University College Hospital Ibadan Research Articles

Statistical Analysis of Breast Cancer Cases in University College Hospital (UCH) Ibadan, Nigeria

Statistical Analysis of Breast Cancer Cases in University College Hospital (UCH) Ibadan, Nigeria

Histopathology of Head and Neck Lymphomas in Ibadan.

Background: Lymphomas are a heterogeneous group of tumors of lymphoid tissue in which there is a malignant proliferation of cells of the lymphatic system. They are the most frequent nonepithelial malignancy in the head and neck region.Objectives: The aim of this study was to evaluate the histological pattern of the disease in the head and neck region and trends in presentation seen in our centerMaterials and Methods: This was a retrospective study of cases of head and neck lymphoma (HNL) seen in the Pathology Department of the University College Hospital Ibadan, Nigeria over a period of 37 years (1981–2017). Information extracted from the records included the sociodemographics of the patients, tumor location, and histological type among others. Data were analyzed and results were presented as frequencies and percentages.Results: There were a total of 373 cases of histologically and/or cytologically diagnosed HNL seen during the study period (an average of 10 cases per year). The mean age of patients was 33.5 ± 21.9 years with male:female ratio of 1.6:1. Most HNL were non-Hodgkin’s lymphomas (NHL), accounting for 91% of cases. Nodal disease was seen in 39% of cases. The bone (prominently, the jaws) predominated (25%) in extranodal lesions. Burkitt’s lymphoma was the most common specific subtype of NHL, occurring in 25.5% of cases.Conclusion: There has been an apparent upward trend in the prevalence of HNL over the past four decades, although other parameters such as age and sex predilection appear unaffected. Factors responsible for this trend need to be interrogated and ascertained.

Pattern and outcome of admission of cancer patients at radiation oncology ward university college hospital Ibadan Nigeria

Background: Cancer is the second leading cause of death globally. Approximately 70% of cancer mortalities occur in low- and middle-income countries like Nigeria largely due to late presentation. Majority of cancer deaths are largely preventable, accessible to screening and early detection. The care of cancer patients on admission is generally known to be time consuming and challenging. Reports on pattern and outcome of admission in cancer patients are scarce in Nigeria. The aim of this study is to provide data on the pattern and outcome of admission on a ward that is solely for the care of cancer patients. Methodology: This is a one-year retrospective study of cancer patients admitted between June 1st 2018 to May 31st 2019. The patients' information was extracted from the ward's admission book and duplicate of the death certificate. Data collected were analysed using the IBM Statistical Package for Social Sciences version 25. Results: A total of 318 admissions were recorded with female preponderance. More than half of the patients admitted were 40 to 59 years old. Majority of the patients 225 (70.8%) came from south western part of the country followed by the south south 55(17.3%). The commonest sites of primary disease were breast 81(25.5%), cervix 74 (23%), head and neck 43 (13.5%), gastrointestinal 49 (12.6%) and genitourinary cancers 23 (7.2%). Most of the patients admitted have stage 4 disease. 127 (39.9%) of the patients died on admission while 191 (60.1%) were discharged. There was statistically significant association between stage 4 disease and increased mortality (p=0.026). Breast cancers accounts for 40(31.5%) of mortality, cervix cancer 31(24.4%), head and neck cancer 16 (12.6%), genitourinary cancer 9 (7.1%), gastrointestinal cancer 6 (4.7%) and skin cancer 6(4.7%). Conclusion: Breast and cervical cancer were the commonest cases admitted. About 40% of the admitted died on the ward. The patients were mostly female in their productive ages.

Survival pattern of rare histological types of breast cancer in a Nigerian institution.

Introductionbreast cancer is the most common cancer affecting women worldwide. It is a heterogeneous disease with diverse histological types that are associated with different natural history and response to therapy. Invasive ductal and lobular carcinoma are the most common histological types. There are rare histological types with different biological behaviours from the common types, although treatment approaches are the same. Data on rare histological types of breast cancer in our population are scarce raising the need to identify these patients and document their treatment outcome. The objectives of this study are to determine the proportion and treatment outcomes of breast cancer patients with rare histological types.Methodsthis was an observational retrospective study using records of patients treated for breast cancer at the University College Hospital Ibadan Nigeria from 2008 to 2012. Patients with rare histological types were selected for further analysis. Data on patient and tumour characteristics were extracted and five-year survival pattern was determined using Kaplan Meier method.Resultsthe total number of patients with breast cancer was 761. Thirty-two (4.2%) had rare histology that consisted of medullary carcinoma 14(1.9%), mucinous carcinoma 10(1.4%) and 2(0.3%) each for squamous cell carcinoma, stromal sarcoma, cribriform carcinoma and Paget's disease. The overall five-year survival was 50% with median survival of 52 months.Conclusionthe proportion of breast cancer patients with rare histology is low similar to other reports among Caucasians. Medullary adenocarcinoma was the most common subtype followed by mucinous adenocarcinoma.

Assessment of Waste Management Practice in Health Institution: A Case Study of University College Hospital Ibadan, Nigeria

Efficient management of medical waste is a necessity because of great risk improper/poor waste management posed to the populace. This study assessed medical waste management practice in University College Hospital Ibadan, Nigeria. Those that improper waste management can affect are identified as the sample frame, and they are health workers, waste handlers, out-patients and residents. Sample size of 5% of the 3000 staff strength of the study area was adopted which amounted to one hundred and fifty (150) respondents. A multistage sampling technique was adopted in the sample selection and the administration of the questionnaires until all copies of questionnaire assigned for each category of respondents were administered. Nine indices were developed, these were: Waste Collection Index (WCI), Waste Storing Index (WSI), Waste Treatment Index (WTI), Facility Condition Index (FCI), Medical Waste Index (MWI), Storage Factor Index (SFI), Waste Effect Index (WEI), Waste Preventive Index (WPI) and Health Workers Satisfactory Index (HSI).The study observed that punctured proof container has WCI of 4.49; lidded container has the highest WSI of 4.56, while compositing and landfill has the highest WTI of 3.67. Gloves and head cap have the highest and lowest FCI with 4.40 and 1.00 respectively. Infectious waste is the major generated waste in the study with MWI of 4.46 and offensive odour with highest WEI of 3.77 while good accessibility has the highest SFI of 4.53. A major preventive measure as perceived the respondents is enforcement of regulation with WPI of 4.16 while workers’ welfare has the highest HSI of 3.57.For proper medical waste management practice, therefore, there should be an incentive package for health workers and adequate fund should be provided to carry out this proper management from on-site to off-site disposal. Time-to-time training for waste handlers in order to keep them abreast of the recent risk involved or update about medical waste and waste management policy should be re-assessed and reviewed where necessary so as to keep it up-to date.

Relative frequencies of odontogenic cysts and their protein and glucose content


 Background: Odontogenic cysts are derived from remnants of odontogenic apparatus entrapped within jawbones. The diagnosis of cysts is based on histology features; however, these features are not clear-cut in many cases, except for a few like OKC and Calcifying Odontogenic cyst. The knowledge of the content of these cysts may assist in the differentiation and diagnosis of the cysts. This study reviewed the pattern of jaw cysts presentation and further analyzed the glucose and protein contents of some odontogenic cysts among them. The findings from our local environment were compared with findings globally as regards jaw cysts.
 Methods: Aretrospective search of the departmental records of Oral and Maxillofacial Surgery and Oral Pathology of the University College Hospital Ibadan was done from the year 2010 to 2017 for jaw cysts. The cystic content of odontogenic cysts was analyzed prospectively from 2016 to 2017 for total protein, albumin and glucose. Some cases of unicystic ameloblastoma were included because as at the time of obtaining the aspirate the working diagnosis was jaw cyst. Total protein, albumin and glucose estimations of the cysts were done by Biuret, Bromocresol Green and Glucose Oxidase methods respectively. The literature search was done on PubMed, using the keywords cysts, jaw cysts, odontogenic cysts, protein, albumin, glucose content.
 Results: 1,156 lesions were diagnosed within the study period of 7 years, among which 45 lesions (3.9%) were jaw cysts of odontogenic origin. Collectively the mean age at presentation was 30.8 (SD ± 17.2) years while it was 32.7 (SD±14.4), 21.6 (SD±14.6) and 40.1 (SD±24.0) years for radicular cyst, dentigerous cyst and OKC respectively. The mean concentration of total protein was highest in radicular cysts (6.2g/dL) compared with the dentigerous cysts.
 Conclusion: Radicular cyst is the most common odontogenic cyst followed by the dentigerous cyst. The radicular cyst favours the anterior maxilla while the dentigerous cyst favours the posterior mandible. Caution should be exercised when interpreting the results of protein estimation of odontogenic cystic fluids.
 

Relative Frequencies of Odontogenic Cysts and their Protein and Glucose Content

Background: Odontogenic cysts are derived from remnants of odontogenic apparatus entrapped within jawbones. The diagnosis of cysts is based on histology features; however, these features are not clear-cut in many cases, except for a few like OKC and Calcifying Odontogenic cyst. The knowledge of the content of these cysts may assist in the differentiation and diagnosis of the cysts. This study reviewed the pattern of jaw cysts presentation and further analyzed the glucose and protein contents of some odontogenic cysts among them. The findings from our local environment were compared with findings globally as regards jaw cysts.
 Methods: Aretrospective search of the departmental records of Oral and Maxillofacial Surgery and Oral Pathology of the University College Hospital Ibadan was done from the year 2010 to 2017 for jaw cysts. The cystic content of odontogenic cysts was analyzed prospectively from 2016 to 2017 for total protein, albumin and glucose. Some cases of unicystic ameloblastoma were included because as at the time of obtaining the aspirate the working diagnosis was jaw cyst. Total protein, albumin and glucose estimations of the cysts were done by Biuret, Bromocresol Green and Glucose Oxidase methods respectively. The literature search was done on PubMed, using the keywords cysts, jaw cysts, odontogenic cysts, protein, albumin, glucose content.
 Results: 1,156 lesions were diagnosed within the study period of 7 years, among which 45 lesions (3.9%) were jaw cysts of odontogenic origin. Collectively the mean age at presentation was 30.8 (SD± 17.2) years while it was 32.7 (SD±14.4), 21.6 (SD±14.6) and 40.1 (SD±24.0) years for radicular cyst, dentigerous cyst and OKC respectively. The mean concentration of total protein was highest in radicular cysts (6.2g/dL) compared with the dentigerous cysts.
 Conclusion: Radicular cyst is the most common odontogenic cyst followed by the dentigerous cyst. The radicular cyst favours the anterior maxilla while the dentigerous cyst favours the posterior mandible. Caution should be exercised when interpreting the results of protein estimation of odontogenic cystic fluids.

Prevalence and determinants of depression among patients with hypertension: A cross-sectional comparison study in Ghana and Nigeria.

Despite evidence linking depression to poor blood pressure (BP) control and increased hypertension-related morbidity and mortality, there is paucity of data about depression among patients with hypertension in sub-Saharan Africa. We assessed factors associated with depression among patients with hypertension in Ghana and Nigeria. Patients with hypertension were recruited from four hospitals: In Ghana, Korle Bu Teaching Hospital (n = 120), and in Nigeria, the University of Port Harcourt Teaching Hospital, the Lagos State General Hospital, and the University College Hospital Ibadan (n = 237). Demographic, socioeconomic, psychosocial, and clinical factors which predicted depression among the study cohort were assessed by logistic regression. Depression and beliefs about medications were assessed with the Patient Health Questionnaire (PHQ-9) and the Beliefs about Medication Questionnaire, respectively. Depression was regarded as PHQ-9 score >4. The mean ages of the Ghanaian and Nigerian cohort were 57.0 ± 13.7 years (58.3% female) and 56.4 ± 12.9 years (57.0% female), respectively. Prevalence of depression was 41.7% and 26.6% among the Ghanaian and Nigerian cohorts, respectively. Significant predictors of depression in the Nigerian cohort were age in years [OR 0.97 (0.95-0.99)], concern about medications [OR 1.15 (1.03-1.30)], and poor BP control [OR 2.06 (1.09-3.88)]. Young age was the only independent predictor of depression in the Nigerian cohort. In the Ghanaian cohort, none of the factors significantly predicted depression. Prevalence of depression is high among patients with hypertension in Ghana and Nigeria. Screening and treatment of depression among patients with hypertension in Ghana and Nigeria may have important implications for improving outcomes.

Palliative external beam radiotherapy for advanced breast cancer patients with brain metastasis in the university college hospital Ibadan.

Background:Brain metastasis is a dreaded complication that significantly reduces the quality of life in breast cancer patients. The treatment options are limited by the inability of many chemotherapeutic agents to cross the blood–brain barrier. Surgery also has a limited role, except in few selected patients with oligometastasis. Therefore, whole-brain radiotherapy (WBRT) remains the available option that gives a gratifying result. However, the benefit of this treatment modality in our resource-poor environment needs to be investigated.Materials and Methods:The data of breast cancer patients with brain metastasis who were treated with WBRT using cobalt-60 equipment between 2005 and 2009 were retrospectively collected from the departmental medical record unit. The information extracted included biodata, presenting symptoms, imaging modality for confirmation of brain metastasis, treatment records, performance status pre-WBRT and 4 weeks post-WBRT, and other supportive treatments.Results:A total of 52 female patients were reviewed between 2005 and 2009. The mean age of patients was 44.7 years. The common clinical features on presentation were headache, nausea, and visual impairment in 30.8% of patients with the WHO performance status score ranging between 2 and 4. Patients with more than three brain deposits accounted for 71.2% of all the brain metastases. The mean radiation dose used for WBRT was 30 Gy in 10 fractions, and total responses recorded were 86.5% with 53.8% complete improvement in patients' performance status 4 weeks after WBRT treatment.Conclusion:WBRT is an effective treatment modality for patients with brain metastasis in our resource-poor environment. However, improvement of patients' performance status declined with advancing age.

Acquired Clitoromegaly Cyst: Consequence of Persistent Unorthodox Practice in the 21st Century

Objective: To present case report a patient with clitoral cyst, following type II female genital cutting performed in childhood, management and literature review. Design: Report of cases managed and review of available current literatures. Setting: University College Hospital Ibadan. Patients: The case was a 30 year old Para 2+0 , 2 alive, known hypertensive, with perineal swelling since childhood. She presented 30 years later with increasing size of the clitoral swelling associated with pain. Management: Surgical excision of the cyst following thorough evaluation of the patients. Results: Better cosmetic outcome, vulvar discomfort subsided and improved sexual satisfaction post-operatively. Conclusion: While a good cosmetic and stoppage of vulvar discomfort can be managed with acceptable outcomes, these case, again, brings to attention of persistence of unacceptable female genital cutting with attendant effects even in the 21st century. Also, to let us know that there is need for more and continuous awareness creation of the need to stop this dehumanizing practice, of female genital cutting, which is of no health importance, rather numerous adverse sequelae.

Effects of Vitamin D3 Supplementation on Antioxidant Status and Lipid Peroxidation Product in Preeclamptic Women

Background: O xidative stress plays a causative role in the pathophysiology of preeclampsia. This study aime d at assessing the effects of vitamin D supplementation on the antioxidant status and lipid peroxidation product of preeclamptic women. Methods: Ninety women between ages of 18 and 35 were recruited at 22weeks gestation from antenatal Clinic in Obstetrics and Gynecology Department of University College Hospital Ibadan, and Adeoyo Maternity Clinic, Yemetu, Nigeria. 30 normotensive pregnant women were grouped into Group A, and 60 preeclamptic women randomly grouped into Group B and Group C. Group C was given 1000IU/day of Vitamin D3 for 8weeks after recruitment at 22 weeks. Serum concentration of antioxidants were done by standard methods at 22 weeks, 30 weeks after supplementation and postpartum in all groups. They were followed up 3 - 7days postpartum, and obstetric data collected. Statistical analysis was done by using Statistical Package for Social sciences (SPSS) soft version 17 .0. Results: There was no significant difference (p>0.05) in gestational age at delivery, weight of fetus between the three group s, while there was a significant increase (p<0.05) in BMI, systolic and diastolic blood pressure in group B and C. The level of Malonaldehyde (MDA) was significantly higher (p<0.05), while SOD, GPX and catalase were lower in the preeclamptic groups at 2nd trimester when compared with control. After supplementation the MDA levels reduced significantly (p<0.05), while SOD, GPX and catalase increased significantly (p<0.05) in 3rd trimester and postpartumly in the supplemented group when compared with non - supplemented group. Vitamin C levels were not statistically different (p>0.05) at 2nd, 3rd trimester and postpartum, while Vit. E was significantly reduced (p<0.05) at the 3rd trimester in the control group. The level of Vit. E was significantly increased (p<0 .05), while Vit. C level was not statistically different (p>0.05) at 2nd trimester in the PE groups when compared with control. After supplementation, a significant increase (p<0.05) occurred in Vit. E, while Vit. C level was not statistically different (p >0.05) when compared with the non - supplemented PE group.Conclusion: Vitamin D supplementation is important in improving the antioxidant status in Preeclampsia.

Defining apolipoprotein B treatment targets.

Apolipoprotein B (apo B) has been widely reported to be a better predictor of cardiovascular risk than low-density lipoprotein cholesterol (LDL-C). This is the reason apo B treatment target values based on the equivalence to LDL-C values in healthy population has been advocated using percentiles from population studies. The aim of this study was to determine the apo B values equivalent to currently used medical decision targets for LDL-C concentration in a population of healthy Nigerians and examine for any demographic influence. A total of 252 apparently healthy individuals (89 males, 163 females), between the ages of 30 and 65 years were selected from core health workers (medical and nursing staffs) of University College Hospital Ibadan between December 2015 and May 2016. Serum lipids and apo B were measured using enzymatic and immunoturbidimetry method, respectively. The mean apo B of the study population were 94 and 98 mg/dL in men and women, respectively. Mean apo B concentration was significantly higher in the female participants in the age groups above 55 years. LDL-C concentrations of 100, 130, 160, and 190 mg/dL corresponded to the 15th, 55th, 87th, and 95th percentile, respectively. The corresponding apo B concentrations were 73 mg/dL (15th percentile), 95 mg/dL (55th percentile), 124 mg/dL (87th percentile), and 145 mg/dL (95th percentile). The group of participants with LDL-C of <130 mg/dL and the group with equivalent apo B of <95 mg/dL has the same clinical and biochemical characteristics in both men and women. This study has defined apo B targets that may potentially be used to guide the initiation of therapy in persons with dyslipidemia. It has also demonstrated the population level relationship that exists between apo B and LDL-cholesterol and has shown the gender and age-related influence of apo B distribution in the population.

Profile of Obstetrics Fistula Clients; is the trend changing?

Aims: To assess the changes in the profiles of obstetric fistula clients.&#x0D; Methods: This was a retrospective review of the medical records of all obstetric fistula clients managed by the Oyo state fistula team at University College Hospital and Adeoyo Maternity Hospital Ibadan, Nigeria. A proforma was used to extract information on socio-demographic and obstetric characteristics of clients and was analyzed using SPSS 25.0. Level of significance was set at P &lt;0.05.&#x0D; Results: The median age and number of pregnancy with occurrence of fistula were 34 years and 2 respectively. Above a quarter (32.2%) had at least secondary level of education, three quarter (75.2%) were currently married and about half were traders. Only 20 (22%) booked the pregnancy that resulted in fistula with 44 (44.9%) delivering through cesarean section. Majority 70 (72.9%) of the fetuses were stillbirth.&#x0D; Conclusions: The widely held believe of a typical obstetric patient still holds but substantial cases of fistula occurred in multiparous women and at older age.

Health Related Quality of Life of Women With Cervical Cancer in the University College Hospital Ibadan, Nigeria

Background: Cancer worldwide accounts for 13% annual death with 8.2 million deaths. Cancer and cancer treatment affects different domains of functioning and the quality of life (QoL) of affected clients. However, there is dearth of information on impacts of cancer and cancer treatment on the different domains of functioning. Aim: This study assessed the health related- QoL of women diagnosed with cervical cancer at the University College Hospital (UCH) Ibadan, Nigeria to provide more information on the impact of cervical cancer treatment on the health status of the women. Methods: The study adopted a descriptive, cross sectional design. A consecutive sampling method was used for data collection from consenting participants over a period of three months. Ethical approval was obtained from the Joint University of Ibadan/UCH ethical review committee. Subsequently, permission was sought from heads of department and charge nurses. Two standardized research instruments (EORTC QLQ30 and EORTC CX24) and a self-structured sociodemographic page were used for data collection. Management of data were performed using SPSS version 20. The levels of QoL and functioning were calculated using EORTC QLQ30 and EORTC CX24 formulae and these levels were categorized as low (0-49) and high (50-100). χ2 statistics was used to determine the association between level of functioning and QoL at 5% level of statistical significance. Results: A total of 57 respondents participated fully in the study. With mean age of 55.0 ± 11.2 years. Overall, 28 (49.1%) had high QoL score while 21 (36.8%) had a high level of functioning. Furthermore, frequencies of women with high level of functioning scores in the different domain are as follows: physical functioning 29 (50.9%), emotional functioning 30 (52.6%), cognitive functioning 37 (64.9%), role functioning 17 (29.8%) and social functioning 15 (26.3%). There was significant association between overall functioning and QoL at P &lt; 0.05. Conclusion: In view of the findings, with very few people having high level of role functioning and social functioning, specific attention should be given to specific domains of level of functioning in planning interventional strategies for management of treatment effects.

Comparative analysis of dietary pattern, anthropometry and serum ascorbate status of persons living with or without non-Hodgkin's lymphoma.

Recent upsurge of cancer cases across the globe is of concern to all and many studies shows the relationship between nutrient and the immune system and consequently cancer. This work aims to compare the dietary pattern, anthropometry and serum ascorbate status of the persons living with and those living without non-Hodgkin’s lymphoma (NHL). A case-control study was conducted using blood samples of eight patients diagnosed for NHL at the University College Hospital (UCH) Ibadan, while eight (8) volunteers were the control group. Socio-economic characteristics, medical history, food preferences, anthropometric indices were retrieved from questionnaires. Ascorbic Serum assay done with ultraviolet absorption spectrophotometry method using Klett-summerson photoelectric. Students’ t-test and Chi-square were used to test the educational levels fruit consumption. 25% of the respondents suffering from NHL skipped lunch and dinner, but none skipped breakfast. 66.67% of the cases and 100% of the control have their weight normally distributed. Cases had 11.11% slightly underweight and 11.11% obese. 25% of the population of the respondents had normal range of 0.4 mg/100 of serum ascorbate, while six had low serum ascorbate levels.

Human Beta Defensin 1 (hbd1) Levels in Sputum and Lysate of Mononuclear Blood Cells of Drug-Sensitive and Drug-Resistant Pulmonary Tuberculosis Patients Attending a Tertiary Hospital in Ibadan, Nigeria.

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Effect of tranexamic acid on coagulation and fibrinolysis in women with postpartum haemorrhage (WOMAN-ETAC): a single-centre, randomised, double-blind, placebo-controlled trial

Background: Postpartum haemorrhage (PPH) is a leading cause of maternal death. The WOMAN trial showed that tranexamic acid (TXA) reduces death due to bleeding in women with PPH. We evaluated the effect of TXA on fibrinolysis and coagulation in a sample of WOMAN trial participants. Methods: Adult women with a clinical diagnosis of PPH were randomised to receive 1 g TXA or matching placebo in the WOMAN trial. Participants in the WOMAN trial at University College Hospital (Ibadan, Nigeria) also had venous blood taken just before administration of the first dose of trial treatment and again 30 (±15) min after the first dose (the ETAC study). We aimed to determine the effects of TXA on fibrinolysis (D-dimer and rotational thromboelastometry maximum clot lysis (ML)) and coagulation (international normalized ratio and clot amplitude at 5 min). We compared outcomes in women receiving TXA and placebo using linear regression, adjusting for baseline measurements. Results: Women (n=167) were randomised to receive TXA (n=83) or matching placebo (n=84). Due to missing data, seven women were excluded from analysis. The mean (SD) D-dimer concentration was 7.1 (7.0) mg/l in TXA-treated women and 9.6 (8.6) mg/l in placebo-treated women (p=0.09). After adjusting for baseline, the D-dimer concentration was 2.16 mg/l lower in TXA-treated women (-2.16, 95% CI -4.31 to 0.00, p=0.05). There was no significant difference in ML between TXA- and placebo-treated women (12.3% (18.4) and 10.7% (12.6), respectively; p=0.52) and no significant difference after adjusting for baseline ML (1.02, 95% CI -3.72 to 5.77, p=0.67). There were no significant effects of TXA on any other parameters. Conclusion: TXA treatment was associated with reduced D-dimer levels but had no apparent effects on thromboelastometry parameters or coagulation tests. Registration: ISRCTN76912190 (initially registered 10/12/2008, WOMAN-ETAC included on 22/03/2012) and NCT00872469 (initially registered 31/03/2009, WOMAN-ETAC included on 22/03/2012).

Effect of tranexamic acid on coagulation and fibrinolysis in women with postpartum haemorrhage (WOMAN-ETAC): a single-centre, randomised, double-blind, placebo-controlled trial.

Background: Postpartum haemorrhage (PPH) is a leading cause of maternal death. The WOMAN trial showed that tranexamic acid (TXA) reduces death due to bleeding in women with PPH. We evaluated the effect of TXA on fibrinolysis and coagulation in a sample of WOMAN trial participants. Methods: Adult women with a clinical diagnosis of PPH were randomised to receive 1 g TXA or matching placebo in the WOMAN trial. Participants in the WOMAN trial at University College Hospital (Ibadan, Nigeria) also had venous blood taken just before administration of the first dose of trial treatment and again 30 (±15) min after the first dose (the ETAC study). We aimed to determine the effects of TXA on fibrinolysis (D-dimer and rotational thromboelastometry maximum clot lysis (ML)) and coagulation (international normalized ratio and clot amplitude at 5 min). We compared outcomes in women receiving TXA and placebo using linear regression, adjusting for baseline measurements. Results: Women (n=167) were randomised to receive TXA (n=83) or matching placebo (n=84). Due to missing data, seven women were excluded from analysis. The mean (SD) D-dimer concentration was 7.1 (7.0) mg/l in TXA-treated women and 9.6 (8.6) mg/l in placebo-treated women (p=0.09). After adjusting for baseline, the D-dimer concentration was 2.16 mg/l lower in TXA-treated women (-2.16, 95% CI -4.31 to 0.00, p=0.05). There was no significant difference in ML between TXA- and placebo-treated women (12.3% (18.4) and 10.7% (12.6), respectively; p=0.52) and no significant difference after adjusting for baseline ML (1.02, 95% CI -3.72 to 5.77, p=0.67). There were no significant effects of TXA on any other parameters. Conclusion: TXA treatment was associated with reduced D-dimer levels but had no apparent effects on thromboelastometry parameters or coagulation tests. Registration: ISRCTN76912190 (initially registered 10/12/2008, WOMAN-ETAC included on 22/03/2012) and NCT00872469 (initially registered 31/03/2009, WOMAN-ETAC included on 22/03/2012).

Abstract 640: Histopathologic and molecular features in a subset of pilocytic astrocytomas in a tertiary African hospital

Abstract Background: Pilocytic astrocytomas are WHO grade I astrocytomas. Worldwide, they have been documented to be the second most common gliomas after WHO grade IV glioblastomas. Definitive diagnosis may be made with traditional hematoxylin and eosin. Increasingly, a number of cases are atypical deceptive in clinical and histopathologic presentation, requiring ancillary immunohistochemical and molecular studies. This study evaluated a subset of pilocytic astrocytomas at the University College Hospital Ibadan. Nigeria. Methods: All cases of Pilocytic Astrocytomas were identified retrospectively within our institutional database over a 12-year period. Inclusion criteria was by availability of the FFPE block. Astrocytic origin was confirmed by GFAP immunohistochemistry; previously stained hematoxylin and eosin slides were reviewed with newly re-sectioned hematoxylin and eosin stained slides along with ancillary Ki-67/MIB immunohistochemistry labelling index. ATRX immunohistochemistry was carried out on all re-sectioned slides. Tissue scrolls were taken for DNA extraction and pyro-sequencing for BRAFV600E BRAF mutation using a Qiagen pyrosequencer. This work was carried out in the molecular neuropathology laboratory at the Texas Children's Hospital, Houston Texas. Results were analyzed using SPSS version 24. Results: 40 cases (30.7%) of all astrocytic neoplasms were documented over this 12-year period. 23(57.5%)of these cases were suitable for analysis in this study. Males accounted for 65.2% of cases. Male: female ratio was 1:0.5. The mean age of all the cases was 14.22+/- 12.90 years, median age of 8 years with an age range of 42 years. 65.2% of all cases were within the 0-15-year age group, 17.4% were within the 16 - 30-year age group while the remaining 17.4% were within the 31 - 45-year age group. Most cases occurred infratentoriallysupratentorially (69.6%). The cerebellum was the commonest location accounting for 47.8%, followed by the supra-sellar region (17.4%). Most cases were centrally sited (47.8%). All cases (100%) showed positive ATRX expression. 3 cases (20%) of BRAF V600E expression were recorded. This included 1 case with malignant/anaplastic features which was previously misdiagnosed as a glioblastoma with suggestive radiologic imaging. Mean age of tumors with BRAF positive expression was 13.95 +/- 12.95years, while the mean age for BRAF negative cases was 17.00 +/-16.97 years. The difference between these ages was not statistically significant. Limitations: The quality of available blocks limited DNA amplification and further analysis in 8 of the cases. Conclusion: This study aims to underscores the importance of BRAF V600E mutations among pilocytic astrocytomas in our environment with regards to its diagnostic and prognostic significance. Citation Format: Michael C. Nweke, Gabriel O. Ogun, Clement A. Okolo, Amos D. Adeleye, Adekunle M. Adesina. Histopathologic and molecular features in a subset of pilocytic astrocytomas in a tertiary African hospital [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 640.

Sexual behavioural correlates of herpes simplex virus type 2 infections among pregnant women in South-western Nigeria

Background: Herpes simplex virus type 2 (HSV-2) is the most common cause of genital ulcer disease. It leads to lifelong latent infection and this raises concerns among women of reproductive age, considering the risk of neonatal transmission. This study was undertaken to identify the sexual behavioural correlates of HSV-2 infection as well as negative pregnancy outcomes.Methods: The cross-sectional study was conducted between March and August 2013, in the antenatal clinic of the University College Hospital Ibadan. A total of 270 pregnant women aged 20 to 44 years were enrolled and their serum samples were tested for HSV-2 IgG using type specific third generation ELISA (DIAPRO Milano Italy). Pretested validated questionnaire were used to obtain bio-data, sexual behaviour and obstetrics history of the participants. Data analyses was done using SPSS version 20.Results: The seroprevalence of HSV-2 type specific IgG was 33.3% (90/270). Logistic regression analysis showed that multiple lifetime sexual partners, early age at sexual debut, previous history of sexually transmitted infections (STIs) and having spouses whose work keep them away from home, were independent risk factors for HSV-2 infection. Obstetrics complications such as intrauterine foetal death, congenital malformations and spontaneous abortion were also strongly associated.Conclusions: The predictors of HSV-2 infection in this study may be important in selecting candidates for screening tests and developing strategies towards effective health promotion campaign.