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  Citation statistics : Table of Contents
   2017| January-June  | Volume 8 | Issue 1  
    Online since January 30, 2018

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A point prevalence survey of antimicrobial prescribing in four Nigerian Tertiary Hospitals
OO Oduyebo, AT Olayinka, KC Iregbu, A Versporten, H Goossens, PI Nwajiobi-Princewill, O Jimoh, TO Ige, AI Aigbe, OI Ola-Bello, AO Aboderin, FT Ogunsola
January-June 2017, 8(1):42-46
Introduction: Antimicrobial resistance has become a global challenge in health care. Its emergence in previously sensitive bacteria is usually associated with poor antibiotic-prescribing patterns. Methodology: A point prevalence survey was carried out in four tertiary hospitals in Nigeria in 2015 to determine the rate and characteristics of antibiotic prescription. Results: Of 828 patients eligible for the study, 69.7% received antibiotics, with highest rates in the adult Intensive Care Unit. There were therapeutic indications in 51.2% of the prescriptions, of which 89.5% were for community-acquired infections. Third-generation cephalosporins were the most prescribed antibiotics. On the evaluation of surgical prophylaxis, only 4.1% were compliant with institutional guidelines and 39.2% gave a reason for prescribing in patient case notes. Less than 1% of the prescriptions were based on the use of biomarkers. Conclusion: The prevalence of antibiotic prescription in Nigerian hospitals is high with only about 50% of prescriptions based on clear therapeutic indications. We provide evidence that the country needs to institute a cohesive antimicrobial stewardship intervention program.
  28 8,672 886
The role of biomarkers (p16INK4a and Ki-67) in cervical cancer screening: An appraisal
Saad A Ahmed, Darlington E Obaseki, Ahmed A Mayun, Aliyu Mohammed, Abdulmumini H Rafindadi, Mohammed A Abdul
January-June 2017, 8(1):1-4
Cervical cancer is a common and important public health problem in developing countries. Even though many developed countries have achieved significant successes in reducing invasive cervical cancer burden, the burden in developing countries is still worrisome. Currently, cervical examinations and Papanicolaou (Pap) tests remain the screening method of choice for most women in many parts of Africa. Molecular diagnostic tests for human papillomavirus (HPV) can augment screening for cervical cancer when used in conjunction with the Pap smear. Due to the inherent limitations of morphologic interpretation and borderline cases, the atypical squamous cells (Atypical Squamous Cells of Undetermined Significance [ASCUS] and Atypical Squamous Cells cannot rule out High Grade [ASC-H]) were introduced and this led to significant colposcopic follow-up and/or treatment of these women. p16INK4a is an efficient triage method; the dual staining with Ki-67 was introduced mainly to increase reproducibility and specificity compared with stand-alone p16INK4a staining. Diffuse p16INK4a immunostaining is the hallmark of high-grade squamous intraepithelial lesions regardless of HPV status.
  5 7,343 621
Intestinal parasites among HIV-infected patients at obafemi awolowo university teaching hospitals complex, Ile-Ife
Bolatito Opeyemi Olopade, Clement Oluwaseun Idowu
January-June 2017, 8(1):34-38
Background: Intestinal parasites are a cause of morbidity and mortality throughout the world particularly in HIV-infected patients. This study determined the prevalence of intestinal parasites among HIV-infected patients, assessed risk factors predisposing to infection and also assessed association of intestinal parasites with the CD4 counts of the patients. Materials and Methods: It was a cross sectional study and 226 HIV-infected patients attending the Virology Research Clinic of OAUTHC were recruited. Questionnaires were administered to obtain relevant demographic information. Stool samples were collected and examined. Data processing was done using SPSS Inc USA version 17. Statistical analysis was done using frequency, proportion, percentages, tables and Pearson's chi-square was used to determine the association between intestinal parasites and risk factors. Results: The overall prevalence of intestinal parasites in this study is 15.4%. Cryptosporidium sp. and Ascaris lumbricoides had the highest prevalence, both had rates of 4.4% followed by Entamoeba histolytica with a rate of 3.1%. Cyclospora sp. had a rate of 1.8%, Strongyloides stercoralis had a rate of 0.9% while Entamoeba coli and hookworm both had rates of 0.4%. Co-existence of Cryptosporidium with Strongyloides stercoralis occurred in one of the HIV-infected patients. Exposure to goats and dogs was found to be significantly associated with intestinal parasites. The CD4 count was not significantly associated with presence of intestinal parasites. Conclusion: Intestinal parasites are still prevalent among HIV-infected patients and exposure to dogs and goats was a risk factor. There was no association between intestinal parasites and CD4 counts of the patients.
  4 4,864 392
Histopathological analysis and clinical correlations of ovarian lesions in a tertiary hospital in Nigeria: A 10-year review
Said Mohammed Amin, Friday Olah, Rukkaiya Mohammed Babandi, Mohammed Idris Liman, Sola Jimoh Abubakar
January-June 2017, 8(1):25-28
Introduction: Ovarian lesions represent a significant cause of morbidity among females in most countries of the world. The prevalence of ovarian lesions in Abuja the Nigerian capital however, has not been adequately reported. We hereby present its incidence and characteristics in the tertiary hospital of a cosmopolitan capital city of Nigeria. Setting: The National Hospital Abuja is a 400-bed tertiary hospital serving Abuja and surrounding cities. Material and Methods: A retrospective analytical study of ovarian samples received in a decade in Histopathology department of the hospital with review of ward folders from Health records department. Results: Ovarian lesions account for 1.3% of all surgical exercised samples involving predominantly the 30 to 49 year females. The commonest encountered lesions are the non-neoplastic (58%) followed by the neoplastic with 23%. Germ cell tumours are the commonest neoplastic conditions (46%). Abnormal vaginal bleeding, abdominal pain and abdominal mass are the predominant symptom bringing patients with ovarian lesions to the hospital. Conclusion: Ovarian lesions are significant causes of surgical mass diseases in National Hospital Abuja.
  3 4,684 361
Triple negative breast cancer at the Jos University Teaching Hospital
Barnabas Mafala Mandong, Innocent Emmanuel, Kwaghe Barka Vandi, Daniel Yakubu
January-June 2017, 8(1):20-24
Background: Breast cancer remains the leading cause of cancer morbidity and mortality in women worldwide. The treatment of breast cancer has drifted from radical mastectomy, to conservative treatment owing to the presence of micro metastasis at even earlier stages of the disease. These novel medical treatments are hinged on characterizing breast cancer at the molecular level. Estrogen receptor (ER), Progesterone receptor (PR), and Human epidermal growth factor 2 receptor (HER2) are the commonest molecular-markers used. Failure to stain for these three receptors, earns a breast cancer the triple negative designation, an aggressive type of the disease with the worst prognosis. Materials and Methods: All histologically confirmed cases of breast cancer at Jos University Teaching Hospital, between 2010 and 2012, were retrieved, and their histological type and grade documented. Using the Avidin-biotin method, the status of each case was established for ER, PR, and HER2. Cases with negative staining for these three antibodies were further stained with CK5/6, a basal biomarker for Triple Negative Breast Cancer (TNBC). Statistical softwares were used to analyse the data and present in tables. Results: Sixty-three cases of female breast cancers met the inclusion criteria. The age range was 28-74 years with mean age of 46.7±11.1 years. Invasive carcinoma (no special type) was the majority of histological type of breast cancer, accounting for 54(85.7%) cases. Histological grades 1, 2 and 3, recorded 18(28.6%), 29(46.0%), and 16(25.4%), cases respectively. TNBC accounted for 26 (41.3%) cases. Fifteen (57.7%) cases of TNBC stained positively for CK 5/6. Conclusion: Indicators of worse prognosis which includes lower hormone receptor status and high percentage of TNBC, as well as greater number of basal subtype of TNBC was exhibited by the study population.
  2 3,410 318
Sudden death in giant pituitary adenomas: Two case reports with literature review
Ayodeji Salami, T Babatunde, O Ogun, A Lawan, S Abubakar-Akanbi, M Nweke, G Ogun, E Akang
January-June 2017, 8(1):47-50
Pituitary macroadenomas are rare tumors constituting <1% of intracranial tumors. The giant macroadenomas are even rarer and have the potential to cause fatality due mostly to mass effects within the intracranial space. Most cases are nonfunctional and are either null cell adenomas or gonadotroph adenomas in which symptoms may have been ignored by the patient. Sudden deaths from intracranial tumors are uncommon and pituitary adenomas are very rarely associated with unexpected deaths. Here, we present two cases of giant pituitary adenomas both of which were undiagnosed before demise of the patient. The autopsy report showed no other findings except the sellar tumor. Immunohistochemistry of both tumors showed null cell adenoma.
  1 6,204 344
Sirenomelia in a Nigerian: A case report and review of literature
Haruna A Nggada, Murray R Bartholomew, Baba U Ahmadu, Dogon Yaro Barnabas, Aminu M. C. Dahiru, Ukaobasi Alex, Auwal Abubakar
January-June 2017, 8(1):51-53
We present a case of sirenomelia delivered by a teenage mother, non-diabetic out of wedlock in a single birth. The multiple congenital anomalies involving fusion of the lower limbs, absent external genitalia, blind rectal end, absent of anal canal, single umbilical artery and embryonic mesonephric apparatus. The sex could not be determined and baby died few hours after delivery. Post mortem examination revealed multiple congenital defects. Conclusion: Rarity of single birth sirenomelia delivered by a teenage mother and emphasis on post mortem examination which revealed the gross morphological associated features that will add to the available literatures. To the best of our knowledge this is the first case to be reported in Northern Nigeria.
  1 4,626 280
Polyostotic osteomyelitis in a sickle cell anemia patient
John Ayodele Olaniyi, Akinyinka Oluwafemi Akinwunmi
January-June 2017, 8(1):54-57
This is a case presentation of a successfully managed 18-year-old female sickle cell disease (SCD) patient with radiologically confirmed multifocal osteomyelitis with associated soft-tissue swellings and chronic leg ulcer. However, blood culture and the culture of soft tissue swellings yielded no growth of organisms, but microscopy showed numerous pus cells. The patient was not under follow-up in any hospital before presentation and freely uses off-the-counter drugs. She was transfused with 3 units of packed cells in a general hospital 6 months before presentation to our tertiary facility. Long course of potent antibiotics and surgical drainage of pus by orthopedic surgeons resulted in good outcome, and the patient is being followed up. In essence, this case has brought into the open the need for high index of suspicion, multidisciplinary approach, a need for possible sensitive serologic and molecular technique in the identification of culprit organism, and most importantly a great need for each SCD patient to submit themselves to available specialist care in their respective vicinities.
  1 5,307 312
Association of Epstein–Barr Virus (EBV) with malignancy of the nasopharynx in Lagos, Nigeria
O Omoseebi, OR Akinde, Omobolade O Obadofin, GO Ogun, Adekunbiola A. F. Banjo
January-June 2017, 8(1):29-33
Background: Nasopharyngeal cancer is a rare cancer worldwide. It is now found to be increasing in incidence in Nigeria, though the incidence is lower when compared to countries in the Mediterranean basin, North Africa and Southeast Asia. This cancer is frequently associated with Epstein-Barr virus (EBV), but no previous study was done in this centre to document the association. Aim and Objectives: To assess the EBV status in Nigerian patients with nasopharyngeal cancer by using Latent membrane protein – 1 immunohistochemistry. ( LMP-1IHC). Materials and Methods: Thirty-five (35) out of Seventy-five (75) histologically-confirmed cases of nasopharyngeal malignancy (NPM) seen in the Department of Anatomic and Molecular Pathology of Lagos University Teaching Hospital, Lagos between January 2003 and December 2012 were available for EBV study using LMP-1 IHC. Results: EBV LMP-1 IHC was positive in thirty (86%) out of the thirty-five cases studied and these consisted of, 14 cases of undifferentiated carcinoma (WHO type 3), 5 cases of non-Hodgkin lymphoma and 2 cases of adenocarcinoma. Also seven out of eleven cases of differentiated non-keratinizing squamous cell carcinoma (WHO type 2) were EBV positive and two of the three cases of keratinizing squamous cell carcinoma (WHO type 1) were EBV positive. Conclusion: This study has shown that nasopharyngeal malignancy in our centre is highly associated with EBV latency as detected by LMP-1 immunohistochemistry.
  1 4,294 351
A descriptive study of patterns of conjunctival lesions in Jos, Nigeria: A 10-year retrospective study
Olugbenga Silas, Olanrewaju Ajetunmobi, Chibuike Enwereuzo
January-June 2017, 8(1):39-41
Background: Conjunctival lesions form the bulk of orbito-ocular pathologies and account for significant morbidity and mortality globally. The spectrum ranges from degenerative and inflammatory lesions to neoplasms which can be either benign or malignant. Malignant neoplasms have been shown to be the predominant class of conjunctival lesions in third world nations. Methods: this study reviewed all histologically diagnosed conjunctival lesions at the Jos University Teaching Hospital from January 2004 to December 2013. Results: Neoplasms were the dominant pathology observed, accounting for 76% of all lesions. Of the neoplasms, 77% were malignant, with squamous cell carcinoma the most frequent malignancy seen. Inflammatory lesions accounted for only 5.2% of all cases seen, while non-neoplastic, non-inflammatory lesions constituted 18.4%. A male predominance was observed for all lesions, while the peak age group for conjunctival pathologies was 30-39years [32.5%]. Conclusion: Malignant neoplasms are the commonest type of conjunctival lesions in Jos, North Central Nigeria. This is a reflection of the pattern of late presentation by affected persons at health facilities, as well as the combined effects of prolonged Ultraviolet irradiation and probably, chronic viral infections.
  1 3,832 300
Priapism in sickle-cell disease: Emergency room intervention
Akinsegun Akinbami, Ebele Uche, Adedoyin Dosunmu
January-June 2017, 8(1):5-10
Priapism is one of the diverse complications of sickle cell disease (SCD). SCD is one of the many causes of priapism. Ischaemic and stuttering priapisms are the types seen in SCD. Apart from pain and psychological trauma associated with ischaemic and stuttering priapism, erectile dysfunction and impotence are the most severe complications of priapism in SCD that may require the use of penile prosthesis in SCD patients. The outcome of priapism complications is time-dependent and dependent on the type of management administered. This review highlights, the anatomy of the penis, physiology of normal erection, focusing on pathophysiology and management of priapism in SCD so as to create better awareness of this condition amongst physicians involved in the management of SCD.
  1 9,726 546
Faculty news and announcement
Tamuno T Wakama
January-June 2017, 8(1):58-59
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Fine needle aspiration cytology of the thyroid gland in Sokoto, Nigeria: A 5 years' Experience
Kabiru Abdullahi, Mohammed Abdullahi
January-June 2017, 8(1):17-19
Background: Fine-needle aspiration cytology (FNAC) of the thyroid gland is a cost-effective and widely used procedure to triage patients with enlargement of the gland. Aims: The aim is to determine the sensitivity, specificity, and accuracy of FNAC, thereby highlighting its usefulness.Materials and Methods: This study was conducted in the Usmanu Danfodiyo University Teaching Hospital, Sokoto, North West Nigeria. Using universal sampling, all cases registered as thyroid FNAB over a 5 years' period were consecutively selected. Their corresponding slides were retrieved and reviewed. Result: A total of 187 FNA of the thyroid glands were retrieved. One hundred and fifty-six (83.4%) were female, and 31 (16.6%) were male (ratio of 5:1). The age range was 4–88 years, with the mean age of 40.6 years. Benign and malignant lesions accounted for 81.8% and 4.8%, respectively. Sensitivity, specificity, and accuracy were calculated as 70%, 100%, and 98.2%, respectively. Conclusion: FNAC of the thyroid gland remains a very useful tool in the management of goiter.
  - 3,754 297
Chemical pathologists' role as part of multidisciplinary teams' approach to health-care delivery
Sikiru Abayomi Biliaminu, IM Abdulazeez, AA Akande, AB Okesina
January-June 2017, 8(1):11-16
Background: The care of the sick has gone beyond a 'one-man show' since the medical profession is dynamic. The dynamism of the profession is to entrench the patients' survival. This is being done by introducing the concept of Multidisciplinary Team (MDT) approach to patients' management. Objective: This review is to have a look at the various roles or ways the Chemical Pathologists can fix into MDT as laboratory physicians. Method: This article discusses the definitions and some terminologies in Chemical Pathology and concept of MDT. Its approach in medicare, went through the historical line and evolution of the subspecialty of Chemical Pathology. It discusses the role of Chemical Pathologists in MDT as well as pros and cons of the concept of MDT. Finally, it also discusses how to improve MDTs in Nigerian Tertiary Hospitals. It was essentially based on literatures written in English. Conclusion: This review article has tried to discuss roles of Chemical Pathologists in MDTs approach to patients' management in our hospitals not leaving out the historical aspects, its advantages, disadvantages, barriers and possible way forward for the suggested challenges.
  - 11,240 529