Testicular Biopsies of Azoospermic Men at The Lagos State University Teaching Hospital

Objectives: This study was conducted to evaluate the histological findings from testicular biopsies in azoospermic men seen at the Lagos State University Teaching Hospital, Ikeja - Lagos, Nigeria.Patients and Methods: A retrospective study of testicular biopsies of azoospermic men who presented to our institution from 2005 to 2006 was performed. The patient’s age, type of infertility and histopathological diagnosis were evaluted. All biopsies were preserved in 10% formaldehydesolution.Results: Of the 51 azoospermic men (mean age 30 years, range 25 – 46 years) 25 (49.0%) had primary infertility, 11 (21.6%) had secondary infertility and 15 (29.0%) were not specified. Five (9.8%) patients had normal spermatogenesis. Abnormal histological parameters occurred in 46 (90.2%) patients: testicular atrophy in 30 (58.8%), maturation arrest in 14 (27.5%) and hypospermatogenesis in 2 (3.9%) patients.Conclusion: The presence of normal spermatogenesis in azoospermic men, which would suggest an obstructive lesion, is not common in our practice, in contrast to previous studies from our country. This may indicate a changing pattern in the aetiology of male infertility in our environment. Identification of the possible causes of testicular damage resulting in non-obstructive azoospermia in our environment may help to prevent male infertility.Key Words: Azoospermia, etiology, diagnosis, testicular biopsies, histopathology, infertility, environmen

Effect Of Chronic Exposure To Low Levels Of Lead On Renal Function And Renal Ultrastructure In SD Rats

Chronic exposure to lead is associated with adverse effects on renal function in laboratory animals and man. There is controversy concerning the direction of change of renal function parameters following chronic lead intoxication. The renal effects of low-dose lead exposure, as opposed to acute and pharmacological doses, require further scrutiny. In order to determine the effect of prolonged low-dose lead exposure, male Sprague Dawley rats (initial weight, 150.5±17.4g; final weight, 300.5±17.4g; n=10) administered lead acetate (100 p.p.m.) in drinking water over a period of 3 months, were investigated for renal function parameters. Treated rats had elevated blood pressures (114.4±4.2 vs. 95.7±3.5 mmHg;

Accurate Completion of Death Certificates: The Need for Formalised Training in the Nigerian Medical Curriculum

Research of medical schools initiative attempting to orient medical students towards future role in society can only serve in pursuance of WHO objectives for medical education. Medical teachers see the natural process of death as an anathema and pay little attention to the subject in both pathology and clinical courses. Doctors and consequently medical students have the notion that their primary responsibility is to save lives and if possible prolong life possibly in perpetuity. The death of a patient is seen as an indictment. Therefore, in the medical school curriculum little emphasis is placed on the training of last offices. A medical school has responded to the need in this area by the use of a dynamic curriculum in which as part of the medical jurisprudence course the future role of doctors are highlighted. A cross sectional survey of 127 final year medical students aptitude to filling the death certificate was carried out by administering a 14 item self administered questionnaires with the filling of a death certificate. These were Medical and Dental Students of the College of Medicine, University of Lagos, who had completed rotations in pathology and Clinical medicine. The aim of the study was to assess the knowledge in performance of last offices and test skills in death certification. Results show that about 96% of the students had no formal teaching in the filling of death certificates. A large percentage, over 70% of them had never seen a death certificate filled. Among the 38 students who had seen or had been taught how to complete death certificates, 23 (18.1%) of the total students surveyed and (61%) of those who had seen certificates filled did this at the Third Year 400 Level of their studies during pathology posting while less than 1% or only 10/38 (27%) of them had seen this event during their clinical years. Of the cadre of medical staff who the students had observed filling death certificates, more Registrars (72%) were responsible for this activity than others. Over 85% of the students were aware of the importance of death certification. We recommend the inclusion of formal training on death certificate completion in Medical School curriculum in Nigeria to enhance the accuracy of health statistics. KEY WORDS: Death certificate, medical students, medical education, Nigeria Nigerian Journal of Health and Biomedical Sciences Vol.4(1) 2005: 76-8

Auditing Autopsies: Lagos University Teaching Hospital Experience

A thirteen-month prospective study was carried out to compare clinical (antemortem diagnosis) with autopsies (post-mortem diagnosis) on patients managed at Lagos University Teaching Hospital (LUTH) between October 1999 and November, 2000. In the study period, a total of 1843 deaths were registered out of which 467 autopsy request were made (hospital and coroner's autopsies). Hospital autopsy request were 411 (88%) while coroner's request constituted 56 (12%) of the autopsies. Only 305 (65%) of the autopsies performed are excluded in the study because of inconclusive clinical report and diagnosis or autopsy not done on them. The result showed that the concordance rate between clinical and autopsy diagnosis was found to be 82.1%: and that 71.9% of deaths occurred within 48 hours of presentation and majority of this category of deaths are the least investigated. Forty five percent (45%) of all the group studied had no clinical investigation done. The low autopsy rate and the attitude of medical practitioners to autopsy do not encourage good medical practice and continue medical education. We need to rely more on autopsy audit to study disease processes and to enhance our diagnostic skill. Autopsy audit should be officially adopted as a means of quality control in hospitals. Nig. Medical Practitioner Vol. 44(5/6) 2003: 96-9

Clinico-pathological patterns of testicular malignancies in Ilorin, Nigeria-a report of 8 cases

Background : The incidence of testicular cancers has been increasing in many populations over the past decades and concerns have been expressed about the possible decrease in semen quality in the period. It may account for one of the factors responsible for increasing male infertility in Ilorin, Nigeria. Objective: To find out the incidence, age distribution clinical presentation, duration before presentation and the occurrence of various Histopathological subtypes of testicular tumours in Ilorin. Design: A retrospective study. Setting: A teaching hospital (University of Ilorin) Patients: Testicular biopsies were done on patients presenting at the hospital with suspected cases of malignancies. Materials and Mehtods: All consecutives cases of testicular malignancies diagnosed in the department of pathology, university of Ilorin Teaching Hospital, during the period of thirteen years (1990-2003) were included in this study. Relevant clinical details such as age, clinical presentation and side of involvement of the testis were also recorded. The slide preparations of this sample were retrieved and reviewed. Result: During the span of thirteen years (1990-2003), testicular cancers accounted for 0.05% of all sample received and 0.14% of the male biopsies. Most of the diagnosed cases were in the first decades of life and are mainly germ cells tumours of which yolk sac tumours are commonest subtypes. Conclusion: Incidence of testicular cancers is still low in this environment and may not account for major contributory factors in male infertility in Ilorin

Medico-Legal Deaths From Road Traffic Accidents In Sagamu, Nigeria

Background: Road Traffic Accidents (RTA's) are a leading cause of death worldwide. Deaths that occur after the first hour of trauma are regarded as preventable deaths. Objectives: To evaluate the pattern and causes of death in the first 24hrs after RTA's. Design: Retrospective study. Setting: Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Participants: Patients that died within 24hours from RTA's, including those brought in dead between January 1st 1998 and December 31st 2002. Main Outcome Measure: Deaths within the first 24hours. Results: A total of 411 cases were identified in the 5-yr period comprising 316 males and 95 females, with a male:female ratio of 3.3:1. The ages ranged from 8months to 97years with mean age of 34.0 + 14.7years. Motor vehicle drivers with their passengers accounted for 346 (84.2%). Three hundred and four patients (74%) were BID from accident scene. The most common causes of death in those patients BID and those who died within an hour of presentation were skull fractures with intracranial haemorrhages followed by hemoperitoneum. Deaths after 1hour after presentation resulted commonly from hemoperitoneum and splenic rupture. Conclusion: Head injury and internal visceral lacerations remain important preventable causes of death in the first 24hours following road traffic accidents. A re-organisation of trauma care may be essential in order to prevent these deaths. Nig. Medical Practitioner Vol. 45(1/2) 2004: 3-

Incomplete and Inaccurate Death Certification by Medical Students in Nigeria, the Need for Guidance

The study aimed to find out the level of knowledge of medical death certification of final year medical students, Objective - (1) To assess their knowledge of death certification (2) find out at what level of their training they came in contact with death certificates (3) who normally fills death certificate (4) if they can fill death certificate correctly (5) if there is need for formalized training session on death certificate in the medical school. Materials and Methods - This was a cross sectional survey of 50 final year medical students of Obafemi Awolowo College of Health Science, Olabisi Onabanjo University, (O.A.C.H.S. O.O.U.) who had completed their rotations in pathology and clinical posting and these students were chosen at random. This was carried out by administering self-structured 15 item questionnaires to the students and they were also given death certificate to fill out on a clinical scenario. Results – About 63% students had no formal teaching in the filling of death certificate and over 55% of them had never seen a death certificate filled. Among the 45% of student who had seen death certificate filled, less than 25% of them did so at various levels of their pathological and clinical postings. The students saw more house offices filling death certificate than other cadre of doctors. 50% of them would want to be trained on death certification at morbid anatomy postings. Over 80% of the students were aware of the importance and indications for death certification. Conclusion – The inclusion of formal training in death certificate completion in the medical school curriculum of the Obafemi Awolowo College of health Science, Olabisi Onabanjo University Ogun State, would be desirable. Key Words: Death Certification, Medical Students, School Curriculum Nigerian Medical Practitioner Vol.46(4) 2004: 84-8

Attitude and Perceptions of Clinicians in Lagos to Autopsy Practice

Using pretested questionnaire instrument, a cross sectional survey of clinicians working in the Lagos University Teaching Hospital to obtain their attitudes and perception towards autopsy practice. 230 questionnaires were administered and the response rate was 80.7% . 41.5% of respondents often requested for autopsy. The indication for autopsy request included medicolegal reasons (63.5%), inability to arrive at antemortem diagnosis (22%) while improving clinical diagnosis and patients care constituted 62%. While 98.2% of the respondents believed that autopsy reports are valuable to medical practice, 98% of them believed that the report will affect their practice in a way. The interval between autopsies and issuances of reports ranges from 0-3 weeks (3% of cases) to 4-6 months, (91% of cases). The reasons for this delay include relegation of autopsy pathology as a surbodinate of research or surgical pathology and lack of motivation for the pathologist who is no longer compensated in any way that would encourage his effort. The study shows that you rarely see requesting clinicians at autopsy demonstration of cases managed by them. Clinicians seldom visit to the autopsy room, this is seen by the pathologist as an expression of lack of interest in the autopsy and the clinicians who received the autopsy report late may find little encouragement to try again with the next case. There is a need to change the attitude and perception of all categories of clinicians to autopsy through proper orientation and education. Nigerian Medical Practitioner 46(2) 2004: 27-2

Endometrial sampling in infertility: the Ilorin, Nigeria, experience

Infertility, the inability of a couple to achieve pregnancy after 12 months, of regular, adequate and unprotected sexual intercourse constitute about 50% of cases seen in most gynaecological clinic in developing countries. This is often associated with pathological lesion of the endometrium. The aim of this study is to determine the diagnosis value of endometrium sampling in detecting endometrial pathology and presence or absence of ovulation in infertility patients. A retrospective study of endometrial tissues histopathological slides of infertility patients as recorded in the register of the department of Pathology, University of Ilorin Teaching Hospital, Ilorin, Nigeria between January 1,1997 and December 31,2001. The prevalence rate of normal and other endometrial pathology expressed in percentages. Five hundred and sixty three (563) endometrial sampling slides representing 52% of the total endometrial sampling were indicated for infertility patients. Out of these, 494 patients were included in the study. Majority of the studied group 195(39.5%)were aged 26-30years, Primary infertility constituted 31.5% of cases while secondary infertility constituted 67%. In 1.8% of cases indications were not specified. Four hundred and seventy –six (476) of the studied patients had normal phase and endometrium with majority, 427(89.7%) being in secretory phase and 49(10%) in proliferative phase. Eighteen (18) patients representing 3.56% of the studied group had endometrial abnormalities. These included chronic non-specific endometritis (27.7%), hormonal imbalance (33%), endometrial hyperplasia (17%) and tuberculous endometritis (11%). Others include sub mucous leiomyoma (6%) and well-differentiated adenocarcinoma (6%). The diagnostic value of endometrial sampling in infertility lies in detecting endometrial pathology and presence or absence of ovulation. This can be improved on through detailed and correct completion of request forms by clinicians coupled with endometrial culture and immunohistochemical techniques when necessary. Also, the fact that majority of our patients (89.7%) were in normal secretory phase, which is indicative of adequate ovulatory function has brought to fore, “the value of routine endometrial biopsy” for evaluation of infertility in this environment where more than 50% of cases of infertility are due to tubal factor. There may be a need to adequately select the patients that would benefit from it. Nigerian Medical Practitioner Vol. 50(1) 2006: 15-1

Anti-Diabetic and Anti-Lipidemic Activities of Metformin-Ascorbic Acid Combination

The present study was designed to investigate the pharmacological effects of metformin-ascorbic acid combination on glycemic and lipids control in glucose-induced insulin resistance rats and elucidate its possible mechanism(s) of action. The anti-hyperglycemic and anti-lipidemic activities of metformin, ascorbic acid, and metformin-ascorbic acid combination were studied in 5 groups consisting of 6 rats per group and weighing 100-130 g, by administering daily oral dosing of 20 g/kg of D - glucose in addition to 10 ml/kg of water, 10, 20 and 30 mg/kg/day of the drugs, respectively, for 42 days. Results of the study showed that metformin and metformin-ascorbic acid combination induced significant and comparable anti-hyperglycemia. This effect was mediated through enhanced sensitivity of peripheral tissues to insulin action. Metformin-ascorbic acid also lowered plasma total cholesterol, LDL-cholesterol (LDL-c), VLDL-cholesterol (VLDL-c) significantly. The results of this study suggest that the drug combination has antidiabetic and anti-lipidemic effects and therefore, could be a novel combination in the management of type 2 diabetes mellitus patients. Keywords: Metformin-ascorbic acid combination, fasting plasma glucose and lipids, glucose-induced insulin resistanceWest African Journal of Pharmacology and Drug Research Vol. 22/23 2007: pp. 10-1