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ORIGINAL ARTICLES
Methicillin-Resistant Staphylococcus aureus in a Central Nigeria Tertiary Hospital
Nasiru Abdullahi, Kenneth Chukwuemeka Iregbu
January-June 2018, 9(1):6-10
DOI:10.4103/atp.atp_37_17  
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of both health care- and community- associated infections worldwide and do present therapeutic challenges to beta-lactam antibiotics and other antibiotics due to the development of multidrug resistance. Aim: This study was carried out to determine the prevalence and antibiotic susceptibility profile of MRSA among patients at National Hospital Abuja with a view to providing information that will guide rational choice of antimicrobial agents in the empirical therapy of its infections. Materials and Methods: Between April 2014 and August 2015, clinical samples of patients submitted to Medical Microbiology laboratory of the hospital were processed and all Staphylococcus aureus isolates recovered, using standard laboratory methods. They were subjected to antibiotic susceptibility testing using the modified Kirby Bauer disc diffusion technique with zones of inhibition interpreted according to the Clinical and Laboratory Standard Institute (CLSI) guidelines. Methicillin resistance was determined using cefoxitin disc diffusion. Other clinical data of the patients were gathered along for analysis. Results: Of the 360 S. aureus isolates recovered, 97 (26.9%) were MRSA. All (100%) the MRSA isolates were susceptible to vancomycin, 88 (90.7%) to imipenem and 71 (73.2%) to clindamycin. All (100%) the MRSA isolates were resistant to penicillin, 85(88.0%) to tetracycline, 61 (62.9%) to ciprofloxacin, 58 (60.0%) to erythromycin and 52 (53.6%) to gentamycin. The MRSA strains showed higher resistance rate than MSSA strains to all tested antibiotics. Multidrug resistance was found in 68.0% of the MRSA strains. Conclusion: There was high prevalence of MRSA with high rates of resistance to commonly used anti-staphylococcal antimicrobials, and a significant proportion of these MRSA isolates were multi-drug resistant. Vancomycin is the best choice for empiric treatment of suspected MRSA infections. Routine screening of clinical S. aureus isolates for methicillin resistance, regular surveillance studies as well as institution of infection control measures and antibiotic stewardship programme are recommended.
  3,384 360 -
Suicide in Warri, Delta State, Nigeria: An autopsy study
Obiora Jude Uchendu, Eseroghene Arthur Ijomone, Nkadi Francis Nwachokor
January-June 2019, 10(1):16-19
DOI:10.4103/atp.atp_44_18  
Background: Suicide is a neglected public health problem in our environment. Objective: To determine the epidemiologic pattern of suicide cases with respect to sex, age, method, and place. Design: This is a 14½-year descriptive retrospective study of suicide cases reported to the coroner of Delta State, arising from Warri and its environs and subjected to postmortem examination by the authors. Materials and Methods: Information on age, sex, place of death, and method used was extracted and analyzed using Microsoft Office Excel 2007. Results: A total of 21 confirmed cases of suicide were analyzed consisting of 16 (76%) males and 5 (24%) females. The age range of the victims is from 9 to 65 years, with 15 (71.4%) of cases in the 2nd to 4th decades. Hanging, poisoning, and firearm were the methods used in 17 (80.95%), 3 (14.29%), and 1 (4.8%) of the cases, respectively. The scene of the suicide included the deceased's home, bush, workplace, and police custody in 16 (76.2%), 2 (9.5%), 2 (9.5%), and 1 (4.8%) of the cases, respectively. Conclusion: The study showed that suicide is a relatively rare problem, affecting mainly young males. The preferred place is usually the victim's homes. Hanging is the preferred method by males. There is a need to improve the welfare and mental health care of young people in the society as well as restrict the sales of poisoning through government policy in the country.
  3,130 253 -
Extended-Spectrum beta-lactamase production and antimicrobial susceptibility pattern of uropathogens in a Tertiary Hospital in Northwestern Nigeria
Fatima Jummai Giwa, Oluwafemi Temidayo Ige, Daniel Musa Haruna, Yahaya Yaqub, Tanko Zainab Lamido, Shuaibu Yahaya Usman
January-June 2018, 9(1):11-16
DOI:10.4103/atp.atp_39_17  
Background: Globally, there is a changing trend in the antibiotic susceptibility pattern of Gram-negative uropathogens to the conventional drugs used in the treatment of urinary tract infections due to the production of extended-spectrum beta-lactamases (ESBLs). Aim: This study aimed to determine ESBL production and antimicrobial susceptibility pattern in uropathogens. Materials and Methods: Five hundred urine samples submitted to the Medical Microbiology Department of Ahmadu Bello University Teaching Hospital from January to June 2012 were analyzed by conventional methods. Modified standardized Kirby-Bauer disc diffusion method was used for antimicrobial susceptibility testing. ESBL production by Escherichia coli and Klebsiella pneumoniae isolates was screened for using the Clinical and Laboratory Standards Institute guidelines 2012 and confirmed by the double-disc synergy tests. Results: Five hundred samples were analyzed. Of these, a total of 175 Gram-negative isolates were obtained. Isolation rates were E. coli – 56%, K. pneumoniae – 20%, Proteus mirabilis – 16%, and Pseudomonas aeruginosa – 4%. ESBL production was observed in 34.3% of all the isolates. Fifty percent (50%) of E. coli and 40% of K. pneumoniae were identified as ESBL producers and were found to be resistant to multiple antimicrobial agents. Imipenem and nitrofurantoin had sensitivity of 100% and 70%, respectively, while susceptibility to ciprofloxacin and gentamicin was low at 35% and 30%, respectively, although 96% sensitivity was observed with amikacin. ESBL producers and nonproducers showed a high level of resistance of over 95% to ampicillin, amoxycillin, and trimethoprim-sulfamethoxazole. Conclusion: This study found a high rate of ESBL production (34.4%) among uropathogens with multidrug resistance. Clinical microbiology laboratories should routinely incorporate ESBL detection methods in their laboratory procedures for continuous surveillance of multidrug-resistant isolates and antibiograms to guide empirical therapy.
  2,314 345 -
REVIEW ARTICLES
Priapism in sickle-cell disease: Emergency room intervention
Akinsegun Akinbami, Ebele Uche, Adedoyin Dosunmu
January-June 2017, 8(1):5-10
DOI:10.4103/atp.atp_17_17  
Priapism is one of the diverse complications of sickle cell disease (SCD). SCD is one of the many causes of priapism. Ischaemic and stuttering priapisms are the types seen in SCD. Apart from pain and psychological trauma associated with ischaemic and stuttering priapism, erectile dysfunction and impotence are the most severe complications of priapism in SCD that may require the use of penile prosthesis in SCD patients. The outcome of priapism complications is time-dependent and dependent on the type of management administered. This review highlights, the anatomy of the penis, physiology of normal erection, focusing on pathophysiology and management of priapism in SCD so as to create better awareness of this condition amongst physicians involved in the management of SCD.
  2,486 169 -
The role of biomarkers (p16INK4a and Ki-67) in cervical cancer screening: An appraisal
Saad A Ahmed, Darlington E Obaseki, Ahmed A Mayun, Aliyu Mohammed, Abdulmumini H Rafindadi, Mohammed A Abdul
January-June 2017, 8(1):1-4
DOI:10.4103/atp.atp_3_17  
Cervical cancer is a common and important public health problem in developing countries. Even though many developed countries have achieved significant successes in reducing invasive cervical cancer burden, the burden in developing countries is still worrisome. Currently, cervical examinations and Papanicolaou (Pap) tests remain the screening method of choice for most women in many parts of Africa. Molecular diagnostic tests for human papillomavirus (HPV) can augment screening for cervical cancer when used in conjunction with the Pap smear. Due to the inherent limitations of morphologic interpretation and borderline cases, the atypical squamous cells (Atypical Squamous Cells of Undetermined Significance [ASCUS] and Atypical Squamous Cells cannot rule out High Grade [ASC-H]) were introduced and this led to significant colposcopic follow-up and/or treatment of these women. p16INK4a is an efficient triage method; the dual staining with Ki-67 was introduced mainly to increase reproducibility and specificity compared with stand-alone p16INK4a staining. Diffuse p16INK4a immunostaining is the hallmark of high-grade squamous intraepithelial lesions regardless of HPV status.
  1,879 219 -
ORIGINAL ARTICLES
Hepatoprotective effect of beetroot juice on liver injury in male Sprague–Dawley rats
Fidelis E Olumese, HA Oboh
January-June 2018, 9(1):83-88
DOI:10.4103/atp.atp_34_17  
Background: The ability of plant extract to improve injury in the liver has gained interest in recent times. This could be due to the side effects and expense of modern medicines that are used to manage hepatic diseases; hence beetroot juice as a potential hepatoprotective agent was evaluated. Materials and Methods: Thirty Sprague–Dawley rats were assigned by weight into six groups average body weight (160.20 ± 2.54 g). Group I: rats plus distilled water (Normal control) 2 ml/kg; Group II: rats received olive oil (2 ml/kg); Group III: rats received carbon tetrachloride (CCl4) suspended in olive oil (2 ml/kg) and 250 mg/kg of beetroot extract. Group IV: rats received CCl4suspended in olive oil (2 ml/kg) and 500 mg/kg of beetroot extract. Group V: rats received olive oil (2 ml/kg) and 100 mg/kg of silymarin; Group VI: rats received (2 ml/kg)CCl4suspended in olive oil. Liver injury was induced by oral administration of CCl4using gastric gavage at 2 ml/kg every 48 h for 14 days, followed by treatment with beetroot extract and silymarin. Animals were euthanized by decapitation, blood and liver tissue harvested for biochemical and histopathological evaluations. Results: Alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase levels were significantly (P < 0.05) increased in the groups treated with extract and silymarin when compared to the animals administered only CCl4, whereas malondialdehyde level was significantly (P < 0.05) increased in the group administered only CCl4when compared to other groups. Histopathologically, the animals treated with 500 mg/kg of extract showed a normal hepatocyte and mild portal congestion. Conclusion: Beetroot juice has potential hepatoprotective effects on the liver in a dose-dependent manner.
  1,829 177 -
Prevalence of gestational trophoblastic disease: An institution experience
Ayuba Madachi Dauda, Isaac Onah Akpor, Barnabas M Mandong, Joseph Ngbea, Barka V Kwaghe, Innocent Emmanuel
July-December 2017, 8(2):81-86
DOI:10.4103/atp.atp_4_17  
Background: A group of diseases related to normal or abnormal gestation that have a common denominator, the abnormal proliferation of trophoblast tissue, are generically designated gestational trophoblastic diseases (GTDs). Individual disorders differ remarkably in their appearance (morphology) and clinical significance. This study was aimed at characterizing all cases of histologically diagnosed GTDs, seen at the Histopathology Department of the Jos University Teaching Hospital (JUTH). Materials and Methods: This study was a 10-year hospital-based retrospective study employing slides and tissue blocks of specimens from uterine evacuation products of gestations of all females diagnosed with GTDs in the Histopathology Department of JUTH from January 2004 to December 2013. The materials used in the study included records from the departmental registry and archival slides and tissue blocks from the archives of the histopathology department of the hospital. Results: A total of 151 cases were diagnosed histologically as GTDs, during the period under review. These accounted for 0.8% of all the surgical pathology specimens received. A total of 151 cases of GTD histologically diagnosed met the inclusion criteria and translated to 5.7 cases/ 1000 pregnancies. The following histological subtypes were seen: 63 cases (41.7%) were diagnosed as partial hydatidiform mole (PHM), 42 cases (27.8%) were choriocarcinoma, and 35 cases (25.8%) were diagnosed as complete hydatidiform mole. Four cases diagnosed as invasive mole accounted for 2.7%, which is closely followed by 3 cases of placental site trophoblastic tumor, accounting for approximately 2% of GTDs. However, no case of epithelioid trophoblastic tumor was seen. Conclusion: GTD was found to be common in Jos and had a frequency of 5.7 cases/1000 pregnancies in our series. The most common histological subtype was PHM, closely followed by choriocarcinoma. The molar lesions peaked in the second and third decades, while choriocarcinoma peaked in the second decade of life.
  1,595 213 -
A point prevalence survey of antimicrobial prescribing in four Nigerian Tertiary Hospitals
OO Oduyebo, AT Olayinka, KC Iregbu, A Versporten, H Goossens, PI Nwajiobi-Princewill, O Jimoh, TO Ige, AI Aigbe, OI Ola-Bello, AO Aboderin, FT Ogunsola
January-June 2017, 8(1):42-46
DOI:10.4103/atp.atp_38_17  
Introduction: Antimicrobial resistance has become a global challenge in health care. Its emergence in previously sensitive bacteria is usually associated with poor antibiotic-prescribing patterns. Methodology: A point prevalence survey was carried out in four tertiary hospitals in Nigeria in 2015 to determine the rate and characteristics of antibiotic prescription. Results: Of 828 patients eligible for the study, 69.7% received antibiotics, with highest rates in the adult Intensive Care Unit. There were therapeutic indications in 51.2% of the prescriptions, of which 89.5% were for community-acquired infections. Third-generation cephalosporins were the most prescribed antibiotics. On the evaluation of surgical prophylaxis, only 4.1% were compliant with institutional guidelines and 39.2% gave a reason for prescribing in patient case notes. Less than 1% of the prescriptions were based on the use of biomarkers. Conclusion: The prevalence of antibiotic prescription in Nigerian hospitals is high with only about 50% of prescriptions based on clear therapeutic indications. We provide evidence that the country needs to institute a cohesive antimicrobial stewardship intervention program.
  1,569 204 1
REVIEW ARTICLE
Hydroxyurea: Modifier of pathophysiology in sickle cell anemia
Akinsegun Akinbami, Ebele Uche, Adedoyin Dosunmu, Adewumi Adediran, Sarah John-Olabode
January-June 2018, 9(1):1-5
DOI:10.4103/atp.atp_31_17  
Sickle cell anemia (SCA) patients have a point mutation in the 6th codon of the hemoglobin gene in which adenine is replaced by thymine resulting in replacement of glutamic acid with valine on the 6th amino acid in the β globin chain of the hemoglobin. Despite identical basic genetic mutation in all SCA patients, significant variation in clinical severity occurs. Clinical severity of SCA varies from mild to very severe types requiring more intensive medical interventions such as use of hydroxyurea (HU) and stem cell transplantation. Use of HU has improved clinical outcome in SCA and is recommended for moderate-to-severe varieties of SCA. This review brings to the fore mode of action, indications, commencement of therapy, monitoring, toxicity, and discontinuation of HU in selected SCA patients.
  1,446 229 -
ORIGINAL ARTICLES
Prevalence of Chlamydia Trachomatis infection among women of reproductive age group in a tertiary hospital in Northern Nigeria
OT Ige, SO Ige, AT Olayinka
January-June 2018, 9(1):17-21
DOI:10.4103/atp.atp_35_17  
Background: Chlamydia trachomatis infections are the most prevalent bacterial sexually transmitted infections recognized globally. There is a paucity of data on the prevalence of C. trachomatis infection in Northern Nigeria. This research was conducted with the objective of determining the prevalence of genital C. trachomatis infection among females in the reproductive age group. Materials and Methods: Three hundred and sixty-five patients were enrolled in this study. Patients were administered questionnaires requesting information on biomedical, sociodemographic data. Endocervical specimens were collected, subjected to DNA extraction and polymerase chain reaction (PCR) using primers from Inqaba Biotechnical industries, South Africa. Data management was done using SPSS software version 20.0 statistical package. Results: Of the 365 patients studied, 95 of them had positive results by the PCR assay, giving 26% prevalence for genital C. trachomatis infection among women of reproductive age group. Associated risk factors for genital chlamydia infection identified include low educational status, early age at sexual debut, early age at marriage, and lack of use of condoms during sexual intercourse. The frequency of positive results was found to be higher among the age group 25-29 years, those living in suburban areas and the unmarried [Table 1] and [Table 2]. Conclusion: A prevalence of 26% was found, in this study, for genital C. trachomatis infection among women of reproductive age group. Risk factors include as follows: low educational status, early age at sexual debut, early age at marriage, and lack of use of protection during sexual intercourse.
  1,383 170 -
Audit of nottingham system grades assigned to breast cancer cases in a Teaching Hospital
Akinfenwa Taoheed Atanda, Mohammed Ibrahim Imam, Ali Bala Umar, Ibrahim Yusuf, Shamsu Sahalu Bello
July-December 2017, 8(2):104-107
DOI:10.4103/atp.atp_9_17  
Background: Histologic grade of breast cancer is a Category I prognostic factor. Thus, accurate and reproducible grading must be ensured by periodic auditing and training. Objective: The objective of this study is to audit interobserver agreement in grading and evaluate agreement of grading on core needle biopsies with surgical pathology. Materials and Methods: Slides of 73 cases of invasive carcinomas of the breast were retrieved from archives. These were grouped into 43 cases on which consensus grades assigned by 3 pathologists were compared with initial grades assigned to the cases. The next 24 cases were graded independently by 4 pathologists and compared. In the last 6 cases, consensus grades were assigned to both the initial core needle biopsy (CNB) and the excisional biopsy. Kappa values were then calculated. Results: Kappa value (κ) for the first 43 cases was 0.50 (moderate agreement; P < 0.05). There was only fair agreement (κ = 0.25) between CNB grade and final surgical pathology grade, with 50% being upgraded from Grades 2–3. There was moderate agreement (κ = 0.53, P < 0.05) in the 24 cases on which inter-rater agreement was tested. Specific rating of both mitotic count and nuclear pleomorphism showed fair agreement (κ = 0.25 and 0.34, respectively) while rating of tubule formation showed moderate agreement (κ = 0.57; P < 0.05). Pairwise kappa agreement ranged from fair to good (0.31–0.63). Conclusion: To ensure reproducibility, greater attention should be paid to accurately assessing nuclear pleomorphism and mitotic activity in particular. Re-grading of excisional breast biopsies after initial CNB is also essential to prevent undergrading.
  1,406 99 -
REVIEW ARTICLES
Chemical pathologists' role as part of multidisciplinary teams' approach to health-care delivery
Sikiru Abayomi Biliaminu, IM Abdulazeez, AA Akande, AB Okesina
January-June 2017, 8(1):11-16
DOI:10.4103/atp.atp_20_17  
Background: The care of the sick has gone beyond a 'one-man show' since the medical profession is dynamic. The dynamism of the profession is to entrench the patients' survival. This is being done by introducing the concept of Multidisciplinary Team (MDT) approach to patients' management. Objective: This review is to have a look at the various roles or ways the Chemical Pathologists can fix into MDT as laboratory physicians. Method: This article discusses the definitions and some terminologies in Chemical Pathology and concept of MDT. Its approach in medicare, went through the historical line and evolution of the subspecialty of Chemical Pathology. It discusses the role of Chemical Pathologists in MDT as well as pros and cons of the concept of MDT. Finally, it also discusses how to improve MDTs in Nigerian Tertiary Hospitals. It was essentially based on literatures written in English. Conclusion: This review article has tried to discuss roles of Chemical Pathologists in MDTs approach to patients' management in our hospitals not leaving out the historical aspects, its advantages, disadvantages, barriers and possible way forward for the suggested challenges.
  1,365 108 -
ORIGINAL ARTICLES
Relationship of cardiac troponin and creatine Kinase-MB fraction at admission in acute ischemic stroke and outcome in a Tertiary Hospital in Nigeria
Hafsatu M Suleiman, IS Aliyu, SA Abubakar, MS Isa, Jibril M El-Bashir, R Adamu, MZ Ibrahim, R Yusuf
July-December 2017, 8(2):61-64
DOI:10.4103/atp.atp_13_17  
Background: Stroke has been a global burden, with increasing morbidity and mortality. Studies had reported elevated levels of serum cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB) fraction in patients with acute ischemic stroke. Therefore, the aim of this study is to relate the serum levels of these biomarkers and outcome in acute ischemic stroke as seen in a tertiary hospital in Nigeria. Subjects and Methods: This study was conducted in Ahmadu Bello University Teaching Hospital, Zaria. One hundred acute ischemic stroke patients were recruited into the study from December 2013 to February 2015. Blood samples were collected within the first 24 h of admission for cTnT and CK-MB concentration measurement using enzyme-linked immunosorbent assay method. Patients' outcome either dead or alive was recorded at 1 month (discharge) and at 24 months. Data were analyzed using SPSS version 20 and P < 0.05 was considered statistically significant. Results: The mean age of stroke patients was 59 years and 38% were women. Forty-one percent of patients had a raised cTnT concentration with mean ± standard deviation (SD) of 108.31 ± 7.82 ng/ml while 59% had normal cTnT with mean ± SD of 79.91 ± 15.64 ng/ml (P = 0.000). Furthermore, 43% had raised CK-MB concentration with mean ± SD of 35.01 ± 8.70 ng/ml and 57% had normal CK-MB with mean ± SD of 17.41 ± 2.06 ng/ml (P = 0.000) on admission. Twenty-two patients signed discharge against medical advice and left the hospital before 1 month. Twenty patients died in hospital within 1 month of admission with cTnT mean ± SD of 100.4 ± 15.5 ng/ml while the 58 patients who survived 1 month had a mean ± SD of admission cTnT of 88.2 ± 21.5 ng/ml (P = 0.009). Similarly, mean ± SD CK-MB of dead patients was 32.6 ± 25.5 ng/ml compared to the live patients who had a mean ± SD of 25.5 ± 11.1 ng/ml (P = 0.04). After 24 months of follow-up, a total of 31 patients died and their mean ± SD cTnT was found to be 97.0 ± 19.2 ng/ml while the live 47 patients had mean ± SD cTnT of 87.6 ± 21.1 ng/ml (P = 0.047). Furthermore, the mean ± SD of CK-MB concentration of dead patients was 29.8 ± 13.0 ng/ml as against live patients who had 25.6 ± 11.2 ng/ml (P = 0.151). Conclusion: Admission serum cTnT concentration is a powerful predictor of mortality outcome in patients admitted with an acute ischemic stroke.
  1,322 147 -
Prevalence and distribution of high risk human papillomavirus subtypes in invasive cervical cancer in South-West Nigeria
Nnamdi Obumneme Orah, Adekunbiola Aina Banjo
July-December 2018, 9(2):106-110
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.
  1,249 191 -
Pattern of diseases in human immunodeficiency virus/AIDS patients in Lagos University Teaching Hospital: A 1-year prospective autopsy study
Izuchukwu Benerdin Achusi, Solomon Raphael, Awodele Nicholas Awolola, Fatima Biade Abdulkareem, Adekunbiola AF Banjo, Stephen O Ojo
July-December 2018, 9(2):111-117
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.
  1,161 136 -
Hematologic profile of battery repair workers occupationally exposed to lead in Lagos, Nigeria
Ann Abiola Ogbenna, Olugbenga Ayanmakinde Ayandokun, Alero Ann Roberts, Ademola Samson Adewoyin, Christiana Oluwakemi Famuyiwa
July-December 2017, 8(2):68-74
DOI:10.4103/atp.atp_26_17  
Background: Lead is one of ten chemicals of key public health concern. It inhibits various enzymes in the synthesis and homeostasis of red blood cells, hence altering hematologic parameters in those chronically exposed. Aim: This study aims to assess the degree of lead exposure among battery lead repair workers in Lagos and relate it to their hematologic profile. Materials and Methods: Structured interviewer-administered questionnaires were used to record demographic data. Blood samples were taken to determine full blood count, erythrocyte protoporphyrin, serum ferritin, and blood lead levels (BLL). BLLs were determined by atomic absorption spectrometry. BLL were categorized as mild, moderate, or severe and were related to hematologic parameters. Categorical data were presented as proportion and continuous data as means or median. The effects of personal protective equipment on BLLs were assessed. Results: A total of 66 men with the mean age 46.15 ± 11.73 years and average duration of exposure to lead of 23.33 ± 11.03 years were enrolled. The median BLL was 20.75 μg/l (interquartile range). Majority had BLL between 20 and 40 μg/l, 4.55% had severely elevated lead levels. Participants with >30 years of exposure had a higher BLL (P = 0.046). BLL was negatively correlated with RBC count (r = −0.322 P = 0.008) and positively correlated with mean cell volume (MCV) (r = 0.277 P = 0.025). Mean MCV was 86.39 fl ± 7.90 fl). Participants with BLL >40 μg/l had higher MCV (P = 0.038). Conclusion: Battery repair workers have moderate exposure to lead which is not enough to lead to significant hematologic effect.
  1,158 129 -
CASE REPORT
Hydatidiform mole coexisting with a live fetus: Case report and literature review
Natalia Adamou, Usman Aliyu Umar, Ali Bala Umar, Aliyu Labaran Dayyabu, Aisha Abdulrahaman
January-June 2018, 9(1):93-97
DOI:10.4103/atp.atp_17_18  
Pregnancy with complete mole and coexisting live fetus is rare with an incidence of 1 in 22,000–100,000 pregnancies. Such pregnancy is also known as “sad fetus syndrome.” We report a case of a 27-year-old Nigerian female (Hausa) G5P 4 + 0A2,who presented to our labor ward on the March 19, 2016, at 34-week gestational age with complaints of bleeding per vaginum and associated labor pains. Transabdominal two-dimensional ultrasound on admission revealed a live fetus in breech presentation, with anteriorly located placenta and a huge mass of mixed echogenicity with “snow-storm” pattern within the uterine cavity posteriorly located and not occluding internal os. She had assisted breech delivery of a live male infant with Apgar scores of 6 and 9 in the first and 15th min, respectively, and weight of 2.5 kg. The placenta was delivered by controlled cord traction, and she expelled “grape-like” tissues as well. In Kano, patients do attend different hospitals and present to the tertiary center when complications arise. We believe that this case will increase vigilance of medical personnel, who evaluate patients during first presentation to the hospital.
  1,168 112 -
REVIEW ARTICLE
A review of epidemiology and management of multiple myeloma in a resource poor country
Adedoyin O Dosunmu, Akinsegun A Akinbami, Ebele Uche
July-December 2018, 9(2):99-105
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.
  1,130 147 -
ORIGINAL ARTICLES
An autopsy review of sudden unexpected natural deaths at Benue State University Teaching Hospital, Makurdi, North Central, Nigeria
Joseph A Ngbea, RA Vhriterhire, Chukwudi Onyeaghana Okani, PO Echekwube, T Nyaga, BA Ugbaje, BA Ojo, OO Jegede, TT Bitto, CO Ojabo
July-December 2017, 8(2):112-115
DOI:10.4103/atp.atp_6_17  
Objectives: In every population, the pattern of sudden unexpected natural deaths (SUNDs) is often associated with the epidemiologic profile of certain common killer diseases. The old narratives have been that infectious/communicable diseases are the most common reasons why people die in our locality. However, changing lifestyle, increasing literacy level, and urbanization in Nigeria must have impacted immensely on the causes of death. We, therefore, embarked on this study to determine the etiology and epidemiologic characteristics of SUND at Benue State University Teaching Hospital, Makurdi. Materials and Methods: A review of all cases of sudden unexpected deaths at Benue State University, Makurdi, Benue State, over a 5-year period, from March 2012 to February 2017. Results: A total of 125 medicolegal autopsies were performed over a 5-year period (2012–2017), 58 (46.4%) represented SUND. Thirty-five (60.3%) cases of SUND were due to cardiovascular disorders, comprising 26 males and 9 females with a male-to-female ratio of 2.9:1, while twenty-eight (80.0%) cases those who died from cardiovascular disorders were due to hypertensive heart disease. Twelve (20.7%) cases classified as SUND were due to central nervous system disorder, eight males and four females, having male-to-female ratio of 2:1. The remaining 11 (19.0%) cases of SUND were due to respiratory diseases comprising 9 males and 2 females with male-to-female ratio of 4.5:1. Conclusion: Cardiovascular, central nervous system, and respiratory disorders were the major causes of SUND. Systemic hypertension-related disorders constituted a large proportion, especially in the middle age group.
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Zinc level is a poor predictor of leg ulcer in patients with sickle cell anemia
Aliyu Dahiru Waziri, Haruna M Muktar, Abdulaziz Hassan, Sani Awwalu, Ismaila N Ibrahim, Ibrahim U Kusfa
July-December 2017, 8(2):65-67
DOI:10.4103/atp.atp_8_17  
Background: Sickle cell leg ulcers (SCLUs) are a major chronic debilitating complication in patients with sickle cell anemia (SCA). These ulcers lead to stigmatization and depression. Zinc deficiency has been implicated as a cause of SCLU. This study determined the predictability of leg ulcers and zinc levels among SCA patients in Zaria. Methods: This was a case–control study in which 100 participants (50 patients with HbSS and 50 controls with HbAA) were enrolled over a 3-month period by convenience sampling technique. Semi-structured questionnaires were used to obtain participants' ages, gender, and presence or absence of leg ulcers. Serum zinc levels were assayed using spectrophotometry. Data obtained were analyzed using IBM SPSS software version 20.0. Means and standard deviations were used to summarize the data, independent sample t-test was used to compare means, and logistic regression was used to assess whether zinc levels can predict the prevalence of leg ulcer among patients. P ≤ 0.05 was considered statistically significant. Results: The mean age of the participants was 24.92 ± 6.2 years while that of the control was 22.92 ± 4.9 (P = 0.172) with a range of 18–42 years in both groups. Leg ulcers were present in 10/50 (20.0%) of the patients with SCA. The mean zinc levels of patients with SCA with and without leg ulcers were 12.0 ± 4.0 μmol/l versus 15.5 ± 7.4 μmol/l (t = 2.060, P = 0.050). A binary logistic regression model using zinc as a predictor could explain only 4.7%–7.5% of the variability in leg ulcers but did not improve classification of cases. There was a negative nonsignificant association between zinc levels and leg ulcers, B = −0.098, odds ratio = 0.906, 95% confidence interval (0.789, 1.042), P = 0.167. Conclusion: Serum Zinc level is a poor predictor of leg ulcers in patients with SCA, thus suggesting other yet unstudied factors as likely better predictors.
  1,038 125 -
Intestinal parasites among HIV-infected patients at obafemi awolowo university teaching hospitals complex, Ile-Ife
Bolatito Opeyemi Olopade, Clement Oluwaseun Idowu
January-June 2017, 8(1):34-38
DOI:10.4103/atp.atp_19_17  
Background: Intestinal parasites are a cause of morbidity and mortality throughout the world particularly in HIV-infected patients. This study determined the prevalence of intestinal parasites among HIV-infected patients, assessed risk factors predisposing to infection and also assessed association of intestinal parasites with the CD4 counts of the patients. Materials and Methods: It was a cross sectional study and 226 HIV-infected patients attending the Virology Research Clinic of OAUTHC were recruited. Questionnaires were administered to obtain relevant demographic information. Stool samples were collected and examined. Data processing was done using SPSS Inc USA version 17. Statistical analysis was done using frequency, proportion, percentages, tables and Pearson's chi-square was used to determine the association between intestinal parasites and risk factors. Results: The overall prevalence of intestinal parasites in this study is 15.4%. Cryptosporidium sp. and Ascaris lumbricoides had the highest prevalence, both had rates of 4.4% followed by Entamoeba histolytica with a rate of 3.1%. Cyclospora sp. had a rate of 1.8%, Strongyloides stercoralis had a rate of 0.9% while Entamoeba coli and hookworm both had rates of 0.4%. Co-existence of Cryptosporidium with Strongyloides stercoralis occurred in one of the HIV-infected patients. Exposure to goats and dogs was found to be significantly associated with intestinal parasites. The CD4 count was not significantly associated with presence of intestinal parasites. Conclusion: Intestinal parasites are still prevalent among HIV-infected patients and exposure to dogs and goats was a risk factor. There was no association between intestinal parasites and CD4 counts of the patients.
  1,064 89 -
Cancer in Kano, Northwestern Nigeria: A 10-year update of the kano cancer registry
Ibrahim Yusuf, Akinfenwa Taoheed Atanda, Ali Bala Umar, Mohammed Ibrahim Imam, AZ Mohammed, Ochicha Ochicha, Muhammad Sanusi Haruna
July-December 2017, 8(2):87-93
DOI:10.4103/atp.atp_12_17  
Background and Objectives: Cancer is an increasing problem in Africa. This study analyzes the profile of cancers recorded in the second decade of Kano cancer registry (KCR), and compare data with a similar previous 10 years (1995–2004) study in the registry to detect changing patterns. Materials and Methods: Cancer cases received by the registry from January 2005 to December 2014 were retrieved from the records and classified by organ/sites of affectation in accordance with the international classification of diseases for oncology. The data are presented in tables according to the organ/sites and ranked accordingly. Results: A total of 47,734 specimens were received within the study period out of which 6548 (13.2%) were malignant. The malignant cases comprised 3598 (54.9%) females and 2950 (45.1%) males (f: m = 1.2:1); there were 516 (7.9%) Paediatric cancers in the series. Overall, breast cancer (14.1%) was the most frequent followed by cancers of the cervix (11.1%), prostate (10.9%), nonmelanoma (nm) skin (7.3%), and colorectum (7.2%), respectively. The leading six cancers among females were the breast (25.0%), cervix (19.8%), colorectum (6.8%), connective tissue (6.6%), nm skin (6.5%), and uterus (5.7%). The corresponding ones in the males were prostate (24.7%), bladder (10.9%), nm skin (8.2%), colorectal (7.8%), connective tissue (7.5%), and eye (4.8%) cancers. Retinoblastoma was responsible for more than half of all Paediatric cancers (61.4%). Conclusion: This study detected some change in the pattern of cancers in KCR. More females than males are affected, and breast cancer is the most common malignancy among women. This contrasts with the previous study which showed male predominance and cervical cancer as the commonest malignancy in women. Prostate and bladder cancer still remain the most common malignancies in men. Data from this study will help to further focus efforts and resources toward tackling the most prevalent cancers in our region most of which are potentially preventable.
  1,040 98 -
Immunohistochemical expression of epstein–Barr virus Latent Membrane Protein-1 in nasopharyngeal carcinoma
Sannom Mildred Yates, Yawale Iliyasu, Saad Aliyu Ahmed, Almustapha Aliyu Liman
July-December 2017, 8(2):99-103
DOI:10.4103/atp.atp_30_17  
Background: Epstein–Barr virus (EBV) has a consistent global association with nasopharyngeal carcinoma (NPC). The detection of EBV in NPC has been shown to have diagnostic and prognostic importance. Latent membrane protein-1 (LMP-1) immunochemical staining is a well-recognized, rapid, and effective method of EBV detection. This study aims to determine the EBV status of NPC seen over 22 years, from 1992 to 2013 in Ahmadu Bello University Teaching Hospital (ABUTH). Materials and Methods: It was a retrospective study of all NPCs diagnosed at the Department of Pathology, ABUTH from January 1, 1992 to December 31, 2013. The paraffin-embedded tissue blocks of all histologically diagnosed NPCs within the study period were retrieved and examined. Cases in which the tissue blocks were missing, badly damaged, or had insufficient tissue were excluded from the study. Histopathological diagnosis was in accordance to the 2005 World Health Organization classification. EBV detection was done using immunohistochemistry (IHC) for EBV LMP-1. Data were analyzed using SPSS 24. Fisher's exact test statistic value is 0.545, which is not significant at P < 0.05. Results: A total of 112 NPC cases were histologically diagnosed, 66 (58.9%) of these were available for EBV LMP-1 IHC and 46 (41.1%) were excluded. EBV LMP-I IHC was positive in 51 samples (77.3%), while 15 (22.7%) were negative. There were 63 (95.5%) cases of nonkeratinizing carcinoma (NKC) seen, of which 49 (77.8%) were EBV positive and 14 (22.2%) were negative. Keratinizing squamous cell carcinoma (KSCC) constituted 3 (4.5%) cases, 2 of which were EBV positive (66.7%) and 1 was negative (33.3%). No basaloid squamous cell carcinoma case was available for the study. Conclusions: There is a high prevalence of EBV in NPC. However, there is no statistical difference in the prevalence of EBV in NKC and KSCC. NPC showed an association with EBV irrespective of histological type. LMP-1 IHC has proved useful in detecting EBV in NPC in this study.
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Histopathology quality assurance: A general survey of physicians' satisfaction in Nigeria
Raymond Akpobome Vhriterhire, Joseph Aondowase Ngbea, Theophilus Ugbem, Ayuba Dauda, Olushola Jegede, Daniel Yakubu, Aaron Amos
July-December 2018, 9(2):121-125
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.
  953 116 -
Prevalence of squamous intraepithelial lesion among women in Kaduna State, Nigeria
Sheba J Magaji, Maryam Aminu, Helen I Inabo, Adekunle O Oguntayo, Saad A Ahmed, Jigo D Yaro, Dauda E Suleiman, Mudashiru Lawal
July-December 2017, 8(2):94-98
DOI:10.4103/atp.atp_5_17  
Background: Cervical cancer is one of the most common cancers in women. Human papillomavirus (HPV) infection is the primary cause of virtually all cervical cancers. Cervical cancer typically develops from precancerous changes, squamous intraepithelial lesion (SIL) over a period of 10–20 years, in about 5%–10% HPV-infected individuals. This study was carried out to determine the prevalence and risk factors of SIL among women in Kaduna State, Nigeria. Materials and Methods: This study was a hospital-based and cross-sectional study that combined the use of a structured questionnaire and analysis of cervical scrapings samples obtained from 276 consenting women in Kaduna State, Nigeria. The samples were analyzed for SIL using conventional Papanicolaou smear. Results: The prevalence rate of 6.2% for SIL was obtained with low-grade SIL being the most common type of cervical abnormality. Sociodemographic factors associated with the development of SIL in the study were marriage type, level of education, and occupation (P ≤ 0.05). The risk factors that were associated to the development of SIL in the study were multiple sexual partners and high parity (P ≤ 0.05). The symptoms associated with SIL were intermenstrual bleeding, dyspareunia, and postcoital bleeding. Conclusion: The prevalence of SIL obtained from this study is appreciable, and this calls for the institution of awareness programs for HPV-associated cervical cancer and the implementation of a routine cervical cancer screening program in Kaduna State, Nigeria.
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