Neo‐adjuvant Capecitabine Chemotherapy in Women with Newly Diagnosed Locally Advanced Breast Cancer in a Resource‐poor Setting (Nigeria): Efficacy and Safety in a Phase II Feasibility Study

The majority of clinical trials of neo‐adjuvant therapy for breast cancer have been conducted in resource‐rich countries. We chose Nigeria, a resource‐poor country, as the major site for a phase II feasibility open‐label multicenter clinical trial designed to evaluate the efficacy, safety, and tolerability of neo‐adjuvant capecitabine in locally advanced breast cancer (LABC). Planned treatment consisted of 24 weeks of capecitabine at a dose of 1,000 mg/m² twice daily (2,000 mg/m² total per day). The primary endpoints were overall, partial, complete clinical response rate (OCR, PCR, CCR) and complete pathologic response (cPR). A total of 16 patients were recruited from August 2007 to April 2010. The study was terminated early as a result of slow accrual. After the first three cycles of therapy, PCR were seen in five of 16 patients (31%; 95% CI 11–59%). Of the remaining 11 patients, eight had no response (NR) or stable disease (SD), and three had progressive disease (PD). Seven patients proceeded with further therapy of which had SD. OCR at the end of eight cycles was 44% (95% CI 20–70%). Clinical response and radiologic response by ultrasonomammography were highly concordant (spearman correlation 0.70). The most common adverse effect was Grade 1 hand–foot syndrome, which was seen in 75% of patients. Despite several limitations, we successfully carried out this phase II feasibility study of neo‐adjuvant capecitabine for LABC in Nigeria. Capecitabine monotherapy showed good overall response rates with minimal toxicity and further studies are warranted.     

Outpatient psychiatry in an urban clinic in a developing country

Summary To illustrate the current status of outpatient psychiatry in a Nigerian university medical centre the records of patients seen over a 3-month period are reviewed. Of the 203 patients, 120 were male. Most patients were 40 years old or less and 56 per cent of the patients has a diagnosis of anxiety or depressive neurosis. Physical complaints dominated the symptomatology in most patients irrespective of degree of formal education. Clinical and social aspects of the findings are discussed with special reference to the role of a general hospitalbased psychiatric unit in a developing country with strictly limited psychiatric facilities.     

Association of high-sensitivity C-reactive protein and odds of breast cancer by molecular subtype: analysis of the MEND study

Breast cancer (BC) in Nigeria is characterized by disproportionately aggressive molecular subtypes. C-reactive protein (CRP) is associated with risk and aggressiveness for several types of cancer. We examined the association of high-sensitivity CRP (hsCRP) with odds of BC by molecular subtype among Nigerian women. Among 296 newly diagnosed BC cases and 259 healthy controls, multivariable logistic regression models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the association between hsCRP and odds of BC overall and by molecular subtype (luminal A, luminal B, HER2-enriched and triple-negative or TNBC). High hsCRP (> 3 mg/L) was observed in 57% of cases and 31% of controls and was associated with 4 times the odds of BC (aOR: 4.43; 95% CI: 2.56, 7.66) after adjusting for socio-demographic, reproductive, and clinical variables. This association persisted regardless of menopausal status and body mass index (BMI) category. High hsCRP was associated with increased odds of TNBC (aOR: 3.32; 95% CI: 1.07, 10.35), luminal A BC (aOR: 4.03; 95% CI: 1.29, 12.64), and HER2-enriched BC (aOR: 6.27; 95% CI: 1.69, 23.25). Future studies are necessary in this population to further evaluate a potential role for CRP as a predictive biomarker for BC.     

African League Against Rheumatism (AFLAR) preliminary recommendations on the management of rheumatic diseases during the COVID-19 pandemic

Objectives

To develop recommendations for the management of rheumatic and musculoskeletal diseases (RMDs) during the COVID-19 pandemic.

Method

A task force comprising of 25 rheumatologists from the 5 regions of the continent was formed and operated through a hub-and-spoke model with a central working committee (CWC) and 4 subgroups. The subgroups championed separate scopes of the clinical questions and formulated preliminary statements of recommendations which were processed centrally in the CWC. The CWC and each subgroup met by several virtual meetings, and two rounds of voting were conducted on the drafted statements of recommendations. Votes were online-delivered and recommendations were pruned down according to predefined criteria. Each statement was rated between 1 and 9 with 1–3, 4–6 and 7–9 representing disagreement, uncertainty and agreement, respectively. The levels of agreement on the statements were stratified as low, moderate or high according to the spread of votes. A statement was retired if it had a mean vote below 7 or a ‘low’ level of agreement.

Results

A total of 126 initial statements of recommendations were drafted, and these were reduced to 22 after the two rounds of voting.

Conclusions

The preliminary statements of recommendations will serve to guide the clinical practice of rheumatology across Africa amidst the changing practices and uncertainties in the current era of COVID-19. It is recognized that further updates to the recommendations will be needed as more evidence emerges.

The effect of demographic and health variables on a modified form of mini-mental state examination scores in nigerian elderly community residents

A culturally relevant form the Mini-Mental State Examination was administered to 502 persons aged 60 years and over living in three locations representing rural and urban settings in southwestern Nigeria. Multivariate statistical methods show that variables like sex, age, education and self-assessed health affect the scores on MMSE. The coefficient alpha for the instrument was low for those with less than complete primary education, but for those with full primary education or more, it gave a value similar to those obtained in some studies in western countries.     

Larval habitats of mosquito fauna in Osogbo metropolis,Southwestern Nigeria

Objective

To determine the larval habitats of mosquito fauna and possible impact of land use/ land cover changes on the epidemiology of mosquito-borne diseases in Osogbo metropolis, Southwestern, Nigeria.

Methods

All accessible larval habitats were surveyed between May and September, 2011 in Osogbo metropolis while Land Use/ Land cover of the city was analyzed using 2 Lansat Multispectral Scanner satellite imagery of SPOT 1986 and LANDSAT TM 2009.

Results

A total of six species namely, Aedes aegypti, Aedes albopictus, Aedes vittatus, Anopheles gambiae complex, Culex quinquefasciatus and Eretmapodite chrysogaster were encountered during the study. The occurrence and contribution of disused tyres was significantly higher (P<0.05) than the other habitats encountered, while there were no significant differences in the contribution of gutters/run-offs, septic tanks/ drums, ground pools/open drains and discarded containers to the breeding of mosquitoes (P>0.05). The accessible land use/ land covered of the study area between 1986 and 2009 showed that the wet land coverage and settlement area increased from 0.19 to 9.09 hectare and 1.00 to 2.01 hectare respectively while the forest area decreased from 60.18 to 50.14 hectare.

Conclusion

The contribution of the habitats coupled with the increasing rate of flooded environment which could provide ample breeding sites for mosquitoes call for sustained environmental sanitation and management in Osogbo metropolis.