Nigerian Postgraduate Medical Journal

ORIGINAL ARTICLE
Year
: 2019  |  Volume : 26  |  Issue : 2  |  Page : 94--99

Mycology-related dissertations from the faculty of pathology, national postgraduate medical college of Nigeria (1980-2017): output and scientific communication


Iriagbonse Iyabo Osaigbovo 
 Department of Medical Microbiology, School of Medicine, College of Medical Sciences, University of Benin; Department of Medical Microbiology, University of Benin Teaching Hospital, Benin City, Nigeria

Correspondence Address:
Dr. Iriagbonse Iyabo Osaigbovo
Department of Medical Microbiology, School of Medicine, College of Medical Sciences, University of Benin, PMB 1154, Benin City
Nigeria

Abstract

Background: The actual burden of fungal infections in Nigeria is uncertain due to the dearth of research in medical mycology. Evidence generated from dissertations is often overlooked, becoming moribund if not appropriately disseminated. The objectives of this study were to assess dissertations submitted to the Faculty of Pathology, National Postgraduate Medical College of Nigeria, for medical mycology-centred research and ascertain their dissemination by scientific communication. Materials and Methods: Dissertations accepted by the faculty of pathology from 1980 to 2017 were analysed and categorised into respective subdisciplines. Medical microbiology dissertations were further categorised into bacteriology, parasitology, virology and mycology. The proportion of titles under each subcategory was determined. A literature search was conducted to determine if mycology-related dissertations were published in peer-reviewed journals. Results: Six hundred dissertations were indexed under the faculty of pathology. There were 95 (15.8%) medical microbiology dissertations. The distribution of subject matter was bacteriology 62 (65.3%), parasitology 13 (13.7%), virology 15 (15.8%) and mycology 5 (5.3%). Two dissertations in anatomic pathology dealt with fungi. Mycology-related dissertations accounted for 0.8% of all dissertations submitted. Research focused on Candida, Histoplasma capsulatum var. duboisii, dermatophytes and others. At least 57.1% of mycology-related dissertations were disseminated by means of publication in peer-reviewed journals and/or abstract at scientific conferences. Conclusion: Mycology is a neglected research domain amongst post-graduates in the faculty. Scientific communication of research findings was above average.



How to cite this article:
Osaigbovo II. Mycology-related dissertations from the faculty of pathology, national postgraduate medical college of Nigeria (1980-2017): output and scientific communication.Niger Postgrad Med J 2019;26:94-99


How to cite this URL:
Osaigbovo II. Mycology-related dissertations from the faculty of pathology, national postgraduate medical college of Nigeria (1980-2017): output and scientific communication. Niger Postgrad Med J [serial online] 2019 [cited 2019 Aug 22 ];26:94-99
Available from: http://www.npmj.org/text.asp?2019/26/2/94/259911


Full Text

 Introduction



Medical mycology is the study of pathogenic fungi and the diseases which they cause. It has increased in relevance over recent years due to increasing number of immunosuppressed and at-risk populations which include people living with human immunodeficiency virus (HIV)/AIDS, cancers, patients receiving immunosuppressive therapies for rheumatoid arthritis, solid organ and stem cell transplant recipients and patients with end-stage renal disease amongst others.[1] Globally, over one billion people are afflicted, 25 million of whom are at high risk of death or blindness.[2] Non-fatal mucocutaneous and subcutaneous fungal infections can result in chronic debilitating conditions with physical and psychosocial sequelae that significantly lower the quality of life of sufferers: occupational impairments with attendant losses in productivity in onychomycosis, vulvodynia and sexual dysfunction in recurrent vulvovaginal candidiasis and deformity and amputation in mycetoma.[3],[4],[5]

Poverty, poor hygiene and tropical climate are amongst the socioeconomic and geo-ecological factors that foster fungal infections in many developing countries including Nigeria.[6] In addition, the high burdens of HIV infection and pulmonary tuberculosis in Nigeria predispose afflicted persons to AIDS-related opportunistic mycoses and chronic pulmonary aspergillosis, respectively.[7],[8],[9],[10] Further risks for fungal infections are posed by burgeoning tertiary health-care facilities offering intensive care, increasing prevalence of end-stage renal disease, rising number of haematological cancers and haematopoietic stem cell transplantation, which are gradually gaining momentum.[11],[12] It is estimated that 11.8% of Nigerians have a serious fungal infection each year, but the actual burden is uncertain due to a number of factors principal amongst which is the dearth of epidemiological studies.[13]

Epidemiological studies are valuable in advancing knowledge about fungal infections. A landmark study by Abbot in 1956 proved that the burden of mycetoma was higher than previously believed.[14] Likewise in the south Americas, epidemiological studies by Nacher et al. and several others were instrumental in exposing disseminated histoplasmosis as the leading AIDS-defining illness in and around the Amazon Basin.[15],[16] These examples highlight the importance of epidemiological data which can be gleaned from a variety of sources including scientific publications, conferences and theses.

The post-graduate thesis or dissertation is considered the capstone to a formal academic training process.[17] The completion of a dissertation is mandatory for aspiring fellows of pathology and indeed all faculties which offer post-graduate medical training under the aegis of the National Postgraduate Medical College of Nigeria (NPMCN). Dissertation writing grounds the post-graduate medical trainee in scientific methods, contributes to the growth of the specialty, extends personal scholarship and advances knowledge.[18]

Post-graduate dissertations are categorised as grey literature, thus the 'new knowledge' they generate has the propensity to remain untapped. Grey literature refers to 'that which is produced on all levels of academics, business, industry and government in print and electronic formats but which is not controlled by commercial publishers'.[19] They are often not accessible by policy-makers and tend to be missed when systematic knowledge reviews are being conducted.[20] Conversion to articles in peer-reviewed journals releases the knowledge produced in dissertations from the confines of grey literature making it readily accessible. Conversion rates of post-graduate theses/dissertations vary widely but range between 7% and 23% in low- and middle-income countries.[21] In Cameroon, only 13.8% of dissertations on HIV/AIDS were published in peer-reviewed journals.[22]

Due to the lack of epidemiological studies on fungal diseases, particularly invasive forms, knowledge generated via dissertations is invaluable and should be made accessible to the medical community, not trapped as grey literature on the shelves of institutions. The aim of this study was to analyse dissertations submitted to the faculty of pathology to identify medical mycology-related research and the extent to which such research has been disseminated by scientific communication.

 Materials and Methods



This was a retrospective analysis of dissertations accepted by the Faculty of Pathology, NPMCN.

Data sources

A list of dissertations in the faculty of pathology from 1980 to 2014 available from the NPMCN website was obtained. This was manually updated to include dissertations submitted from 2015 to 2017. Dissertations from 2018 had not been fully indexed, thus they were excluded from the study.

Data collation

Dissertations were sorted into the respective subdisciplines of anatomic pathology, haematology, chemical pathology and medical microbiology by analysis of their titles for key words denoting the subdiscipline. Where titles were ambiguous i.e., having the possibility of emanating from more than one subdiscipline, confirmation was sought from the physical copy of the dissertation.

Dissertation titles under medical microbiology were further categorised based on the subject matter into bacteriology, virology, parasitology and mycology.

The titles from the other subdisciplines were likewise perused to locate any other mycology-related work.

Literature search

Mycology-related dissertations from within and outside medical microbiology were subjected to online search using PubMed, Google Scholar and African Journals Online to ascertain if they had been published as peer-reviewed journal articles. Appropriate key words from the title combined with the author's name were used to identify corresponding publications in these databases. A published manuscript was considered a derivative of the dissertation if:

At least one of the authors of the publication was an author of the dissertationAt least one of the outcomes from the dissertation, as indicated in the abstract, was an outcome of the publication.

The number of papers published from the dissertation, year of publication, time lag to publication, number of citations and sequential location of the post-graduate candidate's name in the author byline were recorded.

Data analysis

Data were collated and analysed using Microsoft Office Excel 2007 (Microsoft Corp., Redmond, WA, USA). Frequencies and proportions of medical mycology-related dissertations were calculated for medical microbiology subdiscipline and the entire faculty. Results were displayed using tables and charts.

Ethical statement

No human subjects were involved in this study. Data were largely available from a public database and so no ethical clearance was sought.

 Results



Six hundred dissertations are indexed in the faculty of pathology in the 38-year span (1980–2017) with an average output of 15 dissertations/year.

Distribution of pathology dissertations by subdiscipline

[Table 1] shows the distribution of dissertations in the various subdisciplines.{Table 1}

Medical microbiology subgroup analysis

The distribution of the various titles under medical microbiology according to the subject matter is shown in [Figure 1]. Bacteriology was the subject matter in 62 dissertations, parasitology in 13, virology in 15 and mycology in 5. [Figure 2] compares the distribution of medical microbiology dissertations in two time periods, 1982–1999 and 2000–2017 (there were no medical microbiology dissertations in 1980–1981). The proportion of mycology-related dissertations appreciated from 4.5% to 5.5% between the two time periods.{Figure 1}{Figure 2}

Content analysis of mycology-related dissertations

In total, seven (0.8%) of the 600 dissertations were medical mycology related: two from anatomic pathology and five from medical microbiology [Supplementary Table 1]. Four (57.1%) dealt with specific genera, three (42.9%) explored Candida (candidaemia and oropharyngeal candidiasis), whereas one (14.3%) focused on Histoplasma capsulatum var duboisii (African histoplasmosis) in histopathological specimens. Others dealt with dermatophytes causing tinea capitis, explored the clinical significance of moulds isolated from respiratory specimens and retrospectively reviewed mycoses diagnosed by histopathology.[INLINE:1]

Publication characteristics of mycology-related dissertations

Four (57.1%) of the mycology-related dissertations were disseminated by either publication in a peer-reviewed journal or proceedings of a scientific conference: three (42.9%) were published in indexed journals as peer-reviewed articles, whereas two (28.6%) were listed as abstracts in international conference proceedings (including one that was published as a journal article). Three (42.9%) produced no discernible publications.

The number of citations for the articles derived from dissertations ranged from 0 to 3. The post-graduate candidate was named first author in all three cases (100%). The time period between year of indexing in the college database and publication as peer-reviewed article ranged from 2 to 8 years with an average of 5 years.

 Discussion



Despite the tremendous research output from the NPMCN since its inception, the dissertations accepted by various faculties have not been subjected to any formal bibliometric analysis. Dissertation analysis provides unique insights into a field, revealing the foci of research and instruction within an institution and identifying research gaps for new scholars to fill.[23] This study provides empirical evidence of the dearth of medical mycology research amongst post-graduate students, specifically under the medical microbiology subdiscipline of the faculty of pathology. It also compares the trends in subject matter between time spans, before and during the early 21st century. Bacteriology remains the dominant subject matter. While the proportions of virology and parasitology-related topics have risen appreciably, the number of mycology topics has only slightly increased. Future trends can be assessed against this baseline.

Medical mycology was the subject matter of 5.3% of medical microbiology dissertations. This is miniscule compared to the 15.5%–28.3% reported by Evans et al. in 2000 from India, though their report combined data from PhD, MD and MSc microbiology programs.[24] The factors that affect residents' research choices have not been formally assessed in the Nigerian context. In Pakistan, Fakhar et al. identified five main factors namely personal interest, selection from medical journals, ease of data collection, selection based on the advice of supervisors and ongoing departmental interest.[25] Additional factors explored by Isaac et al. were financial limitations, availability of equipment and current trends in the field.[26] The low output from the index analysis could have been influenced by any one of these factors but in the study by Fakhar et al., the advice of supervisors and personal interest were adjudged the dominating factors. Thus, it can be inferred that the lack of mycology-related research reflects a lack of interest and perhaps expertise, amongst residents and trainers alike. Topics chosen for dissertation may lead to permanent commitment in the specified field.[25] The result of this study may, thus, signify a sustained drought in participation in medical mycology research unless measures are taken to pique the interest of trainee and specialist medical microbiologists in particular and pathologists in general.

Although majority of mycology-related dissertations in this study emanated from would-be medical microbiologists, mycoses are by no means the exclusive preserve of this subdiscipline of pathology; two anatomic pathology dissertations were centred on histopathological diagnosis of fungal infections. Even with the best of diagnostic facilities, up to 50% of invasive fungal infections are missed antemortem making autopsy studies useful sources of epidemiological data.[27] Moreover, histopathology is useful for the diagnosis of subcutaneous and invasive tissue mycoses. It is also invaluable in establishing the clinical significance of microbiological isolates. For these reasons, mycology research should interest anatomic pathologists. Fungal infections are common in patients with neutropaenia and haematologic malignancies and those who undergo haematopoietic stem cell transplantation. Thus, medical mycology can be a viable research niche for haematologists. Finally, chemical pathologists can partake in medical mycology research since it is often difficult to isolate the fungi responsible for invasive mycoses such as invasive candidiasis and aspergillosis, and diagnosis may require analysis of blood and body fluids for the presence of immunological and biomarkers.

Publication of post-graduate dissertation findings in a peer-reviewed indexed journal validates the research, making it more likely to be read, cited and included in systematic and meta-analytic reviews.[28],[29] According to the World Medical Association's Declaration of Helsinki, 2013, it is the ethical obligation of researchers to publicise the results of studies conducted on human subjects.[30] In this study, 42.9% of medical mycology-related dissertations resulted in scholarly publication in peer-reviewed journals, whereas 28.6% were presented at scientific conferences. There is no literature on the fate of dissertation-related research from post-graduate medical colleges in Nigeria. The small number of mycology-related dissertations makes it difficult to make general statements about the publication rates of post-graduate medical research. With this caveat in mind, the rate of dissertation publication in this study was higher than the 30.0% reported by Dhaliwal et al. in India but lower than 52.4% reported by Caan and Cole for doctoral theses with clinical topics in the United Kingdom.[20],[28] Lower rates of 13.8% and 18.0% were recorded in Cameroon and Uganda, respectively.[22],[31] A systematic review by Obuku et al. showed that such low rates are typical in low-to-middle income countries.[21] Student's age and type of research design were also shown to be determinants of publication with younger age and cohort studies favouring publication.[31]

Possible barriers to the publication of dissertation findings were identified by Timmons and Park as lack of confidence in the quality and relevance of findings; lack of support and guidance from supervisors; poor manuscript writing skills and a sense of publishing not being a priority due to non-interest in an academic career.[32] One way of ensuring dissemination of research undertaken during post-graduate training is the dissertation by full or partial publication model offered in some climes. This approach grooms candidates in the skill of crafting manuscripts for publication while guaranteeing the broad dissemination of research findings. However, it is not devoid of drawbacks such as the potential for data fragmentation or 'salami-slicing' and lengthy timelines which may not fit into the current residency training structure.[33]

Digitisation and archiving of dissertations to the National Postgraduate Medical College website (as presently being undertaken by the college) make unpublished post-graduate research generated in the college searchable and accessible amongst other benefits. However, there is evidence to show a paradoxical decline in the scientific impact of dissertations and theses despite being increasingly accessible to scholars in electronic format.[34] Thus, publication remains the surest means of ensuring that new knowledge generated in the course of writing a dissertation achieves the desired impact.

Limitations

This analysis did not consider dissertations from the faculty of laboratory medicine, West African College of Physicians, which is the other post-graduate medical college operational in Nigeria. The non-publication status of some dissertations may be false negatives. This is possible if they were published in journals not indexed in the databases that were searched. Similarly, they may have been presented at local conferences not documented online. Finally, this study does not evaluate the quality of the research whether published or not and should not be interpreted as such.

Recommendations

The upload of the dissertations of the NPMCN to an online repository should be expedited to make post-graduate research accessible to a wider scientific community. This will increase their visibility and possible inclusion in systematic reviews. Interest in medical mycology needs to be stimulated amongst residents. A faculty-based mycoses working group made up of all fellows with interest in fungal diagnosis and research can be constituted. Apart from collaborating on research projects, members of this working group can serve as mentors for residents. Medical mycology-themed workshops can be organised to stimulate interest in medical mycology research.

Residents should be encouraged to join local and international medical mycology societies such as the Medical Mycology Society of Nigeria and the International Society for Human and Animal Mycology. They should also be guided on how to access research funds, grants and opportunities for observership at state of the art mycology laboratories overseas.

Following the assessment, residents should endeavour to publish the findings of their dissertation. The likelihood is increased if the resident is mentored and begins partaking in research activities in the department early on in the residency journey.

Further studies are required to elucidate the reasons for non-publication of dissertation research findings in our environment so that appropriate measures can be taken to forestall them.

 Conclusion



The dissertation output of the faculty of pathology with respect to medical mycology is low. However, the relatively few dissertations have been reasonably communicated to the scientific community by publication as peer-reviewed articles or presentation at scientific conferences. Resident doctors should be encouraged to engage in this neglected research domain and disseminate their findings. This will help narrow the gap which currently exists in the field.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Acknowledgement

The author thanks Mr J. Osagie for assistance with data collation.

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