Upper gastrointestinal tract bleeding in Ilorin, Nigeria - a report of 30 cases

Background: Upper gastrointestinal tract bleeding refers to blood loss within the intraluminal gastrointestinal tract from any location between the upper oesophagus to the duodenum at the ligament of Treitz. The onset and severity of blood loss varies widely.Acute gastrointestinal bleeding is a potentially life-threatening abdominal emergency that remains a common cause of hospitalization. There is no local data on the clinical presentation, endoscopic findings and the risk factors for upper gastrointestinal tract bleeding in Ilorin. This study was therefore to review the cases of upper gastrointestinal tract bleed in Ilorin. Aim: To reviewthe cases of upper gastrointestinal tract bleeding seen in Ilorin. Methodology: A retrospective review of the cases of upper gastrointestinal tract bleeding who had upper gastrointestinal tract endoscopy as part of their workup was undertaken to cover a eighteen month period from June 2006 to November 2007. Their clinical presentation, endoscopic findings, and the risk factors which predisposed themto bleedingwere evaluated.The endoscopy register and the request formswere reviewed. Results: Atotal of thirty patients had upper gastrointestinal tract bleeding for which upper gastrointestinal tract endoscopy was performed during the period under review. Twenty-three of the patients were males (76.7%) while seven were females (23.3%). Sixteen patients (53.3%) presented with malaena only; eleven patients (36.7%) with malaena and haematemesis only; while three patients (10.0%) presented with malaena, haematemesis and haematochexia. However all the patients presented with malaena, haematemesis or haematochexia. The commonest clinical presentation of patients with upper gastrointestinal tract bleeding passage of malaena (53.3%). The commonest endoscopic finding was multiple sources of bleeding (66.7%)while the commonest risk factor for upper gastrointestinal tract  bleeding was NSAIDuse (36.7%). Conclusion: The passage of malaena, multiple source of bleeding, and NSAID use are the commonest clinical presentation, endoscopic findings and risk factors respectively in patients with upper gastrointestinal tract bleeding in Ilorin. The spectrum of clinical presentation, endoscopic findings and risk factors for upper gastrointestinal tract bleed found in this study is similar to that found by other workers.Keywords: Upper, gastrointestinal tract, bleeding, Ilori

Awareness of diabetic retinopathy among patients with diabetes mellitus in Ilorin, Nigeria

Background: Diabetic retinopathy is a major cause of blindness worldwide. The associated loss of productivity and quality of life of the patients with diabetic retinopathy will lead to additional socioeconomic burden. This study aims to determine the level of awareness of diabetic retinopathy among diabetic patients.Materials and Methods: This hospital-based cross sectional study, was carried out at the Diabetic and Ophthalmology clinics of University of Ilorin Teaching Hospital, Nigeria from November 2011 to July 2012. A total of 365 patients had validated, semi-structured, and interviewer-administered questionnaires to obtain information on socio-demographic characteristics, clinical information and awareness of diabetic retinopathy.Results: A total of 365 patients were enrolled, with age between 19 and 90 years, and a mean of 45.8 ± 16.3 years. The male to female ratio was 1: 2.2. Ninety-nine respondents (27.1%) had no education. The majority (30.4%) had only primary education; 21.1% had tertiary; 14.5% had secondary while 6.8% had Quranic education. The mean duration of diabetes mellitus was 14.1 ± 13.09 years. Of the 365 patients with diabetes mellitus, 279(76.4%) had heard that diabetes mellitus affects the eyes, while 86 (23.6%) had not. Of those who had heard, 221(79.2%) heard it from health personnel, 45 (16.1%) from radio/television, 25(9.0%) from internet, 23 (8.2%) from books/newspapers, while 16 (5.7%) heard from other sources.Conclusion: There was a high level of awareness of diabetic retinopathy amongst the patients. However, the high level of awareness of the blinding complication of diabetes mellitus did not translate to a correspondingly high level of ocular examination for diabetic retinopathy.Keywords: Awareness, Diabetic retinopathy, Diabetes mellitus, Eye examinatio

A 3-Year Review of the Outcome of Pars Plana Vitrectomy for Dropped Lens Fragments after Cataract Surgery in a Tertiary Eye Hospital in Dhaka, Bangladesh

BACKGROUND: Dropped lens fragments into the vitreous are uncommon, but potentially sight threatening complications of cataract surgery. The recommended approach for removal of dropped lens matter is pars plana vitrectomy with or without ultrasonic emulsification with the fragmatome. This study aimed to determine the visual outcome following pars plana vitrectomy for dropped lens fragments complicating cataract surgery at 6 weeks, 3 months and 6 months.METHODS: This study is a retrospective review of patients who had PPV as treatment for dropped lens fragments complicating cataract surgery at Ispahani Islamia Eye hospital and Institute. The case notes of all patients who had PPV for dropped nucleus from January 2013 to December 2015 were reviewed. Information retrieved included the bio-data of the patients, clinical features such as visual acuity, intraocular pressure, cornea clarity, presence of anterior chamber activity, Lens status and fundus findings at presentation, 6 weeks, 3 months and 6 months post surgery. Details of intra ocular procedure (Cryotherapy, Endo laser, Silicon oil or gas tamponade) in addition to PPV were noted.RESULT: Thirty- two cases were reviewed within the 36-month time period. There were 8(25%) females and 24(75%) males. Male to female ratio was 1:3. The best corrected visual acuity of patients at presentation was better than or equal to 6/60 in 56.3% of the patients. Dropped nucleus occurred during phacoemulsification cataract surgery in the majority (59.6%) of the patients. The best corrected visual acuity was 6/18 or better in 10(31.3%) eyes at 6 months post-surgery. Worsening of visual acuity to light perception occurred in 3(9.4%) eyes at 6 months, and 3 eyes (9.4%) developed phthisis bulbi.CONCLUSION: Modest improvement in visual acuity can be achieved after dropped nucleus complicating cataract surgery by Pars plana vitrectomy and removal of dislocated lens fragment.KEYWORD: Visual outcome, Dropped lens, Pars plana vitrectom

Indications for Oesophagogastroduodenoscopy in Ilorin, Nigeria- A 30 month Review

Background:Oesophagogastroduodenoscopy is one of the most commonly performed endoscopic procedures. Properly performed, it provides valuable information in patients with upper gastrointestinal conditions. Oesophagogastroduodenoscopy is a visual examination of the upper intestinal tract using a lighted, flexible fibreoptic endoscope or videoscope. Oesophagogastroduodenoscopy is generally indicated for evaluating upper abdominal symptoms such as dysphagia or odynophagia, oesophageal reflux symptoms, gastroduodenal or oesophageal ulcer, upper tract stricture or obstruction, gastrointestinal bleeding, persistent vomiting of unknown cause etc. This study is therefore to review the indications for oesophagogastroduodenoscopy in Ilorin, Nigeria. Aim: To review the indications for oesophagogastroduodenoscopy in Ilorin, Nigeria. Methodology: A review of the indications for  oesophagogastroduodenoscopy was undertaken to cover a thirty-month period from June 2006 to November 2008. The endoscopy register of the operating theatre was examined over this period. The biodata of the patients who underwent the procedure over this period was reviewed. Results: A total of 206 patients had oesophagogastroduodenoscopy done on them during the period under review. 124 of the patients were males (60.2%) while 82 were females (39.8%). The indications for oesophagogastroduodenoscopy were dyspepsia, 94 patients (45.6%); upper gastrointestinal tract bleed, 54 patients (26.2%); gastric outlet obstruction, 12 patients (5.8%); gastric cancer, 11 patients (5.3%); dysphagia, 9 patients (4.3%); acute exacerbation of peptic ulcer disease, 8 patients (3.8%); gastro-oesophageal reflux disease, 7 patients (3.4%); recurrent vomiting, 3 patients (1.5%); bloody stool, 2 patients (1.0%); epigastric mass, 2 patients(1.0%); 1 patient (0.5% ) each on account of excessive salivation, foreign body ingestion, ingestion of corrosive, and recurrent anaemia. Conclusion: The commonest indication for oesophagogastroduodenoscopy in Ilorin is dyspepsia.Key Words: Indications, Oesophagogastroduodenoscopy, Ilori

Evaluation of the Community Cataract Surgical Services of a University Teaching Hospital Using Cataract Surgical Coverage in Nigeria

Background: Cataract is the leading cause of blindness in the world. An efficient and effective cataract surgical service is necessary to reduce the backlog of cataract blindness in the community. This study aims to determine the cataract surgical coverage among individuals aged 50 years and above residing in Esie and Arandun communities. This will serve as a measure of the impact of the cataract intervention programme provided by the University of Ilorin Teaching Hospital, Nigeria.Methods: The study was a population-based, cross sectional survey conducted from November to December, 2013. Cataract surgical services are provided by the University of Ilorin Teaching Hospital, Nigeria, at Esie and Arandun communities as out-reach centres. Seven hundred and fifty-five individuals aged 50 years and above residing in these communities had basic ocular examination done.Result: Out of the 765 subjects registered, 755(98.7%) were examined. Out of these, 38.4% were males and 61.6% were females. The prevalence of bilateral cataract blindness was 1.6%. The Cataract Surgical Coverage (eyes) at visual acuity < 3/60 for males and females were 52.3% and 51.2% respectively (X2=19.30, p=0.001), while the Cataract Surgical Coverage (person) at visual acuity less < 3/60 for males and females were 80.6% and 68.4% respectively (X2=2.10, p=0.147).Conclusion: The Cataract Surgical Coverage was high with a correspondingly low prevalence of cataract blindness in these communities. The availability of cataract surgical services via out-reach programmes bridges the gap between eye care-givers and the community.Keywords: Cataract Surgical Coverage, Cataract Surgical Services, Community, Evaluatio

Prevalence of intestinal parasites in newly diagnosed HIV/AIDS patients in Ilorin, Nigeria

AbstractBackgroundHuman immune-deficiency virus/acquired immune-deficiency syndrome predisposes to opportunistic parasitic infestations of the gastrointestinal tract. This study aimed to determine the prevalence of intestinal parasites in newly diagnosed treatment naïve HIV/AIDS patients.MethodsThis hospital-based cross-sectional study was carried out from December 2010 to June 2011. Questionnaires were administered to 238 HIV/AIDS subjects, and 238 age and sex-matched controls. CD4+ T cell count was carried out on HIV-positive subjects. Stool samples were examined using direct microscopic and modified Ziehl-Neelsen methods. Positivity of intestinal parasites was taken as the presence of worms, oocyst, cyst, ova or larvae in the stool samples.ResultsNinety males and 148 females were studied for the HIV-positive and HIV-negative controls respectively. Intestinal parasitic infestation in HIV-positive subjects was 68.5%, and was significantly higher than in the HIV-negative controls 49.2% (P<0.05). In HIV-positive subjects, Cryptosporidium spp. was the commonest (55.0%) parasite isolated. Others were Cyclospora cayetanensis (41.2%), Isospora belli (3.0%), Entamoeba histolytica (8.4%), Giardia lamblia (3.7%), Ascaris lumbricoides (2.5%), Strongyloides stercoralis (1.7%), Trichuris trichiura (0.8%) and Schistosoma mansoni (0.4%). HIV-positive patients with CD4+ T cell count of less than 200 cells/ul were more at risk of opportunistic parasites compared to the HIV-negative controls.ConclusionThe prevalence of intestinal parasites in newly diagnosed HIV/AIDS individuals was high, and its association with CD4+ T cell count was demonstrated. Routine screening for parasitic infestations at diagnosis is indicated to reduce the burden of the disease

Massive rectal bleeding from colonic diverticulosis

Objectives: This is to describe a case of colonic diverticulosis causing massive rectal bleeding in an elderly Nigerian man.Case report: We highlight a case of a 79 year old man who presented with massive rectal bleeding due to colonic diverticulosis from our centre. Colonoscopy identified multiple diverticula in the proximal rectum, sigmoid, descending and transverse colon. The diverticula were more in the descending colon and also oozing blood. He was worked up, and had surgery for hemicolectomy due to massive blood loss following failure of initial conservative management.Conclusion: Colonic divericulosis may cause massive rectal bleeding severe enough to require hemicolectomy. Only few similar cases have been reported in this part of the continent.Keywords: Colon, rectal bleeding, diverticulosis, colonoscop

Awareness of Diabetic Retinopathy among patients with Diabetes Mellitus in Ilorin, Nigeria

Background: Diabetic retinopathy is a major cause of blindness worldwide. The associated loss of productivity and quality of life of the patients with diabetic retinopathy will lead to additional socioeconomic burden. This study aims to determine the level of awareness of diabetic retinopathy among diabetic patients. Materials and Methods: This hospital-based cross sectional study, was carried out at the Diabetic and Ophthalmology clinics of University of Ilorin Teaching Hospital, Nigeria from November 2011 to July 2012. A total of 365 patients had validated, semi-structured, and interviewer-administered questionnaires to obtain information on socio-demographic characteristics, clinical information and awareness of diabetic retinopathy. Results: A total of 365 patients were enrolled, with age between 19 and 90 years, and a mean of 45.8 ±16.3 years. The male to female ratio was 1: 2.2. Ninety-nine respondents (27.1%) had no education. The majority (30.4%) had only primary education; 21.1% had tertiary; 14.5% had secondary while 6.8% had Quranic education. The mean duration of diabetes mellitus was 14.1 ±13.09 years. Of the 365 patients with diabetes mellitus, 279(76.4%) had heard that diabetes mellitus affects the eyes, while 86(23.6%) had not. Of those who had heard, 221(79.2%) heard it from health personnel, 45(16.1%) from radio/television, 25(9.0%) from internet, 23(8.2%) from books/newspapers, while 16(5.7%) heard from other sources.Conclusion: There was a high level of awareness of diabetic retinopathy amongst the patients. However, the high level of awareness of the blinding complication of diabetes mellitus did not translate to a correspondingly high level of ocular examination for diabetic retinopathy. 

Assessment of patients waiting and service times in the ophthalmology clinic of a public tertiary hospital in Nigeria

Introduction: Long waiting time in the out-patient clinic is a major cause of dissatisfaction in Eye care services. This study aimed to assess patients’ waiting and service times in the out-patient Ophthalmology clinic of UITH. Methods: This was a descriptive cross-sectional study conducted in March and April 2019. A multi-staged sampling technique was used. A timing chart was used to record the time in and out of each service station. An experience based exit survey form was used to assess patients’ experience at the clinic. The frequency and mean of variables were generated. Student t-test and Pearson’s correlation were used to establish the association and relationship between the total clinic, service, waiting, and clinic arrival times. Ethical approval was granted by the Ethical Review Board of the UITH. Result: Two hundred and twenty-six patients were sampled. The mean total waiting time was 180.3± 84.3 minutes, while the mean total service time was 63.3±52.0 minutes. Patient’s average total clinic time was 243.7±93.6 minutes. Patients’ total clinic time was determined by the patients’ clinic status and clinic arrival time. Majority of the patients (46.5%) described the time spent in the clinic as long but more than half (53.0%) expressed satisfaction at the total time spent at the clinic. Conclusion: Patients’ clinic and waiting times were long, however, patients expressed satisfaction with the clinic times

Functional dyspepsia in Yola, Nigeria

Objective: Dyspepsia is a common disorder originating from the upper gastrointestinal tract, and is the most common indication for gastrointestinal endoscopy. Even though, functional dyspepsia (non-ulcer dyspepsia) is not life –threatening, it has profound clinical and economic effects, and influences the quality of life of sufferers. Data is scanty on functional dyspepsia from Nigeria. This study aims to determine the prevalence of functional dyspepsia in Yola, Nigeria.Methods: This was a cross-sectional study carried out at the Gastroenterology unit of Federal Medical Centre, Yola from December, 2006 to October, 2010. Patients with dyspepsia who had upper gastrointestinal endoscopy as part of their work-up were recruited. Their biodata, history and duration of dyspepsia were noted on a proforma. The spectrum of endoscopic findings was also noted.Results: A total of 441 patients underwent upper gastrointestinal endoscopy out of which 299 patients had dyspepsia. One hundred and thirteen (37.8%) were males while 186 (62.2%) were females, giving a male to female ratio of 1:1.6. The age range was from 18 to 97 years with a mean of 47.6 ± 9.4 years. Clinically significant endoscopic findings were seen in 94.0% while functional dyspepsia was seen in 18 patients (6.0%).Conclusions: Functional dyspepsia was seen in only a minority of patients with dyspepsia.Keywords: Functional dyspepsia, endoscopic, Nigerian