Immunohistochemical expression of latent membrane protein 1 (LMP1) and p53 in nasopharyngeal carcinoma: Moroccan experience

Background

Nasopharyngeal carcinoma (NPC) is a malignant epithelial tumor intimately associated with Epstein-Barr virus (EBV). NPC is a characteristic tumor displaying epidemiological, genetic and regional distribution properties that makes it unique by its natural behavior.

Objectives

To assess the expression pattern of LMP1 and p53 proteins in the different histological types of NPC in a sample of the Moroccan population and to define any association between the expression of those proteins with the sex, the age and the histological types of NPC.

Methods

Archival formalin-fixed, paraffin-embedded NPC biopsies were evaluated in 23 Moroccan patients for the presence of LMP1 and p53 using immunohistochemistry (IHC).

Results

No LMP1 expression was observed whereas 8 of 23 cases (34. 7%) had detectable p53 protein in the nuclei of tumor cells. After statistical analysis according to the Fisher''s exact probability test, no significant association between p53 expression and histological type, age and sex distributions was demonstrated (p>0.05).

Conclusion

This study confirms that p53 overexpression is present in a subset of Moroccan NPC patients. Our results are consistent with those reported by other studies concerning the same NPC endemic risk area and provide original data concerning Morocco.     

Stray dog trade fuelled by dog meat consumption as a risk factor for rabies infection in Calabar,southern Nigeria

Background

Rabies is a preventable zoonosis with the highest case fatality of any disease in the world. In the developing world, it is transmitted mainly by dog bites. In parts of southern Nigeria, dog meat is a delicacy.

Objective

To highlight trade in stray dogs as a major risk factor for rabies in animals and humans in south-south Nigeria.

Method

Patients admitted into the University of Calabar Teaching Hospital (UCTH) with a diagnosis of rabies between July and October 2012 were analysed for risk factors, post exposure prophylaxis (PEP), health seeking behaviour and outcome. Focused group interview were also conducted among traders/handlers of stray dogs.

Results

Ten cases of rabies in subjects aged 3 to 52 years were recorded in these five months period. Eight of the cases were male and apparently got infected directly or indirectly through the trade in stray dogs for human consumption. None had proper PEP and all patients died.

Conclusion

Stray dog trade, fuelled by eating of dog meat, is a risk factor for human and animal rabies in Calabar, southern Nigeria. Culling of stray dogs, control of stray dogs'' trade and public enlightenment on PEP is recommended.     

Disseminated Histoplasmosis in a 13-year-old girl: a case report

Background

Disseminated histoplasmosis is a rare fungal infection and most documented cases are in immune-compromised individuals such as those with acquired immuno-deficiency syndrome.

Objective

To describe a case of disseminated histoplasmosis in an adolescent girl.

Method

We report a case of disseminated histoplasmosis in a 13-year-old adolescent girl. She was admitted for 16 days because of neck masses of 3 years duration, generalized body swelling of 3 months and reduction in urinary output of 2 months. She tested negative for human immunodeficiency virus antibodies.

Result

An autopsy was performed because a definitive diagnosis could not be made while the patient was still alive. The autopsy revealed central caseating areas in the lymph nodes and membranoproliferative glomerulonephritis. The periodic acid-Schiff staining technique for tissues showed viable yeast cells suggestive of histoplasmosis. Zeihl-Neelsen''s staining for mycobacteria tuberculosis was negative.

Conclusion

Undiagnosed case of disseminated histoplasmosis while the patient was alive is being reported in a 13-year-old girl. Disseminated histoplasmosis should be considered as a differential diagnosis of childhood chronic infections and malignancies as in Nigeria.     

Pattern of facial palsy in a typical Nigerian specialist hospital

Background

Data on incidence of facial palsy is generally lacking in Nigeria.

Objective

To assess six years'' incidence of facial palsy in Murtala Muhammed Specialist Hospital (MMSH), Kano, Nigeria.

Method

The records of patients diagnosed as facial problems between January 2000 and December 2005 were scrutinized. Data on diagnosis, age, sex, side affected, occupation and causes were obtained.

Results

A total number of 698 patients with facial problems were recorded. Five hundred and ninety four (85%) were diagnosed as facial palsy. Out of the diagnosed facial palsy, males (56.2%) had a higher incidence than females; 20–34 years age group (40.3%) had a greater prevalence; the commonest cause of facial palsy was found out to be Idiopathic (39.1%) and was most common among business men (31.6%). Right sided facial palsy (52.2%) was predominant. Incidence of facial palsy was highest in 2003 (25.3%) and decreased from 2004.

Conclusion

It was concluded that the incidence of facial palsy was high and Bell''s palsy remains the most common causes of facial (nerve) paralysis.     

Patent medicine vendors, community pharmacists and STI management in Abuja, Nigeria

Background

Increasingly, literature indicates that Patent Medicine Vendors (PMVs) and Community Pharmacists (CPs) provide sexual reproductive health services and products to their young patrons.

Objectives

This study explored the validity of literature claims, principally from CPs and PMVs perspective in Abuja, Nigeria.

Methods

Participants were recruited with convenience sampling based on their willingness to participate in the study and our judgement of their professional competence. They were administered a semi-structured questionnaire, which was modelled after McCracken''s long interview. We empirically assessed the validity of CPs and PMVs opinions with an exit interview of seven consenting patrons. Interviews were audio taped, transcribed verbatim and subjected to iterative thematic analysis.

Results

Participants'' accounts and our observations indicate that PMVs and CPs serve young people''s sexual reproductive healthcare needs in Abuja. CPs and PMVs provide young people with a seamless and non-judgemental access to contraceptives, sexual health advice and post-sexual risk exposure care.

Conclusion

The study corroborates literature claims that CPs and PMVs provide sexual reproductive health advice, services and products to young people. However, participants contend that the current pharmacy practice laws in Nigeria constrain the scope and quality of services that young unmarried people require. Because it is unlikely that Nigeria will reinvigorate her primary healthcare system soon, we call for the formal co-option of CPs and PMVs into the sexual reproductive health management system to standardize and improve services.     

Human Immunodeficiency Virus Type 1 Subtypes Prevalence in Central China

Purpose

To study the epidemic characteristics, transmission sources and routes of various subtypes of human immunodeficiency virus type 1 (HIV-1) and sequence variations in Henan, central China. To provide theoretical foundation for Acquired Immune Deficiency Syndrome (AIDS) prevention strategy in this region where the primary HIV transmission route was through former paid blood donation.

Materials and Methods

HIV-1 gene env and gag were amplified by nested polymerase chain reaction (PCR) from uncultured peripheral blood mononuclear cells (PBMCs) obtained from 1,287 HIV-1 confirmed samples in Henan.

Results

Among 1,287 samples, 5 HIV-1 strains were found including subtypes B'' (95.9%), C (0.47%) and recombinant subtypes CRF 07_BC (1.09%), CRF 08_BC (1.79%) and CRF 01_AE (0.78%). Phylogenetic tree analysis found that 1,234 Henan subtype B'' were closely related to those commonly found in Thailand, and were distantly related to other international subtypes. The dominant strain in former blood plasma donors (FPDs) was subtype B'', and the dominant strains in sexual transmission were subtype B'' and BC. Among HIV patients who were most likely infected through routes other than paid blood donation, the percentage of non-B'' subtypes was much higher than those of FPD.

Conclusion

These findings suggest that the prevailing strain of HIV-1 in Henan is subtype B'', similar to the B'' subtype found in Thailand. In addition, for the first time we found subtypes C and recombinant subtypes CRF07_BC, CRF08_BC and CRF01_AE in this region. Indicating that the subtype feature of HIV-1 became more complicated than before in central China.     

Evaluation of some anthropometric indices for the diagnosis of obesity in pregnancy in Nigeria: a cross-sectional study

Background

Obesity in pregnancy is a global health problem which is associated with poor pregnancy outcomes. The use of weight and height, measured at about ten weeks of gestation, to produce pre-gestational body mass index is recommended for the diagnoses of the condition but limitations abound in under resourced settings.

Objectives

To measure anthropometric indices such as mid upper arm circumference, calf circumference, waist circumference and waist to hip ratio, for identification of obesity in pregnancy.

Methods

Anthropometric measurements were carried out on cohorts of pregnant women from 4 hospitals in Enugu, South-eastern Nigeria.

Results

There were no significant difference in the mean mid upper arm circumference (MUAC) and calf circumference (CC) across the trimester groups. The mean values of waist circumferences, hip circumference and waist to hip ratios changed significantly across the trimesters. The 75^th percentile of MUAC (33 cm) and CC (39 cm) in all trimesters, had sensitivity and specificity of more than 70% for identifying obesity in pregnancy.

Conclusion

MUAC and CC values of 33cm and 39cm respectively might be reliable cut off points for diagnoses of obesity throughout pregnancy in Enugu, Nigeria     

Pattern and outcome of childhood intestinal obstruction at a Tertiary Hospital in Nigeria

Background

Intestinal obstruction is a common cause of pediatric surgical emergency with a high morbidity and mortality in Africa.

Methods

A retrospective review of cases managed from January 1996 to December 2005 at a teaching hospital in Southwestern, Nigeria was done to examine the pattern of causes of intestinal obstruction in children and the management outcome.

Results

One hundred and thirty cases were seen over the study period with an age range of 2 hours to 14 years. Majority (61.24%) were infants, while 18.46% were neonates.Fifty-five cases (42.31%) were due to congenital causes while the rest were of acquired causes. The major causes of intestinal obstruction in the study were intussusception (29.23%), anorectal malformations (22.31%), obstructed inguinoscrotal hernia (16.92%) and Hirschsprung''s disease (13.85%). Surgical site infection and sepsis were the commonest complications observed with an overall complication rate of 60.78%. The mortality rate was 3.08% and most (75%) occurred in neonates.

Conclusion

While mortality as an outcome of management is low, the morbidity was very high in this study.     

Pattern of Ptosis in Kano North-West Nigeria

Objective

Epidemiological data on ptosis are generally lacking in the developing nations. The aim of this study was to assess the seven years pattern of ptosis in a Nigerian Specialist Hospital, Kano North-West Nigeria.

Method

The records of patients'' diagnosis as ptosis between 2000 and 2006 were scrutinized. Data such as age, sex, cause, socioeconomic status, side of ptosis and management were obtained.

Result

A total number of 104 patients were recorded. High prevalence was found as follows: male 102(65.4%); right side (61.5%); trauma (RTA) (60.9%); civil servants (38.5.8%) and age group: 51–60 years (25.6%).

Conclusion

It was concluded that trauma from road traffic accident (RTA) is the major aetiological factor and the right side mostly affected.

Recommendation

It is recommended that surgical training and facilities for ptosis correction is off priority.     

Testicular and para-testicular tumors in south western Nigeria

Background

Tumors of the testis and paratesticular tissues are rare, especially in men of African descent. In recent reviews however, the incidence is rising among the Caucasians and black Americans. We set out to determine the incidence in South-Western Nigeria and to examine the histopathologic variants.

Methods

A retrospective study of patients who had histopathologically confirmed testicular and para-testicular tumours between 1989 and 2005 (17 years). Their records were documented at the Ife-Ijesha cancer registry which serves 4.7 million men residing in three states of South-Western Nigeria.

Results

There were 26 cases of testicular and para-testicular tumors with an average incidence of 1.5 cases per year. The incidence of testicular cancer in our study was 0.55 per 100,000 population (95% CI, 0.52–0.57) and accounted for 1.1% of all male cancers. Rhabdomyosarcomas were the most common variety (70% of the paratesticular tumors and 26.8% of all tumors of the testis). Seminomas comprised 50% of the germ cell tumors and 15.4% of all testicular tumors in this series.

Conclusion

There still remains a low incidence of testis cancer in the South Western Nigeria. The reduction in the incidence of seminomas makes rhabdomyosarcomas the most predominant tumor in South Western Nigeria.Key words: testis, tumors, Nigeria     

Rapid screening for co-infection of HIV and HCV in pregnant women in Benin City,Edo State,Nigeria

Background

Human Immunodeficiency virus (HIV) and Hepatitis C virus (HCV) are both major global health concerns as they cause high mortality and morbidity in the developing countries. However, while data exists for the co-infection in other countries, little or no information can be found with regard to the sero-prevalence of HIV and HCV co-infection in Nigeria, albeit in pregnant women attending antenatal care clinics in Benin City, Nigeria.

Objective

The objective of the study was to determine the sero-prevalence of HIV and HCV among pregnant women seeking antenatal care in Benin City.

Methods

In determining the sero-prevalence in a cross-sectional study, 200 pregnant women, aged between 15 and 49 years were screened for HIV and HCV using rapid screening test kits. Using closed ended structured questionnaires; the respondents volunteered socio-demographic information associated with risk factors of HIV and HCV acquisition.

Results

Results indicated sero-prevalence of HIV and HCV in the sampled population was 3% and 5% respectively. Thirty three percent of the pregnant women that were HCV positive were co-infected with HIV-1 infection. HIV sero-prevalence was highest in the age group, 25–29 representing 5.1%, while HCV sero-prevalence was noted highest among the women in the age group 30–34 years, representing 7.9%. Two percent of the pregnant women had equivocal (ambivalent) HIV-1 results.

Conclusion

The study has shown a prevalence of HIV-HCV co-infection among the tested pregnant women in Benin City and more epidemiological surveys are needed in larger scale to decipher the prevalence in other states of Nigeria.     

Pattern of bacterial isolates in the middle ear discharge of patients with chronic suppurative otitis media in a tertiary hospital in North central Nigeria

Background

Otitis media (OM) is a major health problem in both developed and developing countries.

Objective

To determine the pattern of bacterial isolates in patients with chronic suppurative otitis media(CSOM) in Ilorin, Nigeria.

Methods

A prospective study carried out in University of Ilorin Teaching Hospital, Nigeria among consenting patients with CSOM attending the ENT clinic over a period of 7months. Informed consent was obtained from the patients or caregivers and approval for the study obtained from ethical committee. Structured questionnaire was administered and microbiological analysis done, data obtained was entered into SPSS statistical software and results presented in tables and figures.

Results

A total of 134 patients aged 5–64yrs with chronic suppurative otitis media were interviewed with a mean age of 17.0 (S.D. =15.1±1.30). About 55.2% of the respondents were under 10yrs. Seventy-two (53.7%) of the respondents were males with M:F=1.2:1. The gram stain showed predominantly gram negative organisms (71.6%). Pseudomonas aeruginosa was the commonest middle ear pathogenic organism identified and the sensitivity pattern highly favoured ciprofloxacin

Conclusion

CSOM is still a childhood problem among the under tens'' more prevalent among males and the commonest agent is Pseudomonas aeruginosa. Ciprofloxacin is still the most sensitive antibiotics in vitro.     

Patients' knowledge and perceived reactions to medical errors in a tertiary health facility in Nigeria

Background

Human errors in healthcare delivery pose serious threats to patients undergoing treatment. While clinical concern is growing in response, there is need to report social and behavioural context of the problem in Nigeria.

Objective

To examine patients'' knowledge and perceived reactions to medical errors.

Methods

A cross-sectional survey was conducted using a semi-structured questionnaire was used to collect data from 269 in-patients and 10 In-Depth Interviews were conducted among health caregivers in the University of Calabar Teaching Hospital, Nigeria.

Results

Majority (64.5%) of respondents reported annoyance and disappointment with medical errors. Severity of error (88.5%) and the perception of negligence mediated intention to litigate. Voluntary disclosure significantly reduced patients'' intention to litigate caregivers (chi²=3.584; df=1; P=0.053). Frustration/anger was not more likely to influence patient to litigate than feelings of resignation/forgiveness (chi²=2.156; df=1; P>.05). Financial difficulties arising from error had an important influence on litigation. Health caregivers admitted possibility of errors; and insisted that although notifying patients/relatives about errors is appropriate, disclosure was dependent on the seriousness, health implications and the causes.

Conclusion

Voluntary disclosure and teamwork is very important in dealing with medical error. The role of medical social workers could be important in the discourse and disclosure of medical error.     

Response of patent medicine vendors in rural areas of Lagos state Nigeria to antimalarial policy change

Background

Patent medicine vendors (PMVs) play an important role in the treatment of malaria, especially in the rural areas. Nigeria recently changed her antimalarial treatment policy from chloroquine to artemisinin-based combination therapy (ACT).

Objectives

To determine the response of PMVs to the new policy.

Methods

A baseline study was conducted in two local government areas (LGAs) of Lagos state Nigeria as the first phase in an intervention study aimed at improving the malarial treatment practices of PMVs in rural Lagos. A mixed method design involving a questionnaire survey of 180 PMVs and four key informant interviews were used. An antimalarial drug (AMD) audit was also performed.

Results

More than 80% of respondents were aware of the policy change in malaria treatment, but only 23.9% sold an ACT for the last case of malaria treated in an under five child. The main determining factor of the particular AMD sold was PMV''s personal choice (70.6%). About half (58.9%) of the shops stocked ACTs, the newly recommended antimalarials.

Conclusions

The high awareness of the policy change did not translate to a commensurate increase in the sale of the new drugs. Factors beyond the PMVs need to be addressed for a successful adoption of the new policy.     

Medical ethics in sub-Sahara Africa: closing the gaps

Background

Health care providers are expected to have the skills and knowledge relevant to their field and should also be familiar with the ethical and legal expectations that arise out of the standard practices.

Objectives

To elucidate the practice of the health care providers in relation to healthcare ethics in Nigeria.

Methods

A self-administered structured questionnaire was devised and distributed to staff of two tertiary health care facilities in Northern Nigeria. The questionnaire comprised of detailed questions regarding day-to-day aspects of Medical ethical issues.

Results

A total of 307(76.2%) out of 403 health care providers responded to the questionnaire. The median age of the respondents was 34 years. More than half 168(54.7%) of the respondents disagreed as to whether “Ethical conduct is important only to avoid legal action. Many respondents 135 (44.0%) agreed to adhering to “patient''s wishes”, on the other hand over two-third of the respondents 211 (68.7%) agreed that “doctor should do what is best” irrespective of the patient''s opinion. There were significant differences (p<0.05) between the perception of physicians and non-physicians on many ethical issues.

Conclusion

This study has shown gap in knowledge and practice of healthcare ethics among health care providers. There is a need for periodic education on clinical ethics in our hospitals.     

The pattern and challenges of infertility management in Lagos,Nigeria

Background

Infertility remains a threat to successful reproduction by couples desirous of pregnancy.

Objective

To determine the pattern of infertility cases amongst infertile couples seeking care in Lagos University Teaching Hospital as well as challenges in their management.

Methods

A review of the management of couples referred for infertility to the gynaecological outpatient clinic of the Lagos University Teaching Hospital (LUTH), Nigeria from 1^st January 2005 to 31^st December 2006.

Results

The incidence of infertility was found to be 26.8% of the gynaecological consultations with a mean duration of infertility of 4.3 ± 3.4 years. The mean age of the women was 33.8 ± 5.2 years and 66.1% were nulliparous. Secondary infertility accounted for 80% of cases. Male factors only was the cause in 11.1%, female factor only in 37.8%, both male and female factors in 40% while no cause was identifiable in 11.1%. There was no association between tubal occlusion and a history of induced abortion in this study (p >0.05). There was a high rate of discontinuation of care by their large numbers lost to follow up.

Conclusion

Infertility is still a public health problem in Lagos, Nigeria.     

Peripheral vascular surgical procedures in Ilorin, Nigeria: indications and outcome

Background

Data on peripheral vascular surgical interventions from Nigeria is scanty. Reports form Western and Eastern Nigeria dates back about twodecades. This study therefore analyses the various etiological conditions necessitating intervention, and their outcome.

Methods

A retrospective analysis of patients requiring surgical intervention on peripheral vessels from a prospectively collected single surgeon database over a two-year period was conducted. Data were analysed using SPSS version 15.0 windows statistical package.

Results

Fourteen peripheral vascular surgical procedures were performed. The age range was 2–70years (24.4±16.3) with five cases (35.7%) in 20–29year group. Trauma accounted for 11 (73.3%) cases. Upper limb involvement occurred in 7 (63.6%) of the traumatic cases whereas all 2 true aneurysm occurred in the lower limb. Direct repair was possible in re-establishing anatomic continuity in about 64% of cases. Of the six morbidities, wound infection accounted for 50% followed by failure of re-vascularizaton (33.3%) and there was one mortality.

Conclusion

Trauma is the leading cause of peripheral vascular condition necessitating surgery from our study. Young adults predominate. Though direct repair are often feasible, there is a need for the availability of graft options. Wound infection constitutes the highest post-operative morbidity.     

Progress in dracunculiasis eradication in Oyo state, South-west Nigeria: a case study

Background

Dracunculiasis currently occurs in only 5 countries, Nigeria inclusive.

Objective

To study the prevalence and management of the guinea worm disease at the threshold of its eradication in Oyo state.

Methods

KAP questionnairres were administered to head of households and cyclopoid copepods in domestic water sources were identified and checked for infection. Prevalence of infection in the study population was monitored and reasons for continued transmission in the area ascertained.

Results

Fifty three cases were reported in study area in 2004 and 2005 but no cases in 2006. Five hundred headof households were interviewed in ten villages. 43.9% believe the disease is in the blood and further probing shows that 54.6% believe infection is due to inherited susceptibility. 1.8% used antibiotics for treatment while 37.1% used herbs. Boreholes, wells, treatment of ponds with Abate™, filter distribution and health education were interventions in place. Un-infected Halicyclops korodiensis and Africyclops curticornis were recovered from ponds.

Conclusion

Ignorance especially belief in inherited susceptibility, lack of sustained safe water sources and influx of infected immigrant farmers are major variables responsible for the continued presence of the disease in the state.     

Uterine Leiomyomata in South Western Nigeria: a clinical study of presentations and management outcome

Background

Uterine leiomyoma is remarkably common, however only a subset of women have their fibroids clinically detected, symptomatic, or warrant surgical treatment. Its removal is commonly associated with complications. To prevent or control the occurrence of this complication requires the understanding of the factors associated with the complications.

Objective

To evaluate the sociodemographic, clinical characteristics, management outcome and its determinants in southwestern Nigeria.

Methods

Study was carried out at two large tertiary hospitals in the south west region of Nigeria.Retrospective review of case records of all surgically managed cases of uterine leiomyoma over a period of 25 years. One hundred and fifty nine women with uterine leiomyoma seen and managed surgically in South-Western Nigeria were the participants.

Results

The common presenting complaints were menstrual irregularities (47.7%), abdominal swelling (39.1%) and infertility (31.9%). The average uterine size at presentation was 15±9.7 weeks. The majority (79.9%) of the women presented with multiple leiomyomata. The commonest anatomical position of the nodules were multiple positions and intramural in 707(60.9%) and 172(14.8%) respectively. Myomectomy was performed in 54.7% of cases. Postoperative complications occurred in 20.9 % of cases with postoperative pyrexia (13.5%), blood loss warranting transfusion (12.8%) and postoperative anaemia (10.4%) been the most common complications.

Conclusion

Uterine fibroid is common in our environment and its removal is commonly associated with post-operative pyrexia, blood loss, and anaemia and wound infection. Midline incision, closure of rectus sheet with chromic catgut and myomectomy were associated with postoperative complications in this review.     

Perception and practice of contraception among male soldiers in Sobi barracks,Ilorin, Nigeria

Background

There is a popular belief among the general population that Nigerian soldiers tend to have large families but this has not been substantiated with evidence-based research. The Nigerian military health authority implements female-targetted contraception strategies, with less focus on their husbands; who are the dominant fertility determinants.

Objective

To determine the perception and practice of contraception among male soldiers of Sobi Cantonment, Ilorin, Nigeria, with a view to instituting male-targeted contraceptive/family planning strategies.

Methodology

A cross-sectional survey of 334 male soldiers using multistage sampling technique and pre-tested interviewer administered questionnaires.

Results

The respondents'' approval of contraception (73.6%) and willingness to discuss it with their spouses/partners (71.6%) were high. Fear of wives/partner''s sexual promiscuity (55.7%), cultural and religious beliefs (43.2%), fear of the side effects of contraceptives (29.5%) and the desire for more children (21.6%) were reported reasons for the non-approval of contraception. The prevalence of contraceptive use among the respondents was low (12.3%). There was a significant relationship between the respondents'' educational level and contraceptive use (p< 0.05).

Conclusion

The study revealed a high approval and willingness to discuss contraception with their spouses/partners but low contraceptive use.