Prospective cross-sectional study on the knowledge and practice of patients visiting outpatient urology clinic in Nigeria on coronavirus disease.

Introduction: coronavirus disease is caused by a respiratory virus (severe acute respiratory syndrome coronavirus 2). It has assumed a health burden worldwide; hence it was declared a public health emergency of international concern. The pandemic has affected all health related disciplines; urology practice is not spared. It has also had its toll on socioeconomic life. The study aims to assess the knowledge and practice of patients visiting outpatient urology clinic on coronavirus disease (COVID-19). Methods: this is a cross-sectional study conducted to assess the knowledge and practice of patients visiting outpatient urology clinic on COVID-19. All patients aged 18 years and above who consented were included. Association between independent variables (social demographic characteristics) and dependent variables (knowledge and practice) using Fisher´s exact, while predictors of dependent variables were assessed using logistics regression model. Results: a total of 154 respondents participated. Majority of respondents (50.0%) were between 60 and 69 years. Male constitute 90.3% of respondent. Majority, 65% of respondent had good knowledge while (80%) adopted good practice towards preventing COVID-19. There was an association between age and practice of preventive measure (p = 0.032). There were no predictors of knowledge and practice of preventive measures towards coronavirus disease amongst the socio-demographic characteristics. Conclusion: concerted efforts should be made at educating the populace on knowledge, good practices across socio-demographic groups on COVID-19, particularly at the Hospital. Measures should be in place to develop Tele-health as this would improve response at curtailing coronavirus disease and improve health care.

Detection rate of prostate cancer following 12-core extended biopsy in a Semi-urban Nigerian Tertiary Hospital.

BACKGROUND: Transrectal prostate biopsy using the extended protocol has become the standard mode of obtaining tissue for histological diagnosis with cancer detection rate varying with race and geographical regions. This study is aimed at evaluating the cancer detection rate following a 12-core extended transrectal biopsy of the prostate in a semi-urban Nigerian tertiary hospital. MATERIALS AND METHODS: This was a hospital-based prospective study. Patients who had one or combination of elevated prostate-specific antigen (PSA) levels, abnormal digital rectal examination (DRE), and suspicious ultrasound findings were recruited into this study. Each had 12-core extended biopsy done. Their clinical and histological information were recorded in a pro forma. Data analysis was performed using the statistical programming for social sciences (SPSS) version 21. For all statistical tests, P < 0.05 was regarded as significant. RESULTS: Of the 120 patients, 78 (65%) had prostate cancer. The cancer detection rate in participants aged 50-59, 60-69, 70-79, 80-89, 90-100 were 75%, 46.7%, 72.3%, 85.7%, and 100%, respectively. Overall, the cancer detection rate at PSA levels 4.0-10.0 was 25%, 10.1-20.0 was 54.7%, 20.1-50.0 was 67.4%, 50.1-100.0 was 100%, and >100.0 was 100%. The cancer detection rate for men with suspicious DRE and prostatic ultrasound findings were comparatively higher than those with normal DRE and prostatic ultrasound findings at similar PSA levels. CONCLUSION: This study showed a higher cancer detection rate with a 12-core biopsy protocol when compared to similar studies from the Western world, the Middle East, and urban centers in Nigeria due to poor awareness and late presentation in our environment.

A Self-Insertion of an Uncommon Urethrovesical Foreign Body for Autoerotism.

Apart from iatrogenic causes, many of the foreign bodies in the bladder and urethra are self-inserted through the urethra as a result of psychiatric disturbances, sexual gratification, or erotic curiosity while intoxicated. Despite the reports on the presentation of urethrovesical foreign bodies in the medical literature, the insertion of foreign bodies through the urethra for the purpose of erotic satisfaction remains an enigma. Here, we report a case of a knotted earphone jack as an urethrovesical foreign body inserted for erotic reason by a 32-year-old man with no history of psychiatric disturbances. He could not retrieve it, and the bladder foreign body remained in this position for about 8 h. He was referred to the accident and emergency unit of our hospital, and open surgery was performed to retrieve it.

Obstructive Sleep Apnea Awareness among Primary Care Physicians in Africa.

Rationale: Obstructive sleep apnea (OSA) is a significant health problem among adults and children globally, resulting in decreased quality of life and increased costs of healthcare. For optimal clinical care, primary care physicians should be familiar with OSA and confident in their ability to screen, diagnose, and manage this condition.Objectives: To assess the knowledge, attitudes, and practices of primary care physicians in Kenya, Nigeria, and South Africa regarding OSA in adults and children.Methods: We conducted a multicenter cross-sectional survey in Kenya (Nairobi), Nigeria (Edo State), and South Africa (Cape Town) between April 2016 and July 2017. At least 40 participants were randomly selected from a register of primary care physicians at each site. Potential participants were contacted to receive online/paper-based, validated OSA Knowledge and Attitudes (OSAKA) and OSAKA in Children (OSAKA-KIDS) questionnaires related to adults and children, respectively. The median percentage knowledge scores and proportions of favorable attitude were computed and current diagnostic and referral practices were documented.Results: The median OSAKA knowledge scores were 83.3% (interquartile range [IQR], 77.8-88.9), 66.7% (IQR, 55.6-77.8), and 61.1% (IQR, 55.6-77.8) among South African, Kenyan, and Nigerian physicians, respectively. For OSAKA-KIDS, the median knowledge scores were 61.1% (IQR, 50.0-72.2), 64.2% (IQR, 35.3-93.2), and 58.3% (IQR, 44.4-66.7) among South African, Kenyan, and Nigerian physicians, respectively. Most physicians (90-94%) considered adult and pediatric OSA very/extremely important. Fewer physicians agreed/strongly agreed that they were confident about OSA diagnosis (55%), management (25%), and continuous positive airway pressure (18%) use in adults. Even fewer physicians agreed/strongly agreed that they were confident about pediatric OSA diagnosis (35%), management (21%), and continuous positive airway pressure use (18%). South African physicians mainly prescribed polysomnography (51%) and overnight oximetry (22%), whereas 49% of Nigerian physicians and 65% of Kenyan physicians commonly requested lateral cervical radiography.Conclusions: Primary care physicians in South Africa, Nigeria, and Kenya considered OSA to be important but had modest knowledge about OSA in adults and children, and had a low perceived confidence in adult and pediatric management. Focused educational interventions during undergraduate training and continuing professional development programs may improve primary physicians' knowledge about OSA and its diagnosis and management.

Erectile dysfunction and its relationship with cardiovascular risk factors and disease.

Penile erection is a complex hydraulic process, in which the cardiovascular system (CVS) plays a central role. Erectile dysfunction (ED) is the inability to achieve, and/or maintain penile erection sufficient for satisfactory sexual intercourse, and was previously regarded as part of aging. It is associated with certain diseases and life style habits with a cause-effect relationship, including diabetes mellitus, hypertension, dyslipidemia, and cigarette smoking. Through atherosclerotic narrowing, these diseases may cause coronary artery disease (CAD) and ED, with ED featuring earlier due to the small size of the pudendal artery. The common denominator in ED and CAD is endothelial dysfunction. Men presenting with ED should be evaluated for CVS risk factors, as there is mounting evidence that ED is a sentinel event for CAD. The treatment of men with CAD and concomitant ED should be individualized, and undertaken jointly by the managing physician and urologist.

A 10-Year Review of Urethral Stricture Management in Irrua, Nigeria.

BACKGROUND: Several authors have demonstrated regional and temporal changes in the demographics of urethral stricture and its management. OBJECTIVES: To assess the changes in the demographics of the patients and the evolution of the management of urethral stricture in this institution. SUBJECTS AND METHODS: This is a retrospective study. The files of all the men who were diagnosed with urethral stricture from May 2006 to April 2016 were retrieved from the database of the records department of the hospital. The predictor variables assessed included age at presentation, occupation, etiology, presenting symptoms, stricture site, length of stricture, treatment method, year of treatment, complications of treatment, result of urine microscopy and sensitivity, comorbidities, and social habits of the patients. The outcome variables were the proportion of men in relation to the predictor variables and the test of correlation (P = 0.05 and below significant). Analysis was done using the Statistical Package for the Social Sciences (SPSS) version 21. RESULTS: Forty-six patients were diagnosed as having urethral stricture within the study period. All were males. The mean age was 53.11 years (standard deviation 17.63852) with a range from 19 to 96. There were 4 (8.7%) students, 11 (23.9%) civil servants, 4 (8.7%) businessmen, 3 (6.5%) military men, and 24 (52.2%) others who were essentially artisans. Majority of them (68.9%) presented with lower urinary tract symptoms while Escherichia coli was the most commonly cultured organism from their urine (17.4%). The most common single etiology was urethritis (30.4%). From 2013 onward, there was an abrupt transition from conservative treatment using dilatation which dropped from 38.9% to 17.9%. More complex surgeries such as buccal mucosal graft urethroplasty for bulbar strictures and two-stage repair for penile strictures increased from 11.1% to 57.1%. CONCLUSION: Urethritis is still the most common single etiological factor in urethral stricture disease in this rural community. Artisans such as drivers and mechanics were the most commonly afflicted. There was an abrupt transition from the old conservative methods of treatment to complex urethroplasties within the study period.

Tube thoracostomy: complications and its management.

Background. Tube thoracostomy is widely used throughout the medical, surgical, and critical care specialities. It is generally used to drain pleural collections either as elective or emergency. Complications resulting from tube thoracostomy can occasionally be life threatening. Aim. To present an update on the complications and management of complications of tube thoracostomy. Methods. A review of the publications obtained from Medline search, medical libraries, and Google on tube thoracostomy and its complications was done. Results. Tube thoracostomy is a common surgical procedure which can be performed by either the blunt dissection technique or the trocar technique. Complication rates are increased by the trocar technique. These complications have been broadly classified as either technical or infective. Technical causes include tube malposition, blocked drain, chest drain dislodgement, reexpansion pulmonary edema, subcutaneous emphysema, nerve injuries, cardiac and vascular injuries, oesophageal injuries, residual/postextubation pneumothorax, fistulae, tumor recurrence at insertion site, herniation through the site of thoracostomy, chylothorax, and cardiac dysrhythmias. Infective complications include empyema and surgical site infection. Conclusion. Tube thoracostomy, though commonly performed is not without risk. Blunt dissection technique has lower risk of complications and is hence recommended.

Intravesical foreign bodies: a case report and a review of the literature.

AIM: We report a case of intravesical polyvinyl-coated electric wire in the urinary bladder. CASE REPORT: A 34-year-old man presented in our clinic with irritative lower urinary tract symptoms. Three weeks earlier he had seen and felt a wire in his urethra of which he was unaware of the origin. Radiologic evaluation revealed an electric wire completely coiled up in the urinary bladder. It was removed through a suprapubic cystotomy. DISCUSSION: Patients are usually too ashamed to admit the cause of an intravesical foreign body, which is often sexual or erotic in origin. Radiologic evaluation usually reveals the nature and size of the foreign body in the bladder of patients evaluated for recurrent urinary tract infection. Open surgery or an endoscopic approach may be used for their extraction.

Deep vein thrombosis: a clinical review.

BACKGROUND: Deep vein thrombosis (DVT) is the formation of blood clots (thrombi) in the deep veins. It commonly affects the deep leg veins (such as the calf veins, femoral vein, or popliteal vein) or the deep veins of the pelvis. It is a potentially dangerous condition that can lead to preventable morbidity and mortality. AIM: To present an update on the causes and management of DVT. METHODS: A review of publications obtained from Medline search, medical libraries, and Google. RESULTS: DVT affects 0.1% of persons per year. It is predominantly a disease of the elderly and has a slight male preponderance. The approach to making a diagnosis currently involves an algorithm combining pretest probability, D-dimer testing, and compression ultrasonography. This will guide further investigations if necessary. Prophylaxis is both mechanical and pharmacological. The goals of treatment are to prevent extension of thrombi, pulmonary embolism, recurrence of thrombi, and the development of complications such as pulmonary hypertension and post-thrombotic syndrome. CONCLUSION: DVT is a potentially dangerous condition with a myriad of risk factors. Prophylaxis is very important and can be mechanical and pharmacological. The mainstay of treatment is anticoagulant therapy. Low-molecular-weight heparin, unfractionated heparin, and vitamin K antagonists have been the treatment of choice. Currently anticoagulants specifically targeting components of the common pathway have been recommended for prophylaxis. These include fondaparinux, a selective indirect factor Xa inhibitor and the new oral selective direct thrombin inhibitors (dabigatran) and selective factor Xa inhibitors (rivaroxaban and apixaban). Others are currently undergoing trials. Thrombolytics and vena caval filters are very rarely indicated in special circumstances.

Knowledge of Hepatitis B Vaccine among Operating Room Personnel in Nigeria and Their Vaccination Status.

Background. Hepatitis B virus (HBV) infection is a well recognised occupational health hazard preventable by vaccination. Objectives. To determine the knowledge of operating room personnel (ORP) in Nigeria about the Hepatitis B vaccine, their perception of Hepatitis B vaccination and vaccination status against HBV. Methods. Four university hospitals were selected by simple random sampling. A structured questionnaire was administered to 228 ORP after obtaining consent. Result. Only 26.8% of ORP were vaccinated against HBV. The primary reason for not being vaccinated or for defaulting from vaccination was lack of time. Differences in age, sex, duration of practice and respondent's institution between vaccinated and unvaccinated ORP were not significant (P > 0.05). The majority (86.8%) had the awareness of the existence of Hepatitis B vaccine. 83.8% of respondents believed that the vaccine should be given to the ORP as part of work place safety measures. The majority were aware of the modes of transmission of HBV infection. 78.9% of respondents believed that Hepatitis B vaccine is safe and 81.1% would recommend it to another staff. Conclusion. Despite a good knowledge about HBV infection and vaccine, most of ORP are still not vaccinated. Hepatitis B vaccination should be a prerequisite for working in the theatre, hence putting surgical patients at reduced risk.