A 37-year-old woman presenting with impaired visual function during antituberculosis drug therapy: a case report

Abstract Introduction Combination antituberculosis drug therapy remains the mainstay of treating tuberculosis. Unfortunately, antituberculosis drugs produce side effects including (toxic) impaired visual function, which may be irreversible. We report a case of antituberculosis-drug-induced impaired visual function that was reversed following early detection and attention. Case presentation A 37-year-old Yoruba woman, weighing 48 kg, presented to our facility with impaired visual functions and mild sensory polyneuropathy in about the fourth month of antituberculosis treatment. Her therapy comprised ethambutol 825 mg, isoniazid 225 mg, rifampicin 450 mg, and pyrazinamide 1200 mg. Her visual acuity was 6/60 in her right eye and 1/60 in her left eye. She had sluggish pupils, red-green dyschromatopsia, hyperemic optic discs and central visual field defects. Her intraocular pressure was 14 mmHg. Her liver and kidney functions were essentially normal. Screening for human immunodeficiency virus was not reactive. Her impaired visual function improved following prompt diagnosis and attention, including the discontinuation of medication. Conclusions The ethambutol and isoniazid in antituberculosis medication are notorious for causing impaired visual function. The diagnosis of ocular toxicity from antituberculosis drugs should never be delayed, and should be possible with the patient's history and simple but basic eye examinations and tests. Tight weight-based antituberculosis therapy, routine peri-therapy visual function monitoring towards early detection of impaired function, and prompt attention will reduce avoidable ocular morbidity.</p

Medical ethics in sub-Sahara Africa: closing the gaps

Background: Health care providers are expected to have the skills and knowledge relevant to their field and should also be familiar with the ethical and legal expectations that arise out of the standard practices. Objectives: To elucidate the practice of the health care providers in relation to healthcare ethics in Nigeria. Methods: A self-administered structured questionnaire was devised and distributed to staff of two tertiary health care facilities in Northern Nigeria. The questionnaire comprised of detailed questions regarding day-to-day aspects of Medical ethical issues. Results: A total of 307(76.2% ) out of 403 health care providers responded to the questionnaire. The median age of the respondents was 34 years. More than half 168(54.7%) of the respondents disagreed as to whether \u201cEthical conduct is important only to avoid legal action. Many respondents 135 (44.0%) agreed to adhering to \u201cpatient\u2019s wishes\u201d, on the other hand over two-third of the respondents 211 (68.7%) agreed that \u201cdoctor should do what is best\u201d irrespective of the patient\u2019s opinion. There were significant differences (p&lt;0.05) between the perception of physicians and non-physicians on many ethical issues. Conclusion: This study has shown gap in knowledge and practice of healthcare ethics among health care providers. There is a need for periodic education on clinical ethics in our hospitals

Intraocular Pressure Changes During Ramadan Fasting: Effect of Change in Weight and Review of Available Reports

Background: Ramadan fasting (RF) alters many systemic milieus. Dehydration from fasting may cause weight loss, while sedentary lifestyle of some Muslims during fasting results in weight gain. RF is associated with low intraocular pressure (IOP). We aim to find out changes in IOP and its relationship to weight changes during and after Ramadan fasting.Materials and Methods: IOP of eligible males was measured at 0900, 1200 and 1500 hours (hrs). Mean fasting IOP (FIOP) and non-fasting IOP (NFIOP) of both eyes at each period were calculated. Weights were also taken during fasting and after fasting. FIOP and NFIOP were compared using paired t-test for all participants category (1) and participants in different categories of weight changes found during fasting: Those who lost weight during fasting, category (2). Those whose weights were unchanged, category (3), and those who gained weight category (4)Results: There were 51eligible males, category (1) consisting 38, 5 and 8 participants in categories 2, 3 and 4 respectively. Mean weight (Kg) of participants were: fasting 64.000, and non-fasting 65.853, P &lt; .001. At 0900hrs, FIOP was higher than NFIOP but not reaching significant level in all categories. At 1500 hrs however, FIOP was significantly lower than NFIOP for categories 1 and 2 but not significantly for categories 3 and 4.Conclusion: Findings of the few previous works are conflicting. IOP changes during Ramadan may be a manifestation of changes in weight only. We suggest further works should categorize participants according to weight changes during fasting before analysing IOP.Keywords: Ramadan Fasting, Intraocular Pressure, Weight Effec

Health status and blood parameters of weaner rabbits fed diets containing varying dietary fibre and digestible energy levels

The maintenance of a good health status in rabbits is hinged upon appropriate balance between dietary fibre and energy level. A 70-day feeding trial was conducted to study the health status and blood parameters of weaner rabbits fed diets containing varying fibre and digestible energy (DE) using a total of ninety 4-weeks-old rabbits. There were 9 dietary treatments laid out in a 3 × 3 factorial arrangement of 3 levels of dietary fibre [low (249-258 g/kg NDF and 149-157 g/kg ADF), optimum (349-381 g/kg NDF and 188-193 g/kg ADF) and high (430-456 g/kg NDF and 249-253 g/kg)] and digestible energy levels [low (8-8.5 MJ/kg), optimum (10.5-11 MJ/kg) and high (12-12.30 MJ/kg)]. Each of the diet was fed to 10 rabbits individually caged in a completely randomized design. Polynomial contrasts were done for linear and quadratic effects. Results indicated that rabbits fed low fibre diets showed high incidence of transitory diarrhoea, total morbidity and symptoms of other sickness. Interaction effect (fibre × digestible energy) indicated that irrespective of the digestible energy level of the diet, mortality, tendency to go off feed and incidence of transitory diarrhoea increased as dietary fibre level increased. Rabbits fed low fibre diets had the least packed cell volume (36.00%) and highest serum uric acid concentration (51.22 mg/dl). Rabbits fed diet containing high fibre + optimum DE recorded the highest packed cell volume (44.00%) and serum glutamate oxaloacetate transaminase (29.00 IU/L). Highest haemoglobin (16.00 g/dl), total serum protein (66.00 g/L) and serum cholesterol concentration (165.00 mg/dl) were recorded with rabbits fed diet containing optimum fibre + optimum DE. It was concluded that feeding low fibre diets increased the susceptibility of rabbits to transitory diarrhoea, morbidity and tendency to go off feed. High fibre diets in rabbit nutrition thus favoured improved health status.   Keywords: Health status, Blood parameters, Weaner rabbits, Dietary fibre, Digestible energ

Questionnaire study to gain an insight into the manufacturing and fitting process of artificial eyes in children: an ocularist perspective

Purpose To gain an insight into the manufacturing and fitting of artificial eyes in children and potential improvements to the process. Method An online qualitative survey was distributed to 39 ocularists/prosthetists in Europe and Canada. Participants were recruited through purposive sampling, specifically maximum variation sampling from the researcher’s contacts and an online search. Results The findings highlighted the current impression technique as being the most difficult yet most important part of the current process for both the ocularist and child patient. Negatively affecting obtaining a good impression, the child patients distress can be reduced by their parents by providing encouragement, reassurance, practicing the insertion and removal of the artificial eye and being matter of fact. Whilst improvements to the current process provided mixed views, the incorporation of current technology was perceived as not being able to meet the requirements to produce aesthetically pleasing artificial eyes. Conclusion The current artificial eye process can be seen as an interaction with its success being dependent on the child patient’s acceptance and adjustment which is dependent on the factors associated to the process. Investigation into the needs of the patient and whether technology can improve the process are the next steps in its advancement

A systematic review of randomised controlled trials on the effectiveness of exercise programs on lumbo pelvic pain among postnatal women

Background: A substantial number of women tend to be affected by Lumbo Pelvic Pain (LPP) following child birth. Physical exercise is indicated as a beneficial method to relieve LPP, but individual studies appear to suggest mixed findings about its effectiveness. This systematic review aimed to synthesise evidence from randomised controlled trials on the effectiveness of exercise on LPP among postnatal women to inform policy, practice and future research. Methods: A systematic review was conducted of all randomised controlled trials published between January 1990 and July 2014, identified through a comprehensive search of following databases: PubMed, PEDro, Embase, Cinahl, Medline, SPORTDiscus, Cochrane Pregnancy and Childbirth Group’s Trials Register, and electronic libraries of authors’institutions. Randomised controlled trials were eligible for inclusion if the intervention comprised of postnatal exercise for women with LPP onset during pregnancy or within 3 months after delivery and the outcome measures included changes in LPP. Selected articles were assessed using the PEDro Scale for methodological quality and findings were synthesised narratively as meta-analysis was found to be inappropriate due to heterogeneity among included studies. Results: Four randomised controlled trials were included, involving 251 postnatal women. Three trials were rated as of ‘good’ methodological quality. All trials, except one, were at low risk of bias. The trials included physical exercise programs with varying components, differing modes of delivery, follow up times and outcome measures. Intervention in one trial, involving physical therapy with specific stabilising exercises, proved to be effective in reducing LPP intensity. An improvement in gluteal pain on the right side was reported in another trial and a significant difference in pain frequency in another. Conclusion: Our review indicates that only few randomised controlled trials have evaluated the effectiveness of exercise on LPP among postnatal women. There is also a great amount of variability across existing trials in the components of exercise programs, modes of delivery, follow up times and outcome measures. While there is some evidence to indicate the effectiveness of exercise for relieving LPP, further good quality trials are needed to ascertain the most effective elements of postnatal exercise programs suited for LPP treatment

Development and feasibility testing of an animated cartoon-based self-care application for low-back pain – a pilot study

Objectives: The use of animated cartoons for pain management is an emerging area, however, in no study has it been explored as a digital platform for the rehabilitation of low-back pain (LBP). This study was aimed to develop and evaluate the feasibility of an animated cartoon-based self-care (ACBSC) app for LBP, and to examine the correlation between the app rating parameters and patients’ pain. Methods: This 2-phase study comprised development and feasibility testing components. Development of the ACBSC app was based on Mckenzie’s Mechanical Diagnosis and Therapy (MDT) extension protocol plus back hygiene following standard it-eration and prototyping process. Twenty-eight consecutive patients with chronic non-specific LBP with ‘direction Preference’ for extension based on the MDT screening algorithm participated in the feasibility phase. The participants utilised the car-toon-based app thrice weekly for 2 weeks. Outcomes were assessed in terms of usability, satisfaction and user experience ap-plying the system usability and mobile application rating scales. The Quadruple Visual Analogue Scale (QVAS) was used to assess the participants’ pain intensity. Results: On a unified scale up to 20, functionality (15.4 ± 2.41) and aesthetics 14 ± 2.00 had highest and least objective quality rating on the app parameters. Total objective and subjective quality rating of the app was 16.9 ± 1.97 and 15.6 ± 2.42, respectively. The total impact and usability scores were 24.1 ± 3.39 (out of 30) and 27.8 ± 3.09 (out of 50). Participants re-ported that the cartoon app for back care mostly affected mindfulness/meditation/relaxation (42.9%), increasing happiness/ well-being (46.4%), leading to behavioural changes (60.7%), while targeting physical health (100%). There was no significant correlation between participants’ pain characteristics and app rating parameters (p>0.05). Conclusion: The animated cartoon-based self-care LBP app has moderate to high usability, functionality, aesthetics and quality rating, and may serve as an effective mobile-app for self-management of long-term LBP

Refractive ocular conditions and reasons for spectacles renewal in a resource-limited economy

<p>Abstract</p> <p>Background</p> <p>Although a leading cause of visual impairment and a treatable cause of blindness globally, the pattern of refractive errors in many populations is unknown. This study determined the pattern of refractive ocular conditions, reasons for spectacles renewal and the effect of correction on refractive errors in a resource-limited community.</p> <p>Methods</p> <p>A retrospective review of case records of 1,413 consecutive patients seen in a private optometry practice, Nigeria between January 2006 and July 2007.</p> <p>Results</p> <p>A total number of 1,216 (86.1%) patients comprising of (486, 40%) males and (730, 60%) females with a mean age of 41.02 years SD 14.19 were analyzed. The age distribution peaked at peri-adolescent and the middle age years. The main ocular complaints were spectacles loss and discomfort (412, 33.9%), blurred near vision (399, 32.8%) and asthenopia (255, 20.9%). The mean duration of ocular symptoms before consultation was 2.05 years SD 1.92. The most common refractive errors include presbyopia (431, 35.3%), hyperopic astigmatism (240, 19.7%) and presbyopia with hyperopia (276, 22.7%). Only (59, 4.9%) had myopia. Following correction, there were reductions in magnitudes of the blind (VA<3/60) and visually impaired (VA<6/18-3/60) patients by (18, 58.1%) and (89, 81.7%) respectively. The main reasons for renewal of spectacles were broken lenses/frame/scratched lenses/lenses' falling off (47, 63.4%).</p> <p>Conclusions</p> <p>Adequate correction of refractive errors reduces visual impairment and avoidable blindness and to achieve optimal control of refractive errors in the community, services should be targeted at individuals in the peri-adolescent and the middle age years.</p

Chronic Diseases in North-West Tanzania and Southern Uganda. Public Perceptions of Terminologies, Aetiologies, Symptoms and Preferred Management

Research outputs produced to support a quantitative population survey, quantitative health facility survey, focus groups and in-depth interviews performed by the projec