Bladder stones in catheterized spinal cord-injured patients in Nigeria.

OBJECTIVE: The objective was to determine the incidence of bladder stones in patients with spinal cord injury (SCI) and to assess if catheter encrustation or positive urinary culture of Proteus mirabilis is predictive of bladder stones. BACKGROUND: Bladder stones are common urological complication in those with SCI managed with indwelling urinary catheter. Detection and removal of bladder stones are important to prevent possible further complications. DESIGN: This was a prospective cohort study. MATERIALS AND METHODS: Ultrasound scan was performed in persons with SCI seen from 1st January to 31st December 2009 who had indwelling urethral catheter for at least 3-month post-injury. Indwelling urethral catheters were examined for encrustation at the time of removal, urine culture taken specifically for P. mirabilis and ultrasound scan done to detect bladder stones. RESULTS: There were 89 patients with spinal cord injury and 68 (76.4%) patients were evaluated during the review period. Twenty-nine (42.6%) patients had bladder stones and 22 (32.3%) patients had catheter encrustation. Of the 22 patients with catheter encrustation, 19 (86.3%) also had bladder stones. Forty-six (67.6%) patients had no catheter encrustation. Of these, 7 (14.7%) were found to have bladder stones. Thirty-seven (38.2%) urine cultures were positive for P. mirabilis. Of these 37 (54.4%) patients, 27 also had bladder stones. Catheter encrustation (P = 0.004) and a positive urine culture of P. mirabilis (P = 0.007) in patients with indwelling urinary catheter is highly predictive of the presence of bladder stone. CONCLUSIONS: This study shows that a large number of SCI patients have an indwelling urethral catheter and suggests that ultrasound scan for the presence of stone should be schedule in a catheterized SCI patient if catheter encrustation or a positive urine culture of P. mirabilis is noted.

A cost analysis of conservative management of spinal cord-injured patients in Nigeria.

STUDY DESIGN: A prospective study. OBJECTIVES: To determine the cost of acute phase of injury (ASCI) among spinal cord-injured patients managed conservatively in Nigeria. SETTINGS: Gwagwalada, Abuja. METHODS: Over a 1-year period (1 January 2009 to 31 December 2009), the cost of ASCI of consecutive spinal cord-injured patients, gainfully employed preinjury, who paid the hospital bill directly from their purses and could estimate their daily income, and who were managed conservatively for 6 weeks before discharge to rehabilitation, was prospectively examined. RESULTS: A total of 34 cases of spinal cord-injured patients with a mean age of 35.4 ± 12.8 years were included in this study. The mean cost of ASCI over 6 weeks was $1598.29, an average of 6.4-232.8% of patients' annual income where >50% of the people live on less than a dollar a day. The mean cost of hospitalization was 14.9% of the total cost of ASCI in this study. It was significantly more expensive to treat tetraplegics compared with paraplegics. CONCLUSION: This study identified the cost of acute phase of spinal cord injury in Nigeria to assist clinicians in planning treatment that could reduce financial burden on the patients but optimize patients' care.

Appropriateness of ophthalmic cases presenting to a Nigerian tertiary health facility: implications for service delivery in a developing country.

OBJECTIVE: To assess whether the ophthalmic cases presenting at a Nigerian tertiary eye unit are appropriate for such level of care and also draw necessary implications for service delivery. METHODS: Data on 1321 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 facilities was collected from key-informants. RESULTS: One thousand and ninety-one (82.6%) presented without any referral and 1095 (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. CONCLUSION: 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 in Nigeria.

Knowledge and practice of hypertensive patients as seen in a tertiary hospital in the middle belt of Nigeria.

BACKGROUND: Hypertension remains the commonest non-communicable disease in Nigeria and a leading cause of cardiovascular morbidity and mortality. Knowledge and practice among hypertensive patients were therefore assessed as a prelude towards attaining better blood pressure control. MATERIALS AND METHOD: 224 consecutive hypertensive patients were prospectively studied using a pre-tested questionnaire. RESULTS: Majority of the hypertensive patients attending University of Ilorin Teaching Hospital were either traders or business men/women (44.5%). Only 35.8% had their blood pressure well controlled and about 61% were diagnosed for the first time to be hypertensive in the teaching hospital. 34% of the patients commuted a distance of more than 5 km to the hospital to receive antihypertensive care. 52% and 25% of the patients checked their blood pressure monthly and three-monthly respectively. One patient volunteered history of smoking. 48% and 51.8% knew that smoking increases the propensity to develop complications and that exercise is beneficial for the control of blood pressure respectively. Knowledge of the possible complications of hypertension was very poor as 58.9% of the patients scored less than average. Only 41.1% and 1.8% of the patients were aware that excessive salt and fat intake could adversely affect the control of hypertension respectively. CONCLUSION: Blood pressure control is still unacceptably poor among hypertensive Nigerians. This may not be unconnected with the poor knowledge of hypertension and adverse practices by the patients.

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

Predictors of psychiatric readmissions to the psychiatric unit of a tertiary health facility in a Nigerian city - a 5-year study.

OBJECTIVE: Little is known about predictors of readmission of psychiatric patients in the study environment. Knowledge of this, we believe could aid effective management of psychiatric patients, as well as judicious and equitable utilization of the limited mental health facilities in the North-central zone. The aim was to identify factors that may be predictive of readmissions to an in-patient psychiatric facility of a Nigerian University Teaching Hospital. METHOD: A retrospective record review of all admissions and discharges to/from the psychiatric inpatient ward of University of Ilorin Teaching Hospital, (UITH) between May 2000 and April 2005. Patients and clinical characteristics were recorded and all the data were characterized according to age, gender, marital status, occupational status, length of stay on admission, number of admissions, and medication compliance. Data were analyzed with SPSS version 11 to derive the chi square figures, Pearson's correlation, and logistic regression. The level of statistical significance was set at 5%. RESULTS: Within the study period, 41.4% of cases were readmissions. Young age, longer length of stay, multiple admissions and the diagnosis of schizophrenia were predictive of readmission while medication non-compliance was not predictive. CONCLUSION: Provision of psycho-education to both the patients and their families, identification of early symptoms of relapse, application of immediate and appropriate measures, and adequate record-keeping by health institutions are advocated.

Knowledge and practice of urethral catheterisation by newly qualified medical interns.

BACKGROUND: Urethral catheterisation is a procedure which is daily performed in clinical practice. Though, interns are expected to be proficient in this, the situation is always not so and complications have occurred due to inadequate knowledge of safe urethral catheterisation. AIMS AND OBJECTIVES: The study is intended to assess the knowledge and the practice of urethral catheterisation of prospective interns with a view of making suggestions for improvement in the teaching of this procedural skill to medical students and interns. METHODOLOGY: Questionnaires were administered to all prospective interns who had applied to do their compulsory one year internship in the University of Ilorin Teaching Hospital, Ilorin, Nigeria. The data were analysed using SPSS 11 statistical package. RESULTS: There were 96 respondents 65 (69.9%) of these were males. They graduated from 6 medical schools in Nigeria and 1 in the Sudan and they were aged between 23 and 36 years. They all had observed urethral catheterisation before while 92.5% have performed urethral catheterisation: 78.5 % under supervision and 14% under no supervision and 7 (7.5%) have not. Only 19.4% had good knowledge of the indications for urethral catheterisation and 53.9% had knowledge of appropriate list of materials for safe urethral catheterisation. Only 29.1% could describe well the steps of safe catheterisation and 31.2%.could list well the possible complications of catheterisation. Less than half had good knowledge of appropriate catheter sizes. CONCLUSION: Urethral catheterisation is yet to be well mastered by many newly qualified interns and improvement in the teaching of procedural skills in medical schools may likely improve the situation.

Prevalence and determinants of erectile dysfunction among people with type 2 diabetes in Ilorin, Nigeria.

STUDY OBJECTIVES: To determine the prevalence and determinants of Erectile Dysfunction (ED) among men with Type 2 diabetes mellitus. MATERIALS AND METHODS: Seventy-seven adult men with Type 2 Diabetes Mellitus were assessed for Erectile Dysfunction using the 'IIEF-5' questionnaire. They were also assessed for the presence of certain clinical factors in other to determine their degree of correlation with ED. RESULTS: The mean age of the study subjects was 56.8(+/-2.4) years. Almost all (96.1%) were married. Forty-four (56.4%) men volunteered a history of Erectile Dysfunction. When assessed with the 'IIEF - 5' questionnaire, the prevalence of any degree of ED was 74% while moderate to severe ED was found in 39(51%) of the patients. The only clinical variables that had statistically significant correlation with ED were the age of the patients (p=0.04) as well as the duration of diabetes (p=0.04). CONCLUSION: - Erectile Dysfunction is a very common condition among men with Type 2 Diabetes mellitus in Ilorin, Nigeria and should therefore be routinely sought for by the clinicians. The two clinical factors that confer significant risk to development of ED, from this study are non-modifiable. More emphasis should therefore be placed on treatment rather than the prevention of this condition.

Surgical emergencies in a Nigerian university hospital.

An audit of surgical emergencies was carried out to monitor acute trauma care and determine areas needing clinical improvement. This is essential for the development of institutional and national health policies on trauma and non-trauma diseases. All patients attending the surgical Accident and Emergency were studied prospectively from September 1999 to August 2000 to obtain their age, sex and diagnosis and to determine causes and injury-arrival time for trauma cases and the outcome of care for all cases. Out of 2,455 patients comprising 1,696 males and 759 females (M:F = 2.2:1) age range two weeks to 95 years, trauma accounted for 1,679 (68.4%). The median age (and the mode) of presentation overall and in males was in the third decade. Females had a 'plateau' age of presentation for the first four decades before the gradual fall to zero. Superficial skin trauma (lacerations, abrasions and bruises) represents the commonest presentation (16.1%) followed by fractures (13.9%), acute abdominal conditions (7.6%), head injury, HI (5.5%), multiple injury (4.1%), urinary retention (3.3%), burns and scalds (3.3%) and others. Eight-one patients died, comprising 54 males and 27 females, out of which 64 were trauma related deaths. Most common causes of death were HI (35 patients, 43.2%) and septicaemia (13 patients, 16.0%). Late presentation and poor finances contributed to the deaths in patients with septicaemia. Trauma is an important entity in our emergency practice. Prompt access to surgical care should reduce the morbidity and mortality from acute abdominal conditions and HI. The high incidence of urinary retention requires further analysis. Statistics of this nature can aid planning of care delivery and study of preventable deaths.

Grinding machine: friend or foe.

Few cases of traumatic loses of the external genitalia have been reported in this part of the world. In a developing country like ours, grinding machines are commonly being used by the people for domestic purposes. Children in their mid fifteens are usually employed to man and operate the machine without proper training and apprenticeship. Many of them have fallen victims of various genito-urinary injuries from grinding machine. Treating a child for complete traumatic loss of penis is rare and challenging any where in the world. A 12 years old boy presented to the emergency unit of our hospital with penile amputation 18 hours after the injury was sustained. A penile reconstruction of corporal cavernosa phalloplasty was used. This method of reconstruction may be used by clinician in our sub-region where other treatment modalities such as replantation by microvascular surgery, use of free radial fore-arm flap or sex reassignment to the female gender may not be feasible or acceptable.