Challenges of dermatology training among internal medicine resident doctors in Nigeria

Background: The scope of dermatology training varies in teaching hospitals across Nigeria. In some institutions, there is a department of dermatology while in others it is a unit in the internal medicine department. Some medical schools have clinical postings in dermatology while others do not. Although the number of dermatologists in the country has increased compared with a few years back when they were a handful, the numbers are still inadequate to train other health practitioners on skin disorders and to meet the needs of patients. The objective of the study was to determine the perceived challenges by residents with regards to dermatology training so as to provide adequate training and ultimately increase the number of dermatologist in the country Methods: This was a cross-sectional descriptive study among resident doctors in internal medicine attending the update course of the National Postgraduate Medical College in April 2012 at Lagos using a selfadministered questionnaire. Data was analysed with SPSS 16. Result: Ninety resident doctors (58 pre-part 1 and 32 post part 1) answered the questionnaire. Seventy two (80.9%) had at least one dermatologist currently in their training institution. Sixty seven (76.1%) of the respondents (35 pre-part 1 and 32 post-part 1) had undergone postings in dermatology. The length of training varied from 1- 6 months. Sixty (66.7%) of the residents had dermatology posting as undergraduates in medical school with the length of the posting ranging from 2-6 weeks (30.0% for two weeks, 23.3% for four weeks and 41.7% for more than four weeks). Residents felt they had inadequate exposure to procedural dermatology (surgery, lasers, aesthetic), dermatopathology and management of wounds. Inadequate research opportunity (55.9%), inadequate mentors (53.2%), and inadequate facilities (53.2%) were more important challenges to dermatology training perceived by more than 50% of the residents.Conclusion: Dermatology training at both undergraduate and post graduate level in Nigeria is variable in content and duration amongst training institutions in Nigeria. There is need to standardise undergraduate and postgraduate Dermatology training. Training institution should operate a standard structured dermatology posting for undergraduate training and adhere to available curriculums provided by the postgraduate colleges for postgraduate training. Adequate facilities should be provided in the training centres and were these are not in place candidates should go to other centres with adequate training facilities for their postings

Kidney Function Status in Nigerian Human Malaria Patients

Malaria is now known to affect over 500 million persons worldwide, killing about 1 to 3 million of them annually. Plasmodium falciparum is the  species mostly implicated in the causation of severe malaria. This study was carried out to investigate the kidney function status of malaria patients in Benin metropolis, Southern Nigeria, to ascertain if there is renal  dysfunction/impairment in them. Plasma levels of sodium, potassium,  bicarbonate, urea, creatinine and blood urea nitrogen (BUN) were assayed in a total of 152 subjects (112 malaria patients infected with Plasmodium falciparum and 40 controls) of both sexes, with their age ranging from 8 to 42 years. The results observed irrespective of age or sex, reveal a  statistically significant (p<0.05) increase in plasma levels of potassium, urea, BUN and creatinine (4.49±0.95 mmol/L;5.88±0.13mmol /L;16.39±0.36mg/dl and 135.05±2.69ìmol/L) when compared to their controls (4.05±0.34mmol/L;3.73±0.12mmol/L;10.34±0.36mg/dl and  80.71±1.69ìmol/L, respectively) and also a statistically significant (P<0.05) reduction in plasma levels of Na+ and HC03- (128.50±0.77 and  19.98±0.28mmol/L) when compared to their controls (l38.58±0.29 and 24.70±0.36mmol/L, respectively). The hyponatraemia and metabolic acidosis observed in the malaria patients are negatively correlated with the degree of parasitaemia (r=-0.241 and r=-0.019, respectively), while the elevated plasma potassium and creatinine levels are positively correlated with the degree of parasitaemia (r=0.153 and r=0.407, respectively). The elevated plasma Urea and BUN levels are also positively correlated with the degree of parasitaemia (r=0.371 and r=0.375, respectively). The results of this study indicate that there is significant renal dysfunction/impairment in patients in southern Nigeria infected with plasmodium falciparum.Keywords: Malaria infection, Kidney function status