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   Table of Contents - Current issue
Coverpage
July-December 2018
Volume 9 | Issue 2
Page Nos. 99-185

Online since Monday, November 19, 2018

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REVIEW ARTICLE  

A review of epidemiology and management of multiple myeloma in a resource poor country Highly accessed article p. 99
Adedoyin O Dosunmu, Akinsegun A Akinbami, Ebele Uche
DOI:10.4103/atp.atp_8_18  
Multiple myeloma (MM) is a B-cell malignancy characterized by clonal proliferation of terminally differentiated B lymphocytes. Rational use of proteasome inhibitors, immunomodulators, anti CD38 or CD 138, and tandem autologous stem cell transplant have improved 5-year overall survival beyond 50% in advanced countries. However, the disease prevalence is probably highest in Sub-Saharan Africa where diagnostic and treatment facilities are lacking. The authors have reviewed published articles on epidemiology and outcomes of MM in Nigeria in the light of international recommendations with the aim of suggesting adaptable practices in a resource-poor environment. Publications from Nigeria were obtained from search engines such as Google Scholar and PubMed while recent guidelines were obtained from websites of the National Comprehensive Cancer Network and Medscape Oncology. The mean age at presentation ranged between 54 and 62 years, and there was a higher prevalence among males (ratio 1.1: 1–4.4: 1). A study in Nigeria found an increased incidence in oil-producing areas. In earlier publications between 2005 and 2007 years, about a quarter of patients could not afford treatment and most of the patients presented in advanced stages of the disease. During that period, the mean survival was 7 months and only 13.3% lived beyond 2 years. The treatment then was based on either melphalan ± prednisolone or combination of vincristine, adriamycin, and dexamethasone. By 2012/14, thalidomide, bortezomib, biphosphonates, radiotherapy, and renal dialysis were introduced with a mean survival of 4 years. Optimization of available facilities would, therefore, improve the disease-free survival.
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ORIGINAL ARTICLES Top

Prevalence and distribution of high risk human papillomavirus subtypes in invasive cervical cancer in South-West Nigeria Highly accessed article p. 106
Nnamdi Obumneme Orah, Adekunbiola Aina Banjo
DOI:10.4103/atp.atp_42_18  
Context: Despite the high incidence of cervical cancer in Nigeria, there are only a few large scale population based studies on HPV prevalence and genotype distribution. Aims: This study was carried out to determine the prevalence and distribution of human papillomavirus (HPV) types in invasive cervical cancer (ICC) in Nigeria. Settings and Design: Cross sectional period prevalence study. Methods and Material: Paraffin embedded tissue blocks of two hundred and thirty five archival cervical cancers diagnosed in three participating laboratories from South West Nigeria were analyzed for the presence of HPV DNA. Statistical Analysis: Data analysis was performed with the Statistical Package STATA 10. Results: Of the one hundred and eighty seven samples that were considered appropriate for HPV detection after histological evaluation 160 (85.6%) were positive for HPV DNA. The five most common types identified as single types among HPV positive cases were HPV16 (46.9%), HPV18 (19.4%), HPV45 (11.9%), HPV35 (5.0%), and HPV31 (3.1%). Others were HPV33, 39, 51, 52, 56, 58, 59, 66, and 68. HPV16 and 18 in single/multiple infections accounted for 69.4% of the samples. Multiple infections were detected in 4.4%. All the adenosquamous and neuroendocrine carcinomas tested positive for HPV, while 86.1% and 66.7% of the squamous cell and the adenocarcinomas were positive, respectively. Conclusion: These results are in consonance with reports from all other parts of the world that HPV16 and 18 accounts for almost 70% of cervical cancers, supporting data that effective vaccination against these two types will reduce the cervical burden in South West Nigeria.
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Pattern of diseases in human immunodeficiency virus/AIDS patients in Lagos University Teaching Hospital: A 1-year prospective autopsy study p. 111
Izuchukwu Benerdin Achusi, Solomon Raphael, Awodele Nicholas Awolola, Fatima Biade Abdulkareem, Adekunbiola AF Banjo, Stephen O Ojo
DOI:10.4103/atp.atp_19_18  
Background and Objective: Nigeria has the second largest number of individuals living with human immunodeficiency virus/AIDS (HIV/AIDS) in the world after South Africa and contributes about 9% of the global HIV burden. It has also been estimated that there are 336,379 annual new HIV infections and about 192,000 of these individuals die of HIV/AIDS annually in Nigeria. Yet, there is a paucity of autopsy data among HIV/AIDS deaths in Nigeria. The objective of this study was to describe autopsy findings in HIV/AIDS cases in Lagos University Teaching Hospital (LUTH), a tertiary health center in Southwest Nigeria, which has one of the highest autopsy rates in the country. Materials and Methods: This 1-year prospective descriptive study included all HIV-1- and HIV-2-positive cases referred for autopsy examination at the Anatomic and Molecular Pathology Department of LUTH, Lagos, Nigeria. The study population included HIV-positive cases of all ages and sex. Results: Seven hundred and fifty-four autopsies were performed over the study period giving an autopsy rate of 33.1%. Forty-four patients (21 males and 23 females) were found to be HIV positive representing a prevalence of 5.8%. Of these, 23 (53.3%) cases were diagnosed antemortem, while 21 (47.7%) were diagnosed in the autopsy room. The patients' age ranged from 6 h to 69 years with a median age of 34 years. Infections were seen in 27 (61.4%) cases, out of which 13 (48.1%) were AIDS defining infections: 8 (18.2%) of them had tuberculosis, 2 (4.5%) cases of nontuberculous bacterial pneumonia, 1 (2.3%) case each of cryptococcosis, Pneumocystis jiroveci pneumonia, and progressive multifocal leukoencephalopathy (2.3%). Two (4.5%) patients had neoplasms (one case each of non-Hodgkin lymphoma and pleomorphic sarcoma). Miscellaneous causes of death included hypertensive heart disease, perforated strangulated right inguinal hernia, perforated ileoileal intussusceptions, and penetrating perineal injury. Conclusion: This study showed a demographic pattern of HIV infection comparable with previous national surveillance data, but a higher HIV seroprevalence than the most recent national surveillance data. Opportunistic infections were the most common cause of mortality in HIV infection and about half of HIV infected persons presented to the autopsy room undiagnosed.
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A 10-year review of thyroid lesions in a tertiary hospital in Abuja, Nigeria p. 118
Said Mohammed Amin, Zabah Muhammad Jawa, Jibrin Paul Gowon, Olah Friday George, Yau A Gagarawa, Owoicho Ikwu Eiyeje
DOI:10.4103/atp.atp_21_18  
Introduction: Thyroid lesions are reputed to be the second most common of all endocrine lesions (next to diabetes mellitus) and thyroid cancer is reported to be the 16th commonest cancer globally. This study reviewed the spectrum and scope of thyroid lesions encountered in a tertiary hospital in Nigeria over a decade. Setting: National Hospital Abuja (NHA) is a 450-bed tertiary public hospital located in the cosmopolitan city of Abuja the capital of Nigeria. Materials and Methods: This is a retrospective analytic study involving the entire thyroid specimen received in the department of histopathology from 1st January 2007 to 31st December 2016. Results: Our study demonstrated that thyroid pathologies are commoner in females than males with a ratio of 6:1. Papillary thyroid carcinoma and follicular adenoma are the commonest malignant and benign tumours respectively. Conclusion: Thyroid diseases are common cause of morbidity in our environment. The commonest malignant thyroid disease in NHA is the papillary carcinoma.
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Histopathology quality assurance: A general survey of physicians' satisfaction in Nigeria p. 121
Raymond Akpobome Vhriterhire, Joseph Aondowase Ngbea, Theophilus Ugbem, Ayuba Dauda, Olushola Jegede, Daniel Yakubu, Aaron Amos
DOI:10.4103/atp.atp_11_18  
Background: The monitoring of clients' satisfaction is paramount to the success of a quality assurance scheme in a histopathology laboratory, from the accessioning of specimens to the delivery of the reports to physicians. This study was designed to determine the levels of physician satisfaction with certain aspects of pathologists' report including accuracy, content, and turnaround time (TAT) in Nigeria. Materials and Methods: Self-administered questionnaires were given to physicians from six hospitals with on-site pathology laboratories. The respondents were required to grade their responses as very satisfied, satisfied, undecided, dissatisfied, and very dissatisfied, on the report accuracy, report completeness, report timeliness, and ease of access to a pathologist, on a Likert-like scale. Results: There were 251 respondents consisting of 197 males, 50 females, and 4 who declined to disclose their gender. The respondents gave a total of 1198 responses. These included very satisfied (54, 4.5%), satisfied (580, 48.4%), undecided (290, 24.2%), dissatisfied (236, 19.7%), and very dissatisfied (38, 3.2%). Physicians from surgery specialty were the mostly contented with histopathology services (19.2 satisfaction rate, n = 1155), followed by responses from obstetrics and gynecology (15.2) and pediatrics (7.3). The specialty of the physician has no statistical influence on levels of satisfaction. Physicians were most satisfied with the diagnostic accuracy of reports (26.7%, n = 634) and least satisfied with report timeliness (12.8%, n = 634). Conclusion: This cross-sectional survey of levels of physician's satisfaction with histopathology service in different hospitals in Nigeria suggests that even though most express satisfaction with the accuracy of reports, there remains low satisfaction with TAT.
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Adenocarcinoma of the prostate: Correlation between serum prostate-specific antigen and Gleason grade group p. 126
Murtala Abubakar, Sani Mohammed Shehu, Saad Aliyu Ahmed, Almustapha Aliyu Liman, Karo Christopher Akpobi, Ahmed Mohammed, Umar Mohammed, Shehu Abdullahi, Dauda Eneyamire Suleiman, Balarabe Kabir
DOI:10.4103/atp.atp_28_18  
Introduction: Serum prostatic-specific antigen (PSA) concentration determination has established itself as the leading tool in screening for, as well as in estimating the prognosis of, adenocarcinoma of the prostate. This prognostication is usually done in conjunction with the Gleason score and other prognostic indices. The aim of this study was to determine the association between serum PSA concentration and the new (2016 modified) Gleason grade group of tumor among patients with adenocarcinoma of the prostate. Study Design: A retrospective, analytic study. Study Setting: Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria. Study Period: January 2006 to December 2013. Materials and Methods: A total of 211 patients with biopsy-based diagnosis of adenocarcinoma of the prostate were studied. Each of the cases was graded using the (2016 modified) Gleason grading system. Prebiopsy serum PSA concentration in each of the patients was retrieved from either the patient's case records in the Urology Unit of the hospital or from the values filled in by the requesting surgeon. Gleason grade groups of patients were correlated with serum PSA concentration. Results: Gleason grade group 1 was most common in our study with 68 (32.2%) of our patients falling within that category. The study revealed a statistically significant relationship between the serum PSA concentration and the Gleason grade group of cancer (P = 0.00). Conclusion: This study concluded that the serum PSA concentration has a statistically significant association with the Gleason grade group of the tumor in prostatic adenocarcinoma patients. Therefore, patients with high serum PSA concentrations are likely to have high tumor grade group.
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Pattern of patients presentation with metastatic breast cancer for palliative external beam radiotherapy in the University College Hospital Ibadan p. 131
Hassan Ibrahim, Adoke Kasimu Umar
DOI:10.4103/atp.atp_36_18  
Background: Breast cancer is the most common cancer among Nigerian women. In Nigeria and indeed Africa as a continent, majority of patients present to the hospital with advanced diseases. This event is a major source of morbidity and mortality in our poor-resource setting and can significantly decrease patient's quality of life. Materials and Methods: Patient's case notes with advanced breast cancers referred for palliative radiotherapy were retrieved from the departmental archives. Patient's biodata was extracted, which included age, sex, and year of referral. Other information extracted includes histology types diagnosed at primary sites, presenting symptoms, type of imaging modality used for confirmation of metastasis, and sites of metastasis. Data collected were analyzed using SPSS version 20. Results: A total of 584 patients with advanced breast cancers were seen during the study period (January 2005 to December 2009), representing an annual referral rate of about 84 patients/year from various centers across the country. Four hundred and twenty-one patients were eligible for the study. The mean age of patients was 45.9 years with only two male patients. Bone was the most common site of metastasis (66.7%) followed by lungs (17.1%). Pain due to bone metastasis accounted for 62.7% of presenting symptoms, followed by dyspnea and cough from lung metastasis (17.1%), multiple symptoms (7.4%), and symptoms associated with brain metastasis (6.2%). Conventional X-ray remained the dominant imaging modality for the confirmation of metastasis in both bones and lungs which accounted for 69.8% of used imaging modalities. Conclusion: Breast cancer metastasis to the bone and lungs remain the major source of morbidity and mortality, with majority of patients presenting with pain and dyspnea. Conventional X-rays remain the common imaging modality for confirmation of metastases in our environment despite advanced imaging techniques (positron emission tomography (PET)–computed tomography and 18F-fluoro-2-deoxyglucose-PET) used for the similar purpose in other parts of the world.
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A histopathologic review of cervical cancers in Jos University Teaching Hospital, Jos, Nigeria p. 135
Olugbenga Akindele Silas, Daniel Yakubu, Olushola O Jegede, Olanrewaju I Ajetunmobi, Oseyimawa Mosugu
DOI:10.4103/atp.atp_26_18  
Background: Cervical cancer is the most common gynecological malignancy globally, with a high prevalence in developing countries. We, therefore, undertook this review to document and evaluate its prevalence and histologic patterns seen at a tertiary hospital in Jos, Northcentral Nigeria. Materials and Methods: This is a 10-year (2006–2015) retrospective study of all cervical cancers diagnosed at the Pathology Department of Jos University Teaching Hospital, Jos Nigeria. Results: Three hundred and six cervical cancers accounting for 92.4% of all gynecologic malignancies were diagnosed during the 10-year study period. Patient's ages ranged from 18 to 85 years (mean 51.12 ± standard deviation 12.63 years), with peak occurrence in the fifth decade. Squamous cell carcinoma (SCC) was by far the most common histologic type (88.9%), the most common histologic grade was moderate differentiation (70%). Adenocarcinomas accounted for 4.3% and leiomyosarcoma accounted for only 0.03% of cases (1 case only). Only 0.65% (2) patients knew their HIV status and both had SCC. Conclusion: Our finding of the dismal proportion of cervical cancer is consistent with most published reports in Nigeria and Sub-Saharan Africa but somewhat at variance with that reported in the developed world where cervical cancer is much less common. A total reappraisal of our preventive efforts is therefore needed urgently.
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Leveraging social media for pathology education: Patterns and perceptions among undergraduates p. 139
Iriagbonse Iyabo Osaigbovo
DOI:10.4103/atp.atp_34_18  
Background: The use of social media in medical education is an emerging field of study in the developed world, but there is little evidence of scholarly inquiry into this field in Nigeria. Acceptability among learners is a crucial factor to consider when adopting technology in education. The aim of this study was to assess how undergraduates use social media and their perceptions about its use in pathology education. Materials and Methods: A paper-based questionnaire was administered to 169 4th year medical and dental students in the University of Benin. Data were analyzed using descriptive and simple inferential statistics. Results: All respondents were aware of social media and most had devices with which they could access the internet; 80.5% used mobile phones. Facebook (95.3%), Instagram (56.8%), and Twitter (44.4%) were the most common social media platforms used by students. Social media is used for educational purposes by 82.8% of students and 68.6% indicated that they would like their pathology educators to teach using social media. Distraction from noneducational feeds was the major aversion to the use of social media in pathology education (66%). Conclusion: Most undergraduate pathology students actively use social media for varied purposes including education. Many find the idea of educators engaging with them through social media acceptable. Opportunities abound for pathology educators to leverage this veritable educational tool.
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Serotype distribution pattern of Streptococcus Pneumoniae isolates from invasive infections at a university teaching hospital in Northern Nigeria p. 145
Medinat Ronke Suleiman, Joan Ejembi, Fatimah Jummai Giwa, Olarenwaju Jimoh, Abdulmajeed Olayinka Suleiman, Adebola Tolulope Olayinka
DOI:10.4103/atp.atp_33_18  
Background: Infections with Streptococcus pneumoniae are endemic worldwide. It is a public health problem and responsible for 1.6 million of 8.8 million annual deaths of children under 5 years of age, with 50% occurring in sub-Saharan Africa. This descriptive study was done to determine the prevalent S. pneumoniae serotypes responsible for infections at Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria. Materials and Methods: Clinical specimens of blood, cerebrospinal fluid, and aspirates from abscess, ear swab, throat swab, pus and sputa were collected over a period of 18 months from 420 patients with pneumonia, meningitis, septicemia, and otitis media. Specimens were cultured on 5% defibrinated sheep blood agar and chocolate agar. Incubation was done aerobically in a CO2-enriched atmosphere at 37°C for 18–24 h. Isolates of S. pneumoniae were identified by standard biochemical techniques using Gram reaction, catalase test, Optochin disc, and bile solubility tests. Antimicrobial susceptibility was determined by the modified Kirby–Bauer disc diffusion method with Mueller–Hinton agar supplemented with 5% sheep blood. Serotyping was done using the slide agglutination method (Denka Seiken Co. Ltd., Japan). The serotype final results were recorded as matching, discordant, or nontypeable. Results: A total of 420 patients participated in this study, in which 227 were males (54%) and 193 were females (46%). Participants' ages ranged from 2 days to 85 years. S. pneumoniae isolates were mainly from blood 12 (52.2%) and sputum 6 (26.1%). Samples with most isolates were from the pediatric age group of 15 years (65.2%). The serotypes identified were 6, 19, and 20 which were all from blood, as none of the strains from sputum was typeable. Conclusion: The major S. pneumoniae serotypes found in this study were 6, 19, and 20.
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Prevalence of overweight and obesity among health-care workers in University of Benin Teaching Hospital, Benin City, Nigeria p. 150
Tomisin Matthew Adaja, Osagie Joseph Idemudia
DOI:10.4103/atp.atp_30_18  
Background: Overweight and obesity seem to be responsible for the occurrence of noncommunicable diseases among the health-care workers. This study was conducted among the health-care workers in the University of Benin Teaching Hospital (UBTH), Benin City, South-South Nigeria, to determine the prevalence of overweight and obesity and assess their lipid profile. Subjects and Methods: Three hundred and twenty-five hospital workers ranging from doctors, nurses, and other health-care workers were recruited for this study. Demographic and socioeconomic data were collected using a structured questionnaire. One hundred and sixty (49%) were male while 165 (51%) were female with average age of 40.9 ± 8.8 years and average body mass index (BMI) of 26.7 ± 5.9 kg/m2. BMI and blood pressure measurements were taken using standard techniques. BMI was classified using the National Institutes of Health criteria, 2000. Results: Based on BMI, the prevalence of overweight and generalized obesity among health-care workers in the UBTH, Benin City, were 31.7% and 25.5%, respectively. Overweight and obesity are more common among female health-care workers than their male counterparts. Using the waist circumference, approximately 60% of the health-care workers had central obesity, while 57.2% are either overweight or obese. More than half of the overweight and obese patients have elevated low-density lipoprotein-cholesterol. Conclusion: The high prevalence of overweight and obesity seen among health-care workers calls for the introduction of therapeutic lifestyle modification in this group of workers. Even though there was no significant difference in the lipid levels across the BMI categories, the means of total cholesterol were found to be elevated among health-care workers.
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Otorhinolaryngological manifestations of pediatric patients with sickle cell disease in Nguru, Nigeria p. 155
Aliyu Ahmadu Babadoko, Adebola Stephen Oluwatosin, Mohammed Ishyaku Lawan, Idi Hadiza Tikau, Mohammed Kabiru Umar
DOI:10.4103/atp.atp_27_18  
Background: Virtually no organ of the body is exempted from the effects of sickle cell disease (SCD) following repeated episodes of vaso-occlusion, infarction, and hemolysis leading to organ dysfunction. However, there is a dearth of data on the anatomic and functional changes of the ears, nose, and throat (ENT) in patients with SCD. Therefore, monitoring and evaluation of the effects of this disease on these organs will be defective due to the absence of baseline data necessary for institution of intervention programs and policy formulation. Aim: To review and determine the prevalence of the general anatomic changes and functional effects of SCD on the ENT in the pediatric age group. Materials and Methods: A cross-sectional prospective study of 52 children with SCD was carried out in 2018. Hematological parameters were determined while otolaryngoscopic examination and audiometric tests were conducted. Data were analyzed using SPSS version 19 software, and Pearson's linear correlation statistical method was also employed and level of significance was set at P ≤ 0.05. Results: The mean age of the children was 8.81 ± 4.58 years. Excessive snoring was present in 28.8% (15) of the participants, of which 60% (9) had >75% occlusion of the nasopharynx. Recurrent ear discharge was seen in 21.2% of the participants. Conductive hearing loss (HL) was 9.6% and 7.7% for the right and left ears, respectively, while sensorineural HL was 13.5% and 3.8% for the right and left ears, respectively. Recurrent sore throat was recorded in 17.3% of the participants, while 73.1% had Brodsky Grade 1 tonsillar enlargement. Conclusion: Ear infections, HL, and tonsillar enlargement are common among pediatric patients with SCD. This may not be unconnected to inadequate clinical care due to lack of good health education, ignorance, poverty, and prophylaxis from infections.
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CASE REPORTS Top

Fatal rupture of descending thoracic aortic aneurysm in a Nigerian patient p. 161
Mustapha Akanji Ajani, Olusina Samson Faniyi, Ayodeji Salami
DOI:10.4103/atp.atp_20_18  
Aortic aneurysms are rare conditions in black patients and carry a high mortality if detected late. Unfortunately, the rarity of the condition makes detection a difficulty for many physicians as diagnosis in the early stages requires a high index of suspicion. The varied symptoms presented by the patient often mimic other less severe, but more common conditions and may cause a misdiagnosis. We report a 79-year-old male known hypertensive patient who presented a day before demise with a 4 h history of severe epigastric pain. He was managed for acute exacerbation of peptic ulcer disease to rule out pancreatitis. However, all investigations done were within normal limits. His clinical condition deteriorated, and he died 18 h after admission. An autopsy revealed massive left hemothorax and a tear in the descending aortic aneurysm. Microscopic examination confirmed complicated atherosclerosis in the descending thoracic aorta. The misdiagnosis, in this case, leads to wrong management with the patient receiving treatment for severe peptic ulcer. There is a need to consider this disease in patients who present with severe nonspecific abdominal symptoms.
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Gluteal malignant proliferating pilar tumor: An unusual presentation in an elderly male p. 164
Garba Dahiru Waziri, Dauda Eneyamire Suleiman, Tahir Turaki Mohammed, Modupeola O.A. Samaila
DOI:10.4103/atp.atp_29_18  
Malignant proliferating trichilemmal tumor, though uncommon, predominantly occurs in the scalp, trunk, head, and neck, and females are more commonly affected. It is rarely seen in the extremities, and malignant transformation is a rarity. Due to the rarity of malignant transformation, only a hand full of cases has been documented in the literature. We present an unusual case of gluteal malignant proliferating pilar tumor in an elderly male.
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Management of essential thrombocythemia in a resource-limited country: A Nigerian case study p. 167
Titilola Stella Akingbola, Olateni Asake Adeoye, Oluwafemi Akinyinka Akinwunmi
DOI:10.4103/atp.atp_37_18  
Essential thrombocythemia (ET) is one of the classical clonal myeloproliferative neoplasms (MPNs) that constitute a clinical entity distinct from the other MPNs such as polycythemia vera and primary myelofibrosis despite the similarities in their molecular basis. The genetic basis of ET has been associated with the detection of the mutation of three mutually exclusive driver mutations, namely, Janus kinase 2 (JAK2), calreticulin, and myeloproliferative leukemia genes, making them important biomarkers in the diagnosis of ET. This condition is clinically characterized by thrombohemorrhagic complications and progression to myelofibrosis and acute myeloid leukemia. The reduction of the thrombotic complication and/or the associated hemorrhage constitutes the primary goal of the therapeutic practice for the management of ET. We report here seven cases of ET referred to the University College Hospital within a 3-year period (2014–2016). This case series describes the management practices and the therapeutic outcomes in the patients (using the resolution of the clinical presentations and decrease in platelet count). The report also highlights some of the challenges encountered in the management of ET in a resource-limited country like Nigeria.
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Postburns sepsis caused by multidrug-resistant Acinetobacter baumannii p. 172
Olanrewaju Jimoh, Joan Ejembi, Shamsudin Aliyu, Muhammed Lawal Abubakar, Mohammed Ibrahim, Adebola Tolulope Olayinka
DOI:10.4103/atp.atp_18_18  
Healthcare-associated infections are among the major complications of modern medical treatment due to the increasing age and complexity of patients, increasing usage of invasive devices, and often inappropriate use of antimicrobial therapy. Acinetobacter species is associated with healthcare-associated infections due to its ability to survive for long periods of time on surfaces and its capacity to develop drug resistance. Multidrug-resistant (MDR) Acinetobacter is a challenge to manage clinically and is associated with mortality rates as high as 35%. We present a 25-year-old home maker with burns wound sepsis due to multidrug-resistant Acinetobacter baumannii which was successively managed with combination of drug regimen and institution of proper infection prevention control practices. We recommend minimization of invasive device in high dependency unit, scaling up of infection control practices, and further research into the efficacy of combination of ciprofloxacin, rifampicin, and amikacin in the treatment of MDR A. baumannii burns wound sepsis.
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A case of gonococcal urethritis coexisting with genital warts in a human immunodeficiency virus-negative man p. 176
Olanrewaju Jimoh, Joan Ejembi, Shamsudin Aliyu, Ibrahim Abdulrasul, Theophilus C Mba, Adebola Tolulope Olayinka
DOI:10.4103/atp.atp_25_18  
Gonorrhoea is an important sexually transmitted infection in both males and females which could consequently lead to different complications affecting both sexes. Despite availability of antimicrobials to treat the disease, transmission of the agent Neisseria gonorrheae (NG) is still prevalent. The ability of Neisseria gonorrhoeae to rapidly develop resistance to routinely used antimicrobials has made it a global public health challenge. We present a 26 year old single, male, professional who presented to our facility with a five weeks history of urethral discharge and painful micturition. He was initially managed at a private hospital with ciprofloxacin for 20 days with no improvement in symptoms. The patient then presented at our facility where he was diagnosed and managed for Neisseria gonorrhoeae urethritis after laboratory investigations. Susceptibility tests revealed penicillin and ciprofloxacin resistant NG. However, molecular characterization was not done as the stored isolate could not be reactivated for further analysis. We advocate for a review of the syndromic management of STIs in the country and a national surveillance on NG susceptibility profile. There is an urgent need to upgrade laboratory facilities to perform both cultural and molecular identification for sexually transmitted infections.
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FACULTY NEWS Top

Faculty news for the annals of tropical pathology September 2018 p. 180
Tamuno T Wakama
DOI:10.4103/atp.atp_53_18  
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ERRATUM Top

Erratum: Serum gonadotrophin levels in breastfeeding mothers presenting at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria p. 185

DOI:10.4103/2251-0060.245705  
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