W Akhiwu

A 20 year retrospective analysis of medicolegal deaths in a tertiary hospital setting in Nigeria

OBJECTIVE To determine and classify the various types of medicolegal deaths as seen at University of Benin Teaching Hospital (UBTH), Benin City, Nigeria. MATERIALS AND METHODS This is a retrospective study of all the medicolegal deaths seen in the Department of Histopathology, (UBTH, Benin City over a 20 year period (January 1990-December 2009) as recorded in the autopsy registers of the department. RESULT A total of 5035 autopsies were done during the period, 89% of which were coroner cases. Four thousand, four hundred and eighty-one coroner cases representing 12.5% of all bodies received by the mortuary during the period were studied. The male to female ratio was 1.9:1, with an overall mean age of 38.3 years. The ages ranged from 1 day to 101 years with a peak incidence in the 25-44 years age group. A total of 553 children and 3928 adults were involved. The commonest indication for coroners autopsy was sudden unexpected natural deaths (SUNDs) which accounted for 65.5% of the cases. Other causes of death were accidents, homicide, suicide, and undetermined causes representing 28.6, 5.0, 0.5, and 0.4%, respectively. Commonest cause of SUND was cardiovascular diseases with complications of hypertension being the most common CVS disease (26.9%). Road traffic accident was the commonest form of accident causing death (88.7%). Public enlightenment and health education about routine medical screening will help to reduce causes of natural deaths. CONCLUSION This study shows the pattern of medicolegal autopsies in UBTH and this preliminary data will provide a baseline for future research and help in formulating policies to help in reduction of preventable causes of death.

Breast tumours of adolescents in an African population

BACKGROUND Tumours of the breast are uncommon in childhood and adolescence. Patients in this age group often require a different approach to diagnosis and treatment. The purpose of this study is to highlight the clinicopathologic features of breast tumours in adolescents in a Nigerian city. MATERIALS AND METHODS Eighty-four breast tumour materials from patients aged 10-19 years were analyzed over a 10-year period at the Department of Pathology, University of Benin Teaching Hospital (UBTH), Benin City, Edo State, Benin City, Nigeria. RESULTS A majority of the breast tumours were benign. Fibroadenoma was the most common tumour with 46 cases (54.8%), followed by fibrocystic changes with 15 cases (17%). Malignancy was extremely rare in this group, with only one case (1.2%) of an invasive ductal carcinoma. Histologically, most tumours were indistinguishable from the adult types. CONCLUSION Fibroadenoma is the most common breast tumour in adolescents in Benin City, Nigeria. Breast cancer and male breast tumours are rare in this age group. Routine complete physical examination of children and adolescents should include breast examination.

Fatal gunshot injuries in Benin City, Nigeria

An upsurge in gun violence in recent times in our environment necessitated this study, which aims to document the patterns of fatal gunshot injuries with the hope of finding a solution to this problem. The study was a retrospective analysis of cases of fatal gunshot injuries on which autopsies were carried out over the 5-year period from January 1998 to December 2002 at Police Medical Services, Benin City – a Nigerian ancient town located in the South-South zone of the country. Most cases of medico-legal death in Benin City and environs are referred to the Police Pathologist at the center for autopsy. A total of 210 cases representing 27.2% of all medico-legal deaths during the study period were reviewed. Males were far more affected than females (M:F = 10.7:1). The intent for the fatal gunshots was murder (88.5%), excusable homicide (4.8%), accident (4.3%) and suicide (0.5%). In 1.9% of the deaths, the circumstances were not clear. Armed robbers, thugs and assassins accounted for 88.1% of the fatal shots, while the Police accounted for 9.0%. The trunk was affected much more than the head, neck and limbs. There is a need to improve security in the country and reduce poverty. Illegal firearms should also be removed from circulation. An improvement in emergency health services will reduce deaths from gunshots.

Screening of Gynaecological Surgical Patients for HIV-1 Infection in Nigeria

Background : HIV infection in gynaecological surgical diseases (GSDs) is associated with higher complications but epidemiological data in Nigeria is scarce. Objective : To determine the proportion, pattern and factors associated with HIV-1 infections among GSDs patients and early linkage to HIV care and treatment. Materials and Method : This one-year prospective study enrolled consecutive volunteers admitted January 1 through December 31, 2007 for gynaecological surgeries in a tertiary Nigerian hospital. The women were pre- and post-test counselled and screened for HIV-1 antibodies using Abbott Determine for HIV- 1 and 2 (Abbott Laboratories, Illinois, USA) and Uni-Gold Recombigen HIV (Trinity Biotech, Wicklow, Ireland) in a serial test algorithm. Repeatedly reactive samples were considered positive. Discordant results were confirmed using HIV-1/2 Stat-Pak (Chembio, Medford, NY) as tie-breaker. The patients’ socio-demographic characteristics and associated factors were obtained using structured questionnaire. Seropositive women were linked to care. The outcome measures were proportion of women with HIV positive results, associated factors and mortality rate over a one year follow up period. Results : The overall proportion of HIV positive result was 6.3% (26/413) with women aged ≥ 45 years having the highest proportion (8.45%). Only 9.4 % (39/413) were aware of their HIV status prior to testing. Of the HIV positive patients, 7.7% (2/26) knew their status and were on antiretroviral drugs. They had not been sexually active in the last six months. Multiple sexual partners (p<0.000), STIs (p<0.000), traditional medications (p<0.003), pelvic abscess (p=0.008), cervical cancer (p<0.003), induced abortions (p<0.001) were HIV-associated factors. Previous blood transfusion, surgeries, benign tumors, non-cervical gynaecological malignancies were not. There were no mortalities over a one year follow up period. Conclusion : The proportion of HIV infection among women admitted for GSDs was high but prior knowledge of HIV status was low. The study has provided a window of opportunity for screening, diagnosis and early treatment. Integration of HIV counselling and testing into gynecological services would be desirable.

Accidental deaths in a University Teaching Hospital 1990-2009

Objective: The aim of this study is to describe the pattern of accidental deaths seen in University Benin Teaching Hospital (UBTH) and to highlight the need for implementation of preventive measures. Materials and Methods: This is a retrospective study of all cases of accidental deaths in which autopsy was performed at University of Benin Teaching Hospital (UBTH), Benin City, Edo state, Nigeria, from January 1990 to to December 2009. The major source of information was the autopsy registers of the DDepartment of Histopathology, UBTH. Result: A total of 35,914 bodies were received into the mortuary of UBTH during the study period; autopsy was performed on 5035 bodies out of which 4481 cases were medicolegal autopsies. Accidental deaths accounted for 1285 cases (26.8%): 1,016 cases were males and269 cases were females, giving a male to female ratio of 3.8:1. The youngest victim was an infant and the oldest 100 years old, with a a mean age of 35.46 years and 2SD of 5.81. The mean age for males and females were 34.67 years and 33.80 years, respectively. Of the 1136 cases of road traffic accidentss, 927 (81.6%) were of of males and 209 (18.4%) were of of females. Road traffic accident death victims were drivers and passengers (48%), pedestrians (30.2%), and bike riders/passengers (21.8%). Conclusion: The pattern of accidental deaths in Benin shows that road traffic accidents is the major cause of death. Efforts must be made to improve our roads so as to reduce the number of lives lost.

Epidemiology of Retinoblastoma

It is widely acknowledged that cancers are disorders of cell growth and behavior and that its cause has to be defined at cellular levels. However, studies have shown that the cause of cancer can be deduced from a study of its epidemiology. Sir Percival Pott is credited with linking chemicals to causing cancer when he observed astutely that Chimney sweeps, because of their chronic exposure to sooth, were prone to scrotal cancers. Subsequently, the Danish Chimney sweeps guild ruled that its members must have their bath daily and this prevented the problem.1 Prior to this, John Hill had linked nasal polyps to “immoderate use of snuff”. Epidemiology has also contributed in linking cervical cancer to human papilloma viruses and radiation to different cancers1. It is also important for the purposes of health planning and allocation of resources to know the distribution of any particular disease.