OBJECTIVE: To determine the risk factors that predispose patients to post-caesarean wound infection at a tertiary health institution in developing country. METHOD: It was an observational study of all women that had caesarean (elective and emergency) delivery between July and September, 2004. The outcome of their post-caesarean wound was assessed. Statistical analysis (Bivariate and logistic regression) of the identified risk factors in patients who developed wound infection was performed at a 95% level of confidence. RESULTS: The post-caesarean wound infection rate was 16.2%. The identified risk factors were lower educational status, multiple pelvic examination, offensive liquor at surgery and patients that are unbooked. Following logistic regression, women with up to primary school were 20 times more likely than those with secondary education and above to develop wound infection (95% CI OR = 1.8 to 250.0). CONCLUSION: The outcome showed that the identified determinants of post-caesarean wound infection were comparable with earlier reports. Women with lower educational status are more at risk in this study. Therefore, these women need special attention to reduce the risk.

OBJECTIVES: To screen non-diabetic hypertensive Nigerian patients with a view to determining their haematological and coagulation profiles. SUBJECTS AND METHODS: Thirty (30) consecutive non-diabetic hypertensive patients, aged 20-60 years and 30 age and sex-matched, apparently healthy subjects, were investigated for some haematological and coagulation parameters, blood pressure, pulse, body weight, height and body mass index. RESULTS: There were statistically significant differences (p < 0.05), in some haematological parameters, blood pressure, body mass index and height in the total number of patients studied when compared with the total control group. The separate genders each showed statistically significant differences in both haematological parameters and blood pressure (P < 0.05) when compared with their corresponding control groups. In addition, haematological values, body mass index and height showed statistically significant differences (p < 0.05) when the male and female patients were compared. Overall, 25 (83.33%) of the patient's blood films were normochromic and normocytic. CONCLUSION: It appears that hypertension has adverse effects on haematological parameters. We therefore recommended that coagulations studies should be included in the investigation work-up of hypertensive patients.

BACKGROUND:Accurate and reliable diagnosis of HIV plays a central role in any effective HIV intervention. We decided to evaluate 4 commercial HIV test kits to determine their reliability for use in developing countries. METHODS: Serum samples obtained from clients accessing tertiary health services at the STI clinic, Jos University Teaching Hospital were used to evaluate Sdbioline, Diaspot, Determine and DIALAB Elisa kits. A Western blot was used as the reference kit. RESULTS: DETERMINE kit gave 34 positive and 58 negative reactions and the positive sera were all confirmed by Western blot while DIASPOT kit gave 27 false negative results, which was at variance with the reference kit result. Other kits were SDBIOLINE with 5 false positive and DIALAB Elisa kit, which gave one false positive, and one false negative result. CONCLUSION: We conclude that Determine, SDbioline and DIALAB Elisa kits are reliable for HIV antibody testing in Nigeria and other developing countries.

INTRODUCTION: Hypertension is associated with increased morbidity and mortality. Paradigm shift and novel drugs that go beyond blood pressure control have debuted in the last decade globally and in Nigeria. The study therefore proposed to investigate the effect of the above if any on hypertension related acute deaths in patients admitted to the emergency room of the Lagos University Teaching Hospital. METHOD: Autopsy reports for bodies deposited from the medical emergency room (ER) were reviewed. Details of the time of admission, time of death and blood pressure status prior to the event were obtained. Subjects were batched into two groups 1982 1991 and 1992 2001 based on periods of paradigm shift in hypertension diagnosis and management. RESULT: There were 297 hypertension related deaths but 252 were analyzed. There were 168 (66.7%) males and 84 (33.3%) females (M:F 2:1) and mean age was 47.33 +/- 12.18 years (14-85 yr). Two thirds of the subjects (65.5%) were = 50 yrs of age. The mean duration of admission was 5.88 +/- 6.41 hours. One third (35.3%) died within an hour of admission. The commonest causes of death were stroke (52.8%) and heart failure 103 (40.9%). Intra-cerebral hemorrhage was the commonest type of stroke seen, 69 (52.3%). There were fewer cases of acute deaths in the second decade under review 95 (37.7%) vs. 157 (62.3%), p = 0.02 and strokes during this period, 47 (49.47) Vs 86 (54.78), p = 0.06. CONCLUSION: There is a trend towards reduction of hypertension related acute deaths. However stroke remains a major cause of acute hypertensive death and the patients are still dying young.

BACKGROUND: Biochemical laboratory investigations potentially contribute to the diagnosis of over 50-75% of couples being investigated for infertility. Both hormonal and anti-hormonal treatments have achieved great successes in the treatment of infertility. Our aim therefore was to investigate the pattern of biochemical abnormalities in females diagnosed as infertile form anovulation. MATERIAL AND METHODOLOGY: One hundred and twenty women diagnosed clinically as primary or secondary infertility from anovulation referred from the gynecological clinic of UITH and private hospitals in Ilorin were investigated by routine fertility test profile. RESULT: The age ranged between 20-40 years (mean = 32.9, sd +/- 4.7) for the primary infertility and 23-47 years (mean = 34.4, sd +/- 5.4) for the secondary infertility groups respectively. Ninety six (80%) subjects were found to have hormonal abnormalities. Pattern of biochemical diagnosis amongst the 33 (34.4%) primary infertility subjects included hypergonadotrophic hypogonadism 21 (63.6%), hypogonadotrophic hypogonadism 9 (27.3%), and hyperprolactinemia 3 (9.1%). Among the 63 (65.6%) cases of secondary infertility, there were 31 (49.2%) cases of hypergonadotrophic hypogonadism, 30 (47.6%) hypogonadotrophic hypogonadism, and 2 (3.2%) hyperprolactinemia. There was no statistical difference in the mean values in the various biochemical parameters. CONCLUSION: Hormonal profile should be a goal standard in the diagnosis of anovulation.

BACKGROUND: Neuro-imaging is generally considered as part of the evaluation of seizures and epilepsy. There is limited information about its usefulness in our environment. We describe the pattern of CT findings in children with seizures in our environment. METHOD: We carried out a retrospective review of the computerized tomography findings in children with recurrent seizures over a one year period, November 2005 to October 2006. RESULTS: During the study period, 49 infants and children had computerized tomography performed on them out of which 19 had CT done for recurrent seizures. They ranged in age from 4 months to 16 years with 13 of them being boys. Generalized tonic--clonic seizures was the most predominant seizure type, being present in 10 of the 19 (52.6%) children while simple partial seizure, myoclonic jerk and mixed seizure types were present in 2 cases each. Abnormal scan was demonstrated in 10 of the 19 children (52.6%) with 3 of them having double cerebral lesions, giving a total of 13 cerebral lesion demonstrated by the CT scan. Cerebral infarct was the most common lesion demonstrated, being present in 5 of the 13 lesions (38.5%). Others were cerebral atrophy in 4 cases (30.8%), moderate ventricular dilatation 2 (15.4%) and 1 each ofporencephalic cyst, hydrocephalus and linear skull fracture. Of the 10 children with abnormal scan, 90% of them had significant past medical history, with birth asphyxia (44.4%) and meningitis (33.3%) being the commonest significant past medical history in them. CCONCLUSION There is a high incidence of abnormal scan findings in children with seizure disorder in our environment compared to what is obtained from the developed countries. Cerebral infarct appears to be the most common abnormal CT findings in our children with seizures.

OBJECTIVES: Efficient pre-hospital transport (emergency medical services, EMS) is associated with improved outcomes in road traffic injuries (RTI). This study aims to discover possible interventions in the existing mode of transport. METHODS: Persons bringing all RTI victims to the Emergency room (ER) over a 4-year period and the injury arrival intervals were noted prospectively. FINDINGS: There were 2,624 patients (1,886 males and 738 females); only 2,046 (78%) had clear documentations of three categories of persons bringing victims to ER: Relatives (REL, 1,081, 52.83%); Police/Federal Road Safety Corps (P/F, 827, 40.42%) and Bystanders (BS, 138, 6.74%). No intervention was provided during transport: Within 1 hour, 986 victims (48.2% of 2,046) arrived ERbrought by P/F (448, 21.9%), REL (439, 21.5% of 2,046), and BS (99, 4.8%). These figures, in each instance, represent 40.6 % of total victims brought by REL; 54.2% by P/F and 71.7% by BS. However, after 6 hours, REL were the main active group as they brought 94.5% (359 of 380) patients of this period. In 91 victims (4.4%) the injury arrival time was not captured. CONCLUSION: This study has identified three groups of persons involved in pre-hospital transport with nearly 50% getting to ER within 1 hour without any intervention or prior notification of ER. Absence of EMS obscures pre-hospital death records. The P/F responsible for only 40% of transport should be trained and equipped to offer basic trauma life support (BTLS). The REL and BS (both responsible for 60% of transport) represent a pool of volunteers for BTLS to be trained.

Health care workers who have occupational exposure to blood and other potentially infectious materials are at increased risk for acquiring blood-borne infections. The emotional impact of a needle-stick injury can be severe and long lasting, even when a serious infection is not transmitted. OBJECTIVE: To assess the prevalence and attitude towards needle-stick injuries by Nigerian gynaecological surgeons. METHODOLOGY: A cross-sectional study was conducted at the 40th Annual General Meeting and Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) held in Ibadan, southwest Nigeria from the 23rd to the 26th of November 2005. Data was collected using a self-administered questionnaire. RESULTS: Seventy two questionnaires out ofa hundred administered were finally analysed. Sixty-five (90.3%) respondents had experienced needle-stick injuries in the workplace. This occurred in the majority of cases (86.2%) during suturing. Only 9.2% of those experiencing a needle-stick injury took the correct or appropriate action afterwards. Consultants were not significantly more likely than Residents to take appropriate actions after needle-stick injuries (p > 0.10, X2 = 2.11, 1 df). Fifty-two (80%) of those with needle-stick injuries did not report the incident to the appropriate office. Only 26 (37.1%) of 70 respondents indicated the presence of a needle-stick policy in their centres. Conclusion: The prevalence of needle-stick injuries among sampled Nigerian gynaecological surgeons is high. Majority are either unaware or do not take appropriate actions after exposure to hazardous body fluids from needle-stick injuries, either through first-aid steps or post-e4posure prophylaxis. All health institutions should have a working needle-stick policy in their centres, and health care workers continually educated on it.

BACKGROUND: One of the leading causes of death from malignancies is cancer of the large gut. Elsewhere in the developed world, the disease severity and operative mortality are falling due to increased use of screening, earlier diagnosis and improvement in surgical techniques. AIM: To report our experience with this disease at the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto. PATIENTS AND METHODS: This is an 8-year retrospective analysis (January 1998 December 2005) of all established cases of large bowel cancer managed at the surgical services of the Usmanu Danfodio University Teaching Hospital (UDUTH), Sokoto. RESULTS: A total of 40 cases of colorectal cancer were seen in this centre during the study period. There were 21 (52.5%) males and 19 (47.5%) females, representing a male: female ratio of approximately 1:1. The modal age was the 5th decade. The youngest patient was 15 years old. Forty-two percent of patients were below 40 years of age. All were symptomatic at time of detection. There was no patient in Dukes' stage A category. Nineteen (47.5%) were stage D at presentation. Potentially curative resection was performed in 5 (12.5%) patients. Another 22 (55.0%) cases had palliative surgical treatment. The remainder were either inoperable (n= 3; 7.5%), refused colostomy (9; 22.5%) or died before surgical treatment (1; 2.5%). Among those who were surgically treated, 6 (22.2%) died within 30 days of operation. The mean duration of post-operative follow up was 16 months (5 67 months). CONCLUSION: Cancers of the large intestine are not uncommon in this part of the world. A rising frequency of colorectal cancers in our locality is observed. Presentation to hospital is usually late. A significant number of patients are below 40 years of age.

BACKGROUND AND OBJECTIVES: Several risk factors predispose the diabetic patient to foot ulceration, including "inadequate care of the foot". This risk factor for foot ulceration has not been previously evaluated among Nigeria diabetic patients and is the objective of this study. SUBJECTS AND METHODS: One hundred and twenty (120) diabetic patients with and without symptoms of peripheral neuropathy receiving care at the medical outpatient department (MOPD) and the diabetic clinic of the Nnamdi Azikiwe University Teaching Hospital Nnewi were recruited consecutively as they presented. They were administered structured questionnaires to assess some variables concerning care of their feet as provided to them by their physicians. RESULTS: Among the 120 diabetic participants, 83 (69.2%) had neuropathic symptoms (the symptomatic participants) while 37 (30.8%) were asymptomatic (the asymptomatic participants). Eighty (80; 96.4%) of the symptomatic vs 36 (97.3%) of the asymptomatic participants had never had their feet examined by their physician. Also, 26 (31.3%) of the symptomatic vs 12 (32.4%) of the asymptomatic participants had never received any form of advice on how to take special care of their feet by their physician, and 26 (31.3%) of the symptomatic vs 6 (16.2%) of the asymptomatic participants walked unshod most times in their immediate surroundings. CONCLUSION: Physicians do not provide adequate care to the feet of their diabetic patients irrespective of the presence or absence of neuropathic symptoms, making this variable a critical risk factor for diabetic foot ulceration and amputation. Continuing medical education to health care providers emphasizing adequate "care of the foot" of the diabetic patient, will reduce avoidable loss of limbs to diabetes.

AIMS: A descriptive study to determine the pattern of gynaecological consultations at Ladoke Akintola University of Technology Teaching Hospital, and to know the factors that determine the pattern as well as the outcome of such consultations. MATERIAL AND METHODS: The case notes of all the patients that attended the gynaecology clinic between 1st January 2004 and 31st December 2005 were studied. RESULTS: Two hundred and fifty patients attended the gynaecology clinic during the study period, however, 208 (83.2%) case notes were available for analysis. Most of the patients that had gynaecological consultations during the study period were married (88.0%), and infertility (48.1%) was the commonest reason for the consultations. Many of the patients (60.1%) did not receive definitive treatment for their consultation. CONCLUSION: Infertility being the commonest reason for gynaecological consultations, and tubal factor the commonest cause of infertility, there is need to establish assisted reproductive technology in public health institutions to render services at a highly subsidized rate in helping this population of patients who could not afford this treatment which is presently being offered by private health institutions.

BACKGROUND: Ligation excision haemorrhoidectomies are usually done on inpatient basis. Over the years however, there has been an increase in the numbers done on outpatient basis. This retrospective review was conducted to evaluate the results of day case haemorrhoidectomy in a developing country. MATERIALS AND METHODS: Forty three consecutive patients, who met the criteria for day case surgery, had ligation excision haemorrhoidectomy, between January 2004 and September 2005 at the Royal Victoria Teaching Hospital (RVTH) Banjul with the intention of same-day discharge from hospital. For each patient, data collected included age, sex, duration of symptoms, degree of haemorrhoids, and duration of rest after the procedure in minutes or hours, whether the patient was discharged same day or needed admission for complications. Local anaesthesia, 1% lignocaine was used for all the patients. RESULTS: Forty three patients comprising 28 males (65.1%) and 15 females (34.9%), with a male female ratio of 1.87:1 underwent planned day case haemorrhoidectomy. Their mean age was 36.27 +/- 10.26 years and range was 25 to 56 years. Forty patients (93%) were discharged on the same day of surgery after a rest period in the day care theatre ranging between 25 minutes and 60 minutes with a mean of 41.2 +/- 11.08 minutes. Three (7%) of the patients required admission, two for acute urinary retention and control of excessive pain and the other 5 days postoperative on account of secondary haemorrhage. Pain control was achieved by oral non steroidal antiinflammatory agents. There were no deaths and majority of the patients were satisfied with the procedure. CONCLUSION: Ligation excision (Milligan-Morgan) haemorrhoidectomy is safe and can be performed successfully on out patient basis, saving inpatient health care costs. This is suitable for developing country.

BACKGROUND: Over 90% full term normal newborns are known to pass meconium (first stools) within the first 24 hrs of life especially among Caucasians. This has not been fully documented among African neonates. This study was therefore done to determine time of passage of first stools (meconium) in African neonates and also the serum levels of calcium and magnesium in these children in order to establish a data base for normal standards. METHODOLOGY: Two thousand and four hundred neonates were recruited from Hospitals in Benin City urban areas for the study. 76.7% of these were full term and AGA babies (37-40 weeks; 2.8 kg-4.3 kg) while 23.3% of them were preterm and low birth weight neonates (34-36 weeks and weight between 2.4 to 1.5 kg) respectively. RESULTS: 88% of the full term neonates passed meconium at 15.4 +/- 3.6 hrs of life while only 12.0% of them passed meconium after 24 hrs of life and all by 48 hrs of life. The mean time of passage of stools by preterm, low birth weight babies was 45.2 +/- 2.4 hrs. The values of serum calcium in the full term neonates ranged from 6.5 9.2 mEq/l with mean of 7.8 +/- 1.2 mEq/l while the level in the preterm low birthweight neonates was much lower (5.4 8.3 mEq/l) with a mean of 6.7 +/- 1.3 mEq/l. The values of serum magnesium ranged from 0.9 1.6 mEq/l with a mean of 1.2 +/- 0.3 mEq/l in full term neonates while preterm low birthweight neonates had levels as low as 0.5 1.1 mEq/l with a mean of 0.7 +/- 0.2 mEq/l CONCLUSION: This study has shown a relatively shorter time of passage of first stools (meconium) in Nigerian neonates (blacks) than in the Caucasians. The implication of the findings in this study is that a delay in the passage of first stools (meconium) and early appearance of jaundice in normal black neonates could be due to gastrointestinal abnormalities. This observation could lead to early identification of these neonates with resultant early intervention.

OBJECTIVE: To determine blood levels of lead and its effects on haematological parameters among occupational lead handlers in Enugu, Enugu State, Nigeria. In developing countries, rapid industrialisation has lead to an alarming demand for lead. Furthermore, the burden of lead toxicity is greatly underestimated. Hence, the need to assess the unavoidable toxic effects of lead as done in this study. METHODS: Blood lead levels were measured by atomic absorption spectrometry (AAS) in eighty one (81) male subjects from three manufacturing companies, all located in Enugu metropolis, Nigeria. Thirty (30) staff of the industries not directly involved in lead handling served as control group I, while twenty (20) apparently healthy individuals from within the same locality not involved in lead handling served as control group II. Haematological values, blood lead levels and blood pressure (BP) were established using standard procedures. Statistical Analysis System (SAS) software was used to analyze the results. P value of < 0.05 was taken as significant. RESULTS: Mean blood levels were 7.00 +/- 0.07 microg/dl in test subjects; 3.00 +/- 0.19 microg/dl in control group I and 2.00 +/- 0.04 microg/dl in the control group II. There were significant statistical differences (p < 0.05 for each) in haemoglobin (Hb), packed cell volume (PCV), reticulocyte, total white blood cell (WBC), monocyte, autohaemolysis without glucose, and systolic and diastolic pressure between subjects and control group I. There were also significant differences (p < 0.05 for each) in the mean levels of Hb, PCV, reticulocyte, eosinophil, monocytes and systolic and diastolic pressures between the test subjects and control group II. There were however, no statistically significant differences (p > 0.05) in the means of other parameters. Basophilic stipplings were not observed in the red cells of those directly exposed to lead. CONCLUSIONS: It is suggested, therefore, that comprehensive and preventive measures towards exposure to lead in work places, and routine haemotological investigations be included in the bio-monitoring of the health status of lead workers.

BACKGROUND: Liver disease due to Hepatitis C viral (HCV) infection is the most common indication for liver transplant. It is a viral pandemic that is five times as widespread as the human immunodeficiency virus type 1 infection. In spite of this, vaccines were yet unavailable for protection of the human race due to the morphology and fastidious nature of the organism. While the scanty data available on this infection in our environment are limited to blood donors, people continue to be screened for and deprived of renal dialysis if any patient is found to have HCV infection. Also in this environment, data on HCV infection in pregnancy is virtually nonexistent even though the infection can have a deleterious effect on materno-fetal outcome. OBJECTIVE OF THE STUDY: To determine the seroprevalence of hepatitis C viral antibodies among antenatal women attending a tertiary health facility in Nigeria. METHODOLOGY: This was a prospective cross-sectional study whose subjects were booked consecutive antenatal women volunteers attending the University of Benin Teaching Hospital, Benin City, Nigeria between June 1 and December 31, 2005. Hepatitis C viral antibodies were determined and confirmed using a second and a third generation Enzyme Linked immunosorbent assay respectively. Both HCV sero-positive and seronegative women had both pre-and post-test counseling. RESULTS: Of the 269 samples screened for HCV antibodies, 5 (1.86%) samples were confirmed seropositive. None of the HCV seropositive women had liver enzyme derangement. CONCLUSION: Hepatitis C viral infection in pregnancy is not uncommon in Nigeria. It's prevalence in pregnant women South-South of Nigerian is similar to that of their Cameroonian counterparts, an immediate neighbouring country. A multi-centre study to determine the national prevalence of HCV and in addition to elevation of public awareness is suggested. Hepatitis C viral-induced liver disease remains the major indication for liver transplant for which our present levels of economy and health infrastructures can least support. With no vaccines and no cure, the time to act is now.

BACKGROUND: An effective Disease surveillance system provides information that is required for appropriate action. Although evaluated by attributes like sensitivity, predictive value and representativeness, the assessment of its operational status is critical, especially in developing countries. METHODS: We conducted this cross sectional survey among 144 health personnel from facilities and Local Government disease surveillance officers, using pre-tested, semi-structured, self-administered questionnaire and observational checklist. RESULTS: This showed that only 55 (38.2%) of the respondents were aware of the Disease surveillance and notification (DSN) system. Fifty-eight (65.9%) and 7 (8.0%) of the facilities had up-to-date registers and DSN forms respectively. Diagnostic support was lacking in most of the health facilities. Data was not analysed at LGA level, and forms and logistics for supervising disease surveillance activities and feedback were inadequate. CONCLUSION: We recommend training/retraining of health personnel on infectious disease surveillance, provision of logistics, improved supervision and feedback of information.

OBJECTIVE: To determine the changing pattern of antibiotic sensitivity of Neisseriae meningitidis from children with Meningococcal meningitis in North Eastern Nigeria. MATERIALS AND METHODS: This study was carried out over 31 months, from January 2003 to July 2005 in the Paediatric ward of Federal Medical Centre (FMC), Azare. The cerebrospinal fluid (CSF) of all patients with clinical features of meningitis admitted were examined microbiologically, including culture for bacterial organisms and their sensitivity pattern as well as biochemical tests determined. RESULTS: The CSF specimens from 44 patients, aged between 2 months and 12 years (20 females and 24 males) yielded gram negative intracellular diplococci by gram staining. Of these, Neisseriae meningitidis was cultured in 18 (40.9%). The remaining bacterial isolates did not survive culture. The analysis of antibiotic sensitivity of Neisseriae meningitides from the eighteen CSF specimens showed 100 per cent sensitivity to ceftriaxone. Resistance of the bacterial isolates to benzyl penicillin, ampicillin and chloramphenicol was 80%, 71.4% and 20% respectively. Varying levels of sensitivity of the organisms to augmentin (amoxicillin-clavulanic acid), gentamicin and cotrimoxazole were also documented. CONCLUSION: This study highlights the increasing resistance of Neisseriae meningitidis to empirically used antimicrobial drugs.

BACKGROUND: Hypertensive disorders in pregnancy are common in our environment. The aetiology is unknown and the prognostic indicators of the severity of maternal and fetal complications are variable. The level of uric acid, which is one of the prognostic indicators, is altered in normal pregnancy and as pregnancy advances. Base line values are thus extremely important to enable reasonable prognostic assessment in hypertensive pregnancies. OBJECTIVES: To determine levels of serum uric acid during normal pregnancy in University of Nigeria Teaching Hospital (UNTH) Enugu. STUDY DESIGN: settings and methods: Sixty- five pregnant and 65 non-pregnant women with age range 20-38 years were recruited. The pregnant women were in their second and third trimesters, attending antenatal clinic at the University of Nigeria Teaching Hospital Enugu. Serum levels of uric acid were determined for the entire subjects. RESULTS: The serum uric acid levels were significantly lower in the pregnant women than in controls (P < 0.001). 0.15 +/- 0.03 mmol/L in the second trimester, 0.14 +/- 0.02 mmol/L in the third trimester and 0.29 +/- 0.04 mmoL for control. CONCLUSION: The low levels in pregnancy and as pregnancy progresses should be taken into consideration when monitoring hypertensive disorders in pregnancy using serum uric acid. Thus levels that are within normal for non pregnant population may indeed be an indication for intervention in pregnancies complicated by preeclampsia.

OBJECTIVES: With increasing adoption of Western Lifestyle in Nigeria, the incidence of Diabetes Mellitus is on the increase in the country with its attendant complications. The objective of this study was to determine the prevalence of patients at risk of developing diabetic complications in Ilorin, Nigeria, among our patients with diabetes mellitus. METHODS: A cross-sectional study of diabetic patients attending the University of Ilorin Teaching Hospital ted haemoglobin as an index of medium term glucose control was assayed in established diabetics. The result obtained was evaluated against the bench mark HbA1c value of 7.2% for the development of complication. RESULTS: Fifty-six percent of the subjects were females and all of them were forty years and above in age. Only four percent of the patients were below the age of forty years. Seventy-two percent of the subjects had diabetes for less than 10 years. Only female patients had BMI values greater than 30 kg/m2. About 64% of the patients had HbA1c value > 7.2%. More males (73.7%) had HbA1c 7.2% than females (64.5%) (P < 0.05). The patients had a mean HbA1c value of 8.0%, while the mean HbA1c in the control was 5.2%. These two mean HbA1c values gave a P-value of 0.0001 on Student t-test. The female diabetic patients had a mean HbA1c value of 7.8% (SD = 1.96) against the value of 5.1% (SD = 1.13) for the female control patients (P-value of 0.0001). Similarly, the male patients and male control subjects had mean HbA1c values of 8.1% (SD = 1.96) and 5.6% (SD = 1.00) respectively with P-value of 0.0001. The control subjects had a mean fasting blood glucose level of (+/- SD) 4.93 +/- 1.09 mmol/L and the corresponding value for the diabetics was 8.5 +/- 4.2 mmol/L. when these two values were compared we got a P-Value < 0.05. CONCLUSIONS: The mean HbA1c values between the patients and the control subjects were significantly different. Diabetics in our environment with mean HbA1c value of 8.0% are prone to developing complications because of poor glycaemic control. We therefore advise that, periodic estimation ofglycated haemoglobin be carried out along side fasting blood glucose, in our diabetics.

BACKGROUND: The concept of reproductive health, which adopts a holistic approach to the management of reproductive disorders, was developed in 1994 at the International Conference on Population and Development. This together with the adoption of a right-based approach to the relationship between reproductive health and population and development and the emergence of the concept of sexual and reproductive right marked a turning point in contemporary global health care initiative. Sexual and reproductive healthcare raises ethical questions that fall within the purview of bio-ethics. OBJECTIVE: To review ethical issues related to women's sexual and reproductive healthcare. METHODOLOGY: A critical review of available literature on the subject matter was conducted. FINDINGS: Four key principles form the basis of Bioethical analysis--respect for person, beneficence, non-maleficence, and justice, applicable at four different levels microethical, macroethical, mesoethical, and megaethical levels each of which can be employed in the ethical analysis of sexual and reproductive health care. Medical practitioners caring for women, for the fact that they work in areas of a woman's body that are of particular psychosocial sensitivity, are expected to adhere to strict ethical principles in their practice. The International Federation of Gynaecology and Obstetrics (FIGO) in collaboration with the Society of Gynaecology and Obstetrics of Nigeria (SOGON) has developed a human right based code of ethics related to sexual and reproductive health care to guide medical practitioners caring for women in their daily practice. CONCLUSION: An understanding and proper application of the ethical principles is expected to enable these medical practitioners to actualize the ultimate and desired goal of uplifting the sexual and reproductive healthcare and right of women.

Myomectomy during Caesarean section is conventionally reserved for pedunculated myomas. When fibroids located in the lower uterine segment are encountered in pregnancy, due to fear of haemorrhage, obstetricians would prefer to perform a classical Caesarean section even with its high risk of subsequent uterine rupture and avoid the fibroids. We hereby present a case where removal of intra-mural fibroids in a 34-year old primigravida though inevitably performed, was successful.

AIM: To review the current literature on squamous cell carcinoma [SCC] of the conjunctiva and report 2 presentations in Sagamu, Nigeria since the availability of histopathological services. METHODS: The available literature using e-medicine and pubmed internet websites were summarized. The 2 cases seen by the first author since histopathological services started at Olabisi Onabanjo University Teaching Hospital [O.O.U.T.H.], Sagamu were summarized using the case note records and the pathological reports of their surgical specimens. RESULTS: The 2 cases showed the variable ways SCC of the conjunctiva can present in an equatorial African country like Nigeria. DISCUSSION: Limbal interpalpebral conjunctival lesions should arouse the possibility of this rare neoplasia even in patients with no evidence of predisposing factors. CONCLUSION: Even though SCC of the conjunctiva is commoner in Caucasians, its possible presentations should be kept in mind in equatorial non-Caucasian populations like Nigeria.

A rare case of non-puerperal chronic uterine inversion secondary to sub mucous fibroid in a 38-year-old woman is presented. There was complete uterine inversion with the incarcerated inverted uterus protruding through the vvgina beyond the vulva. The sub mucous fibroid was attached to the fundus. At laparotomy, a dimple with a constriction ring was found in the position of the uterus. The distal ends of the fallopian tubes and part of the ovary were visible through the constriction ring. Histological examination of the uterus and fibroid following hysterectomy confirmed their benign nature.

INTRODUCTION: Nephrotic syndrome is a chronic renal disease that can lead to end stage renal disease. There are different histological types with global variations in frequency. Literatures reviewed showed that the African variant is less likely to be minimal change variant. No clear treatment protocol for it has been most beneficial. OBJECTIVE: This paper aims to evaluate the outcome of a treatment protocol using cyclophosphamide and prednisolone concurrently. METHODS: A low dose and short duration concurrent use of cyclophosphamide and prednisolone was used for treating children with nephrotic syndrome who had not developed derangements of their renal function. The case files of those that were treated and followed up over a 10 year period or until they were above 18 years of age were analysed for their clinical parameters. RESULTS: Five cases were treated and all have been in clinical remission for more than 4 years as at the time of the review, though 2 of them relapsed twice initially. They were all aged above 6 years and had microscopic hematuria. The 3 cases whose ESRs were done had high levels. Two cases that presented 1 yr after the onset of their symptoms resolved without relapse while 2 out of the remaining 3 in whom this interval was less than 6 months relapsed. CONCLUSION: This treatment protocol appears beneficial to childhood nephrotics in this environment and should be used.