Immunohistochemical analysis of pituitary adenomas in a West African hospital

Purpose: Pituitary adenomas are the commonest tumors of the sellar region and constitute 10% to 15% of intracranial neoplasms. The conventional classification of pituitary adenomas is according to the hormone expression of the tumors as determined by immunohistochemical methods. There is paucity of existing research on the frequencies of the various immunohistochemical types in our environment. The purpose of this retrospective study was to determine the relative frequency of specific pituitary adenoma subtypes seen at our hospital over a period of twelve years.Methods: Forty seven pituitary adenomas received over the study period satisfied the inclusion criteria and their paraffin blocks were retrieved from the archives of the department of Pathology, University College Hospital, Ibadan. Tissue sections were stained with antibodies for Prolactin, Growth hormone, ACTH, TSH, FSH and LH using the streptavidin-biotin-peroxidase method. The tumors were classified using the 2004 WHO classification of pituitary adenomas. Results were tabulated and analyzed using the SPSS statistical software package.Results: Most adenomas presented between the fourth and seventh decades with a slight female preponderance. Gonadotroph and null cell adenomas were commonest and each constituted 34%, followed by prolactinomas, which accounted for 14.9% of the tumors. There were no thyrotroph adenomas.Conclusion: The lower incidence of prolactinomas in this study may be due to the use of other therapeutic modes rather than surgical treatment but may also indicate racial differences. However there is a need for further characterization of the null cell adenomas using ultrastructural and molecular studies.Keywords: Pituitary, Adenoma, Classification, Immunohistochemistry, Endocrin

Noxious effect of Moringa oleifera leave extract on the developing brain, morphology and behaviour of Wistar rat

The effects of Moringa oleifera leave extracts on the morphology and behaviour of the postnatal developing rat brain was studied. Twenty pregnant rats of Wistar strain weighing between 160 g and 180 g were used in the study. The pregnant rats were divided into two groups of ten animals per group. Group I animals received distilled water and served as control animals, while group II animals received 200 mg/kg body weight of Moringa oleifera leave extract orally. All the animals were provided with rat cubes and water ad libitum during pregnancy and lactation. After birth, five pups of day 21 were weighed and subjected to behavioural study. Animals of days 1, 7, 14, 21 and 28 of age were sacrificed by cervical dislocation, the brain dissected out, weighed and fixed in 10% formol-saline for microscopic studies. Some congenital malformations such as meromelia, phocomelia and amelia were observed in the Moringa oleifera group only. There was a significant increase in body weight of the Moringa oleifera animals on days 7, 14 and 21, in brain weight on days 1 and 7, and in cerebral weight on days 1, 7 and 21 (p<0.05). The behaviour of the rats was significantly worse in the Moringa oleifera group, especially in the area of motor function. Microscopically, there was significant reduction in the cerebral cortical thickness of Moringa oleifera group on days 21 and 28. Immunohistochemical studies revealed poor myelination in the Moringa oleifera group. The results indicate that maternal consumption of Moringa oleifera significantly affected the general morphology as well as behaviour of their pups, therefore it should be consumed with caution in pregnancy until better knowledge on humans is available

Proliferaton index in pituitary adenomas from a black African population

Background: The WHO has recognized a variant of pituitary adenomas with potential aggressive behaviour which have been termed atypical pituitary adenomas. This group of tumours are recognized by their mitotic rate of more than >3%, p53 expression and invasion of surrounding structures. There has however been no study of the occurrence of these tumours in a black African population. This study is a preliminary attempt to examine this group of tumours in blacks.Methods: This study retrospectively reviewed fifty-seven histologically diagnosed and immunohistochemically characterized pituitary adenomas received in our department over a twenty-one year period. Specimens were stained with ki67, a nuclear marker of cell proliferation which has been identified as the single best predictor of atypical pituitary adenoma.Results: Twelve of the tumours showed atypical features with eight (67%) of these tumours being prolactinomas. Two of the tumours were gonadotrophs and two were null cell adenomas. There was no correlation with age or gender. Two of the tumours required neurosurgical re-exploration with one of these showing a higher mitotic index in the second biopsy.Conclusion: The study suggests similarity in the rate of occurrence of pituitary adenomas with atypical features in a black African population with what is seen in Caucasians. Prolactinomas constitute a significant percentage of the tumours with this feature.Keywords: Pituitary adenoma, Immunohistochemistry, Atypical, Ki6

Determinants of Timing of Presentation of Neurotrauma Patients to a Neurosurgical Center in a Developing Country

Background: A major goal in neurotrauma management is the prevention of secondary neuronal injuries. This goal is time bound as neurological deficits once established are usually irreversible. Late presentation is the norm in most neurotrauma patients in developing countries. Aims: The aim of the study was to review the timing of presentation of neurotrauma patients and the possible causes of their late presentation for neurosurgical care in our practice. Methods: A cross-sectional study of a 4-month prospective database of neurotrauma patients presenting to the University College Hospital, Ibadan, was done. The participants’ biodata, injury characteristics, initial-care details before referral, and information on timing and causes of delay were analyzed. Results: The study subjects included 111 patients, 80.2% (89/111) were males, and 52.8% aged 21–40 years. Head injury (HI), spinal cord injury (SCI), and combined HI and SCI occurred, respectively, in 80.2%, 14.4%, and 5.4%. Road accidents followed by falls were seen in 73.9% and 14.4% (16), respectively. Just 46.8% (52/111) cases presented within 12 h of injury and only 37 (33.3%) within 4 h. Majority, 83.8% (93/111) were referrals from primary care. These referrals were delayed in 81.7% (76/93) of these. The referring health facilities were located intracity with our center in 54%. Other causes of delayed presentation of these study participants included long-distance travel to our center, lack of funds, or a combination of the above factors. Eighty-nine patients (80.2%) were brought in by family members and the remaining minority by passers-by and road safety personnel. Conclusions: Delayed referral from primary care features prominently in timing of presentation of neurotrauma patients in Nigeria. There is a need for collaboration as well as continuing medical education between the neurotrauma specialists and primary care physicians

Comparative analysis of clinical and computed tomography features of basal skull fractures in head injury in southwestern Nigeria

Background: Basal skull fractures (BSF) in head injury may be missed clinically. Early detection ensures prompt treatment and prevention of complications We compared the clinical and Computed Tomography (CT) features of basal skull fractures in head injured patients in a southwestern Nigerian hospital. Materials and Methods: Head injury patients who had cranial CT at a Southwestern Nigerian hospital were selected. CT images were acquired with a 64-slice Toshiba Aquillion CT scanner using a standard head protocol. The images were evaluated for evidence of skull fractures, and associated complications. The clinical data and CT findings were analyzed. Results: One hundred and thirty patients were evaluated, including 103 (79.2%) males. Their ages ranged between 7 months and 81 years, mean 35 years (SD, 20.3). In 59 patients (45.4%, 59/130) BSF was detected on CT, while 71 (54.6%) had no evidence BSF. Forty-two (71.2%) of the 59 patients detected on CT had clinical suspicion of BSF (P 0.05). The commonest observed clinical feature in patients with confirmed BSF was otorrhagia (45.8%) and the petrous temporal bone (45.8%) was the most commonly fractured bone. The BSF was caused most commonly by motor bike accidents in 53 (40.8%). The most common associated intracranial injuries were intracerebral haemorrhage (34.6%) and subdural (17.3%) Conclusion: It appears that neurosurgical evaluation is comparatively reliable in evaluating basal skull fractures in this study area even as they are consistently demonstrated by high resolution CT scanners. A clinical suspicion of BSF should warrant a closer detailed CT evaluation and reporting by radiologists

Content development footprints for the establishment of a National Bioethics Committee: lessons from Nigeria

Nigeria is experiencing, together with the rest of the world, consequences of relentlessly accelerating technological developments, in the contexts of relative lagging of developments in the Humanities, new discoveries in sciences and technological innovations, advances in medicine, changes in government policies and norms, rapid changes in the society, unhealthy practices in the area of food and agriculture, degradation of the environment as well as climate change. Furthermore, Nigeria as a Member State of UNESCO Bioethics is expected to have a National Bioethics Committee to enhance her participation in global concerns, as well as increase her opportunities to tap into global Bioethics resources. For this Committee to be established, the National Bioethics Framework and Policy Documents must be put in place. This paper discusses the rigorous process of developing the National Bioethics Framework and the National Bioethics Policy Documents as well as the need for a National Bioethics Committee in Nigeria

Clinical profile and outcome of surgical management of intramedullary spinal cord tumours: A single center study in a developing country

Objective: There is as yet a paucity of data on intramedullary spinal cord tumours (IMSCTs) in sub-Saharan Africa. This study aims to define the clinical profile and outcome of management of IMSCTs in a Nigerian tertiary hospital. Methods: This is a retrospective study of all the patients who had surgery for IMSCTs in our hospital over a 14 year period. Results: There were 20 patients, 9 males, 11 females, in this study. The median age was 33 years (range = 7–78 years). The median duration of symptoms was 12 months (range = 1–120 months). Motor deficit was present in all but one (95%) of our patients. Only 25% of the patients presented in good functional status (McCormick grades I and II). The tumours were confined to the thoracic region in 10 patients (50%), while tumours in the thoracic region extending to the adjoining cervical and lumbar regions were seen in 6 patients (30%). Gross total tumour resection was achieved in 60% of the patients and subtotal resection in the remaining 40%. Astrocytoma and ependymoma were the most common tumours, each occurring in 35% of the cases. Six patients (30.0%) improved, 12 patients (60.0%) remained neurologically the same, while 2 patients (10.0%) deteriorated at the time of last follow up. The mortality rate was 15%. The preoperative functional status was a significant predictor of postoperative outcome (p = 0.03). Conclusion: Astrocytoma and ependymoma were the most common histological tumour types among our patients. Late presentation and poor pre-operative functional status were prominent features of our patients’ cohort

Perceived causes and prevention of catheter-associated urinary tract infections among spinal cord injured patients

Catheter-associated urinary tract infection (CAUTI) is among the most common nosocomial infections especially in acute care settings. Its economic and unanticipated health implications make it burdensome for the healthcare providers and patients. The paper examined the perceived causes and mode of preventing urinary tract infections in patients with spinal cord injury. Qualitative research approach was utilized; the study site was a Tertiary Hospital in Nigeria. Eight (8) in-depth interviews (IDI) were conducted with healthcare providers managing patients with spinal cord injured in the hospital. The major risk factors causing urinary tract infection identified include financial problems, organization of care, human error, hospital environment and patient-related factors. To prevent urinary tract infections among patients in the hospital, a number of suggestions were made by the participants such as training of caregivers and educating patients and relations. The authors concluded that the incidence of CAUTI could be reduced in the hospital if the opinions of stakeholders are fairly considered

Postgraduate students’ perception of the educational environment of a wet lab training in Neurological Surgery Division, UCH, Ibadan

Objective: The importance of understanding the perceptions of medical students to their training environment cannot be overemphasized. The study evaluated the wet lab training organized for Senior Registrars in the Neurosurgery, Division of the University College Hospital, Ibadan. Aim: The purpose of this study is to assess the experiences of postgraduate students during wet-lab training with the aim of improving the course content and introducing evidence-based and student-centered changes. Methodology: The study made use of a cross-sectional design and data were collected using the qualitative research approach. Information was elicited from all the Senior Registrars who participated in the training through in-depth interviews. Result: All the postgraduate students who participated in the training were satisfied with the course content and the method of delivery appropriated during the training. They also found it relevant to their practice. However, certain shortcomings were observed such as high cost of training, poor standard of equipment/tools, tight work schedule and short training duration. Conclusion: Hands-on training plays an important role in enhancing the quality of care and high performance in health-care service delivery. The shortcomings and suggestions for improving future trainings as reported by the residents should be addressed in order to maximize the gains of the hands-on training experienc