Orient Journal of Medicine

Histopathologic Spectrum of Lymph Node Lesions in a Teaching Hospital in East Nigeria. A Nine-Year Review

Ifeoma F. Ezejiofor — 2024-03-31

Background: The lymph node is a very important structure in the haemopoietic and lymphatic systems. The lesions are wide-ranging and include non-neoplastic conditions, benign and malignant neoplastic diseases, to metastatic deposits. Histopathology is considered the gold standard in its diagnosis.

Objectives: To determine the spectrum of lesions in both peripheral and visceral lymphadenopathies in a tertiary hospital in Nnewi and compare it with other studies.

Methodology: This is a retrospective study involving 207 cases of histologically diagnosed lymph node biopsies in the Department of Histopathology, Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria, over a 9-year period. Cases with incomplete biographic data such as age, sex, nature of tissue, and unrepresentative or inadequate tissue were excluded from the study. Few fine needle aspiration cytology of lymph nodes done within this study period were excluded because of inconclusive results in the majority of the cases, however, biopsies requested in those cases were used.

Results: Two hundred and seven lymph node biopsies were studied. The age of these patients ranged from 0.9 to 89 years, with a mean age of 41.4 years (SD±20.9) and median age of 41.0 years. Females slightly outnumbered males with a ratio of 1.1:1. Neoplastic lesions were more common: comprising of 58.4% (121/207) and including metastatic deposits to the lymph nodes 31.9% (66/207), non-Hodgkin lymphoma 23.7.1% (49/207), Hodgkin lymphoma 2.4% (5/207) and one case of Kaposi sarcoma: 0.5%(1/207). Non- neoplastic lesions were the second commonest and included: majorly inflammatory lesions 41.5% (85/207) such as non-specific reactive hyperplasia accounting for 24.6% (52/207), other specific reactive hyperplasia 2.8% (6/207), 9.7% (20/207) of Tuberculous lymphadenitis, 3.4% (7/207) of other chronic necrotizing granulomatous lymphadenitis, and one case of ectopic thyroid inclusion accounting for 0.5%(1/207).

Conclusion: Histopathology plays an important role in establishing the cause of lymphadenopathy. Among the lymph nodes examined, neoplastic lesions were the most prevalent cases in our environment, which is contrary to the popular belief, that infectious diseases of lymph nodes are more common in developing countries. This study also concluded that the cervical group of lymph nodes was the most frequently encountered palpable nodal swelling, followed by the axillary group. Further studies are also required, where extensive immunohistochemical stains and molecular studies would be applied for further classifications of lymphomas.

Computerized Tomographic Assessment of the Normal Dimensions of the Sella Turcica in Adults in Benin City Edo State Nigeria

Catherine N. Obasikene — 2024-03-31

Background: The sella turcica is a saddle-shaped structure in the sphenoid bone and it houses the pituitary gland within the pituitary fossa. The size of the sella turcica varies from individual to individual and the establishment of the normal standards will aid in the process of detecting variation from normality in this region. Computed Tomography (CT) is a preferred imaging modality in the study of sella turcica morphometry.

Objectives: This study aims to determine the normal dimensions of the sella turcica using a CT-scan at different planes in an adult population in Benin City, and to assess the possible determinants of its size.

Methodology: This was a prospective study of CT measurement of the normal dimensions of sella turcica in adults which was carried out at the University of Benin Teaching Hospital, Benin City. The sella turcica was measured on the monitor in different planes using a GE Bright speed series CT scanner. Data collected was analyzed using Statistical Package for Social Sciences version 16.0. The relationship between the dimensions of sella turcica with age, sex, weight, height and body mass index were analyzed using Pearson correlation(statistical significance at p<0.05)

Result: The mean values for the dimensions of sella were 1.08±0.10 cm for height, 1.87±0.12 cm for width and 1.70±0.35 cm for length. There was no correlation found between the dimensions of the sella turcica and body biometrics.

Conclusion: The normal reference values for description of the CTdimensions in Benin City were established.

Neoadjuvant Chemotherapy in Breast Cancer: How Many Courses are Adequate?

Chimezie I. Madubogwu — 2024-03-31

Background: Neoadjuvant chemotherapy (NAC) has been found very useful in the treatment of locally advanced breast cancer. The number of chemotherapy cycles given during NAC varied between 4-6 cycles in most studies.

Objectives: To assess the number of courses of NAC that will show the earliest and most significant reduction in sizes of breast mass.

Methodology: The size of breast masses and regional lymph nodes in the pre-menopausal women were assessed before each course of chemotherapy and three weeks after the 4th course of NAC. A Doxorubicin containing regimen: cyclophosphamide, doxorubicin and 5- fluorouracil (CAF) was given at 3 weekly intervals. Medication response was evaluated using a modification of the RECIST (Response Evaluation Criteria In Solid Tumours) methodology. The data were analyzed using the SPSS statistical software version 23.0. (Statistical Package for Social Sciences SPSS Inc.).

Results: Forty-nine patients completed the four courses of neoadjuvant chemotherapy with age range of 24-54years and mean age of 40.92±7.98 years. The initial sizes of the breast masses ranged from 3.0-25.0cm with mean of 9.70±4.33cm. The mean size of the breast masses after 1st, 2nd, 3rd and 4th course were: 8.26±4.13cm, 6.72±4.32cm, 6.09±4.97cm and 5.79±5.35cm respectively. The size reduction were very significant, Spearman's correlation coefficients rs values of 0.869, 0.667, 0.619 and 0.599 from 1st to 4th course. The patients achieved clinical complete response (cCR) of 0%, 2.0%, 10.2% and 18.4% after the 1st to 4th courses.

Conclusion: The tumour sizes in premenopausal breast cancer showed significant reduction after the first to the fourth courses of neoadjuvant chemotherapy. Chemotherapy regimen should be reviewed after the third course if there is no significant clinical response.

Preoperative Shaving with Razor Blades Versus no Preoperative Shaving in Elective Inguinal Hernia Repair: Impact on Surgical Site Infection

Joseph O. Ossai — 2024-03-31

Background: Body hair could be removed for various reasons including religious, aesthetic, cultural, medical or as a part of preoperative preparations of surgical patients. It is a common tradition or routine in surgical practice to remove body hair preoperatively as its presence can interfere with the surgical incisions, wound closure and the application of adhesive wound dressings. Hair is also perceived to be associated with poor personal hygiene and the removal of body hair is thought to reduce the risk of surgical site infection (SSI). However, there are studies which claim that preoperative hair removal is deleterious perhaps by increasing the incidence of SSI, and should not necessarily be carried out.

Objectives: To determine the rate of surgical site infection associated with preoperative shaving of the operative site with razor blade versus no preoperative shaving in elective inguinal hernia repair, and to determine patients' levels of satisfaction with each preoperative method.

Methods: We enrolled sixty consecutively consenting patients who met the inclusion criteria for elective inguinal hernia repair in this study. Thirty patients received preoperative hair removal with razor while 30 patients did not. We assessed postoperative surgical site infection on post-operative days 3, 7, 14, 21and 30. Statistical analysis was done using the statistical package for social sciences (SPSS) version 17. The results obtained were presented in tables, bar charts and pie charts. P-value of <0.05 was considered statistically significant by chi-square test.

Results: Out of 60 patients who were recruited for the study, 3(5%) had postoperative surgical site infection (2 in the shaved group (6.7%) and 1 in the unshaved group (3.3%)) within 30 days in form of mild erythema. The difference, however, was not statistically significant with P-value of 0.554.

Conclusion: This study showed no advantage of preoperative shaving with razor over no preoperative shaving in elective inguinal hernia repair with respect to prevention of surgical site infection. There was slightly higher surgical site infection rate associated with preoperative shaving, but the difference is not statistically significant.

Aetiology and Management of Congenital Club Foot: Evaluation of Perception of Mothers in Nnewi

Chibuzo U. Ndukwu — 2024-03-31

Background: Congenital Club foot (CF) also known as Congenital Talipes EquinoVarus deformity (CTEV) is a common congenital deformity of the foot involving one or both feet. Numerous aetiologic hypotheses have evolved on how club foot develops. However, research findings do not support any particular theory. Parents and care givers have given different interpretations to the cause of club foot and this has, to a large extent influenced their careseeking attitude. It is therefore important to ascertain the knowledge and perception of mothers, in our environment, on the aetiology and management of club foot, thus necessitating this study in Nnewi.

Methodology: This is a cross sectional descriptive study involving pregnant women and mothers, who were consecutively recruited from the antenatal and postnatal clinics, and the orthopaedicout patient clinic of Nnamdi Azikiwe University Teaching Hospital Nnewi. Information were obtained from them using an interviewer based structured questionnaire. Data were analysed using SPSS statistical package version 20.IBM Illinois.

Results: One hundred and thirty women were recruited for the study. Most of them were educated with up to 114 (87.7%) of them having either senior secondary or tertiary education as their highest educational level. Ninety of the respondents (69.2%) had heard about club foot deformities and 20 (15.4%) of them, felt that club foot deformity was as a result of poor delivery method. Up to 85 of the respondents (94.4%) had no perception about the cause of the deformity. Only 70 (53.8%) mothers felt that this problem could be treated.

Conclusion: This study has shown poor perception amongst women and mothers in our environment, about the cause of club foot and its management. This may serve as a guide for public enlightenment.

Maternal Healthcare Utilization among Women of Child Bearing Age Attending the Out-Patient Clinics of a Tertiary Health Facility Outstations in South-East, Nigeria

Silvia I. Ezemenahi — 2024-03-31

Background: Most maternal deaths are preventable, as the healthcare solutions to prevent or manage complications are well known, yet the global burden is still high in many developing countries, including Nigeria. Although access to healthcare services is the right of every woman around the globe, irrespective of economic position and social group but there is still a low level of maternal health care seeking behavior that is compounded by the extremely low skilled attendants especially in low and middle-income countries.

Objective: To assess the maternal healthcare utilization among women of child-bearing ages attending out-patient clinics in all Nnamdi Azikiwe University Teaching Hospital Outstations in Anambra State, SouthEast, Nigeria. Methodology: After obtaining approval from the ethics and research committees in Nnamdi Azikiwe University Teaching Hospital, a cross-sectional survey of 300 consenting women who met the eligibility criteria was conducted. They were selected by systematic random sampling from 15th February to 15th March, 2021. Data collection was by the use of a self-administered structured questionnaire and analyzed using the statistical package for Social Sciences (SPSS) version 20.0. The level of significance for this study was set at P < 0.05 for all analyses.

Results: A total of 300 women with a mean age and standard deviation of 29.4±0.7 years participated in the study. The proportion of respondents who utilized the health care facilities was 252 (84.67%), while 12.67% attended maternity homes and 2.66% preferred to stay at home.

Conclusion: Many women did utilize the health care facilities and utilization was influenced by their level of education. Health awareness campaigns should be conducted at the community level to raise the women's level of understanding about the importance of utilization of maternal health services.

Prevalence and Pattern of Selected Cardiovascular Disease Risk Factors amongst a Cohort of Public Servants in Abakaliki Nigeria

Chukwuemeka O. Eze — 2024-03-31

Background: Cardiovascular diseases have become the leading cause of premature morbidity and mortality worldwide, with 80% originating from developing countries. The prevalence of cardiovascular risk factors is on the increase, especially in the developing nations of the world. There are limited data on the burden of cardiovascular disease risk factors among a cohort of educated public servants in Abakaliki, Nigeria.

Objectives: To determine the prevalence and pattern of selected cardiovascular risk factors among a cohort of public servants in Abakaliki, Nigeria.

Methodology: This is a crosssectional descriptive study where a cohort of public servants was screened for the presence of selected cardiovascular risk factors during their annual th meeting at Abakaliki, Nigeria on the 16 of December 2022. They were made up of males and females of working-class age and they all possessed a minimum educational attainment of a university degree (≥17 years of formal education).

Results: Out of the 120 participants screened, cardiovascular disease risk factors were present in 66 persons (55%) (male- 35.8%, female19.2%) and were more preponderant among older participants. Overweight (27.5%), and hypertension (25.8%) were the most prevalent risk factors identified. The mean age, heart rate, systolic blood pressure, and fasting blood glucose were significantly higher in male participants while the mean body mass index was significantly higher in their female counterparts. The majority (40.8%) of the participants had a single risk factor while few others had multiple risk factors.

Conclusion: Cardiovascular disease risk factors are prevalent among a cohort of public servants in Abakaliki, Nigeria with a preponderance of overweight and hypertension.

Surgical Management of a Case of Debilitating Multiple Joint Osteoarthritis [MJOA] Co-Existing with Degenerative Disease of the Spine in an Elderly Patient

Ifeanyi C. Nwagbara — 2024-03-31

The management of multiple joint osteoarthritis is a challenging ordeal especially in the Low- and Middle- income Countries where most victims present late as a result of poverty and ignorance. This is particularly so in the elderly patients with the added problems of osteoporosis, increased risk of deep venous thrombosis and co- morbidities. We have discussed our experience in the management of an elderly patient who presented with incapacitating osteoarthritis of both knees and right hip with associated spine disease and who was bed ridden for two years prior to presentation. Debilitating Polyarthritis, Multiple joint replacements, Surgery in the elderly, distal femoral replacement.