A retrospective review of 17,833 prescription items was undertaken at the National Orthopaedic Hospital, Lagos, Nigeria with the aim of determining the prevalence and types of prescription error. The percentage prescription error was 4.5 with type C (minor nuisance) being the most common prescription error. Incomplete prescription was the reason for these errors in 71% of cases. Our results revealed that the higher the professional status of the prescriber, the lower the prescription error. Even though the errors were recognised and corrected at the dispensing point, there was no indication that the prescriber was informed of his mistakes. We suggest, amongst others, regular clinical meeting of Doctors and Pharmacists where various aspects of rational drug could be discussed.

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BACKGROUND: Children are minors in health decision- making and discharges against medical advice (DAMA) may portend adverse health, social and psychological consequences . This study was aimed at ascertaining the prevalence rate and the determining clinical, sociodemographic factors as well as caregivers' perceptions associated with paediatric DAMA with the view of proferring possible control measures. DESIGN: Pre-tested administered questionnaires were used to collect relevant data prospectively (March 2000- March 2002) from consecutive patients undertaking DAMA. RESULTS: Prevalence rate of DAMA was 1.2%, comprising 202 of 16,440 discharges, of which 95 (47.0%) were neonates. Neonatal jaundice, gross congenital anomalies and severe birth asphyxia among neonates, and bronchopneumonia, gastroenteritis, malaria and malignancies among infant and older children,were the commonest diagnoses. Twenty (9.9%) cases were critically ill and 53(26.2%) were partially improved at discharge. Perceived improvement of illness, preference for outpatient care, financial constraints, high cost of hospital services, dissatisfaction and disagreements with care, were the commonest reasons for DAMA. CONCLUSION: DAMA is of multifactorial aetiology, involving clinically heterogeneous patients who may be critically ill or partially recovered. Socioeconomic, quality and cost of health care are implicated. This study recommends some control measures.

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OBJECTIVE: To determine the precipitants of relapse among patients admitted to a Psychiatric Hospital in Nigeria for substance abuse. PATIENTS AND METHODS: A cross-sectional survey of consecutive admitted drug abuse patients was carried out at the Psychiatric Hospital, Yaba, Lagos, using Marlatt's categories to measure high risk situations for relapse. RESULTS: Eighty-two subjects who were mostly male (87.9%), never married (53.7%), privately employed (58.5%), professionals (32%) with mean age 31.2 (+/- 6.56) years were evaluated. Most had used two or three different drugs. Coping with negative emotional states or enhancement of positive emotions were the main reasons for relapse determinants given by the subjects. Substance abuse management in Nigeria should embrace inquiries into these emotional states during both the admission and the post-discharge periods. CONCLUSION: Routine use of Marlatt' relapse precipitant categories may be helpful in designing intervention strategies to sustain abstinence in Nigerian drug abuser.

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OBJECTIVE: To determine the vertical facial height and proportions of face in Hausa-Fulani children.MATERIALS AND METHODS: 100 subjects aged 11-13 years of Hausa-Fulani ancestry and with no previous orthodontic treatment were selected for the study. Lateral cephalometric radiographs were traced and measurements made to produce values for-Upper Anterior Facial Height (UAFH), Lower Anterior Facial Height (LAFH), Lower Posterior Facial Height (LPFH), and Total Posterior Facial Height (TPFH). From these measurements the various ratios were then derived. RESULTS: The range of normal values in both sexes for UAFH =53.1-57.8mm with a mean value of 55.8+/- 3.9mm: LAFH =67.6- 73.8mm with a mean value of 70.7 4.9mm;LPFH =42.0-47.7mm with a mean of 44.7+/-4.6mm; TPFH=73.0- 80.7mm with a mean value of 44.7+/-4.6mm; TPFH= 73.0-80.7mm with a mean value of 76.7+/-6.0 mm. UAFH/TAFH was 44.2% for males and 44. 1% for females. LPFH/TPFH was constant (58.4%) for both sexes. TPFH/TAFH was 61.5% for males and 63.0% for females. CONCLUSIONS: Vertical facial height and proportions of face among Hausa-Fulani children differ from those of other ethnic groups and should be used in orthodontic diagnosis and treatment planning in Hausa-Fulani children.

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Thirty-two pregnant women in their first trimester with a mean age of 29.5 years, 32 age matched non-pregnant controls were included in this study. They were bled after 14-hour fasting. This study was between October 2000 and October 2001. Plasma total cholesterol, triglyceride and HDL- cholesterol were assayed. LDL-cholesterol was obtained through Frieldwald formula average as mean were calculated using Epi info version 6.0 and level of significant difference decided at p<0. 05. The mean age of the subjects was 9.5 years. Compared to the concentration in non-pregnant women [controls] the plasma level of total cholesterol and HDL-cholesterol were found to be significantly lower p<0.05. However the levels of plasma triglyceride and LDL-cholesterol were found to be significantly higher in the pregnant women than the control group [p<0.05]. This study revealed that the level of total plasma cholesterol is low in middle part of first trimester. We therefore suggest that in interpreting the result of total cholesterol in first trimester the gestation age should be put into consideration.

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The concept of restoring a pulpless tooth with post, core and/or crown is based on the belief that the root-filled tooth becomes brittle as a result of loss of moisture content. However, recent studies revealed that the moisture content of a root-filled tooth is not significantly different from that of a vital tooth. A survey of dentist' philosophies and techniques of restoring pulpless tooth conducted in the United States of America (U.S.A.) revealed that approximately 50 per cent of the respondents believed that a post would reinforce an endodontically treated tooth, while other studies reported no statistically significant advantage to reinforcing the teeth. Therefore, the concept that all anterior teeth that have received root canal therapy require posts and crowns is not supported by recent studies. But the access cavity for the root canal treatment should be as conservative as possible so that the tooth is not weakened unnecessarily. Based on a review of the literature, this article intends to provide a guideline for the restoration of endodontically treated teeth.

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This study compared the prevalences of malocclusion and Orthodontic needs between normal Nigerian children and their handicapped counterparts using the Dental Aesthetic Index. The samples consisted of 1,010 children -614 normal (321 males; 294 females) and 396 handicapped (199 males;197 females) aged 12-18 years with mean ages for normal and handicapped children as 14.8+/-1.9 and 15.0+/- 2.2 respectively. They were drawn randomly from their respective schools in Ibadan, Nigeria. Although some differences were observed in the ten malocclusion traits of DAI between the normal and the handicapped children, none was found statistially significant (P> 0.05). Missing teeth were noted in 1.9% of the normal children as against 4.8% of the handicapped. Crowding of incisal segments was observed in 20.0% of the normal and in 21.7% of the disabled children. Spacing of incisal segments was recorded in 47% and 55.5% of normal and handicapped children respectively. Others in that order were: Disatema-31.7% and 32.3%; Anterior maxillary irregularity - 55.5% and 40.9%; Anterior mandibular irregularity- 50.2% and 34.3%; Overjet - 20.7% and 13.1 %; Reversed overjet - 1.9% and 2.3%; Open bite - 7.5% and 9.8% and total deviations from normal molar relation in 23.8% and 31.3%. Also, although higher proportions of handicapped children than the normal group were noted having DAI scores indicative of treatment needs ranging from elective to mandatory, no significant differences were noted (P>0.05). About 13% of the normal and 16% of the handicapped children in the study sample deserved publicly funded orthodontic care.

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This study was undertaken to determine nosocomial bacterial infections (NI) in surgical patients in a developing country using the detailed option of the Center for Disease Control (CDC) surgical patient surveillance technique. From 1994 - 1995. Paediatrics surgical patients at the Lagos University Teaching Hospital (LUTH) were prospectively monitored for NI at all body sites. Standard definitions of NI were used, and NI sites were categorised by type of operation. A total of 304 NI occurred in 245 out of 664 surgical patients investigated. SSI (77.3 %) and urinary tract infections (19.1%) were in preponderance. Seventy three per cent of SSI were superficial incisions, 20.5% organ/space and 6.8% deep incisions. The overall wound infection rate was 30.9%. The SSI rate for emergency surgery was 35.6% and 26.5% for elective procedures. Rates within each wound class were 20.2, 23.8, 51.9 and 52.8% respectively and 17, 37.6, 43.4 and 47. 1% for patients with ASA scores of I II III and IV in that order. The SSI rates for patients with scores of 0, 1, 2 and 3 were 20.4; 43.5, 57.1 and 75% respectively. Mean infection rates in the various wound classes were highly correlated with the number of risk factors present. Klebsiella pneumoniae (38. 7%), Escherichia coli (22.7%), Pseudomonas aeruginosa (16.8%) and Staphylococcus aureus (10. 7%) were the most common pathogens.

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A 75-year-old woman presented at the eye clinic of the University of llorin Teaching Hospital with swelling of the left eyelids and protrusion of the left eyeball. The swelling was painless. Physical examination revealed no systemic abnormality. An incisional biopsy of the lid swelling revealed tuberculous orbital involvement. She responded well to anti-tuberculosis therapy, with regression of the lid swelling and proptosis. The importance of including intraorbital tuberculosis as a differential of orbital swelling in the environment is emphasised.

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The degenerative changes in PD also affect the autonomic nervous system. The frequency and predictors of such involvement in Africans with PD has not been reported.OBJECTIVE: i) To determine the frequency and type of autonomic dysfunction in Nigerians with idiopathic Parkinson's disease (PD). ii) To determine the predictors of autonomic dysfunction in PD. METHODS: Cardiovascular autonomic function assessed in 33 study subjects with PD and 33 age-matched controls, utilising heart rate variability to deep breathing, standing and the Valsalva manoeuvre, and the blood pressure (BP) response to standing. The results were compared based on treatment category, grade of severity on the Columbia scale of Hoehn and Yahr, duration of PD, age at onset of PD, present age and occurrence of autonomic symptoms. RESULTS: Parasympathetic function was abnormal in 51.5% of PD subjects, significantly higher than controls (P<0.001). Of these, 76.5% had early parasympathetic involvement and 23.5% definite parasympathetic involvement. Age above 65 years (at time of study or onset of PD) was the only clinical variable associated with parasympathetic autonomic dysfunction (p<0.05). Symptoms dysfunction occurred in 60.6% of PD patients and only 6.1% of controls (p<0. 001). There was however no demonstrable relationship between the occurrence of symptoms and objective evidence of autonomic dysfunction: 41.2% of PD patients with parasympathetic dysfunction had no symptoms. CONCLUSION: Autonomic dysfunction was found to be common in Africans with PD, particularly those above 65 years and tends to affect the parasympathetic system. However, the abnormality may be detectable even before symptoms appear. As such, we recommend that cardiovascular tests of autonomic function be a routine aspect of the evaluation of PD patients, especially with advancing age.

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BACKGROUND: Contrary to our local experience, published data elsewhere show increased survival rates from major burns due to improvements in management. This study aimed at examining problems of burns management in children. DESIGN: Relevant data extracted from the records of 44 children included sociodemographic, clinical, management characteristics and outcomes. RESULTS: There were 86.0% thermal burns due to accidental, domiciliary events in 36 (81.8%. Mean (range) BSA was 35.9% +/- 4.0 (1%-95%), mostly 2nd degree burns in 34 (77.3%). Mean (range) duration of symptoms before presentation was 1.1 +/- 0.3 days (1-7 days). Following hospitalisation, involvement of key experts in acute burns care was either delayed or omitted. Intensive care monitoring and support including mechanical ventilation were unavailable for 11 (25.0%) cases with cardiorespiratory compromise. Septicaemia & pneumonias were associated with death in 9 (56.3%) of the 16 deaths. Klebsiella, pseudomonas and coliform organisms were isolated from most burns wound. Oral acetominophen and intramuscular dipyrone were the main analgesics used in 24 (54.6%) and 8 (18.2%) cases respectively. Anxiolytics were used in only 2 94.5%). Case fatality rate was 36.4%. Mortalities were 100% with BSA 50-100% (p=0. 000). CONCLUSION: Prevention and improvements in management of burns including early multidisciplinary care, critical care support, aggressive wound care and adequate pain control should be emphasised.

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BACKGROUND: There is yet no formula to predict the expected date of death, however this information may be invaluable to the terminally ill, care givers, friends and family members to write the will, arrange for end-of-life care, settle disputes, and to make plans for burial ceremonies. OBJECTIVE: The study is an audit of all deaths in the gynaecological wards to determine the causes of death and highlight the care option for the terminally ill patient. STUDY METHODS: The admission ward registers and the duplicate copies of issued death certificates between 1986-2000 were studied. Details of the individual patients diagnosis and at death or discharge were collected and crosschecked with the patient's casenote. The collected data was subjected to statistical analysis using appropriate computer software. RESULTS: A total of 10,485 admissions were recorded in the study period. There were 89 (0.85%) deaths and 27(0.26%) discharges against medical advice. The yearly rate of death varied between 0.36% and 1.66% admissions. Patients' discharging themselves from the gynaecological wards against medical advice started in 1992, and was at a maximum (2.0%%) in 1996. Carcinoma of the cervix (30.3%) was the most frequent cause of death next was ovarian cancer (29.2%). Death following complications from criminal abortions (11.2%) was fourth while deaths subsequent to operation for uterine fibroids and ectopic pregnancies were 2.2% each. Patients dying from complication of abortion were the youngest (22.6 years +/- 9.13), while patients dying from endometrial carcinoma were the oldest (64.75 years +/- 9.84). The mean age of patients dying from advance gynacological malignancies was 44.13 years +/- 17.07, which is significantly higher than the mean age of patients dying from complications of abortion, P<0.00015 (Student's T-Test, two tail, type 2). CONCLUSION: Advanced malignancies of the cervix, ovary and chorion carcinoma are the major causes of gynaecological deaths. Next, are deaths resulting from the complication of criminal abortion. Patients' discharge against medical advice as option of care needs further investigation.

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OBJECTIVE: To determine the accuracy of initial diagnosis of cerebral malaria in adolescents and adults presenting at our tertiary centre and identify the clinical and laboratory parameters helpful in distinguishing cerebral malaria from other differential diagnosis. METHODS: A retrospective review of 112 adolescents and adults initially diagnosed as having cerebral malaria was carried out. Clinical features (risk factors, mode of presentation, clinical course and final diagnosis) and laboratory parameters (level of parasitaemia, haematologic and biochemical values) were documented. RESULTS: A correct diagnosis was made in 52 patients (46.4%), with septicaemia (20.5%) and meningitis (15.2%) accounting for most misdiagnosis. The majority of correctly diagnosed were aged 11-25 years (92.3%), and a predisposing factor was identifiable in 46.2%. Parasitaemia was predominantly moderate to heavy in correctly diagnosed cases, compared to those misdiagnosed in whom it was mild to moderate. Case fatality was higher for misdiagnosed cases (18.6%). CONCLUSION: The probability of an alternate diagnosis amenable to other treatment regimes should always be explored. This is particularly important in patients of middle age and those with either absent predisposing factors or mild parasitaemia, in order to reduce case fatality.

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BACKGROUND: Tetanus, an ubiquitous disease still ravages our population despite the fact that it is totally preventable. The mortality had remained high with its attendant socio-economic implications as it affects mainly farmers in their prime of life. We conducted this retrospective review to be able to determine pattern of presentation, case fatality rate and factors influencing mortality with a view to mapping out control strategies. PATIENTS, MATERIALS AND METHODS: The case records of all managed patients aged 16 and above over a ten-year period (1992-2001) were retrieved and socio-demographic and clinical data as well as results of laboratory investigations were collated. Analysis was done using SPSS package. Chi-square analysis and student t-test were used for comparison of means as appropriate. P-values of <0. 05 was taken as significant. RESULTS: There were a total of 114 patients managed during the period, which comprised of 85 males and 29 females. The means age (+/- SD) was 35.96 (+/-17.76). Sixty six (57.89%) patients are either jobless or farmers. Majority of the patients had injuries in the lower limb 59.65% when compared with 20.18% that had theirs in the upper limb. 107 (93.86%) of the patients presented with trismus while only 82 (71.93%) had opsthotonus. Only 51 (44.73%) patients survived while 61 (53.5%) died. The mean age (+/- SD) of the survivors was 32.35 (+ 14.45) years while that of those that died was 39.4 (+/- 19.89) years (P = 0.036). Other factors that significantly influenced survival included severity of spasms (P = 0/003), tachycardia (P = 0.044), and degree of sedation (P <0.0001). No association was found between survival and incubation period, period of onset, site of injury and associated medical conditions. CONCLUSIONS: Tetanus is still associated with high mortality rate. Factors such as severity of spasma, age, sedation and tachycardia were found to significantly influence mortality. It is recommended that prophylactic life immunisation against tetanus be given to all Nigerians.

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