Olugbenga Akindele Silas

Open cervical lymph node biopsy for head and neck cancers: any benefit?

BackgroundMost patients with head and neck cancers in our environment present late and usually first to the general surgeons whose practice is to subject these patients to open cervical lymph node biopsy without a prior examination under anesthesia and endoscopic biopsy from the primary tumor site in order to obtain a histological diagnosis.This paper presents the influence of open cervical lymph node biopsy on the clinical outcome of patients with head and neck cancers in our environment.MethodsThis is a ten-year retrospective review of patients with head and neck cancers in the Jos University Teaching Hospital, Jos, Nigeria.ResultsEighty nine patients aged between 23 and 78 years had head and neck cancers with 38/89 (42.7%) patients having cervical lymphadenopathy at presentation and these initially presented to the general surgeons. Twenty six (68.4%) patients had open cervical lymph node biopsy and 12/38 (31.6%) patients had FNAB. Eleven (28.9%) patients presented to the otolaryngology unit 6 months after they presented to the general surgeons and 27 (71.1%) patients beyond 6 months. Nine deaths were recorded. Ten patients were lost to follow-up.ConclusionAll patients with head and neck lymphadenopathy who present to any physician for diagnostic examination should undergo formal ENT staging and FNAB to avoid the problems of tumor spread and the reduction in consequent prognosis.

High-risk human papilloma virus and cervical abnormalities in HIV-infected women with normal cervical cytology

BackgroundThe prevalence of High-Risk Human papilloma virus (HR-HPV), a necessary cause of invasive cervical cancer (ICC) is relatively high in HIV infected women. Gaps exist in our knowledge of the optimal approaches for managing women who have HR-HPV with normal cervical cytology (NCC) particularly in settings of HIV infection.MethodsBetween May 2012 and June 2013 we conducted a colposcopic assessment of HIV-infected women with prior (NCC) and known HR-HPV status to compare cervical abnormalities in women with and without HR-HPV. Colposcopic examinations were done at the Operation Stop Cervical Cancer (OSCC) unit of the Jos University Teaching Hospital (JUTH), Jos, Nigeria. Abnormal colposcopic finding (ACF) was defined as areas of aceto-white epithelium involving the squamo-coulumnar junction, areas of punctation, mosaic pattern or atypical vessels. We compared proportions of ACF as well as histologic grades of cervical intra-epithelial neoplasia (CIN) in women with or without HR-HPV. Statistical analysis was done on STATA.ResultsWe conducted colposcopic examinations in 78 out of 89 (86.5%) eligible women. The mean age of the cohort was 32.4 years (SD ±4.6) with a median 32 years (IQR 29–36). After a mean follow up time of 20.1 months from the initial cervical pap cytology and HR-HPV testing, we found 12 of 78 (15.4%) women with ACF. The odds for an ACF was statistically higher [OR = 4.0 (95% CI: 1.1-14.7)] in women with HR-HPV compared to those without. Of the twelve women with ACF, subsequent histologic examination of colposcopically directed cervical biopsies confirmed CIN 1 in 4 cases (33.3%), CIN 2 in 1 case (8.3%), CIN 3 in 2 cases (16.7%), carcinoma-in-situ (CIS) in 2 cases (16.7%), and normal cervix in 3 (25.0%). Overall, the proportion of women detected with any grade of CIN was 11.5% (9/78) and 6.4% (5/78) were CIN 2 or greater lesion (CIN2+).ConclusionHIV-infected women with NCC and HR-HPV had a four-fold higher likelihood for an ACF. The practice of early colposcopic examination of HIV-infected women with prior NCC and HR-HPV may increase early detection of higher grade CIN and CIS cancer stages in our setting.

Persistent alveolar soft-part sarcoma with liver metastasis: a case report

IntroductionAlveolar soft-part sarcomas are rare, slow-growing tumors that metastasize commonly via vascular routes to the lungs, bones, lymph nodes and brain, causing morbidity and mortality. To the best of our knowledge, this is the first case describing metastasis to the liver reported from Nigeria.Case presentationA 57-year-old man of the Urhobo ethnic group of Nigeria presented with a persistent mass in his left calf. It was initially diagnosed as soft-tissue sarcoma, and its associated systemic effects lead to his death before a histological diagnosis could be obtained.ConclusionsAlveolar soft-part sarcoma with metastasis to the liver can occur in our region (northeast Africa), and a high index of suspicion is required to make an early diagnosis, followed by prompt surgical excision with clear margins in order to prevent mortality.

The role of necropsy in diagnostic dilemmas as seen in a tertiary hospital in north central Nigeria.

Background. Necropsy (autopsy) has helped medical science and law. It has given rise to numerous diagnostic surprises as it explains cause of death, pathogenesis of diseases, and circumstances of death. It also explains reasons for most therapeutic failures. In spite of its usefulness, the rate has dropped worldwide and Africa is worse hit. This work aims to highlight the role autopsy (Necropsy) plays in demystifying diagnostic dilemmas and to encourage its patronage by medical practitioners, law enforcement agents and society. Methods. This is a retrospective review of autopsy and clinical reports of cases seen by pathologists and physicians in the Jos University Teaching Hospital (JUTH), Jos, North central Nigeria. Results. A total 166 cases were studied out of which 52 had same diagnosis for both attending physician and pathologist, 106 had different diagnoses and in eight cases diagnoses remained unknown even after autopsy was performed. Conclusions. Autopsy remains an important tool for obtaining definitive diagnosis, determining cause of death to explain pathogenesis of diseases, medical auditing and a vital source of data for health statistics and planning.

Menace of Asbestos: Health Impact and Politics

Background: Asbestos is identified as a hazardous substance of public health concern and has led to its regulation or ban in many countries. Local and international politics have hampered the regulation and outright ban of this hazardous substance in many countries. While UK and USA did not out rightly ban but regulated its use, most developing countries continue in the production, sale and use of asbestos mostly due to economic reasons. The objective of this review is to identify previous publications on asbestos highlighting health effects and politics bordering its regulation. Also to recommend measures to curtail its production, use and sale especially in developing countries. Methods: A systematic review to identify suitable studies from MEDLINE and Electronic search through GOOGLE for original, review articles and documents on politics, law and health effects of asbestos. A total of 19 articles and online documents were finally selected and reviewed after screening out those not falling within the inclusion criteria. Results: The materials used in this review highlight the negative health impact of asbestos in various countries. Factors identified as militating against effective regulation or ban of this hazardous substance in many counties includes politics, economic gain, ignorance and unavailability of safe asbestos substitutes. Conclusion: Though the production and sale of asbestos have decreased in many developed countries, many developing countries still trade in this hazardous substance with its attendant health consequences. Increased political will, continuous research on health impact and financial aid to developing nations to acquire alternatives will help to reduce the menace of asbestos.

Erratum to: Outcome of HIV-associated lymphoma in a resource-limited setting of Jos, Nigeria

[This corrects the article DOI: 10.1186/s13027-017-0144-7.].

Cost effectiveness of human papilloma virus vaccination in low and middle income countries: a systematic review of literature

ABSTRACT Introduction: Low and middle income countries (LMICs) bear more than 50% of the current cervical cancer burden over the last decade with linkages to lack of HPV vaccination, high levels of poverty, illiteracy and nonexistent or poor screening programs. Governments of LMICs need enough convincing evidence that HPV vaccination will be more cost-effective in reducing the scourge of cervical cancer. Area covered: A systematic review to identify suitable studies from MEDLINE(via PubMed), EMBASE and Electronic search through GOOGLE for original and review articles from 2007 to 2014 on cost-effectiveness of human papilloma virus vaccination of pre-adolescent girls in LMICs was conducted. A total of 19 full articles were finally selected and reviewed after screening out those not consistent with the inclusion and exclusion criteria. Expert commentary: Most studies on cost-effectiveness of HPV vaccine in LMICs show that lowering cost of HPV vaccination with or without Pap smear screening is cost-effective in areas with high incidence of cervical cancer.

A descriptive study of patterns of conjunctival lesions in Jos, Nigeria: A 10-year retrospective study

Background: Conjunctival lesions form the bulk of orbito-ocular pathologies and account for significant morbidity and mortality globally. The spectrum ranges from degenerative and inflammatory lesions to neoplasms which can be either benign or malignant. Malignant neoplasms have been shown to be the predominant class of conjunctival lesions in third world nations. Methods: this study reviewed all histologically diagnosed conjunctival lesions at the Jos University Teaching Hospital from January 2004 to December 2013. Results: Neoplasms were the dominant pathology observed, accounting for 76% of all lesions. Of the neoplasms, 77% were malignant, with squamous cell carcinoma the most frequent malignancy seen. Inflammatory lesions accounted for only 5.2% of all cases seen, while non-neoplastic, non-inflammatory lesions constituted 18.4%. A male predominance was observed for all lesions, while the peak age group for conjunctival pathologies was 30-39years [32.5%]. Conclusion: Malignant neoplasms are the commonest type of conjunctival lesions in Jos, North Central Nigeria. This is a reflection of the pattern of late presentation by affected persons at health facilities, as well as the combined effects of prolonged Ultraviolet irradiation and probably, chronic viral infections.

Chorioamnionitis in pregnancy: a comparative study of HIV-positive and HIV-negative parturients

Chorioamnionitis is an important risk factor for vertical transmission of HIV/AIDS. We compared the prevalence and correlates of histologic chorioamnionitis (HCA) in HIV-positive and HIV-negative pregnant women. HIV-positive and -negative parturients were interviewed, examined and had their placentas examined histologically for chorioamnionitis. Data regarding HIV were also retrieved from their hospital records. A total of 298 parturients (150 HIV positive and 148 HIV negative) were enrolled. The two groups were similar in socio-demographic and obstetric parameters except for age. The prevalence of HCA was 57.1% in HIV-positive women and 61.6% in HIV-negative women (p = 0.43). HCA staging was associated with the number of intrapartum vaginal examinations in HIV-positive subjects and nulliparity in HIV-negative subjects. The number of intrapartum vaginal examinations and coitus in the week prior to delivery significantly affected the grade of HCA in HIV-negative subjects. The prevalence of HCA in both HIV-positive and HIV-negative is high. Most variables did not affect the occurrence of HCA in both groups studied except number of intrapartum examinations, coitus in the preceding one week and nulliparity, which were related to severity of the disease.