Objectives: This study was generally aimed at determining the prevalence and pattern of obesity using body mass index (BMI) criterion and specifically screening for its common primary co-morbidities among adult Nigerians attending a rural Mission General Hospital in Imo state, South-Eastern Nigeria. Materials and Methods: A descriptive study was carried out from June 2008 to May 2009. A total of 2156 consecutive new adult patients aged 18-90 years were screened for obesity using the BMI criterion, and 129 patients had BMI ≥30 kg/m ² and met the inclusion criteria. The data collected included age, sex, marital status, education, occupation, social class, weight, height and blood pressure, fasting blood sugar and lipid profile. Results: The prevalence of obesity was 6.0%, with class I obesity (86.1%) being the most common pattern. Hypertension (16.3%) was the most common primary co-morbidity; others included low high-density lipoprotein-cholesterol (21.7%), high low-density lipoprotein-cholesterol (9.3%), high total cholesterol (7.8%), high triglyceridemia (4.7%) and diabetes mellitus (3.9%). Conclusions: This study has shown that obesity and its primary co-morbidities are emerging as a serious health problem among the study population, with class I obesity being the most common pattern and hypertension being the most common primary co-morbidity. Anthropometric determination of obesity and screening for its common primary co-morbidities should be integrated as part of the clinic baseline assessment of adult Nigerians attending rural hospitals to facilitate their early detection and institutionalization of appropriate preventive and therapeutic measures.

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A review of home management of childhood diarrhea in under-five children among 203 Nigerian mothers was carried out over a period of 3 months in order to ascertain how effectively they manage their children with diarrhea outside a hospital setup (infrastructural health facility). Mothers whose children had diarrhea, with or without other symptoms, and presented at the Children's Out Patient unit (CHOP), of the UNTH over the study period were consecutively interviewed through a questionnaire designed for the study. The questionnaires were designed and administered by the authors. There were 30 mothers in social class 1; 59 in social class 2; 52 in social class 3; 13 in social class 4, and 7 mothers in social class 5. Information was obtained on the method of detection, causes of diarrhea, and treatment including their knowledge and use of oral rehydration salts with or without anti diarrheal and antibacterial agents. Out of the 203 mothers interviewed, 140 (71%) correctly defined diarrhea. 112 (55.2%) could identify correct causes of childhood diarrhea. Only 80 (39.4%) could correctly manage diarrhea at home. About 76% (154 mothers) knew that they should use an oral rehydration salt; of this number, 56 (27.6%) could correctly prepare SSS, while 29 (14.3%) could do the same for the UNICEF ORS. In addition, anti bacterial, anti-diarrheal, and/or herbal preparations were used by 38 (18.7%) of the mothers. The level of knowledge of oral rehydration therapy has dropped in our locality since its inception in the early 1990s. There is need to intensify maternal education in this area since we now have a new generation of mothers who were not there during the inception of the program.

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Gangrene of the extremities in the newborn is extremely rare at birth. Less than 100 cases have been reported worldwide. Its etiology is obscure in many cases; however, some factors have been associated with it in the newborn, which include vascular injury and embolism. We report a case of a baby with congenital bilateral lower limb gangrene caused by thromboembolic phenomenon from retroplacental hematoma following abruptio placentae and highlight the challenges of managing such condition in resource-poor setting.

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Background : Smoking control is urgently needed to prevent the epidemic of tobacco-related diseases and deaths in developing countries. This requires data on smoking, especially among vulnerable groups like students. We have surveyed cigarette smoking among undergraduates of the University of Ilorin, in the North Central region of Nigeria. Materials and Methods: This was a questionnaire-based survey among undergraduates of the University of Ilorin. A total of 1800 students were selected by multistage random sampling. Results: A total of 1754 students (234 medical and 1520 non-medical students) completed the questionnaires. They were 1148 (65.5%) males and 606 (34.5%) females with a mean age of 21.6 ΁ 3.1 years. The prevalence rate of current smoking was 5.7% (males 7.7%, females 2.0%) and of ever smoking was 17.1% (males 22.9%, females 6.2%). Smoking was more common in non-medical students. Eighty-three (83.8%) of the smokers had already started smoking by their eighteenth birthday. Fifty-one (51.5%) of them smoked ≤ 5 sticks of cigarettes daily. Most of them were influenced into smoking by peer pressure and commercial advertisements. Sixty-seven (67.6%) of them believed that smoking could never have a negative impact on their health status and quality of life and just 39 (39.4%) smokers were willing to quit. Conclusions: Despite the low prevalence rate of smoking in the studied population, a majority of them were not willing to quit because of a low perception of the negative effects of smoking on their health and quality of life. Comprehensive antismoking campaigns were urgently needed to control cigarette smoking among University undergraduates in Nigeria.

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Background: Hepatic encephalopathy (HE) is an important neuropsychiatry complication of liver disease causing significant morbidity and mortality worldwide. Efforts at improving the outcome have resulted in development of new strategies in the management given the background of new insights in the pathogenesis of this disease entity. Understanding the disease profile including precipitants as well as prognostic factors will contribute in this regard as new strategies are yet to be widely applied. The aim of this report is to document the profile of patients with HE, the precipitants, prognostic factors as well as the scope of the burden associated with it. Materials and Methods: In this prospective study, all patients managed for HE from January to December 2008 were recruited. A questionnaire was used to extract their basic demographics, clinical features noting any possible precipitants, complications, management protocol as well as outcome. Results: A total of 21 subjects (11 females and 10 males) within the age range of 16-83 years were seen during the period under review. (mean age 57.9 ΁ 13). There was no significant difference in the mean ages of males and females. Two patients had acute encephalopathy, while others had acute-on chronic encephalopathy. The risk factors for liver disease included significant alcohol ingestion, hepatitis B virus infection, and previous jaundice, while other complications of liver disease noted were deepening jaundice, ascites, bleeding tendencies, and renal failure. The identified precipitants for HE were sepsis 6 (29%), electrolyte inbalance 3 (14%), gastrointestinal bleed 5 (24%), drugs (5%), and possible malignant transformation 6 (29%). Focus of sepsis was bacterial peritonitis in two cases. Majority of our patients (61%) came during advanced stage of liver disease (Child-Pugh class C). Length of hospital stay ranged from 1 to 7 weeks and a mortality of 48% was observed. Predictors of mortality were a history of significant alcohol ingestion, previous blood transfusion, Hepatitis B and C infections, and severe liver dysfunction on presentation (Child-Pugh class C). Conclusions: HE is associated with a high mortality rate and this scenario is associated with a history of previous blood transfusion, Hepatitis B and C infections, and severe liver dysfunction on presentation. Measures to reduce the burden of viral Hepatitis B and C, safe blood transfusion, and responsible use of alcohol should be promoted. Screening of those at risk of encephalopathy (liver disease patients) with a psychometric test of good predictability should be part of their routine evaluation in daily practice so as to detect cases of latent encephalopathy. Intensive care facilities and necessary personnel should be provided.

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Background: Chlamydia infections in women cause pelvic inflammatory disease, which often results in devastating consequences of infertility, ectopic pregnancy, or chronic pelvic pain. The infection is largely asymptomatic. Objective: To determine the seroprevalence of Chlamydia trachomatis in Enugu, South Eastern Nigeria. Materials and Methods: A population-based prospective study comprising female residents of Enugu, South Eastern Nigeria. Indirect solid phase enzyme immunoassay of Chlamydia antibodies was done using ImmunoComb C0. Trachomatis IgG Kit (Orgenics). Results: The population comprised 136 female undergraduate students and 150 non-student women. The overall prevalence of C. trachomatis in the population studied was 29.4%. The percentage of subjects who admitted to be having multiple sexual partners was higher among the student population (71.2%) compared to those from the non-student population (28.8%). The highest percentage of seroprevalence was 28 (33.3%) in the age group of 20-24 years for the student population and 18 (21.4%) in the age group of 25-29 years for the non-student population. The highest seroprevalence of C. trachomatis antibodies (69.0%) in both populations was observed in females without any history of infection. Females that had pelvic inflammatory disease, sexually transmitted infection, and secondary infertility assayed for C. trachomatis had seroprevalence levels of 19%, 9.5%, and 2.4%, respectively. There was a positive correlation between positive Chlamydia assay and the type of subject population (student or non-student) with r² value of 1.55 at P < 0.01. Conclusions: C. trachomatis infection is largely underdiagnosed and remains a silent disease in the apparently healthy population of Enugu, South eastern Nigeria.

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Objective : To determine the serosusceptibility of rubella infection in pregnancy and the feasibility of establishing an organized prevention program in a tertiary hospital in Nigeria. Materials and Methods: This prospective, cross-sectional, laboratory-based study involved 300 consecutive pregnant women who gave informed consent and were screened for rubella immunoglobulins G (IgG) and M (IgM), using the ELISA-based quantitative assay at the University of Benin Teaching Hospital, Nigeria. Of the cohort, 30 women later withdrew. IgG seropositive samples were screened for IgM antibodies. Results: The mean age and parity of the women were 30.0 ± 4.8 years, 95% CI 29.727-30.873 and 2.0 ± 1.4; 95% CI 1.317-1.661, respectively. IgG seroprevalence was 53%, while 10.0% of all IgG seropositive women were IgM seropositive. Most infections were acquired before the age of 35. None of the women ever had previous rubella vaccination. Rubella vaccine is scarce in Nigeria. Conclusions : Prevalence of rubella seromarkers for previous and current infection is high. Facilities for routine diagnosis and vaccination are lacking. Initiation of organized screening and vaccination programs is limited by lack of vaccine. We recommend immunization of children and women of child-bearing age as a cost-effective public health intervention strategy for managing the sequelae of the congenital rubella syndrome.

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Background and Objective: To document bilateral tubal ligation (BTL) rates and highlight the need to improve on the rates. Materials and Methods: A retrospective review of BTLs done in a five-year period from January 2000 to December 2004 constituted the study group. Results: There were a total of 103 BTLs, 58 were Caesarean BTLs, six were cases of BTL with repair of uterine rupture and 39 had BTL from mini-laparotomy. There were 937 Caesarean sections and 2,356 deliveries during the study period. BTL therefore constituted 0.044% of the total deliveries. The majority (51.7%) were above 35 years of age and grandmultiparity constituted 60.4% of BTL cases. The majority was in the low social Class 4 and 5 (41.3%). Grandmultiparity was the most common indication (60.4%). Previous Caesarean sections were more in the highest social class with a mean of 2.9 ΁ 1.21 while ruptured uterus had the lowest. Unbooked cases of BTL constituted 62.1% of BTL. Conclusions: Bilateral tubal ligation rate was low in this study with grandmultiparity being the commonest indication, the majority of patients were elderly parturient and largely unbooked. Social class was highest among those with previous Caesarean section.

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Objectives: To review the hysterosalpingographic (HSG) findings in women investigated for infertility in a tertiary center in north eastern Nigeria. Materials and Methods : A retrospective review of HSG films of 272 women investigated for infertility between January 2000 and December 2006 were reviewed. Results : One hundred and thirty (47.8%) were investigated for primary infertility, while 142 (52.2%) were investigated for secondary infertility. Most of the women investigated for infertility by HSG had abnormal findings 192(70.6%). The most common pathology revealed among the infertile women was tuboperitoneal factor in 196 (72.1%) followed by uterine synechia in 35(12.9%). Seventeen (6.3%) had bilateral tubal block and 5 (1.8%) had bicornuate uterus. Conclusion : HSG is helpful in the investigation of infertile women.

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Congenital aganglionic mega colon (Hirschsprung's disease) is a motor disorder in the gut, due to a defect in the craniocaudal migration of the neuroblast originating from the neural crest that occurs during the first twelve weeks of gestation, causing a functional intestinal obstruction, with its attendant complications, in infants. Despite modern pediatric practice, with emphasis on early diagnosis, Hirschsprung's disease is seen in adults in regions where perinatal care is limited. We report two cases of Nigerian adults with longstanding, recurrent constipation, getting relieved by laxatives and herbal enemata, and then presented to our Emergency Department with a history of progressive abdominal distention, colicky pain, occasional vomiting, and weight loss. Per rectal examination revealed a gripping sensation in the rectum, 10 cm from the anal verge, with rectal fecal load. Barium enema showed a grossly distended proximal large colon, with high fecal retention, with the transition zone at the middle one-third of the rectum. Due to difficulty in bowel preparation of these patients, emergency laparotomy was done. The first case had a diverting sigmoid colostomy and later had a low anterior resection. The second case had a one-stage procedure. Histology of both the cases showed aganglionosis of the stenotic segment and a normal distal rectum. Both patients had complete resolution of the symptoms, without complications, in a three-year follow-up. The related literatures were reviewed. Hirschsprung's disease should be considered in adults patient presenting with chronic constipation. Low anterior resection of the rectum would be a surgical option for the treatment of short and zonal segment of adult Hirschsprung's disease.

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Aim : This cross-sectional study was conducted to evaluate the diagnostic performance of a new rapid immunochromatographic test named "Paracheck pf" in the diagnosis of malaria in Nigerian children. Materials and Methods: A total of 380 Nigerian children aged between 6 and 59 months who presented at the University of Nigeria Teaching Hospital (UNTH) Enugu with fever and no obvious focus of any other infection were consecutively recruited. Malaria parasitemia was determined using simple microscopy and "Paracheck pf" . Results: "Paracheck pf" has the following diagnostic performance characteristics: Sensitivity of 82%, specificity of 91.5%, negative predictive value of 91.5%, positive predictive value of 82%, a strong positive correlation between parasite density and test sensitivity, and a detection limit of 397 parasites/μl. Conclusions: The test is, therefore, recommended for the use in Nigerian children aged between 6 and 59 months in Enugu for the diagnosis of malaria, but negative results should be cautiously interpreted in infants because symptomatic malaria may occur in these children at parasite densities as low as 100/μl.

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Background: The increasing use of commercial motorcycle as mode of transportation in urban cities in Nigeria has become important source of morbidity and mortality. This is coupled with poor helmet use, narrow roads, increasing traffic, and poor licensing of the motorcycle riders. The objectives of this study are to determine the pattern of injuries following accident involving motorcycles, the mortality rate, and the immediate causes of mortality. Materials and Methods: This is a combined retrospective and prospective study spanning over 2 years (1 year each). Patient's records were retrieved to collate data for the retrospective study while all the patients presenting to the casualty unit of Jos University Teaching Hospital following involvement in motorcycle accidents between April 2006 and March 2007 were selected for the study. Results: Out of 485 motorcycle injured patients, 295 and 190 were recruited from the retrospective and prospective study respectively. The male: female (M: F) ratio was 4.8:1. The ages ranged from 2.5 to 84 years with a peak at 21-30 years. The total number of injuries was 559 with 443 patients singly injured and 42 patients multiply traumatized. Head injury (40.1%) was the most frequently occurring injury followed closely by extremity injuries (38.1%). None of the patients wore protective helmet. Thirty-six (36) mortalities (7.4%) were recorded and all dead patients had head injuries. All deaths occurred within 24 h. Conclusions: Head injury represents a common cause of morbidity and mortality following motorcycle injuries in our environment. Therefore, strict enforcement of helmet laws from May 10, 2010 may reduce morbidity and mortality.

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Objective : To determine if there are monthly variations in the rate of deliveries in Benin City, Nigeria. Materials and Methods : A retrospective descriptive study carried out in the three major obstetric centers in Benin City, Nigeria. We extracted the total number of deliveries from the hospitals' records for over a five-year period and analyzed the figures for monthly variation in delivery rates. This was repeated for a standardized 30-day month and the findings noted. Results : There were 28,686 deliveries during the study period with an average monthly delivery of 2,390. The monthly distribution showed a sinusoidal pattern with peak delivery rates in April-May and October and lowest rates in July-August and December. The months of April, May, and October had delivery rates that were significantly higher than the monthly average delivery rate, while the converse was true for July, August, and December at the 99% confidence interval. Conclusions: There exists a significant monthly variation in delivery rates in Benin City. This finding will prove valuable in health system planning and in the interpretation of seasonal variations in other reproductive parameters.

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Background: Gynecological and early pregnancy complaints (GEPC)/lower abdominal complaints (LAC) are common in female patients seeking medical advice or treatments. Clinical limitations of GEPC or LAC are better resolved through appropriate laboratory and imaging investigation, among which the ultrasound examination (USS) is one. Aim: To determine the distribution/clinical pattern of female patients with GEPC/LAC, and to evaluate the correlation between the clinical and sonographical diagnoses, as seen in a private diagnostic center in the Ilorin metropolis. Materials and Methods: Records of 253 consecutive cases with GEPC/LAC, who had USS, were retrieved using 3.5 and 5 MHZ probes with SIEMENS Sonoline SL-1 machine, from January 2004 to December 2006, and retrospectively analyzed for the following variables: Age, occupation, complaints of vaginal bleeding, with or without pain, history of amenorrhea or infertility, clinical and ultrasound impression of early pregnancy complaints, including ectopic pregnancies and pelvic inflammatory diseases (PID), with exclusion of urogenital and gastrointestinal complaints/cases. Pregnancies greater than 12 weeks were excluded, bringing the total number of cases examined to 242. Results: Mean age was 30.44 years, median = 29.00; Mode = 25.00; with an STD of 7.69973. The youngest patient was 15-years-old while the oldest was 70 years. Cases of bleeding per vaginam Bleeding per vaginam (BPV), with or without pain, were the highest, 149 cases (61.6%), followed by threatened abortion, 45 cases (18.6%), and non-viable or incomplete abortions, 13 cases (5.4%). In contrast dysfunctional uterine bleedings (DUB) ranked the highest among the USS results, with 62 cases (25.6%), incomplete abortion cases were 44 (18.2%), while the non-viable pregnancies (missed abortions, blighted ovum, and early intrauterine fetal deaths (IUFD) cases) contributed to 26 cases (10.7%). Viable pregnancies were nine; incomplete abortions, nine; DUB, seven; Non-viable pregnancies, six; Threatened abortions, four; PID, four; complete abortions, two; Query-infected or degenerating fibroids, two; and others two. Threatened abortion ranked the highest among the definite clinical diagnoses. Conclusions : Bleeding per vaginam ranked the highest among GEPC/LACS in this environment, while there was poor correlation between clinical impressions and USS findings.

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Background : There is a paucity of information on treatment options and outcome of treatment of patients that have MRI findings of FJA presenting with low back pain in the developing country. This prospective cohort study conducted mainly in the University of Abuja Teaching Hospital Gwagwalada, Abuja Nigeria is to compare the short-term clinical outcome between two groups, one having undergone facet joints infiltration (FJI) and the other physiotherapy for facet joint arthropathy (FJA). Materials and Methods : All patients with clinical lower back pain (LBP) and MRI features of FJA were recruited into this prospective study randomly. All the FJI patients had depot methylprednisolone and the physiotherapy patients had McKenzie regimen. Outcome questionnaires comprising Oswentry disability index scores (ODI), visual analogue scores (VAS), and patient satisfaction scores (PSS) were completed at all clinic visits. Follow-up was for 6 months for both groups. The results were analyzed using SPSS 17.0. Result: There were 10 FJI patients and 8 physiotherapy patients (1.25: 1). The outcome scores comprised the following ODI, VAS, and PSS. The FJI group had a better score compared to the physiotherapy group at short-term evaluation and this difference was statistically significant. The female patients in both groups fare better compared to the male counterparts. Conclusions : FJI offered added benefit over physiotherapy in LBPs diagnosed with FJA. Patients with FJI have a significant reduction in pain symptom than the patients in the physiotherapy group. Though majority of the patients reported satisfactory outcome, the FJI patients group had a better outcome.

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Background: The surgical management of symptomatic benign bone tumor has been described in various manners in medical literature. However, there are few published reports on the presentation and surgical management of benign bone tumors in black African patients. Objectives: To determine the pattern of presentation of benign bone tumors and evaluate the common indications for surgery in a Nigerian Orthopedic Center. Materials and Methods: This is a prospective study of 67 patients, surgically treated for benign bone tumors, over a three-year period, at the National Orthopedic Hospital, Lagos, Nigeria. Results: The common histological types include, osteochondroma, giant cell tumor, and the simple bone cyst. These tumors have varying anatomic locations, but are more commonly located around the knee joint. In this series, most of the patients have presented with an active or aggressive stage of the disease. The most common indication for surgery is painful swelling; other indications include a pathological fracture, restricted range of movement, and peripheral nerve compression. The surgical procedures performed are simple excision, curettage, and stabilization; and 1-stage and 2-stage wide resection with reconstruction. Patients with significant bone defects have autologous bone grafting or methylmethacrylate cement application. Further stabilization is achieved with intramedullary or compression plate and screw fixation. Amputation has only been necessary in one patient with a huge aneurysmal bone cyst. At the average follow-up period of 28.6 months, five patients showed recurrence. All were with a histological diagnosis of giant cell tumor. Conclusions: The mode of presentation of benign bone tumors in this group of black African patients is heterogenous, demanding various surgical options. Limb sparing is a largely feasible option, but the recurrence rate is particularly higher for giant cell tumors. Increase in the number of patients presenting with giant cell tumors raises the possibility of an increase in the incidence of this condition in the black African population. Larger multicenter studies in the black African population may shed more light on the actual incidence of giant cell tumors and other bone tumors in this group of patients.

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Background: Dyslipidemia has been identified as a risk factor for the development and progression of diabetic renal disease. Objective: This study was done to determine the prevalence of dyslipidemia among diabetic patients with overt nephropathy. Materials and Methods: A total of 72 diabetic patients with overt diabetic nephropathy and 36 age- and sex-matched normoalbuminuric diabetic patients were studied. Their fasting lipid profile, fasting blood sugar, and renal function tests were evaluated. Results: Total serum cholesterol and serum triglycerides were significantly higher in patients with overt diabetic nephropathy compared to the controls; 66.7% and 62.5% versus 36.1% and 30.6%, respectively ( P = 0.003 and 0.002, respectively). Conclusions: Diabetic patients with overt diabetic nephropathy have significant dyslipidemia and aggressive lipid lowering in these patients may retard their progression to end-stage renal disease.

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Background: Tuberculosis (TB) co-infection with HIV is becoming a global emergency especially in the sub-Saharan Africa. Its diagnosis is notoriously challenging in countries with poor resource settings with limited diagnostic facilities. Objective : To determine the prevalence, pattern, outcome, and clinical risk factors of TB in HIV co-infected children in Abuja, Nigeria. Materials and Methods: An 18 months retrospective review of HIV-infected children diagnosed as having co-infection with TB was carried out at the special treatment clinic of the University of Abuja Teaching Hospital (UATH), Gwagwalada, from February 2007 to August 2008 for the above objectives. Results: Of a total 210 HIV-infected children observed during the review period, 41 (19.5%) were diagnosed as having co-existing TB. Their mean age, weight, CD4 cell count and its percentage were 6.3 ± 2.4 years, 14.3 ± 3.4 kg, 262 ± 28.0 cells/ml, and 9.9%, respectively. Pulmonary TB accounted for 59% of all TB cases seen, while disseminated form was seen in 26.8%. Bone involvement was the least common form seen in only (2.4%) of cases. Confirmation of TB was only possible by positive smear and histology in 22.0% of cases, while 78.0% of cases remained unconfirmed. Co-infection was significantly higher in older children (>5 years) than in younger children <5 years (32 vs 9, P < 0.05). Severe weight loss was the only clinical feature found to have a fairly good sensitivity (88.9%) and specificity (88.6%) for TB in co-infected children, with a positive predictive value of 23.0%. While immune reconstitution syndrome (IRS) occurred in 2 (4.9%) of the patients, only one death (2.4%) was recorded among the co-infected children. Conclusions: TB co-infection with HIV in children is common in this environment. Severe weight loss can be used as a clinical guide to identify HIV-infected children at risk of co-infection with TB who will require further evaluation.

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Oral lipomas, though rare, predominantly affect the buccal mucosa, tongue, and lips. The occurrence of lipomas in the palate is extremely rare. Osteolipoma is a very rare histological variant of lipoma accounting for less than 1% of all cases. Although a few cases involving the soft palate have been reported, there is only one reported case of osteolipoma of the hard palate in the English-language literature and it was a congenital osteolipoma associated with a cleft palate in a 6-year-old male child. This paper aims to describe an additional case uniquely located in the hard palate of an adult female.

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Objective : The study was designed to determine the prevalence of aggression and clinical factors associated with aggression among psychiatric in-patients at Jos University Teaching Hospital. This will help create a good knowledge base about management of these patients. Materials and Methods : All admitted psychiatric patients between December, 2005, and February, 2007, that met the ICD-10 criteria for a specific clinical diagnosis were included. The modified overt aggression scale was subsequently used to assess the type and severity of aggression. Additional information was obtained through a self-designed questionnaire containing sociodemographic and psychiatric illness variables. Results: A total of 300 subjects satisfied the inclusion criteria, but only 298 were assessed because two patients absconded from the wards during the study period. The prevalence of aggression in this study was 19.5%. Of the 58 aggressive patients, 35 (21.7%) and 23 (16.8%) were male and female, respectively. Schizophrenic patients (31%) exhibited aggression more than any other diagnostic category. Most of the aggressive behavior occurred without provocation (63.3%). Aggression among psychiatric patients was associated with a history of previous acts of aggression and delusion of persecution. Conclusions: Aggression is a significant clinical problem in psychiatric facilities. Consequences of aggression among psychiatric patients can be far reaching for the mental health worker. More longitudinal studies should be carried out among specific diagnostic categories of psychiatric patients to determine factors associated with aggression in each.

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Background: Suppurative otitis media (SOM) is the most common pediatric problem seen by otolaryngologists in Nigeria. Devising simple and effective ways of treating pediatric patients with suppurating ears, especially in situations without a specialist care, will help prevent chronicity. Our experience with SOM at the Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki, is reviewed in this study. It may serve as a guide in patient care. Objective: Determine the bacteriology of SOM in children in Abakaliki and ascertain their sensitivity to common antibiotics. Materials and Methods: A 2-year retrospective analysis of ear swabs culture results and case files of children aged 0-18 years with SOM managed in EBSUTH. Results: Sixty-five patients with discharging ears were reviewed. Of these, 73% were ≤5 years, of which 41.5% were infants. About 83% had unilateral ear discharge. Acute suppuration was seen in 67%. Overall swab yield was 87.7%; Pseudomonas was (57.4%), Klebsiella (16.4%), and Proteus species (11.5%). Ciprofloxacin showed 60% sensitivity, Gentamicin (58%), and Ceftazidime (35%). Amoxicillin/Clavulanic acid, ceftriaxone, and cefuroxime showed sensitivity of 4.3%-9.7%. Conclusions: Treatment protocols of SOM in children should emphasize the use of Ciprofloxacin or Gentamicin, especially in situations with limited access to laboratory services or specialist care.

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Background: Lichen planus (LP) is a chronic mucocutaneous disease of uncertain etiology. Recent reports suggest that LP is an extrahepatic manifestation of Hepatitis C infection. Objective: To determine the association of Hepatitis C virus (HCV) infection with oral LP and to study the tests of liver function in patients with oral LP. Study Design : A cross-sectional case-control study was carried out on 25 patients with oral LP and an equal number of controls. The study was conducted in the outpatient department of a dental college for a period of six months between January and June 2008. The sera of the patients and controls were tested for HCV ribonucleic acid (RNA) using reverse transcription primed-polymerase chain reaction and liver function tests (bilirubin, transaminases, and alkaline phosphatase). Results: Of the 25 patients with LP, three (12%) had HCV infection. None of the controls had HCV RNA positivity ( P = 0.2347). Oral LP patients had higher serum bilirubin and transaminases when compared with controls ( P < 0.05). However, there was no significant difference in alkaline phosphatase. HCV-positive and -negative patients did not differ significantly in liver function tests. Conclusions: An increased prevalence of HCV infection was seen in oral LP patients. Our findings support a possible etiological association between these two diseases.

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Background: Neck masses are common in children; they could present diagnostic challenges, and some may be malignant. This study determines the etiology, histopathology, and outcome of treatment in a Nigerian tertiary center. Materials and Methods: This is a three-year retrospective study of children managed with neck masses at the University of Benin Teaching Hospital between January 2007 and December 2009. The biodata, side distribution of the masses, clinical conditions of the children at presentation, methods of biopsy, histopathology results, definitive treatment options, follow-up, and outcome were analyzed. Results: A total of 35 children who were aged between one month and 16 years (mean, 8.1 ΁ 2.6 years) with a male : female ratio of 1.9 : 1 (23 males to 12 females) were managed with 26 (74.3%) acquired and nine (25.7%) congenital neck masses. The masses were located in the anterior triangle in 14 (40%) cases, right side of the neck in 12 (34.3%), and left side of the neck in seven (20%), with two (5.7%) bilateral/confluent. Twelve (34.3%) cases were enlarged lymph nodes; five (41.7%) of them due to malignant lesions. Except for the neck mass, 16 (45.7%) of the children enjoyed clinically stable health on presentation. Twenty (57.1%) acquired tumors were malignant compared with 15 (42.9%) mainly congenital tumors which were benign. Four malignant tumors (11.4%) were rare in anterior triangle. Hodgkin's lymphoma, 9 (25.7%), and thyroglossal duct cyst, 5 (14.3%), were most common malignant and nonmalignant masses, respectively. Surgical excision was curative in 12 (34.3%) cases, but others required additional chemo and/or radiotherapy, with two (5.7%) mortality recorded due to late referral of children with Hodgkin's lymphoma. Conclusions: Many neck masses in otherwise healthy children in our setting were malignant. We advocate early surgical consultation and thorough histopathologic analysis of neck masses in children in our subregion.

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Objective: The objective of the study is to investigate the prevalence and risk factors of non-consensual sex/rape in Benin. Materials and Methods: We surveyed 580 females in the University Community of Benin, 414 questionnaires were sufficiently completed for analysis. Results: Seventy-six (18.4%) respondents reported that they had been victims of non-consensual sex (NCS), 36 in their current relationship. The unmarried single respondents had the lowest mean age at NCS experience of 18 years, while the divorced victims had the highest mean age of 32.5 ( P = 0.000). There was a major exposure peak age at 19 years with a smaller peak at 25. The majority of sex offenders were their present partners and next the husbands (22.2%). The father was the perpetrator on one (2.78%) occasion, while armed robbers raped two of the victims. Eighteen of the seventy-six respondents made a formal report. Cumulatively, 95.4% of the respondents felt it was futile reporting, four (5.3%) felt it was not all a bad experience. The risk of being infected with the HIV/AIDS virus was the worst fear. Ninety-five of four hundred and fourteen respondents want the public and parents to be educated, 64 would like the penal code to be tougher and better implemented, while 64 (14.0%) crave for a dress code for the University community. Conclusions: The self-reported incidence of NCS is high, majority were not formally reported as most of the sex offenders were the (ex)partners of the victims. There was a major exposure peak age at 19 with a smaller peak at 25 years. There was a condoned sense of futility and frustration in reporting.

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Background : Renal failure is accompanied by oxidative stress, which is caused by enhanced production of reactive oxygen species and impaired antioxidant defense. Aim: To assess the effect of hemodialysis (by cellulose membrane dialyzer) on plasma total antioxidant status and lipid peroxidation of patients in chronic renal failure before and after dialysis. Objective : The finding would serve as guide to administration or otherwise of supplementary therapeutic antioxidant before or after hemodialysis. Also, it will assist in the choice of antioxidant impregnated over the conventional non-impregnated dialyzer membrane. Materials and Methods : Twenty-five patients (14 men and 11 women, aged 24-75 years; median 61) with end-stage renal failure who were undergoing hemodialysis for the first time were recruited. Plasma level of potassium (K+), sodium (Na+), blood urea nitrogen (BUN), creatinine, total antioxidant status (TAS), and lipid peroxidation (MDA) were measured, before and after hemodialysis. Results: The mean ± SD of plasma level of TAS (1.10 ± 0.3 mmol/L trolox Eq) for males and (1.09 ± 0.2 mmol/L trolox Eq) for females postdialysis were significantly reduced ( P < 0.05) in comparison with (1.72 ± 0.4 mmol/L trolox Eq) for males and (1.83 ± 0.7 mmol/L trolox Eq) for females predialysis, respectively. However, the mean ± SD plasma level of MDA (6.03 ± 0.4 nmol/ml) for males and (6.71 ± 0.7 nmol/ml) for females were significantly increased postdialysis ( P < 0.01) compared to predialysis (3.98 ± 0.8 nmol/ml) for males and (4.05 ± 0.9 nmol/ml) for females, respectively. Conclusions : Based on the outcome of this study, it is suggested that antioxidant-impregnated dialysis membranes and/or exogenous supplementary antioxidant would be beneficial to patients with chronic renal failure. Removal of reactive oxygen species could improve the health and general quality of life of uremic patients.

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Background and Objective: The existence of a psychosocial dysfunction in the siblings of children with chronic illness has been documented. There are very few reports on siblings of children with epilepsy. The aim of this study is to investigate to what extent the children's epilepsy has affected their healthy siblings in our own center. Materials and Methods: Epileptic patients who consecutively referred to the Pediatric Neurology Clinic of the University of Nigeria Teaching Hospital, Enugu, from October 1999 to September 2000 were recruited. Demographic data were obtained, with a questionnaire administered to the parents. Information on the behavior of the school-age siblings and control was obtained by the class teachers using Rutter's behavior scale (B2) for children (Teacher's Scale). Results: One hundred and fifty-six children with epilepsy, of age four to fifteen years, 124 males and 32 females, with a Male: Female ratio of 4: 1, were recruited; and 156 school-age siblings of the epileptic children (index children) and 156 controls were studied. Prevalence of behavioral problems was 38.5 and 15.4%, respectively, among the index and control children ( P < 0.001). There was no significant sex difference in the two groups. There was a significant difference in the distribution of the types of behavior problems between the index and controls ( P < 0.05). The duration of epilepsy did not affect the prevalence of behavior problems ( P < 0.05), but seizure control had a significant effect on the prevalence of behavior problems ( P < 0.001). Conclusions: Siblings of children with epilepsy have more behavioral disturbances than controls. A strong association was found between poor seizure control and the prevalence of behavioral problems.

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Objective: The aim of this article is to document the experience of urologists on clients' demand for prostate cancer screening among Nigerians. Materials and Methods: The study is a cross-sectional evaluation of the urologists that attended the Fourteenth Annual Meeting and the Scientific Conference of the Nigerian Association of Urological Surgeons. A structured questionnaire was used to assess the estimated workload of the respondents, with reference to prostate cancer management, the stage proportion at the time of diagnosis, and the proportion of patients requesting for CaP screening. The data was analyzed using the SPSS version 15 statistical software. Results: Twenty-two respondents completed and returned the questionnaire and formed the basis of further analysis. About 76.9% of the consultant urologists were also lecturers in their respective universities. They were all actively practicing and a majority of them, 76.9%, had up to 10 years experience as practicing urologists. The majority of the respondents managed between one and fifteen new patients with CaP every month, with 36.4% of them managing more than 15 new patients on an average every month. About 95.4% of all the patients seen by the respondents were diagnosed with advanced stages of the disease, while the remaining ones were incidental findings. About one half of the respondents attended to clients seeking for advice on CaP 'often' or 'very often,' while 40.9% attended to them 'occasionally,' with a mean of 4.67 clients seeking advice per month. The majority of respondents, 20 (22); 90.9%, were 'not aware' of any national guideline on CaP screening. Conclusions: A majority of practitioners affirmed that patients with prostate cancer present late. The mean number of patients requesting for screening for prostate cancer per month, per respondent, for CaP, is still low. It is the authors' belief that the trend may not change until there is an appropriate effort at health education, to enlighten the populace.

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