OBJECTIVE: To determine guardians' knowledge and attitude towards pupils' eye health and draw implication for designing children-oriented ocular health messages. METHODS: A survey of 1,393 guardians selected through multistage random sampling in Ilorin, Nigeria. Using structured questionnaire, information sought included guardians' demographic characteristics, relationship to pupils, occupation, awareness of eye specialists, perception of normal vision, pupils' eye complaints, and ways of treating children eye conditions. Data analysis was done with SPSS 12.0.1. The test of significance was performed using Chi square test and significance was taken at p < 0.05. RESULTS: Guardians comprised 689 (49.4%) males and 704 (50.6%) females, mean age 43.61 SD 11.45. Most (88.54%) were pupils' parents and (11.46%) were relations (n=1,318); (55.15%) were in low-paying occupations (n=1,311); (87.92%) were aware of eye specialists, (12.08%) unaware, (n=1192); (97.27%) adjudged normal vision at least important, (2.73%) not important (n=1,174). Pupils' eye complaints (n=914) included pain (26.04%), itching (24.73%), redness (21.12%), discharge (8.53%), blur vision (8.21%), photophobia (7.33%) and lacrimation (4.05%). Guardians (n=1,069) managed pupils' eye diseases using hospital treatment (61.65%), neglect (21.33%), self medication (9.26%) and traditional medication (7.76%). There were no significant associations between guardians' ways of managing pupils' eye diseases and their views on normal vision (p = 0.940); awareness of eye care specialists (p = 0.952); and economic occupational grouping (p = 0.959). CONCLUSION: The negative implications of neglecting eye diseases and use of self and harmful traditional eye-medications by some of the guardians need to be discouraged by appropriate eye health education.

OBJECTIVES: Across the world, basic medical scientists and physician scientists work on common platforms in state-of-the-arts laboratories doing translational research that occasionally results in bedside application. Biotechnology industries capitalise on useful findings for colossal profit.1 In Nigeria and the rest of Africa, biomedical science has not thrived and the contribution of publications to global high impact journals is low.2 This work investigated facilities available for modern biomedical research in Lagos public universities to extract culprit factors. METHODS: The two public universities in Lagos, Nigeria were investigated by a cross sectional questionnaire survey of the technical staff manning biomedical science departments. They were asked about availability of 47 modern biomedical science research laboratory components such as cold room and microscopes and six research administration components such as director of research and grants administration. MAIN RESULTS: For convenient basic laboratory components such as autoclaves and balances, 50% responses indicated "well maintained and always functional" whereas for less convenient complex, high maintenance, state-of-the-arts equipment 19% responses indicated "well maintained and always functional." Respondents indicated that components of modern biomedical science research administration were 44% of expectation. CONCLUSIONS: The survey reveal a deficit in state-of the-arts research equipment and also a deficit in high maintenance, expensive equipment indicating that biomedical science in the investigated environment lacks the momentum of global trends and also lacks buoyant funding. In addition, administration supporting biomedical science is below expectation and may also account for the low contributions of research articles to global high impact journals.

OBJECTIVE: To evaluate the necessity and benefits of the use of drains and their limitations in thyroidectomy and assess their relationship with cost of surgery and hospital stay. METHODS: We conducted a prospective randomised study on 67 patients divided into two groups. A consisted of 35 patients with drain and B, 32 patients without drain between January 2005 and June 2007. All had subtotal thyroidectomy and the technique and method of closure were the same. No anticoagulant was used and the clotting profiles were within normal range in the two groups. RESULTS: The sixty seven patients recruited for the study were made up of 60 females (89.6%) and 7 males (10.4%). The mean age for group A was 50.14 +/- 10.7 years, group B was 51.97 +/- 9.5 years. The P value for the mean ages of the two groups is 0.464 (p=0.05,t=3.98).There was no blood transfusion. Three patients developed features of respiratory obstruction (respiratory distress and stridor) -the first 2, one from each group was as a result of laryngeal oedema from trauma of difficult intubation. The third was from group B, as a result of hemorrhage and haematoma collection (she was one of the controlled thyrotoxic patients). Two patients (5.7%) developed wound infections in group A, which increased morbidity, hospital bill and prolonged hospital stay as compared to group B. The highest volume of drainage of 35ml was from a woman with a big goiter (120g). Average drainage was 17.7 +/- 6.9ml. CONCLUSION: The use of drains is not necessary in all cases of thyroidectomy but for cases with large cavity post extraction and copious oozing in vascular glands. Some of the limitations to the use of drains are infections, this can prolong hospital stay and thereby increase hospital bill.

OBJECTIVE: To describe the acid base and electrolyte pattern of morbidity and mortality in children with diarrhoea and protein energy malnutrition. SETTING: The diarrhoea treatment and training unit of the university of Calabar teaching hospital was used for the study. DESIGN/ METHODS: It was a prospective study in which consecutive children below the age of 15 years with protein energy malnutrition and diarrhoeal diseases admitted into the DTU were screened for acid base and serum electrolyte abnormalities. The study was carried out over a two year period from January 1997 to December 1998. RESULTS: Hypokalaemia was seen in 45 (23.4%) patients. This was second to acidosis. Metabolic acidosis was the commonest abnormality in this study and was seen in 108(56.3%) of the patients included in the study. There was hyponatraemia in 25(13%). Hypochloraemia in 8(4.2%) and hypernatraemia in 6(3.1%) of the patients respectively. CONCLUSION: This study has shown that hypokalaemia is a common electrolyte abnormality in children with severe protein energy malnutrition and diarrhoeal diseases. There is need to encourage the use of readily available interventions such as the UNICEF and WHO oral rehydration solution in patients with diarrhoea and/or severe protein energy malnutrition to reduce morbidity and mortality from acid base and electrolyte disturbances.

BACKGROUND: Bone tumours are associated with high morbidity and mortality, especially in Lagos where late presentation, lack of diagnostic and therapeutic facilities as well as cultural and religious beliefs/practices constitute a formidable challenge to appropriate management. OBJECTIVE: To study the clinico-pathologic pattern of primary bone tumours in Lagos. METHODS: A 2.5 decade retrospective review of cases of primary bone tumours at National Orthopaedic Hospital, Lagos (NOH), Lagos University Teaching Hospital (LUTH), and Havana Specialist Hospital (HSH) was done. Data such as age, gender, tumour type were extracted from the medical records and analysed. RESULTS: Six hundred and ninety-eight (698) cases were reviewed. 364 cases were from NOH, 242 from LUTH and 92 from HSH. There were 10 cases in 1981, 13 in 1985, 19 in 1990, 30 in 1995, 38 in 2000 and 46 in 2005. The age range of cases was 6 to 85 years with a mean of 25.8 years and peak frequency in the 11-20 year age group. 423 patients (60.6%) were males and 275(39.4%) were females giving a male to female ratio of 1.5: 1. Three hundred and fifty-six (51.0%) were of benign while 342 (49.0%) were malignant. The commonest types were osteosarcoma 197 cases (28.2%), osteochondroma 106 cases (15.2%) and osteoclastoma 78 cases (11.2%) CONCLUSION: Primary bone tumours presenting to hospitals in Lagos are on the rise. They are common amongst males and teenagers. Majority are benign and comprise osteochondroma, osteosarcoma, osteoclastoma, aneurysmal bone cysts and chondrosarcoma.

BACKGROUND: Liposarcoma is a tumour derived from primitive cells that undergo adipose differentiation. OBJECTIVE: To describe the clinico-pathological pattern of extremity liposarcoma in Lagos, Nigeria. METHODS: This is a descriptive study of patients with histologically established liposarcoma affecting the extremities seen at the Oncology unit of the National Orthopaedic Hospital, Lagos Nigeria. Demographic and clinical data ( including age, gender, presenting complaints anatomic location of lesions ), histologic type, clinical stage and treatment outcome were collected using a prepared proforma and analysed. RESULTS: Liposarcoma accounted for 6 [27.3%] of 22 cases of soft tissue sarcomas seen within the study period. All 6 were males with a M:F of 6:0. The age range was 36- 59 years. Lesions were mostly located in the thigh 5/6 (83.3%). The most common histologic type was myxoid seen in 3/6 [50%]. All presented at stage T2bNoMo. Five (83.3%) had limb salvage surgery with adjuvant radiotherapy while one had ablative surgery. Survival and recurrent rates could not be determined as all patients were lost to follow-up soon after surgery. CONCLUSION: Liposarcoma is the commonest extremity soft tissue sarcoma seen in our centre, the myxoid type being the commonest histologic subtype.

BACKGROUND AND OBJECTIVES: Adequate birth preparedness and emergency/complication readiness (BP/CR) planning could determine the survival of a pregnant woman and her unborn child in maternal emergency. The study assessed adequacy of BP/CR plans of antenatal clinic attendees in Ile-Ife, Osun State, Nigeria. METHODS: Pregnant women (less than 36 weeks gestation) attending antenatal clinics in selected health facilities were serially recruited into the study after they had given verbal informed consent. Data were collected with a purpose-designed questionnaire. SPSS version 11 statistical software was used for data entry and analysis. RESULTS: Four hundred pregnant women were recruited; 284 (71%) registered for antenatal care by 20 weeks of gestation. Concerning delivery planning, 350 (87.5%) had decided their place of delivery although 32 (9.1%) of these planned to deliver in mission houses or at home; 351 (87.8%) had started to purchase items needed for delivery or newborn care, 289 (71.0%) had identified someone to accompany them to health facility for delivery while 259 (64.8%) were saving money for delivery. Regarding emergency or complication readiness, knowledge of signs of severe maternal illness for which immediate care should be sought in an appropriate health facility was low, 113 (28.3%) respondents were able to mention 4 or more of such signs without prompting; 249 (62.3%) had made arrangements for transportation and 45 (11.3%) had identified potential blood donor. CONCLUSION: By the study criteria, 61% of the pregnant women studied made adequate preparations for delivery while 4.8% were ready for emergency/complication. It is recommended that greater emphasis be given to emergency/complication readiness during antenatal care sessions.

OBJECTIVE: To present a 15 year retrospective pathologic study of bladder cancers. The aim is to document histologic pattern, prevalence, sex and age distribution of urinary bladder cancer. MATERIALS AND METHODS: The materials consisted of slides, paraffin embedded tissue blocks and histology request forms of all urinary bladder biopsies received at the Morbid Anatomy department of Lagos University Teaching Hospital Idi-Araba, Lagos from 1991 to 2005. Each sample represents a different patient. The study did not include information regarding the clinical or pathological stage of the tumours. RESULTS: Bladder malignancies comprised 39 (72.2 %) cases of all bladder biopsies and 0.86% of all diagnosed cancers in LUTH. The malignant lesions of the bladder showed a male preponderance with a M:F ratio of 4.6:1. The age range was 4-75 years with a mean age of 51.37 years and peak at 61-70 years age group. Transitional cell carcinoma was the commonest histological type accounting for 61.5% with a male to female ratio of 5:1 and mean age of 59 years. Squamous cell carcinoma accounted for 20.5% with a M:F ratio of 3:1 and showed a mean age of 47 years. Adenocarcinoma, anaplastic carcinoma and embryonal rhabdomyosarcoma accounted for 5.1%, 5.1% and 7.8% of cases respectively. CONCLUSION: Bladder cancer is not common in Lagos. The histopathologic pattern, prevalence, sex and age distribution of bladder cancer are similar to previous reports from schistosomiasis non endemic regions of Nigeria, Africa and the rest of the world.

BACKGROUND: Macromastia is a condition of abnormal enlargement of the breast tissue in excess of the normal proportion. The condition may be caused by glandular hypertrophy, excessive fatty tissue or combination of both. The usual physiologic enlargement of female breast occurs over 3 to 5 years and the female breast size is related to body habitus and hereditary characteristics. METHOD: A review of the literatures of Macromastia was undertaken with emphasis on presentation and management. RESULT: The aetiology of macromastia is usually undetermined, however, hormonal excesses and hypersensitivity of the target organ have been found in some cases. Cases of hyperprolactinaemia has been reported by some workers. Immunological risk factors for development of macromastia have also been seen in some groups of patients with Myasthenia gravis, Chronic arthritis, and Hashimoto thyroiditis. Ultrasonography may show no breast parenchyma abnormalities, while mammography may be indicated in some patients who are 40 years or older. Hormonal assay can be done but its value in treatment is doubtful. Drugs are only marginally effective in reversing gigantomastia, therefore surgery remains the mainstay of treatment. CONCLUSION: Management of macromastia can be physically, socially and psychologically satisfying to both the patients and the surgeons.

BACKGROUND AND OBJECTIVES: There is dearth of information on skull base surgery in Nigerians. This study was conducted to determine types of skull base lesions describe surgical approaches to the lesions and determine outcome of surgical management of the lesions over the study period. METHODS: We retrospectively reviewed the case notes of the patients who underwent skull base neurosurgical procedures between January 2001 and June 2007 in our centre. We obtained information on demography, clinical presentation, diagnosis, cranial computerised tomography findings, type of surgery, intraoperative findings and outcome of surgical management at the time of discharge from the hospital. RESULTS: Brain tumours were diagnosed in 28 patients, head injuries in 9 patients and one patient each had anterior encephalocele and frontal sinus mucocele. Eighteen patients had frontal craniotomy, three patients had temporal craniotomy and two patients had lateral rhinotomy in addition to bifrontal craniotomy. Two patients had frontoorbitotomy while retrosigmoid craniectomy was performed in one patient. Thirty three patients showed significant postoperative improvement at discharge. CONCLUSION: Brain tumour was the most common indication for skull base surgery in our centre. These tumours were mainly located in the anterior cranial fossa. Frontal craniotomy was the most common surgical approach. Non-availability of modern neurosurgical facilities confined us to the use of mainly traditional approaches. The availability of these facilities will assist in improving our management outcome in the future.

AIMS AND OBJECTIVES: To evaluate the effectiveness of intra-operative Mitomycin-C application after pterygium surgery in Irrua, Nigeria. MATERIALS AND METHODS: The medical records of all patients who had pterygium excision with intra-operative application of 0.4mg/ml Mitomycin C between June 2002 and May 2007 and followed up for at least a year were reviewed. RESULTS: Two hundred and forty three eyes (196 patients) had pterygium excision with intra-operative application of 0.4mg/ml Mitomycin C over this period. Male to female ratio was 2:1. The mean age of the patients was 47.1years (SD+ 15.4) Eleven eyes had recurrence after a minimum follow up period of one year. Six (54.5%) out of the eleven eyes that had recurrence had conjunctival granuloma and in such cases recurrence was early (between 2 to 3 months of surgery). Conjunctival granuloma was the main complication occurring in 35 eyes (14.4%). Occurrence of granuloma was significantly associated with recurrence (P =0.0006). Delayed wound healing occurred in 5 eyes (2.1%). There was no case of either scleral or corneal melting. CONCLUSION: Intra-operative application of 0.4mg/ml Mitomycin C is very effective in reduction of recurrence of pterygium after excision. Hence patients should be given the benefit of intra-operative use of Mitomycin C during pterygium surgery.

OBJECTIVES: To highlight the problems encountered in the set up, organisation and operations of a microsurgery laboratory in a low resource tertiary care hospital in Lagos, Nigeria. METHODS: The basic infrastructural deficiencies of this setting were encountered. Significant administrative, logistic and technical obstacles needed to be overcome. The need for improvisation and flexibility in the organisation and operations of such a laboratory is highlighted. The use of locally available, cheaper variety of instruments and consumables in the microsurgery laboratories of developing countries with limited resources was demonstrated by our experience . CONCLUSION: We conclude that even in the setting of low resource tertiary centres found in many developing countries, challenges could be overcome and standard acceptable patency rates obtained in the microsurgery laboratory.

This was a case of Gishiri cut in a patient with Meyer-Rokitansky-Kuster-Hauser syndrome resulting in a vesico-vaginal fistula and urethral loss. This followed an attempt to enlarge and lengthen the vagina to enhance penile penetration. Few cases of MRKH syndrome presenting with complications after an attempt at treatment by traditional birth attendants have been reported. This report is particularly of essence as most urinary fistulae in Nigeria are obstetric fistulae following prolonged obstructed labour.