Sunday Sokunle Soyemi

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.

Clinico-Pathological Presentation of Colorectal Cancer Seen in Lagos State University Teaching Hospital

Abstract Aim: The objective is to describe the age and gender distribution, pattern of presentation, sites of colorectal cancers and the histological types of colorectal cancers seen over a 5 year period in a tertiary health institution (Lagos State University Teaching Hospital, Nigeria). Design: A collected data of 104 patients with colorectal cancer from 2006 to 2011 formed the basis of this study. Results: Sixty-five were males and thirty-nine female out of 104 colorectal cases. Age range was between 19 and 78 years. The male female ratio was 1.3:1. 28.8% (30) of the patients presented with stage IV, 46.1 (48) presented with stage III, and 24% (25) presented with stage II. The commonest histological type was adenocarcinoma (84.2%), 46.4% of which were well differentiated. 14.3% had no grade stated. The most common clinical features were suggestive of intestinal obstruction (vomiting & abdominal pain). Conclusion: Most patients in our study presented with late stage disease and this trend especially in this part of the world frequently result in high morbidity and mortality. Policies that promote Public Health education, screening programme which will lead to early diagnosis affordable and effective treatment should be considered.

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.

Spectrum of intracranial tumours in a tertiary health carefacility: our findings.

Introduction Primary brain tumours are uncommon with an annual incidence of 5-10/100000. This study has attempted to analyse the histological pattern of intracranial tumours seen in our centre. Methods A retrospective study of cases of intracranial tumours seen was conducted over a period of 5 years ie from January 2008 to December 2012. All the slides were reviewed. The age, sex, diagnosis using the WHO grading and the histological subtypes were recorded. Data were analysed using the (SPSS) Software version 17. Results Altogether, 56 cases of intracranial tumours were seen out of a total of 12,610biopsies representing 0.004%. The male to female ratio (M: F) was approximately 1:1.1The mean age of the patients was 36 ± 20.35 (range, 2 to 85). Astrocytomas accounted for 30% (17)while 29% (16) had Meningioma. Medulloblastoma accounted for 18%.(10). Of the cases of Gliomas, majority(52%) fell under WHO grade II. (38%)of the Meningioma were of the mixed type while 25% had transitional type. Conclusion Astrocytomas was the commonest brain tumour. These patterns corroboratedmost studies that have been done. Metastasis to the brain was however, not seen in this study.

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.

Morphological Features of Wilms Tumour in a Tertiary Health Care Institution: Our Findings

Nephroblastoma or Wilms’ tumour is the most common primary renal malignancy of childhood. Despite being a malignant tumour, a survival rate of over 90% is now seen today (compared to 30% in the thirties) and this resulted from the success of collaborative trials and the use of multimodal therapy. Black children have a 2.5 times increased incidence over their white counterparts and the sex ratio is approximately 1.0. It is also associated with a number of recognised syndromes. The most important prognostic indicators for Wilms’ tumour are the histological subtype and the stage at presentation. Although, studies have been carried out on this tumour focussing on the clinical aspect, it is worthy of note that very little study has been done on the morphological features of this tumour in this centre and the country at large. The purpose of this study is therefore to look at the morphological patterns of Wilms’ tumour seen in this centre and if possible determine whether a relationship exists between the size, position of the tumour and the histological subtype, and finally, if a particular histological subtype is age-related. Patients and method: This is a retrospective study of the cases of Wilms’ tumour seen in the division of paediatric surgery in our tertiary health care institution over a 5-year period i.e. (from Jan 2008 to Dec 2012). The nephrectomy samples of these patients were sent to the department of pathology and forensic medicine in the same institution. During grossing of the samples, adequate attention was paid to any obvious degenerative changes such as haemorrhage and necrosis. Where these changes were seen, they were recorded. The tumour sizes in the largest diameter and weights were also recorded. This was followed by histopathological reports which not only included the diagnosis, but also the histological types. These were all recorded in a pre-designed data form. The age at presentation in months and sex were also recorded in the form. All these were analysed using the statistical package for social science (SPSS) Software version 17. Results: In this study, 44 patients had Wilms’ tumour with males representing 26 (59.1%) while females accounted for 18 (40.9%) and a male to female ratio was 1.4:1. The ages of the patients ranged from 10 months to 8 years with mean age value of 4 ± 2.91. The mode as well as the median age was 3 years. 24 (54.5%) of the tumours were located on the left position while 20 (45.5%) were seen on the right side. Most of the tumours weighed between 501-1000 grams representing (40.9%). In terms of tumour volume, majority measured between 1001-2000 cm3 accounting for (40.9%). Necrosis was observed in 95.5% of the cases. It is also worthy of note that all the tumours had areas of haemorrhage grossly, and 100% exhibiting triphasic histological pattern. This characterizes the classical WT. Bilateral or Synchronous tumour was not seen in this study. Conclusion: The predominant histological pattern of Wilms’ tumour in this centre is the triphasic pattern representing the classical wilm’s tumour. It is most common in children between the ages of 1 and 5 years with average tumour weight of between 501 and 1000 gm. The bilateral (synchronous) or metachronous type of Wilms’ tumour was not seen in this study.

Neoplasms of the oral cavity and oropharynx seen in lagos general hospitals: A histopathological analysis

Material and method: Ninety cases diagnosed as RCC have been examined in terms of clinicopathologic prognostic parameters. Then, immunohistochemical cyclin D1, ki67, p27, p53, CAIX monoclonal antibodies applied. Positive staining cells in unit area have been counted on digitally taken photographs by NEO image analysing program V.2.0 on PC. Furthermore, mean nuclear diameter of tumor cells have been determined on photos by using the same image analysing program on PC. All results have been compared with each other and relationship between clinicopathologic, histomorphometric and immunohistochemical prognostic parameters have been evaluated statistically.