Prevalence of Themes Linked to Delayed Presentation of Breast Cancer in Africa: A Meta-Analysis of Patient-Reported Studies.

PURPOSE: The prevalence of themes linked to delay in presentation of breast cancer (BC) and their underlying factors vary considerably throughout Africa. Regional differences and trends are largely unreported. The purpose of this research was to provide summary estimates of the prevalence and distribution of the themes and underlying factors linked to delay in the presentation of BC, regional variation, and trends in an effort to identify targets for intervention. DESIGN: We screened articles found through PubMed/Medline, African Journal OnLine, Science Direct, Google/Google Scholar, and ResearchGate. We included patient-reported surveys on the reasons linked to delayed presentation under 6 previously identified themes: symptom misinterpretation, fear, preference for alternative care, social influence, hospital-related factors, and access factors. The meta-analytical procedure in MetaXL used the quality-effect model. RESULTS: Twelve of the 236 identified articles were eligible for this review. The overall summary estimate of late presentation (> 90 days) was 54% (95% CI, 23 to 85) and was worst in the eastern and central regions. Symptom misinterpretation was the most common theme (50%; 95% CI, 21 to 56), followed by fear (17%; 95% CI, 3 to 27), hospital-related theme (11%; 95% CI, 1 to 21), preference for alternative care (10%; 95% CI, 0 to 21), social influence (7%; 95% CI, 0 to 14), and access-related theme (6%; 95% CI, 0 to 13). The most common factor underlying symptom misinterpretation was mischaracterizing the breast lesion as benign (60%; 95% CI, 4 to 100) which surpassed lack of awareness in the last decade. Misdiagnosis and failure to refer were the dominant hospital-related factors. CONCLUSION: Modifiable factors such as mischaracterizing malignant masses as benign, fear, misdiagnosis, and failure to refer were the prevalent factors contributing to delays throughout Africa. These factors are promising targets for intervention.

An observation of umbilical coiling index in a low risk population in Nigeria.

OBJECTIVES: The umbilical coiling index (UCI) is one of cord parameters for foetal assessment with limited studies in our environment. With recent advances in its evaluation, its significance, pattern, abnormalities and correlates need to be defined in our parturients. METHODS: The umbilical cords of 436 neonates were examined. Gross examination was done within 5 min of delivery. The UCI was defined as the number of complete coils per centimetre of cord. Normal UCI was defined as values between the 10th and 90th percentiles of the study population. RESULTS: The mean umbilical cord length was 52.7±11.5 cm, mean number of coils was 10.8±5.1 and mean UCI was 0.21±0.099. The range was between 0.0 and 1.0. UCI values of 0.13 and 0.30 were 10th and 90th percentiles, respectively. Normal UCI was observed in 351 (80.5%) neonates, 44 (10.4%) and 41 (9.1%) had hypo- and hypercoiled cords, respectively. Congenital abnormalities occurred in the normocoiled and hypercoiled groups but was not demonstrated in the hypocoiled group. The mean value of UCI in neonates with congenital abnormalities was 0.29±0.12 (P=0.011). There was no significant statistical relationship between foetal outcome and degree of UCI. CONCLUSION: The UCI was not associated with adverse perinatal outcome in this study.

Mammographic Parenchymal Patterns in Asymptomatic Women.

BACKGROUND: Breast density has been found to be an independent risk factor for breast cancer. Mammographic breast parenchymal pattern or percent density is mainly a reflection of the proportion of glandular tissue to fatty tissue, and studies have shown that it works synergistically with other risk factors such as nulliparity in predicting breast cancer risk. This study analyses the various mammographic breast patterns and correlates this with some demographic variables and final Breast Imaging Reporting and Data System outcomes of asymptomatic women in our center. MATERIALS AND METHODS: This is a prospective descriptive study of mammographic breast pattern in 459 females who presented at the breast imaging suite of our institution. Mammography was performed after completion of an assisted administered questionnaire for demographic information. A GE Senographe DMR machine using two standard views (craniocaudal and mediolateral oblique) and additional views were used when necessary. RESULTS: A total of 459 women ranging in age from 34 to 80 years were included in the study, of which 46.6% were in the age range of 41 to 50 years. The scattered fibroglandular pattern was the most common pattern found (44%), and the homogeneous dense pattern was the least common (0.4%). A significant association with age and menopause status was found, while no association was found with age at the time of the woman's first delivery and family history of breast cancer. CONCLUSION: This study demonstrates that there is a significant association between breast cancer and age and menopause status. However, no correlation was found with the age of women at their first delivery and family history of breast cancer.

Relationship between gross placental characteristics and perinatal outcome of low-risk singleton deliveries.

BACKGROUND: Gross examination of the placenta may provide useful insight into the aetiology of newborn and maternal complications. A review of literature revealed only a few epidemiological studies that determined the relationships between placental abnormalities, gestational age and occurrence of adverse outcome in babies of healthy pregnant women in our region. PATIENTS AND METHODS: A prospective cross-sectional study was conducted at the Department of Obstetrics and Gynecology of University of Ilorin Teaching Hospital, between 1 st February and August 2013. Pregnant women in labour at ≥28 weeks' gestational age with singleton pregnancies were recruited. Gross examination of the placenta and umbilical cord after delivery were performed. RESULTS: Four hundred and twenty-eight singleton deliveries were studied. The average placental weight was 580.8 ± 130.6 g (range = 125-1500 g). The mean values of the umbilical cord length and width were 52.7 ± 10.5 cm and 1.96 ± 1.11 cm, respectively. Placental abnormalities occurred in 1.2%. The umbilical cord was centrally inserted in 290 (67.8%), marginally in 31% of cases. There was significant but weak positive correlation between the placental weight, birth weight and gestational age at 40 weeks (P ≤ 0.001, r = 0.356). Placental weight was directly related to birth weight (P < 0.0001, r = 0.244) and greater in babies with congenital abnormalities (P = 0.002). CONCLUSIONS: There was an association between placental parameters and foetal outcome at birth. Placental weight was positively correlated with birth weight, gestational age and occurrence of congenital abnormalities.