Tropical Pathology

Toxicological findings in occupants of a crashed commercial aircraft and the legal implications on personal injuries claims John Oladapo Obafunwa, Mathias Ikechukwu Okoye, Francis Adedayo Faduyile, Sunday Shokunle Soyemi Annals of Tropical Pathology 2019 10(1):1-5 Background: A commercial aircraft operated by DANA Air crashed just outside the Lagos International Airport, Nigeria, killing a total of at least 150 people. The crash was accompanied by a fire outbreak. There were no survivors. There is a consideration that some victims might have survived for some time and consequently suffered agonal pain. Materials and Methods: Postmortem examination for the purpose of disaster victim identification, and determination of the cause of death was carried out for the first time in the country. Part of the mass disaster investigation entailed toxicological studies conducted on bodies that were fairly well preserved, and where body fluids were available. A total of 148 victims were positively identified and toxicological samples could only be obtained from 82 of them, comprising the blood, urine, vitreous, and marrow. One hundred and twenty-one samples were collected and of this, only 74 were sufficient for analysis. Results: Toxicology revealed postmortem endogenous alcohol production in 30 victims. Although 27 victims showed morphological features suggestive of carbon monoxide poisoning, only 4 revealed significantly elevated levels of carboxyhemoglobin saturation. Discussion: Some of the victims were apparently alive for some time in the fire that followed the crash, and probably suffered pain during this agonal period. This paper discusses the relevant aspects of personal injury claims and further damages under the Montreal Convention as it relates to possible pain and suffering. Conclusion: The authors opine that the next-of-kin of the victims might be entitled to some compensation based on agonal pain and other loses.

Pattern of unnatural death among females in niger delta: A retrospective medicolegal study Eseroghene Arthur Ijomone, Obiora Jude Uchendu, Nkadi Francis Nwachokor Annals of Tropical Pathology 2019 10(1):6-10 Background: Unnatural death among women is rarely emphasized but an important public health index of the community and society. Objective: The objective is to study the epidemiologic profile of unnatural death among females using autopsy data. Design: This is a 14-year descriptive retrospective study of all female unnatural death victims within Warri and its neighboring communities subjected to medicolegal autopsy. Materials and Methods: Information on age as well as manner and method of death were extracted from the autopsy report of the cases and subsequently analyzed using Microsoft Office Excel 2007. Results: Ninety-six females were examined in this study, representing 9.9% of the 975 medicolegal performed and 11.4% of the 805 unnatural deaths encountered during the study period. The age range is 1–70 years and the mean age is 29.82 years. These cases represent a mean annual incidence of about seven cases. The peak incidence of unnatural death occurred in the third decade (27.1%), followed by the fourth (19.8%) and fifth (15.6%) decades, respectively. The peak incidence for homicide and accidental deaths is in the third and fourth decades, respectively. Firearm-related death is the leading method of homicide accounting for 24 (53.3%) of the 45 homicide deaths. The use of blunt and sharp weapons each accounts for 10 (22.2%) of the cases. Road traffic accident (RTA) accounts for 28 cases, representing 59.6% of accidental deaths and 29.1% of unnatural deaths. Burns and drowning are the second and third leading causes of accidental death accounting for 11 (23.4%) and 3 (6.4%) of the accidental deaths. Four cases of suicide were encountered with three deaths as a result of ingestion of chemical poisons, while the fourth case was by hanging using rope. Conclusion: The study showed that unnatural deaths in women are mainly accidental, homicidal, and suicidal representing 49.0%, 46.0%, and 4.2% of the cases respectively. RTA, burns, drowning, and poisoning (in descending order) are the major causes of accidental deaths. Firearm, sharp, and blunt injuries (in descending order) are the major methods of executing homicides. The peak age for unnatural death is in the third decade with 75% of the death clustering within the 2nd–4th decade. Education, accident consciousness, parental supervision, and implementation of appropriate policy measures are paramount to reducing such death.

Profile of hanging deaths in Lagos, Nigeria: A 9-year retrospective autopsy study Francis Adedayo Faduyile, Sunday Sokunle Soyemi, Alban Ikenna Mgbehoma, Daniel Ayodele Sanni Annals of Tropical Pathology 2019 10(1):11-15 Introduction: Hanging is seen worldwide and is the most common method of suicide globally. Hanging in Western nations has been well documented. However, there appears to be a dearth of published data on hanging in Nigeria, Africa. The essence of this work is to look at the morphological characteristics and the epidemiological profile of victims who died from hanging. Materials and Methods: This was a 9-year retrospective autopsy study on hanging deaths from January 1, 2005, to December 31, 2013. The details of the injuries present were recorded in a predesigned format so as to minimize error. Such findings included age, sex, type of hanging, position of knot, number of turns of the ligature, and fracture of hyoid and thyroid cartilages. The findings noted were carefully compiled, tabulated, and analyzed using the Statistical Package for the Social Sciences version 20. Results: There were 22 cases of hanging during the study period representing 0.2% of the total autopsy cases. The mean age was 38 ± 12 years, ranging from 15 to 60 years. This was predominantly a male phenomenon, with males constituting 94.5%, whereas females accounted for only 4.5%. Hanging was most common in the fifth decade (27.3%). This was closely followed by the third and fourth decades. This study revealed that 95.5% had single loop. The knot was most common on the right representing 54.5% and least common at the occiput accounting for 13.6%. Hyoid bone fracture and thyroid cartilage fracture were seen in 22.7% each. Conclusion: This study has shown that the mean age of hanging was in the fourth decade in this environment, with an overwhelming male preponderance. Fixed single loop on the right side was the most common picture and a quarter had fracture of hyoid bone and thyroid cartilage. All the ligature marks were obliquely placed, and no fracture of cervical vertebrae was identified. A future study will be needed to determine what percentage of suicide is hanging in this part of the world.

Suicide in Warri, Delta State, Nigeria: An autopsy study Obiora Jude Uchendu, Eseroghene Arthur Ijomone, Nkadi Francis Nwachokor Annals of Tropical Pathology 2019 10(1):16-19 Background: Suicide is a neglected public health problem in our environment. Objective: To determine the epidemiologic pattern of suicide cases with respect to sex, age, method, and place. Design: This is a 14½-year descriptive retrospective study of suicide cases reported to the coroner of Delta State, arising from Warri and its environs and subjected to postmortem examination by the authors. Materials and Methods: Information on age, sex, place of death, and method used was extracted and analyzed using Microsoft Office Excel 2007. Results: A total of 21 confirmed cases of suicide were analyzed consisting of 16 (76%) males and 5 (24%) females. The age range of the victims is from 9 to 65 years, with 15 (71.4%) of cases in the 2nd to 4th decades. Hanging, poisoning, and firearm were the methods used in 17 (80.95%), 3 (14.29%), and 1 (4.8%) of the cases, respectively. The scene of the suicide included the deceased's home, bush, workplace, and police custody in 16 (76.2%), 2 (9.5%), 2 (9.5%), and 1 (4.8%) of the cases, respectively. Conclusion: The study showed that suicide is a relatively rare problem, affecting mainly young males. The preferred place is usually the victim's homes. Hanging is the preferred method by males. There is a need to improve the welfare and mental health care of young people in the society as well as restrict the sales of poisoning through government policy in the country.

Molecular subtyping of carcinoma of the female breast in a tertiary teaching hospital in Northern Nigeria Asma'u Usman, Yawale Iliyasu, Akinfenwa Taoheed Atanda Annals of Tropical Pathology 2019 10(1):20-26 Background: Cancer of the breast is globally the most common female cancer including in Nigeria. Newer treatment modalities are based on tumor immunophenotyping, thus the need to characterize these tumors among women with the disease in Northern Nigeria. Aims: This study aims to classify carcinomas of the breast diagnosed in the pathology laboratory of a teaching hospital based on their expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2/neu (HER2/neu) overexpression. Methodology: The histology slides of 478 carcinomas of the breast as well as the ER, PR, and HER2 immunohistochemistry records of 118 stained cases were retrieved and reviewed. Results: Age range of cases was from 20 to 80 years (mean = 46.9 ± 13). The most common histomorphologic entity was invasive carcinoma (NST) which accounted for 73.2% of cases. These were followed in frequency by invasive lobular carcinoma accounting for 6.8% of cases and invasive papillary carcinoma representing 6.5% of cases. Overall, 169 cases (37.6%) were Grade III tumors while Grades II and I tumors accounted for 35.1% and 27.3% of cases, respectively. Triple-negative tumors were the most common molecular subtype and comprised 46.6% of all cases. Luminal B (LUMB) was the least common and accounted for 8% of all cases. HER2 overexpression and LUMA were seen in 17.9% and 28.8% of cases, respectively. Conclusion: Carcinoma of the breast in the population studied occurs at a younger age than among Caucasians. The tumors are characterized by preponderance of invasive carcinoma (NST), high histological grade, and triple-negative phenotype.

Histopathological spectrum of gastrointestinal lesions seen in university of uyo teaching hospital, South–South Nigeria Chukwuemeka Charles Nwafor, Nkem Nnenna Nwafor, Emmanuel Benjamin Etuk, Obioha Kanu Annals of Tropical Pathology 2019 10(1):27-33 Introduction: This is a retrospective study of all gastrointestinal tract (GIT) specimens seen in University of Uyo Teaching Hospital over a 10-year period from January 1, 2008 to December 31, 2017. Materials and Methods: Data were extracted from the departmental registers, patient request forms, and duplicate copies of histology reports of all cases seen. Results: GIT specimens accounted for 4.3% of all specimens. Majority of them were inflammatory lesions, distantly followed by malignant lesions. Inflammatory diagnoses were seen in all parts of the GIT with the appendix accounting for 76.3% of the inflammatory lesions. Appendicitis was the most common diagnosis, while negative appendix was the second most common diagnosis. In all sites except the anus, males were affected more than females in a sex ratio of 1.5:1. Age groups 10–39 years accounted for 79.9% of all appendix inflammatory lesions, with age group 20–29 contributing the highest. Age groups 40–59 had most gastritis cases. Age group 50–59 years accounted for most malignant lesions, with the majority seen in the colon. Adenocarcinomas distantly followed by squamous cell carcinomas were the most common histologic malignant diagnoses made. Conclusion: The pattern of GIT lesions seen in our institute has been documented and this will serve as a baseline data for future local studies.

Salivary adenoid cystic carcinoma: A clinicohistologic study in a nigerian tertiary institution Oluseyi Folake Ajayi, Oladunni Mojirayo Ogundana, Abdulwarith Olaitan Akinshipo, Adetokunbo Babajide Olawuyi, Onatolu Odukoya Annals of Tropical Pathology 2019 10(1):34-39 Background: Adenoid cystic carcinoma (ADCC) is a slow-growing salivary gland tumor with high recurrence and mortality rates. Histologic variants present variable aggression. This has not been investigated in Nigeria. This study aimed to investigate association of histologic variants with clinical aggression in Nigerian cases. Patients and Methods: Fifty-nine ADCC from 363 salivary gland tumors were selected from the departmental oral biopsy archives. Clinical data were retrieved, and hematoxylin and eosin sections were reviewed for confirmation and categorization into solid, cribriform, and tubular (modified Perzin, Spiro and van Weert systems). Estimated mean tumor growth rates (EMTGRs) were computed and matched with histologic variants. Statistical analysis was Chi-square, Kruskal–Wallis, and Mann–Whitney's test. P value was ≤0.05. Statistical package was SPSS. Results: Age ranged between 7 and 83 years (mean 49.2 ± 16.8 years). About 75.1% occurred in the 4th–6th decade (P = 0.02). Most common histologic variant was predominantly cribriform no solid (PCNS) pattern (40.7%). In major salivary glands, there was association between histologic variant and EMTGR (P = 0.025). PCNS had the highest EMTGR (0.840) followed by predominantly solid (PS) (EMTGR, 0.744). These were significantly higher than predominantly tubular no solid (PTNS) (EMTGR, 0.442) and predominantly tubular 30% solid (EMTGR, 0.115). In minor glands, there was also association between histologic variants and EMTGR (P = 0.017). However, the highest EMTGR (0.509) occurred in PTNS followed by PCNS (0.428). These were significantly higher than PS (0.259) with the least EMTGR. Conclusion: Trend of clinical aggression of histological variants based on EMTGR of ADCC varies depending on the type of salivary gland (major vs. minor).

Proinflammatory cytokine profile in head and neck squamous cell carcinoma patients: Preliminary report Victor I Akinmoladun, Clara A Akinyamoju, Fabian Edem, Eniola J Ezeyi, Olatubosun G Arinola Annals of Tropical Pathology 2019 10(1):40-43 Background: Head and neck squamous cell carcinoma (HNSCC) is one of the most common malignant neoplasms globally. Tobacco and alcohol use are predominant risk factors. Inflammation plays a major role in the etiopathogenesis of cancers and cytokines influence activation, growth, and differentiation of several target cells. This study aimed at profiling head and neck cancer patients with regards to the serum level of proinflammatory cytokines and disease stage. Materials and Methods: This study involved thirty newly diagnosed cases of HNSCC and thirty apparently healthy comparable group. Five milliliter of venous blood was collected from the antecubital vein of each individual. The blood samples dispensed in plain bottles were allowed to clot and retract; serum was stored at −20°C until analysis. Cytokine assay was carried out by enzyme-linked immunosorbent assay technique using a commercial kit. Results: The study group was made up of 19 (63.3%) males and 11 (36.7%) females. The ages ranged from 19 to 92 years with a mean of 59.1 ± 19.1 years. The comparative group was made up of 14 (46.7%) males and 16 (53.3%) females with a mean age of 63.2 ± 7.5 years. The oral cavity was the most common site of SCC [6 (20.0%)]. The cases were mostly advanced in 28 (93.3%, Stages III and IV). Serum interleukin-1 IL-1 (β), IL-6, IL-8, TNF – α, and IFN – γ were elevated in the test cases relative to the controls. This however, was only statistically significantly so with IL-6 and IL-8. The mean values for both cytokines for all tumor sites were exceeded in nasopharyngeal carcinoma. Conclusion: Serum IL-6 and IL-8 appear to be significant in the pathology of head and neck cancer and could be explored for possible roles in the management of HNSCC.

Osteosarcoma of the jaws seen in a Nigerian tertiary health institution Benjamin Fomete, Rowland Agbara, Ezekiel Taiwo Adebayo, Davis Sunday Adeola Annals of Tropical Pathology 2019 10(1):44-47 Introduction: Jaw morbidity and mortality among African descend are rarely caused by bone tumors of malignant origin. Osteosarcoma being the most frequent primary malignant bone tumor account for 5.3%–9.5% of malignancies in some part of Africa, Nigeria, included. Its late occurrence and higher survival rate helps to differentiate it from that of a long bone and other locations. Patients and Methods: This is a retrospective study of patients seen at the Oral and Maxillofacial Clinic between January 2003 and December 2015. Results: Osteosarcoma constituted about 3% of all tumor seen within the study period with a high male dominance (60%). The mean age was 31.3 years, and the mandible was 74.3% more affected than the maxilla. Conclusion: Osteosarcoma of the jaws remains a challenge to the oral and maxillofacial surgeon in this part of the world.

Survey of antimicrobial consumption in a university teaching hospital in Southern Nigeria Agantem Emmanuel Ekuma, Echey Ijezie, Tiemah Akpabio, Ifeanyi Abraham Onwuezobe Annals of Tropical Pathology 2019 10(1):48-51 Background: There is increasing use of antimicrobial agents worldwide and especially in low- and middle-income countries. Point prevalence studies of antimicrobial consumption can be used to determine intervention areas for antimicrobial stewardship programs. This point prevalence study was conducted in preparation for antimicrobial stewardship program in our hospital. Methods: Data on antimicrobial consumption was collected from patients in the hospital during 4 weeks by hospital doctors. Data was entered into the Global Point Prevalence Survey internet-based application, downloaded, analyzed, and presented in frequencies and percentages. Results: Of 197 patients surveyed across 21 wards, 62.4% had one or more antimicrobial agents. Metronidazole was the most frequently prescribed agent, whereas cephalosporins were the most frequent class prescribed. Community-acquired infection was the most common indication for antimicrobial therapy, whereas skin and soft-tissue infections were the most common diagnosis. Reason for prescription was stated in notes of 61.4% of patients, whereas 34.8% had stop or review dates documented. There was no record of the use of biomarkers to guide antimicrobial treatment. Conclusion: There is a high antimicrobial prevalence in our institution with cephalosporins as the most frequently prescribed class of antimicrobials. Community-acquired infections are the most common indication for an antimicrobial prescription but are surpassed by medical and surgical prophylaxis combined. There is a need for clinicians in this institution to use guidelines and microbiology laboratory reports to guide antimicrobial prescribing to reduce the antimicrobial prevalence among patients.