The case-notes and records of grandmultiparous patients delivered at the Lagos University Teaching Hospital between 1st January, 1994 and 31st December, 1996 were analysed. The incidence of grandmultiparity was 4.11%. There were no cases of extreme grandmultiparity. The mean age +/- SD was 33.26 +/- 1.8 years, and the mean parity +/- SD 5.57 +/- 0.38. No patient was under 20 years and none had a parity greater than 9. Fifty-seven (42.22%) were booked patients and 78(57.78%) were unbooked. Anaemia and malpresentation were commonest in the antenatal period, whilst hypertension and disproportion were commonest intrapartum. Fifty per cent of the patients had a spontaneous vaginal delivery. The Caesarean section rate was 30.37%. The incidence of intrapartum complications, cephalopelvic disproportion, obstructed labour and Caesarean section, were found to be higher in the unbooked patients. There was an increased incidence of twin pregnancy and placenta praevia. The maternal mortality ratio was 44.4/1000 amongst the grandmultipara which was not statistically more significant than in the general obstetric population. The perinatal mortality rate was 169/1000 deliveries.

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One hundred and thirteen patients (62 males and 51 females, aged 5-70 years) with chronic sinusitis seen between January 1995 and December 1998 in the Ear, Nose and Throat (ENT) Diseases Clinic of University of Ilorin Teaching Hospital, Ilorin, Nigeria are presented. A provisional diagnosis of chronic sinusitis was made if there were at least two of the following signs and symptoms: nasal blockage, nasal discharge, post nasal drip, excessive sneezing or halitosis. The radiographic abnormalities observed include gross mucosal thickening; haziness; complete opacity and air-fluid level. Seventy-eight (69.0%) showed abnormality in one or both maxillary antra; 39 (34.5%) in the ethmoid; 13 (11.5%) in the frontal; and 1(0.9%) in the sphenoidal sinuses. Thus the maxillary sinus was observed to be the most commonly involved in the disease process, while the sphenoidal sinus is the least commonly involved. This is consistent with findings in most similar studies.

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The objective of this study was to determine the relationship between plasma magnesium levels and epilepsy. The study was carried out at the Lagos University Teaching Hospital. Plasma magnesium was estimated using the calmigite dye colorimetric method in 45 adults with epilepsy and 35 healthy controls. Plasma concentrations of calcium, phosphorus and albumin were also estimated. The mean plasma magnesium in the patients was 0.98 mm0l/L (0.05) while that in the controls was 1.15 mmol/L (0.28). The mean plasma magnesium in the epileptics was significantly lower than that obtained in the controls (p < 0.001). Age of onset of seizures, seizure frequency and duration of treatment did not influence the plasma magnesium levels. Low plasma magnesium is associated with epilepsy, further studies may determine the influence of anti-epileptic drug therapy on plasma magnesium levels.KEYWORDS: magnesium, seizures, Nigeria.

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Magnetic Resonance Scanning has revolutionized the imaging world since its invention about two decades ago. Despite its proven efficacy in patient care, it is largely non-available in the Nigeria healthcare system. This article discusses the worldwide distribution of this modality, highlights its diagnostic efficacy and emphasizes the need for Nigeria to join other countries of the world that are already utilizing this innovation in patient care. Measures at sustaining the availability of these services are suggested.

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We report a case of fractured internal jugular catheter, a rare but life threatening complication of the use of intravascular catheter in a 73 year-old man. He had an internal jugular catheter in-situ for nine months, much longer than the manufacturer's recommended duration.

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Serological methods based on enzyme linked immunosorbent assay (ELISA) and Western blot tests for detecting the presence of antibodies against the human immune deficiency virus are the standard techniques for identifying infected blood donors. However, these tests could not detect infected seronegative donors who were in the window period at the time of donation. Such donors can be identified by more elaborate methods including antigen detecting ELISA and polymerase chain reaction, which can detect viral antigens and nucleic acids in infected donor blood even in window period. In addition, the process of donor selection whereby individuals who were at high risk for HIV infections were excluded from the donor panel had substantially reduced the risk of window period donation. Furthermore, in order to ensure greater safety, transfusion centers nowadays undertake additional measures in the form of virucidal techniques such as the use of heat, detergents and photochemical agents to treat blood and blood products. Despite all of these measures, a risk-free transfusion was not practically achievable. However, risk-free transfusion is now possible with the introduction of recombinant blood products, the use of which is severely limited by their cost. Nonetheless, a risk-free transfusion is still achievable at a relatively little cost by transfusing suitably eligible patients with their own blood through the autologous blood transfusion program. Antibody testing is virtually the only method currently available in Nigerian blood banks. There is the need to reactivate and expand the scope of our National Blood Transfusion Service in order to make our blood and products safer.

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One of the consequences of exposures to microwave (MW) radiations is the enhanced production of free O2, free radicals, peroxides and superoxides. The effects on the lipid peroxidation status (LPS) of whole body irradiation of 120 Wistar rats with 2.45 GHz MW at a power density of 6mWcm(-2) have been studied using the MW generator model ER6660E from Toshiba UK Ltd. The LPS in the rats was monitored for a period of 8 weeks post irradiation using thiobarbituric acid (TRA) method. The MW exposures caused an increase in the LPS from the mean control value of 4.18 x 10(-6)g 1(-1)to a maximum of 6.50 x 10(-6) g 1(-1) within the first 24 hrs, and then gradually reduced to control value after about a week. 1mg kg(-1) of ascorbic acid administered before irradiation caused a decrease in the LPS from the control value to a minimum of 2.86 x 10(-6)g 1(-1) within the first week. The value then gradually rose to a maximum of 3.96 x 10(-6)g 1(-1) within the monitoring period. 1 mg kg(-1) of a-tocopherol also administered before irradiation also caused a decrease in the LPS from the control value to a minimum of 2.10 x 10(-6) g 1(-1) within the first week. The value then gradually rose to a maximum of 3.94 x 10(-6) g 1(-1) within the monitoring period. The results obtained from this study demonstrate that MW exposures cause significant increase in the LPS and there are protective effects of the anti-oxidants ascorbic acid and alpha-tocopherol.

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Good management/administration is vital in the realisation of any business objective whether in a private or public establishment. The aims of this study were to assess the level of knowledge and ability on management/administrative skills by Medical/Dental consultants as perceived by themselves; to stimulate more interest in management/administrative skills acquisition, and to suggest possible ways in achieving such skills by doctors. A self-evaluation questionnaire was distributed to the doctors and 88 of them completed and returned their forms. They consisted of 55 (62.5%) males and 33 (37.5%) females cutting across all the specialities in medicine and dentistry in the University College Hospital, Ibadan, Nigeria. In all, 42 (47.7%) of the respondents reported that they had good ability of management/administration while 46 (52.3%) were below average. Of the 55 males, 28 (31.8%) had good ability while 27 (30.7%) were below average. Fourteen (15.9%) of the females had good ability while (21.6%) were below average. Good knowledge was assumed by 41 (46.6%) of the respondents while 47 (53.4%) were below average. Twenty-seven (30.7%) of the males showed good knowledge as against 14 (15.9%) of the females. Twenty-eight (31.8%) of the males were below average as against 19 (21.6%) of the female respondents. The sex differences were not statistically significant (P>0.05). The surgeons significantly (P<0.05) claimed better knowledge of management/administrative skills than physicians though their claim of ability to perform was higher too but significant (P>0.05). The percentage of the consultants with good knowledge and ability was found to increase with increasing age except for those under 40 years of age. The differences were not significant (P>0.05). A strong positive correlation (r=0.948; P<0.001) was found between ability and knowledge. Knowledge of the respondents was found to be good predictor of the ability using the regression equation: Ability = 11.151 + 0.835 (Knowledge). Suggestions on possible way forward were made. It was concluded that improving the knowledge of the doctors while in training on management/administrative skills will positively affect their performance abilities.

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Twenty cases of histologically proven carcinoma of the gall bladder (GB) seen in the University College Hospital, Ibadan, Nigeria between 1983 and 1997 were reviewed. There were seven males and thirteen females, thus giving a sex ratio of 1:2. The majority of the cancers occurred between the fourth and seventh decade of life. The pre-operative diagnosis has improved and about 70% of the ten patients with adequate clinical information had definitive surgical treatment. The advent of new imaging techniques at this hospital, consisting of ultasound (US) and computerized axial tomography(CT) has made pre-operative diagnosis possible. This is in contrast to the situation noted twenty years earlier in a similar study. Surgical intervention can now be timed and planned appropriately in the majority of cases although late presentation is still a problem. With earlier presentation, prompt diagnosis and appropriately planned surgery, a better survival figure is anticipated at this institution.

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The benefits of utilisation of guidelines for radiographic skull examination of head injured patients were studied in one hundred and eleven patients. The causes of head injury were road traffic accidents (RTA) 87.4%, fall and assault 4.5% each, collapsed wall 1.8%, gunshot injury and industrial accident 0.9% each. RTA resulted predominantly from burst tyre 34%, vehicle pedestrian accidents 23.7% and vehicle collision 18.6%. Compliance with the use of the guidelines was 48%. Radiographic skull examination was carried out in 22 patients (20% of study population) and the positive yield for skull fracture was 32% (7/22 of all radiographs). At discharge, 14 of those who had radiographic examination (n=20) recovered without neurological complications while 39 among those not examined (n=58) similarly recovered, p=0.96. Among those who had skull radiography, neurological deficit occurred in 6 that had skull fractures (n=7) and in 5 of those without skull fractures (n=13), p=0.07. It was concluded that radiographic skull examination based on selective guidelines increases the yield of skull fractures and reduces unnecessary examinations, thereby saving costs. Skull radiography may not be predictive of neurological outcome of treatment. Cranial computed tomography (CT) should be obtained if available and clinically indicated.

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The information revolution is changing the way medicine is practised globally. Patients can now access the storehouses of knowledge, which hitherto were out of bounds, to acquire, process and use the medical evidence from a variety of sources such as the World Wide Web. The way medicine is being taught is changing. Many medical and dental schools have revised, or are in the process of revising their curricula. The ability to access information resources and apply up to date information, diagnosis and therapeutic protocols to their practice calls for a paradigm shift. Cybermedicine is fast becoming the twenty-first century practice. The challenge is real. If emphasis is being placed on fluency with information technology in the developed countries, learning to use the computer remains, in our opinion, the place to start from in the developing countries.

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As part of a wider study aimed at establishing baseline information (for planning purposes), the pattern of disabilities in a Residential School for the handicap was determined. Information on demographic data, nature of handicap, age of enrollment, present class and length of stay in the school were obtained. The study involved 82 pupils (28 females) aged 5-30 years (mean 16.9 + 5.08 years). Seventy nine percent (65) were deaf, 13.6%(11) blind and 6.2% (5) had mental retardation. The mean age of enrollment was 10.6 + 4.12 years. Only two (2.5%) of the pupils/students stayed in the school beyond the regulation time. These findings show that deafness was the commonest disability and strongly suggest that none of the disabilities observed had major impact on learning ability in this school system.

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The study set out to assess the health status of pupils of a school for children with mental disability. The school is Modupe Cole Memorial Child Care and Treatment Home School, Akoka, Lagos. The records of 211 pupils were reviewed and the pupils were clinically examined by the author. Seventy-four (35.1%) of the subjects had complete immunization, 48(22.7%) had incomplete immunization while 44(20.9%) received no immunization. The probable aetiology of mental disability in the subjects was due to postnatal causes (96; 45.5%), natal causes (44; 20.8%), prenatal causes (12; 5.7%) and unknown (59; 28.0%). The most abnormal findings on physical examination were in the central nervous system (199; 94.3%), the musculoskeletal system (137; 64.9%), the mouth/teeth (125; 59.2%) and the skin (98; 46.4%). These findings were worse amongst the residential students than in the non-residential students (p < 0.001). The information obtained from this study will help to serve as a reference for purposes of health planning and policy formulation for children with mental disability.

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Pulmonary tuberculosis (PTB) remains a disease of serious socio-economic and public health importance in Nigeria. This study was carried out to appraise its radiological features with the aim of identifying any changes or new patterns. The chest radiographs of PTB patients examined in the radiology department, UITH, Ilorin over a 5-year period from January 1995 to December 1999 were studied. There were 423 patients including 47 children (0-14 years). Adults of working age (21-60 years) were more affected. There was a female preponderance. The most common radiological features were cavity formation, streaky opacities, reticulonodular opacities and nodular opacities. These features often occurred together in same patients and more usually bilaterally. However, where cavity formation was unilateral, it was more on the left side. In childhood disease, hilar lymphadenopathy, bronchopneumonia and pleural fluid collection were the most common. Cavity formation in children was equally frequent in the 0-5 years and the 6-10 years age groups. The chest radiograph remains an important tool in the diagnosis of PTB. The major radiological features remain the same but the patterns of sex distribution and cavity formation are probably changing. Key words: Pulmonary tuberculosis; radiological features.

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The objective is to evaluate the relative roles of urinary creatinine and serum albumin as biochemical markers for monitoring the nutritional status of pulmonary tuberculosis patients during treatment. Thirty-one newly diagnosed pulmonary tuberculosis patients were placed on six months short course regimen. Their weight, body mass index, serum albumin and 24-hour urinary creatinine excretion were determined before treatment, at the end of the 1st, 2nd, 4th and 6th month of treatment. Subjecting the mean values of the weight, BMI and Urinary Creatinine excretion and serum albumin to Friedman test showed significant changes for all the four indices. Further analysis with paired student t-test of the pre-treatment values with end of 6th month values confirmed significant changes in the mean values of weight, BMI and serum albumin. Of these three indices serum albumin with chi-square value of 103.515 demonstrated the most significant changes, while the minimal change observed in urinary creatinine excretion could not be confirmed with paired t-test. We recommend serum albumin (as a more sensitive index) for monitoring the nutrition of patient with pulmonary tuberculosis.

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The principal objective of typing in epidemiology is to trace a strain as it passes from one individual to another. Resistotyping is a phenotypic method that consists of testing bacterial strains against a set of arbitrarily chosen chemical agents, whereby, a resistance pattern that is characteristic of a strain is generated and, is believed to describe the isolates for epidemiological purposes. This simple typing system is described for campylobacter isolated in Lagos, Nigeria. Resistotyping was performed with twenty chemical agents incorporated into disc. The resistotyping results revealed that the twenty isolates from human and chickens belonged to 14 different resistotypes with the largest group comprising 25% of the isolates. The human strains were distinctly differentiated into eight resistotypes. All the Campylobacter Jejuni isolates were resistant to potassium chloride (A), Boric acid (B), Sodium biselenite (C), potassium dischromate (F), potassium permanganate (I) ferrous sulphate (N), magnesium sulphate (O), sodium hydrogen phosphate (P), sodium sulphate (Q), and magnesium chloride (R). Only one strain was resistant to mercuric chloride (M) while three of the strains were sensitive to disodium orthophosphate (H), sodium azide (J), and metronidazole (T). The method seems to be adequate for defining the relatedness of our isolates in epidemiologic situation and has proven promising for Campylobacter jejuni in our environment.

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Records of voluntary and remunerative blood donors bled at the OAUTHC, Ile-Ife, Nigeria between January 1993 and December 2000 were reviewed for HIV sero-positivity. With a structured questionnaire, and over a period of 2 months, the attitudes and awareness of some of the donors of HIV/AIDS epidemic in the country were also assessed. Of the 16,080 units of blood collected in the period under review, only 1073(6.7%) were obtained from voluntary donors. The cumulative HIV seroprevalence rate was 2.1% in the paid donors as against 0.3% in the voluntary donors (c2 = 16.3, df = 1, p = 0.00003). Sixty-five (805) of the donors interviewed confirmed previous knowledge of HIV/AIDS before the interview. All the respondents appreciated the roles of blood transfusion in the transmission of AIDS viruses. The majority (74%) of the respondents were unemployed. Poverty was the reason given by 61(75%) of the commercial donors for selling their blood. We conclude that there is a greater risk of transmitting AIDS viruses (and possibly other blood transmissible diseases) through remunerated blood donors.

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