A Clinico-Pathological Study of Vulvo-Vaginal Disease at a Nigerian Tertiary Health Facility.

INTRODUCTION: The vulva and vagina are of great significance to womanhood owing to the myriads of specialized functions they perform. The diseases of this organ have physical, social, mental, and psychological ramifications. The aim of this work is to study the pathological pattern and clinical presentation of diseases of the vulva and vagina at the Department of Anatomical Pathology and Forensic Medicine of the Jos University Teaching Hospital between 1st January 2011 and December 31st, 2020. METHODOLOGY: This study is descriptive of all cases of histologically diagnosed vulval and vaginal lesions seen at the Center. Histological diagnosis, biodata, and clinical information of patients were retrieved from the medical records. Data realized were analyzed and presented in tables as simple frequencies, percentages, ranges, and measures of central tendencies. RESULTS: Two hundred and fifteen vulval and vaginal biopsies were included in the study. Squamous cell carcinoma was the commonest histologically diagnosed lesion accounting for 70(32.6%) cases of all lesions and 77.8% of all malignancies. The second commonest lesion and the most frequent benign pathology is the Condyloma acuminatum (viral warts) which accounted for 41(19.1%) cases. The age bracket 20 to 59 years constituted 79.5% of cases (171 cases). The age range, mean, median, and mode in years were 5.0-85.0, 39.5+15.9, 38.0, and 50.0 respectively. CONCLUSION: Squamous cell carcinoma and veneral warts are the commonest lesions of the vulva and vagina in our environment. Robust vaccination programs against the etiological agent, the human papilloma virus is highly recommended.

INTRODUCTION: La vulve et le vagin ont une importance considérable pour la féminité en raison des myriades de fonctions spécialisées qu'ils remplissent. Les maladies de cet organe ont des ramifications physiques, sociales, mentales et psychologiques. L'objectif de ce travail est d'étudier le modèle pathologique et la présentation clinique des maladies de la vulve et du vagin au département de pathologie anatomique et de médecine légale de l'hôpital universitaire de Jos entre le 1er janvier 2011 et le 31 décembre 2020. METHODOLOGIE: Cette étude est descriptive de tous les cas de lésions vulvaires et vaginales diagnostiquées histologiquement au Centre. Le diagnostic histologique, les données biologiques et les informations cliniques des patientes ont été extraits des dossiers médicaux. Les données obtenues ont été analysées et présentées dans des tableaux sous forme de fréquences simples, de pourcentages, d'intervalles et de mesures de tendances centrales. RÉSULTATS: Deux cent quinze biopsies vulvaires et vaginales ont été incluses dans l'étude. Le carcinome épidermoïde était la lésion histologiquement diagnostiquée la plus fréquente, représentant 70 (32,6 %) cas de toutes les lésions et 77,8 % de toutes les tumeurs malignes. La deuxième lésion la plus fréquente et la pathologie bénigne la plus fréquente est le condylome acuminé (verrues virales), qui représente 41 (19,1 %) cas. La tranche d'âge de 20 à 59 ans représentait 79,5 % des cas (171 cas). La fourchette d'âge, la moyenne, la médiane et le mode en années étaient respectivement de 5,0-85,0, 39,5+15,9, 38,0 et 50,0. CONCLUSION: le carcinome épidermoïde et les verrues générales sont les lésions les plus fréquentes de la vulve et du vagin dans notre environnement. Des programmes de vaccination robustes contre l'agent étiologique de cette pathologie, le virus du papillome humain, sont fortement recommandés. Mots clés: Vulve, Vagin, Cancer, Verrue.

Sarcomas in Nigerian Children in Jos North Central Nigeria.

BACKGROUND: There is a growing concern about childhood sarcomas, with recent studies suggesting an increase in the frequency of childhood sarcomas in sub-Saharan Africa. This study was carried out to determine the pattern of childhood sarcomas in Jos, North Central Nigeria and to compare the data obtained with other previous related studies. METHODS: Review of the Jos University Teaching Hospital cancer registry from January 2001 to December 2010. Data of all children (0-15 years) in the data base were retrieved for analysis. RESULTS: Two hundred and ten histological diagnosis of malignancies were made in children over the period, with 81 cases (39%) being childhood Sarcomas. The sarcomas occurred predominantly in males (54%) with male/female ratio of 2:1. The minimum age was 2 months and the maximum age was 15 years. Soft tissue sarcoma (STS) was the most predominant group which accounted for 73 cases (90%) of all sarcomas seen. Rhabdomyosarcoma (RMS) was the most common STS, it accounted for 65 cases (89%) of the STS and 80% of all the sarcomas. This is followed by Kaposi Sarcoma (KS) accounting for 6.9% of STS. There were 8 cases of Osteosarcoma which accounted for 10% of all the sarcomas. Embryonal RMS predominated in the very young children while all other sarcomas affected the older children. Extremities were the sites of predilection for most of the sarcomas (36%). Seventeen (17) cases of the RMS were of superior prognostic group, 34 (54%) were of intermediate prognostic group while 24 cases (37%) were of poor prognostic group. CONCLUSION: Childhood sarcomas are common in our environment and RMS is the single most common sarcoma while the non-rhabdomyosarcoma soft tissue sarcomas (NRSTS) are rare.

Ontogeny and nutritional programming of mitochondrial proteins in the ovine kidney, liver and lung.

This study investigated the developmental and nutritional programming of two important mitochondrial proteins, namely voltage-dependent anion channel (VDAC) and cytochrome c, in the sheep kidney, liver and lung. The effect of maternal nutrient restriction between early and mid-gestation (i.e. 28- to 80-day gestation, the period of maximal placental growth) on the abundance of these proteins was also examined in fetal and juvenile offspring. Fetuses were sampled at 80 and 140 days of gestation (term approximately 147 days), and postnatal animals at 1 and 30 days and 6 months of age. The abundance of VDAC peaked at 140 days of gestation in the lung, compared with 1 day after birth in the kidney and liver, whereas cytochrome c abundance was greatest at 140 days of gestation in the liver, 1 day after birth in the kidney and 6 months of age in lungs. This differential ontogeny in mitochondrial protein abundance between tissues was accompanied with very different tissue-specific responses to changes in maternal food intake. In the liver, maternal nutrient restriction only increased mitochondrial protein abundance at 80 days of gestation, compared with no effect in the kidney. In contrast, in the lung mitochondrial protein, abundance was raised near to term, whereas VDAC abundance was decreased by 6 months of age. These findings demonstrate the tissue-specific nature of mitochondrial protein development that reflects differences in functional adaptation after birth. The divergence in mitochondrial response between tissues to maternal nutrient restriction early in pregnancy further reflects these differential ontogenies.

Different effects of maternal parity, cold exposure and nutrient restriction in late pregnancy on the abundance of mitochondrial proteins in the kidney, liver and lung of postnatal sheep.

Adaptation to the extrauterine environment at birth relies upon the onset of postnatal function and increased metabolism in the lungs, liver and kidney, mediated partly by activation of mitochondrial proteins such as the voltage-dependent anion channel (VDAC), cytochrome c and, in the lung only, uncoupling protein (UCP)2. The magnitude of adaptation is dependent on the maternal metabolic and endocrine environment. We, therefore, examined the influence of maternal cold exposure (MCE) induced by winter shearing of pregnant sheep in conjunction with nutrient restriction (NR; 50% reduction in maternal food intake from 110 days gestation up to term). The effect of parity was also examined, as the offspring of nulliparous mothers are growth restricted compared with multiparous offspring. All sheep were twin bearing. One twin was sampled after birth and its sibling at 30 days. In the lung, both MCE and maternal nulliparity enhanced UCP2 abundance. However, whilst VDAC abundance was decreased in both the offspring of nulliparous mothers and by NR, it was transiently raised by MCE. Kidney VDAC abundance was reduced by MCE and nulliparity, adaptations only influenced by NR in multiparous mothers. Cytochrome c abundance was raised by MCE and by NR in multiparous controls and raised in offspring of nulliparous mothers. Liver VDAC and cytochrome c abundance were transiently reduced by MCE and persistently lower in offspring of nulliparous mothers. In conclusion, changes in the maternal metabolic environment have marked tissue-specific effects on mitochondrial protein abundance in the lungs, liver and kidney that may be important in enabling the newborn to effectively adapt to the extrauterine environment.

Ontogeny and nutritional programming of uncoupling protein-2 and glucocorticoid receptor mRNA in the ovine lung.

This study investigated the developmental and nutritional programming of uncoupling protein-2 (UCP2), glucocorticoid receptor (GR) and 11beta-hydroxysteroid dehydrogenase type 1 (11betaHSD1) mRNA in the sheep lung from the time of uterine attachment to 6 months of age. The effect of maternal nutrient restriction on lung development was determined in early to mid gestation (i.e. 28-80 days gestation, period of maximal placental growth, and embryonic and pseudoglandular stages of fetal lung development) and late gestation (i.e. 110-147 days gestation, period of maximal fetal growth, and canalicular and saccular stages of fetal lung development). Fetal lungs were sampled at 80 and 140 days (term approximately 148 days) gestation, and sheep lungs at 1, 7, 30 days and 6 months. GR and 11betaHSD1 mRNA were maximal at 140 days gestation, whereas UCP2 mRNA peaked at 1 day of age and then declined with postnatal age. Maternal nutrient restriction in both early-to-mid and late gestation had no effect on lung weight, but increased UCP2, GR and 11betaHSD1 mRNA abundance at every sampling age. These findings suggest that the developmental ontogeny of UCP2 mRNA in the ovine lung is under local glucocorticoid hormone action and that maternal nutrient restriction has long-term consequences for UCP2 and GR mRNA abundance in the lung irrespective of its timing.

Ontogeny and nutritional manipulation of mitochondrial protein abundance in adipose tissue and the lungs of postnatal sheep.

The present study examined the ontogeny of mitochondrial protein abundance in adipose tissue and lungs over the first month of life in the sheep and the extent to which this may be altered by maternal undernutrition during the final month of gestation. The ontogeny of uncoupling protein (UCP), voltage-dependent anion channel (VDAC) and cytochrome c abundance were determined in adipose tissue and lungs sampled from near-term fetuses and young sheep aged 4 h, 1, 7 and 30 d. In adipose tissue, the abundance of UCP1, VDAC and cytochrome c all peaked at 1 d of age and then decreased by 30 d of age, at which stage the brown adipose tissue-specific UCP1 was no longer detectable but UCP2 was clearly abundant. For the lungs, however, UCP2 and VDAC abundance both peaked 7 d after birth and then decreased by 30 d of age. During postnatal development, therefore, a marked change in mitochondrial protein abundance occurs within both adipose tissue and lungs. Maternal nutrient restriction had no effect on lamb growth or tissue weights at 30 d of age but was associated with increased abundance of UCP2 and VDAC but not cytochrome c in both adipose tissue and lungs. These mitochondrial adaptations within both adipose tissue and the lungs of offspring born to previously nutrient-restricted mothers may compromise adipose tissue and lung function during periods of environmental stress.

In vitro activities of meropenem and other antimicrobial agents against British meningococcal isolates.

The in vitro activity of meropenem was compared with those of penicillin, ampicillin, cefuroxime, cetriaxone, cefotaxime, rifampicin, chloramphenicol, sulphadiazine and ciprofloxacin against 121 British meningococcal isolates by a microdilution method in Mueller-Hinton broth and by the E test. All meningococcal strains were susceptible to the agents except for ampicillin (88.4%), penicillin (88.4%), sulphadiazine (57.9%) and rifampicin (95%). The emergence of resistance problems among meningococcal isolates stresses the need for their constant monitoring and of the development of new agents. In this study we have shown that meropenem is highly active in vitro against Neisseria meningitidis. Recent studies have indicated that meropenem is highly active clinically and bacteriologically in the treatment of bacterial meningitis. Thus, the potentials of meropenem as meningococcal prophylactic and therapeutic agent needs to be fully evaluated.

Influence of maternal bodyweight on size, conformation and survival of newborn lambs.

Although body condition score was not significantly different between light (<55 kg, n = 6) and heavy (> or =60 kg, n = 7) ewes at mating, it declined between Day 30 and Day 90 of gestation in light but not heavy ewes, and remained lower up to term. All ewes bore twins, delivered near term (Days 144-146) by Caesarean section. One lamb was immediately placed into a warm (30 degrees C; WD) and its twin into a cool (15 degrees C; CD) ambient temperature, and tissues were sampled at 0.5 h or 6 h. All CD lambs born to light ewes exhibited hypothermia and/or respiratory failure and did not survive longer than 30 min; these symptoms were not observed in their WD twins or any lamb born to heavy ewes. Total lamb birth weight, placental weight and fetal cotyledonary weight were lower with light than with heavy ewes. Lambs born to light ewes had less perirenal adipose tissue and smaller liver, heart, kidneys, brain, adrenals and thyroid, although their heart, brain and pancreas represented a larger proportion of total bodyweight; pancreas weight was similar to that in lambs born to heavy ewes. Hence, maternal bodyweight critically influences placental weight and lamb size and survival after birth.

Antimicrobial susceptibility of penicillin-sensitive and penicillin-resistant meningococci.

Ceftriaxone showed high in-vitro activity against 119 penicillin-sensitive, penicillin-resistant and rifampicin-resistant UK isolates of meningococci. Unlike ciprofloxacin and minocycline, ceftriaxone is suitable for use in young children or in pregnancy and should be considered for therapy or prophylaxis in an outbreak of meningococcal disease. The E test gave results comparable to those given by broth microdilution method in the determination of meningococcal susceptibility to antimicrobials. It is convenient for use in small laboratories and can be used to determine antimicrobial subgroups of meningococci.

Epidemiological evaluation of Neisseria meningitidis serogroup B by pulsed-field gel electrophoresis.

Genomic DNA from 25 strains of serogroup B Neisseria meningitidis was subjected to pulsed-field gel electrophoresis (PFGE) after digestion with Spe I. N. meningitidis genomic DNA displayed considerable diversity. The diversity we observed among these strains was stable and included isolates from an outbreak that were phenotypically identical. This confirms the value of macrorestriction profiling and PFGE in providing epidemiologically stable strain markers for typing meningococci.

Molecular epidemiology of recent United Kingdom isolates of Neisseria meningitidis serogroup C.

The genomes of 34 recent United Kingdom isolates of Neisseria meningitidis serogroup C were examined by restriction enzyme digestion and by conventional and pulsed-field gel electrophoresis (PFGE). Strains were assigned to groups on the basis of the Dice similarity coefficient; strains with values of > 92% were considered to be clonally related. Twelve clones were identified by PFGE. Strains of two clonal groups predominated. Restriction endonuclease analyses using the 'high frequency cleavage' endonuclease Stu I and conventional electrophoresis gave 11 groups; in general it had lower resolving power than PFGE.

Molecular characterization of rifampin-resistant Neisseria meningitidis.

Primers were designed to amplify the rpoB gene of Neisseria meningitidis. The region of the gene amplified covered clusters I and II of the rifampin resistance (Rifr) mutation sites identified in Escherichia coli. DNAs from six Rifr isolates and 21 rifampin-susceptible isolates from the United Kingdom representing a number of serogroups were amplified and sequenced. All six Rifr isolates had identical DNA sequences and the same amino acid change, a His to an Asn change at position 35 (H35N). This His residue is equivalent to the His residue at position 526 in E. coli, one of the known Rifr mutation sites. DNAs from an additional six Rifr mutations generated in vitro were amplified and sequenced. Three had H35Y changes, one had an H35R change, one had an H35N change and one had an S40F change. The predominance of mutations at the His residue at position 35 in Rifr N. meningitidis isolates suggests that it plays a critical role in the selection of antibiotic-resistant variants. All six Rifr isolates belonged to the same clonal group when analyzed by restriction enzyme analysis and pulsed-field gel electrophoresis. These data suggest that a single clone of Rifr N. meningitidis is present and widespread throughout the United Kingdom.

Production of a mannose-resistant fibrillar haemagglutinin by strains of Escherichia coli of EPEC serotype O111:H12.

Two strains of Escherichia coli of serotype O111:H12 produced a mannose-resistant haemagglutinin (MREHA) of Duguid's pattern 7 that reacted strongly with the red cells of ox and sheep. These strains also adhered to HEp2-epithelial cells and formed fibrillae demonstrable by negative staining and immunogold labelling.

The haemagglutinins and fimbriae of Proteus penneri.

The haemagglutinins and fimbriae produced by 18 strains of Proteus penneri were studied and compared with those formed by representative strains of other species of Proteeae. After repeated subcultures at 30 degrees C, 12 P. penneri strains formed only MR/K haemagglutinins which were associated with thin, non-channelled, type-3 fimbriae. Two strains formed simultaneously both MS and MR/K haemagglutinins associated with thick, channelled, type-1 fimbriae and type-3 fimbriae, respectively. Four strains formed simultaneously both MR/K and MR/P haemagglutinins. No P. penneri strain formed either MS or MR/P haemagglutinins alone under these conditions. The type-3 fimbriae from P. penneri strain E180 were isolated, purified and found to be protein of 19 Kda. Immunoelectronmicroscopy studies with antibody to the type-3 fimbriae of strain E180 showed that P. penneri strains at least two antigenic types of type-3 fimbriae. The type-3 fimbrial antigen of the vaccine strain E180 was shared by another eight strains of P. penneri. A further eight P. penneri strains and the strains representative of other genera within Proteeae had type-3 fimbriae of a different antigenic type. The formation of these haemagglutinins and fimbriae suggests that this organism is well endowed to be a urinary-tract pathogen.

Characterisation of a fimbrial, mannose-resistant and eluting haemagglutinin (MREHA) produced by strains of Salmonella of serotype Sendai.

Strains of Salmonella of serotype Sendai, producing a mannose-resistant and eluting haemagglutinin (MREHA) when cultured at 37 degrees C but not at 18 degrees C, were examined by electronmicroscopy after negative staining. Production of this MREHA, previously thought to be nonfimbrial, was correlated with the presence of thick fimbriae with an external diameter of 13.6 nm. These fimbriae were readily fragmented and, when purified, had an estimated Mr of 28 Kda. Production of fimbrial MREHA by Sendai strains was associated with the ability to adhere to a wide range of substrates and to form a fimbrial pellicle at the surface of liquid media incubated statically in air. The origin of this unusual Sendai fimbrial MREHA is unknown. Thin filamentous structures produced independently of fimbrial MREHA by Sendai strains were also described. Fimbrial MREHA was not produced by strains of the antigenically similar serotype Miami which, however, and unlike Sendai strains, formed mannose-sensitive haemagglutinin and type-1 fimbriae. The ability to differentiate strains of Miami and Sendai (serotype 1,9,12:a: 1,5) by means of their fimbriae is noted.

Immunological and genetical relatedness of type-1 and type-2 fimbriae in salmonellas of serotypes Gallinarum, Pullorum and Typhimurium.

The fimbriae of 50 strains of serotype Gallinarum and 35 strains of serotype Pullorum of the genus Salmonella were compared with the type-1 fimbriae of serotype Typhimurium strains by immune electron microscopy and dot blot hybridization tests with gene probes for type-1 fimbriation in Typhimurium. The fimbriae of Gallinarum and Pullorum strains were coated with Typhimurium type-1 fimbrial antiserum and probes hybridized strongly with DNA of Gallinarum and Pullorum strains under stringent conditions. Furthermore, when Typhimurium type-1 fimbrial antiserum, that had been absorbed with fimbriate Gallinarum or Pullorum bacteria, was used in immune gold labelling experiments, it was shown that residual antibody recognized sites of possible adhesin incorporation at intervals along the length of Typhimurium type-1 fimbriae. These findings suggest that the type-2 fimbriae produced by all Gallinarum and Pullorum strains are non-adhesive forms of adhesive, type-1 fimbriae. This observation is of interest because type-1 fimbriae have never been reported in naturally occurring strains of these two avian-adapted serotypes.

Some strains of Escherichia coli of putative enteroadherent-aggregative serotypes produce an unusual fibrillar haemagglutinin.

Two strains of Escherichia coli that formed on unusual kind of mannose-resistant and eluting haemagglutinin (MREHA) reacting with the red blood cells of rat and mouse, when cultured at 37 degrees C but not at 18 degrees C, were examined by electron microscopy. Production of this rare rodent-positive MREHA was correlated with the presence of fine fibrillae of estimated diameter 2.5 nm that were demonstrated by negative staining and immuno-gold labelling with MREHA-specific anti-serum. These two strains belonged to serotypes 078:H- and 078:H33; thus, it would be useful to know whether enteroadherent-aggregative strains of E. coli of these and other serotypes also possess this unusual MREHA.

A novel fimbrial haemagglutinin produced by a strain of Salmonella of serotype Salinatis.

A strain of Salmonella of serotype Salinatis, that produced a mannose-resistant and eluting haemagglutinin (MREHA) when cultured at 37 degrees C but not at 18 degrees C, was examined by electron microscopy after negative staining. Production of this MREHA, previously described as being non-fimbrial, was correlated with the presence of thin fimbriae which had an external diameter of 3.6 nm. The purified Salinatis thin fimbriae had an estimated Mr of 19 kDa. This fimbrial MREHA was not produced by strains of the antigenically related serotypes Duisburg and Sandiego.

Demonstration by immuno-electronmicroscopy of antigenic heterogeneity among P fimbriae of strains of Escherichia coli.

The identification of P fimbriae on urinary strains of Escherichia coli isolated from urine was made by observation of the patterns of mannose-resistant and eluting haemagglutination of erythrocytes of seven animal species (and including those of human p phenotype), and by haemagglutination-inhibition tests with hydatid-cyst fluid known to contain an analogue of P-fimbrial receptor. In tests with five different, pure P-fimbrial antisera prepared in rabbits, agglutinin titres of 37 P-fimbriate strains revealed differences in their reactivity; immuno-electronmicroscopy studies with the same five antisera showed that P-fimbriate strains were markedly different in the extent to which their P fimbriae were coated with antibody. The antigenic heterogeneity observed among P fimbriae is discussed with regard to the development of P-fimbrial vaccines.