Childhood traumatic cataract in Nigeria; a multicentre study: 2017-2021.

OBJECTIVE: To determine the frequency, demography, aetiology and mechanisms of ocular injuries associated with childhood traumatic cataract in Nigeria. METHODS: A retrospective multicentre study conducted across ten child eye health tertiary facilities in Nigeria between January 2017 and December 2021. Clinic records of all children aged 0-17 years who had been diagnosed with cataract at the various participating centres were reviewed. Information collected include: biodata, mechanism of injury; laterality, place of injury; object responsible; person responsible; duration before presentation and surgical intervention. RESULTS: A total of 636 out of 1656 children (38.4%) had traumatic cataracts during the study period. Their mean age was 109.4 ± 45.2 months with a male-to-female ratio of 2:1. Most injuries were unilateral, two (0.3%) children had bilateral involvement. Only 78 (15.3%) children presented within 4 weeks of the injury. Closed globe injuries were responsible for the traumatic cataract in 475 (74.7%) children, while open globe injuries were more likely to present within 24 h (P < 0.001). The commonest objects of injury were cane, sticks, plant, wood and play materials. Self-inflicted injuries occurred in about 82 (13%) children while 407 (64.0%) were caused by close relatives and contacts. The location where trauma occurred was home in 375 (59.8%) and school in 107 (16.8%) children. CONCLUSION: This multicentre study demonstrates that more than one-third of all childhood cataracts in Nigeria are trauma-related and majority are due to closed globe injuries. Public health interventions to reduce the occurrence of ocular trauma and to encourage early presentation after trauma are advocated.

Ophthalmic Injuries in Patients with Maxillofacial Trauma Presenting to a Teaching Hospital in North Central Nigeria.

Background: Ophthalmic injuries in patients with maxillofacial trauma are potential causes of a permanent visual loss. These injuries can easily be missed; hence, there is a need for the ophthalmic evaluation of patients with maxillofacial trauma. The main objective of this study was to determine the prevalence, patterns, etiology, and risk factors of ophthalmic injuries in patients presenting with maxillofacial trauma in a teaching hospital in North Central Nigeria. Materials and Methods: The study was a hospital-based, descriptive, cross-sectional study of 67 patients with maxillofacial trauma recruited over a 6-month study period. Information on the sociodemographic and clinical characteristics of the study participants was obtained. The data were analysed using SPSS version 20 statistical software. Pearson's chi-square test was used to test for statistical significance. Results: Ophthalmic involvement was seen in 77.6% of the study participants, with males and individuals aged 21-30 years being more commonly affected. The leading cause of ophthalmic injuries in patients with maxillofacial trauma was road traffic accident (RTA) (75.5%). Others included assaults and fall from heights. Amongst the RTA cases, 71.4% was due to motorcycle-related accident with 91.9% of the patients with ophthalmic injuries observed not to use helmet/seat belt. The use of alcohol and not wearing protective gears were seen as the risk factors. Simple zygomatic complex fracture was the most common trauma observed (44.2%). Conclusion: Ophthalmologic assessment should be conducted for all patients presenting with maxillofacial trauma. The laws on the use of protective gears such as helmets and seat belts should be enforced.

Isolated Ankyloblepharon Filiforme Adnatum: A Case Report.

Ankyloblepharon filiforme adnatum (AFA) is a rare congenital anomaly consisting of partial or complete adhesion of the upper and lower eyelids, and it can be an isolated finding, or associated with other multisystemic anomalies. Its presence should alert the neonatologist of the need for a detailed systemic evaluation. We present a twenty day old baby who presented to our facility on the 8th of August 2019, with bilateral adhesions of the upper and lower eyelids, and had them excised with the use of McPherson's forceps and Vannas scissors, with no sedation or anesthesia. Timely separation of the lids is important to prevent the onset of stimulus deprivation amblyopia.

Conservative Management of Congenital Unilateral Eyelid Ectropion in a 3-day-old Neonate in Jos North-Central Nigeria.

Background: Congenital ectropion is a rare congenital eyelid eversion with chemosis. It is twice more common in males. We report a case of congenital unilateral eversion of the upper eyelid with severe chemosis that was successfully managed conservatively. Aim: The case is being reported for its rarity, demonstrating effectiveness of conservative management with 3% hypertonic saline. Also to create awareness of the diseases and ease of management amongst health workers. Case Presentation: The patient was a 4 day old female child with a congenital unilateral eversion of the right upper eyelid and severe chemosis following uneventful delivery. Patient was also noticed to be febrile, but no other physical or systemic anomaly. A conservative treatment approach was used which consisted of the application of antibiotics eye drop and ointment and padding of the eye with 3% hypertonic saline soaked gauze. The eyelid reverted spontaneously after 3 days and the condition was completely resolved without complications. Conclusion: Congenital eyelid eversion is a benign condition that excellently responds to conservative treatment. Creating awareness of its existence and treatment approach amongst health workers is essential.

Targeting airway inflammation in cystic fibrosis.

Introduction: The major cause of morbidity and mortality in patients with cystic fibrosis (CF) is lung disease. Inflammation in the CF airways occurs from a young age and contributes significantly to disease progression and shortened life expectancy. Areas covered: In this review, we discuss the key immune cells involved in airway inflammation in CF, the contribution of the intrinsic genetic defect to the CF inflammatory phenotype, and anti-inflammatory strategies designed to overcome what is a critical factor in the pathogenesis of CF lung disease. Review of the literature was carried out using the MEDLINE (from 1975 to 2018), Google Scholar and The Cochrane Library databases. Expert opinion: Therapeutic interventions specifically targeting the defective CF transmembrane conductance regulator (CFTR) protein have changed the clinical landscape and significantly improved the outlook for CF. As survival estimates for people with CF increase, long-term management has become an important focus, with an increased need for therapies targeted at specific elements of inflammation, to complement CFTR modulator therapies.

The Effect of a Reminder Short Message Service on the Uptake of Glaucoma Screening by First-Degree Relatives of Glaucoma Patients: A Randomized Controlled Trial.

PURPOSE: The purpose of this study was to determine the role of a reminder short message service (SMS) on the uptake of glaucoma screening by first-degree relatives (FDRs) of patients with primary open-angle glaucoma (POAG) in North-central Nigeria following a telephone invitation for screening. MATERIALS AND METHODS: A randomized controlled trial was conducted in the eye clinic of a tertiary hospital in Jos, North-central Nigeria. Two hundred FDRs of patients with POAG were invited through phone for free glaucoma screening and randomly allocated into two groups. The intervention group received a reminder SMS, whereas the control group did not receive a reminder. Those who failed to turn up for screening were contacted through phone to determine the reasons for their nonattendance. Chi-square test and bivariate analysis were used to compare attendance rate between the two groups. RESULTS: Sending a reminder SMS following a telephone invitation had no effect on the uptake of glaucoma screening. The response rate was lower in the phone call plus reminder SMS group (43.0% vs. 53.0%) though the difference was not statistically significant (P = 0.157). Competing needs such as work and lack of transport fare were the most common reasons given for not attending the screening. CONCLUSION: A reminder text message is not an effective tool for increasing the uptake of glaucoma screening in at-risk individuals in North-central Nigeria. Existing barriers to health care in the country need to be addressed before mobile phone technology can be effectively used in increasing the utilization of any free eye screening service.

Examining rater and occasion influences in observational assessments obtained from within the clinical environment.

BACKGROUND: When ratings of student performance within the clerkship consist of a variable number of ratings per clinical teacher (rater), an important measurement question arises regarding how to combine such ratings to accurately summarize performance. As previous G studies have not estimated the independent influence of occasion and rater facets in observational ratings within the clinic, this study was designed to provide estimates of these two sources of error. METHOD: During 2 years of an emergency medicine clerkship at a large midwestern university, 592 students were evaluated an average of 15.9 times. Ratings were performed at the end of clinical shifts, and students often received multiple ratings from the same rater. A completely nested G study model (occasion: rater: person) was used to analyze sampled rating data. RESULTS: The variance component (VC) related to occasion was small relative to the VC associated with rater. The D study clearly demonstrates that having a preceptor rate a student on multiple occasions does not substantially enhance the reliability of a clerkship performance summary score. CONCLUSIONS: Although further research is needed, it is clear that case-specific factors do not explain the low correlation between ratings and that having one or two raters repeatedly rate a student on different occasions/cases is unlikely to yield a reliable mean score. This research suggests that it may be more efficient to have a preceptor rate a student just once. However, when multiple ratings from a single preceptor are available for a student, it is recommended that a mean of the preceptor's ratings be used to calculate the student's overall mean performance score.

Prevalence of Trachoma in Jigawa State, Northwestern Nigeria.

PURPOSE: To determine the magnitude of trachoma and the prevalent forms of the disease, and to provide baseline data for the establishment of a trachoma control program in Jigawa State, northwestern Nigeria. METHODS: A population-based cross-sectional survey was conducted in Jigawa State in May 2007 using a 2-stage cluster random sampling technique to select 4598 persons from 40 villages based on probability proportional to size. All participants were examined using a penlight and a 2.5 × binocular loupe for signs of trachoma, and graded using the World Health Organization (WHO) simplified grading system. RESULTS: A total of 4598 people were seen with 99.96% coverage. Of these, 2460 (53.5%) were female and 2138 (46.5%) were male. Mean age was 21.6 years ( ± 19.8 years). The prevalence of follicular trachoma in children aged ≤9 years was 20.5% (95% confidence interval, CI, 18.7-22.4%) with no difference between the sexes. The prevalence of trichiasis in adults aged ≥15 years was 5%, and the prevalence was higher in females than males (odds ratio 2.60, 95% CI 2.06-3.28; p < 0.001). CONCLUSION: Trachoma is a major problem in Jigawa State; there is a need to train trichiasis surgeons and empower them to carry out community-based surgery. District-level prevalence of trachoma needs to be determined to know which aspects of the WHO SAFE strategy (surgery, antibiotics, facial cleanliness and environmental improvements) need to be emphasized in each district.

Developing a culture of collaboration in the operating room: more than effective communication.

The purpose of this literature review was to examine the current state of knowledge on successful collaborative practice in the operating room. Using the determinants of successful collaborative practice, developed by San-Martin-Rodriguez, Beaulieu, D'Amour, & Ferrada-Videla, the current literature on collaboration in the operating room was reviewed in order to identify the gaps in knowledge and identify future research avenues. The review highlighted that communication patterns among operating room team members was the most extensively researched aspect of teamwork. Other aspects, such as the willingness to engage in collaborative practice, trust, respect, societal factors, and cultural factors, were absent from the literature. Future research will need to focus on these gaps in knowledge in order to maximize our limited research resources and improve patient safety.

Historical trends influencing the future of perioperative nursing.

This paper explores the historical trends that have shaped the perioperative nursing specialty. The educational, societal, and political influences are examined through different historical periods. After, initially, being the first recognized nursing specialty operating room nursing was later removed from the nursing education curriculum. A debate as to whether perioperative nursing was simply a technical skill or actually "real" nursing was beginning and it continues to this day. Today, students' lack of exposure to the operating room, unsuccessful preceptorship programs, and poor working conditions are creating major recruitment and retention challenges. Because these historical trends have led to the decline of perioperative nursing, it is crucial for modern nurses to understand the factors that are influencing our practice and to make collective efforts to positively influence the future of our specialty.

Allergic conjunctivitis at sheikh zayed regional eye care center, gambia.

PURPOSE: To assess the prevalence of allergic conjunctivitis in Gambia and to determine its epidemiologic features, seasonal variations and associated ocular and systemic conditions. METHODS: Records of patients clinically diagnosed with allergic conjunctivitis between April 2007 and March 2008 were reviewed. Variables including age, sex, date of presentation, and systemic and ocular findings were recorded. RESULTS: A total of 7,912 patients were visited within the study period, out of which 624 (7.9%) were diagnosed with allergic conjunctivitis. The disease was equally distributed in male and female subjects, with high preponderance in children (54.5%). Most patients (60.7%) presented during the dry season as compared to the rainy season. Refractive error was the most common ocular condition associated with the condition present in 7.4% of patients while the most common systemic association was asthma, reported in 1.4% of cases. CONCLUSION: Allergic conjunctivitis in Gambia is more common in children than in adults and has seasonal variation with more patients presenting during dry seasons. Refractive errors are the most common ocular problem associated with the disease and asthma is a systemic association.