Surgical management of benign prostate hyperplasia in Nigeria: open prostatectomy versus transurethral resection of the prostate.

INTRODUCTION: transvesical (open) prostatectomy (OP), an invasive surgical procedure, is a common form of treatment offered to patients with benign prostatic enlargement in emerging economies. Recently, there has been an increase in the use of electrosurgical means in treating benign prostate hyperplasia in our environment, especially transurethral resection of the prostate (TURP). This study compares the perioperative, short-term outcomes and complications of open prostatectomy and TURP. METHODS: the records of men who had prostatectomies (OP and TURP) from Jan 2016 to Dec 2019 for prostate gland less than 80g were reviewed. The patients´ age, size of the prostate gland, duration of surgery (mins), blood transfusion, clot retention, length of catheterisation (days), hospital stay (days), postoperative infection, postoperative incontinence, reoperation, bladder neck stenosis and urethral stricture were analysed. RESULTS: fifty-nine patients were studied. Twenty-nine patients had OP, while 30 had TURP. Mean age for OP was 63.8 (SD 7.2) years, while for TURP is 68.5 (SD 8.0) years (p=0.019). The mean for length of catheterisation for OP vs TURP was 9.1 (SD 3.7) vs 3.3 (SD 1.03) days (p=0.001), mean hospital stay was 9.6 (SD 4.1) and 4.7 (SD 2.2) days (p=0.001) for OP and TURP while duration of surgery (mins) for OP and TURP was 106.7 (SD 15.2) vs 53.8 (SD 14.0) minutes (p=0.001). The blood transfusion rate was 13.8% and postoperative incontinence 13.8% in OP, while in the TURP group, the reoperation rate was 3.3% and urethral stricture at a rate of 3.3%. Overall complications showed no statistical difference (p=0.462) between the two groups. CONCLUSION: the patients who underwent TURP had shorter hospital stay, shorter duration of surgery and catheterisation, and less frequently required blood transfusion compared to those who had open prostatectomy. However, reoperation rate was higher compared to open prostatectomy. The overall complication was fewer with TURP, but this is not statistically significant; hence both forms of surgical therapy remain relevant in a poor resource setting.

Cigarette Smoking, Alcohol Consumption, and the Risk of Prostate Cancer-A Retrospective Analysis of Prostate Cancer Patients in Southern Nigeria.

Background: Tobacco contains harmful carcinogens that have been associated with cancers. Some studies have associated tobacco smoking with prostate cancer (PCa). The relationship between alcohol consumption as a risk factor for prostate cancer has been debated. Some studies associated alcohol consumption with increased risk of PCa, associating alcohol consumption with higher-grade cancers and poorer prognosis. Other studies have found a minimal relationship with PCa, with some even suggesting that alcohol consumption may even be protective. This study evaluates the association between smoking and alcohol consumption in prostate cancer patients. Methodology: This is a retrospective study on one hundred and fifty-two patients diagnosed with prostate cancer with a known history of both smoking and or alcohol consumption managed over a 9year period from January 2012 to December 2020 from three Urology referrals hospitals. Patients with incomplete history were excluded. Their data such as age, a history of cigarette smoking, prostate-specific antigen level, prostate biopsy histopathology reports, and Gleason's grade were extracted. This was coded into Microsoft Excel and analyzed with SPSS version 20. The results were analyzed and presented in tables and charts. Results: One hundred and thirty-five patients had a premorbid history of smoking and alcohol consumption with a mean age of 69 years and a modal age in the 70-79-year age group. Fifty-three (39.3%) of the patients had a history of cigarette smoking, ninety-four (69.6%) had a history of alcohol consumption. In comparison, fifty-one (37.8%) had a history of cigarette smoking and alcohol consumption. The high-risk Gleason's 8-10 prostate cancer was commoner among smokers than nonsmokers. There was no statistically significant association between cigarette smoking and alcohol consumption alone and combined with PCa. Conclusion: The high-risk Gleason's 8-10 prostate cancer was commoner among smokers than nonsmokers. There was no statistically significant association between cigarette smoking and alcohol consumption and the risk of prostate cancer.

Pilot Study on the Locoregional Demographics of Prostate Cancer in River State, Nigeria.

Background: The aetiology of prostate cancer is a subject of intense research and has been attributed to several risk factors. Geographical variations have also been observed with high incidence in western countries and rising rates in developing countries. This study aims to evaluate the locoregional distribution of histologically confirmed prostate cancer patients and discuss the risk factors for the observed variations according to their Local Government Areas (LGA) in Rivers State. Methodology: This is a descriptive retrospective study on patients with histologically confirmed prostate cancer from three hospitals that take urology referrals over 10years. The patient's hospital records were obtained, and records of their ages, permanent place of residence, prostate biopsy histopathology reports, and Gleason's scores were extracted. These data were collated and analyzed using SPSS version 20. Results: There were 278 patients managed over a 10year period with a mean age of 68.39years+_10.06. Prostate cancer was the commonest in the 60-69year age group (37.1%), followed by the 70-79year range. The high-risk, poorly differentiated cancer (Gleason 8-10; ISUP 4,5) was the commonest, followed by the intermediate-risk cancers (Gleason 7; ISUP 2,3). Port Harcourt (41.0%) and ObiaAkpo (36.0%) Local Government Areas (LGAs) in Port Harcourt City had the highest frequencies of prostate cancer. There was no relationship between age and Gleason's score in the men. Conclusion: Prostate cancer appears more common in the LGAs in Port Harcourt City compared to the semi-urban and rural LGAs in Rivers State. High-grade cancers are more frequent both in rural and urban LGA. High Gleason score cancers appear more frequently in the metropolitan Port Harcourt City than rural LGAs.

The Outcome of Transurethral Electro-Endoscopic Resection of Orthotopic Single System Ureterocoeles in Adults Nigerians.

Background: Endoscopic transurethral electro-incision and resection are minimally invasive options for treating adult single system ureterocoele. Vesicoureteral (VU) reflux is frequently associated with ureterocoeles and can complicate the treatment. The literature on endoscopic management isscanty from sub-Saharan Africa. This study aimed to describe the technique and outcome of adult patients who had transurethral incision and or deroofing of orthotopic single system ureterocoele. Methodology: This was a prospective study on patients who presented with single system ureterocoeles. All were diagnosed either by computerized axial tomography urography or intravenous urography and were followed up and monitored for resolution of symptoms, development of urinary tract infection, and ureterovesical reflux. The patients' demographic information such as their age, sex, details of endoscopic treatments, complications on follow-up were entered into Excel and analyzed using SPSS version 21. Results: There were eighteen ureteric units managed in 10 patients with single system ureterocoeles. The male: female ratio was 3:2. The 30-39-year age group (four; 40%) and 60-69year age groups (four; 40%) had the highest frequency. Six (33.33%) had calculi, and 83.30% presented with lower urinary tract symptoms (LUTS). Nine (50%) of the ureteric systems had transurethral deroofing of ureterocoele (TUDU), while eight (44.4%) had transurethral incision of ureterocoele (TUIU). Urinary tract infection was the commonest complication. Ureterovesical reflux was present in two and two developed refluxes after TUDU. The patients with refluxes had antibiotics with the resolution of the ipsilateral symptoms. All had preserved renal function. Conclusion: VU reflux inpatients that underwent endoscopic incision or deroofing for single system ureterocoele is infrequent and can be managed conservatively. It is an effective treatment for single system ureterocoeles and has minimal complications.

Correlation between Uroflowmetry and International Prostate Symptoms Score in the evaluation of Nigerian men with Benign Prostatic Enlargement.

Background: Benign prostatic enlargement (BPE) may obstruct the urethra, reduce urine flow, and cause Lower Urinary Tract Symptoms (LUTS). Patients with LUTS can be evaluated with the International Prostate Symptom Score (IPSS) and uroflowmetry for diagnosis, treatment selection, and monitoring. There are challenges, especially in developing countries with these two investigative modalities. A level of education is needed to fill the IPSS form while most centres do not have a uroflowmeter. Studies to evaluate the relationship and compare the beneficial value of IPSS and uroflowmetry are few.This study aims to assess the correlation between IPSS and uroflowmetry in adult patients who present with LUTS secondary to BPE and compare their beneficial values. Methodology: The study was a hospital-based, descriptive prospective cross-sectional study of patients with LUTS secondary to BPE. Ethical committee approval and informed consent were obtained. Every patient had the study questionnaire and IPSS questionnaire completed. Each patient also had uroflowmetry performed. The researcher filled out the study questionnaire. Data were coded and entered using Microsoft Excel version 2010 and transferred into Statistical Package for Social Sciences Version 20 for analysis. Results: Two hundred eighty-six patients were evaluated, but 100 met the inclusion criteria and were included in the study. The ages ranged from 48 to 93years with a mean age of 64.71± 9years. The 60 to 69 years age group had the highest frequency, 43(43%). The mean Total Prostate Volume (TPV) was 83±32.28ml. Most patients (65 patients) presented with severe LUTS (p=0.001).There was a statistically significant inverse relation between IPSS and Maximum Flow Rate (p=0.001; r= -0.624) and Average Flow Rate (p= 0,001; r= -0.578), indicating that the higher the degree of bother, the lower the Mean and Average Flow Rates. This suggests that the more the degree of bother from BPE as assessed by IPSS, the lower the urine flow rates on uroflowmetry. Conclusion: There was a strong negative correlation between IPSS and MFR a moderate negative correlation between IPSS and AFR, showing that the higher the IPSS, the poorer the urine flow. IPSS can be used instead of the uroflowmetry to evaluate patients with BPE if a uroflowmeter is unavailable.

Assessment of Health-care Research and Its Challenges among Medical Doctors in Nigeria.

INTRODUCTION: Health-care research in Nigeria has been growing over the years but is constrained by many difficulties. This study aimed to identify the challenges encountered in health-care research and suggest policies to address these problems. MATERIALS AND METHODS: It was a cross-sectional study of medical doctors who have been involved in health-related researches. All participants filled a self-administered online questionnaire comprising 31 questions in five sections. The responses were analyzed using the Google forms and the Statistical Package for the Social Sciences software version 23. RESULTS: The mean age of the study participants was 41.0 ± 8.4 years. Three-quarters of the respondents (75.5%) worked in teaching hospitals. Nearly all (96.6%) carried out their studies using personal funds and only one in 10 had been involved in high-budget projects (≥₦1,000,000). The generation of quality researches was impeded by the restriction of literature review to free online journals (93.2%), incomplete health records (88.0%), limited access to research kits (65.7%), limited use of advanced statistical analysis (29.8%), and challenges with obtaining ethical approval (21.2%). Despite the average online visibility of these researches (52.2%), only 28.5% stated that it has been locally adopted to influence medical practice in their center. CONCLUSION: There is a wide disparity in research capacity among hospital tiers. It is important to leverage on and expand existing partnerships to provide institutional access to premium literature, offer robust, and assessable financial support for the conduct of high-quality researches and provide a framework to bridge the gap in the use of these works to influence practice change in Nigeria.

Common, Difficult Questions about Providing Nutrition at End of Life: Bedside Application of Catholic Moral Teaching.

There is much confusion surrounding how to interpret provision of artificial nutrition and hydration (ANH) at the bedside in complicated clinical circumstances. The specific scenario that prompted these questions was a request by a patient and her family to remove a feeding tube that had become, in the patient's eyes and opinion, disproportionately burdensome in her particular set of clinical circumstances. This clinically relevant article can be viewed as a bedside interpretation of Catholic bioethical teachings on provision of ANH to the dying patient. Please note that this article does not address specific ethical issues that pertain to persistent vegetative state, which is beyond the scope of this particular discussion.

Case Series and Literature Review of Ophthalmologic Disorders Seen in a Specialist Rheumatology Clinic in Lagos, Nigeria.

Purpose: To highlight the pattern and treatment outcomes of ophthalmologic disorders referred to a private specialist rheumatology clinic. Methods: Retrospective review (January 2015-December 2016) of referrals from Eye Foundation Hospital, Lagos to Arthrimed Specialist Clinic, Lagos. Case records were retrieved and relevant information extracted. Ethical standards were observed. Results: Twenty-two referrals (35 eyes) were received out of 643 patients (3.4%) seen during the study period. The majority were female (63.6%) with mean age 48.9 ± 19.3 years and bilateral disease (59%). Diagnoses included uveitis (45.5%), optic neuritis (36.4%), non-specific autoimmune eye disease (9.1%), keratoconjunctivitis sicca (4.5%), and giant cell arteritis (4.5%). Treatment was with steroids and immunosuppressive agents. Fourteen patients improved (63.6%), five remained unchanged (22.7%), while three worsened (13.6%). Conclusions: Our patients were mostly fourth-decade females with bilateral disease. Uveitis was the commonest presentation, and two-thirds of the treated patients improved after treatment. Early specialist referral and co-management of severe autoimmune eye diseases are desirable.

Cesarean section in Australian women with epilepsy.

The literature suggests that cesarean delivery or birth is carried out more often in pregnant women with epilepsy (WWE) than in pregnant women in the general population. Data were utilized from the Australian Pregnancy Register (APR) for Women on Antiepileptic Medication to investigate this issue in Australia. Over almost two decades, the mean CS rate in 1900 APR women was 39.2%, but was only 29.9% in women in the general population (relative risk (R.R.) = 1.31, 95% confidence interval (C.I.) 1.24, 1.39). Rates for forceps and suction-assisted delivery were similar in the two datasets. The 9.3% excess CS rate was almost entirely accounted for by operations carried out prior to the onset of labor. The rates for CS during labor were very similar. Only 11.0% of the WWE knew the indication for their prelabor CS, whereas 69.8% knew why theirs had been carried out during labor (odds ratio (O.R.) = 0.054; 99% C.I. 0.032, 0.089). Slightly older mothers and increased proportions of primipara probably made small contributions to the increased prelabor CS rate in the Australian WWE, but most of the excess could not be accounted for in the Register data. Australian obstetricians may have tended to regard prelabor CS as a preferable course of action in managing delivery in WWE, even in the absence of other indications.

Physician-Assisted Suicide and Euthanasia in the ICU: A Dialogue on Core Ethical Issues.

OBJECTIVE: Many patients are admitted to the ICU at or near the end of their lives. Consequently, the increasingly common debate regarding physician-assisted suicide and euthanasia holds implications for the practice of critical care medicine. The objective of this article is to explore core ethical issues related to physician-assisted suicide and euthanasia from the perspective of healthcare professionals and ethicists on both sides of the debate. SYNTHESIS: We identified four issues highlighting the key areas of ethical tension central to evaluating physician-assisted suicide and euthanasia in medical practice: 1) the benefit or harm of death itself, 2) the relationship between physician-assisted suicide and euthanasia and withholding or withdrawing life support, 3) the morality of a physician deliberately causing death, and 4) the management of conscientious objection related to physician-assisted suicide and euthanasia in the critical care setting. We present areas of common ground and important unresolved differences. CONCLUSIONS: We reached differing positions on the first three core ethical questions and achieved unanimity on how critical care clinicians should manage conscientious objections related to physician-assisted suicide and euthanasia. The alternative positions presented in this article may serve to promote open and informed dialogue within the critical care community.

The effectiveness and cost-effectiveness of spinal cord stimulation for refractory angina (RASCAL study): study protocol for a pilot randomized controlled trial.

BACKGROUND: The RASCAL (Refractory Angina Spinal Cord stimulation and usuAL care) pilot study seeks to assess the feasibility of a definitive trial to assess if addition of spinal cord stimulation (SCS) to usual care is clinically superior and more cost-effective than usual care alone in patients with refractory angina. METHODS/DESIGN: This is an external pilot, patient-randomized controlled trial.The study will take place at three centers in the United Kingdom - South Tees Hospitals NHS Foundation Trust (The James Cook University Hospital), Dudley Group of Hospitals NHS Foundation Trust, and Basildon and Thurrock University Hospitals NHS Foundation Trust.The subjects will be 45 adults with refractory angina, that is, limiting angina despite optimal anti-angina therapy, Canadian Cardiovascular Society Functional Classification Class III and IV, angiographically documented coronary artery disease not suitable for revascularization, satisfactory multidisciplinary assessment and demonstrable ischemia on functional testing.The study will be stratified by center, age and Canadian Cardiovascular Society Functional Classification.Interventions will involve spinal cord stimulation plus usual care ('SCS group') or usual care alone ('UC group'). Usual care received by both groups will include consideration of an education session with a pain consultant, trial of a transcutaneous electrical neurostimulation, serial thoracic sympathectomy and oral/systemic analgesics.Expected outcomes will be recruitment and retention rates; reasons for agreeing/declining participation; variability in primary and secondary outcomes (to inform power calculations for a definitive trial); and completion rates of outcome measures. Trial patient-related outcomes include disease-specific and generic health-related quality of life, angina exercise capacity, intake of angina medications, frequency of angina attacks, complications and adverse events, and satisfaction. DISCUSSION: The RASCAL pilot trial seeks to determine the feasibility and design of a definitive randomized controlled trial comparing the addition of spinal cord stimulation to usual care versus usual care alone for patients with refractory angina.Fifteen patients have been recruited since recruitment opened in October 2011. The trial was originally scheduled to end in April 2013 but due to slow recruitment may have to be extended to late 2013. TRIAL REGISTRATION: ISRCTN65254102.

Photobiology of vitamin D in mushrooms and its bioavailability in humans.

Mushrooms exposed to sunlight or UV radiation are an excellent source of dietary vitamin D2 because they contain high concentrations of the vitamin D precursor, provitamin D2. When mushrooms are exposed to UV radiation, provitamin D2 is converted to previtamin D2. Once formed, previtamin D2 rapidly isomerizes to vitamin D2 in a similar manner that previtamin D3 isomerizes to vitamin D3 in human skin. Continued exposure of mushrooms to UV radiation results in the production of lumisterol2 and tachysterol2. It was observed that the concentration of lumisterol2 remained constant in white button mushrooms for up to 24 h after being produced. However, in the same mushroom tachysterol2 concentrations rapidly declined and were undetectable after 24 h. Shiitake mushrooms not only produce vitamin D2 but also produce vitamin D3 and vitamin D4. A study of the bioavailability of vitamin D2 in mushrooms compared with the bioavailability of vitamin D2 or vitamin D3 in a supplement revealed that ingestion of 2000 IUs of vitamin D2 in mushrooms is as effective as ingesting 2000 IUs of vitamin D2 or vitamin D3 in a supplement in raising and maintaining blood levels of 25-hydroxyvitamin D which is a marker for a person's vitamin D status. Therefore, mushrooms are a rich source of vitamin D2 that when consumed can increase and maintain blood levels of 25-hydroxyvitamin D in a healthy range. Ingestion of mushrooms may also provide the consumer with a source of vitamin D3 and vitamin D4.