Prevalence of, and risk factors for erectile dysfunction in male type 2 diabetic outpatient attendees in Enugu, South East Nigeria.

Context: Erectile dysfunction (ED) is a strong predictor of poor quality of life in men with type 2 Diabetes mellitus (T2DM). Several studies evaluating ED in men with diabetes mellitus have been carried out, but few of these have been done in Nigeria. In Enugu, South East Nigeria, paucity of studies on this subject was observed. Aims: This study aims to determine the prevalence and predictors of ED in men with T2DM attending the diabetes clinics. Settings and Design: A descriptive cross-sectional study of men with T2DM in UNTH and Saint Mary's Hospital, Enugu, was carried out. The systematic sampling method was used to recruit participants. Subjects and Methods: Data collection from participants and their hospital records was done using semi-structured questionnaire. ED was assessed using the 5 items, international index of erectile function questionnaire. Statistical Analysis Used: Data analysis was done using SPSS version 20 and results presented as texts and tables. P value was set at <0.05. Results: A total of 325 participants with mean age of 57.8 ± 13.2 years were involved out of which 94.7% had ED. The proportion of participants with ED had increased with its severity. Predictors of ED included poor glycemic control, longer duration of diabetes, overweight/obesity, and older age. Poor ED health-seeking behavior and treatment were noted. Conclusions: The prevalence of ED is high. Lifestyle interventions targeted at improving glycemic control and weight loss may reduce the burden of this complication. We recommend objective ED screening using standard but brief instruments as part of routine evaluation of men with T2DM.

RésuméContexte: La dysfonction érectile (DE) est un puissant facteur prédictif de la qualité de vie médiocre chez les hommes atteints de diabète de type 2 (DT2). Plusieurs études L'évaluation de la dysfonction érectile chez les hommes atteints de diabète sucré a été réalisée, mais peu d'entre elles ont été réalisées au Nigéria. Enugu, sud-est du Nigeria, le manque d'études sur ce sujet a été observé. Objectifs: Cette étude vise à déterminer la prévalence et les prédicteurs de la dysfonction érectile chez les hommes atteints de DT2. assister aux cliniques de diabète. Paramètres et conception: Une étude transversale descriptive des hommes atteints de DT2 à l'UNTH et à l'Hôpital Saint Mary's, Enugu, a été réalisée. La méthode d'échantillonnage systématique a été utilisée pour recruter des participants. Sujets et méthodes: Collecte de données à partir de les participants et leurs dossiers d'hôpital ont été réalisés à l'aide d'un questionnaire semi-structuré. La DE a été évaluée en utilisant les 5 items, index international questionnaire sur la fonction érectile. Analyse statistique utilisée: L'analyse des données a été réalisée à l'aide de SPSS version 20 et les résultats présentés sous forme de texte et les tables. La valeur de p a été fixée à <0,05. Résultats: Au total, 325 participants âgés de 57,8 ± 13,2 ans ont été impliqués, dont 94,7% avaient ED. La proportion de participants atteints de dysfonction érectile avait augmenté avec sa gravité. Les prédicteurs de la dysfonction érectile comprenaient un contrôle glycémique médiocre, une durée plus longue du diabète, du surpoids / obésité et du troisième âge. Des comportements médiocres en matière de recherche de soins de santé et de traitement ont été notés. Conclusions: La prévalence de ED est élevé. Les interventions axées sur le mode de vie visant à améliorer le contrôle glycémique et la perte de poids peuvent réduire le fardeau de cette complication. nous recommander un dépistage objectif dans l'urgence à l'aide d'instruments standard mais brefs dans le cadre de l'évaluation de routine des hommes atteints de DT2. Mots-clés: Diabète, dysfonction érectile, Nigéria, prévalence, facteurs de risque.

Prostate Cancer Detected by Screening in a Semi Urban Community in Southeast Nigeria: Correlations and Associations between Anthropometric Measurements and Prostate-specific Antigen.

CONTEXT: Prostate cancer (PCa) is frequently diagnosed at advanced stages in Nigeria. AIMS: To determine the screen detected PCa prevalence in a suburban community and explore any relationships between prostate-specific antigen (PSA) and anthropometric measurements. SETTINGS AND DESIGN: Nsukka is a town and local government area (LGA) in Southeast Nigeria in Enugu State. Towns that share a common border with Nsukka are Edem Ani, Alor-uno, Opi, Orba, and Ede-Oballa. Nsukka LGA has an area of 1810 km2 and a population of 309,633 at the 2006 census. All consecutive responders who met the inclusion criteria were recruited. SUBJECTS AND METHODS: A screening outreach was conducted in one location in Nsukka. PSA testing and digital rectal examinations were performed. Height and weight were measured and body mass index (BMI) was calculated. STATISTICAL ANALYSIS USED: Results were subjected to statistical analysis using SPSS 20 (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY, USA). Categorical data were analyzed using the Chi-square test, with significance level set at P < 0.05. Pearson's correlation was conducted for interval data (P < 0.05). RESULTS: One-hundred and sixty men met the inclusion criteria and were screened. Age range was 40-81 years; PSA range was 1.20-33.9 ng/ml. Digital rectal examinations (DREs) was abnormal in 17 men. Median BMI was 27.49. A Pearson's correlation coefficient showed a significant correlation between age and PSA, r = 0.127; P ≤ 0.05, and DRE findings and PSA, r = 0.178; P ≤ 0.05. There was no significant correlation between height and PSA, r = -0.99; P = 0.211; weight and PSA, r = -0. 81 P = 0.308; and BMI and PSA, r = -0.066; P = 0.407. 8/21 men consented to prostate biopsy with three positive, giving a screen detected PCa prevalence of 1.875%. CONCLUSIONS: Screen detected PCa prevalence in high this population and efforts to improve early detection may be of value in improving treatment outcomes.

Prostate cancer detected by screening in a semi urban community in Southeast Nigeria: Correlations and associations between anthropometric measurements and prostate-specific antigen

Context: Prostate cancer (PCa) is frequently diagnosed at advanced stages in Nigeria. Aims: To determine the screen detected PCa prevalence in a suburban community and explore any relationships between prostate-specific antigen (PSA) and anthropometric measurements. Settings and Design: Nsukka is a town and local government area (LGA) in Southeast Nigeria in Enugu State. Towns that share a common border with Nsukka are Edem Ani, Alor-uno, Opi, Orba, and Ede-Oballa. Nsukka LGA has an area of 1810 km2 and a population of 309,633 at the 2006 census. All consecutive responders who met the inclusion criteria were recruited. Subjects and Methods: A screening outreach was conducted in one location in Nsukka. PSA testing and digital rectal examinations were performed. Height and weight were measured and body mass index (BMI) was calculated. Statistical Analysis Used: Results were subjected to statistical analysis using SPSS 20 (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY, USA). Categorical data were analyzed using the Chi-square test, with significance level set at P< 0.05. Pearson's correlation was conducted for interval data (P < 0.05). Results: One-hundred and sixty men met the inclusion criteria and were screened. Age range was 40­81 years; PSA range was 1.20­33.9 ng/ml. Digital rectal examinations (DREs) was abnormal in 17 men. Median BMI was 27.49. A Pearson's correlation coefficient showed a significant correlation between age and PSA, r = 0.127; P ≤ 0.05, and DRE findings and PSA, r = 0.178; P ≤ 0.05. There was no significant correlation between height and PSA, r = −0.99; P = 0.211; weight and PSA, r = −0. 81 P = 0.308; and BMI and PSA, r = −0.066; P = 0.407. 8/21 men consented to prostate biopsy with three positive, giving a screen detected PCa prevalence of 1.875%. Conclusions: Screen detected PCa prevalence in high this population and efforts to improve early detection may be of value in improving treatment outcomes

Testicular Cancer and Testicular Self-Examination; Knowledge, Attitudes and Practice in Final Year Medical Students in Nigeria

The testicular cancer (TCa) incidence is increasing in many countries, with age-standardized incidence rates up to 7.8/100,000 men in the Western world, although reductions in mortality and increasingly high cure rates are being witnessed at the same time. In Africa, where rates are lower, presentation is often late and morbidity and mortality high. Given this scenario, awareness of testicular cancer and practice of testicular self-examination among future first response doctors is very important. This study was conducted to determine knowledge and attitude to testicular cancer, and practice of testicular self-examination (TSE) among final (6th) year medical students. In addition, the effect of an intervention in the form of a single PowerPoint® lecture, lasting 40 minutes with image content on testicular cancer and testicular self examination was assessed. Pre and post intervention administration of a self-administered structured pre tested questionnaire was performed on 151 medical students, 101 of whom returned answers (response rate of 66.8%). In the TC domain, there was a high level of awareness of testicular cancer, but poor knowledge of the age group most affected, with significant improvement post intervention (p<0.001). Notable also was the poor awareness of the potential curability of TC, this also being improved following the intervention (p<0.001). A poor level of awareness and practice of testicular self-examination pre-intervention was found considering the nature of the study group..Respondents had surprisingly weak/poor responses to the question "How important to men's health is regular testicular self-examination?" Answers to the questions "Do you think it is worthwhile to examine your testis regularly?" and "Would you be interested in more information on testicular cancer and testicular self-examination?" were also suboptimal, but improved post intervention p<0.001, p<0.001 and p=0.037. Age, gender and marital status were without specific influence. In conclusion, this study showed poor levels of knowledge regarding epidemiology of TCa and its potential curability when detected early. There was also a poor awareness of, practice of, and poor attitudes to TSE. The significant improvement in these parameters post intervention indicates value in educational intervention. We recommend inclusion of TCa coverage and TSE teaching in the secondary school curriculum (targeting adolescents). Greater emphasis should also be given to testicular cancer in the curricula of medical schools and other training institutions for health care personnel.

Prostate-specific antigen density values among patients with symptomatic prostatic enlargement in Nigeria.

BACKGROUND: This study aims to estimate the prostate-specific antigen density (PSAD) cutoff level for detecting prostate cancer (CAP) in Nigerian men with "grey zone PSA" (4-10 ng/ml) and normal digital rectal examination findings. We addressed this research question: Is the international PSAD cutoff of 0.15 ideal for detecting CAP in our symptomatic patients with "grey zone PSA?" AIM: To estimate the prostate-specific antigen density (PSAD) cutoff level for detecting CAP in Nigerian men with "grey zone PSA" (4-10 ng/ml) and normal digital rectal examination findings. DESIGN: Prospective. SETTING: A tertiary medical center in Enugu, Nigeria. PARTICIPANTS: Two hundred and fifty-four men with either benign prostatic hyperplasia (BPH) or CAP were recruited. INTERVENTION: Patients with PSA above 4 ng/ml or abnormal digital rectal examination or hypoechoic lesion in the prostate were biopsied. OUTCOME MEASURES: PSAD and histology report of BPH or CAP. RESULTS: Ninety-seven patients had CAP while 157 had benign prostatic hyperplasia (BPH). Seventy-two patients had their serum PSA value within the range of 4.0 and 10 ng/ml. PSAD cutoff level to detect CAP was 0.04 (sensitivity 95.88 %; specificity 28.7 %). CONCLUSIONS: The PSAD cutoff level generated for Nigerian men in this study is 0.04 which is relatively different from international consensus. This PSAD cutoff level has a positive correlation with histology and could detect patients with CAP who have "grey zone PSA."

Renal Angiomyolipoma in Pregnancy: Surgical Management with Fetal Preservation - Approach in a Developing Setting.

Renal angiomyolipomas (RAML) are uncommon benign renal tumours that are associated with a tendency to rupture resulting in sometimes-torrential retroperitoneal hemorrhage as the Wunderlich syndrome or as severe potentially exsanguinating hematuria. When hemorrhage from RAML occurs in pregnancy it presents a unique challenge requiring timely and appropriately adapted intervention with the goal of preventing fatality, preserving renal function as well as preventing fetal loss if possible. We report the management of severe bleeding from RAML in pregnancy and highlight the need to adopt a management strategy that suits the practice environment and offers the patient standard and enduring care.

Serum total prostate-specific antigen values in men with symptomatic prostate enlargement in Nigeria: role in clinical decision-making.

BACKGROUND: Prostatic enlargement is a common cause of bladder outlet obstruction in men in Nigeria. Malignant enlargements must be differentiated from benign enlargements for adequate treatment of each patient. High serum total prostate-specific antigen (tPSA) levels suggest malignancy, but some of the biopsies done due to a serum tPSA value >4 ng/mL would be negative for malignancy because of the low specificity of tPSA for prostate cancer. This study aims to compare the histologic findings of all prostate specimens obtained from core needle biopsy, open simple prostatectomy, and transurethral resection of the prostate with the respective serum tPSA values in an attempt to decipher the role of serum tPSA in the management of these patients. METHODS: The case notes of patients attended to from April 2009 to March 2012 were analyzed. Essentially, the age of the patient, findings on digital rectal examination, abdominopelvic ultrasonography report on the prostate, serum tPSA, and histology reports from biopsy or prostatectomy specimens as indicated were extracted for analysis. RESULTS: The relationship between age, findings on digital rectal examination, serum tPSA, abdominopelvic ultrasonography report, and histology are compared. A statistically significant relationship existed between a malignant histology and age 65 years and older, suspicious findings on digital rectal examination, suspicious ultrasonography findings, and serum tPSA >10 ng/mL, but not tPSA >4 ng/mL. CONCLUSION: In Nigerian patients with symptomatic prostate enlargement, serum tPSA should be seen as a continuum with increasing risk of prostate malignancy.

Reducing the burden of regular indwelling urinary catheter changes in the catheter clinics: the opinion of patients and relatives on the practice of self-catheterization.

BACKGROUND: Clean intermittent self-catheterization is accepted worldwide as a standard of care for patients with long-standing need for urinary bladder decompression. Evidence of its routine practice in our low-resource setting is lacking, leading to increasing number of patients with a long-standing indwelling urinary catheter. OBJECTIVE: To seek the opinion of patients already using indwelling catheters regarding the practice of self-catheterization. PATIENTS AND METHODS: Over a 4-month period, the opinion of every patient and patient's relative that attended the regular urinary catheter clinic was sought using an intern-administered questionnaire. The data was analyzed using SPSS version 20. RESULTS: A total of 108 patients completed the questionnaire. Age range was 16-100 years with a mean of 62.2±15.5 years. Only 30.5% of the patients had formal education beyond the primary level. The median cost for change of the indwelling catheter was 1,325 naira ($8.28 US) with a range of 500-4,000 naira ($3.13-$25 USD). Analysis showed that: 70.8% of patients aged under 60 years/60.6% of those with formal education beyond primary level/61.9% of those wearing catheters for <3 months would give consent for training in self-catheterization. Higher cost of catheter change did not influence the decision to consider self-catheterization. Of the 59 patient relatives who completed the questionnaire, 63% of those younger than 50 years old and 69.2% of those with tertiary education would be willing to undertake training to administer self-catheterization. CONCLUSION: A select group of patients and accompanying relatives in our low-resource setting are willing to learn and practice self-catheterization.

Phaeochromocytoma in a 20-year-old Nigerian, resolving the dilemma of benignity or malignancy.

Pheochromocytomas are rare tumors that present a diagnostic challenge in developing countries. They occur in the adrenal gland and as paragangliomas along the sympathetic chain. Clinical features are usually those of sustained or paroxysmal hypertension and complications thereof. Surgical extirpation remains the mainstay of treatment and is greatly facilitated by accurate pre-operative tumor localization. Pre-operative medical management with antihypertensive medication has led to significant reductions in peri-operative mortality. Determination of malignancy is difficult in the absence of obvious metastases. We present a case of left adrenal phechromocytoma that was stabilized. Adrenalectomy had a good outcome and the patient has so far been followed up for a year.

Paratesticular myxoid liposarcoma in a 23-year old Nigerian.

Paratesticular liposarcomas are rare tumors and are usually seen in patients in middle age or older. Optimal treatment is radical orchidectomy. Radiotherapy or chemotherapy is added for advanced disease or recurrences. These practice guidelines often vary from the experience in developing countries.We present a 23-year old man who presented with paratesticular myxoid liposarcoma, after transscrotal orchidectomy for 'testicular tumor' without histology. He was subsequently managed by neoadjuvant chemotherapy and complete tumor excision.A case of paratesticular myxoid liposarcoma in a young man is highlighted. Also noted is the fact that complete extirpation at primary surgery reduces the risk of local recurrence. The practice of transscrotal orchidectomy and non-submission of surgical specimens is highlighted and condemned.