Discrepancies between clinical diagnoses and autopsy findings: A comparative study conducted in South Africa

The anatomical pathology autopsy serves several purposes, notably as a quality management tool for evaluation of accuracy in clinical diagnosis. Despite its value, for various reasons there has been an international decline in autopsies conducted. In the modern medical era, with all its advances in technology, diagnostic techniques and interventions, there is still a high discrepancy between clinical diagnoses and postmortem findings.Objectives. To establish the discrepancies between clinical diagnoses and postmortem findings in anatomical pathology autopsies.Methods. A retrospective, descriptive study was conducted over the 4-year-period 2014 - 2017. The clinical diagnoses and postmortem findings of cases referred to the Department of Anatomical Pathology at the University of Pretoria, South Africa, were evaluated and compared using the modified Goldman criteria.Results. A total of 288 cases qualified for the study and were evaluated. The gender distribution was 155 (53.8%) male and 133 (48.2%) female, with the majority of cases in the age group 19 - 60 years (mean 36.4). The majority of the cases were referred by internal medicine, followed by paediatrics. The most common cause of death in major missed diagnoses was pulmonary conditions. Of the cases, 115 (39.3%) had a major discrepancy and 62 (21.5%) a minor discrepancy.Conclusion. This study showed that there is still a high discrepancy between clinical diagnoses and postmortem findings, similar to studies conducted globally. The current COVID-19 pandemic may be a driver for revival of the anatomical pathology autopsy, and future studies are recommended to evaluate whether the decline can be reversed

The application of sigma metrics in the laboratory to assess quality control processes in South Africa

Objective: This study aimed to determine the sigma metrics of analytes when using different total allowable error guidelines.Methods: A retrospective analysis was performed on 19 general chemistry analytes at Charlotte Maxeke Johannesburg Academic Hospital in South Africa between January 2017 and December 2017. Sigma metrics were calculated on two identical analysers, using internal quality control data and total allowable error guidelines from the Ricos biological variation database and three alternative sources (the Royal College of Pathologists of Australasia, the Clinical Laboratory Improvements Amendment, and the European Federation of Clinical Chemistry and Laboratory Medicine). Results: The sigma performance was similar on both analysers but varied based on the guideline used, with the Clinical Laboratory Improvements Amendment guidelines resulting in the best sigma metrics (53% of analytes on one analyser and 46% on the other had acceptable sigma metrics) and the Royal College of Pathologists of Australia guidelines being the most stringent (21% and 23%). Sodium and chloride performed poorly across all guidelines (sigma < 3). There were also month-to-month variations that may result in acceptable sigma despite poor performance during certain months.Conclusion: The sigma varies greatly depending on the total allowable error, but could be a valuable tool to save time and decrease costs in high-volume laboratories. Sigma metrics calculations need to be standardised

Pathologic changes in patients infected with SARS-CoV-2: a review

Severe acute respiratory syndrome­coronavirus-2 (SARS-CoV-2) enters cells using the angiotensin converting enzyme 2 (ACE2), which are expressed by the respiratory tract endothelium, epithelial cells of the stomach, duodenum, ileum, rectum, cholangiocytes, and hepatocytes. Pathological examinations of these organs are not feasible method of diagnosis but can explain pathological changes, pathogenesis of the disease, and the cause of death in COVID-19 cases. In this review, we performed a literature search for COVID-19-related pathological changes seen during post-mortem examinations in different organs of the body including the lungs, gastrointestinal tract, liver, kidney, skin, heart and blood. Our findings showed that SARS-CoV-2 has damaging effects on many organs, probably due to the host immune responses to the presence of the virus. It is recommended that both antiviral and immunomodulatory agents should be considered in the management of COVID-19 patients for better prognosis, and clinical outcome

Profil des patients suivis pour affections urologiques chirurgicales aux Cliniques universitaires de Kisangani-RDC

Introduction. Les pathologies urologiques regroupent un ensemble des pathologies multiples et variées.Ces pathologies comme toutes celles chirurgicales constituent l'une des causes de mortalité en chirurgie curative surtout dans les pays en voie de développement. Le but de notre étude était donc de ressortir le profil des patientes avec pathologies chirurgicales urologiques rencontrées aux Cliniques Universitaires de Kisangani. Méthodologie.Etude transversale, descriptiveportant sur tous les cas despathologies urologiques chirurgicalesdiagnostiquées et traitéesaux cliniques universitaires de Kisangani durantla période du1er janvier 2013 au31 décembre 2017.Résultats.Les affections urologiques chirurgicales représentaient 9,7% des cas, concernant essentiellement les hypertrophies prostatiques avec 57,3% des cas. La plupart des patients avec affection urologique chirurgicale étaient de sexe masculin (98,7%), âgés de 61 ans et plus (58,7%) avec une moyenne d'âge de 55,7 ans et des extrêmes allant de 2 à 81ans, mariés (74,6%) et agents de l'état (46,7 %).Conclusion.Les pathologies urologiques chirurgicales dominées par les hypertrophies de la prostate sont fréquentes aux Cliniques universitaires de Kisangani

Perceived and real histopathology turnaround time: A teaching hospital experience

Background: This study aims to audit analytic turnaround time (TAT) in a histopathology laboratory with a view to assessing the timeliness of its reports, identify causes of delay in its TAT, and compare this with client perception of its performance. Materials and Methods: Records of 1440 batches of specimens processed over a 5-year period in the histopathology laboratory of a teaching hospital were retrieved from archives. From these, median and mean TATs were calculated and causes of delay identified. Questionnaires were also deployed to assess physicians' perception of the laboratory's performance. Results: Analytic TAT was 3.6 ± 2 days, with 86.7% of reports being ready within 5 working days. The delays in timeliness of report generation were due mainly to residency training-related factors; tissue processing-related factors, and inadequate clinical information among others. Client perception of TAT rated the laboratory below average by 18.4%; average by 57.5%; good by 20.7%, and excellent in its performance by 3.4% of respondents. Conclusion: Even though physicians perceived the laboratory's TAT to be just average, its analytic TAT for reports is within acceptable international standards but with room for improvement in its performance

Indications et aspects histopathologiques des biopsies de l'endometre a l'Hopital Gyneco-Obstetrique et Pediatrique de Yaoundé (Cameroun)

Une étude rétrospective et descriptive de 118 biopsies endo-métriales a été effectuée à l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé pour répertorier les indications et les aspects histologiques. Résultats. L'âge moyen était de 46,85 ±13,57 ans. Les saignements utérins anormaux et l'hydrorrhée vaginale constituaient les indications les plus fréquentes (84,76% et 8,47% respectivement). Le mode de prélèvement le plus utilisé était le curetage biopsique (91,5%). Les lésions histologiques étaient dysfonctionnelles (79,66%), cancéreuses(13,56%) et inflammatoires (6,78%). Les cancers les plus fréquentes étaient l'adénocarcinome endométrial invasif (50,0%) et le carcinome épidermoïde invasif (25,0%); Certains de ces cancers étaient probablement d'origine cervicale. Les lésions dysfonctionnelles (69,49%)et cancéreuses (13,55%) étaient statistiquement associées aux saignements utérins anormaux et les lésions inflammatoires (3,38%) à l'hy-drorrhée vaginale. Conclusion. Les lésions dysfonctionnelles occupent une place plus importante chez les femmes en période d'activité géni-tale et devraient être pris en compte dans la mise en place des algo-rithmes de prise en charge de la pathologie endométriale

Pattern of Surgical Diseases Based on Histopathological Findings: A 13-years Personal Experience in a Rural Hospital in Kenya

Background: Church/mission hospitals and other non-government health institutions inKenya provide 30of the healthcare needs; providing affordable care to the rural poor. This review presents the surgical pathology to which a general surgeon working in a rural Kenyan hospital is exposed through training and beyond. Additionally; some ofthe rarer surgical pathology; `rare birds'; encountered during this period is reported. Methods: In this retrospective study; all the surgical specimens submitted by the author for histopathological examination over a period of thirteen years were reviewed and analyzed. The findings are reported. Results: The results of 1826 surgical specimens were divided into the major surgical specialties that a surgeon working in this environment is exposed to. General surgical specimens constituted 48.4of the total specimens; while urology; gynecology; maxillofacial/otolaryngology and `other' specialties made up 34.6; 7.8; 6.7; and 2.5respectively. There were a total of 389 malignancies; of which 55were in general surgery and 31.1in urology. Rare surgical pathologies encountered over this period included acne conglobata; an intramuscular lipoma of the forearm; intraosseous lipoma of the fibula; primary tuberculosis of the prostate gland and of the thyroid gland; amongst others. Conclusion: Church/mission hospitals currently present excellent opportunities both for training and career development in general surgery and related disciplines

Quantitative pathology : historical background, clinical research and application of nuclear morphometry and dna image cytometry

Quantitative analysis of histo- and cytochemical components such as DNA, RNA or chromatin pattern on one hand (cytometry) and the quantitative analysis of geometric non-chemical cell and tissue components (morphometry and sterology) on the other, have developed somewhat independently. Today, many different techniques, such as morphometry, sterology, and static image and flow cytometry are well established and routinely used in diagnostic quantitative pathology. The potential significance of these techniques in the individualization of care in cancer patients include the objective distinction between benign, borderline and malignant lesions, objective grading of invasive tumours, prediction of prognosis, and therapy response

Aspects anatomo-pathologiques des pseudo-tumeurs et tumeurs naso-sinusiennes a Abidjan

Cette etude retrospective sur 10 ans (1er Janvier 1993 au 31 Decembre 2003) portant sur 96 dossiers rend compte de la rarete des tumeurs et pseudo-tumeurs des cavites naso-sinusiennes a Abidjan. Les facteurs a risque les plus frequents sont les infections naso-sinusiennes chroniques; suivis des facteurs exogenes d'origine professionnelle. La biopsie locale a ete le type de prelevement le plus pratique (60;41pour cent). Les pseudo-tumeurs et les tumeurs benignes sont les plus frequentes; retrouvees a pourcentage egale de 30;20pour cent. Ils sont respectivement domines par le polype inflammatoire (89;47pour cent) et le papillome (55;17pour cent). Les tumeurs malignes representent 27;8pour cent ou le carcinome epidermoide en constitue 65;38pour cent. Les infections specifiques constituent 12;5pour cent de notre echantillon dont le rhinosclerome (66;66pour cent). Ces lesions ont le plus souvent interesse le sujet de sexe masculin age entre 20et 40 ans (44;78pour cent) avec un pic de frequence pour les 30 a 40 ans. Ces resultats sont en partie superposables aux donnees de la litterature. Il a ete etonnant de ne pas retrouver le type histologique favorise par les expositions aux poussieres de bois exotique a savoir l'adenocarcinome dans cette etude realisee en milieu tropical. Le bois de Cote d'Ivoire serait-il peu agressif? Il s'agit la d'une base de donnees initiale des pseudo-tumeurs et tumeurs des cavites naso-sinusiennes a Abidjan qui devrait etre completee et regulierement mise a jour

Fractures de l'orbite : aspects etiopathologeniques; anatomo-patologiques; cliniques et therapeutiques

Il s'agit d'une etude retroprospective portant sur les fractures de l'orbite dans leurs aspects etiopathogeniques; anatomopathologiques; cliniques et therapeutiques dans le service de chirurgie maxillo-faciale et stomatologie au CHU de Treichville. Notre etude a couvert une periode de un an six mois allant du 21 fevrier 2001 au 24 juillet 2002. Au decours de cette etude qui a porte sur 43 cas de fractures de l'orbite; nous avons obtenu les resultats suivants: -La population des patients est dominee d'une part par les tranches d'ages comprises entre 20 et 40 ans (72;1pour cent) avec l'age moyen situe a 32;1 ans et d'autre part par une nette predominance masculine; le sexe-ratio etant de 5 hommes pour une femme ; -Les circonstances etiologiques dans les fractures sont plus representees par les accidents de la circulation avec une proportion de 79;1pour cent ; -Les fractures de l'orbite les plus rencontrees sont les fractures de la paroi inferieure avec 76;7pour cent des cas et les fractures de la paroi externe avec 37.2pour cent des cas ; -Les varietes anatomo-pathologiques des fractures de la paroi inferieure sont representees par les fractures isolees du plancher constituant 39;4pour cent des cas. Elles sont rencontrees a 46;1pour cent des cas dans le blow-out pur et 38pour cent des cas dans l'impur. Le trap door est survenu clins 15;4pour cent des cas ; Les DCF sont plus representes par le fort type III dans les proportions de 45;4pour cent des cas ; -Les patients ont beneficie dans 93pour cent des cas d'un traitement a type d'osteosynthese. Les fils d'acier et la plaque grillagee ont ete utilises respectivement avec un taux de 93pour cent et de 32;6pour cent des cas. L'analyse des resultats a permis de montrer la necessite d'une prise en charge multidisciplinaire avec en esprit la sauvegarde de la fonction visuelle et de l'esthetique

Les cancers du tractus genital feminin : aspects epidemiologiques et histologiques de 1455 cas diagnostiques dans les laboratoires d'anatomie pathologique des CHU de Cocody et de Treichville (1984-1993)

Notre travail a porte sur l'etude de 1455 cancers du tractus genital de la femme histologiquement diagnostiques de 1984 a 1993 dans les laboratoires d'anatomie pathologique des CHU de Cocody et Treichville. II ressort de notre etude que : les cancers du tractus genital feminin representaient 20;13 pour cent de l'ensemble des cancers et 40;27 pour cent des cancers de la femme ; la localisation cervicale etait nettement la plus frequente avec 70;45 pour cent et un age moyen de 35;28 ans ; une nette predominance des tumeurs d'origine epitheliales avec 84;81 pour cent en particulier le carcinome epidermoide (78;04 pour cent) ; les sarcomes et les autres types histologiques representaient respectivement 2;34 pour cent et 12;85 pour cent

Nephropathie diabetique : caracteristiques anatomo-cliniques des cas observes aux Cliniques universitaires de Kinshasa

La nephropathie diabetique complication majeure du diabete sucre est associee a une forte mortalite liee a l'insuffisance renale terminale et aux complications cardiovasculaires. Environ 30-40 pour cent des diabetiques insulinodependants et 10-20 pour cent des non insulinodependants developperont au cours de leur diabete

Turberculose nasale: à propos d'un cas, et revue de la litterature

La tuberculose nasale est une affection rare. Nous rapportons un cas de forme pseudo-tumorale siegeant aux depens du corner inferieur de la fosse nasale gauche; chez un homme de 40 ans; en bon etat general. Le diagnostic a ete fait grace a l'histopathologie. Le traitement a ete medico-chirurgical. Une revue de la litterature a ete faite

Leukokeratosis nicotinica; tobacco/snuff and tobacco smoking-pre-cancerous and malignant potentials

Leukokeratosis nicotinica is keratosis found in the oral mucosa of chronic chain smokers especially pipe smokers and commonest in the palate. There is no sex predilection so far as the smoking habit is chronic. The lesion is also known as nicotine stomatitis and smoker's keratosis. Though leukokeratosis nicotinica is not ranked mainly as precancerous lesion; it may have some degrees of dyplastic changes indicative of premalignancy and in some cases carcinoma in situ

Collagen content of normal human myocardium

Hydroxyproline concentration; representing the collagen content of the normal right and left ventricular muscle in young adult Nigerians was estimated. The hydroxyproline concentration in the left ventricular muscle was lower than in the right ventricle; (Mean collagen content of right ventricle was 5.58 + 0.95 ug/mg dry weight and left ventricle 3.15 + 0.35 ug/mg dry weight). The results of this preliminary study demonstrates that changes in myocardial collagen parameters may be useful in the diagnosis of cardiac hypertrophy; heart failure; endomyocardial fibrosis or other pathogenesis of cardiac diseases in the tropics