THE RELEVANCE OF PATHOLOGY IN HEALTH CARE DELIVERY: PAEDIATRICS IN FOCUS
In the second edition of the Institute of Child Health Monthly Seminar held on Thursday the 9th April 2014; Dr. E. E. Ugiagbe, a Senior Lecturer and Consultant Pathologist in Department of Morbid Anatomy/Histopathology, University of Benin/ University of Benin Teaching Hospital, Benin City discussed ‘The Relevance of Pathology in Health Care Delivery: Pediatrics in Focus’. The lecturer highlighted the different branches of pathology as follows: Histopathology (Surgical Pathology), Medical Microbiology, Hematology and Blood Transfusion, and Chemical Pathology. Under Histopathology which was his main focus, he stated that histology was the microscopic examination of tissues and the aim is to distinguish neoplastic from non-neoplastic lesions. He then gave examples of non-neoplastic as Inflammatory lesions, Choristomas, Hamartomas, Congenital anomalies, Hyperplasia, Metaplasia, Dysplasia while the neoplastic lesions (new growth) can be either benign (examples haemangiomas, lymphangiomas, fibrous tumors, fibromatosis, benign teratomas); or malignant (cancer such as Leukaemias [blood], Retinoblastoma [eye], Nephroblastoma [kidneys], Hepatoblastoma [liver], Rhabdomyosarcoma [any skeletal muscle of the body], Ewing sarcoma [bone/soft tissues], Lymphoma [lymphoid organs such as the lymph nodes]). The lecturer stressed that the implication of this is that parents/ caregivers are encouraged to present early to the hospital whenever they notice any mass on their children; and that any mass removed from any patient whether adults or children must be examined by the doctor and then sent to the Histopathologist for categorization. Parents/Guardians are also encouraged to do all outline investigations when such mass is suspected.
Information highlighted in this lecture was that cytology which is the microscopic examination of cells can be useful for screening purposes and for diagnosis. An example includes Pap (cervical smear) – useful for screening (detection of pre-cancerous cases) and therefore an important tool for the prevention of cervical cancer in women. Those to be screened included any sexually active female (ages 15 – 49 years) as follows: First 2 – 3 years after sexual exposure or at age 21 years, and thereafter 2 – 3 yearly until menopause or 70 years for patients at risk. The essence of this is that vaccination is available for the female at risk from ages 9 – 13 years.
Dr. Ugiagbe then discussed Forensic Pathology (Autopsy/ Postmortem) which means opening up of the dead to ascertain the cause of death. He said that this procedure dated as far back as 3000 BC and can be classified as Complete, Limited or Specialized Autopsy. The indications for Autopsy included Coroner’s Autopsy and Request Autopsy either by the Clinician or by the Family to ascertain the cause of death. He stressed that Coroner’s autopsies are mandatory by the law and it is usually requested for by the Coroner (i.e. a person appointed by law to investigate the cause death, for example, the Magistrate and A Justice of Peace; which is what applies in our environment). Common cases referred to a Coroner include the following; death within 24 hours on arrival in a hospital, death whose cause is unknown by the physician, violent or unnatural death, accidental death, child’s neglect (by self or others), industrial death, death in an institution such as schools, illegal abortion, death on operation table, maternal/perinatal death, suicide, homicide/manslaughter, death in custody (police, prison), poisoning, drowning, arson, following mob action, gunshot, death within 365 after accident or surgery. Request autopsy is usually for death in a hospital facility, death beyond 14 days of admission if there is no definitive diagnosis, the sudden death of a patient that is relatively stable, death at home or brought in dead. The benefits of autopsies include to accurately establishing the cause of death, confirmation of antemortem diagnosis, classification and correction of antemortem diagnosis and also for medical audit/quality assurance tool, identification of new and re-emerging disease. In all, autopsies help in protecting and improving health care delivery. The benefit of an autopsy to the bereaved family include the possible discovery of genetic/congenital diseases in the family for appropriate counseling for survivors.
Apart from coroner’s autopsy which is mandatory by law (no consent is needed), all other autopsies require that a consent is given usually from the relative (next of kin) of the deceased and autopsies are done FREE OF CHARGE in the pediatric age group.
Some issues concerning autopsies to be addressed include the following that autopsy is not an experiment but a medical procedure which will be carried out by a qualified medical personnel. There should be assurance that the bodies of the deceased will not be mutilated nor disfigured and the assurance that the funeral arrangement will not be distorted/ delayed by the procedure. Therefore, the clinicians should acquire the skill of convincing the relatives/bereaved to give consent for autopsy.
The lecturer also said that ‘WITHOUT AUTOPSY, NO DEATH CERTIFICATE CAN BE ISSUED BY A PATHOLOGIST’.
The lecturer concluded by saying that everyone should ensure that any lesion removed from his/her body or that of his ward surgically should be examined by the Pathologist. He also advised all the female audience present to go for cervical (Pap) smear; and that younger female children should go for Human Papilloma Virus (HPV) vaccination. Autopsies, a medical service, should be encouraged at all levels to ascertain the cause of all unknown forms of death (natural or unnatural).
Written and edited by Dr. Damian, U. NWANERI (Research Fellow I, Institute of Child Health, University of Benin)