Appropriateness of Ophthalmic Cases Presenting to a Nigerian Tertiary Health Facility: Implications for Service Delivery in a Developing Country

To assesswhether the ophthalmic cases presenting at aNigerian tertiary eye unit are appropriate for such level of care and also drawnecessary implications for service delivery. : Data on 1,321 consecutive new patients that presented at the ophthalmic clinic of the University of Teaching Hospital, Ilorin, Nigeria between February and July 2005 were reviewed on demographics, referral routes, and reasons for patronage, diagnoses and disease categories. Information on the general situation of health infrastructures prevailing at the surrounding health facilitieswas collected fromkey-informants. One thousand and ninety-one (82.6%) presentedwithout any referral and 1,095 (82.9%) patronized in order to access perceived good quality of eye care service being rendered. However, only a small proportion of their ailments (191, 14.5%) actually required attention at the tertiary level of eye care. The key informants painted a picture of severely-challenged general and health infrastructures particularly at the primary health care facility level An overwhelming majority of ophthalmic patients directly accessed eye care at the tertiary level, even though most of their ailments could have been satisfactorily treated at the lower facilities of health care were the latter to be functioning optimally. A better coordinated and strengthened health care system, particularly at the primary and secondary health care facilities would ease the burden of inappropriate presentations on tertiary health facilities inNigeria.Keywords: Health care utilization pattern, referral routes

Non-exposed Bisphosphonate-related Osteonecrosis of the Jaw: A Critical Assessment of Current Definition, Staging, and Treatment Guidelines

Non-exposed bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a newly reported complication arising from bisphosphonate therapy that presents with atypical symptoms and no apparent mucosal fenestration or exposure of necrotic bone. The clinical observation of the presence of necrotic bone underneath normal epithelial coverage was not conclusive for the diagnosis of BRONJ based on current guidelines established by the American Association of Oral and Maxillofacial Surgeons (AAOMS) and the American Society for Bone and Mineral Research (ASBMR), which specify the presence of clinically exposed necrotic bone for more than 8weeks. Hence, the purpose of this review is to critically assess the current guidelines for diagnosis and management of BRONJ and propose a modified staging system and treatment guidelines to properly address the non-exposed variant of BRONJ lesions. © 2012 John Wiley & Sons A/S

Ophthalmic surgical practice In Ilorin, Nigeria in the 1990s

The treatment of ocular morbidity to restore vision often requires surgery. This study was done to determine the frequency of such surgical interventions and the various types of ophthalmic surgery done at the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria. A retrospective review of all ophthalmic surgical procedures done in UITH between January 1990 and December, 2000 was carried out. The records were obtained from the operating theatre's register. Data analysis was with SPSS version 10. Within the study period, 1398 ocular surgeries were performed. Cataract surgery was the commonest (54.5%) and mostly performed in the 50-69 years age group; repair of corneal laceration was next (6.9%). The third most common surgery was pterygium excision (6.7%), common in the 30-69 years age group. Trabeculectomy for glaucoma was in the fourth position (6.2%). Destructive surgery (evisceration, enucleation and exenteration) was performed more in the paediatric age group. Cataract blindness is curable by surgery; the progression of glaucoma could be arrested with surgery. Early surgical intervention in ocular trauma would not only restore anatomical integrity but functional ability of the eye. The cataract surgical output could be improved upon by organizing outreach program and peripheral eye clinics. Use of protective eye shields by susceptible individuals would minimize ocular morbidity from trauma. Prompt referral of children with potential blinding eye injury or treatable ocular tumour would reduce the incidence of destructive surgeries in children. Keywords: ophthalmic surgeries, practice, Ilorin, Nigeria The Tropical Journal of Health Sciences Vol. 13(2) 2006: 31-3