Francis Adedayo Faduyile

Awareness and uptake of the Pap smear among market women in Lagos, Nigeria

Our study evaluates the effect of an educational programme on awareness and uptake of the cervical cancer screening test (Pap smear) by women in a model market in Lagos, Nigeria. This was a quasi-experimental study using a multistage sampling technique. A total of 350 women were divided into two groups. A baseline survey on awareness of the Pap test and screening practices was carried out using pre-tested, interviewer administered, structured questionnaires. Participants in the intervention group received sessions of community based health information on cervical cancer screening tests while participants in the control group received health information on hypertension. Subsequently, participants in both groups were reassessed to evaluate the effect of the educational programme on the Pap test and cervical screening uptake. Data were analysed with the Epi-info version 6.04. Awareness about the Pap test was low at baseline; only 6.9% and 12.0% of participants in the intervention and control groups, respectively, had heard of Pap smears. Furthermore, less than 10% had correct information on the use of the Pap test. Post-intervention, there was a significant and proportional increase in the knowledge of the Pap test in the intervention group (P<0.05). However, uptake of the test was quite low in the intervention and control groups both pre- and post-intervention and there was no significant change in uptake. We concluded that essential schemes are required to enhance access to screening, as knowledge alone is insufficient to promote acceptance and use of cervical cytological screening tests.

Forensic Investigation of mass disasters in Nigeria: A review

This paper is to establish the present state of things in the country in terms of legal framework and the availability of personnel with a view to presenting an overview of proper mass disaster investigations. This is a retrospective review of mass disasters in Nigeria that occurred within the last 20 years. The study therefore reviews the state of the forensic investigation of the mass disasters as well as the efforts made to identify the victims of the disaster. The process of proper forensic investigation from the stage of evaluation of the scene and recovery process to the final identification of victims are presented to serve as a protocol for the country. The assessment of the present state of preparedness in Nigeria is also examined with a view to improving the practice to international standards. Data were retrieved from official documents from the aviation industry as well as Nigeria news reports. The standard protocols for disaster victim identification were retrieved from the guide released by the INTERPOL. The state of preparedness of the country and recommendations for improvement are presented. The Federal government and the states of the federation should without further delay put in place the process of reviewing the law of Coroner′s system and provide the enabling environment for the proper forensic investigation. The training curriculum of the first responders should incorporate mass disaster investigations in order to produce efficient officers and personnel. A functional disaster victim identification (DVI) team is strongly advocated to incorporate different professionals involved in mass disaster management.

Maxillary cementifying fibroma: A case report with fine-needle aspiration cytology highlighting the expanding role of e-medicine in cytopathologist collaborations

Cementifying fibroma is an uncommon fibro‐osseous lesion presenting in the oral cavity, which may present in children as an aggressive juvenile subtype of either psammomatoid or trabecular variant. Appropriate management, to achieve local control and prevent destructive expansion, requires early diagnosis, which fine‐needle aspiration cytology (FNAC) can provide rapidly in a minimally invasive manner. The role of FNAC is even more powerful in situations where medical facilities are limited or where surgical biopsy is contraindicated. We report a case of a 6‐year‐old boy from Lagos, Nigeria, whose initial diagnosis of cementifying fibroma was made on photographed digital images in jpeg format of FNAC slides, which were then emailed as attachments to Sydney, Australia and to Scottsdale, USA. The tumor was subsequently confirmed as a juvenile trabecular variant of cementifying fibroma on histopathology on a surgical excision in London, United Kingdom. The ability to electronically send cytopathology images around the world for a definitive second opinion is a practical example of the power of e‐medicine to achieve an accurate FNAC diagnosis. Diagn. Cytopathol. 2012.

Acute aflatoxin B1 – Induced hepatotoxicity alters gene expression and disrupts lipid and lipoprotein metabolism in rats

Graphical abstract

Histological changes and testicular dysfunction in severely burned rats.

Histological Changes and Testicular Dysfunction in Severely Burned Rats Background: The immediate and early sequelae of burns such as vascular collapse and wound sepsis have been extensively studied. Some studies now show that burns cause significant changes in most body systems including the male reproductive system. Only few studies have addressed the reproductive consequences of burns in the male however. Objective: To delineate histologic changes induced in rat testes exposed to major burns. Setting: Medical School Anatomy department. Design: Experimental animal study. Materials & Methods: We induced 3rd degree burns in Wistar rats equivalent to 40% of total body surface area and observed them over several weeks. They were sacrificed at 8 and 16 weeks. Main Outcome Measures: Epididymal sperm parameters, serum FSH, LH and testosterone (T) were measured. A semi-quantitative evaluation of histo-pathological changes in the testis was also carried out. Results: Burns caused significant reduction in all sperm parameters (p<0.05). FSH, LH and T were also significantly reduced at 8weeks. By 16 weeks however, only T was still reduced. The key histologic change was germ cell atrophy. In cases with chronic wounds, sloughing left only basal cells such as spermatogonia and Sertoli cells in many tubules. Conclusion: Burns impair spermatogenesis and damages testicular histology in rats.

An autopsy review of five hundred and sixty nine non-traumatic brought in dead patients in Lagos, Nigeria

BackgroundThere are many cases that present to the emergency room as brought in dead (BID) and in such cases, previous medical history of the deceased is unknown. Many of the medical problems are either preventable or treatable if managed on time. This study is aimed to determine the age, gender and causes of BID.ResultsThis is a 6xa0year retrospective autopsy study of all BID patients in Lagos State University Teaching Hospital, Ikeja between 1st January 2010 and 31st December 2015. The data were retrieved from the autopsy reports and were analysed using Statistical Package for Social Sciences version 18. Test for statistical significance was set as pu2009<u20090.05. There were 1016 BID recorded representing 9.3% of all deaths during the period under study. A total of 569 cases of BID that were analysed in this study after excluding hypertension related deaths. The male to female ratio was 1.37:1. The 4th decade was the predominant age group (22.7%). Cardiovascular (25.5%), Asphyxia related (23.0%), Gastrointestinal tract [GIT] (16.5%) and respiratory (15.1%) were the common system seen. Thromboembolism and haemorrhage, drowning, severe dehydration and tuberculosis were the most common causes of cardiovascular, asphyxia, GIT and respiratory system deaths respectively.ConclusionsCardiovascular system related death was the most common cause of BID with thromboembolism and haemorrhage as major secondary causes. Tuberculosis was the commonest cause of respiratory system death. BIDs are seen more in male than the female gender. There is need for the government to increase the awareness and health seeking behaviour among the populace.

Histopathological study of surgical cervical biopsies in Lagos, Nigeria

Introduction: Benign lesions of the cervix such as hyperplasia, endometriosis, cervicitis and endocervical polyps are health concerns for women globally. Meanwhile, Cervical cancer is the fourth most common cancer among women in the world, with developing countries bearing the brunt of the burden in terms of morbidity and mortality. This study examines the histopathological pattern of cervical biopsies in a tertiary health institution in Lagos, Nigeria. Materials and Methods: This was a retrospective study of all cervical biopsies received in a government-owned tertiary health institution and a private pathology laboratory both in Ikeja over an 8-year period. All the slides were retrieved and reviewed while socio-demographic and clinical details were obtained from request and clinical notes. Data analysis was conducted using the Statistical Package for Social Science version 20. Results: A total of 901 biopsies were retrieved, representing 4.8% of the total biopsies conducted. The age range of patients was 19–87 years with a mean age of 49 ± 13.0 years. The benign tumours accounted for 58.8% of the cases, with a benign to malignant ratio of 1.5:1. Squamous cell carcinoma (SCC), endocervical polyps, and cervical intraepithelial neoplasm accounted for 36.1%, 30.9%, and 15.1% of the total cervical biopsies, respectively. The benign tumours were statistically related to the younger age groups (P = 0.00), however, malignant tumours showed no relationship with age group (P = 0.325). Conclusion: SCC and endocervical polyps were the most common malignant and benign cervical biopsies, respectively. The benign tumours were seen more in the younger age group. Early detection of some of these benign conditions may provide an opportunity for appropriate interventions to prevent further complications.

Pattern of Injuries in Fatal Motorcycle Accidents Seen in Lagos State University Teaching Hospital: An Autopsy-Based Study

BACKGROUND: Deaths from motorcycle accident injuries have remained a major public health issue in Nigeria over the years. AIM: The study is to determine the age and gender distribution of the victims and to identify the cause of death and the anatomical pattern of injuries seen. METHODOLOGY: This is a 5-year autopsy-based study of all motorcycle accident deaths seen in Lagos State University Teaching Hospital between December 2009 and November 2014. The data were retrieved from autopsy reports, hospital case notes extracts from police diary and were analysed using SPSS version 20. RESULTS: Motorcycle accidents accounted for 156 (2.8%) of all the autopsies done (5,661), and 156 (18.4%) of all Road Traffic Accidents (RTA) autopsies (849) performed over the study period, with a male: female ratio of 6:1. The peak age of victims was 31-40 years (30.9%). Head injuries accounted for most (41.4%) of the injuries seen, and the majority of the victims died of craniocerebral injury 53 (50.7%). CONCLUSION: This study showed that males in the fourth decade of life are the major victims of motorcycle accident death. The majority of the victims were the rider of the motorcycle. Most of them died of the craniocerebral injury.

A 10 years autopsy‑based study of maternal mortality in Lagos State University Teaching Hospital, Lagos, Nigeria

Background: Maternal mortality is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy. Nigeria is among the six countries that record over 50% of all maternal deaths in the world. There are few papers on autopsy based causes of maternal mortality. This paper is to present the causes of maternal mortality that had postmortem done in our center. Materials and Methods: This is a 10-year retrospective study of all maternal deaths seen in our center from January 01, 2005 to December 31, 2014. Lagos State University Teaching Hospital is the only state-owned tertiary center and the main referral center in Lagos State. Autopsy records are taken from the death register and other information were extracted from the postmortem reports. Results: Most maternal deaths 98/328 (29.9%) were seen in the age group 26–30 years which was followed by 31–35 years (24.7%). Postpartum hemorrhage was the most common cause of death followed by eclampsia. Direct causes accounted for 60% of maternal deaths with hemorrhage as the most common while cardiovascular related diseases are the most common indirect cause of death. Conclusion: The leading causes of death in this study, hemorrhage, cardiovascular disease and eclampsia are highly avoidable and treatable. We recommend that thorough cardiovascular management should be instituted during antenatal care, and the government should focus more on an emergency response such as availability of adequate blood and blood products in the hospitals.

Forensic odontological observations in the victims of DANA air crash

Introduction Forensic odontology or forensic dentistry is that aspect of forensic science that uses the application of dental science for the identification of unknown human remains and bite marks. Deaths resulting from mass disasters such as plane crash or fire incidence have always been given mass burial in Nigeria. This was obviously due to the fact that Forensic Pathologists whose roles involve disaster victim identification were not available at that time. However, in the DANA air crash in Lagos in 2012, the Forensic pathologist and dental teams were invited for the first time to identify the victims. The objectives of this paper are to identify the extent of victims’ identification using Forensic odontology alone and its combination with DNA analysis. It also presents the pattern of fractures seen in the mandible and maxilla of the victims. Methods The bodies were dissected using following the standard protocol dissection. Prior to this all the victims had Dental Radiological Examination. The oral cavities were exposed after which the Odontology team was invited for photographing first, followed by dental charting. Fractures of the mandible, maxilla including the anatomical regions were all recorded and photographed. Dental prosthesis, restorations, crowns and bridge and other findings were also noted, recorded and compared with ante mortem records where available. Results A total of152 bodies were recovered from the crash site while 148 victims were eventually identified through a combination of DNA analysis and forensic odontology. This represented 97.4%. Forensic odontology was the primary identifier in 10%. There were no fingerprinting information in this country at present therefore, it could not be used. A total of 89 (60%) were males while females accounted for 59(40%). This gives a ratio of 1.5:1. Most of the victims were in the age group 30-49years; this represented 52% of the victims while the least involved age groups were victims above 60 years of age which accounted for only 4.7%. Mandibular fractures were seen in 29 victims, maxilla in 15, combined mandibullo/maxillary in 15 victims, while 89victims had nojaw fracture. The most common area of fracture in the mandible was the body which accounted for 36.4%, closely followed byparasymphysealregion 31.9%, symphyseal 22.7% and the angle 9.0%. The most common fracture in the maxillae was palatal split fracture which accounted for 52%, this was followed by pterygoid 24%, alveolar 8% and multiple locations 16%. Conclusion A combination of DNA analysis and forensic odontology was able to identify a total of 148 victims out of 152 representing 97.4%. Forensic odontology was the primary identifier in only 10%. In the latter, poor and lack of dental records were responsible for this very low figure. The most common area of fracture in the mandible was th ebody which accounted for 36.4%, while that of the maxillae was palatal fracture which accounted for 52%. Padding of the back of the seats in the aircraft should be canvassed for to provide Cushing effect for passengers.