Common side effects of tramadol encountered in a private rheumatology clinic

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Evaluation of rheumatology lectures by clinical students in a Nigerian medical school: learning from the learners

Objectives: To identify the most and least preferred rheumatology lectures, the proportional increase in students able to identify rheumatic conditions after the lectures as well as evaluate resident teaching effectiveness.Methods: All 134 clinical students in the University of Uyo Medical School,  Southsouth Nigeria were asked to evaluate their rheumatology lectures using a selfadministered instrument containing the augmented Stanford Faculty Development Performance Questionnaire (aSFDPQ). Mann-Whitney U test was used for ordinal data with p<0.05.Results: Response rate was 126 (94%) with 78 (61.9%) males. Rheumatoid arthritis was best preferred by 63 (50%) students while 42 (33.3%) of them cited spondyloarthropathies as their worst topic. Twenty six (20.6%) students identified a rheumatic condition before the lectures compared to 57 (45.2%) after the classes. Mean aSFDPQ score was 3.76±0.47. Best and least domains were learning climate (4.03) and evaluation (3.39). Mann-Whitney U values ranged from (1647.5<U<1869.5), (0.257<p<0.990) with no significant aSFDPQ difference by gender (p=0.825) or year of study (p=0.162). Mean global teacher rating was 74.64±13.65%.Conclusions: Rheumatoid arthritis and spondyloarthropathies were the most and least preferred topics respectively. The proportion of students able to identify rheumatic conditions after the lectures increased by 24.6%. Despite good global rating (74.6%), teaching effectiveness was suboptimal (mean aSFDPQ<4.0). Formal pedagogic training is urgently needed to improve  residents’ teaching effectiveness in Nigeria.Keywords: Student evaluation, Rheumatology lectures, Medical educatio

Familial systemic autoimmune rheumatic disease in Nigerians: a case series

Systemic Autoimmune Rheumatic Diseases (SARD) are chronic disorders affecting multiple organs. Most SARDs have a female preponderance. SARDs have rarely been reported in African blacks, although there is increasing reportage of recent. Different SARDs are believed to have genetic predisposition and familial clustering.SARDs occasionally run in families - among mothers and daughters, among siblings. Such clustering has however not been documented among black Africans. We present four Nigerian families with clustering of systemic autoimmune rheumatic disease.Keywords: Systemic autoimmune disease, Familial clustering, Nigerian

SPECTRUM AND OUTCOME OF CLINICAL DISEASES IN ADULTS LIVING WITH AIDS AT THE OGUN STATE UNIVERSITY TEACHING HOSPITAL

ABSTRACTObjectives: To evaluate the changing frequency of HIV/AIDS amongst medical admissionsas well as the spectrum and outcome of clinical diseases among these patients.Design: Retrospective study.Setting: Tertiary hospital in Nigeria.Participants: Two hundred and six People Living With AIDS (PLWA) admitted at themedical wards during the period 1992 to 2002.Intervention: Treatment was symptomatic in all patients and where appropriate, specifictreatment was administered for indicator diseases. Highly Active Anti-retroviral Therapy(HAART) was not used.Main outcome measures: Mortality within six months of diagnosis.Results: PLWA constituted 4.2% of all medical admissions. The frequency increasedfrom 0% in 1992 to 7.6% in 2001, and dropped to 5% by the year 2002. Seventy patients(34%) died within six months of diagnosis.Results: This study has demonstrated an increasing frequency of HIV/AIDS amongstour medical in-patients from none in 1992 to 7.6% in 2001, and thereafter, a declinein 2002. We suspect that this decline could be a reflection of the health education onHIV, its increasing awareness and the widespread utilisation of effective controlmeasures. Furthermore, the administration of highly active anti retroviral therapy(HAART) to a segment of PLWA in Sagamu by the community medicine departmentcould be contributory.Conclusion: A community based study would be needed to assess the efficacy or otherwiseof these current control measures. The advent of saliva and urine tests for HIV detectionwould ease specimen collection and increase compliance and participation at thecommunity level

Gout is more frequent in sickle cell disease than in haemoglobin AA among sub-Saharan Africans

Background: Sickle Cell Disease (SCD) is a common autosomal recessive disorder worldwide that mostly affects Africans. Hyperuricemia, a common biochemical finding, occurs in up to 41% of SCD patients. Although hyperuricaemia is the most important risk factor for gout, thelatter is uncommonly reported in SCD.Objective: To determine the frequency and factors associated with hyperuricaemia and gout among patients with Sickle Cell Disease  (SCD).Design: This was a cross sectional study.Methods: The study involved 104 SCD patients and 104 haemoglobin AA (HbAA) controls. The diagnosis of gout was based on the  demonstration of monosodium urate crystals in the synovial fluid of symptomatic individuals. Hyperuricaemia was found in 28 (26.9%) and 2 (1.9%) of SCD and control participants respectively (p<0.001). The median (range) Serum Uric Acid (SUA) was higher among patients (330 μmol/L [146 to 702 μmol/]) than in controls (232 μmol/L [143 to 440 μmol/L]), (p<0.01). Six (5.8%) cases of gout were found among the patients and none among the controls (p=0.029). The pattern of articular involvement was monoarticular in 2 (33.3%), oligoarticular in 3 (50%) and polyarticular in 1 (16.7%). One (16.7%) patient had subcutaneous tophi. Factors associated with gout in SCD were age, hyperuricaemia, more than two SCD crises in the past year and more than two hospital admissions in the past year.Conclusion: Gout as is hyperuricaemia, is more frequent in persons with SCD than in the general population. It is mostly oligoarticular and older patients with multiple attacks of painful joint swelling as well as frequent hospital admissions may be at higher risk of gout