Annals of Ibadan postgraduate medicine最新文献

Introduction: During our posting at the Renal Unit, Department of Medicine, University College Hospital, Ibadan, we observed numerous difficulties encountered by patients requiring renal replacement therapy and the family members/caregivers of these patients. These are broadly categorized into patents' related challenges, institutional inadequacies, infrastructural challenges, policy, and funding issues.

Perspective: Patients' challenges are poor health-seeking habits culminating in late diagnosis in advanced uremic state and poor economic status resulting in catastrophic out-of-pocket spending. Institutional and infrastructural challenges include epileptic power supply in the dialysis unit, a lack of necessary materials needed for dialysis, among others. Policy issues included the absence of an organ donor system and regulations guiding them. More importantly, there is insufficient support from the government concerning patients with end-stage kidney disease.

Conclusion: Tackling the management of end-stage kidney disease would require paying attention to and addressing these challenges.

Introduction: The internship period is a peculiar time in a doctor's career, and some have described it as a "nuisance year" during which the junior doctor assumes many roles at the same time. Junior doctors especially house officers are faced with many unique challenges; this is even more pronounced in poor resource settings like Nigeria. This study aimed to unravel and improve understanding of the challenges faced by medical and dental interns in Nigeria.

Methodology: A nine-member House officers Research and Statistics Committee (HRSC) was immediately set up to include three senior colleagues - Senior Registrars and Registrar. To carry out her responsibility efficiently the committee created the House Officers Research Collaboration Network (HRCN), a 103- member team comprising medical and dental interns from across Nigeria under a collaborative - Medical INternship Training in Nigeria (MINTING) study.

Results: Out of a total of the 103 House Officers Research Collaboration Network, 80 of them participated in this survey giving a 78% response rate. Ten of the intern Collaborators had additional qualification and seven of them had BSc as an initial degree. About 66 % of the Collaborators have never authored any publication. Of the 27 that have published an article; three collaborators are said to have published 15, 13, 16 articles respectively. Male collaborators where more likely to have published at least one article in the past. Thirty one of the 80 Collaborators have never been in a research collaborative group prior to this MINTING collaborative.

Conclusion: This commentary is set out to describe in detail Nigerian House Officers initiative in terms of the structure, functions, operational modalities, and to investigate the demographics of the HRCN collaborators which showed that over two third of collaborators have never authored any publication and about a third of them have never been involved in collaborative research. We also believe the findings will serve as policy guide and benchmark in training the critical medical health force.

Introduction: There has been an upsurge in the reporting of cases of Left Ventricular Noncompaction (LVNC) cardiomyopathy in medical literature in the last 35 years due to advances in medical imaging.The condition was first described in 1926 and the first reported case by echocardiography was in 1984. The American Heart Association considers LVNC a primary cardiomyopathy of genetic origin, while the European Society of Cardiology and the World Health Organization grouped it as an unclassified cardiomyopathy. Its variability in terms of genetic profile, phenotypic expression, clinical presentation, and histopathological findings makes it somewhat a variant of other cardiomyopathies.

Case presentation: Patients with LVNC cardiomyopathy may not have any symptoms or may present with ventricular arrhythmias, heart failure, thromboembolism, or sudden death. LVNC cardiomyopathy diagnosis is typically made by echocardiography, although there are higher resolution cardiac imaging techniques. Management will depend on the patient's clinical presentation. Due to its genetic association, there is a need to screen living relatives once the diagnosis is made in an individual.

Conclusion: The aim of this paper is to review current knowledge on this condition.

Background: Prostate cancer is one of the most common malignancies afflicting men worldwide. In the male population, it is estimated that one in seven will be diagnosed and one in 38 will die from prostate cancer. Majority of patients in Sub Saharan Africa present with advanced disease.

Objective: To identify among prostate cancer patients, the age, clinical manifestation and stage at presentation as well as treatment received.

Materials and method: The study reviewed patients with prostate cancer at the Jos University Teaching Hospital between January 2014 and December 2017. The demographic and clinical characteristics as well as treatment given were analysed.

Results: A total of 82 patients were studied. Age range was 41-100 years with a median of 67.9 years. The peak age group was 71-80 years, accounting for 41.4% of patients. Lower urinary tract symptom was present in all patients at the time of presentation. 59.8% of these patients presented with metastatic symptoms. Persistent low back pain was seen in 61.2 % of patients with metastatic symptoms, and digital rectal examination was suggestive of malignancy in 62.2% of patients. PSA was >20ng/ml in 73.3% of patients. Histology for all patients was adenocarcinoma, with a predominant Gleason score of 8 (29.3%). Bilateral total orchidectomy was offered in 59.8% of patients.

Conclusion: Majority of patients with carcinoma of the prostate in Jos have features of metastasis at the time of diagnosis. Orchidectomy is the most common treatment offered in our environment.

Introduction: Patient safety in primary care setting is important and effort geared towards this cannot be over-emphasised. Patient safety can be achieved through various means, but one mechanism to improve patient safety in resourceconstrained settings is through a practice known as safety netting. Safety netting is widely recommended in national guidelines with varying definitions and scope; hence there is no consensus on when safety netting should be used and what should be the content.

Methodology: A narrative overview of the evidence on safety netting concept in primary care consultation was conducted. Scholastic articles and Papers by International organizations were searched using terms like 'safety netting', 'primary care consultation', 'family physician', 'consultation technique', and 'patient safety' in primary care. Most resources found were in the developed countries (the West) and none was found in Africa or the Middle East.Safety netting is a technique in consultation to communicate uncertainty, provide patient information on red-flag symptoms, and plan for future appointments to ensure timely re-assessment of a patient's condition. The content of safetynetting advice may encompass the chronology of the illness, advice on worrying symptoms to look out for, and specific information on how, when and where to seek help. Safety netting was considered to be particularly important when consulting with the acutely unwell, patients with multi-morbidity, children and those with mental health problems.

Conclusion: Safety netting is more than solely the communication of uncertainty within a consultation. It should include plans for follow-up as well as important administrative aspects, such as the communication of test results. Effective safety netting should be geared towards the patient and provide enough practical clue for self-care and re-consultation.

Introduction: Myiasis is the infestation of tissues of humans and other living vertebrates with the larva of flies, and it can affect any part of the body. Cutaneous myiasis is the commonest form of presentation. Furuncular myiasis which is a sub-type of cutaneous myiasis typifies the presentation in this index patient. It is commonly caused by Cordylobia anthropophaga in Sub-Saharan African countries including Nigeria. It commonly occurs among rural dwellers, as well as people of low socio-economic and poor educational status.

Case presentation: We present a case of balanitis from distal penile myiasis in a 3 year 8-month-old male child of a health worker in a tertiary hospital in Nigeria.

Conclusion: It is believed that with adequate knowledge, measures such as good hygiene and proper drying and ironing of underwear are helpful.

Background: Surgical site infections (SSI) remain a problem in surgical practice despite the improvement in advanced technology and the use of antibiotics. Also, there is also a growing menace of antibiotic resistance which poses a great challenge in treating SSI. The study aimed to find out the most common bacterial pathogens responsible for surgical site infection and their antibiotic sensitivity profile.

Material and methods: It was a descriptive study carried out in Federal Medical Centre, Bida. 500 surgical procedures were carried out and samples were obtained from 73 patients that showed clinical evidence of SSI for culture and susceptibility test. Samples were collected from each patient using a swab stick. Bacteriological culture examination and identification were done following standard microbiological techniques. Susceptibility testing was performed by Kirby-Bauer technique according to Clinical and Laboratory Standards institute 26th edition. Data were analysed using SPSS 26.

Results: Out of the 73 samples taken, 83 isolates were obtained while five samples yielded no growth. Gram-negative bacteria (GNB) were predominant in 73(88.1%) with the dominant being E. Coli species (38.6%). From the strains that were isolated, there were 9(10.8%) Staph aureus was the only Gram-positive organism. Concerning antibiotic susceptibility, the results demonstrated remarkably high multidrug resistance. However, the meropenems and amikacin demonstrated good activities against all gram-negative isolates. The resistance pattern of enterobacteriaceae to tested antibiotics were to ciprofloxacin (90.2%) levofloxacin (82.2%) augmentin (88.5%) ceftriaxone (85.2%) ceftazidime (80.3%), gentamicin (80.3%) meropenems (14.8%) amikacin (16.4%.).

Conclusion: The study demonstrated a high alarming rate of multidrug resistance following SSI and this should call for concerns and surveillance among surgeons.

Background: The surgical condition termed hydrocoele of the canal of Nuck is one of the rarest clinical entities in the female group. It occurs due to the failure of obliteration of the derivative of the peritoneum, the processus vaginalis. It usually presents with painless inguinal swellings and is sometimes associated with features of intestinal obstruction if there is hernia coexisting with it that has become obstructed. Abdominopelvic ultrasonography and magnetic resonance imaging provide the basis for diagnosis, where these imaging modalities are available. However, a definite diagnosis may only be made during surgery. Definitive treatment includes groin exploration and excision of the cyst with high ligation of the neck of the sac up to the peritoneal pouch, along with repair of the inguinal hernia, if present.

Case presentation: We present a rare case of a 34-year-old woman who presented with clinical features of a left inguinolabial swelling post-surgery, and diagnosed as left recurrent irreducible inguinal hernia. Intraoperatively, a cystic swelling with serous collection was observed. She had hydrocoelectomy and repair of the left groin surgical wound.

Conclusion: Hydrocoele of the canal of Nuck may be misdiagnosed as inguinal hernia because of its rarity, lack of adequate knowledge regarding the entity and paucity of literature on the subject matter. This report is to furthermore increase our level of awareness of this condition especially after a previous groin surgery.

Introduction: This article presents an overview of MRI training in Africa, emphasizing its current status and the obstacles it encounters, with a report from a recent MRI workshop held in Uganda in September 2022. Africa's medical imaging sector faces unique challenges due to limited access to advanced technology, skilled professionals, and educational resources. While some regions have made notable strides in establishing MRI training programs, others struggle with a shortage of qualified MRI technicians and radiologists. These disparities underscore the urgent need for a more equitable distribution of resources and expertise across the continent. The aim of the MRI workshop was to initiate actions to address these challenges. This workshop leveraged the expertise of MRI clinicians and scientists to devise strategies for enhancing MRI training in Africa. The report outlines the key outcomes, recommendations, and initiatives resulting from this collaborative endeavor.

Conclusion: This report offers a crucial overview of MRI training in Africa, highlighting its challenges and disparities. It emphasizes the necessity of coordinated efforts to improve MRI education, ultimately contributing to enhanced healthcare outcomes for Africa's population.