were assessed for Her-2/neu status. These included 67 (80.7%) cases of invasive ductal carcinoma, nine cases of invasive lobular carcinoma (10.8%), three cases of medullary carcinoma (3.6%), two cases of papillary carcinoma (2.4%), and a case each of mucinous and clear cell carcinoma (1.2%). Mean age of patients was 48.9 ± 13.6 years with an age range of 25 to 83 years. Only nine (10.8%) cases showed immunopositivity for Her-2/neu. Seven of these were cases of invasive ductal carcinoma, while two were invasive lobular carcinoma. Tumors were predominantly high grade with grade III, II, and I accounting for 42, 28, and 13 cases, respectively. There was no significant correlation between patient age, the various histological types, tumor grade, and Her-2/neu positivity. CONCLUSIONS: This study indicates that Her-2/neu may not be useful in defining the prognosis of breast cancer in this environment. Nevertheless, it highlights the need for routine immunostaining for Her-2/neu before institution of trastuzumab (Herceptin) therapy.

Diagnostic accuracy of fine needle aspiration cytology of palpable breast masses in Benin City, Nigeria.

BACKGROUND: Beast cancer is the commonest malignancy afflicting women. It accounts for 18.4% of all female cancers worldwide. OBJECTIVE: To determine the diagnostic accuracy of fine needle aspiration cytology (FNAC) of palpable breast masses at a Nigerian University Teaching Hospital.. METHODS: Fine Needle Aspiration Cytology was done on all consecutive cases of palpable breast masses referred from the surgical outpatient clinic of the University of Benin Teaching Hospital between January 2005 and March 2006. Comparison was made with subsequent histological diagnoses in order to ascertain the diagnostic accuracy of the procedure. RESULTS: One hundred and three fine needle aspirates of breast masses were performed during the study period. Subsequent biopsies were done on 43 of these cases yielding a biopsy rate of 41.8%. The absolute and complete sensitivities of this study were 84.6% and 97.4% respectively. The full specificity was 64% while the specificity for biopsy cases was 75%. The positive predictive value for malignancies was 100% with a false positive rate of 0%; however the false negative rate was 2.6% with a suspicious rate of 9.7%. The inadequacy rate was 19.4%. CONCLUSION: These results show that FNAC of palpable breast masses in UBTH is an accurate procedure with results comparable to those from other centres and well above the minimum standards recommended internationally. It is, therefore, recommended that FNAC be done on all palpable breast masses.

Churg Strauss syndrome: a review.

BACKGROUND: Churg Strauss syndrome is a medical condition of unknown aetiology characterized by asthma, eosinophilia and finally vasculitis involving small vessels in the limbs and nasal sinuses and the lungs. The purpose of this review is to highlight the natural history of this condition, the pathogenesis, clinical features and treatment modalities available and the prognosis. METHODS: Literature on the subject was reviewed using manual library search, articles in journals, internet search and conference abstracts. RESULT: Churg Strauss syndrome has been reported to be predominantly common in middle aged individuals in their middle age of life with a history of new onset or worsened asthma. The condition has a male predisposition. Prior to the advent of steroid therapy this condition invariably leads to death, but since the introduction of prednisolone therapy and other immunosuppressive therapy the outlook has improved for sufferers and long-term survival has been seen. CONCLUSION: Suspicion of this condition should be based on a good history, physical examination and laboratory investigations and diagnosis based on the criteria that has been drawn by the American College of Rheumatology.

Frequency of cryptococcal meningitis in HIV-1 infected patients in north central Nigeria.

BACKGROUND: Cryptococcal meningitis (CM) is the most common severe life threatening fungal infection in AIDS patients. It is an important cause of morbidity and mortality There is paucity of data on the prevalence of CM in Nigeria. We aimed to determine the frequency of CM, the clinical presentation and immunological profile. METHODS: A cross sectional study was carried out at the Jos University Teaching Hospital (JUTH). A total of 100 HIV-1 infected patients suspected of having meningitis or meningoencephalitis were subjected to cerebrospinal fluid (CSF) analysis (including Indian ink preparation and fungal culture by conventional methods) and CD4 count was determined using flow cytometry (count bit Y-R 1004 Partec Muster Germany). RESULTS: The freguency of CM was 36% in our cohort. The commonest clinical presentation included headache (100.0%), neck stiffness (77.8%), fever (72.0%), vomiting 55.6%), personality changes (55.6%), photophobia (27.8%) and convulsions (27.8%). The mean duration of symptoms was 24 +/- 22 days with a median of 17 days. The mean CD4 count was 89 +/- 60 cells/mm3 with a median of 82 cells/mm3. CONCLUSION: The high prevalence of CM and the associated severe immunosuppression underscores the importance of early diagnosis of HIV infection which may reduce the incidence of CM. There is the urgent need for access to Amphotericin B and fluconazole in resource constrained settings in addition to a wide access to HAART.