Appropriateness of Ophthalmic Cases Presenting to a Nigerian Tertiary Health Facility: Implications for Service Delivery in a Developing Country

To assesswhether the ophthalmic cases presenting at aNigerian tertiary eye unit are appropriate for such level of care and also drawnecessary implications for service delivery. : Data on 1,321 consecutive new patients that presented at the ophthalmic clinic of the University of Teaching Hospital, Ilorin, Nigeria between February and July 2005 were reviewed on demographics, referral routes, and reasons for patronage, diagnoses and disease categories. Information on the general situation of health infrastructures prevailing at the surrounding health facilitieswas collected fromkey-informants. One thousand and ninety-one (82.6%) presentedwithout any referral and 1,095 (82.9%) patronized in order to access perceived good quality of eye care service being rendered. However, only a small proportion of their ailments (191, 14.5%) actually required attention at the tertiary level of eye care. The key informants painted a picture of severely-challenged general and health infrastructures particularly at the primary health care facility level An overwhelming majority of ophthalmic patients directly accessed eye care at the tertiary level, even though most of their ailments could have been satisfactorily treated at the lower facilities of health care were the latter to be functioning optimally. A better coordinated and strengthened health care system, particularly at the primary and secondary health care facilities would ease the burden of inappropriate presentations on tertiary health facilities inNigeria.Keywords: Health care utilization pattern, referral routes

Hypoglycaemia from misuse of oral hypoglycaemic agent in patients with lower urinary tract symptoms in Ilorin, Nigeria

Hypoglycaemia can be defined biochemically as level of blood glucose below 2.8 mmol/L (50mg/dL) in otherwise healthy adult. It is often characterized by variety of symptoms including confusion, loss of consciousness, seizures and rarely death may occur. The most common cause of hypoglycaemia is medications used to treat diabetes. Although, only some few recent studies found a significant association between factors in the metabolic syndrome and presence of benign prostatic hypertrophy (BPH); there has been no documented beneficial effect of the use of oral hypoglycaemic agent in the treatment of lower urinary tract symptoms (LUTS) from BPH either in diabetes or non-diabetes individuals.The incidence of diabetes mellitus is high about the same decades of life when the prevalence of LUTS/BPH is also at its peak. This coincidence may influence the pattern of presentations of such patients with LUTS associated with BPH especially in the rural African settings where patients tend to share their medications or prescription because of similarity in perception of their symptomatology.Case series of five patients with lower urinary tract symptoms, who had abused oral hypoglycaemic agents and presenting in various stages of altered consciousness and frank hypoglycaemic coma, were presented to illustrate this occasional occurrence and suggestion on how to militate this trend.In conclusion, misuse of oral hypoglycaemic agents (OHA) to treat LUTS with subsequent presentation in hypoglycaemic coma should be of concern to the health care provider especially the urologist. It is of no benefit and constitutes drug abuse that should be discouraged.Keywords: drug abuse, hypoglycaemia, lower urinary tract symptom

Toxic catheters and urethral strictures: A concern about types of catheters used in resource-poor countries

Various reports in the literature have confirmed urethral toxicity caused by the use of catheters, mostly latex catheters and their coated versions, resulting in long-segment urethral strictures or strictures located in multiple areas of the urethra. Most catheters used in resource-poor countries, such as Nigeria, are latex catheters with various coatings, such as silicone. The reasons for the widespread use of these potentially toxic catheters are mainly non-availability and/or the high cost of less toxic catheters. We report three cases of urethral strictures following the use of siliconized latex catheters in order to highlight the potential urethral toxicity associated with the use of latex catheters and to draw the authorities’ attention to the need to regulate the types of catheters used in the country

“Close-loop” urethral obstruction: Clinico-radiological features and management consideration in a resource-constraint environment

Objective: To document our observation of “close-loop” obstruction among patients with dual urethral obstruction from BPH and urethral stricture disease. Materials and Methods: The hospital records of all patients that presented to our centres with evidences of urethral stricture co-existing with BPH were retrospectively reviewed from January 2007 to December 2011. Among other things, the salient features in the contrast radiograph of those with “close-loop” obstruction and their treatment were documented and analysed. Results: Forty three patients were managed for radiological evidence of urethral stricture and elevated bladder base (dual obstruction). Thirty (69.7%) of these patients had open prostatectomy with easy dilatation of the urethral stricture. Twelve (27.9%) of the patients had urethroplasty for urethral stricture diseases; of these twelve, five patients presented with persistent LUTS (“close loop” obstruction). These five (11.6%) patients were aged between 50 to 80 years; they all had suprapubic cystostomy. In addition to delineating the anatomy of the urethral stricture and elevated bladder base, other salient features on the contrast radiographies included dilated prostatic urethral, visualization of the seminal vesicles and closed bladder neck on voiding cystogram. The initial treatment was urethroplasty but two each had combination therapy (with alpha adrenergic blocker and 5-alpha reductase inhibitor) and open prostatectomy respectively as further treatment while the last patient had perineal urethrostomy as first-stage redo-urethroplasty. Conclusion: “Close-loop” urethral obstruction appears to be an entity that needs further evaluation

Machinery penile injuries associated with traditional trousers of the Yoruba of South-western Nigeria: A consideration for proper work clothes

AbstractAppropriateness of garments for different vocations to avoid unintended injury to the worker has always been recognized. This report of two cases of machinery penile injuries in patients wearing the traditional trousers of the Yoruba tribe of south-western Nigeria emphasizes the need for wearing appropriate clothes when operating machines