OBJECTIVE: To compare suxamethonium with atracurium using the priming principle, for rapid sequence orotracheal intubation assessing onset time, time to successful laryngoscopy and intubation and quality of intubating conditions. PATIENTS AND METHODS: A prospective double-blind, randomised study was performed in 90 ASA physical status I and II patients aged between 18 and 64 years undergoing elective surgery requiring endotracheal intubation between October 2002 and June 2003 in a university teaching hospital . All patients were premedicated with 5-10mg oral diazepam and randomly assigned to one of two groups to receive either suxamethonium as a bolus dose (group A) or atracurium (priming with 0.05 mg/kg followed by 0.55 mg/kg after induction of anaesthesia) (group B). In both groups, the trachea was intubated when there was maximal muscle relaxation, determined clinically by jaw muscle relaxation. Muscle paralysis using a PNS, quality of intubating conditions, and occurrence of muscle weakness due to the priming dose of atracurium, time to laryngoscopy and onset time were all noted. RESULTS: Onset time was 87.1 +/- 25.60s and 135.8 +/- 46.23s in groups A and B respectively (P < 0.05). Group A had a laryngoscopy time of 73.6 +/- 25.22s compared to 107.7 +/- 41.32s in group B (P < 0.05). Intubating conditions were significantly better in group A compared to group B (P < 0.05). The frequency of muscle weakness from the priming dose of atracurium was 6.6%. CONCLUSION: Atracurium, using the priming principle, is an option in our environment for modified rapid sequence induction when suxamethonium is contraindicated.

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Road traffic accidents (rtas) represent a major epidemic of non communicable disease in the country and has since escalated with the introduction of the new phenomenon of commercial motorcycle transportation such as is found in the two urban towns of nnewi and Awka of Anambra state, Nigeria. making use of a pre-tested, semi structured, interviewer administered questionnaire, relevant data on socio demographic and motorcycle characteristics were collected from a sample of commercial motorcyclists selected by systematic sampling technique. their knowledge of and attitude towards road traffic and safety codes were elicited. The result showed that the all-male commercial motorcyclists had a mean age of 30+8.9 years. one hundred and seventy six (32.6%) possessed good knowledge of road traffic codes and safety, while 35 (6.5%) exhibited good attitude towards them. both knowledge of and attitude towards traffic codes and safety improved with increase in educational level (p<0.005, p<0.001 respectively). the younger motorcyclists also possessed statistically significant better knowledge of traffic codes than their older counterparts (p<0.025). attitude to traffic codes and safety had no association with age of the motorcyclists (p>0.25). the study has provided useful information on the knowledge of and attitude towards road traffic and safety codes among commercial motorcyclists in nigeria. pursuit of knowledge through formal and informal education should run pari pasu with efforts to improve the nigerian economy in order to ensure a sustainable positive attitudinal change towards road traffic codes and safety among commercial motorcyclists.

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AIM: To determine the perception and aspiration of medical students towards ophthalmology. METHOD: Information for the study was obtained through forced-choice questionnaire set to 102 medical students in 2000/2001 graduating class in Nnamdi Azikiwe University. RESULTS: One hundred questionnaires were completed. As a specialty of choice ophthalmology ranked fourth {16.0%} as a first choice; second {21.0%} as a second choice and first {26.0%} as a third choice. Ninety-five of respondents found ophthalmology training useful. CONCLUSION: This cohort of medical students considered ophthalmic training in this institution essential and adequate. Undergraduate ophthalmic course should ensure an understanding of the basic principles of ophthalmology and should be designed to motivate the interest and confidence of the medical students in the specialty. Training period should be at least 4 weeks. With appropriate training ophthalmology can attract reasonable interest as a choice for specification.

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AIM: To show the value of sub-Tenon's depo-methylprednisolone acetate followed by oral prednisolone in the management of optic neuritis in African patients. METHODOLOGY: Two female patients who presented to the University of Benin Teaching Hospital, Benin city, Nigeria and one male patient who presented to the Eye clinic of the Nigerian National Petroleum Corporation, Warri, Nigeria with optic neuritis were given a single dose of sub-Tenon's depo-methylprednisolone acetate 40 mg followed by oral prednisolone 60 mg daily and their vision monitored. RESULTS: In all the 3 cases, there was rapid improvement in visual acuity from as low as ? light perception, counting fingers at 1 metre and at 4 metre to 6/6 within 2-3 weeks with improvement in colour vision. After 3 years and 5 years follow-up in 2 cases, there was no recurrence of optic neuritis and no neurological deficit occurred. CONCLUSION: Sub-Tenon's depo-methylprednisolone acetate followed by oral prednisolone is a safe and effective alternative treatment for optic neuritis in black African patients.

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In the light of increasing prevalence of the human immunodeficiency virus (HIV), anaesthetists are likely to see more patients with this virus in their practice. This study evaluated, using a questionnaire format, the knowledge, attitude and practices of anaesthetists in the management of HIV infected surgical patients. The questionnaire sought demographic information, the knowledge of risks involved as well as attitude and practices. One hundred (66.7%) out of 150 questionnaires distributed amongst members of the Nigerian Society of Anaesthetists were completed and returned. Fifty-five per cent (55%) of the respondents confirmed their willingness to be screened but only 45% had had a personal HIV screening test. Even though 23% of all the respondents will transfuse unscreened blood in an emergency, only 1(8.3%) of the consultants will do so. This trend was also reflected in gloving behaviour as 11(91.6%) of consultants will routinely wear gloves whilst only 12(70.5%) of the senior house officers will routinely glove for venepuncture despite the availability of gloves. Other precautionary facilities such as goggles, sharp disposal bins, routine screening of all surgical patients were more available in private than in government hospitals. Ninety- six per-cent of all respondents will initiate an action after a needle stick injury whilst 4% will ignore. General Anaesthesia was the choice of anaesthetic in an HIV/AIDS infected patient by 43% of respondents whilst 22% of respondents would choose regional technique. However, only 85% of respondents were willing to anaesthetise an infected patient. This study suggested a dearth of knowledge and perception of risks of HIV/AIDs amongst Nigerian Anaesthetists. Appropriate training and greater education is highly recommended. Rigorous infection control policy is imperative and hospital authorities must ensure availability of protective facilities.

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SUMMARY: One hundred and forty endometrial specimens of women with infertility were examined with oil immersion at X100 magnification for evidence of secretory activity, presence of any inflammatory cells and characteristic features suggestive of specific pathogens. Twenty-three (16.4%) had evidence of chronic endometritis the majority being non-specific. Only two (1.4%) were granulomatous. There was a significant eosinophilic infiltrate in nine cases (6.4%) some numbering up to 55 eosinophils per 5 high power fields (5 hpf). Sensitive immunohistochemical techniques would be needed to correlate findings with specific pathogens for effective treatment.

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INTRODUCTION: The ability to examine the posterior segment of the eye accurately in patients with opaque media is essential to good surgical care of the cataract patient. In dense cataracts, the posterior segment is inaccessible to direct and indirect ophthalmoscopy and so adequate evaluation of posterior segment to exclude abnormalities become difficult. There is a risk of poor prognosis in eyes of patients with cataracts who may also have co-existing posterior segment abnormalities. Ultrasonography provides a method of assessing the structural changes in the posterior segment of the eye in such patients. OBJECTIVE: To determine the relevance and prevalence of posterior segment abnormalities in patients with dense cataracts prior to surgery by ultrasonography. METHOD: A 12- month prospective study of patients with clinically diagnosed dense cataracts in either or both eyes, in which the posterior segment cannot be evaluated properly during ophthalmoscopy, and therefore were sent for ocular ultrasonography. B-scan ultrasound was done on 116 eyes of 80 patients. RESULTS: Eighty patients were involved in the study, 116 eyes demonstrated dense cataract. One hundred and ten eyes (94.8%) had a normal posterior segment. Total retinal detachment was noted in 3 eyes (2.59%), a left partial retinal detachment was observed in 1 eye (0.87%), 2 eyes with total retinal detachment in conjunction with vitreous haemorrhage were noted in a single patient, 1.72% CONCLUSION: Posterior segment assessment with ultrasound is advisable and important in the preoperative evaluation of patients with dense cataract prior to surgery.

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BACKGROUND: Laboratory services delivery face criticisms on daily basis by the patients (the beneficiary), the clinicians (the user), and the hospital management (the policy maker). The service provider (the laboratory) is faced with the task of trying to explain her problems. OBJECTIVE OF THE STUDY: Was to critically do a policy analysis of the problems of laboratory service delivery, with the aim of identifying the causes of these problems and making recommendations to the policy makers. SETTING: The University of Benin Teaching Hospital, a foremost tertiary institution in Nigeria. METHOD: George Kent's normative policy analysis model was used to analyse the laboratory guidelines and procedures of sample collection, transportation, analysis and eventual generation of laboratory results. All the steps in the guidelines are analysed using the fifteen steps in Kent's normative model of policy analysis. RESULTS: The policy analysis shows that problems of laboratory services delivery are triangular with the patient at the center of the triangle. The most important finding of this analysis is that there is no formal laboratory service policy to guide all the actors i.e. the hospital management, laboratory staff and the clinicians. Problems arising from the laboratory are solved through the use of circular letters, likened to administrative incremental model of decision-making. CONCLUSION: There is a need to have a formal policy. A formal policy on laboratory service delivery will guide the provider, the user and the policy makers in solving the problems that originate from the laboratory service on a permanent basis. It will also establish a regular method of evaluating the services that are provided by the laboratory.

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AIMS AND OBJECTIVES: To help stem cult activities on campuses by identifying motives for joining cult groups and highlighting psychosocial attributes/profile of a potential or already initiated cult member. METHOD: Using snow-balling method, 25 consecutive consenting cult members of University of Ilorin were interviewed over a six month period using a semi-structured questionnaire. Those who had symptoms suggestive of psychiatric disorders were further assessed based on ICD-10 criteria. All patients with previous psychiatric illness were excluded. RESULT: A significant proportion of the respondents were first year, male, previously shy students from high socioeconomic background. There was a significant increase in the proportion of respondents who had palpitation, sweated more, felt bolder, and became current users of alcohol and tobacco after initiation. Also, there was a significant decrease in the proportion of respondents who slept well, felt accepted by friends and performed well in academic activities after initiation. CONCLUSION: In spite of the small sample size and method of data collection, the preliminary findings in this study, could be useful in stemming the increasing menace of cultism among students in tertiary institutions. It was suggested that control of cult activities should be multidimensional with students, parents and university administration taking active parts. Establishment of 'Help Centres' on campuses was suggested.

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Eye care facilities in Nigeria are still not uniformly distributed. Benin City has more eye care health facilities than most other parts of the country. This is probably due to the privilege of having training schools for both Ophthalmologists Ophthalmic Nurses and Optometrists. OBJECTIVE: This study was carried out with the aim of determining the pattern of utilisation of available eye care services in Benin City by the general public. METHODS: This is a cross sectional descriptive study in which 420 staff of ministries were randomly selected. With the aid of a self-administered questionnaire, we determined the previous use of eye care personnel for those who had had eye complaints in the past. The type of services they sought and the eye care personnel involved was documented RESULTS: Nearly 72% of respondents had received eye care services from professionals, that is ophthalmologists, optometrists and opticians. About 28% received treatment from sources that could be considered as inappropriate consisting of 14.1% that had self medication, 7.2% from patent medicine shops, 4.8% from traditional healers and 1.2% on advice from friends. CONCLUSION: Though a high percentage of respondents have received treatment for their eye ailments from appropriate professionals, an appreciable number still patronise inappropriate sources considering that the sampled population were privileged to have a minimum basic education

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INTRODUCTION: The mechanisms responsible for genesis of salt-induced hypertension and its prevention by dietary calcium supplementation are still not clear. Hence, the effect of salt (NaCl) and calcium supplement on blood pressure and renal excretion were investigated. METHODOLOGY: Daily food consumption, water, salt and calcium intake, as well as urine volume and pH were determined. At the end of the feeding period, animals were anaesthetised and the electrocardiographic and blood pressure measurements were done. RESULTS: Salt-loaded rats (SR) consumed more salt and water but less calcium, and excreted more urine and hydrogen ion than control rats (NR). There was elevation of mean arterial pressure (MAP) in SR (132.63 +/- 2.3 mmHg) compared with NR (94.00 +/- 2.2 mmHg) but there was no significant difference in their heart rates (HR) (395 +/- 11.7 vs. 429 +/- 15.4 beats/min). However, salt-loaded-calcium-fed rats (SCaR) had similar MAP as NR (99.29 +/- 1.8 mmHg) and a lower HR (379 +/- 14.9 beats/min). A reduction in water consumption and an increase in urine output as well as urinary hydrogen ion were noted in SCaR compared with SR. Calcium alone (CaR) did not have any effect on MAP (88.01 +/- 1.3 mmHg) and HR (413 +/- 7.98 beats/min). There was no difference in the organ/body-weight ratios of the aortae among the experimental rats. However, there was renal hypertrophy in SR and SCaR. Also, the hearts of SR were bigger than CaR. The mean electrical axis of hearts showed a tendency towards left ventricular hypertrophy in SR, which was greater than SCaR. CONCLUSION: The results suggest that salt loading caused renal hypertrophy and a tendency towards left ventricular hypertrophy. There are associated salt and water retention resulting in alteration of some cardiovascular function. Dietary calcium supplementation reversed these functional defects.

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BACKGROUND: Conjunctival melanoma is a rare occurrence in the Negroid race. PURPOSE: To report a case of a 55 year old security man with right conjunctival melanoma. METHOD: A 55 old man was operated on to remove a pigmented right bulbar conjuctival growth. The specimen was submitted to Lagos University Teaching Hospital Lagos and Harold Wood Hospital England for histopathologic examination and confirmation. RESULTS: Surgery was successful and histopathologic and immunohistochemical studies confirmed a diagnosis of a nodular malignant melanoma. CONCLUSION: The need for the provision of definitive investigative tool (immunohistochemical studies) to facilitate definitive diagnosis and management of such cases in some recognised centres in Nigeria cannot be overemphasised.

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INTRODUCTION: Reports of penetrating injuries of the cranium have been mainly craniocerebral or faciocerebral, craniocerebellar projectiles are few. CASE: We present a case of a 23 year old Nigerian with a craniofacial penetrating injury by a hunting arrow. The trajectory of the arrow through the facial skeleton across the craniocervical junction into the posterior fossa makes this unique in the literature. Successful operative retrieval by a joint team of neurosurgeons and otorhinolaryngologists, problems of delayed presentation and inadequate diagnostic facilities are highlighted. CONCLUSION: The morbidity-free outcome of surgical removal despite the delay in presentation and management in our practice setting with limited facilities are the salient points of this presentation.

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Anaemia of prematurity is a common problem encountered in most special care baby units warranting often repeated blood transfusions with its inherent dangers. We present three patients in Nigeria who were very low birth weight premature babies on whom recombinant erythropoietin was used as an efficient replacement for blood transfusions. All three patients showed a progressive drop in haemoglobin concentration from the first to the sixth to eight week of life with development of heamic murmurs and insignificant reticulocyte responses, and were planned for transfusion therapy. The parents of all the patients strongly refused transfusion therapy (one on religious grounds) warranting the use of recombinant erythropoietin to which there was a significant response in all three patients with elevation of haemoglobin concentration, PCV, and reticulocyte counts, and obviating the planned transfusions. No significant side effects were also noticed. We suggest further controlled trials to establish this mode of therapy.

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OBJECTIVES: This study was conducted to determine the distribution and severity of byssinosis and other respiratory problems in the different operation sections in a textile mill industry in Asaba. PATIENTS AND METHODS: This is a cross-sectional and analytic study in which workers directly exposed to cotton dust are compared with those not directly exposed to cotton dust at one point in time. RESULTS: A total of 735 workers were interviewed and 437 workers had respiratory examinations carried out on them. Byssinosis was diagnosed in 8 out of 405 workers (prevalence of 1.98%) who were not directly exposed to cotton dust, and 21 out of 330 workers (prevalence of 6.36%) who were directly exposed to cotton dust. The difference was found to be statistically significant (chi2 = 9.25; df =1; 0.01 < p <0.001). The spinning department had the highest prevalence of 11.5%. The prevalence of respiratory abnormalities which did not necessarily meet the criteria for a diagnosis of byssinosis was 4.9% for persistent cough and persistent phlegm; 8.0% for dyspnoea grade 2 +; 3.3% for dyspnoea grade 4 and 2.59% for dyspnoea grade 5. Smoking was not found to be associated with the disease as none of the byssinotics were current smokers CONCLUSION: Byssinosis and other respiratory problems were found to be more prevalent in sections of the textile mill industry that were directly exposed to cotton dust. These findings form a basis for making suitable recommendations for the prevention of byssinosis and respiratory diseases in textile mills in Nigeria.

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BACKGROUND: Adequate asthma control in children includes optimal medical management of acute exacerbations of the disorder. Asthma guidelines provide critical information and serve as quick reference decision-support material for clinicians. AIM: This clinical audit aimed at evaluating emergency management of acute asthma as well as proposing for use a management protocol, with the view of improving quality of care. METHOD: This is a retrospective audit of the management of acute asthma over 18 months (October 2000-April 2002) Relevant data related to diagnostic and therapeutic procedures in thirty asthmatics were extracted and examined. RESULTS: There were 20 males and 10 females (M:F ratio 2:1). Mean age (range) was 5.9 years (10 months-12.5 years) and mean (range) duration of symptoms prior to presentation was 1.9 days (2 hours-8 days). Trigger factors, current medications, clinical and functional indices of severity of acute asthma were not documented in 73.3%, 93.3% and 96.7% cases respectively. Diagnostic labels used in 28 (93.3%) did not reflect the acute nature or severity of the acute episode. Although nebulized salbutamol and oral corticosteroids were used for 80.0% of cases, aminophylline was frequently prescribed in addition. Discharge medications and instructions, including follow up in the respiratory clinic were not given in 21 (70.0%) and 28 (93.3%) cases respectively. CONCLUSION: This audit noted that the overall management of acute asthma in the emergency room and the documentation of crucial information vital in the acute and long-term care of asthmatics were inadequate. We propose and recommend for use in the Children's Emergency Room, acute asthma management guideline and protocol-based asthma paper records as well as computerization of patient records.

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STUDY OBJECTIVES: To determine the prevalence and determinants of Erectile Dysfunction (ED) among men with Type 2 diabetes mellitus. MATERIALS AND METHODS: Seventy-seven adult men with Type 2 Diabetes Mellitus were assessed for Erectile Dysfunction using the 'IIEF-5' questionnaire. They were also assessed for the presence of certain clinical factors in other to determine their degree of correlation with ED. RESULTS: The mean age of the study subjects was 56.8(+/-2.4) years. Almost all (96.1%) were married. Forty-four (56.4%) men volunteered a history of Erectile Dysfunction. When assessed with the 'IIEF - 5' questionnaire, the prevalence of any degree of ED was 74% while moderate to severe ED was found in 39(51%) of the patients. The only clinical variables that had statistically significant correlation with ED were the age of the patients (p=0.04) as well as the duration of diabetes (p=0.04). CONCLUSION: - Erectile Dysfunction is a very common condition among men with Type 2 Diabetes mellitus in Ilorin, Nigeria and should therefore be routinely sought for by the clinicians. The two clinical factors that confer significant risk to development of ED, from this study are non-modifiable. More emphasis should therefore be placed on treatment rather than the prevention of this condition.

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OBJECTIVE: Administration of oral contraceptive (OC) steroids is associated with an increased risk of developing hypertension, although the mechanisms underlying this effect are not well established. This study therefore sought to investigate the effect of L-type calcium channel blocker, nifedipine on OC-induced hypertension. METHODS: Female Sprague-Dawley rats received OC (norgestrel/ethinyloestradiol) and/or nifedipine orally for 10 weeks. . Blood pressure and heart rate were thereafter recorded under anaesthesia from the femoral artery with a Grass Polygraph 7D model, whereas plasma and urinary Na+ and K+ concentrations were measured using a flame photometer. The stable oxidation products of nitric oxide, urinary nitrite/nitrate (NO) were measured in urine by means of the brucine method. RESULTS: OC administration led to significant (p<0.05) increases in blood pressure and plasma Na+, and decreases in body weight, food and water consumption, excretion of Na+ and NO. Concomitant treatment with nifedipine significantly (p<0.05) abrogated the alterations induced by OC administration. CONCLUSION : This study provides evidence that the development of OC-induced hypertension is prevented by calcium channel blockade via improved renal handling of sodium and nitric oxide. The finding confirms the involvement of calcium channels in OC hypertension.

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SUMMARY The study evaluated the effect of frequent suckling on neonatal serum bilirubin level, weight gain and passage of meconium in exclusively breastfed (Ebfed) neonates in the first week of lactation. These variables were investigated for 358 healthy full-term, EBfed Nigerian newborn, delivered vaginally without complications at the Jos University Teaching Hospital (JUTH) in their first week of life. Their maternal breast problems and time of achievement of let-down reflex were also evaluated. Mothers nursed their newborns on the average of 13.3 + 1.6 times in the first 24 hours. This non-significantly decreased to 13.1 + 1.2 by the 7th day. Significant positive correlations were found between the frequency of EBfing and passage of meconium in the first 24 hours of life ( r = 0.41, p < 0.05), and weight gain by day 7 ( r = 0.34, p<0.001). Inverse relationship was observed between frequency of suckling and neonatal serum bilirubin level on days 3 and 7 (r = -.13 and -.15), time of achievement of maternal let-down reflex ( r = -.43) and their breast problems (r = -.38), P values < 0.05. We therefore concluded that frequent suckling during EBfing has beneficial health effect on both the mother and her newborn in the first week of lactation. BG.

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OBJECTIVE: A histopathologic analysis of epidermal skin tumours and tumour-like lesions seen between 1991 - 2000 in the Department of Pathology, Ahmadu Bello University Teaching Hospital [A.B.U.T.H], Zaria is presented. PATIENTS AND METHOD: These tumours were classified according to World Health Organisation's International Histological Classification for Skin Tumours and were tabulated. RESULTS: A total of 350 such lesions comprising 9.9% of all cutaneous neoplasms seen within the study period were collected. Overall, they have a male to female ratio of 1.7:1. Malignant tumours constituted 72.5%; benign tumours 18.3% and tumour-like lesions 9.2%. The commonest malignant lesion was squamous cell carcinoma, which constituted 68.3% of all the lesions with a male to female ratio of 1.7:1. Epidermal cyst comprised 16.3% with a male to female ratio of 1.5:1. CONCLUSION: It is concluded that epidermal tumours and tumour-like lesions are not uncommon in Zaria and they show a male preponderance with squamous cell carcinoma being the commonest epidermal tumour and it also predominantly affects males.

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OBJECTIVE: To examine the relationship, if any, between the geographical season in which a baby is born and the baby's birth weight and sex. METHODS: The birth weights and sexes of 6141 babies delivered over a five- year period in a Nigerian mission hospital were prospectively recorded according to the month and year of delivery. The mean birth weights and sexes of infants born in the wet season (May to October) were compared with those of their counterparts born in the dry season (November to April). RESULTS: Comparison of the mean birth weight during the wet and dry seasons showed that for male infants it was 3333 (542)g versus 3197 (566)g (p<0.01), while for female infants it was 3203 (559)g versus 3110 (601)g (p<0.01). When both sexes were combined, the mean birth weights were 3249 (488)g and 3164 (524)g in wet and dry seasons respectively(p<0.01). Slightly more boys than girls were born in the dry season compared with the wet season (p>0. 05). CONCLUSION: Irrespective of gender, babies born during the wet season were significantly heavier than their counterparts born during the dry season. There was a higher probability of a boy birth in the dry season

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