Causes of ma xillofacial patient mortality in a Nigerian tertiary hospital

BACKGROUND: An analysis of maxillofacial mortality was done in a Nigerian tertiary health care centre to determine the major causes of mortality and identify possible predisposing factors in our environment.MATERIALS AND METHODS: A retrospective analysis of mortality in maxillofacial surgery department of Aminu Kano Teaching Hospital from January 2005 to December 2014 was done. Data were analyzed using statistical package for social sciences (SPSS) version 15.0 (SPSS Inc, Chicago, IL).RESULTS: A mortality rate of 1.8% (46 deaths from 2,540 admissions) was recorded. There were 35 males (76.1%) and 11 (23.9%) females. The mean age of the deceased patients was 40.0±13.0 years. Orofacial infections (41.3%) and advanced (stage IV) orofacial malignancies (28.3%) accounted for most deaths.CONCLUSION: Fascial space infections and orofacial malignancies contribute largely to mortality in our setting. Late presentation was a major factor predisposing to mortality.Key Words: Audit, Maxillofacial Patient, Mortalit

Infections Mimicking Malignancy in Kano, Nigeria: A Teaching Hospital Experience

Objective: This study aimed to evaluate the pattern of presentation of infectious lesions mimicking malignancy. This will serve to heighten clinical indices of suspicion and prevent unwarranted aggressive management. Methods: This is a 19-year (1999-2017) audit review of all morphologically diagnosed infection-related lesions in which malignancy was primarily clinically suspected. Results: Fifty-six cases of infection-related mimics of malignancy were diagnosed in the study period: schistosomiasis related, 22 (39.2%); actinomycosis, 21(37.5%); tuberculosis-related, 10 (17.9%); fungi-related, 3(5.4%). Twenty-one cases of actinomycosis of the lower limbs and oropharynx were mistaken for melanoma, squamous cell carcinoma, sarcoma, and oropharyngeal carcinoma. The mean age was 33±17years.The 10 patients with atypical Mycobacterium tuberculosis-mimicking malignancy had mean age of 37±14 years and included three in the testes, testicular cases, one from the jaw, and two cases each from ovary, breast, and uterus. Of the three fungal lesions, there was a case each from the brain, skin, and bone. All were males with mean age of 21±7 years. Conclusion: For accurate diagnosis of infection-related mimics of malignancy, a high index of clinical suspicion, knowledge of and attention to characteristic radiological signs, and obtaining representative tissues for histopathologic and cytopathologic diagnoses are paramount

Renal cell carcinoma in Nigeria: A systematic review

Literature on renal cell carcinoma (RCC) in Nigeria is characterized by lacunae in several important areas with resultant incomprehensiveness of data. This requires a review of the literature so as to streamline the data. Using internet search engines, data were extracted from a total of twelve studies reported in peer reviewed journals between 2000 and 2015 from various states of Nigeria including Kano. These were subsequently collated, analyzed, and then compared with those from other parts of the world. There is relatively low incidence rate of 0.3/100,000 population; slight male preponderance and affectation of younger age groups with average age at diagnosis of 45 ± 4 years. Significant smoking history, exposure to industrial dye, family history, and HIV associated immunodeficiency are major risk factors of RCC in Nigeria. A significant number of cases presented with triad of loin pain, hematuria, and loin mass; advanced disease and bulky tumors of up to 3.8 kg and 56 cm. The predominant histological subtypes were clear cell carcinoma 60%–85.7% and papillary carcinoma 23.8%–46.2%. In general, there has been poor overall outcome for RCC bearing patients in the country. RCC in Nigeria is characterized by earlier age at onset and poor outcome, thus necessitating more aggressive case identification at early stages so as to improve prognosis

Perceived and Real Histopathology Turnaround Time: A Teaching Hospital Experience

Background: This study aims to audit analytic turnaround time (TAT) in a histopathology laboratory with a view to assessing the timeliness of its reports, identify causes of delay in its TAT, and compare this with client perception of its performance. Materials and Methods: Records of 1440 batches of specimens processed over a 5‑year period in the histopathology laboratory of a teaching hospital were retrieved from archives. From these, median and mean TATs were calculated and causes of delay identified. Questionnaires were also deployed to assess physicians’ perception of the laboratory’s performance. Results: Analytic TAT was 3.6 ± 2 days, with 86.7% of reports being ready within 5 working days. The delays in timeliness of report generation were due mainly to residency training‑related factors; tissue processing‑related factors, and inadequate clinical information among others. Client perception of TAT rated the laboratory below average by 18.4%; average by 57.5%; good by 20.7%, and excellent in its performance by 3.4% of respondents. Conclusion: Even though physicians perceived the laboratory’s TAT to be just average, its analytic TAT for reports is within acceptable international standards but with room for improvement in its performance.Keywords: Clients, histopathology, reports, turnaround tim

Pattern of HER2 Overexpression in Urinary Bladder Carcinomas in Kano, Nigeria

Background: The worldwide distribution of bladder cancer varies, conforming to differences in environmental and genetic risk factors. HER2 neu is overexpressed in many human cancers, including urinary bladder carcinomas. The aim of this study is therefore to evaluate the pattern of HER2 positivity, and correlate HER2 positivity of urinary bladder carcinomas with age, gender of patients, histological subtypes, and tumor grades. Methods: This is a 2-year retrospective study from January 2015 to December 2016. Patients’ clinicopathological information was extracted from their case folders and pathology reports. The histological subtyping using the WHO 2016 classification and grading was done and then reviewed by authors. HER2 scoring was done using the recommendations of the American Society of Clinical Oncology/College of American Pathologists. Results: Sixty cases of bladder cancer were diagnosed during the study period. HER2/neu positivity (3+) was observed in 24 (40%) of all the cases. Statistically significant association was observed between HER2 neu protein overexpression and increasing tumor grade (p≤ 0.001). Conclusion: This study recorded HER2 overexpression in 40% of study subjects. There is a statistically significant association between HER2 overexpression and increasing tumor grade

Perceived and real histopathology turnaround time: A teaching hospital experience

Background: This study aims to audit analytic turnaround time (TAT) in a histopathology laboratory with a view to assessing the timeliness of its reports, identify causes of delay in its TAT, and compare this with client perception of its performance. Materials and Methods: Records of 1440 batches of specimens processed over a 5-year period in the histopathology laboratory of a teaching hospital were retrieved from archives. From these, median and mean TATs were calculated and causes of delay identified. Questionnaires were also deployed to assess physicians' perception of the laboratory's performance. Results: Analytic TAT was 3.6 ± 2 days, with 86.7% of reports being ready within 5 working days. The delays in timeliness of report generation were due mainly to residency training-related factors; tissue processing-related factors, and inadequate clinical information among others. Client perception of TAT rated the laboratory below average by 18.4%; average by 57.5%; good by 20.7%, and excellent in its performance by 3.4% of respondents. Conclusion: Even though physicians perceived the laboratory's TAT to be just average, its analytic TAT for reports is within acceptable international standards but with room for improvement in its performance

Autopsy and religion: A review of the literature

In spite of immense benefits derivable from carrying out autopsy on the dead, its practice has been very limited in northern Nigeria. One of the reasons for this is the perception that religion opposes the practice of autopsy. Using online search engines and religious doctrinal literature including the Qur'an, Bible and Talmud, a review of their teachings regarding autopsies was conducted. Findings were then harmonized with the practice of autopsy in its present form. Available literature reveals that the religious impediments include the permissibility or otherwise of the procedure, timing, opposite sexes seeing the corpse's nakedness, body mutilation, exhumation of the dead and retention of organs or tissues for teaching purposes. This study concludes that no religion expressly condemns the practice of autopsying the dead, and that the meeting points for various religions and the practice of autopsy is the need for learning and dispensation of justice. However, there is also a common agreement on the need for the procedure to be done promptly and to maintain the dignity of the dead during the procedure

Wilms′ tumour: Determinants of prognosis in an African setting

Background: The few studies available in the literature on Wilms′ tumour (WT) from sub-Saharan Africa have reported a dismal outcome for children with the tumour. This study evaluated the risk factors that have been correlated with outcome in the literature and compare these with outcome among our patients. Materials and Methods: Cases of histologically confirmed WT between 2009 and 2013 in a tertiary hospital in Northwestern Nigeria were evaluated for gender, age, laterality, symptoms, duration before presentation, stage at presentation, histologic subtype and p53 mutation. These were then correlated with outcome. Results: Totally, 30 cases of WT were diagnosed with mean age of 4.8 ± 1.9 years; and male:female ratio of 2:1. No statistically significant relationship with outcome was found for gender (P = 0.138) or histologic subtype (P = 0.671). The most significant variables which positively influenced the outcome were presentation at earlier stages (P = 0.007) and completion of therapy (P = 0.0007). p53 mutation was seen in 3 (16.7%) of 18 cases and was not associated with a poor outcome (P = 0.089). However, 2 of the 3 cases presented in Stage IV and none of them survived the 1 st year. Conclusion: This study shows that even though p53 mutation was associated with a more aggressive phenotype, the most significant determinants of a good outcome among patients in a developing country like ours is non-blastemal dominant histologic subtype, early stage at presentation and completion of therapy

Causes of maxillofacial patients mortality in a Nigerian tertiary hospital

Background. An analysis of maxillofacial mortality was done in a Nigerian tertiary health care centre to determine the major causes of mortality and identify possible predisposing factors in our environment. Materials and methods. A retrospective analysis of mortality in maxillofacial surgery department of Aminu Kano Teaching Hospital from January 2005 to December 2014 was done. Data were analyzed using statistical package for social sciences (SPSS) version 15.0 (SPSS Inc, Chicago, IL). Results. A mortality rate of 1.8% (46 deaths from 2,540 admissions) was recorded. There were 35 males (76.1%) and 11 (23.9%) females. The mean age of the deceased patients was 40.0±13.0years. Orofacial infections (41.3%) and advanced (stage IV) orofacial malignancies (28.3%) accounted for most deaths. Conclusion. Fascial space infections and orofacial malignancies contribute largely to mortality in our setting. Late presentation was a major factor predisposing to mortality

Incidence and risk factors of cervical dysplasia among human immune deficiency virus positive and human immune deficiency virus negative women at Aminu Kano Teaching Hospital

>Background: HIV infection is a risk factor for cervical cancer and both diseases are prevalent in Nigeria. HIV positive women are at greater risk of cervical dysplasia than HIV negative women which may be as a result of immunosupression, hence adding more burdens to their already worsening health condition. It has become relevant to screen these women early and refer for appropriate and effective therapeutic intervention.Objective: To compare the incidence and risk factors of cervical dysplasia among HIV positive and HIV negative women at Aminu Kano Teaching Hospital, Kano.Methods: This was a comparative cross sectional studyl, which involved HIV positive women attending HIV clinic and HIV negative women attending the gynecological clinic at Aminu Kano Teaching Hospital. A cohort of 150 consenting HIV- positive women not on HAART and 150 HIV- negative women, selected by systematic random sampling were sent for Pap smear examination. On the same day blood samples were taken from antecubital vein and sent for both CD4 count and viral load among the HIV positive group. A pretested questionnaire was administered to the women of both groups on same day to determine the presence or absence of risk factors of cervical dysplasia in them. The results obtained were recorded using proforma and analyses of risk factors of cervical dysplasia was done using Chi square test and Fisher exact test to compare variables between those with normal and abnormal smears and student t test to determine the relationship of lesions with CD4count and viral load among the HIV positive women.Results: The incidence of cervical dysplasia among HIV- positive women was 49 (32.7%) and was significantly higher than 12(8%) found among the HIV- negative. Age ≥ 35years and parity ≥5, early coitarche, multiple sexual partners, low-socioeconomic status, cigarette smoking did confer some risk of dysplasia however. This study also showed that among the HIV positive group, CD4 count was inversely associated with risk of cervical dysplasia and women with a CD4 count 500 cells/mm3.Conclusion: It Ais important to carryout cervical smear screening for HIV-positive women, especially those with a CD4 count<500 at first contact