Timothy Olanrewaju

Interest in neurology during medical clerkship in three Nigerian medical schools.

BackgroundThis study sought to ascertain perception of Nigerian medical students of neurology in comparison with 7 other major medical specialties. To also determine whether neurology was the specialty students consider most difficult and the reasons for this and to appraise their opinion on how neurosciences and neurology were taught in their different universities.MethodsSelf-administered questionnaires were used to obtain information from randomly selected clinical students from 3 medical colleges in Nigeria (University of Ibadan, Ibadan; University of Ilorin, Ilorin; Ladoke Akintola University of Technology, Osogbo).ResultsOf 320 questionnaires sent out, 302 were returned given 94% response rate. Students felt they knew neurology least of all the 8 medical specialties, and were not confident of making neurological diagnoses. About 82% of the students indicated they learnt neurology best from bedside teaching, followed by use of medical textbooks. Close to 15% found online resources very useful for learning neurology and 6% indicated that group discussion was quite useful in the acquisition of knowledge on neurology. Histology and biochemistry were the preclinical subjects participants opined were least useful in learning neurology. The most frequent reasons students felt neurology was difficult were problems with understanding neuroanatomy (49%), insufficient exposure to neurological cases (41%), too many complex diagnoses (32%) and inadequate neurology teachers (32%).ConclusionsNigerian medical students perceived neurology as the most difficult medical specialty and are not interested in specializing in it. Neurology education could be improved upon by provision of more bedside tutorials and increased availability of online resources to enhance learning. There is need to emphasize increased frequency of small group discussions amongst students so that they will be used to teamwork after graduation.

Profile and causes of mortality among elderly patients seen in a tertiary care hospital in Nigeria

BACKGROUND Old age is one of the factors associated with increased risk of dying when admitted to hospital. Therefore, aim of this study was to examine causes and pattern of death among elderly patients managed in a tertiary care hospital in Nigeria with scanty mortality records. MATERIALS AND METHODS This prospective study was on deaths that occurred in patients 60 years and above admitted to University of Ilorin Teaching Hospital (UITH), Ilorin, between January 2005 and June 2007. Excluded were all brought-in-dead during the study period. Information obtained included demographic data, duration on admission, and diagnosis. Causes of death were determined from clinical progress notes and diagnosis. RESULTS A total of 1298 deaths occurred during the study period, of which 297 occurred in persons 60 years and above with crude death rate of 22.8%. The mean age at death was 68 ± 9 years (ranged 60-100 years). This consisted of 59% males and 41% females. Mean age at death for females was 69.7 ± 8.7 years and for males 68.1 ± 9.8 years (P = 0.05). Mean values of serum chemistry were sodium 137 ± 8 mMol/l, potassium 3.6 ± 1 mMol/l, urea 11 ± 8 mMol/l, and creatinine 126 ± 91 μmol/l. The value of mean haemogram concentration was 10.5 ± 3 gm/dl and white cell count was 12 ± 2 × 10(9)/mm3. The three most common diagnoses at deaths were stroke (19.8%), sepsis (16.5%), and lower respiratory tract disease (8.1%). Infectious diseases accounted for 38.2% of all diagnoses. Collective mean length of hospital stay (LOS) at death was 6.8 ± 8.6 (ranged 15 minutes-60 days). Close to 27.4% of the deaths occurred within 24 hours and neurological disorder had shortest hospital stay (4.6 ± 6.3 days), followed by endocrine disorders (6.8 ± 8.4 days) and respiratory diseases (8.4 ± 5.6 days) [P = 0.001]. CONCLUSION Hospital mortality is high amongst older people. Stroke and infectious diseases are leading causes of death. Efforts should be geared toward reducing risk for cardiovascular diseases and improvement on level of personal and community hygiene.

Chronic renal failure in a patient with bilateral ureterocele

Ureterocele is a congenital anomaly, in which there is mal-development of the caudal segments of the ureter. There is a female preponderance with most cases seen in Caucasians. Among the reported complications of this condition, chronic renal failure occurring in the setting of ureterocele has not been well documented. We report a case of a young girl with bilateral ureterocele presenting with chronic renal failure, whose management presented a diagnostic failure and inadequate treatment.

Discharge against medical advice: Experience from a rural Nigerian hospital

Introduction: Discharge against medical advice (DAMA) is a worldwide problem with negative health and socioeconomic effects. Factors that have been implicated as causes or contributing to DAMA include financial constraints, lack of health insurance, deteriorating clinical condition of the patient, and problematic doctor-patient relationships. Aims: determine the incidence and profiles ofDAMA on the medical wards, so as to allows for evidence-based interventions to reduce this problem to a minimum. Materials and Methods: This was a case-control study carried out on the medical wards of Federal Medical Center, Ido-Ekiti, South-West Nigeria. The medical records of all patients admitted to the male and female medical wards between January 2008 and April 2011 were reviewed. After being identified through the admission/discharge log, patients who were DAMA and a similar number of patients with regular discharge had their case notes retrieved. Information extracted included bio-data, diagnosis, duration of hospital stay, and reason for discharge. Results: One hundred and thirty-eight patients representing 7.2% were DAMA during the study period. Ninety five cases had complete medical records, and full analysis was carried out on these and 94 other cases with regular discharge as control. The mean age of the DAMA cases was 50.8 ± 18.3 years, with 58 (61.1%) of these patients being male; while the mean age of the control group was 54.1 ± 16.5, of which 54 (57.4%) were male. The mean duration of admission for patients with DAMA was 10.4 ± 9.2 days as against 11.9 ± 10 in the control group, a difference that is not statistically significant. The associations between type of discharge, sex, and duration of admission are shown through odds ratios of 0.883 and 0.833 respectively. Financial problems (48%), lack of clinical improvement (28.8%) and leaving to seek alternative/complimentary medical care (23.1%) were the factors found to be responsible for DAMA in the study. Conclusion: The incidence of discharge against medicine is high in this study. There is a need for all stakeholders to evaluate factors responsible for DAMA, with the aim of reducing this trend.

Usefulness of renal length and volume by ultrasound in determining severity of chronic kidney disease

To determine the correlation of renal ultrasonic parameters and degree of kidney function among chronic kidney disease patients seen at the Nephrology unit of the University of Ilorin Teaching Hospital (UITH) Ilorin, we studied 322 patients. The results were analyzed with specific reference to socio-demography and correlating renal length and volume with estimated glomerular filtration rate. The male to female ratio was 2:1, with an age range from 20 to 80 years and mean age of 45.06 (±13.0) years. The serum creatinine levels ranged from 201 to 1205 μmol/L, with a mean of 388 ± 168 μmol/L, while the estimated glomerular filtration rate (eGFR) ranged from 3.77 to 44.32 mL/min, with a mean of 18.2 ± 7.19 mL/min. The right and left renal lengths ranged from 6.9 to 13.0 cm, with a mean of 9.11 ± 1.06, and 6.5-13.4 cm, with a mean of 9.23 ± 1.07 cm, respectively. The mean volumes of the right and left kidneys were 98.6 ± 41.9 cm 3 and 105 ± 46.2 cm 3 , respectively. The Pearson correlation of the right and left kidneys length to eGFR were -0.197 and -0.137 respectively, while that of the right and left kidney volume to eGFR were -0.122 and -0.043, respectively. Our study showed that there is a positive correlation between ultrasonic renal measurements and degree of kidney function.

Cardiac autonomic dysfunction in sickle cell anaemia and its correlation with QT parameters

Background: Abnormalities of QT parameters together with cardiac autonomic neuropathy (CAN) confer significant risks of cardiac morbidity and mortality in patients with diabetes mellitus. We questioned whether or not CAN influences occurrence of QT interval prolongation and dispersion in patients with sickle cell anaemia (SCA). Materials and Methods: Forty stable adult sickle cell patients with 44 healthy haemoglobin AA controls were studied. Baseline electrocardiograms were obtained and cardiovascular autonomic function tests were performed using standard protocols. Results: Mean corrected QT (QTc) in sickle cell patients was significantly higher (P = 0.001) than the mean of controls. Similarly, mean QT dispersion (QTcd) was higher (P = 0.001) in the former than in the latter. Mean QTc in patients with CAN was longer than patients with normal autonomic function (461 ± 26 ms versus 411 ± 23 ms), P = 0.001 (OR of 17.1, CI 3.48–83.71). Similarly, QTcd was higher (P = 0.001) in patients with CAN than those with normal cardiac autonomic function. Positive correlations were found between CAN with QTc and QTcd (r = 0.604, P = 0.001, r = 0.523, P = 0.001, respectively). Conclusion: CAN is a risk factor for abnormalities of QT parameters in SCA and both may be harbinger for cardiac death.