Comorbidities and the COVID-19 pandemic dynamics in Africa.

The debate around the COVID-19 response in Africa has mostly focused on effects and implications of public health measures, in light of the socio-economic peculiarities of the continent. However, there has been limited exploration of the impact of differences in epidemiology of key comorbidities, and related healthcare factors, on the course and parameters of the pandemic. We summarise what is known about (a) the pathophysiological processes underlying the interaction of coinfections and comorbidities in shaping prognosis of COVID-19 patients, (b) the epidemiology of key coinfections and comorbidities, and the state of related healthcare infrastructure that might shape the course of the pandemic, and (c) implications of (a) and (b) for pandemic management and post-pandemic priorities. There is a critical need to generate empirical data on clinical profiles and the predictors of morbidity and mortality from COVID-19. Improved protocols for acute febrile illness and access to diagnostic facilities, not just for SARS-CoV-2 but also other viral infections, are of urgent importance. The role of malaria, HIV/TB and chronic malnutrition on pandemic dynamics should be further investigated. Although chronic non-communicable diseases account for a relatively lighter burden, they have a significant effect on COVID-19 prognosis, and the fragility of care delivery systems implies that adjustments to clinical procedures and re-organisation of care delivery that have been useful in other regions are unlikely to be feasible. Africa is a large region with local variations in factors that can shape pandemic dynamics. A one-size-fits-all response is not optimal, but there are broad lessons relating to differences in epidemiology and healthcare delivery factors, that should be considered as part of a regional COVID-19 response framework.

Morphology of colorectal carcinoma among Nigerians: a 30-year review.

BACKGROUND: The incidence of colorectal carcinoma has been on the increase in the developing countries, including Nigeria, as a result of change in diet and adoption of western lifestyle. OBJECTIVES: The aim of this review is to highlight the prevalence, age and sex distribution, anatomical location, and morphological characteristics of colorectal carcinomas in Ilorin, Nigeria. MATERIALS AND METHODS: This is a retrospective study of all cases of histologically diagnosed colorectal carcinoma in the University of Ilorin Teaching Hospital, Ilorin, Nigeria, over a 30-year period (January 1979-December 2008), using the departmental record and histological slides of the cases. RESULT: A total of 241 cases of colorectal carcinoma were reported, 144 cases (60%) in males and 96 cases (40%) in females with a male: female ratio of 1.5:1. The peak age of occurrence for males was between 51 and 60 years, while that of the females was between 41 and 50 years. The malignancy was found in the rectum in 60.2% of the cases, while the least affected site is the descending colon (1.2%). The exophytic occluding masses were found in 82.2% of the cases, and the most common histological type is adenocarcinoma (77.2%) with well-, moderately, and poorly differentiated forms constituting 52.3%, 32.8%, and 14.9% respectively. Of the 241 cases that were seen over the last 30 years, 93 cases (38.6%) were seen in the last 5 years. CONCLUSION: Colorectal carcinoma is no longer a rare disease in Nigeria. The surge in the incidence reported in the last 5 years in this center calls for a pragmatic action in its control, with emphasize on colonoscopic screening for those with family history, and possibly making digital rectal examination a mandatory aspect of clinical examination, because most colorectal carcinomas are within the reach of examining finger.

Morphology of Colorectal Carcinoma among Nigerians: A 30-Year Review

Background: The incidence of colorectal carcinoma has been on the increase in the developing countries; including Nigeria; as a result of change in diet and adoption of western lifestyle. Objectives: The aim of this review is to highlight the prevalence; age and sex distribution; anatomical location; and morphological characteristics of colorectal carcinomas in Ilorin; Nigeria. Materials and Methods: This is a retrospective study of all cases of histologically diagnosed colorectal carcinoma in the University of Ilorin Teaching Hospital; Ilorin; Nigeria; over a 30-year period (January 1979-December 2008); using the departmental record and histological slides of the cases. Result: A total of 241 cases of colorectal carcinoma were reported; 144 cases (60) in males and 96 cases (40) in females with a male: female ratio of 1.5:1. The peak age of occurrence for males was between 51 and 60 years; while that of the females was between 41 and 50 years. The malignancy was found in the rectum in 60.2of the cases; while the least affected site is the descending colon (1.2). The exophytic occluding masses were found in 82.2of the cases; and the most common histological type is adenocarcinoma (77.2) with well-; moderately; and poorly differentiated forms constituting 52.3; 32.8; and 14.9respectively. Of the 241 cases that were seen over the last 30 years; 93 cases (38.6) were seen in the last 5 years. Conclusion: Colorectal carcinoma is no longer a rare disease in Nigeria. The surge in the incidence reported in the last 5 years in this center calls for a pragmatic action in its control; with emphasize on colonoscopic screening for those with family history; and possibly making digital rectal examination a mandatory aspect of clinical examination; because most colorectal carcinomas are within the reach of examining finger

Pathological characterization of colorectal polyps in Ilorin, Nigeria.

Colorectal polyps especially the adenomas are recognized precursors of colorectal carcinoma. Identification and removal of such polyps before malignant transformation could reduce the burden of colorectal carcinoma. To document the demography and the histopathological types ofcolorectal polyps received by the Department of Pathology of University of Ilorin Teaching Hospital over a period of thirty years. This is a retrospective review of all cases ofcolorectal polyps that were received, processed and had histological diagnosis in our centre between 1979 and 2008 using the request cards and hematoxylin and eosin stained slides. Forty-four cases of colorectal polyps were reviewed constituting 6.7 percent of all colorectal biopsies/resections received in the same period. The male to female ratio was 2.1:1. Seventeen (38.6%) were adenomas, 9 (20.5%) were juvenile polyps, 8 (18.2%) were inflammatory polyps, 4 cases were lipomatous polyps, 3 were leiomatous polyps, and one each of lymphoid polyp, hamartomatous polyp and neurofibromatous polyp. Of the adenomas, 11 (58.8%) were tubular, 5 (29.4%) were villous, 1 (5.9%) was tubulovillous, and one was a villous adenoma with a focus of malignant transformation. Adenomatous polyp is the commonest pathological type ofcolorectal polyps in our centre. This study therefore sets out to review the age and sex distribution, location and morphological characteristics of all cases of colorectal polyps in our centre over the study period.

[MRI-based flow measurements in the main pulmonary artery to detect pulmonary arterial hypertension in patients with cystic fibrosis]. / MRT-basierte Flussmessungen im Truncus pulmonalis zur Detektion einer pulmonal-arteriellen Hypertonie in Patienten mit zystischer Fibrose.

PURPOSE: Development of pulmonary arterial hypertension (PH) is a common problem in the course of patients suffering from cystic fibrosis (CF). This study was performed to evaluate MRI based flow measurements (MR(venc); Velocity ENCoding) to detect signs of an evolving PH in patients suffering from CF. MATERIALS AND METHODS: 48 patients (median age: 16 years, range: 10 - 40 years, 25 female) suffering from CF of different severity (mean FEV (1): 74% +/- 23, mean Shwachman-score: 63 +/- 10) were examined using MRI based flow measurements of the main pulmonary artery (MPA). Phase-contrast flash sequences (TR: 9.6 ms, TE: 2.5 ms, bandwidth: 1395 Hertz/Pixel) were utilized. Results were compared to an age- and sex-matched group of 48 healthy subjects. Analyzed flow data where: heart frequency (HF), cardiac output (HZV), acceleration time (AT), proportional acceleration time related to heart rate (ATr), mean systolic blood velocity (MFG), peak velocity (Peak), maximum fow (Fluss(max)), mean flow (Fluss(mitt)) and distensibility (Dist). RESULTS: The comparison of means revealed significant differences only for MFG, Fluss(max) and Dist, but overlap was marked. However, using a scatter-plot of AT versus MFG, it was possible to identify five CF-patients demonstrating definite signs of PH: AT = 81 ms +/- 14, MFG = 46 +/- 11 cm/s, Dist = 41% +/- 7. These CF-patients where the most severely affected in the investigated group, two of them were listed for complete heart and lung transplantation. The comparison of this subgroup and the remaining CF-patients revealed a highly significant difference for the AT (p = 0.000001) without overlap. CONCLUSION: Screening of CF-patients for the development of PH using MRvenc of the MPA is not possible. In later stages of disease, the quantification of AT, MFG and Dist in the MPA may be useful for the detection, follow-up and control of therapy of PH. MR(venc) of the MPA completes the MRI-based follow-up of lung parenchyma damage in patients suffering from CF.

DISC1 association, heterogeneity and interplay in schizophrenia and bipolar disorder.

Disrupted in schizophrenia 1 (DISC1) has been associated with risk of schizophrenia, schizoaffective disorder, bipolar disorder, major depression, autism and Asperger syndrome, but apart from in the original translocation family, true causal variants have yet to be confirmed. Here we report a harmonized association study for DISC1 in European cohorts of schizophrenia and bipolar disorder. We identify regions of significant association, demonstrate allele frequency heterogeneity and provide preliminary evidence for modifying interplay between variants. Whereas no associations survived permutation analysis in the combined data set, significant corrected associations were observed for bipolar disorder at rs1538979 in the Finnish cohorts (uncorrected P=0.00020; corrected P=0.016; odds ratio=2.73+/-95% confidence interval (CI) 1.42-5.27) and at rs821577 in the London cohort (uncorrected P=0.00070; corrected P=0.040; odds ratio=1.64+/-95% CI 1.23-2.19). The rs821577 single nucleotide polymorphism (SNP) showed evidence for increased risk within the combined European cohorts (odds ratio=1.27+/-95% CI 1.07-1.51), even though significant corrected association was not detected (uncorrected P=0.0058; corrected P=0.28). After conditioning the European data set on the two risk alleles, reanalysis revealed a third significant SNP association (uncorrected P=0.00050; corrected P=0.025). This SNP showed evidence for interplay, either increasing or decreasing risk, dependent upon the presence or absence of rs1538979 or rs821577. These findings provide further support for the role of DISC1 in psychiatric illness and demonstrate the presence of locus heterogeneity, with the effect that clinically relevant genetic variants may go undetected by standard analysis of combined cohorts.

Whole-genome association study of bipolar disorder.

We performed a genome-wide association scan in 1461 patients with bipolar (BP) 1 disorder, 2008 controls drawn from the Systematic Treatment Enhancement Program for Bipolar Disorder and the University College London sample collections with successful genotyping for 372,193 single nucleotide polymorphisms (SNPs). Our strongest single SNP results are found in myosin5B (MYO5B; P=1.66 x 10(-7)) and tetraspanin-8 (TSPAN8; P=6.11 x 10(-7)). Haplotype analysis further supported single SNP results highlighting MYO5B, TSPAN8 and the epidermal growth factor receptor (MYO5B; P=2.04 x 10(-8), TSPAN8; P=7.57 x 10(-7) and EGFR; P=8.36 x 10(-8)). For replication, we genotyped 304 SNPs in family-based NIMH samples (n=409 trios) and University of Edinburgh case-control samples (n=365 cases, 351 controls) that did not provide independent replication after correction for multiple testing. A comparison of our strongest associations with the genome-wide scan of 1868 patients with BP disorder and 2938 controls who completed the scan as part of the Wellcome Trust Case-Control Consortium indicates concordant signals for SNPs within the voltage-dependent calcium channel, L-type, alpha 1C subunit (CACNA1C) gene. Given the heritability of BP disorder, the lack of agreement between studies emphasizes that susceptibility alleles are likely to be modest in effect size and require even larger samples for detection.

The pattern of malignant tumours of the liver in a tertiary health institution in Nigeria.

This study aims at establishing the histopathological pattern of liver cancers reported in the Department of Pathology, University of Ilorin Teaching Hospital between January 1979 and December 1996. Histopathological slides and duplicate copies of reports were retrieved and re-examined while fresh sections were processed from original paraffin blocks when necessary. Liver cancers constituted 56.6% of all liver biopsies. Hepatocellular carcinoma, which was commonest in the fifth decade, occurred in 64.1%, while metastatic tumours, which were commonest in the sixth decade, accounted for 24.7%. Primary sites could only be determined in 5 out of the 35 metastatic tumours. The age range of patients with Burkitt's lymphoma was 6-17 years with an average of 10.8 years and a male/female ratio of 3:2. Overall, there was preponderance of hepatocellular carcinoma in males while metastatic tumours were commoner in females. The pattern of Burkitt's lymphoma demonstrated in this study agrees with what generally obtains for endemic Burkitt's lymphoma in this environment.

Histopathological assessment of the pattern of liver cirrhosis in a tropical population.

This study aims at establishing the pattern of liver cirrhosis. Histology slides and duplicate copies of reports were retrieved and re-examined while fresh sections were processed from original paraffin blocks when necessary. Cirrhosis was the second commonest cause of chronic liver disease after hepatocellular carcinoma. The commonest morphological type was macronodular cirrhosis. Micronodular cirrhosis is not as common in black Africans as among the Caucasians. This is not unexpected since alcoholic liver disease that is of aetiopathogenetic importance is also not as common as what is often found in Causasians. Biliary cirrhosis was reported in an 8 months old girl consequent upon congenital absence of gallbladder and biliary tree. There was male preponderance in the occurrence of cirrhosis with a male, female ratio of 2.5:1. The incidence gradually increased from early adult life but was highest in the middle age especially between the age group of 51-60 years and subsequently dropped sharply. Adequate diagnostic facilities should be provided to determine the incidence of hepatotropic viruses and their contribution to the incidence of chronic liver diseases. Case-controlled studies should be carried out to determine the role of local cultural practices on hepatocellular injury and the development of chronic liver disease.

Incidence of primary extranodal lymphoma involving gastrointestinal tract by histological type at Ilorin.

We report 21 cases of primary extranodal lymphoma of the gastrointestinal tract over a period of 10 years (1986-1995) at the Department of Morbid Anatomy and Histopathology, University of Ilorin Teaching Hospital, Ilorin, Kwara State of Nigeria. This represents 6% of the total gastrointestinal tract malignancies diagnosed during same period. All were Non Hodgkin's Lymphoma. The ages ranged from 4 to 60 years, while the mean age was 23 years. Male to female ratio was 4:3. The anatomic sites involved were stomach 4, (19%), small intestine 13, (62%), and large intestine 4, (19%). There was no single case of rectal lymphoma. The histological types were Burkitt's lymphoma 9 (42.8%), diffuse mixed (small and large) cells 4 (19.1%), diffuse large cells 4 (9.1%), small lymphocytic cells, 2 (9.5%) and large immunoblastic cells 2 (9.5%). All the cases of Burkitt's lymphoma occurred under 20 years of age. Distribution into prognostic groups (grades) according to working formulation for clinical usage was low grade, 2 (9.5%), intermediate grade, 8 (38.1%) and High grade, 22 (52.4%). We conclude that extranodal malignant lymphoma involving the gastrointestinal tract is not rare and should be considered for differential diagnosis in gastrointestinal tract malignancies.

Peripheral lymphadenopathy in Nigeria.

A review was carried out on the histopathological diagnosis of peripheral lymph node biopsies processed and reported within a period of 18 years (1979-1996) in the Department of Pathology of University of Ilorin Teaching Hospital, Ilorin, Nigeria. A total of 751 cases from 468 male and 283 female patients within the age range of 1 year to 80 years were reviewed. Non-neoplastic lesions made up 50.8% while neoplastic lesions constituted 49.2%. Tuberculosis was the commonest cause of peripheral lymphadenopathy (31.4%) followed by metastatic lesions (19.3%). As a group, the lymphomas constituted 28.2% and were made up of Hodgkin's disease 12.6%, non-Hodgkin's lymphoma including Burkitt's lymphoma 15.6% (with Burkitt's alone constituting 3.3%). Few other infectious diseases found included toxoplasmosis, histoplasmosis and onchocerciasis. Non-specific reactive and inflammatory changes (both acute and chronic) collectively formed 17.6%. The primary sites of lymph node metastases could not be determined in 36.6% of netastatic lesions while the breast was the origin in 13.8% and was the highest incidence of metastatis. The commonest lymph node group affected was the cervical (42.6%) followed by inguinal (24.1%).

Nephroblastoma and renal dysplasia in a 40 year old Nigerian man with an atrophic contralateral foetal kidney.

This report concerns a 40 year old Nigerian man whose initial presentation mimicked acute pyelonephritis. He was subsequently found to have a renal tumour which turned out to be a nephroblastoma. In addition, there was marked renal dysplasia and the contralateral kidney was atrophic and foetal in configuration. The possible link between these observations is discussed.

Unusual oesophageal cancer: a report of four cases.

The prognosis for carcinoma of the oesophagus is generally dismal especially when patients present late. Any clues to early diagnosis and management and identification of rapidly progressive variants are therefore helpful. Reports and review of the literature are presented with respect to four unusual cases of oesophageal carcinoma treated in the University of Ilorin Teaching Hospital in 1985 and 1986. Four men aged 59, 60, 55 and 60 years respectively presented with multiple polypoid carcinoma of the oesophagus, malignant oesophago-bronchial fistula at the level of the left main stem bronchus, achalasia co-existing with oesophago-gastric carcinoma and a small focus of carcinoma of the distal thoracic oesophagus presenting with widespread thoracic metastases and malignant pleural effusion mimicking advanced bronchogenic carcinoma. The unusual clinico-pathological features with the autopsy findings in the last case can influence diagnosis, management and prognosis of oesophageal cancer in general and of such cancer associated with pre-malignant conditions like achalasia and oesophageal polyps in particular.

An unusual presentation of urogenital rhabdomyosarcoma (sarcoma botryoides) in a Nigerian child.

A 5-year-old child who presented with what was diagnosed clinically as posterior urethral valve and radiologically as multiple urethral and vesical polyps is described. This lesion was found on histological investigation to be a rhabdomyosarcoma (sarcoma botryoides).

Surgical diagnosis of bronchopulmonary disease in Nigerians: the role of mediastinal biopsy.

Surgical diagnostic procedures were done on 33 Nigerians (20 males and 13 females [mean age 47.0 years +/- 20.5 SD]) who presented with atypical noneffusive bronchopulmonary diseases between 1982 and 1988. Rigid bronchoscopy was done 16 times with or without mediastinal biopsy. Mediastinal biopsy was done through scalene, supraclavicular, or suprasternal approach or by anterior mediastinotomy on 23 occasions. Diagnostic yield and clinicopathologic concurrence for the 23 mediastinal biopsies were 91.3% and 95.6%, respectively. No deaths were associated with these biopsy procedures.

Pattern of congenital malformations in Nigerian children.

A series of 252 abortuses, stillbirths and neonates at the University of Ilorin Teaching Hospital and ECWA Hospital, Egbe, in Nigeria, were examined by autopsy dissection between 1983 and 1985. Their clinical cohorts in the nurseries, pediatric wards and those subjected to operations were also reviewed. Primary school children volunteers in two Ilorin schools were also examined in 1987 for cardiopulmonary malformations and umbilical hernia. Incident rates for congenital malformations ranged from 0.08 to 38.27% for congenital groin hernia, 2.39 to 8.73% for umbilical hernia, and 0.21 to 21.05% for the entire gastrointestinal tract. Other incident rates are 0.10 to 7.14% for genitourinary tract, 0.33 to 6.69% for CNS, 0.16 to 5.55% for musculoskeletal system, 0.26 to 4.76% for cardiovascular and 0.06 to 3.9% for bronchopulmonary malformations. The scope of the study is expected to make it adaptable in other developing countries.

Clinical, operative and pathological correlations in fatal and near-fatal thoracic trauma in Nigerians.

A combined retrospective and prospective review of 248 chest trauma patients has been carried out at the University of Ilorin Teaching Hospital between 1979 and 1986. Eight and 12 of these patients respectively were so severely injured that they were certified dead on arrival in the Emergency Room or at varying periods during resuscitation but before definitive management. Ten others were subjected to major operation. The peculiar clinical features of this sub-group of 30 patients within the context of the entire series are analysed in detail and correlated with autopsy and operative findings in 20 and 10 patients respectively. Most (36.7%) of the severe injuries occurred in the 21-30 age group followed by children under 10 years of age (16.7%). When injuries are classified into life-threatening, potentially life-threatening and mild (including incidental pathology found at autopsy), the majority (95%) of autopsy cases sustained multiple trauma combining cranio-encephalic, abdominal, extremity and spinal injuries, in descending order, with chest trauma. Penetrating trauma constituted 50% of the thoracotomy group while all but one of 20 autopsy cases sustained blunt injuries. Multiple rib fractures including proximal ones were common. No major tracheobronchial or aortic disruptions were encountered while two cases of heart injury were seen. Suggestions are made towards decreasing the injury treatment interval, improving the general level of preparedness and diagnosis of visceral injury despite more obvious non-visceral trauma.

Surgical diagnosis of effusive bronchopulmonary disease in Nigerians: the role of pleural biopsy at tube thoracostomy.

Seventy-two consecutive patients who had pleural biopsy through tube thoracostomy sites (TTSPB) for pleuro-pulmonary diseases associated with pleural effusion at the University of Ilorin Teaching Hospital between April 1982 and September 1987 were reviewed. The objective was to determine the diagnostic yield of pleural biopsy material in these patients. The patients, whose ages ranged from 9 months to 90 years, had final diagnoses of non-tuberculous pleuritis (35 patients), tuberculous pleuritis (14 patients), primary and secondary malignancies and reticulosis (23 patients). Diagnostic yield by TTSPB was 95.8% (69 patients) while clinicopathologic concurrence was 90.3% (65 patients). For patients presenting with pleural fluid collection secondary to pleuropulmonary disease, TTSPB is a reliable, safe, cost-effective and relatively simple thoracic surgical diagnostic procedure which gives a higher diagnostic yield and clinico-pathologic concurrence than percutaneous needle biopsy.