Aims and Objectives: Congenital heart diseases (CHDs) contribute significantly to childhood morbidity and mortality in many developing countries, largely due to late recognition and lack of skill and facilities for definitive intervention. Though data is available from other parts of the country, little is known about the pattern of CHD in the study area. The profile and outcome of CHD among children presenting to Pediatric Department of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, North Western Nigeria is described. Materials and methods: A prospective study was conducted between 1st September 2011 and 31st August 2013. Study subjects included all children who presented to our hospital and had clinical and confirmed echocardiographic diagnosis of CHD. Results : A total of 112 children were diagnosed with CHD during the 2-year study period. Male: Female ratio was 1:1.2, with a median age at presentation of 11months. Ventricular septal defect (VSD), atrial septal defect (ASD), patent ducuts arteriosus (PDA) and tetralogy of Fallot (TOF) were the most common lesions seen in 48(42.9%), 21 (18.8%), 13 (11.6%) and 11 (9.8%) patients respectively. Five (4.5%) patients had transposition of the great arteries while three (2.7%) had complete atrioventricular septal defect. Less frequent lesions included truncus arteriosus, total anomalous pulmonary venous return, isolated pulmonary stenosis, tricuspid atresia, single atrium, Ebstein anomaly, bicuspid aortic valve and cor triatriatum sinister. Definitive treatment was possible in only 12 (9.8%) patients whereas 15.3% of the patients who had no intervention died. Conclusion : The spectrum of CHD in our series is similar to reports from other centers in Nigeria. Only a few patients could afford definitive treatment abroad, highlighting the need for urgent establishment of well-equipped and functioning cardiac centers across the country.

Aims and objective: To determine the prevalence of overweight and obesity among primary school children in Port Harcourt. Materials and methods: A stratified multi-staged sampling technique was used to recruit pupils from primary schools in Port Harcourt. Data was collected using questionnaires completed by parents. The average of two measurements of height and weight were taken and BMI was calculated manually. Using the BMI for age charts developed by the US National Centre for Health Statistics in collaboration with the National Centre for Chronic Diseases Prevention and Health Promotion, overweight was defined as BMI greater than the 85th but less than the 95th percentile and obesity as BMI equal to or greater than the 95th percentile. Results: A total of 1302 pupils (585 (44.9%) males and 717 (55.1%) females) were studied. Seventy five (5.8%) of the pupils were overweight while 77 (5.9%) were obese. The prevalence of overweight and obesity of 127 (15.5%) among younger children was higher than that of 25 (5.2%) among the older children (p < 0.001). Female pupils had a higher prevalence of overweight and obesity (12.8%) compared to male pupils (10.3%). A higher prevalence of overweight and obesity was found among the higher (18.1%) than among the lower (2.4%) social class (p < 0.001). Conclusion: The prevalence of overweight and obesity in primary school children in Port Harcourt, Nigeria is 5.8% and 5.9% respectively. Children from higher socioeconomic class were significantly more overweight and obese than those from lower socioeconomic classes.

Aims and Objectives: This study was to determine the prevalence and socio- clinical factors associated with severe acute malnutrition (SAM) among hospitalized under-five children. Patients and Method: A cross-sectional survey of children aged less than 59 months was carried out at the Children's Ward of the Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria using the 2006 WHO criteria for SAM. Results: A total of 208 children were studied. Overall, 64.9% had normal nutrition while 18.3% had SAM. Of the 38 children with SAM, 68.4% were hospitalised primarily for severe protein-energy malnutrition using the Wellcome classification. Low maternal education (84.2% vs 65.2%; p = 0.025), non-exclusive breastfeeding (84.2% vs 61.5%; p = 0.009), untimely commencement of weaning (77.8% vs 47.1%; p = 0.006), cessation of breastfeeding before the age of 12 months (45.5% vs 0.0%; p < 0.0001) and presence of infections (84.2% vs 58.5%; p = 0.004) were associated with SAM. Multivariate analysis identified presence of infections (OR = 4.9; p = 0.002), non- exclusive breastfeeding (OR = 1.1; p = 0.048) and low maternal education (OR = 2.1; p = 0.02) as strong determinants of SAM. Conclusion: The prevalence of SAM among hospitalized Under-Fives was high. This justifies the routine use of the WHO diagnostic criteria at the community level for early detection of at-risk children.

Aims and Objectives: Nasal bubble continuous positive airway pressure (NBCPAP) respiratory support, though decades old, is beginning to gain popularity in developing countries including Nigeria. We reviewed neonates who benefitted from NBCPAP, to describe the demographics and outcome of NBCPAP respiratory support in newborns admitted to the neonatal unit of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, over a one year period. Materials and Methods: The study is a descriptive observational review of all neonates who required NBCPAP respiratory support in the neonatal unit of ABUTH Zaria. Data was extracted from a specifically designed proforma used to obtain information on each neonate throughout the period of admission. Results: Twenty babies received NBCPAP respiratory support during the period of study. Seventeen (85%) of the neonates were successfully weaned off CPAP while three (15%) failed CPAP. Three neonates developed complications with two having CPAP belly syndrome and the third had facial swelling which resolved spontaneously after 6 hours. Overall, seven (41%) of the neonates who were successfully weaned off CPAP were discharged home. Conclusion: Majority of newborns who require respiratory support will benefit from NBCPAP therefore, this method of respiratory support should be popularized and neonatal units in the country should be supported to efficiently offer the service.

Aims and objective: To assess the uptake of maternal health services; its determinants and the perception of users about these services. Materials and methods: A descriptive cross sectional study was carried out in Edo North Senatorial Zone of Nigeria. Respondents were selected using a multi- stage sampling technique. A structured, interviewer administered questionnaire was used to collect data from the respondents. The data were analysed using SPSS version 17. Binary logistic regression model was used to identify predictors of utilization of these services. Results: A total of 342 respondents participated in the study; with 171(50%) from the sub-urban communities and the other half from the rural communities. The utilization of the ANC services was 79% and 81% for the sub-urban and rural communities respectively. As for delivery services, it varied from 60.2% to 81.3% for the sub-urban and rural communities respectively. Family planning services uptake was about the same for both types of communities; being 43.7% for the sub-urban communities and 44.4% for the rural communities. Educational status and type of community were significantly associated with delivery service utilization. The predictors of the antenatal services utilization included: educational status, cost per illness, self assessment of health, clean environment and sources of information on maternal care. Marital status, average income and type of community were the predictors of family planning services utilization. Conclusion: The utilization of maternal services was good; being higher than the national average with the exception of postnatal service, which was completely absent. The major determinants of utilization of maternal health services included educational status and the average monthly income of the respondents. Services were perceived by more than half of the respondents to be generally good. There is need for the provision of the minimum service components of maternal health care services especially postnatal service at the PHC facilities.

Aims and objectives: This study determined the history of reported road traffic accidents among the young adult population, and the prevalence of injury, as well as report of subjects' witness of involved accident deaths among the accident victims. Also, it described the sociodemographic factors associated with increased incidence of RTA. The time of the day, month and year of accident occurrence were also described. Materials and methods: This descriptive cross sectional study was conducted among young adults of a semi urban community in Delta State, Nigeria. The study participants were selected by means of cluster sampling method. Researcher administered semi structured questionnaires were used to collect data. Results: Fifty-seven (34.5 %) of the 165 respondents had been involved in road traffic accident (RTA). The incidence rate of road traffic accident was 34.5%. The age group 15-19 years had the highest rate of RTA (45.0%) more than any other group. Males (38.7%) were more involved in RTA than the females (31.1%). The rate of injury was higher among the females (60.7%) than the males (58.6%). The two months with the highest rate of RTA were June (17.3%) and October (9.6%), while the least was recorded in February (3.8%). The RTA rate increased from 5.3% in 1997-2000 to 61.4% in 2009-2012. Conclusion: There is need to improve road safety education among the young adult, especially the adolescent with more effort during the rainy season.

Aims and Objectives : Trauma continues to assume a prominent role in the cause of disease in the developing world with increased westernization. This study highlights the pattern, management and outcome of gastrointestinal injuries following abdominal trauma in our hospital. Patients and Methods: A descriptive retrospective study of all patients who had laparotomy following abdominal trauma at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife between January 2008 and April 2013. Results : A total of 120 patients had laparotomy following abdominal trauma. Forty- five patients comprising 41 males and 4 females whose ages ranged between 14 and 65 years had gastrointestinal injuries. Majority (68.9%) were in the third and fourth decades with penetrating injury occurring in 55.6% .Causes of injury included gunshots (44.4%), road traffic accidents (37.8%), stabs (8.9%), falls (6.7%) and impalement (2.2%). The small intestine was the commonest site of injury (57.8 %) irrespective of the mechanism. Gut perforations accounted for 71.1% of all injuries. Two-thirds of patients had other associated injuries with retroperitoneal trauma being the commonest associated intra-abdominal injury. Majority (44.4%) had bowel resection and anastomosis with surgical site infection recorded in 35.6%. Overall mortality was 6.7% and this was significantly associated with pre-operative blood transfusion (p<0.05). Conclusion: Gut perforations from gunshot especially of the small intestine are the commonest gastro-intestinal injury in our setting. Pre-operative blood transfusion, perhaps indicating severity of injury, implies poor prognosis.

Background: Antegrade reamed interlocked intramedullary nailing is the treatment of choice forfemoral diaphyseal fractures. More recently, retrograde intramedullary nailing of the femur has been seen as a viable alternative to the antegrade nail. Methods: This was a prospective comparative study. Consecutive patients were placed alternately into a study group (retrograde nailing) and a control group (antegrade nailing) in a ratio of 2:1 i.e two retrograde nailing for every antegrade nailing. Forty one fractures had interlocking intramedullary fixation via the retrograde approach (study group), while the control group consisted of twenty fractures that had fixation via the antegrade approach. All were followed up for a minimum period of nine months (range of nine to twenty-four months). Results: The mean duration of surgery in the retrograde group was 157.07minutes and 137.40 minutes in the antegrade group (p=0.093). The mean duration to fracture union was 16.98±4.71 weeks in the retrograde group and 15.80±5.43 weeks in the antegrade group (p = 0.388). There was no incidence of non-union in the two groups. Conclusion: Retrograde approach compares favourably with antegrade approach for intramedullary interlocking nail fixation of diaphyseal femoral fracture in adults with respect to time of fracture healing.

Summary: Decompressive craniectomy (DC) is the surgical management of increasing intracranial pressure (ICP) following a severe traumatic brain injury (TBI) as well as severe cerebrovascular insult. Established protocols for the use of DC include monitoring ICP and going through non-surgical methods to reduce ICP before DC which is the last resort. ICP monitors and facilities to render patients hypothermic and for inducing barbiturate coma are not readily available in resource depleted facilities, hence the need for a timely DC. DC when timely done saves lives and improves chances of survival following severe brain injury. Aims and objectives: This study intends to justify early and appropriate DC in selected patients with radiological and clinical increasing ICP in resource poor centres. Patients and method: A one-year prospective study of patients with severe brain injury with CT and clinical evidence of increasing ICP who had DC as the main modality of management. Results: Ten patients were recruited into the study on the basis of deterioration in level of consciousness and CT evidence of raised intracranial pressure. Males were 8 (80%) and females were 2 (20%) with a ratio of 4:1. RTA accounted for 80% of aetiology of TBI. Out of the ten patients, 4 (40%) died after DC. Six (60%) of the patients survived and had cranioplasty with bone flap replacement (3), titanium (2) and acrylic (1). Two (20%) were discharged with GOS of 5, another 2 (20%) with 4 and last 2 (20%) with GOS of 3. Conclusion: Early decompressive craniectomy is beneficial for selected groups of patients most especially in settings where facilities for ICP monitoring and other medical options are not available.

Aim and objective : There is growing increase in the rate of caesarean section delivery. Opioid analgesic use, one of the corner stone options is limited by the development of adverse effects. This study evaluated the efficacy of a multimodal method of pain management with or without opioid analgesic. Patients and Method : Sixty four pregnant women scheduled for elective caesarean section under spinal anesthesia, were randomized to two groups of 32 subjects each. Group PD received 1gm of intravenous paracetamol infusion and 75mg of intramuscular diclofenac while group P received 50mg of IV pethidine at the end of surgery. Both groups also had wound infiltration with 20mls of 0.1% plain bupivacaine (20mg) after skin closure. The proportion of patients who had VAS of d"3 at various time intervals, time to first analgesic request, patient's satisfaction and side effects/ wound break down were compared. Results : There was no statistical difference between the proportions of patients that were pain free at various time intervals over a period of 24 hours post- operatively, the time to first analgesic request between the groups was not statistically significant. The duration was 242±2.1minutes for the PD group and 181.7±22.1minutes for P group. (P value=0.28). Higher incidences of side effects were observed in the P group with no statistical differences. Patients' satisfaction was better in the PD group compared to the P group. Conclusion : The study demonstrates that a combination of paracetamol infusion and intramuscular diclofenac has similar analgesic efficacy as intravenous pethidine. This combination can be a good substitute for pethidine.

Aims and objectives: Hypertension is the most common modifiable risk factor for stroke and treatment of hypertension has been known to reduce the risk of recurrent stroke. There are no studies done to evaluate the optimal blood pressure (BP) control in long-term stroke survivors in Nigeria. This study is aimed at determining the proportion of stroke survivors attending stroke prevention clinic who have optimal BP control of hypertension one year post stroke and to determine what factors are associated with the suboptimal BP control. Patients and Methods: The subjects were consecutively presenting long term stroke survivors attending Neurology Outpatients' Clinic of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. After informed consent, socio-demographic data and clinical characteristic were obtained from the patient using structured questionnaire. Admission stroke severity was obtained retrospectively using National Institute of Health Stroke Score (NIHSS). Modified Rankin scale (mRs) was used to assess the level of handicap . The presence of depression was determined using the Hamilton Depression Rating Scale (HDRS). Blood pressure was measured in the dominant, non-stroke arm of the patients using mercury sphygmomanometer. Results: A total of 68 patients were studied with a mean age of 55.15±11.9 years. Most common comorbid condition was diabetes mellitus. Only 3(4.4%) patients had a repeat stroke during the one year period. Twenty five (36.8%) of these patients still had sub-optimal BP control. Forty seven (69.1%) of these patients were on combination therapy (including angiotensin converting enzyme inhibitors and diuretics) and 18 (26.5%) were on calcium channel blockers alone. The difference in mean age of stroke survivors with optimal and sub-optima BP control was not statistically significant. However, the mean duration of formal education of the stroke survivors with optimally controlled blood pressure was significantly higher than those with sub-optimal BP control. Eighteen (26.5%) of long term stroke survivors had clinical depression. Significantly higher proportion of the clinically depressed patients had sub-optimal blood pressure at one year compared to those that were not depressed. Formally educated patients had a better blood pressure control compared to those without formal education. Following a multivariate logistic regression, the major independent determinants of sub-optimal blood pressure control at one year post stroke were presence of depression and low levels of formal educational attainment. Conclusion : majority of stroke survivors attending the ABUTH neurology outpatients clinic have suboptimal blood pressure control and major determinant of suboptimal BP control were presence of clinical depression and low formal educational status.

Aims and Objectives : This study aims to classify the various types of lymphomas seen in our center by morphology and immunopenotyping using basic antibody panel. Materials and Methods: Using 3-5 member antibody panels in sequential batches as primary, secondary and tertiary antibodies selected from the list of available antibodies), immunohistochemical staining were done on 110 cases of formalin- fixed paraffin-embedded lymphoma tissue blocks from the archive. A prior microscopic assessment of the hematoxylin-eosin-stained sections of each tissue block was done. All cases were diagnosed and sub typed by their morphology and pattern of antigen immunoreactivity. Results ; of the 110 cases of lymphoma, non Hodgkin lymphoma (NHL) constituted 84.5 % (93 of 110 cases), while Hodgkin lymphoma (HL) was 15.5 % (17 of 110 cases). The B cell NHL was 65.5 % (71 of 110 cases) and T cell NHL was only 20 % (22 of 110 cases). Of the B cell NHL, Diffuse large B cell lymphoma (DLBL) constituted 45.1 % (32 of 71 cases), while Small lymphocytic lymphoma (SLL) and Follicular lymphoma (FL) were 21.1 % (15 of 71) and 10.0 % (7 of 71) respectively. Burkitt lymphoma (BL) was only 7.0 % (5 of 71); while 5 (7.0 %) and 3 (4.2 %) cases of Mantle cell lymphoma (MCL) and Mantle zone lymphoma (MZL) were seen respectively. Only 3 (4.2 %) and 1 (1.4 %) cases of MALTOMA and precursor B cell lymphoma were seen respectively. T / NK -cell lymphomas constituted 31 % (22/110) of all the lymphomas and 20 % of NHL and 36.4% (8/22) were extranodal. Peripheral T cell lymphoma (PTCL) constituted 45.5 % (10 of 22) of the T cell lymphomas. Precursor T cell lymphoma (pre TCL) constituted 22.7% (5 of 22), while 18.2% (4 of 22) and 13.6% (3 of 22) were cases of mycosis fungoides (MF) and anaplastic large cell lymphoma (ALCL) respectively The overall male: female ratio was 1.4:1 while the mean age for adult and childhood NHL were 46 and 9 years respectively. All the cases of lymphomas in our study could be diagnosed and classified using CD 20 or CD79a, CD5, CD 23, CYCLIN D1, CD 10, BCL6, and Ki - 67 for mature B cell lymphoma, including DLBCL. CD 15, CD30, CD45, pancytokeratin, EMA, ALK 1 are useful for cases with large cell morphology while CD 3, CD7, CD4, CD8, PD1, CD25, CD10, and CD23 are required for mature T cell lymphomas. A consideration for Acute lymphoma / leukemia will require in addition to B and T cell markers (CD3,CD79a), CD 34 and Tdt and differentiating between reactive and malignant lymphoproliferative lesions requires BCL 2, CD 43, CD56, and ALK -1. Conclusion : This study further underscored the importance of immunohistochemistry in diagnostic haematolymphoid oncology. Starting with the availability of at least 10 antibodies (CD20, CD 79a, CD5, CD10, BCL 6, Tdt / CD34, CD15, CD 30, ALK-1, CYCLID D1, Ki67, CD3, pancytokeratin) and good diagnostic skill, most of the tertiary hospitals in developing countries will be able to perform, to a large extent, meaningful diagnosis of most of the common lymphomas. The list can be expanded with time as demanded. More detailed studies will be necessary to find out the potential infective aetiological factors in the development of high grade B-cell lymphomas in the environment.

Aims and objectives: The aim of this study was to describe the role of computed tomography (CT) scan in the management and evaluation of children with cerebral palsy (CP) and to categorize the CT findings and then relate them to their respective aetiologies, as well as the types of CP. Materials and methods: The CT findings in 32 children consisted of 16 boys and 16 girls with age range of 2-61 months who were diagnosed of CP and with detailed clinical information were analysed. The 84.4% positive CT findings were analyzed to evaluate their relationship with the clinical types, as well as the aetiological basis for the CP. Results: The spastic type found in 78.1% of the total number of children, had the highest positive findings. The yield was increased in children with birth asphyxia (46.9%) and neonatal jaundice (37.5%). The findings were those of cerebral atrophy in 46.9%, infarcts in 12.5%, hydrocephalus in 9.4% and porencephaly 6.3% of cases. Treatable lesions, such as Dandy Walker syndrome, tumour, hydrocephalus and porencephaly were identified in 25% of cases. Conclusion: CT scan is no doubt efficacious in the management and evaluation of children with CP.

Aims and objectives: The objective of this paper is to give a review of the literature on the aetiopathogenesis, clinical presentation, differential diagnosis and treatment of Papillon-Lefθvre Syndrome, and present three cases of PLS in siblings of the same parents demonstrating typical clinical and radiological features of the condition. Cases: Three cases of Papillon-Lefθvre syndrome affecting three girls among six siblings of normal parents who are first-degree cousins. The three siblings aged 14, 6 and 4΍ years all had severe gingivitis, periodontitis with grossly mobile teeth and tooth migration. Other findings included premature exfoliation of deciduous teeth (2/3), premature loss of permanent teeth in one sibling. Plantar hyperkeratosis was detected in all of the cases, leading to a difficult and painful walking in two cases due to lesions on the soles. Palmar hyperkeratosis was present in the oldest sibling as well. Radiologic study confirmed alveolar bone destruction in two cases. Conclusion: Early recognition of this entity as well as multidisciplinary management may help in the prognosis of these cases.

Aims and Objectives: This case report is aimed at increasing awareness of fibrodysplasia ossificans progressiva, emphasizing the cardinal features comprising congenital great toe abnormality, initial soft tissue masses, eventual heterotopic ossifications with progressive limitation of joint movements and at reiterating the need to avoid unnecessary and potentially harmful surgical procedures in these patients. Patient and Method: We present a case report of an 11-year-old girl with characteristic heterotopic ossifications and bilateral hallux valgi deformities with previous history of biopsies. Excision of right axillary bony masses caused deterioration in her shoulder movements. Result: The patient was not improved by the surgical procedure. Conclusion: Orthopaedic surgeons and other health care workers need to be aware of this condition and avoid potentially harmful procedures like biopsies, excisions and surgical releases in these patients.