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ORIGINAL ARTICLES
Cytolytic vaginosis: A common yet underdiagnosed entity
Shailja Puri
January-June 2020, 11(1):29-32
DOI:10.4103/atp.atp_18_19  
Objective: The objective of this study is to determine the incidence of cytolytic vaginosis among patients undergoing cervicovaginal cytology for vaginal discharge, pruritus, dyspareunia, and other symptoms. Cytolytic vaginosis is also known as Lactobacillus overgrowth syndrome or Doderlein's cytolysis. It is characterized by an abundant growth of Lactobacilli resulting in lysis of vaginal epithelial cells. Methods: A total of 308 women presented to gynecological outpatient department. All of the patients were subjected to Pap test with the help of cytobrush. The cervicovaginal smears were fixed in methanol, stained with papanicolaou stain, and studied under a microscope independently by two pathologists. Results: Of 308 patients, 190 (61.7%) had an inflammatory lesion and were negative for intraepithelial malignancy. Of 190 cases, 31 (16.3%) were diagnosed with cytolytic vaginosis based on the clinical and morphological features. Conclusion: Cytolytic vaginosis is a fairly common entity often misdiagnosed as candidiasis. Morphological features play an important role in identifying cytolytic vaginosis. The results of this study may contribute to reports in the literature indicating the importance of cytolytic vaginosis which is not included in the current Bethesda system for reporting of cervical cytology.
  21,865 438 3
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.
  18,536 1,056 1
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.
  17,703 700 5
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.
  16,844 1,179 7
Breast cysts with masses versus breast masses with cysts: Sonographic sub-types of complex breast cysts with pathologic correlations
Olarinoye - Akorede Sefiya Adebanke, Aliyu Halima, Lawal Suleiman, Bello Nafisa, Mohammed Halima Mono
July-December 2020, 11(2):180-185
DOI:10.4103/atp.atp_21_20  
Background: Cystic lesions of the breast are generally classified as simple, complicated or complex. A complex breast cyst is however defined as a lesion which contains both cystic (anechoic) and solid (echogenic) components. There is a need to understand the sonographic criteria and differential diagnoses of complex cysts which have varying risks of malignancy, as against simple or complicated cysts which are typically benign. Objectives: To examine the sonographic subdivisions of complex breast cysts, correlating with histopathological diagnosis as seen in Ahmadu Bello University Teaching Hospital, Zaria. Materials and Methods: A 5-year retrospective review of 106 women who had complex breast cysts diagnosed on high resolution ultrasound (Mindray DC- 8, 2013; transducer frequency 7.5–12 MHz). The lesions were categorized as: Type 1 (cysts with thick wall or septa), Type 2 (cysts with a small mural nodule), Type 3 (cystic and solid lesion with >50% cystic component), Type 4 (cystic and solid lesion with >50% solid component). The final diagnosis was either by short term ultrasound follow-up, Ultrasound-guided fine needle aspiration cytology/core biopsy or excision biopsy. Results: Out of a total of 248 patients with breast cysts, 106 women had complex cysts. 27 (25.4%) patients had cysts with either thick wall or septa or both; 11 (10.4%) had a small intra-mural nodule; 14 (13.2%) had solid-cystic mass with >50% cystic component and 54 (50.9%) had solid-cystic mass with >50% solid component. Overall 66% were benign while 34% were malignant. The commonest pathology to present as a complex breast cyst was invasive ductal carcinoma not otherwise specified. Conclusion: Complex cysts are associated with varying risks of malignancy. Also, a certain pathology could exhibit sonographic features of any of the subdivisions (Type 1-4). Therefore, meticulous attention should be paid to other associated imaging findings as well as detailed history and thorough clinical examination.
  13,577 312 -
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.
  11,384 532 -
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.
  10,679 1,102 12
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 -
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.
  9,954 487 -
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.
  9,846 546 1
ORIGINAL ARTICLES
Profile of hanging deaths in Lagos, Nigeria: A 9-year retrospective autopsy study
Francis Adedayo Faduyile, Sunday Sokunle Soyemi, Alban Ikenna Mgbehoma, Daniel Ayodele Sanni
January-June 2019, 10(1):11-15
DOI:10.4103/atp.atp_3_19  
Introduction: Hanging is seen worldwide and is the most common method of suicide globally. Hanging in Western nations has been well documented. However, there appears to be a dearth of published data on hanging in Nigeria, Africa. The essence of this work is to look at the morphological characteristics and the epidemiological profile of victims who died from hanging. Materials and Methods: This was a 9-year retrospective autopsy study on hanging deaths from January 1, 2005, to December 31, 2013. The details of the injuries present were recorded in a predesigned format so as to minimize error. Such findings included age, sex, type of hanging, position of knot, number of turns of the ligature, and fracture of hyoid and thyroid cartilages. The findings noted were carefully compiled, tabulated, and analyzed using the Statistical Package for the Social Sciences version 20. Results: There were 22 cases of hanging during the study period representing 0.2% of the total autopsy cases. The mean age was 38 ± 12 years, ranging from 15 to 60 years. This was predominantly a male phenomenon, with males constituting 94.5%, whereas females accounted for only 4.5%. Hanging was most common in the fifth decade (27.3%). This was closely followed by the third and fourth decades. This study revealed that 95.5% had single loop. The knot was most common on the right representing 54.5% and least common at the occiput accounting for 13.6%. Hyoid bone fracture and thyroid cartilage fracture were seen in 22.7% each. Conclusion: This study has shown that the mean age of hanging was in the fourth decade in this environment, with an overwhelming male preponderance. Fixed single loop on the right side was the most common picture and a quarter had fracture of hyoid bone and thyroid cartilage. All the ligature marks were obliquely placed, and no fracture of cervical vertebrae was identified. A future study will be needed to determine what percentage of suicide is hanging in this part of the world.
  9,846 504 2
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.
  8,860 891 28
Aqueous beetroot juice extract improves renal function and some biochemical parameters in carbon tetrachloride-induced toxicity in sprague dawley rats
Fidelis Ehidiamen Olumese, Henrietta Ayodele Oboh
July-December 2020, 11(2):171-175
DOI:10.4103/atp.atp_38_20  
Background: The ability of plant extracts to improve toxicity in the kidney is gaining attention. This may be due to the untoward effects and high cost of orthodox drugs used for the management of kidney disease, therefore, the use of aqueous beetroot juice as a potential ameliorative agent was evaluated. Materials and Methods: Group 1 received 2 ml/kg distilled water (normal control); Group II received 2 ml/kg olive oil; Group III received 2 ml/kg carbon tetrachloride (CCl4) in olive oil 48 hourly (negative control); Group IV received 2 ml/kg CCl4 in olive oil and 250 mg/kg of beetroot/day; Group V received 2 ml/kg CCl4 in olive oil and 500 mg/kg of beetroot/day; and Group VI received 2 ml/kg CCl4 in olive oil and 100 mg/kg silymarin/day (positive control) for 14 days. Animals were euthanized, and blood was collected for the evaluation of electrolytes, urea, and creatinine, whereas the kidney tissue was assessed for histopathological changes. Results: There was a significant (P < 0.05) decrease in the level of K + in the group of rats administered 250 mg and 500 mg/kg of aqueous beetroot extract, when compared to negative control. The levels of Na + were reduced in the treated groups when compared to normal control. There were no significant changes in Cl − levels in all the group of animals. The urea levels decreased in the groups treated with extract or silymarin, and a similar trend of creatinine was observed in the groups administered beetroot extract. However, creatinine concentration was significantly (P < 0.05) increased in the group of rats administered only silymarin when compared to other groups. Histopathological evaluation revealed that the tubular necrosis observed in the kidney was ameliorated after beetroot juice administration. Conclusion: Beetroot juice showed nephroprotective effects against CCl4-induced renal toxicity.
  9,375 252 -
Prevalence of overweight and obesity among health-care workers in University of Benin Teaching Hospital, Benin City, Nigeria
Tomisin Matthew Adaja, Osagie Joseph Idemudia
July-December 2018, 9(2):150-154
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.
  8,634 710 7
Molecular subtyping of carcinoma of the female breast in a tertiary teaching hospital in Northern Nigeria
Asma'u Usman, Yawale Iliyasu, Akinfenwa Taoheed Atanda
January-June 2019, 10(1):20-26
DOI:10.4103/atp.atp_51_18  
Background: Cancer of the breast is globally the most common female cancer including in Nigeria. Newer treatment modalities are based on tumor immunophenotyping, thus the need to characterize these tumors among women with the disease in Northern Nigeria. Aims: This study aims to classify carcinomas of the breast diagnosed in the pathology laboratory of a teaching hospital based on their expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2/neu (HER2/neu) overexpression. Methodology: The histology slides of 478 carcinomas of the breast as well as the ER, PR, and HER2 immunohistochemistry records of 118 stained cases were retrieved and reviewed. Results: Age range of cases was from 20 to 80 years (mean = 46.9 ± 13). The most common histomorphologic entity was invasive carcinoma (NST) which accounted for 73.2% of cases. These were followed in frequency by invasive lobular carcinoma accounting for 6.8% of cases and invasive papillary carcinoma representing 6.5% of cases. Overall, 169 cases (37.6%) were Grade III tumors while Grades II and I tumors accounted for 35.1% and 27.3% of cases, respectively. Triple-negative tumors were the most common molecular subtype and comprised 46.6% of all cases. Luminal B (LUMB) was the least common and accounted for 8% of all cases. HER2 overexpression and LUMA were seen in 17.9% and 28.8% of cases, respectively. Conclusion: Carcinoma of the breast in the population studied occurs at a younger age than among Caucasians. The tumors are characterized by preponderance of invasive carcinoma (NST), high histological grade, and triple-negative phenotype.
  8,542 653 7
REVIEW ARTICLE
Gastrointestinal stromal tumor – A systemic review literature
Debajani Deka, Md Faizzal, Bipul Kumar Das
January-June 2022, 13(1):1-3
DOI:10.4103/atp.atp_5_22  
Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors of the gastrointestinal tract and originate from the interstitial cells of Cajal. They arise most commonly from the stomach or small intestine, with a median age of 60 years. We did not find any relationship between GIST and ABO blood group and Rh factor. Mutations in KIT exon 11 are found to be more common in larger tumors, and the presence of this mutation has been shown to have an adverse prognostic influence. Deletions compared with point mutations in exon 11 have also been found to be a significant unfavorable factor in patients with gastric GISTs. The study group includes all cases of GIST and extra-GIST. Review literatures were taken from Internet Google search and some websites of high index journals. The data extruded mainly were sites of the gastrointestinal tract, histological types, different immunohistochemical markers, etc., Stomach is the most common site of GIST around 70%. Spindle cell is the most common histological variety; CD117 is frequently found immunohistochemical finding. From the abovementioned results, we can easily come to the diagnosis of specific type of GIST and its respective therapeutic measures.
  8,472 663 -
ORIGINAL ARTICLES
An assessment of infection prevention and control in hospitals in Akwa Ibom State, Nigeria
Agantem Ekuma, Ini Etukudo, Asukwo Onukak, Rosemary Umoh, Betini Christian
January-June 2022, 13(1):8-11
DOI:10.4103/atp.atp_1_22  
Background: Infection prevention and control (IPC) programs are important in controlling healthcare associated infections (HAIs). In low and middle income countries, IPC programs targeting HCAIs are frequently underdeveloped and sometimes nonexistent. Aim: The aim of this study was to assess and identify gaps in IPC practice across selected hospitals in Akwa Ibom State. Methods: This was a survey of hospitals in Akwa Ibom State in Southern Nigeria. Information for each hospital was provided by IPC representatives of each hospital through a 24 point questionnaire covering administrative controls, hand hygiene, available laboratory tests for infections, and waste disposal. Results: There were 25 hospitals across 15 local government areas in the state included in the survey. The average number of beds in the hospitals was 57 (6–300); the average number of wards was 6 (1–20); the average number of staff was: doctors 9 (2–40); nurses 33 (6–200); other staff 19 (3–100). There were 16 hospitals with a designated staff to oversee IPC activities, 4 with a staff dedicated to IPC activities, and one with a written IPC policy. Adequate number of hand washing stations was reported in 11 centers while 9 had regular supply of running water and 9 had regular supply of alcohol based hand sanitizers for hand hygiene. There was low capacity for onsite microbiology cultures to identify infectious agents, although most centers had HIV and hepatitis B virus rapid diagnostic test kits. Conclusion: There are variable levels of implementation of IPC in hospitals in Akwa Ibom State with a lack of structure, guidelines, and resources being a hindrance to high level of IPC in these hospitals.
  8,462 647 -
Hematological parameters of children with sickle cell anemia in steady and crisis states in Zaria, Nigeria
Yakubu Abubakar, Hafsat Rufa'i Ahmad, Jamilu Abdullahi Faruk
July-December 2019, 10(2):122-125
DOI:10.4103/atp.atp_22_19  
Background: Sickle cell anemia (SCA) is the most common and severest form of sickle cell disease. It affects about 3% of the Nigerian population with a high mortality in children. Hematological parameters are routinely used in the monitoring of SCA patients and might vary in crisis and steady states. Aims and Objectives: This study was aimed at comparing the hematological parameters of SCA patients in steady state with those in hemolytic and vaso-occlusive crisis states. Methodology: It was a cross-sectional study carried out at the pediatric outpatient clinic of a tertiary hospital in North West Nigeria. We recruited 170 SCA patients in steady state or in crisis state. Five milliliters of blood sample was collected for full blood count analysis using the Sysmex Xt 2000i automated hematology analyzer. Results: Hemoglobin (Hb) and hematocrit (HCT) levels for SCA patients in steady state were 8.28 ± 1.64 g/dl and 21.8 ± 4.04% while in vaso-occlusive crisis (VOC) state were 7.81 ± 1.37 g/dl and 22.05 ± 1.37% and those with hemolytic crisis were 4.45 ± 0.12 and 13.35 ± 0.67, respectively. Total white blood cell (WBC) count in steady and VOC states was 14.51 ± 5.21 × 109/l and 17.46 ± 5.26 × 109/l, respectively, while those in hemolytic crisis had WBC of 14.92 ± 5.82 × 106/l. ANOVA test was 0.0001, 0.0001, and 0.03, respectively, which indicates a statistically significant difference between the groups. The mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) in steady state were 76.67 fl ± 9.02, 27.18 pg ± 4.36, and 35.17 g/dl ± 4.25, while in VOC state, they were 74.88 fl ± 11.60, 27.24 pg ± 3.70, and 35.49 g/dl ± 1.42 and, in anemic crisis state, they were 76.63 ± 11.74, 26.71 ± 3.78 and 35.03 ± 1.20, respectively. Conclusion: Hematological parameters were lower during crisis states, although most of these were not significantly different from those in steady state apart from the WBC count, Hb, and HCT. Therefore, routine monitoring of hematological parameters should remain an important component in the management of SCA children.
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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.
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Human epidermal growth factor receptor-2 overexpression in endometrial carcinomas at a tertiary center in Sub-Saharan Africa
Segun S Odetola, Mustapha Akanji Ajani, Ifeanyichukwu D Nwanji, Ayodeji A Salami, Clement Abu Okolo
January-June 2022, 13(1):4-7
DOI:10.4103/atp.atp_6_22  
Background: Endometrial cancer is the third most common gynecological malignancy, following cervical and ovarian malignancies. Prognosis among the women of African origin is, however, worse as they tend to have high-grade tumors and late presentation. Close to 50% of high-grade endometrial cancers show human epidermal growth factor receptor 2 (HER2) overexpression and may thus benefit from targeted treatment. Aims: This study aimed to determine the overexpression status of HER2 protein among the cases of endometrial carcinoma. Materials and Methods: All cases of histologically diagnosed endometrial carcinoma from January 2007 to December 2016 were retrieved from the files and records of department of pathology in our hospital. Cases were classified and graded according to the World Health Organization (2014 version) classification of endometrial carcinoma followed by immunohistochemical staining for HER2 overexpression. Results: There were a total of 51 cases of endometrial carcinoma that met the inclusion criteria during the study. The mean age of patients was 63 years. As a group, nonendometrioid carcinomas predominated (55%). The majority (70%) of cases showed high-grade histological morphology. Positive Her2/Neu expression was seen in 11 cases (22%) of endometrial carcinoma. There was no statistically significant association between hormone expression status and age, histological variant, or grade. Conclusion: Endometrial carcinomas among Nigerian women are predominantly nonendometroid and high grade. HER2 overexpression was seen in a fifth of cases. Future studies should explore the response of targeted therapy among Nigerian patients showing HER2 overexpression.
  7,994 635 -
Pattern of unnatural death among females in niger delta: A retrospective medicolegal study
Eseroghene Arthur Ijomone, Obiora Jude Uchendu, Nkadi Francis Nwachokor
January-June 2019, 10(1):6-10
DOI:10.4103/atp.atp_54_18  
Background: Unnatural death among women is rarely emphasized but an important public health index of the community and society. Objective: The objective is to study the epidemiologic profile of unnatural death among females using autopsy data. Design: This is a 14-year descriptive retrospective study of all female unnatural death victims within Warri and its neighboring communities subjected to medicolegal autopsy. Materials and Methods: Information on age as well as manner and method of death were extracted from the autopsy report of the cases and subsequently analyzed using Microsoft Office Excel 2007. Results: Ninety-six females were examined in this study, representing 9.9% of the 975 medicolegal performed and 11.4% of the 805 unnatural deaths encountered during the study period. The age range is 1–70 years and the mean age is 29.82 years. These cases represent a mean annual incidence of about seven cases. The peak incidence of unnatural death occurred in the third decade (27.1%), followed by the fourth (19.8%) and fifth (15.6%) decades, respectively. The peak incidence for homicide and accidental deaths is in the third and fourth decades, respectively. Firearm-related death is the leading method of homicide accounting for 24 (53.3%) of the 45 homicide deaths. The use of blunt and sharp weapons each accounts for 10 (22.2%) of the cases. Road traffic accident (RTA) accounts for 28 cases, representing 59.6% of accidental deaths and 29.1% of unnatural deaths. Burns and drowning are the second and third leading causes of accidental death accounting for 11 (23.4%) and 3 (6.4%) of the accidental deaths. Four cases of suicide were encountered with three deaths as a result of ingestion of chemical poisons, while the fourth case was by hanging using rope. Conclusion: The study showed that unnatural deaths in women are mainly accidental, homicidal, and suicidal representing 49.0%, 46.0%, and 4.2% of the cases respectively. RTA, burns, drowning, and poisoning (in descending order) are the major causes of accidental deaths. Firearm, sharp, and blunt injuries (in descending order) are the major methods of executing homicides. The peak age for unnatural death is in the third decade with 75% of the death clustering within the 2nd–4th decade. Education, accident consciousness, parental supervision, and implementation of appropriate policy measures are paramount to reducing such death.
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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.
  7,947 510 2
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.
  7,443 694 2
REVIEW ARTICLES
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.
  7,443 624 5
ORIGINAL ARTICLES
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.
  7,377 605 -