Background: Cigarette smoke with its toxic ingredients leads to chronic inflammations in the airways. Objectives: In this study, the effect of cigarette smoke on the levels of inflammatory markers, interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-α) in induced sputum was investigated. Materials and Methods: Twenty patients with chronic obstructive pulmonary disease (COPD) (group I), 20 healthy smokers (group II), and 20 healthy nonsmokers (group III) were included in the study. The levels of IL-6, IL-8, and TNF-α in induced sputum were measured in these groups, and comparison analysis between the groups and correlation analysis for smoking load (pack-years) and spirometric parameters were performed. Results: Mean age of the patients in groups I, II, and III were 61.2 ± 1.7, 58.2 ± 1.6, and 59.1 ± 5.4 years, respectively (P > 0.05). Smoking loads of group I and group II were 38.6 ± 2.1 and 29.5 ± 2.3 pack-years, respectively (P < 0.05). All cytokine levels were significantly higher in group I than groups II and III (P < 0.05). In addition to this, mean cytokines levels were significantly higher in group II than group III (P < 0.05). Smoking load of group II subjects was positively correlated with IL-6, IL-8, and TNF-α in induced sputum (P < 0.05). Conclusions: We found that inflammatory marker levels in induced sputum were significantly higher in COPD patients and smokers than nonsmokers. Moreover, there was a moderate positive correlation between IL-6, IL-8, and TNF-α levels and smoking load in the healthy smokers. We think that further studies are needed to determine whether higher levels of cytokine levels in sputum might be helpful in predicting the healthy smokers who will develop COPD in future.

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Background: The attitudes toward people with epilepsy are influenced by the degree of knowledge of the condition. The social problems encountered by school children with epilepsy as a result of negative attitude and beliefs are quite enormous. Objectives The study therefore looked at the knowledge, attitudes, and perceptions of teachers, who see a lot of epileptics, relate to them on a daily basis and have influence on them. Materials and Methods: A cross-sectional survey, using a self-administered questionnaire obtained from the author of a similar study in the United States, was carried out among 269 school teachers randomly selected from various secondary schools in Osogbo, the Osun State capital in South-West Nigeria. The questionnaire included the scale of attitudes toward persons with epilepsy and knowledge about epilepsy as well as demographic and teaching experience survey among others. Results Despite the high level of education of the teachers ranging from Masters Degree to National Certificate in Education, there were significant deficits in terms of general knowledge about epilepsy (70% of the respondents reported their general knowledge about epilepsy in the lower half of the scale). There was also poor knowledge of the first aids measures in the classrooms. Below one-third (29.2%) felt it was contagious and 40% of respondents reported that sufferers should not be kept in regular classes. However, their attitudes toward epilepsy were generally positive. Conclusions and Recommendations: We concluded that teachers need to have health education courses on common disease conditions such as epilepsy that are prevalent in school age; this might help to reduce the prejudice and increase the acceptance of epileptic individuals in the classrooms. Also, generally public health campaigns should be encouraged in this field.

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Objectives: The objective was to evaluate seminal fluid indices of male partners of infertile couples so as to identify the current status of the contributions of male factor to infertility in our environment. Materials and Methods: This is a prospective study of the seminal fluid indices of consecutively consenting male partners of infertile couples seen at the Fertility and Endocrinology Research unit of the Department of Obstetrics Gynaecology and Perinatology, Obafemi Awolowo University Teaching Hospital Ile-Ife between May 2004 and June 2008. Results: The results of the semen analysis of 661 male partners of the infertile couples were retrieved and analyzed. The patterns of semen parameters noted in infertile males were oligozoospermia, teratozoospermia, asthenozoospermia, azoospermia, oligoteratozoospermia, oligoasthenozoospermia, and oligoasthenoteratozoospermia, asthenoteratozoospermia found in 25.6%, 18.5%, 11.5%, 6.2%, 3.2%, 2.3%, 2.1%, and 0.9%, respectively. Among the age groups, age group 31-40 had a higher prevalence of oligozoospermia (13.3%) while among the occupational groups, the civil servants had the highest prevalence of oligozoospermia (12%). There was a high of level of leucocytospermia and bacterial infections in both normospermic and oligospermic semen. Conclusion: This study showed a high rate of abnormal semen quality of male partners of infertile couple in our environment and is an indication for the need to focus on the management of this condition and the institution of preventive program for male infertility. There is urgent need for advocacy for men to accept responsibility for their contribution to infertility and to reduce stigmatization and ostracizing of women for infertility.

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Although substance abuse is fairly common among adolescents, poisoning from Datura stramonium (a broadleaf annual erect herb with spine-covered seed capsule) is uncommon in children and has not been reported in our locality. We present the case of two children admitted at the Children Emergency Room of a teaching hospital following ingestion of extract of Datura stramonium. They developed neurotoxicity (confusion, agitation, mydriasis, and hallucination) and were managed symptomatically with good outcome. A high index of suspicion and early management of poison in children is imperative if a favorable outcome is expected. Early presentation and the presence of an eyewitness contributed to the very good outcome in these index cases. In this report, we discussed the symptomatology and management of Datura toxicity in children.

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Background: Recent studies revealed elevated serum ferritin levels predict new-onset type 2 diabetes. Further studies proved ferritin to be an important and independent predictor of the development of diabetes. The link between hyperglycemia, enhanced free radical activity (oxidative stress) and serum iron and its stores (serum ferritin levels) levels is not clear. Objectives: The present study is an attempt to understand the relationship between serum ferritin levels and oxidative stress (measured by malondialdehyde). Materials and Methods: The study comprised of 30 apparently healthy controls and 30 type 2 diabetic patients who attended the outpatient and inpatient departments of Medical College, Kolkata. Levels of fasting blood glucose, postprandial blood glucose, serum iron, serum ferritin, glycosylated hemoglobin (HbA1c) and malondialdehyde (MDA), serum urea and creatinine were estimated. The statistical software SPSS 11.0 and Systat 8.0 were used for the analysis of the data and Microsoft Word and Excel have been used to generate tables and graphs. Results: Serum iron (82.16 ± 13.24 μg/dl), serum ferritin (224.53 ± 96.06 μg/L), HbA1c (8.62 ± 1.79%), MDA (2.66 ± 0.76 nmol/ml) levels were significantly higher in type 2 diabetics compared with apparently healthy controls. Elevations in serum iron, ferritin and HbA1c are accompanied by a parallel increase in blood glucose. Based on groups of glycemic control, i.e. HbA1c levels >8%, serum ferritin levels were highest, 258.63 ± 22.67 μg/dl. There is an inverse correlation of serum ferritin levels to MDA levels in the diabetic cases of longer duration of more than 10 years. Conclusion: Serum ferritin level in the present study is found to be higher in the newly diagnosed cases and lower in those patients suffering from diabetes for more than 10 years. This study probably suggests that serum ferritin can represent either as a pro-oxidant or as an antioxidant in a time-dependent manner.

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Objective: To study the pattern of gynecological malignancies in Aminu Kano Teaching Hospital. Materials and Methods: This was a retrospective observational study carried out in the Gynecology Department of Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria between October 2008 and September 2011. Case notes of all patients seen with gynecological cancers were studied to determine the pattern, age and parity distribution. Results: A total of 2339 women were seen during the study period, while 249 were found to have gynecological malignancy. Therefore the proportion of gynecological malignancies was 10.7%. Out of the 249 patients with gynecological malignancies, most (48.6%) had cervical cancer, followed by ovarian cancer (30.5%), endometrial cancer (11.25%) and the least was choriocarcinoma (9.24%). The mean age for cervical carcinoma patients (46.25 ± 4.99 years) was higher than that of choriocarcinoma (29 ± 14.5 years) but lower than ovarian (57 ± 4.5years) and endometrial (62.4 ± 8.3 years) cancers. However, the mean parity for cervical cancer (7.0 ± 3) was higher than those of ovarian cancer (3 ± 3), choriocarcinoma (3.5 ± 4) and endometrial cancer (4 ± 3). The mean age at menarche for women with cervical cancer (14.5 ± 0.71 years) was lower than for those with choriocarcinoma (15 ± 0 years), ovarian (15.5 ± 2.1 years) and endometrial (16 ± 0 years) cancers. There was one case of vulva cancer and none with vaginal cancer. Conclusion: Cervical cancer was the most frequent malignant tumor and the least was choriocarcinoma. Estimates of this important public health problem need to be addressed in various regions of Nigeria.

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Background: Gallstones (GS) in the gallbladder (GB) can be responsible for a whole spectrum of disease entities which may lead to a surgical emergency with high mortality. Diabetes mellitus (DM) is a debilitating disease that affects all systems in the body, and literature documents a higher incidence of gallstone disease (GSD) and its complications in diabetics than in the non-diabetic population. Most local studies on the association between GS formation and DM have focused on type 2 diabetics. This study was therefore designed to determine the prevalence of GS in both type 1 and type 2 DM and elucidate the demographic and social factors associated with formation of GS in diabetic patients. Materials and Methods: Four hundred diabetic patients aged between 15 and 82 years had abdominal ultrasound to diagnose or exclude the presence of GS. Results: GS was found in 70 (17.5%) of the 400 patients. Positive cases had a male to female ratio of 3:4 and 59 (51.92%) were above the age of 40 years with type 2 DM. Body mass index (BMI) greater than 25 kg/m ² was seen in 56 (48.3%) patients; smoking and alcohol intake were insignificantly implicated. Jaundice was recorded in 8 (11.4%) while abdominal pain was in 24 (34.3%) patients, and 52 (74.3%) patients of those with GSD had had diabetes for more than 4 years. Conclusion: GSD in DM is influenced significantly by age, BMI, and duration of the disease, while gender, social factors, and parity do not influence as strong associated factors.

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Background: The cubital fossa is a common site for the removal of venous blood for analysis, transfusion, and intravenous therapy. The superficial venous return from the upper limb follows two or three major superficial veins, which are extremely variable; these include the cephalic, basilic, median cubital, and antebrachial veins and their tributaries. Objective: This anthroposcopic study was to determine the patterns of superficial venous arrangement in the cubital fossa of adult Nigerians. Materials and Methods: One hundred and thirty-five subjects (100 males and 35 females), aged between 20 and 27 years, were studied. The judgment sampling technique was employed. A tourniquet was firmly tied at the midarm level and the conspicuous superficial veins were diagrammatized and photographed with a camera. Results: Ten types of venous pattern arranged in six groups were noted. The most common pattern observed was the median antebrachial vein, dividing into median cephalic and median basilic veins, which join the cephalic and the basilic veins, respectively, with a variation. The result showed bilateral difference between the incidence of each type in males and females with the male values being statistically higher (P < 0.05). Conclusion: Appreciation of these venous patterns is useful to the medical and paramedical workers, especially in conditions that require venepuncture.

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Background: Upper respiratory tract obstruction resulting from bilateral recurrent laryngeal nerve damage is commonly managed with permanent tracheostomy in our environment. Objective: To evaluate the social impacts of permanent tracheostomy and its management in Ondo State, Southwest Nigeria. Materials and Methods: Four patients were managed with permanent tracheostomy due to bilateral laryngeal nerve paralysis following thyroidectomy. The observed complications are grouped as surgical/medical and social complications. Results: Surgical/medical complications include excessive mucus production, 29 (43.2%), stoma infection 18 (26.8%), stoma polyp and soft tissue blockage of tube fenestrations were 10 (15%) each. The observed impacts on patients' social life include: Negative attitude of family members, difficulty with professional use of voice, problems of social integration and scarcity of tracheostomy tube with speaking valves. Conclusion: Management of social impacts of permanent tracheostomy is more difficult than other complications and family members must be involved in it.

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Introduction: Orphans like other vulnerable children face a number of challenges including limited or no access to basic health care including oral health care, which is one of their unmet health care needs. Neglected oral health care is associated with the development and progression of periodontal diseases among others. Objective: To determine the oral hygiene status of institution dwelling orphans. Materials and Methods: Thirty eight orphans from four orphanages in Benin City, Edo State of Nigeria were clinically examined and their oral hygiene status determined using the simplified oral hygiene index of Greene and Vermillion (OHI-S). Results: Seventy-three percent of the orphans were found to have fair oral hygiene comprising mostly of those aged 6-13 years. More females were in this category while more males presented with poor oral hygiene status. Conclusion: More orphans presented with fair oral hygiene that indicated inadequate oral care. There was poor oral health education and limited access to services. There is need for these to be improved as a solution to poor oral health status of these vulnerable children.

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There are very few cases of radiation-induced femoral head necrosis described in the literature, therefore, this case will add new knowledge and highlights important aspects in the diagnosis and management of this uncommon condition. Our patient was 74 years old and presented with left hip and groin pain for 8 months, with no previous history of trauma or osteoarthritis. However, he had been treated for metastatic prostate cancer, to the pelvis and roof of the left acetabulum, with androgen ablation, and radiotherapy 5 years before presentation. Examination of the left hip revealed painful movements, but no restriction in the range of motion. Initial X-rays did not show any abnormalities, but MRI scan revealed a suspicious lesion in the roof of the left acetabulum, with no indication of secondary weakening of the femoral neck. The patient was therefore referred to the oncologists to consider radiotherapy, but they were not convinced it was metastatic, because he had no new urinary symptoms, and the PSA remained normal throughout this period. He was subsequently referred for a bone scan to look for possible secondary lesions (from the prostate gland), but this did not reveal any abnormal increased uptake. Three months later, he was reviewed in the clinic with a repeat X-ray of the pelvis which revealed complete destruction of the left femoral head and the acetabular roof, but CT-guided biopsy revealed no evidence of malignancy in the left hip. However, in view of the persistent pain and radiological evidence of left hip destruction, the patient had left Total Hip Replacement (THR), and excellent post-operative recovery. He mobilised fully, and was discharged on day five. Histology of the femoral head and hip capsule, revealed no evidence of metastasis from the prostate cancer, but confirmed osteonecrosis of the femoral head, presumably caused by the previous radiotherapy. MRI of the spine was clear and he was discharged to the oncologists and urologists for follow up

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Background: Atherosclerotic disease is the most common cause of death in the United States and prostate cancer has the highest incidence among males in the United States. Reports have indicated that atherosclerosis and cancers my share common pathoetiologic and pathogenetic cascades. If atherosclerosis and cancers have common pathoetiologic and pathogenetic cascades, both diseases will co-occur and patients may represent a potential target group for cancer screening interventions. Materials and Methods: Prostates and coronary vessels were examined from 37 deceased men, aged 50 years and older, who died unexpectedly and suddenly from traumatic causes. Tissue sections of the entire prostate were examined for benign and malignant lesions. Analysis of Variance was used to compare mean coronary artery atherosclerosis scores among groups of men with diagnosis of adenocarcinoma, intraepithelial neoplasm, benign hyperplasia and normal prostate glands. Results: Twelve prostates (32.5%) showed adenocarcinoma of the prostate, four with Gleason score 7 and eight with Gleason score 6. After adjustment for age and race, there remained no statistical difference between prostate pathology groups and atherosclerosis score (F = 0.72; P = 0.55). Conclusions: To our knowledge, ours is the first study to use direct pathological examination of tissues for definitive identification of atherosclerosis and prostate cancer. In our case series, the occurrence and progression of coronary atherosclerotic disease and cancer of the prostate were not associated.

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Purpose of Study: Esophageal stricture is a debilitating condition with significant morbidity and mortality, occurring often as a complication of the ingestion of corrosives. In the adult, majority of cases are intentional whilst being accidental in the pediatric population. We therefore sought to describe the circumstances of intentional corrosive ingestion and determine the presence and impact of psychiatric illness on the outcome of management. Materials and Methods: A retrospective analysis of case folders of patients managed with this condition over a ten-year period (2000-2009) was done by comparing sociodemographics and outcome of management in patients with and without psychiatric disorders. Results: Twenty seven cases were reviewed. Mean age was 30.7 (SD =16.01), with a M:F ratio of 1.25:1.86.2% had a diagnosable psychiatric condition, the most common being depression in 55.6% of the patients. Caustic soda (55.6%) was the most common corrosive ingested. There was a significant difference in mean duration before presentation in patients with (1.7 days) and without (6.6 days) previous psychiatric illness (P = 0.01). A significant positive association was also found between surgical outcome and previous history of psychiatric disorder (P = 0.02). Conclusion: Early recognition of psychosocial distress is important to prevent deliberate self-harm. Counter-intuitively, a previous history of psychopathology limits esophageal injury by early presentation and therefore improve chances of a good surgical outcome.

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Background: Hypertension and other noncommunicable diseases are currently responsible for at least 20% of all deaths in Nigeria, and constitute up to 60% of the patients admitted into the medical wards of most tertiary hospitals in Nigeria. Yet, the treatment outcomes for the diseases have remained very poor, prompting calls for better patient education. It has however been established that the effectiveness of patient education is linked to the healthy habits of the doctor. This study was conducted to find out the prevalence of hypertension and its modifiable risk factors among the lecturers of the University of Port Harcourt Medical School. Materials and Methods: A descriptive cross-sectional study design was used, with the data collected using a modified form of the WHO STEPS instrument that consists of a questionnaire component and the measurement of body mass index (BMI) and blood pressure. The questionnaire was used to collect information on the sociodemographic characteristics of the respondents, the use of tobacco, the consumption of alcohol, the type of diet, and the amount and types of physical activities undertaken. Results : A total of 75 lecturers participated fully in the study, out of an eligible total of 109. They were mostly males (65.33%), married (88.33%), and had an average age of 46.06 ± 9.62 years. The prevalence of hypertension was 21.33%; out of which 12 (75.00%) were already aware of their status, and were on appropriate therapy. Only 13 (17.33%) of the lecturers were of normal weight, 45 (60.00%) were overweight, while 17 (22.67%) were obese. Only 2 (2.67%) currently smoke, while most (94.67%) drank less than three standard units of alcohol in a day, mainly in social occasions. Conclusion: The prevalence of hypertension among the lecturers in the medical school was lower than that in the general population, mainly due to their better health-seeking behavior and healthy lifestyle.

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Background: Head injuries rank high among morbidities due to trauma. Computerised tomography is an important modality in the investigation of these cases. However, literature on this subject in the south-south geopolitical zone of Nigeria is sparse. This study therefore aimed to document the computerized tomographic features of patients with head injury managed at the University of Benin Teaching Hospital (UBTH). Materials and Methods: A prospective study involving patients with head injury referred for CT scan from the Accident and Emergency Unit of UBTH over a 12-month period. A total of 100 patients were studied, using non-enhanced cranial CT scans. Findings were recorded and data analysis using SPSS done. Results: The age group 21-30 years was most frequently involved. Sex preponderance was 4.3:1 (male: female). Twenty-six patients had normal CT scans. The most common abnormal finding was intracerebral hemorrhage 35 cases (33%). This was followed by skull fractures, 23 cases (31%); subdural hemorrhage, 16 cases (21%); cerebral edema, 11 cases (15%). Others included mass effect, nine cases (12%). Conclusion: CT plays a very significant role in management of head injuries, as demonstrated in this study, by making such diagnoses that guided eventual patient management. Intracerebral hemorrhage was the most common abnormal finding in this report. Regular use of CT in moderate to severe cases of head injury is advocated.

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Background: Recent studies revealed an association between sleep disturbance and metabolic disorders, such as obesity and metabolic syndrome. An aim of this study was to assess the relation between sleep duration and diabetes mellitus in a representative sample of the Iranian population. Materials and Methods: Participants were 12514 individuals, (6123 men and 6391 women) studied in the baseline survey of a community based program entitled Isfahan healthy heart program (IHHP). Sleep time was obtained by validated questionnaire. Diabetes mellitus was defined as fasting glucose over 126 mg/dl or 2 hour post prandial glucose at glucose tolerance test over 200 mg/dl, or if the patient was on diabetic medication. The relation between the sleep time and diabetes was examined using categorical logistic regression with adjustment for sex, body mass index and waist circumference. Results: Compared with those, sleeping 7-8 hours per night, the individuals with sleeping time of 5 hours or less and aged <60 years had an increased odd ratio for diabetes and an impaired glucose tolerance. (OR = 1.37 and 95% CI = 1.13, 1.67). Conclusion: Sleep duration of 5 hours or less in individuals under age 60 years is associated with an increased prevalence of diabetes mellitus and an impaired glucose tolerance test. This finding should be confirmed in longitudinal studies.

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Background: Trauma is one of the leading causes of mortality in developing countries. Nonspecialist doctors are the first caregivers to attend to trauma patients. Most nonspecialist doctors in Nigeria lack extra training in trauma care including the ATLS training for doctors. Objectives: To determine the knowledge of the ATLS protocol among nonspecialist doctors involved in trauma care in Enugu, Nigeria. Materials and Methods: We prepared and shared out questionnaires to the respondents, and later analyzed the information received using the SPSS 15. Results: 65 out of 110 respondents (59.1%) filled and returned their questionnaires. 59 (90.8%) were males and 6 (9.2%) females. Their ages ranged from 29 to 47 years (35.6 ± 3.85 years) and they had been practicing for 1-16 years (mean 4.40 ± 3.540 years). 5 (7.7%) were medical officers while 60 (92.3%) were residents at various stages of training in different Surgical subspecialties. 41 or 63.1% rated their knowledge of the ATLS protocol as satisfactory. 22 (33.8%) demonstrated a satisfactory knowledge of ATLS. The three respondents (4.8%) who had undertaken a formal training in ATLS demonstrated excellent knowledge of ATLS. All believed that training in the protocol would be beneficial in their career. Conclusion: There is a poor knowledge of ATLS among nonspecialist doctors involved in trauma care in Enugu, Nigeria. ATLS training should be adopted by the hospitals involved in the training of doctors and should become a condition to employ surgery residents.

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Background: There has been a decline in the auscultatory and other clinical skills of physicians especially in developed countries. The advent of echocardiography has revolutionized the diagnosis of cardiovascular diseases and made up for the decline in clinical skills. Objective: To assess the sensitivity and specificity of auscultatory and clinical skills in the diagnosis of cardiovascular diseases using echocardiography as the gold standard. Materials and Methods : All the adult echocardiographic studies (321) performed over a 1-year period were collated for analysis. The clinical indications of the studies were compared with the final diagnoses by echocardiography. The sensitivity and specificity of the clinical diagnosis of hypertensive heart disease (HHD), rheumatic heart disease (RHD), and the cardiomyopathies were determined. Results: Of the 244 (76.0%) clinically diagnosed as HHD, 188 (58.6%) were confirmed by echocardiography. For RHD 9 (2.8%) were diagnosed clinically while on echocardiography, 13 (4.1%) were diagnosed. All the 31 (9.7%) cases of dilated cardiomyopathy were confirmed on echocardiography. No case of ischemic heart disease was confirmed. Seventy-one (22.0%) had normal studies. The sensitivity of clinical diagnosis for RHD was low (41.7%) while for HHD and dilated cardiomyopathy, sensitivity was high, 95.7% and 75.0%, respectively. Specificity was high for all three cardiovascular diseases analyzed. Conclusion: Auscultatory and clinical skills are still sensitive and specific tools in the diagnosis of cardiovascular diseases in developing countries and should be sustained. However, echocardiography is indispensable in the diagnosis of cases with subtle clinical signs and should be made more available and affordable.

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Background: Patients with sickle cell anemia (SCA) are prone to recurrent pain crises related to red blood cell sickling and vaso-occlusion with subsequent tissue hypoxia. Alveolar hypoxia has been shown to be associated with entrapment of sickle cells in the pulmonary microcirculation which may propagate a cycle of further hypoxemia and sickling. Pulmonary complications are common in sickle cell disease (SCD) and may exacerbate microvascular occlusive phenomena. Thus, detecting hypoxemia is of particular importance in SCD. Objectives: This study was designed to determine the prevalence of hypoxemia among children with SCA and compare the oxygen saturation of those in crises with those in steady state. Materials and Methods: This is a prospective observational study involving 46 children with SCA in steady state, 42 with crises, and 42 with HbAA genotype carried out between August and December 2010. The study compared the oxygen saturation of sickle cell anaemic children in steady state and in crises with normal hemoglobin genotype using Nellcon pulse oximeter while the hemoglobin concentration was analyzed using automated Sysmex KX-21N model. Results: A total of 130 participants aged 6 months to 18 years were recruited. The overall prevalence of hypoxemia in this study was 13.8%. Hypoxemia was highest among SCA patients in the crisis state (23.8%) compared to 13% and 0% for those in the steady state and in those with normal hemoglobin genotype, respectively (χ² = 6.425, P = 0.04). Hypoxemia was higher among those with hemoglobin less than 5 g/dl (30%) and least among those whose hemoglobin levels were 10 g/dl and above. Conclusions: Hypoxemia was significantly higher among children with SCA during Vaso-occlusion crises. We recommend that one should have a high index of suspicion and take prompt action in managing these individuals especially those with acute chest syndrome.

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Many factors, including relatively young age of thyroid cancer diagnoses and improved survival, have led to increased concerns about the occurrence of second primary malignancies. This paper describes the pattern of occurrence of second primary malignancies in patients who were treated for malignant thyroid neoplasms in an Indian hospital. There were 21 affected patients of the approximately 4500 seen over 25 years. Most of the second primary cancers are solid tumors, and when nonthyroid cancers are the second tumors, ductal carcinoma of the female breast is the most common. Most of these tumors have very short detection intervals (including synchronous occurrences), suggesting that therapy with internal radiation was not contributory to the tumor development. When thyroid malignancies were the second primary cancers, they usually follow radiotherapy to the head and neck region for treatment of the first primary tumor and tend to be of aggressive histologic types than the common well differentiated thyroid carcinomas.

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Background: Rasmussen's encephalitis is an uncommon chronic inflammatory disease disorder of unknown etiology. Objectives: The aim of this report was to create an awareness of Rasmussen's encephalitis in our clinical practice in Africa. Materials and Methods: We searched online for literature on Rasmussen's encephalitis with an emphasis on documented cases in Africa and in blacks all over the world. Results: Master F.M., a 14-year-old male, presented with history of recurrent seizures on three occasions. The first was after an upper respiratory tract infection, the second was a post-complicated meningo-encephalitis and the third episode was associated with receptive aphasia, hemiparesis and intellectual impairment. Neuroimaging studies revealed cerebellar atrophy and infarction of territory of the middle cerebral artery. His electroencephalogram showed bi-frontal theta activity left>right and poly spikes left>>right, diagnostic of complex partial seizures. In a period of 12 months, his gait and speech had improved while his intellectual impairment permitted re-admission into a lower academic class. He is presently on phenytion and prednisolone tablets only. Conclusion: Master F.M. had all the clinical features buttressed with neuroimaging results of a clinically probable Rasmussen's encephalitis. However, an advanced neuroimaging study is needed to detect and quantify hemispherical volume loss.

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Background: Expectedly, daycase surgery (DCS) is today witnessing a boom in developing countries as a reasonable option in the face of global economic recession, although with limited scope. Aim: The aim of this study was to describe the urologic day surgery experience at the Lagos State University Teaching Hospital, Ikeja. Materials and Methods: All day-case urologic surgeries done between January 2006 and December 2010 were retrospectively studied. Data obtained were patients' personal details, diagnoses, procedures performed, mode of anesthesia, and surgical complications as well as admission rate. Results: A total of 1070 operations were performed. The patients were aged 7 days to 92 years. Local anesthesia was employed in 42.2% while general anesthesia was used in 1.7% of patients, mostly pediatric cases. Caudal block anesthesia (55.8%) was administered for transrectal prostate biopsy and urethrocystoscopic procedures. The diagnostic and therapeutic urologic procedures in adults were mainly prostate biopsy (n = 344, 32.1%), urethrocystoscopy (n = 218, 20.4%), varicocelectomy (n = 143, 13.4%), and orchidectomy (n = 93, 8.7%). Mohan's valvotomy was the most common pediatric operation (n = 19, 1.8%). Postoperative morbidities that warranted hospital admission were observed in 17 (1.6%) cases. Conclusion: Urologic day surgery is feasible with minimal morbidities. The provisions of a dedicated day-case unit or a mobile DCS service may further improve on the volume of cases that can be operated on a day-case basis and has the potential of further reducing the waiting time for surgery.

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Background : An interdisciplinary team approach concept has been proposed for management of oro-facial cleft in the last two decades. Our objective was to evaluate the practice of the team approach concept and practices of the specialists involved in oro-facial cleft care in Africa. Materials and Methods: A snapshot survey was conducted among the attendees of the 2 ^nd Pan-African Congress on Cleft Lip and Palate, at the International Institute of Tropical Agriculture, Nigeria, in February 2007. Result : Of the 120 questionnaires distributed, 91 were returned for analysis (75.8% response rate). Mean age of respondents was 43.6 ± 4.97 years and the range was 36-62 years. Male-to-female ratio was 3.5:1. Oral and Maxillofacial Surgeons and Plastic Surgeons constituted the majority of respondents (34.1% and 29.7% respectively). Only 48.4% (44 respondents) of the specialists belonged to cleft teams. Majority of Oral and Maxillofacial Surgeons and Plastic Surgeons belonged to cleft teams (65.9 and 79.5% respectively), while Speech Pathologists and Orthodontists were less represented (18.2% and 40.9% respectively). Conclusion : Findings from this study have shown that interdisciplinary care for the cleft patient is not yet fully established in Africa. The result obtained also suggests that cleft care in African population is young, and team care is perhaps many years behind the global trend. This may be a result of several reasons ranging from lack of sufficient specialists in African population generally to the relatively young age of cleft care practice in that part of the world

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Two cases of reimplantation of avulsed teeth that occurred after 72 hours are reported. The two patients were male and female aged 13 and 24 years, respectively. The avulsed teeth were not placed in any storage medium for the duration they were out of the mouth and there was no periodontal ligament remaining on their root surfaces before the reimplantation. The teeth in these two patients are still firm without complications after 7 and 17 months. We suggest that the procedures adopted in treating these case should be used by clinicians in treating carefully selected cases that match the cases presented in this paper, which may present to them in their clinics.

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Background: Health education is an important tool required for reducing the burden of birth asphyxia in the developing world. Objective: The objective of this study was to assess the knowledge of mothers, who received health facility-based antenatal care during their last pregnancy, about birth asphyxia and relate their knowledge to their places of antenatal care. Materials and Methods: A cross-sectional survey of mothers of infants attending the Immunization clinic in a Nigerian Teaching Hospital was done between July and October 2010 using a close-ended questionnaire. Consecutively consenting mothers were enrolled into the study. Results: Out of 354 mothers, 56.5% received counseling about birth asphyxia during antenatal clinic visits in their last pregnancy; 85.5% of attendees of teaching hospital; and 26.4% of attendees of private antenatal clinics received counseling about birth asphyxia. Overall, 38.9% of the respondents had satisfactory knowledge about birth asphyxia; 47.5% of teaching hospital attendees; and 28.1% of private clinic attendees had satisfactory knowledge about birth asphyxia. Lower socioeconomic status, lack of counseling, and nonattendance of teaching hospital antenatal clinic were associated with poor knowledge about birth asphyxia. Conclusion: Most of the mothers surveyed had poor knowledge about the risk factors and sequelae of birth asphyxia. The health system needs to improve health education of expectant mothers about birth asphyxia.

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Background: The quality of healthcare has become a topical issue in recent years and the introduction of quality assurance that constitute some of the tools for change is now an important development in healthcare practice. Objectives: This study aims at evaluating the quality of care provided at the Paediatric Dental Clinic of the University College Hospital (UCH), Ibadan. Materials and Methods: A descriptive study was conducted among 141 parents of children who attended the clinic over a 3-month period using a modified quality of care questionnaire by Ygge and Arnetz (2001). Results: Majority of the parents (93.6%) were pleased with the registration process, while 81.6% and 66.7% were satisfied with the waiting arrangements and social amenities such as light and water respectively. Ratings of the quality of care indices revealed that 50.4% and 41.1% of the parents were happy with the information process and accessibility respectively. Over 80.0% of the respondents were pleased to a great degree with the dental treatment their children received. However, 44 (31.2%) said that they felt that they could not especially/not at all contact their dentist by telephone. About a fifth, (21.2%), felt they had not especially/not at all received information about how to prevent their child's dental problem. Inability of the dentists to introduce themselves was reported by 56.8% of the parents. The mean waiting time spent before being attended was 64.9 minutes while the desired average waiting time was 20.1 minutes. Conclusion: Parents were extremely satisfied with the dental treatment their children received at the UCH and had great confidence in staff competence even though they complained of long waiting time. However, there is a communication gap between the dentist, patients, and parents, since some of the dentists failed to introduce themselves and give information on prevention of dental diseases. For this reason, patients' appointments should be spread out to reduce waiting time. Furthermore, staff should introduce themselves and efforts must be made to improve health education given to parents. The dental curriculum should emphasize patient-dentist relationships.

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We report a rare presentation of mitral stenosis (MS). MS is a common valvular disease, the first manifestation of which is usually easy fatigability and exertional dyspnea. As the disease progresses in severity, other signs and symptoms appear, such as orthopnea, hemoptysis, and peripheral edema. This is the first report of a case of mitral stenosis presenting with exertional abdominal pain as the first manifestation. This case report describes the clinical characteristics of a 55-year-old woman with mitral stenosis and severe pulmonary hypertension, whose first symptom was exertional abdominal pain.

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Background: Oesophagogastroduodenoscopy (EGD) should be very safe, but there are many potential hazards, although the rate of serious complications is small. There are so many complications that can arise during this procedure. Most of these complications involve the respiratory or cardiovascular systems, especially in sick or sedated patients.The aim of this study was to determine the various electrocardiographic changes that can occur at different stages of diagnostic EGD and to determine their severity. Materials and Methods : The study is a descriptive one which was carried out at the endoscopy unit of Ladoke Akintola University of Technology Teaching Hospital, (LAUTECH), Osogbo, Osun State. Consecutive patients who were referred for oesophagogastroduodenoscopy (EGD) over a 3-month period and who consented to take part in the study were recruited. The electrodes of a portable electrocardiographic (ECG) machine (model Cardiovit AT_1ECG Machine) were attached to the patients accordingly and remained fixed till the end of the procedure. ECG recordings were done at baseline, postpremedication, during intubation and 5 minutes postprocedure. The results of the study were analyzed using simple descriptive statistical methods such as range, mean and standard deviation for continuous variables, and numbers and percentages for discreet variables. Results : Twenty-six (26) patients were studied, comprising 14 (53.8%) males and 12 (46.2%) females. The mean age of the patients was 47.19 ± 14.42 years. Three (11.5%) patients had tachycardia at the beginning of the procedure, while 13 (50%) patients developed tachycardia postpremedication and during the procedure, whereas 17 (65.4%) patients had tachycardia at the end of the procedure. Only one patient had bradycardia. Various ST-T wave abnormalities were observed at each stage of the procedure. Conduction abnormality was observed in 8 (30.8%), 9 (34.6%), 7 (26.9%) and 5 (19.2%) patients at rest, post-premedication, during the procedure and postprocedure respectively. Premature ventricular complexes (PVC) were observed in 4 (15.4%), 5 (19.2%), 4 (15.4%), and 4 (15.4%) patients at rest, post-premedication, during the procedure and post procedure respectively. Conclusion: This study has shown that, although ECG abnormalities do occur during EGD, these abnormalities are not severe enough to warrant specific interventions or discontinuation of the procedure.

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