Background: Neonatal morbidity and mortality rates reflect a nation's socio-economic status, the efficiency and effectiveness of health care services. This important indicator is useful in planning for improved healthcare delivery. A four year review of neonatal outcome was therefore conducted in the special care baby Unit (SCBU) of University of Benin Teaching Hospital (UBTH). Methods and Subjects: The study was done between 2003 and 2006 and sought to review the morbidity, mortality, salvage rate of low birth weight babies and outcome of all inborn and outborn babies admitted into the SCBU of UBTH. The biodata, birth weight, sex, APGAR scores and reasons for admissions and outcome were abstracted from case notes/admission records. Result: A total of 3075 babies were admitted to the unit during the period under review. 2602 (84.6%) were inborn while 473 (15.4%) were out-born. There were more males 1676 (54.6%). There were 855(27.8%) preterm babies of which 803(26.1%) were low birth weight babies. Neonatal sepsis, severe birth asphyxia, pre-maturity and neonatal tetanus were the most common morbidities suffered by the neonates. Mortality was recorded amongst 625 (20.3%) babies. Mortality rate was significantly higher amongst the out-born than in born babies, P value < 0.0001. Conclusion: The neonatal mortality rate in this study is high. The morbidity profile observed in the study is attributable to preventable causes. Of note is the contribution of NNT to morbidity and mortality. Strengthening of linkages in perinatal care, improving maternal emergency obstetric care and neonatal resuscitation skills are proposed measures to reduce neonatal mortality.

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Background: Cancer is an occasional incidental finding in nodular goiter, but there has been no formal study on this disease in our locality. Aims and objectives: To determine the occurrence of histologically diagnosed malignancy in patients who present with nodular goiters. Methodology: This is a 7- year (2000-2006) retrospective study of all histologically diagnosed malignancies within nodular goiters at Aminu Kano Teaching Hospital, Kano Results: There were 160 multinodular goiters during the study period, out of which 24 (15.0%) had histologically diagnosed cancer, and 1 out of the thirteen patients with solitary thyroid nodule (7.6%) had carcinoma. The ages of the patients with carcinoma ranged from 16 to 65 years, with a mean age of 38.8 years. Eighteen (72%) were females, and 7(28%) were males. Six out of the 25 cases of carcinoma were detected preoperatively by fine needle aspiration cytology. Well differentiated follicular carcinoma was the predominant histological type in 13(52%) cases, followed by papillary in 10(40%), medullary carcinoma in 1(4%) and anaplastic carcinoma in 1(4%) patient. Conclusion: One-seventh of nodular goiters in our center harboured malignancy, and follicular carcinoma was the prevalent histological type. This is consistent with the findings elsewhere in endemic goitrous regions. Ultrasound guided fine needle aspiration would improve preoperative diagnosis and guide appropriate surgical management.

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Background: Trauma is the most common cause of paediatric deaths. In 75% of paediatric trauma deaths, head injury is responsible, and most are from falls. Recent reports from Nigeria, however, appear to indicate a predominance of road traffic accidents, instead of falls. Objective: To evaluate the aetiology of paediatric head trauma, management protocols and outcome from our Centre, in order to acquire a baseline data base and recommend measures to reduce childhood trauma. Patients and Methods: A prospective study of all paediatric head trauma cases presenting to Nnamdi Azikiwe University Teaching Hospital, Nnewi, for 12months from April 21, 2006 to April 20, 2007, was done and collated data subsequently analyzed. The paediatric age group was taken as =15years, and grading of head injury was with the Glasgow Coma Scale (3 15) and the modified scale for non-verbal children; while outcome was measured with the Glasgow Outcome Scale (1 5). Results: Out of 334 patients treated within the period of study, 210 were head trauma cases. Of these, 52 were paediatric head trauma, representing 24.8% of all head trauma cases; and 19.2% (10 of 52) of them were aged 0- 2years. About 62% (32 of 52) were males. Falls and RTA were each responsible in 25(48.1%) cases. Mild head injury occurred in 31(59.6%), and 49(94.2%) patients were evaluated by plain radiography. Treatment was conservative in 39(75%) cases; with satisfactory outcome in 36(69.2%), and a mortality rate of 15.4%. Conclusions: Road traffic injury, mostly from motorcycles, has become the major cause of morbidity and mortality amongst the paediatric age group, especially the male gender, and outcome from management is mostly satisfactory.

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Objectives: To determine the magnitude and pattern of aggressive behaviour among psychiatric in-patients and identity associated socio-demographic and clinical factors. Method: The study was cross-sectional in design. Among patients admitted to the Neuro-psychiatric Hospital, Aro (and its Lantoro annex), Abeokuta between January 1 to December 31, 2005, those who manifested aggressive behaviour were identified. Each was evaluated by the medical team, and a questionnaire detailing socio-demographic and clinic variables was administered on them. Results: A total of 305 patients comprising 213 (69.8%) males and 92(30.2%) females were managed as inpatients during the period of the survey. Out of these, 43 patients manifested aggressive behaviour representing a rate of 13.8%. The aggressive patients consisted of 26 males and 17 females, representing rates of 12.2 and 18.5 percent for the sexes respectively. Of the 11 diagnoses entered for all the patients, only 3 were associated with aggressive behaviour. These included schizophrenia, 21 patients (48.8%); bipolar manic illness, 12 patients (27.9%) and co-morbid substance use (mainly cannabis) and mental disorder, 10 patients (22.3%). Nursing personnel constituted the majority of target of aggression. Unemployment was the only socio demographic variable observed with significant positive relationship with aggressive behaviour. In addition, the commonest probable precipitants of aggressive behaviour included hallucinations, clamouring for discharge and attempting to abscond, reaction to confrontational interview, impulsivity and reaction to unmet demands. Conclusion: Mental health practitioners (especially nurses) should be equipped with necessary skills in managing aggressive and potentially aggressive patients. The present observations may be useful in raising the suspicion of care providers on potentially aggressive patients for preventive purpose.

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Objective: To assess whether the ophthalmic cases presenting at a Nigerian tertiary eye unit are appropriate for such level of care and also draw necessary implications for service delivery. Methods: Data on 1,321 consecutive new patients that presented at the ophthalmic clinic of the University of Teaching Hospital, Ilorin, Nigeria between February and July 2005 were reviewed on demographics, referral routes, and reasons for patronage, diagnoses and disease categories. Information on the general situation of health infrastructures prevailing at the surrounding health facilities was collected from key-informants. Results: One thousand and ninety-one (82.6%) presented without any referral and 1,095 (82.9%) patronized in order to access perceived good quality of eye care service being rendered. However, only a small proportion of their ailments (191, 14.5%) actually required attention at the tertiary level of eye care. The key informants painted a picture of severely-challenged general and health infrastructures particularly at the primary health care facility level. Conclusion: An overwhelming majority of ophthalmic patients directly accessed eye care at the tertiary level, even though most of their ailments could have been satisfactorily treated at the lower facilities of health care were the latter to be functioning optimally. A better coordinated and strengthened health care system, particularly at the primary and secondary health care facilities would ease the burden of inappropriate presentations on tertiary health facilities in Nigeria.

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Objective: Infection at the pin tract is a common complication of external fixation. This study was done to compare the rate of pin site infection following combined 1 % silver sulphadiazine and 5 % chlorhexidine dressing with 5% chlorhexidine dressing alone. Method: This was a prospective controlled study which compared the results of pin site dressing using a combination of chlorhexidine and silver sulphadiazine cream (Study group) with dressing using chlorhexidine alone. Eligible patients had external fixation in the treatment of open fractures or orthopaedic conditions. Pintract infection was deemed to be present if erythema, cellulitis or purulent discharge occurred around a pin site. We did not distinguish between deep and superficial infection. Results: The study group had one hundred and seventy pin sites while the control group had one hundred and sixty-four pin sites. Thirty-eight patients, in whom thirty-seven uniplanar external fixators and one Ilizarov ring fixator were used, made up both groups. Three patients (7.9%) had pin tract infection in the study group while nine patients (23.7%) had pin tract infection in the control group. Conclusion: There was a significantly lower prevalence of pin-tract infection amongst patients whose external fixation pins were dressed with 1 % silver sulphadiazine and 5 % chlorhexidine than in those dressed with chlorhexidine alone (P=0.03). Therefore, we advocate the use of a combination of silver sulphadiazine and chlorhexidine for pin site dressing.

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Background:Oesophagogastroduodenoscopy is one of the most commonly performed endoscopic procedures. Properly performed, it provides valuable information in patients with upper gastrointestinal conditions. Oesophagogastroduodenoscopy is a visual examination of the upper intestinal tract using a lighted, flexible fibreoptic endoscope or videoscope. Oesophagogastroduodenoscopy is generally indicated for evaluating upper abdominal symptoms such as dysphagia or odynophagia, oesophageal reflux symptoms, gastroduodenal or oesophageal ulcer, upper tract stricture or obstruction, gastrointestinal bleeding, persistent vomiting of unknown cause etc. This study is therefore to review the indications for oesophagogastroduodenoscopy in Ilorin, Nigeria. Aim: To review the indications for oesophagogastroduodenoscopy in Ilorin, Nigeria. Methodology: A review of the indications for oesophagogastroduodenoscopy was undertaken to cover a thirty-month period from June 2006 to November 2008. The endoscopy register of the operating theatre was examined over this period. The biodata of the patients who underwent the procedure over this period was reviewed. Results: A total of 206 patients had oesophagogastroduodenoscopy done on them during the period under review. 124 of the patients were males (60.2%) while 82 were females (39.8%). The indications for oesophagogastroduodenoscopy were dyspepsia, 94 patients (45.6%); upper gastrointestinal tract bleed, 54 patients (26.2%); gastric outlet obstruction, 12 patients (5.8%); gastric cancer, 11 patients (5.3%); dysphagia, 9 patients (4.3%); acute exacerbation of peptic ulcer disease, 8 patients (3.8%); gastro-oesophageal reflux disease, 7 patients (3.4%); recurrent vomiting, 3 patients (1.5%); bloody stool, 2 patients (1.0%); epigastric mass, 2 patients(1.0%); 1 patient (0.5% ) each on account of excessive salivation, foreign body ingestion, ingestion of corrosive, and recurrent anaemia. Conclusion: The commonest indication for oesophagogastroduodenoscopy in Ilorin is dyspepsia.

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Embryonal rhabdomyosarcomas (Sarcoma botyroides) are malignancies of connective tissue with abnormal cells which are thought to arise from skeletal muscle progenitors. It is a rare childhood malignant solid tumour and occurs in children mostly less than 10 years. It can occur at any age but two commonest peaks are 1-5years (when approximately 66.6% occur) and 15-19 years accounting for the rest. Sarcoma botyroides which usually occurs in the vagina in childhood is rare in the female reproductive tract of adult women especially those over the age of 40. We report here a case of a 45 year old HIV-positive woman who presented with profuse bleeding from the vagina with severe anaemia. Macroscopically, a cauliflower polypoid growth was seen protruding from the cervix into the vagina. Histopathological studies confirmed a diagnosis of sarcoma botyroides. Conclusion: The need for a high index of suspicion of sarcoma botyroides of the cervix must be borne in mind when making a diagnosis on all cervical polypoidal masses. Also the importance of looking out for lesions and malignancies on all HIV positive patients cannot be over-emphasized.

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Background/Aim: The grandmultiparae have basically been regarded as high risk obstetric patients. This study was undertaken to estimate the prevalence in this area as well as evaluate the problems, associated factors and ways of reducing the burden. Methodology: This was a retrospective study of the problems of grandmultiparity (five or more previous viable babies) at Amaku General Hospital, Awka over a three year period, January 2006 to December 2008. One hundred and thirty five (135) grandmultiparous women (study group) were matched with a similar number of women of lower parity (Para 2 and 3), who attended and delivered in the hospital during the same period. The problems seen in both groups during pregnancy and labour, mode of delivery, birth weight, perinatal and maternal mortalities were compared. The soccio-demographic characteristics were also compared. Results: The incidence of grandmultiparae was 7.53%. Twenty nine (21.5%) of the grandmultiparae were unbooked compared to 6(4.4%) of the control group. Ninety four (69.7%) of the study group belonged to the low social class IV and V compared to 27(20%) of the control. Anaemia in pregnancy was commoner in study than in the control group (49(36.3%) versus 12 (8.9%). There was a high caesarean section rate in the study group compared to the control (31(23.0%) versus 6(4.4%). The maternal mortality rate in the study group was 22.2/1000. There was no maternal death in the control. Conclusion: Improving the socio-economic standard of our women and increased awareness in the importance of family planning will reduce the incidence and complications of grandmultiparity.

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Background: Obstetric fistulae with Urinary incontinence are one of the most distressing maternal morbidities. It is associated with physical and social deprivation such as wife abandonment and violent reactions against the victims particularly in the developing countries of the world. Aims and Objectives: To study the demographic and reproductive profiles as well as management of patients with obstetric fistulae in UCTH, Calabar, Nigeria Patients and Method: A five-year retrospective study of case records of 37 patients managed in Maternity Annex of University of Calabar Teaching Hospital, Calabar Nigeria for obstetric genito-urinary fistulae was carried out. Results: One in every 122 parturients during the period had fistula. Eleven (29.7%) were teenagers. Many patients were married (54.1%), nulliparous (59.4%), come from low socioeconomic class (72.9%) and did not utilize modern obstetric facilities properly. Many cases resulted from prolonged obstructed labour (51.4%) and 70.2% presented with total incontinence of urine. Eighteen (48.7%) were diagnosed within 6 month of delivery. The main types encountered included were vesico-vaginal (34.4%) or complex (10.8%) fistulae who were manage conservatively (21.6%) or with bladder repairs. Majority (29.7 %) were referred for further treatment. Conclusion: Parturient in Calabar still suffer from this age long obstetric morbidity mainly due to poor utilization of modern obstetric care facilities. Results of treatment are largely unsatisfactory; therefore resources should be channeled towards prevention.

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Objective: To assess the delays and define the causes of delay in presentation and treatment of breast cancer patients in Enugu, Nigeria. Design: A cross-sectional survey of breast cancer patients using a semi structured questionnaire. Setting: Surgical Oncology unit, University of Nigeria Teaching Hospital Enugu, (UNTH-E), Nigeria. Subjects: 164 consecutively presenting breast cancer patients seen between June 1999 and May 2005. Results: Most of the patients (82.3%) reported for initial evaluation at a modern health facility while 17.5% reported first to Alternative practitioners. Forty six patients (26.4%) presented within a month of noticing the symptoms while 72 (45.3%) delayed more than 3 months. In contrast, 18 (17%) were seen at the site of definitive treatment within one month of seeking help at the initial hospital while 73.4% had a delay of more than 3 months after the initial hospital contact. Institutional or physician induced delays were present in 46.2% of the cases while patient related delays were present in 79.2% of cases. Only use of alternative practitioners for initial treatment was significantly related to delays of more than three months before presentation (p= 0.017). Conclusion: For breast cancer prevention programs in Nigeria to succeed, they must in addition to breast awareness and screening programs, address the institutional bottlenecks, the dearth of knowledge among primary care physicians and improve referrals from alternative practitioners and prayer houses.

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Congenital orbital teratoma though rare is available in this environment. This is a case report of a baby with a protruding orbital mass in the left eye with all classical clinical features of teratoma. Though the histopathological report fell short of confirming the diagnosis the clinical features and outcome of management strongly suggest that the lesion is a teratoma. Multidisciplinary approach to the management not only saved the life of the baby in question but also enhanced the outcome of treatment. Good and compliant follow up for six months was experienced. Cytological test is mandatory for any suspected cases of teratoma.

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Neurobrucellosis is a rare form of systemic brucellosis, a disease acquired through ingestion of unpasteurized dairy products, which may manifest as stroke, encephalitis, meningitis, or psychiatric disorders. Presently there is no known report of neurobrucellosis in Nigeria, although consumption of unpasteurized dairy products is not uncommon in this country. In this report we present a 28 year old spinster with history of significant ingestion of unpasteurized cow milk and brucellosis of the brain diagnosed in our centre through brain magnetic resonance imagining (MRI) and brucella antigen agglutination test. Because of the indolent nature of brucellosis infection, it should be suspected in individuals with pyrexia of unknown origin so that early detection and treatment could prevent long-term sequelae such as focal neurologic deficits, hydrocephalus and psychiatric illness.

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The objective of this study was to determine some common behavioural risk factors for intestinal helminthiasis in nursery and primary school children in Enugu. Design: A cross-sectional survey on 460 children attending nursery and primary schools in Enugu was carried out in 2003 with a view to determine some behavioural risk factors for intestinal helminthiasis. Setting: This study was carried out in the research laboratory of the Federal Ministry of Health, National Arbovirus and Vector Research Centre, Enugu. Method: Intestinal helminthiasis was diagnosed using the kato-katz method in analysing fresh stool samples collected from nursery and primary school children in Enugu. These fresh stool samples were collected into appropriately labeled clean containers. Questionnaires were administered by the researchers to obtain data from the children and their parents or guardians as regards some behavioural risk factors for intestinal helminthiasis. Results: The results from this study showed that the prevalence of intestinal helminthiasis was significantly affected by various behavioural risk factors. The rate of helminthic infection varied significantly with hand washing habits after defeacation (X ² = 75.77; df = 2; p = 0.001) and with different habits of washing fruits before eating (X ²= 52.79; df = 2; p = 0.001) among the pupils. Also, the rate of helminthic infection varied significantly with the source of drinking water (X ² = 55.12; df = 3; p = 0.01), water boiling habits (X ² = 40.89; df = 2; p = 0.001), use of footwear after school hours (X ² = 30.72; df = 2; p = 0.001). Sites utilized for defeacation by the pupils (X ² = 80.25; df = 3; p = 0.001) also significantly influenced the rate of helminthic infection. Conclusion: Various behavioural factors which significantly affect the rate of helminthic infection abound in children living in Enugu. The government should give attention to the control of these behavioural risk factors. A lot of health education will be needed to curb the poor personal hygienic habits which are obvious risk factors for intestinal helminthiasis.

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Background: The Human Fertilization and Embryology Authority is considering limiting the number of embryos that can be transferred to single embryo per cycle as has been done in several European countries, with the aim of reducing the rate of multiple pregnancies and its attendant complications following in vitro fertilization (IVF) / Intracytoplasmic sperm injection (ICSI). Objective: To determine the number of embryos patients' attending a fertility clinic in Nigeria, would prefer transferred during IVF/ICSI. Materials and Methods: Fifty four consecutive female patients who underwent IVF/ICSI procedures between May 2006 and April 2007 at the Port Harcourt Fertility Centre, Rivers State were interviewed using structured questionnaires. They were informed of all the obstetric and perinatal complications of multiple pregnancies and the advantages and trend towards single embryo transfer and then asked to choose the number of embryos (one, two or three) they would prefer transferred assuming similar implantation rates. Each respondent was allowed to give reason(s) for their choice. Design: Prospective, descriptive study. Results: Fifty one (94.4%) of the respondents preferred the transfer of multiple (2 or 3) embryos. Only three (5.6%) patients opted for single embryo transfer. Majority of the patients (31 or 60.8%) preferred multiple embryo transfer because of their desire for twins while twenty (39.2%) cited cost of IVF as their reason. Fifteen (29.4%) patients saw multiple pregnancies as a compensation for their long periods of infertility. Conclusion: With the desire for twins and high poverty level in Nigeria, a policy of single embryo transfer might be difficult to implement. Health economic studies would be required to determine if the accumulative cost of taking care of twins/triplets is less, equal or outweighs the cost of several single embryo transfers.

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Background and Objectives: Risk factors predisposing to foot ulceration in diabetic subjects are multiple. Long duration of diabetes mellitus is a major risk factor, likewise peripheral neuropathy (PN), which globally, is recognized as the commonest risk factor for foot disease in diabetic subjects. Objectives: To evaluate the effect of duration of diabetes mellitus on peripheral neuropathy using the United Kingdom Screening Test (UKST) Scoring System, Bio-thesiometry and Aesthesiometry, in Nigerian diabetic subjects without current or previous foot ulceration. Subjects and methods: One hundred and twenty (120) diabetes mellitus (DM) subjects 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, Nigeria, were recruited consecutively as they presented. Data collected included subjects age (years), gender, age at first diagnosis of DM, duration of DM (years) and baseline fasting venous plasma glucose. The United Kingdom Screening Test (UKST) symptom score was used to separate the participants into two groups those with symptoms of PN and those without and the subjects further assessed by three methods the UKST Signs score, Bio-thesiometry and Aesthesiometry to determine the presence of PN. Results: Among the 120 diabetic participants, 83(69.2%) had neuropathic symptoms (the symptomatic participants) while 37(30.8%) were asymptomatic (the asymptomatic participants). The different methods of diagnosing PN increasingly detected PN with increasing duration of diabetes. For the symptomatic group, the UKST method detected PN least in those with duration of DM <5 years (73.9%) and 100.0% in those with duration of DM >15 years while for the asymptomatic group, it detected PN in 25.0% of those with duration of DM <5 years, and 100.0% for those with duration of DM >15 years. For the symptomatic group, Aesthesiometry detected PN in 65.2% of those with duration of DM <5 years and 91.7% in those with duration of DM >15 years. For the asymptomatic group, it detected PN in 29.2% of those with duration of DM <5 years and 100.0% in those with duration of DM >15 years. Likewise, for the symptomatic group, Bio-thesiometry detected PN in 47.8% of those with duration of DM <5 years and 100.0% in those with duration of DM >15 years. For the asymptomatic group, it detected PN in 16.7% of those with duration of DM <5 years and 100.0% in those with duration of DM >15 years. Conclusion: Long duration of diabetes mellitus and peripheral neuropathy are risk factors for foot complication in Nigerians with diabetes mellitus. Diabetic subjects with long duration of diabetes (>10 years) almost always have associated peripheral neuropathy, and should be recognized as a special group at high risk for foot disease from DM.

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Objective: To determine the causes and prevalence of ocular morbidity among primary school children in Ilorin, Nigeria. Materials and Methods: A cross sectional survey of primary school children in 10 randomly selected primary schools within Ilorin, Nigeria was carried out between July 2005 and January 2006. Relevant ocular history and basic ocular examinations were carried out on the children that were selected from a multi-stage sampling process. Results: One thousand three hundred and ninety three pupils were surveyed. There were 689 (49.4%) boys and 704 (50.6%) girls. The age range was between 4 and 15 years. The mean and modal ages were 10.16 SD 2.5 and 10 respectively. Two hundred and seventy seven pupils had ocular pathology giving a prevalence of 19.9%. The two most common ocular disorders found among the pupils were refractive errors and vernal conjunctivitis with prevalence of 6.9% and 6.7% respectively. Others included genetic / congenital / developmental ocular disorders 39 (2.8%), glaucoma / glaucoma suspect 20 (1.4%), ocular infections 18 (1.3%), and ocular trauma 11 (0.8%). More than three-quarters (86.7%) of the causes of visual impairment and blindness among the pupils were avoidable (preventable or treatable). Conclusion: The sheer magnitude of avoidable causes of visual impairment and blindness in the study underscores the need for effective school eye-health programmes in developing countries.

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Background: Previous studies on aneurysms in Nigeria have either been case reports or studies of peripheral aneurysms. No study has comprehensively evaluated all aspects of this disease as an entity among Nigerians. The need therefore arises to re-evaluate this lesion so as to make deductions on incidence, sex ratio, aetiology and management. Study design: This is a retrospective descriptive study of arterial aneurysms at the University of Nigeria Teaching Hospital (UNTH), Enugu. Those treated between January 1993 and December 2002 were included for the study. Data were obtained from medical records for all patients admitted with aneurysms over the study period. Results: A total of 26 patients were admitted during the period, but 24 case notes were analysed. The age range was 10-75 years with male: female ratio of 1.4:1. Traumatic pseudo aneurysms accounted for 16 cases (67.0%) while true aneurysms comprised the remaining. Of all the aneurysms, femoral artery with most of the pseudo aneurysms had 8 out of 24 (33.0%). This is followed by the infra-renal abdominal aorta (5/24, 21.0%) and other sites (11/24, 46.0%). Diagnoses were made clinically in most cases and by abdominal ultrasonography in abdominal aortic aneurysms. Twenty-one patients had surgical intervention with 9.5% operative mortality. Conclusion: The incidence of aneurysm is low in our locality (2.6/year) based on the rate of diagnosis. Abdominal aorta harbours most of the true aneurysms with diameter ranging from 8.0-15.0cm without rupture. Untreated, all will eventually rupture with catastrophic consequences. Treatment involved excision with graft interposition. This is not only expensive but the graft is often not readily available. As a solution, grafts should be stocked with drug revolving fund.

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Objective: To report a case of cancer of the colon which presented as secondaries to the ovaries. Method: Case report. Summary: The case presented is that of a 39 year old female who presented with lower abdominal pain and a multinodular pelvic mass which led to an initial diagnosis of multiple uterine fibroids and pelvic inflammatory disease. The presence of a colonic mass was first suggested by ultrasound .Laparotomy revealed carcinoma of the colon with bilateral krukenberg's tumour and an insignificant fibroleiomyoma. Conclusion: This case is reported to alert practitioners that all multinodular pelvic masses should not be assumed to be multiple fibroids.

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Background: Viral load (VL) quantification is considered an integral part of the standard care in human immunodeficiency virus (HIV) infected individuals but in Nigeria as in most of sub-Saharan Africa, this has not reached the majority of patients. Methods: We report the first field application of the NucliSens EasyQ HIV-1 platform for the real time quantification of HIV-1 VL combining NASBA amplification and real time detection with molecular beacons among HIV-1 infected individuals in north central Nigeria where the predominant HIV-1 subtypes are CRF02_AG and G. CD4 ⁺ counts were enumerated using a fluorescence-activated cell sorter system. Results: Of one hundred and forty nine (n=149) plasma sample from patients with mean age of 32 years and made up of 77 males and 72 females, fifty {n = 50 (37.9%); 28 males and 22 females}had VLs below the lower detection limit (LDL=25 IU/ml) set by the assay while eighty- two {n = 82 (62.1%); 39 males and 43 females}had VL levels above the LDL. Furthermore, 13 of 82 (15.9%) patients with viral loads above the LDL had VLs between 26-1000 IU/ml while 69 (84.1%) had VLs of 1001-2400000 IU/ml. 17 (11.4%) of the samples could not be analyzed due to poor viral amplification. Among individuals with both CD4 ⁺ and VL results (n=56), those with CD4 ⁺ of 1-418 cell/μl presented with higher VL usually above 45,000 IU/ml when compared with those with CD4 ⁺ of over 500 cell/μl. Conclusion: Our findings highlight the pattern, usefulness and feasibility of VL quantification by NucliSens EasyQ in monitoring HIV-1 patients in Nigeria.

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Aim: This study is to assess the effect of CD₄ T lymphocytes, on features of pulmonary tuberculosis on HIV positive patients with co-existing tuberculosis attending clinic in university of Benin Teaching Hospital Benin Nigeria. Setting: University of Benin Teaching Hospital Benin, Nigeria. Method: This study was carried out on 200 patients who had laboratory confirmation of HIV, CD₄ T lymphocytes measured, with tuberculosis co-infection, and control group of 100 patients, who were HIV negative, but positive for tuberculosis infection, between 1st July, 2003 and 30th May, 2004, were further examined with chest radiography, in the hospital. The standard procedures of chest radiography were used, with minor adjustment to allow good image quality on the radiograph. Two Radiologists analyzed these on standard image viewing box. Results: The average CD ₄ T lymphocyte count in the study group (HIV sero-positive) was 173.90 cells/nl and median of 172 cells/nl. 128(64%) subjects had CD ₄ T lymphocyte counts less than 200cell/nl while 72(36%) subjects had CD ₄ lymphocyte count above or equal to 200 cells/nl. 111(86.72%) subjects with a CD ₄ T lymphocyte count less than 200 cells/nl and 31(43.1%) subjects with CD₄ T lymphocyte count 200cells/nl or more had an atypical chest radiographic pattern of primary pulmonary tuberculosis. Atypical chest radiographic pattern was more frequent among patients with CD T lymphocyte count less than 200 cell/nl (86.72%) compared with patients with CD₄ T lymphocyte count greater than 200cells/nl (43.1%) (P < 0.001). Conclusion: There is significant relationship and correlation between immune status of HIV positive patient and pulmonary pattern of tuberculosis. The variation on pulmonary pattern of tuberculosis noted also collaborated well with the level of CD4 T lymphocyte in the patients.

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Background: Tubal occlusion is the commonest cause of female infertility in the developing societies. Hysterosalpingography remains a vital method of assessing tubal patency especially in resource limited settings such as ours. Objective: To review the pattern of hysterosalpingographic findings among women being investigated for infertility in Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria over a period of five years (2001-2005). Method: The data obtained from the request forms and radiologists' reports were analyzed using SPSS version 11. The level of statistical significance was set at p<0.05. Results: Of the 320 studied, 230 were found suitable for analysis. Their ages ranged from 20 to 44years (mean 32.8± 5.8years). The indications were primary infertility in 103 (44.8%), secondary infertility in 88(38.3%), while in 39(16.9%) patients the type of infertility was not specified. The reports revealed that 67(29.1%) had normal HSG. Cervical abnormalities were found in 34 (14.8%), uterine cavity abnormalities in 108(47.0%). Tubal pathologies were seen in 100(43.5%) with bilateral tubal occlusion in 43(18.7%) and bilateral hydrosalpinges in 6(2.6%) patients. Conclusion: Tubal pathology remains a major contributor to female infertility in this part of the world.

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Mesenchymal tumours of the gastrointestinal tract (GIT) are uncommon. Recent progress in the understanding of the biology and origin of these tumours has led to their reclassification. A new subclass designated Gastrointestinal Stromal Tumours (GIST) is diagnosed based on the presence of a mutational over expression of c-kit protein that is thought to be critical in the pathogenesis of these tumours. This new class of tumours may form the majority of gastrointestinal mesenchymal tumours. Even though the diagnosis of GIST is mainly based on positive staining with CD117, a minority of tumours with histological characteristics of GIST are CD117 negative and are classified as CD117 negative GIST. In this first review of mesenchymal GIT tumours from Nigeria, we present 11 cases of mesenchymal tumours of the gastrointestinal tract seen within a six-year period at our centre. Immunohistochemistry was performed on 7 of them in which histological appearances suggested GIST. Only two cases had all the criteria defined in the consensus conference on the diagnosis of GIST. Our findings, albeit in a very small sample, contrasts with what obtains in developed countries in the proportion of GIT mesenchymal tumours that are truly GIST. This raises a question to be answered on the true nature and proportion of gastrointestinal strumal tumours among GIT tumours in Nigerian patients.

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Background: Hepatitis B virus) infection is contracted through contact with body fluid of infected persons. Patients with sickle cell anaemia (SCA), a common haematological disorder in Nigeria, have tendencies to visit traditional healers who administer scarifications and ritual marks that may expose them to HBV infection. Objective: To determine the demographic and socio-cultural characteristics of children with SCA infected with HBV at the University of Nigeria Teaching Hospital Enugu. Subjects and Method: Two hundred and twenty one children aged 6months to 17years with SCA were recruited consecutively from October 2004 to April 2005. They were screened for HBsAg using ELISA method. Results: There was no statistically difference in hepatitis B surface antigenaemia among different age group (P=0.907). Social class did not significantly influence the prevalence of HBsAg among subjects (p=0.887). Socio-cultural practices like circumcision and scarification did not influence the prevalence of HBsAg, (p=0.636) (p=0.771) respectively. Significantly higher number of people from lowest socioeconomic class practice scarification (p=0.0001). Conclusion: Demographic and sociocultural factors do not appear to influence the prevalence of HBsAg among children with SCA in Enugu, Nigeria.

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Objective: The study evaluated the safety, efficacy and acceptability of Implanon (etonogestrel) subdermal implant contraceptive amongst its acceptors. Study Design: This was part of an ongoing prospective longitudinal study that involved 32 women out of 46 sexually active healthy informed volunteers recruited from our family planning clinic between February and March 2007. All the subjects received the single rod subdermal implant Implanon which contains 68mg etonogestrel. Data on socio-demographic characteristics, menstrual pattern, haematological indices, weight, blood pressure, side effects and user's satisfaction were collected and analysed. The subjects served as their own control. Results: The mean age and parity were 33.9 ± 5.2 years and 3.1 ± 1.7 respectively. The mean weight was 71.4 ± 12.0kg at pre-insertion. At 6 months the weight reduced to a non significant (p < 0.13) mean value of 70.0 ± 10.5kg and increased to a non significant (p < 0.88) mean value of 71.5 ± 11.6kg at 12 months. The mean systolic and diastolic blood pressures did not show statistical significant changes at 6 months follow up (p<0.17/0.64). However at 12 months there were significant but within normal reductions (p < 0.003/0.05) in the systolic and diastolic blood pressures. The side effects were menstrual abnormalities. Eighteen (56.3%), 1 (3.1%) and 13 (40.6%) reported reduced, increased and combinations of bleeding patterns respectively. No participant had normal cycle. Other experiences were headache, 4 (12.5%) and reduced libido 3 (9.4%). The mean packed and white blood cell concentrations did not show statistical significant changes at 6 and 12 months follow up. At 12 months there was statistical significant increase (p<0.04) in the mean ± SD platelet count (205312.5 ± 75694.8per ul) when compared with the pre-insertion mean value (176343.8 ±52945.3per ul). One acceptor had thrombocytopenia without any untoward effect. Two subjects discontinued method on account of menorrhagia and headache. The efficacy and continuation rate were 100% and 93.8% respectively. All the clients received adequate information about the method and most of them were satisfied with it at follow up. Conclusion: Implanon was an effective, safe and acceptable method of contraception amongst its acceptors. Menstrual abnormalities were the major side effects which most of the subjects found tolerable with adequate counseling. The reduced platelet concentration of the one acceptor would require follow up to ascertain the trend.

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