Patrick Temi Adegun

Erectile Dysfunction in Men with and without Lower Urinary Tract Symptoms in Nigeria

Purpose Much attention has been focused in recent decades on the effects of erectile dysfunction (ED) secondary to lower urinary tract symptoms (LUTS), potentially underestimating its effects in men without LUTS. This study aimed to compare the prevalence and predictors of ED in men with and without LUTS. Materials and Methods The International Index of Erectile Function questionnaire was administered to 303 patients between January 2014 and June 2016. Within this sample, 147 patients with LUTS (cases) were compared to 156 men without LUTS who were matched for age, level of education, and occupation (controls). Results The mean age was 66.03±9.64 years and 65.78±8.61 years for the cases and controls, respectively. The prevalence of ED was 64.6% and 73.7% (odds ratio [OR], 1.54; 95% confidence interval [CI], 0.94∼2.51) in the case cohort and controls, respectively (p=0.086). There was no difference in the prevalence of impaired erectile function (p=0.067), impaired orgasmic function (p=0.108), impaired sexual desire (p=0.291), impaired intercourse satisfaction (p=0.869), or impaired overall satisfaction (p=0.191). Multivariate logistic regression analysis showed that being currently employed was a significant predictor of ED both in men with LUTS (OR, 8.08; 95% CI, 1.51∼9.27; p=0.004) and in men without LUTS (OR, 7.00; 95% CI, 1.49∼14.51; p=0.008). Being married only predicted for impaired EF in men without LUTS (OR, 6.34; 95% CI, 1.40∼15.20; p<0.05). Conclusions ED was not found to be more prevalent in men with LUTS. Being employed was a predictor of ED in both groups of men, while being married was also a predictor of ED in men without LUTS.

Healthcare workers knowledge and attitude toward palliative care in an emerging tertiary centre in South-West Nigeria

Background: Palliative care is an emerging area of medicine with potential to affect positively many chronically ill patients. This study investigated the knowledge and attitude of healthcare workers in a tertiary level hospital in Nigeria where a palliative care unit is being established. Material and Methods: The study was a cross-sectional questionnaire-based study carried out among healthcare workers in Ekiti State University Teaching Hospital, Ado-Ekiti, south-west Nigeria. The questionnaire had sections about definition of palliative care, its philosophy, communication issues, medications, and contexts about its practice. The information obtained from the questionnaire was coded, entered, and analyzed using IBM SPSS version 19. Results: A total of 170 questionnaires were returned within the stipulated time frame with response rate of 66.7%. Majority, (135, 86%) respondents felt palliative care was about the active management of the dying while 70.5% of respondents equated palliative care to pain management. Regarding the philosophy of palliative care, 70 (57.9%) thought that it affirms life while 116 (78.4%) felt palliative care recognizes dying as a normal process. One hundred and twenty-two (78.7%) respondents were of the opinion that all dying patients would require palliative care. The patient should be told about the prognosis according to 122 (83%) respondents and not doing so could lead to lack of trust (85%). Regarding the area of opioid use in palliative care, 76% of respondents agreed that morphine improves the quality of life of patients. Conclusion: There are plausible gaps in the knowledge of the healthcare workers in the area of palliative care. Interventions are needed to improve their capacity.

Severity of Lower Urinary Tract Symptoms among Middle Aged and Elderly Nigerian Men: Impact on Quality of Life

Objectives. To compare the severity of LUTS among middle aged and elderly Nigerian men and determine the influence of LUTS severity on QoL. Methods. This cross-sectional study was conducted among new patients presenting with LUTS attending Urology clinic between 2011 and 2015. Assessment of symptoms was based on IPSS and bother score completed by the eligible subjects on the same day of their clinic visits. Results. Four hundred patients were studied comprising 229 middle aged and 171 elderly men. Interquartile range (IQR) of IPSS scores for men <65 years and those ≥65 years was 14.0 (16.0) and 19 (15.0), respectively (p < 0.001). Mild LUTS was significantly associated with best, good, and poor quality of life while moderate LUTS was associated with poor QoL. Severe LUTS was significantly associated with all the categories of QoL (Best-Worst). Among the cohort of subjects with poor QoL, elderly patients had a significantly higher median IPSS score (p < 0.05). Conclusions. There is no level of severity of LUTS in which patients QoL is not impaired although mild symptomatology may be associated with better QoL and severe symptomatology with poor QoL. Careful attention to QoL may help identify patients who require early and prompt treatment irrespective of the IPSS.

Awareness and Knowledge of Sexually Transmitted Infections among Secondary School Adolescents in Ado Ekiti, South Western Nigeria.

Objective. To determine the awareness and knowledge of sexually transmitted infections among adolescents in Ado, South Western Nigeria. Methods. The study was a descriptive cross-sectional design. Five hundred and fifty adolescents selected from public and private secondary schools in Ado Local Government Area of Ekiti State were recruited using a multistage sampling technique. Results. Four hundred and ninety-nine (92.4%) respondents had heard about sexually transmitted infections before, the three most important sources of information being electronic media (68.7%); teachers (68.1%); and print media (44.9%). Eighty percent of the respondents knew only one STI and the two most commonly mentioned ones were HIV/AIDS (78.0%) and gonorrhea (23.0%). More than 75% of the respondents knew the modes of transmission of STIs while some of them equally had misconceptions. The most important symptoms mentioned were weight loss (77.4%), painful micturition (68.9%), and genital ulcer (54.1%). On the whole, only 6.9% of the respondents had good knowledge of STIs; the rest had fair and poor knowledge. Conclusion. Secondary school adolescents in Ado Local Government Area have only a fair knowledge of sexually transmitted diseases. STI studies should be inculcated into the school curriculum and media publicity/enlightenment campaigns about them should be intensified.

Comparison of uropathogens and antibiotic susceptibility patterns in catheterized ambulant middle-aged and elderly Nigerian patients with bladder outlet obstruction

OBJECTIVEnAdvanced age is one of the notable risk factors for catheter-associated urinary tract infections (CAUTIs), and differences between middle aged and elderly men with CAUTIs is poorly understood. This study aimed at comparing the pattern of urinary pathogens and antibiotic susceptibility in ambulant catheterized middle-aged and elderly Nigerian men.nnnMATERIAL AND METHODSnOne hundred and fifty-four patients catheterized for >48 hours had provided clean catch mid-stream urine samples for microscopic analysis, culture and sensitivity tests. Eighty-two men aged <65, and 72 men aged ≥65 years matched for age, level of education, occupation and marital status were compared.nnnRESULTSnPrevalence of CAUTIs among middle-aged men was middle-aged men was higher than the elderly (90.2% and 80.6% respectively) but this was not statistically significant (p=0.086). CAUTIs in middle-aged men with suprapubic catheters were significantly more frequent than those with urethral catheters (p=0.000). The prevalence of CAUTIs in middle-aged men with urethral stricture was different from other causes of bladder outlet obstruction (p=0.004). Men with indwelling catheters longer than 2 weeks had higher CAUTIs (p=0.000). Escherichia coli was the commonest pathogen in both groups while nitrofurantoin was the most sensitive drug.nnnCONCLUSIONnThere are differential rates of CAUTIs in both the middle-aged men and the elderly with bladder outlet obstruction in our environment. The knowledge of the common pathogens and the antibiotic susceptibility will prevent irrational antibiotic use. Middle-aged men had higher prevalence of CAUTIs when Proteus spp. was the infectious agent. However, E. coli was the commonest pathogen of CAUTIs in all men. Also, middle- aged men with suprapubic catheters had higher rates of CAUTIs. Nitrofurantoin was the best drug in all men with CAUTIs but elderly men had higher rates of multi-resistance.

Comparison of ease of induction of spinal anaesthesia in sitting with legs parallel on the table versus traditional sitting position

Introduction It is sometimes difficult for some patients to optimally flex their hips and knees making traditional position for induction of spinal anaesthesia difficult to achieve. The ease of induction of spinal anaesthesia was compared with patients in sitting position with legs remaining on the table (new sitting method) versus legs placed on the side stool (traditional sitting method). Methods One hundred eligible elderly patients, aged between 65 and 80 years, scheduled for open prostactectomy, were prospectively randomized to 2 groups, LS and LT. Patients in (LS group) had their spinal anaesthesia induced in sitting position with their legs placed on the stool while patients in (LT group) had their spinal anaesthesia induced in sitting position with their legs remaning on the operating table. The primary endpoint was correct needle placement. Numbers of attempts, needle redirections and patients comfort were determined to compare outcome in the two groups. Results More patients in LS group (78%) than those in the LT group (64%) had successful placement of spinal needle at first attempt (P = 0.12, RR = 1.6, 95% CI = 0.863-3.102). Needle redirections were similar at first attempt (52% versus 40%; P = 0.22). The groups were equivalent with respect to 100% overall success rate (P = 1.000). It took longer time to induce spinal anaesthesia in patients in LS group (240 vs 125s, p < 0.001). Patients in LT were more comfotable. Conclusion The 100% overall success rate was comparable. However, patients were generally more comfortable with their legs placed on the table.

Prevalence and health care seeking behaviour for sexually transmitted infections among in-school adolescents in Ado-Ekiti, South-Western Nigeria.

Abstract Background: In Nigeria, adolescents are highly vulnerable to sexually transmitted infections (STIs) which have the potential of jeopardising their future reproductive lives if poorly treated. Objective: To determine the prevalence and health care seeking behaviour for STIs among secondary school adolescents in Ado, South-Western Nigeria. Subjects: Male and female adolescents aged 10–19 years. Methods: The study employed a descriptive cross-sectional design. A pre-tested, self-administered, semi-structured questionnaire was used to elicit information from 560 adolescents selected from public and private secondary schools in Ado Local Government Area (LGA) of Ekiti State, using a multistage sampling technique. The data were analyzed using descriptive and inferential statistics. Analyzed data were presented in the form of tables and charts. Results: Two hundred and fifty-one (47.1%) respondents had previous symptoms of STIs. The commonest symptoms among the males were penile discharge (30.5%), painful micturition (30.5%) and stomach pain with swollen testes (25.4%). The commonest symptoms among the females were genital itching (27.6%), genital sores (14.1%) and painful micturition (13.1%). Only 26.7% sought treatment from a health facility; 37.0% did nothing; 15.9% went to patent medicine stores, 10.0% used herbs; the rest did self-medication or prayed. Conclusion: The prevalence of STI symptoms among adolescents in Ado-Ekiti is high but their health care seeking behaviour is poor. Health education about the dangers of untreated STI and the importance of seeking treatment early, targeted at adolescents, should be intensified.

Effectiveness of triple therapy regimens in the eradication of Helicobacter pylori in patients with uninvestigated dyspepsia in Ekiti State, Nigeria.

Aim and Objective: The term dyspepsia has been used inconsistently by healthcare professionals to describe different patterns of upper gastrointestinal symptoms. It denotes a symptom and does Original Research Article Solomon et al.; BJMMR, 6(3): 278-285, 2015; Article no.BJMMR.2015.203 279 not itself represent a disease. In this study, we seek to determine the effectiveness of common triple therapy regimens in use in the eradication of H. pylori in this environment and to compare it what is obtained worldwide. Materials and Methods: One hundred and four Consecutive adult patients, aged 18 to 50 years presenting newly with uninvestigated dyspepsia and without alarm symptoms at General Outpatient Clinics of the Ekiti State University Teaching Hospital, Ado-Ekiti and the Federal Medical Centre, Ido-Ekiti, Nigeria were randomized into five treatment groups in the study. Approval was obtained from Ethical Committees of the two study centres. Treatment outcome was computed using frequency table. Results: The mean age of the studied population was 37.8±12.98 years. 32.7% were males while 67.3% were females. Most prevalent symptom for uninvestigated dyspepsia was abdominal discomfort 100 (96.2%), this was followed by early satiety, abdominal fullness and vomiting with 32 (30.8%), 26 (25%) and 13 (12.5%) of the participants respectively. 76.0% were positive for H. pylori infection by Urea Breath Test Heliprobe® System with highest prevalence of H. Pylori infection within age group 31-45 years (36.7%). Rabeprazole-Clarithromycin-Metronidazole group (RCM) had the highest eradication rate per protocol [77.8%], followed in descending order by Rabeprazole-AmoxilLevofloxacin group (RAL) [53.3%], Omeprazole-Tinidazole-Clarithromycin “ulcer kit” (OTC) [44.4%], Rabeprazole-AmoxilMetronidazole group (RAM) [44.4%] and Rabeprazole-Amoxil-Clarithromycin (RAC) [30.0%]. Conclusion: This study showed there is difference in eradication rates of popularly known triple therapy regimens. This may be due to geographical differences in antibiotics resistant pattern to H. pylori. Further study is suggested to find out the national sensitivity pattern to the commonly used triple therapy regimens in Nigeria.

The likelihood of having serum level of PSA of ≥4.0 ng/mL and ≥10.0 ng/mL in non-obese and obese Nigerian men with LUTS

Objective This study was undertaken to determine the likelihood of having serum total prostate specific antigen (PSA) levels ≥4.0 ng/mL and ≥10.0 ng/mL among a cohort of non-obese and obese Nigerian men with lower urinary tract symptoms (LUTS). Methods This was a prospective cross-sectional survey among men who presented with benign prostatic hypertrophy to the urology clinic of the Ekiti State University Teaching Hospital, Ado -Ekiti with LUTS between January 1 and December 31, 2014. One hundred and forty men who presented in the urologic clinic with LUTS were recruited. PSA was analyzed using standard method while other clinical variables were collected using a clinical case form. Multivariate logistic regression was used to estimate the odds of an abnormal PSA of ≥4.0 ng/mL or ≥10.0 ng/mL in these men. Results The mean ages of obese and non-obese men were 64.8 and 64.0 years respectively. The mean total serum PSA were 14.8 and 13.2 ng/mL for obese and non-obese men respectively. Univariate analysis showed no difference (p > 0.05) in the proportion of obese and non-obese men with LUTS who had a PSA threshold of at least 4.0 ng/mL. Multivariate logistic regression showed that, at a PSA threshold of 10.0 ng/mL, obese men had a statistically significant proportion (p < 0.05). Although not significant, non-obese patients were less likely to have PSA level of ≥4.0 ng/mL (OR 0.701; 95% CI 0.301–1.630) compared to obese men. In the same vein, non-obese men were less likely to have a PSA level of 10.0 ng/mL (OR, 0.686; 95% CI, 0.318–1.478) in a simultaneous context of age. Conclusion Our study demonstrated that, in a sample population of predominantly native African men, there was a non-significantly higher likelihood of overweight/obese patients having a higher serum PSA level than the non-obese. A community based study is needed to further confirm this finding.