Aims and Objectives: The aim of this prospective case controlled study was to evaluate the tissue levels of selenium in patients with cases of fibroadenoma, cancer of the breast and in the controls in order to relate them to the occurrence of breast diseases. Subjects and Methods: Consecutive consenting patients who had histologically confirmed breast cancer and fibroadenoma attending the General surgical outpatients departments of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, were recruited for the study. One gram of core disease breast tissues was taken for Selenium level estimation. Results: There were 127 female subjects;. 95 (74.8%) cases of fibroadenoma and 32 (25.2%) of breast cancer. While breast cancer was common on the left, fibroadenoma was more common on the right breast (? = 8.994; p=0.011). The median tissue level of selenium in patients with fibroadenoma was 0.0272mg/g with a range of 0.0124 to 0.0576mg/g and that of the cancer patients was 0.0178mg/g with a range 0.0072 to 0.0436mg/g. These were statistically significantly different ( p=0.001). Factors affecting tissue selenium level include age (p<0.001), overall stage of breast cancer (p<0.001), maximum length of breast mass (p=0.023), previous delivery (p=0.004), age at last confinement (p=0.007), parity (p<0.001), oestrogen receptor (ER) status (p<0.001) and progesterone receptor (PR) status (p=0.021). Conclusion: Tissue selenium was lower in breast cancer than in fibroadenoma; Tissue selenium inhibits carcinogenesis; low tissue level of selenium therefore may be a factor in the development of breast cancer.

Aims and Objectives: To determine the pattern of visual impairment and blindness in patients seen at a hospital in North Central Nigeria. Patients and Methods: All new eye patients seen at Adoose Specialist Hospital, Jos, North Central Nigeria with conditions potentially leading to blindness and visual impairment over a ten year period were studied.The patients' demographic information, diagnosis and visual acuity were retrieved from the records. Results: A total of 2536 patients were reviewed. There were 1315 (51.9%) males. Bilateral blindness was seen in 279 (11.0%) of the patients. Visual impairment was seen in 745 (29.4%) patients. Severe visual impairment (SVI) was seen in 4(0.2%), moderate (MoVI) in 225 (8.9%) and mild (MVI) in 237(9.3%). Blindness and visual impairment increased significantly with age. Blindness was most prevalent among the farmers (40.2%), followed by the house wives (24.4%). It was attributable to refractive error in 33.3%, cataract in 28.3%, glaucoma in 13.3%, posterior segment disease in 8.2%, glaucoma/cataract in 7.9%, cataract/posterior segment disease in 1.8%, trauma and uveitis each in 1.4%, with other ocular conditions (affecting the globe) seen in 1.1% and corneal disorders in 0.7%. Proportionately more males had glaucoma, trauma, corneal disorders and posterior segment disease, while females predominated with refractive error, conjunctivitis and cataract. Conclusions: Refractive error, cataract and glaucoma were the major causes of blindness, underpinning the significance of these conditions in ocular morbidity.

Aims and Objectives: To investigate the profile of physical activity (PA) among Lagos State senior civil servants (LSCSs). Subjects and Methods: A cross-sectional survey in which 305 LSCSs (163 men, 142 women) with age range 25 65 years, in five ministries of the LSCS was carried out in May of 2011. The Global Physical Activity Questionnaire (GPAQ) was used to assess respondents' PA at work, for transport, and during leisure time during the last 7 days. Results: Overall, 56.7% of the respondents (58.3% men and 54.9% women) were active; equivalent to 43.3% inactive respondents (41.7% men and 54.9% women). In spite of the high prevalence of physical inactivity in the women, gender was not significantly associated with PA levels (p = 0.718). However, the educational status and cadre of respondents were significantly associated with PA levels (p < 0.05). Conclusion: The findings of this study showed that close to half of LSCSs were physically inactive. There was no significant difference between the PA levels of men and women but educational status and cadre were associated with the PA levels of respondents. The results provided by this study suggests the need for the Lagos State government and stakeholders to formulate polices, plan programmes and interventions for LSCSs to get more physically active.

Aims and objectives: This study aims to present the symptoms first observed by patients diagnosed of oral squamous cell carcinoma (OSCC) presenting at the University College Hospital, Ibadan between January 1990 and December 2008 as well as the time lag between the observation and presentation in the hospital. Patients and methods: This is a retrospective review of patients that have been diagnosed histologically as squamous cell carcinoma of the oral cavity at the University College Hospital Ibadan, Nigeria between January 1990 and December 2008. Results: Painful tooth/teeth which are not mobile were the most common symptom in these patients (27.5%). However, about 59.4% of patients had painless symptoms at the onset of the disease. The interval between onset of symptoms and clinical presentation ranged from 3 weeks to 36 months with a mean duration of 7 ± 6.3 months. Paradoxically, patients that experienced painful symptoms at the onset of disease presented later than those who had painless symptoms Conclusion: The first symptoms observed by these patients were not pathognomonic of oral cancer but are shared by several relatively more common oral diseases. Awareness of the populace about oral cancer should be increased as well as the index of suspicion of the medical practitioner for OSCC.

Aims and Objectives: There is a paucity of data onthe human resourcesand ophthalmic equipmentavailable for the diagnosis and management of glaucoma in Nigeria. This study is aimed at describing the ophthalmic human resources, as well as available and functioning equipment used in diagnosing and managing glaucoma in Lagos State, Nigeria. Materials and Methods: This was a prospective multicentre cross sectional study.Data on human resources and equipmentavailable were collected from all government tertiaryand secondary health institutions in the state. One large-practice private eye hospital in the state was included for comparative purposes. Results: The average number of ophthalmologists per hospital was 1.3 and 4.5 in the secondary and tertiary centres respectively, with overall ophthalmologists to population ratio of 1:400,000, and ophthalmic nurses to population ratio of 1:150,000. There were only 2 full time low vision therapists and 3 equipment technicians. Only the private hospital had a dedicated patient counsellor and an eye unit manager. 64% of ophthalmic equipment in the government sector were functioning compared with 100% in the private centre. Overall, equipment to population ratios were; slit lamp=1:517,000, 78/90D lens=1:1,487,000, tonometer=1:660,000, visual field analyser=1:2,380,000, and pachymeter=1:5,950,000. Conclusions: Current population ratios for ophthalmologists and ophthalmic nurses in the state meets vision 2020 recommendations, but there are shortages of other key human resources such as equipment technicians, low vision therapists and patient counsellors. In addition, equipment required for the management of glaucoma wereinadequate, not available or not functioning. Findings from this study suggest that there is an urgent need for increased government funding to glaucoma services in Lagos State.

Aims and Objectives: The study seeks to determine the advantages of using the pistol-grip syringe holder in the performance of FNAB over the use of direct finger grip method. Patients and Methods: The skin is cleaned with gauze soaked in methylated spirit and the lump is located and firmly held between the thumb and fore finger of the free hand. The syringe is held by the out side of the barrel or by pistol-grip, and the needle tip pushed into the lesion. The plunger is partially retracted, creating a negative pressure. The cutting edge of the needle tip frees the cells inside the lesion which are sucked into the fine bore of the needle. The contents of the needle are then emptied on a microscopic slide and thinly smeared. The slides are then fixed in alcohol and later stained. These were examined under the microscope and a comparison between the aspirations using pistol-grip and direct finger grip was made. Results: A total of 266 cases of FNABs were carried out from 1st January to 31st December, 2008. There were 89 breast cases out of which 42 (47%) had pistol-grip method and 47 (53%) had direct finger grip method; 74 thyroid cases out of which 28 (38%) were pistol-grip and 46 (62%) were direct finger grip cases; 56 cases of lymph node FNABs of which 18(32%) and 38 (68%) had pistol-grip and direct finger grip methods respectively. There were 23 cases of salivary gland FNABs having 8 (35%) and 15 (65%) as pistol-grip and direct finger grip methods respectively. Marked cellularity was observed in the majority of cases using both methods of FNABs. Conclusion: This study has shown that the use of pistol-grip syringe holder in the performance of FNABs has no significant advantage compared to the direct finger grip method.

Aims and objectives: To evaluate the Pattern of Paediatricsolid cancers seen over 5 years in the Radiotherapy and Oncology Department of Ahmadu Bello University Teaching Hospital, Zaria-Nigeria. Materials and methods: The study involved patients aged 16 years and below diagnosed with solid cancers referred to the Radiotherapy and Oncology Centre for further management. Between January 2006 and December 2010, a total of 136 new patients with paediatric solid cancers were seen and evaluated. Only patients with histological confirmation were included in the study (136 out of 141 patients) irrespective of cancer type, sex, co-morbidity and performance status. Patients' folders were reviewed retrospectively with a structured pro forma. Information retrieved from patients folder included age, sex, histological type, stage and types of treatments received. Results were presented in tables. Results: A total of 136 patients were evaluated with a mean age of 6.9 years (median of 5 years, age range 1.5 - 16 years). 74 patients (54.4%) were 5 years and below and 98 patients (72%) were 10 years and below. The sex ratio M:F was 1.3:1. At presentation at the Radiotherapy and Oncology centre, only 4 (3%) patients had early stage disease, 100 (73.5%) with locally advanced disease and 32 (23.5%) with metastatic disease. Retinoblastoma 48 (35.3%) was the commonest cancer seen followed by soft tissue sarcoma 20 (14.7%, all rhabdomyosarcoma), lymphomas 15 (11%) (9 Burkitt's and 6 Hodgkin's lymphoma), nephroblastoma 13 (9.6%), bone sarcoma 12 (8.8%) (8 Osteosarcoma and 4 Ewing's sarcoma), nasopharyngeal cancers 8 (5.9%), brain cancer 6 (4.4%), sacrococcygealtumours 6 (4.4%) and other cancers accounted for 8 (5.9%). 116 (85.3%) patients received chemotherapy, 86 (63.2%) patients were scheduled for radiotherapy but only 21 (15.4%) received local field irradiation due to financial constraints and 43 (31.6%) had definitive surgery. Palliative care with medications was done in 22 (16.2%) patients. Of 48 patients with retinoblastoma, 30 affected left eye, 16 affected right eye and 2 patients were with bilateral retinoblastoma. The mean age for retinoblastoma was 3.8 years (median age of 3 years and mode is 3 years). The mean age for rhabdomyosarcoma was 8.7 yr (median age of 6.5 years). Conclusion: Paediatric solid cancers were found to be more common in males than females with more than half being diagnosed in children aged 5 years and below. Retinoblastoma and rhabdomyosarcoma were the most common neoplasms. Most patients presented with locally advanced and metastatic cancers. Geographic variation exists withhistological types.

Aims and Objectives: To evaluate tuberculosis treatment outcomes in a Nigerian tertiary-care setting and to identify factors associated with unsuccessful treatment outcome. Patients and Methods: Retrospective audit of tuberculosis patients registered for treatment from January 2006 to December 2010 at Federal Medical Centre Abakaliki, Nigeria. Six treatment outcome criteria were assessed based on guidelines set by the World Health Organisation (WHO). Analysis was conducted using SPSS. Multivariable logistic regression analysis were used to identify independent predictors for unsuccessful treatment outcome and statistical significance was taken as P <0.05. Results: A total of 671 patients (55% male, 45% female) with a mean age of 36.4 years were registered for treatment; 147 (22%) were smear-positive, 270 (40%) smear-negative and 254 (38%) had extra-pulmonary tuberculosis. Also, 189 (28.2%) of them were HIV positive and; 341 (51%) lived in a rural area. Overall, 387 patients (57.7%) had a successful treatment outcome and 284 (42.3%) had an unsuccessful treatment outcome. Of the patients with unsuccessful treatment outcome, 192 (67.6%) had defaulted, 55 (19.4%) had died, 3 (1%) had treatment failure and 34 (12%) were transferred-out. Nil significant change in trend of treatment success over the study period [P = 0.75 for trend]. In multivariable analysis, unsuccessful treatment was associated with older age (aOR = 2.3), rural residence (aOR = 2.1), smear negative PTB (aOR=1.6), being on retreatment (aOR 3.8), and HIV seropositivity (aOR=1.7). Conclusion: Treatment success rate was poor; targeted measures should be considered to improve treatment success among identified high-risk groups.

Aims and Objectives: This study assesses the prevalence of erectile dysfunction as well as its risk factors. Materials and Methods: This is a descriptive cross-sectional study among 650 adult males, aged between 18 and 70 years selected by multi-stage sampling technique. Data were obtained from respondents selected from 4 wards in Olorunda local government area of Osogbo in Osun state, Southwest, Nigeria, using pre-tested semi-structured questionnaires. Results: Majority of the respondents were between ages 20-29 years with mean age of 33.6 ΁ 13.4 years. Most of the respondents [547(91.2%)] were aware of ED and 63.4% of them said it can be treated. The prevalence of ED was 43.8% and factors such as increasing age (p=0.00), hypertension (p=0.000), diabetes mellitus (p=0.000), perineal surgery (p=0.000), alcohol consumption (p=0.000), and smoking (p=0.000) were found to be significantly associated with developing ED. Conclusion and Recommendation: The level of awareness about erectile dysfunction was high among respondents and the prevalence from this study was 43.8%. Factors associated with ED from this study included increasing age, alcohol consumption, hypertension, perineal injury and surgery. Hence, the risk of developing ED can be significantly reduced by educating men about life style modifications such as reduction in alcohol intake and smoking, as well as regular exercises.

Aims and objectives: The objectives of the study were to determine the socio demographic and clinical correlates of knee pain in women in a primary care clinic. Patients and Methods: The study was a cross-sectional survey of 400 women attending the General Outpatients' clinic of the University College Hospital (U.C.H.), Ibadan, Nigeria using the systematic random sampling technique. Results: The prevalence of knee pain was 42.0% (95% CI 40.0- 41.0). The radiographic findings in the knees showed mostly osteophytes in 24 out of the 28(85.7%) respondents who had radiographs done. The highest prevalence of knee pain was found in caterers and traders, 62.5% and 51.6%, respectively (p= 0.001). Multivariate analysis done using logistic regression with a backward selection showed that the odds of developing knee pain increases with age (Odds Ratio=1.585, 95% CI 1.321-1.903, p=0.000), and body mass index (Odds Ratio 1.587, 95% CI 1.295-1.946, p=0.000). Conclusion: The prevalence of knee pain in women seen at the primary care clinic is high. Preventive measures for knee pain need to be instituted.

The human immunodeficiency virus (HIV) infection has become a pandemic with more than 40 million infected people worldwide. The virus attacks the immune system of the host thus exposing them to opportunistic infections in various systems of the body. The use of highly active anti-retroviral therapy (HAART) has converted a previously lethal condition to a chronic condition with relatively benign cause. This has allowed infected patients to live longer than before. Though beneficial, however, this has been associated with increased incidence of complications seen in these patients involving many systems. Urogenital system is not an exception to this and indeed is a common site for these complications. Urological symptoms or signs are often seen in HIV patients and sometimes appear as the first indicator of the disease. These manifestations can be benign or malignant, infective or non-infective, disease or drug-related. Their appearance may also be a pointer to the deterioration of the infection into a full blown AIDS. It is therefore important that every doctor has a good knowledge of the possible urological manifestations of the disease. Early recognition and prompt treatment of these complications may be of prognostic significance as they may produce significant morbidity and mortality if left untreated. This article highlights the clinical features and management of common urological manifestations of HIV.

Aims and Objectives: Nigeria's maternal mortality indices are among the worst in the world. Various approaches aimed at combatting the persistently high maternal mortality rates in the past have been ineffective. The objective of this article was to evaluate the fairness and equitability of financing for maternal health in the Nigerian health system. Methods: A review of the performance of the Nigerian Health system with regards to financing for maternal healthcare and comparison with other health systems utilising internationally accepted criteria was done. Results: Household out-of -pocket payment was found to be the largest source of health care financing in the Nigerian health system contributing as much as 65.6 % of total health expenditure. This is in sharp contrast to the performance of more effective health systems like that in South Africa where health care is free for pregnant and breast feeding mothers. The result is that South Africa reports less than a tenth of total maternal mortalities reported from Nigeria annually. The current Nigeria health financing system is not equitable and appears to encourage maternal mortalities since it does not cater for the most vulnerable. Conclusion: There is an urgent need for a review of financing of maternal health in Nigeria to achieve universal access to maternal health care. An urgent overhaul of the currently underperforming National Health Insurance scheme or adoption of the simpler system based on funding from taxation with universal access for health care including maternal care and services free at the point of access is suggested.

Cortical blindness can complicate pre-eclampsia/eclampsia. This normally resolves between a few hours and days with full restoration of patients sight. In this case report, we present the clinical course of two women in whom eclampsia was further complicated with blindness. One had pre-partum blindness which resolved after few hours while the second developed post-partum blindness that occurred after an episode of ischaemic cerebrovascular accident (CVA) and it became persistent. The patients were managed by standard pre-eclampsia/ eclampsia regimen; these entail the use of intravenous magnesium sulphate, i/v hydralazine and fluid restriction, as well as expedite delivery. Diagnosis was further confirmed by computed tomography (CT) that demonstrated low density areas localised predominantly in the occipital areas.

Haemangiomas are abnormal proliferation of blood vessels in any vascularised tissue. They can be capillary or cavernous varieties. Cavernous are either of cutaneous or deep types. Cavernous when compared with the capillary haemangioma is rare. Rarer still is the deep type of cavernous haemangioma. This is a report of a 10 year old Nigerian girl who presented with a right posterior leg swelling of 8 year duration, size initially was that of a peanut but increased to fill the entire calf region causing pain to the patient as well as cosmetic and anxiety concern to the parents. No preceding history of trauma, no associated systematic symptoms. She had exploratory laparatomy at 1 year of age at a private hospital for an abdominal mass which was excised. Pre-operative plain radiograph, Magnetic Resonance Imaging(MRI), Abdominopelvic ultrasound scan (USS) were done, fine needle aspiration cytology (FNAC) though done was not helpful. Histo-pathology result of excised leg mass confirmed diagnosis; there was a free margin of excision. Post-operatively, clinical improvement was marked.

Objective: The objective is to report a case of utero-peritoneal fistula caused by laparoscopic myomectomy dehiscence, diagnosed by colour Doppler ultrasound scan and confirmed by x-ray HSG and MRI. The aim of our report lies on the importance of imaging in the diagnosis of fistulous processes involving the uterus. Case report: A 36 year old woman (G6,P0)presented with intense dysmenorrheal and intermenstrual spotting since laparoscopic myomectomy 2 years before. A laparoscopic myomectomy dehiscence with utero-peritoneal fistula was diagnosed by pelvic ultrasound, hysterosalpingogram (HSG) and magnetic resonance imaging (MRI).