Background/Objective: Ultrasonogrphy is a good modality for the detection of splenomegaly even when it is not clinically palpable. The objective of this study was to establish the normal values of splenic length in healthy school children in South-East, Nigeria and to correlate them with body indices. Materials and Methods: This is a cross-sectional prospective study of 1315 children (633 boys and 682 girls) between the ages of 5 and 17 years. The splenic length was measured between the most superiomedial and the most inferiolateral margins, at the level of the hilum. Only the spleens that had normal shape and echotexture were measured. The mean splenic length and the 5 ^th and 95 ^th percentiles were determined for each age. The length was correlated with the sex, age, weight (WT), height, body mass index (BMI) and body surface area (BSA) of the subjects. A regression model for prediction of spleen dimension from age and body habitus was computed. Results: There was a significant correlation between splenic length and age, P < 0.001. Males had statistically significant longer spleen length than females. The splenic length correlated best with BSA, followed by body WT and least with BMI. Conclusions: This study noted racial variation between the established Nigerian values and results from other countries of the world. For the first time, a baseline value for splenic size for the Nigerian Children of various ages has been established with a regression model for predicting the splenic sizes.

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Background: Topical anesthetic cream (TAC) is not in use in pediatric practice in Sub-saharan regions. Knowledge of Caregivers' willingness-to-pay (WTP) for the cream is necessary for its deployment. Objective: To determine the WTP for TAC for minor pediatric painful procedures. Materials and Methods: The study was a questionnaire-based conducted in two tertiary health institutions in southeast Nigeria. WTP was elicited using the contingent valuation method. The respondents were caregivers to children that attended out-patient clinics and in-patient. Data analysis was by Statistical Package for the Social Sciences software (SPSS) and STATA11. Results: Majority (94%) of the respondents were willing to pay for TAC. The mean maximum WTP was US$8.31. Multivariate analysis showed no statistically significant association between many variables with WTP for TAC. Conclusions: Their average WTP was higher than the market price of topical anesthetic cream. Therefore, there is a good prospect for TAC if deployed in Nigeria.

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Background: Chorionic villous sampling is a first trimester invasive diagnosis procedure that was introduced in Nigeria < 2 decades ago. Objective: The objective of the following study is to review experience with chorionic villous sampling in relation to clinical and laboratory procedures, including general characteristics of women, indications and outcome, complications, laboratory analysis and learning curve. Materials and Methods: Descriptive study of chorionic villous samplings between 2005 and 2012. Clinical and laboratory data were extracted from records. The women had trans-abdominal or trans-cervical procedure after counseling. Deoxyribonucleic acid extraction was by boiling method and molecular diagnosis by restriction fragment length polymorphism or quantitative fluorescence polymerase chain reaction. Analyzed data were presented using simple frequency tables. Results: A total of 426 women were analyzed. The major indications were Sickle cell anemia (97.2%), gender determination (1.9%) and aneuploidy (0.7%) respectively. Most procedures (71.2%) were done between 11 ⁺⁰ and 13 ⁺⁶ weeks by trans-abdominal approach (88.7%). Overall success at the first sampling was 98.8%. Error in laboratory diagnosis recorded in 3 (0.7%) pregnancies, while 5 (1.2%) were reanalyzed due to maternal decidua/inadequate fetal sample (0.7%) or failure of amplification (0.5%) respectively. Primary sex ratio was 5 (XY): 3 (XX). Down syndrome was the most common aneuploidy diagnosed with a detection rate of 66.7%. Learning curve was evident from reducing the incidence of abortion, number of aspirations and increasing success at the first attempt and villi yield. Conclusion: The present study shows acceptance and utilization of chorionic villus sampling and also demonstrates its safety and reliability.

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Objective: In this study, we aim to compare the relationship between the Alvarado score, ultrasonography, and multislice computerized tomography (CT) findings used for the diagnosis of the patients who presented to our emergency unit with clinical features suggestive of acute appendicitis. Materials and Methods: Seventy-four patients operated with the diagnosis of acute appendicitis were included in the study. The demographic characteristics of the patients, physical findings, blood parameters, Alvarado scores, the radiological method used for the diagnosis, the surgical methods (open or laparoscopic) and the pathology results were recorded on the standard proforma. The collected data were analyzed with Statistical Package for Social Sciences (SPSS 15 for Windows, SPSS Inc., Chicago, Illinois, USA) computer program. Results: During study period, the sensitivity of ultrasonography was found to be as 71.2%, specificity as 46.7%, the positive predictive value (PPV) as 82.2%, the negative predictive value (NPV) as 31.8%, and the accuracy rate was determined as 65.7%. The sensitivity of tomography was determined as 97.2%, the specificity as 62.5%, PPV as 92.1%, and NPV as 83.3%, and the accuracy rate was determined as 90%. The sensitivity of the Alvarado score was calculated as 54%, the specificity as 73.3%, the PPV as 88.2% and the NPV as 29.7%, and the accuracy rate was determined as 57.7%. Conclusion: In conclusion, computerized tomography (CT) was found to have higher specificity and sensitivity than Alvarado score and USG which are not sufficient on their own for taking the decision for surgery. We also found that CT scan had lower negative laparotomy rate when compared with the other two modalities.

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Background: Fetal movement, a sign of life, is widely considered as an indicator of fetal health status. Therefore, perceived alteration in regular fetal movement after the age of viability may signify impending adverse perinatal outcome. Aims: This study aimed to determine maternal knowledge, behavior, and concerns about abnormal fetal movement in the third trimester of pregnancy. Materials and Methods: A total of 225 women were surveyed using a self-administered questionnaire at the out-patient prenatal clinics of two tertiary health facilities in Nigeria between December 1, 2012 through January 31, 2013. Questions addressed knowledge, perception behavior, and concerns about experience of abnormal fetal movement. Results: Correct Knowledge of excessive and decreased fetal movement was found in 47% and 31.1% of respondents, respectively. Majority of women (87.6%) either had no knowledge of normal parameters of fetal activity or did not recall being told that movement frequency and strength should increase in the third trimester. The proportion of women who expressed concern over excessive and decreased fetal movement was 31.1% and 21.8%, respectively. Maternal education was significantly associated with correct knowledge of decreased fetal movement ( P = 0.026). Almost 36% of respondents had knowledge of at least one potential consequence of abnormal fetal movement. Conclusion: Maternal educational level is an important factor in the early identification of abnormality of fetal movement. The unsatisfactory knowledge and poor perception behavior among respondents reflect the need for a guideline, particularly during antenatal care, on information and management of abnormal fetal movement in our setting to prevent avoidable stillbirth.

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Background: Gestational diabetes mellitus (GDM) is associated with increased risk of mortality and morbidity for pregnant women and newborns. Identifying pregnant women with risk factors for GDM based on the clinical suspicion is a popular approach. However, the effectiveness of the use of a structured checklist of risk factors is yet to be evaluated. This study assessed the effectiveness of a structured checklist of risk factors in identifying pregnant women at risk of GDM at the University College Hospital, Ibadan. Materials and Methods: It was a comparative cross-sectional study implemented in two phases. The first phase (Group A) of the study was a prospective study that involved 530 pregnant women who presented at the booking clinic. A structured checklist containing risk factors was used to identify women at the risk of GDM. The second phase (Group B) was a retrospective study of 530 pregnant women managed 2 years previously who were selected by systematic random technique. Results: The mean age, gestational age at booking, gestational age at delivery and birth weight were 30.2 ± 5.2 years, 21 ± 10.8 weeks, 38.7 ± 2.7 weeks and 3.1 ± 0.7 kg respectively. The prevalence of GDM in Group A and B were 4.9% and 1.6% respectively ( P < 0.05). There was about three fold increase in identification of women at risk of GDM by use of a checklist. Conclusion: Identification of women at risk of GDM was approximately 3-4 fold higher with the use of checklist of risk factors. Exhaustive clinical identification with a checklist of risk factors for GDM should be encouraged.

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Introduction: Unsafe injections are a major source of infection with blood borne pathogens including hepatitis B virus, hepatitis C virus and human immunodeficiency virus. World Health Organization estimates the burden of disease associated with unsafe injection practices to be about 1.3 million early deaths, loss of about 26 million years of life and an annual burden of 535 million US dollars in direct medical costs. The present study was aimed at determining the prevalence of needle stick injury and the level of reporting among resident doctors in University of Benin Teaching Hospital, Benin. Methodology: A descriptive cross-sectional study was carried out from September 2009 to March 2010 among 152 resident doctors in a tertiary health facility in Benin City. The study population was stratified based on their specialty of training. Proportional allocation was applied to obtain the number of participants to be selected from each stratum. Self-administered questionnaire was used to collect data and analysis was by Statistical Package for Scientific Solution (SPSS) version 16.0. (IBM SPSS solution for Education) Result: The prevalence of needle stick injury among the respondents was 61.8%. The most frequent reason for non-reporting was; the injury was due to a clean needle 68.9%. Awareness of reporting was 92.1% but the level of reporting was 14.9%. Conclusion: The prevalence of needle stick injury was high, awareness of reporting was high but the level of reporting was low. Behavior change communication models are required to bring about a positive change in the practice of reporting.

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The central giant cell granuloma (CGCG) is benign, nonodontogenic, and intraosseous lesion of the jaw. Aggressive subtypes of CGCG have a tendency to recur after excision and require wide resection that leads to major defects in the jaw. In this case report a patient who had severe mandibular bony deficiency as a result of excision of aggressive CGCG, orthodontic, and prosthetic treatment was described. The defect was reconstructed with iliac bone graft. Four years later vertical distraction osteogenesis was performed on the grafted mandible in order to obtain a satisfactory bony height of mandibular ridge. After healing period three endosseous dental implants were placed to grafted region. Because of pubertal growth stage, a hybrid removable denture was constructed. The construction of a hybrid removable denture markedly improved the patient's speech, mastication, and appearance. After pubertal growth stage, a fixed partial denture construction was planned and future parts of treatment procedures were described to the patient. Distraction osteogenesis and endosseous dental implants can be a good alternative method for the unsatisfactory reconstructions of mandibular deficiencies.

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Aims and objectives: The objective of the following study is to analyze the trauma type (causes), injury pattern and factors that may have contributed to death within 72 h of admission into our emergency department (E.D). Materials and Methods: An 18 month prospective observational study, done from April 2009 to September 2010. All the patients were that admitted for 72 h following a full assessment by the attending clinician were enlisted for the study. The demographic data of each patient, time of arrival at the E.D, type of injury sustained, time of incident, previous care at any peripheral hospital, clinical state of the patient, Glasgow coma scale (GCS), Injury severity score (ISS) and treatment offered before death were entered into a Proforma. Data Analysis: This was done using EPI-Info statistical programme version 3.4.3 of 2007(by CDC Atlanta Georgia , USA). Results: A total of 4011 patients were seen in the E.D during the period. 1943 (48.4%), were trauma emergencies, with a (147; 41.4%) mortality. Their ages ranged from 4 to 87 years, with an average of 34.5 years. The male:female ratio was 7:1. The assessed GCS ranged from 6 to 15, with an average of 9.1, the ISS ranged from 9 to 75 with an average of 31.3. Road traffic accidents (RTAs) accounted for 118 (80.3%) of the deaths, assaults 14.3%, falls from height 4.0% and gunshot injuries 1.4%. The overall mortality was 17.1%. Conclusion: The major source of trauma death was RTA; The most frequently injured part of the body was head, with death resulting clinically hemorrhage. The 17.1% mortality is multifactorial: The late presentation (in some cases occasioned by interference by persons not knowledgeable in the basics of trauma care) lack of trained personnel and the systemic deficiencies.

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Context: Aversion for cesarean delivery is common in our practice and risks associated with caesarean section may contribute to this phenomenon. Objective: The objective of this study was to estimate the risks associated with subsequent pregnancies in women with one previous cesarean section in a low resource setting. Setting and Design: A prospective cohort study carried out at two major tertiary maternity centers in Enugu. Materials and Methods: Maternal and perinatal outcomes were compared between women with one previous caesarean and women who had only previous vaginal deliveries. Statistical Analysis Used: Analysis was performed with SPSS statistical software version 17.0 for windows (IBM Incorporated, Armonk, NY, USA) using descriptive and inferential statistics at 95% of the confidence level confidence. Results: A total of 870 women were studied. These were divided into 435 cases and 435 controls. The absolute risk of cesarean section in a subsequent pregnancy in women with one previous cesarean was 75.8% (95% confidence interval [CI]: 72.0, 80.0). Cesarean section was significantly commoner in women with one previous cesarean compared with those who had previous vaginal delivery (Relative risk [RR] =3.78; 95% CI: 1.8, 6.2). Placenta praevia (RR = 5.0; 95% CI: 2.6, 7.2.), labor dystocia (RR = 6.4, 95% CI: 3.2, 11.2) intrapartum hemorrhage (RR = 5.0, 95% CI: 2.1, 9.3) primary postpartum hemorrhage (RR = 5.0, 95% CI: 1.5, 4.3.), blood transfusion (RR = 6.0, 95% CI: 3.4, 10.6) and Newborn special care admission (RR = 2.5; 95% CI: 1.1, 4.9) were significantly more common in women with one previous cesarean compared with those with previous vaginal deliveries. The absolute risk of failed trial of vaginal birth after a cesarean was 45% (95% CI: 38.5, 51.5). Conclusion: Women who have one previous C-section face a markedly increased risk of repeat caesarean sections and feto-maternal complications in subsequent pregnancies. There is a need for doctors in Nigeria to be mindful of these risks while offering primary cesarean section in this low resource setting.

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Aim: The aim of this study was to investigate the effect of different types of anesthesia on stress hormones. Materials and Methods: The study was included 60 ASAI-II cases scheduled for major lower extremity surgery. The cases were randomized into 2 groups: The EA group was administered epidural anesthesia and the GA group was administered standard general anesthesia. In order to evaluate the surgical trauma - related stress response, CRP, TSH, cortisol, and fasting blood sugar(FBS) levels were measured preoperatively, 30 min after surgical incision, and 24 h post surgery. Results: Between-group comparisons; Preoperative values were not significantly different between the groups.( P > 0,05) Pulse rate and cortisol values significantly higher in general group at 30 min. ( P < 0,05), and the FBS values were significantly higher in the epidural group at 24 h.( P < 0,05) There were not found differences for other parameters at evaluation times. Conclusion: No differences were observed between the two anesthesia methods, in terms of minimizing the stress response due to surgical trauma during major low extremity surgery.

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Context: It has been suggested that women with early miscarriage or ectopic pregnancy are best cared for in dedicated units which offer rapid and definitive ultrasonographic and biochemical assessment at the initial review of the patient. Aims: To describe the current protocols for the assessment and treatment of women with early miscarriage or ectopic pregnancy as reported by Nigerian Gynecologists, and determine if dedicated early pregnancy services such as Early Pregnancy Assessment Units could be introduced to improve care. Settings and Design: A cross-sectional survey of Nigerian Gynecologists attending the 46 ^th Annual Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria. Materials and Methods: This was a questionnaire-based study. Statistical Analysis: Data analysis was by descriptive statistics using Statistical Package for the Social Sciences software, version 17.0 for Windows (IBM Corporation, Armonk, NY, USA). Results: A total of 232 gynecologists working in 52 different secondary and tertiary health facilities participated in the survey. The mean age of the respondents was 42.6 ± 9.1 years (range 28-70 years). The proportion of gynecologists reporting that women with early miscarriage or ectopic pregnancy were first managed within the hospital general emergency room was 92%. The mean reported interval between arrival in hospital and first ultrasound scan was 4.9 ± 1.4 hours (range ½-8 hours). Transvaginal scan was stated as the routine initial imaging investigation by only 17.2% of respondents. Approximately 94.8% of respondents felt that dedicated early pregnancy services were feasible and should be introduced to improve the care of women with early miscarriage and ectopic pregnancy. Conclusions: Reported protocols for managing early miscarriage or ectopic pregnancy in many health facilities in Nigeria appear to engender unnecessary delays and avoidable costs, and dedicated early pregnancy services could be both useful and feasible in addressing these shortcomings in the way women with such conditions are currently managed.

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Background: Prune belly syndrome (PBS) is a rare congenital malformation of unclear etiology. The disease progress and outcome in developing countries are not clear as most reports are isolated case reports. Materials and Methods: A review of 9 patients managed for PBS in 5 years. Results: There were 7 males and 2 females, aged 30 min-11 days (median = 5 days) at the time of presentation (a child presented as neonate, defaulted from follow-up and represented at 10 years of life). Their weights on admission were 2.5-4.2 kg (median = 3 kg). Maternal age range was 26-37 years (median = 32 years), with five mothers being above 30 years. Seven mothers had febrile illness in the first trimester and took antimalarial drugs or antibiotics. Intestinal malrotation was the most common associated anomaly. The degree of the anterior abdominal wall and the urinary tract morphology varies from patient to patient. Urinary tract anomalies were initially managed conservatively. Two infants however later had cutaneous ureterostomy due to worsening renal function and recalcitrant urinary tract infection (UTI). Four infants had abdominoplasty at the 2 ^nd week, 6 ^th week, 3 ^rd year and 10 ^th year of life. Seven orchiopexies were done. Four were done by Fowler-Stephen's method while the rest were via the inguinal route. Of the former, 3 testicles have normal volume 6 months after, whereas one atrophied. Post abdominoplasty, there was a significant reduction in the frequency of respiratory tract infection (RTI), UTI and post void urine volume in three infants. In addition, there was improved peer interaction and academic performance in the 10-year-old child. One infant died of pulmonary hypoplasia and two others from worsening urosepsis and progressive renal failure. Conclusion: PBS presents with a spectrum of features. Initial conservative management of the urinary tract was beneficial. Abdominoplasty and orchiopexy have both physiological and improved quality of life benefits. Early Parental education helped in reducing defaults from follow-up.

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Background: Post-operative nausea and vomiting (PONV); early or late, has detrimental effects on surgical patients such as surgical wound disruption, esophageal tear and delayed discharge from the post anesthetic care unit. This study evaluated the effects of dexamethasone-metoclopramide (DM) in the prevention of early and late PONV in women undergoing myomectomy under subarachnoid block. Materials and Methods: Following approval from the Research and Ethics Committee of the Hospital, informed consent was obtained from each prospective patient. Patients were randomly allocated to either the DM group, metoclopramide only (MO) group or dexamethasones only (DO) group using the computer-generated random numbers in sealed envelopes. Immediately after the induction of spinal anesthesia, the DM group received intravenous (i.v.) dexamethasone 8 mg and metoclopramide 10 mg, the MO group received metoclopramide 10 mg i.v and the DO group received dexamethasone 8 mg i.v. The incidence of early and late PONV formed the primary outcome. Results: A total of 90 patients, with aged range between 21-64 years were studied. Dexamethasone alone group had the highest incidence of 40% for early but no for late PONV ( P = 0.003) Metoclopramide alone group had an incidence of 29.97% for early PONV and 26.6% for late PONV. There was reduced incidence of both early and late PONV in the DM group, but of lesser magnitude than DO or MO respectively. Conclusion: Dexamethasone protects against the incidence of late PONV with a minimal effect on early PONV. The combination of dexamethasone and metoclopramide had comparable effect on both and of better magnitude than metoclopramide alone.

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Background: In a resource-limited country visual problems of mentally challenged individuals are often neglected. Aim: The present study aims to study refractive errors in children diagnosed with autism in a developing country. Materials and Methods: Ophthalmic examination was carried out on children diagnosed with autism attending a school for the mentally challenged in Enugu, Nigeria between December 2009 and May 2010. Visual acuity was assessed using Lea symbols. Anterior and posterior segments were examined. Cycloplegic refraction was performed. Data was entered on the protocol prepared for the study and analyzed using Statistical Package for the Social Sciences version 17 (Chicago IL, USA). Results: A total of 21 children with autism were enrolled in the school; 18 of whom were examined giving coverage of 85.7%. The age range was 5-15 years, with a mean of 10.28 years (standard deviation ± 3.20). There were 13 boys and 5 girls. One child had bilateral temporal pallor of the disc and one had bilateral maculopathy with diffuse chorioretinal atrophy. Refraction revealed 4 children (22.2%) had astigmatism and 2 children (11.1%) had hypermetropia. Conclusion: Significant refractive error mainly astigmatism was noted in the children with autism. Identifying refractive errors in these children early and providing appropriate corrective lenses may help optimize their visual functioning and impact their activities of daily life in a positive way.

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Background: Acrylic and bisacryl resins are widely used both during the temporization phase as well as for provisional restorations and the effect of external agents on dentin sensitivity can be reduced by the obliteration of the tubules. Objective: The purpose of this study was to evaluate diffusion of methyl methacrylate monomer through dentin by high performance liquid chromatography (HPLC) after three different desensitizing procedures during the fabrication of two different provisional crown materials. Materials and Methods: Forty extracted restoration and caries free human premolar teeth were used in this study. Thermoplastic vacuum formed material was used as a matrix to fabricate provisional restorations for each tooth before crown preparation. Teeth were prepared for a metal supported ceramic crown with 1 mm shoulder margins and then crown parts were separated from cementoenamel junction with a carborundum disk perpendicular to the long axis of the teeth. To the cementoenamel junction of each tooth a polypropylene chamber was attached that contains 1.5 cm ³ of deionized distilled water. Prepared teeth were divided into four groups ( n = 10) including control, desensitizing agent (DA) application, neodymium-doped yttrium aluminum garnet (Nd: YAG) laser irradiation (LI), and LI after DA application groups. After application of DA (except control) each group were divided into two subgroups for fabrication of provisional restorations ( n = 5). Two autopolymerizing provisional materials (Imident (Imicryl) and Systemp C and B (Ivoclar, vivadent)) were used to fabricate provisional restorations using the strips. Water elutes were analyzed by HPLC at 10 min and 24 h. Results: The monomer diffusion values varied statistically according to desensitizing procedures, provisional resin systems, and the time periods. Monomer diffusion through dentin surfaces desensitized with Nd: YAG LI after DA application was the lowest. Conclusions: Nd: YAG LI in association with DA application is an effective combination to eliminate monomer diffusion through dentin to pulpal chamber.

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Phthiriasis palpebrarum is an infestation of the eyelashes caused by the louse Pthirus pubis (Linnaeus, 1758). We report a case of phthiriasis palpebrarum in a 6-year-old girl, which was initially misdiagnosed as allergic blepharoconjunctivitis. Parasites and their nits were found adhering to the eyelashes and eyelids of her right eye as well as scalp hairs. No abnormality was found in the left eye. The histopathology exam revealed the presence of adults and eggs of Pthirus pubis. We mechanically removed all the eyelashes of the right eye at their base, with lice and nits. The scalp was shaved and washed with phenothrin shampoo. No recurrence was found during 3 months of follow-up. Removal of the eyelashes, cutting of scalp hairs, and phenothrin shampoo may be effective in treating phthiriasis palpebrarum. In cases of blepharoconjunctivitis, eyelids and eyelashes should be carefully examined by slit lamp to avoid misdiagnosis.

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Background: We report our experience in the hospital management of mass casualty following the Jos civil crisis of 2001. Materials and Methods: A retrospective analysis of the records of patients managed in the Jos civil crisis of September 2001, in Plateau State, Nigeria. Information extracted included demographic data of patients, mechanisms of injury, nature and site of injury, treatment modalities and outcome of care. Results: A total of 463 crisis victims presented over a 5 day period. Out of these, the records of 389 (84.0%) were available and analyzed. There were 348 (89.5%) males and 41 females (10.5%) aged between 3 weeks and 70 years, with a median age of 26 years. Most common mechanisms of injury were gunshot in 176 patients (45.2%) and blunt injuries from clubs and sticks in 140 patients (36.0%). Debridement with or without suturing was the most common surgical procedure, performed in 128 patients (33%) followed by exploratory laparotomy in 27 (6.9%) patients. Complications were documented in 55 patients (14.1%) and there were 16 hospital deaths (4.1% mortality). Challenges included exhaustion of supplies, poor communication and security threats both within the hospital and outside. Conclusion: Most patients reaching the hospital alive had injuries that did not require lifesaving interventions. Institutional preparedness plan would enable the hospital to have an organized approach to care, with better chances of success. More effective means of containing crises should be employed to reduce the attendant casualty rate.

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Context: Bilirubin has been shown to influence the mechanisms of both apoptosis and inflammation. Aims: The aim of the following study is to investigate the relationship between the serum bilirubin level with sepsis progression. Settings and Design: A total of 20 patients from intensive care unit were included for this study. Materials and Methods: Patients were divided into two groups: Patients diagnosed with sepsis according to the American College of Chest Physicians/Society of Clinical Care Medicine consensus conference criteria (n0 = 10) and patients treated for various other diagnoses ( n = 10). Blood samples were collected for both groups at the time of origin (defined as the time of diagnosis) and 24 and 48 h after diagnosis. Serum interleukin (IL)-6, IL-10 and bilirubin levels were analyzed and compared. Acute physiology and chronic health evaluation (APACHE) II and sepsis related organ failure (SOFA) scores of the patients were also evaluated. Statistical Analysis Used: We used Statistical Package for Social Sciences (SPSS for Windows, version 17.0, SPSS Inc. 233 South Wacker Drive, Chicago) for statistical analysis. Results: At all-time intervals, serum IL-6, IL-10 and total, direct and indirect serum bilirubin levels were significantly higher in the sepsis group ( P < 0.05); APACHE II and SOFA scores were also significantly higher. Both SOFA scores and serum IL-10 levels were positively correlated with bilirubin levels 24 h after diagnosis (P < 0.05, r = −0.76). Conclusions: Although levels of bilirubin and other associated parameters were higher for the sepsis group, only SOFA score and bilirubin levels were correlated. Because bilirubin is already a SOFA parameter, this correlation was not considered as clinically significant.

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Tropical diabetic hand syndrome is a term used to describe diabetes complication of the hand affecting people in the tropics. It consists of localized cellulitis with variable swelling and ulceration of the hands, progressive, fulminant hand sepsis and gangrene in extreme cases. This syndrome is not well-recognized and is therefore less frequently reported. The authors describe three different female patients who were known diabetics of varying duration presenting with this syndrome at our tertiary health center and who were successfully managed by both the surgical and medical units. The need for early diagnosis and aggressive management is emphasized.

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Objective and Aim: The objective of the following study is to examine the effectiveness and safety of suspension laryngoscopy under intubation with propofol and remifentanil alone for vocal fold nodule (VFN) excision. Materials and Methods: A total of 40 patients were equally and randomly assigned to elective VFN excision using suspension laryngoscopy under intubation with propofol and remifentanil alone (Group A) or with supplementary cisatracurium (Group B). Results: Intubation time was significantly longer in Group A than in Group B (300.0 ± 30.0 s vs. 265.2 ± 38.7 s, P = 0.003). The two groups showed similar Cormack-Lehane classifications, intubation conditions and ease of suspension laryngoscopy. Both groups showed favorable cardiopulmonary safety profiles. Post-anesthesia recovery was significantly more rapid in Group A than in Group B, in terms of times to spontaneous breathing return (7.2 ± 1.4 min vs. 10.9 ± 1.6 min, P < 0.001), consciousness return (7.4 ± 1.5 min vs. 12.3 ± 1.8 min, P < 0.001), removal of tracheal intubation (8.1 ± 1.5 min vs. 13.2 ± 1.7 min, P < 0.001) and operating room discharge (12.7 ± 1.4 min vs. 22.1 ± 1.3 min, P < 0.001). Conclusion: Use of propofol and remifentanil alone provides favorable intubation and anesthesia conditions for suspension laryngoscopic VFN excision and accelerates post-anesthesia recovery.

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Context: Emergency contraception (EC) is widely used to prevent unwanted pregnancy and it is largely adopted in many countries as over the counter drug to improve access. Aims: To determine and compare the correct knowledge, attitude and current use of EC among newly graduated medical doctors (MDs). Settings and Design: A cross-sectional study conducted among 255 newly graduated MDs at the University College Hospital, Ibadan, Nigeria. Materials and Methods: A pretested self-administered questionnaire was used to obtain data from consenting participants. Statistical Analysis Used: Descriptive, bivariate, and multivariable analyses were performed, and statistical significance was set at 0.05. Statistical Package for Social Science version 15.0 (Chicago, IL, USA) software was used. Results: The mean age of the respondents was 27.2 years (standard deviation = 2.1). The commonest indication for emergency contraceptive use mentioned was rape-96.5%. About 70% support EC in Nigeria, while about a quarter (26.9%) routinely counsel women about ECP use. About 21% of respondents currently use EC. Logistic regression analysis revealed significant results for gender [odds ratio (OR) =3.64; 95% confidence interval (CI) OR = 1.31-10.01), religion (OR = 0.26; 95% CI OR = 0.11-0.630) and marital status (OR = 0.19; 95% CI = 0.07-0.56). Conclusion: The correct knowledge and professional disposition toward EC as a form of contraception is low. We recommend that in-service training should focus more on EC to improve the quality of their knowledge and attitude towards it.

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Background: Outcome of managing intestinal atresias has improved in many developed countries, but most reports from low and middle income countries (LMICs) still show high morbidity and mortality. Objective: The objective of the following study is to evaluate the outcome of surgically managed intestinal atresias in our health resource-limited setting. Patients and Methods: All cases of intestinal atresias managed surgically from July 2007 to July 2012 were retrospectively analyzed. Results: There were 23 patients comprised of 11 males and 12 females; 10 duodenal atresias (DA), 13 jejunoileal atresias (JIA) and no colonic atresias. The mean age at presentation to the surgeon was 10.3 days (range 2-43 days) for JIA and 10.6 days (range 1-35 days) for DA. Average weight at presentation was 2.2 kg for JIA and 2.4 kg for DA. Mean duration from presentation to surgery was 3.4 days for JIA and 4.8 days DA. All the JIA had primary repair; type 1 DA had duodenotomy and web excision while others had diamond duodenoduodenostomy. However one DA had duodenojejunostomy. 7 out of 10 DA patients (70%) had at least one associated anomaly, the most common being annular pancreas. There were 4 re-operations in JIA and none in DA (17.4% reoperation rate for 3 anastomotic leaks, 1 anastomotic stricture). Average hospital stay was 23 days for JIA and 12.3 days for DA. Overall, 5 (5) patients died (2 JIA and 3 DA) giving a mortality rate of 21.7%. Mortality rate for DA is 30% while for JIA is 15.4%. Causes of death were: Sepsis with disseminated intravascular coagulation (1), sepsis from anastomotic leakage (1), septic shock (1), anesthesia-related (1), undetermined (1). Two of the mortalities (40%) had re-operation for anastomotic leak. Conclusions: Short-term survival of neonates with intestinal atresias in our unit is still poor when compared with statistics from developed countries. Late presentation is common in this series, but does not appear to have negatively affected outcome. A high proportion of the mortalities had reoperation for anastomotic leak.

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Introduction: The aim of this study was to assess the knowledge and attitudes of Turkish endodontists toward digital radiological imaging (DRI) and cone-beam computed tomography (CBCT). Materials and Methods: One hundred and fifty questionnaires were distributed. Questionnaires were given to a sample of endodontists and PhD students in endodontics who attended the 11 ^th International Congress of the Turkish Endodontic Society in Istanbul in 2012. Following the congress, the same questionnaires were sent electronically to endodontists who did not attend the congress. The participants were asked to answer 28 multiple-choice questions concerning their knowledge and practice regarding recent imaging techniques. The questions were subdivided into 2 main topics; general information; general approach to digital imaging. The statistical analysis was carried out by an χ²-test to compare the means at a significance level of P < 0.05. Results: The response rate for this study was 74%. The mean age of the endodontists who participated in this study was 32.74 ± 10.40 (range 22-61 years). Of the endodontists, 76.6% used digital imaging techniques (DUEs) in their clinics. Statistically significant differences were found between the DUEs and endodontists not using digital imaging (NDUEs), regarding age, gender, graduation year and place of employment ( P < 0.01). Endodontists 40-years-old and above had significantly lower knowledge of CBCT compared to the younger groups ( P = 0.001). Conclusions: The number of endodontists using digital imaging has been increasing in Turkey. The findings of the present study highlighted the need for adapting to new technologies via continuing education.

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Objective: The objective of the following study is to determine the incidence of retinal vein occlusion (RVO) and identify the risk factors in RVO in patients presenting to a tertiary hospital in Rivers State. Materials and Methods: The medical records of consecutive patients with RVO who presented to the retina clinic of the eye Department of University of Port Harcourt Teaching Hospital over a 5 year period were retrieved. Information extracted from the data included the demographic data of patients, presenting visual acuity, history of systemic and ocular disease, blood pressure and intraocular pressure. Data was analyzed using the Statistical Package for Social Sciences 20.0. (IBM Corporation and its licensors 1989,2011). Results: Out of the 364 patients seen at the retina clinic during this period, 27 (7.4%) had RVO. Seven patients had bilateral disease. The incidence of RVO in the retinal clinic was 7.4%. Systemic hypertension, diabetes mellitus, hyperlipidemia and glaucoma were the main risk factors recorded in our patients. Central retinal vein occlusion (CRVO) 20 (74%) was more predominant than branch retinal vein occlusion (BRVO) 7 (26%). 21 eyes of patients with CRVO had visual acuities of < 3/60, while 7 eyes of patients with BRVO had visual acuities less than 3/60. Vitreous hemorrhage 10 (52.6%) was the most common complication encountered. All cases of non-perfused vein occlusion 4 (14.8%) were seen in patients who had CRVO. Conclusion: The incidence of RVO in our hospital is high. RVO is a significant cause of visual impairment, with CRVO being more common. Identifying associated risk factors and treating these could help reduce the incidence of RVO.

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Context: Day procedures are preferred by many surgeons for minor and intermediate procedures in fit patients. It is however considered to transfer the burden of care to care-givers and other healthcare providers. Aim: The aim of the following study is to assess the tendency of day care patients seeking attention from health care providers and their ability to ambulate in the first week. Settings and Design: Prospective study in a tertiary health facility in South-South Nigeria. Materials and Methods: Patients in American Society of Anesthesiologists class I and II undergoing day-care procedures in a surgery unit were assessed at one week for the effects of the procedure on ambulation and their likelihood to seek medical attention. Data on the sex, type of procedure, pain, bleeding and ambulation was analyzed. A visual analog pain score of 0- 3 (mild); 4-6 (moderate) and 7-10 (severe) was used. Bleeding was defined as complete soaking of the two-layered gauze dressing with blood. Statistical Analysis: Analysis was performed with SPSS 17 for Windows (SPSS Inc. Chicago, Illinois) and presented as percentages, mean and tables. Results: A total of 99 patients comprised of 47 males and 52 females registered in the study; with a mean age of 38 years (range 16-70); 76 patients (77%) complained of pain at the operation site while 23 (23%) had no complaints. Pain was mild in 59 (78%) and moderate 17 (22%). None had severe pain or bleeding from the operation site; 85 patients (86%) could ambulate easily, 14 (14%) partially and none completely unable to ambulate. Conclusion: Day procedures in selected patients has minimal affects on their ambulation and no increased risk of seeking medical attention in the first week and would appear not to transfer the burden of care to the community.

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Pulmonary thromboembolism occurring either abruptly or insidious poses a greater challenge in diag-nosis. A high index of suspicion is required to proceed with proper investigations in patients with nonspecific cardiac or respiratory presentation to make the diagnosis of pulmonary embolism (PE). Early diagnosis of PE with prompt initiating of anticoagulation therapy has been proven to have a pos-itive impact in mortality reduction associated with recurrent episodes of this condition. We present a case of a 76-year-old man, known to have cardiac failure on regular treatment who presented with predominant features of right-sided heart failure accompanied with dizziness. He was diagnosed to have pulmonary artery thrombosis by computerized tomography. Anticoagulation therapy was initiated with marked clinical improvement.

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