Annals of Tropical Pathology : Table of Contents

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Table of Contents

June 2013
Volume 4 | Issue 1
Page Nos. 5-52

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EDITORIAL

	Contemporary issues in postgraduate medical education in Nigeria: A trainees' perspective	p. 5
	Blessing Odia, Omolade Adegoke, Ajenifuja Kayode Olusegun
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ORIGINAL ARTICLES


	Integration of visual inspection with acetic acid as a screening tool for cervical premalignant lesion into the primary health care programme in a Southwestern State of Nigeria: Report of a pilot study	p. 7
	KO Ajenifuja, CA Adepiti, M Adeyanju, OM Loto *Objectives:* The aim of this pilot study was to determine the feasibility of integrating cervical cancer screening into the health programmes of the local government using direct visualisation of the cervix with dilute acetic acid with immediate treatment of positive cases to maximize treatment adherence. Other objectives were to determine the acceptability of a “see and treat” approach among women diagnosed with cervical premalignant lesions in Ekiti state and tolerability and side effects of treatment with cryotherapy *Method:* The pilot study was carried out in Ekiti state in the south western part of Nigeria. Forty doctors drawn from all the 16 Local Government Areas' primary health facilities across the state were trained for a period of one week on how to screen for cervical premalignant lesions of the cervix using direct visualization with dilute acetic acid and how to treat screened positive women with cryotherapy. *Results:* A total of 1431 women were screened with Visual Inspection with Acetic Acid (VIA) . Their ages ranged from less than 20 years but sexually active to women who were over 60 years. Majority of the women were traders while 22% were house wives. The parity of the women ranged from zero to e”6. Forty-four (3.1%) were VIA positive, while 1318 (92.1%) were VIA negative, 6 (0.4%) had suspicious looking cervix and 63 (4.4%) were referred for Pap smear because their entire Squamo –columnar junction could not be visualized. *Conclussion:* Cervical cancer screening can be successfully incorporated into the health programmes of the local government in Nigeria.
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	Serum and seminal fluid zinc in males presenting with infertility in a Nigerian population	p. 15
	OA Ajose, TA Adedeji, OK Ogunye, JI Anetor *Background:* The usefulness of serum and seminal fluid zinc measurements, in investigating male infertility in the Nigerian population has been evaluated, by determining the relationship between zinc levels in these body fluids and % spermatozoa headpiece abnormality, % spermatozoa motility and sperm count. We have also explored the possibility of substituting serum zinc for seminal fluid zinc measurement, in investigating this condition, by determining the relationship between serum and seminal fluid zinc levels. *Materials and Methods:* Sixty (60) infertile males, aged 32 – 53 years, were recruited for the study by random selection. The subjects were classified on the basis of sperm cunt into three groups: azospermic (3.3%); oligospermic (75%) and normospermic (21.7%). Pairs of samples (blood sample and semen) were obtained from the subjects for laboratory analysis. Atomic absorption spectroscopy was used to measure zinc levels. Semen analysis was done by employing the conventional method (World Health Organisation-1987). Statistical analysis of all data was done using SPSS 14. *Results:* Mean serum zinc concentration in the three groups was not significantly different, likewise mean seminal zinc level. There was a positive correlation between serum and seminal fluid zinc levels in the normospermic and oligospermic groups (r=0.4; p < 0.05 and r=0.6; p<0.01) respectively. Furthermore, a strong positive correlation existed between seminal zinc concentration and percentage spermatozoa headpiece abnormality (r=0.84, p < 0.01), and also between serum zinc levels and percentage headpiece abnormality (r=0.60, p < 0.05). However, a significant negative correlation exists between seminal zinc level and percentage motile spermatozoa (r=0.57, p < 0.05). *Conclusion:* Zinc is one of the major components that determine semen quality. Routine seminal zinc analysis is useful as a complementary test in investigating male infertility, especially in the normospermic group, while serum zinc could serve as substitute for seminal fluid zinc analysis.
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	Autopsy study of accidental mortality in rivers state, Nigeria	p. 23
	CC Obiorah, S.A.U Offia *Background:* Accidents constitute serious healthcare burden and public health challenge globally. In Nigeria, it is responsible for significant morbidity and mortality. This work describes the common forms, patterns, causes and demographic distribution of accident related mortality in Rivers state and proffers preventive and mitigation measures. *Methods:* A review of coroner autopsy findings of accident victims between 1998 and 2008 was retrospectively undertaken. Information on age, gender, circumstances, mechanisms, and causes of death were obtained and analyzed. *Results:* Accidental deaths constituted 35.8% of 2087 reviewed medicolegal autopsies. Males constituted 76.9%. The commonest circumstances of accidental deaths were road traffic accidents (RTA) with 63.5% while other forms of accidents in descending order of occurrence were plane crash, drowning, electrocution, fire explosions, falls, and building collapse. The mean age of victims was 30.8 ± 14.5 years while the peak age was 20-29 years. Children and adolescents constituted 20.6% of the cases while adults aged between 20 and 59 constituted 73.9%. The commonest vehicle types involved in RTA were commercial buses with 44.7% and 91.6% of the victims were vehicular occupants. Head and neck injuries dominated in the victims with 58.6%. Unsafe motorists' behaviour especially non compliance with wearing of seat belt by drivers and passengers predisposed to majority of the deaths. *Conclusion:* Improvement in our road infrastructure and provision of critical care facilities and trained personnel in the accident and emergency units of our hospitals will reduce preventable deaths from accidents. Provision of toxicological diagnostic infrastructure will obviate the missed opportunities in poisoning and medical errors uncommonly recorded in Nigerian studies.
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	Reproducibility of gleason grading of prostatic adenocarcinoma	p. 33
	AT Atanda, AB Umar, I Yusuf, MI Imam *Background:* Gleason grading system for carcinomas of the prostate is important in determining treatment and outcome for patients. However, there is need to audit its use among pathologists to ensure reproducibility, thus avoiding undesirable consequences of inappropriate treatment. *Materials and Methods:* Ten slides made from needle biopsies of varying primary patterns and scores were administered to 11 general pathologists. Their ratings were measured against consensus expert ratings of the lesions and degrees of inter- and intra-rater agreements were measured using kappa statistics. *Results:* The inter-rater agreement for primary pattern recognition showed a range of kappa from 0.07 to 0.47 with most raters (45.5%) showing fair agreement with consensus rating. Overall kappa for primary pattern was 0.25 (fair agreement). Pattern underrating occurred overall in 49.1% of ratings and overrating in 3.6% with Gleason pattern 4 being the most underrated. Kappa coefficient for intra-rater consistency ranged from 0.29 to 0.78 (fair to substantial) with intra-rater consistency being highest for Gleason pattern 3. The inter-rater agreement for Gleason scores showed a range of kappa from – 0.12 to 0.54 (poor to moderate) and majority of raters (54.5%) being in the slight agreement range of kappa. The overall kappa was 0.35 (fair reproducibility). Gleason score 7, was undergraded in 63.6% of ratings, score group 8 – 10 by 45.5% and group 5 – 6 was undergraded in 38.6% of ratings. *Conclusion:* the study shows fair inter- and intra-rater consistency in Gleason pattern recognition and scoring with underscoring being the major factor identified. This underscores the need for constant revision of the use of grading systems to ensure consistency among raters.
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	Intralaboratory Turnaround Time (TAT) in a developing country: An audit of a histopathology department of a Nigerian Teaching Hospital	p. 41
	OJ Uchendu, GI Eze *Introduction:* Timeliness of surgical reports, along with diagnostic accuracy and completeness of report content, has been recognized as one of the key indicators of quality in surgical pathology. Various methods have been used by various experts in assessing turnaround time (TAT) in surgical pathology laboratories. *Objective:* To determine the TAT of processing surgical pathology specimen and to identify the possible sources of delay with a view to resolving them. *Materials and method:* This is a prospective study. A total of 100 routine surgical specimens were followed up from reception to verification and dispatch of results. The average TAT is presented in days. *Results:* The mean TAT of a surgical specimen was 11.10 days. Reception and gross handling, histology processing, resident reporting, consultant reporting, transcription and verification accounting for 23.80%, 34.10%, 18.10%, 10.00%, 11.20% and 2.70% respectively of the TAT. *Conclusion:* This study shows that in our centre, TAT of the surgical pathology reports can be improved upon by educating and motivating the staff to mind this index of quality of performance. There is also a need to improve infrastructure and introduce ICT into routine work. This will be applicable to most laboratories of our type in developing countries.
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CASE REPORT


	Case studies involving bilateral lower limb lymphoedema following pentazocine abuse in sickle cell disease patients	p. 47
	OE Iheanacho, N. K. D Halim, ME Enosolease, OA Awodu, GN Bazuaye, CE Omoti, U Aigberadion, JC Obieche, B Nwogoh *Background:* Lymphoedema which results from lymphatic obstruction can cause significant morbidity in affected individuals. Pentazocine injection has several complications including skin ulceration, scaring and fibrous myopathy and these may predispose to lymphoedema. Sickle cell disease (SCD) being a condition characterized by chronic pain tends to provide a background for frequent pentazocine injection or abuse, and this could in turn be accompanied by other complications. Reports of lymphoedema as a remote complication of repeated pentazocine injection are scarce and efforts must be made to prevent this vicious sequel. This case series highlights Nigerian SCD patients who developed bilateral lower limb lymphoedema following prolonged self administration of pentazocine injection. *Setting:* University of Benin Teaching Hospital, Benin City, Edo state. *Subjects:* Three cases of bilateral lower limb lymphoedema following pentazocine abuse in SCD patients. *Clinical Findings:* The patients all had prolonged self injection of pentazocine. Examination revealed bilateral lower limb lymphoedema. The diagnoses were made largely from clinical evidence and multidisciplinary management instituted for the cases. *Conclusion:* Preventive and proactive measures must be taken to forestall this apparently increasing complication of pentazocine injection. Such intervention will include minimizing the use of parenteral pentazocine. A high index of suspicion for intramuscular pentazocine abuse is required when dealing with young SCD patients who develop lymphoedema of the extremities.
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