OCULOPLASTIC TRAINING AND ITS ROLE IN EYE CARE SERVICES IN A NIGERIA TERTIARY HOSPITAL

ABSTRACT Oculoplasty subspecialty in Ophthalmology was barely 7 years in Nigeria. National statistics show an increased number of cases that should have benefitted from this expertise that is rare. As a result of this deficit, a consultant ophthalmologist was sent to Sankara Nethralaya Eye Hospital, Chennai, India for 3 months oculoplastic training with the help of International Council Ophthalmology (ICO). To evaluate the role of oculoplastic training in eye-service care in our hospital, all patients seen at our oculoplastic unit during the 8 months period from April to November 2017, had information extracted from their medical record. The data obtained was analysed using SPSS version 20. Out of 53 patients seen 30 (56.65) were males and 23 (43.4%) were females. Majority 10 (18.9%) were diagnosed with a traumatic irreparable ruptured globe, while 10 (18.9%) had congenital nasolacrimal duct obstruction. Page 7 of 23 https://mc.manuscriptcentral.com/sljbr Sierra Leone Journal of Biomedical Research Oculoplastic training and its role in eye care services in a Nigeria tertiary hospital for Review Only 2 Thirty-six (67.9%) patients had surgery and 10 (18.9%) were successfully managed with lacrimal sac massage for congenital nasolacrimal duct obstruction in children. Majority 10(18.9%) of the surgery were evisceration with primary ocular implants. One patient with clinically significant orbital floor fracture was referred. Four cases of congenital ptosis declined surgery. This expertise resulted in increased patient turnout by 30% and income to the department, while it saves cost to patients who need not be referred. The skills acquired from oculoplastic training have help in rendering oculoplastic services to the people of Kebbi State and its environs at a reduced cost. Also, there is improved internally generated revenue to the hospital. The importance of skill transfers and subspecialty training is underscored. Keywords: oculoplastic; subspecialty training; Kebbi State; tertiary hospita

Subspecialty training in Ophthalmology; How far?

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Facial and eye injury following a fridge cylinder gas explosion

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Blindness and scalp haematoma in a child following a snakebite

Background: Snake envenomation is a major public health problem of the Savannah regions of West Africa. Ocular manifestations of snakebites are rare with few reports documenting blindness as a complication. Objective: To highlight an unusual manifestation of snake bites and its attendant problems Methods: A report of scalp haematoma and blindness in a 10 year old child presenting 2 weeks after a snake bite (presumably carpet viper) is a rare manifestation. Local swelling, epistaxis, bilateral proptosis, exposure keratopathy and use of traditional eye medications were associated findings. Anti-venom though administered late saved the child\u2019s life but blindness could not be reversed. Results: Ocular ultrasonography revealed layered retrobulbar collection in the left eye, presumably due to hemorrhage. The skull x-ray showed a soft tissue swelling and aspirate from scalp swelling was bloody. Cranial Computed Tomography (CT) scan done late detected no abnormalities. Conclusion: Snakebite is associated with lifelong morbidity. Ocular manifestations must be treated as emergency. This case highlights the effect of ignorance and poverty in a setting of a common medical emergency leading to blindness and reduced quality of life

Importance of ultrasonography in evaluating eye injuries: data from Birnin Kebbi, Nigeria

Background: Ocular trauma remains an important cause of poor vision and blindness world-wide. Management of ocular trauma with haze media poses a great challenge to ophthalmologist. However the potential role of B scan ultrasonography in the diagnosis and management of a patient with hazy or non-visible posterior segment following ocular trauma has not been fully explored. Objective: To describe the use of B scans ultrasound (US) in the diagnosis and management of posterior segment ocular trauma in patients with media opacities. Methods: This was a 5-year retrospective study of patients with ocular trauma who presented at the Department of Ophthalmology Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria and sent for B scan US because of hazy or non-visible fundus. The ultrasound diagnosis was compared with clinical diagnosis. The data were analysed with SPSS 20 Version. Results: A total of 119 patients with ocular trauma had B scan US; 62.2% were male; the mean age was 34.2±20.1years. Patients were either students (27.7%) or full-time housewives (27.7%). Ocular injury was unilateral in 103 (86.6%) participants and bilateral in 13 (13.4%) participants. The right eye, 75 (63%) was most affected by the trauma. Most of the trauma 116 (97.5%) were due to closed eye injury. Ocular B scan was normal in 3 (2.5%) of the patients. The correlation between clinical diagnosis and B scan US diagnosis was 58.9%. Conclusion: B scan ultrasonography enabled diagnosis of 97.5% of ocular injuries not diagnosed at clinical examination due to haze media. Therefore the importance of B scan ultrasonography in the management of ocular trauma with hazy media is underscored

Uniocular Blindness Following Thermal Injury

A hot water burn is a thermal injury that results in cell death. Thermal eye injury triggers inflammatory processes, including inflammatory cell influx and/or the activation of various inflammatory cells, which result in the rapid accumulation of extravascular fluid in the ocular tissue. The ocular effect depends on the temperature of the water, and the final visual outcome depends on the severity of the damage to the intraocular structures. We report a 23-year-old woman who experienced a facial hot water burn that resulted in blindness. The patient presented late to the hospital after the unsuccessful use of traditional medication. Facial burns are a known cause of blindness. Public health education on prompt hospital presentation, and resistance to the use of potentially harmful traditional medicine in facial burns is suggested

Case Report: Facial and eye injury following a fridge cylinder gas explosion

Fridge cylinders contain liquefied petroleum gas (LPG), an inflammable gas of mixture of propane and butane [1]. It’s colourless but odourised to give warning during leakage. Injury from accidental fridge cylinder explosion is similar to any other blast injuries in terms of the release of hot gases, blast wave and metal fragments resulting in extensive skin burns, abrasions, penetrating injury and tissue loss [2-4]. Ocular trauma following gas cylinder explosion is rare however, Babar et al reported 20% of ocular trauma to be secondary to gas cylinder and battery explosion [2]. To our knowledge, this is the first case of facial and eye injury following a fridge cylinder gas explosion reported in the literature

Traumatic Enucleation and Bilateral Colles’ Fracture in a 70 Year Old Farmer

Purpose: To report a case of traumatic enucleation and Colles’ fracture in a 70-year-old male farmer following a fall from a height. Design: A case report. Findings: Enucleated right eye and bilateral Colles’ fracture. Practical implications: The attending health care personnel should do a complete assessment of a patient with a history of fall from a height to avoid missing important bodily injuries. Fall from height is a cause of avoidable blindness. Originality: Rare original case of traumatic enucleation after a fall

Family functioning and adherence to medication: A study of hypertensive in a tertiary hospital, South Western Nigeria

Background: Hypertension is one of the most important risk factors for coronary heart disease, stroke, heart failure, and end-stage renal disease. It remains an important public health challenge, despite effective medical therapies for its management, patients' poor adherence remains a global problem. Aim: The main objective of this study is to determine the relationship between family functioning and medication adherence among hypertensive, attending a tertiary care center in South-West Nigeria. Materials and Methods: This was a descriptive cross-sectional study. The systematic sampling method was used to select 420 patients attending the outpatient clinic of the tertiary hospital. Relevant data were collected using interviewer-administered pretested semi-structured questionnaires. Results: Four hundred and twenty people participated in the study. The mean age of respondents was 60.97 ± 11.28 years, and a slight female preponderance (M:F = 1:1.7). Three hundred and forty-nine (83.1%) were married, 273 (65.0%) were from a monogamous family and 375 (89.2%) had a family size of >4. More than half of the study participants had a functional family (66.4%) and were adherent (61.2%) to their medication. Increased medication adherence proportion was observed in patients with a functional family. Adherence to medication is three times (odds ratio = 2.585, 95%CI = 1.636, 4.084) higher among patients with functional family. Conclusion: The structure and nature of family relationships, both of which determines family functioning, are important to medication adherence. A functional family enhances adherence to medication. Primary care physicians should create a positive treatment alliance with their patients to better family functioning

Hand hygiene practices among doctors in health facility in a semi-urban setting

INTRODUCTION: Hand hygiene is an integral part of personal hygiene; poor hand hygiene practice may result not only in self-hurt but also may serve as a vehicle for transmission of infection among patients. Hence, knowledge of proper hand hygiene practice will significantly reduce the burden of infectious diseases. MATERIALS AND METHODS: This was a cross-sectional study involving doctors at Federal Medical Centre Birnin Kebbi; it was conducted from September 2015 to November 2015. Convenience sampling method was adopted. Pretested self-administered questionnaire based was used; relevant information such as age, sex, profession, years of working experience, awareness of Global HandWashing Day, hand-washing technique, steps in hand washing, ability to list the five moments in hand washing, and principles of hand washing were obtained. RESULTS: There were 33 males and 12 females with a male to female ratio of 2.8:1. All respondents believed hand washing reduces the risk of transmitting or contracting infections. Soap and water was the most common agent for hand cleansing, majority of the respondents (86.7%) had been taught on the technique of hand washing; however, only 19 (42.2%) of them wash their hands before examining patients; but all the respondents (100%) wash their hands after examining patient or handling their secretions; similarly, they all reported washing their hands after using the restroom. Almost all of the respondents (97.8%) use water and soap for hand washing. Furthermore, only 44.4% of the respondents had their personal hand rub. CONCLUSION: Soap and water was the most common agent for hand cleansing, and there was poor utilization of hand rub; and most respondents did not wash their hands before patient contact