Appropriateness of Indication and Diagnostic Yield of Colonoscopy in a Southern Nigerian Tertiary Hospital.

Background and Objectives: For optimum use of resources in an open access system, official guidelines for the appropriate use of colonoscopy have been proposed by the American Society for Gastrointestinal Endoscopy (ASGE). The objectives of this study were to determine the appropriateness of referrals and to assess the diagnostic yield of colonoscopy based on the 2000 ASGE guidelines. Methods: This was a retrospective study of patients that had colonoscopy in the University of Benin Teaching Hospital from January 2010 to December 2014. The biodata, indications for the procedure, and findings at colonoscopy were retrieved from the colonoscopy register of the endoscopy unit. The year 2000 ASGE guidelines were used to determine the appropriateness of indications for the procedure. Diagnostic yield was defined as the ratio between significant findings detected on colonoscopy and the total number of procedures performed for the indication. Results: Of the 283 patients (158 males; 125 females; mean age 55.2±15.0 years) studied, 66% had colonoscopy for an indication that was considered ‘generally indicated’. It was ‘generally not indicated’ for 2.5%, while 31.4% underwent colonoscopy for reasons ‘not listed’ in the guidelines. The diagnostic yield of the procedure was significantly higher in the ‘generally indicated’ group (41.7%) than in the ‘not listed’ (29.2%) and the generally not indicated (0%) groups. In the multivariate analysis, diagnostic yield was associated with appropriateness of indications that was’ generally indicated’ (odds ratio=1.263, confidence interval=1.072-1.488). Conclusion: About one third of patients had colonoscopy performed for reasons considered inappropriate by the ASGE 2000 guidelines. The diagnostic yield of colonoscopy is predicted by the appropriateness of the indication. Positive diagnostic yield also occurs in the unlisted category. Further studies are required to evaluate the indications for colonoscopy and the possibility of adding some of the unlisted indications to the ASGE guidelines in future revisions. There is need to develop a local guideline well adapted to our environment.

Post-Stroke Depression in a Sub-Saharan Africans: Validation of the Japanese Stroke Scale for Depression

Background: Japanese Stroke Scale for Depression (JSS-D) is not a validated instrument for post stroke depression (PSD) in sub-Saharan Africans. Methods: Ninety-two subjects on follow-up in a stroke clinic were consecutively assessed for demographic and clinical variables; and all were subsequently assessed for depression with the JSS-D. Functional ability was assessed with Rankin score and good functional recovery was defined as Rankin score of =2. Stroke type was determined using cranial computed tomography or magnetic resonance imaging as cerebral infarct or intracerebral hemorrhage. Data was compared between subjects with and without PSD. Symmetric agreement between JSS-D and Diagnostic and Statistical Manual of Mental Disorders; Fourth Edition (DSM IV) criteria for depression was compared on Cohen's kappa statistics and the sensitivity; specificity of JSS-D was tested on a receiver operated characteristics (ROC) curve. Results: PSD occurred in 17 (18.5) of study subjects. Mean age was not significantly different between PSD and no PSD; P = 0.226; but there was a difference in the sex distribution (P = 0.034) with a male sex preponderance for both groups. Rankin score was higher in PSD and significantly different both at discharge and the time of evaluation (P = 0.019 and 0.003). JSS-D agreed with DSM IV criteria for mild depression significantly on Cohen's kappa statistics; kappa = 0.69; P 0.0001. The sensitivity and specificity of JSS-D on ROC curve were 94.1and 97.2 respectively at a JSS-D cut-off value of 2.37; area under the curve

Erectile Dysfunction in a Sub-Saharan African population: Profile and Correlates in a Tertiary Care Hospital

Background: Erectile dysfunction (ED) is a common complaint in general medical practice. This study describes the clinicodemographic features of ED. Materials and Methods: Two hundred and twelve subjects in the outpatient clinic of a tertiary care hospital were interviewed for demographic data; tobacco smoking; alcohol consumption; history of medications; previous abdominal surgery; history of diabetes mellitus; hypertension and ED; duration of ED if present; self-assessment of the level of sexual satisfaction; partner's assessment of the level of sexual satisfaction; type of remedies sought and used for ED in the past; whether or not subject has discussed the problem and patients' perception of the cause of the ED; all were interviewed with the international index of erectile function questionnaire for ED. Data was analyzed as appropriate. Results: Forty-two (19.8) had ED and ED score was associated with age (P = 0.013); educational level (P 0.001); monthly income (P 0.001); alcohol consumption (P

Orthostatic hypertension: profile of a Nigerian population

Background: The aim of this study was to determine the prevalence, age, sex distribution and blood pressure (BP) pattern of patients with orthostatic hypertension in a cohort of hypertensives. Method: A total of 179 patients on follow-up treatment in a hypertension clinic were assessed for age, sex and BP in the seated position, and after two minutes in the erect position, on three consecutive visits. Orthostatic hypertension was defined as an increase in systolic blood pressure (SBP) of ≥ 20 mmHg on more than one occasion in the erect position. Orthostatic hypotension was defined as a decrease in BP on more than one occasion, between the seated and erect SBP, of ≥ 20 mmHg. The mean ages of the participants with and without orthostatic hypertension were compared by t-test for any significant difference. The means of the seated SBP of participants with and without orthostatic hypertension were also compared with the t-test. The effect of gender on orthostatic hypertension was tested with a chi-square (χ²). The differences between the mean seated and mean erect SBPs of participants with and without orthostatic hypertension were compared with the paired t-test. Results: Thirty-eight (21.23%) of the participants had orthostatic hypertension. The mean age of those with orthostatic hypertension was not significantly different from that of the participants without orthostatic hypertension (p-value = 0.789). There was no significant effect of gender on orthostatic hypertension (p-value = 0.795). The mean of the seated SBP was significantly lower in the participants with orthostatic hypertension (p-value = 0.008). The mean seated SBP was significantly different from the mean erect SBP for those with orthostatic hypertension, compared to those without orthostatic hypertension (p-value = 0.000 vs. p-value = 0.169). Five (2.79%) of the participants had orthostatic hypotension. Conclusion: Orthostatic hypertension, a form of BP dysregulation, may be more common among treated hypertensives than what is presently known

Blood Pressure Abnormalities in Parkinson's Disease in a Nigerian Population

To compare the effect of posture on blood pressure in levodopa-treated Parkinson's disease (PD) patients with that of age-matched controls. The design is a case control study. Blood pressure was recorded manually in the seated position with Accossonsr mercury sphygmomanometer in 30 consecutive patients with PD on levodopa who had no hypertension and it was repeated after two minutes in the erect position to test for orthostatic hypotension (OH). The results were compared with blood pressure in the seated and erect positions in 30 consecutive age-matched controls that had no hypertension. The mean seated and erect systolic and diastolic blood pressures of both groups were compared with t-test for any significant difference(s); the mean seated and erect systolic and diastolic blood pressures of each group were also compared with paired t-test for any significant difference(s) and the proportion of study participants in both groups with orthostatic hypotension were determined. (a) Mean seated and erect systolic and diastolic blood pressures were significantly higher in PD subjects than age matched controls (p=0.000; 0.000) and (p=0.001; 0.000) (b) Mean erect systolic blood pressure was significantly lower than seated blood pressure in PD and significantly higher in controls (p=0.025 and 0.027) (c) OH was found in 6/30(20) versus 0/30(0) for cases and controls respectively. Higher seated and erect blood pressures and OH were found in levodopa treated PD compared to age-matched controls and these abnormalities should be assiduously looked out for in the evaluation of PD