OBJECTIVE: To determine the seroprevalence of HIV I & II antibodies among prisoners in Lagos State. PATIENTS & METHODS: A total of 300 male prisoners from Kirikiri Maximum and Medium security prisons and Ikoyi prisons had their blood samples screened for antibodies against human immunodeficiency virus (HIV) types I & II by ELISA-based technique using immunocomb II HIV I & II Bispot kits. Samples that were positive were confirmed by another ELISA-based technique using immunocomb I & II combifirm kits. RESULTS: The seroprevalence of HIV antibodies was 6.7, which translated to 20 of the 300 prisoners screened. Only one (0.3) of the prisoners had HIV II infection, the rest being due to HIV I. There was no prisoner with concomitant HIV I & II infection. The age groups 20-29 and 30-39 were most affected. CONCLUSION: The finding of 6.7 as prevalence in this study, which is slightly higher than the national prevalence in the year 2000 confirms that there may be activities in the prisons that increase the risk of acquiring HIV infection.

OBJECTIVE: To investigate the effect of birth interval on the relationship between the birthweights of successive siblings. METHODS: The records of women who had delivered two consecutive, same-sex, live, singletons babies (1983 through 1997) in a private hospital were analysed. The intervals between the birth dates of the siblings were calculated. The first of the siblings was coded Set A and the second, Set B. The ratios of the birthweights (Set B/Set A) were calculated. Comparison of findings was made between various ranges of birth interval. RESULTS: The birth interval band 24-29 months was associated with the highest mean birthweight for Set B babies and the highest birthweight ratio (p=0.016). Set A babies weighing less than 3000 g were most likely to be outweighed by their Set B siblings (p=0.000001). CONCLUSION: Birth intervals of 24 to 29 months and small size of Set A babies were associated with most significant advantages in birthweight for Set B siblings.

The Zaria Colobelt and bag is an improvised aesthetic, functional, cheap, affordable and reusable colostomy appliance for the bulky high fiber stool of the African. It is made from cotton, polyethylene mackintosh and a bag. The device is useful in developing countries where colostomy bags are not easily available or affordable when available. The appliance protects the surgical wound from faecal soiling, improves on postoperative cough effort, and the bag can hold 900 g of liquid or semi-solid stool.

BACKGROUND: It is widely reported that obesity is one of the major risk factors for developing type 2 Diabetes Mellitus, and also carries with it a higher risk of diabetic complications. OBJECTIVE: Body Mass Index was examined in type 2 diabetes mellitus complications and the prevalence of overweight and obesity were determined. PATIENTS AND METHODS: fifty-two type 2 diabetic patients were studied. 13 patients with diabetic nephropathy, 16 were hypertensive diabetics while 23 were normotensive diabetics. The weight, height and blood pressure of the patients were measured and the BMI were calculated. RESULTS: The mean BMI was highest in the diabetic nephropathy patients (27.9+/-1.0) and lowest in the hypertensive diabetics (25.5+/-5.2) P=0.0001. The prevalence of overweight and obesity were 31 and 46 respectively in diabetic nephropathy compared with 19 and 12.5 respectively in diabetics with hypertension. CONCLUSION: Overweight and obesity are more common in diabetics with nephropathy compared with normotensive and hypertensive diabetic patients.

BACKGROUND: Although the incidence of Placenta Praevia (PP) is low, its association with increased perinatal and maternal morbidity and mortality underscores the imperative of accurate pre-labour diagnosis. OBJECTIVE: To compare through a prospective study, the accuracy, sensitivity and specificity of Trans-Abdominal Sonography (TAS) and Trans-Perineal Sonography (TPS) in the diagnosis of Placenta Praevia and to determine the causes, if any, of avoidable diagnostic errors. METHODS: During the study period from 1999 to 2001, 133 patients were evaluated by TAS and TPS. The age ranged from 19-41 years while the gestational age ranged from 20-weeks to term. All had examination with 3.5 MHz mechanical sector real-time scanner (Siemens high-resolution Sonoline SL-1 ultrasound machine). The accuracy of TAS and TPS in diagnosing PP was then compared with surgical outcome in each patient. RESULTS: Out of the 133 patients diagnosed to have PP early on in pregnancy, 41 (30.8%) had persistent praevia till delivery, while in 92 (69.2%), the placenta converted to a normal location. The diagnosis at delivery confirmed the TPS diagnosis in 40 of 41 cases, while TAS diagnosis was confirmed in 39 of 41. TPS did not predict the delivery diagnosis in 1 patient where it ruled out a PP, TAS did not predict the delivery diagnosis in 2 patients who were believed not to have a clinically significant placenta praevia. In 1 patient TAS suggested PP but delivery diagnosis showed a normal placental implantation. The overall accuracy, specificity and sensitivity for TPS and TAS were 99.3%, 100%, 99.2% and 97.7%, 98.9%, and 95.1% respectively. CONCLUSION: TPS is a safe, accurate and rapid technique, which complement TAS for evaluation of patients with PP. In patients who decline this method however, graded bladder distension, Trendelenburg and traction scanning and determination of the absence of focal uterine contraction, which distorts the lower uterine segment, are techniques, which significantly improve the diagnosis of PP by TAS.

AIMS AND OBJECTIVES: To highlight the indications, problems and prospects of bedside non-surgically inserted jugular and subclavian dual lumen catheters. PATIENTS AND METHODS: Renal failure patients being managed in our centre with indications for central catheterisation were consecutively recruited at presentation. They had bedside non-surgical jugular and subclavian insertion of central catheters using modified Seldinger wire technique and the performance of the catheters monitored. RESULTS: Sixteen patients aged between 23 and 65 years had 32 central catheterizations during the 12-month period. The indications included its use as haemodialysis access in all catheterisations, additional indications were CVP monitoring in 5, and parenteral hyperalimentation in 1. Three catheterisations were in right subclavian vein, 4 in left internal jugular vein and 25 in right internal jugular vein. The duration of use ranged between 3 days and 11 weeks and blood flow rate used ranged between 250 and 350 mls/min. Nine (28.1%) catheterisations were complicated with exit site and systemic infection. Catheter blockage and accidental catheter removal were recorded in 3 patients each. Carotid artery puncture was recorded in 2 patients but haemostasis was maintained with direct digital compression. CONCLUSION: We conclude that percutaneous bedside internal jugular and subclavian (venous) catheterisation using dual lumen catheter is safe and devoid of major complications.

The study was designed to establish a reference interval for serum heat-stable ALP activity in pregnancy, which is not available in this environment. MATERIALS AND METHODS: One hundred (100) apparently healthy pregnant women in their third (3rd) trimester who were attending the antenatal clinic (ANC) of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria were recruited for the study. The serum heat-stable ALP activity was measured using the 4-nitrophenyl phosphate (4-NPP) method introduced in 1946 by Bessey, Lowry and Brock. RESULTS: The reference interval for the serum heat-stable ALP activity was found to be 24-161 IU/L. This was similar to some earlier reports elsewhere. CONCLUSION: The finding will help in the evaluation/diagnosis of patients with placental insufficiency.

OBJECTIVE: To ascertain the efficacy of Lodoxamide 0.1 in the reduction of Clinicopathological signs of the conjunctiva in Vernal Keratoconjunctivitis. STUDY DESIGN: Prospective, non-comparative, Convenient Interventional Case Series. PARTICIPANTS: One Hundred consecutive patients; 57 males and 43 females within age range 2-55 years diagnosed with active and untreated Vernal conjunctivitis were enrolled. Approval was obtained from Ethical committee of Lagos University Teaching Hospital, Idi- Araba, Lagos. METHODS: Patients were given a bottle of Lodoxamide 0.1 each to instill four times daily into both eyes. Pre-treatment Clinical photographs and conjunctival biopsies were taken in 15 volunteered patients. Ocular signs and symptoms were evaluated on day 1 (baseline), days 2-3 (Interim) and then weekly for 6 weeks (final). Post treatment Clinical photographs and conjunctival biopsies were done at the 6th week. The conjunctival tissues were fixed for 24 hours in 10 Neutral buffered formalin prior to paraffin wax embedding and routinely stained with Haematoxylin and Eosin (H & E) stains. MAIN OUTCOME MEASURE: Primary outcome was based on the reduction of inflammatory cells especially the eosinophils on histological micrographs. Secondary efficacy was based on the rate and extent of reduction of the severity scores of the clinical signs and symptoms. RESULTS: Lodoxamide 0.1 ophthalmic solution significantly reduced the density of the inflammatory cells especially eosinophils in the post treatment conjunctival biopsy cytology specimen. The mean physician severity scores for signs and symptoms consistently reduced from 72 hours of commencement of Lodoxamide with remarkable improvement in a week and complete resolution of all parameters at the end of 5th week. CONCLUSION: Lodoxamide 0.1 ophthalmic solution is highly effective in alleviating the clinical signs and symptoms of Vernal Keratoconjunctivitis and its antiallergic activity is exerted by inhibiting migration of inflammatory cells mainly eosinophlis.

OBJECTIVE: We present a retrospective histopathological study of 345 liver biopsies over a 12-year period. The study sought to record the frequencies of the range of histopathological changes observed in liver biopsy specimens. MATERIALS AND METHODS: the materials consisted of slides and paraffin embedded blocks of all liver biopsy specimens received from within and outside the hospital. The clinical data such as the age, sex, and clinical summary were extracted from the request forms. RESULTS: there were 222 males and 123 females; M: F=1.8:1; peak age incidence of 41-50 years. The three common histopathological diagnoses were hepatocellular carcinoma-33%, chronic hepatitis-17.7%, and liver cirrhosis-17.7%. Thirty per cent of hepatocellular carcinoma was post-cirrhotic. The peak age incidence of chronic hepatitis precedes that of liver cirrhosis and hepatocellular carcinoma by one decade. CONCLUSION: the common forms of liver disease diagnosed histologically are hepatocellular carcinoma, chronic hepatitis and liver cirrhosis. The age and sex distribution are similar to those already established in the African literature.

AIMS AND OBJECTIVES: Chronic myeloid leukemia (CML). PATIENTS AND METHODS: CML patients confirmed at the OAUTHC, Ile-Ife between June 1986 and December 1999 were studied prospectively until death or the last visit to the clinic. Stages of the disease at diagnosis, presenting clinical features and laboratory parameters, as well as the drug history were noted for each patient. Survival of each patient was computed from the date of diagnosis until the date of death. Kaplan-Meier statistical technique was used for analysis of survival. Factors were compared with log rank test. Student's t-test was used for comparing means of presenting clinical and laboratory parameters between groups. P-value of <0.05 was considered significant. SPSS for windows Release 10 (Real Stats, Real Easy, 1989-1999) was used for all calculations. RESULTS AND CONCLUSION: There were 42 patients (27 males and 15 females, ratio of 1.8:1) with ages ranging from 12-74 (median=38.0) years. Philadelphia chromosome was positive in the five patients (12.0%) that underwent cytogenetic analysis.Thirty-three of the patients (78.6%) presented in treatable chronic phase and the other 9 (21.4%) were seen in advanced stages (7 in accelerated & 2 in blastic phase). The median survival of patients that presented in chronic phase was 31.7 months compared to 0.16 months in patients presenting in advanced stages, the difference was statistically significant (log rank=7.8, p-value=0.005). Significant positive correlation was obtained between spleen size and total white cell count at diagnosis (r=0.36, p=0.02). Univariate regression analysis showed negative relationship between survival and ages of patients at diagnosis, haematocrit value, spleen and liver sizes, and blast count. The relationships were statistically significant for only liver and spleen (b=-0.63, p=0.004 and b=-0.51, p=0.026, respectively). Regression of both the liver and spleen with survival, still confirms the significant negative relationship between hepatomegaly and survival.

OBJECTIVES: To determine the pattern of chronic diarrhoea in children in Oman. STUDY DESIGN: This is a prospective study carried out over a 7 year period at the Sultan Qaboos University Hospital, Muscat, Oman. SUBJECTS: Sixty two children (37 M:25 F), aged 3 months to 13 years who presented with chronic diarrhoea, defined as diarrhoea persisting for more than 4 weeks, were studied. RESULTS: Principal identifiable causes in the study population include post-gastroenteritis syndrome in 50% of cases, enteric infections and infestations in 27%, and coeliac disease in 13%. On presentation 63% were malnourished, 27% were anaemic while 39% were dehydrated. The median duration of hospital admission was 50 days. Majority of the patients responded to conservative therapy with correction of dehydration, and careful nutritional supplementation, in addition to specific therapy where necessary. Mortality was low (1.5%) resulting from immunodeficiency and gram-negative septicaemia. CONCLUSION: Chronic diarrhoea remains an important cause of morbidity especially malnutrition in children and early and adequate nutritional rehabilitation plays a pivotal role in the management.

A retrospective study was done to determine the incidence of congenital malformation of the brain among African infants over a 5 year period. Transfontanelle ultrasound (US) was performed on 98 infants consisting of 45 males and 53 females. The mean age was 2.6 months (range 1-11 months). Congenital malformation was present in 25.5% of the 98 cases studied, most of which were associated with hydrocephalus. Cerebral aqueduct stenosis was the commonest congenital anomaly encountered and was found in 24% of case. This study shows that transfontanelle US is a useful tool for diagnosis of congenital brain malformations in infants.

BACKGROUND: The management of anorectal anomaly remains a challenge to Surgeons. This study was carried out to determine the pattern and outcome of management of anorectal malformations (ARM) in a Nigerian tertiary hospital. PATIENTS AND METHODS: The clinical and operative records of consecutive children with anorectal anomaly managed between October 1990 and September 2000 at the Jos University Teaching Hospital, Jos, were reviewed. RESULTS: There were 82 patients, (57.3%) males and 35 (42.3%) females (m:f=1.3:1). There were 20 (24.4%) cases each of the high and intermediate types, 40 (48.8%) low variety and 2 (2.4%) cases of persistent cloaca. The high type was proportionately commoner in the males. Less than one-third presented within 24 hours. Eighty three percent of patients (mainly males) presented in acute intestinal obstruction. Passage of stools from abnormal sites and "imperforate" anus were complaints in 60 (73.1%) patients each. A total of 63 patients had definitive corrective procedure. Four patients with stenotic anus were treated by serial anal dilatations while 29 with low anomaly had anoplasty during the neonatal period. Twenty eight patients with intermediate or high anomalies or persistent cloaca had definitive repair or pull-through operations carried out 6-12 months after an initial colostomy. The definitive pull-through operations included abdominoperineal pull-through in 11 patients, PSARP in 15, while 2 girls with persistent cloaca had posterior sagittal anorectovaginoure-throplasty (PSARVUP). Twenty nine children were fully continent of stools after surgery; three patients developed occasional faecal soiling; while six patients had faecal incontinence. CONCLUSION: Anorectal anomaly is common, but presentation is late in our environment. Although mortality rate was high (26%), early results of definitive operation among survivors were generally good after a mean follow-up period of 19 months.

The development of carcinoma within a burn scar is an uncommon sequelae. When it does occur, the diagnosis is often delayed and consequently outcome less favourable. We present two cases seen and review existing literature on the aetiology, diagnosis and treatment of this problem. Delay in presentation and treatment is often the norm rather than the exception in this part of the world. We recommend early closure of all burn wounds and frequent biopsies of chronic leg ulcers.

BACKGROUND AND OBJECTIVE: Poverty, drug resistance and the advent of human immunodeficiency virus infection (HIV) have led to a recent upsurge in the incidence of tuberculosis including intracranial tuberculosis. In this article, we report 3 patients who had solitary brain tuberculomas and were otherwise healthy to underscore the importance of continuing vigilance for this disease. CASE REPORTS: Three patients (57 years, female; 52 years, male; 7 years male) presented to our unit with features of intracranial tumours. They were all HIV negative with no previous history of tuberculosis. Cranial computed tomography scans demonstrated uniformly contrast enhancing falcine supratentorial masses in the adult patients and a cerebellar hemispheric lesion with peripheral contrast enhancement in the paediatric patient INTERVENTION: All the patients had gross total tumour excision. The histology confirmed a tuberculoma. They all had antituberculous therapy after histological confirmation. The outcome was good in all the patients. CONCLUSION: Intracranial tuberculoma can occur in otherwise healthy individuals and should always be considered in the differential diagnosis of solitary intracranial mass lesions in sub-Saharan Africans so that minimally invasive procedures can be used to establish the correct diagnosis.