A Review of Scrotal Ultrasonography in Uyo, Nigeria

BACKGROUND

Scrotal ultrasonography is a useful, sensitive, readily available and safe imaging modality in the investigation of scrotal pathologies, including those possibly contributory to male infertility. The aim of this study was to review the scrotal ultrasound scans (SUSS) done in the University of Uyo Teaching Hospital over a period of 18 months from July 2018 to December 2019.

METHODOLOGY

This was a retrospective study of all the SUSS performed in the Department of Radiology of University of Uyo Teaching Hospital (UUTH) within an 18-month period. All subjects who presented for scrotal ultrasound with adequately filled request forms which included the biodata and clinical information were included in the study.

RESULTS

A total of 79 scans were reviewed during the period. The age range of study patients was 4 - 78 years, with a mean of 41.2 ±15 years. The modal age group was 30-39 years, made up of 20 cases (25.6%). Primary and secondary infertility were the major indications for referrals, in 17 cases (21.8%) and 13 cases (16.7%) respectively. Following SUSS, the findings were normal in 11 patients (14.1%), while hydrocele, and varicocele accounted for 19 cases (24.3%) and 9 cases (11.5%) respectively. Microlitiasis was seen in 7 cases (9%) while a diagnosis of testicular tumor was made in 5 (6.4%) of cases. Three (3) of the 5 testicular tumors, were confirmed histologically.

CONCLUSION

Infertility was the main indication for SUSS and hydrocele the commonest finding. Ultrasound is recommended as first line imaging modality in the investigation of scrotal lesions.

Primary Small Intestinal Non-Hodgkin's Lymphoma: A Case Report

BACKGROUND

Primary intestinal lymphoma has not been previously reported in our unit, and we consider it to be a very rare cause of acute small bowel obstruction.

METHODS

We present an adult male with features of recurrent small intestinal obstruction who previously underwent umbilical hernia repair for the same pain. A plain x-ray and ultrasound scan showed features of intestinal obstruction but did not suggest an aetiology of his symptoms.

RESULTS

He was resuscitated and underwent an exploratory laparotomy and resection of an obstructing ileal mass with mesenteric nodes. Primary anastomosis of healthy ileum was done and the post-operative period was uneventful. The tissue was reported as low-grade B-cell non-Hodgkin's lymphoma (NHL). He was placed on CHOP with a satisfactory response.

CONCLUSION

Small intestinal lymphoma is a rare cause of intestinal obstruction.

Retrospective Post Mortem Study of Custodial Deaths in Uyo, South-South, Nigeria

INTRODUCTION

The medicolegal auditing of the pattern of death among detainees in police and prison custody is a useful tool in planning for quality care to be given to detainees, who do not have access to stable health care as seen in the free world.

AIM

To retrospectively study the peculiarities of custodial deaths (CD), among individuals detained in police and prison custody in Uyo, South-Soth Nigeria and to suggest preventive measures.

MATERIALS AND METHODS

This is a review of all the post mortem examinations (PME) that were performed on detainees that died in police or prison custody over 4 years.

RESULTS

They were 9 detainees aged between 22-44 years with an average age of 31.1 years. All the detainees were males. Six (66.7%) persons died in police custody, while 2 (22.2%) died in prison custody and 1 (11.1%) person died in police clinic. The shortest duration of detention before death was 1 day (24 hours) and the longest 80 days. Marks of torture were seen in 2 (22.2%) cases. The cause of death was seen in 8 (88.9%) cases. In 1 (11.1%) no anatomic pathologic cause of death was seen. The manner of death was natural in 4 (44.4%), homicide 3 (33.3%), accidental 1 (11.1%) and undetermined 1 (11.1%). The 4 natural causes of death were 2 cases of hypertensive cardiovascular disease, a case of myocardial infarction and a case of alcoholic hepatitis. The cause of death in all the homicidal and accidental cases were massive intracranial bleeding.

CONCLUSION

Natural death is the most common manner of death among detainees in Uyo.

Review of Medicolegal Autopsies in South-South Nigeria

BACKGROUND

Study of medicolegal autopsies (MLA) in an area helps to equip policy makers about the nature and pattern of preventable deaths in that area.

OBJECTIVE

To review the pattern of MLA seen in a typical Nigerian population.

METHODOLOGY

The duplicate copies of the autopsy reports issued over 12 years, were retrieved and analyzed for age, sex, cause of death, autopsy diagnosis and circumstances of death.

RESULTS

A total of 1, 664 MLA were done during the period. The mean age of cases seen was 39.10±17.02, with a male to female ratio of 3.6: 1. All age groups were seen with age groups 20-29 and 30-39 years accounting for majority of cases. Homicidal deaths (45.4%) was the commonest manner of deaths, followed by accidental deaths (32.5%). There was a significant association between manner of death and sex. Sixty-two point nine percent of the homicidal deaths were due to firearm injuries. In both sexes, road traffic accident (RTA) was the major cause of accidental deaths accounting for 82.8%. There was no significant association between type of accidental death and sex, though the male to female ratio was 3.3:1. Hanging was the method of choice for suicide and accounted for 68.4% of all suicides. Cardiovascular system diseases accounted for most cases of natural deaths (59.9%), with myocardial infarction being responsible for 29.1% of all natural deaths.

CONCLUSION

Unfortunately, preventable deaths due to homicides by firearm injuries and accidental deaths due to RTA are still prevalent in our environment and mainly involves young people.

Assessment of community knowledge, attitude, and stigma of Buruli ulcer disease in Southern Nigeria

Background

Poor knowledge can influence timely care-seeking among persons with Buruli ulcer disease (BUD).

Objectives

To assess community knowledge, attitude and stigma towards persons with BUD in endemic settings of Southern Nigeria.

Methods

This was a cross-sectional survey conducted among adult community members in four States of Southern Nigeria. A semi-structured interviewer-administered questionnaire was administered to all participants.

Results

Of 491 adults who completed the survey, 315 (64.2%) belonged to the ≤40 years age group, 257 (52.3%) were males and 415 (84.5%) had some formal education. The overall mean (SD) knowledge score was 5.5±2.3 (maximum 10). Only 172 (35.0%) of the participants had a good knowledge of BUD. A total of 327 (66.6%) considered BUD as a very serious illness. Also, there was a high-level of stigma against BUD patients; 372 (75.8%) of the participants felt compassion for and desire to help them, 77 (15.7%) felt compassion but tended to stay away from them, and 53 (10.8%) feared them because they may infect them with the disease. Having a formal education and ethnicity were independent predictors of good knowledge of BUD.

Conclusion

There is poor community knowledge of BUD in endemic settings of Southern Nigeria which influenced the attitude and perceptions of community members towards persons with BUD

The pattern and distribution of cancers in Akwa Ibom State, Nigeria

Introduction

The pattern of cancer is known to vary by location based on people's lifestyle and socioeconomic development status. Aim: The aim of this study is to describe the pattern of cancers seen in University of Uyo Teaching Hospital.

Materials and Methods

This is a retrospective study of all cancer cases that were histologically diagnosed in the Histopathology Department of University of Uyo Teaching Hospital for 9 years (January 2007-December 2015).

Results

There were 1186 cases, identified and included in this study. Females accounted for 59.7% of cases while males accounted for 40.3% of cases, with the mean ages for females and males being 45.69 ± 14.38 and 59.63 ± 17.77 years, respectively. Age group 60-69 years accounted for most cases (20.4%). The common cancers in both sexes were breast (33%), prostate (25.8%), cervix (11.1%), skin (4.9%), sarcoma (4.8%), and colorectal (3.8%).

Conclusion

There is a variation between the pattern of cancer in Akwa Ibom and other regions of Nigeria warranting further clinicopathological evaluation, and these results will be useful in the overall context of planning and evaluation of cancer control activities in Akwa Ibom State. A population-based cancer registration in Uyo is suggested.

Pattern of hormone receptors and human epidermal growth factor receptor 2 status in sub-Saharan breast cancer cases: Private practice experience

INTRODUCTION

Breast cancer is the most common cancer among women globally. With immunohistochemistry (IHC), breast cancer is classified into four groups based on IHC profile of estrogen receptor (ER)/progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2/neu) expression, positive (+) and/or negative (-). The IHC classification correlates well with intrinsic gene expression microarray categorization. ER-positive tumors may benefit from being treated with selective ER modulators and aromatase inhibitors, whereas patients with HER2/neu positive tumors have been shown to experience a significant survival advantage when treated with humanized monoclonal antibodies against HER2/neu.

OBJECTIVE

To determine ER/PR, HER2/neu expression and their association with histological prognostic markers in female breast carcinomas seen in a private diagnostic laboratory based in Lagos.

MATERIALS AND METHODS

Immunohistochemistry reports of breast cancer patients, which were diagnosed by histopathology section of a private diagnostic laboratory based in Lagos, Nigeria from August 2009 to August 2014.

RESULTS

About 18.7% of breast cancers had IHC (ER, PR and HER2) done on them and were all females. The mean age of all subjects was 49.5 years (standard deviation, 13.2; range, 29-78 years). Most (95.8%) of the breast cancers were of invasive ductal carcinoma type, with 77.4% of them been >5 cm. IHC pattern was as follows: ER/PR+, HER2-=19 (39.6%), ER/PR-, HER2- (triple negative [TN])=14 (29.2%), ER/PR+, HER2+=9 (18.8%), ER/PR-, HER2+=6 (12.5%), corresponding to Lumina A, TN/basal-like, Lumina B and HER2 over expressed respectively.

CONCLUSION

Triple negative breast cancers are common in our environment and affect young females most and could be contributory to the poorer prognosis of breast cancer in our environment.

Study of natural causes of death in medicolegal autopsies seen in University of Benin Teaching Hospital

AIMS AND OBJECTIVES

To provide a comprehensive report on the various causes of natural death in our centre and consider its implication for prevention.

MATERIALS AND METHODS

A descriptive cross sectional study of post mortem reports, autopsy registers and duplicate copies of death certificates of all cases of SND on which autopsy was performed on in UBTH, Benin City, between 1990 and 2009.

RESULTS

Of the 4481 medicolegal deaths autopsied during the period, 2734 (61.0%) cases were SND, involving 1614 males and 1120 females with a M:F ratio of 1:4:1. The modal age group was 25-44 years which accounted for 30.2% of the cases. Cardiovascular system diseases occurred most and accounted for 30.2% of all cases, with complications of hypertension accounting for 79.5% of all cardiovascular system diseases. Other causes of SND include; gastrointestinal/hepatic diseases, 15.1%; respiratory system diseases, 13.8%; genitourinary system diseases, 10.1%; immune/infectious diseases, 9.9% and endocrine/metabolic diseases, 7.7%. Less common causes are central nervous system diseases, haematolymphoid system diseases, breast diseases retroperitoneal diseases and musculoskeletal system disease each accounting for 6.6%, 5.4%, 0.7%, 0.4%, and 0.1% respectively.

CONCLUSION

Cardiovascular system diseases, with complications of hypertension are the leading cause of SND in our environment. Public enlightenment on the need for routine medical health checks will help to reduce the incidence of SND.

A 20 year retrospective analysis of medicolegal deaths in a tertiary hospital setting in Nigeria

OBJECTIVE

To determine and classify the various types of medicolegal deaths as seen at University of Benin Teaching Hospital (UBTH), Benin City, Nigeria.

MATERIALS AND METHODS

This is a retrospective study of all the medicolegal deaths seen in the Department of Histopathology, (UBTH, Benin City over a 20 year period (January 1990-December 2009) as recorded in the autopsy registers of the department.

RESULT

A total of 5035 autopsies were done during the period, 89% of which were coroner cases. Four thousand, four hundred and eighty-one coroner cases representing 12.5% of all bodies received by the mortuary during the period were studied. The male to female ratio was 1.9:1, with an overall mean age of 38.3 years. The ages ranged from 1 day to 101 years with a peak incidence in the 25-44 years age group. A total of 553 children and 3928 adults were involved. The commonest indication for coroner's autopsy was sudden unexpected natural deaths (SUNDs) which accounted for 65.5% of the cases. Other causes of death were accidents, homicide, suicide, and undetermined causes representing 28.6, 5.0, 0.5, and 0.4%, respectively. Commonest cause of SUND was cardiovascular diseases with complications of hypertension being the most common CVS disease (26.9%). Road traffic accident was the commonest form of accident causing death (88.7%). Public enlightenment and health education about routine medical screening will help to reduce causes of natural deaths.

CONCLUSION

This study shows the pattern of medicolegal autopsies in UBTH and this preliminary data will provide a baseline for future research and help in formulating policies to help in reduction of preventable causes of death.

Assessment of pattern of cigarette smoking and associated factors among male students in public secondary schools in Anambra State, Nigeria

BACKGROUND

The WHO has estimated that there are about 1300 million smokers globally and about 75 of these are in the developing countries. It is also predicted that if the current pattern of smoking continues, by 2020, there will be 10 million tobacco-related deaths annually worldwide and seven million (70%) of these deaths will occur in the developing countries. The objective of the study was to assess the cigarette smoking pattern and associated factors among male students in public secondary schools in Anambra State.

METHODS

The setting was public secondary schools in Anambra State. The study was in April 2008. It was a cross-sectional survey involving six schools, selected by multistage sampling technique. Eight hundred and fifty male students participated in the study. A semistructured self-administered questionnaire was used. Qualitative data were collected using focus group discussion (FGD).

RESULTS

The mean age of respondents was 16 +/- 2.1 years. The ever-smoked and current smoking prevalence were 13.1% and 8.7% respectively. Mean age of commencement of cigarette smoking 13.7 +/- 2.6 years. Among smokers, 37.8% were dai smokers. Television (40.7%) and radio (33.3%) were the main sources of advertisement. Peer influence (34.2%) was the main reason for uptake of cigarette smoking. Major reason for not smoking among non-smokers was health concerns (57.9%). There were significant associations between smoking status and age of respondents (2 = 25.08; P = < 0.05), father's smoking status (2 = 158.77, P < 0.05), awareness of health hazards of smoking (2 = 5.13, P = 0.023) and advertisement on television (2 = 4.05, P = 0.044) and billboards (2 = 44.39, P < 0.05).

CONCLUSION

Cigarette smoking prevalence among secondary school boys in Anambra State is high. Health education and strict implementation of anti-smoking policies of the federal government of Nigeria is recommended.