Autopsy Study of the Liver in Adult Nigerians at Lagos University Teaching Hospital.

BACKGROUND: Liver diseases are one of the major causes of morbidity and mortality in Nigeria. Detection of liver involvement in many disease conditions is often delayed till after death when autopsy is conducted, hence the importance of this study. STUDY DESIGN AND METHOD: This was a prospective study to assess the pathologic findings in the liver of one hundred (100) consecutive adults (without pre-mortem diagnosis of liver disease) at autopsy, at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. The organs were examined macroscopically, weighed and representative biopsies taken for histopathological assessment. Special histochemical stains to confirm diagnosis were carried out as appropriate. The biodata and other clinical information were obtained from the case notes. Analysis was carried using descriptive statistics. RESULTS: One hundred cases were studied, comprising of 46 males and 54 females, with overall mean age 47±15.6 years. The mean weight of the liver was 1737±586.02 grams (normal 1200-1400gm). In 19.0% of the cases, the liver showed normal histology. Of the others with pathological findings (81%), the three most common pathologies were chronic venous congestion, steatosis, and metastatic tumours. There was significant correlation of liver pathologies diagnosed with causes of death at autopsy (p=0.001). CONCLUSION: In view of the fact that major liver diseases may be asymptomatic and may not be diagnosed until death, there is need for a high index of suspicion by clinicians. It is therefore important that clinicians properly assess the functional state of the liver to prevent, detect and promptly treat these disorders.

Investigations into the Risk of Reproductive Toxicity Following Exposure to Highly Active Anti-Retroviral Drugs in Rodents.

With the introduction of Highly Active Antiretroviral Therapy (HAART), there has been drastic decline in morbidity and mortality associated with HIV/AIDS. However, many patients experience adverse drug reactions perhaps due to the inherent toxic nature of HAART. The possible toxic effect of HAART (combination ARVs) on reproduction and sexual dysfunction in seropositive HIV patients remains a subject of intense research. This study was designed to investigate the toxic effects of HAART on the reproductive hormones and organs of male and female rats. Sexually mature adult male and female rats were administered therapeutic doses of single and combination antiretroviral drugs for 48 days and thereafter sacrificed under anaesthesia. Morphological and histopathological examination of the testes and ovaries were carried out. Serum biochemical assay, semen quality analysis and hormonal assays were also conducted using standard methods. Results show significant (p < 0.05) reductions in the weight of testes and epididymis across all groups versus control; sperm count and motility were also significantly reduced in the test groups while hormonal analysis in males revealed significant reductions in LH, FSH and Testosterone. In the females, there was a significant (p < 0.05) reduction in the number of ovarian follicles, prolactin, estrogen and progesterone. We thus conclude that the administration of single and combined antiretroviral drugs have potential reproductive toxic effects.

Audit of fibroepithelial tumors of the breast in a Nigerian tertiary institution.

BACKGROUND AND OBJECTIVES: Fibroepithelial lesions are the most common lesions of the breast seen in our laboratory consisting of fibroadenomas (FAs) and phyllodes tumors (PT). The aim of the study was to audit all fibroepithelial lesions and to reclassify all confirmed cases of PTs seen in the study period according to standard criteria. METHODOLOGY: Records and slides of fibroepithelial lesions of the breast received at the department between January 2008 and December 2013 were retrieved and reviewed by the authors. RESULTS: Out of the 1242 fibroepithelial lesions of the breast retrieved, all but 19 were FAs. The 19 were initially reported as PT: 11 benign, 2 borderlines, 2 malignant, and 4 not classified; however, only 16 of these 19, PTs (84%) met the WHO criteria on review. The remaining 3 (16%) turned out to be FAs based on the absence of stroma overgrowth and hypercellularity. The PTs were reclassified into benign PT, borderline PT, and malignant PT accounting for 75% (12/16), 18.7% (3/16), and 6.3% (1/16), respectively. All of the PTs previously not classified turned out benign on review. One of the borderline PTs was originally reported as malignant PT. All cases initially diagnosed as FAs did not change on review. CONCLUSION: These results show that FAs are rarely misdiagnosed. The three cases misdiagnosed as phyllodes may have been prevented if standard data sets were in use. Cases simply referred to as PT without further classification, limit the patients' access to appropriate management as accurate classification helps in the overall management and prognostication.

The combined fixed-dose antituberculous drugs alter some reproductive functions with oxidative stress involvement in wistar rats.

The reproductive toxicity of combined fixed-dose first-line antituberculosis (CFDAT) regimen was assessed in rats. Thirty-two (32) Wistar rats weighing 168.1 ± 8.0 g were divided into four groups of eight rats per group. Two groups of male and female rats were administered oral distilled water (1.6 ml) and CFDAT drugs containing rifampicin, isoniazid, pyrazinamide and ethambutol (RIPE, 92.5 mg/m2 per body surface area) respectively for forty-five days. Serum follicle stimulating hormone, luteinizing and testosterone were reduced significantly (p < 0.05) in the treated male rats. Similarly, sperm count levels were decreased by 27.3% when compared with control. RIPE elevated serum oestrogen (p < 0.05), progesterone (p < 0.05) as well as prolactin (p > 0.05) levels in the treated females. In addition, RIPE reduced (p < 0.05) total proteins levels and increased (p < 0.05, 53%) catalase levels in male but not female animals. Superoxide dismutase, glutathione-S-transferase, glutathione peroxidase, reduced glutathione levels as well as lipid peroxidation were unaltered in all rats respectively. Histopathological studies revealed congested peritesticular vessels and no changes in the ovary when compared with control. Overall, our results demonstrate reproductive toxicity potentials of RIPE in the rat, thus, suggesting that these reproductive parameters be monitored during antituberculous chemotherapy.

Emerging Trends in the Epidemiological Pattern of Head and Neck Cancers in Lagos, Nigeria.

BACKGROUND: Unfortunately, despite an increase in medical knowledge, survival rates of head and neck cancers (HNCs) have not been observed to improve greatly. This is true, especially in tumors located in obscure primary sites or late presentation. AIM: The purpose of this study is to assess the epidemiologic pattern of HNCs and to evaluate its emerging trends and patterns in Lagos state. SUBJECTS AND METHODS: A retrospective study was conducted from 2003 to 2013 that analyzed histologically diagnosed cases of HNC at the Pathology Departments of the two tertiary teaching hospitals in Lagos. Data analysis was performed using the Statistical Package for the Social Sciences (version 20) statistical software. RESULTS: One thousand and eighty-three cases of head and neck malignancies were recorded. A female: male ratio of 1.01:1 was reported with mean age of 39.6 (standard deviation 21.1) years. The oral cavity was the most affected anatomic site (21.2%, 230/1083) in the period under review. Malignant epithelial tumors accounted for 72% (779/1083) of cases seen. Carcinomas were the most common histological variant seen (67%, 726/1083) and squamous cell carcinoma accounted for 58% (421/726) of carcinomas recorded. Oral cavity malignancies (21.8%, 118/540) were the most common in males while thyroid malignancies (28.5%, 155/543) were the most seen in females. In children (≤15 years), the most common histologic findings were carcinomas (42.3%; 77/182) and retinoblastomas (23.6%; 43/182). CONCLUSION: Epithelial malignancies were the most common malignancy in the study, and the oral cavity appears to be the increasingly predominant site for HNCs. A changing pattern in gender predominance, age distribution, and frequency with histological variants and anatomical sites was also observed in this study.

Her-2 Over-Expression in Gastric Carcinoma:A 5-Year Retrospective Study in A Lagos Cohort Population.

BACKGROUND: Gastric cancer is the fifth most common cancer and the prognosis has remained poor over the decades due to a high percentage of advanced stage presentation. OBJECTIVE: To determine the frequency of HER-2 over-expression in gastric carcinoma in a Lagos cohort population, comparing it with known clinico-pathologic and prognostic factors. MATERIALS AND METHODS: Data on 54 patients with gastric carcinoma were retrieved from the Histopathology Department of Lagos University Teaching Hospital. Haematoxylin and Eosin slides were made from the patients' paraffin blocks. These were reviewed for confirmation of diagnosis and determination of pathological prognostic factors. HER-2 over-expression was assessed using immunohistochemistry. The data was analyzed using SPSS 16. RESULTS: Forty-two gastric biopsies and twelve gastrectomy specimens were available for study from the 54 patients. The ages ranged from 30 to 83 years (mean = 55.96 years). The male to female ratio was 3.2:1. Majority of the carcinomas were intestinal type (83.3%), with diffuse, mixed and indeterminate types accounting for 13%, 1.9% and 1.9% respectively. About 44% of the cases were moderately-differentiated grade and patients who had gastrectomies presented mostly with stage T3 disease (75%). HER-2 was over-expressed in 13% of cases, with one equivocal case. There were no statistically significant associations between HER-2 over-expression and the prognostic factors. CONCLUSION: HER-2 over-expression occurs in a small percentage of gastric carcinoma in Lagos and is independent of most of the pathological parameters. Further work, with larger cohort, is needed to better characterize the possible prognostic benefits of targeted anti-HER-2 therapy in gastric carcinomas.

The agreement of point-of-care and standard laboratory electrolyte and glucose analysis in critically ill patients in a sub-Saharan tertiary teaching hospital.

BACKGROUND: The critically ill patient undergoes rapid changes in the internal milieu requiring quick intervention. Point of care testing has been shown to be valuable in the early diagnosis and management of such patients. OBJECTIVE: This study determined the agreement between I-STAT Abbot point of care testing with standard laboratory testing in the analysis of electrolytes and glucose concentrations in critically ill patients. METHODS: The study was performed in a Sub-Saharan Tertiary Teaching Hospital in critically ill patients. Electrolyte and glucose analysis were measured with I-STAT Abbot Analyzer unit with parallel blood specimens (n = 30) tested in the laboratory on an ion-selective electrode, SFRI analyzer ISE 6000. RESULTS: There was no significant difference in mean sodium, potassium, chloride and glucose between I-STAT POCT and standard laboratory measurements. The agreement between POCT and laboratory glucose was good p(c) = 0.967, mean difference of 0.79 and 95% limit of agreement from -3.83 to +5.107 mmol/L, p = 0.733. Bicarbonate was moderate (p) = 0.637, mean difference of 1.95 and 95% limit of agreement from -4.294 to +0.394 mmol/L, p = 0.101. There was moderate agreement for sodium (p(c)) = 0.32, mean difference of 5.8 and 95% limit of agreement from -0.378 to +11.98 mmol/L, p = 0.064. Agreement for potassium was moderate (p(c)) = 0.439, mean difference of 0.15 and limit of agreement from -0.401 to +0.701 mmol/L, p = 0.588. There was, however, a significant difference in mean chloride, and BUN values; chloride (p(c)) = 0.0796, mean difference of 13.8 and 95% limit of agreement from -7.55 to + 20.015 mmol/L. Blood urea nitrogen (p(c)) = 0.064, mean difference of 18.55 and 95% limit of agreement from -30.126 to +6.974 mmol/L. CONCLUSION: The mean sodium, potassium, glucose and bicarbonate were comparable with moderate to good agreement between I-STAT POCT and ISE 6000 Analyzer. Though, the mean BUN and chloride levels between the analytical methods differ significantly.

The relationship between microalbuminuria, cardiovascular risk factors and disease management in type 2 diabetes.

BACKGROUND: In patients with type 2 diabetes, microalbuminuria is an early clinical sign suggestive of vascular damage to the glomerulus. Microalbuminuria has also been currently reported as an important risk factor for cardiovascular disease and becomes relevant in the management of type 2 diabetes. OBJECTIVES: This study is to determine the prevalence of microalbuminuria, identify the risk factors associated with microalbuminuria in type 2 diabetes, and to asses the achievement of treatment goals for cardiovascular risk reduction in type 2 diabetics. SUBJECTS AND METHODS: Seventy- two subjects with microalbuminuria were recruited from three hundred consecutively screened type 2 diabetics attending the Diabetic Clinic at the Lagos University Teaching Hospital. Clinical data were obtained by interviewing the participants. Anthropometric measurements were made and blood specimens were collected for analysis. RESULTS: The prevalence of microalbuminuria was twenty-four percent (24%) in type 2 diabetes. Multiple logistic regression identified duration of diabetes (odds ratio 1.3 (95% CI; 0.03-1.58), hypertension(odds ratio 5.2 (95% Cl; 1.24-18.62), Body mass index (BMI) (odds ratio 1.27 (95% CI; 1.0-1.6), waist/hip ratio (WHR) (odds ratio 1.9 (95% Cl; 1.3-3.5), andHbA,c (odds ratio 6.6 (95% Cl; 1.02-27) as independent risk factors associated with microalbuminuria in type 2 diabetics. Optimum blood pressure, glycemic and weight control were achieved in eighty five percent (85%), fifty eight percent (58%) and nineteen percent (19%) of the type 2 diabetes respectively. CONCLUSION: This study showed that microalbuminuria is common among patients with type 2 diabetes. It also showed improvement in glycemic control and modifiable cardiovascular risk factor control when compared with previous studies.

The accuracy of ultrasonography in the diagnosis of breast pathology in symptomatic women.

BACKGROUND: Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23% of total cancer cases and 14% of cancer deaths worldwide. The developing countries are catching up with this trend. Breast ultrasound when properly performed and interpreted, is an indispensable tool in breast imaging. The early diagnosis and treatment of breast masses reduces the morbidity and mortality associated with delayed diagnosis of breast carcinoma. The use of breast ultrasound is gaining ground in recent time, this is due to current advances in ultrasound technology which permit greater spatial and contrast resolution and shortened scan time. OBJECTIVE: To determine the sensitivity, specificity and positive predictive value of ultrasound in the detection of palpable breast masses and to correlate the findings of ultrasound with the findings of fine needle aspiration cytology, or histopathology. METHODS: Breast ultrasound scanning was done in 100 patients with signs and symptoms of breast lesion referred from the Surgical out Patient Clinic to the Radiodiagnosis Department of Lagos University Teaching Hospital (LUTH). Histology reports were collected from either the case note or Morbid Anatomy department to correlate the findings with ultrasound diagnosis. RESULTS: The mean age was 41.7 +/- 11.34 (18-59) years. Symptoms of breast lesion were highest in the age group 41-50 years 38 (38%), and least in 18-20 years 4 (4%). When the use of ultrasonography was compared with the histopathology report in the diagnosis of breast lesion in the studied population, the sensitivity was 100%, specificity (96.6%), accuracy (97%), posting predictive value (PPV) 81.3%, and negative predictive value (NPV) 100%. The accuracy, specificity and PPV however decreased with increasing age. CONCLUSION: Ultrasonography of the breast is useful in the diagnosis of breast lesions, because of the high sensitivity, specificity and diagnostic value it exhibited with histopathologic findings.

Honey improves healing of circumscribed excision injury to the paniculus adiposus in albino rats.

BACKGROUND: Honey promoteswound healing. OBJECTIVE: In this study, we described the anatomical perspective of honey on wound healing in male rats. METHODS: The twenty-four male rats used were randomly divided equally into treated Experimental (E) and Control (C) groups. Infliction of wound done under anaesthesia; honey was used for wound dressing in E, distilled water firmly held by plaster in C. Monitoring of wound contraction were carried out at the interval of three days till the wound healed. The histology of granulation tissue excised from the wounds of rats was also done. RESULTS: Mean wound contraction (%) of rats in E on days 3, 6, and 9 were: 35.32 +/- 5.5; 57.56 +/- 0.7 and 82.30 +/- 0.9% compared to 26.50 +/- 1.2; 46.69 +/- 0.4 and 61.24 +/- 1.0% of rats in C. Honey treated groups showed significant increase (p < 0.05) in percentage of wound contraction in all treatment days. Complete wound closure day was also significantly shorter. On day 3, E showed a more intense infiltration by neutrophils and macrophages as well as features suggestive of edema and necrosis. On day 9, the connective tissues of E revealed markedly increased fibroblasts, less neutrophils, and presence of numerous new capillary blood vessels. CONCLUSION: The use of honey accelerates the wound healing process.

The spectrum of malignant neoplasms in Ekiti State, south-west Nigeria.

BACKGROUND: Geographic pathology is an accepted basis for unravelling trends of disease patterns. Proper documentation at the initial stage assists in establishing a foundation data. The authors are not aware of a documented pattern of malignant neoplasm in Ekiti State. OBJECTIVE: The aim of this study is to update the available literature on malignant neoplasms and compare our findings with previous work done by other investigators. METHODS: The estimates are based on a systematic retrospective survey of cancer cases identified in the Pathology Laboratories of Federal Medical Centre, Ido-Ekiti and University Teaching Hospital, Ado-Ekiti for the period; January 2002 to December 2009. The data recorded on each case were: source of information (histology or cytology), name, age, and sex, date of diagnosis and site of tumour. Tumour site and histology were coded according to the International Classification of Diseases, ICD-10 for presentation in tabular form. RESULTS: A total of 498 cancers were recorded. There were 177 (35.5%) males with average age of 54.5 years and 321 (64.5%) females with average age of 48.6 years. The estimated Crude Incidence (CI) rates for all cancer sites are 14.7 for males and 27.4 for females, per 100,000 population. In males, the most frequent cancer is prostate cancer (37.9%) followed by cancer of the liver (10.7%) and NonHodgkin's Lymphoma, NHL (7.9%). In females, the most common cancer is that of the breast (49.3%) followed by the cervix (8.5%) and the ovary (5.32%). A total of 28 childhood cancers were registered (17 males, 11 females). The most frequent tumours were Burkitt's lymphoma (8 cases) and soft tissue sarcomas (3 cases). CONCLUSION: This study shows that malignant neoplasms are not uncommon in Ekiti State. There is underreporting of cases as the crude incidence rates are low. This study will serve as baseline to more population-based studies in future.

Clinico-pathological review of malignant gastric tumours in Lagos, Nigeria.

BACKGROUND: Gastric cancer is one of the most common cancers and the 2d most common cause of cancer deaths worldwide. Contrary to earlier reports from Africa, prevalence of this cancer has been found to be comparable to that of other parts of the world. OBJECTIVE: To describe the clinico-pathological features of gastric cancer diagnosed in Lagos and determine the prevalence of H. pylori infection in gastric adenocarcinoma. METHODS: This was a retrospective histopathological study of all gastric cancer seen between 1995 and 2007 in the Morbid Anatomy Department of Lagos University Teaching Hospital as well as two other private histopathology laboratories in Lagos (2002-2007). The blocks and slides of gastric cancer tissue were the materials used for the study. The patients' bio data and relevant clinical details were extracted from the demographic records. RESULTS: There were 105 cases of gastric cancer (M:F = 2:1, mean age-55.3 years), 81% of which occurred above 45 yrs. There were 95 cases (90%) of adenocarcinomas, 8 (7.6%) mesenchymal tumours with one case each of small cell non-Hodgkin's lymphoma and carcinoid tumour. H. pylori was detected in 15.5% of 45 cases of adenocarcinoma with 36% showing evidence of chronic gastritis in adjacent non cancerous gastric tissue. All patients with clinical data had one or more alarm features; most recurring being abdominal fullness, recurrent vomiting, anorexia and weight loss. CONCLUSION: This study suggests that gastric malignancies are not uncommon in Lagos and often manifest with alarm features which should raise a suspicion particularly in our setting with poor diagnostic endoscopic facilities.

A clinicopathologic review of oesophageal carcinoma in Lagos.

BACKGROUND: Oesophageal cancer is the 6th most common cause of cancer death world wide. While the incidence is low in some parts of Africa such as Nigeria accounting for 0.4-0.6% of all malignant tumours, it is endemic in Transkei, in South Africa, which is regarded as an epicentre of the disease in Africa. OBJECTIVE: To document the age and sex distribution, clinical as well as histopathological characteristics of oesophageal carcinoma in Lagos, SW Nigeria, METHODS: The paraffin embedded blocks and slides as well as pathology reports of oesophageal carcinoma collected between 1995 and 2007 from Morbid Anatomy Department of the Lagos University Teaching Hospital and between 2002 and 2007 from two private histopathology laboratories in Lagos State were reviewed. The clinical data such as the age, sex, and clinical summary were extracted from demographic information in patients' case file. RESULTS: Twenty cases representing 2.8% of all gastrointestinal tumours were recorded. The mean age was 65.4 years (SD-12.3) with M:F ratio of 1:1. Squamous cell carcinoma predominated; 18 cases (90%); the remaining two cases (one of which showed evidence of Barrett's oesophagus) were adenocarcinoma (10%). All presented at advanced stage with dysphagia and weight loss with or without vomiting, regurgitation, and/or haematamesis. Two third had mid oesophageal fungating masses, the remaining were located in the lower third. Two cases had surgery, the rest were not fit for any intervention. CONCLUSION: Oesophageal cancer is not common in Lagos, Nigeria, majority are squamous cell carcinoma. Late presentation gives it a dismal outlook. Although the overall survival is poor, efforts at improving quality of life by palliative measures should be encouraged.