Breast Cancer Stage at Diagnosis in a Nigerian Hospital: Trend over a Decade

BACKGROUND

Breast cancer outcomes are poor in Nigeria, partly due to late-stage diagnosis. To assess the impact of past and present interventions, a review of an institutional data base was performed to determine the trend with respect to stage at diagnosis over a decade.

METHODS

A retrospective analysis of an institutional data base was performed over a decade. The review period was divided into segments (2013-2015, 2016-2018 and 2019-2022). The latter period (2019-2022), corresponds to a time of more intense community interventions aimed at promoting early diagnosis and treatment around the locality of the teaching hospital. The stage at diagnosis within these periods were compared. The relationship between stage and sociodemographic variables (age, religion, marital status, menopausal status, and level of education) was assessed.

RESULTS

There were 910 patients, 144 within the first period (2013-2015), 318 in the second (2016-2018) and 454 in the third period (2019-2022). The majority presented with stage 3 disease (73.8%). There was a significant decline in the proportion of metastatic cases and a concomitant increase in early cases in the latter part of the review. The proportion of metastatic cases reduced from 23.6% (2013-2015), to 15.7% (2016-2018) and 9.3% (2019-2022) (p=0.001). Level of education was significantly associated with stage (p=0.001).

CONCLUSION

This study shows a trend towards downstaging of breast cancer in our locality. This trend corresponds to the period of more intense community interventions, justifying the need to further interrogate the direct impact of each of the interventions. This will provide a firm basis for sustaining or improving on current efforts to achieve more robust gains.

Effectiveness of Triclosan Coated Suture for Subcutaneous Wound Closure in Preventing Surgical Site Infection following Mesh Repair of Inguinal Hernia: A Pilot Study

BACKGROUND

The role of prophylactic antibiotics in mesh repair of inguinal hernia is controversial and often based on institutional policies. Surgical site infection rate from earlier studies in Nigeria justifies the continued use of prophylactic antibiotics during hernia repair. With increased use of antibiotics comes the challenge of antibiotic resistance and toxicity. The use of antimicrobial coated suture may help avoid these challenges but its efficacy needs to be tested.

OBJECTIVE

To compare Triclosan coated suture with intravenous antibiotics for the repair of inguinal hernia with mesh.

METHODS

Patients with uncomplicated inguinal hernia undergoing mesh repair were randomized to either have intravenous antibiotics administered for prophylaxis or to have wound closure with Triclosan coated Vicryl 2/0 suture. Post operatively, wound infection rates were compared between the two groups. Follow up was for 1 year.

RESULTS

We studied 49 patients with 59 hernias with a mean age of 53 years. Hernias were solitary in 75% of cases, the majority of which were right sided, while 25% were bilateral. There were 25 patients with 32 hernias in the Intravenous antibiotic group (Group A) and 24 patients with 27 hernias in the Triclosan suture group (Group B). Wound grades were similar between the two groups with one patient in the Triclosan group confirmed to have wound infection (4.2%) and none in the Intravenous antibiotics group (p=0.27). Wound infection was of the superficial type which resolved with wound care within 1 month.

CONCLUSION

Triclosan coated suture may be safely used as an alternative to intravenous antibiotics for the mesh repair of inguinal hernia. Further studies are required to validate this finding.

Intrathoracic Complications of Amoebic Liver Abscess

Amoebiasis is a world-wide parasitic infestation but is more prevalent and virulent in warm countries. Of 33 patients with amoebic liver abscess (ALA) seen over a 5-year period, 24 had intrathoracic complications. Management consisted mainly of the administration of the antiamoebic agent metronidazole (Flagyl), repeated needle aspiration of ALA and surgical drainage when aspiration failed. Closed tube thoracostomy was the preferred management of amoebic empyema. Associated cerebral involvement in 4 cases improved with parenteral metronidazole. Pericardial amoebic abscess claimed 100% mortality in our series.