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

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

Traditional eye medication: A rural-urban comparison of use and association with glaucoma among adults in Ilorin-west Local Government Area, North-Central Nigeria

Background: Globally, the last two decades witnessed increase in the use of  Traditional Eye Medication (TEM); and its use worsens the prognosis of visual outcome. This study assessed and compared the use of TEM and its association with glaucoma among adults in selected rural and urban communities of Ilorin-west Local Government Area, North-Central Nigeria.Methodology: This was a comparative cross-sectional study. Respondents were selected using multi-stage sampling technique. Interviewer-administered structured questionnaire, and clinical report form were used to collect data. Data were analyzed using SPSS version 15. Level of statistical significance was set at p&lt;0.05.Results: A higher proportion of the rural, 174 (38.7%) than the urban, 111 (24.7%) respondents knew about TEM (p&lt;0.001). More of the rural, 83 (18.4%) than the urban, 78 (17.3%) respondents had ever used TEM (p=0.664). TEM known to the respondents in rural versus urban areas included camphor (47.1% vs 28.8%), personal urine (3.5% vs 2.7%) and salt-sugar solution (1.7% vs 14.4%) among others. There exists an association between the use of traditional eye medication and presence of glaucoma within rural (p=0.011) and urban (p&lt;0.001) areas.Conclusion: The use of TEM among the respondents was associated with glaucoma. While the association between glaucoma and uptake of TEM may not be causal, it provides a window of thought for further researches. There is need to strengthen awareness on the dangers of using TEM in the communities. Regular  community-based eye screening involving measurement of intraocular pressure will be useful in early detection of glaucoma.Keywords: Traditional eye medication; Glaucoma; Rural-Urban; Nigeri

Hepatocellular Carcinoma - A synopsis of current developments

This review highlights the burden associated with hepatocellular carcinoma and the progress made so far in the diagnosis, management, and treatment of the disease. It is based on a search of Medline, the Cochrane database of Systemic Reviews, and citation lists of relevant and current publications. Subject headings and key words used included "hepatocellular carcinoma", "pathogenesis", "liver transplantation", "local ablative therapy”, and “novel drug therapies”. Additional information was obtained by a manual search of the references from the key articles, current advances in treatment. Only articles in English were included.  Currently, surgical resection and liver transplantation are the treatment strategies offering the best long-term outcomes in patients with hepatocellular carcinoma. Non-transplant treatment as a bridge to transplantation also helps in lessening the risk of tumour progression or death during the waiting period. Targeted multi-cellular therapy with Sorafenib, is the first systemic agent to have yielded survival benefits in patients with advanced disease. Other agents: Brivanib, Erlotinib, monoclonal antibodies, Bevacizumab and Cetuximab, are currently being studied to determine their use in hepatocellular carcinoma.  Radionuclide Yttrium-90 microspheres, or combined subcutaneous interferon alpha and intra-arterial infusion chemotherapy, seem to be more promising strategies than Sorafenib treatment to downstage advanced hepatocellular carcinoma, including cases with macroscopic portal venous invasion.Although numerous modalities of diagnosis and treatment of hepatocellular carcinoma have been studied, there is still need for further evaluation of newer adjuvant treatment to provide more effective and tolerable methods for the patients with hepatocellular carcinoma.Keywords: Hepatocellular carcinoma, Hepato-carcinogenesis, Current diagnostic methods and techniques, Advances in treatmen

Multiple antibiotic resistance iIndex of EscherichiaColi isolates in a tertiary hospital in south-west Nigeria

Background: The effectiveness of available antibiotics is reducing as  microorganisms device means of evading its effects, resulting in the development of superbugs. Pathogens previously susceptible are becoming resistant, and spreading beyond the hospital environment. This change is a major concern for infection control and prevention and a huge economic burden for health care. This study aims to determine the drug sensitivity pattern of E. coli isolated in a tertiary hospital labMethodology: Gram negative bacilli, lactose fermenter, motile, indole positive,  glucose fermenter, gas producing isolate were identified as E.coli. Antimicrobial susceptibility testing to commonly prescribed antibiotics was carried out using the modified Kirby Bauer method and reported with the Clinical and Laboratory Standard Institute Interpretative chart. Mulitiple Antibiotic Resistance index was calculated as number of antibiotics to which isolate is resistant divided by the total number of antibiotics against which isolate was tested.Result: Five hundred and twenty–seven isolates were identified, among which a high rate of resistance to cefuroxime (407), high rate of intermediate susceptibility to nalidixic acid (264) and high rate of sensitivity to ceftriaxone (388) was noted. Sixty percent of the isolates had an index 0.2. Of the 40% with Multiple Antibiotic Resistance index &gt; 0.2, 61 % were from inpatient samples.Conclusion: The high Multiple Antibiotic Resistance index of the E. coli isolates indicates previous exposure to antibiotics and development of resistance to commonly prescribed antibiotics, hence, antimicrobial susceptibility testing is imperative in selecting therapeutic options. Attention also needs be paid to effective infection control and prevention to curb its spread among individuals

Knowledge Of glaucoma and its socio-demographic determinants: a comparative study of selected rural and urban communities in Kwara State, North-central Nigeria

Background Information: Glaucoma causes an irreversible blindness and presents a greater public health challenge than cataracts. One of the problems fueling this is inadequate knowledge of the disease, particularly in developing countries. This study aimed to assess and compare the knowledge of glaucoma among adults in selected communities of Kwara State, NigeriaMethodology: This was a cross-sectional comparative study. Respondents were selected through multi-stage sampling technique. Interviewer- administered structured questionnaire was used to collect data. Data were analyzed using SPSS version 15. Level of statistical significance was set at p&lt;0.05Result: Higher proportion of urban respondents demonstrated better knowledge of symptoms, 139 (30.9%) and risk factors 122 (27.1%) than the rural respondents. However, the mean scores for knowledge of symptoms (7.3±1.5 vs 6.7±1.9)) and risk factors (8.0±2.2 vs 7.8±2.3) among the rural respondents were higher compared with the urban respondents, but the observed difference was not statistically significant (p&gt;0.05). Sex and Educational status were the two significant socio-demographic determinants (Rural versus Urban) associated with both knowledge of symptoms and risk factors.Conclusion: Poor knowledge of glaucoma has been demonstrated among the respondents in both rural and urban communities in this study. This gap in knowledge among the respondents is inimical to the efforts towards reduction of burden of glaucoma.Recommendation: There is need for the Government to scale-up efforts at educating the public on glaucoma to prevent avoidable irreversible blindness.Keywords: Knowledge, glaucoma, determinants, NigeriaSavannah Journal of Medical Research and Practice 2017;6(2):16-2