This document summarizes a study on nasopharyngeal carcinoma (NPC) conducted at a Nigerian tertiary hospital. The study found that NPC accounted for 8.33% of head and neck cancers seen over 14 years. Most patients were male, with a mean age of 54.5 years. The most common presentations were neck swelling, nasal obstruction, and epistaxis. 75% of patients presented with late stage 4 disease. Treatment was primarily radiotherapy, but 46.88% of patients defaulted treatment due to financial constraints. Prognosis was very poor, with 1-year and 5-year survival rates of 21.9% and 9.25% respectively. The study concluded that late presentation and inability to
Pattern of Head and Neck Cancer in a Tertiary Institution in Lagos Nigeriaiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Clinico-demographic trend of Benign Vocal Cord Lesions among Urban Population...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Premalignant Lesions of Oral Cavity - A Clinicopathological Study by Mohit Srivastava in Experiments in Rhinology & Otolaryngology
We conducted a study on a total of 360 patients to find out the incidence of premalignant disorders in the oral cavity who attended the ENT opd of Saraswathi Institute of Medical Sciences, Hapur. The study design was cross sectional in nature. Out of all the 360 patients who were suspected to have premalignant disorders of oral cavity were subjected to biopsy and 87 of them were found to be premalignant. Incidence was found to be 24.53% in males and 23.6% in females. Buccal mucosa was most common site of involvement.
https://crimsonpublishers.com/ero/fulltext/ERO.000515.php
Letter: Is the Stupp Protocol an expensive and unsustainable standard of care...Ahmad Ozair
Glioblastoma multiforme (GBM) is the most common and aggressive primary adult brain neoplasm with an age-adjusted incidence rate of 3.22 per 100 000 individuals and a 5-yr survival rate of 6.8%.1 In 2005, Stupp and colleagues proposed maximal safe resection, concomitant temozolomide (TMZ) with radiotherapy, and adjuvant TMZ as the optimal treatment. Implementation of the Stupp protocol in high-income countries (HICs) has resulted in increased survival compared to previous regimens. With little-to-no literature on the management and outcomes of patients with GBM in low- and middle-income countries (LMICs), it is unclear whether the Stupp protocol is being adopted or whether it is, or ever can be, the optimal strategy in LMICs...
- The document describes a study that used multispectral cystoscopy with different light wavelengths to examine bladder mucosa and tumors.
- When green light was used, blood vessels in the bladder mucosa and submucosa showed up clearly in 3D. Blue light also made vessels visible but less clearly. Under red light, the mucosal surface appeared completely red and vessels could not be distinguished.
- For bladder tumors, green light allowed observation of tumor vessels and assessment of invasion depth, while white light showed intact muscle layer after tumor resection but not blood vessels.
16 cco korean perspectives of nasopharynx cancer managementYong Chan Ahn
This document discusses nasopharynx cancer (NPC) in Korea. It begins by providing background on NPC epidemiology and the association between NPC subtypes and Epstein-Barr virus prevalence. It then discusses the establishment of a Korean NPC database and findings from analyses of the database. Key findings include improvements in survival over time associated with advances in imaging, radiation technique, and use of concurrent chemotherapy. Studies from the database found concurrent chemoradiation is optimal for stage II NPC and that neoadjuvant or adjuvant chemotherapy did not provide additional benefits when added to concurrent chemoradiation for advanced stages.
This study examined 186 treated leprosy patients in the Diamer district of Gilgit-Baltistan, Pakistan to document their clinical status and disabilities. The majority of patients were male (75.8%) with a mean age of 53 years. Borderline tuberculoid leprosy was the most common subtype (43.54%). Many patients still had disabilities after treatment, including claw hand (11.82%), foot drop (10.21%), and visual impairment (11.29-6.9%). The results suggest leprosy remains prevalent in the area and a significant number of treated patients still have disabling effects of the disease. Addressing disabilities through an integrated healthcare approach is recommended.
Pattern of Head and Neck Cancer in a Tertiary Institution in Lagos Nigeriaiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Clinico-demographic trend of Benign Vocal Cord Lesions among Urban Population...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Premalignant Lesions of Oral Cavity - A Clinicopathological Study by Mohit Srivastava in Experiments in Rhinology & Otolaryngology
We conducted a study on a total of 360 patients to find out the incidence of premalignant disorders in the oral cavity who attended the ENT opd of Saraswathi Institute of Medical Sciences, Hapur. The study design was cross sectional in nature. Out of all the 360 patients who were suspected to have premalignant disorders of oral cavity were subjected to biopsy and 87 of them were found to be premalignant. Incidence was found to be 24.53% in males and 23.6% in females. Buccal mucosa was most common site of involvement.
https://crimsonpublishers.com/ero/fulltext/ERO.000515.php
Letter: Is the Stupp Protocol an expensive and unsustainable standard of care...Ahmad Ozair
Glioblastoma multiforme (GBM) is the most common and aggressive primary adult brain neoplasm with an age-adjusted incidence rate of 3.22 per 100 000 individuals and a 5-yr survival rate of 6.8%.1 In 2005, Stupp and colleagues proposed maximal safe resection, concomitant temozolomide (TMZ) with radiotherapy, and adjuvant TMZ as the optimal treatment. Implementation of the Stupp protocol in high-income countries (HICs) has resulted in increased survival compared to previous regimens. With little-to-no literature on the management and outcomes of patients with GBM in low- and middle-income countries (LMICs), it is unclear whether the Stupp protocol is being adopted or whether it is, or ever can be, the optimal strategy in LMICs...
- The document describes a study that used multispectral cystoscopy with different light wavelengths to examine bladder mucosa and tumors.
- When green light was used, blood vessels in the bladder mucosa and submucosa showed up clearly in 3D. Blue light also made vessels visible but less clearly. Under red light, the mucosal surface appeared completely red and vessels could not be distinguished.
- For bladder tumors, green light allowed observation of tumor vessels and assessment of invasion depth, while white light showed intact muscle layer after tumor resection but not blood vessels.
16 cco korean perspectives of nasopharynx cancer managementYong Chan Ahn
This document discusses nasopharynx cancer (NPC) in Korea. It begins by providing background on NPC epidemiology and the association between NPC subtypes and Epstein-Barr virus prevalence. It then discusses the establishment of a Korean NPC database and findings from analyses of the database. Key findings include improvements in survival over time associated with advances in imaging, radiation technique, and use of concurrent chemotherapy. Studies from the database found concurrent chemoradiation is optimal for stage II NPC and that neoadjuvant or adjuvant chemotherapy did not provide additional benefits when added to concurrent chemoradiation for advanced stages.
This study examined 186 treated leprosy patients in the Diamer district of Gilgit-Baltistan, Pakistan to document their clinical status and disabilities. The majority of patients were male (75.8%) with a mean age of 53 years. Borderline tuberculoid leprosy was the most common subtype (43.54%). Many patients still had disabilities after treatment, including claw hand (11.82%), foot drop (10.21%), and visual impairment (11.29-6.9%). The results suggest leprosy remains prevalent in the area and a significant number of treated patients still have disabling effects of the disease. Addressing disabilities through an integrated healthcare approach is recommended.
This document summarizes a study on cervical lymph node enlargement. It analyzed 70 patients with enlarged cervical lymph nodes. Tuberculosis was found to be the most common cause, affecting females more than males. Lymph node enlargement was most common in patients under 40 years old. Histopathological examination was required for accurate diagnosis. The upper cervical lymph nodes were most frequently involved. The study concluded that tuberculosis was a major factor for cervical lymphadenopathy in younger patients, while secondary cancers were more common in older patients above 50 years old.
Cerebrovascular stroke recurrence among critically ill patients (2)Alexander Decker
This document summarizes a study on risk factors, frequency, and severity of recurrent cerebrovascular stroke among critically ill patients admitted to intensive care units at a university hospital in Egypt. The study aimed to identify risk factors for recurrent stroke and examine recurrence intervals, frequency, and severity. Medical records of 80 patients admitted with recurrent stroke over 6 months were analyzed. Results found the majority had hypertension and diabetes as comorbidities. 30% experienced recurrence 2-5 years after initial stroke. Over 36% of cases were severe, with a mean severity score of 19.17 out of 42. The study concluded uncontrolled risk factors like age, gender, medical noncompliance and lifestyle factors like smoking contributed to recurrent strokes of varying severity.
This document reviews the use of open lung biopsy (OLB) in critically ill patients and those with respiratory failure. OLB is considered the gold standard for diagnosing parenchymal lung disease, but its use in intensive care unit patients is controversial due to risks. The document analyzes 22 studies on OLB outcomes in critically ill patients. It finds that OLB frequently results in specific diagnoses in over 50% of cases, sometimes 100%, and leads to significant changes in treatment in the majority of cases. However, OLB also carries risks of complications. More research is needed to determine the risks and benefits of OLB for critically ill respiratory failure patients.
This study retrospectively analyzed 163 patients treated for spondylodiscitis (spinal infection) between 1992-2000. Patients were divided into 3 treatment groups:
Group A (70 patients) received non-operative treatment including antibiotics and bracing. 8 later required surgery.
Group B (56 patients) underwent posterior decompression alone. 24 later required additional surgery for debridement and stabilization.
Group C (37 patients) received decompression and internal stabilization. Only 6 later required re-operation.
Non-operative treatment was effective for most patients. Decompression alone had a higher re-operation rate compared to decompression with internal stabilization. Overall, surgical treatment improved neurological outcomes compared to non-
This study analyzed 52 pediatric patients who underwent intestinal resection over a 10-year period at a hospital in Nigeria. The most common indication for resection was gangrenous or irreducible intussusception (28 cases, 53.8%). Other common reasons included strangulated hernia (7 cases) and typhoid intestinal perforation (6 cases). Most patients were infants under 1 year old. Complications occurred in 38.4% of patients, most commonly surgical site infection. The mortality rate was 15.4%. The study concluded that late presentation and lack of awareness contributed significantly to the high number of intestinal resections required in this patient population.
This study analyzed the incidence of gastric cancer and colorectal cancer in Iraq between 1965-2006 using data from over 2,000 patient cases. The results showed:
1) Gastric cancer was initially more common than colorectal cancer, but colorectal cancer rates increased significantly over time, surpassing gastric cancer by the 2000s.
2) Both cancers affected males more than females and were most common in the 50s-60s age range.
3) Earlier cancer stages (I and II) increased over time for both cancers, while later stages (III and IV) decreased, indicating improved diagnosis and treatment.
4) The changing incidence patterns mirror global trends and are likely due to
This study compared two methods for closing the sternum in high-risk cardiac surgery patients - a steel wire-titanium hooks combination vs a steel wire-titanium plates and screws combination. 67 patients were randomly assigned to one of the two closure methods. No cases of sternal dehiscence or mediastinitis occurred with either method. Post-operative outcomes like bleeding, ventilation time, and intensive care stay were similar between the groups. The study concluded that the choice of sternum closure technique in high-risk patients should be based on individual patient characteristics and surgeon experience, and both techniques appeared equally effective.
This document summarizes and critiques a study on the epidemiology of glioma and its section on cellular phones. It finds deficiencies in the studies cited by the section. In particular, it notes that incidence time trend studies failed to account for late cancer reporting, changing phone use over time, and missing cancer cases. Cohort studies are unable to determine cancer risks for rare diseases. While one case-control study found increased glioma risks, other relevant case-control studies were not cited that also found increasing risks with greater phone use. In conclusion, the evidence does not support the conclusion that phone use is unrelated to glioma risk.
Radiological Findings in Infertile Men in a Fertility Centre in Jos, Nigeria.QUESTJOURNAL
ABSTRACT:Infertility is a great psychological burden to the infertile couple. Scrotal ultrasonography and colour Doppler imaging of the scrotum are useful adjuncts to clinical examination in assessing intratesticular and extratesticular abnormalities. Methodology:All men who presented with infertility were evaluated. These included comprehensive history, physical examination and investigation, in this case seminal fluid analysis and scrotal ultrasonography. Results:This was prospective study carried out at the Jos University Teaching Hospital and a fertility centre in Jos from 2012 to 2017. A total of 67 men were involved in this study. The mean age was 39.39yrs. Age range was 28 to 59yrs. Sixty three (N=63) of the men had abnormal semen parameters representing 94.03% while four men (N=4) had normal semen parameters. Thirty eight patients representing 56.72% had azoospermia while 5.97% had normozoospermia following seminal fluid analysis. The mean volume of the right testis was 11.93ml. The range was 2.9ml to 25ml. The mean volume of the left testis was 11.76ml. The range was 2.9ml to 22ml. Overall mean testicular volume was 11.85ml. Forty two men (N=42) had abnormalities on scrotal ultrasound representing 62.69%. Abnormalities on ultrasonographyinclude varicocele33%, cryptorchidism31%, hydrocele 17%, testicularmicrolithiasis7%, multiple complex testicular cyst5%, epididymal cyst5% and echogenic testis2%. Conclusion:Scrotal ultrasonography is important in the assessment of testicular volume and abnormalities such as varicocele, cryptorchidism and hydrocele which affects male fertility.
This study analyzed data from the California Patient Discharge Database between 2005-2013 to determine rates of subsequent major amputation after initial minor amputation due to peripheral artery disease (PAD) and/or diabetes mellitus (DM). Patients with combined PAD/DM had the highest rates of major amputation (6.3%) and repeat minor amputation (16%) compared to those with DM or PAD alone. The median time to major amputation was 12.9 months, with no significant differences between groups. Mortality rates were also highest in the PAD/DM group at 49%. Revascularization before subsequent amputation was associated with lower risk of limb loss.
Volume 12, issue 2, august 2011 prevalence of crohn’s disease in endoscopic...Ari Anta
This study aimed to characterize Crohn's disease (CD) in patients undergoing colonoscopy at an Indonesian hospital between 2007-2008. Of 921 colonoscopies, 19 (2.1%) patients were diagnosed with CD. The mean age was 47.7 years with most patients presenting between 51-60 years. The main complaints were diarrhea (42.1%) and lower gastrointestinal bleeding (36.8%). Colonoscopic findings most commonly included hyperemia (94.7%), ulcerations (89.5%), and erosions (63.2%). The dominant site of involvement was pancolitis (57.9%), followed by ileocolitis (36.8%) and isolated left colon involvement (26.3
Clinical Study of Foreign Bodies in Tracheo-Bronchialtree with Specific Atten...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study evaluated 120 thyroid nodule patients using ultrasonography to assess diagnostic accuracy. Ultrasonography detected multiple nodules in 58% of patients, compared to 17% on clinical exam. 50% of clinically solitary nodules were shown to be multiple by ultrasound. Ultrasound features like composition, borders, calcifications and vascularity were analyzed. 80 patients (66.6%) were diagnosed with benign disease and 40 (33.3%) with thyroid malignancy based on ultrasound and histopathology results. The study concludes that ultrasonography is a useful complementary method to physical exam for diagnosing thyroid nodules due to its ability to detect more nodules and evaluate characteristics that suggest benign or malignant lesions.
This study examined predictors of contralateral breast cancer in unilateral breast cancer patients undergoing contralateral prophylactic mastectomy (CPM). The study analyzed 542 patients who underwent CPM at one cancer center between 2000-2007. Univariate analysis found that younger age, Gail risk score >1.67%, ipsilateral invasive lobular histology, additional ipsilateral moderate-high risk pathology, and multicentric ipsilateral tumor predicted higher risk of contralateral breast cancer. However, multivariate analysis identified only younger age and ipsilateral invasive lobular histology as independent predictors of contralateral breast cancer. The study aimed to help identify which unilateral breast cancer patients might most benefit from CPM.
Onconesthesia : An emerging subspecialityAbhijit Nair
This document discusses the emerging sub-specialty of oncoanesthesia. It notes that anesthesiology involves many sub-specialties and cancer patients have special medical needs. Oncoanesthesia draws upon multiple sub-specialties of anesthesiology due to the complex health issues of cancer patients and high-risk nature of cancer treatments and surgeries. The document outlines the various roles of anesthesiologists in cancer care, including management of complex airways, regional anesthesia, intensive care, pain management, and more. It also discusses the opportunities for training and research in oncoanesthesia.
This lecture proves an overview of assessing the thyrod nodule upon presentation. The use of imaging, including nuclear medicine, PET, CT/MR and Ultrasound is discussed.
There is more detail on ultrasound evaluation with particular emphasis on ACR TIRADS
Background: The incidence of cancers is increasing worldwide, particularly in the developing countries as shown by recent cancer stastics from the WHO. It is even anticipated that with the increase in life expentancy, consequent upon inproved standard of living and globalization, the burden of cancers will increase within this millenium. With respective to cancer of the prostate, it is the most common type of cancer in urology. In developing countries, diagnostic is done at a late stage of evolution. In Cameroon, data on prostate cancer are scanty whereas the incidence of this disease is increasing. Objective: This article is designed to describe the epidemiological features of prostate cancer at the General Hospital of Yaoundé. Patients and methods: A 4-year retrospective study of patients seen with the diagnosis of cancer at the Medical Oncology unit of the Yaoundé General Hospital between January 2012 and December 2015. The demographic pattern (age of patients, socio professional activity, marital status), clinical features (cancer diagnosis), treatment modalities and outcome were studied. Main results: Of the 7 775 patients enrolled in the Medical Oncology Service over the study period, 1.4% (n = 108) cases of prostate cancer were seen. The prevalence over the study period was 1.38% and a relatively large annual growth of cases with an annual average of 27 cases was noted. The average age of patients was 67.82 years with a range of 34-83 years. The commonest presenting symptoms were the urinary frequency (54.63%) whereas the least common were fatigue (05.5%) and straining (03.70%). PSA was obtained in 49 patients, representing about 45.4% of all patients. Only 14 (01.26%) had biopsy reports. Conclusion: Prostate cancer is a major problem facing the aging male, and inadequate facilities make early detection difficult. Therefore, treatment is mainly palliative because of late diagnosis.
Introduction: Stroke is an even more dramatic major public health problem in young people. Goal of the study: Contribute to the knowledge of strokes in young people. Methodology: This was a retrospective study carried out over a period of 02 years (January 2017 to December 2018) including the files of patients aged 18 to 49 years hospitalized for any suspected case of stroke in the Neurology department of the University Hospital
Center of the Sino-Central African Friendship (CHUSCA) of Bangui.
Study of clinical and etiological profile of community acquired pneumonia in ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document discusses the rising incidence of oropharyngeal cancer, which is increasingly associated with human papillomavirus (HPV) infection. HPV-positive oropharyngeal cancer has distinct clinical and biological features compared to HPV-negative cancer, including younger patient age, fewer risk factors, and better prognosis. Detection of HPV status is important for prognostication and potentially de-escalating treatment intensity for HPV-positive patients due to their improved survival. Immunohistochemistry for p16 is a practical and widely applicable method for determining HPV status in clinical specimens.
This document summarizes a study on cervical lymph node enlargement. It analyzed 70 patients with enlarged cervical lymph nodes. Tuberculosis was found to be the most common cause, affecting females more than males. Lymph node enlargement was most common in patients under 40 years old. Histopathological examination was required for accurate diagnosis. The upper cervical lymph nodes were most frequently involved. The study concluded that tuberculosis was a major factor for cervical lymphadenopathy in younger patients, while secondary cancers were more common in older patients above 50 years old.
Cerebrovascular stroke recurrence among critically ill patients (2)Alexander Decker
This document summarizes a study on risk factors, frequency, and severity of recurrent cerebrovascular stroke among critically ill patients admitted to intensive care units at a university hospital in Egypt. The study aimed to identify risk factors for recurrent stroke and examine recurrence intervals, frequency, and severity. Medical records of 80 patients admitted with recurrent stroke over 6 months were analyzed. Results found the majority had hypertension and diabetes as comorbidities. 30% experienced recurrence 2-5 years after initial stroke. Over 36% of cases were severe, with a mean severity score of 19.17 out of 42. The study concluded uncontrolled risk factors like age, gender, medical noncompliance and lifestyle factors like smoking contributed to recurrent strokes of varying severity.
This document reviews the use of open lung biopsy (OLB) in critically ill patients and those with respiratory failure. OLB is considered the gold standard for diagnosing parenchymal lung disease, but its use in intensive care unit patients is controversial due to risks. The document analyzes 22 studies on OLB outcomes in critically ill patients. It finds that OLB frequently results in specific diagnoses in over 50% of cases, sometimes 100%, and leads to significant changes in treatment in the majority of cases. However, OLB also carries risks of complications. More research is needed to determine the risks and benefits of OLB for critically ill respiratory failure patients.
This study retrospectively analyzed 163 patients treated for spondylodiscitis (spinal infection) between 1992-2000. Patients were divided into 3 treatment groups:
Group A (70 patients) received non-operative treatment including antibiotics and bracing. 8 later required surgery.
Group B (56 patients) underwent posterior decompression alone. 24 later required additional surgery for debridement and stabilization.
Group C (37 patients) received decompression and internal stabilization. Only 6 later required re-operation.
Non-operative treatment was effective for most patients. Decompression alone had a higher re-operation rate compared to decompression with internal stabilization. Overall, surgical treatment improved neurological outcomes compared to non-
This study analyzed 52 pediatric patients who underwent intestinal resection over a 10-year period at a hospital in Nigeria. The most common indication for resection was gangrenous or irreducible intussusception (28 cases, 53.8%). Other common reasons included strangulated hernia (7 cases) and typhoid intestinal perforation (6 cases). Most patients were infants under 1 year old. Complications occurred in 38.4% of patients, most commonly surgical site infection. The mortality rate was 15.4%. The study concluded that late presentation and lack of awareness contributed significantly to the high number of intestinal resections required in this patient population.
This study analyzed the incidence of gastric cancer and colorectal cancer in Iraq between 1965-2006 using data from over 2,000 patient cases. The results showed:
1) Gastric cancer was initially more common than colorectal cancer, but colorectal cancer rates increased significantly over time, surpassing gastric cancer by the 2000s.
2) Both cancers affected males more than females and were most common in the 50s-60s age range.
3) Earlier cancer stages (I and II) increased over time for both cancers, while later stages (III and IV) decreased, indicating improved diagnosis and treatment.
4) The changing incidence patterns mirror global trends and are likely due to
This study compared two methods for closing the sternum in high-risk cardiac surgery patients - a steel wire-titanium hooks combination vs a steel wire-titanium plates and screws combination. 67 patients were randomly assigned to one of the two closure methods. No cases of sternal dehiscence or mediastinitis occurred with either method. Post-operative outcomes like bleeding, ventilation time, and intensive care stay were similar between the groups. The study concluded that the choice of sternum closure technique in high-risk patients should be based on individual patient characteristics and surgeon experience, and both techniques appeared equally effective.
This document summarizes and critiques a study on the epidemiology of glioma and its section on cellular phones. It finds deficiencies in the studies cited by the section. In particular, it notes that incidence time trend studies failed to account for late cancer reporting, changing phone use over time, and missing cancer cases. Cohort studies are unable to determine cancer risks for rare diseases. While one case-control study found increased glioma risks, other relevant case-control studies were not cited that also found increasing risks with greater phone use. In conclusion, the evidence does not support the conclusion that phone use is unrelated to glioma risk.
Radiological Findings in Infertile Men in a Fertility Centre in Jos, Nigeria.QUESTJOURNAL
ABSTRACT:Infertility is a great psychological burden to the infertile couple. Scrotal ultrasonography and colour Doppler imaging of the scrotum are useful adjuncts to clinical examination in assessing intratesticular and extratesticular abnormalities. Methodology:All men who presented with infertility were evaluated. These included comprehensive history, physical examination and investigation, in this case seminal fluid analysis and scrotal ultrasonography. Results:This was prospective study carried out at the Jos University Teaching Hospital and a fertility centre in Jos from 2012 to 2017. A total of 67 men were involved in this study. The mean age was 39.39yrs. Age range was 28 to 59yrs. Sixty three (N=63) of the men had abnormal semen parameters representing 94.03% while four men (N=4) had normal semen parameters. Thirty eight patients representing 56.72% had azoospermia while 5.97% had normozoospermia following seminal fluid analysis. The mean volume of the right testis was 11.93ml. The range was 2.9ml to 25ml. The mean volume of the left testis was 11.76ml. The range was 2.9ml to 22ml. Overall mean testicular volume was 11.85ml. Forty two men (N=42) had abnormalities on scrotal ultrasound representing 62.69%. Abnormalities on ultrasonographyinclude varicocele33%, cryptorchidism31%, hydrocele 17%, testicularmicrolithiasis7%, multiple complex testicular cyst5%, epididymal cyst5% and echogenic testis2%. Conclusion:Scrotal ultrasonography is important in the assessment of testicular volume and abnormalities such as varicocele, cryptorchidism and hydrocele which affects male fertility.
This study analyzed data from the California Patient Discharge Database between 2005-2013 to determine rates of subsequent major amputation after initial minor amputation due to peripheral artery disease (PAD) and/or diabetes mellitus (DM). Patients with combined PAD/DM had the highest rates of major amputation (6.3%) and repeat minor amputation (16%) compared to those with DM or PAD alone. The median time to major amputation was 12.9 months, with no significant differences between groups. Mortality rates were also highest in the PAD/DM group at 49%. Revascularization before subsequent amputation was associated with lower risk of limb loss.
Volume 12, issue 2, august 2011 prevalence of crohn’s disease in endoscopic...Ari Anta
This study aimed to characterize Crohn's disease (CD) in patients undergoing colonoscopy at an Indonesian hospital between 2007-2008. Of 921 colonoscopies, 19 (2.1%) patients were diagnosed with CD. The mean age was 47.7 years with most patients presenting between 51-60 years. The main complaints were diarrhea (42.1%) and lower gastrointestinal bleeding (36.8%). Colonoscopic findings most commonly included hyperemia (94.7%), ulcerations (89.5%), and erosions (63.2%). The dominant site of involvement was pancolitis (57.9%), followed by ileocolitis (36.8%) and isolated left colon involvement (26.3
Clinical Study of Foreign Bodies in Tracheo-Bronchialtree with Specific Atten...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study evaluated 120 thyroid nodule patients using ultrasonography to assess diagnostic accuracy. Ultrasonography detected multiple nodules in 58% of patients, compared to 17% on clinical exam. 50% of clinically solitary nodules were shown to be multiple by ultrasound. Ultrasound features like composition, borders, calcifications and vascularity were analyzed. 80 patients (66.6%) were diagnosed with benign disease and 40 (33.3%) with thyroid malignancy based on ultrasound and histopathology results. The study concludes that ultrasonography is a useful complementary method to physical exam for diagnosing thyroid nodules due to its ability to detect more nodules and evaluate characteristics that suggest benign or malignant lesions.
This study examined predictors of contralateral breast cancer in unilateral breast cancer patients undergoing contralateral prophylactic mastectomy (CPM). The study analyzed 542 patients who underwent CPM at one cancer center between 2000-2007. Univariate analysis found that younger age, Gail risk score >1.67%, ipsilateral invasive lobular histology, additional ipsilateral moderate-high risk pathology, and multicentric ipsilateral tumor predicted higher risk of contralateral breast cancer. However, multivariate analysis identified only younger age and ipsilateral invasive lobular histology as independent predictors of contralateral breast cancer. The study aimed to help identify which unilateral breast cancer patients might most benefit from CPM.
Onconesthesia : An emerging subspecialityAbhijit Nair
This document discusses the emerging sub-specialty of oncoanesthesia. It notes that anesthesiology involves many sub-specialties and cancer patients have special medical needs. Oncoanesthesia draws upon multiple sub-specialties of anesthesiology due to the complex health issues of cancer patients and high-risk nature of cancer treatments and surgeries. The document outlines the various roles of anesthesiologists in cancer care, including management of complex airways, regional anesthesia, intensive care, pain management, and more. It also discusses the opportunities for training and research in oncoanesthesia.
This lecture proves an overview of assessing the thyrod nodule upon presentation. The use of imaging, including nuclear medicine, PET, CT/MR and Ultrasound is discussed.
There is more detail on ultrasound evaluation with particular emphasis on ACR TIRADS
Background: The incidence of cancers is increasing worldwide, particularly in the developing countries as shown by recent cancer stastics from the WHO. It is even anticipated that with the increase in life expentancy, consequent upon inproved standard of living and globalization, the burden of cancers will increase within this millenium. With respective to cancer of the prostate, it is the most common type of cancer in urology. In developing countries, diagnostic is done at a late stage of evolution. In Cameroon, data on prostate cancer are scanty whereas the incidence of this disease is increasing. Objective: This article is designed to describe the epidemiological features of prostate cancer at the General Hospital of Yaoundé. Patients and methods: A 4-year retrospective study of patients seen with the diagnosis of cancer at the Medical Oncology unit of the Yaoundé General Hospital between January 2012 and December 2015. The demographic pattern (age of patients, socio professional activity, marital status), clinical features (cancer diagnosis), treatment modalities and outcome were studied. Main results: Of the 7 775 patients enrolled in the Medical Oncology Service over the study period, 1.4% (n = 108) cases of prostate cancer were seen. The prevalence over the study period was 1.38% and a relatively large annual growth of cases with an annual average of 27 cases was noted. The average age of patients was 67.82 years with a range of 34-83 years. The commonest presenting symptoms were the urinary frequency (54.63%) whereas the least common were fatigue (05.5%) and straining (03.70%). PSA was obtained in 49 patients, representing about 45.4% of all patients. Only 14 (01.26%) had biopsy reports. Conclusion: Prostate cancer is a major problem facing the aging male, and inadequate facilities make early detection difficult. Therefore, treatment is mainly palliative because of late diagnosis.
Introduction: Stroke is an even more dramatic major public health problem in young people. Goal of the study: Contribute to the knowledge of strokes in young people. Methodology: This was a retrospective study carried out over a period of 02 years (January 2017 to December 2018) including the files of patients aged 18 to 49 years hospitalized for any suspected case of stroke in the Neurology department of the University Hospital
Center of the Sino-Central African Friendship (CHUSCA) of Bangui.
Study of clinical and etiological profile of community acquired pneumonia in ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document discusses the rising incidence of oropharyngeal cancer, which is increasingly associated with human papillomavirus (HPV) infection. HPV-positive oropharyngeal cancer has distinct clinical and biological features compared to HPV-negative cancer, including younger patient age, fewer risk factors, and better prognosis. Detection of HPV status is important for prognostication and potentially de-escalating treatment intensity for HPV-positive patients due to their improved survival. Immunohistochemistry for p16 is a practical and widely applicable method for determining HPV status in clinical specimens.
This study was performed Department of Otor hinolaryngology, Jubilee Mission Medical College, thrissur, Kerala for a period of 2 years commencing from December 2012 to November 2014. To review our experience with deep neck space infections and to study changing trends. The objectives were to study clinical presentation, etiology, associated systemic diseases, bacteriology, radiology, management and outcome of deep neck space infections.40 Patients coming from both urban and rural areas irrespective of age and sex admitted in department of ENT with deep neck space infections which was confirmed either clinically or radiologically. Superficial skin abscesses and abscesses due to infections of external neck injuries were excluded from the study \r\n.
Vitiligo clinical findings in 1436 patientstloanphan
This study analyzed clinical findings from 1436 patients with vitiligo seen between 1989-1993. The key findings were:
1) Vitiligo vulgaris was the most common type (69.8% of patients), followed by focal (14.9%) and segmental (5.0%) vitiligo.
2) The most common sites of onset were the face (22.9%), trunk (22.3%), and legs (18.6%). Less than 20% body area was involved in 94.4% of patients.
3) Associated conditions included atopic/nummular eczema (1.4%), bronchial asthma (0.7%), diabetes (0.
The document presents a matched-pair analysis comparing outcomes of young patients (<45 years old) and older patients (>45 years old) with squamous cell carcinoma of the oral tongue. Younger patients had fewer locoregional recurrences, and better overall and disease-specific survival rates. The study was limited by small sample size but found tentative evidence that tongue cancer in young patients may be a distinct disease influenced by factors like HPV infection rather than tobacco and alcohol use.
Profile of Chest Injury in the Peri-COVID-19 Period: A Single Centre Seriessemualkaira
Chest traumas continue to constitute about 30% of all traumas and contribute to 25-50% of trauma-related deaths. COVID-19 has its primary pathophysiologies in the lung, and can worsen the morbidity and mortality of chest trauma if it occurs concomitantly.
Profile of Chest Injury in the Peri-COVID-19 Period: A Single Centre Seriessemualkaira
Chest traumas continue to constitute about 30%
of all traumas and contribute to 25-50% of trauma-related deaths.
COVID-19 has its primary pathophysiologies in the lung, and can
worsen the morbidity and mortality of chest trauma if it occurs
concomitantly.
Profile of Chest Injury in the Peri-COVID-19 Period: A Single Centre Seriessemualkaira
Chest traumas continue to constitute about 30%
of all traumas and contribute to 25-50% of trauma-related deaths.
COVID-19 has its primary pathophysiologies in the lung, and can
worsen the morbidity and mortality of chest trauma if it occurs
concomitantly.
This document summarizes a study on nasopharyngeal cancer patients treated between 1995-2000 in Benghazi, Libya. It found that 59% of patients received neoadjuvant chemotherapy and radiotherapy, while 30% received radiotherapy alone. Patients who received chemotherapy had a better mean survival rate (37.8 months vs 16.2 months) and less metastasis. The study concluded that chemotherapy improves survival outcomes for nasopharyngeal cancer patients.
Clinicopathological study of tuberculosis patients in a tertiary care medical...Government Medical College
This study examined the clinical and socio-demographic characteristics of 112 tuberculosis patients in Bangladesh. The majority of patients (61.7%) were aged 15-34 years. Over half (55.4%) were female. Pulmonary tuberculosis was more common in men (54.4%) while extrapulmonary tuberculosis was more prevalent in women (55.4%). The most frequent sites of extrapulmonary tuberculosis were the lymph nodes (38.2%) and pleura (36.4%). Cough with expectoration was the most common symptom of pulmonary tuberculosis (96.5%). The study concludes that tuberculosis control programs should target young adults, especially women, for early diagnosis and treatment.
Oral cancer is a term used for cancers occurring in the oral cavity. It is the most common type of head and neck cancer. Risk factors for oral cancer include tobacco use, heavy alcohol consumption, human papillomavirus infection, and sun exposure. Data from the SEER program shows that from 2002-2006 the age-adjusted incidence of oral cancer in the United States was 10.4 per 100,000 people, while the age-adjusted mortality rate was 2.6 per 100,000. Survival rates are lower for advanced stage cancers, cancers in black males, and HPV-negative tonsillar cancers.
This document is a survey report on understanding of lung cancer among male and female students at Taylor's University. It includes an introduction to lung cancer, the objective of comparing understanding between genders, methodology of distributing surveys to 260 students, statistical analysis of the survey results, and conclusions. The analysis found that female respondents had a slightly better understanding of lung cancer than males, though overall understanding was low. Many were unaware that lung cancer can spread to other organs and that surgery is a primary treatment. The report provides statistics on lung cancer in Malaysia and factors that influence risk.
This document is a survey report on understanding of lung cancer among male and female students at Taylor's University. It includes an introduction to lung cancer, the objective to compare understanding between genders, methodology of distributing surveys to 260 students, statistical analysis of responses, and conclusions. The analysis found that female students had a slightly better understanding than males, though overall understanding was low. Many were unaware that lung cancer can affect other cancers and that surgery is a primary treatment. The report provides statistics on lung cancer in Malaysia and causes/risk factors.
This study analyzed 75 patients with oral squamous cell carcinoma (OSCC) who were divided into two groups - those over 40 years old (group I, n=50) and those 40 years old or younger (group II, n=25). The study compared clinicopathological features and recurrence rates between the two groups using the STNMP staging system. Group II presented with higher STNMP stages at diagnosis compared to group I. Both groups showed higher recurrence rates for those with higher STNMP stages. However, the percentage of uncontrolled tumors after treatment did not significantly differ between the two groups. Therefore, while younger patients presented at higher stages, their treatment outcomes were similar to older patients.
Changing pattern of mechanical bowel obstruction and management outcome in no...BRNSSPublicationHubI
This study reviewed 94 patients treated for mechanical bowel obstruction over 5 years in North-Eastern Nigeria. Tumor was the most common cause of obstruction (27.66%), surpassing hernias which had previously been most common. Bowel resection was the most common procedure (54.26%). Post-operative complications included surgical site infections (22.34%) and enterocutaneous fistulas (3.19%). Mortality was 15.96%, primarily due to metastatic colon tumors. The rising incidence of colon tumors and availability of elective hernia repair have led to tumors becoming the predominant cause of mechanical bowel obstruction.
Assessing the effects of prognostic factors in recovery of tuberculosis patie...Alexander Decker
- The study assessed prognostic factors affecting recovery of tuberculosis patients in Ghana's Upper West Region. 400 patients were analyzed.
- Key factors found to significantly contribute to recovery were age, type of patient (pulmonary vs extra-pulmonary), duration of treatment, and HIV status.
- The median recovery time was 25.43 weeks. Older age was found to decrease the risk of relapse. Patients co-infected with HIV had a higher risk of treatment failure.
People Living with Human Immunodeficiency Virus in Hadhramout: Clinical Prese...asclepiuspdfs
The objective of the study was to determine the clinical features and outcome of patients living with human immunodeficiency virus (HIV) in Hadhramout and nearby governorates. Materials and Methods: This descriptive study was conducted in the antiretroviral therapy (ART) site at Ibn-Sina General Hospital, Mukalla, Hadhramout governorate. All 145 patients were enrolled in HIV treatment and care program from December 2008 to the end of December 2016 with confirmed HIV test. Data included all personal data, clinical staging, drugs taken, and outcomes. Patients were grouped according to the decades to five groups, ≤15 years, 16–30 years, 31–50 years, 51–70 years, and >70 years. Cases classify according to the antiretroviral drugs to ART group and Pre-ART group. The relevant data parameters were analyzed using SPSS statistical software version 21 and Excel 10. Results: A total of 145 cases, most adults (97.9%), males and females were104 (71.7%) and 41 (28.3%), respectively. Mean age was 36.46 years and 30–50 years the most affected age group (55.2%). Clinical Stages 3 and 4 were the common presentation in 73.8%, and most cases were from Mukalla city. Of the total cases, 74.5% were on ART 53.1 of them improved, pulmonary tuberculosis was found in 4 cases, and death cases were (18.5%), mostly due to late presentation and non-adherence, and mostly occurred in early 6 months of starting the ART. 37 patients were in a pre-treatment group (21.6%), where the mortality rate is 35.1%, mainly due to loss of follow-up. Conclusions: Most cases were adult males, young age and have had late presentation, where mortality is higher in the pre-treatment group due to loss of follow-up and in early 6 months of treatment.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Similar to Nasopharyngeal Carcinoma: Profile, Challenges and 5-Year Outcome in a Nigerian Tertiary Hospital (20)
Carbon monoxide (CO) poisoning is a major public health issue in the United States that accounts for approximately 50% of poisoning cases in the nation each year and around 50,000 emergency room visits. In most instances of CO poisoning, the culprit is a malfunctioning or poorly tended heating system within the home or, occasionally, commercial building, which causes the system to leak this hazardous gas. One of the more insidious aspects of CO poisoning is that the gas is odorless and colorless, and victims of CO poisoning often do not realize that there is a problem until they begin to experience the effects of poisoning and have no choice but to seek medical attention. Unfortunately, many victims of CO poisoning die before they are able to seek treatment. This paper makes use of a qualitative, systematic literature review to examine the four major parts of the brain that are most severely affected by CO poisoning. Overall, the literature review showed that the white matter, globus pallidus, basal ganglia, and cortex are the parts of the brain most severely impacted by CO poisoning. While many CO poisoning victims do make it to the hospital on time and are treated, they may nonetheless suffer long-term neurological consequences as a result of their exposure. As such, CO poisoning is a major public health issue.
Drug abuse has now become a major public health problem in Nigeria requiring urgent attention. Although drug abuse cut across all age groups, the youths are however the most affected. This study aimed at assessing Community Pharmacists involvement in the rehabilitation of drug abuse victims. The study was carried out in Abuja Municipal Area Council, questionnaires were administered to Community Pharmacists practicing within the Area Council. A total of 176 Community Pharmacists participated in the study, and slightly above a quarter (27.43%) of them had post-graduate degrees. More than three-quarters (79.5%) of the study participants had received training on drug abuse. A total of 89.2% of the study participants had come across persons suspected to be abusing prescription medicines. Almost all (96.6%) of the study participants indicated that they are willing to advise persons suspected to be abusing drugs on the dangers of drug abuse, and 88.1% of the study participants had spoken to clients concerning abuse of prescription medicines. Also, more than three-quarters (80.1%) of the study participants indicated that pharmacists’ role in the prevention of drug abuse is very important. The study has revealed that Community Pharmacists can play an invaluable role in the rehabilitation of drug abuse victims in Nigeria.
Background; Social Class has shown relation with admissions at Emergency Departments. To assess whether there is a relationship between the level of triage and the social class of patients who attend the emergency department and whether there are other variables that can modulate this association. Methods Observational study with 1000 patients was carried out between May and July 2018 in the Emergency Department of the University Hospital Arnau de Vilanova in Lleida. Sociodemographic variables such as age, gender, country of origin and marital status were analyzed. The triage level and the main explanatory variable was social class. Social class was calculated based on the CSO-SEE 2012 scale. Results 49.4% were male and the average age was 51.7 years. Most of the patients (66.6%) attended the emergency department under their own volition and the most common triage levels were level III or Emergency (45%). There is a significant relationship between age and triage level. The younger patients had a lower triage level (p <0.001). The percentage of patients with lower social class who attended the emergency department for minor reasons was 42% higher compared to the rest of the patients (RR = 1.42; 1.21-1.67 95% CI, p <0.001). Conclusions; Patients with a lower socioeconomic class go to the Emergency Department for less serious pathologies.
This document summarizes a study exploring child healthcare and treatment-seeking behavior in a village located in a haor region of Bangladesh. The study utilized interviews and focus groups to understand the various factors influencing healthcare choices, including the interrelationship between local ecology and health. Key findings were that the haor ecosystem is declining due to overuse of resources, and villagers utilize multiple healthcare sectors - including popular/family-based care, folk healers, and biomedical professionals - with choices influenced by cultural and socioeconomic factors. Government and NGOs could help improve child health by increasing access to services and promoting awareness of nutrition and sanitation practices.
Objective: The purpose of this paper is to review literature on music and biomarkers of stress in order to (1) Identify music interventions and (2) Detail the biomarkers of stress associated with music. Methods: PRISMA guidelines were followed in performing this systematic review. Studies published from January 1995 to January 2020 that pertain to biomarkers of stress and music were identified through the use of the PubMed database, using the keywords: ‘music’ AND ‘biomarker’ OR ‘marker’ OR ‘hormone’. Two authors independently conducted a focused analysis and reached a final consensus on 16 studies that met the specific selection criteria and passed the study quality checks. Results: The reviewed studies were all randomized controlled trials. Reviewed music interventions included Music Listening (ML), Meditational Music (MM), ‘Guided Imagery and Music’ (GIM), and Singing. The studies showed that music is associated with a decreasing trend in cortisol, salivary α-amylase, heart rate, and blood pressure, as well as an increasing trend in Immunoglobulin A (IgA), oxytocin, and EEG theta wave, while testosterone was associated with sex-related differences. Conclusion: Music is associated with significant changes in biomarkers of stress, suggesting that it could be utilized for the development of stress reduction tools.
Background: Nurse practitioners play a vital role in wound care and management because of the prevalence of wounds in the community and hospital setting. Aims and objectives: The purpose was to identify current knowledge and practices of nurses with respect to wound management. Method: A qualitative descriptive research was designed, nineteen nurses in wound care wards in Bingham University teaching hospital were recruited into this study. This was achieved with the aid of a self-administered questionnaire for a two-week period. Results: Three groups of nurses responded to this survey (73.7% males; 31.6% aged 31-40 years). Registered nurses dominated (68.4%), majority of them worked in male ward (36.8%) and private ward (36.8%). Almost on full-time (94.7%), more than half were diploma holders (57.9%) with 1 to 5 years of experience (47.4%). Majority (84.2%) were involved in wound treatment and management, there were significant association between years of experience and wound classification, wound treatment, treatment failure and treatment failure factors. Conclusion: Wound care practices require accurate knowledge and assessment skills, a better understanding of wound management provides comprehensible, rapid patient wound care and minimizes patient mortality as well as reduces health services financial costs.
Background: Job satisfaction is a significant indicator of the way nurses feel about their profession, the efforts to perform their professional duties, or otherwise abandons it willingly. Method: cross-sectional research design approach was used to assess the job satisfaction and the associated factors among 300 hundred nurses. Data was analyzed using descriptive statistics and kruskal wallis test for association between the socio-demographic variables and job satisfaction at significance level of 0.05 Result: About 1/3 of the respondents (31%) reported gross dissatisfaction with their job, 0% reported being well satisfaction while (68.7%) respondents reported moderate satisfaction with their job. Across items on the scale, gross dissatisfaction was noted on key managerial factors and the salary of the workers. Job satisfaction was associated with specialty (p<0.018), gender (P<0.002) and age (P<0.000) of Nurses. Conclusion: majority of the respondents were moderately satisfied with their job but grossly dissatisfied with salary and administrative roles like communication flow.
Viral infections have always been of major concern in communities, health care settings and medical fields including radiotherapy and Radiology. Recently corona virus infection has attained global attention in the wake of covid-19 outbreak and consequently highlighted importance of viral prevention, diagnostic and therapeutic strategies to control and treat viral disease. In view of the recent events, the author reviewed the current and past literature to discuss contagious versus infectious viral transmission, as well as simple and effective ways of preventing the spread of viral diseases in community and health care setting so that this information can be used for preventing viral transmission at all levels. The article is written for a wide variety of audiences i.e. scientific and medical communities policy makers and general public.
The Coronavirus Disease – 2019 (COVID-19) is officially now a pandemic and not just a public health emergency of international concern as previously labelled. Worldwide, the new coronavirus has infected more than 4.9 million people and leaving more than 300,000 people dead in 188 countries. As countries of the world get locked down in an effort to contain the widespread of the virus, experts are concern about the global impacts of the pandemic on individuals, countries and the world at large. Millions of people are currently under quarantine across the globe. Many countries have responded by proclaiming a public health emergency, closed their borders and restrict incoming flights from high risk countries. This has grossly affected the travel plan of many. Several international programs, conferences, workshops and sporting activities are either postponed or cancelled. As the number of confirmed cases continues to escalate across the globe, hospitals seems to be running out of medical supplies, hospital spaces and personnel. Health workers are being overwhelmed by the numbers of people requesting for testing and treatment. Many of such health workers have been infected with the coronavirus and even lost their lives since the fight against COVID-19 started. Public health experts are also concerned about the huge medical wastes coming from the hospitals at this time and the adverse effects associated with improper management of such medical wastes, both at the hospital and community levels. The pandemic has also impacted negatively on the global economy. There have been serious crises in the stock market, with gross fall in the price of crude oil resulting in inflation and economic hardship among the populace. Many are currently out of job and as a result, the level of crime, protest and violence have continued to escalate in different parts of the world. The deaths of loved ones due to the coronavirus has left many emotionally traumatized. Nigeria, like other African countries is not spared of the ravaging effects of the pandemic, even as the government take strict measures to contain the virus. No doubt, this is very challenging, but the country is capable of surmounting the virus with the needed help from her international partners and cooperation from the citizenry. But if we as a people, remain complacent and continue with business as usual, without taking measures to flatten the curve, the disease will escalate too quickly beyond our capacity to handle and our health system will be overwhelmed and may collapse eventually. We cannot therefore afford to be complacent in our response to containing the pandemic.
Purpose: To investigate the effect of sulfur dioxide on the lung microbiota of healthy rats. Methods Fifteen male rats were randomly divided into high dose and low dose exposure group and control group. After 7 days of SO2 exposure, the lung tissues were obtained and the lung microbiota was identified by Illumina high-throughput sequencing. Results The microbial community of lung microbiota was significantly alternated in the exposure group and the dominant phylum changed from Firmicutes to Proteobacteria. In addition, the SO2 exposure caused the bronchial wall thickening and a large number of inflammatory cell infiltration in the lungs of rats in exposure groups. Conclusions The results suggest that SO2 can significantly alter the lung microbiota and pathological structure of the lungs.
Malaria is still considered globally as a leading cause of morbidity with Nigeria carrying the highest burden of 19%. Coinfection of malaria and Human Immunodeficiency Virus (HIV) accelerate disease progression of HIV/AIDS subjects. This study investigated the prevalence and predictors of malaria among HIV infected subjects attending the antiretroviral therapy Clinic at Federal the Medical Centre, Keffi, Nigeria. After ethical clearance, 200 whole blood specimens were collected from patients who gave informed consent and completed a self-structured questionnaire. The specimens were examined for malarial parasite using rapid kits and microscopy. The overall prevalence of the infection was 78/200 (39.0%). The prevalence was higher in male (44.7%) than female (34.0%) subjects. Those subjects aged < 20 years (54.5), male gender (44.7%), non-formal education holders (61.5%), farmers (62.5%), stream water users (48.1%), those that lives in rural setting (43.6%), those that do not use Insecticides Treated Nets (ITNs) (39.4%) and swampy environment dwellers (41.7%) were identified predictors for malaria infection in the area. All the predictors studied did not show any statistically significant difference with the infection but some arithmetic difference exists (P > 0.05). The 39.0% prevalence of malaria in HIV infected subjects is a public health concern. Therefore, Public health surveillance and health education among HIV population should be advocated to help eradicate malaria comes 2030. Further study that will characterize the genes of the parasite should be carried out.
This document presents a mathematical model to eliminate malaria transmission by breaking the life cycle of Anopheles mosquitoes. The model introduces two natural enemies - copepods to prey on mosquito larvae and tadpoles to prey on pupae. Differential equations were derived to model the growth of each mosquito life stage from egg to adult when under attack by these predators. Stability analysis of the disease-free equilibrium was conducted using equilibrium points, Beltrami's conditions, and Diekmann's conditions. The results indicate that introducing copepods and tadpoles makes the disease-free equilibrium stable, meaning the mosquito life cycle would be broken and no adult mosquitoes emerge to transmit malaria.
Spindle cell neoplasms usually occur in head, neck, orbit, soft tissues of scalp and along the upper aerodigestive tract. They are relatively uncommon in lower gastrointestinal tract and represent a distinct clinical entity. Increased awareness is required among colorectal surgeons and pathologists due to their benign nature & uncertain etiology, to avoid misdiagnosis of rectal cancer. Definitive diagnosis necessitates immunohistochemical analysis. We present an unusual case of spindle cell neoplasm of rectum in an asymptomatic elderly gentleman, detected on screening colonoscopy. Following thorough evaluation with MRI pelvis, CT scan thorax, abdomen, pelvis with contrast and multidisciplinary meeting discussion (MDT) at our institution, he was successfully treated with a specialized minimally invasive approach (TAMIS). Histopathology with immunohistochemistry confirmed the diagnosis of spindle cell neoplasm. As they are uncommon in colorectum & non-invasive, management and long-term follow-up is still under study. These lesions should be differentiated from other stromal tumours in GIT.
This document summarizes a study on the relationship between socio-demographic characteristics and the prevalence of brucellosis among community members in Mandera East Sub-County, Kenya. Blood samples from 420 respondents were tested for brucellosis using the Rose Bengal Plate Test (RBPT) and Serum Slow Agglutination Test (SSAT). The RBPT indicated a prevalence of 24.8% while the SSAT, a confirmatory test, indicated a prevalence of 14.3%. The study found the seroprevalence was higher among males (98% by RBPT and 98% by SSAT) and there was a significant relationship between gender and seroprevalence. Socio-demographic data
The Matrix metalloproteinase-9 is involved in several pathologies. Its strong presence in ocular pathologies explains our interest for its genetic variation in cataract, glaucoma and retinoblastoma in Senegal. MMP9 is highly polymorphic with cataract and glaucoma. 77 mutations were noted with 21 haplotypes for the entire population. The haplotype diversity Hd is 0.831 and the nucleotide diversity Pi is 0.016; k = 17.395. The polymorphism of the Matrix metalloproteinase-9 gene is associated with all three diseases and SNP 3918249 is found in both cataract and glaucoma.
This paper proposes the development of a software that performs the pre-diagnosis of malignant melanoma, spincellular carcinoma and basal-cell carcinoma. The software is divided into five modules, these being: digital imaging, analysis and processing, storage, feature extraction and classification by means of an Artificial Neural Network (ANN). The results shown the performance of the software for two different combination of activation functions in the network. With the use of spectroscopic techniques for the acquisition of images and the combination of non-linear and linear activation functions in the ANN, the software shows an effectiveness greater than 80%, concluding that it can be an effective tool as an aid in the diagnosis of cancer of skin.
Background: Tuberculous meningitis is defined as an inflammatory response to mycobacterial bacterial infection of the pia, arachnoid and CSF of the subarachnoid space. It is a dangerous form of extrapulmonary tuberculosis because it can cause permanent neurological disabilities and even death. Stroke is a devastating complication which further increase the morbidity and mortality in the disease. Matrix metalloproteinases are endopeptidases which degrade all the components of the extracellular matrix and thus have potential to disrupt blood brain barrier and cause CNS damage. Matrix metalloproteinases have been associated with pathophysiology of ischemic stroke. MMP levels in serum and CSF have also been seen to rise with advancing stage of TBM. So it is postulated that MMP may have role in the pathophysiology of stroke in TBM and may serve as a biomarker to predict stroke in TBM. Aims: To compare Serum Matrix metalloproteinase-9 in patients with Tuberculous Meningitis with and without Stroke and correlate it with various clinical, biochemical and radiological features of TBM. Methods: 40 Patients of probable or definite TBM and 40 age and sex matched patients of TBM with clinical stroke were enrolled in the study and formed two groups i.e. cases and controls. The two groups were compared for various clinical parameters, biochemical parameters (CSF cytology, glucose and protein), neuroimaging parameters and serum MMP-9 levels. Serum MMP-9 was estimated by ELISA method. Results: Serum MMP-9 levels were (224 ± 261.627 ng/ml) in cases and (157.23 ± 197.155 ng/ml) controls, which though higher in cases but no difference was statistically significant (p value 0.157) between two groups. Also there was no correlation between the serum MMP-9 levels and various clinical features (duration of illness, fever, headache, vomiting, weight loss, seizure, hemiparesis), CSF characteristics (protein, sugar and cytology) and radiological findings (tuberculoma, and hydrocephalus). Conclusion: we conclude that MMP-9 levels is not correlated with occurrence of stroke in TBM. MMP-9 levels were not increased with severity of disease, complications and outcomes.
This study aimed to determine factors influencing postnatal monitoring in the Bafang Health District of Cameroon. The study found that women who were informed of postnatal appointment dates by midwives, those who believed the appropriate period for follow-up was 6 weeks postpartum, and those who massaged their abdomen after childbirth were more likely to have knowledge of postnatal follow-up. In contrast, women with no knowledge of the appropriate periods for postnatal consultations were less likely to have knowledge. The study concluded that lack of knowledge about postnatal consultations and traditional practices are factors influencing postnatal follow-up in the district, and increased awareness campaigns are needed.
Aim: To highlight the challenge in the management of Arginosuccinic acidemia as well as demonstrate the importance of newborn screening for inborn errors of metabolism. Method: Report of two cases of neonatal onset ASA with encephalopathy and review of relevant literature. Conclusion: Early diagnosis and institution of appropriate intervention can significantly improve outcome. Routine newborn metabolic screening should not only be implemented universally, the result should be available promptly.
To form the basis of a respiratory disease model in rats by investigating the microbial distribution and composition in the lower respiratory tracts of normal rats. Methods: DNA was extracted from the intestine, trachea, bronchus and lung samples collected from healthy rats under sterile conditions. The 16S rDNA V4-V5 region was sequenced using Illumina high-throughput technology. Results: The sequencing results showed that there was no significant difference in abundance and species diversity of microbiota between the lower respiratory and the intestine. The microbiota structure analysis showed samples from lungs and intestinal shared similarity. However, the dominant species at the levels of phylum, family, and genus diverged. The similarity analysis showed that the lung microbiota were different from the intestines. The linear discriminant analysis showed significantly different species in different tissues; function prediction also showed different microbiota function in different tissues. Conclusions: These results suggest that bacterial colonization depends on the sample’s anatomical location. The human pathogen Acinetobacter lwoffii was also detected in the rat lower respiratory tract samples.
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTblessyjannu21
Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
It is a type of chronic obstructive
pulmonary disease.
It is a progressive disease of lungs.
Basics of Electrocardiogram
CONTENTS
●Conduction System of the Heart
●What is ECG or EKG?
●ECG Leads
●Normal waves of ECG.
●Dimensions of ECG.
● Abnormalities of ECG
CONDUCTION SYSTEM OF THE HEART
ECG:
●ECG is a graphic record of the electrical activity of the heart.
●Electrical activity precedes the mechanical activity of the heart.
●Electrical activity has two phases:
Depolarization- contraction of muscle
Repolarization- relaxation of muscle
ECG Leads:
●6 Chest leads
●6 Limb leads
1. Bipolar Limb Leads:
Lead 1- Between right arm(-ve) and left arm(+ve)
Lead 2- Between right arm(-ve) and left leg(+ve)
Lead 3- Between left arm(-ve)
and left leg(+ve)
2. Augmented unipolar Limb Leads:
AvR- Right arm
AvL- Left arm
AvF- Left leg
3.Chest Leads:
V1 : Over 4th intercostal
space near right sternal margin
V2: Over 4th intercostal space near left sternal margin
V3:In between V2 and V4
V4:Over left 5th intercostal space on the mid
clavicular line
V5:Over left 5th intercostal space on the anterior
axillary line
V6:Over left 5th intercostal space on the mid
axillary line.
Normal ECG:
Waves of ECG:
P Wave
•P Wave is a positive wave and the first wave in ECG.
•It is also called as atrial complex.
Cause: Atrial depolarisation
Duration: 0.1 sec
QRS Complex:
•QRS’ complex is also called the initial ventricular complex.
•‘Q’ wave is a small negative wave. It is continued as the tall ‘R’ wave, which is a positive wave.
‘R’ wave is followed by a small negative wave, the ‘S’ wave.
Cause:Ventricular depolarization and atrial repolarization
Duration: 0.08- 0.10 sec
T Wave:
•‘T’ wave is the final ventricular complex and is a positive wave.
Cause:Ventricular repolarization Duration: 0.2 sec
Intervals and Segments of ECG:
P-R Interval:
•‘P-R’ interval is the interval
between the onset of ‘P’wave and onset of ‘Q’ wave.
•‘P-R’ interval cause atrial depolarization and conduction of impulses through AV node.
Duration:0.18 (0.12 to 0.2) sec
Q-T Interval:
•‘Q-T’ interval is the interval between the onset of ‘Q’
wave and the end of ‘T’ wave.
•‘Q-T’ interval indicates the ventricular depolarization
and ventricular repolarization,
i.e. it signifies the
electrical activity in ventricles.
Duration:0.4-0.42sec
S-T Segment:
•‘S-T’ segment is the time interval between the end of ‘S’ wave and the onset of ‘T’ wave.
Duration: 0.08 sec
R-R Interval:
•‘R-R’ interval is the time interval between two consecutive ‘R’ waves.
•It signifies the duration of one cardiac cycle.
Duration: 0.8 sec
Dimension of ECG:
How to find heart rhytm of the heart?
Regular rhytm:
Irregular rhytm:
More than or less than 4
How to find heart rate using ECG?
If heart Rhytm is Regular :
Heart rate =
300/No.of large b/w 2 QRS complex
= 300/4
=75 beats/mins
How to find heart rate using ECG?
If heart Rhytm is irregular:
Heart rate = 10×No.of QRS complex in 6 sec 5large box = 1sec
5×6=30
10×7 = 70 Beats/min
Abnormalities of ECG:
Cardiac Arrythmias:
1.Tachycardia
Heart Rate more than 100 beats/min
THE SPECIAL SENCES- Unlocking the Wonders of the Special Senses: Sight, Sound...Nursing Mastery
Title: Unlocking the Wonders of the Special Senses: Sight, Sound, Smell, Taste, and Balance
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Welcome to our captivating SlideShare presentation on the Special Senses, where we delve into the extraordinary capabilities that allow us to perceive and interact with the world around us. Join us on a sensory journey as we explore the intricate structures and functions of sight, sound, smell, taste, and balance.
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Join us as we unlock the wonders of the special senses and gain a deeper appreciation for the intricate mechanisms that allow us to experience the richness of our environment.
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Example of Market Research working
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Competitive Analysis: Analyzed competitors offering similar solutions in healthcare analytics and interoperability. Identified gaps in comprehensive data aggregation, real-time analytics, and actionable insights.
Regulatory Compliance: Ensured their platform complied with HIPAA and other healthcare data privacy regulations. This compliance was crucial to gaining trust from healthcare providers wary of data security issues.
Customer Validation: Conducted pilot programs with several healthcare organizations to validate the platform's effectiveness in improving care outcomes and operational efficiency. Gathered feedback to refine features and user interface.
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Nasopharyngeal Carcinoma: Profile, Challenges and 5-Year Outcome in a Nigerian Tertiary Hospital
1. International Journal of Healthcare and Medical Sciences
ISSN(e): 2414-2999, ISSN(p): 2415-5233
Vol. 4, Issue. 2, pp: 25-30, 2018
URL: http://arpgweb.com/?ic=journal&journal=13&info=aims
Academic Research Publishing
Group
*Corresponding Author
25
Original Research Open Access
Nasopharyngeal Carcinoma: Profile, Challenges and 5-Year Outcome in a
Nigerian Tertiary Hospital
Eziyi Josephine Adetinuola Eniola*
ORL Unit, Department of Surgery, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
Department of Otolaryngology-Head and Neck Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
Amusa Yemisi Bola
ORL Unit, Department of Surgery, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
Department of Otolaryngology-Head and Neck Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
Olusoga-Peters Pelumi
Department of Otolaryngology-Head and Neck Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
Uchendu Dubem
Department of Otolaryngology-Head and Neck Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
Ikoko Mike
Department of Otolaryngology-Head and Neck Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
Okunola Babatunde
Department of Otolaryngology-Head and Neck Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
Abstract
BACKGROUND: Nasopharyngeal carcinoma is encountered regularly in otolaryngological practice in Nigeria.
However, it is often misdiagnosed due to varied presenting symptoms, hence the need to describe the pattern of
presentation and the challenges of treatment of the patients that presented to our centre with nasopharyngeal
carcinoma. METHODS: The pathology and clinical records were retrieved for all histologically confirmed cases of
nasopharyngeal carcinoma from the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) cancer
registry. The epidemiological data, symptoms and stage at presentation, type of treatment, outcome and challenges
encountered were obtained from the records. RESULTS: A total of 384 histologically confirmed head and neck
malignancies were seen over the review period, and nasopharyngeal carcinoma constituted 32 (8.33%). There were
24(75.0%) male and 8(25.0%) female. The age ranged from 17 - 80 years with a mean of 54.5 + 12.2 years. All the
patients presented with neck swelling, Nasal obstruction 14(43.75), Epistaxis 11(37.5%), Trismus 2(6.25%), and
proptosis 2(6.25%). Twenty-four (75%) presented with stage four tumour. Treatment was primarily radiotherapy.
Fifteen (46.88%) completed radiotherapy. Two (6.25%) patients had chemo-radiation and 15(46.88%) defaulted at
different stages of treatment mainly due to financial constraints, others include beliefs and breakdown of
radiotherapy machines. Prognosis was very poor with 1-year survival of 21.9% and five-year survival of 9.25%.
Conclusion: Neck swelling, Epistaxis and nasal blockade are the most common presenting symptoms. Patients
present late leading to poor prognosis. Financing treatment out of pocket is a major reason for presenting late and
defaulting during management.
Keywords: Nasopharyngeal; Neck swelling; Carcinoma; Nigerian.
CC BY: Creative Commons Attribution License 4.0
1. Introduction
Nasopharyngeal carcinoma (NPC) occurs worldwide with high incidence in the south east Asian countries such
as china, the Pacific Island and Mediterranean countries [1, 2]. It is a unique tumor of the head and neck region as a
result of its epidemiology, racial predisposition, distinctive immunogenetics as well as its association with Epstein
Barr (EB) virus [3, 4].
There is a male preponderance in the incidence of NPC with M: F ratio of 2-3:1 and a bimodal age incidence has
been described in endemic areas [5, 6]. The first peak age incidence is in the 2nd decade of life and this is commonly
seen in an endemic area while the 2nd peak is in the 5th
decade of life [7].
The aetiological factors associated with NPC are exposure to Epstein Barr (EB) virus infection. This is based on
the fact that the EB viral capsid antigen VCA, nuclear Antigen (EBNA) and early Antigen were demonstrated in the
tumor cells and EB viral antibody had been demonstrated in affected patients [8-11]. A genetic factor has also been
implicated based on the fact that it is commoner in the Chinese, and the Orientals in addition to the association with
the HLA A, B, CD, DR, BW6 2 and 17, 5, 6. SIN 2 + HZ (California) (Singapore).
2. International Journal of Healthcare and Medical Sciences
26
Other factors implicated in the aetiology of NPC are food and cooking habits, it is found to be commoner in
people who consumed a lot of ungutted smoked fish, engage in religious activity with burning of incense, and the
use of Joss stick [12-16] .Also implicated are exposure to industrial fumes in certain occupations and to heavy metal
like Arsenic and several other factors [15, 16]. Tumors of the nasopharynx may masquerade their symptoms to
regions other than the primary site thereby presenting in many different ways [17-19]. Diagnosis is also often
difficult because of the non-specific nature of early clinical symptoms and the difficulty in visualizing the
nasopharynx leading to late diagnosis and this is associated with a poor prognosis.
This article describes the incidence, pattern of presentation and the challenges of treatment of nasopharyngeal
cancer in a tertiary health care facility in South-Western Nigeria.
2. Materials and Methods
This is a retrospective study of all histologically confirmed cases of nasopharyngeal carcinoma from the
Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) cancer registry over a fourteen year period
(2008-2012) with patients' entry points of NPC being mainly from the Otolaryngological unit. The hospital records
of the patients as well as the histopathology files of the hospital over the stated period were reviewed. The
demographic details, two major presenting complaints and their duration or complaints elicited during history taking
or principal clinical findings, stage of the disease at presentation, histological types based on WHO classification,
treatment modalities and outcome after 5 years were recorded. All the patients had panendoscopy and biopsy with
tissue specimens sent for histopathology. Staging of the disease was done using the TNM classification. The
absolute survival rates using the percentage of patients that are alive after one and five years of diagnosis were
calculated. The data were entered into a proforma and analyzed using descriptive statistics.
3. Results
The total number of Head and Neck malignancies seen over the review period was 384. The numbers of
histologically diagnosed NPC were 32. Nasopharyngeal carcinoma accounted for 8.33 % of all head and neck
malignancies in our hospital.
3.1. Age and Sex Distribution
There was a male preponderance with 24(75.0%) males and 8(25.0%) female. The Male: Female ratio is 3:1.
The age of the patients ranged from 17 - 80 years with a mean age of 54.5years +12.2years. Peak incidence is in the
51-60 age group (Table I).
3.2. Presenting Symptoms
Table II shows the presenting complaints with painless neck swelling being the most common presentation and
unilateral in 84.4% of patients, other symptoms include; epistaxis, nasal blockade, proptosis and trismus.
3.3. Staging of the Disease
Table III shows the clinical staging of the disease at presentation. Seventy five percent (24) of the patients
present with a stage IV disease while only 6.25% had stage I disease.
3.4. Histology
Keratinizing Squamous Cell Carcinoma was seen in 19 (59.38%), undifferentiated in 8 (25.00%) and non
keratinizing squamous cell carcinoma in 5(15.62%)
3.5. Treatment
All the patients were referred for Radiotherapy alone except two patients (6.25%) who was referred for chemo-
radiotherapy. however, only 15(46.88%) out of the 30 patients for radiotherapy alone completed it, the remaining
15(46.88%) could not complete the appropriate treatment modality due majorly to financial constraints. Two
(6.25%) patients for concomitant chemotherapy and radiotherapy also completed treatment.
3.6. Challenges
The challenges experienced during the course of management ranged from late presentation, financial
constraints, and lack of family support or support group to availability of few functioning radiotherapy centers at any
particular time (Table IV).
3.7. Prognosis
Prognosis was found to be very poor, only seven patients survived for one year after the commencement of
therapy. The overall one year survival was 21.9%. Five-year survival was 9.4% with no recurrence.
4. Discussion
Nasopharyngeal Carcinoma is a disease with a remarkable racial and geographical distribution. It is very rare in
most parts of the World except in Southern China in the Eskimos of the Arctic region, South East Asia, The Arabs of
Northern Africa and Kuwait [20]. In the present study Nasopharyngeal Carcinoma accounted for 8.3% of all head
3. International Journal of Healthcare and Medical Sciences
27
and neck malignancies. This figure is quite high when compared with the reports from Europe and America that
found NPC to account for less than 2% of all head and neck cancers.
There was a male preponderance with a male to female ratio of 3:1. Obafunwa et al and Fong et al also found a
male preponderance with a male to female ratio of 2:1 and 2.5:1 respectively[21, 22]. The mean age of our patients
was 54.5years and peak age incidence was found to be in the 6th decade of life. The average age is similar with
findings by Carla et al that found a mean age of 53years and differs from the peak age incidence of 2nd and 4th -5th
decade of life found by Kitcher and Chu et al respectively [6, 23, 24]. However the bimodal peak age incidence was
not observed in this series.
The most common presentations include painless neck swelling, Epistaxis, and nasal blockade (Table III). These
features are similar to what had been documented in the literature [6, 25]. Other presentations include some degree
of hearing impairment usually associated with blockage of Eustachian tube, Tinnitus and cranial nerve palsies due to
extension into the base of the skull. All our patients (32,100%) presented with painless neck swelling which is more
than the documented 63-80% mostly because majority of them present late [26].
Late presentation is a common finding in these patients, the late presentation as seen in this work could be due
to the fact that the tumor could masquerade their symptoms to other regions other than the primary site, inadequate
diagnostic facilities, inadequate number of otolaryngologists and the endemic poverty in developing countries. Other
attributed causes of late presentation include inefficiency of referral system, delay in diagnosis by primary care
physicians and initial treatment by alternative medical practitioner [6, 27, 28].Keratinizing Squamous cell Carcinoma
(WHO type I) was the most commonhistopathological variant observed in this work, this was seen in over fifty
percent of the patients. Obafunwa in Northern part of Nigeria had 40% of his patients with WHO type I while WHO
type III was more common in Ghana. While the most common type of nasopharyngeal carcinoma among US-born
Chinese and Whites is WHO type I tumors, among Chinese who reside in Hong Kong, Taiwan, and Macao, WHO
type III tumors predominate. WHO type I has been said to be common in endemic regions [6, 21, 29].
Radiotherapy was the mainstay of management in our patients. Chemotherapy can also be combined with
radiotherapy as in two patients (6.3%). However 15 (46.9%) did not complete radiotherapy majorly due to socio-
economic constraints. This has also been documented in treatment of other cancers in developing Countries [30]. To
get placement for radiotherapy is also becoming difficult due to availability of the service in only few centres
necessitating long queues, incessant break down of machines and consequent ineffective radiotherapy at the hospital
they were referred to because of the large volume of patients using the same facility [30]. Delayed placement
worsens the prognosis even when patients present relatively early, they do not get to commence radiotherapy
immediately. Some Oncology centres however gives neoadjuvant chemotherapy while waiting for the radiotherapy.
The challenges encountered in our facility during management also include limited, unavailable or broken down
diagnostic and treatment facilities, the inability of the patients to afford the cost of investigations and treatment due
to high cost of services when available and poverty state of the patients [30-32]. All the patients treated were referred
to another tertiary hospital for radiotherapy +/- Chemotherapy and majority subsequently defaulted or are haphazard
in clinic appointments in our facility. They defaulted from our facility because of the distance they had to cover from
their homes to attend both hospitals appointment and the fact that the available fund was being kept for chemo-
radiotherapy bills such that when they develop complications either from the disease or treatment, the patients may
not present early leading to late treatment.
One-year survival was 7(21.9%) while 5 years survival was found to be 9.4%. This is low compared to Carla et
al who had a five year actuarial survival rate of 65.1% although 58% of his cases were WHO Type III and it is
known that WHO Types II and III also have a better prognosis than WHO type I tumours [3, 23, 33]. Early age of
diagnosis, localized stage at presentation (versus distant), radiation therapy (versus none), undifferentiated non-
keratinizing carcinoma (versus keratinizing squamous cell carcinoma) were associated with improved survival [34].
The 5-year survival rate is significantly better for non-keratinizing carcinoma than keratinizing squamous cell
carcinoma of the nasopharynx (51% versus 6%) [34]. In addition, non keratinizing carcinomas are generally
associated with EBV positivity and EBV positivity in turn has been shown to be associated with improved survival
[35]. Recent studies have demonstrated that concurrent chemotherapy and radiotherapy are effective in the treatment
of local and regionally advanced nasopharyngeal cancer [36, 37]. Similarly, neoadjuvant and adjuvant chemotherapy
in local and regionally advanced disease has resulted in consistently high response rates [38, 39]. Nevertheless,
distant metastases continue to impede improvement of survival rates for patients with nasopharyngeal cancer. The
prognosis in this series is poor. Delay in diagnosis leading to late presentation as well as the cancer type, financial
constraints, the long waiting period at the radiotherapy clinic could have been responsible for this poor outcome.
There is need to create awareness about this disease among clinicians so as to heighten their suspicion and to
encourage early referral. The government also need to attend to these challenges urgently by implementing policies
to equips the available cancer treating hospitals with state of art equipment, increase coverage of national health
insurance scheme to cover non- government workers or makes cancer treatment free of charge so that many more
patients will have access to diagnostic tests, treatment and therefore better prognosis and outcome [30].
5. Conclusion
Nasopharyngeal Carcinoma has an incidence of 8.3% of all head and neck malignancies at OAUTHC. Neck
swelling, Epistaxis and nasal blockade are the most common presenting symptoms. Financing treatment out of
pocket is a major reason for presenting late and defaulting during management thereby leading to poor prognosis.
4. International Journal of Healthcare and Medical Sciences
28
Table-I. Age and Sex Distribution of Patients with NPC.
Age group Male (%) Female (%) Total (%)
0-10 0 (0.00) 0 (0.00) 0(0.00)
11-20 1(3.13) 0 (0.00) 1 (3.13)
21-30 0 (0.00) 1(3.13) 1(3.13)
31-40 3(9.38) 2 (6.25) 5 (15.63)
41-50 6(18.75) 0 (0.00) 6 (18.75)
51-60 6(18.75) 4 (12.50) 10 (31.25)
61-70 5(15.63) 1 (3.13) 6 (18.75)
71-80 3(9.38) 0 (0.00) 3 (9.38)
Total 24(75.00) 8 (25.00) 32 (100.00)
Mean age: 54.5 +12.2years
Table-2. The two prominent presenting complaints in patients with NPC.
Table-3. Staging of the disease at presentation.
Clinical staging Male Female Number (%)
Stage IV 17 7 24 (75.00)
Stage III 0 0 0 ( 0.00 )
Stage II 6 0 6 (18.75)
Stage I 1 1 2 ( 6.25)
Total 24 8 32 (100)
Table-4. Challenges experienced during management of Patients with NPC
1 Late Presentation to specialists
2 Lack of family support/Support group
3 Out of pocket payment/Poverty
4 Different radio-oncology Centres with different protocols of treatment
5 Few functional machine at any point in time/incessant breakdown of
machines for long periods
6 Long waiting time (queue)
7 Influence of spiritual undertones/Personal Beliefs concerning diseases
and treatment.
8 Distance covered to Oncology Centres
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Trismus 2 0 2 (6.25)
Facial swelling 2 0 2 (6.25)
Proptosis 2 0 2 (6.25)
Post nasal dripping 0 1 1 (3.13)
others 9 3 12 (37.50)
5. International Journal of Healthcare and Medical Sciences
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