Pattern of childhood leukaemia in University College Hospital, Ibadan.

BACKGROUND: Leukaemias are haematological malignancies characterized by unregulated clonal proliferation of haematopoietic cells. OBJECTIVE: To determine the pattern of childhood leukaemia in Ibadan. METHODOLOGY: This was a retrospective study of leukaemia cases diagnosed at the University College Hospital (UCH), Ibadan between January 1991 and December 2010 in children less than 15 years of age. Data obtained was subjected to statistical analysis using the Statistical Package for Social Sciences version 20. RESULTS: There were 64 cases of childhood leukaemia, accounting for 10.2% of childhood cancers seen during this study period. The male to female ratio was 2:1 and modal age group was between 10 and 14 years. Thirty (46.9%) cases were acute lymphoblastic leukaemia (ALL), 22 (34.4%) were acute myelogenous leukaemia (AML) and 12 (18.8%) were unspecified acute leukaemias. There was no case of chronic myeloid or lymphocytic leukaemia. CONCLUSION: There has been a relative increase in the frequency of leukaemia cases at UCH, Ibadan, which may be largely explained by increased awareness and referrals. There is a need for further collaborative multicentre studies of childhood leukaemias in Nigeria and other developing countries and focused research on childhood leukaemias in order to unravel the aetiology.

Pediatric brain tumors in Nigeria: clinical profile, management strategies, and outcome.

INTRODUCTION: Although modern neuroimaging has facilitated early care of brain tumors in children worldwide, there are, however, few published reports on clinical profile, treatment, and outcome of brain tumors in children from our subregion. PURPOSE: We aimed to retrospectively study the clinical profile and outcome of pediatric brain tumors in a tertiary referral center from a developing country. METHODS: Forty pediatric patients with histologically verified brain tumors managed by the authors over a 13-year period (May 1994-April 2006) were studied. Patients' data from clinical, radiological, and pathology records were analyzed using the statistical package for social sciences version 16. RESULTS: The mean age was 9.75 years (range 1-15 years). Twenty-two males, 18 females. Common presenting symptoms were headaches (23 patients, 57.5%) and seizures (15 patients, 37.5%). Hyperreflexia (72.5%) and focal motor deficits (62.5%) were the most common neurologic signs. The mean interval from onset of symptoms to neurosurgical diagnosis was 13.4 months (95% CI). All patients had tumor resection, while 11 (27.5%) patients received adjuvant radiotherapy. Hydrocephalus occurred in 19 (47.5%) patients and was associated with early presentation (X2 = 10.65, p < 0.01). Low-grade astrocytoma (25%) and medulloblastoma (25%) were the most common tumors. Survival at 1 and 5 years were 56 and 47%, respectively. CONCLUSION: Focal motor signs and elevated intracranial pressure are the salient presenting features of brain tumors in children seen in Nigeria. Those of them with hydrocephalus are likely to present early. The outcome for pediatric brain tumors remains poor.

Oro-facial squamous cell carcinoma--a twenty-year retrospective clinicopathological study.

BACKGROUND: Squamous cell carcinoma of the orofacial region is a potentially life-threatening malignant epithelial neoplasm. There have been few studies on the relationship between clinical variables and histological grade among patients with oro-facial carcinoma. We sought to find correlation (if any) between clinical profile, anatomical location and histological grade of these tumours. METHODOLOGY: A retrospective study of all histologically diagnosed oro-facial squamous cell carcinoma cases seen at the University College Hospital, Ibadan between 1990 and 2009. RESULTS: Squamous cell carcinomas constituted 176 (38%) of all oro-facial malignancies. They comprised 91 males and 85 females with mean age of 57 (+/- 16.4) years. The maxillary region was most frequently affected (25%) while the lip was least involved (3.4%). Well-differentiated squamous cell carcinomas constituted 49%, moderately differentiated carcinoma accounted for 36.8% while poorly-differentiated squamous cell carcinomas constituted 14.2%. Well-differentiated and moderately differentiated tumours were relatively more common among subjects older than 50 years of age and poorly-differentiated tumours were more common before 50 years of age (p= 0.001). Degree of tumour differentiation was not correlated with gender (p = 0.88), and anatomical location (p = 0.17). CONCLUSION: Further clinical studies may be required to determine whether oro-facial carcinoma in patients less than 50 years of age has a more aggressive behaviour than in older patients.

Serum antioxidant vitamins and the risk of oral cancer in patients seen at a tertiary institution in Nigeria.

OBJECTIVES: Tobacco and alcohol are major risk factors of oral cancer, but nutritional deficiency may also contribute to development of oral cancer. This study compared serum antioxidant vitamin levels in oral cancer patients and controls in order to validate the role of vitamin deficiencies in the etiology of oral cancer. MATERIALS AND METHODS: Serum vitamin A, C, and E levels of 33 oral cancer patients and 30 controls at University College Hospital, Ibadan, Nigeria, were determined using standard methods. The data obtained were analyzed using the Student t-test, odds ratio, and logistic regression. RESULTS: Mean vitamin A, C, and E levels were significantly lower in oral cancer patients (P=0.022, P=0.000, and P=0.013 respectively). Risk of oral cancer was 10.89, 11.35, and 5.6 times more in patients with low serum vitamins A, C, and E, respectively. However, on logistic regression analysis, only low serum vitamin E independently predicted occurrence of oral cancer. CONCLUSIONS: The lower serum vitamin A, C, and E levels in oral cancer patients could be either a cause or an effect of the oral cancer. Further studies using a larger sample size and cohort studies with long-term follow-up of subjects are desirable.

Squamous papillomas of the conjunctiva: a retrospective clinicopathological study.

BACKGROUND: There is very limited literature on squamous papillomas of the conjunctiva from Nigeria and sub-Saharan Africa. In an attempt to contribute to the literature on the subject, we studied the clinicopathological characteristics of patients histologically diagnosed with squamous papilloma of the conjunctiva in Ibadan, Nigeria. MATERIALS AND METHODS: Clinical and pathological records of patients with histological diagnosis of squamous papilloma of the conjunctiva made in the Department of Pathology, University College Hospital, Ibadan, between January 1985 and December 2004, were reviewed. RESULTS: There were totally 26 cases. Patients' ages ranged from 2 to 58 years with a mean age of 32 years. Male to female ratio was 1.4:1. Size of tumors ranged from 2 to 10 mm. Duration of presenting complaints was from 2 months to 10 years. The lesions in 10 cases were located in the medial canthus, at or close to the limbus in another 10 cases, and in the tarsal conjunctiva in a single case. Five cases had no documentation of location. Sixteen cases (61.5%) had multiple papillomas. Four cases had a history of chemical injury (alkaline based - hair relaxer in a single case, acid based - wet cell car battery fluid in two cases, and unknown chemical in a single case) preceding the lesion by at least 6 weeks. Fourteen cases had koilocytosis on histology suggestive of Human Papilloma Virus (HPV) etiology. HIV screening test was negative in the three patients who had the screening done. Preoperative clinical diagnosis was squamous papilloma in 16 cases, pterygium in 6 cases and squamous cell carcinoma in 2 cases. CONCLUSION: In the environment where we practice, conjunctival squamous papilloma occurs most commonly in the fourth decade of life. Only very few cases are submitted for histological diagnosis. HPV infection and chemical injury are the main etiology. We strongly advocate that all excisions of the conjunctiva, irrespective of the clinical impression, should be submitted routinely for histological assessment.

Pattern of homicide coroner's autopsies at University College Hospital, Ibadan, Nigeria: 1997-2006.

There is relatively little information regarding the pattern of homicides in developing countries such as Nigeria. This study is aimed at determining the pattern and demographic factors associated with homicide cases seen in a Nigerian Teaching Hospital. It is a descriptive autopsy study of homicide cases seen at the University College Hospital (UCH), Ibadan over a 10-year period from January 1997 to December 2006. All the coroner's autopsies for the period, of homicides or suspected homicides, were reviewed with emphasis on the following: gender, age, occupation, circumstances surrounding event, likely motive, type of weapon used, site(s) of injury and mechanism of death. Homicides accounted for 153 (3.1%) of the 4928 coroner's cases at the UCH within the study period. One hundred and thirty-seven of the 152 cases were men, and the overall age range was 4-83 years. The mechanism of death was haemorrhagic shock in 91 cases (59.9%); severe raised intracranial pressure in 58 cases (38.2%); septicaemic shock in two cases (1.3%); and asphyxia in one case (0.7%). Gunshot injuries accounted for 64.5% of the fatalities, sharp objects 21.1% and blunt force 14.5%. Most were victims of armed robbery attacks. The head, abdomen, chest and lower limbs were single sites of injuries in descending order of frequency and most of the cases sustained multiple injuries involving two or more of these sites. Gunshot deaths were the commonest form of homicides in the period under review. Young males and victims of armed robbery attacks were most susceptible.

A retrospective histopathological review of oral squamous cell carcinoma in a Nigerian teaching hospital.

This study was undertaken to describe the demographic pattern of oral squamous cell carcinoma (OSCC) in Ibadan, Nigeria and compare our findings with that of other countries. It involved a retrospective review of OSCC diagnosed at the University College Hospital Ibadan, Nigeria between 1990 and 2008. A review of studies from other countries was done with respect to the three most frequently affected sites by OSCC, as well as mean ages and gender ratios. OSCC comprised 181 (43.7%) of the 414 malignant neoplasms diagnosed in the oral cavity within the study period. The most frequently affected sites were the maxillary gingiva (24.9%) and mandibular gingiva (21.5%). There was a slight male preponderance; with a male to female ratio of 1.2:1. The peak age was in the eighth decade of life. About 17.7% of cases were diagnosed in patients below the age of 40 years and 1.1% of cases occurred in children. Worldwide, the tongue is the most frequently affected site by squamous cell carcinoma followed by the floor of the mouth. Males are also more frequently affected. In conclusion, OSCC remains an important cause of morbidity and mortality among middle aged individuals in our environment and worldwide, but sometimes affecting younger individuals.

Disorders of the sleep-wake cycle in blindness.

BACKGROUND: Alteration of the intensity of light reaching the pineal gland through the visual pathway affects the sleepwake cycle in humans. OBJECTIVE: To determine the prevalence, types and severity of sleep-wake disorders in the blind and their relation to the degree and cause of blindness. METHODS: One hundred and seventy consecutive blind patients were included in the study. The patients were interviewed and administered the Montgomery Asberg Depression Rating Scale (MADRS) and the Pittsburg Sleep Quang Index (PSQI) questionnaire. Information collected included age, sex, visual loss parameters, type and degree of sleep-wake disorder. RESULTS: A total of 138 (81.2%) blind patients had sleep-wake disorders with significant disorder found in 84(49.4%). The mean PSQI+/- SD were 8.4 +/-2.91, 9.6+/- 3.3 and 8.0+/-2.7 globally, no light perception group and the remaining blind patients respectively. The commonest type of sleep-wake disorder was day time nap [112(65.9%)]. Forty-one (46.1%), 33(58.9%), 8(80.0%), 2(100%) and 0(0.0%) of those that had cataract, glaucoma, optic atrophy, uveitis and others respectively had moderate and/or severe sleep-wake disorder. The relationship between degree of blindness and prevalence and severity of sleep-wake disorder was very significant statistically (p= 0.008 and 0.002 respectively). The relationship between causes of blindness and prevalence and degree of sleep-wake disorder was statistically significant (p=0.009 and 0.007 respectively). CONCLUSION: This study has shown that the prevalence of sleep-wake disorders in the blind is high and a strong relationship exists between visual loss and the sleep-wake cycle in humans.

Retrospective analysis of intra-oral salivary gland tumours in Ibadan, Nigeria.

BACKGROUND: Salivary gland neoplasms constitute an important group of intraoral tumours, with their malignant histological types being the second most frequently diagnosed intraoral malignancy. The incidence as well as the anatomical distribution of this heterogeneous group of neoplasms varies from one racial group and geographical location to the other. However, studies from Africa on intraoral salivary gland neoplasms are relatively sparse in the medical literature. OBJECTIVE: To report the frequency and anatomical distribution of the various histological types of minor salivary gland neoplasms diagnosed at the University College Hospital, Ibadan and to provide data for comparison with other epidemiological findings in different geographic locations. METHODS: A retrospective study of intraoral salivary gland neoplasms diagnosed at the University Teaching Hospital, Ibadan between January I991- December 2007. Included in the study were charts of patients with minor salivary glands in the mouth. Information obtained about each patient included age, sex, tumour location and histological classification based on the 1991 WHO recommendations. RESULTS: Of a total of 309 neoplasms of salivary gland origin, 92 were from the intra-oral minor salivary glands constituting 4.5% of head and neck neoplasm. There was no significant gender predilection. Fifty-seven (62%) cases were malignant, while 35 (38%) were benign. The most frequently diagnosed tumour was adenoid cystic carcinoma 35(38%), followed by pleomorphic adenoma 30(32.6%). About 73% of the salivary gland neoplasms affected the palate, followed by the buccal mucosa (16.3%). Patients with malignant neoplasms were about 10 years older than those with benign tumours (p=0.012). CONCLUSION: A large proportion of intraoral salivary gland neoplasms are malignant, the most frequently affected site being the palate.

Histopathological pattern of renal cell carcinoma in Ibadan.

There has been a paucity of Nigerian studies on renal cell carcinomas (RCC). This retrospective review analyzes cases of RCC diagnosed in the University College Hospital, Ibadan from January 1960 to June 2007. Cases were typed using the 2004 World Health Organization classification of renal tumours. Papillary RCC were further grouped into Type 1 or 2 and Fuhrman's nuclear grade was determined for clear cell and papillary RCC. There were 159 cases, 108 being females, with a male to female ratio of 1:2.1. Peak age of occurrence was in the fourth decade. The right kidney was more commonly affected (58.6%). Papillary RCC was the most common variant accounting for 27 of the 62 cases that were available for review. Six (22.2%) of the 27 papillary RCC had the distinctive histological features that have been associated with Xp 11 translocation carcinoma. All 27 cases of papillary RCC were Type 2. Twenty-one (61.8%) RCC were Fuhrman's nuclear grade 1 and 2. Renal cell carcinoma in Ibadan occurs two decades earlier than in Caucasians. Papillary RCC is the most common histological sub type of RCC in Ibadan, and Xp translocation carcinomas may be more common in this environment than earlier described in America. This is in contrast to the observation that clear cell carcinomas is the most common histological sub type of RCC in Caucasians series.

Case control study of dry eye and related ocular surface abnormalities in Ibadan, Nigeria.

BACKGROUND: Tear instability is associated with symptoms of ocular discomfort and irritation. Many patients with dry eyes remain untreated due to improper diagnoses. OBJECTIVE: To identify symptoms and surface abnormalities associated with dry eyes. MATERIALS AND METHODS: One hundred and fifty-six eyes of 78 subjects attending the Eye Clinic of the University College Hospital Ibadan were screened for dry eyes/tear instability using rose Bengal stain (graded 0-9), tear break-up time (TBUT), Schirmer's 1 tests, tear meniscus height and a standardised symptoms questionnaire. Grades 4-9 rose Bengal staining were considered as positive dry eye and were compared with grades 0-3 staining eyes as negative controls. RESULTS: Mean tear meniscus height, Schirmer's test and TBUT were lower among cases than their corresponding control eyes. The difference between the mean Schirmer's test values of cases and their controls were statistically significant (P = 0.00 for right eyes and P = 0.002 for left eyes). Rose Bengal grades were inversely correlated with the mean Schirmer's values (Pearson correlation -0.429, P = 0.05 for right eyes and -0.335, P = 0.03 for left eyes) and TBUT (Pearson correlation -0.316, P = 0.05 for right eyes and -0.212, P = 0.06 for left eyes). About 95.8% of the cases were symptomatic, as opposed to 70.4% of the controls (P = 0.01, Fisher's exact test) and 95.8% of dry right eyes compared to 61.1% of their controls had ocular surface abnormalities (P = 0.001), while 89.5% of dry left eyes compared to 62.7% of controls had surface abnormalities (P = 0.07). CONCLUSION: A close relationship exists between ocular irritation symptoms, surface abnormalities and functional evidence of tear instability. Such patients should be treated empirically or screened for dry eyes.

Review of fine needle aspiration cytology in the management of goitres in Ibadan, Nigeria.

OBJECTIVE: The use of Fine Needle Aspiration Cytology (FNAC) in the investigation of goitres was introduced into our practice more than a decade ago. This is a review of its diagnostic accuracy for thyroid carcinoma seven years after the first evaluation and following the establishment of the 'FNAC Clinic'. METHOD: This is a retrospective study of patients who had FNAC of goitres and the histopathology of their thyroidectomy specimens between 1995 and 2004. The accuracy of the cytology reports were evaluated against the histology reports. The turnaround time of the patients for surgery was also determined. RESULTS: There were 130 females and 21 males with an age range of 7-86 years. The diagnostic accuracy of the procedure for carcinoma was 89% with a sensitivity of 35%, specificity of 97%, positive predictive value of 64%, and a negative predictive value of 91%. The average turnaround time for surgery was 178.7 +/- 248.7 days with a range of five days to three and a half years. CONCLUSION: The diagnostic accuracy of FNAC of goitre for carcinoma improved in the period under review. However, the long surgery turnaround time may reduce the usefulness of the procedure. The accuracy may be improved further by a protocol of ultrasound guidance, capillary collection with no-aspiration technique, on-site review of slides with a repeat of FNA as necessary.

Pattern of coroners' autopsies at Ring Road State Hospital, Ibadan, Nigeria: a retrospective study (1994-2000).

This study reviews 1,993 coroners' autopsies performed at the Adeoyo and Ring Road State Hospitals, Ibadan, over a seven-year period (January 1994 to December 2000). The most common indication for a coroner's autopsy was accidental death (59.6%), followed by homicidal death (20.7%), sudden natural death (11.6%), maternal death (1.4%) and suicidal death (0.4%). The overall male to female ratio was 2.8:1 and the majority of victims were in the fourth decade of life. Road traffic accidents were the leading cause of accidental death. Homicidal deaths were 9.3 times more common in male than female victims and the most common mode of death was firearm injuries. In contrast to an earlier study from University College Hospital, Ibadan, the present study has revealed a predominance of accidental and homicidal deaths, with a relatively lower rate of maternal deaths.

Malignant childhood solid tumours in Benin City, Nigeria.

BACKGROUND: Tumours are uncommon in childhood; malignancies are even more uncommon. Yet malignancies are among the leading causes of childhood death in many parts of the world. The pattern of these tumours in Benin City Nigeria, however, is not known. OBJECTIVE: To describe the pattern and histological types of childhood tumours in a Nigerian teaching hospital. METHODS: All histologically diagnosed cases of malignant solid tumours in children less than 15 years of age seen over a 10 year at the University of Benin Teaching Hospital (UBTH) Benin City of southern Nigeria were analysed in order to determine their histological patterns. RESULTS: Eighty-four cases of malignant tumours were seen during the 10-year period (1993 to 2002) in children less than 15 years of age at the UBTH Benin City. Forty-nine (50.3%) cases occurred in males and 35 (41.7%) in females. There was a decline in the frequency of childhood cancer with increasing age. The histological types, in descending order of frequency, were lymphoma 28(33.3%), nephroblastoma 18 (21.4%), retinoblastoma, rhabdomyosarcoma 12 (14.3%) each, and carcinoma 9 (10.7%). The head and neck region was the commonest location for all the various histological types (except tumours arising from tissues specific to other regions e.g. nephroblastoma). About 40% of all tumours occurred in the head and neck compared to 32% that occurred in the abdomen. CONCLUSION: Malignant childhood solid tumour pattern in Benin City Nigeria is similar to that observed in other third world countries.

Paediatric head and neck malignancies in Ibadan, Nigeria.

Studies on paediatric head and neck cancer are limited in the medical literature. Most studies have been restricted to specific histological types such as rhabdomyosarcoma, osteogenic sarcoma or Burkitt's lymphoma. This study describes the relative frequency of cancers seen in the head and neck region of children below 16 years of age at the University College Hospital, Ibadan, Nigeria. A total of 281 cases of paediatric head and neck tumours were diagnosed within the study period, out of which 84 cases were malignant. Fifty-four of these cases were males while 30 were females, giving a male to female ratio of 1.8:1. The age range for these cases was 3 days to 15 years with a mean age of 9.03 +/- 4.63 years. The most frequently diagnosed tumours were haematopoietic malignancies, accounting for 47.6% of cases, followed by sarcomas (27.4%) and carcinomas (21.4%). Burkitt's lymphoma constituted 28.6%, followed by rhabdomyosarcoma accounting for 17.9% of cases. Malignant neoplasms of the head and neck region are rare in the paediatric age group. The pattern of these neoplasms also differs from that in the adult population. However, malignant head and neck neoplasms in the paediatric age group also showed the male preponderance characteristic of head and neck malignancies in the adult population.

Benign childhood tumours in Benin City, Nigeria.

A retrospective analysis of benign tumours seen in children aged 0-14 years over a 10-year period (1993-2002) was carried out in Benin City Nigeria, in order to determine the various histological types of such tumours. A total of 76 cases were seen during the study period, out of which 32 occurred in males and 44 in females. The commonest histological categories were tumours of connective tissues, peripheral nerve and teratoma. Haemangioma and neurofibroma occurred with equal frequency and were the single most common histological types of benign childhood tumours. Head and neck was the most common anatomic region to be involved with childhood benign tumours.

Primary malignant bone tumours in Ibadan, Nigeria: an update.

Bone tumours are relatively rare compared to tumours of other sites. The frequency of primary malignant bone tumours is low in our environment, as was observed in an earlier study. The aim of this study is to update the information available on the pattern of primary malignant bone tumours at the University College Hospital (UCH), Ibadan, Nigeria. The medical records of 49 patients with malignant bone tumours documented in the Cancer Registry of UCH, Ibadan between January 2001 and September 2007 were reviewed retrospectively. The results were then added to those of the previous study published in 2002. This brought the number of cases of primary malignant bone tumours to 163 from January 1977 to September 2007. Primary malignant bone tumours represented 0.53% of the 30462 cases of cancer seen in the hospital in the period studied. The male female ratio was 1.5:1. About 44% of the tumours occurred among patients less than 20 years of age. Osteogenic sarcoma was the commonest malignant bone tumour. Important changes recorded in the seven years since the last review from this centre include; a rise in the prevalence rate of primary malignant bone tumours (49 new cases in the last seven years as compared to 114 cases over 23 years), the male-female ratio of Osteogenic sarcoma showed a decline (1.5:1 as compared to 1.6:1), and there was an increase in the prevalence of primary malignant bone tumours in the 0-9 years and > 60 years age groups. The significance of these findings will need to be determined by further studies.

Factors influencing visual and clinical outcome in Nigerian patients with cranial meningioma.

We retrospectively analysed the impact of selected clinicopathological factors on visual and clinical outcome in patients with histologically verified cranial meningioma. The 60 patients analysed for tumour characteristics consisted of 32 females and 28 males (sex ratio 1.1:1) aged 9-77 years (mean 40 years) seen between 1977 and 1999 at the University College Hospital, Ibadan, Nigeria. The patients for whom sufficient clinical data was available (n=35) presented within 2-60 months (mean 18 months) of symptom onset with large tumours (mean size 52 mm), and perifocal oedema (26/35), poor vision, focal neurological deficits, seizures and clinical evidence of intracranial hypertension. The most common tumour site was the convexity. There was loss of vision in 30/35 (85.7%) patients. Loss of vision was significantly related to tumour site and tumour size as well as perifocal oedema, (P<0.05). The case-mortality rate was 11.4% at 1 month and 20% at 6 months post-operation and was significantly correlated with intracranial hypertension. Neither age nor sex affected the outcome (P>0.05).

The most appropriate site for endoscopic biopsy for the detection of H. pylori among Nigerians in Ibadan.

BACKGROUND: Helicobacter pylori is a significant aetiological factor for acid peptic diseases and gastric cancer. Detection of the organism in gastric mucosal biopsies is important, hence the need to ascertain the optimal site for biopsy that will facilitate identification of the organism. STUDY DESIGN: The study was carried out by obtaining directed gastric and duodenal endoscopic biopsies from twenty-five adult Nigerian patients clinically diagnosed to have gastroduodenitis at the University College Hospital, Ibadan, Nigeria. Biopsies were obtained from the gastric body, pyloric antrum, first and second parts of the duodenum at endoscopy. The biopsy specimens were tested for H. pylori by Campylobacter-like organism (CLO) test and histology. RESULTS: Positive results for H. pylori by CLO test were detected in 67% each for the biopsies taken from the gastric antrum and incisura angularis; and 28% and 17% for those taken from first and second parts of the duodenum respectively. There was no benefit in taking additional biopsy from incisura angularis to that from the antrum. Helicobacter pylori was better detected in the mucosa of the antrum (72%) than that of the duodenum (28%), p < 0.05. The organism was detected in 28% by histological examination of the tissue specimen of the patients compared to 72% by CLO test, p < 0.05. CONCLUSION: The study shows that the detection of H. pylori by invasive technique is better obtained by taking biopsy at the gastric antrum in Nigerian patients with gastroduodenitis. Furthermore, the CLO test yields more positive results than histological evaluation in the detection of the infection.

Prevalence of venous thromboembolism at post-mortem in an African population: a cause for concern.

Venous thromboembolism (VTE) remains a fatal complication and a frequent cause of death among patients hospitalized for remediable and often minor conditions. Various prevalence and associated risk factors of VTE have been documented in different parts of the world. It has been reported that the prevalence of VTE in Africans and Asians is not as pronounced as it is in the Caucasians. However, there is still a relative paucity of information about the prevalence of VTE and its associated risk factors in Nigeria, which is an African population. Data was collected retrospectively from records of post-mortem reports at the University College Hospital, Ibadan, Nigeria between January 1991 and December 1998. Of the 989 autopsies documented within the 8-year period, 29 autopsies confirmed VTE. This indicates a prevalence of 2.9%. Sixty five percent of the subjects were older than 40 years and male to female ratio was 2.6:1. Hence the condition is more prevalent in males than females. Malignancy was the commonest predisposing risk factor for VTE (37.9%). Other predisposing factors included immobility for more than 4 days (27.6%), neuromuscular paralysis (24.1%), septicaemia (20.7%), multiple trauma involving the pelvis, abdomen and head (17.2%), major surgery (13.8%), congestive cardiac failure (3.4%) and obesity (3.4%). This study highlights the need to have a closer look at this grave but preventable and treatable health condition. VTE is a preventable and treatable condition, especially where haematological services, intensive care management and good pre-emptive physiotherapy are available. Thus, mortality from this condition should be considered as a cause for concern even in a poorly funded health care delivery system such as in Africa. It is therefore recommended that appropriate physical and pharmacological methods of prophylaxis should be prescribed according to the degree of risk of VTE in individual patients.