Ophthalmic Presentations in Leprosy Patients in (South-Eastern) Nigeria

Objective: To determine the magnitude and pattern of ocular disorders and blindness among leprosy patients, presenting at three leprosy clinics in South —Eastern Nigeria. Methodology: All the in- patients, as well as the out- patients that presented to the 3 leprosy clinics during the 2- month period of the study were examined. Altogether, 171 patients were studied. All data were entered into the computer and analyzed using the SPSS software package. Results: Ocular examinations revealed that 60.2% of the patients had leprotic lesions. Other findings were cataract 24.6%; pterygium 24.6%; refractive errors 21.6%; glaucoma 12.3%; age- related macular degeneration 4.6%; presumed toxoplasmosis 1.2%; optic atrophy 1.2% and squint 0.6%.A total of 10.5% of patients were blind and 39.8% visually impaired. Cataract accounted for 55.6% blindness. Conclusion: It is concluded that non- leprotic lesions, particularly cataract were responsible for most of the blindness. We recommend that ophthalmic surgeons should organize regular and periodic surgical outreaches to leprosy centers with the aim of dealing with non- leprotic causes of avoidable blindness in such centres. Key Words: Leprosy, Leprotic eye lesions, non-leprotic eye lesions, surgical outreaches. Orient Journal of Medicine Vol.16(3&4) 2004: 18-2

Specialty Choice of Residents in the University of Nigeria teaching Hospital, Enugu 1989 - 1999.

Objective: To analyze the specialty choice of residents in the University of Nigeria Teaching Hospital Enugu from 1989 - 1999, and to assess the ratio of community physicians to the clinical specialties of residents. Method: The record of admissions into the residency training programme in the University of Nigeria Teaching Hospital Enugu was analyzed. Simple percentages and proportions of residents in the different specialties were computed and compared with one another and with community medicine. Result: The ratio of community medicine to the other clinical departments of Surgery, Internal medicine, Obstetrics & Gynaecology and Paediatrics is 1:7. When compared individually, each of these four were at a ratio of about 2:1 to community medicine. Conclusion: This study and other studies from other parts of the nation show that Nigeria is producing more core clinicians than community health physicians. As the nation's health policy is anchored on Primary Health Care, Community Health Physicians may be better suited to implement the nation's health policy. It would therefore be beneficial to increase the number of community Health Physicians produced by training institutions in Nigeria. Key Words: Residency training; Health manpower, Primary Health Care; Community physicians Orient Journal of Medicine Vol.16(3&4) 2004: 7-1

Microbial Keratitis—A Review of Epidemiology, Pathogenesis, Ocular Manifestations, and Management

Purpose: To review updated knowledge on the epidemiology, pathogenesis, clinical features, and treatment of microbial keratitis (MK).Source of Data: International and local journals containing current literature on MK were sourced through the Internet.Study Selection: Findings consistent with our objectives were compiled and reviewed. Data Extraction: Data were extracted using endnotes. Results: MKis a sight-threatening ocular infection caused by bacteria, fungi, and protist pathogens. The pathogenesis comprises molecular mechanismsdescribing microbial activities which involve virulence and host factors  responsible for ocular tissue damage and progression in keratitis. Clinical features include redness, pain, tearing, blurred vision, and inflammation, but symptoms vary depending on the causative agent. The primary treatment goal is the elimination of causative organism in addition to neutralization of virulence factors and healing of damaged host tissue. A timely review of our current understanding of MK with the recent advances in its treatment will ensure improved management outcomes. Conclusion: Optimal outcome from management of MK will require an  updated knowledge of its pathogenesis, clinical features, and treatment protocols, especially in sub-Saharan Africa where its prevalence is on the increase.Keywords: Epidemiology, management, microbial keratitis, ocular manifestations, pathogenesi