Background: It is well known that Hepatitis B virus infection is endemic in Nigeria. Even though studies have been carried out on Hepatitis B virus infection in different parts of Nigeria, and in different sub-groups of individuals, information regarding the prevalence of Hepatitis B virus infection in pregnant women is scanty especially from the North-eastern region of Nigeria. We therefore determined the seroprevalence of Hepatitis B surface antigen (HBsAg) amongst pregnant women in North Eastern Nigeria. Materials and Methods: A hospital-based cross-sectional study was carried out. The setting was the ante-natal clinic of the Federal Medical Centre, Yola, Nigeria. The duration of the study was from July 2008 to December 2008. Two hundred and thirty-one consecutively recruited pregnant women were screened for Hepatitis B surface antigen. Positive samples were re-tested using ELISA to eliminate false positives. Their biodata were obtained using a questionnaire to establish the presence of possible risk factors such as blood transfusion, surgery, etc. Written informed consent was obtained from each woman. Results: Out of the 231 pregnant women tested, nineteen of them were seropositive for Hepatitis B virus infection giving an infection rate of 8.2%. Women in the age group 25-29 years had the highest HBV infection rate. Conclusion: This study confirms a high seroprevalence of Hepatitis B virus infect ion amongst pregnant women. It is recommended that pregnant women should be routinely screened for Hepatitis B virus infection as part of antenatal care services.

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Background: Dermatophytic infections have been known to impact negatively on health and well-being of children. This study was undertaken to determine the prevalence, clinical types as well as the etiologic organisms of dermatophyte infection among primary school children aged 5-16 years in Oke-Oyi community in Kwara state. Materials and Methods: A 4-months descriptive cross-sectional survey was carried out among 602 children aged 5-16 years in Oke-Oyi community, in Kwara state. Results: The prevalence of clinically suspected dermatophytoses lesion was 29.9% (180/602). Dermatophyte accounted for 5.0% (30/602) on Sabouraud dextrose agar culture, while non-dermatophyte molds represent majority of isolate i.e., 15.4% (93/602). Tinea capitis is the commonest clinical type, followed by Tinea coporis and then Tinea pedis. Multiple infections are noted in nine respondents. Three species of dermatophytes belonging to only two of the three genera of dermatophytes were responsible for human infection in the area studied, of which Trichophyton mentagrophyte is the commonest, followed by Microsporum audouinii and Trichophyton verucossum. Among the non-dermatophytes, Aspergillus fumigatus and Candida albicans predominate. Conclusion: This study demonstrates that the prevalence of dermatophytoses in the school studied was significant. Control efforts should target this vulnerable group to reduce its prevalence.

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Objective: To determine the occurrence of percutaneous injuries (PI) and accidental exposure to patients' blood (AEPB) in surgical residents in Enugu, Nigeria, their awareness of universal precautions (UP), and use of post-exposure prophylaxis (PEP). Materials and Methods: Self-administered semi-structured pre-tested questionnaires were administered to 230 consenting trainee surgeons. Results: The rate of exposure to PI/ABE was 67.5%. The number of exposures ranged from 1 to 5 with a mean of 1.9±0.99. Senior registrars had the highest rate of exposure (76.9%). In 89 exposures (63.6%) needle-prick injuries were reported. Adequate knowledge of the UP and PEP to HIV virus was only 41%. In most cases (72.1%) respondents subsequently disregarded the exposure. Conclusion : The high rate of exposure to PI/ABE, inadequate knowledge and poor practice of UP/PEP seen in this study underscore the need for creating high level of awareness about UP/PEP, the development of clear institutional guideline and the provision of adequate materials and supervision to ensure adherence with the guideline. The practice of UP and PEP in PI and AEPB are life saving and should be emphasized in residency training.

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Objective: To assess the Knowledge Attitude and Practice (KAP) of MOH Primary Health Care Physician in the management of Type 2 Diabetes Mellitus (DM) Materials and Methods: A cross sectional survey was conduced between April and October 2010 on MOH Primary Health Care physicians working in Al Hasa district of Saudi Arabia by filling up of pre-tested specially designed questionnaires focused on Knowledge, Attitude and practice towards Type 2 DM patients. The answers were scored by assigning marks. A SPSS 18 was used for statistical analysis. Results: The mean of overall KAP score (±SD) for all the respondents were 66.59±8.82 (Maximum 100). Male physicians scored better than the females physicians (66.90, P=.018 Vs 64.67, P=.018) and the same was true with the rural physicians who scored higher (68.65 ±10.19, P=.003) than the urban physicians (65.34±7.36, P=.003).The main weakness of knowledge was on epidemiology of Diabetes Mellitus (DM). 28.3 % (n=28) of physicians didn't know the correct diagnostic criteria of Type 2 DM and only 34.7% physicians knew the correct angle of insulin injection. 86.8% (n=86) of the physicians did not agree that Diabetic Self Management Education (DSME) is an essential part of diabetic care. The mean overall KAP score was significantly higher for physicians with 1-5 years of experience (70.16, P=<.05)) than those with more than 5 years of practice (P=<.05). This difference was found in all the segments of KAP. Overall KAP score of those GPs who had a copy of Clinical practice guidelines (CPG) in their clinic was 70.90 ±10.94 which was higher than KAP Score of those GPs who did not have a copy of CPG (65.10 ±7.01, P=.005). Checking patients' ability to manage their diabetes, checking blood pressure, eye exam, lipids , serum creatinine, baseline ECG, chest X ray and serum electrolyte were the best followed tests while foot exam and urinary protein were performed more often than recommended in the guideline. Serum HbAc1was the most delayed test. Conclusion : This study explored several aspects of diabetes related KAP of Ministry of Health appointed GPs and identified the need for improvement in their knowledge, attitude and practices for treating Type 2 DM patients.

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Objective: The objective was to review the obstetric performance of booked grand multiparae. Design and Setting: A 5-year prospective observational study of cases between January 1, 2002, and December 31, 2006, was conducted in Aminu Kano Teaching Hospital, a tertiary institution, in Kano, Nigeria. Materials and Methods: The antenatal complications and pregnancy outcomes among booked grand mulitparous women (pregnancy after fifth delivery), who delivered in our labor ward, were compared with those of the booked mulitparae (parae 1-4) who delivered immediately after a grand multipara. Outcome Measures: These were obstetric factors of maternal age and parity, antepartum hemorrhage, fetal malpresentations, and multiple pregnancy. Medical complications were gestational diabetes, hypertension, anemia, and heart disease. Pregnancy outcomes measured were gestational age at delivery, birth weight, mode of delivery, postpartum hemorrhage, and maternal and perinatal mortality. Results: The age range of the grand multiparae was between 22 and 43 years, with a mean age of 29.72 + 2.07 years. The parity range was between 5 and 15, with a mean parity of 7.78 + 0.63. There was increased occurrence of gestational diabetes mellitus (OR = 12.55, CI = 6.72-23.91), hypertension (OR = 3.07, CI = 2.07-4.59), heart disease (OR = 2.01, CI = 0.70-6.08), anemia (OR = 3.16, CI = 1.42-7.24), antepartum hemorrhage (OR = 2.18, CI = 1.22-3.92), fetal malpresentations (OR = 3.04, CI = 2.38-3.88), cephalopelvic disproportion (OR = 2.09, CI = 1.33-3.29), and fetal macrosomia (OR = 2.27, CI = 1.72-3.00) among the grand multiparae compared with multiparae. Conclusion: The effects of these complications were minimized by good antenatal care.

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Background: Coma is a medical emergency, and optimal management, especially in a resource-poor setting, would depend on the knowledge of its etiology and predictors of outcome. This communication reviews the etiology and outcome of non-traumatic childhood coma in Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki. Objective: To determine the incidence, etiology and outcome of non-traumatic coma in children seen at the EBSUTH, Abakaliki. Materials and Methods: This is a retrospective analysis of records of all children admitted to the children emergency ward of EBSUTH in coma of a non-traumatic origin between 1 ^st of January and 31 ^st of December, 2007. Results: Forty children presented with coma out of 673 children admitted during the study period, giving an incidence rate of 5.9%. The majority of the children (62.5%) were aged between 1 and 5 years of age, and 79.5% of them were deeply comatose on admission. Most of the cases (85%) of non-traumatic coma were due to infective causes, mainly cerebral malaria (47.5%), pyogenic meningitis (17.5%) and septicemia (10%). Twenty-four (60%) children recovered while 13 (32.5%) died. Conclusion : Infections were the predominant causes of non-traumatic coma in EBSUTH. In view of the high mortality among this group of patients, efforts at the control of malaria and other infections would significantly reduce the incidence of non-traumatic coma in this study site.

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Introduction: Death of a fetus in-utero or intrapartum is both devastating to the couple and of concern to the clinician. Identifying the etiological and risk factors of stillbirths will help in the prevention or reduction of its occurrence. Materials and Methods: This was a prospective observational study of all stillbirths over a 16-month period (from January 2006 to April 2007) at the maternity Unit of Jos University Teaching Hospital. Information on maternal socio-demographic details, history of antenatal complications of the index pregnancy, and maternal medical history were obtained by personal interview of all mothers who had a stillbirth. For each stillbirth, information was obtained on the type of stillbirth, estimated gestational age at delivery, sex of baby, and the mode of delivery. These characteristics were subjected to analysis. Etiological causes were assessed using the clinico-pathological approach advocated by Baird−Pattinson. Results: There were a total of 3,904 deliveries with 158 stillbirths during the study period, giving a stillbirth rate of 40.5 per 1,000 total births. There were 84 (53.2%) macerated and 74 (46.8%) fresh stillbirths. Of the 3,904 total deliveries, there were 2,022 (51.8%) males and 1,882 (48.2%) females. There were 84 male and 74 female stillbirths, giving stillbirth rates of 41.5 per 1,000 and 39.3 per 1,000 total deliveries for male and female deliveries, respectively, which was not statistically significant (X2 = 4.6865, P < 0.3564). The major causes were abruptio placentae (17.7%), hypertensive disorders of pregnancy (12.7%) and maternal HIV infection 10.7% of stillbirths. Other causes were cord accidents (7.0%), placenta praevia (3.8%), and anemia in pregnancy (3.8%). Forty-six (29.1%) of the stillbirths were unexplained. The main risk factors identified were lack of antenatal care, poor antenatal clinic attendance, home delivery, and late presentation of complicated labor to the facility. Conclusion: The stillbirth rate in our centre is high, major causes being abruptio placenta and maternal medical conditions. Maternal HIV infection has emerged as a major contributor to stillbirths in this study.

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Objective: Women are at a higher risk of being sexually harassed. There is a need to document the clinical findings of this crime and its outcome in order to improve the quality of care the victims receive. Materials and Methods: Case notes of patients who presented with alleged rape at Jos University Teaching Hospital between January 2001 and December 2003 were retrieved and analyzed. Results : During the study period, 2,135 patients were seen in the Gynaecological Emergency Unit. A total of 120 were for alleged rape, representing 5.6% of the total cases seen. However, only 105 case notes were available for analysis. Of these, 63.8% of the alleged rapes were in children, with the infantile age group accounting for 26.7%. 36.2% of the victims had experienced some form of sexual exposure prior to the rape. A previous relationship with the rapist was established in 77.4% of the cases. Most cases delayed in presenting to hospital. Thirty six percent of the cases did not have a human immunodeficiency virus screening test done. Candida albicans (13.3%) accounted for most of the infectious agents. Emergency contraception was administered to the victims when indicated. Conclusion: Women under 16 years of age were at an increased risk of being raped, possibly because they are defenseless and vulnerable. Three quarters (3/4) of the assailants had some form of relationship with the victims, which may account for the delays in reporting. Children and young adolescents were more at risk than adults to be raped.

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Objective: To evaluated the economic burden to families of managing chronic heart failure in children with congenital heart disease. Materials and Methods: This longitudinal study was conducted over a year. The families of children with congenital heart disease who were being managed for chronic heart failure in the clinic were recruited for the study. With the aid of a structured questionnaire, data were collected on a monthly basis for three consecutive months, on the family's monthly income, cost of anti-failure medicines, transportation and the number of man-hours spent on clinic visitation. The percentage of the mean monthly income spent on medicines, transportation and the total cost of care were also computed. Results: Thirty two families were recruited for the study. The children were 16(50%) each of males and females with a mean age of 2.2 ± 1.7 years. The mean monthly income was $314.93 ± 271.36 while the mean cost of total care was $17.61 ± 10.58. The mean percentage of income spent on total care was 16.3 ± 26.2 % with a range of 0.7 - 122%. Families from low socioeconomic class spent significantly higher percentage of income on medicines and total care compared to those in middle or high socioeconomic classes, P = 0.0095 and 0.041 respectively. Only three (0.09%) patients had surgery for their condition. Conclusion: The mean percentage of income spent on care was significant and amounted to catastrophic health expenditure for a third of the families. Government input in strengthening the existing cardiac centres, establish new ones and subsidising the cost of surgery to meet the needs for open heart surgery for children with CHDs is recommended.

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Introduction: Postpartum maternal morbidity is a serious public health problem. Major acute and long-term obstetric morbidities affect the life and reproductive career of women. Objective: To determine the incidence, pattern and associated factors of postpartum maternal morbidity in the Jos University Teaching Hospital (JUTH) and offer suggestions on various interventions to reduce this postpartum morbidity. Materials and Methods: This was a 3-year prospective observational study at the JUTH between April 2005 and March 2008. All patients who delivered or were treated in the hospital for postpartum morbidity were recruited for the study. Results: A total of 9056 women delivered, of which 246 (2.72%) were treated for postpartum morbidity. Most of the patients (32.9%) were between 25 and 29 years old. A majority of the women (58.5%) were of Parity 2 to 4. House officers and senior house officers supervised most (43.5%) of the deliveries. The most common postpartum maternal morbidity was primary postpartum hemorrhage (35.4%). This was followed by hypertensive disorders (24.8%) and genital tract sepsis (16.7%). There was a statistically significant relationship between accoucher and postpartum maternal morbidity. Conclusion: The incidence of postpartum morbidity was high, with hemorrhage, hypertensive disorders and genital tract sepsis being common problems. It is hoped that supervision of deliveries by skilled medical personnel and active management of the third stage of labor will reduce the incidence of postpartum hemorrhage.

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Background: The perinatal mortality rate remains an important indicator of maternal care and maternal health and nutrition, and also reflects the quality of obstetric and pediatric care available. The causes of most of the perinatal deaths are preventable, thus making it important to identify the risk factors in each health environment. Objective: The aim was to prospectively audit the perinatal mortality and associated risk factors in a tertiary health facility in a developing country. Materials and Methods: Data for all consecutive deliveries in the labor ward complex of Lagos University Teaching Hospital (LUTH) between June 2002 and November 2002 were obtained from the patients' record and by interviewing the mothers using a questionnaire. The babies were followed up for 7 days postdelivery. Results: There were 51 (8.5%) perinatal deaths made up of 43 (7.1%) stillbirths (15 fresh and 28 macerated) and 8 (6.1%) early neonatal deaths giving a perinatal mortality rate of 84.6/1000. Maternal factors that significantly affected perinatal deaths were maternal age, parity, antenatal care booking and the hospital where the mother was booked for antenatal care, number of previous child deaths, and complications of pregnancy. Mode of delivery and complications of labor were the significant intrapartum factors. Fetal factors that influenced perinatal deaths were fetal presentation, birth weight, and Apgar scores at 1 and 5 min. When multiple logistic regression (multivariable analysis) of perinatal mortality on possible risk factors was done, only the Apgar score at 5 min, birth weight, and parity were significant risk factors. Conclusion: The study shows a high perinatal mortality rate with majority of perinatal deaths occurring before the delivery. Significant risk factors are a low Apgar score at 5 min, low birth weight, and high parity.

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Background and Aim: The risk of death from coronary heart disease (CHD) in women with diabetes is more than three times that of non-diabetic women. We assessed the difference in CHD risk levels of Afro-Caribbean diabetic women provided with facilities for self-monitoring of blood glucose and their counterparts without such facilities Materials and Methods: Forty-nine patients who never used gluco-meters were studied as intervention (23) and control (26) groups. The intervention group was trained on self-monitoring of blood glucose. At baseline, BP, anthropometric indices, and fasting blood glucose of all patients were measured. Subsequently, the intervention patients were provided with gluco-meters, testing strips, and advised to self-monitor fasting and postprandial blood glucose every other day for 6 months. CHD risk was determined with the United Kingdom Prospective Diabetes Study risk engine calculator. Results: The age, duration of diagnosis of diabetes, BP, and anthropometric indices were similar in the two groups (all, P > 0.05). The majority of the patients were unemployed or retired with only primary education. After 3 months, the HbA _1c levels of the control patients did not change (8.3 ± 0.4% vs. 7.8 ± 0.4%, P > 0.05) whereas the HbA _1c levels of the intervention patients reduced significantly from the baseline at 3 (9.2 ± 0.4% vs. 7.4 ± 0.3%, P <0.001) and 6 (9.2 ± 0.4% vs. 7.3 ± 0.3%, P <0.001) months. The 10-year CHD risk level of the intervention group was remarkably reduced from the baseline level after 6 months (7.4 ± 1.3% vs. 4.5 ± 0.9%) of the study. Conclusion: Provision of facilities for self-monitoring of blood glucose in Afro-Caribbean women with type 2 diabetes improves both their glycemic control and CHD risk profile.

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Objective: Despite advantages of propofol use such as providing a good anesthesia and rapid recovery; pain due to intravenous propofol injection continues to be a problem. The aim of this study was to compare the effects of generic propofol and propofol lipuro with and without lidocaine on injection pain in children. Materials and Methods: This study performed between 01 December 2009 and 16 May 2010. A total of 120 children, who planned to undergo elective surgery under general anesthesia, were included in four groups of 30 in a prospectively, randomized and double-blind study. Generic propofol was given to first and second groups and propofol lipuro was given to third and fourth groups. In addition to propofol, lidocaine was given to second and fourth groups. Injection pain was assessed using Ontario Children's Hospital Pain Scale (mCHEOPS). Results: No differences were found in the mean age, weight and given dose of propofol administered between all groups (P>0.05). Double comparison of groups revealed no significant difference in pain scores between Group 1 and 2 (mean pain scores, 1.34 ± 1.42 vs. 1.22 ± 1.31 points, respectively; P>0.05). However, significant difference was found between propofol lipuro groups with or without lidocaine (3.20 ± 2.10 vs. 0.95 ± 1.21 points, respectively; P<0.001). Conclusion: The highest pain scores were found in the propofol lipuro without lidocaine use while propofol lipuro plus lidocaine had the lowest pain scores. Because adding lidocaine to propofol lipuro decreased injection pain scores to minimum levels, this practice seems to be the most appropriate alternative in order to diminish propofol injection pain during anesthesia in children.

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The submental / transmylohyoid intubation technique, as an alternative technique of airway management in oral and maxillofacial surgery, and its modifications, have been widely reported in the literature since it was first described by Altemir in 1986. However, the technique is not yet popular in Nigeria and Africa in general. A report of two cases in which this technique was used in orofacial reconstruction is presented here. The surgical / anesthetic outcome was satisfactory. No complication was seen in the two cases, and healing of the submental wound was uneventful. Submental intubation is a reliable technique of alternative airway management in oral and maxillofacial surgery. The submental / transmylohyoid technique should be considered by both the anesthetist and the maxillofacial surgeon in challenging cases, where an alternative airway technique is required for maxillofacial surgery.

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Introduction: Malaria is a major public health problem in Nigeria, with adverse outcomes on the poor, pregnant women and children living in rural communities. A major component of current intervention in roll back malaria (RBM) initiative is vector control and insecticide-treated nets (ITNs). Aims and Objective: This research studied the impact of free distribution of ITNs on malaria parasitemia in a rural community in Nigeria. Materials and Methods: This is a longitudinal survey involving 990 pregnant and nursing mothers who received free ITNs between February 2007 and September 2008. Blood samples were collected at contact, then every 2 months to check for malaria parasites using standard methods. Result: There was a sustained but insignificant rise in asymptomatic malaria parasitemia post-distribution of ITNs. Conclusion: We conclude that ITN intervention remains important in malaria prophylaxis but must be complemented with awareness campaigns and other vector control strategies.

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Herpes simplex encephalitis (HSE) is a condition that may follow herpes simplex virus (HSV) infection with high mortality and serious morbidity among survivors. We report the case of a 2-year-old boy who presented to us with features of a central nervous system infection associated with visual and auditory impairments. Serology for HSV was positive and cerebro-spinal fluid culture yielded the virus. He was commenced on intravenous acyclovir and eventually responded to treatment after 21 days of therapy. Neurological deficits observed at discharge resolved by the third month. This case highlights the challenges of early recognition, accurate diagnosis, appropriate treatment and follow-up of such patients. In addition, there is a need for urgent documentation of the prevalence and associated factors of HSE in Nigeria.

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Aim: The aim was to report the experience an ophthalmologist gained in a structured intraocular lens (IOL) microsurgery training program for the information and benefit of colleagues in ophthalmology training institutions. Materials and Methods: An ophthalmologist was trained in extracapsular cataract extraction (ECCE)-IOL implant in Aravind Eye Hospital (AEH), Madurai, for a period of 8 weeks. Details of patients operated on, procedures observed, and conferences attended were prospectively recorded in a log book. Results: Training was available in conventional ECCE with posterior chamber IOL (ECCE-PCIOL), small incision sutureless cataract surgery, and phacoemulsification. During the period, this trainee observed a total of 1527 cataract extractions, administered 528 retrobulbar and 1047 facial blocks, and also operated on 75 patients. The trainee gained experience and confidence to perform high-quality, low-cost cataract surgery. Conclusion: Hands-on experience and competence in quality ECCE-IOL implant microsurgery can be acquired in a short period of time in a high-volume cataract center. Trainees can also be exposed to other techniques of cataract surgery. Ophthalmology training centers with diminishing surgical training opportunities can also benefit from this structured training in a high-volume cataract center like Aravind Eye Hospital.

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Background and Objectives: The glycemic response to commonly eaten fruits in Nigeria has not been reported. Therefore, this study assessed the plasma glucose response to selected fruits in Nigeria. Patients and Methods: Ten normal glucose-tolerant subjects randomly consumed 50 g carbohydrate portions of three fruits: banana (Musa paradisiaca), pineapple (Ananus comosus), and pawpaw (Carica papaya), and a 50-g glucose load at 1-week intervals. Blood samples were collected in the fasting state and half-hourly over a 2-h period post-ingestion of the fruits or glucose. The samples were analyzed for plasma glucose concentrations. Plasma glucose responses were assessed by the peak plasma glucose concentration, maximum increase in plasma glucose, 2-h postprandial plasma glucose level, and incremental area under the glucose curve and glycemic index (Gl). Results: The results showed that the blood glucose response to these three fruits was similar in terms of their incremental areas under the glucose curve, maximum increase in plasma glucose, and glycemic indices (GIs). The 2-h postprandial plasma glucose level of banana was significantly higher than that of pineapple, P < 0.025. The mean ± SEM GI values were as follows: pawpaw; 86 ± 26.8%; banana, 75.1 ± 21.8%; pineapple, 64.5 ± 11.3%. The GI of glucose is taken as 100. The GI of pineapple was significantly lower than that of glucose (P < 0.05). Conclusion: Banana, pawpaw, and pineapple produced a similar postprandial glucose response. Measured portions of these fruits may be used as fruit exchanges with pineapple having the most favorable glycemic response.

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Objective: The aim of the present study is to identify the facial nerve dissection technique routinely used during parotidectomy for benign parotid tumors by Nigerian Oral and Maxillofacial (OMF) and Ear, Nose, and Throat (ENT) Surgeons. Materials and Methods: A questionnaire-based study was conducted among Oral and Maxillofacial and Ear, Nose, and Throat Surgeons in Nigeria, on their experience with antegrade and retrograde facial nerve dissection techniques in parotid surgery. The respondents were asked to indicate their choice of dissection techniques in revision parotidectomy, limited superficial parotidectomy, and in obese patients with large tumors. They were also asked to indicate if they routinely used perioperative facial nerve monitoring devices in parotid surgery for benign tumors. Result: About half (47.5%) of them routinely used the antegrade technique, while only a few (12.5%) used the retrograde technique. A large number of them (40%), however, used a combination of antegrade and retrograde routinely. Technical ease was the main reason for the choice of technique. The antegrade technique was the technique of choice by most respondents for revision parotidectomy (60%) and limited superficial parotidectomy (62%). However, the retrograde approach was the technique of choice by most of them (47%) in case of parotidectomy in obese patients with large tumors. The routine use of perioperative facial nerve monitoring devices is an uncommon practice among OMF and ENT surgeons in Nigeria. Conclusions: The antegrade approach for facial nerve dissection is the most common technique used in parotid surgery by Nigerian OMF and ENT surgeons. Nigerian surgeons need to consider the retrograde approach in selected cases of parotid surgery especially for localized tumors that are amenable to limited superficial parotidectomy. Inclusion of perioperative facial nerve monitoring devices is also advocated.

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When used correctly, laryngeal mask airway is a life saver. We report two cases wherein it was used for rescue airway management and as a ventilatory device during anesthesia. It is concluded that an anesthetist should be familiar with the use of this device.

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Adrenal insufficiency can often manifest with nonspecific complaints. Primary adrenal lymphoma is a rare cause of adrenal insufficiency. We present the case of a 55-year-old female who presented with nonspecific complaints of abdominal pain, pallor and weight loss and was found to have primary adrenal lymphoma. The case highlights the need to expeditiously initiate steroid replacement in patients with adrenal insufficiency, while efforts are made to establish the etiology of adrenal insufficiency.

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Various studies have proved the success of the osseointegration concept, if proper and strict protocols are followed for the success. In clinical practice, certain situations arise that makes the clinician to modify his treatment modality to favor the final outcome of the treatment. This paper presents a clinical case report of re-osseointegration of the loosened bead implant occurred during the torque application to tighten the abutment during cementation, which was splinting along with the adjacent well-osseoingrated implant by using fixed partial denture prosthesis. The clinical outcome suggests that proper stabilisation of a loosened implant can re-osseointegrate the implant.

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Pentalogy of Cantrell which usually comprises of anomalies of the ectodermal and mesodermal tissues is a very rare congenital condition which in the extreme of cases is incompatible with life. In this report a variant of the condition in a live newborn baby who presented to the University of Nigeria Teaching Hospital with abnormalities of the heart, urinary bladder and sternum is discussed. The aim of the report is to create an awareness and high index of suspicion amongst health professionals

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A case of late first trimester/early second trimester recurrent pregnancy loss in a 30-year-old para 3+0 Nigerian woman is reported. She was referred to the Radiologist for Hysterosalpingography (HSG) work-up following repeated spontaneous abortions at early pregnancy stage. There was no history of trauma, surgery, alcohol/drug abuse or haematological disorder such as sickle cell anaemia or Thalassemia. Her body weight was 105kg. Systemic examination was normal. The HSG however demonstrated widely separated horns of the single endometrial cavity with intercornual angle measuring 107 degrees indicating a congenital abnormality of bicornuate type.

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Objectives: This study aimed to determine the prevalent age, pattern of presentation, histopathology type, and outcome of management of laryngeal carcinoma in our environment. Design and Setting: This was a 10-year retrospective study carried out at a teaching hospital. Materials and Methods: Records of patients managed for laryngeal carcinoma from January 1994 to December 2004 were reviewed. Only 13 cases with tissue diagnosis were included in this review. The age, sex, occupation, presentation, use of cigarette and alcohol, investigations, histology, outcome of management, and duration of follow-up were extracted and analyzed. Results: The patients had a mean age of 69.9 years (range 38-88 years) and a male-to-female ratio of 12:1. Histopathology was squamous cell carcinoma in all. Symptoms included hoarseness in voice and breathlessness in all, cough in 7 (53.8%), weight loss in 7 (53.8%), and otalgia in 6 (46.2%). Two patients indulged in alcohol and two were also regular cigarette smokers. All the patients presented with stage IV disease and in respiratory distress necessitating emergency tracheostomy. Seven (53.8%) patients had total laryngectomy plus postoperative radiotherapy while 2 (15.4%) had pharyngolaryngectomy, thyroidectomy, radical neck dissection plus postoperative radiotherapy and thyroxine supplement. Surgical complications included pharyngocutaneous fistula in 2 (15.4%) patients, pharyngeal stenosis, stomal stenosis, and hypocalcemia with hypothyroidism in 1 patient each. The fistulae were managed conservatively and prognosis was good despite late presentation. Conclusion: Laryngeal carcinoma mainly occurs in males. Presentation is late with hoarseness in voice and breathlessness in our community. Soft-tissue neck x-ray is a useful diagnostic tool. Scarce radiotherapy centers, ignorance, local taboo, poverty, and poor recognition by primary healthcare providers have a negative impact on its management. Laryngeal carcinoma should be excluded when managing elderly patients for bronchial asthma.

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Purpose: To evaluate the safety and efficacy of timolol 0.5%/travoprost 0.004% combination (duotrav) as observed in primary open-angle glaucoma (POAG), ocular hypertension (OHT) and normal tension glaucoma (NTG) in real-life conditions. Materials and Methods: Patients with uncontrolled intraocular pressure (IOP) on other medication and no contraindication to β-blockers were switched to duotrav in 56 eyes of 28 patients. The drop in IOP was the primary outcome measured. Results: Switch to duotrav provided an additional IOP reduction after 3-month follow-up that was statistically significant for those on latanoprost (P=0.02857), bimatoprost (P =0.04978) and travoprost (P =0.0078). Patients on latanotrost had an additional 25.9% drop 3 months after switching to duotrav while those on bimatoprost and travatan had 18.04% and 17.59% drop, respectively, after the switch. It was effective in lowering the IOP to clinically significant levels of ≤18.5 mmHg in POAG, NTG and OHT (12.5-17.9% drop), but not in chronic angle closure glaucoma. Conclusion: Duotrav was well-tolerated and produced significant additional IOP reduction when switched from other anti-glaucoma drugs in patients with uncontrolled glaucoma. It also achieved IOP of ≤ 18.5 mmHg in glaucoma patients.

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