Histo-pathological Features of Genital Tract Malignancies as Seen in a Tertiary Health Center in North-Western Nigeria: A 10-year Review

Background:

The pattern of gynecological malignancies varies among nations and even within health institution in the same country. Understanding the histo-pathological pattern of these malignancies will help in the management of the patient.

Aim:

The aim of the following study is to establish the frequency, histo-pathological features, and distribution of genital tract malignancies as seen in a tertiary health institution in North - western Nigeria.

Materials and Methods:

A retrospective analysis of data from ward admissions and discharge records, surgical biopsy materials from the theater and the histopathology laboratory results of slides. The study was carried out at the Usmanu Dan-Fodiyo University Teaching Hospital Sokoto, Nigeria. Data were entered into a study proforma and analysis was through SPSS version 15 (Chicago IL) for windows. The results were expressed in simple percentages, tables and charts.

Results:

During the study period (2000-2009), there were 404 cases of gynecological malignancies recorded in the hospital. Cervical cancer was the most common gynecological malignancy 274/404 (69%), followed by choriocarcinoma 52/404 (13.1%), ovarian cancer 46/404 (11.4%) while the least common was vaginal cancer 1/404 (0.3%). The mean age of the cancers was 54 years (28.3). The mean age of incidence of all ovarian cancers was 52.5 years (SD ± 16.2). Epithelial ovarian tumors had a mean age incidence of 67 (12) years, while that of ovarian germ cell tumors was 18.5 (8) years. The incidence of cervical cancer showed a rising trend. Moderately differentiated squamous cell carcinoma was the most common histological variant of cervical carcinoma 170/252 (67.5%). Among the ovarian tumors, epithelial cancers were the most common 38/46 (82.6%), and were followed by the germ cell tumors 5/46 (10.9%). Dysgerminoma was the predominant ovarian germ cell tumour 4/5 (80%). There were 50 deaths from these cancers in our hospital.

Conclusion:

Cervical cancer is the most common gynecological malignancy in our centerand it was followed by Choriocarcinoma. Efforts to reduce the cancer burden should focus on heath education of the masses, national organized screening especially for cervical cancer and establishing regional centers for monitoring and evaluation of these programs.

First Report of Verticillium Wilt of Mango (Mangifera indica) Caused by Verticillium dahliae in Italy

Mango (Mangifera indica L.) is an important fruit crop in many tropical and subtropical countries. This crop has been recently introduced in Italy, mainly in Sicily (southern Italy), where it proves to be a good commodity for the national market. However, the future of mango cultivation in Sicily is threatened by diverse biotic and abiotic factors, which may limit production and fruit quality. For this reason, an investigation into soilborne diseases of mango was carried out in summer 2009 and spring 2010 (1). During May 2009, typical symptoms of Verticillium wilt were observed in four young mango orchards, cv. Kensington Pride, in Catania Province. The symptoms observed included gradual leaf yellowing, marginal browning, slow growth, and dieback on one side of the shoots. The dead leaves remained attached to infected branches and no defoliation was observed. Cross sections of affected branches showed brown vascular discoloration. The incidence of infected trees was about 25% of 96 examined trees. Small pieces of brownish, vascular wood tissues were surface disinfested and placed onto potato dextrose agar (PDA). After 5 days of incubation at 25°C in the dark, the isolates were purified using the single-spore isolation method. Pathogen identification was initially based on morphological characteristics, and then confirmed by molecular methods. The colonies produced from all the tested isolates showed irregular shape, black microsclerotia, and hyaline, elliptical, single-celled conidia developed on verticillate conidiophores (2). For molecular identification, two specific primer pairs (Ver2-Ver3 and Vd7b-Vd10) of the intergenic spacer region (IGS) were used (3). A fragment of 339 bp was obtained by Ver2-Ver3 primer pair, which is a genus-specific primer, while a fragment of 139 bp was amplified by Vd7b-Vd10 primer pair specific for V. dahliae. To fulfil Koch's postulates, 10-month-old mango plants cv. Kensington Pride were inoculated by dipping the roots in Verticillium conidial suspension for 10 min. Conidial suspension was approximately 4 × 10⁶ conidia/ml, prepared from Verticillium isolates Vd-1 and Vd-2 (10 plants for each isolate). Plants dipped in sterile water were used as controls. All plants were kept in a greenhouse at 25°C and 90 to 95% relative humidity. After 10 months, all inoculated plants showed symptoms identical to those observed in mango plants in the field; plants inoculated with water did not show symptoms. V. dahliae was consistently isolated from symptomatic plants but not from plants inoculated with water. To our knowledge, this is the first report of Verticillium wilt caused by V. dahliae on mango in Italy. Verticillium wilt is known to be a serious threat for the mango industry worldwide. The disease, still localized in Catania Province, may soon affects all Sicilian mango-growing provinces with serious economic consequences. References: (1) Y. M. Ahmed et al. J. Plant Pathol. 92:S4.71, 2010. (2) D. L. Hawksworth and P. W. Talboys. CMI Descriptions of Pathogenic Fungi and Bacteria, No. 256. CAB International, Wallingford, UK, 1970. (3) L. Schena et al. Phytopathol. Mediterr. 43:273, 2004.

First Report of Citrus Root Rot Caused by Phytophthora palmivora in Egypt

During spring-summer 2009, a survey was conducted to determine the species of Phytophthora present in citrus nurseries in Egypt. A total of 300 samples of soil and fibrous roots were collected from the rhizosphere of symptomatic Volkameriana lemon (Citrus volkameriana Tan. & Pasq.) plants growing in Delta (Benha-Qalyubia) and a desert (Cairo/Alexandria desert road) citrus nurseries. Plants showed various symptoms. Canopies of affected plants showed few and yellowish leaves, a general stunted growth, no new vegetation, and sometimes sudden desiccation; the root system showed few dark brown feeder roots, no new yellow-white apexes, and a fibrous appearance of the rootlets due to disintegration of the cortical bark but not of the xylem. Collected rootlets and soil were plated in Petri dishes containing a selective medium for the oomycete Phytophthora (2) and incubated for 3 to 6 days at 19 ± 1°C as described by Ippolito et al. (1). Pure cultures were obtained by single-hypha transfers and the isolates were identified as Phytophthora palmivora (Butler) Butler on the basis of morphological and cultural characteristics (3). Isolates formed stoloniferous colonies on potato dextrose agar (PDA) and grew between 10 and 30°C, with the optimum at 25°C. On V8 juice agar, they showed a highly fluffy pattern and produced terminal and intercalary globose chlamydospores. Sporangia were papillate, elliptical (45 to 51 × 29 to 35 μm; length/breadth ratio of 1.3:1.8), and were caducous with short pedicel. All isolates were A2 mating type, forming spherical oogonia and amphigynous antheridia in dual cultures with reference P. palmivora isolate of A1 mating type. Identification of the isolates was further confirmed by amplification and sequencing of the internal transcribed spacer (ITS) region using the universal primers ITS4 and ITS6. BLASTn analysis of ITS sequences (GenBank Accession No. HE583183) showed 99% homology with P. palmivora isolates available in GenBank. Pathogenicity tests for P. palmivora were conducted by inoculating three groups of ten 6-month-old Volkameriana lemon plants, transplanted into 1.4 liter pots with growing medium artificially inoculated at the rate of 1% (v/v) of P. palmivora inoculum produced according to Yaseen (4). Ten uninoculated plants served as a control. Two months after the inoculation, plants were analyzed for canopy symptoms and the presence of pathogen in feeder roots. More than 50% of inoculated plants showed foliage symptoms and extensive decay of feeder roots. Colonies of Phytophthora were recovered from necrotic rootlets and identified as P. palmivora, fulfilling Koch's postulates. To the best of our knowledge, this is the first report of P. palmivora as a pathogen to citrus plants in the Egyptian nurseries. P. palmivora should be considered a potential threat to the Egyptian citrus industry since it may negatively influence the nurseries and orchards production in the future. References: (1) A. Ippolito, V. De Cicco, and M. Salerno. Rivista di Patologia Vegetale 2:57, 1992. (2) H. Masago, M. Yoshikawa, M. Fukada, and N. Nakanishi. Phytopathology 67:425, 1977. (3) D. J. Stamps. Revised tabular key to the species of Phytophthora. CAB International Mycological Institute, Kew, Surrey, 1990. (4) T. Yaseen. Molecular diagnosis and biological control of Phytophthora-citrus root rot. PhD thesis. University of Bari, Italy, 2004.

Age at menarche among school girls in Sokoto, Northern Nigeria

BACKGROUND/OBJECTIVES

Menarche, the first menstrual period, is influenced by many factors including socio-economic status and rural or urban dwelling. The aims of the study were to compare the age at menarche between rural and urban girls and evaluate the anthropometric indices at menarche.

MATERIALS AND METHODS

A cross-sectional study of rural secondary school girls and urban school girls. A structured questionnaire was used to obtain information on their age at menarche and other relevant data. Their weights and heights were measured using computerized scales and calibrated walls.

RESULTS

Two hundred and twenty eight (228) rural girls and four hundred and eighty (480) urban girls that had attained menarche within a year were studied. Mean age at menarche for all the girls was 15.26 years. Mean menarcheal age for the rural and urban girls were 15.32 years and 15.20 years, respectively. Mean weight and height were 47.6 kg and 156.76 cm, respectively for the rural girls and 48.12 kg and 156.8 cm, respectively for the urban girls. There was no significance difference in age of menarche among the groups (P > 0.05).

CONCLUSION

The mean age at menarche for the school girls is 15.26 years. There was no difference in menarcheal age between the rural and urban school girls. Further longitudinal studies to compare rural school girls and urban school girls in private schools are required.

First Report of Cylindrocarpon pauciseptatum Associated with Root Rot and Decline of Peach in Southern Italy (Apulia Region)

During a survey for the sanitary status of stone fruits in southern Italy (Apulia region), symptoms of low vigor, sparse foliage, and chlorosis of leaves, frequently leading to decline or death of the plants, were observed on 3- to 5-year-old peach trees (Prunus persica) cvs. Tardi Belle, Zee Lady, and O'Henry grafted on GF677. Brown-to-black discolorations of the wood were observed in cross-sections of the trunks just below the graft union. Samples were collected from May to June 2010 from two symptomatic orchards in Brindisi and Foggia provinces. Small pieces of brownish, vascular wood and necrotic root tissues were surface disinfested, placed onto potato dextrose agar (PDA), and incubated for 7 days at 25°C in the dark. Single-conidial isolates were subsequently grown on PDA at 25°C for 10 days. Fungal colonies were presumptively identified as members of the genus Cylindrocarpon on the basis of their morphological and conidial characteristics. On PDA, the isolates developed abundant mycelium, which gradually became yellowish or partially brownish. Macroconidia were predominantly three septate, straight and cylindrical with both ends broadly rounded. Chlamydospores and ovoidal microconidia were observed on synthetic nutrient-poor agar (1). Sequence of the ribosomal internal transcribed spacer (ITS) region was obtained using universal primers (ITS6-ITS4) and deposited in GenBank (Accession No. HE577846). This sequence revealed 100% genetic identity with a sequence from Cylindrocarpon pauciseptatum Schroers & Crous (Accession No. EF607090), a recently described species (3). In nature, several species of the genus Cylindrocarpon affect a large number of woody plants, mainly grapevine, olive, and stone fruits, in which they attack the root surface (2). To verify Koch's postulates, the roots of 20 3-month-old peach seedlings (GF305) were dipped for 30 min in a spore suspension of the fungus (1 × 10⁸ conidia ml^-1). Seedlings were then transplanted in an artificial soil mix and held under controlled conditions in a greenhouse at 24°C. Typical black-foot symptoms developed on 92% of the inoculated plants within 3 months, whereas the control plants, whose roots had been dipped in distilled water, remained healthy. C. pauciseptatum was reisolated from infected tissues and internal vascular lesions of 45% of the inoculated plants, but none of the plants used as controls, fulfilling Koch's postulates. To our knowledge, this is the first report of this pathogen on peach in the Apulia Region of Italy. Currently, C. pauciseptatum is limited to a few orchards where presumably it was introduced with infected propagating material from extra-regional nurseries. C. pauciseptatum has the potential to negatively affect the stone fruit industry in Italy including reducing nursery production and productivity and vigor of trees in orchards, or even rapid death of young trees. References: (1) W. Gams et al. CBS Course of Mycology. 4th ed. Centraalbureau voor Schimmelcultures, Baarn, the Netherlands, 1998. (2) M. E. S. Hernandez et al. Eur. J. Plant Pathol. 104:347, 1998. (3) H. J. Schroers et al. Mycol. Res. 112:82, 2008.

Endophthalmitis following open-globe injuries

The incidence of traumatic endophthalmitis may be decreasing due to earlier wound closure and prompt initiation of antibiotics. Risk factors for endophthalmitis include retained intraocular foreign body, rural setting of injury, disruption of the crystalline lens, and a delay in primary wound closure. The microbiology in the post-traumatic setting includes a higher frequency of virulent organisms such as Bacillus species. Recognizing early clinical signs of endophthalmitis, including pain, hypopyon, vitritis, or retinal periphlebitis may prompt early treatment with intravitreal antibiotics. Prophylaxis of endophthalmitis in high-risk open-globe injuries may include systemic broad-spectrum antibiotics, topical antibiotics, and intravitreal antibiotics to cover both Gram-positive and Gram-negative bacteria. For clinically diagnosed post-traumatic endophthalmitis, intravitreal vancomycin, and ceftazidime are routinely used. Concurrent retinal detachment with endophthalmitis can be successfully managed with vitrectomy and use of intravitreal antibiotics along with a long acting gas or silicone oil tamponade. Endophthalmitis is a visually significant complication of open-globe injuries but early wound closure as well as comprehensive prophylactic antibiotic treatment at the time of injury repair may improve visual acuity outcomes.

Mapping Postgraduate Research at the University of Zambia: a review of dissertations for the Master of Medicine Programme

BACKGROUND

The publication of a dissertation is an integral part of the four-year postgraduate degree of Master of Medicine (in clinical disciplines) within the School of Medicine at the University of Zambia. The governing research policy states that the subject matter of the dissertation is expected to cover a topic relevant to health care in the Zambian context, that it be conducted in a way that is consistent with international ethical guidelines for biomedical research involving human subjects, and that research outcomes should be maximally utilized. The aim of the study is to explore the characteristics of the Masters of Medicine research at the University of Zambia.

METHODOLOGY

This descriptive study explores the subject matter and research methodology by type of clinical specialty of all dissertations from 1986 to 2009.

RESULTS

The 132 dissertations included 36 (27.3%) in Surgery, 35 (26.5%) in Paediatrics, 32 (24.2%) in Internal Medicine, 24 (18.2%) in Obstetrics and Gynaecology, and 5 (3.8%) in Orthopaedic Surgery. Only 7 (5.3%) were interventional/experimental studies (4 of which were randomized controlled trials). Cross-sectional studies were the predominant type of the 125 observational studies (n=112, 84.8%). Thirty-three dissertations (25.0%) predominantly addressed HIV (16 Internal Medicine, 10 Paediatrics, 6 Surgery and 1 Obstetrics and Gynaecology); and 18 (13.6%) predominantly addressed infections, excluding TB (11 in Paediatrics). Other subjects included malignancy (n=6), TB (n=5), and diabetes mellitus (n=4). Over half of the dissertations (76, 57.6%) addressed the determinants of the cause, risk and development of diseases; and a third dealt with management and evaluation of diseases (26 and 18, respectively).

CONCLUSIONS

Few dissertations were based on experimental designs and most addressed determinants of the cause of diseases through cross-sectional studies. HIV and infections predominate as diseases reflecting the prevailing disease patterns in Lusaka in particular, and Zambia in general.

Abdominal pregnancy with a full term live fetus: case report

This is a case report of an abdominal pregnancy that was carried to term with live fetus. Illiteracy, poverty and lack of antenatal care had resulted in her late presentation. Bleeding per vagina, persistence abdominal pain, weight loss and pallor were the main clinical features. She had laparotomy and delivery of a live fetus.

U.K. linesmen's experience of microshocks on HV overhead lines

Linesmen working on high voltage equipment occasionally report unpleasant discharges from equipment. The sensation is known as microshocks, which result from capacitive coupling of the linesmen to high voltage sources and subsequent discharging when in very close proximity to grounded objects. Often, this is just an annoyance, but the levels can become such that work has to cease. Microshocks are unpredictable, and therefore, planning maintenance work around them has not been possible. A survey has been developed to investigate and quantify different factors that may have a direct influence on the frequency and intensity of discharges. Transmission line workers (N = 102) from England and Wales participated in the survey and provided details of personal body characteristics as well as their experiences of microshocks. Survey results suggest a correlation between body mass index and certain work activities to the likelihood of a person experiencing microshocks, and their severity. Higher body mass index reduces the likelihood of experiencing painful microshocks. Climbing lattice towers adjacent to energized conductors is the area most associated with the phenomenon. Microshock incidents have increased or are occurring at the same rate as 5 years ago. Results presented will aid the development of policy statements and mitigation techniques that minimize linesmen's exposure to microshocks. [Supplementary materials are available for this article. Go to the publisher's online edition of the Journal of Occupational and Environmental Hygiene for the following free supplemental resources: a PDF file containing survey questions.].

The influence of motivational messages on future planning behaviors among HIV concordant positive and discordant couples in Lusaka, Zambia

In Zambia the HIV/AIDS epidemic has resulted in many single female-headed households. Strong patriarchal laws and customs prevent widows and children from maintaining economic assets. This study examines the impact of a video-based motivational intervention promoting future planning in 1,504 HIV-infected couples in Lusaka, Zambia. Following a group video session, couples randomized to the motivational arm could choose to write a will, identify a guardian for their children and make financial plans. Desirable behaviours modelled in the motivational video were measured at quarterly intervals for a year and compared in intervention and control arms. Demographic measures including age, income and educational status were not associated with planning behaviours. Participation in the intervention was associated with will writing (23% versus 5%) and naming a guardian (32% versus 17%) but not with other planning behaviours. The study demonstrates the ability of motivational messages integrated into HIV VCT to encourage future planning behaviour and points to the need to expand existing HIV and VCT services to meet other non-health needs of those living with HIV.