Sialolithiasis is the most common disease of salivary glands. Its estimated frequency is 1.2% in the adult population. Sialoliths most commonly occur in the submandibular glands. The sublingual gland and minor salivary glands are rarely affected. The sialolith usually measures from 1 to <10 mm. Giant sialoliths are classified as those exceeding 15 mm in any one dimension. In literature, large sialoliths or megalith (> mm) of Wharton's duct have rarely been reported. This case report describes a patient presenting with an unusually large sialolith (megalith) of Wharton's duct, which was 37 mm ×16 mm in the size, the subsequent patient management, the etiology, diagnosis, and its treatment.

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Introduction: Chronic otitis media (COM), affecting all over the world and in a wide range of age groups in Turkey, is an important cause of ear discharge and hearing loss. The main clinical manifestations are tympanic membrane perforation, ear, nose and throat problems. On the tympanic membrane perforation becomes persistent and cholesteatoma development, there are a lot of opinions today. Especially in the pathology associated with otitis media with effusion eustachian tube, it is known that COM and cholesteatoma develop. Materials and Methods: In our study, we interpreted 210 patients' temporal computed tomography (CT). Seventy of these 210 patients had otitis media with cholesteatoma, 70 patients had only otitis media without cholesteatoma, and 70 patients had no otitis media. The eustachian tubes were evaluated using temporal CT multiplanar reconstruction method. Angles with the horizontal plane of the eustachian tube and Reid and tubotympanic angles were measured. Results: The angles between eustachian tube and horizontally oriented Reid plane of the patients with cholesteatoma were found to be significantly lower than the patients with otitis media without cholesteatoma and the patients with no history of otitis media. For the tubotympanic angle, no statistically significant differences were observed between the groups. Conclusion: These results suggest that the decrease in the angle with the horizontal plane of Reid in the eustachian tube in adults may play a significant role in the etiology of cholesteatoma.

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Pseudoachalasia presents typically like achalasia. It account for only 2.4-4% of patients presenting with achalasia-like symptoms. Clinical, radiologic and endoscopic findings resemble those of achalasia but treatment and prognosis are different in these conditions. The aim of this review is to give an overview of the condition and highlight challenges in diagnosis and distinguishing features between the two conditions. A review of the publications obtained from Medline search, medical libraries, and Google on 'pseudoachalasia' and 'secondary achalasia' was done. A total of 50 articles were retrieved and used for this review. There has been tremendous efforts towards establishing the diagnosis of pseudoachalasia both clinically and with the use of modern investigative modalities but to date its still difficult to distinguish it from achalasia. Endoscopy, endoscopic ultrasonography and computerized tomography scan have shown promising results.

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Objective: The aim of this study was to evaluate the mechanical behavior of different rigid fixation methods in mandibular angle fractures. Materials and Methods: Three different three-dimensional finite element models of the mandible were developed to simulate the biomechanical responses of titanium plates and screws. The fracture lines were fixed with double 4-hole straight, 4-hole square, and 5-hole Y plates with monocortical screws. 150 N incisal occlusal loads were simulated on the models. The commercial ANSYS software was utilized to calculate the Von Mises stresses on fixative appliances. Results: The highest Von Mises stress values were observed in the Y plate, whereas the lowest stress values have been found in the square plate. Conclusions: The use of square plate led to better stability and lower mechanical stresses than other techniques.

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To share experience on the presentation and management of 4 cases of isolated penile Fournier's gangrene. Clinical and demographic data of four patients with isolated penile Fournier's gangrene seen over an 8-year period (January 2006–December 2013) were reviewed. All patients had intravenous fluid resuscitation, emergency surgical debridement, and broad-spectrum intravenous antibiotics. Fournier's gangrene of the penis was, respectively, due to long segment anterior urethral stricture, penile edema from poorly controlled congestive cardiac failure, penile abrasion from oral sex and idiopathic. The mean age of the patients was 34.3 ± 5.6 years. One patient with urethral stricture had urinary tract infection. The patients presented with a prodromal period of genital pain and fever followed by genital swelling, gangrene, and ulceration. The most common wound swab isolates were Staphylococcus aureus and Escherichia coli. Only the skin and dartos fascia were affected with sparing of the corporal cylinders. Mean hospital stay was 17.3 ± 3.0 days and mean Fournier's gangrene severity index (FGSI) was 4.0 ± 0.8. Wound closure was achieved by split skin grafting in 2 patients, delayed primary closure in the third and healing by secondary intention in the fourth patient. Subjectively assessed erectile function was preserved in all four patients. Isolated Fournier's gangrene of the penis is very rare. It is associated with low FGSI and sparing of the three corporal cylinders. It may rarely follow oral sexual practice.

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Introduction: Although the methods used in thoracic surgery have been developing rapidly over the last five decades, postoperative pulmonary complications are seen in this field more than in other surgical branches. We aimed at comparing the acute effects of incentive spirometry (IS) and breathing retraining exercises by a respiratory physiotherapist or experienced physiotherapist. Methods: Patients were randomized into two groups as spirometry and physiotherapist. Combined respiratory exercises were implemented through IS inspirometry group and by a physiotherapist in physiotherapist group. Blood gas, respiratory function tests, survey results of the Burford pain thermometer, discharge days, and cost analyses of both groups were examined just before the beginning of physiotherapy and on the 3^rd day of therapy. Results: There were no statistical difference in first and last values of pH and PCO₂and also there were no difference between groups (P > 0.05). Forced expiratory volume one second (FEV₁) values are statistically increased compared to basal levels in both groups and mean difference in FEV₁values was statistically increased in physiotherapist group compared to spirometry group (P < 0.001). Forced vital capacity (FVC), PO₂and SaO₂ values are statistically increased compared to basal levels in both groups but mean difference in FVC values was not statistically different between groups (P > 0.05). Cost analysis was not statistically different, mean hospitalization day and mean pain score were statistically decreased in physiotherapist group. Conclusions: Based on the outcome of this study, respiratory physiotherapy methods carried out by a respiratory physiotherapist are more effective in acute cardiothoracic conditions after thoracotomy compared to IS by patients.

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Background: Accurate clinical diagnosis of fibroadenoma in young females is desirable because of the possibility of nonoperative treatment for those desiring it. Objectives: To determine the accuracy of the clinical diagnosis of fibroadenoma in patients aged ≤ 25 years. Patients and Methods: A prospective study of all patients with breast disease presenting to the breast clinic was conducted from January 2004 to December 2008. Results: During the study period, 145 patients aged ≤25 years presented with breast lumps. In this group, a clinical diagnosis of fibroadenoma was made in 100 (69.0%), fibrocystic disease in 32 (22.1%), breast cancer in 4 (0.03%) patients, the remaining were benign lesions. Excision biopsy was done for 81 (55.9%) patients. Of these 81 patients, only 62 (76.5%) returned with histology report. The histological diagnosis was fibroadenoma in 45 (72.5%) patients with a mean age of 21.4 years. Their ages range from 18 to 25 years. The histological diagnosis was fibrocystic disease in 9 (14.5%) and malignant phyllodes in 1 (1.6%) patient. The remaining 7 (11.3%) patients had other types of benign lesions. For fibroadenoma, true positive cases were 42, false positive 7 and false negative 3, and true negative 10. Therefore, the sensitivity of clinical diagnosis of fibroadenoma was 93.3%, while specificity was 58.8%. Conclusion: The sensitivity of clinical diagnosis of fibroadenoma in patients aged ≤25 years was good, though specificity is low.

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Aim: We aimed to determine the prevalence and associated risk factors for nasal methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MSSA/MRSA) carriage among patients admitted to a chest clinic of a tertiary care hospital in this study. Materials and Methods: Nasal samples were taken from anterior nares were cultured in CHROMagar S. aureus plates, MRSA was determined by disc diffusion method (cefoxitin 30 μg) according to the Clinical and Laboratory Standards Institute guidelines and CHROMagar MRSA plates. A questionnaire was applied to determine the demographic characteristics of the participants and risk factors for carriage. Fisher's exact test, univariate and multivariate logistic regression analysis were used. A P < 0.05 indicated a statistically significant difference. Results: This is a cross-sectional study covering all the patients (n = 431) admitted to Kayseri Training and Research Hospital's Chest Clinic from January 1^st to 31^st 2014. Of all these patients 55 (12.8%) were nasal S. aureus carriers. MRSA positivity was in five among these patients. In multivariate analysis, being under 65 years of age (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.0–3.3), and having prosthesis (OR, 4.8; 95% CI, 1.6–13.9) were found as risk factors for MSSA colonization. Conclusion: The prevalence of nasal carriage of MSSA was low in our study population. The only risk factors playing role in carriage were found as being under the age of 65 and having prosthesis.

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Introduction: Cervical necrotizing fasciitis is a rare but very severe infection that affects the soft-tissues of the cephalic extremity. Cervical necrotizing fasciitis most frequently occurs secondarily to inflammatory odontogenic disorders and represents the most severe infection of maxillofacial spaces, with a high lethal potential. Materials and Methods: In this study, we selected 55 patients with confirmed cervical necrotizing fasciitis of odontogenic origin, treated in the Clinic of Oral and Maxillofacial Surgery in Cluj-Napoca during January 1996-December 2012. Results: In the majority of cases, the disease evolved without the presence of associated systemic disorders (60% [45.49-72.69]), the rest of the patients having 1-4 types of systemic disorders; type 2 diabetes mellitus was the most frequent type of underlying systemic disorder. From the appearance of the first symptoms until the presentation for treatment, a time interval of 2-30 days elapsed. During this time period, 78.18% (95% confidence interval [CI] [65.49-89.06]) of the patients received antibiotic treatment, but without results. Mandibular molars were the most frequent starting point of the disease, and the submandibular space was the first affected by the disease, 47.27% (95% CI [32.76-61.79]). Bacteriological exams showed that facultatively aerobic/anaerobic G + bacteria were the most frequently identified (72.22% [58.21-83.60]). Conclusion: The odontogenic lesions of the lower molars, complicated by submandibular space infections, are the most frequent starting point of odontogenic cervicofacial necrotizing fasciitis. Delayed surgical treatment and strict antibiotic therapy play an important role in favoring the development of odontogenic necrotizing fasciitis.

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Objective: The aim of this study was to assess and compare the knowledge and attitudes of dentists toward shortened dental arch (SDA) therapy in Saudi Arabia. Materials and Methods: In this cross-sectional study, self-designed-structured questionnaires were distributed among specialists (SP), residents (RES), and general dental practitioners (GDP) in Saudi Arabia. The questionnaire enquired about dentists' opinion regarding function, esthetic, and comfort in patients with SDA. It also enquired about the risks associated with SDA treatment (tooth wear, temporomandibular dysfunction (TMD), and tooth migration). Participants also graded SDA decision-making factors for their significance. Frequency distribution and Chi-square test were performed to compare the responses. Results: A total of 300 questionnaires were completed. 53.9% of SP applied SDA therapy in <10% of patients. However, 54.8% of RES and 46.6% of GDP never used SDA therapy. SDA was considered by dentists to provide a satisfactory or acceptable function (76.4%), esthetics (76.1%), and comfort (76.8%). There was a significant difference in opinions of SP, GDP, and RES, in relation to the effect of SDA on esthetics (P = 0.039), tooth-wear (P < 0.001), TMD (P < 0.001), and tooth migration (P = 0.002). Conclusion: The knowledge of SP and GDP with regards to SDA therapy was broadly in line with current standards. Less than 10% of patients had objections towards SDA therapy. SDA therapy was clinically applied in fewer than 10% of cases.

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Background: There is paucity of literatures on audit of mortality in the surgical units of tertiary hospitals in the country. This has made the spectrum of mortality not to been known in some of the centers and therefore, there is a great disparity and dearth in apportioning health care services appropriately. Aim: The determination of the pattern of mortality in a surgical unit helps in planning, provision of quality surgical care and prioritizing of limited resources in developing countries. Methods: This is a retrospective study of all patients who died during admission into surgical wards of our hospital between 2007 and 2012. Data on demography and events leading to death were collected and analyzed from all surgical wards, the emergency unit, surgical outpatients, and theater records. Results: A total of 527 deaths occurred among the 8230 patients admitted during the 6-year period giving a mortality rate of 6.4%. Three hundred and forty-five (65.5%) were male, while 282 (34.5%) were females. The mortality rates in units were as follows: Burn and plastic (23.1%), general surgery (5.5%), neurosurgery (7.9%), urology (6.0%), orthopedics (3.8%), pediatric surgery (3.4%), and cardiothoracic surgery (11.9%). The yearly mortality rate were as follows, respectively: 2007 (7.1%), 2008 (6.0%), 2009 (4.5%), 2010 (6.5%), 2011 (7.2%), and 2012 (7.5%). About 84.6% of the patients died within 1 month on admission. The leading causes of mortality were trauma (41.8%) and cancer (32.4%). Most of the deaths (64.9%) occurred between 20- and 70-year-old. Conclusion: Trauma and cancer constitute a great deal of health burden in our region. Strong legislation and screenings with timely interventions are required.

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Background: Knowledge, perception, and acceptance of plastic surgery among any population are influenced by channel of presentation. A good understanding of the public awareness will define the way plastic surgery services will be provided. Aim: To assess the knowledge, awareness of availability, and acceptance of plastic surgery practice in Enugu, South East Nigeria. Materials and Methods: A questionnaire-based prospective study. Results: The electronic media is the most common medium of awareness. Less than half the sample knew about the existence of plastic surgeons in Enugu even though a large proportion was aware of the existence of plastic surgery as a specialty. The concentration of plastic surgeons in a center is directly related to awareness of plastic surgery services in that facility. The most common esthetic procedure done by a plastic surgeon in Enugu is tattoo removal and scar refashioning. Orthopedic surgeons are thought to be key players in the management of burn patients as much as the plastic surgeons due to the “SIGNPOST EFFECT.” Conclusion: The level of awareness is high in the sampled population with associated increase in acceptance of its practice and willing utilization. All public hospitals should be encouraged to employ the services of plastic surgeons. Appropriate branding of specialized hospitals where plastic surgery service is available will advance the practice significantly.

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Background: Peripheral limb vascular diseases form one of the most common diseases that affect the middle-aged and the elderly. Duplex ultrasound has revolutionized medicare and is an important modality for investigating them. Unfortunately, this modality is still not popular in our environment and in Calabar was used for the 1^st time 4 years ago. This work is, therefore, to report our findings and hopefully increase the awareness of its benefits thereby improving and hastening the diagnosis of vascular pathologies in our environment. Methods: A prospective study that took place in the University of Calabar Teaching Hospital, Calabar between March 2011 and August 2014. The study included patients with pain, swelling, ulceration, as well as outright gangrene of the upper or lower limbs. Others were stroke or transient ischemic attack (TIA) patients, and patients with renal grafts. The scans were carried out in Radiology Department using a digital color Doppler ultrasound. Results: Seventy-six patients were scanned during this period. They were more males (67%) than females (33%). The indications were mainly leg swelling and pain 25 (33%), stroke/TIA 10 (13%), and deep venous thrombosis (DVT) 10 (13%) The most common scan done was peripheral limb Doppler, 49 (64.5%).The majority of the scans showed no abnormality followed by chronic venous insufficiency 13 (17.1%) and lower limb arteriosclerosis 7 (9.2%) which was noted to be common among diabetics and hypertensive. DVT was another common finding and 4 out of 10 patients in whom DVT was suspected clinically showed sonographic evidence of the condition. Conclusion: Duplex ultrasound has been shown to diagnose varied vascular pathologies even in a locale where it is a relatively new technique. It is recommended that timely referrals be made, and mobile Doppler units be acquired to save more lives and limbs in the developing world.

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Introduction: Craniofacial orthodontics has been shown to be a critical component of the care of patients with craniofacial anomalies such as cleft lip and palate. Thus, the purpose of this study was to assess the perceptions and clinical experience in cleft and craniofacial care, of orthodontic residents in Nigeria. Methodology: Questionnaires were sent out to orthodontic residents in the six Postgraduate Orthodontic Training Centers in the country at that time. The questionnaires were self-administered and covered areas in beliefs in cleft care and the clinical experience and challenges faced by the residents in the provision of craniofacial orthodontic care at their various institutions. Results: Thirty-three respondents returned completed questionnaires, with a response rate of 97%. All the respondents believed that residents should be involved in cleft and craniofacial care. Postnatal counseling was the clinical procedure in which the residents reported the highest level of clinical experience (47.4%). The least clinical experience was recorded in pre-bone graft orthodontics (7.4%) and orthodontic preparation for orthognathic surgery (5.5%). Some of the challenges highlighted by the residents were low patients turn out for orthodontic care and the absence of multidisciplinary treatment for craniofacial patients in their centers. Conclusion: Orthodontic residents in Nigeria believe that they should be involved in the management of patients with craniofacial anomalies and cleft lip and palate. However, majority of the residents have limited clinical experience in the management of these patients. A lot more needs to be done, to expose orthodontic residents in training, to all aspects of the orthodontic and multidisciplinary team care required for the cleft/craniofacial patient.

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Background: Stroke is a medical emergency of public health importance which affects the physical, mental, and emotional well-being of its victims. Management and rehabilitation are cumbersome for patients and caregivers. Ocular involvement and visual loss could further increase the burden of care. Aim: To determine the prevalence of ocular disorders in patients with stroke in a Tertiary Hospital in Nigeria. Materials and Methods: A descriptive hospital-based study was performed on all consenting and conscious adult patients aged 18 years and above with a diagnosis of stroke made within 1-year who were admitted to the stroke ward or attended the stroke clinic of the Neurology Unit in the Department of Medicine, University of Benin Teaching Hospital, Benin City from October 2013 to December 2013. Results: A total of 170 eyes of 85 patients were studied with a mean age of 66.08 years ± 10.99; range 43–88 years. There was a male: female ratio of 2.6:1. Ocular abnormalities were documented in 95.5% of the patients. A presenting visual acuity of ≥6/18 was found in 66.7%. Mild ptosis and exotropia were seen in 2.9% and 0.6% of the eyes respectively. Intraocular pressure was between 10–21 mmHg in 87.7% eyes while 11.8% eyes had afferent pupillary defects. Cataract was seen in 71.8% eyes and optic nerve head changes in 48.8% eyes which includes temporal disc pallor and glaucomatous optic neuropathy in 29.4% and 14.2% eyes, respectively. Abnormalities found in the retina include retinal hemorrhages in 10.6% eyes, cotton wool spots in 2.4% eyes, and hard exudates in 7.8% eyes. Retinal vascular abnormalities were documented in 32.4% eyes. Visual complaints following stroke were documented in 9.6% of the patients. Conclusion: Ocular abnormalities are present in patients with stroke, mostly due to predisposing risk factors for stroke, and age-related changes. Routine ophthalmic evaluation is suggested in the management of patients with cerebrovascular accident in our environment for better quality of care.

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Background: Testicular torsion compromises the blood supply to the testes and may result in testicular loss or damage if not dealt with promptly. It can occur either as acute testicular torsion (ATT) or intermittent testicular torsion (ITT). This study examines the presentation, management, and outcome of adult testicular torsion. Patients and Methods: During the period January 1999 and December 2009, 34 out of 59 patients treated for testicular torsion, who had complete records, were evaluated. Operating theater and urology ward admission registers were used to identify patients. Results: Age range was 16–50 years. Of the 34 patients, 11 (32.4%) were between 26 and 30 years old, while 16 (47.1%) were between 16 and 25 years old. Mean age was 27 years. Scrotal pain of varying severity was noted in all patients; there was associated vomiting in 21% of cases and abdominal pain in 38% of cases. Clinical diagnosis was ATT in 12 (35.3%) patients and ITT in 22 (64.7%) patients. In the ATT group, only one patient (8.3%) presented within 6 h of onset of symptoms. In the ITT group, 3 patients (13.6%) presented within 1 month of onset of symptoms while 7 (31.8%) of patients presented between 1 and 6 months after the onset of symptoms. Testicular salvage rate was 58.3% for ATT. Surgical intervention occurred within 3 h in the ATT group in 7 patients (58.3%) and in 5 patients (41.7%) within 3–6 h of onset of symptoms. In the patients with ITT, 12 patients (54.5%) were operated upon within 1 month of presentation. Preoperative external manual detorsion was performed in 1 patient. Conclusion: Late presentation was observed, especially in the intermittent variety. Delay occurred both at pre- and intra-hospital phases. Testicular salvage rate may be improved by physician/health worker and community enlightenment. Adoption of local anesthetic may reduce intrahospital delay.

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Introduction: The incidence rates and location of nontraumatic intracerebral hemorrhage (ICH) have been shown to vary between population and races. Knowledge of ICH patterns may give some insight into the etiology of ICH and help reduce its burden particularly among Africans where health infrastructure is poorly developed. We present a retrospective review of ICH using a modern neuroimaging technique. Objectives: To determine the pattern and location of ICH among patients presenting in a tertiary hospital in Enugu. Methods: All the medical and computer tomography records of patients with a clinical diagnosis of hemorrhagic stroke with the location of hemorrhage clearly specified and complete patients' data were reviewed. The study duration was 11 years (January 2003 to December 2013). Relevant data were obtained, and statistical analysis was done using SPSS version 19 (IBM Corporation, New York, USA). Results: A total of 139 (17.4%) out of 799 scans done over the period under review were analyzed. The frequency of lobar and deep cerebral hemorrhages (LH and DCHs) was 46.8% and 53.2%, respectively. The most common types of hemorrhage in men and women were deep cerebral (52.2% and 55.3%, respectively). Five percent (7/139) of all hemorrhages occurred in the cerebellum. Age distribution of the location of ICH shows that LHs peaked at 16–39 years while DCHs peaked at 40–49 years. There was not statistically significant difference between mean ages of occurrence of LH and hemorrhages of other locations. Conclusion: Frequency of LH and DCH varied with age as LH peaked before the age of 40 while deep cerebral at 40–49 years. The age distribution of different types of ICH may suggest a higher role of other factors apart from hypertension. Further studies are required to establish the risk factors of LH and DCHs in our environment.

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Background: Current methods of detection of childhood hypertension are cumbersome and contribute to under-diagnosis hence, the need to generate simpler diagnostic tools. The blood pressure to height ratio has recently been proposed as a novel screening tool for prehypertension and hypertension in some populations. We evaluated its applicability in our environment. Materials and Methods: The weights, heights, and blood pressure measurements of 2364 apparently healthy adolescents were determined. Sex-specific systolic and diastolic blood pressure to height ratios (SBPHR) and (DBPHR) were calculated, and their ability to detect prehypertension and hypertension was determined using receiver operating curves. Discriminatory ability was measured by the area under the curve (AUC) and optimal cutoff points along the curve were determined. P < 0.05 was considered statistically significant. Results: The SBPHR and DBPHR were similar across all age groups and sexes. The AUC of SBPHR and DBPHR for diagnosing prehypertension and hypertension by sex was >0.95 for both diastolic and systolic hypertension in both sexes. It ranged between 0.803 and 0.922 for prehypertension and 0.954–0.978 for hypertension indicating higher accuracy for hypertension. Sensitivity was higher for systolic and diastolic hypertension (90–98%) compared with prehypertension (87–98%). Specificity was lower than sensitivity across all categories of hypertension and prehypertension (0.64–0.88%) though higher for hypertension (0.75–0.88) compared with prehypertension (0.64–0.75). Conclusion: BPHR is a useful screening tool for prehypertension and hypertension in black adolescents. Accuracy increased with higher degrees of hypertension.

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Leiomyomas are rare benign esophageal tumors. Association of this subepithelial lesion with abnormal epithelium is rarer. Endoscopic mucosal resection is an alternative to surgery for removing suitable mucosal and submucosal lesions from the gastrointestinal tract. This procedure is seldom performed in developing countries due to limited equipment and expertise. We describe a case of esophageal leiomyoma with overlying dysplasia in the mid esophagus that was completely removed endoscopically in a developing country without the standard accessory equipment. Traditional thoracotomy would have been associated with higher cost and morbidity.

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Background: On the 17 of January 2010, a sectarian crisis broke out in Jos the capital of Plateau state, Nigeria. It created a mass casualty situation in the Jos University Teaching Hospital. We present the result of the hospital management of that mass casualty incident. Objective: To share our experience in the management of the mass casualty situation arising from the sectarian crisis of Jos in January 2010. Methodology: We retrospectively reviewed the hospital records of patients who were treated in our hospital with injuries sustained in the Jos crisis of January 2010. Results: A total of 168 patients presented over a four day period. There were 108 males (64.3%) and 60 females (35.7%). The mean age was 26 ± 16 years. Injury was caused by gunshots in 68 patients (40.5%), machete in 56 (33.3%), falls in 22 (13.1%) and burning in 21 (13.1%). The body parts injured were the upper limbs in 61(36.3%) patients, lower limbs 44 (26.2%) and scalp 43 (25.6%). Majority, 125 (74.4%) did not require formal operative care. Fourteen (8.3%) patients had complications out of which 10 (6.0%) were related to infections. There were 5 (3.1%) hospital mortalities and the mean duration of hospital stay was 4.2 days. The hospital operations returned to routine 24 hours after the last patient was brought in. As a result of changes made to our protocol, management proceeded smoothly and there was no stoppage of the hospital response at any point. Conclusion: This civil crisis involved mostly young males. Injuries were mainly lacerations from machete and gunshot injuries. Majority of the victims did not require formal surgical operations beyond initial care. Maintaining continuity in the positions of the Incident commander and the mass casualty commander ensure a smooth disaster response with fewer challenges.

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Introduction: Investigation results traditionally are given in two parts: Investigation results and report. When both are provided for a test done, reports offer in depth information, explanation and clarification of results. This trend has been lost over time as results are the only documentation routinely given currently in conventional hospital practice except reports are specially requested for although the service is obtainable at no extra cost to the patient or attending physician. Aim: To access the necessity of laboratory report as part of investigation results and reasons for non utilization of laboratory report services by physicians. Method: A descriptive cross-sectional study was conducted amongst doctors of varying cadres in 3 specialties (Physician, Surgeon, Gender practitioners) at the University of Benin Teaching Hospital, Benin City, Nigeria. Data was collected from 121 participating doctors using a structured 19 item self administered questionnaire. The data was analyzed using IBM-SPSS Version 20.0. Results: Most respondents agreed that the investigation results currently obtained from the laboratory were useful but would be better if laboratory reports accompanied them. Over 70% of the doctors noted that the above sometimes held true only sometimes and not always as stated by 28.1% of doctors. More than 90% of the doctors have knowledge of the difference between laboratory results and report; the necessity of a lab physician's report for every investigation requested for and its potential benefits such an investigation reporting system will have on patient management. Although most doctors (81.8%) discuss laboratory results with lab physicians, they do not routinely consult them to achieve the improved value of investigation results until a critical period of necessity arises. Conclusion: Laboratory investigations would offer doctors more information, which translates to enhanced patient care if investigation results are mandatorily accompanied by a laboratory report.

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A number of treatment strategies for complex coronary lesions have been utilized in varying clinical settings over the last decade. However, cardiologists still encounter some difficult scenarios such as variant coronary artery origins, severely calcified and highly tortuous lesions. We report four cases in which the stents failed to cross lesions using the conventional percutaneous coronary intervention techniques, but all the target lesions were successfully stented finally using a new combined technique of anchor balloon assisted deep intubation of 5F “child-in-mother” catheter.

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Aim: This study examined the caregivers' perception of the effect of dental conditions on general well-being and family life of a group of human immunodeficiency virus (HIV)-infected Nigerian children. A secondary aim was to investigate correlations between the children's sociodemographic and health-related variables and caregivers' global ratings of oral health and well-being. Study Design A cross-sectional questionnaire-based survey was conducted among parents/caregivers of 95 HIV-positive children receiving care at the Lagos State University Teaching Hospital, Nigeria. Materials and Methods: The “Parental-Caregivers Perception Questionnaire” which included measures of global ratings of oral health and well-being as well as effects of oral health on domains of oral symptoms, functional limitations, emotional well-being, and family well-being/parental distress was used. Assessment was based on the child's oral health within the preceding 3 months of the study. Results: The most affected subscale of the oral health-related quality of life was functional limitation followed by parental distress and then oral symptoms. Caregivers of older children were 2½ times more likely to view oral health as impacting their child's overall health (P = 0.034). Furthermore, caregivers of children who had not yet commenced antiretroviral therapy were 15% more likely to report oral symptoms (P = 0.024) and 11% were more likely to be distressed. Statistics: Data entry, validation, and analysis were done using SPSS version 17.0. Findings were considered to be statistically significant when 95% confidence intervals were not overlapping. Conclusions: According to caregivers' perceptions, oral symptoms, functional limitations, and parental distress outweighed emotional well-being in impacting a child's oral health quality of life. Oral health programs to improve the knowledge of caregivers on the importance of oral health in HIV-positive children are necessary for improvement in overall quality of life.

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Retrograde jejunal intussusception is a rare disease. A 60-year-old female patient was hospitalized due to vomiting for 2 days, with a history of radical gastrectomy plus esophagus jejunum Rouxs-en-Y. On examination, there was a palpable wax-like mass on the left-hand side underneath the umbilicus. Computerized tomography scan showed a proximal jejunal intussusception. During surgery, the distal jejunum was found set into the proximal jejunum for a length of 30 cm, and bowel necrosis was also observed. The necrotic tube was resected and anastomosis was performed. Four days after the surgery, gastrointestinal function resumed. After a 10-month follow-up, the patient had no discomfort.

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Background: Hemoglobin electrophoresis (HBE) is a part of the preoperative routine requested by anesthetists. However, the prevalence of hemoglobinopathy in the population is low. This study aims to determine the clinical risk factors for hemoglobinopathies and propose clinical guidelines for preoperative screening of patients for pediatric day care surgery. Patients and Methods: A prospective study carried out over 12 months. Consecutive patients aged 6 months and older who had day case surgery were recruited to the study. Biodata and relevant clinical data were collated and documented in a proforma and analyzed using a statistical package for social sciences version 17. Results: There were 124 patients106 boys and 18 girls. The median age was 3 years. Scrotal lesions were the most common conditions managed (71.7%). Seventy-eight percent of patients had HbAA, 15.3% had HbAS, and 4.8% had HbAC while 0.8% each had both HbSC and HbSS. At least one parent of 78.2% knew their Hb phenotype, of which, 79% were HbAA. A history of jaundice (P = 0.0001), hand and foot syndrome (P = 0.0001), frontal bossing (P = 0.0001), and low packed cell volume at surgery (P = 0.001) were found significant in predicting hemoglobinopathies. There was no mortality. Conclusion: Risk factors for hemoglobinopathies from this study included a positive history of jaundice, hand and foot syndrome, frontal bossing, and anemia. Proposed guidelines for HBE screening include the presence of hemoglobinopathy in one parent if one parent has sickle cell trait, and the other parent's genotype is unknown or if any of the risk factors is present.

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Objective: Mucociliary transport (MCT) is an important defense mechanism of the respiratory tract. One of the major factors determining MCT is the ciliary activity of the respiratory epithelium. Rhinoscintigraphy is the most commonly used method for the analysis of mucociliary activity. The aim of this study was to investigate the effect of facial paralysis on the nasal mucociliary clearance. Materials and Methods: This study included 38 Bell's palsy patients as the study group and 10 subjects without any history of paranasal sinus disease or facial paralysis as the control group. A drop of technetium 99m-labeled macroaggregated albumin (Tc-99m MAA) was placed posterior to the head of the inferior turbinate and followed with a gamma camera. MCT rate was measured as the velocity of Tc-99m MAA drop. Results: The mean MCT rate was 4.27 ± 0.76 millimeters per minute (mm/min) on 20 sides of 10 healthy controls, 4.11 ± 2.91 mm/min on the affected sides of the patients with Bell's palsy, and 6.03 ± 3.13 mm/min on the nonparalyzed sides of the patients. MCT rate was statistically significantly faster in the nonparalyzed side when compared to the paralyzed side in Bell's palsy patients (P = 0.001). MCT rates were not significantly different in the control group and paralyzed sides of the Bell's palsy patients (P = 0.810). The MCT rate was statistically significantly faster in the nonparalyzed sides of Bell's palsy patients when compared to the controls (P = 0.017). Conclusion: This study showed a faster MCT rate on the nonparalyzed side in Bell's palsy patients when compared to the paralyzed side and the control subjects. A compensatory mechanism could be the underlying reason for faster MCT on the nonparalyzed side. Further studies on larger patient groups are needed to investigate the effect of facial paralysis on the MCT and changes of facial nerve function on the opposite, nonparalyzed side of the face.

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Objectives: Our aim was to examine changes in insulin resistance, Carotid Intima-Media Thickness (CIMT), in morbid obese patients without any known associated chronic diseases who underwent sleeve gastrectomy. Materials and Methods: The subjects of this study were patients with minimum BMI of 40, who did not have any known chronic diseases. Sleeve gastrectomy was performed and perioperative control endoscopy was performed. The following values were measured before the operation and after follow-up period after the operation: Fasting blood glucose and insulin, lipid profile, BMI, liver function tests, right and left CIMT. Furthermore, the patients' insulin resistance was calculated by HOMA method, and the values of 2.7. Participants: Six-teen patients (14 women and 2 men, average age: 39.12 ± 10.63 years), who did not have a known additional chronic disease, took part in the study. Results: There was a significant difference between baseline and follow-up values of the patients, and the mean weight loss was 20.5%. Given the statistical evaluation of baseline and follow-up values, there was a significant difference in BMI, insulin resistance rates and right and left CIMT values. Conclusions: Bariatric surgery may provide some additional advantages for the management of cardiovascular risks in obese patients. However, it should be kept in mind that the most important components of fight against obesity are appropriate diet and exercise programs.

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