Fournier's gangrene -- analysis of management and outcome in south-eastern Nigeria.

BACKGROUND: Fournier's gangrene is a necrotising fasciitis of the genitalia and perineum, with associated polymicrobial infection and risk of organ failure or death. The purpose of this study was to determine the presentation, systemic and local predisposing factors, management challenges and outcome in south-eastern Nigeria. PATIENTS AND METHODS: We studied 28 out of 34 consecutive male patients with complete case notes seen in two centres (the University of Nigeria Teaching Hospital and St Mary's Hospital) between January 1995 and December 2008. Operating theatre registers and urology ward admission registers were used to identify patients. RESULTS: The mean patient age was 48.3 years (range 28 - 66 years), with a peak age incidence of 50 - 59 years. The majority of patients were farmers, manual labourers and artisans. The site of gangrene was scrotal in 22 patients (78.6%), penoscrotal in 3 (10.7%), abdominoscrotal in 2 (7.1%) and scroto-perianal in 1 (3.6%). The mean interval between onset of symptoms and presentation was 7.2 days (range 3 - 14 days). Systemic predisposing factors identified were diabetes mellitus in 6 patients (21.4%), filariasis in 2 (7.2%), congestive cardiac failure in 1 (3.6%) and HIV infection in 1 (3.6%). In 18 patients (64.3%) no systemic factor was identified. Local predisposing factors identified were chronic scrotal skin itching in 16 patients (57.1%), scrotal thorn injury in 2 (7.1%) and urethral catheterisation in 2 (7.1%). Scrotal carbuncle and scrotal surgery each accounted for 2 patients (7.1%), and zipper injury and ischiorectal abscess occurred in 1 patient each (3.6%). No local predisposing factor was identified in 1 patient (3.6%). The common clinical features were fever, scrotal swelling/pain, and later a malodorous painless wound. Treatment involved fluid administration, correction of electrolyte imbalance, antibiotics, debridement and daily wound inspection/dressing with hydrogen peroxide soaks and sodium hypochlorite. The mean duration of hospital stay was 37.1.days (range 21 - 84 days). One patient died (3.6%). CONCLUSION: Fournier's gangrene is a challenging surgical problem, with significant morbidity. Diabetes mellitus is a significant systemic risk factor. In the majority of our cases, no systemic predisposing factor was identified. Local risk factors, especially chronic scrotal itching, were contributory. With proper management, mortality is low.

The relationship between prostate volume and international prostate symptom score in Africans with benign prostatic hyperplasia.

OBJECTIVE: To determine the relationship between prostate volume and international prostate symptom score (IPSS) in Africans with benign prostatic hyperplasia (BPH). PATIENTS AND METHOD: This was a prospective study of 120 men aged between 45 to 85 years, who were referred to the urology outpatient facility for treatment of clinical BPH between July 2007 and October 2008 in Jos University Teaching Hospital. These patients were properly evaluated; a digital rectal examination was done to estimate the prostate size. The pre-treatment IPSS of the patient was also obtained. The prostate volume of each patient was then estimated by transabdominal ultrasound. RESULTS: The mean prostate volume was 72.79 +/- 44.38cm3. The mean values for the different diameters of the prostate were 5.63 +/- 1.17cm (longitudinal diameter), 4.48 +/- 0.95cm (anterior posterior diameter), 4.97 +/- 1.06cm (transverse diameter). The Pearson's correlation between pre-treatment International prostate symptom score and prostate volume was -0.0035 (P > 0.05). CONCLUSION: This study has shown that there is no significant relationship between international prostate symptom score and prostate volume in Africans. This is e with similar studies done in other parts of the world.

Assessment of Iron Content of Breast Milk in Preterm and Term Mothers in Enugu Urban

Background: It is commonly assumed that preterm babies are malnourished and this has led to all forms of micronutrient supplementation including iron. Objective:The aim of the study is to compare the iron content in breast milk of mothers who had preterm and term babies.Methods:Ninety six (96) lactating mothers who delivered their babies at term and 68 lactating mothers who had preterm deliveries were recruited for the study. The mothers were attending the postnatal clinic of one secondary and two tertiary healthcare facilities in Enugu. Breast milk iron concentration was determined by Atomic Absorption Spectrophotometer.Results:The differences in the mean values for the iron concentrations in preterm and term breast milk were statistically significant (39.06±10.78 versus 32.79±14.17 µmol/L, P =0.02). In both groups, the breast milk iron concentration gradually decreased as lactation progressed. (P <0.0001).Conclusion:The iron content of breast milk from mothers who had preterm babies is higher when compared to mothers who had term babies. It may thus be needless to introduce exogenous iron during lactation

Factors That Affect Medical Students' Performance in Anatomy in the University Of Nigeria

Background: Much attention has been drawn to the area of medical education in contemporary times with the aim of developing effective teaching strategies in our medical schools. Objectives: To identify the problems encountered by students in the study of Anatomy and suggest ways of enhancing their performance in the subject.Materials and Methods: Three hundred structured; pretested self administered questionnaires were applied to medical students of the Faculty of Medical Sciences; University of Nigeria Enugu Campus (UNEC); who had spent at least two years in the medical school. Data analysis was by SPSS version 15.Results: Of the 300questionnaires; 201(67.0) were correctly filled and analysed. One hundred and three (51.2) of the respondents were females; 163 (81.1) were aged 21 to 30 years and 105(52.3) had spent more than two years in the medical school. One hundred and eleven (55.2) believed that dissection followed by audio-visual aids 101(50.3) offered students adequate exposure to the learning of anatomy. One hundred and eleven; (55.2) also implicated overcrowding as a major cause of students' aversion for dissection leading to inadequate exposure to the subject and the resultant poor performance. One hundred and seven (53.2) believed that the preparatory period for 2nd MBBS exams should be extended so as to offer students adequate exposure to laboratory specimens.Conclusion: Over-population causes inadequate exposure of students to anatomical specimens and thus affects their performance negatively

The prevalence pattern of external male genital defects among secondary school students in Enugu State of Nigeria.

BACKGROUND: Enugu State typifies a Third World environment where most deliveries occur outside the hospital setting. In such circumstances, hospital-based data about congenital defects are unreliable and call for special methods of approach. OBJECTIVE: To determine the prevalence and pattern of male external genital defects in Igbo male secondary school students in Nigeria. METHOD: Samples of male students aged 10 years and above seen in randomly selected secondary schools in Enugu State, of South-East Nigeria were guided through a protocol involving, self administered questionnaires, personal interviews and physical examinations for evidence and types of anomalies present in their external genitalia. The participating schools were selected by stratified random sampling; first by local government Areas (LGA) and then by schools. Consents for the study were obtained from Local Government Authorities, Heads of the schools and Parents' Teachers Associations, (PTA) Executives. RESULTS: Altogether, four urban and thirteen rural schools were studied, and a total of 6225 male students participated. Overall, 416 (6.8%) were identified with various types of external genital anomalies, with the prevalence observed being within, the ranges of population prevalence reported in the literature. The commonest types of anomalies encountered were crypto- orchidism with / or without scrotal hypoplasia 268 (4.30%), inguino- scrotal 56 (0.90%), and hydrocoeles 52 (0.83%). As many as 183 (44%) of those with congenital genital defects were not aware that they had them. CONCLUSION: External male genital defects among Igbos appear to be within the prevalence rate reported in the literature. However the ignorance rate of such defects is high within the Igbo society.

The Incidence of External Male Genital Defects in Enugu State of Nigeria: an Estimate Based on the Prevalence among Secondary School Students

Background: Enugu State typifies a Third World environment where most deliveries occur outside the hospital setting. In such circumstances; therefore; hospital-based data about congenital defects are unreliable and call for special methods of approach. Objective: To assess the place of school prevalence survey results in estimating the population incidence of anomalies of the male external genitalia.Method: From February 2; 2002 to August 1; 2004 a sample of male students aged 10 years and above seen in randomly selected secondary schools in Enugu State of Southeast Nigeria were guided through a protocol involving; self-administered questionnaires; physical examinations for evidence and types of anomalies present in their external genitalia and personal interviews. The participant schools were selected by stratified random sampling; first by Local Government Area (LGA) and then by school. Consents for the study were obtained from Local Government authorities; Heads of the schools; and Parents' Teachers Associations; (P T A) Executives. Results: Altogether; four urban and thirteen rural schools were studied over the 18 month-period of the investigation and a total of 6226 male students participated. Overall; 416 (6.8) were identified with various types of external genital anomalies; with the prevalence rates observed being within the ranges of population prevalence reported in the literature. The commonest types of anomalies encountered were crypto-orchidism with / or without scrotal hypoplasia 268 (4.30); inguino-(scrotal) hernias 56 (0.90); and hydrocoeles 52 (0.83); in descending order. As many as 183 (44) of those with congenital genital defects were not aware they had them. When compared with urban schools; rural schools were characterized by a higher frequency [8.4 vs. 2.8respectively; x2 = 58.35; P 0.0001] and a lower level of awareness about anomalies of the external male genitalia [P