Background: Hemorrhage is a serious challenge in vascular malformations (VMs). This problem makes the surgical excision of the lesions difficult and sometimes impossible. Objective: The objective was to design a technique that will meet with the challenges of hemorrhage while performing surgery in such lesions in our environment. Patients and Methods: Seven patients with deep and moderately large VMs of the facial region were selected and treated with hot 7.5% hypertonic saline after compressing the feeder vessels. This was then complemented with surgical excisions. Results: There were successful surgical extirpations of the lesions without eventful hemorrhage. Conclusion: Hot 7.5% hypertonic saline injected into VMs after emptying their hematic content caused sclerosis of the anomalous vessels. This made bleeding during surgery uneventful.

Background: Musculoskeletal disorders (MSD) are the major cause of morbidity throughout the world, having a substantial influence on quality of life (QOL). We studied QOL ascertained by limitations of activities of daily living, impact on family and social relationships, and sleep disturbances among patients with MSD. Aim: Ascertain QOL in MSD. Materials and Methods: A cross-sectional study among 2633 randomly selected subjects. The study was carried out in the field practice area of D Y Patil Medical College, Pune, India. In the first phase of the study, patients of MSD were identified by house-to-house surveys, by face-to-face interviews, and clinical examination carried out by trained interns in random samples of selected households. Subsequently, QOL in patients with MSD was elicited by measuring limitations of activities of daily living, impact on family and social relationships and sleep disturbances by structured instrument, using Likert/Dichotomous Scale. Statistical software EPI Info 2002 was used for estimation of sample size, data entry, and analysis. Data were summarized using proportions and percentages. Association of gender and rural-urban background with prevalence of musculoskeletal disorders was explored with odds ratio (OR) with 95% confidence intervals. Results: A total of 2633 subjects were examined. Out of these, 190 (7.2%) suffered from various types of MSD, with higher prevalence in females than males (OR=1.43, 95% CI=1.05 to 1.95). Prevalence was also higher in the rural population compared with urban (OR=2.02, 95% CI=1.45 to 2.83). However, the rural-urban difference may be due to the confounding effect of age, as prevalence was higher in the elderly (48.78%) and the mean age of the rural population was significantly higher than the urban population. Different degrees of limitations among patients of MSD in carrying out specific activities were: Dressing 9.5%, washing hair 11.6%, rising from bed 50%, feeding themselves 6%, walking 39%, taking bath 10%, toilet 37%, rising from chair 47%, rising from floor 55%, boarding bus 30%, and sleep disturbances 47%. These limitations also had impact on their family and social relationships. Conclusions: Patients of musculoskeletal disorders face appreciable limitations in their activities of daily living, which adversely impact their QOL.

Background: Depression is a common psychiatric disorder in epilepsy patients. A bidirectional interaction is thought to be present between epilepsy and depression. There are few studies of this relationship in Nigerian Africans. Objectives: This was a cross-sectional study of the frequency and pattern of depression in a cohort of epilepsy patients in Enugu, South East Nigeria. Materials and Methods: Adult patients with epilepsy seen at the University of Nigeria Teaching Hospital, Enugu, from May to September 2009 were assessed for depression using the Becks Inventory for Depression. Informed consent was obtained from each patient. Clinical data obtained were analyzed using Statistical Package for the Social Sciences, version 15. The hospital's ethical review committee approved the study. Results: I0 n all, 83 subjects were studied (50 males and 33 females). They were aged from 18 to 75 years, with an average of 29.87 years. Most subjects were <25 years of age, single (53, 64%) and had at least secondary school education (65, 78%). Depression was present in 71 (85.5%) subjects - minimal 57 (68.7%), mild 10 (12%), and moderate 4 (4.8%). No case of severe depression was seen. Patients <25 years of age were the most affected. Depression was not significantly associated with age, gender, seizure type, or educational level. Conclusion: A significant proportion of Nigerian African epilepsy patients have depression, which may be easily overlooked, with far-reaching consequences on patients' quality of life, morbidity, and mortality rates. There is need to regularly assess for and manage epilepsy-related depression in this population.

Background: Awareness of malocclusion and the need to make corrections has increasingly becomes prevalent among our population. However, very few patients have presented in the orthodontic clinics with referrals from medical practitioners, an indication that the primary caregivers may be deficient in the knowledge of orthodontic practice. Objective: To assess the knowledge of orthodontics and the awareness of the effects of malocclusion on the general well-being, among medical students at the Lagos State University College of Medicine (LASUCOM). Materials and Methods: This cross-sectional study was conducted using a self-administered questionnaire. A total of 85 medical students in the institution participated in the study. Data entry and analysis was done using Epi info version 3.5. Frequency counts were generated for all variables and measures of central tendency for numerical variables. Results: All participants were medical students. Majority (75.3%) were in their clinical years while 24.7% were in their preclinical years. Only 45.9% of the respondents had heard of the term "orthodontics" and only 20% correctly answered that orthodontics involves malocclusion and its management. Concerning the treatment procedures used in orthodontic clinics, 54.1% of them selected rearrangement of teeth. When asked to identify the appliances used in orthodontics, 49.4% selected dentures, 40% selected removable appliances, and 57.7% selected braces. Most of the respondents (81.2%) agreed that as medical doctors they would refer patients for orthodontic care, while 3.5% were undecided and 15.3% disagreed. Conclusion: The medical students surveyed had limited knowledge of orthodontics as a specialty and also knew very little about the impact of malocclusion on the well-being of the individual. They would, therefore, benefit from basic education in orthodontics to stimulate their interest in the specialty and improve their ability to refer patients appropriately.

Background: There are several problems militating against satisfactory residency training in Nigeria. These problems may not be effectively identified and resolved if the opinion of the trainee doctors is ignored. Objectives: To review surgical residents' perspectives of their training program in South-eastern Nigeria, with the aim of suggesting evidence-based innovative changes to enable the programs meet global trends and standards. Materials and Methods: A total of 90 semi-structured and pre-tested questionnaires were evenly distributed (30 per hospital) to the surgical residents at three tertiary healthcare facilities in South-eastern Nigeria. Information sought included sociodemographic variables, level in the residency training, rating of program and different aspects, learning environments/opportunities, and suggestions on ways to improve either part or overall program. Results: Analysis of 56 properly completed questionnaires (response rate=62.2%) shows that the respondents were aged 29 to 53 years [mean(SD) = 35.3(1.7)], mostly males (91.1%) and junior residents (75%). A significant majority of residents (47 or 83.8%) rated the surgical residency training in their respective centers as inadequate. Grand rounds were roundly criticized as having misplaced objectives and tending toward fault-finding by Consultants. Suggested interventions for improvement included enhanced supervision/mentoring/teaching by senior colleagues, inclusion of didactic lecture sessions, research trainings, and foreign postings. Conclusion: There exist gaps between expectations of surgical residents and the training offered. These create needed support for an evidenced-based review of surgical residency training program to enable it meet the aspirations of trainees and the ever-changing trend in Medicine. More studies on surgical residents covering other regions of Nigeria, and including the trainers (Consultants), will be of immense value.

Background: The development of success-oriented hepatitis-B vaccine uptake approach among dental surgeons is dependent on the availability of comprehensive baseline data. Objective: To determine the hepatitis-B vaccination status among dental surgeons in Benin City. Materials and Methods: This questionnaire-based cross-sectional study of dental surgeons in Benin City was conducted in May 2011. The questionnaire elicited information on demography, occupational risk rating of contracting hepatitis-B infection, hepatitis-B vaccination status, barriers to uptake of hepatitis vaccine, and suggestions on how to improve hepatitis-B vaccination rates among dental surgeons. Results: Participation rate in the study was 93.3%. More than half (51.4%) of the respondents were 20-30 years old and 52 (74.3%) were males. The occupational risk of contracting hepatitis-B infection among dental surgeons was rated as either high or very high by 51 (72.9%) of the respondents. Amongst the respondents, 14 (20.0%) had received three doses of the hepatitis-B vaccine, 34 (48.6%) either two doses or a single dose, and 22 (31.4%) were not vaccinated. The major barriers reported among the respondents who were not vaccinated were lack of opportunity and the fear of side effects of the vaccines. The suggested ways to increase the vaccination rate among the respondents in descending order include: Making the vaccine available at no cost (51.4%), educating dentists on the merits of vaccination (17.1%), and using the evidence of vaccination as a requirement for annual practicing license renewal (14.3%) and for the employment of dental surgeons (11.4%) and others (2.9%). Conclusion: This study revealed low prevalence of complete hepatitis-B vaccination among the respondents. Improvement in uptake following the respondents' recommendations will serve as a template in developing success-oriented strategies among stakeholders.

Background: Urinary tract infection (UTI) is a common childhood infection in the Tropics which causes significant illness and is frequently missed, probably because of its non-specific presentation and similarity with other common illnesses. Objectives: To determine the prevalence, common etiological agents, and the susceptibility of these pathogens to the commonly available antimicrobial agents in this center. Materials and Methods: This was a retrospective study carried out at the Children's Outpatient Clinic and Children's Emergency Ward of Ebonyi State University Teaching Hospital Abakaliki (EBSUTH). The study was carried out between January 1, 2007 and December 31, 2009. Results: One hundred ten subjects of the 3625 children seen in the center during the period of study had UTI giving a case prevalence rate of 3.0%. Majority of the patients (59, 53.6%) were less than 2 years of age with a male:female ratio of 1:1.3. Fever was the commonest presenting symptom and the commonest organisms isolated in urine were Klebsiella (27, 24.5%), and Staphylococcus aureus (24, 21.8%). The drugs that were most sensitive to these organisms were Gentamicin (50, 45.5%), Ceftriaxone (49, 44.5%), and Ciprofloxacin (36, 32.7%). Conclusion: The study revealed a high prevalence of UTI among children. Klebsiella was the commonest causative organism isolated in the urine. Gentamicin, Ceftriaxone, and Ciprofloxacin were the antimicrobials with the highest sensitivity to all the isolated microorganisms.

Objectives: To determine the prevalence, risk factors and common bacterial pathogens for surgical site infection (SSI), following cesarean section (CS). Materials and Methods: A retrospective case-control study of patients delivered by CS in Aminu Kano Teaching Hospital, Kano, Nigeria. The cases were the patients whose CS was complicated by SSI; they were matched by other patients delivered by CS who had had no SSI as controls. Hospital records of cases and controls were compared. Results: Four hundred and eighty five hospital records were available for review, 44 (9.1%) had SSI. Statistically significant determinants of infection are: Long duration of labor before CS (P<0.001), Long operation time (P=0.009), heavy intraoperative blood loss and blood transfusion (P<0.001). Eleven (25%) of the cases had CS due to obstructed labor compared to 15.3% of controls. Staphylococcus aureus was isolated in 31.8% of the cases. Cephalosporins and quinolones were the most sensitive antibiotics. Conclusion: The incidence of SSI following CS in our unit was 9.1%. Most cases followed prolonged obstructed labor, with long operation time and heavy blood loss. Staphylococcus aureus sensitive to cephalosporins was the most frequently isolated pathogen. Strategies for preventing prolonged obstructed labor and appropriate antibiotic prophylaxis may prove effective.

Background: Emergency obstetric hysterectomy (EOH) is a life-saving procedure which is often performed to treat some obstetric complications, as a last resort, to prevent maternal mortality. Objectives: This study was designed to determine the rate, indications, and complications of the EOH procedure at Usmanu Danfodito University Teaching Hospital (UDUTH), Sokoto. Materials and Methods: This retrospective study involved all the patients who had EOH at UDUTH, Sokoto, Nigeria, between January 2005 and December 2010. The case records of these patients were retrieved from the medical record library and information relating to age, parity, booking status, indications, type of hysterectomy, cadre of the surgeon, type of anesthesia, and complications of the procedure were extracted. The data were processed via SPSS version 11.5 and the χ² test was used to analyze some of the results with the confidence limit set at 95%. Results: During the 6-year period, 83 EOH were performed out of 16,249 deliveries giving the rate of the former as 0.51%, i.e. 1 in 196 deliveries. However, the case records of only 74 patients (82.9%) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2%) were unbooked for antenatal care, and the rate of the procedure among these patients (1.82%) was significantly higher than 0.07% observed amongst booked subjects (P<0.001). The main indication for the procedure was ruptured uterus (93.2%) and the majority of the patients (95.9%) had subtotal hysterectomy. Anemia (66.2%), excessive hemorrhage (35.5%), septicemia (18.9%), and wound infection (16.2%) were the leading complications. Excessive hemorrhage was significantly higher in the procedure performed by the senior registrars (51.2%) compared to those undertaken by consultants (16.2%); P=0.03. The case fatality rate of the EOH procedure was 12.1%. However, the case fatality rates in the procedure performed by consultants and senior registrars were 6.5% and 16.3%, respectively. Conclusion: The rate of EOH in the centre is relatively high and ruptured uterus is responsible for the majority of the procedure. Prevention of prolonged obstructed labor, and therefore uterine rupture, through antenatal care and supervision of labor will reduce the rate of EOH whereas performance of the procedure by the most experienced surgeon will minimize the maternal morbidity and mortality.

Background: Andropause, a prevalent pathology of men, results from an imbalance in steroid hormone concentrations that often is associated with aging, and reduces the quality of life of the sufferer. This study investigates the usefulness of a diet containing 15% Telfairia occidentalis seeds in the inhibition of the induction of experimental andropause. Materials and Methods: Twenty male rats were divided into four equal groups. Rats in the test group received dihydrotestosterone and estradiol valerate (ratio 10:1) subcutaneously every other day for 28 days and were placed on the test diet. Those in control I received the hormones, but not the test diet. Rats in controls II and III received olive oil (vehicle) and were placed on the test diet and normal diet, respectively. Testes weights and relative weights, serum testosterone concentrations, and testosterone concentration per gram of testicular tissue were measured or determined in all rats using standard protocols. Data were analyzed and differences between means separated using one-way analysis of variance. Results: Rats in the test group had slightly larger mean relative testes weights compared to those in control I, though both were significantly (P<0.001) smaller than the values obtained in controls II and III, respectively. Rats in the test group had significantly higher (P=0.034) serum testosterone concentrations relative to the control I group 6.9(0.3) ng/ml vs. 4.7(0.1) ng/ml, while the testosterone relative to testes weight values (ng/ml/g) of the test group was 16.8(3.4), and for controls I, II, and III the values were 12.3(1.4), 5.5(0.4), and 4.6(0.7), respectively. The differences between the test and control groups were all significant (P=0.04 in control I, and <0.001 in controls II and III). Conclusion: The test diet resulted in a modest reduction of biochemical castration and an improvement in secretory capacity of the testes of the test rats, relative to the control group that received the hormones but was placed on a normal diet. T. occidentalis seeds-incorporated diet may be useful in inhibiting the induction of experimental andropause.

Background: Tobacco snuffing, like cigarette smoking, is known to be a common habit among the adults of Igbo communities in Nigeria. In view of the various pharmacological actions of nicotine and other additive constituents of tobacco snuff, there is growing concern that ascorbic acid, which is a vital antioxidant, and blood cell production or morphology may be affected. Objective: To investigate the possible effects of prolonged use of tobacco snuff on plasma ascorbic acid concentrations and some hematological parameters. Materials and Methods: Fifty adults of Igbo extraction (35 males and 15 females) residents in and around Enugu metropolis, who have been snuffing tobacco for 6 years and above, were recruited for the study, after they gave informed consent. Also, 50 apparently healthy, age-matched persons (25 males, 25 females), who do not smoke or take tobacco snuff, served as controls. Spectrophotometric method was adopted for ascorbic acid determination while hematological profiles were assessed by Bain method. Results: The results showed no significant difference in the measured parameters relative to the controls AA (P=0.08); Hb (P=0.19); PCV (P=0.10); RC (P=0.06); PC (P=0.20); WBC (P=0.09). Conclusion: The results of the study suggest that tobacco snuff inhalation may not adversely affect plasma ascorbic acid concentration and hematological parameters in adult humans. The study, however, has not concluded that tobacco snuffing is totally wholesome.

Background: In developing countries, under nutrition is common, and this plays a crucial role in the pathogenesis of malaria and anemia. Indeed it has been associated with adverse pregnancy outcomes. Unfortunately, published evidence concerning the situation is lacking. Objectives: To evaluate some nutritional function indices of pregnant women in a rural Nigerian community. Subjects and Methods: This is a cross sectional study involving of 171 pregnant women from a rural area in South-eastern Nigeria. They included 72 and 99 women in their second and third trimesters respectively. The control group was of 60 women, matched in age, parity and socioeconomic conditions, non-pregnant, non-menstruating and non lactating apparently healthy women. The parameters measured by standard methods included serum iron, total proteins, albumin, globulin, packed cell volume and hemoglobin. Results: The results obtained from control group, second and third trimesters, recorded as Mean (SEM) were 134.60(3.12) μg/L, 101.20(4.48) μg/L and 91.87(3.42) μg/L respectively for iron; 69.12(0.80) g/L, 63.60(0.71) g/L and 57.74(0.75) g/L for total proteins; 42.95(0.92) g/L, 35.74(1.00) g/L and 35.26(0.64) g/L for albumin; 26.77(1.00) g/L, 27.78(1.07) g/L and 22.93(0.88) g/L for globulin; 32.80(0.36%), 27.92(0.37%) and 27.73(0.34%) for packed cell volume, and 11.25(0.11) g/L, 9.59(0.13) g/L and 9.57(0.14) g/L for hemoglobin respectively. These results showed that all the parameters decreased significantly in pregnancy (P<0.001) except globulin that did not show immediate, significant decrease. Conclusion: There is a general decrease in the nutrition parameters studied among the pregnant women from our study area, indicating under-nutrition. Urgent measures should be taken to improve the nutritional status of rural dwellers especially the antioxidant micronutrients.

Despite the proven effectiveness of the prevention of mother to child transmission (PMTCT) of human immunodeficiency virus (HIV) program, Nigeria currently has the highest burden of vertical transmission of HIV in the world due to poor coverage of the PMTCT program partly as a result of poor knowledge of PMTCT interventions amongst healthcare providers in the country. This paper aims at making information on PMTCT interventions more readily available to healthcare providers in developing countries. The internet was searched using Google and Google scholar. In addition, relevant electronic journals from the Universities library including PubMed and Scirus, Medline, Cochrane library, and World Health Organization (WHO)'s Hinari were used. There was paucity of published work on PMCT from Nigeria. Most of the information concerning PMCT in Nigeria was obtained from technical reports from the Federal Ministry of Health and WHO. It is expected that this article will help in improving healthcare providers' knowledge of PMTCT interventions and thus help in the urgently needed rapid scale-up of PMTCT services in Nigeria.

There is still a high burden of protein-energy malnutrition in Nigeria. The severe forms of the disease are usually associated with high level of mortality even in the tertiary health facilities. To review the cost-effective health promotional strategies at community levels that could aid prevention, early detection, and prompt treatment of protein-energy malnutrition. The strategy used for locating articles used for this review was to search databases like Google, Google scholar, relevant electronic journals from the universities' libraries, including PubMed and Scirus, Medline, Cochrane library and WHO's Hinari. We believe that strategies beyond the health care setting have potential of significantly reducing the morbidity and mortality associated with protein-energy malnutrition in Nigeria.

Nigeria, due to its large population, has the highest absolute number of female genital mutilation (FGM) worldwide, accounting for about one-quarter of the estimated 115-130 million circumcised women in the world. The objective of this review is to ascertain the current status of FGM in Nigeria. Pertinent literature on FGM retrieved from internet services [Google search on FGM in Nigeria, www.online Nigeria, PubMed of the national library of medicine www.medconsumer. Info/tropics/fgm.htm, Biomedcentral and African Journal Online (AJOL) (FGM)] and textbooks, journals, and selected references for proper understanding of the topic was included in this review. The national prevalence rate of FGM is 41% among adult women. Evidence abound that the prevalence of FGM is declining. The ongoing drive to eradicate FGM is tackled by World Health Organization, United Nations International Children Emergency Fund, Federation of International Obstetrics and Gynecology (FIGO), African Union, The economic commission for Africa, and many women organizations. However, there is no federal law banning FGM in Nigeria. There is need to eradicate FGM in Nigeria. Education of the general public at all levels with emphasis on the dangers and undesirability of FGM is paramount.

Obstructive sleep apnea hypopnea syndrome (OSAHS) is an important medical condition which is on the increase in the past 50 years. It causes significant morbidity and mortality in both developed and developing nations of the world. To review the relevant literature on obstructive sleep apnea. Literature review was carried out on the pathophysiology, clinical presentation, complications, diagnostic modalities, and treatment using computerized search. Additional information was obtained by cross referencing and using texts and journals in the medical libraries of Federal Medical Centre Owerri and University of Nigeria, Enugu. Most of the literature was from developed countries, with very few reports from Africa. Comprehensive management plan was lacking in many textbooks. OSAHS is an increasing medical and, more importantly, respiratory condition across the world. Early recognition and prompt appropriate intervention measures will reduce the mortality and improve the quality of life in patients with such conditions.

Background: Even though intimate partner violence represents a major public health problem in Nigeria, much of its associated burden of psychiatric morbidity presenting in the clinical setting goes unrecognized and untreated. Objectives: The purpose of this paper is to clarify the psychiatric perspectives on intimate partner violence and highlight the barriers that militate against the detection of these problems in clinical contexts. Method: This paper utilized the framework of relevant case series and a focused review of the relevant literature to describe and annotate the psychiatric problems of the victims and perpetrators of intimate partner violence in southeast Nigeria. Results: The major barriers to detection of the psychiatric disorders occurring in the context of intimate partner violence include patients' feelings of shame, reticence about the abuse experiences in the clinical encounter, and cloaking of their emotional distress in somatic complaints. Also, the poor interviewing skills of many doctors and their difficulty in processing psychosocial matters contributes to the non-detection of psychiatric problems occurring in the context of partner violence. Conclusion: Concerted efforts directed towards the improved detection, treatment and/or referral of patients presenting with these difficulties will enhance their wellbeing and quality of life.

We present a rare case of mucopolysaccharidosis (MPS) with a typical presentation of mental retardation and absence of corneal clouding. The purpose of presenting this case report is to highlight the distinctive manifestation of MPS (Hunter's disease) and to provide a concise report of Hunter's disease for medical practitioners with the hope that such information will help identify boys earlier in the course of their disease. This report is of a 7-year-old boy who presented to the children outpatient through a referral with a history of inability to grasp objects, inability to express self, and coarse skin, which started 5 years ago. On examination, he was short statured, with a big head, protruding abdomen, coarse skin, swollen wrist joints, and clubbed fingers. There was mild mental retardation. Investigations revealed mucopolysaccharides in urine ad radiographic findings were in keeping with diagnosis. Based on the clinical features and radiological findings, one can diagnose a case of MPS. However, careful and critical approach is necessary to exactly diagnose the type of MPS as enzymatic studies are not available in most centers.