This study was conducted to determine awareness, level of use of computers and the use of the Internet for medical research amongst final year medical and dental students at the University of Lagos. A self-administered structured questionnaire was used to collect data. A response rate of 88% was achieved (136/155). Eighty per cent had used the computer before. Use of software applications was poor with computer games being the most frequently used (19%) followed by word processing softwares (18%). The Internet and electronic mail had been used by 58% but only 23% had used the Internet for medical research. Twenty-one percent classified themselves as proficient on the computer, 59% had little skills and 20% had no skills. Younger students (age less than 26 years) were found to have significantly better skills than older colleagues (p = 004). Majority of final year students at College of Medicine, University of Lagos have little computing skills.

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A total of 75 (45 males, 30 females) patients with sickle cell disease (SCD) at the university of Maiduguri Teaching Hospital were screened for G-6-PD deficiency and their steady state levels of haematocrit, reticulocyte count and irreversibly sickled cells (ISC) as well as the occurrence of vaso-occlusive crises were analysed with respect to their G-6-PD status during a 3 year period (1998-2000). None of the female patients was G-6-PD deficient, while (15.6%) male patients had the enzyme deficiency. The patients with G-6-PD deficiency had significantly lower mean level of haematocrit (0.221/l) with higher level of reticulocyte count (15%) as compared to their non-G-6-PD deficient counter parts who had mean values of 0.271/l and 9% for haematocrit count respectively. However, there was no significant difference in mean levels of ISC between G-6-PD deficient (6%) and non-G-6-PD deficient (5%) patients with SCD. Patients with G-6-PD deficiency had significantly lower episodes of vaso-occlusive crises (2.1 episodes/patient). This data would suggest that co-inheritance of G-6-PD deficiency in SCD reduces frequency of crises and improves prognosis.

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This study is to review the pattern of intrathoracic goiter in a large black population. In a retrospective review, the cardiothoracic unit managed ninety-eight primary mediastinal masses of which sixteen patients with intrathoracic goiters were treated during the same period. This constitutes 1.3% of treated goiters and 16.3% of primary mediastinal masses. Seventy-five per cent of the intrathoracic goiters were in association with cervical goiters. Twelve of the intrathoratic goiters were located in the anterosuperior mediastinum, and two in the middle mediastinum. There were three goiters in the posterior mediastinum. Six patients had cervical exploration and median sternotomy, three had cervical exploration and thoractomy, 3 had only thoractomy, two had only median sternotomy for excision. Thirteen patients (81.3%) had either simple colloid or multinodular intrathoracic goiter, one had follicular adenoma, and 2 patients had malignant goiters. One patient had recurrent cervical goiter. The endemicity of thyroid disease does not seem to increase the frequency of intrathoracic goiter.

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Prenatal alcohol is associated with a variety of developmental abnormalies, including neuroanatomical, physical and behavioural features. This study was designed to determine the effects of administration of alcohol, exemplified mostly by ethanol (15 ml/kg, 25%, v/v) and acetylsalicylic acid (ASA, 15 mg/kg) as a representative of nonsteroidal anti-inflammatory drugs, individually and their combination (ethanol 15 ml/kg, 25%, v/v ASA 15 mg/kg) on semen quality and fertility after paternal intraperitoneal administration in Sprague-Dawley rats. In the combination study, the rats received ASA about 1 hour before ethanol administration. The combination experiments were conducted to determine if the effects of ethanol can be prevented by pre-treatment with acetyl salicylic acid (ASA) which has been reported to antagonise the rate-depressant effects of ethanol. All animals received this treatment for ten weeks. Semen parameters were determined and compared with controls. The result showed that when given alone, ethanol significantly reduced the sperm density and percentage of motile spermatozoa relative to controls. Pre-treatment with ASA failed to stop the decrease in sperm density and percentage motility caused by ethanol. Moreover none of the experimental male rats was able to fertilize the females exposed to them despite successful mating demonstrated by the presence of sperm plug. The present study demonstrates that chronic consumption of ethanol or ingestion of ASA has toxic effect on spermatozoa and impairs fertility in male Sprague-Dawley rats. Moreover, pre-treatment with ASA has no effect on the deleterious effects caused by ethanol.

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Colostomy is a commonly performed procedure in the neonatal period but the procedure is frequently underestimated. This report is aimed at raising awareness to technical errors made in performing the procedure. In a period of 4 years, 5 patients who had colostomy in the neonatal period developed problems, which were attributed to errors made in performing the procedure and have been retrospectively reviewed. In 3 patients, the sigmoid colon was erroneously used for transverse colostomy resulting in poor function. There was increased blood loss and increase in operation time from colostomy take down at subsequent definitive surgery in all 3. In one other patient, the ileum was mistaken for the transverse colon and opened, requiring closure; the closure leaked necessitating laparotomy, resection and anastomosis but death occurred from peritonitis. The fifth patient developed stoma necrosis due to ligation of the marginal artery and narrow fascial opening. Colostomy refashioning was necessary but death occurred from overwhelming infection. The colostomies were performed at a peripheral hospital and by unsupervised residents. Colostomy in the newborn can be associated with significant morbidity and mortality and great care is necessary to avoid these. Some technical points to avoid these errors are highlighted.

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Ruptured uterus, the largest contributor to maternal deaths in our center was reviewed to find ways of reducing it and improve the outcome. Sixty cases treated at Ogun State University Teaching Hospital, Sagamu between January 1988 and December 1997 were scrutinised. During the 10 year period, total deliveries were 5,214 giving an incidence of 11.5 per 1,000. 76.7% of cases occurred in patients aged 30 years and more; and 58.6% in para 4 and more. 88.3% were unbooked. The ruptures were spontaneous in 76.7% and lower uterine segment was the most common (80%). Uterine repair with sterilisation was carried out in 46.7%, sub total hysterectomy in 26.7% and repair only in 11.7%. Most of the aetiological factors were preventable by good antenatal care and the outcome improved by early referral and efficient blood transfusion system.

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In an 11 year period, 17 newborns aged < or = 42 days had repair of 21 inguinal hernias. Eleven 52%) of the hernias were incarcerated or strangulated, necessitating bowel resection in 4 (36%) and orchidectomy for testicular infarction in 2 (18%). Only 4 babies with 7 hernias had elective herniotomy for uncomplicated hernia. In one baby with Hirschsprung's disease (bilateral hernia) and another with anorectal malformation, herniotomy was performed at the time of initial colostomy. Postoperatively, wound infection occurred in 4 (36%) of the 11 incarcerated or strangulated hernias (3 had bowel resection). One baby who had intestinal resection died from overwhelming infection. The median hospital stay in babies with uncomplicated hernia was one day and 4 days in those with complicated hernia. The morbidity of incarcerated and strangulated inguinal hernia in newborns is high, with attendant risk of bowel gangrene and testicular infarction. The principle of early referral and repair of inguinal hernias should be encouraged to avoid such morbidity and possible mortality.

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Underdiagnosis of asthma may lead to inappropriate management including undertreatment, and consequently to high morbidity and mortality. This study aimed at determining the rates of diagnosis and treatment of childhood asthma among medical practitioners. Relevant information on 45 asthmatic children was collected using pre-tested questionnaires. There were 30 (66.7%) males and 15 (33.3%) females (M:F, 2:1). Mean age, average ages for onset of symptoms and diagnosis of asthma were 9.4 years, 1.8 years and 6.6 years respectively. An average of 4 previous medical consultations were undertaken for asthma symptoms, but only 11 (24.4%) cases were labeled as asthma. Alternative diagnostic labels including allergy, bronchitis (wheezy), pneumonia (chest infection), and tuberculosis, were used in 29 (64.4%). Five (11.1%) cases were unlabelled. Alternative labeling for asthma was associated with frequent usage of non-bronchodilator medications including antihistamines, antibiotics, antituberculous drugs, cough mixtures, and herbal concoctions. Only 15 (33.3%) cases received bronchodilators, rarely prescribed regularly in the absence of asthma label. This study reveals low diagnosis and treatment rates for asthma, emphasising the need to audit the management of childhood asthma among medical practitioners, with the view of providing information.

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The contraceptive potential of an aqueous crude extract of the bark of Carica papaya administered orally is reported at the dose regime of 5 and 10 ml/animal/day for 4 weeks. Although the body weight or the weights of reproductive organs, kidneys, adrenals remained unaltered during the course of treatment, there was significant alteration in the histology of the testis and semen analysis when compared to the intact control group. The seminiferous tubules of rats treated with low doses of Carica papaya for 4 weeks showed no significant histological changes compared with the control. At the high dose concentration of the extract there was disorganisation in some of the seminiferous tubules with arrest of spermatogenesis beyond the level of spermatocytes. There was also widening of the lumen of the tubules. Seminal analysis showed some of the motile spermatozoa with abnormal feature in all the experimental groups. There was a dose-dependent suppression of sperm progressive forward motility which coincided with a decrease in sperm count, viability and a dose-dependent increase in percentage abnormal spermatozoa during the 14-28 days experimental period. Taken together, the present experiment showed that complete loss of fertility is attributed to decline in sperm motility and alteration in their morphology and suggest that the aqueous extracts of Carica papaya bark is safe and could serve as an effective male contraceptive in animals.

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Serum Cadmium and lead were measured in 61 in- and out-patients of the Mental Health Unit of a University Teaching Hospital. Diagnosis using the ICD-10 Criteria divided the patients into 21 Depressives, 20 Manic-depressive and 20 Schizophrenics. Twenty "healthy" individuals matched for age and sex were used as controls. The measurements of cadmium and lead were done on admission and at 3 and 7 weeks after the relevant treatment had been given. Serum zinc was also measured because of the interaction between zinc and these toxic metals. Measurement was with the Atomic Absorption Spectrophotometer. Results showed that cadmium was raised in depressives (p < 0.02) and reduced in mania patients (p < 0.01). Lead was increased in depressives (p < 0.01) and schizophrenics (p < 0.05) but not in mania patients. Serum zinc was reduced in all mental patients. Serum levels of the toxic metals of the mental patients tended to move towards the values of the control group with treatment.

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A case of massive anaplastic carcinoma of the left parotid gland in a 29-year old female Nigerian, of Yoruba tribe, for which radical left parotidectomy with external carotid artery ligation and post-operative radiotherapy was performed is presented Nine years post-operatively, no evidence of recurrence or metastasis was found. The patient is in apparent good health, despite the amount of tumour spillage that was experienced intra-operatively. As far as we have been able to check, it is to our knowledge the first of such from Nigeria.

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A total of ninety-seven paediatric and adult patients with sickle cell anaemia and fourty-eight control subjects were investigated with the aim of determining the content of the gallbladder. The patients and control subjects were categorised according to the presence or otherwise of gallbladder stones, and, or sludge. The age last birthday, PCV and number of crises per year were recorded in order to determine their influence on the development of gallbladder stones and sludge. The gallbladder contents were examined using ultrasonographic technique. The age and number of crises per year was determined from the clinical record files and direct questioning of patients. Seventy patients had normal gallbladder content while eighteen had sludge, six had stones, and three had a combination of sludge and stones. None of the control subjects had sludge or stone. The age of patients increased from progressively from those with normal content through those with sludge to those with stones. The PCV and number of crises per year only differentiated between normal and abnormal gallbladder contents. While the prevalence of gallbladder stones in this study falls within the range in previous studies, a high prevalence of sludge was observed. The association between the occurrence of sludge and stones with age, PVC and number of crises per year suggests the need for a larger series and that they may identify a group of patients requiring closer monitoring.

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Beta-lactamase production was investigated in 1033 bacterial pathogens--262 gram-positive bacteria, 482 Enterobacteriaceae, 289 non-fermenting bacilli. These were isolated from nosocomial infections in paediatric patients. Beta-lactamase was detected using chromogenic cephalosporin and starch paper methods. More than 80% of the isolates produced the enzyme, which was not detected in enterococci and streptococci. There was no appreciable difference ([symbol: see text] 2 = 5.31, P > 0.05) in the number of Beta-lactamase producers obtained using the two methods. Great caution must be exercised in the therapeutic use of Beta-lactam drugs for nosocomial bacterial infections.

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One hundred and one (6%) of 1,678 patient studied had bilateral reexpansion pulmonary oedema(RPO). On the whole, one thousand, seven hundred and seventy nine (1,779) pleural spaces were studied, fifteen pleural spaces (0.8%), with mean age of 23 +/- 4.5 years had RPO. Among these 15 patients with RPO, the mean period of lung collapse before pneumothorax (PThx) was evacuated was 31.8 +/- 21.8 days and for hydrothorax (HThx) was 31.3 +/- 30.1 days; for 15 patients without RPO (controls), matched for age and sex, the mean period of lung collapse before CTTD was 7.5 +/- 4.1 days and 5.4 +/- 1.3 days respectively for PThx and HThx. The differences in the period of lung collapse among patients with RPO and those without, for each pleural disease was statistically significant (P < 0.03). Volume of pleural fluid drained before RPO was noticed was 2196 +/- 1103 mls, for the 15 matched patients without RPO (controls), it was 1060 +/- 115 mls (p < 0.05). Volume of pleural fluid drained among the patients with SR (Severe response), MR (mild to moderate response) and RD (radiological diagnosis) did not correlate with severity of response. We conclude that prevention of RPO is the desired goal in the management of pleural effusion or Pneumothorax. RPO is commonest among young patients who have had lung collapse for 7 or more days. In these circumstances RPO is prevented, its incidence and severity reduced by methods of gradual evacuation of PThx or pleural fluid drainage.

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Two patients presented to our centre with dextrocardia and complete situs inversus. The first a 35-year-old presented for the first time with respiratory symptoms but no cardiac symptoms and the second patient (14-year-old) presented with cardiac symptoms. Dextrocardia and situs inversus were confirmed by the chest radiograph, electrocardiograph, and abdominal ultrasound and computerised axial tomography in the two patients. Echocardiography established atrio-ventricular great arteries ventricular concordance and bicuspid aortic valve in the second patient that presented with cardiac symptoms.

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