Martin Nnoli

Biochemical and histologic changes in rats after prolonged administration of the crude aqueous extract of the leaves of Vitex grandifolia.

Background: In recent times, many herbal remedies are used to treat variety of ailments. The leaves of Vitex grandifolia is claimed to be effective in the treatment of diabetes mellitus and as a diuretic in the treatment of high blood pressure. However, there are no scientific reports on the therapeutic benefits or toxicity of this plant. This study therefore investigated the effect of prolonged administration of the aqueous extract of the leaves of this plant in Sprague–Dawley rats. Methods: The plant leaves (No. FHI 107055) were dried at 40° C, powdered and extracted at room temperature in water (pH 5.72) by percolation. Extract was dried in vacuo to give a yield of 27.32 %w/v. The extract, 0.5–2 g/kg b. wt. was administered by gastric probe to rats for 14 days. The liver and kidney functions, blood chemistry, histopathologic alterations of vital organs and extract effect on rats b. wt. were investigated. Results: V. grandifolia caused significant increase in the serum electrolytes, creatinine, and liver function enzyme dose dependently compared with the control (P≤ 0.001). The extract had no effect on the heart; however, the architecture of the liver, kidney, and lungs were significantly altered in the treated groups compared with the control. The treated rats had significantly reduced body weight compared with the control (P≤ 0.001). Major clinical signs observed in the treated groups were polydipsia, polyuria, puffiness of hair, and calmness, which were consistent with increase in dose of the extract. Conclusion: It could be clearly concluded that prolonged administration of the aqueous leaf extract of V. grandifolia at the dose used in this study tends to be toxic to the rats. Its use in folkloric medicine should be with utmost care.

Infantile asphyxia due to aberrant uvula – An anatomic misadventure

A case of unexpected death of an infant with an abnormally elongated uvula is presented. The child, born prematurely, was recovering from protracted treatment in hospital, including surgical interventions and periods of ventilation support necessitating recurrent intubations and anesthesia. She was discharged home in good general health, affected by episodes of cough, and was found dead in her crib a week later. The proximity of the aberrant uvula to the vocal cords may have caused intermittent laryngospasm, with subsequent symptoms of cough and airway obstruction, ending in a fatal outcome. Recurrent airway irritation may have contributed to uvular hypertrophy, due to inflammatory and reactive changes. It is pertinent for the pathologist to thoroughly examine the structures of the pharynx, and the uvula in particular, in any case of pediatric death suspected to result from asphyxia or sudden infant death syndrome (SIDS).

Multiple myeloma in Niger Delta, Nigeria: complications and the outcome of palliative interventions

Background Multiple myeloma (MM) is one of the hematological malignancies that require palliative care. This is because of the life-threatening nature and the suffering associated with the illness. The aim of this study is to bring to the fore the complications experienced by people living with MM in the Niger-Delta region of Nigeria and the outcome of various palliative interventions. Methods This was a 10-year multi-center retrospective study of 26 patients diagnosed and managed in three major centers in the Niger-Delta region of Nigeria from January 2003 to December 2012. Information on the clinical, laboratory, radiological data, and palliative treatment was obtained at presentation and subsequently at intervals of 3 months until the patient was lost to follow-up. Result The mean duration from onset of symptoms to diagnosis was 13.12 months (95% CI, 6.65–19.58). A total of 16 (61.5%), eight (30.8%), and two subjects (7.7%) presented in Durie–Salmon (DS) stages III, II, and I, respectively. The complications presented by patients at diagnoses included bone pain (84.6%), anemia (61.5%), nephropathy (23.1%), and hemiplegia (35%). All the patients received analgesics, while 50.0% received blood transfusion, 56.7% had surgery performed, 19% had hemodialysis, and 3.8% received radiotherapy. A total of 10 (38%) patients benefited from bisphosphonates (BPs). A total of 57.6% of patients were on melphalan–prednisone (MP) double regimen, while 19% and 8% patients were on MP–thalidomide and MP–bortezomib triple regimens, respectively. A total of 3.8% of patients at DS stage IIIB disease had autologous stem-cell transplantation (ASCT). Only 7.6% of the myeloma patients survived up to 5 years post diagnosis. The overall mean survival interval was 39.7 months (95% CI, 32.1–47.2). Conclusion Late diagnosis and inadequate palliative care account for major complications encountered by MM patients in the Niger-Delta region of Nigeria. This could be responsible for the poor prognostic outcome and low survival interval of MM individuals in this region. There is, therefore, a need to improve the quality of palliative care received by myeloma patients in this region. This is achievable via provision of relevant and affordable health care facilities for diagnosis and treatment of the disease.

Giant Mucoepidermoid Carcinoma of the Parotid Gland: A Case Report and Review of Literature

Mucoepidermoid carcinoma is the most frequently encountered salivary gland carcinoma usually presenting as small, painless, asymptomatic mass. Presented is a 54-year-old male security personnel with a 5-year history of giant locally advanced, nodular, and ulcerated left sided facial tumour diagnosed as mucoepidermoid carcinoma on histology. Mucoepidermoid carcinoma can attain a grotesque dimension with management challenges. We present this case, as we have not encountered MEC as large as this and conclude that it should be considered as a differential diagnosis of facial tumours.

Taming the tide of HIV and TTI scourge in Sub-Saharan Africa using autologous blood transfusion

Background and objective: The re-emergence of Transfusion Transmissible Infections (TTIs) and Human Immunodeficiency Virus (HIV) through allogeneic blood transfusion has made the subject of autologous blood transfusion to begin to gain adequate attention globally in recent times. This study aimed at enlightening the public on the importance of Autologous blood transfusion as a strategy in curbing HIV, TTI and allogeneic blood transfusion reaction in sub-saharan Africa where poor screening of blood contributes to their spread. To ascertain the suitability of autologous blood transfusion as a safe blood transfusion strategy, the whole essence of which is to achieve better quality of care for our patients. Methodology: The study was divided into 2 parts, one was questionnaire-driven and the other was on the use of Autologous blood transfusion.A total of 40 patients (30 of whom were HIV sero-positive while 10 were HIV sero-negative) aged between 19-55years were randomly recruited for this study in the Dept of Haematology, University of Benin and Port Harcourt Teaching Hospitals between 1997-2008. Thirty (30) of the patients, who had previously received allogeneic blood transfusions and were HIV seropositive, were given only questionnaire while the 10 HIV sero-negative patients received Autologous blood transfusion following surgical procedures. Result: A-6-month pre- and post-surgical retroviral screening of the ten (10/25%) patients who received autologous blood transfusion revealed that they remained HIV I&II sero-negative with no TTI or blood transfusion reaction recorded. One (2.5%) of the allogeneic group who was apparently HIV negative prior to surgery was found HIV sero-positive 6 months following transfusion of unscreened blood. Conclusion: There is a place for autologous blood transfusion as a safe blood transfusion strategy in low income countries of sub-Saharan Africa.

Neonatal Deaths and Autopsy Rates in a Nigerian Tertiary Hospital: A 10-Year Trend Analysis in University of Calabar Teaching Hospital, Calabar, Nigeria

The pains and challenges of pregnancy and delivery are made worse when the resultant neonate dies. Fortunately, many of these neonatal deaths can be prevented if autopsies are routinely conducted to ascertain the immediate and remote causes of death toward subsequent prevention. Unfortunately, there is paucity of studies on neonatal autopsy rates (NARs) in many developing countries, with few reports indicating unacceptably low rates. This study was therefore aimed at assessing the trend in neonatal deaths and autopsy rates in Calabar, Nigeria. Trend analysis of retrospective data obtained from medical records of neonatal deaths and deliveries was conducted. Neonatal mortality rate (NMR) and NAR were obtained for each of the years within 2004-2013. Ethical approval was obtained from the ethical committee of University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria. In the 10-year study period, there were 22,916 deliveries with a male:female ratio of 1:0.95. There were 1136 neonatal deaths, yielding a total NMR of 49.6 per 1000 live births (ranging from 26.7 in 2011 to 93.7 in 2004). Bimodal peak in NMR was found at 2008 and 2012. Eighty six neonatal autopsies were conducted within the study period yielding a mean autopsy rate of 7.57%, ranging from 0% in 2008 to 25.0% in 2013. This study found unacceptably high NMR and low NAR in the study setting. There was, however, gradual decrease in mortality and increase in autopsy rates through the study period. It is essential to redouble the efforts at improving public health education and awareness on the relevance of autopsy toward improved health service delivery. Similar studies are recommended in other similar and dissimilar settings.

Cervical Cancer and its Aetiology in Sub-saharan Africa: A Literature Review

Cervical cancer represents a huge burden of non-inf ect ous disease globally. It is the second commonest cancer in the female. There are over half a million deaths recorded every year as result of cervical cancer. The aetiological agent i mpl cated in this disease is the human Papillomavirus. The high-risk human papillomavirus has been mostly implicated. The commonest high-risk human papillomavirus implicated in cervical cancer worldwide is type 16 and 18. The viral infection of the uterine cervical epithelium initially causes the development of precancerous lesions referred to as cervical intrae pithelial lesions/squamous intraepithelial lesions which take many years to progress into canc er. The Papanicoulao smear test done for the screening of precancerous cervical lesions has been known to be effective in preventing the disease. The commonest types of cervical cancer are the cervical squamous cell carcinoma and

Prostate Cancer Incidence in Calabar - Nigeria

Aim: The aim of this study is to determine the incidence of prostate cancer in men living in Calabar- Nigeria, which has not been determined up till now. Study Design: A trend analysis of prostate cancer cases in Calabar between 1

Validation of Siriraj Stroke Score in southeast Nigeria.

The aim of the study is to validate the use of Siriraj Stroke Score (SSS) in the diagnosis of acute hemorrhagic and acute ischemic stroke in southeast Nigeria. This was a prospective study on validity of SSS in the diagnosis of stroke types in southeast Nigeria. Subjects diagnosed with stroke for whom brain computerized tomography (CT) scan was performed on admission were recruited during the study period. SSS was calculated for each subject, and the SSS diagnosis was compared with brain CT scan-based diagnosis. A total of 2,307 patients were admitted in the hospital medical wards during the study period, of whom 360 (15.6%) were stroke patients and of these, 113 (31.4%) adult subjects met the inclusion criteria. The mean age of the subjects was 66.5±2.6 years. The mean interval between ictus and presentation was 2.5±0.4 days. Ischemic stroke was confirmed by CT in 74 subjects; however, SSS predicted 60 (81.1%) of these subjects correctly (P<0.05). Hemorrhagic stroke was confirmed by CT in 39 subjects, and SSS predicted 36 (92.3%) of them correctly (P<0.05). In acute ischemic stroke, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SSS were 92%, 94%, 97%, 86%, and 93%, respectively, while in patients with hemorrhagic stroke, the corresponding percentages were 94%, 92%, 86%, 97%, and 93%, respectively. SSS is not reliable enough to clinically differentiate stroke types in southeast Nigeria to warrant interventions like thrombolysis in acute ischemic stroke.

Sudden deaths in hotels following sexual intercourse at south eastern Nigeria from 2010 to 2013

Aim/Objectives: This is to determine the actual cause of deaths of guests that walked in-to lodge in hotels in south eastern part of Nigeria. Materials and Methods: A sectional study of all reported deaths in hotels in Abia state, South Eastern Nigeria was undertaken. A total of seven (7) bodies were reported within the period of 2010-2013. All victims affected were males with an age range of 45-58 years and a mean age of 48.9 years. A detailed autopsy of all bodies was done at different time when they inquest (from coroner) was served by the law enforcement as the results of autopsies/court sermons kept intact. Results: All the bodies were seen to have died of cardiovascular-related disorder despite the ploy of report on the youngest of all-35 years that was said to have died in the swimming pool; we found out that he was already dead by the time the body was recovered from the pool. Conclusion: This shows that sexual activity is associated with augmented adrenergic stimulation that increases sympathetic output which resulted in increased heart rate with ventricular ectopic/fibrillation thus resulting to myocardiac infarction.