Management of Lower Urinary Retention in a Limited Resource Setting

Background: There is a projected increase in lower urinary tract obstruction by 2018, especially in the developing economies of Asia and Africa. However in many of these countries, the problems encountered both by the patients and the clinicians are not well documented. Our aims are, to prospectively analyse the management of urinary retention, the associated difficulties, and complications in our setting, where access to investigative modalities such as Computerize Tomography and Magnetic Resonance Imaging are not available.Patients and Methods: The study was approved by the University Of Calabar Teaching Hospital ethical committee. A validated Proforma was used to collect data from all patients who were clinically diagnosed with urinary retention based on history, and physical examination, from July 2009 to June 2010. Data collected from the 1st of July 2009 to the 30th of June 2010, include demographics, findings on physical examination, previous medical history and co-morbid conditions. The results of investigations done such as: urinalysis, full blood count, electrolytes, urea and creatinine, intravenous urography, trans- abdominal ultrasonography, chest X-ray and histology of trans-rectal biopsies of the prostate . The total number of new patients seen, including those with urinary retention during the study was documented. The retentions were also classified into acute and chronic. All the patients were followed up throughout the study. The data was analysed using Epi-Info statistical program version 3.4 of 2007 to analyse the data, estimating averages, mean, median and percentages. Results: The total number of new patients seen, including those with urinary retention was Seventy thousand, one hundred and thirty nine (70,139).Of this number, hundred and fifty nine (0.23%), presented with urinary retention; 145 (91.2%) were acute, and14 (8.8%) were chronic. The male: female ratio was 39:1.The patients ages ranged from 4 to 94 years, with a mean of 53.7±11.2. Seventy seven [48.4%] of them were in the 6th and 7th decades of life. The common causes were; prostatic diseases [BPH and cancer of the prostate] 77.0%, infections 75.8%, trauma 12.1%, and congenital 12.1%. Urinary retention was relieved by: indwelling urethral catheterization [IUC] 120 patients (75.5%), supra- pubic cystostomy [SC] 34 (21.4%) and intermittent urethral catheterization [IC] 5 (3.1%). The most frequently encountered complications include pyuria (18.2%), pericatheter sepsis 17.5%, and haemorrhage during change of catheter 16.8% [figure 2].Conclusion: Lower urinary retention is common in our environment. The management is appropriate and standard. The man power and facilities are inadequate, and requires urgent improvement.Keywords: Urinary retention; management; limited resource

Anatomical classification of the shape and topography of the stomach

The aim of the study was to present the classification of anatomical variations of the stomach, based on the radiological and historical data. In years 2006–2010, 2,034 examinations of the upper digestive tract were performed. Normal stomach anatomy or different variations of the organ shape and/or topography without any organic radiologically detectable gastric lesions were revealed in 568 and 821 cases, respectively. Five primary groups were established: abnormal position along longitudinal (I) and horizontal axis (II), as well as abnormal shape (III) and stomach connections (IV) or mixed forms (V). The first group contains abnormalities most commonly observed among examined patients such as stomach rotation and translocation to the chest cavity, including sliding, paraesophageal, mixed-form and upside-down hiatal diaphragmatic hernias, as well as short esophagus, and the other diaphragmatic hernias, that were not found in the evaluated population. The second group includes the stomach cascade. The third and fourth groups comprise developmental variations and organ malformations that were not observed in evaluated patients. The last group (V) encloses mixed forms that connect two or more previous variations

Gunshot injuries in Calabar, Nigeria: an indication of increasing societal violence and police brutality

BACKGROUND: Gunshot injuries were rare in Calabar before the Nigerian civil war. This has changed in subsequent years and has reached a near epidemic proportion in the last three years. These are caused by civil violence, police brutality and armed robberies. OBJECTIVE: To evaluate the incidence, pattern and causes of gunshot injuries in this region and draw the attention of Nigerians and the Government to the above problems for a possible solution. METHODOLOGY: Records of patients admitted into the University of Calabar Teaching Hospital (UCTH) with gunshot wounds between April 2002 and May 2004 were extracted. Parameters analyzed included patients' biodata, sources of injury, anatomical site (s) of injury, modalities of treatment and the outcome RESULT: There were 51 injuries in 49 patients as follows: The lower limbs 25 (51%), upper limbs 6 (12.4%), upper limbs/ chest 2 (4.1%), chest 4 (8.2%), abdomen 7(14.1%) and head/neck 5(10.2%). Male/female ratio was 48:1. Twenty-four (49%) sustained their injuries from either accidental discharge or deliberate shooting by the police while armed robbers wounded 10 (20.4%) and cultists, 2 (4.1%). Two patients had amputations and mortality was 8.2%. CONCLUSION/RECOMMENDATIONS: The police should be cautious with guns; they and the Government should be alert to the menace of robbery, political violence, cultism and communal clashes. Good Governance, creation of employment, eradication of corruption and political violence may help

Tourism potential of the confluence between river Niger and river Benue in Nigeria: implication for project finance

Abstract Introduction This research proposes the development of the confluence of river Niger and river Benue in Nigeria as a viable international tourist center. Case description The confluence of river Niger and river Benue in Lokoja Nigeria, is the site proposed for intervention. The study recommends the use of the mechanism of project financing for the funding of the project by the government. Discussion and Evaluation. Existing studies indicates that inadequate empirical data on viability of investments in most tourism destinations in Nigeria has been a challenge to investors as well as policy makers. Using the case study method which also included actual site visitation for on the spot assessment, this paper attempts to provide information on the prospects of tourism development in Lokoja town of Nigeria by simulating real-world scenarios. The research found that investments in tourism in Lokoja town has better viability prospects with the application of Project finance models of Management Contract and Forfeiting Contract. Conclusion The study showed that the confluence of river Niger and river Benue can be developed based on the methods outlined above and that the project can be a great benefit to tourists, investors and the government