Renal Artery Aneurysm at a Nigerian Tertiary Centre: Case Report and Review of Literature

Renal artery aneurysms are rare urologic conditions, with rupture being the most feared complication. We discuss the management of two womenwith this disease at our center. The first was a 58‑year‑old woman who presented with torrential hematuria and hemodynamic compromise.  Abdominal computed tomography (CT) angiography revealed a left renal artery aneurysm, and she had emergency nephrectomy. The second was a 40‑year‑old woman with recurrent flank pain of 2 years duration. Serial CT scans showed a calcified renal aneurysm remaining stable over this period. She was managed nonoperatively, with serial follow‑up imaging to determine if future intervention is warranted. We conclude on the need for adequate evaluation and imaging to promptly diagnose renal artery aneurysms, and that care should be individualized. Keywords: Aneurysm, angiography, artery, nephrectomy, renal, ruptur

Breast cancer patients’ presentation for oncological treatment: a single centre study

Introduction: Breast cancer patients are presenting at advanced stages for oncological treatment in Nigeria and World Health Organization predicted developing countries’ breast cancer incidence and mortality to increase by year 2020. Methods: Prospective observational hospital based study that enrolled breast cancer patients from catchment area of an oncology service hospital in Nigeria between 2007 and 2013. Patients’ demographics, breast cancer burden and health care giver presentation variables were analysed for causal factors of seeking medical help and what determines commencement of effective oncological treatment. Results: Forty-six patients were enrolled, 19.6% of them presented primarily to oncologist while 80.4% presented secondarily for oncological treatment. There is a significant difference in presentation time for oncological treatment (t = -3.56, df = 42.90, p = 0.001) between primary (M =11.56 ± 5.21 weeks) and secondary presentation (M= 52.56 ± 10.27weeks) . Tumor burden of those that presented secondarily were significantly more advanced (U = 78.5, p = 0.011) and, univariate analysis reveals that: patients’ matrimonial setting, breast cancer awareness and mode of discovery of breast symptoms are patient related factors that determines their choice of health care providers and, determinant of effective oncological treatment is patient first contact health care provider. Conclusion: Patients’ bio-characteristics that determine their choice of health care provider should be incorporated into community breast cancer sensitization drives. Additionally, there is a need for a government agency assign the task of accrediting and defining scope of enterprise of health care institutions and their health care providers in our pluralist health system.Pan African Medical Journal 2016; 2

Unusual presentation of advanced prostate cancer in a black population of South-Western Nigeria

There are growing concerns on the varying pattern of advanced prostate cancer (PCa) presentation across the world. We report some of the unusual presentations of PCa at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, South-Western Nigeria. A review of all patients with histologically confirmed PCa who had unusual presentations between January 2014 and December 2015 was done. Unusual presentation was defined as an atypical feature in the absence of lower urinary tract symptoms (LUTS), with the diagnosis of PCa only suspected after abnormal digital rectal examination (DRE) and/or elevated prostate specific antigen (PSA) assay. Thirteen patients had an unusual presentation in OAUTHC during the study period. Five (38.5%) had left supraclavicular swellings while four (30.8%) had haematochyzia and tenesmus. Other unusual presentations include large bowel obstruction requiring emergency colostomy (2;15.4%) and a scalp mass (1;7.7%). All patients had appropriate treatment for stage of CaP and are being followed up in the out-patient clinic. The change in presentations of PCa may suggest the need for DRE and serum PSA assay among all middle-aged and elderly men presenting at health facilities. Large scale studies on PCa across different population groups may also help at identifying related clinical, demographic and epidemiological factors as well as possible validation of some of these unusual presentations

Management of pelviureteric junction obstruction at a tertiary teaching hospital in southwestern Nigeria: A retrospective analysis of case records

Background: Pelviureteric junction obstruction (PUJO) is an important cause of upper urinary tract obstruction. It can cause marked impairment of renal function, especially in bilateral cases, if not diagnosed and treated promptly. Surgical intervention is currently the mainstay of treatment. We aimed to review the pattern of presentation and management outcomes of patients diagnosed with PUJO. Methods: We conducted a retrospective study of patients aged 2–60 years who presented with PUJO between January 2005 and December 2014. Demographic characteristics, clinical presentation, investigations, and treatment modalities were extracted from case notes. Data were analysed using SPSS version 20. Results: The age range of the 32 included PUJO patients was 2–60 years, with a median age of 30 years. Children constituted 31% of patients. There were 15 males and a male-to-female ratio of 0.88:1. Most PUJO was unilateral and left-sided (n = 19; 59%). Loin pain was the commonest symptom (n = 26; 81%), while 25% of patients had a urinary tract infection at presentation. All patients had normal renal function at the time of surgery, and Anderson–Hynes pyeloplasty was the most common technique employed (72% of cases). Postoperatively, the majority of patients (n = 31; 97%) had complete symptom resolution. Surgical site infection (n = 3; 9%) was the commonest postoperative complication, and the median hospital stay was 11 days. There was no mortality. Conclusions: Most patients with PUJO presented late. Most of our patients underwent Anderson–Hynes pyeloplasty with satisfactory outcomes. Keywords: pelviureteric junction obstruction; PUJO; loin pain; Anderson–Hynes pyeloplasty; Foley Y-V plasty; Nigeria

Challenges of residency training and early career doctors in Nigeria study (charting study): a protocol paper

Introduction: Early career doctors (ECDs) make up a significant proportion of the workforce of medical/dental practitioners in Nigeria. ECDs play pivotal roles in the Nigerian healthcare system. However, several factors affect ECDs in their career endeavours, ranging from poor remuneration to psychosocial problems (such as burn out, job dissatisfaction, etc.). While other countries have tried to investigate these factors and their impact, no national inquiry has been done yet in Nigeria. This demonstrates the critical need to conduct a nationally representativestudy exploring these factors, such as demographic, workplace and psychosocial factors, among ECDs in Nigeria. This article is a protocol paper for the challenges of residency training and early career doctors in Nigeria study; charting study to be conducted under the auspices of the Nigerian Association of Resident Doctors of Nigeria(NARD).Methods: The Charting Study would be a mixed study design, utilizing both qualitative and quantitative study designs and access data from structured questionnaire, focus group interview and secondary data available to the association.Conclusion: The outcome of this study will provide great insight into various issues affecting ECDs in Nigeria and make necessary recommendations.Keywords: Nigeria, early career doctors, junior doctors, physicians, dentists, workplace, psychosocial issue

Challenges of Residency Training and Early Career Doctors in Nigeria Phase II: Update on Objectives, Design, and Rationale of Study

Background: Early career doctors (ECDs) are a dynamic and highly mobile group of medical and dental practitioners who form a significant proportion of the health workforce in Nigeria. The challenges of residency training and ECDs in Nigeria CHARTING Phase I study explored limited challenges affecting ECDs under the broad themes of demography, workplace issues, and psychosocial issues. The CHARTING II was expanded to provide wider insight into the challenges of ECDs in Nigeria. Objective: This protocol aims to provide clear objectives including description of objectives, design, and rationale for the conduct of the proposed CHARTING II study which seeks to explore other components under the various themes of demographic, workplace, psychosocial issues affecting the ECDs in Nigeria, and which were not explored under CHARTING I.   Methodology: This shall be a mixed study design that will combine qualitative and quantitative methods, to investigate 27 subthemes among 2000 ECDs spread across 31 centers, accredited by the Nigerian Association of Resident Doctors. Participants shall be selected using the multistage sampling method. The primary data will be generated using structured proforma and validated questionnaires,while administrative sources would serve as a source of secondary data. Data will be entered and analyzed using appropriate statisticalsoftware. Conclusion: CHARTING II study would provide more robust data and insight into the problems encountered by ECDs in Nigeria. This would in turn build a platform for institutional engagement and advocacy in order to drive relevant policies to mitigate these challenges. Keywords: Early career doctors, Nigeria, residency, resident doctors, trainin