Period of onset and lack of clinical manifestation of hepatotoxicity after commencing highly active antiretroviral therapy

Aim: The period of onset of hepatotoxicity varies between cohorts as do their clinical manifestations. Clinical manifestations of hepatotoxicity that have been previously reported include fatal portal hypertension, dress syndrome, and lipodystrophy syndrome. The aim of this study was to determine the period of onset and clinical manifestation of hepatotoxicity after commencing HAART. Materials and Methods: This study was carried out on patients with HIV on HAART attending infectious disease clinic, gastroenterology clinic or admitted into the medical wards of University of Benin Teaching Hospital. Patients with HIV but not on HAART were used as controls. A clinical evaluation and relevant laboratory investigations were done. Hepatotoxicity was defined using a standardized toxicity grade scale. Results: A total of 84 cases and 42 controls were studied. The mean ages were 35.2 ± 9.9 years and 35.5 ± 9.0 years for the cases and the controls respectively. Over 70% of the study population and controls were females. The overall incidence of hepatotoxicity was 17.85% and severe hepatotoxicity occurred in 10.71% of the patients. Over 80% of liver enzyme elevations occurred within 3 months, most of which were asymptomatic. Conclusion: This study shows that over 80% of enzyme elevations occurred within 3 months and were mostly asymptomatic. There is a need for regular monitoring of liver function tests at short intervals in HIV patients starting HAART since most of the cases of hepatotoxicity found in this study occurred early and were asymptomatic.Keywords: Clinical manifestation, HAART, hepatotoxicityNigerian Journal of Clinical Practice • Jan-Mar 2012 • Vol 15 • Issue

The prevalence and challenges of abandoned dead neonates in an African referral center

Background Dead neonates are often preserved in the mortuary pending until parents/caregivers’ collect them for formal burial. This study reports the prevalence and challenges of abandoned dead neonates in an African referral center.Materials and methods The clinical and mortuary records of all dead neonates at the University of Benin Teaching Hospital between January 2006 and December 2010 were retrospectively reviewed to determine the prevalence, influencing factors, and challenges of abandoned dead neonates.Results A total of 1093 (22.9%) mortalities were recorded among 4781 neonates. The prevalence of abandoned dead neonates was 77.2% as 844 of the 1093 dead neonates were abandoned to the hospital and given mass burial by an assigned government agency after at least 3 months of abandonment. This was challenging as an average of 85 dead neonates were given mass burial every 6 months to decongest the mortuary. Of 618 illiterate parents/caregivers of low socioeconomic class, 520 (84.1%) abandoned their dead babies. This was extremely significant statistically when compared with 324 (68.2%) bodies abandoned by 475 literate parents/caregivers in upper/middle class (P < 0.0001). Surgical neonates, neonates with obvious congenital anomalies, and babies from the third birth positions onward were mostly abandoned.Conclusion We advocate the need for public enlightenment campaign to modify present parents/caregivers’ attitudes toward dead neonates. Hospital-based postbereavement programs should be organized to help parents/caregivers adjust appropriately to neonatal deaths. Those with dead neonates should be exempted from paying hospital bills.Keywords: abandonment, challenges, dead neonates, prevalenc

Neck masses in children: Etiopathology in a tertiary center

Background: Neck masses are common in children; they could present diagnostic challenges, and some may be malignant. This study determines the etiology, histopathology, and outcome of treatment in a Nigerian tertiary center.Materials and Methods: This is a three-year retrospective study of children managed with neck masses at the University of Benin Teaching Hospital between January 2007 and December 2009. The biodata, side distribution of the masses, clinical conditions of the children at presentation, methods of biopsy, histopathology results, definitive treatment options, follow-up, and outcome were analyzed.Results: A total of 35 children who were aged between one month and 16 years (mean, 8.1 ± 2.6 years) with a male : female ratio of 1.9 : 1 (23 males to 12 females) were managed with 26 (74.3%) acquired and nine (25.7%) congenital neck masses. The masses were located in the anterior triangle in 14 (40%) cases, right side of the neck in 12 (34.3%), and left side of the neck in seven (20%), with two (5.7%) bilateral/confluent. Twelve (34.3%) cases were enlarged lymph nodes; five (41.7%) of them due to malignant lesions. Except for the neck mass, 16 (45.7%) of the children enjoyed clinically stable health on presentation. Twenty (57.1%) acquired tumors were malignant compared with 15 (42.9%) mainly congenital tumors which were benign. Four malignant tumors (11.4%) were rare in anterior triangle. Hodgkin’s lymphoma, 9 (25.7%), and thyroglossal duct cyst, 5 (14.3%), were most common malignant and nonmalignant masses, respectively. Surgical excision was curative in 12 (34.3%) cases, but others required additional chemo and/or radiotherapy, with two (5.7%) mortality recorded due to late referral of children with Hodgkin’s lymphoma.Conclusions: Many neck masses in otherwise healthy children in our setting were malignant. We advocate early surgical consultation and thorough histopathologic analysis of neck masses in children in our subregion

The histopathological pattern of liver biopsies at the University of Benin Teaching Hospital

Objective: Microscopic examination of liver tissues remains an essential part in the diagnostic work‑up of patients with liver diseases. The aim of this study is to determine the histopathological pattern of liver diseases at the University of Benin Teaching Hospital, Benin City, Nigeria.Materials and Methods: This is a retrospective study of all cases of liver biopsies between January 2005 and December 2011. The appropriate data was obtained from the Surgical day book of the department of histopathology. The data was analyzed to reflect age, sex, and pathological diagnosis of the lesions.Results: A total of 80 cases of liver biopsies were reported during the 7‑year period. There were 50 males and 30 females with a male:female ratio of 1.7:1. The age ranged from 4 months to 69 years with a mean age of 38.4 ± 13.3 years. The highest incidence was in the 4th decade. The three common histopathological diagnoses were inflammatory lesions, 63.8%; malignant neoplasms, 22.5%, and liver cirrhosis in 6.3% of cases. Other less common lesions were alcoholic liver disease and steatosis. This peak age incidence of chronic hepatitis precedes that of hepatocellular carcinoma by about two decades.Conclusion: The preponderance of chronic hepatitis, hepatocellular carcinoma, and liver cirrhosis in this study is similar to those already established in the African literature, with hepatitis B and/or C being the most incriminated risk factors due to their endemicity in our environment. Public enlightenment programs, widespread implementation of hepatitis B virus vaccination, and surveillance of individual at‑risk are essential for the control of hepatitis infection and its late complications.Keywords: Chronic hepatitis, cirrhosis, hepatocellular carcinoma, liver biopsyNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Immunohistochemical detection of Her-2/neu overexpression in breast carcinoma in Nigerians: A 5-year retrospective study

Objective: To determine the pattern of Her-2/neu status among breast carcinoma in the University of Benin Teaching Hospital, Benin City, Nigeria.Materials and Methods: Immunohistochemical staining for Her-2/neu was performed on 10% formalin-fixed, paraffinembedded primary carcinoma of the breast from 83 patients, between 2003 and 2007 using anti-Her-2/neu rabbit polyclonal antibody (DakoCytomation, CA, USA) and reactivity detected by an avidin-biotin immunoperoxidase method. The clinicopathologic parameters analyzed were patients’ age, histological types, and tumor grade. The Her-2/neu Dako scoring system was used.Results: During the 5-year period, 83 histologically confirmed cases of invasive breast carcinoma were assessed for Her-2/neu status. These included 67 (80.7%) cases of invasive ductal carcinoma, nine cases of invasive lobular carcinoma (10.8%), three cases of medullary carcinoma (3.6%), two cases of papillary carcinoma (2.4%), and a case each of mucinous and clear cell carcinoma (1.2%). Mean age of patients was 48.9 ± 13.6 years with an age range of 25 to 83 years. Only nine (10.8%) cases showed immunopositivity for Her-2/neu. Seven of these were cases of invasive ductal carcinoma, while two were invasive lobular carcinoma. Tumors were predominantly high grade with grade III, II, and I accounting for 42, 28, and 13 cases, respectively. There was no significant correlation between patient age, the various histological types, tumor grade, and Her-2/neu positivity.Conclusions: This study indicates that Her-2/neu may not be useful in defining the prognosis of breast cancer in this environment. Nevertheless, it highlights the need for routine immunostaining for Her-2/neu before institution of trastuzumab (Herceptin) therapy

Congenital anomalies in low- and middle-income countries: the unborn child of global surgery.

Surgically correctable congenital anomalies cause a substantial burden of global morbidity and mortality. These anomalies disproportionately affect children in low- and middle-income countries (LMICs) due to sociocultural, economic, and structural factors that limit the accessibility and quality of pediatric surgery. While data from LMICs are sparse, available evidence suggests that the true human and financial cost of congenital anomalies is grossly underestimated and that pediatric surgery is a cost-effective intervention with the potential to avert significant premature mortality and lifelong disability

Colonoscopic And Histological Assessment Of Colonic Lesions In University Of Benin Teaching Hospital, Benin City

Context: Colonoscopy has assumed a significant role in the diagnosis and treatment of colorectal lesions as it enables biopsies to be obtained for histological examination as a means of confirming diagnosis.Objective: The aim of this study is to evaluate the colonoscopic and histological findings in patients referred for colonoscopy at the University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.Methods: Colonoscopy was performed on consecutive patients that were referred for colonoscopy in the endoscopy unit at the University of Benin Teaching Hospital, over a period of 18months (Dec2009-May2011). The biodata and clinical information of the patients were obtained from records of the endoscopy unit and the surgical day books of the department of histopathology.Results: A total of 37 patients were studied during the period under review. The male to female ratio was 1.3:1 with a mean age of 52±16 years. This study showed colonoscopic abnormality in 24(64.9%) patients while 13(35.1%) patients had colonoscopically normal mucosa. The most common colonoscopic abnormality was colorectal malignancy which was seen in nine(24.3%) patients. Chronic nonspecific colitis was the most common histological diagnosis and was seen in 17(45.9%) patients. The histological finding correlated with the colonoscopic findings in 16(43.2%) cases. Eight of the 13 patients (61.5%) with normal mucosal on colonoscopy had chronic nonspecific colitis on histology.Conclusion: This study shows that sampling of macroscopically normal colonic mucosa could reveal a colorectal lesion on histology, as such a routine biopsy for histology should be encouraged in all patients referred for colonoscopic evaluation.Keywords: Colonoscopy, histology, colorectal, Benin-cit

Causes of sudden natural death: A medicolegal (coroner’s) autopsy study of medical cases in an African referral centre

Objective: To evaluate and characterise the causes of sudden natural deaths (SNDs) that occurred in medical cases in an African referral centre.Design: A descriptive retrospective study.Setting: University of Benin Teaching Hospital, between January 2005 and December 2011.Subjects: Autopsy reports of 626 cases that were referred to the coroner.Results: A total of 626 cases of SNDs were identified representing 30.3% of all autopsies performed within the period. There were 390 (62.3%) males and 236 (37.7%) females with a M:F ratio of 1.7:1. The age range of the cases was 19-105 years with a mean age of 51±17 years. The modal age group was 40-49 years which accounted for 19.8% of the cases, and most of the cases (56.8%) were seen in the 30-59 year age groups. In majority of cases (39.3%), the cause of death was related to the cardio-vascular systemprincipally death due to complications of hypertension which was seen in 88.2% of the cardio-vascular system diseases. Immune/infectious diseases (mainly AIDS), gastro-intestinal/hepatic lesions and respiratory diseases were seen in 15.2, 14.1 and 12.5% of cases respectively. SNDs due to malignant neoplasms were not a common finding as they occurred in 5.1% of cases.Conclusion: This study shows that with the increasing modernisation of our lifestyle and dietary habits, cardio-vascular system diseases-particularly complications of hypertension have become the leading cause of sudden natural death in our environment

Breast Masses in Children and Adolescents: What is the Burden of Breast Cancer?

Breast masses in children and adolescence are uncommon and are mostly benign. Nevertheless, the increasing awareness of breast cancer in the population has increased the anxiety over breast masses in these patients. Breast lesions in these patients are discussed in this article with a review of world literature Aim: To review the age incidence and histopathologic types of breast lesions in children and adolescents. Method: A 25 year (January 1985- December 2009) retrospective study of all patients who had breast biopsies. Setting: Departments of Pathology and Surgery, University of Benin Teaching Hospital, Benin City, Nigeria. Results: Of 2967 cases of breast lesions encountered within the 25 year period of study, 330 (11.1%) cases occurred in children and adolescents. Most cases were in females [321 cases (97.3%)] with only 9(0.7%) cases in males giving a female to male ratio of 35.6:1. Age range was 9-19 years. Mean age was 16.99 years±Std 2.0 years, with median and modal ages of 18 and 19 years respectively. Breast lesions were rare in the 1st decade of life with only one case [ a case of fibroadenoma in a 9 year old female]. Histologically, majority of cases were benign 326(98.8%). Only 4(1.2%) cases were malignant. Fibroadenoma was the most common lesion constituting 194(58.8%) cases, followed by fibrocystic change accounting for 54 cases (16.4%)]. Conclusion: Lesions were mostly benign and predominantly fibro-adenomas. Though malignant lesions were very rare, the possibility of malignant disease must be considered in the differential diagnosis of breast masses in this age group.Keywords. Breast mass; childhood; adolescen