Striving for excellence in subspecialty medical training in Nigeria: The 6th theophilus oladapo ogunlesi lecture.

The solid foundation laid by Prof Theophilus Oladapo Ogunlesi and other founding fathers of the National Postgraduate Medical College of Nigeria (NPMCN) has consistently achieved its mandate of producing specialist medical practitioners in Nigeria. The ever-changing world requires that we have in Nigeria a critical mass of subspecialists to tackle the various old and emerging ailments that afflict the citizenry. Subspecialist training is popular among Nigerian specialists. While those who are not yet subspecialists crave for the training. Nigerian-born sub-specialists in the diaspora are willing to assist in the training. It is now left to policy makers and captains of the training institutions to seize the chance and move us forward with a view to improving the current embarrassingly low number of subspecialists in Nigeria. The NPMCN is hereby beckoned to take the lead. In doing so, it should combine excellence with relevance.

Outcome of surgery for Rhegmatogenous Retinal Detachment In a Nigerian eye hospital.

AIMS AND OBJECTIVES: To determine the treatment outcome of rhegmatogenous retinal detachment at the Guinness Eye Centre Onitsha, Nigeria. MATERIALS AND METHODS: Case files of patients who had surgery for rhegmatogenous retinal detachment at the Guinness Eye Center Onitsha between June 1997 and May 2012 were reviewed. Information obtained included age, sex, presenting and post-operative visual acuity, anatomical reattachment, post- operative complications and causes of treatment failure. RESULTS: Fifty four patients, 33 males and 21 females, age range: 48-79 years, median-56 years, had surgery. Three patients had giant retinal tears; 10 patients also had proliferative vitreo-retinopathy(PVR). Symptoms duration was 7 days to 18 months; median-7 months; the post-surgery follow-up was 9 months to 6 years; median -2 years.While 47(87%) patients had pre-operative visual acuity<3/60 in the affected eye, post-operatively 48(88.9%) patients achieved acuity e" 3/60, with 14(25.9%) attaining uncorrected visual acuity of 6/9 - 6/18. The retina remained attached 6 months after surgery in 45(83.3%) patients.The post- operative complications included re-detachment, 12(22.2%) patients, cataract, 5(9.3%), exposed explant, 2(3.7%), suture granuloma, diplopia and retinal haemorrhage, 1(1.9%) patient each.The surgical failure in the 12 patients were were due to PVR (9 patients) and missed retinal holes (3 patients). CONCLUSIONS: Despite poor infrastructure and late presentation by patients, the anatomical and visual results of surgical treatment of rhegmatogenous retinal detachment using cryo-retinopexy and scleral buckling technique are encouraging. Better results would be expected if patients presented early and facilities for vitrectomy provided for tackling complex detachments.

Conjunctival Fungal Flora in a Tertiary Eye Hospital in Nigeria.

Objectives: The aim of this study is to determine the hospital incidence and pattern of conjunctival fungal flora in adult patients at the Guinness Eye Center Onitsha, Nigeria. Materials and Methods: New adult patients, without anterior segment disease, were randomly recruited. Using a sterile swab stick, specimen was taken from the inferior conjunctival fornix of each participant's right eye and inoculated into Sabouraud dextrose agar slant in a test tube and incubated at 27°C. The specimens were examined for fungal growth every 48 h for 4 weeks. Specimens with fungal growth were further examined under a high power microscope for fungal identification and characterization. Results: A total of 225 patients (105 males, 120 females) were examined. The age range was 18-75 years; mean age was 41 ± 17.1 years; 62 (27.6%) were culture-positive: 25 (40.3%) were males and 37 (59.7%) were females (P >0.05). Both moulds and yeasts were isolated with moulds constituting 44 (74.2%). Aspergillus [26 (41.9%)] and Candida [16 (25.8%)] were the commonest organisms. Participants >60 years had the greatest burden. Pensioners (61.5%), traders (44.0%), farmers (30.1%), and artisans (27.3%) were occupational groups with significantly higher proportions of culture-positive specimens (P < 0.05). Conclusion: Over a quarter of new adult patients without anterior segment disease harbour fungi, some of which are pathogenic, in their conjunctival fungal organisms. While Aspergillus and Candida were the commonest isolates, older participants, pensioners, traders, farmers, and artisans had significantly higher proportion of culture-positive specimens. These findings should be considered when formulating pre-operative guidelines for ocular surgery in our environment.

Bilateral Self-enucleation of the Eyes: Case Report and Literature Review.

Self-removal of the eyeball is an extreme form of self-harm, which is rare especially in a society ill-disposed to self-maiming. We report the case of a 75-year old man who plucked out his own two eyes in obedience to a voice urging him to do so. According to his wife, the patient had been exhibiting symptoms suggestive of a psychiatric disorder just before the incident. But this was overlooked. This case report draws attention to the devastating ophthalmic consequences of neglected psychiatric disorders in the elderly. We recommend greater attention to the mental health of the elderly. Prevention and management of auto-enucleation requires a collaboration between psychiatrists and ophthalmologists.

Eye Health-seeking Behaviour of Traders in Rural Nigeria.

Aim: The aim of this article was to determine the healthcare provider first sought, reasons for the choice, and symptom duration before hospital presentation among traders in rural Nigeria. Materials and Methods: This was a cross-sectional study of traders at a rural Nigerian market, selected by systematic random sampling. A structured questionnaire was used to obtain information on sociodemographics, eye disease symptoms, eye care provider first sought, and reasons for choice. The analysis was carried out with Statistical Package for Social Sciences using descriptive and inferential statistics with an alpha level at 0.05. Results: Of the 177 traders, 88 (49.7%) were males and 89 (50.3%) were females. The mean age was 46.5 ± 13.75 years (range 19-72). Of the 83 traders who had ocular symptoms 23 (27.7%) never sought any care. The eye care providers first sought were patent medicine vendors 22 (26.5%), orthodox hospital 17 (20.5%), eye glass vendors 3 (3.6%), and traditional healers 3 (3.6%). The median symptom duration before presentation to an eye health facility was 83 days. Reasons for not seeking orthodox eye care first included cost 33 (39.8%), 'ailment not serious' 22 (26.5%), and advice from friends 7 (8.4%). Females were more likely to seek orthodox care (χ2=4.22, P=0.04), whereas males were more likely to feel that their ailment was not serious. Traders aged >50 years were less likely to seek any care for eye ailment (χ2 =8.41, P=0.04). Conclusion: Traders with eye disorders seek care late and most first seek care outside the orthodox hospital. Cost and feeling that ailment was not serious are barriers to seeking orthodox eye care. Eye health education and cost reduction would improve uptake of orthodox eye care services.

Pattern of eye diseases in adults at the general outpatient clinic of a Tertiary Hospital in Nigeria.

Objective: To determine the pattern of eye diseases at the general outpatient department (GOPD) of a Nigerian tertiary hospital. Materials and Methods: Patients selected by systematic random sampling at the GOPD of a Nigerian tertiary hospital were studied. Information on sociodemographics and ocular complaints were obtained using interviewer-administered questionnaire. Ocular examination included visual acuity measurement and anterior and posterior segments examinations. Data analysis was with Statistical Package for the Social Sciences. Results: Three hundred and eighty-two patients, comprising 124 (32.5%) males and 258 (67.5%) females, aged between 18 and 86 years, mean 44.8 ± 15.4 years, were studied; 112 (29.3%) had eye diseases but only 88 (78.6%) patients complained of ocular disorder(s). Common complaints were poor vision 53 (60.4%), red eye and grittiness 15 (17.0%) each. Common eye diseases were lens 52 (13.6%) and conjunctiva 46 (12.0%) disorders. Attaining higher education was protective against eye diseases (P < 0.05). Conclusion: Nearly a third of patients at the GOPD have eye diseases. Therefore, primary eye care should be integrated into the GOPD service with provision of relevant manpower and facilities for care of the ophthalmic patients.

Résumé Objectif: Pour déterminer le schéma des maladies oculaires au service général de consultation externe d'un hôpital tertiaire nigérian. Matériels et Méthodes: Des malades sélectionnés par échantillonnages aléatoires systématiques au service ambulatoire général, d'un hôpital tertiaire au nigérian on été étudies. Les informations sur les données sociodémographiques et les plaintes oculaires ont été obtenues à l'aide d'un questionnaire lors d un interview. L'examen oculaire comprenait la mesure de l'acuité visuelle et de l'examen des segments antérieur et postérieur. L'analyse données a été effectuée par le progiciel des sciences sociales. Résultats: Trois cent quatre-vingt-deux malades, comprenant 124(32,5%) hommes et 258 (67,5%) femmes, âges entre 18 et 86 ans, moyenne 44,8 ± 15,4 ans, ont été étudiés ; 112 (29,3%) avaient des maladies oculaires mais seulement 88 (78,6%) malades se plaignaient de trouble(s) oculaire(s). Les plaintes les plus courantes étaient une mauvaise vision 53 (60,4%), les yeux rouges et la sécheresse oculaire 15(17,0%) chacun. les maladies oculaires courants étaient les troubles du cristallin 52(13,6%) et la conjonctive 46 (12,0%). le fait d'avoir fait des études supérieures ont protégé contre les maladies oculaires courant (P<0.05). Conclusion: Près d'un tiers des malades de la service ambulatoire général, Nigérian ont des maladies oculaires. Par conséquent, les soins oculaires primaires doivent être intégrés dans le service ambulatoire généra avec la fourniture de la main-d'œuvre et des installations nécessaires pour les soins a les malades d'ophtalmiques. Mots-clés: Maladies oculaires, troubles oculaire, service ambulatoire général, Nigérian.

Hand Hygiene Knowledge Among Eye Care Workers at an Eye Hospital in Nigeria.

Aim: The aim of this article is to determine the knowledge of hand hygiene (HH) practices among eye care workers in a tertiary eye hospital in Nigeria. Materials and Methods: This was a cross-sectional study of eye care workers at a tertiary eye hospital in Nigeria. Eye care workers, involved with clinical duties, responded to the WHO Hand Hygiene Knowledge questionnaire containing 24 multiple choice questions on HH knowledge. Each correct answer earned one point; zero was given for a wrong answer. Overall scores were expressed in percentage. An overall score of ≥75% was considered as good; 50-74% moderate; and <50% poor knowledge. Data analysis was with SPSS version 23. Results: Fifty-eight workers participated. Thirty-nine (67.2%) were females and 19 (32.8%) were males; the age range was 25-68 years; mean 39.6 ± 7.4 years. The average work experience was 15.3 ± 8.9 years; range 1-40 years. The mean knowledge score was 12.0 ± 2.9 (50%) which is moderate knowledge; range 3-18. Workers who had received training in HH had a significantly higher mean knowledge score than those who did not receive training (12.8 ± 2.3 vs. 11.3 ± 3.2; P = 0.04). There was no statistically significant association between knowledge of HH and age, sex, work experience, and professional category (P > 0.05). Conclusion: HH knowledge of the eye care workers studied is sub-optimal. This has negative implication for hospital infection control. Eye care workers' knowledge of HH can be improved through formal training and frequent rehearsals.

Sub-tenon Versus Sub-conjunctiva Anaesthesia for Intraocular Surgery.

Objective: To compare the pain relief achieved using sub-Tenon anesthesia with that of sub-conjunctival anesthesia technique in intraocular surgery at the Guinness Eye Centre Onitsha Nigeria. Materials and Methods: Consecutive adult patients who had intraocular surgery under local anesthesia were randomized into having sub-Tenon (3 mL) or sub-conjunctival (0.5 mL) injections using xylocaine ± adrenaline. The manual suture-less surgery technique was used for cataract surgery alone and cataract surgery with pterygium excision; the extra-capsular cataract extraction technique was adopted for combined trabeculectomy and cataract surgery. Surgery duration was recorded. Patient's pain perception graded as none, mild, moderate or severe. Results: 100 patients made up 51 (51.0%) males and 49 (49.0%) females, age range was 31-88 years, median - 68 years, participated. Sub-Tenon anesthetic technique was used in 52 (52.0%) and sub-conjunctival in 48 (48.0%) participants. Seventy-eight (78.0%) patients had cataract surgery; 10 (10.0%) had trabeculectomy; 7 (7.0%) had combined trabeculectomy and cataract surgery and 5 (5.0%) had pterygium excision with cataract surgery. The mean surgery duration in the sub-Tenon anesthesia group was 31.8 ± 8.5 minutes and 30.2 ± 9.8 minutes in the sub-conjunctival group (P > 0.05). Fifty (96.2%) patients in the sub-Tenon group and 38 (79.2%) in the sub-conjunctival group experienced mild or no pains; 2 (4.2%) patients in the sub-Tenon group and 10 (20.8%) in the sub-conjunctival group experienced moderate to severe pains (P < 0.05). Conclusions: Both sub-conjunctival and sub-Tenon anesthetic achieved effective analgesia in intraocular surgery. But sub-Tenon anesthesia is significantly associated with lower incidence of severe pains.

Retinitis Pigmentosa in Onitsha, Nigeria.

Background: Retinitis pigmentosa describes a heterogenous group of progressive hereditary degeneration of the photoreceptor-retinal pigment epithelium complex with varying clinical manifestations. Although studies on the epidemiology of blindness and visual impairment in Nigeria have documented the contribution of retinitis pigmentosa, detailed study of the prevalence, incidence, and pattern of retinitis pigmentosa in Nigeria are few. Objectives: The aim of this study was to describe the relative frequency rate and pattern of retinitis pigmentosa among new patients at the Guinness Eye Center Onitsha Nigeria. Materials and Methods: Case files of new patients with clinical features of retinitis pigmentosa seen over a 6-year period were reviewed. Information on age, sex, and associated clinical features were extracted into a standard proforma and analyzed. Results: Thirty-seven (0.6%) of 5876 new patients had retinitis pigmentosa. There were 25 (67.6%) males and 12 (32.4%) females with an age range of 4-76 years; the median age was 33 years. Family history suggested autosomal dominant inheritance in 15 (40.6%) patients, autosomal recessive inheritance 4 (10.8%), X-linked inheritance 9 (24.3%), and 9 (24.3%) sporadic. Six (16.2%) patients were blind (acuity <3/60) and 22 (59.5%) patients had visual impairment (acuity <6/18). Eight (21.6%) patients had coexistent deafness (syndromic retinitis pigmentosa) including two (5.4%) cases of Usher syndrome. Conclusions: The relative frequency rate of retinitis pigmentosa among new patients in our hospital is low but the associated visual and otologic incapacitation are enormous. A prospective study incorporating molecular genetics would more exactly determine the inheritance pattern and the common genes of retinitis pigmentosa in Nigerians.