The association of Zika virus (ZIKV) infection with congenital malformation and neurological sequelae has brought significant global concern. Consequently, the World Health Organization (WHO) declared it “a public health emergency of International concern” on 1 February, 2016. A critical review of its pathogenesis would lead to a better understanding of the clinical features and the neurological complications. This review is based on literature search in PubMed/Medline, Google Scholar and the WHO, http://www.who.int. This include all relevant articles written in English published through June 2018, with subject heading and keywords such as Zika, ZIKV, Zika pathogenesis, diagnosis of Zika, Zika Nigeria, Zika Africa and Zika resource-limited settings. Following ZIKV infection, viraemia ensues targeting primarily the monocytes for both the Asian and African strains. ZIKV infection by an African strain appears to be more pathogenic, in early pregnancy tends to result in spontaneous abortion. Whereas an Asian strain tends to be less pathogenic and more chronic, this allows the pregnancy to continue, ultimately resulting in congenital malformations. There is no routine laboratory diagnosis of ZIKV infection in resource-constrained countries. Serologic tests should be interpreted with caution since there can be cross-reactivity with other flaviviruses, especially in Africa where the burden of infection with flaviviruses is comparatively high. There is a paucity of well-equipped laboratories for comprehensive ZIKV diagnosis. It is imperative to strengthen the health systems, improve health workforce and diagnostic capacity of such settings.

Context: Self-rated health (SRH) is a subjective measure of health considered valid to predict mortality among the elderly. With the rapid increase of older people living in Nigeria and the lack of adequate social security, it is important to identify factors affecting their SRH. Social support has also taken on added importance among the elderly in view of scarce resources. Objective: To determine the level of satisfaction with the forms of social support received by the elderly and the factors associated with their SRH. Settings and Design: The study was a descriptive cross-sectional study design among the elderly in Southwest Nigeria. Subjects and Methods: A multistage sampling technique was employed to select 360 elderly respondents for the study. A standardised questionnaire, Short Form Health Survey-36 was interviewer administered. The data were analysed using Statistical Package for the Social Sciences version 20. Significant associations between categorical variables were evaluated using Chi-square (χ²) test. Multiple regression test and adjusted odds ratios (ORs) were employed to assess the relationship of the various predictors of SRH. The level of significance was set at P < 0.05. Results: The mean age of the 360 elderly respondents was 73 ± 9.3 years, 60.3% were female and 43.9% were widowed. Almost all (91.9%) the respondents received emotional while domestic support was the least in 50.3%. About 30.0% of the elderly self-rated their health as poor. The predictors of good SRH after multiple logistic regression included being married (OR = 1.84, 95% confidence interval [CI]: 1.01–3.33, P = 0.04); engagement in work (OR = 2.27, 95% CI: 1.11–4.63, P = 0.02); the absence of morbid conditions (OR = 12.6, 95% CI: 2.86–55.4, P = 0.001) and higher levels of education (OR = 0.41, 95% CI: 0.19–0.91, P = 0.03). Conclusions: About one-third of the elderly had poor SRH. Targeted interventions such as creating employment fit for the elderly and improving healthcare access is recommended.

Background: Axillary lymph node (LN) status of patients with breast cancer is important in the surgical management. Sonographic evaluation of axillary LNs in newly diagnosed breast cancer is required to predict prognosis. Objective: The purpose of this study was to describe the morphologic features by sonographic evaluation of the cortices and sinuses as well as patterns of blood flow of axillary LNs and correlate same with the clinical staging in women with newly diagnosed breast cancer in a tertiary referral centre. Patients and Methods: This was a prospective and descriptive study of 106 newly diagnosed female breast cancer patients recruited from the surgical outpatient clinic of the University College Hospital, Ibadan, during a period of 9 months in 2015. All 106 patients had clinical evaluation, sociodemographic documentation and ultrasound scans of the breast and axillae performed. Results: The mean age of patients was 48.1 (±11.1) years with age range 20–82 years. Most patients have a negative family history of breast cancer as seen in 97 (91.4%) of them. Abnormal cortex-hilum area ratio was more frequent in the right (66.7%) than the left (41.2%) axillary LNs. Longitudinal-transverse ratio was abnormal in 93.5% and 86.3% of LNs in the right and left axillae, respectively. Slit-like hilum, eccentric cortical thickening, replaced node and rat-bite appearance, respectively, were found in 40.7%, 10.4%, 48.4% and 44.4% of LNs in the right axilla. The peripheral flow type was demonstrated in 46.8% and 48.1% of LNs in the right and left axillae, respectively. Conclusion: Ultrasonography is a good diagnostic tool that can be employed with reasonable accuracy in the initial assessment of axillary involvement in breast cancer. Although the assessment of tumour size and clinical staging leaves little doubt as to the stage of breast cancer disease, sonographic evaluation of the breast and the axilla painted a more ominous picture.

Background: The burden of stillbirth is disproportionately more in rural areas of developing countries where unskilled birth attendants contribute a large quota in the management of pregnant women. Tracking stillbirth should include the pattern of referral from the primary institutions that take care of these women. Aims and Objectives: This study evaluated the causes and determinants of stillbirth by the referral pattern in a rural area in southern Nigeria. Subjects and Methods: This was a retrospective case–controlled study of stillbirth at the Madonna University Teaching Hospital, Elele, from 2010 to 2014. The lying-in, delivery and theatre registers were used to extract the relevant information. For each stillbirth, two controls were selected which were live births. Data analysis was performed using SPSS version 20. The confidence interval was 95% set at value of P = 0.05. Result: During the study, a total of 1243 neonates were delivered at the hospital, the number of live births and stillbirths were 1025 and 218, respectively. This gives a stillbirth rate of 175/1000 deliveries. Only 179 neonates whose case files were retrieved were used in the analysis. There were 87 fresh and 92 macerated stillbirths. Intrapartum complications contributed 91 (51.40%) of the stillbirths with traditional birth attendants and maternity homes contributing 72%. Determinants include booking status, educational level, abruptio placentae, preeclampsia, ruptured uterus, prolonged labor and low birthweight. Conclusion: The study showed an unacceptably high rate of stillbirth in rural Nigeria. Early recognition of complications and prompt referral may reduce stillbirth rate.

Background: Seminal fluid analysis (SFA) is the most important investigation of infertile males. It is however limited in revealing the aetiologies of the various spermatozoa abnormalities observed on microscopy. Increasing prevalence of male infertility and the challenges of diagnosis require biochemical investigations, such as assay of seminal malondialdehyde (MDA), a marker of sperm peroxidation and to support SFA in investigation of infertile males. Aims: The aim of this study was to determine the seminal level of biomarker of lipid peroxidation by measuring seminal MDA levels among infertile males in Ilorin. Settings and Design: This was a descriptive cross-sectional study. Subjects and Methods: One hundred and thirty infertile males served as patients and 50 fertile males as controls. Seminal MDA was assayed using ELISA method. Statistical Analysis Used: Statistical Package for the Social Sciences (SPSS) version 20.0 (SPSS Inc., Chicago, IL, USA) was used. Normally distributed data were expressed as mean ± standard deviation. Results: The mean age of the patients who were mainly civil servants was 38.6 ± 6.6 years compared to 37.0 ± 5.8 years among controls. Seminal MDA was significantly higher among infertile males in this study (P < 0.05) indicating higher degree of lipid peroxidation in their semen. Seminal MDA concentrations were found to be significantly higher among infertile males with a history of alcohol consumption (P < 0.05), cigarette smoking (P < 0.001) and sexually transmitted infections (P < 0.001) when compared to control with similar history. Conclusions: There is significant lipid peroxidation of spermatozoa among infertile males with lifestyle playing a significant role. Evaluation of infertile males should include assessment of seminal MDA. Prophylactic administration of antioxidants to this group of patients may be beneficial.

Aim: This study aims to compare the incidence of flare-up and operating time in root canal treatments where rotary or manual step-back canal preparatory technique was employed. Materials and Methods: A randomised study was conducted in a Nigerian Teaching Hospital. One hundred and twenty teeth belonging to 95 patients were randomised into two (Rotary and Manual) groups. Root canal treatment was performed using either rotary or manual step-back canal preparatory technique. Canal preparation time and total operating time were measured. Patients were monitored for severe pain and/or swelling over 1-week. Data were analysed using SPSS version 20.0, at alpha-level of P ≤ 0.05. Chi-square and independent Student's t-test were employed for comparison where categorical and numeric variables were involved, respectively. Results: There was neither associated pain/swelling before treatment in 28 (46.7%) of the teeth in rotary group nor in 27 (45.0%) of the teeth in manual group. Pain incidence was 11.7% and 16.7% in rotary and manual groups, respectively, at 1-week review. Severe pain was experienced by 3.3% patients in both groups at 1-week review. Only 1.7% and 6.7% in rotary and manual groups, respectively, presented with swelling over 1-week. Flare-up incidence at 1-week review was 3.3% in rotary and 8.3% in manual groups, the difference was not significant (P = 0.243). Canal preparation and total operating times were significantly shorter (P < 0.05) in the rotary group in all tooth categories. Conclusion: No significant difference was noted in flare-up incidence between rotary and manual groups. Canal preparation time and total operating time were significantly shorter for rotary technique. Time efficiency is clinically invaluable, especially for multi-rooted teeth.

Aim: The aim of this study was to determine the pattern of childhood visual impairment and blindness (VI and BL) among students attending schools for the visually impaired in Lagos State, with a view to providing information on avoidable causes as well as emerging trends that would be useful to policy-makers for the planning and implementation of strategies for the control of avoidable childhood BL in Lagos State. Subjects and Methods: The study was conducted among students enrolled in two schools for the visually impaired in Lagos State who developed VI/BL before the age of 16 years. Participants and their parents/guardians were interviewed to obtain medical history. Ocular and systemic examinations were also performed. Information was recorded using a modified World Health Organization/Prevention of BL Eye Examination Record for Children with BL and Low Vision and analysed using the Statistical Package for the Social Sciences version 23.0. Z-test determined differences in the proportions of the causes of VI/BL between this study and an earlier study. Results: A total of 116 students were enrolled in this study of which 65 (56.0%) were males. Avoidable causes accounted for 58.5% of VI/BL. Preventable causes predominated with measles (15; 12.9%) accounting for the largest proportion. Surgical complications (16; 13.8%) were the largest cause of VI/BL. A statistically significant decrease (P = 0.004; 95% confidence interval = 0.09–0.50) in the proportion of avoidable BL between a previous study carried out in Lagos State and this study was found. Hereditary cataract and cortical VI were the findings of this study not recorded in the previous study. Conclusion: Avoidable causes of childhood VI/BL still predominate among students in the schools for the visually impaired in Lagos State; however, there is a statistically significant decrease.

Background: Ocular dimensions are important in the refractive status of the eye. Aim: The aim of this study is to determine the effect of age and gender on ocular axial dimensions of emmetropic Nigerian Children. Materials and Methods: A cross-sectional study of 468 children from selected pre-nursery, nursery and primary schools with normal visual acuity were recruited into the study. Lens thickness (LT), anterior chamber depth (ACD) and vitreous chamber depth (VCD) were measured using a B-mode CLEA Vue 550 PHILLIP ultrasound Machine 2013 model, with a 4–12 MHz linear transducer. Results were entered into the personal computer and analysed using the SPSS statistical package version 21. Results: There were 235 boys (50.2%) and 233 girls (49.8%) with a ratio of 1.01: 1. Mean age for the study participants as a whole, 8.81 ± 3.81 years. The mean ACD, LT, and VCD were 3.6 mm, 3.7 mm and 17.5 mm in the RE and 3.7 mm, 3.8 mm and 24.8 mm in the LE. Only LT showed a significant difference between the sexes in both eyes. All ocular dimensions increased with age with the exception of ACD in the left eye. Conclusion: Of all the ocular dimensions, only LT showed the effect of gender, but no effect of age and age groups, particularly on the left eye.

Background: Medical tourism is a fast-growing business worldwide with almost every country involved as either a provider and/or consumer. The degree of participation may vary depending on the status of health-care system in that country. This study aims to present our experience in the management of patients who sought urologic care abroad or returned from medical tourism with urologic complications. Methods: The method of study was based on the documentation of interaction with patients, patients' relations and their agents in a questionnaire between January 2010 and December 2015. The data obtained included, their demographics, indications/motivations for seeking treatment abroad, procedures performed and complications. We also documented the secondary procedures that were performed and complications managed in our center. The data were entered into Microsoft Excel and analysed using descriptive statistics, tables and figures. Results: A total of 113 have either indicated intention of going to seek for urological care abroad or had already had urologic procedures abroad but were attending our clinic for follow up or for management of complications. Only about 12% of these patients were found to have genuine indications for seeking care abroad. Most of the indications were not justifiably based on the current capabilities of our health facility but more due to a lack of trust in the system or at worst pretentious. Conclusion: Patients seek for treatment abroad for variable reasons but and most could not be justified based on available local options. India and some Middle-East countries were the favoured destinations, and the quality of care and relative lower cost are the major attractions. The rising trend in medical tourism is fuelled by the poor state of our health-care system, perceived dearth of expertise and a general apathy and lack of trust.

Background: At present, selective and clinical assessment-based pre-operative investigations are advocated, but it is yet far from routine practice. Aim: This study aims to assess the prevalence and impact of abnormal routine pre-operative test results among co-morbid and non-co-morbid elective surgical patients. Methods: Data for this prospective study were collected by reviewing the medical charts of the patients attending pre-anaesthetic clinic from December 2016 to April 2017. The cohort was divided into non-co-morbid and co-morbid. Routine pre-operative tests were done, their results and impacts of abnormal test results were noted; number needed to investigate (NNI) was calculated. Data were compared using Fisher's exact test, unpaired t-test, etc., P < 0.05 was considered statistically significant. Results: Data from 887 patients; 322 (36.30%) co-morbid were analysed. Co-morbid patients were older (53.79 ± 14.99 vs. 40.33 ± 15.68 year). No difference was found in the number of tests done in co-morbid patients except significantly higher number of electrocardiogram and echocardiography (P < 0.0001). Abnormal test results were significantly higher among co-morbid (relative risk – 1.63, P < 0.0001). Impacts were similar in co-morbid as compared to non-co-morbid for most of the tests, but thyroid function and blood sugar tests showed NNI for significant impact below 10 in co-morbid group. Conclusion: Co-morbid patients have more abnormal results than non-co-morbid patients, but impacts of such tests are nearly indifferent. Routine testing is not favourable even in co-morbid patients. Selective or co-morbid disease-specific tests are having more significant impacts and should replace the 'routine testing' even in co-morbid patients.

Non-ossifying fibromas (NOFs) or fibroxanthomas are benign intracortical, multilocular and well-circumscribed lesions, which most commonly affect children and adolescents with an estimated prevalence of 30%–40% of all normal children. They are most commonly located in the distal femoral and distal tibial metaphysis although they can also be found in the fibula and upper extremity. Clinically, NOFs are asymptomatic and are detected only incidentally on radiographs where they appear as solitary, eccentric and lytic lesion in the metaphysis of a long bone and often polycyclic in shape. In most cases, no treatment is needed for an NOF other than simple observation due to a high rate of spontaneous regression at skeletal maturity. However, surgical treatment is considered in certain cases when the NOF is large or symptoms are present. We present an unusual case of a large NOF in the right clavicle of a 27-year-old woman who came to us with a 3-year history of a painless swelling on the right side of her upper chest. Radiographic evaluation of her tumour revealed a Ritschl Stage C lesion which was subsequently treated successfully by a near-total cleidectomy without recurrence over a 4-year of the follow-up period. We concluded that open-mindedness remains an important attribute a doctor must possess in order not to miss some rather unlikely diagnosis.