Diagnostic Correlation between General Practitioners and the Ophthalmologist in the Management of Eye Diseases.

OBJECTIVES: To determine the accuracy of diagnosis of ophthalmic disorders as well as the adequacy of referral of patients with ophthalmic disorders for specialist eye care by the general practitioners (GP). MATERIALS AND METHODS: This was a hospital-based descriptive study. Patients selected by systematic random sampling at the General Out-Patient Department (GOPD) of a tertiary hospital were evaluated by the ophthalmologist after they had been independently assessed by the General Practitioners. Diagnoses and referral decisions of the GP were compared with those of the ophthalmologist using Kappa Statistics. RESULTS: A total of 382 patients were studied while 22 GPs participated in the study. Ocular disorders were found by the ophthalmologist in 112 (29.3%) patients while the remaining 270 (70.7%) were normal . Only 36 (32.1%) of those with ocular disorders had a diagnosis of ocular disorders by the General Practitioners. A correct diagnosis was made by the GPs for 18 (16.1%) patients (k=0.102, p =0.001); and the highest diagnostic agreement was obtained for conjunctivitis (k=0.464, P= 0.001). No patient with posterior segment disorder was diagnosed by the GPs. Majority (81%; k = 0.616, p=0.001) of referrals were in agreement with expected referral decision. However, 28 (25.0%) under-referrals and 16 (19.0%) over-referrals were noted. CONCLUSION: About one-third of all the patients assessed had an ocular disorder, but the general practitioners detected these disorders only one-third of the time; a correct diagnosis of ocular disorders was made in only 16.1%, while no posterior segment disease was diagnosed. Wrong referral decisions were made in up to one-third of patients. Regular update courses for general practitioners on ophthalmic evaluation will help address these observed deficiencies.

OBJECTIFS: Déterminer le niveau d'accord entre les médecins généralistes (MG) et l'ophtalmologiste dans le diagnostique et l'orientation des patients atteints de troubles oculaires. MATERIAUX ET METHODES: Il s'agissait d'une étude descriptive en milieu hospitalier. Les patients sélectionnés par échantillonnage aléatoire systématique au service général de consultation externe d'un hôpital tertiaire ont été évalué par l'ophtalmologiste après avoir été évalués de manière indépendante par les médecins généralistes. Les diagnostiques et les décisions d'orientation du médecin généraliste ont été comparés à ceux de l'ophtalmologiste à l'aide de Kappa Statistique. LE RESULTATS: Au total, 382 patients ont été étudiés. 22 MG ont participé. Des troubles oculaires ont été trouvés par un ophtalmologiste chez 112(29,3%) patients tandis que les autres 270(70,7%) étaient normaux. Seulement 36(32,1%) des personnes atteintes de troubles oculaires ont été diagnostiquées par un médecin généraliste. Le diagnostic correct a été posé par le médecin généraliste pour 18(16,1%) patients (K= 0,102, P= 0,001). La concordance diagnostique la plus élevée a été obtenue pour la conjonctivite (K= 0,102, P = 0,001). Aucun patient présentant un trouble du segment postérieur n'a été diagnostiqué par le médecin généraliste. La majorité (81% ; K = 0,616, P= 0,001) des références étaient en accord avec la décision de référence attendu. Cependant, 28 (25,0%) sur-références se sont produites. CONCLUSION: Environ un tiers de tous les patients évalués présentaient des trouble oculaires, mais le médecin généraliste n'a détecté ces troubles qu'un tiers du temps ; un diagnostic correct de troubles oculaires n'a été posé que dans 16,1% des cas, alors qu'aucune maladie du segment postérieur n'a été diagnostiquée. De mauvaises décisions d'orientation avaient été prises chez près d'un tiers des patients, des cours de mise à niveau régulier pour les médecins généralistes sur l'évaluation ophtalmique permettront de combler les lacunes observées. Mots-clés: Médecin Généraliste, Troubles Oculaires, Diagnostic, Référence, Accord.

Prevalence of visual impairment among the destitute in Onitsha, Southern Nigeria.

Background: Visual impairment is a global problem. The World Health Organization (WHO) in 2017 estimated that 36 million people were blind and 217 million people had moderate or severe visual impairment. An untreated or undetected eye problem becomes a threat to the general health of the individual, particularly the health of those that lack the basic needs of life. Most blind people live in low-income countries where increasing poverty perpetuates destitution. Aim: This study aimed at determining the prevalence of visual impairment among the destitute in Onitsha metropolis, which would provide a solid database for designing an effective eye care delivery system for them in the state. Subjects and Methods: This was a cross-sectional study of 168 destitute individuals in Onitsha. The study was carried out between June and July 2011. Destitute clusters were randomly selected, and all of the eligible participants were interviewed. Presenting visual acuity (VA) at 6 m, refraction, and anterior and posterior segment evaluation were done. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 16. Results: One hundred sixty-eight destitute individuals-consisting of 93 males (55.4%) and 75 females (44.6%)-were studied, and the age range was 11-78 years with a median age of 45 years. One hundred twenty-nine participants (76.8%) did not have any formal education, all were unemployed, and none had any personal assets or property. Fifty-six participants (33.3%) had ocular disorder. The prevalence of blindness was 12.5% and that of visual impairment was 10.2%. The causes of blindness were glaucoma (6, 28.6%), cataract (5, 23.8%), corneal acuity (5, 23.8%), and empty socket from tumor nucleation and trauma (2, 9.5%). Conclusion: Ocular findings in all eyes of the destitute are similar to that in the eyes of normal individuals. Destitution is an offshoot of health, social, and economic frustration, and therefore requires a comprehensive approach.

Pterygium in Onitsha, Nigeria.

OBJECTIVE: To determine the pattern and risk factors of pterygium in adults at the Guinness Eye Centre Onitsha, Nigeria. MATERIALS AND METHODS: Consecutive adults aged ≥30 years with pterygium were studied. Each patient had comprehensive ocular examination including visual acuity, anterior segment, and adnexal assessment and fundoscopy. The pterygium was graded in terms of severity and type. RESULTS: A total of 156 patients with pterygium participated; 92 (59%) females versus 64 (41%) males (F:M =3:2). The age range was 30-65 years; mean: 43.9 ± 8.4 years. The majority of the study population (36.5%) was of the age group 40-49 years. The subjects were predominately traders 78 (50%) and 93 (59.6%) of the pterygium patients were outdoor workers. Bivariate analysis indicated that those involved in outdoor work were six times at greater risk of developing pterygium than indoor workers (P = 0.001; OR = 6.2). Out of the 156 pterygium patients seen, 107 (68.6%) of them complained of associated symptoms. Redness of the eye was the commonest symptom reported by 79 (50.9%) cases while 8 (5.1%) cases complained of burning sensation. There was a preponderance of nasal pterygia with temporal pterygia being the least. Blinding pterygium was seen in three eyes (1.3%). CONCLUSION: Pterygium is a common disorder presenting at eye clinics. Outdoor workers are at a greater risk of developing pterygium. Thus, health education is of great importance.

Self-reported confidence with ocular examination and management of eye diseases by general medical practitioners.

AIMS: The aim of the study is to determine the confidence of general practitioners (GPs) with ophthalmic exam and management of eye diseases. MATERIALS AND METHODS: Using self-administered questionnaire, information on sociodemographics, medical practice experience, confidence with eye exam, and management of eye diseases was obtained from GP at the General Outpatient Department. Responses on level of confidence were ranked with Likert scale and analyzed with the Statistical Package for Social Science, version 23. RESULTS: Twenty-two GPs with mean medical practice experience of 17.4 ± 8.5 years participated. Twelve (54.5%) GPs routinely examined patients' eyes. Pen torch assessment of ocular surface was most commonly performed eye exam, 1 (4.6%) did visual acuity, while none performed ophthalmoscopy. Seventeen (77.3%) GPs rated themselves average or higher in interpreting pen torch examination of ocular surface. Expressed diagnostic confidence was highest for pterygium, 19 (86.4%), and low for interpreting visual acuity, 8 (36.4%); 13 (59.1%) were confident with diagnosing cataract. While all GPs (100.0%) were not confident with diagnosing and managing posterior segment diseases, 19 (86.4%) felt that they could confidently manage allergic and bacterial conjunctivitis, respectively. Seventeen (77.3%) GPs thought their undergraduate exposure in ophthalmology was inadequate and 21 (95.5%) felt that update courses in ophthalmology were necessary. CONCLUSIONS: Half of the GPs performed eye examination. Self-reported confidence in ophthalmoscopy, diagnosis, and management of posterior segment diseases was low among GPs. Diagnostic confidence was highest for pterygium. Continuing ophthalmic education and provision of basic ophthalmic equipment are recommended to improve confidence of GP in management of ocular disorders.

KOOS pain as a marker for significant knee pain two and six years after primary ACL reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) prospective longitudinal cohort study.

OBJECTIVE: The prevalence of radiographic osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR) approaches 50%, yet the prevalence of significant knee pain is unknown. We applied three different models of Knee injury and Osteoarthritis Outcome Score (KOOS) thresholds for significant knee pain to an ACLR cohort to identify prevalence and risk factors. DESIGN: Multicenter Orthopaedic Outcomes Network (MOON) prospective cohort patients with a unilateral primary ACLR and normal contralateral knee were assessed at 2 and 6 years. Independent variables included patient demographics, validated Patient Reported Outcomes (PRO; Marx activity score, KOOS), and surgical characteristics. Models included: (1) KOOS criteria for a painful knee = quality of life subscale <87.5 and ≥2 of: KOOSpain <86.1, KOOSsymptoms <85.7, KOOSADL <86.8, or KOOSsports/rec <85.0; (2) KOOSpain subscale score ≤72 (≥2 standard deviations below population mean); (3) 10-point KOOSpain drop from 2 to 6 years. Proportional odds models (alpha ≤ 0.05) were used. RESULTS: 1761 patients of median age 23 years, median body mass index (BMI) 24.8 kg/m(2) and 56% male met inclusion, with 87% (1530/1761) and 86% (1506/1761) follow-up at 2 and 6 years, respectively. At 6 years, n = 592 (39%), n = 131 (9%) and n = 169 (12%) met criteria for models #1 through #3, respectively. The most consistent and strongest independent risk factor at both time-points was subsequent ipsilateral knee surgery. Low 2-year Marx activity score increased the odds of a painful knee at 6 years. CONCLUSIONS: Significant knee pain is prevalent after ACLR; with those who undergo subsequent ipsilateral surgery at greatest risk. The relationship between pain and structural OA warrants further study.

The anterior chamber angle width in adults in a tertiary eye hospital in Nigeria.

OBJECTIVE: The objective was to determine the anterior chamber angle width in adult Nigerian patients seen at the Guinness Eye Center Onitsha Nigeria. MATERIALS AND METHODS: Consecutive new adult patients (aged ≥21 years) seen between March and July 2006 were the subjects of this study. Exclusion criteria included refusal to consent to the test, previous intraocular surgery that could distort the angle integrity and anterior segment pathology precluding the visualization of the angle. Each patient had visual acuity assessment, visual field analysis, ophthalmoscopy, intraocular pressure measurement, refraction, and gonioscopy. The angle grading was by the Shaffer method. RESULTS: Of the 328 patients (648 eyes), aged 21-85 years (median age 59 years), 195 (59.5%) were females and patients older than 50 years constituted 64.9%. Gonioscopy showed that 245 eyes (37.8%) had wide open angles (grades III and IV); 227 (35.0%) had grade II angles; 176 (27.2%) had narrow angles (grade I or slit), 9 of which were deemed occludable. Of the 80 patients with chronic simple glaucoma, 20 (25%) had at least grade III angle; 34 (42.5%) had grade II angle; and 26 (32.5%) had grade I angle. Peripheral anterior synechiae were observed in three eyes. Compared with nonglaucomatous eyes, the angles of the glaucomatous eyes were significantly narrower (P <0.01). Similarly patients older than 50 years were more likely to have narrower angles (P < 0.001). However there was no significant difference between the angle width of male compared to female patients (P >0.05). CONCLUSIONS: A little more than a third of adult patients seen in our hospital have wide open angles; a third of the glaucoma patients usually taken as open angle cases actually have very narrow angles some of which are occludable. A population-based study is therefore recommended to clearly define the epidemiologic characteristics of glaucoma including the anterior chamber width in different parts of Nigeria.

Age-related macular degeneration in Onitsha, Nigeria.

OBJECTIVES: To determine the incidence, pattern and ocular morbidity associated with age-related macular degeneration (AMD) at the Guinness Eye Center Onitsha Nigeria. MATERIALS AND METHODS: The case files of all new patients aged 50 years and above seen between January 1997 and December 2004 were reviewed. The files of patients with AMD were further studied. Information on age, gender, occupation, duration of symptoms, type of maculopathy, visual acuity, ocular and systemic co-morbidities were abstracted into a standard proforma and analyzed using the chi-square test, student t-test and confidence interval estimation. RESULTS: Two hundred and fifty-six of 7966 (3.2%) new patients had AMD; M:F = 2:3; 60 -79 year age group constitute 70% of the cases. Non-neovascular AMD occurred in 210 (82%) patients with 182 (71.1%) having early AMD and 28 (10.9%) geographic atrophy. Neovascular AMD occurred in 46 (18%) patients. AMD was bilateral in 221 (86.3%) patients. Most patients presented late. Systemic co-morbidities were hypertension and diabetes; the main ocular co-morbidities were cataract and glaucoma. Thirty-four (13.3%) patients were bilaterally blind and 130 (50.8%) had bilateral visual impairment. Of the blind patients 13(38.3%) had neovascular AMD and 6 (17.7%) had geographic atrophy. This makes AMD the cause of blindness in 7.4% of the patients. An affected eye was more likely to have low vision than an unaffected eye (95%CI: 0.07, 0.21; P<0.05); persons aged 70 years and above were more likely to be blind (χ2 - 7.26, df -1; P<0.05); females were also more likely to be blind than males (t - 2.857, df - 8; P<0.05) and neovascular AMD significantly causes more blindness than the non-neovascular type (95% CI: 0.11, 0.37; P<0.05). CONCLUSIONS: AMD was the main cause of blindness in 7.4% of the patients. Treatment facilities including low vision aids for AMD patients should be provided in eye hospitals in Nigeria. Health education of the public highlighting the risk factors for AMD should be mounted as part of Vision 2020 programme in Nigeria. A community based study is required to fully define the epidemiologic characteristics of AMD in Nigerians.

A histopathological study of carcinoma of the prostate in Port Harcourt, Nigeria.

OBJECTIVES: To determine the incidence of prostate cancer in Port Harcourt and the surrounding towns whose residents patronize the University of Port Harcourt Teaching Hospital for tertiary health care, histologically characterize the patterns of these cancers, and grade them according to the Gleason scheme. MATERIALS AND METHODS: Blocks and slides of prostate specimens received at the Department of Anatomical Pathology, University of Port Harcourt Teaching Hospital between January 1997 and December 2006 were retrospectively selected for this study. The slides were studied using a binocular Olympus light microscope. Patients' age at presentation, presenting symptoms, and clinical diagnosis were sorted out from the request cards and the department's archival register. RESULTS: Carcinoma was diagnosed in 198 specimens (37.4%) of the 529 cases reviewed. Of these, 164 (82.8%) were clinical carcinoma (having been found in clinically suspected carcinoma cases for which trucut biopsies were undertaken), while 34 (17.2%) were incidental carcinoma cases (being found in prostatectomy biopsy cases of patients clinically diagnosed with nodular hyperplasia). All of the clinical carcinomas were adenocarcinomas predominantly moderately differentiated and of large acinar pattern. Also, all of the incidental carcinomas were adenocarcinomas predominantly well differentiated and of large acinar pattern. The Gleason scores (GSs) were varied but predominantly of high values, particularly with clinical carcinoma cases. The age range was 42 to 90 years and the mean was 70 years with a peak of 70 to 79 years. CONCLUSION: The incidence of prostate cancer in Port Harcourt is high relative to other Nigerian centers where similar studies have been carried out and compares well with the high incidence found among African American men. Histologically, all cases are acinar adenocarcinomas. Most patients present late with high GS carcinoma and therefore have poor prognosis. There is a need for enlightenment of the male populace on the high incidence of this deadly disease as well as for screening to reduce the number of patients presenting late and therefore improve prognosis.

Incidence and risk factors for traditional eye medicine use among patients at a tertiary eye hospital in Nigeria.

OBJECTIVE: To determine the incidence and risk factors for traditional eye medicine use among patients at the Guinness Eye Center Onitsha, Nigeria. MATERIALS AND METHODS: Consecutive new adult ophthalmic patients seen at the Guinness Eye Center Onitsha between January and April 2007 were interviewed on the use of traditional eye medicines and the type of traditional eye medicine used. RESULTS: Of the 500 patients interviewed, 66 (13.2%) had used traditional eye medicines (TEM). The 66 patients, aged 18-84, were made up of 32 males and 34 females. The commonly used TEM were liquid from plant leaves and roots and other concoctions of unknown origin. Conjunctivitis and cataract constituted 54.5% of the ocular problems; 15(22.7%) patients had visual impairment while 5(7.6%) other patients were blind. Risk factors for TEM use include age above 50 years (P<0.001); residence outside Onitsha metropolis (P<0.001) or ≥ 25 kilometres away from our hospital (P<0.02) and lack of any formal education (P<0.02). Decision to use TEM was not affected bygender (P>0.05); chronic nature (P>0.05) or painfulness of the ocular disease (P>0.05). CONCLUSIONS: Traditional eye medicine is highly patronized by the people. Health education programmes with emphasis on safe eye care practices need be intensified in traditional healers and among the groups at risk.

Retrobulbar versus subconjunctival anesthesia for cataract surgery.

OBJECTIVES: To compare the effectiveness, in terms of pain relief and akinesia of retrobulbar and subconjunctival an aesthesia during cataract surgery and also to compare the degree of postoperative ptosis associated with each technique. MATERIALS AND METHODS: Consecutive adult patients undergoing cataract surgery between March and June 2008 at the Guinness Eye Center Onitsha, were randomized into retrobulbar and subconjunctival an aesthesia by simple random sampling. Patients' subjective perception of pain was graded into none, mild, moderate and severe; eyeball movement during surgery was graded into none, slight, moderate excessive. Two weeks after surgery, the palpebral fissure width was measured with the metre rule to determine the degree of post-operative ptosis. RESULTS: Of the 90 patients studied, 55 (61.1%) patients had subconjunctival an anesthesia while 35(38.9%) had retrobulbar injection. In the retrobulbar injection group 25 (71.4%) patients had none or mild pains compared to 44 (80.0%) in the subconjunctival injection group; while 10 (28.6%) patients in the retrobulbar group experienced moderate to severe pains, 11 (20%) patients in the subconjunctival group had moderate pains and none experienced severe pains. But the difference in the degree of pain perception between the 2 groups is not statistically significant (χ2 = 0.01; df - 1; P>0.05 ). In the retrobulbar injection group, there was none or slight movement of the globe in 30 (85.7%) patients compared to 49 (89.1%) patients in the subconjunctival group. While 5 (14.3%) patients in the retrobulbar injection group had moderate globe movement, no patient in this group had excessive movement. In the subconjunctival injection group, 5 (9.1%) patients had moderate movement and 1 (1.8%) patient had excessive eyeball movement. The difference in the movement of the eyeball between the retrobulbar and the subconjunctival injections group was not significant (χ2 = 0.004; df - 1; P>0.05 ). In the retrobulbar injection group, the palpebral fissure width was within ≥ 10mm in 18 (51.0%) patients compared with 29 (53.0%) patients in the subconjunctival group. This difference was not statistically significant (χ2 = 0.0006; df - 1; P>0.05 ). CONCLUSIONS: Both retrobulbar and subconjunctival an aesthetic techniques are effective and safe for cataract surgery although the pain experience may be slightly more for patients being operated upon under retrobulbar anaesthesia.

Intraocular pressure, retrobulbar anaesthesia and digital ocular massage.

OBJECTIVES: To determine the degree of intraocular pressure (IOP) rise following retrobulbar anaesthetic injection as well as the optimal time required for the return of the IOP to the pre-injection level following ocular massage. MATERIALS AND METHODS: Using the Perkins hand-held tonometer, the IOP of consecutive adult patients were measured in the operating room before local anaesthetic (3 ml of 2% xylocaine with or without adrenaline) injection; immediately after injection and every minute following ocular massage for the next 5 minutes. RESULTS: Twenty-three eyes of 17 patients, aged 23-71 years, were studied. The mean (+/- SD) baseline (preinjection) IOP was 16.6 (+/- 6.8) mmHg. Immediately after the injection the IOP rose by 11.8-80% with a mean of 37.3 +/- 16.8% (95% CI: 30.4-44.2). By 3 minutes the IOP had returned to the pre-injection level. After 3 minutes the IOP had become lower than the pre-injection level (p < 0.05) CONCLUSIONS: IOP rise following retrobulbar injection of 3 ml of local anesthetic varies from 11.8-80%. Digital ocular massage lowers the IOP to pre-injection level in 60.2% in 3 minutes; in 5 minutes it lowers the IOP to preinjection level in all eyes and to below pre-injection level 86%.

Histopathologic characterisation of prostate diseases in Port Harcourt.

OBJECTIVE: To carry out histopathologic analysis of diseases of the prostate gland reported at the department of Anatomical Pathology of the University of Port Harcourt Teaching Hospital between January 1996 and December 2005. PATIENTS AND METHODS: This is a retrospective histologic analysis of prostate samples seen at the University of Port Harcourt Teaching Hospital. Where necessary, new slides were prepared from blocks of the samples. The request cards of the patients were also retrieved and scrutinized for age, presenting symptoms and clinical diagnosis. RESULTS: Prostate biopsies constituted 8.8% of all surgical specimens and 30.9% of all male specimens received during this study period. Only 529 (7.6%) of all prostate specimens where included for the review because the slides or blocks of the rest could not be traced. Of the 529 specimens reviewed, 301 (56.9%) were needle biopsies while 228 (43.1%) were prostatectomies. Three hundred and thirty one (62.6%) of the cases were nodular hyperplasia and 198 (37.4%) were invasive adenocarcinomas, thirty-four (17.2%) of the invasive adenocarcinomas were incidental carcinomas. There was prostatic intraepithelial neoplasia (PIN) in 79 (14.9%) cases. Prostatitis was found in 223 cases (42.2%) of the entire specimen studied. All cases of prostatitis occurred in association with nodular hyperplasia, invasive carcinoma or prostatic intraepithelial neoplasia (PIN). CONCLUSION: The burden of prostate diseases among adult males in Port Harcourt is high and malignant neoplastic diseases in the form of clinical and incidental carcinomas as well as premalignant diseases in the form of prostatic intraepithelial neoplasia (PIN) were quite common.

The Gustilo-Anderson classification system as predictor of nonunion and infection in open tibia fractures.

PURPOSE: We sought to conduct the largest retrospective study to date of open tibia fractures and describe the incidence of complications and evaluate the potential predictive risk factors for complications. METHODS: Patients with open tibia fractures treated with reamed intramedullary nail (IMN) across a 10-year period were evaluated. Patient charts were reviewed for demographics, type of open fracture (T), comorbidities, and postoperative complications. A multivariate model was conducted to determine the risk factors for each type of complication. RESULTS: Of the 486 patients with open tibia fractures, 13 % (n = 64) had infections, 12 % (n = 56) had nonunions, and 1 % (n = 7) had amputations. TIII fractures had much higher rates of each complication than TI and TII fractures. Fracture type was the only significant risk factor for both nonunion and infection. CONCLUSION: Our study found that the Gustilo grade of open tibia fracture is by far the greatest predictor of nonunion and infection.

Medical students perception of undergraduate ophthalmology training in Nnamdi Azikiwe University Nnewi Campus.

AIM: To determine the perception and aspiration of medical students towards ophthalmology. METHOD: Information for the study was obtained through forced-choice questionnaire set to 102 medical students in 2000/2001 graduating class in Nnamdi Azikiwe University. RESULTS: One hundred questionnaires were completed. As a specialty of choice ophthalmology ranked fourth {16.0%} as a first choice; second {21.0%} as a second choice and first {26.0%} as a third choice. Ninety-five of respondents found ophthalmology training useful. CONCLUSION: This cohort of medical students considered ophthalmic training in this institution essential and adequate. Undergraduate ophthalmic course should ensure an understanding of the basic principles of ophthalmology and should be designed to motivate the interest and confidence of the medical students in the specialty. Training period should be at least 4 weeks. With appropriate training ophthalmology can attract reasonable interest as a choice for specification.

Histopathological characteristics of female breast carcinomas seen at the University of Port Harcourt Teaching Hospital, Port Harcourt Nigeria.

BACKGROUND: Breast carcinoma is an unpredictable disease in the sense that some patients may present with relatively early disease and die of widespread metastases within six months to one year, while others present with fairy advanced disease and yet survive longer. The aim of this study was to characterize breast carcinomas into prognostic groups using histological features. METHODOLOGY: A total of 269 breast carcinomas in females received during a five-year period (January 1991 to December 1995 inclusive) were analyzed. Archive records (request forms and microscopic slides) of all breast malignancies diagnosed in the department of Anatomical Pathology of University of Port Harcourt Teaching Hospital were retrieved and evaluated with respect to histological type, histological grades, and mononuclear cell infiltration within the primary tumour. The modified Bloom-Richardson system of microscopic grading of breast carcinoma was used. RESULTS: The majority of carcinomas showed scanty or absent tubule formation (43.1%) and 59% of cases showed numerous mitotic figures. Forty-nine percent of carcinomas show poorly differentiated or anaplastic nuclei. The final tumour grade (FG) which is the summation of tubular pattern, nuclear pleomorphism and mitotic grades of each of the tumours reveals that 53% fall in FG3, 26% in FG2while only 21% fall in FG1. The majority of the breast carcinomas in this study, 58%, show scanty or absent mononuclear infiltration. CONCLUSION: The majority of breast carcinomas in this study are poorly differentiated invasive ductal carcinoma, "not otherwise specified" which exhibit high proliferation ratio and are associated with poor host cellular immune reaction. These attributes translate to poor prognosis.

Knowledge, attitude, and practice of female health professionals regarding cervical cancer and Pap smear.

BACKGROUND: The objectives of this paper was to determine what female health professionals knew and felt about cervical cancer and Pap smear and their uptake of Pap smear. METHODS: A questionnaire survey of 144 female health professionals at two referral hospitals with facilities for Pap smear. RESULTS: Nurses constituted 52.8% of respondents followed by laboratory scientists (18.8%), doctors (14.6%) and pharmacists (13.9%). One hundred and thirty two (91.7%) respondents had heard of cervical cancer and 80.6% knew it was associated with vaginal bleeding. Twenty two percent could not list any risk factor A significantly greater proportion of doctors (100%) knew the purpose of a Pap smear compared to 59.2% of nurses, 50% of pharmacisits and 48.1% of laboratory scientists (p = 0.003). Only 13 respondents (9%) had everhad a Pap smear with doctors (p = 0.003) and divorced/separated women (p = 0.005) significantly more likely to have done so. Perceived non-availability of Pap smearservice was the main reason (51.3%) for not having had a Pap smear. However, 30.3% had not thought of it or did not consider themselves at risk of cervical cancer. CONCLUSION: Health professionals themselves need to be properly informed about cervical cancer and Pap smears because of their own needs as women and also to improve their effectiveness in educating and encouraging other women to have Pap smears. Available Pap smear services should be publicized and made more affordable.

Soft tissue sarcomas in the Niger Delta Region of Nigeria (a referral hospital's study).

BACKGROUND: Soft tissue sarcomas are rare tumours in this environment. Recently, an upsurge in frequency was noticed that called for attention. The aim of this study is to study soft tissue sarcomas based on age, sex of patients, tumour sites and histologic types. METHODOLOGY: A 14 year retrospective study in University of Port Harcourt Teaching Hospital (UPTH) Port Harcourt. Histological slides previously processed and stained with hematoxylin and eosin stains (H & E) were reviewed and re-evaluated. Special stains were also used for proper diagnosis of some tumours. The tumours were classified based on World Health Organization (WHO) classification of soft tissue tumours. RESULTS: Only 66 soft tissue sarcomas were used for this study which accounted for 2.8% of the total malignancies diagnosed during the period under review. The youngest was a 3 year old girl while the eldest was a 76 year old female. A total of 38 and 28 tumours were diagnosed in males and females respectively, giving a sex ratio of 1.4:1. Rhabdomyosarcoma was most frequent (39.4%) while the least was leiomyosarcoma (1.5%). These tumours are more frequent in the under 20 years (22.7%) and least in 70 years and above (7.6%). The lower limb was most affected (36.4%) while the least was the retroperitoneum (6.1%). The commonest predilection sites vary with different classes of these group malignancies. CONCLUSION: Soft tissue malignancies are globally uncommon but they constituted an integral part of malignant tumours causing serious morbidity and mortality in this environment. The recent upsurge noticed necessitated the need for regional studies in Nigeria in order to come up with a national epidemiologic data of these malignancies.

Destructive ophthalmic surgical procedures in Onitsha, Nigeria.

OBJECTIVES: to determine the incidence, trend and causes for surgical removal of the eyeball at the Guinness Eye Center Onitsha, Nigeria. PATIENTS AND METHODS: Case files and theatre records of all patients who had eviscreration, enucleation or exenteration at the Guinness Eye Center Onitsha between 1995 and 2001 were reviewed. Information on age, sex, disease duration before hospital presentation, indication for surgery and the type of surgery were analysed. RESULTS: 56 eyes of 56 patients were surgically removed. Patients including some with penetrating eye injuries presented late for treatment; 37.5% and 53.5% had used traditional eye medicines (TEM) and eye drops possibly containing steroids, respectively, prior to hospital consultation. The indications for surgery were severe ocular infections, especially panophthalmitis; severe penetrating eye injuries and orbito-ocular tumours. The annual incidence ranged from 1.9 - 4.2% with an average of 3.4% . The downward trend observed in the later part of the study was associated with reduced incidence of ocular gunshot injuries, which in turn coincided with a reduction in violent crime in Onitsha and its environs. CONCLUSIONS: In spite of the observed downward trend in the rate of destructive eye surgery, the incidence of such procedures could be reduced further by timely intervention with modern microsurgical techniques; intraocular antibiotics and radiotherapy. The public should be educated on the harmful effects of TEM and abuse of eye drops. Those with eye problems should seek early hospital treatment.

Pattern of cerebral malaria in children at the Lagos University Teaching Hospital.

UNLABELLED: Cerebral malaria is one of the most lethal forms of malaria. Given that malaria is a constantly evolving disease, it is therefore necessary to document patterns of presentation even in the same centre over a period of time. OBJECTIVE: To document the prevalence and pattern of cerebral malaria in children. DESIGN: Cross-sectional descriptive study of children with cerebral malaria attending the emergency room of the Lagos University Teaching Hospital. Age, sex, month at which diagnosis was made, associated clinical features, condition at discharge and mortality were assessed. RESULTS: Cerebral malaria was documented in 107/3309 (3.2%) children. There was an equal male:female ratio. Cerebral malaria occurred most frequently between July and September and in children between 2 and 2.9 years. A total of 79/107 (73.8) recovered fully at discharge, 9/107 (8.4%) recovered with some neurological sequelae while 19/107 (17.8%) died. Coma score on admission was significantly lower among those who died compared with those who survived (p = 0.001). Clinical signs observed in these children were seizures-88/107 (82.2%), pallor-75/107 (70.1%), jaundice-55/107 (51.4%) and hepato-splenomegaly-18 (16.8%). However, decerebrate posturing was the only clinical sign associated with a fatal outcome OR, 11.47 (p = 0.009). CONCLUSION: This study shows that cerebral malaria still remains a problem of the under fives with unacceptably high mortality. The clinical significance of decerebrate posture as an indicator of mortality would require further evaluation.

Prevalence and pattern of retinal diseases at the Guinness Eye Hospital, Onitsha, Nigeria.

OBJECTIVES: To determine the prevalence and pattern of retinal diseases at the Guinness Eye Hospital, Onitsha, Nigeria. MATERIALS AND METHODS: This was a prospective study. All new patients seen by the author at the outpatients clinic of the Guinness Eye Hospital, Onitsha, Nigeria were examined for evidence of retinal diseases, using the Snellen chart, tonometry, indirect ophthalmoscopy after full mydriasis, slit-lamp examination with a 78D non-contact fundus lens, fundus contact lens examination, and slit-lamp examination of the anterior segment. Ancillary tests performed, as applicable, included Mantoux, skin-snip, hemoglobin genotype, urinalysis, fasting blood sugar, oral glucose tolerance test, full blood count, platelet count, ESR, VDRL, and HIV tests. RESULTS: 8.1% of the patients had retinal diseases. The leading retinal diseases were age-related macular degeneration (ARMD), diabetic retinopathy, retinal vein occlusion, retinal tears/detachment, retinitis pigmentosa and retinochoroiditis with epiretinal membrane. ARMD, diabetic retinopathy, and retinitis pigmentosa often caused bilateral lesions. Bilateral blindness was present in 14% and bilateral visual impairment in 16%, with macular degeneration, retinitis pigmentosa and retinal vascular diseases as major causes. CONCLUSIONS: Retinal diseases may be a significant cause of blindness and visual impairment in this part of Nigeria. Since most of the diseases are treatable with laser and vitrectomy techniques, it is recommended that these facilities be provided in all major eye hospitals in the area.