A case of bilateral congenital eversion of the lids in a newborn is presented. The baby presented at the Eye Clinic of Otibhor Okhae Teaching Hospital about four hours after a spontaneous vaginal delivery. Surgical correction was carried out one eye at a time with absorbable sutures. Recovery was uneventful and normal anatomical configuration was regained 8-10 days post operatively. The aim of this case report is to create awareness among workers in maternity homes, primary health centres and other health institutions about the existence of this congenital anomaly. Prompt referral to the Ophthalmologist is advised, as the condition is very amenable to treatment.

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Medical records and radiographs of 450 consecutive patients that had extractions of impacted third molars at a semi urban Nigerian Teaching Hospital were studied to highlight common indications for such extraction. Infections accounted for majority (69.6%) of third molars extracted at the lower jaw, followed by periodontal pocket formation distal to second molars (12.5%). Caries, cysts, jaw fractures and neoplasm were respectively responsible for 5.7%, 0.6%,0.5% and 0.3% of impacted lower third molars extracted. Obscure jaw pain (48.4%) was the most common reason for removing impacted upper third molars. Only 2 (3.2%) upper third molars were extracted because of infections. Since pericoronitis was the most common indication for the extraction of impacted lower third molars, it was suggested that where resources for third molar surgery are limited, it may seem reasonable to prioritise removal of asymptomatic third molar covered by soft tissue alone.

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The morphological features of bone marrow aspiration biopsies performed at the University of Maiduguri Teaching Hospital from 1997 to 1999 (3 years) on 24 anaemic AIDS patients (Table i) were retrospectively reviewed. The marrow was normocellular in 7(29.2%) cases and hypocellular in 17(70.8%) cases. Erythropoiesis was normoblastic in 5(20.8%) cases, micronormoblastic in 8(33.3%) cases and megaloblastic in 11(45.8%) cases. All of the 8(33.3%) cases with micronormoblastic erythropoiesis had no stainable iron stores while the remaining 16(66.7%) cases with either normoblastic or megaloblastic erythropoiesis had increased stainable iron stores. Myelopoiesis was sequential in all cases studied. Megakaryocytes were adequate in all cases. Dysplasia in the form of cytoplasmic vacuolations affecting both erythroid and myeloid precursors was seen in 4(16.7%) cases. Lymphocytes counts were normal in 17(70.8%) cases and increased in 7(29.2%) cases. Plasma cells were increased in all cases. Haemophagocytosis was seen in only 1(4.2%) case. Of the 24 cases studied. 10 and 14 cases had positive and negative history of Chloramphenicol ingestion respectively and the cases with positive history of the drug ingestion had significantly higher frequency (90%) of marrow hypocellularity as compared to the lower frequency of 51.7% seen among cases with negative history of chloramphenicol ingestion. These marrow features were thought to reflect the combined effect of malnutrition and drug (Chloramphenicol) in a background state of advanced chronic disease due to AIDS.

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The objective of the study is to determine whether Absolute Lymphocyte Count (ALC) can serve as a surrogate for CD4 T-lymphocyte Cell Count (CCC) in HIV infected Nigerians on Lamivudine/Zidovudine anti-retroviral therapy. 32 adult Nigerians infected with HIV were recruited into the study. They were assessed clinically and categorised into three clinical stages A, B and C according to CDC criteria. They all received lamivudine 150 mg b.d and Zidovodine 300 mg b.d for six months. Blood specimens were taken on enrollment and at four weekly intervals for paired ALC and CCC determination. ANOVA statistics was used to determine whether ALC and CCC (separately) change significantly with increasing duration of therapy. Paired ALC and CCC values were tested for correlation. Sensitivity and specificity of low ALC values in predicting low CCC values were also calculated. The 32 patients comprised 18 males and 14 females aged between 16 and 49 years. The mean age (SD) was 36.1 (+/-7.85) years. The mean ALC value rose from 2485/l and 2352/microl before commencement of therapy to 3026/microl and 3151/microl four weeks after for males and females respectively. These changes were not significant, P>0.05. No further changes were noted over the next 24 weeks. However, the mean CCC values increased from 233/microl before therapy through 339/microl at four weeks, 362/microl at eight weeks to 398/micro1 at 12 weeks. It then fluctuated between 372/microl and 310/microl for the remaining part of the study. These changes were not significant: F: ratio = 1.28 (df = 6,181), P>0.05. A weak but significant positive correlation was established between ALC and CCC. Correlation coefficient was 0.25, P<0.05. The sensitivity and specificity of ALC 2000/microl as a predictor of CCC 200/microl were 57% and 72% respectively. ALC correlates weakly with CCC in patients undergoing antiretroviral therapy and it may not serve as a perfect surrogate for CCC as a monitor of immunological response to therapy.

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An observer blind clinical study was carried out among 64 Nigerian patients with allergic rhinitis to assess the efficacy and tolerance of loratadine a new generation H1 antihistamine. Patients were allotted randomly to receive treatment for 1 week with either loratadine + Vit. C (group A), chlorpheniramine + Vit. C (group B), or Vit. C alone (group C). Assessment was by subjective symptom scoring of three nasal symptoms namely; sneezing, rhinorrhoea and nasal blockage. Difference between pre treatment and post treatment mean symptom scores was used as degree of improvement for statistical analysis and this formed the primary efficacy parameter. Adverse effects namely; anticholinergic effects, gastrointestinal effects and drowsiness were assessed following treatment. The results showed that loratadine was significantly better than Vit. C. alone (P = 0.0002) and chlorpheniramine was also significantly better than Vit. C. alone (P = 0.039). However, loratadine was significantly better than chlorpheniramine P = 0.046. Drowsiness was noted in 19.2% of patients on loratadine compared with 57.1% of patients on chlorpheniramine. lt is concluded that though both loratadine and chlorpheniramine were effective in the relief of symptoms of allergic rhinitis in Nigerian patients, loratadine was significantly more effective with minimal sedating effect.

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Maintenance of gastric juxtamucosal pH at a stable near neutral value may be the cumulative effect of the various components of the mucosal defense system. In order to assess the effect of helicobacter pylori (HP) infection on mucosal defense, we measured the gastric antral juxtamucosal pH in 40 dyspeptic patients by using a flexible glass pH microelectrode which can be passed down the instrument channel of standard gastroscopes. HP status was determined using serology, culture, histology and urease test. We also investigated the relationship between juxtamucosal pH and the severity of antral HP infection. The mean antral juxtamucosal pH in 26 (65%) HP positive patients was 6.49 +/- 0.20 compared to 6.19 +/- 0.21 in 14 (35%) HP negative patients (p < 0.00001). Other factors like age, sex, duodenogastric reflux or presence of chronic duodenal ulcer did not significantly affect juxtamucosal pH (p > 0.05). Subset analysis of data on HP positive patients (n = 26) revealed no significant correlations between antral chronic gastritis anti-HP IgG titre and antral juxtamucosal pH (p > 0.05). This study shows that HP increases gastric antral juxtamucosal pH. This finding supports the suggested role of HP in producing hypergastrinaemia and gastric acid hypersecretion.

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Five hundred and fifty randomly selected healthy non-pregnant females and males aged 15 years and above were studied to determine the variation of blood pressure with body build and sex. Of the 550 respondents, 265 (48.2%) and 285 (51.8%) were males and females respectively while 60.2% were youths. Body build rose steadily with increasing age groups until middle age. In the males, it levelled up at the 6th decade of life while in the female this levelling up was at the 4th decade. Systolic and diastolic blood pressures rose with body build (p < 0.05). Body build was higher in those respondents with elevated blood pressure than in normotensives (p < 0.05). This community survey has demonstrated a similar pattern of variation of body build with blood pressure observed in European and American populations in a rural West African population.

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The purpose of the paper is to review available information on hypertension in the elderly. Study design applicability of the results to management of patients at risk. Although systolic blood pressure is the strongest cardiovascular risk factor in the elderly, diastolic blood pressure continues to be an independent risk predictor. Structural changes in the major vessels play a predominant role in the pathogenesis of hypertension in the elderly. Such changes include a decrease in aortic compliance and atherosclerosis. The most consistent cardiovascular physiologic change in elderly patients with hypertension is increased peripheral resistance. The most appropriate anti-hypertensive agent would decrease peripheral resistance by relaxing vascular smooth muscle or by blocking the peripheral alpha-adrenergic system. It is concluded that a review of the pathophysiologic mechanisms of hypertension in the elderly will guide physicians in making appropriate treatment decisions.

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A 37 year old hide and skin trader in Northern Nigeria, presented with massive right sided purulent pleural effusion. This started with cough, chest pain and fever for 5 weeks following endotracheal intubation. He had chest tube inserted and was treated with antituberculous drugs for 10 weeks without improvement. Fungal studies on the sputum, and pleural fluid yielded Blastomycetes dermatitidis which responded excellently to ketoconazole and saline pleural lavage. This experience underscores the need for early suspicion of systemic mycosis in suspected cases of tuberculosis with poor or no response to treatment. This will reduce morbidity, mortality and cost of treatment.

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The use of ultrasound in the evaluation of eye disease is a recent development in Benin City, Nigeria. This study was carried out to find out the usefulness of ocular ultrasound in the diagnosis and management of eye diseases in Benin City. A total of thirty nine patients who had B scan ultrasound examination of their eyes over a one year period (March 1999 February 2000 ) are included in the study. There were twenty five males and fourteen females. The most common diagnosis was retinal detachment in twenty one patients. Other conditions detected by ultrasound examination were vitreous haemorrhage, intraocular foreign bodies, mucocoele, orbital tumours and trauma. There was a 92.3% correlation between the clinical diagnosis and B scan ultrasound diagnosis. B scan ultrasound examination is a safe, non invasive, inexpensive, atraumatic and accurate means of evaluating the eye. Its use is strongly recommended in Nigeria

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A retrospective review was carried out, of cases of amputation, which were performed between 1985 and 1999 at the Baptist Medical Centre, Ogbomoso with the aims of documenting our experience and complications. The majority of the operations were performed by trainee family practitioners. There was a preponderance of males (M/F ratio of 1.89:1) and over half of the patients were between 21 and 50 years of age. Most of the patients were admitted for trauma and most of them underwent a two stage operation. Slightly less than half of the amputations performed were below knee amputation (BKA). Eleven patients died, 6 of whom were diabetics (55%). It is recommended that medical practitioners be aggressive with wound care, especially in diabetics and that special attention be paid to the foot hygiene of these patients in order to prevent limb loss.

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