University College Hospital Ibadan Research Articles

Trabeculectomy for congenital glaucoma in University College Hospital, Ibadan: A 7 year review of cases

Introduction: Congenital glaucoma is an uncommon ocular condition affecting about 1/15,000 live births. About two third of cases are bilateral with a higher prevalence in males. The definitive treatment requires surgery which could be trabeculectomy, trabeculotomy, goniotomy, drainage tubes or a combination of trabeculotomy and trabeculectomy. Aim: To determine the outcome of trabeculectomy in patients with congenital glaucoma seen at the University College Hospital Ibadan between 2007 and 2013. Methods: The medical records of all patients with congenital glaucoma seen between the years 2007 and 2013 were retrieved. Inclusion criteria were patients who had trabeculectomy with or without anti-metabolites within this period. The main outcome measures assessed were postoperative intraocular pressure (IOP) and corneal clarity. Data was analyzed with the statistical Package for Social Sciences version 21. Results: Thirty-four eyes of 18 patients were reviewed out of which 16 patients had bilateral trabeculectomy while two had unilateral trabeculectomy. The mean preoperative IOP was 26.31 mmHg while the mean IOP in the immediate postoperative period, at 3 months after surgery and at last follow-up visit were 13.31 mmHg, 12.78 mmHg and 15.89 mmHg respectively. IOP was <21 mmHg in 81.82% of the eyes as at last clinic visit. All eyes had cloudy corneas preoperatively while 38.24% had minimal residual corneal opacity (Haab's striae) as at last follow-up visit. Conclusion: In the absence of equipment for other surgical options, trabeculectomy is an effective surgical approach in the management of congenital glaucoma in the short term.

Factors Associated with Medication Nonadherence among Hypertensives in Ghana and Nigeria.

Background. Blood pressure (BP) control is poor among hypertensives in many parts of sub-Saharan Africa. A potentially modifiable factor for control of BP is medication nonadherence (MNA); our study therefore aimed to determine factors associated with MNA among hypertensives in Ghana and Nigeria. Methodology. We conducted a multicenter cross-sectional study. Patients were recruited from Korle-Bu Hospital (n = 120), Ghana; and University of Port Harcourt Teaching Hospital, (n = 73) Apapa General Hospital Lagos (n = 79) and University College Hospital Ibadan (n = 85), Nigeria. Results. 357 hypertensive patients (42.6% males) participated. MNA was found in 66.7%. Adherence showed correlation with depression (r = −0.208, P < 0.001), concern about medications (r = −0.0347, P = 0.002), and knowledge of hypertension (r = 0.14, P = 0.006). MNA was associated with formal education (P = 0.001) and use of herbal preparation (P = 0.014). MNA was found in 61.7% of uninsured participants versus 73.1% of insured participants (P = 0.032). Poor BP control was observed in 69.7% and there was significant association between MNA and poor BP control (P = 0.006). Conclusion. MNA is high among hypertensives in Ghana and Nigeria and is associated with depression, concern about hypertensive medications, formal education, and use of herbal preparations. The negative association between health insurance and MNA suggests interplay of other factors and needs further investigation.

Patterns of sexually transmitted infections in patients presenting in special treatment clinic in Ibadan south western Nigeria.

IntroductionSexually transmitted infections (STIs) are infections that are often transferred from one person to another during sexual activity. In developing countries, an increase in the incidence of STIs is attributed to increasing urbanization, modernization, travel, education and exposure to Western media which has led to increased sexual activity, especially among young people.MethodsThis is a retrospective study carried out in the University College Hospital (UCH) Ibadan, Nigeria. The records of a total of 506 patients who attended the clinic between Jan 2010-Dec 2011 were retrieved. The records of the patients’ complaints were taken. Detailed demographic data and history of genital symptoms was taken.ResultsThe records of 506 patients were used 43.7% (221) were males and 56.3% (285) were females. The patient's age ranged from one to eighty, the 1-10 age groups and the 71-80 ages were the least represented age group. Age, sex, level of education, presenting complaints, presence of yeast cells, VDRL positivity were variables that were looked at. Of these only sex and occupation were risk factors for transmission of STI.ConclusionGood clinical care for patients with STIs should extend beyond therapy and include help to avoid future infections. Control activities should focus on the primary prevention of infection through safer sexual practices. Strategies for improving secondary prevention (health care-seeking behavior and case management) should include identification of people at risk and targeting them for intervention.

Clinicopathological features of gastric carcinoma in Ibadan, Nigeria, 2000-2011.

Aim:The most recent study on the clinicopathological features of gastric carcinoma from the University College Hospital (UCH), Ibadan, was done in 2000. The aim of this study is to update the knowledge on the clinicopathological features of gastric carcinoma diagnosed in the Pathology Department of the UCH Ibadan between 2000 and 2011.Materials and Methods:This was a 12-year retrospective review of clinical and demographic data and the histopathological features of gastric cancers diagnosed at the Pathology Department of the UCH. The chi square test, Fisher's exact test, and the t-independent test were used as applicable in the statistical analyses.Results:A total of 117 cases of gastric carcinoma were histologically diagnosed at the Pathology Department of UCH, Ibadan in this period giving a relative ratio frequency of 1.38% for all cancers. It represented 18.4% of all gastrointestinal tract malignancies diagnosed in the same period. There was a male preponderance with male:female ratio of 1.72:1; the middle-aged and elderly made up about 76.1% of cases. The disease was clinically and histologically advanced in 92.8% of cases. Gastric tumours were predominantly antral/ pyloric in 80% of cases and exophytic in 62.3% of cases. The intestinal histotype constituted 47.0% cases although a rise in the diffuse histological type was observed.Conclusion:There is a decline in the relative ratio frequency of gastric carcinoma in Ibadan; and a fall in the rate of the intestinal type of gastric carcinoma relative to the diffuse type when compared to previous studies from our centre.

Social barriers to diagnosis and treatment of breast cancer in patients presenting at a teaching hospital in Ibadan, Nigeria

Globally, breast cancer is the most frequent malignancy in women, and stage at diagnosis is a key determinant of outcome. In low- to middle-income countries, including Nigeria, advanced stage diagnosis and delayed treatment represent a significant problem. That social barriers contribute to delay has been noted in previous research; however, few specific factors have been studied. Using semi-structured interviews, this study identifies social barriers to diagnosis and treatment for patients who presented at University College Hospital Ibadan, Nigeria. Transcripts from the interviews were coded and analysed thematically. Thirty-one patients and five physicians were interviewed. The median age of patients was 51 (range: 28 to above 80), 83% were Christian and 17% were Muslim. Preliminary analysis showed that delays in diagnosis reflected a lack of education as well as the utilisation of non-physician medical services such as pharmacists. Delays in treatment were often due to fear of unanticipated surgery and cost. The majority of women did not know the cause of their breast cancer, but some believed it was caused by a spiritual affliction. This study suggests that further education and awareness of breast cancer for both patients and providers is needed in order to increase early stage diagnosis.

Mobile Phones for Fundus Photography in Ibadan, Sub Sahara Africa

Back ground: Fundus photography is essential for documentation, patient education and monitoring follow up treatments in patients with retina diseases. The equipment for fundus photography is expensive for most ophthalmic facilities in Sub Sahara Africa. Mobile technology is a cheaper alternative, as this will enhance telemedical services in the region. Aim: The aim of this study was to investigate the use of iphone 5 in combination with a 20D lens to capture retinal image. The iphone 5 was also compared with the cheaper Android phone Techno phantom A+. Methods: We selected consecutive patients attending the retinal clinic of the University College Hospital Ibadan for the study. Informed consent was obtained before the study. Five patients each with retinal diseases affecting the posterior pole within the field of view of the 20D lens were enrolled to either iphone 5 plus 20D lens or Techno A+ plus 20D lens after full pupillary dilatation. The setup is used as a binocular indirect ophthalmoscope. The eye of the patient, the 20D lens and the flash/camera of the mobile phone must be on the same axis. The 20D lens captures the image of the retina which is viewed by the examiner on the screen of the mobile phone. The Application Filmic Pro improves stability of image capturing in the iphone system. The two systems were compared for ease of use, resolution and clarity of pictures. Results: The iphone 5 system and the Techno system showed comparable results. The iphone 5 produced fewer glare with clearer pictures. Conclusion: The mobile technology described is a cheaper alternative to standard fundus photography in Sub Sahara Africa.

English

This study examined the effects of anthropometric variables and metabolic imbalance on platelet aggregation in diabetic patients. A total of 109 volunteer were used; 58 diabetes mellitus (DM) patients (28 males and 30 females) who were receiving treatment at the University College Hospital Ibadan and 51 non diabetic control recruited from residents of Agbowo and Teachers of some secondary schools within the University of Ibadan. Body mass index (BMI)&nbsp; and body surface area (BSA) were assessed as indices of anthropometry, fasting blood sugar (FBS), plasma cholesterol and triglycerides (TAG)&nbsp; were determined using standard method and platelet aggregation test was done on the whole blood. Platelet aggregation ratio was higher in non diabetic compared to the diabetic subjects (P&lt;0.001). The mean platelet aggregation ratio was also significantly higher in the male diabetic when compared to the female diabetic group (P&lt;0.001). There was a significant linear relationship between platelet aggregation ratio and BMI (P&lt;0.01), age (P0.05), FBS (P&lt; 0.01), plasma cholesterol (P&lt;0.01) and plasma TAG (P&lt;0.05). However, the correlation coefficient between platelet aggregation ratio and BSA is not significant. In the non diabetic control subjects the correlation coefficient is not significant. Findings from this study suggest that, the increased platelet aggregation found in diabetic patients increased significantly with increased BMI but decrease with age. The mean platelet aggregation is also increased significantly with increase metabolic imbalance. &nbsp; Key word: Platelet aggregation, anthropometry, diabetes mellitus, Body mass index (BMI), fasting blood sugar (FBS).

The UCH bladder manikin

s 115 Review of posterior urethral valve in UCH Ibadan B. Abiola 1,∗, A.O. Takure 1, O.B. Shittu 1,2,3, L.I. Okeke 1,2,3, E.O. Olapade-Olaopa 1,2,3 1 University College Hospital, Ibadan, Nigeria 2 College of Medicine, University of Ibadan, Nigeria 3 Ibadan PUITA Center, Department of Surgery, University College Hospital, Ibadan, Nigeria ∗Corresponding author at: Department of Surgery, University College Hospital, Nigeria. E-mail address: tundexxl@yahoo.com (B. Abiola) Introduction: Posterior urethral valve is a well recognized cause of obstructive uropathy in infancy and childhood with long term implication on renal function in later life. It is commonly diagnosed in utero and immediately after birth. Objectives: To describe the clinical presentation, treatment, and eventual outcome of patients with posterior urethral valves to our service. Methods: A retrospective analysis of patients with posterior urethral valve over a period between 2006 and 2013 was done. Case notes were retrieved and data on patients age, clinical and radiological features, treatment modality, outcome, duration of follow up and condition as at last follow up were extracted. Results: Forty patients were managed during this period and 31 (77.5%) patients had available data. No patient was identified pre-natally. The median age at presentation was 5 years 7 months (range 2 weeks-25 years). Twentythree patients (92%) had back pressure changes on ultrasound. MCUG was confirmatory in all the patients. Twenty patients (64.5%) had Mohan’s valvotomy done while 9 (29%) were treated with endoscopic valve ablation. One patient (3.2%) had closed suprapubic cystostomy. Sixty-percent of patients had follow-up outpatient visits, 40%defaulted. The median follow up postoperation was 8 months (range 1 week–6 years). All patients seen after surgery had normal renal function at the time of last visit. Conclusion: Majority of our patients presented late with features of back pressure changes. Though surgery was successful, and renal function preserved, a large number of patients defaulted from follow up. http://dx.doi.org/10.1016/j.afju.2014.03.015 The UCH bladder manikin I.N. Chibuzo 1,∗, S.A. Adebayo 1,3, E.O. Olapade-Olaopa 1,2,3, A. Takure 1,3, L.I. Okeke 1,2,3, O.B. Shittu 1,2,3 1 Department of Surgery, University College Hospital Ibadan, Nigeria 2 College of Medicine, University of Ibadan, Nigeria 3 Ibadan PIUTA Centre, Department of Surgery, University College Hospital Ibadan, Nigeria ∗Corresponding author at: Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria. E-mail address: ijeomanc2002@yahoo.com (I.N. Chibuzo) Introduction and objectives: Emergency suprapubic catheterisation (ESPC) is an indispensable skill for medical practice. It may be done via open or closed techniques. In Nigeria, majority of the general medical practitioners and non-urological residents have no formal training in suprapubic catheterisation. A low-cost manikin was designed locally for the purpose of training doctors in ESPC. This paper describes the development of the manikin and assesses its usefulness in teaching ESPC. Methods: A foundation of urology workshop was organised by the Ibadan PIUTA Centre, in March 2013, at which general medical practitioners and non-urological residents were given instruction in suprapubic catheterisation using the locally manufactured manikin. At the end, questionnaires were administered to evaluate the effectiveness of the manikin in SPC training. Six months later, questionnaires were administered to the surgical residents to evaluate the impact of the training on their practice. Results: There were twenty-five medical practitioners in attendance, which included eighteen non-urological surgical residents. The others were family physicians and gynaecologists. All were taught the open and closed techniques using the manikin. At the end of the workshop, 100% of the participants stated that the manikin was an effective teaching aid. Six months later, 67% of the surgical residents had independently performed successful ESPCs. The closed technique was used by 83%, while 17% used both open and closed methods. Conclusion: The UCH bladder manikin is an effective, low-cost and easily manufactured aid for teaching doctors emergency suprapubic catheterisation. We recommend its use by other centers in low resource countries. http://dx.doi.org/10.1016/j.afju.2014.03.016 Endourology/Robotics The emergence of Da Vinci Robotic surgery in urologic oncology-Kokilaben Dhirubhai Ambani Hospital Experience

Review of posterior urethral valve in UCH Ibadan

s 115 Review of posterior urethral valve in UCH Ibadan B. Abiola 1,∗, A.O. Takure 1, O.B. Shittu 1,2,3, L.I. Okeke 1,2,3, E.O. Olapade-Olaopa 1,2,3 1 University College Hospital, Ibadan, Nigeria 2 College of Medicine, University of Ibadan, Nigeria 3 Ibadan PUITA Center, Department of Surgery, University College Hospital, Ibadan, Nigeria ∗Corresponding author at: Department of Surgery, University College Hospital, Nigeria. E-mail address: tundexxl@yahoo.com (B. Abiola) Introduction: Posterior urethral valve is a well recognized cause of obstructive uropathy in infancy and childhood with long term implication on renal function in later life. It is commonly diagnosed in utero and immediately after birth. Objectives: To describe the clinical presentation, treatment, and eventual outcome of patients with posterior urethral valves to our service. Methods: A retrospective analysis of patients with posterior urethral valve over a period between 2006 and 2013 was done. Case notes were retrieved and data on patients age, clinical and radiological features, treatment modality, outcome, duration of follow up and condition as at last follow up were extracted. Results: Forty patients were managed during this period and 31 (77.5%) patients had available data. No patient was identified pre-natally. The median age at presentation was 5 years 7 months (range 2 weeks-25 years). Twentythree patients (92%) had back pressure changes on ultrasound. MCUG was confirmatory in all the patients. Twenty patients (64.5%) had Mohan’s valvotomy done while 9 (29%) were treated with endoscopic valve ablation. One patient (3.2%) had closed suprapubic cystostomy. Sixty-percent of patients had follow-up outpatient visits, 40%defaulted. The median follow up postoperation was 8 months (range 1 week–6 years). All patients seen after surgery had normal renal function at the time of last visit. Conclusion: Majority of our patients presented late with features of back pressure changes. Though surgery was successful, and renal function preserved, a large number of patients defaulted from follow up. http://dx.doi.org/10.1016/j.afju.2014.03.015 The UCH bladder manikin I.N. Chibuzo 1,∗, S.A. Adebayo 1,3, E.O. Olapade-Olaopa 1,2,3, A. Takure 1,3, L.I. Okeke 1,2,3, O.B. Shittu 1,2,3 1 Department of Surgery, University College Hospital Ibadan, Nigeria 2 College of Medicine, University of Ibadan, Nigeria 3 Ibadan PIUTA Centre, Department of Surgery, University College Hospital Ibadan, Nigeria ∗Corresponding author at: Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria. E-mail address: ijeomanc2002@yahoo.com (I.N. Chibuzo) Introduction and objectives: Emergency suprapubic catheterisation (ESPC) is an indispensable skill for medical practice. It may be done via open or closed techniques. In Nigeria, majority of the general medical practitioners and non-urological residents have no formal training in suprapubic catheterisation. A low-cost manikin was designed locally for the purpose of training doctors in ESPC. This paper describes the development of the manikin and assesses its usefulness in teaching ESPC. Methods: A foundation of urology workshop was organised by the Ibadan PIUTA Centre, in March 2013, at which general medical practitioners and non-urological residents were given instruction in suprapubic catheterisation using the locally manufactured manikin. At the end, questionnaires were administered to evaluate the effectiveness of the manikin in SPC training. Six months later, questionnaires were administered to the surgical residents to evaluate the impact of the training on their practice. Results: There were twenty-five medical practitioners in attendance, which included eighteen non-urological surgical residents. The others were family physicians and gynaecologists. All were taught the open and closed techniques using the manikin. At the end of the workshop, 100% of the participants stated that the manikin was an effective teaching aid. Six months later, 67% of the surgical residents had independently performed successful ESPCs. The closed technique was used by 83%, while 17% used both open and closed methods. Conclusion: The UCH bladder manikin is an effective, low-cost and easily manufactured aid for teaching doctors emergency suprapubic catheterisation. We recommend its use by other centers in low resource countries. http://dx.doi.org/10.1016/j.afju.2014.03.016 Endourology/Robotics The emergence of Da Vinci Robotic surgery in urologic oncology-Kokilaben Dhirubhai Ambani Hospital Experience

Outbreak Of Lassa fever in a bakery: investigation and epidemiological surveillance of contact persons, Ibadan Oyo State, Southwestern Nigeria

Contact information; favouradedire@gmail.com +2348066410801 Nigeria Field Epidemiology and Laboratory Training Programme, Abuja Nigeria Acknowledgements Nigeria Field Epidemiology and Laboratory Training Programme, University College Hospital Ibadan Federal Ministry of Health & Oyo State Ministry of Health Public Health Actions/Recommendation Descriptive study −Active case search/record review −Cases (time, place and persons −Case definition: A suspected case was a person who reported sick at the health facility between July and August 2012 with fever >38◦C (101◦F) and one or more of following: bleeding, chest pain, and not responding to appropriate antimalarial or antibiotics treatment within 24 -72hours of treatment. A confirmed case was a suspected case with positive ELISA IgM. Surveillance of contact persons –Contact tracing −Visit to the home of the index case −Visit to health facilities visited by the index case −Risk stratification interview (time of exposure, non usage of PPE, procedure done) Laboratory analysis −Blood sample were collected from high risk contacts; including household contacts, bakery staff and health workers for serological tests of index case and health workers Environmental assessment Inspection of the environment Rodent search and trapping Conclusion Epidemiological findings

Paediatric end-stage renal disease in a tertiary hospital in South West Nigeria

BackgroundChildren and adolescents with end-stage renal disease (ESRD) in sub-Saharan Africa may have the worst outcomes globally. Barriers to management include late presentation, poor socioeconomic conditions, absence of medical insurance, limited diagnostic facilities and non-availability of chronic renal replacement therapy (RRT). Our study was to determine the incidence, aetiology, management and outcomes of paediatric ESRD in a tertiary hospital in Nigeria.MethodsA retrospective case review of paediatric ESRD at the University College Hospital Ibadan, Nigeria, over 8 years, from January 2005 to December 2012.Results53 patients (56.6% male), median age 11 (inter quartile range 8.5-12) years were studied. Mean annual incidence of ESRD in Ibadan for children aged 14 years and below was 4 per million age related population (PMARP) while for those aged 5-14 years it was 6.0 PMARP. Glomerulonephritis was the cause in 41 (77.4%) patients amongst whom, 29 had chronic glomerulonephritis and 12 had nephrotic syndrome. Congenital anomalies of the kidneys and urinary tract (CAKUT) accounted for 11 (21.2%) cases, posterior urethral valves being the most common. Acute haemodialysis, acute peritoneal dialysis or a combination of these were performed in 33 (62.3%), 6 (11.3%) and 4 (7.5%) patients respectively. Median survival was 47 days and in-hospital mortality was 59%.ConclusionsIncidence of paediatric ESRD in Ibadan is higher than previous reports from sub-Saharan Africa. Glomerulonephritis, and then CAKUT are the most common causes. Mortality is high, primarily due to lack of resources. Preventive nephrology and chronic RRT programmes are urgently needed.

Comparing Oxygen Saturation of Normal Children with that of Children with Adenotonsillar Hypertrophy.

To compare the nocturnal oxygen saturation profiles of children with adenotonsillar enlargement with that of normal children. A 1year comparative study. The study was carried out at the Otorhinolaryngology Ward of the University College Hospital Ibadan. These comprise of 60 children (1-9years) with clinically confirmed adenotonsillar enlargement admitted for adenotonsillectomy and 60 normal children matched for age and sex. The biodata and common clinical presentations of the study group were acquired with a structured proforma. The severity of nasopharyngeal obstruction was determined by the adenoidal-nasopharyngeal ratio while the degree of tonsillar enlargement was graded by the Brodsky's classification. The nocturnal oxygen saturation of all the participants were recorded with a wrist worn pulse oximeter. Recording was for at least for 4h. Oxygen saturation <92% was regarded as desaturation. The oximetric values of the study and control group were compared. The mean nocturnal SPO2 (peripheral saturation of oxygen) profiles of children with adenotonsillar enlargement were as follows: basal=96.86%, minimum=84.99%; maximum=99% and average SPO2 <92%=87.74% while the saturation profiles of the control group were as follows; basal=97.88%, minimum=89.71%; maximum=99%, average SPO2 <92%=90.82%. Normal children have better nocturnal saturation profiles than children with adenotonsillar enlargement.

Ultrasound Reference Range for Diameters of Posterior Atrium of Lateral Ventricles for Normal Nigerian Foetuses, at the University College Hospital (UCH) Ibadan, Nigeria: A Cross – Sectional Study

Aims: The diameter of the posterior atrium of the lateral cerebral ventricles (PALV) does not vary substantially in size during foetal development and has thus become a stable marker for the identification of foetal ventriculomegaly in developed countries. Currently, the accepted upper limit of PADLV is 10 mm. Ventricular atrial diameters greater than 10mm require more radiological evaluation to rule out ventriculomegaly. The aim of this study was to establish the normal range of values for the posterior atrium [PA] of foetal lateral ventricles in our environment and to determine a cut-off value for Original Research Article British Journal of Medicine & Medical Research, 4(16): 3208-3219, 2014 3209 prenatal diagnosis of ventriculomegaly. Methods: The mean of two measurements was obtained from the transverse diameter of the atrium of the lateral ventricles of foetuses that met the inclusion criteria, as part of the routine obstetric ultrasound scan at the antenatal clinic or ultrasound suite of radiology department of the University College Hospital (UCH), Ibadan. The SPSS version 15 was used to analyse the data obtained. Results: The mean posterior atrial diameter [PAD] of the lateral ventricl was 6.5mm with standard deviation (SD) 1.3mm and mean ±2SD 3.9–9.1mm. Male foetuses had larger atrial diameters than female. Student’s t-test and Pearson’s correlation coefficient were used to explore association. Conclusion: With the existing resources in our environment, prenatal screening for ventriculomegaly during routine obstetric scan is achievable. Measurement of 10mm is a reasonable upper limit of normal in our environment. Foetuses with larger values need further evaluation to rule out hydrocephalus.

Association between Anthropometric Indices, Plasma Insulin, Lipids and Lipoproteins in Overweight and Obese Nigerians

AIM : The aim of this study was to determine the relationship between excess body weight gain and plasma insulin, lipid profile and anthropometric indices in overweight/obese civil servants urban city dwellers in Nigeria where fast food outlets are fast growing. Study Design: This study was designed to access anthropometric indices, plasma lipid profile and insulin in non diagnosed disease overweight/obese individuals. Place and Duration of Study: The study was carried out in the Department of Chemical Pathology University College Hospital Ibadan Nigeria, between February 2010 and June 2011.

Hypogonadism and Metabolic Syndrome in Nigerian Male Patients With Both Type 2 Diabetes and Hypertension

Background:The association between testosterone level and the components of metabolic syndrome remains controversial. Relevant studies from Sub-Saharan Africa are few and incohesive.Objectives:The current study was designed to investigate the level of testosterone in patients with both diabetes and hypertension and the association of low testosterone with metabolic syndrome in these patients.Materials and Methods:In this prospective case-control study, 83 male subjects (49 newly diagnosed men with both diabetes and hypertension and 34 apparently healthy controls) were recruited from Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria and University College Hospital Ibadan, Ibadan, Nigeria. Demographic, anthropometric and sexual characteristics were obtained using structured questionnaires and standard methods. Blood plasma glucose (BPG), total cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol (LDL-C) were measured by conventional methods. Testosterone (T) was analyzed by enzyme immunoassay. Data obtained were statically analyzed with the SPSS 15.0 software, and results were expressed as mean ± SEM.Results:This study showed significantly lowered concentrations of testosterone (3.11 nm/L ± 0.34) and HDL (0.39 mmol/L ± 0.02), in addition to the expected increased concentrations of fasting plasma glucose (9.61 mmol/L ± 0.37) in the subjects compared to controls (P < 0.05). An inverse significant correlation was observed between the serum testosterone concentration and metabolic syndrome (BMI, r = -0.477; waist/Hip ratio, r = -0.376 and dyslipidemia, r = -0.364, P < 0.05). Also, the testosterone level decreased with increase in central obesity (P < 0.05).Conclusions:This study established a strong association between low serum testosterone and metabolic syndrome in subjects with both type 2 diabetes and hypertension. It may therefore be advisable to include routine measurement of the testosterone level in the management of patients presented with both diabetes and hypertension. Furthermore, these patients may benefit from testosterone replacement therapy.

Hypogonadism and Metabolic Syndrome in Nigerian Male Patients With Both Type 2 Diabetes and Hypertension

Background:: The association between testosterone level and the components of metabolic syndrome remains controversial. Relevant studies from Sub-Saharan Africa are few and incohesive. Objectives:: The current study was designed to investigate the level of testosterone in patients with both diabetes and hypertension and the association of low testosterone with metabolic syndrome in these patients. Materials and Methods:: In this prospective case-control study, 83 male subjects (49 newly diagnosed men with both diabetes and hypertension and 34 apparently healthy controls) were recruited from Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria and University College Hospital Ibadan, Ibadan, Nigeria. Demographic, anthropometric and sexual characteristics were obtained using structured questionnaires and standard methods. Blood plasma glucose (BPG), total cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol (LDL-C) were measured by conventional methods. Testosterone (T) was analyzed by enzyme immunoassay. Data obtained were statically analyzed with the SPSS 15.0 software, and results were expressed as mean ± SEM. Results:: This study showed significantly lowered concentrations of testosterone (3.11 nm/L ± 0.34) and HDL (0.39 mmol/L ± 0.02), in addition to the expected increased concentrations of fasting plasma glucose (9.61 mmol/L ± 0.37) in the subjects compared to controls (P < 0.05). An inverse significant correlation was observed between the serum testosterone concentration and metabolic syndrome (BMI, r = -0.477; waist/Hip ratio, r = -0.376 and dyslipidemia, r = -0.364, P < 0.05). Also, the testosterone level decreased with increase in central obesity (P < 0.05). Conclusions:: This study established a strong association between low serum testosterone and metabolic syndrome in subjects with both type 2 diabetes and hypertension. It may therefore be advisable to include routine measurement of the testosterone level in the management of patients presented with both diabetes and hypertension. Furthermore, these patients may benefit from testosterone replacement therapy.

Perception of Patients and Other Health Care Professionals about Nurses at the University College Hospital, Ibadan, Oyo State, Nigeria

Objective: To explore the perception of patients and other health care professionals about the attitude and behavior of nurses working at the University College Hospital Ibadan Oyo State. Background: Observation has shown that despite the efforts nurses put into carrying out their duties, the acknowledgement of a job well done from co-professionals and patients still leaves much to be desired. Could this be due to impressions formed about nurses? Hence, this study attempts to explore the perception of patients and other health care professionals about nurses. Methods: Two hundred (200) consented respondents were randomly selected for this study. This consists of 165 patients and 35 doctors representing other health care professionals. Data were collected through a pretested questionnaire. Analysis was done by using SPSS version 16.0. Result: Results showed that 68% of patients and 58% of doctors perceived that nurses were competent. About 75% of patients and 54% of doctors agreed that the nurses had adequate skills. Patients (70%) and doctors (49%) agreed that the nurses had a positive attitude towards work. About 74% of patients and 59% of doctors agreed to the fact that the nurses maintained a professional demeanor. Findings also showed that patients rated the nurses higher than the doctors did. A significant difference was found between the perception of patients and doctors about the communication skills of nurses (t = 2.423; df = 198; p = 0.016). Conclusion: The study shows relative satisfaction with the quality of nurse’s work, perceptions of people about their attitudes and behaviors. Nurses could improve on how they relate with other health care providers to achieve positive patient care outcomes.

Mastectomy for management of breast cancer in Ibadan, Nigeria

BackgroundModified radical mastectomy remains the standard therapeutic surgical operation for breast cancer in most parts of the world. This retrospective study reviews mastectomy for management of breast cancer in a surgical oncology division over a ten year period.MethodsWe reviewed the case records of consecutive breast cancer patients who underwent mastectomy at the Surgical Oncology Division, University College Hospital (UCH) Ibadan between November 1999 and October 2009.ResultsOf the 1226 newly diagnosed breast cancer patients over the study period, 431 (35.2%) patients underwent mastectomy making an average of 43 mastectomies per year. Most patients were young women, premenopausal, had invasive ductal carcinoma and underwent modified radical mastectomy as the definitive surgical treatment. Prior to mastectomy, locally advanced tumors were down staged in about half of the patients that received neo-adjuvant combination chemotherapy. Surgical complication rate was low. The most frequent operative complication was seroma collection in six percent of patients. The average hospital stay was ten days and most patients were followed up at the surgical outpatients department for about two years post-surgery.ConclusionsThere was low rate of mastectomy in this cohort which could partly be attributable to late presentation of many patients with inoperable local or metastatic tumors necessitating only palliative or terminal care. Tumor down-staging with neo-adjuvant chemotherapy enhanced surgical loco-regional tumor control in some patients. The overall morbidity and the rates of postoperative events were minimal. Long-term post-operative out-patients follow-up was not achieved as many patients were lost to follow up after two years of mastectomy.

Significance of Dna Mismatch Repair Genes and Microsatellite Instability in Colorectal Carcinoma in Ibadan, Nigeria

Background: Though the incidence of colorectal carcinoma (CRC) is relatively uncommon in Nigeria, compared to the developed countries, recent studies indicate an increasing trend. Our patients often present at an earlier age, which has important implications for the pathogenesis in Nigeria. MLH1, MSH2, MSH6, PMS2 are the commonly mutated MMR genes in descending order of frequency, with PMS1 and MLH3 mutations being very rare. This study attempts to determine the significance of microsatellite instability (MSI) in colorectal carcinogenesis using immunohistochemistry (IHC) for detection of defects of DNA mismatch repair gene (MMR) amongst cases diagnosed at University College Hospital (UCH) Ibadan, Nigeria. Methodology: Suitable consecutive CRC cases identified from UCH, Ibadan, Pathology Department, 2006 files were stained with MMR IHC antibody panel (MLH1, MSH2, MSH6, PMS2). Stained sections were reviewed for nuclear reactivity and graded according to staining intensity (weak +, moderate ++, strong +++, very strong ++++). Result: IHC was performed on 26 cases. The age range is 22-74 years with 9 cases <40 years. One case with no reactivity with any of the antibody was considered unsuitable. Two cases with only PMS2 nuclear reactivity but no reaction with other antibodies were considered equivocal. Five cases had no nuclear reactivity with single antibody: MLH1 (2); MSH2 (3); and one case had no nuclear reactivity with MLH1 & MSH2. These six cases included 3 cases aged 22, 27 and 32 years with tumors showing no nuclear reactivity for MSH2 and (MLH1 & MSH2) respectively. Conclusion: Though the number cases tested are small, the identification of the loss of MMR gene protein (MLH1 and MSH2) by IHC, indicating MSI, in a significant number of the 26 cases tested (23%), particularly young individuals, suggests that defects of DNA mismatch repair genes are important factors in colorectal carcinogenesis in Nigerians.

Assessing cancer patients' quality of life and coping mechanisms in Radiotherapy Department of the University College Hospital, Ibadan

Cancer is often associated with a lot of pain and suffering. These suggest that coping with the symptoms, diagnosis and treatment of cancer is a major life stressor that is capable of influencing patients' quality of life (QoL). The purpose of the study is to assess the relationship between cancer patients' QoL dimensions and coping strategies in the Radiotherapy Department of the University College Hospital Ibadan, Nigeria. Data were collected on clinic days from all available and consenting cancer patients who were receiving treatment at the radiotherapy department. Participants were informed of their right to decline to fill the questionnaires. In this study, 237 cancer patients participated. They had an age range of 15 to 95 years with a mean age of 49.91 years. There was significant inverse relationship between physical well-being with behavioural disengagement, venting, planning and self-blame (p < 0.05); social/family well-being has significant linear relationship with active coping, emotional support, positive reframing, instrumental support, acceptance and religion (p < 0.05); emotional well-being has significant inverse relationship with behavioural disengagement and self-blame (p < 0.05); functional well-being has significant linear relationship with active coping, instrumental support and acceptance (p < 0.05). It is important to assess cancer patients for the kind of coping strategies they are adopting to use in coping with their cancer burden, thereby guiding against lower QoL due to negative coping strategies. Intervention programmes could be developed to help cancer patients adopt more positive and effective coping strategies to improve patients' QoL.