Aims and Objectives : The economic impact of epilepsy is enormous in terms of use of health care resources and loss of productivity. There is presently scanty data on economic impact of epilepsy in Nigeria,which necessitated this study. Subjects and Methods : This cross-sectional study is on epilepsy patients age e"16years who attended Neurology clinic at UITH Ilorin. Data collected included clinical characteristics, utilisation of resources and cost of care. Direct medical costs included recurring costs like consultation, hospitalisation, medication and investigation fees. Indirect costs were number of days lost due to seizure attack and travelling to clinic by patients and relatives. Results: Sixty-five patients (32 males, 33 females) participated in the study with age range of 16 to 74 years and mean (SD) of 35±17years. Total clinic attendance was 314 days and 53days were spent on admission. Close to 25 % of patients resided outside Ilorin metropolis and distance traveled to attend clinic varied from 4 to 200km (mean=47±30.6km). The total annual cost per patient was 41, 878 ($279.2 USD). It consisted of direct cost [DC] of 33,616 (80%) and indirect cost [IC] of 8262 (20%). The three leading consumptive items in DC were: antiepileptic drugs (AEDs) - 24,138, investigations - 5373 and transportation - 2387. Majority (76.9%) of the patients were on carbamazepine. Self-estimated monthly family income varies from 3000 to 200,000 (median of 25,000). Only 23 patients (35.4%) bore the cost of care themselves. Of the IC, lost earnings due to absenteeism from work amounted to 6177. Equivalent of 1 USD was 150 at time of study. Conclusion: AEDs accounted for a significant proportion of TC. Increase in availability of generic drugs could help bring down the cost of care within affordable reach of indigent patients.

Aims and Objectives: The immunogenicity, reactogenicity and safety of the 10- valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) were evaluated in a cohort of Nigerian infants included in a study conducted in Mali and Nigeria (ClinicalTrials.gov identifier: NCT00678301). Subjects and Methods In this open, randomised, controlled study, 119 healthy infants received combined diphtheria-tetanus-whole-cell pertussis-hepatitis B/ Haemophilus influenzae type b vaccine (DTPw-HBV/Hib) and oral poliovirus vaccine (OPV) co-administered with PHiD-CV (PHiD-CV group) or without PHiD-CV (control group) at 6-10-14 weeks of age. Pneumococcal antibody responses and opsonophagocytic activity were measured and adverse events were recorded. Results : One month post-dose 3, for each of the vaccine pneumococcal serotypes, e"90.1% of PHiD-CV recipients had an antibody concentration e"0.2 μg/mL compared to <9% (except for serotypes 14 [32.4%] and 19F [27.8%]) in the control group. For each of the vaccine pneumococcal serotypes, e"90.6% of infants in the PHiD-CV group had an OPA titre e"8, compared to <18% (except for serotype 7F [60.0%]) in the control group. Anti-protein D antibody geometric mean antibody concentrations were 2949.7 EL.U/mL in the PHiD-CV group and 68.9 EL.U/mL in the control group. For each DTPw-HBV/Hib antigen antibody seroprotection/seropositivity rates were e"94.4%. Tolerability was generally comparable between the PHiD-CV and control vaccination groups. Conclusions : PHiD-CV co-administered with routine vaccines was immunogenic for all vaccine pneumococcal serotypes and protein D in Nigerian infants. Vaccine tolerability was generally comparable between the PHiD-CV and control groups. These results suggest PHiD-CV can be co-administered with other vaccines included in the National Programme on Immunisation.

Aims and Objectives: After the initial gains in Tuberculosis case detection and cure rates, progress became stunted by persisting constraints and challenges in the implementation of the Directly Observed Treatment Short course strategy. This prompted the Stop Tuberculosis partners in 2006 to adopt innovative approaches including the Public-Private Mix, to improve access to and quality of care. This paper assesses the level of Public-Private Mix in Tuberculosis control in Jos, Plateau State. Materials and Methods: This was a facility-based, cross sectional study where data from all consenting private health care facilities owned by medically trained personnel and private medical practitioners in Jos North and Jos South Local Government Areas was collected using structured questionnaires. Results: Eight (47.1%) of all 17 facilities assessed gave anti Tuberculosis drugs on clinical suspicion of Tuberculosis, 5(29.4%) required Acid Fast Bacillus result and 3(17.6%) referred elsewhere for the Tuberculosis management. Only 6 facilities (35.3%) were microscopy, treatment centres, or both. Ten (58.8%) of the facilities had the Directly Observed Treatment Short course guidelines, but these could be sighted in only 5 (29.4%), while six (35.3%) had Tuberculosis record and referral forms. In 13 (76.5%) of the facilities, no local government Tuberculosis and Leprosy supervisors had ever visited them. Only 30 (57.7%) medical practitioners had access to the Directly Observed Treatment Short course. Thirty two (61.5%) respondents treated Tuberculosis according to the Directly Observed Treatment Short course strategy, but 19 (36.5%) still used the conventional method. Only 22(42.3%) practitioners had ever received any training on the Directly Observed Treatment Short course strategy. Conclusion: The level of Public-Private Mix in Tuberculosis control in Jos is low.

Aims and Objectives : The aim of our study was to examine the levels of thyroid hormones, total plasma homocysteine and C-reactive protein in metabolic syndrome patients and assess the possibility of an association between these four risk factors for cardiovascular disease. Patients and Methods : A total of 93 subjects were recruited for this study. (48 with metabolic syndrome and 45 as the control group). Basic demographic data, components of the metabolic syndrome, thyroid hormones, high-sensitivity C-reactive protein and total plasma homocysteine were estimated for all subjects using standards methods. Appropriate statistic was used for data analysis. Results : Components of the metabolic syndrome, thyrotropin, total plasma homocysteine and high sensitivity C-reactive protein were significantly higher in the study group (P<0.05) while free thyroxine and high density lipoprotein cholesterol were significantly lower in the study group (P<0.05). The predominant type of thyroid dysfunction in the study group was sub-clinical hypothyroidism (87.5% in the study group compared to 18% in the control; P<0.05). Logistic regression showed significant association between sub-clinical hypothyroidism, total plasma homocysteine and high-sensitivity C-reactive protein in the study group. Conclusion: There was a strong association between metabolic syndrome, sub- clinical hypopthyroidism, total plasma homocysteine and high-sensitivity C- reactive protein. Females are at an increased risk of this association.

Aims and Objectives: The objective of this study was to determine the factors that affect the interest in respiratory medicine (RM) as a subspecialty of choice among internal medicine residents in Nigeria. Subjects, Materials and Methods: This was a cross-sectional study of 136 internal medicine residents recruited from seven teaching hospitals from January 2011 to June 2011. A semi-structured questionnaire that was self administered by residents was used to obtain socio-demographic information and factors affecting residents' interest in respiratory medicine. Results: Out of 136 residents that completed the study, 78 (57.4 %) were junior residents (PG year 1-3) and 58(42.6%) were senior residents (PG year >3). Thirty four (43.6%) junior residents and 21(36.2%) senior residents considered respiratory medicine as a sub-specialty of choice. Only 2(3.5%) of the senior residents were presently committed to RM. In the junior residents, interest in respiratory medicine was correlated with personal intelligence and ability (RR=2.58, ;95% confidence interval(CI): 1.16-7.07, p-0.01) , availability of respiratory physician (RR=2.42; 95% CI 1.07-7.63 ,p-0.02) and postgraduate examiners in RM in training institutions RR= (2.20; 95% CI 1.06-5.45,p-0.03), experience during rotation in medical school and residency (RR=2.11 ; 95% CI 1.11-4.21,p-0.03) and future annual income (RR=2.04;C:I1.03-4.68,p-0.04). In the senior residents, interest in RM was correlated with the availability of postgraduate examiners in RM in training institutions (RR- 6.36; 95% CI 1.16-66.80, P-<0.01), future opportunity for scholarships and travel grants (RR- 4.23; 95% CI 1.19-25.92,p-< 0.01), personal intelligence and ability (RR= 3.41; 95% CI.16-13.87,p-0.01) and prospect for rapid elevation in career (RR=2.92; 95% CI 1.03-11.91,p -0.04). Provisions of modern facilities in training institutions, mentoring by senior colleagues and promotion of subspecialty by respiratory physicians were rated by the senior residents as the most important ways of increasing interest in respiratory medicine and making it a specialty of choice. Conclusion: The interest in respiratory medicine among internal medicine residents is low and decline as their level of training advances. The factors affecting the interest in respiratory medicine have been highlighted and the policy makers need to understand, and if possible modify these factors by formulating appropriate changes to our training programs so as to increase future numbers of respiratory physician.

Aims and objectives: Anaemia is a major cardiovascular risk factor in chronic kidney disease (CKD). Treatment and correction of anaemia leads to im- provement of cardiovascular status and quality of life of patients with CKD. This interventional open labeled randomised controlled study comparing the effect of intravenous and oral iron therapy in improving red cell indices and iron status in anaemic pre-dialysis Chronic Kidney Disease was carried out to determine iron status in anaemic pre-dialysis CKD patients to assess the benefit of parenteral iron supplementation as against empirical oral iron in CKD patients with iron deficiency. Patients and Methods: Sixty consecutive pre-dialysis chronic kidney disease patients attending the renal clinic over a six month period were screened. Forty- one subjects (68.3%) were found to be anaemic and were subsequently studied. Results: The ages of the patients ranged between 19 and 71 years with a mean age of 39years. The mean serum creatinine and mean creatinine clear- ance were 201.80 (±70.25)μmol/L and 37.90 (±12.17)ml/minute respectively. The haematocrit concentration was found to correlate inversely with the level of serum creatinine and 56.1% of the anaemic patients had iron defi- ciency. The mean PCV rise in the intravenous iron group was 2.42 (±1.98)% and this was statistically significant (p=0.002) while the mean PCV differ- ence was 0.909 (±0.94)% in the oral iron group. Intravenously administered iron alone permitted anaemia correction in about one-third of these patients without any life threatening adverse drug event. Conclusion:Anaemia is very common in the pre-dialysis CKD population and the prevalence of iron deficiency is high. Intravenous iron supplementa- tion is an effective and safe treatment for the anaemia in the pre-dialysis CKD patients. Response to oral iron was poor.

Aims and Objectives : To determine the prevalence of LEAD and compare the accuracy of ABI obtained by automated oscillometric method with Doppler ultrasonography. Patients and Method s: This study compared the accuracy of ABI obtained by automated oscillometric method versus that by Doppler among 153 hypertensive patients aged 18 years and above, attending the hypertension clinic of the University of Benin Teaching Hospital, Benin-City. Results : Of the 153 patients studied, 64 (41.8%) and 48 (31.4%) had ABI <0.9 using hand held Doppler ultrasound and automated oscillometric method respectively, while 39 (25.5%) had LEAD detected by both methods. Assuming the gold standard for diagnosis of LEAD was by Doppler ABI <0.9, ABI obtained by automated oscillometric method had a sensitivity, specificity, positive and negative likelihood ratios of 60.9%, 89.9%, 6.03 and 0.43 respectively while the area under the receiver operating characteristic curve was 0.787. There was good and positive correlation between ABI obtained by automated oscillometric method and Doppler ultrasound with a Pearson's correlation coefficient of 0.73 and 0.74 for left and right lower limbs respectively (p<0.001) Conclusion: ABI obtained using automated oscillometric method is a good alternative to Doppler ultrasonography when screening for LEAD.

Aims and Objectives : The aim of this study was to determine the relationship between the concentration of volatile sulphur compounds in mouth air of young adult and their self perception of malodour and also to determine the relationship between the organoleptic assessment of young adult and their perception of malodour. Patients and methods: A total of 400 willing participants were studied and they were grouped into two based on the health of their periodontium. Subjects were asked for self perception of malodour and organoleptic assessment was done to assess the level of malodour using the Rosenberg 0-5 scoring system. The concentration of volatile sulphur compounds (VSC) was determined objectively using the Halimeter. Results: Eighty subjects reported self perception of malodour i.e. 39 males (48.7%) and 41 females (51.3%). Only 9% of the subjects without periodontal diseases reported self perception of oral malodour while 31% of subjects with periodontal disease had similar claims. Majority (86%) of those who had VSC concentration less than 181 ppb claimed to have no self perception of malodour while 41% of those who had VSC concentration greater than 250 ppb had self perception of malodour. More than half (53.8%) of subjects with VSC concentration greater than 250 ppb had organoleptic score of 3. Half of subjects with organoleptic assessment score of 3 had self perception of malodour. Conclusion: It can be concluded from this study that a relationship exists between self-perception of oral malodour, organoleptic assessment and the concentration of volatile sulphur compounds in mouth air of subjects.

Aims and Objectives: To determine the average interocclusal space values in a dentate Nigerian population,and to examine the effect of gender, age and different molar relationships on the values obtained. Subjects and methods: Three hundred and fifty onesubjects mainly of Yoruba extractionwith ages ranging from 16 to 78 yearswere involved in the study. They included 165 males and 186 females. Inclusion criteria in the study included the presence of a stable posterior occlusion with all first molars present and the absence of moderate to deep wear facets suggestive of parafunction. Subject's occlusal dimensions were measured with a calliper at rest and in occlusion. Interocclusal distances were determined by subtracting the occlusal vertical dimension from the rest vertical dimension. The Angles molar relationship was then recorded for each subject. Results: The average freeway space was 2.93mm witha standard deviation of 1.38; with the females having marginally higher values. The mean values according to age groups were 15-25 years: 3.15mm, 26-35 years: 2.68mm, 36-45 years: 2.66mm, 46-55 years: 3.22mm, 56-65 years: 2.74mm and 66 years and over: 3.10mm.Class Imolar relationship predominated in the sample with 312 patients (88.9%).Nineteen patients (5.4%) had Class II and 20 patients (5.7%) had Class III.Mean freeway space values for Class I, Class II and Class III were: 2.84mm, 3.88mm and 3.37mm respectively. The difference in values was statistically significant. Conclusion: The average interocclusal space amongst the population assessed was 2.93mm; a value which is similar to that previously reported for Nigerians. Marginally higher values were observed in females while the 26-35 and 36-45 year old groups had lower values than the other age groups. Angle's Class II and III subjects had higher values when compared to class I subjects and was statistically significant. A multi-centre study is recommended to assess possible ethnic variations in these values.

Aims and objectives: To determine the knowledge, prevalence and psychological effect of miscarriage among women of reproductive age attending the obstetrics and gynaecology clinics of a tertiary healthcare facility in Lagos Nigeria. Materials and methods: Study design was a descriptive cross sectional study and 300 respondents were enrolled. A pre-tested interviewer-administered questionnaire and Multiple Affect Adjective Check List (MAACL) authored by M. Zukerman and B. Lubin (1965) were used for data collection. Responses of the respondents on the knowledge of various aspects of miscarriage was scored and graded as good (e"50%) and poor (<50%). The study was carried out in February 2011. Results: Response rate was 97%. Only 0.7% of the respondents were not aware of miscarriage. A total of 214(73.5%) of the respondents had good knowledge of miscarriage and the mean knowledge score (%) was 60.4±22.1. Most common myth about the cause of miscarriage among the respondents was eating of snail (63.2%). About 49% of respondents who had ever been pregnant have had miscarriage. Approximately 1 in 3.7 pregnancies was miscarried. The level of emotional distress in terms of anxiety, depression and hostility is significantly higher in women who have had miscarriage than their counterparts who had not. Conclusion: Level of knowledge of miscarriage was high though some miscarriage myths exist among the respondents. Approximately 1 in 3.7 pregnancies was miscarried. Miscarriage had negative psychological effect on women.

Aims and Objectives: This study was to determine any significant difference between the incidence of infectious morbidity with the use of a 24 hour antibiotics regimen compared to a 7-day course of antibiotics following elective caesarean section using a cheap and easily available combination of Ampicillin/Cloxacillin and Metronidazole. Patients and Methods: Two hundred patients planned to have elective caesarean section for various indications and who satisfied the inclusion criteria were enrolled in the study in two groups of 100 patients each between the period of January to June 2010. Patients were randomized to receive either Ampiclox as 4 intravenous doses of 1g stat and 500mg each 6 hourly and Metronidazole as 3 intravenous doses of 500mg each 8 hourly both for 24 hours or same combination intravenously for 48 hours and subsequent oral use for 5 days. Results: The mean maternal age, parity, gestational age and indication for caesarean section were similar in the two groups of participants. There was no statistical difference in the incidence of febrile morbidity (17%/18%, p=0.852), urinary tract infection (6%/4%, p=0.196), wound infection (4%/3%, p=0.056) and endometritis (3%/2%, p=0.367). The mean cost of antibiotics per patient (N730/$4.65) in the short term prophylaxis group was half that of the long term prophylaxis group (N1, 540/$9.81). Conclusion: There was no difference in the incidence of infection related morbidity when short term prophylactic antibiotics was used at elective caesarean section compared to long term prophylactic antibiotics.

Aims and Objectives - Pulse oximetry is mandatory during anaesthesia, sedation and transfer of critically ill patients. The effect of nail polish and acrylic nails on the accuracy of saturation reading is inconsistent. The Lifebox pulse oximeter is reliable and recommended for low and middle income countries. We investigated its accuracy in the presence of 4 nail colours and acrylic nails Subjects and Methods Fifty non-smoking volunteers had their fingers numbered from right to left (little finger of right hand =1 and little finger of left hand =10). Alternate fingers were nails painted with clear, red, brown and black nail polish and the 5th finger had acrylic nail applied. The corresponding finger on the other hand acted as control. The oxygen saturation was determined using the Lifebox pulse oximeter. Results All fingers (100%) with clear nail polish, red nail polish and acrylic nails recorded a saturation value. Each of the mean saturation value for clear nail polish, red nail polish and acrylic nails was not significantly different from the control mean (p= 0.378, 0.427 and 0.921). Only 12% and 64% of nails polished black and brown respectively recorded a saturation value. The mean SpO- for black and brown polish were significantly different from their control mean (p<0.001). Conclusion Black and brown polish resulted in a significant decrease in SpO with the Lifebox oximeter. Dark coloured nail polish should be removed prior to SpO₂ determination to ensure that accurate readings can be obtained.

Aims and Objectives: Intrauterine contraceptive device is a highly acceptable method of contraception, however despite itsacceptability many users still discontinue its use for various reasons, this study was embarked upon to determine the rate of its discontinuation and the factors associated with its discontinuation. Materials and methods: It was a retrospective study of 10years duration starting from January1997 to December 2006 at the University College Hospital, Ibadan. A total of 6,515 had insertion of IUCD (Copper T380 A) over the study period and 1,295(19.9%) discontinued within the period with the highest discontinuation rate being the first year while the least discontinuation rate was the 9th year. Results: The commonest reason for discontinuation was the desire for pregnancy which accounted for 665(51.4%) of removal followed by menopause in 225(17.4%), no reason was found in 204(15.7%), side effects accounted for 101(7.8%) of removal, husbands wish 53(4.1%) and changing to another method accounted for 47(3.6%) of removal. The reasons for discontinuation were significantly associated with the clients age, side effects, number of living children and their educational status. Conclusion: The rate of discontinuation is still high especially because of the desire to get pregnant while some even discontinued for no reason. It therefore becomes imperative for providers of family planning to further enlighten the populace on the benefit of limiting their family sizeand to also encourage the prolonged use of the device in those who discontinue for no reason by improving on our counseling methods.

Aims and Objectives : This is to study the incidence, predisposing factors, clinical presentation and management of ectopic pregnancy that presented over a four year period. Patients, Materials and Methods : This is a retrospective study of 98 ectopic pregnancies managed at the gynaecological unit of University of Ilorin Teaching Hospital, Ilorin from 1st January 2004 to 31st December 2007. Information was obtained from the case notes, theatre and labour ward registers. Results: A total of 10,054 deliveries were recorded while 1,430 gynaecological patients were admitted. Ninety eight patients had ectopic gestation accounting for 1% of all deliveries and 6.9% of all gynaecological admissions. The peak age group was 25-29 years (33%); 70 (74.5%) were married and 16 (17%) were students mostly undergraduates. Previous pelvic inflammatory disease 78 (83%), previous pelvic surgery 7 (7.4%) and previous history of ectopic pregnancy 2 (2.1%) were the most common risk factors in the patients. Lower abdominal pain 90 (95.7%), missed period 82 (87.2%), dizziness/fainting attack 57( 60.6%) and vaginal bleeding 50 (53.2%) were the predominant symptoms at presentation. There were 2 (2.1%) bilateral ampullary tubal ectopic with one unruptured ec- topic which was treated with linear salpingostomy. Only one (1.1%) case of heterotrophic pregnancy. Open abdominal surgery was the treatment employed in all the patients. No Mortality was recorded. Conclusion:The incidence of ectopic pregnancy can be reduced by putting in place measures to reduce induced abortion and pelvic inflammatory disease. In addition, early presentation, prompt diagnosis and efficient blood transfusion services will decrease the morbidity and mortality associated with ectopic preg- nancy.

Mammography has undergone significant improvement as screening tool for early diagnosis of breast cancer as a means of reducing mortality rate in them. The quality of mammograms and interpretative skills of the radiologist are important determinants required to achieve the favourable mortality reduction rates that have been established in randomised trials and also in service screening.Standardised reporting using the Breast Imaging Reporting And Data Systems (BI-RADS) lexicon, developed by the American College of Radiology (ACR) has been found useful as a practical way of communication between radiologists and clinicians compared with the free style, which is according to the opinion of each radiologist. This reporting system takes into account important features in the breast such as parenchyma pattern among others, which has been reported as an important risk factor in breast cancer. The objective of this review is to present this lexicon to radiologists andreferring physicians as a reporting method which will enhance communication,improve patient management and auditing of performance.

Choanal atresia is a developmental failure of the nasal cavity to communicate with nasopharynx. It can be membranous or bony; unilateral or bilateral; complete or incomplete. Bilateral choanal atresia is less common and usually present in neonatal period with severe respiratory distress. Imaging provides definitive diagnosis by choanography. This report shows the value of computed tomography in the diagnosis of choanal atresia in a patient that presented with bilateral choanal atresia, undiagnosed until about seven years.