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

TESTICULAR TORSION: EXPERIENCE IN THE MIDDLE BELT OF NIGERIA

Objective To determine the fate of the testis affected by testicular torsion (TT) in relation to the duration of the symptoms and to know the relative frequency of testicular torsion in the middle belt of Nigeria. Patients and Methods All patients presenting with TT presenting at the University of Ilorin Teaching Hospital, Ilorin, Nigeria between January 1989 and December 1998 were reviewed retrospectively by analyzing data from the medical records department, operating theatre and the surgical wards. Results Ninety-two patients with clinical suspicion of TT were reviewed. In 87 patients TT was confirmed at surgical exploration. Three were diagnosed as epididymo-orchitis, while two patients absconded. The patients age ranged from 6 months to 50 years (mean age 22.1 9 years). Eighty-one cases (93.1%) were unilateral, 36 (41.4%) right-sided, while 45 (51.7%) were left-sided. Six patients (7%) had bilateral disease which was synchronous in one and asynchronous in five patients. Seventy-five of the 87 testes (86.2%) were found to be viable at operation, while 12 (13.8%) were grossly non-viable and were removed. Orchidopexy was performed on testes found to be viable as well as on the contralateral testis in the case of unilateral cases. Conclusion Testicular torsion is the second most frequent urological emergency in our institution. In this series, the pathology was more prevalent on the left side with a salvage rate of 86.2% which can still be improved. Emphasis should be placed on the correct diagnosis as opposed to other acute scrotal conditions, particularly epididymo-orchitis and epididymitis with which TT is often confused. Torsion du Testicule: Expérience de la Ceinture Moyenne du Nigéria Objectif Déterminer la vitalité du testicule affectée par une torsion du cordon spermatique en relation avec la durée des symptômes et de connaître la fréquence relative de la torsion du testicule dans la ceinture moyenne du Nigéria. Patients et Méthodes Tous les dossiers des patients qui se sont pré-sentés à lHôpital Universitaire de Ilorin, Nigéria, et reçus entre Janvier 1989 et Décembre 1998 ont été revus rétrospectivement. Les données ont été collectées à partir des archives médicales, du bloc opératoire et des unités dhospitalisation chirurgicale. Résultats Les dossiers de 92 patients ayant eu une suspicion clinique de torsion du cordon ont été revus. La confirmation a été faite à lexploration chirurgicale dans 87 cas. Une orchi-épididymite a été diagnostiquée dans trois cas. Lâge moyen des patients était de 22,1 9 avec des extrêmes de 6 mois et 50 ans. La torsion était unilatérale dans 81 cas (93,1%). Il sagissait du côté droit dans 36 cas (41,4%) et du côté gauche dans 45 cas (51,7%). Six patients avaient une forme bilatérale (7%) dont une forme synchrone et 5 formes asynchrones. Soixante-quinze des 87 testicules (86,2%) étaient viables à lexploration tandis que 12 (13,8%) étaient nécrosés et ont été enlevés. Une orchidopexie a été pratiquée sur tous les testicules retrouvés viables et sur le testicule controlatérale dans les formes unilatérales. Conclusion La torsion du cordon spermatique est la seconde urgence urologique dans notre institution. Dans cette série, le côté gauche était plus atteint. Le testicule a été sauvé dans 86,2% mais ce taux peut être amélioré. Doù limportance du diagnostic correct de la torsion du cordon spermatique quil faut distinguer des autres causes de bourses aiguës particulièrement lorchi-épididymite et lépididymite qui peuvent souvent prêter à confusion. African Journal of Urology Vol.8(2) 2002: 78-8

Hypoglycaemia from misuse of oral hypoglycaemic agent in patients with lower urinary tract symptoms in Ilorin, Nigeria

Hypoglycaemia can be defined biochemically as level of blood glucose below 2.8 mmol/L (50mg/dL) in otherwise healthy adult. It is often characterized by variety of symptoms including confusion, loss of consciousness, seizures and rarely death may occur. The most common cause of hypoglycaemia is medications used to treat diabetes. Although, only some few recent studies found a significant association between factors in the metabolic syndrome and presence of benign prostatic hypertrophy (BPH); there has been no documented beneficial effect of the use of oral hypoglycaemic agent in the treatment of lower urinary tract symptoms (LUTS) from BPH either in diabetes or non-diabetes individuals.The incidence of diabetes mellitus is high about the same decades of life when the prevalence of LUTS/BPH is also at its peak. This coincidence may influence the pattern of presentations of such patients with LUTS associated with BPH especially in the rural African settings where patients tend to share their medications or prescription because of similarity in perception of their symptomatology.Case series of five patients with lower urinary tract symptoms, who had abused oral hypoglycaemic agents and presenting in various stages of altered consciousness and frank hypoglycaemic coma, were presented to illustrate this occasional occurrence and suggestion on how to militate this trend.In conclusion, misuse of oral hypoglycaemic agents (OHA) to treat LUTS with subsequent presentation in hypoglycaemic coma should be of concern to the health care provider especially the urologist. It is of no benefit and constitutes drug abuse that should be discouraged.Keywords: drug abuse, hypoglycaemia, lower urinary tract symptom

Machinery penile injuries associated with traditional trousers of the Yoruba of South-western Nigeria: A consideration for proper work clothes

AbstractAppropriateness of garments for different vocations to avoid unintended injury to the worker has always been recognized. This report of two cases of machinery penile injuries in patients wearing the traditional trousers of the Yoruba tribe of south-western Nigeria emphasizes the need for wearing appropriate clothes when operating machines

Prolonged use of indwelling urinary catheter following acute urinary retention in a tertiary care centre in sub-Saharan Africa: Causes, costs and concerns

Objectives: To evaluate the causes, estimate out-of-pocket payments and assess concerns associated with prolonged use of urinary catheters following acute urinary retention secondary to benign prostate enlargement (BPE) and urethral stricture disease (USD) in men attending the urology out-patient clinic of a tertiary referral centre in North-central Nigeria. Patients and methods: This was a cross-sectional survey of men attending urology clinic and who are using indwelling urinary catheter for >3 months following acute urinary retention due to BPE or USD. The study was conducted over a six-month period (1st March 2012 to 31st August 2012) at a tertiary hospital in North-central Nigeria using interviewer administered questionnaires. Results: Of seventy-six men, 36/76 (47.4%) had BPE and 40/76 (52.6%) had USD. Median age, median duration of catheter use and median out-of-pocket payment per catheter change was 65 years (range 20–90 years), 12 months (range 3–120 months) and US$9.31 (range$3.63–18.75) respectively. There was no significant difference in the duration of catheter use and out-of-pocket payments between men with BPE and USD; however, men with USD were significantly younger than those with BPE. One-fifth and half of the men with BPE and USD, respectively attributed inability to pay for surgery as the reason for prolonged use of catheters. The second common reason was long waiting list for surgery. Men with BPE had their sexual relationships disrupted significantly more than those with USD and unexpectedly, we found that men using catheters for less than 6 months describe themselves as unhappy significantly more than those using the catheters for longer periods (p = 0.033). Conclusions: Inability to pay for definitive surgery and long waiting lists are the leading causes of prolonged use of indwelling urinary catheters in men with BPE and USD in our sub-Saharan setting. Prolonged catheter use adversely affected quality of life disrupting sexual relationships especially of men with BPE. Recommendations made to reduce out-of-pocket payments and shorten waiting times may help to improve access to urologic surgical care for these men