Reemergence of Human Monkeypox in Nigeria, 2017.

In Nigeria, before 2017 the most recent case of human monkeypox had been reported in 1978. By mid-November 2017, a large outbreak caused by the West African clade resulted in 146 suspected cases and 42 laboratory-confirmed cases from 14 states. Although the source is unknown, multiple sources are suspected.

Body size preference among Yoruba in three Nigerian communities.

Following our previous observation of an aversion to weight reduction in Nigerians with type 2 diabetes, we measured several parameters of body dimensions and preferences in otherwise healthy adults in three communities to study the phenomenon further. The study population of 524 participants (304 F) was 99.8% of Yoruba ethnic origin with a mean age of 43.9 ± 17.2 years. Females had a significantly (p > 0.001) higher body mass index (BMI), waist circumference, hip circumference compared to the males; the values being 24.55 ± 5.5 vs. 21.75 ± 3.71 kg/m(2); 84.98 ± 12.67 vs. 80.92 ± 9.85 cm; 96.32 ± 12.94 vs. 89.36 ± 8.06 cm, respectively. There was a high level of satisfaction amongst respondents with their body size (Kendall's t = 0.52, p < 0.001) which they also predicted with a high degree of certainty even without the prior use of a weighing scale. The relationship between current body size (CBI) and BMI emerged as CBI = 1.22 + 0.32 BMI. In the 41% of respondents who expressed unhappiness with their current body size, there was a strong aversion for a smaller body size and the preference was often for a bigger body figure. Strikingly, many more women than men were less dissatisfied with their bigger body sizes. Stepwise regression indicated that CBI and gender were the two most important variables that best related to casual blood sugar (RBS) among the factors entered. The mathematical relationship between these variables that emerged was: [Formula: see text] where gender = 0 for male and 1 for female. The results suggest that larger body sizes were positively viewed in these communities consistent with our previous observations in type 2 diabetes.

Pathology of cause of death from penetrating weapons in the Niger Delta region of Nigeria: an autopsy study of 254 cases.

AIMS AND OBJECTIVES: To study the pattern of death caused by penetrating weapons. This is a prospective autopsy study of 254 cases over 8 years (1995 - 2002) SUBJECTS AND METHODS: A retrospective analysis of all the medico-legal autopsies performed by the authors on bodies in which the circumstances of death suggested the use of penetrating weapons over a period of 8 years was carried out by the authors. RESULTS: A total of 254 bodies that died during close combat, communal clashes, militant attacks and armed banditry of penetrating weapons were recorded. The youngest was 2 years old male while the oldest was 75 years old male. The highest death toll occurred between the ages of 20-49 years 197(77.6% cases) with a peak at the age group 20 - 29 years 75(29.5%) cases. There were 218(85.8%) males and 36 (14.2%) females giving a male to female ratio of 6:1. The most common cause of penetrating death was gunshot missiles 136(53.5%), while the most common anatomic site of the wound was the chest wall 85(33.5%). Instant death occurred in 179(70.5%) cases and haemorrhagic shock caused the death of 229(90.2%) cases, while the brain was the most common organ lacerated 61(24.0%). CONCLUSION: Penetrating wounds were commonly sustained in close combats, during communal clashes, militant and armed robbery attacks, and youth restiveness in the Niger Delta region of Nigeria. Guns which are prohibited by law and other sharp and pointed instruments were freely used. The condition is preventable by enforcing stringent laws, but it resulted into a lot of mortalities.

Problems of identification associated with victims of aerodisaster: the Port Harcourt experience in December 2005.

BACKGROUND: The problems associated with identification of victims after mass disaster such as aero-accident require an elaborate study with an attempt at proffering solutions in the midst of limited facilities. METHODOLOGY: This is a case study of aero-disaster carried out by the authors at Port Harcourt International Airport on 10th December 2005. Information was adequately disseminated through different media to alert the public to come for the identification of the bodies. The 106 victims were then separated into those whose bodies were intact with few areas of burns, crushed/multiple fractures, those with severe burns, and dismembered or disintegrated bodies. RESULTS: Problems of identification was noticed in 26 (24.5%) of the victims which form the basis for this study. Those disputed by more than one family n = 11 (42.3%), those without dispute but very difficult to identify n = 6 (23.1%) and those that could not be identified n = 9 (34.6%). The cause of the identification difficulty also ranged from total disintegration of the bodies n = 9 (34.6%), severely burnt bodies n = 12 (46.2%) to those crushed with multiple fractures n = 5 (19.2%). CONCLUSION: Problems of identification of severely injured victims of aero-disaster in a limited facility setting can be minimized if strict and well documented pre-travel biometric profiles are taken. Facility for DNA fingerprint, forensic odontologists and forensic anthropologist should be provided. There should also be institution of aviation accident investigation team (AAIT) and mass disaster planning team (MDPT) to aid the identification of victims and probe into the cause and effect of the accident.

Postmortem findings of victims of sexual assault: a study of 15 autopsies in the Niger Delta region of Nigeria.

AIMS AND OBJECTIVES: To study the frequency, status of the victims and assailants as well as the pattern of death in sexually assaulted females. SUBJECTS AND METHODS: A eight year (1st January 1995 to 31st December 2002) autopsy study of sexual assault in the Niger Delta region of Nigeria. Coroner's autopsies performed by the authors at different parts of the Niger Delta region of Nigeria, where the circumstances of death and autopsy finding fit into sexual assault and/or complications were studied after being served with the Coroner's inquest forms by the Police. Reports and death certificates were returned to the coroner through the police. RESULTS: A total of 1,265 autopsies were performed by the authors during the period under review of which 15 cases were deaths from sexual assault constituting 1.2% of the total autopsies. The youngest was 7 years old while the oldest was 59 years old. The highest frequency of death n=4(26.7%) occurred in the age group 10-19 years. Unmarried females n=6(40.0%) were the most common victims. Militants n=7(46.7%) were the most common real/suspected assailants and Asphyxial death n=7(46.7%) was the most common pattern of death of which neck break was the foremost n=4(26.7%). CONCLUSION: Death from sexual assault on women is becoming a common event that is posing an undue social problem to the victims, relations and the government in the Niger Delta region of Nigeria. There should be a government intervention to arrest and prosecute the perpetrators of this crime. This will discourage other assailants from committing the crime and thereby reducing the frequency of death.

Pathology of deaths from carbon monoxide poisoning in Port Harcourt: an autopsy study of 75 cases.

BACKGROUND: Carbon monoxide (CO) poisoning is a notable cause of death at homes and industries that is posing public health problem worldwide that requires an elaborate study. OBJECTIVE: To study and characterize deaths resulting from the noxious gas (CO). DESIGN: A ten year (January 1st, 1995 December 31st 2004) autopsy study. SETTING: Port Harcourt, Nigeria. METHODOLOGY: Coroners and hospital autopsies performed by the authors at the University of Port Harcourt Teaching Hospital (UPTH), other hospitals and private mortuaries in Port Harcourt on deaths from carbon monoxide poisoning were studied over ten years. The circumstances of death reported by police were accidental, homicidal or suicidal; and other autopsy findings were used for the study. RESULTS: A total of seventy five autopsies were studied; out which 21 (28.0%) were females and 54 (72.0%) males giving a ratio 1:2.6 male dominance. The highest frequency of death 25 (33.3%) occurred in the age group 60 69 years; while the least 3 (4%) occurred in the age group 0 9 years. The youngest was an unborn 7 month old male fetus while the eldest was 85 years old female. The most common was accidental carbon monoxide poisoning which accounted for 48 (64%) cases. While Homicidal CO poisoning .was 24 (32%) and suicidal CO poisoning was 3 (4.0%). Body recovered from fumy electric generator rooms was 46 (61.3%) while least frequency was bodies recovered from naked flame 3 (4%). CONCLUSION: Carbon monoxide poisoning is posing a serious public health problem when ever it occurs. There is need for public enlightenment about this gas as it is related to fumes from generator, car exhausts, poorly ventilated rooms and enclosed chambers in order to reduce the carnage associated with it both at home and industries.

Pathology of deaths from mob action in the Niger Delta Region of Nigeria. A study of 38 consecutive autopsies.

BACKGROUND: Mob action is posing an undue social and public health problems in Niger Delta region of Nigeria; as victims who were said to have committed crime were violently killed without fair trial by law. There is need to research into the pattern, cause and frequency of deaths from mob action. AIM: To study the pattern cause and frequency of death from mob action. SETTING: Niger Delta Region of Nigeria. DESIGN: Aten (1999-2008) consecutive autopsy on victims ofmob action. METHODOLOGY: A thorough autopsy was performed on all the victims following standard method after being severed with the coroner's inquest form by police. Variables considered were the ages and sex, yearly frequency, methods applied in the killing and reasons that motivated the killing. These were obtained from the coroner's inquest forms, police, relations and eye witnesses. RESULT: A total of thirty eight bodies were examined. Thirty four (89.5%) were males and four (10.5%) females; giving a male to female ratio of 8.5:1. The youngest was 16 years old male while the oldest 72-year-old male. Majority 30 (78.9%) of deaths occurred below the age of 50 years. Youths of the age group 20 29 were most involved and the highest frequency 12 (21.1%) of death was recorded in 2004. Beating 14 (36.8%) was the most common method applied for the killing while political violence 15 (39.5%) was the most common circumstances for the killing. CONCLUSION: Killing by mob action is a social, legal and public health problem in the Niger Delta region of Nigeria that requires a swift government intervention to reduce the carnage associated with it. Problems of economic inequality, youth unemployment and corruption should be adequately addressed by the Nigerian government.

Aero-disaster in Port Harcourt, Nigeria: a case study.

BACKGROUND: Aero-disaster in Nigeria is posing a serious problem to government, the public and relatives of victims, as many lives are lost in a single event. MATERIALS AND METHODS: A case study based on an incident at an international airport in Nigeria on December 10, 2005. Detailed autopsy was performed on 97 fully identified bodies out of the 106 victims. Variables considered include ages, sex, pattern of injuries and death as well as problems associated with identification of bodies. RESULTS: A total of 97 (91.5%) out of the 106 deaths recorded were autopsied. Nine (8.5%) bodies were beyond identification, and hence autopsy could not be properly done on them. Fifty-nine (60.8%) were males and 38 (39.2%) were females, giving a ratio of 1.4:1. Sixty-one (62.9%) were children and adolescents below the age of 20 years. Severe burns 27 (27.8%), multiple injuries with burns 21 (21.6%), inhalation of fumes 20 (20.6%), multiple injuries only 16 (16.5%), severe head injury alone 11 (11.3%) and ruptured viscous 2 (2.1%) were the causes of death at autopsy in that order of frequency. CONCLUSION: Aero-disaster, though rare in Port Harcourt, is posing a serious problem in Nigeria in recent times. Various agencies should be established to adequately control mass disasters in Nigeria. Adequate maintenance of aircraft and strict observation and enforcement of aviation laws may drastically reduce the frequency of accidents and subsequent deaths.

Pathology of death from severe head injuries in Rivers State: a study of sixty eight consecutive cases in five years.

BACKGROUND: Traumatic head injury and subsequent death is a public health problem in Nigeria. There is an urgent need to study the various factors leading to this problem. OBJECTIVE: To study the cause and characteristic of fatal head injuries. DESIGN/SETTING: A five year (1998 2003) autopsy study in Rivers State, Nigeria. RESULT: A total of 68 deaths from severe head injuries were studied. Traumatic head injury occurred in every age of both sexes. The youngest was a day old female while the oldest was a 72 year old male. The age group 20 29 years was most affected 26 (30.9%). Males were 55 (82.4%) and females 13 (17.6%) giving a ratio of 4.7:1. Road traffic accident 25 (36.8%) and gunshot 16 (23.5%) were the most common cause of head injury and death. Fractures of the vault of the skull 37 (54.4%) were the most common type of head injury and death. Others include fracture of the base of skull 15 (22.1%), combined fracture of the base of skull and vault 4 (5.9%). Intracranial hemorrhage 9 (13.2%), cerebral laceration 2 (2.9%) and cerebral contusion 1 (1.5%). There were associated injuries in 36(52.9%) cases. CONCLUSION: Head injury is most common cause of death especially in road traffic accidents, gun shot and assault in this environment. There is an urgent need to address the frequency of RTA and gun handling to drastically reduce these fatalities.

Pathology of firearm mortalities in the Niger Delta region of Nigeria: a study of 136 consecutive autopsies.

A prospective autopsy study of firearms-related death was carried out by the authors in the Niger Delta region of Nigeria. The purpose of the study was to evaluate the pattern, frequency, and anatomical sites of wounds, also the cause of death and the age and sex distribution of victims. The autopsies were performed after being served with the coroner's inquest forms. In all cases standard autopsy procedures were adopted and reports issued. A total of 136 consecutive firearm deaths were autopsied. There were 122 (89.7%) males and 14 (10.3%) females, giving a male to female ratio of 8.7:1. The highest number of deaths, 95 (69.8%), occurred in the age group of 10-39 years with a peak of 51 (37.5%) deaths at 20-29 years. In 112 (82.4%) cases death occurred from homicidal gunshot wounds. The commonest targets of gunshot wounds were the head, 58 (42.6%); multiple anatomical sites, 30 (22.1%); chest, 16 (11.8%); abdomen, 11 (8.1%) and neck, 10 (7.4%). Haemorrhagic shock was the cause of death in 131 (96.3%) cases. Significant causes of traumatic death in the Niger Delta region of Nigeria are gunshot wounds and associated complications. Stringent laws on illegal firearms handling should be passed and enforced by the government to reduce the frequency of such deaths.

Juvenile rhabdomyosarcomas in Port Harcourt, Nigeria: A twelve year review.

BACKGROUND: Juvenile rhabdomyosarcoma (JRMS) though rare, is the most common soft tissue malignancy of childhood that exhibits bimodal age distribution pattern. OBJECTIVE: Review the pattern of JRMS in Port Harcourt based on sex, age, tumor sites and histologic types. DESIGN: A retrospective descriptive study. SETTING: The study was conducted in the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria over 12 years. METHODOLOGY: We studied 21 juvenile rhabdomyosarcomas during the period under review. The hematoxylin and eosin stained histological slides were retrieved and reviewed to confirm previous diagnosis and histologically typed for the study. The sex, age and tumor sites were retrieved from the histology consultation forms, RESULT: These tumors were diagnosed from patients aged 0 - 20 years with the highest frequencies (38.1% each) occurring at 0 - 5 and 16 - 20 years age group. Males are more affected with a ratio 3.2:1. The trunk is the most common site of occurrence (47.7%) of which the genitourinary system is the most affected (23.8%) in this study. The most common histologic type is the embryonal rhabdomyosarcoma (71.5%). Alveolar rhabdomyosarcoma accounted for (19%) and the sarcoma botryoides (9.5%). CONCLUSION: The age of presentation and anatomic sites of the tumor are important in the diagnosis of these tumors. If a tumor histologically shows as small round blue cells, rhabdomyosarcoma should be considered as a differential diagnosis.

Electrocution attributed to supernatural forces in the Niger delta region of Nigeria: a report of three cases.

BACKGROUND: Accidental deaths from electrocution in this environment are sometimes related to charm and witchcraft caused by one's enemies. The aim of this article is to highlight the problems of beliefs and accidental electrocution. METHOD: We report three cases of accidental electrocution which was believed to be associated with traditional beliefs of witchcraft and charm. RESULTS: Autopsy findings in two cases showed characteristic electric burns (the joule burn which is the area of entry) without obvious organ changes. The third case revealed no burn but investigation of the scene of incidence and other sources of information are consistent with a diagnosis of electrocution. CONCLUSION: Post mortem examination can assist to dispel misconception and unnecessary belief on cause of death in our community.

Histological review of melanocarcinoma in Port Harcourt.

BACKGROUND: Melanocarcinoma is a malignancy of melanocytes affecting more females; and commoner in the farming population. It is also associated with high morbidity and mortality. OBJECTIVE: To determine the pattern, outcome of melanocarcinoma and a survey of presentation of the tumor in Port Harcourt was undertaken. DESIGN: A retrospective descriptive study for 11 years (1st January 1990- 31st December 2000). SETTING: University of the Port Harcourt Teaching Hospital, Port Harcourt. METHOD: Histological slides previously stained with hematoxylin and eosin of 15 cases of melanocarcinoma were retrieved and re- evaluated for the study. Special stain like Mason Fontana stain was also used for proper diagnosis of some of the tumors. Tissue slides or blocks which could not be located and those with inadequate documentations were excluded from the study. The 15 cases were staged according to Clark's Staging System. RESULT: Melanocarcinoma is rare in this environment as it accounted for 0.8% of total malignancies for the period under review. The age ranged from 39-76 years. Majority of the cases were female with F:M ratio of 3:2. The peak (73.3%) frequency of occurrence was among the age group (51-70) years. Only the nodular and the acral leniginous types were seen, of which the nodular type was the commonest (80%). The feet and the legs were the commonest predilection sites (46.7%) while the head and neck as well as the knee were the least site of occurrence. There was no stage I and II melanocarcinoma in this study. The cancers were seen in stage V, IV and III in decreasing frequency. CONCLUSION: melanocarcinoma. thought rare in this environment, present at advanced stage of the disease. Public enlightenment and awareness campaign as to the physical characteristics of the tumor is needed to make patients present early for diagnosis of the disease and treatment.

Tuberculosis in Rivers state: autopsy and surgical pathology study in the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt (1990-2002).

BACKGROUND: A 13 year (1st January 1990 - 31st December 2002) retrospective study of 138 surgical and autopsy specimens diagnosed as Tuberculosis (Tb) was studied in Port Harcourt, based on the age, sex, affected tissue and the immune status of the patients. METHOD: The tissues were initially fixed in 10% formal saline, processed and embedded in paraffin wax. The tissue were sectioned, mounted on glass slide and stained with hematoxylin and eosin (H & E). In some cases (12.3%) special stains were used to confirm the bacilli and to exclude parasitic or fungal agents. The immune status and the causes of death were extracted from the request forms, case notes and autopsy reports. RESULTS: Of the 138 specimens, 37 (26.8%) and 101(73.2%) were obtained from autopsy and surgery respectively. Male to female ratio was 2:1. The youngest was a 3 year old male and the eldest was a 83 year old female. Children below 11 years contributed the highest specimens at autopsy while the highest frequency of surgical specimens were removed from 41-50 years age group (23.8%). The commonest cause of death was pulmonary tuberculosis with respiratory failure. The commonest tissue affected was the lymph node presenting either singly or matted together. Primary tuberculosis accounted for 15.9% (22) of cases while secondary tuberculosis was 116 (84.1%) presenting in different forms. HIV screening was positive in 39 (28.3%) cases. CONCLUSION: Despite the preventive measures and treatment of tuberculosis, the disease is still on the increase in this environment. The upsurge may be associated with HIV infection and immunodeficiency. It is therefore necessary to screen all tuberculosis patients for possible HIV positivity.

Paediatric accidental deaths in Port Harcourt, Nigeria: a 10-year retrospective study.

BACKGROUND: Some studies on medicolegal autopsies have been conducted in Nigeria. This study was carried out to highlight the causes, peculiarities and possible factors responsible for paediatric accidental deaths in Port Harcourt, Nigeria. METHODS: All 3058 medicolegal autopsies referred to the coroner and performed in the department of Anatomical Pathology University of Port Harcourt Teaching Hospital, over a 10 year period covering January 1986 to December 1995 were analyzed. The accidental death subset was specially analyzed with respect to the paediatric age group of 0-16 years. RESULTS: A total of 3084 coroners autopsies were carried out during the study period. Of these 356 (11.5%) were paediatric accidental deaths. The commonest cause of death was road traffic accidents constituting 84.3% (n=300). The male:female ratio was about the same. The head was the commonest body region affected (n=90). Cars and buses were the commonest vehicles involved. Pedestrians were most at risk constituting 66 percent. Bulk of the cases occurred over the weekends. Drowning, electrocution and burns accounted for 8.7%, 2.8% and 4.2% respectively. CONCLUSION: Most of the deaths are avoidable. Parental monitoring, control of movements, legislation and general concern of the adult population for children's welfare will reduce these largely preventable deaths.