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

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

Should glaucoma be public funded in Nigeria? Arguments against funding glaucoma treatment and rebuttal

Global studies indicate glaucoma treatment can preserve valueable vision, especially when commenced in its early stage and sustained. Despite glaucoma being responsible for blindness in thousands of Nigerians and accompanying disruption of their flourishing lives, Nigeria’s funding glaucoma would not be easy to accomplish. This essay analyses opponents’ arguments against Nigeria’s funding glaucoma treatment. These include an inherent complexity of glaucoma, inadequate healthcare resources, the individual with glaucoma factor, and economic reason.Keywords: Glaucoma, glaucoma awareness and education, Nigeria, resource for glaucoma care, resource-limited econom

Blinding Bilateral Hyperviscosity Retinopathy in a 43-Year-Old Nigerian Male with Lymphoplasmacytic Lymphoma: A Case Report and Management Challenges

Lymphoplasmacytic lymphomas are rare and may present with uncommon and devastating symptoms. We report a case of a 43-year-old male who presented with bleeding gums and sudden onset of bilateral blindness but was not on anticoagulants and had no family history of bleeding disorder. He had bilateral hyperpigmented infraorbital skin lesions, visual acuities (VA) of hand motion in both eyes (blindness), round and sluggish pupils, and bilateral diffuse and extensive retinal haemorrhages obliterating the retinal details with central visual field defects. The optical coherence tomography revealed retinal haemorrhage, oedema, detachment, and diffuse photoreceptors damage. Investigations revealed elevated ESR and β2 microglobulin, monoclonal peak on serum protein electrophoresis, high IG with lambda restriction on serum, and urine immunofixation with increased lymphocytes and plasma cells in the bone marrow. A diagnosis of lymphoplasmacytic lymphoma complicated by blinding hyperviscosity retinopathy was made. In the absence of an aphaeresis machine, he received four cycles of manual exchange blood transfusion (EBT) and commenced with chlorambucil/prednisolone due to difficulty in obtaining blood for continued EBT. His general condition and VA has improved and he is stable for more than six months into treatment

Ophthalmic Research Priorities and Practices in Nigeria: An Assessment of the Views of Nigerian Ophthalmologists

Purpose : To study the views of ophthalmologists on research priorities and outcomes in Nigeria. Materials and Methods : A structured questionnaire was distributed to 120 ophthalmologists and ophthalmic residents who were attending an annual congress in Nigeria. The participants′ background information, relative research priorities, frequency of publications, research types, publication media, challenges faced in publishing and impact on health practice or policy were collected. Results : Eighty-nine (74.2%) of the 120 questionnaires were returned. Childhood blindness was given the highest priority for ophthalmic research by 42.9% of the respondents, and genetic studies had the least priority (19.8%). About two-thirds of the respondents had either never been involved or only involved occasionally in any type of ophthalmic research. Clinical trials (13.1%) and basic science studies (12%) were the least-performed types of research. About 51% of the respondents indicated that they had never published in journals nor did so "occasionally"; only 9% quarterly and 43% published less than once a year. They also indicated that their research very rarely resulted in change of clinical practice or health policy (20%). Conclusions : Research works conducted by respondents were largely simple low-budget ones that rarely had significant impacts and outcomes, including publication. There is a need to retrain and emphasize the importance of research during undergraduate and postgraduate medical education. Adequate resources and research infrastructure should be provided for ophthalmic research in Nigeria

Awareness and knowledge of ocular cancers in a resource-limited economy

Aims: To determine awareness and knowledge of ocular cancers in a resource-limited setting. Material and Methods: A descriptive cross-sectional survey (2009) of 1,887 Nigerians using interviewer-administered questionnaire. Results: Respondents were 55.6% males, and mean age was 30 years, SD 9.5. Most respondents (77.8%) had at least secondary education. Fewer respondents were aware of eye cancers (57.1%) compared to cancers in general (73.7%) (P<.001). Despite the male preponderance there were no associations between gender and awareness of ocular cancers (P=0.07) and cancers in general (P=0.85). However, education was associated with awareness of ocular cancers (P<.001) and cancers in general (P<.001). Ocular cancers were thought to be caused by corrosives 33.2%, trauma 21.4%, witchcraft 18.6%, genetic transmission 15.7%, sunlight 8.0%, radiations 2.5% and infections 0.6% (n = 883). Of 280 respondents, 41.1% based their knowledge of patients having ocular cancers on sources other than hospital diagnosis. Of 148 respondents, 16.2% were related to ‘patients’ they knew had ocular cancers. There were 202 respondents who indicated challenges to accessing orthodox medical eye care services by ocular cancer patients as high cost 55.5%, long waiting period 23.3%, long distance 15.4% and poor attitude of health workers 5.9%. Conclusion: Awareness of ocular cancers compared to other cancers is low. Misconceptions on the causes of ocular cancers exist. Public ocular cancers health education can enhance awareness. The need to address barriers to accessing eye care is underscored