Pattern of morphine prescription by doctors in a Nigeria tertiary hospital.

BACKGROUND: Morphine was reintroduced into Nigeria after a long period of absence due to technical problems relating to stock accounting. With this reintroduction, prescriber education was commenced in many centers including the University of Ibadan. AIMS AND OBJECTIVE: The aim of this study is to review the morphine prescription habits of the medical doctors practicing at the University College Hospital, Ibadan, and to assess the level of conformity with international guidelines. MATERIALS AND METHODS: All the prescriptions on oral morphine in the hospital's pharmacy records within a 6 months period were reviewed. RESULTS: The results showed that more than half (51.7%) of all morphine prescriptions were from the Radiation Oncology Department, while the newly created Day Care Hospice Unit accounted for 31.8% of the prescriptions. No prescriptions were seen from the Labor ward. Only 1.1% of all the prescriptions conformed to international guideline as contained in the "Blue Book." CONCLUSION: The results showed that there is a need for more education and advocacy programmes to increase awareness among doctors about morphine prescriptions.

Radiation nephritis: anti-inflammatory effect of dexamethasone in adult Wistar rats (Rattus norvegicus) / Nefritis por radiación: efecto anti-inflamatorio de la dexametasona en ratas Wistar adultas (Rattus norvegicus)

The anti-inflammatory effect of dexamethasone on the irradiated kidneys of adult Wistar rats (Rattus norvegicus) was studied. Eighteen adult Wistar rats were, after acclimatization, randomly divided into 3 groups of 6 animals per group. The control group had normal saline, receiving neither drugs nor radiation. The second group received normal saline and radiation. The third group received pretreatment with dexamethasone at 1mg/kg body weight/day for 2 days followed by radiation. Radiation was delivered to the animals as a single fraction of 2.5 Gy of gamma rays from Cobalt-60 source, using an AECL Theatron 780-C Teletherapy machine. After exposure to the different interventions, the animals were sacrificed on the 14th post-irradiation day and the kidneys dissected out from each animal. The renal tissues were subjected to histological processing, and then studied using an eyepiece objective ruler calibrated with a 2mm stage micrometer for histomorphometric studies. The result of the study showed that all irradiated animals suffered weight loss by the 14th day post-irradiation (p<0.05) irrespective of the additional treatment with dexamethasone and this was statistically significant. Histomorphometry showed that the maximum width of the glomerular capsule was significantly greater in the radiation groups than in the control at p<0.05. The maximal glomerular diameter was significantly greater in irradiated animals compared with the control animals at p<0.05. The outcome of this study showed that the intraperitoneal administration of dexamethasone at 1mg/kg body weight/day for 2 days prior to treatment with irradiation did not prevent weight loss nor ameliorate the swelling of the nephrons resulting from the effect of radiation injury to the Wistar rat.

Fue estudiado el efecto anti-inflamatorio de la dexametasona en riñones irradiados de 18 ratas Wistar adultas (Rattus norvegicus). Luego de la aclimatización, aleatoriamente se dividieron en 3 grupos de 6 animales por grupo. El grupo control recibió una solución salina normal, sin recibir drogas ni radiación. El segundo grupo recibió solución salina normal y radiación. El tercer grupo recibió tratamiento previo con dexametasona con 1 mg / kg de peso corporal / día, durante 2 días, seguido de radiación. Los animales fueron expuestos a radiación con una fracción independiente de 2.5 Gy de rayos gamma por una fuente de Cobalto-60, usando una máquina de teleterapia AECL Theatron 780-C. Después de la exposición a las diferentes intervenciones, los animales fueron sacrificados el día 14 post-irradiación y los riñones de cada uno de los animales fueron disecados. Los tejidos renales fueron sometidos a procesamiento histológico, y luego se estudiaron utilizando un objetivo ocular milimetrado calibrado a 2mm para el estudio histomorfométrico. Se demostró que todos los animales irradiados sufrieron pérdida de peso 14 días después de ésta (p <0.05), independientemente de los tratamientos adicionales con dexametasona , siendo estadísticamente significativo. La histomorfometría mostró que el ancho máximo de la cápsula glomerular fue significativamente mayor en los grupos irradiados que en el control en p <0.05. El diámetro máximo del glomérulo fue significativamente mayor en los animales irradiados en comparación con los animales control p <0.05. Los resultados de este estudio mostraron que la administración intraperitoneal, de 1 mg / kg de peso corporal / día durante 2 días, de dexametasona antes de comenzar el tratamiento con irradiación, no impide la pérdida de peso ni permite aliviar el edema de los nefrones, injuria producto de la radiación a las Ratas Wistar.

Pattern of paediatric malignancies seen at the Radiotherapy Department of the University College Hospital, Ibadan, Nigeria.

BACKGROUND: Paediatric tumours are seen by the radiotherapist following referral from other specialists. Patients seen by the radiotherapists may not conform to the full spectrum seen in the hospital. OBJECTIVE: To review the pattern of presentation of paediatric malignancies seen at the radiotherapy department of the UCH, Ibadan. METHODS: Retrospective study of all patients below the age of 12 seen in Radiotherapy Department of UCH, Ibadan over a 19-year period was undertaken. Data were collected from the case files and the radiotherapy treatment cards. RESULTS: 244 cases were evaluated with age ranged between 4 months and 12 years. Male to female ratio was 1.15 to 1.0. 23 tumour types were seen with retinoblastoma accounting for about 45% of all the patients reviewed. Burkitt's lymphoma accounted for only about 2.5%. CONCLUSION: Retinoblastoma, nephroblastoma, intracranial malignancies and rhabdomyosarcoma are the tumours most commonly seen at the Radiotherapy Department of the UCH, Ibadan.

Chemo-radiation in advanced nasopharyngeal carcinoma, disease free after 6 years--a case report.

This is a case report of a patient with advanced nasopharyngeal Carcinoma, (T4 N2 MO) who had chemo-radiation with Cisplatin based chemotherapy and total midplane dose of 60 Gray external beam radiation. Six years after treatment patient has remained disease free and the primary site histologically confirmed disease free with no clinical evidence of regional or distance metastases

The effect of dexamethasone, metronidazole and ascorbic acid on the morphological changes induced by gamma rays on the spinal cord of Wistar rats.

We studied the effects of dexamethasone, ascorbic acid, and metronidazole on the irradiated spinal cord of Wistar rats. Thirty adult Wistar rats were randomly assigned into 3 groups. Five rats served as the control group. Another group of 5 rats were irradiated in the neural axis with 2.5 Gy of gamma rays. The last group of 20 rats were irradiated and then divided into four subgroups of 5 rats each: one subgroup was administered dexamethasone alone, a second subgroup had metronidazole alone, a third subgroup was treated with dexamethasone and metronidazole combined, and a fourth subgroup had ascorbic acid alone, given intraperitoneally for 7 days before exposure to radiation, and also for 5 days after-irradiation. All irradiated animals demonstrated similar vascular changes in form of splitting of the smooth muscle layers of the arterioles of the anterior spinal arteries. Similarly, all the irradiated spinal cord demonstrated shrinkages as noted in the diminution of the neuronal sizes measured by a microscope with a micrometer embedded in the eye-piece objective. The drugs did not individually protect neurons from damage at the level of our investigation. However, the combination of dexamethasone and metronidazole produced a reduction of the degenerative effect of radiation on the neurons when the post-irradiation diameters of the neurons were compared with the control and those of the other experimental groups. We conclude that gamma ray induced damage in the spinal cord may be ameliorated by combining dexamethasone with metronidazole but not by individual treatment with any of the three drugs.

Knowledge and attitudes of terminally ill patients and their family to palliative care and hospice services in Nigeria.

BACKGROUND: A palliative care and Hospice service is a neglected aspect of medical discipline especially in a developing country like Nigeria. With the global increase in incidence of cancer and HIV/AIDS and 70% of them presenting late, coupled with limited resources, for effective symptom control, palliative care therefore remains the only option left to improve the quality of life of the patients. OBJECTIVE: To assess the knowledge and attitudes of patients and their relations to palliative care and hospice services {PC&H} and to fashion out appropriate services for the patients. MATERIALS AND METHODS: A total of 130 participants were studied using a questionnaire which comprised of three parts: Socio-demographic variables, Information about Knowledge and Attitudes towards PC&H. RESULTS: Sixty nine were patients while 61 were family members. Ninety four [72.3%] had no knowledge of PC&H regardless of level of education and social status. 109 [84%] agreed that symptoms of the terminally ill patients should be treated to improve their quality of life and 75% of the participants agreed that this will be better done in a Hospice. 106 [83%] participants desire to have hospice established in every community, this again was regardless of tribe CONCLUSION: There is a gross lack of knowledge about PC&H in our community as evidenced among the participants studied. However, there is a positive attitude towards PC&H suggesting a general acceptance, since there is presently no well established Hospice in Nigeria; we recommend that government and Non governmental organizations should assist in this area. A hospital based Hospice might be a starting point.

The management of metastatic bone pain in a developing country: the role of radiotherapy as an adjunct to weak opioids.

Bone pain secondary to metastatic cancer is the commonest intractable pain and is a major concern in most oncology units the world over. Cancer pain management is multidisciplinary in approach, so there is no universal or singular modality of treatment. In a developing country like Nigeria, only external radiotherapy and adjuvant weak opioids are readily available, so it is of interest to review the response of these patients to this management option. This is a retrospective review of 92 patients aged 16-80 years with radiologically confirmed metastatic bone disease associated with pain who received external radiotherapy and weak analgesics. The results showed that 23 (25%) patients had a complete response and 67 (73%) had a partial response within four weeks of treatment. Total response was over 90%, which suggests external radiotherapy has an effective palliative role. The study also demonstrated the pattern of bony involvement among the common cancers seen in our environment. The availability of strong opioids (e.g. morphine and pethidine) will obviously consolidate the gains achieved with external radiotherapy in the management of metastatic bone pain in our environment.

Radiotherapy in the management of early breast cancer in Ibadan: outcome of chest wall irradiation alone in clinically nodes free axilla.

The study was carried out to identify the group of patients with early breast cancer [stage I and II] after surgery in which chest wall irradiation alone was given without lymphatic irradiation thus reducing morbidity and also creating room for more patients on the available limited treatment facility. 92 patients with histologically confirmed early breast cancer that attended Radiotherapy clinic between June 1995 and May 1998 that satisfied selection criteria were studied. They all received External Radiotherapy to the chest wall, meadiasternum inclusive and breast if still in-situ. All also received cytotoxic chemotherapy. Majority of the patients 67 [84.8%] were recurrence free in 2 years while 12 [15.2%] had recurrent disease, the recurrent sites were axilla 4 [5.06%], chest wall 3 [3.80%] and supraclavicular 2 [2.52%]. Average time to recurrence was 3-12 months. In view of majority being recurrence free, chest wall irradiation alone in early breast cancer [stage I and II] could be encouraged, thus creating access to treatment for more patients in centers like ours with limited therapy facilities.