Drug-resistance in chronic tuberculosis cases in Southern Nigeria

Nigeria has a high burden of tuberculosis but the drug resistant situationwas previously unknown. This report evaluates the firstline drug resistance and associated factors among chronic tuberculosis cases fromthe tuberculosis control programme in South south and South east zones ofNigeria. Descriptive study of chronic tuberculosis patients consecutively referred from March 2003 to December 2005. Information collected by indepth interview of patients and tuberculosis microscopy, culture and sensitivity of patients sputum. Of 82 patients infected with M. tuberculosis strains, 57(64.0%)weremaleswhile theirmean agewas 38.0 13.2 years. Fifty nine (72.0%) patients hadmultidrug-resistance tuberculosis with 35(42.7%) resistant to rifampicin, isoniazid, ethambutol, streptomycinwhile 14(17.1%) had poly-drug resistance and one patient had monoresistance to isoniazid. Within and outside the national control programme, drug therapy was inappropriate (69.5-81.7%) and treatment poorly supervised (26.8-39.0%). Factors associated with multidrug resistancewere amale age less than 45years andCategory 1 treatment in a private health facility. The multidrug resistance burden in chronic tuberculosis cases is very high in southern Nigeria and should be urgently and adequately controlled in the interest of public health.Keywords: Multidrug-resistance tuberculosis, chronic, Mycobacterium tuberculosis, Nigeria

Prostatic cancer after prostatectomy for benign prstatic hyperplasia in Nigeria

Objectives: To establish the prevalence of ‘prostatic cancer after a previous prostatectomy for benign prostatic hyperplasia (BPH)’ and to find out if there are any differences in clinical presentation, histological characteristics and response to treatment, between this type ofcancer of prostate and that of prostatic cancer in patients with intact prostate.Design: A prospective study carried out between January 1989 and December 1998.Setting: University of Nigeria Teaching Hospital, Enugu and JAMA Urological Clinic in Enugu, Nigeria .Subjects: All patients presenting with histologically diagnosed carcinoma of the prostate during the study period.Interventions: Transperineal, transurethral and open prostatic biopsies. Hormonal manipulations, transurethral prostatic resections, and ureteroneocystostomies.Main outcome measures: Clinical presentation, histological characteristics of the tumour, and patient survival.Results: Eight hundred and forty seven new cases of cancer of prostate were seen during the study period and 39 of them had had prostatectomy for histologically diagnosed BPH in the past (tissues were cut by step sectioning technique), giving a prevalence rate of 4.6%. Ages of these 39 patients ranged from 64 to 89 years (mean 71.6 years), while that for the rest of carcinoma of prostate ranged from 56 to 87 (mean 70.4 years). Time interval between prostatectomy for BPH and presentation with prostatic cancer ranged from one to 10 years in 36 patients (mean 6.6 years) while the remaining three patients presented after 15, 20 and 22 years respectively. Histology in all the 847 patients showed adenocarcinoma. When the two groups were compared, there were no statistically significant differences in clinicalpresentation, histological grading, type of treatment and final outcome.Conclusion: Prostatic carcinoma after prostatectomy for BPH is not uncommon. It should be managed in the same line as those with cancer in intact prostate

Anatomical sex conversion in a 21-year-old — a case report and review of literature

A journal article on a sex-change procedure in a Nigerian hospital.A case of anatomical sex conversion in a 21-year-old genotypic male Nigerian with ambiguous genitalia but who was reared as a girl is presented. The clinical features observed in this particular case and the result obtained after surgery, adjuvant hormone therapy and supportive psychotherapy are discussed. The relevant literature pertaining to the clinical entity is reviewed

Testicular cancer: Management challenges in an African developing country

Background. Advances in oncology have greatly improved the prognosis of testicular cancer. In developing countries, however, the outcome is still poor. Patients and methods. Twenty-four patients managed for testicular cancer at two centres (University of Nigeria Teaching Hospital, Enugu, Nigeria, and JAMA Urological Clinic, Enugu) between April 1984 and March 2003 were prospectively studied. Histopathological data were obtained in all cases. Results. Peak age incidence was 20 - 29 years. Testicular swelling was the principal complaint in 23 patients. The mean interval between onset of symptoms and presentation was 5.3 months. Two patients (8.3%) presented with stage 1 disease, 7 (29.2%) with stage 2, 7 (29.2%) with stage 3, and 8 (33.3%) with stage 4. Seventy-five per cent of tumours were right-sided, and 25% were left-sided. Treatment consisted of radical orchidectomy in all patients and cisplatin-based chemotherapy and radiotherapy in some patients. One patient with a tumour in an intra-abdominal testis underwent laparotomy. The most common histological types were seminoma and embryonal carcinoma. A fifth of the patients died, while half were lost to follow-up. The mean follow-up period was 9 months. Conclusion. Morbidity and mortality of testicular cancer is high in developing countries. Late presentation, poverty, paucity of resources and the high cost of newer imaging modalities and treatment are major challenges to management. Better health funding and education regarding testicular self-examination is essential

Neuroblastoma occurring in a 38-year old Nigerian man: a rare finding

Neuroblastoma (NB) is a common malignancy in children, but rarely occurs in adults. Accepted unfavorable prognostic factors include age over one year, low histological grade and advanced stage, MYCN amplification, chromosomal aberrations, elevations of neuron specific enolase and lactate dehydrogenase, and increased catecholamine metabolites in urine or serum. In adults, abdomen/retroperitoneum are the primary sites and in children the adrenal gland. We report a 38-year old civil servant who presented at our urology clinic on the 21st of December 2007 with a six month history of right flank dull pain which was worse on walking and relieved by rest, hypertension and a large right retroperitoneal mass. Tumor resection revealed a grade III NB. Chemotherapy using a combination of vincristine, adriamycin and cyclophosphamide was started. Follow-up showed regression of the mass initially with a relapse after patient absconded for three months. He resurfaced with new masses and he had a repeat chemotherapy with disappearance of the masses and is currently undergoing further treatment. To our knowledge this is the only report of NB in an adult registered so far in Nigeria and perhaps the whole of Africa. Currently, there are no standard treatment guidelines for patients with NB in adulthood. This study emphasizes the need for a standard treatment regime for adult onset neuroblastoma and its recognition as a possible differential in intra-abdominal mass in adults

Inequitable coverage of vitamin A supplementation in Nigeria and implications for childhood blindness.

BACKGROUND: Vitamin A deficiency (VAD) is of major public health significance; it is a risk factor for childhood deaths from diarrhoea and measles in low and middle-income countries and an important cause of preventable childhood blindness in low income countries. Vitamin A supplementation (VAS) is being implemented in many LMICs and high coverage reduces the prevalence of blinding corneal diseases in children. However, national estimates of coverage may not reveal any inequities in intra country coverage. The aim of this study is to assess factors influencing VAS coverage and also assess the relationship between VAS coverage and childhood corneal blindness in Nigeria. METHODS: Data were collected from the Nigeria Demographic and Health Survey (NDHS) 2013 and the published literature on population-based childhood blindness surveys in Nigeria. The main outcome measure was the proportion of eligible children who received VAS in the last 6 months preceding the survey. Study factors comprised a range of socioeconomic, and individual factors. Data were analysed using STATA V.12.1 (Statcorp, Texas). To explore the effects of the independent variables on VAS coverage, bivariate and multivariate regression was done. Variables with p < 0.05 in the final multivariable model were considered as independent factors. For the population-based childhood blindness surveys, aggregated and disaggregated data were used. Causes of blindness were stratified into corneal blindness and 'others'. Odds ratios were computed to determine the odds of developing corneal blindness in each geopolitical region. Tests of significance were set at the 95% level. RESULTS: The total VAS coverage in 2013 was 41.5%. VAS coverage was inequitable. Children with very educated mothers (OR 3.27 p < 0.001), from the south-south region (OR 2.38 p < 0.001) or in the highest wealth quintile (OR 2.81 p < 0.001) had higher odds of receiving VAS. The northwest zone had the lowest VAS coverage and the highest prevalence of corneal blindness. CONCLUSION: Regional and socioeconomic inequities in VAS exist in Nigeria and these may have grave implications for the causes of childhood blindness. The development and implementation of context specific and effective strategies are needed to reduce these inequities in VAS

Patients’ satisfaction with eye care services in a Nigerian Teaching Hospital

Background: Understanding the patientsf perception of services received is essential as the parameters important to the patient may be quite  different from that to the eye health provider.Aim: This study aims to evaluate patientsf satisfaction with the care received from the pioneer teaching hospital in south.eastern Nigeria and use it to audit services.Materials and Methods: This was a descriptive cross.sectional study. An interviewer.administered questionnaire was administered to 307 consecutive consenting patients seen at the eye clinic of the University of Nigeria Teaching Hospital Enugu in April 2013. The questionnaire asked questions regarding satisfaction with the time spent in the clinic, attitudeof various categories of staff, physical facilities, cleanliness of the clinic and willingness to come again to the clinic or recommend it to others.Results: The respondents were more satisfied with the attitude of the doctors and nurses than that of revenue and medical records clerks (P = 0.001). Most patients, 288 (93.8%) expressed satisfaction with the overall cleanliness of the eye clinic; 220 (71.7%) and 288 (93.8%) were not satisfied with the toilet facilities and cost of services, respectively. Only 140 (45.6%) participants will recommend the hospital to others strongly, 145 (47.2%) will do so hesitantly.Conclusion: Majority of the patients were satisfied with the services  received. The major dissatisfaction points were cost of services and inadequate toilet facilities.Key words: Developing country, eye care services, patient satisfactio

The prevalence of cervical ribs in Enugu, Nigeria

Background: Cervical rib is an important cause of nontraumatic thoracic outlet neurovascular compression. This study was undertaken as there is no known documented report on its prevalence in the study environment.Aims: To evaluate the prevalence of cervical ribs and its variation with sex and age among patients presenting at radiological facilities for a chest radiograph.Settings and Design: Retrospective evaluation of plain posterior‑anterior view chest radiographs done in radiological facilities in Enugu, Southeast, Nigeria.Subjects and Methods: Evaluated in this study were all 6571 chest radiographs consecutively obtained between 2009 and 2012 in three randomly selected radiological facilities in Enugu. Statistical Analysis Used: SPSS version 17 software was used in data analysis. Chi‑square and student t‑tests were used to test for the significance of findings at 95% confidence level.Results: This study reports the overall prevalence of cervical ribs as 48 (0.7%) with a significantly higher rate in females 43 (1.1%) when compared to males 5 (0.2%) (P = 0.000). In 27 (0.4%) cases, the cervical ribs were bilateral; whereas in 21 (0.3%) cases, they were unilateral with 8 (0.1%) on the left and 13 (0.2%) on the right. There was no age‑related variability with prevalence (P = −0.813).Conclusions: The prevalence of cervical rib in the study population is low and within the known range as seen in other geographical regions of Nigeria.Keywords: Cervical ribs, chest radiographs, Nigeri

The effect of ginger on testis of Broiler breeders

The rhizome of ginger is a fresh or dried organ of the plant Zingiber officinale, which has been used as a medicine since ancient times. The present study was conducted to examine the effects of ginger on testicular histomorphometry in roosters of broiler chicken flocks. Eighty single-day rooster of broiler chickens belonging to 308 Ross breed was used in the present study. The chickens were divided into two groups with 40 broiler roosters (experimental and control groups). Initially, the rhizome of ginger was powdered; 1 g/kg of ginger powder was added to the ration of the group treated with ginger from the beginning of the breeding season. The blood samples were taken from each chick at 20 weeks of age. The samples were stained with H&amp;E. Data was expressed as mean ± SD. T-test was used to analyse and compare the difference between the control is also an experimental groups using SPSS 9.0 software. The testosterone level, weight of the testicle, thickness of seminal tube and number of spermatids in the experimental group compared to the control group increased significantly P&lt;0.05. The most important difference between the control and the intervention group treated with ginger was the number and density of spermatids and spermatozoids cells in the lumen area of the seminal tubes. The present study obtained positive results for the efficacy of using ginger in roosters of broiler chick flocks

Delivering eye health promotion: why and how

Eye health promotion is vital for supporting the health and wellbeing of eye patients and the community, and there is a lot we can all do to help