Roseline Duke

Angiotensin II type 1 receptor A1166C gene polymorphism and essential hypertension in Calabar and Uyo cities, Nigeria.

OBJECTIVES: The angiotensin II protein is a vasoconstrictor that exerts most of its influence through the angiotensin II type 1 receptor (AT1R). Inconsistent association between the A1166C polymorphism of the AT1R gene and hypertension has been reported among various populations but not among the peoples of Calabar and Uyo. This study was designed to determine the frequency of the A1166C polymorphism of the AT1R gene and its association with hypertension in a sample population of Calabar and Uyo. MATERIALS AND METHODS: A population-based case control design consisting of total of 1224 participants, 612 each of patients and controls were randomly recruited from hypertension clinics and the general population. Genotyping of the A1166C allele of the AT1R gene to identify variants was performed using polymerase chain reaction and restriction enzyme digestion. Multiple regressions were applied to test whether the A1166 genotypes were predictors of hypertension. RESULTS: 99% of the study population had the wild type AA genotype, and 1% was AC heterozygous carriers of the A1166C polymorphism. CONCLUSION: The A1166C polymorphism was not a predictor of hypertension in the sample population of Calabar and Uyo.

A Case of Orbital Rosai-Dorfman Disease with IgG4 Positive Plasma Cells

Abstract A case of a 9-year-old Black African male with right-sided proptosis is presented. The clinical interpretation was that of orbital rhabdomyosarcoma and an incisional biopsy was performed. This revealed the typical features of Rosai-Dorfman disease, featuring S100 positive non-Langerhans histiocytes with emperipolesis. There were also numerous plasma cells in the biopsy, in the more fibrotic areas. More than 40% of these plasma cells were positive for IgG4. This case represents the first case in the orbit to make the association of IgG4 plasma cell positivity with Rosai-Dorfman disease. Potential associations are discussed, and the relevance of this finding to ophthalmic pathology interpretation and differential diagnosis are highighted.

Systemic Comorbidity in Children with Cataracts in Nigeria: Advocacy for Rubella Immunization

Background. Congenital and developmental cataracts are leading causes of childhood blindness and severe visual impairment. They may be associated with systemic diseases including congenital heart diseases which are among the major causes of morbidity and mortality in childhood. The pattern of systemic comorbidities seen in children diagnosed with cataract in Calabar, Nigeria, was studied. Methods. A retrospective review was conducted on the children who had cataract surgery between 2011 and 2012. Diagnosis of the systemic condition was documented. Results. A total of 66 children were recruited for the study. Cardiac disease was seen in 26 children (39.9%), followed by delayed milestone in 16 (24.2%), intellectual disability in 14 (21.2%), deafness in 11 (16.7%), epilepsy in 4 (6.1%), and physical handicap in 3 (4.5%) of them. Clinically confirmed Congenital Rubella Syndrome was seen in 30 (45%) of the children. The pattern of CHD seen was as follows: patent ductus arteriosus in 16 (24.2%) followed by ventricular-septal defect in 5 (7.6%), atrial-septal defect in 3 (4.5%), and pulmonary stenosis in 2 (3%). Conclusion. Systemic comorbidities, especially cardiac anomalies, are common among children with cataract in Nigeria. Congenital Rubella Syndrome may be a prominent cause of childhood cataract in our environment. Routine immunization of school girls against rubella is advocated as a measure to mitigate this trend.

Challenges faced by key informants practicing case finding for vision loss in children: the experience in Cross River State, Nigeria

BACKGROUND To identify challenges faced by key informants (KIs) in a childhood blindness and severe visual impairment survey in Cross River State (CRS), Nigeria. METHODS Based on eligibility 742 KIs were selected by their village/clan heads in the 18 local government areas (LGAs) of Cross River State. After training in each LGA, KIs were to identify children with visual problems. KIs used a number of methods to identify children with vision loss. After the case detection period, KIs were requested to bring children suspected of vision problems to a central site for examination. Following this, an interviewer-administered semi-structured interview was used to obtain information from the KIs. Thematic content analysis was used to identify these challenges. RESULTS Among the 742 KIs, 642 did not provide any comment on challenges during interview; 100 KIs reported challenges. Major challenge themes identified were issues related to the family of the child and issues related to operational conditions, principally transportation, communication, and incentives. CONCLUSIONS It is likely that challenges were under-reported. Research is needed to understand why some parents feel stigmatized by having children with vision problems. Community based programmes need to strengthen community awareness, address trust issues, and ensure transportation and communication are improved in order to enhance programme success.

Refractive errors and spectacle use behavior among medical students in a Nigerian medical school.

Aim: To determine the prevalence of refractive errors and spectacle use behavior among medical students in University of Calabar Teaching Hospital, Nigeria. Study Design: Cross sectional study. Place and Duration of Study: Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria, between April 2010 and July 2010. Methodology: The study population consisted of fifth year medical students. Subjects had cycloplegic auto refraction with Topcon auto refractor during their rotation in ophthalmology at the Ophthalmology department of the University of Calabar Teaching Hospital. A spherical equivalents (SE) ≥ +0.50D were determined as hyperopia; SE of >Original Research Article British Journal of Medicine & Medical Research, 4(13): 2581-2589, 2014 2582 0.50D myopia and >-0.50D cylinder as astigmatism. Statistical analysis, which included chi-square test was carried out with Statistical Package for Social Sciences (SPSS) version 20.0. Results: Sixty-six (79.5%) of subjects had a form of refractive error; 63.6%%, 16.7% and 19.7% were myope, hyperope or simple estigmat, respectively. The prevalence of ametropia was 82% in female and 78% in males. The association between refractive errors and gender was not statistically significant (p = 0.35, 95% Confidence Interval [CI], 0.34-0.36).Minus spherical errors ranged from -0.16 to -5.25 diopters (D) and plus spherical errors ranged from +0.25 to +1.00D, spherical equivalent between -0.25D and 2.75D being the most common type (85.5%). Eight students (12.1%) were wearing glasses at the time of the study corresponding with 10 (15.2%) who had eye pains while reading. Conclusion: The prevalence of refractive errors among fifth year medical students of the University of Calabar was high and eyeglasses were worn by students who were symptomatic.

Challenges in the management of glaucoma in university of Calabar teaching hospital, Calabar, Nigeria: A 10 year review

Background: Glaucoma is a common cause of blindness in developing nations. The objective of this study is to determine the severity of primary open angle glaucoma and audit health records of glaucoma patients in our center. Materials and Methods: A retrospective case note search of glaucoma patients from out-patient clinic was carried out between January 2001 and December 2010. Data analysis included descriptive statistics and exact binomial 95% confidence interval (CI) calculated for the mean estimates. Results: Seventy-six patients (152 eyes), comprising 49 (64.5%) males and 27 (35.5%) females were included in the study. The age ranged from 15 to 88 years (mean: 54.2 ± 14.5). Forty-five (59.7%) presented with normal vision and 10 (13.2%) had visual acuity 0.6 0.9 = 35 (46.1%) and left eyes were 15 (19.7%), 29 (38.2%), 28 (36.8%), respectively. Mean intraocular pressure (right eyes) at presentation was 20.3 mmHg (95% CI, 17.4-23.3) and reduced to 13.4 mmHg (95% CI, 10.7-16.0) at the last readings while left eyes from a mean of 20.3 mmHg (95% CI, 16.9-23.8) reduced to 12.1 mmHg (95% CI, 10.0-14.3). The mean presenting CDR were 0.79 (95% CI, 0.74-0.83) and 0.73 (95% CI, 0.68-0.79) in right and left eyes, respectively. CDR showed statistical significance with age ( p 2 -test) but not with sex ( p = 0.807). Conclusion: Late presentation of glaucoma cases is a major problem in Calabar. We recommend public enlightenment, case detection, and early treatment to reduce ocular morbidity.

Evaluation of a Public Child Eye Health Tertiary Facility for Pediatric Cataract in Southern Nigeria I: Visual Acuity Outcome

Purpose: A retrospective study of the outcome of congenital and developmental cataract surgery was conducted in a public child eye health tertiary facility in children <16 years of age in Southern Nigeria, as part of an evaluation. Materials and Method: Manual Small Incision Cataract Surgery with or without anterior vitrectomy was performed. The outcome measures were visual acuity (VA) and change (gain) in visual acuity. The age of the child at onset, duration of delay in presentation, ocular co-morbidity, non ocular co-morbidity, gender, and pre operative visual acuity were matched with postoperative visual acuity. A total of 66 children were studied for a period of six weeks following surgery. Results: Forty eight (72.7%) children had bilateral congenital cataracts and 18 (27.3%) children had bilateral developmental cataracts. There were 38(57.6%) males and 28 (42.4%) females in the study. Thirty Five (53%) children had good visual outcome (normal vision range 6/6/ -6/18) post-operatively. The number of children with blindness (vision <3/60) decreased from 61 (92.4%) pre-operatively to 4 (6.1%) post-operatively. Post operative complication occurred in 6.8% of cases six week after surgery. Delayed presentation had an inverse relationship with change (gain) in visual acuity (r = - 0.342; p-value = 0.005). Pre-operative visual acuity had a positive relationship with post operative change (gain) in visual acuity (r = 0.618; p-value = 0.000). Conclusion: Predictors of change in visual acuity in our study were; delayed presentation and pre-operative VA. Cataract surgery in children showed clinical benefit.

Vernal Keratoconjunctivitis in Public Primary School Children in Nigeria: Prevalence and Nomenclature

Objective. This study sought to add to the body of information on the prevalence and pattern of vernal keratoconjunctivitis (VKC) among school aged children in Cross River State, Nigeria. Method. A cross-sectional survey of children in public primary schools in Cross River State, Nigeria, was studied for VKC. Five schools were included, using a multistage sampling technique. Comprehensive eye examinations were conducted in one thousand two hundred and twenty-six (1226) school children. Main Outcome Measures/Results. The mean age of the population of 1226 school attending children was . The prevalence of VKC was 18.1% in this population study. The ratio of males to females is 1.8 : 1. The clinical grading of the 223 children with VKC is as follows: 43 (19.3%) quiescent, 134 (60.1%) mild, 44 (19.7%) moderate, and 2 (0.9%) severe VKC. The clinical types reported are as follows: limbal 67 (30.0%), tarsal 105 (47.1%), and mixed 51 (22.9%). The clinical types were used to describe a modified nomenclature. Conclusions. Vernal keratoconjunctivitis is a commonly occurring chronic condition and an important public health problem. A simple diagnostic nomenclature for describing VKC for primary health care workers is recommended.

Evaluation of Competence of Medical Students in Performing Direct Ophthalmoscopy

Aim: The aim was to determine the competence of medical students in performing direct ophthalmoscopy. Materials and Methods: It was a cross-sectional study whereby year 5 medical students were assessed during Objective Structure Clinical Examination (OSCE) at the end of 4 weeks clinical rotation in ophthalmology. Every student had 5 min in each OSCE station, including the station for direct ophthalmoscopy. The correctness or otherwise of students′ quantitative assessment of cup-disc ratio (CDR) was analyzed using Statistical Package of Social Sciences (SPSS, USA) version 20.0. Result: A total of 96 students were assessed in 6 groups over a 6 months period; age range was 20-33 years and a mean age of 24.8 ± 3.2. There were 57 males and 39 females (M:F = 1:0.25). Seventy-eight (81.3%) were satisfied with teachings and tutorials on direct ophthalmoscopy. Eighty-nine (92.7%) admitted visualizing the disc in the course of tutelage while 7 (7.3%) had never seen the disc with the direct ophthalmoscope. The retinal vessels were seen with the ophthalmoscope by 93 (96.9%). Direct Ophthalmoscopy was not considered to be difficult by 87(90.6%). Forty-six (47.9%) got CDR correct on the right eyes while 50 (52.1%) got it correct on the left eyes. There was statistically significant relationship between the group students belonged and performance with χ2 = <0.001. Conclusion: Based on the CDR benchmark, students′ performance was not satisfactory.

Presenting Visual Acuity and Ocular Comorbidity in Patients with Primary Open Angle Glaucoma in a Private Tertiary Eye Center in Nigeria.

ABSTRACT Purpose: To determine the presenting visual acuity (VA) of patients with primary open angle glaucoma (POAG) and the relationship to ocular comorbidity. Materials and methods: A retrospective case note audit was undertaken in Eye Foundation Hospital, Calabar, between 1st January 2010 and 31st June 2011. The case notes of all newly presenting patients diagnosed with POAG were retrieved and data were extracted for analysis. Inclusion criteria for glaucoma was defined. Results: Out of a total of 320 new patients, 88 patients were diagnosed with POAG, with a prevalence of 27.5% (95% CI: 22.7-32.7). The mean age for males is 57.1 ± 8.8 while that of females is 52.6 ± 11.2 and the total mean of 55.8 ± 9.7. Of the 88 patients, there were 84 self referrals [95.5% (95% CI: 88.8-98.7)], of these, 45, 53.6% (95% CI: 42.4-64.5) were for second opinion. There was no statistical significance between the gender, education and occupation and the level of VA seen on presentation. The best corrected visual acuity (BCVA ) in the right and left eye respectively, was significantly (p < 0.0001) related to the cup disk ratio. Ocular comorbid conditions were seen in 19 (22%) patients in the study. The presenting BCVA was significantly related to the presence of ocular comorbidity in the best eye. Comorbidity was not strongly related to the age of the patients. Conclusion: The course of glaucomatous progression is highly variable, identifying factors that not only predict progression but influence the VA and ocular health of the eye can help to guide clinical practice and patient treatment and monitoring. How to cite this article: Duke R, Akinye A, Ameh S. Presenting Visual Acuity and Ocular Comorbidity in Patients with Primary Open Angle Glaucoma in a Private Tertiary Eye Center in Nigeria. J Current Glau Prac 2013;7(1):6-10.