AIM: A prospective study was carried out to determine the incidence of intercurrent medical diseases and peri-operative course of such patients presenting for surgery under anaesthesia at the University of Benin Teaching Hospital, Benin City, for a period of twelve months.(March 2002 - February 2003). PATIENTS AND METHODS: All patients presenting for surgery at our general modular operating rooms formed the subjects for this study. A standardized form was used to document patients characteristics, presence of medical diseases, level of control, indication for surgery, type of anaesthesia, perioperative complications and outcome. RESULTS: Five hundred patients had surgery under anaesthesia. Our data showed incidence of intercurrent medical diseases (IMD) to be 19.6% . The prevalent age of intercurrent medical diseases was 60 years and above. The incidence of common illnesses was: hypertension (41.86% ), diabetes (14.2% ), upper respiratory tract infection (11.22% ), obesity (9% ) and anaemia (6.1% ). The most frequent observed intraoperative complications in patients with IMD were cardiovascular (hypertension-19.04% , bradycardia-19.04% , hypotension- 14.29% and tachycardia-14.29% . In recovery room, the common documented complications were hypertension-30% , tachycardia-22.5% , hypotension- 12.5% and prolonged unconsciousness-10% . The incidence of perioperative adverse events was higher in patients with IMD than in those without IMD. It was extremely significant. (P=0.0006; Odds ratio=0.5115; 95% CI: 0.3510 - 0.7455 using the approximation of Woolf). Patients aged over 60 years were more likely to present for surgical treatment with intercurrent medical conditions. (p < 0.0001, Odds ratio=0.03843, 95% CI: 0.2141 - 0.06900). CONCLUSION: Intercurrent medical disease was commonly found in patients above 60years and is a predictor of both intraoperative and postoperative adverse events.

BACKGROUND: There is currently no consensus among the clinicians regarding the tractive force to be employed during cervical traction (CT) that will correlate precisely with the percentage body weight of the patient and reduce the side effects associated with CT therapy. OBJECTIVE: This study therefore aimed to investigate the response of cervical spondylosis (CS) patients to different CT weights and to establish the effect of CT on the cardiovascular system of patients with cervical spondylosis (CS). METHODS: Sixty out of 78 subjects participated in the study. They were randomly assigned into three experimental groups A, B and C. Their systolic and diastolic blood pressures (SBP and DBP) and heart rates (HR) were measured. Rate pressure product (RPP) was calculated using standard equation18 and ECG recorded using the KENZ, 201 machine. Subjects' cardiovascular and ECG responses were monitored in a supine resting position (baseline) and under three experimental conditions using the subjects' 7.5% kg total body weights (TBW), 10% kg TBW and 15% TBW at different time intervals (5, 10 and 15 minutes respectively). RESULTS: Compared with the baseline values, there was a drop in SBP, DBP and RPP for all subjects in the three groups. The SBP, DBP and RPP alteration were not significant for the 7.5% TBW CT, but significant (p <0.05) for the 10% and 15% TBW tractions. The HR and ECG variables revealed no significant difference in all the groups, these results signified that the cardiac muscles were not adversely affected by any of the traction weights during application. Twenty subjects had side-effects including 5 subjects that terminated the treatment due to pain during the CT application. CONCLUSIONS: Cardiovascular alterations do occur during the application of cervical traction weights resulting in untoward patient's reactions. Efforts should be made to monitor the cardiovascular variables during and immediately after CT especially in "high risk" patients, that is, elderly patients and patients with unstable cardiovascular systems.

OBJECTIVES: A prospective study to find out the prevalence, pattern of distribution of rampant caries in patients treated at the outpatient clinic of the Dental Hospital, Obafemi Awolowo University Teaching Hospital Complex ( OAUTHC) Ile - Ife, Nigeria. METHOD: A total of 403 child patients aged 1 to 5 years who attended the hospital from January 1998 to December 2002 were examined by the authors. Questionaires were given to the parents or guardians to complete. RESULTS: The sample consisted of 213 males (52.8% ) and 190 females (47.2% ). Twenty two children (15males, 7 females) presented with rampant caries which was not statistically significant P >0.5. The prevalence of rampant caries was 5.5% . The peak age incidence was 4 years. More boys suffered rampant caries than girls with boy to girl ratio of 2:1. The pattern of distribution showed that the labial surfaces of the maxillary incisors were affected in all the patients. Five patients had proximal caries out of which mandibular primary incisors of 3 children were involved and one child presented with palatal caries of the maxillary primary incisors. CONCLUSION: The Dental Hospital, OAUTHC has experienced increased in number of rampant caries patients. Therefore emphasis on prevention of caries in suburban Nigerian children in Ile-Ife should be stepped up before it constitutes a significant oral health problem.

AIM: To assess the usefulness of fructosamine in evaluating the glycaemic status in patients with sickle cell anaemia. METHOD: Serum fructosamine, glucose, albumin and bilirubin were measured in one hundred and fifty patients with sickle cell anaemia (HbSS), fifty poorly controlled diabetics and one hundred healthy control subjects. Fructosamine was assayed using the method of Johnson et al. RESULTS: None of the HbSS patients had hyperglycaemia. Serum fructosamine was significantly higher in the poorly controlled Diabetics compared to the HbSS patients and the Controls. The mean serum albumin levels were within the laboratory's reference interval in the three groups of subjects studied. There was no significant correlation between fructosamine and normal serum albumin in the three groups of subjects. Moderately raised serum bilirubin concentrations in the HbSS patients did not cause any significant interference in the assay of fructosamine in the patients. CONCLUSION: Serum fructosamine could be reliably employed as a measure of glycaemic status of patients with sickle cell anaemia with moderate hyperbilirubinaemia.

OBJECTIVES: Deficient action of insulin is associated with derangement of carbohydrate, fat and protein metabolism. Determination of the extent of such derangement in steady state type 2 diabetic patients enhances management planning and prevents diabetic complications. This is necessary in a poor resource setting where functional national health insurance scheme is not available. The study aimed at assessing the level of plasma glucose and lipids, renal function, total calcium, inorganic phosphates and albumin and their relevance in steady state type 2 diabetic patients in north-eastern Nigeria in order to minimize the cost of laboratory investigations while preventing diabetic complications. METHOD: Two hundred and eighteen steady state type 2-diabetic patients were recruited at the Chemical pathology laboratory of the University of Maiduguri Teaching Hospital over a period of one year. Tests requested by the Clinicians for steady state diabetics were collated, the pattern of biochemistry laboratory requests and results were determined. The mean and standard deviation of the results were calculated. RESULTS: Out of the 218 steady state diabetics, only 48 (22.2 % ) had good short-term glycaemic control (fasting blood glucose < 7mmol/l). No test for long-term glycaemic control was requested during the study period. Lipid profile and protein assessment were carried out in 30% and 52.3 % of the patients respectively. Biochemical tests were not optimally utilised and this resulted in poor glycaemic control. CONCLUSION: Proper utilisation of laboratory tests for adequate long-term glycaemic control through team work approach with laboratory physicians are recommended.

The objective of this cross-sectional survey was to determine the prevalence of anti bodies to hepatitis C virus in 366 consecutively recruited individuals comprising 209 males and 157 females. Anti-HCV was detected in 11 (3.0% ) of the subjects tested. The highest prevalence was found in the 30-39 year age group (3.8% ) while the lowest prevalence occurred in the 40-49 year group (2.2% ). Anti-HCV infection prevalence was higher in less educated subjects (4.6% ) compared to highly educated (1.4% ), in females (3.8% ) compared to males (2.4% ) and was found to be almost two times higher among unmarried (4.1% ) compared to married subjects (2.2% ). This study confirms a high prevalence of anti-HCV and calls for urgent health education and awareness in the Niger Delta area of Nigeria to check further spread of the virus.

OBJECTIVE: We examined HIV seropositivity rates among blood donors, subjects screened for certificate purposes, and four sentinel surveys. Demographic and clinical features were analysed over periods to determine changes in risk factors and groups at risks. METHODOLOGY: Questionnaires and protocols were completed for patients screening or clinically assessed, while HIV positivity was determined on the basis of reactivity with two different ELIZA techniques. RESULTS: The positivity rates were below 2% in blood donors, maximum of 4.3% for sentinel surveys, and 11% among subjects screened for certificate purposes. Results showed decreasing male:female ratio, younger female patients, and preponderance of traders and artisans. Weight loss, fever, and diarrhoea were the commonest presenting features. 41% live away from their spouses. CONCLUSION: The 11% positivity rate among subjects requiring certificates raises questions on the reliability of sentinel survey figures. Campaigns should be targeted at artisans, traders and those living away from their spouses.

OBJECTIVES: This article assesses religious leaders' perceptions of young people's reproductive health in Anambra State. PATIENTS AND METHODS: Through self-administered semi-structured questionnaires, and in depth interviews, religious leaders perceptions of young peoples reproductive health in Anambra State Nigeria was elicited from two hundred and fifty religious leaders selected by multistage random sampling. RESULTS: Over 85% of the religious leaders thought that young people are sexually active, and are involved in high risk behaviour for unintended pregnancy, unsafe abortion, and STD and HIV/AIDS. Eighty five per cent felt that there is need for sexuality education in schools, and that sexuality education will reduce unintended pregnancy, abortion, STDS and HIV/AIDS among young people. However 52.2% felt that sexuality education in school would increase promiscuity. Some religious leaders did not support teaching of contraception and safe abortion in schools. CONCLUSION: Religious leaders in Anambra State have a high awareness of young people's reproductive health problem, and are in support of sexuality education in schools. They differ however in what should be the content of the curriculum. There is need to harmonise and agree on programme contents to minimise sending conflicting and confusing messages to young people.

INTRODUCTION AND OBJECTIVES: Adolescent sexual and reproductive ill health is a major global public health issue, contributing to high levels of morbidity and mortality in adolescents. Although adolescents are known to have low levels of doctor consultations, private medical practitioners remain the preferred health care providers. This study was carried out to document the attitudes and experiences of private medical practitioners to adolescent reproductive health issues and to assess the factors that may influence their attitudes. METHODS: Information was obtained from a random sample of 187 out of 352 (53% ) registered private medical practitioners in 5 of the 20 Local Government Areas in Lagos State using a self-administered structured questionnaire. RESULTS: Sixty-two per cent of the doctors claimed they saw adolescents regularly, mainly for the treatment of sexually transmitted infections (STIs). Many (86% ) believed that adolescents should use contraception and suggested that parents, teachers and health workers provide sexuality information to adolescents. Sixty one percent of the practitioners believed that abortion should be legalised, though with restrictions. Many of them admitted to providing post abortion care to adolescents. The religious affiliation of the private medical practitioners influenced their perception and practices. CONCLUSION AND RECOMMENDATIONS: Improving the reproductive health care of adolescents is key to improving the world's future economic and social well being. It is recommended that appropriate sexuality education be made widely available to adolescents. In addition, private medical practitioners should strengthen their skills and be more actively involved in the care of adolescents by making their facilities more adolescent friendly.

BACKGROUND: Neuroradiologic imaging has revolutionised the management of brain tumours through precise presurgery diagnosis and accurate definition of the extent of disease. This report attempts to evaluate our five years of clinical experience with intracranial CT scanning in the management of adult brain tumours. MATERIALS AND METHODS: The study included 160 adults with demonstrable brain tumours on CT imaging between 1997 and 2001. Surgical confirmation and histologic typings were recorded. All CT scans were carried out on Siemens Somatom AR.T scanner. A complete CT examination includes pre- and post-contrast examination done at 5 to 10 mm slice thickness and 10 mm interval from the base of skull to the vertex. All scans were viewed and documented in soft tissue and bone windows and multiplanar reconstruction appropriate for optimum visualisation of the areas of interest. All CT scans of the study population were analysed by age, sex, symptomatology, type and location of tumour. RESULTS: There were 92 males and 68 females with a mean age of 48 +/- 0.68 years. Headache accounted for 41.2% of the presenting symptoms while cerebral hemispheric tumours are more frequently (60.6% ) encountered. Gliomas are the commonest group (68.8% ). CONCLUSION: CT examination has improved the management of patients with brain tumours in our teaching hospital and will continue to remain the mainstream neuroradiologic imaging technique for a very long time.

A slaughterhouse survey for rabies virus infection among apparently healthy dogs slaughtered for human consumption was carried out in Maiduguri, Nigeria. Formalin-fixed and paraffin-embedded tissues (salivary gland, hippocampus, cerebrum, medulla, and trigeminal ganglion) were obtained from a total of 52 head samples from slaughtered dogs. The paraffin-embedded tissues were analysed histologically using the haematoxylin and eosin (H&E) method for the presence of inclusion bodies and histochemically by streptavidin - biotin peroxidase staining method for detection of rabies virus antigens. Prior to fixation of tissue, impression smears were made from the hippocampus and stained by Sellers method to detect the presence of Negri bodies. Rabies virus antigen was detected in tissues from 16 (31% ) of the 52 dog heads. Histological diagnosis by H&E revealed various degrees of inflammatory changes in the salivary gland and brain tissues with few Negri bodies from 10 (19% ) of the 52 dogs tested. However, all tissues positive by H&E were also positive by immunoperoxidase method using the streptavidin- biotin peroxidase staining procedure. Ten (30% ) of the 33 male and 6 (32% ) of the 19 female dogs tested were positive for presence of rabies virus antigen. There was no significant difference between sexes in relation to rabies virus infection. The application of immunoperoxidase staining technique in the localization of rabies virus antigen in the submaxillary salivary gland was more sensitive (based on the relative number of positive tissues) when compared with the application of the method to other organs. Apparently healthy dogs may be important in the epidemiology and control of rabies in this environment.

AIMS AND OBJECTIVES: This study was undertaken to evaluate the feasibility and tolerability of fracture fixation implants (FFI) removal under local anaesthesia. MATERIALS AND METHODS: We reviewed 176 patients who had osteosynthetic materials inserted for the treatment of fractures and whose implants were removed under local anaesthesia. Pain and tolerance were determined using a pain severity score determined by the patients. About 60% of the implants were Kuntcher nails while 31% were Krischner wires. In 171 (97.2% ) patients the implants were removed under local anaesthesia while in 5 (2.8% ) patients with Kuntcher nails the procedures were difficult and painful which necessitated the use of intravenous ketamine. RESULTS: About 89% of patients felt no pain during the procedures while 8.5% felt mild to moderate pain, which was easily tolerated. CONCLUSION: The use of local anaesthesia for fracture fixation implants removal is recommended because it is simple and safe and reduced the cost and complications of treatment.

BACKGROUND AND OBJECTIVE: This study was done to estimate the seroprevalence rate among Nigerian patients presenting to hospital with neurosurgical disease. PATIENTS AND METHOD: We reviewed our patients' hospital records from October 1996 to October 2001 for clinical presentation and diagnosis, cranial CT findings, results of retrovirus screening and mode of management. RESULTS: Sixteen (10 males and 6 females) out of 601 patients screened for HIV by ELISA were confirmed by Western Blot to be positive, giving a seroprevalence rate of 2.7% . Twelve of the HIV-positive patients were asymptomatic for HIV disease. CONCLUSION: There is a low but definite risk of HIV transmission to health workers managing patients with surgical lesions of the brain in areas where HIV is prevalent. Asymptomatic seropositive HIV patients with surgically curable intracranial disease should be managed with the most minimally invasive procedure appropriate for the surgical lesion under universal protective measures.

BACKGROUND: Management of any injury is expensive to the individual and the community. For this reason modification of methods of managing trauma very often is necessary in resource poor countries. OBJECTIVE: To verify the effectiveness of metal hinge joints in prevention of contractures and ankylosis of the elbow joint in cast immobilisation of reduced open forearm fractures. PATIENTS: 20 patients who had sideswipe injuries were managed from the year 01/01/2000 to date (20/5/2004) by the orthopaedic unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. They were referred from General Hospitals and Rural/Primary Health centers in northwestern Nigeria. They were all males, between the third and fourth decades of life (mean age was 35.54+1.52years). METHODS: Management of these patients involved early anti tetanus prophylaxis, good wound hygiene, internal fixation of the reduced fractures with kirschner wires, cast immobilisation and incorporation of metal hinge joints at the elbow joint. Three days after surgery the casts were windowed and patients were discharged to continue wound dressing at the nearest Health Centres. The metal hinge joints permitted elbow joint movement throughout the period of immobilization. After 12.45+0.42 weeks (mean length of time of wound healing in these cases) casts and implants were removed. RESULTS: Active movement of the elbows was rated as very good (8 cases), good (6 cases) and fair (6 cases). Plain radiography of the forearms showed fifteen cases of union and five cases of nonunion of fractures. CONCLUSIONS: The outcome of treatment of these injuries discerns the effectiveness of functional cast bracing in the prevention of contractures and ankylosis of the elbow joint in cast immobilization of reduced open forearm fractures. The healed wounds made the skin safer for further management of the cases of nonunion.

AIM: This article reviewed the diagnostic values of ultrasound in head and neck lesions with a view to emphasising its importance to Maxillo-Facial Surgeons in Nigeria. MATERIALS AND METHODS: A computerised literature search using MEDLINE was conducted for publications on ultrasonography in head and neck region. Mesh phrases used in the search were: ultrasound and head and neck; ultrasound and oral lesions. RESULTS: Ultrasound has been found to be a reliable and sensitive diagnostic tool in the diagnosis of soft tissue cysts, vascular neoplasms, deep neck abscesses, palatal tumours, salivary gland diseases, fractures of facial bone, solid and cystic lesions of the jaws, temporomandibular joint pathology, head and neck cancer and nodal metastases. Its sensitivity and specificity for some lesions have been found to be comparable to those of computerised tomography and magnetic resonance imaging. CONCLUSIONS: Ultrasound is an established valuable diagnostic tool for head and neck lesions. The success of ultrasonography is highly dependent on the frequency of the probe, the higher the resolution the better the accuracy. Its advantages include being non-invasive, without any known deleterious biological effect, rapid, painless, inexpensive and easily reproducible.

OBJECTIVE: To review the pattern of adult surgical admissions into the Intensive Care Unit (ICU) of Lagos University Teaching Hospital (LUTH). METHODS: A six-year retrospective review of data of patients above 12 years old admitted to the ICU of LUTH was performed. RESULTS: 290 patients representing 82.6% of the total ICU admissions (351) during the study period were evaluated. 251 (86.6% ) were surgical and 39 (13.4% ) non-surgical. The overall mortality was 40.3% (Surgical - 37.8% , Medical 62.9% ). Emergency admissions accounted for 221 (76.2% ) while electives were 69(33.8% ). The Mean hospital stay (MHS) was 4.8 +/- 0.4 days (Surgical: Medical - 3.9 +/- 0.2:10.1 +/- 2.5). The highest admissions were as a result of trauma (32.1% ) and obstetric complications (9.7% ). Cardiorespiratory monitoring (57.2% ) and respiratory distress (34.1% ) were the main indications for admission. Emergency admission and artificial ventilation contributed significantly to the observed mortality (p < 0.0001) CONCLUSION: At LUTH, trauma and obstetric complications constituted the major causes for ICU adult surgical admissions.

OBJECTIVE: To highlight the occurrence, and review the literature on stroke in young adults. METHODS: This paper reports three cases of young strokes. Brain imaging was done for two cases. The two were haemorrhagic stroke; one from an identified arteriovenous malformation and the other from a suspected vascular malformation or intracranial aneurysm. The third case was a young man with nephrotic syndrome who presented with clinical features of a thrombotic stroke. A review of the literature on stroke in young adults was done via Medline search for relevant publications. RESULTS: The literature review shows that a thorough diagnostic work up is required in young adults with stroke if one is to identify the diverse, but often treatable, causes of stroke in this age group. CONCLUSION: Stroke is a significant, albeit uncommon, cause of mortality and morbidity in young adults.

A 25-year old male student who was seen in the emergency unit of our hospital with symptoms and signs of acute intestinal obstruction of 4 days duration is presented. Following resuscitation, an exploratory laparotomy revealed a long gangrenous jejunoileal segment with its base firmly knotted around the mesentery of the sigmoid colon which was also gangrenous. Resection and primary anastomosis of the small bowel was carried out. Hartmann's colostomy was also done following resection of the sigmoid colon. The features of this uncommon presentation of intestinal obstruction described in the literature as ileosigmoid knotting or compound volvolus are highlighted, with particular note that its recognition, rapid resuscitation and exploration will improve prognosis.

A case is presented of a spontaneously conceived heterotopic pregnancy in a 38-year-old Haemoglobin SS woman, with intrauterine foetal demise and survival of the extra-uterine pregnancy, which was an abdominal pregnancy. The diagnosis was not made until delivery. This report should create the awareness of the possibility of abdominal or heterotopic pregnancy in spontaneous cycles, particularly in patients with recurrent severe anaemia in pregnancy, whether or not they have haemoglobinopathies.

BACKGROUND: Recently in some areas there has been an upsurge in rural electrification. Though electricity is desirable, it is one of the most potentially dangerous commodities in the society. OBJECTIVE: We present this report highlighting the need for prevention as high tension electricity injury though uncommon is reputed for significant morbidity and mortality. METHOD: A case report of a 30 year old female trader with high tension electricity burns in a rural community seen in the University of Calabar Teaching Hospital, Calabar. RESULT: Successful management of 10% burn involving multiple sites. Patient's husband was electrocuted in the incident. CONCLUSION: High tension burns are reputed for significant morbidity and mortality hence the need for prevention. Strategies recommended should include safety of electrical installations, protective apparels for electricity workers as well as health education for consumers.