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  Citation statistics : Table of Contents
   2018| January-June  | Volume 9 | Issue 1  
    Online since June 11, 2018

 
 
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ORIGINAL ARTICLES
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.
  12 10,679 1,102
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.
  7 16,844 1,179
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.
  5 17,703 700
Clinicopathological diagnostic discrepancies: An analysis of 1703 surgical pathology specimens
Raymond Akpobome Vhriterhire, Joseph Aondowase Ngbea, Isaac Onah Akpor, David Gyenger, Olanrewaju Ajetumobi, Amali Adekwu, Joseph Namgwa Kortor
January-June 2018, 9(1):50-54
DOI:10.4103/atp.atp_10_18  
Background: Evaluation of error occurrence is a vital component of laboratory-quality assurance. One method of the measuring errors is by an assessment of discrepancies in clinical and pathology diagnosis. This study was carried out to determine the occurrence of such differences in our institution and to find out if any association exists between clinical diagnostic reasoning and the nature of the lesion. Materials and Methods: A 3-year retrospective analysis of surgical pathology specimen records was performed for report contents, clinical diagnosis, clinical suspicion, or diagnostic questions. Discrepancy index (Di) was calculated as the number of incompatible cases/total number of cases ×100. Results: An analysis of 1703 cases showed complete agreement between the clinical and pathology diagnosis in majority of the cases (1514, 89.9%) while discordance occurred in 189 (11.1%). There was more discrepancy in benign cases (12.3%, n = 1144) than malignant conditions (8.6%, n = 559). Using Chi-square test of independence, there was association between the nature of the lesion (benign or malignant) and diagnostic concordance (χ2 = 5.24, P = 0.02207) at 0.01 level of significance. There was more discordance in diagnosis of soft tissue lesions (Di = 23.8, n = 1587). Conclusion: This study suggests that greater discrepancies are likely to occur in the diagnoses of benign conditions than malignant diseases.
  2 4,969 352
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.
  2 7,443 694
Haemoglobin F and A2 profiles among sickle cell anaemia patients in Lagos State University Teaching Hospital (LASUTH), Nigeria
Akinsegun Akinbami, Ebele Uche, Adedoyin Dosunmu, Bodunrin Osikomaiya, Adewumi Adediran, John-Olabode Sarah, Oluwole Esther, Mulikat Badiru, Rafat Bamiro
January-June 2018, 9(1):26-31
DOI:10.4103/atp.atp_45_17  
Background: The choice of high-performance liquid chromatography (HPLC) to measure HbF and HbA2in sickle cell disease patients is regarded as a method of choice by many researchers. This study was aimed at using HPLC in determining the mean and gender-specific reference values of HbF and HbA2in sickle cell anemia (SCA) population and bringing to fore all associated implications. Materials and Methods: This was a cross-sectional, retrospective, descriptive study involving SCA patients. All case notes containing HPLC hemoglobin quantification reports were reviewed to extract the percentages of HbA2, HbF, and HbS of patients. The demographic data of individual patients were also obtained from the records. Data were analyzed with IBM SPSS Statistics for Windows, Version 20.0 Armonk, New York, USA. Results: A total of 100 participants' records were reviewed consisting of 40 (40%) males and 60 (60%) females. The overall mean age (±standard deviation [SD]) of participants was 25.89 years ±9.34. The overall mean HbF and HbA2were 6.94% ±5.05 and 3.75% ±0.74, respectively. Thirty percent had HbF <3%, whereas 34% of them had elevated HbA2level >4%. The mean (±SD) HbF and HbA2for both males and females were 6.97% ±5.45 and 3.68% ±0.58, 6.92% ±4.87, and 3.80% ±0.83, respectively. Conclusions: Thirty percent of the study participants had HbF <3%, whereas 34% of them had elevated HbA2level >4% and could indeed be carrying beta thalassemia trait with the sickle cell gene.
  2 7,947 510
Incomplete patient data on chemical pathology laboratory forms in a Tertiary Hospital in Nigeria
S Adamu, Abdullahi Mohammed, Jibril M El-Bashir, JD Abubakar, DS Mshelia
January-June 2018, 9(1):47-49
DOI:10.4103/atp.atp_44_17  
Background: Correct and complete filling of information on the laboratory request forms is necessary if preanalytical errors are to be minimized. It also gives the laboratory opportunity to compare results with the clinical details of the patient, which can point out the possibility of errors in either laboratory test or clinical diagnosis. Appropriately, filled laboratory forms allow for timely communication of critical results to physicians providing early intervention and improved patient care. We, therefore, evaluated the extent of incomplete laboratory forms in our center. Methodology: The study was a cross-sectional where assessment of forms received over 3 months from February 17, 2014, to May 28, 2014, in the Chemical Pathology Department of Federal Teaching Hospital, Gombe, during working hours were analyzed for the frequency of incomplete data. The forms were scrutinized for the presence of name, gender, age, clinical details, ward/clinic, consultant, hospital number, and doctor's signature. Results: Only 8% of a total of 4638 forms provided all the required data. Only patient's name appeared in all the forms. Time of sample collection (58%) was the most omitted parameter. Age and gender did not appear in 39% and 38%, respectively. No clinical details or location of the patient was provided in 25% and 24% of the cases. Consultant in charge was missing in 38% of forms. Date of request, doctor's signature, and hospital number were missing on 18%, 18%, and 13%, respectively. Conclusion: The study has demonstrated high frequency of incomplete information needed on the laboratory request forms. This may be responsible for many preanalytical errors. Increased interaction between clinicians and pathologist with a view to reducing the frequency of preanalytical errors should be encouraged.
  1 4,308 312
Correlation of fine-needle aspiration cytology and surgical excision in the diagnosis of patients with cancer
Kasimu Umar Adoke, Balarabe Kabir
January-June 2018, 9(1):69-74
DOI:10.4103/atp.atp_27_17  
Background: Cancer is a generic term for a large group of diseases that can affect any part of the body. Other terms used are malignant tumors and neoplasms. Fine-needle aspiration cytology (FNAC) has been extensively used for many years in the diagnosis of cancers, especially breast cancers, but its use has gradually been reduced in some hospitals because of its controversial inadequate rates and suboptimal accuracy in inexperienced hands and in some cases conflicting reports when compared with the excised biopsy of the same lesion. This is a prospective study to correlate the cytological findings in patients diagnosed with cancer with the histological diagnosis on excision. Materials and Methods: This was a prospective study of 30 patients that attended the Department of Pathology, Federal Medical Centre, Birnin Kebbi, from July 2016 to June 2017. All patients who were diagnosed after FNAC as having a malignant lesion were followed up for surgery for their excision biopsy. FNAC of the 30 patients was performed using 23-gauge needle under direct palpation (27 cases) by the pathologist and by ultrasonographic guidance (3 cases) before the surgical excision. Specimen after excision was fixed in 10% buffered formalin and stained with routine hematoxylin and eosin. Diagnosis on FNAC was subsequently compared with diagnosis after excision. Immunohistochemistry studies using limited antibody panels (CD5, CD10, CD20, CD30, and Bcl-2) were used on some surgical tissues (mostly lymphoid tissues) using Genemed biotechnology protocol to arrive at a definitive diagnosis. Results: A total of 30 patients had FNAC of various cancers during the study period, and all patients had excision biopsy subsequently. The age range was 5–65 years, with the most common sites of FNAC been the breast 17 (56.7%), abdomen 5 (16.5%), and cervical lymph nodes 4 (13.3%). There was 100% concordance between the diagnosis on FNAC and the excised tissues. Conclusion: FNAC correlates very well with histology of the excised tissues and remains a useful tool to guide the clinician for better management of patients.
  1 4,322 367
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.
  - 6,410 472
ORIGINAL ARTICLES
Histopathological review of dermatological malignancies in Makurdi, North Central Nigeria
Joseph Aondowase Ngbea, Akpobome Raymond Vhriterhire, Isaac O Akpor, Nyaga Terhemba, Boniface A Ugbaje, Babarinde A Ojo, David Terkula Gyenger, Chukwukadibia N Ahachi, Olushola O Jegede, Patrick O Echekwube
January-June 2018, 9(1):75-78
DOI:10.4103/atp.atp_12_18  
Objective: Dermatological malignancies are among the common forms of cancer worldwide, especially Caucasians, and are noted to be in the skins of Africans and Negroid. The study aims to determine the frequency and patterns of dermatological malignancies in Benue State University Teaching Hospital (BSUTH), Makurdi, Nigeria. Methods: This was a 5-year retrospective study of skin samples seen at the Department of Anatomical Pathology, BSUTH, Makurdi, between March 2012 and February 2017. Results: A total of 215 skin biopsies were seen at the department during the study. Of these, 151 cases were dermatological malignancies constituting 70.2% of all skin lesions. Majority of these malignancies occurred between the fourth and fifth decades with a male-to-female ratio of 1.4:1. Kaposi sarcoma (KS) was the most common dermatological malignancy (n = 78; 52%). Squamous cell carcinoma constituted second majority (n = 30, 20%), followed by malignant melanoma (n = 22.1, 14.7%), dermatofi brosarcoma protuberans (n = 17, 11.3%), and basal cell carcinoma (n = 9, 6%). Leg, foot, and forearm were the common sites affected. Conclusion: KS was the most common dermatological malignancy in the study. Nearly all patients were HIV/AIDS positive. The findings in this study are similar to those from other parts of Africa and Nigeria. Therefore, HIV/AIDS control can substantially reduce the incidence, morbidity, and mortality of KS.
  - 4,347 306
Pattern of adult renal cell carcinoma in Kano, Nigeria: A 16-year retrospective review
Ali Bala Umar, Abubakar Abdulkadir, Sule Alfa Alhaji, Haruna Muhammad Sanusi, Abdurrahman Abba Sheshe, Amina El-Yakubu, Salihu Aliyu
January-June 2018, 9(1):79-82
DOI:10.4103/atp.atp_7_18  
Background and Objective: Renal cell carcinomas (RCCs) are the most common histological types of adults' renal cancer worldwide. Reviews on RCC distribution displayed predominant prevalence in the industrialized nations attributable to variations in vulnerability to environmental risks and genetic makeup. Nonetheless, the statistical conclusions of RCC in most sections of the Nigerian populace remain inadequate. This study aimed to evaluate the epidemiological pattern of the histologically confirmed renal cell carcinoma cases in Aminu Kano Teaching Hospital (AKTH), Kano - Nigeria. Materials and Methods: This was a 16-year retrospective review of the histologically confirmed RCC in AKTH, Kano, from January 2, 2001, to December 31, 2016. The data available during the period were collated and analyzed. Results: Twenty-four cases of RCCs were histologically confirmed during the study. The patient's ages ranged from 18 to 80 years, with a peak age in the sixth decade (50–59 years), and the male-to-female ratio of 2:1. Clear-cell variant was the predominant histological type. The tumors were all of the high-grade types, with 79% of patients having advanced disease. Conclusion: RCC is relatively rare in Kano. The precedence of high-grade and advanced-staged tumors in our review necessitates a search for better strategies that will enable early detection and prompt therapy.
  - 4,528 300
Histopathological pattern of thyroid cancers in Zaria: A 10-year review
Nasiru Raheem, Modupeola O.A. Samaila, Saad A Ahmed
January-June 2018, 9(1):89-92
DOI:10.4103/atp.atp_23_18  
Background: Thyroid cancer is a relatively rare malignancy representing only 1.5% of all cancers worldwide. However, it is the most common endocrine cancer globally and accounts for 92% of all endocrine malignancies. The annual incidence of thyroid cancer varies worldwide from 0.5 to 10/100,000 populations. This is an analysis of thyroid cancers diagnosed at the Department of Pathology, Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. Materials and Methods: This was a retrospective study carried out between January 2005 and December 2014. All the cases diagnosed with thyroid cancers within the period formed the study materials. Patient's biodata were retrieved from request cards. All histology slides stained with routine hematoxylin and eosin were retrieved and fresh sections made from formalin-fixed, paraffin-embedded stored tissue blocks where necessary. Results: Thyroid cancers constituted 4.6% of the total thyroid specimens submitted for histology during the study. The peak age of occurrence was between 21 and 30 years with a male-to-female ratio of 1:2.5. There were 14 thyroid cancer cases. Ten (71.4%) of the 14 thyroid cancer cases seen were papillary carcinoma, two cases (14.3%) were follicular carcinoma, and a case each (7.1%) of medullary and undifferentiated carcinoma. Conclusion: Thyroid cancer in our locality is uncommon. It is also more common in females and occurs predominantly within the third to fifth decades of life. Furthermore, the most common histologic variant in this environment is the papillary variant of the malignancy.
  - 4,151 273
Malignant odontogenic tumors: An analysis of 15 cases and review of the literature
Benjamin Fomete, Ezekiel Taiwo Adebayo, Kelvin U Omeje, Benedict Amaliemeh, Modupe A.O. Samaila
January-June 2018, 9(1):55-58
DOI:10.4103/atp.atp_5_18  
Introduction: Malignant odontogenic tumors (MOTs) are uncommon primary jaw lesions that represent approximately 6% of all odontogenic tumors. The rarity and complex classification reported for MOTs have also created challenges in their study over the years. Patients and Methods: All patients with a histopathological diagnosis of odontogenic tumor from 2003 to 2017 formed the study population. Their departmental and medical records were analyzed. Results: A total of 15 MOTs patients were studied. There were 10 males and five females with a M:F ratio of 1.6:1, and the ages ranged from 17 to 80 years with a mean of 48.06 years. The sites were the mandible and maxilla. The mandible to maxilla ratio was 2.25 to 1. Conclusion: Ameloblastic carcinoma was the most common MOT.
  - 4,451 322
Ectopic gestational trophoblastic disease: A 20-Year histopathological review in a tertiary center
Ikponmwosa Obahiagbon, Victor James Ekanem
January-June 2018, 9(1):59-63
DOI:10.4103/atp.atp_33_17  
Background: Gestational trophoblastic disease (GTD) is a group of proliferative disorders of the placental trophoblast. While the etiopathogenesis is not fully understood, this spectrum of diseases has varied histological appearances, with clinical behaviors ranging from benign to malignant. The burden of this group of lesions seems to be more in the developing countries. A high index of clinical suspicion, early laboratory confirmation of the diagnosis, and prompt treatment ensure total cures, even of malignant disease. These diseases, just like gestation itself, are known to occur in both intrauterine and extrauterine (ectopic) sites. Aim and Objectives: This study sought to determine the morphological pattern as well as the age and site distribution of the various forms of ectopic GTD histologically diagnosed in the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria, between January 1993 and December 2012. It is a hospital-based, retrospective review utilizing materials from the archives of the Department of Pathology, UBTH. The parameters studied include the specific histological diagnoses and the age and site distribution. Results: A total of 28 cases of ectopic GTDs were encountered. There were 17 cases (60.7%) and 8 cases (28.6%) of GTD found in the right and left fallopian tubes, respectively. Other sites of ectopic GTD were the left ovary (2 cases; 7.1%) and the right ovary (1 case; 3.5%). Partial mole was the most common (75.0%), followed by complete mole and invasive mole (10.7% each), and then choriocarcinoma (3.6%). The malignant: benign ratio was 1:27. Conclusion: Ectopic GTD, though still a relatively uncommon occurrence, should not be overlooked as a possibility in women with ectopic gestation, hence the need for histopathological and other ancillary evaluation of all ectopic conceptuses.
  - 3,675 292
Microscopic evidence of prostatic stromal and epithelial hyperplasia: A Post- Mortem study
Dele Eradebamwen Imasogie, Akhator Terence Azeke
January-June 2018, 9(1):64-68
DOI:10.4103/atp.atp_6_18  
Background: The natural history of prostatic nodular hyperplasia (PNH) begins from the pathological phase. This may progress to the clinical phase. The clinical phase is a subset of macroscopic PNH, while the latter is a subset of pathological phase of PNH. The aim of this study is, therefore, to determine the pathological phase of PNH as a prelude to the clinical phase. Subjects and Methods: The prostate glands from adult males who died from nonprostate related cause at the University of Benin Teaching Hospital, Benin City were studied. Their glands were obtained during the autopsy, weighed, and the respective weight recorded. Sections were assessed for microscopic evidence of prostatic stromal and epithelial hyperplasia. The clinical case note of each male patient as well as the mortuary/autopsy register was consulted for details of the age and clinical diagnosis. Results: The population under study was 86 cases. Of these, 67 (77.9%) cases were in the pathological phase of PNH and their ages ranged from 31 to 78 years. Their mean age was 52.60 ± 12.02 years, while their median and modal ages were 53 and 50 years, respectively. The most common cause of death in these patients was accident/unnatural cause (24%). Nearly 49% (33 cases) had macroscopic PNH with a mean weight of 38.64 ± 8.59 g at a mean age of 59.64 ± 9.73 years. Fifty-one percent (34 cases) had microscopic PNH. Their mean age and mean weight were 45.76 ± 9.97 years and 21.32 g ± 4.13, respectively. There was a significant increase in the mean weight of the prostate gland with age (P < 0.001). Cystic change (73%), chronic inflammation (51%), and acute inflammation (5%) in decreasing frequency were associated with the pathological phase of nodular hyperplasia. Conclusion: The natural history of nodular hyperplasia of the prostate is age-dependent, whereas the actual pathogenesis is largely undetermined, although various postulates exist. Of these, chronic inflammation may play a role as observed in this study.
  - 3,927 267
The relationship between donor deferral and seropositivity of transfusion-transmissible infections: Implication for transfusion services in the University of Calabar Teaching Hospital, Calabar
Kingsley Akaba, Benedict Nwogoh
January-June 2018, 9(1):22-25
DOI:10.4103/atp.atp_24_18  
Introduction: Providing adequate and safe blood has remained a daunting challenge to medical practice, especially in sub-Saharan Africa. Objectives: The objectives of this study were to identify the common reasons for donor deferrals and to determine the seroprevalence of common transfusion-transmissible infections (TTIs) at the University of Calabar Teaching Hospital (UCTH), Calabar. Materials and Methods: This is a retrospective study. Data of blood donors between June 2016 and August 2017 were obtained from the donor registry of the blood bank and analyzed using Microsoft Excel sheet. Results: Reactive test for TTIs and suboptimal packed cell volume (PCV) were the most common reasons for donor deferrals in UCTH, Calabar. A total of 12.3% of potential donors were deferred mainly due to positive screening test for TTIs and suboptimal PCV. The seroprevalence for hepatitis B, hepatitis C, human immunodeficiency viruses, and syphilis was 2.9%, 2.8%, 1.5%, and 2.5%, respectively. Conclusion: Seropositivity for TTIs and suboptimal hematocrit levels were the major reasons for donor deferrals in UCTH, Calabar.
  - 4,272 409
Perception and practice of thromboprophylaxis in patients with hematological malignancies among hemato-oncology practitioners in Nigeria
Benedict Nwogoh, Helen Chioma Okoye, Kaladada I Korubo, Anazoeze Jude Madu
January-June 2018, 9(1):32-36
DOI:10.4103/atp.atp_15_18  
Background: Cancer-associated thrombosis is a cause of increased morbidity and mortality in patients with hematological malignancies. Thromboprophylaxis may reduce this risk and improve the patients' prognosis and quality of life. Objectives: The study evaluates the awareness and practice of thromboprophylaxis by physicians managing patients with hematological malignancies and identifies challenges with such practice. Subjects and Methods: This descriptive cross-sectional study was conducted during the 42nd Annual General Meetings of the Nigerian Society of Haematology and Blood Transfusion held in Lagos 2016. A 12-item pretested questionnaire was used to obtain data on the perception and practice of thromboprophylaxis of hemato-oncologic patients from the 55 consenting hematologists in attendance. Data were analyzed with SPSS version 21. Results: The awareness and practice rate of cancer thromboprophylaxis are 96.4% and 92.7%, respectively. Multiple myeloma is the most common neoplasm of which hematologists practice thromboprophylaxis. Warfarin is the most prescribed anticoagulant. Doppler ultrasonography and basic coagulation screening tests are most readily available investigations. Funding and laboratory insufficiency are the leading challenges mitigating against effective management of venous thromboembolism (VTE). Conclusion: There is a high level of awareness and practice of thromboprophylaxis in cancer patients by Nigerian hematologists; however, scarcity of fund for investigation and drug procurement and limited laboratory capacity to diagnose and monitor patients still constitute a challenge to effective management of VTE.
  - 4,094 318
Serum gonadotrophin levels in breastfeeding mothers presenting at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Ikechukwu Samuel Obi, SC Das, Rabiyu A Umar, Abubakar Abubakar Panti, M El-Bashir, Lawson E Ekpe
January-June 2018, 9(1):37-41
DOI:10.4103/atp.atp_16_18  
Background: There is paucity of data on serum gonadotrophin levels in breastfeeding mothers in our environment. The study aims at determining the serum level of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and beta human chorionic gonadotrophins (β-hCG) in breastfeeding mothers and comparing with that of the controls. Subject and Method: Serum gonadotrophins levels were measured using commercially prepared enzyme-linked immunosorbent assay kit in 100 breastfeeding Nigerian women while 60 nonbreastfeeding ones (30 nonpregnant and 30 pregnant) served as controls. The participants were recruited consecutively from clients attending antenatal care at Usmanu Danfodiyo University Teaching Hospital, Sokoto. Results: The mean ± standard error of the mean serum level of FSH, LH, and β-hCG in mIU/ml was 5.97 ± 0.53, 7.15 ± 1.04, and 27.03 ± 3.16, respectively, at puerperium. Serum β-hCG level was significantly higher in breastfeeding group compared to the nonpregnant control (P < 0.05), but lower than that of the pregnant control (P < 0.05). Serum FSH is significantly lower (P < 0.05) in the breastfeeding group (5.97 ± 0.53 mIU/ml) compared to the nonpregnant control (8.99 ± 0.68 mIU/ml), but similar to that of the pregnant control. Serum LH however was significantly lower (P < 0.05) in the breastfeeding group (7.15 ± 1.04 mIU/ml) compared to the pregnant control (11.58 ± 0.7 mIU/ml). Conclusions: The serum β-hCG level was higher in breastfeeding mothers compared to the nonpregnant control. Thus, there is the need to establish separate reference values for gonadotrophins in mothers during puerperium. These reference values may be beneficial for detection of impaired level, especially of β-hCG in choriocarcinoma and other trophoblastic diseases at puerperium.
  - 10,334 295
Relationship between prostate specific antigen and body mass index among men in Lagos, South West Nigeria
Adeyemi O Dada, Oyetunji O Soriyan, Henry Okpara, Chinelo P Onyenekwu, Ephraim Egbuagha
January-June 2018, 9(1):42-46
DOI:10.4103/atp.atp_46_17  
Background: Obesity and overweight are health problems marked by excess adiposity which contribute to a number of preventable deaths and are significant risk factors for many chronic diseases including cancer. Prostate-specific antigen (PSA) has been used over the years to screen, diagnose, and monitor the treatment of prostate cancer. The aim of this study is to evaluate the relationship between body mass index (BMI) and PSA levels. Materials and Methods: A cross-sectional study of 125 overweight, 77 obese men and 78 controls aged 40–89 years was conducted in Lagos, South West Nigeria. The BMI, abdominal circumference (AC) serum total, and free PSA (tPSA; fPSA) were determined. Spearman correlation was used to determine the relationship between PSA and BMI and a significant level of P < 0.05 was used. Results: Participants with AC ≤102 cm had a higher median tPSA of 1.20 ng/ml (0.93, 1.55) than participants with AC >102 cm with a P = 0.006, but their median fPSA did not show any difference. The median tPSA among controls was higher than that of overweight and obese participants with P = 0.008 and P = 0.000, respectively. The control group had a higher median fPSA than the obese group (P = 0.029). There was also a significant negative correlation between tPSA and BMI (r − 0.30, P = 0.00) as well as between fPSA and BMI (r − 0.14, P = 0.01). Conclusion: The serum PSA levels in obese and overweight men are significantly lower than those of the controls. This can potentially prevent early detection of prostate cancer when using serum PSA as a screening tool in overweight and obese men.
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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.
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