Angiomyolipoma presenting as renal abscesses: a consideration for further evaluation of renal abscess.

AIMS AND OBJECTIVES: This is to describe an usual presentation of renal angiomyolipoma as renal abscess CASE REPORT: This is a case report of a 51 year old man with clinical and radiological features suggestive of renal abscess. The patient had exploratory laparatomy and a simple nephrectomy for a non functioning kidney which was more like a bag of pus. The histological report however revealed renal abscess coexisting with angiomyolipoma supporting previous reports that renal abscess may be a harbinger of other renal pathologies. CONCLUSION: Abscesses are usually managed by drainage and the dictum of 'wherever there is pus let it out' holds generally but this does not always suffice in renal abscesses because renal abscesses are often found in the background of other diseases which may be of more clinical importance.

Awareness and knowledge of glaucoma among workers in a Nigerian tertiary health care institution.

PURPOSE: The aim of this study reports the level of awareness and knowledge of glaucoma among selected health care personnel at a health institution in southwestern Nigeria. MATERIALS AND METHODS: Health personnel at the Federal Medical Centre, Owo, Nigeria, a tertiary health care institution were stratified into a clinical and an administrative directorate. One-hundred twenty participants were selected from each directorate by a random sampling technique. A structured questionnaire was used to collect sociodemographic data and data on the level of knowledge and awareness of glaucoma. Statistical analyses included the independent t-test and Pearson's chi-square test for categorical variables. Statistical significance was indicated by P < 0.05. RESULTS: From the target population of 240 participants, 216 (98 males; 118 females) completed the questionnaire. The mean age of the participants was 35.07 ± 07 years. A total of 148 (68.6%) participants had heard of glaucoma comprising all participants from the clinical directorate and 28 participants from the administrative directorate. There was no statistically significant difference between the clinical and administrative directorates about the knowledge of the aspect of vision that is first affected by glaucoma, the painless nature of glaucoma among most Africans and the irreversible nature of glaucoma-related blindness (P > 0.05, all comparisons). CONCLUSION: There is the need to update the knowledge base of these workers if they are to be useful in propagating information of the irreversible blindness that could arise from delay in glaucoma diagnosis and treatment.

Outcome of trabeculectomy with 5-fluorouracil using releasable suture technique in a Nigerian Tertiary Hospital.

BACKGROUND: Trabeculectomy has undergone a series of modifications in recent times most of which are aimed at improving the efficacy of the procedure while reducing complications. The use of releasable sutures is one of such modifications. OBJECTIVE: To assess the efficacy and complications associated with the use of releasable sutures and 5-Fluorouracil(5-FU) in trabeculectomy among indigenous African patients with primary open angle glaucoma. METHODS: This was a chart review of 22 eyes of 17 patients diagnosed with primary open angle glaucoma. All the eyes included in the review had trabeculectomy with 5-Fluorouracil using releasable suture technique with postoperative clinic follow- up visit for a minimum period of 72 weeks. Information sought included patient's demographics, preoperative antiglaucoma medications, pre- and post- operative intraocular pressure, and associated complications. RESULTS: There were 17(13 M, 4 F) patients with 22 eye surgeries. Their mean age was 49.8 ± 9.3 years. The mean preoperative intraocular pressure was 27.7 ± 5.9 mmHg. The intraocular pressure on the first post-operative day was 10.6 ± 11.1 mmHg. The mean pressure before the removal of the releasable suture was 14.1 ± 10.8 mmHg and after removal was 6.0 ± 7.2 mmHg, (p > 0.0001). The mean intraocular pressure at 72 weeks of follow up was 16.9 ±5.6 mmHg. A qualified success rate of 81.8% was achieved in terms of intraocular pressure control. There were two eyes complicated by blebitis and an eye complicated by malignant glaucoma. CONCLUSION: The use of releasable suture in trabeculectomy helped in maintaining the intraocular pressure at a lower level in the early postoperative period and in reducing postoperative shallowing of the anterior chamber. The procedure appears to be associated with some sight- threatening complications such as endophthalmitis.

African traditional medication and keloid formation in herpes zoster ophthalmicus.

Keloid scar complicating herpes zoster ophthalmicus (HZO) has not been much reported among Africans despite the African population having dark skin. We report on a middle-aged Nigerian with HZO who developed keloid scar following use of traditional herbs to the herpetic rashes. A 52-year-old immune-competent Nigerian male presented with a 2-week history of vesicular rashes involving the left side of the forehead down to the tip of the nose. He initially presented to an African traditional healer who had advised application of various herbs to the lesion. When he presented to the eye clinic, he was treated for the associated uveitis with significant improvement. The cicatricial skin change gradually became raised with clinical appearance of keloid at 1 year of follow-up. Cicatricial skin changes in HZO are not unusual, but keloid formation among Africans has not been much described. Late presentation, use of traditional herbs some of which have corrosive effect and secondary bacterial infection are the possible factors that may encourage such abnormal wound healing. The myth associated with HZO in the local African setting as well as the fact that African traditional healers are still widely accepted among most African communities may play a role in increasing the risk of keloid formation among our population following HZO infection.

Visual impairment from age-related cataract among an indigenous African population.

AIM: To determine the magnitude of visual impairment (VI) resulting from lens opacity/cataract among a rural population in southwestern Nigeria. METHOD: A population-based cross-sectional survey using a multistage sampling method to select subjects >or=50 years. Participants with pinhole visual acuity of

Visual outcome of cataract surgery in University College Hospital, Ibadan Nigeria.

BACKGROUND: Cataract is a leading cause of avoidable blindness, while cataract surgery is the commonest major surgical procedure worldwide. OBJECTIVE: To evaluate the visual outcome and causes of poor vision in patients who had cataract extraction at a major hospital in Nigeria. METHODS: A retrospective study of the case notes of patients who had cataract extraction in the Eye Clinic of University College Hospital, Ibadan between July and Dec. 2004 was done. The visual outcome was analyzed using the WHO categorization of visual outcome and those with poor visual outcome evaluated for the cause of such poor outcome. RESULTS: Forty-seven (40.2%) of the eyes had good outcome before refraction and the number increased to 80 (67.8%) after correcting for postoperative refractive error. The highest single cause of poor visual outcome was uncorrected refractive error, 32 (47%) eyes. Other causes included posterior capsule opacification 7 (18.4%) eyes, preexisting ocular co-morbidity such as glaucoma, optic atrophy and maculopathy 6 (15.9%) eyes. CONCLUSIONS: This review showed that uncorrected refractive error and posterior capsular opacification were the major causes of poor visual outcome after cataract surgery. Preoperative biometry for all patients, meticulous intra operative cortical clean up, adoption of the cataract surgery outcome tally sheet and better patient selection will help improve the outcome of our cataract surgeries.

Post-operative complication of trabeculectomy in Ibadan, Nigeria: outcome of 1-year follow-up.

OBJECTIVE: To describe the post-operative complications reported in patients who had trabeculectomy with and without antimetabolite in UCH, Ibadan between 1999 and 2003 and the success rate achieved in term of the post-operative intraocular pressure (IOP). METHODS: A retrospective study of the records of glaucoma patients who had trabeculectomy between 1999 and 2003 and had follow-up in UCH Ibadan eye clinic for a minimum of 1 year was carried out. RESULTS: Seventy-six out of 171 eyes that had trabeculectomy during the period were reviewed. Mean age of patients was 49.4 years. The mean preoperative IOP was 31.8 mm Hg. Success rate of 79.4% was achieved in term of IOP control at a year of follow-up. The most frequent early post-operative complication was shallow AC (13 eyes; 17.1%) while late complication was elevated IOP (21 eyes; 27.6%). Others were encapsulated bleb 7.9% and hyphema 3.9%. There was no significant difference in the complication rate in those who had intraoperative antimetabolite (5-fluorouracil) when compared with those operated without antimetabolite. CONCLUSION: Guarded filtration surgery is effective in controlling IOP. Most of the complications noted were transient and not visually threatening.

Combined central retinal artery and vein occlusion complicating orbital cellulitis.

Orbital Cellulitis is a dreaded ophthalmologic disease. It may destroy vision and the eye and may even become life threatening. Often visual loss is the result of exposure and subsequent destruction of ocular tissue commonly the cornea and the uvea. We report a case of combined central retinal artery and vein occlusion complicating orbital cellulitis in a 35 year old patient who was 37 weeks pregnant resulting in loss of vision in the affected eye. There have been few case reports of this type of complication of orbital cellulitis.

A comparative study of the ileum in rat (Rattus norvegicus), Bat (Eidolon helvum) and Pangolin (Manis tricuspis) as investigated using histological method / Estudio comparativo del íleon en rata (Rattus norvegicus), murciélago (Eidolon helvum) y pangolín (Manis tricuspis) utilizando como investigación el método histológico

The histological and morphometric differences in some parts of the gastrointestinal tracts of rat, bat and pangolin have been well established. This investigation aims at comparatively elucidating any adaptational changes the ileum of the three mammals must have adopted to meet its dietary requirements and also cope with their morphological differences. The investigation was carried out using ten rats, ten bats and ten pangolins of both sexes. The animals were slightly anaesthetized under chloroform inhalation. The intestines were harvested and the ileum excised and fixed in 10 percent formol saline. The tissues were processed for light microscopic study. The following stains were employed: Haematoxylin and eosin (H & E), Van Gieson and Verhoeff's haematoxylin elastic tissue stain. Stained slides were also analysed morphometrically. The results revealed microstructural modifications which characterized the mucosa as well as the pattern of distribution of the conjuntive tissue fibers in the ileum of the three mammals. These modifications are means of successfully coping with their respective diets and morphological differences.

Las diferencias histológicas y morfométricas en algunas partes del tubo digestivo de ratas, murciélagos y pangolines han sido bien establecidos. Esta investigación tiene por objeto aclarar comparativamente cualquier cambio de adaptación del íleon de los tres mamíferos que hayan adoptado para satisfacer sus necesidades dietéticas y también hacer frente a sus diferencias morfológicas. La investigación se llevó a cabo usando 10 ratas, 10 murciélagos y 10 pangolines, de ambos sexos. Los animales fueron ligeramente anestesiados bajo inhalación de cloroformo. Los intestinos fueron expuestos, el íleon extirpado y fijado en formol salino al 10 por ciento. Los tejidos fueron procesados para su estudio por microscopía de luz. Los siguientes tinciones fueron empleadas: Hematoxilina y eosina (H & E), Van Gieson y tinción de hematoxilina para tejidos elásticos de Verhoeff. Los cortes teñidos también se analizaron morfométricamente. Los resultados revelaron modificaciones microestructurales características de la mucosa, así como el patrón de distribución de las fibras de tejido conjuntivo en el íleon de los tres mamíferos. Estas modificaciones son el medio para entender sus diferencias en la dieta y morfología respectivamente.

HIV prevalence among prison inmates in a central prison in southern Malawi, 2005.

A cross-sectional study of 164 prison inmates (142 men [86.6%] and 22 women [13.4%]) in Malawi estimated a HIV prevalence rate of 36.6%; 29.9% among men and 50% among women. Three (2.1%) men reported having sex with men, and none reported intravenous drug use.

Reproductive strategy of Oreochromis niloticus (Pisces: Cichlidae) in Opa reservoir, Ile-Ife, Nigeria

The fish family Cichlidae has a large diversity and dominates African freshwater bodies, with over 200 species reported in inland waters. Sampling for the fish Oreochromis niloticus (Linnaeus) in Opa reservoir, Nigeria, started in October 1997 and extended until February 2000. The fishing methods employed for collecting the 1 430 specimens were cast netting and gillnetting. Egg diameter varied between 2.12 mm and 2.69 mm with a mean of 2.47±0.02. Female gonadosomatic index was 1.34±0.01 (0.12-4.06, n= 637). The male gonadosomatic index was 0.39±0.02 (0.03-1.67, n= 789). In Opa reservoir, O. niloticus bred throughout the study period. The species was a maternal mouth brooder with the female fish carrying eggs and fry in the buccal cavities. The sex ratio of O. niloticus was approximately 1:1 in the reservoir. The fecundity of the species was between 73 eggs and 1 810 eggs per female with a mean fecundity of 815 eggs. Rev. Biol. Trop. 55 (2): 595-602. Epub 2007 June, 29.

Estudiamos la tilapia, Oreochromis niloticus (Linnaeus) en la reserva de Opa, Nigeria, desde octubre 1997 hasta febrero del 2000. Recolectamos 1 430 especímenes con red lanzada y red de arrastre. El diámetro de los huevos varía entre los 2.12 mm y 2.69 mm con un promedio de 2.47±0.02. El índice gonadosomático de las hembras fue de 1.34±0.01 (0.12-4.06, n= 637), y en machos fue de 0.39±0.02 (0.03-1.67, n= 789). En la reserva este pez se reprodujo durante todo el periodo de estudio. Hay cuido materno: la hembra lleva los huevos y alevines en la boca. La proporción machos/hembras fue aproximadamente 1:1. La fecundidad varía entre 73 y 1 810 huevos por hembra con un promedio de 815 huevos.

Reproductive strategy of Oreochromis niloticus (Pisces: Cichlidae) in Opa reservoir, Ile-Ife, Nigeria.

The fish family Cichlidae has a large diversity and dominates African freshwater bodies, with over 200 species reported in inland waters. Sampling for the fish Oreochromis niloticus (Linnaeus) in Opa reservoir, Nigeria, started in October 1997 and extended until February 2000. The fishing methods employed for collecting the 1 430 specimens were cast netting and gillnetting. Egg diameter varied between 2.12 mm and 2.69 mm with a mean of 2.47+/-0.02. Female gonadosomatic index was 1.34+/-0.01 (0.12-4.06, n= 637). The male gonadosomatic index was 0.39+/-0.02 (0.03-1.67, n=789). In Opa reservoir, O. niloticus bred throughout the study period. The species was a maternal mouth brooder with the female fish carrying eggs and fry in the buccal cavities. The sex ratio of O. niloticus was approximately 1:1 in the reservoir. The fecundity of the species was between 73 eggs and 1 810 eggs per female with a mean fecundity of 815 eggs.

Evaluation of syndromic management of sexually transmitted infections in Blantyre, Malawi.

Sixty-five consecutive patients presenting to the sexually transmitted infections (STI) clinic, Queen Elizabeth Central Hospital (QECH), Blantyre were interviewed and six health centres were visited to assess the quality of syndromic management of STIs and also to evaluate the success of partner treatment of index cases. The results showed that more females (55%) than males (45%) presented and 69% of interviewed patients were between 17 - 25 years. Age range was between 17 and 56 years and median age was 27. Married people predominated at 69% while singles were only 20%. 66%, 20% and 14% were index case, sexual partners and repeat cases respectively while 33% of the attendees had had an STI within the previous 3 months. Approximately 95% of patients had formal education and 97% had religious affiliations. When compared to previously criteria, the result of this survey showed that information dissemination, health education and counselling of patients with STIs were poor with only 29% being adequately managed. We also observed that only 20% of partners were treated in this study. Health centers lacked the necessary equipment, personnel and supplies to adequately provide syndromic management services. Furthermore, record keeping in these centres was poor.

Bacteriology of burns at the Queen Elizabeth Central Hospital, Blantyre, Malawi.

A retrospective study to determine the bacterial profile and antibiotic susceptibility pattern of burn isolates at the Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi was undertaken. While a total of 1825 burn patients were admitted to the hospital over a 6-year period (January 1994 to December 1999) only 317 (17.4%) specimens selected from as many patients were processed. One hundred and seventy (170/53.6%) specimens yielded single while the rest (147/46.4%) had multiple isolates giving a total of 535 bacterial isolates. Of this number, 236 (44.1%) were Gram-negatives and 299 (55.9%), Gram-positives. Among the Gram-negatives, Pseudomonas aeruginosa, Proteus mirabilis, Coliforms/Escherichia coli and Klebsiella pneumoniae were the most common accounting for 94.1% while in the Gram-positive group, staphylococcal and streptococcal spp. predominated (100%). However, the three most common isolates were Staphylococcus aureus (37.6%), P. aeruginosa (22.4%) and beta-haemolytic streptococci (13.6%). While S. aureus and beta-haemolytic streptococci were most susceptible to penicillin (33.3 and 64.4% susceptibility, respectively), gentamycin appeared most effective against P. aeruginosa (53.3%). A general broad-spectrum resistance to panels of antibiotics used in the study was however observed among the bacterial isolates. From these results, S. aureus, P. aeruginosa, streptococcal spp., P. mirabilis, Coliforms and K. pneumoniae representing 96.4% of all isolates were the most common in the Burns Unit.

The prevalence of HIV infection among burn patients in a burns unit in Malawi and its influence on outcome.

In a 1 year study, 342 patients admitted to the Burns Unit at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi underwent a voluntary HIV test. Forty (11.7%) tested HIV positive: of those aged above 15 years, 31% (34 out of 112) were HIV positive, whilst 3% (6 of 231) aged under 15 were HIV positive of whom the majority were in those aged under 5 years (5 of 125, 4%). Patients who were HIV positive had an increased risk of death (P=0.04) which was mainly due to sepsis, but those HIV patients, who did not develop infection or recovered from an episode of sepsis, had similar hospital stay, need for skin grafting and graft take as nonHIV patients. There was no difference in pathogens cultured from wound swabs taken from HIV positive and negative patients. HIV positive patients had significantly lower CD4 counts as compared to HIV negative patients (mean 383mm3 (S.D. 320) and 937mm3 (S.D. 497), respectively). However, low CD4 counts were also found in the HIV negative patients (mean 901, range 131-1964) and 24% had CD4 <500/mm3. Both HIV status and the total body surface area (TBSA) burned were independent predictors of CD4 count. TBSA was an independent risk factor for death (odds ratio 1.3; 95% CI 1.1, 1.4). In patients with TBSA burns of over 30%, mortality approached 100% irrespective of HIV status, but in patients with burns of 11-20% TBSA and who were HIV positive have a mortality of 25% compared to 12% in HIV negative patients; for 21-30% TBSA burns mortality was 100% compared to 50% for HIV positive and HIV negative patients, respectively.

Antibiotic resistance in bacteria - an emerging public health problem.

The discovery and eventual introduction of anti-microbial agents to clinical medicine was one of the greatest medical triumphs of the twentieth century that revolutionized the treatment of bacterial diseases. However, the gradual emergence of populations of antibiotic-resistant bacteria resulting from use, misuse and outright abuse of antibiotics has today become a major public health problem of global proportions. This review paper examines the origins and molecular epidemiology of resistance genes, global picture of antibacterial resistance, factors that favour its spread, strategies for its control, problems of control and the consequences of failure to contain antibiotic resistance in bacteria.