Indications for Surgical Removal of the Eye in Irrua, Nigeria

Objective: To determine the reasons for removal of the eye at the Irrua Specialist Teaching hospital, Irrua, Edo State, southern Nigeria. Method: A retrospective study of all cases of enucleation and evisceration carried out over a 10-year period – July 1997 to June 2007 – at the Irrua Specialist Teaching Hospital. Data from theatre records and case notes were analysed with respect to age, sex, interval between onset of symptoms and presentation, indications for surgery and type of surgery done. Results: A total of 42 patients had enucleation or evisceration during the period, accounting for 6.96% of all ophthalmic surgeries (603) over the same period. Eight eyes were enucleated (19.05%) and 34 eyes were eviscerated (80.95%). There were 21 males (50%) and 21 females (50%). The most common reason for removal of the eye was a ruptured globe secondary to severe ocular trauma (35.71%). This was followed by panophthalmitis (26.19%) and intraocular tumours (9.52%). Forty patients (95.2%) presented after one week of onset of ocular lesions; 20(47.6%) had used traditional eye medication, and 4 (9.5%) had used eye drops containing corticosteroids. Conclusion: Health education programmes aimed at increasing public awareness on dangers of self medication, the use of native medication and the need to present early to hospital are highly recommended. Also, protective goggles and helmets with plastic facial coverings are recommended for workers who are at risk for eye trauma. Keywords: eye, enucleation, evisceration, NigeriaNigerian Journal of Ophthalmology Vol. 16 (1) 2008: pp. 16-1

Nighttime assaults: using a national emergency department monitoring system to predict occurrence, target prevention and plan services

Background: Emergency department (ED) data have the potential to provide critical intelligence on when violence is most likely to occur and the characteristics of those who suffer the greatest health impacts. We use a national experimental ED monitoring system to examine how it could target violence prevention interventions towards at risk communities and optimise acute responses to calendar, holiday and other celebration-related changes in nighttime assaults. Methods: A cross-sectional examination of nighttime assault presentations (6.01 pm to 6.00 am; n = 330,172) over a three-year period (31st March 2008 to 30th March 2011) to English EDs analysing changes by weekday, month, holidays, major sporting events, and demographics of those presenting. Results: Males are at greater risk of assault presentation (adjusted odds ratio [AOR] 3.14, 95% confidence intervals [CIs] 3.11-3.16; P < 0.001); with male:female ratios increasing on more violent nights. Risks peak at age 18 years. Deprived individuals have greater risks of presenting across all ages (AOR 3.87, 95% CIs 3.82-3.92; P < 0.001). Proportions of assaults from deprived communities increase midweek. Female presentations in affluent areas peak aged 20 years. By age 13, females from deprived communities exceed this peak. Presentations peak on Friday and Saturday nights and the eves of public holidays; the largest peak is on New Year’s Eve. Assaults increase over summer with a nadir in January. Impacts of annual celebrations without holidays vary. Some (Halloween, Guy Fawkes and St Patrick’s nights) see increased assaults while others (St George’s and Valentine’s Day nights) do not. Home nation World Cup football matches are associated with nearly a three times increase in midweek assault presentation. Other football and rugby events examined show no impact. The 2008 Olympics saw assaults fall. The overall calendar model strongly predicts observed presentations (R2 = 0.918; P < 0.001). Conclusions: To date, the role of ED data has focused on helping target nightlife police activity. Its utility is much greater; capable of targeting and evaluating multi-agency life course approaches to violence prevention and optimising frontline resources. National ED data are critical for fully engaging health services in the prevention of violence

Glaucomatocyclitic Crisis In Edo State, Nigeria: Report Of Two Cases

Objective: To report two classical cases of glaucomatocylitic crisis in tertiary Health Centres in Edo State, Nigeria Method: Two cases of glaucomatocylitic crisis seen at Irrua Specialist Teaching Hospital, Irrua, and University of Benin Teaching Hospital, Benin City, both in Edo State, Nigeria are reported. Diagnosis was based on typical history and findings on examination. Results: The first was a female who presented in December 2002 at Irrua Specialist Teaching Hospital and the second was a male who presented at the University of Benin Teaching Hospital, in March 2004. Both presented with blurring of vision in the affected eye and seeing halos around light. The intraocular pressures in the affected eyes were markedly elevated, there were fine keratic precipitates in the corneal endothelium of the involved eyes and the optic discs and visual fields were normal. Repeated episodes of the symptoms confirmed the diagnosis of glaucomatocyclitic crisis. Conclusion: This report shows that typical cases of glaucomatocylitic crisis occur in Nigerians but require a high index of suspicion for the diagnosis. Keywords: Glaucomatocylitic crisis, Posner-Schlossman syndrome, Nigeria Nigerian Journal of Clinical Practice Vol. 11 (2) 2008: pp. 162-16