OBJECTIVES: To determine the rates of psychoactive substance use before and during imprisonment among a sample of prisoners and the factors that are associated with current drug use among them. METHODS: All the inmates of Ilesa medium security prison, who gave informed consent to participate, were interviewed with a questionnaire detailing socio-demographic, drug-use and imprisonment-related information. RESULTS: Majority of the prisoners were young adults. The current (one month) use rates of the substances were: tobacco, 13.7%; hypnosedatives, 11.4%; alcohol, 10.7%; stimulants, 9.6%; cannabis, 7.0%; pethidine/morphine, 2.3%; inhalants, 2.3%; cocaine, 2.3%; heroin, 1.3% and LSD, 0.0%. These rates were just slightly lower than rates of use before imprisonment for hypnosedatives, stimulants, cannabis, pethidine/ morphine and inhalants. Majority of current users of cannabis (71.4%) and tobacco (68.3%) were engaged in 'heavy use' of these substances. Analyses of factors that were significantly associated with the five commonly used substances (tobacco, hypnosedatives, alcohol, stimulants and cannabis) indicated that current tobacco use was associated with unemployment before imprisonment, being a sentenced prisoner, previous mental disorder and previous arrest(s) for drug offense. Current hypnosedatives use was associated with being a sentenced prisoner, previous arrest(s) for drug offense and being held for a major offense. Current stimulants use was associated with unemployment, previous arrest(s) for drug offense, previous imprisonment and longer duration of imprisonment. Current cannabis use was associated with higher age groups and being a sentenced prisoner. Cannabis use was also associated with previous arrest(s) for drug offense, previous imprisonment and being held for a major offense, a pattern which suggests that cannabis use may be associated with criminality than the other substances. The observation on pethidire/morphine does not conform to previous observation of non-use by prisoners in Nigeria. CONCLUSION: The rates of drug use are lower than figures reported from samples in western countries but similar to previous reports from Nigeria. The present observation on pethidine suggests that injecting drugs may be an emerging behaviour among prisoners in Nigeria. The prevalence rates of the substances and the similarity in the prisoners' access to drug before and during imprisonment call for drug prevention and treatment programmes within the criminal justice system in Nigeria.

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OBJECTIVES: This study evaluated the impact of nutritional education on knowledge, attitude and practices (KAP) of mothers concerning infants and young children feeding and their children's nutritional status in two semi-urban communities of south-west Nigeria. MATERIALS AND METHODS: This is a community intervention study. We recruited 150 mothers of children aged 0-18 months independently from the intervention and control communities through a multi-stage sampling technique. We collected data with the aid of an interviewer-administered questionnaire at baseline and at six months after intervention from both communities to obtain information on feeding of infants and young children. In addition, we measured weights and heights of recruited children. Intervention involved group counselling of mothers and food demonstrations at designated health facilities. Data analysis for quantitative data was done using Epi-Info software, and for qualitative data, content analysis of major themes was used. RESULTS: Before intervention, recruited mothers and their children from the two communities were comparable in terms of all the parameters assessed (P>0.05 in all cases). After six months of intervention, mothers who had nutritional education demonstrated better knowledge and attitudes to key infant and young children feeding recommendations. There was also limited improvement in feeding practices. Mothers from the intervention community exclusively breastfed their infants longer with mean age at introduction of complementary foods at 5.3 months compared to 4.5 months in the control community (P<0.05), breastfed their children longer (P<0.05). However, there was no statistically significant improvement in the weight of their children. CONCLUSION: In this study, nutritional education of mothers only had positive impact on their level of KAP on infant and young children feeding.

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OBJECTIVES: Laryngoscopy and tracheal intubation lead to acute elevation in intraocular pressure (IOP); the ocular hypertensive response. The Laryngeal mask airway prevents sudden surges in IOP. We compared IOP changes to the insertion and removal of the Laryngeal mask airway (LMA) and the endotracheal tube (ETT). PATIENTS AND METHODS: Seventy ASA I and II patients aged 18 to 60 years at the Lagos University Teaching Hospital between January and December 2003 were randomly allocated to receive either an LMA or ETT for airway management. Anaesthesia was induced with propofol and atracurium. Intraocular pressure was measured by applanation tonometry post induction (baseline) and prior to removal (pre-extubation), after insertion or removal (0 minute), at 1,2,3,5 and 10 minutes after insertion or removal. RESULTS: Insertion of the airway device caused an immediate rise in IOP of 4.6% in the LMA group (from 13.1 +/- 2.4 to 13.7 +/- 2.4 mmHg) and 49.2 in the ETT group (from 12.0 +/- 2.5 to 17.9 +/- 4.0 mmHg) (p<0.001). Removal of the airway device caused an immediate rise in IOP of 14.6 in the LMA group (from 11.26 +/- 2.4 to 12.9 +/-2.4 mmHg) and 50.3 in the ETT group (from 11.37 +/- 2.0 to 17.1 +/- 3.3 mmHg) (p<0.001). IOP thereafter declined towards baseline in both groups. Cardiovascular responses accompanied IOP changes. The mean insertion time was 39.8 +/- 9.1 seconds (ETT) vs 31.5 +/- 4.4 seconds (LMA). (p<0.001) Cough (17.1) and mild laryngeal spasm (2.9) occurred in the ETT group only following removal. CONCLUSION: The LMA produced better IOP stability following its insertion and removal compared to the tracheal tube.

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OBJECTIVES: The study is a follow up to two separate studies done in this centre 42 and 20 years ago on the changing pattern of urethral stricture disease(USD). It assesses the aetiology,the general pattern and treatment outcome in our centre. PATIENTS AND METHODS: This is an 8 year review of all cases of USD managed at the Lagos University Teaching Hospital between January 1998 to December 2005. Diagnosis was confirmed mainly by urethrographic studies and occasionally by endoscopy. Data collected included age, sex, aetiology, site and length of stricture, treatment and outcome. RESULTS: Eighty four patients (83 males and 1 female) with USD were seen within the period with a mean age of 43.1 years. Trauma was responsible for 60 (72.3%) cases, with road traffic accident topping the list with 29 (34.9%), with iatrogenic trauma now accounting for 17 (20.5%) of all cases of USD. Indwelling urethral catheter was responsible for 13 (76.5%) of iatrogenic cases. Purulent Urethritis was responsible for 22 (26.5%) of cases. Fifty (60.2%) cases were located in the anterior urethral while twenty three (39.8%) were in the posterior. Fifty seven patients had urethroplasty with a recurrence of 14% and 8 patients had urethral dilatation with 50% 1 year recurrence. CONCLUSION: Trauma is now the undisputed leading cause of USD in our environment. The incidence of post catheterisation strictures has also risen rapidly. Increased safety on our roads, improvement in medical education and quality of urethral catheters are suggested by this study in order to reduce the incidence of USD.

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BACKGROUND: Cytomegalovirus, otherwise called human herpes virus type 5, is a transfusion transmissible pathogen responsible for significant morbidity and mortality among various groups of individuals with damaged or impaired host immunity. Although it has a worldwide distribution, the infection is thought to be more widespread in developing countries where certain demographic factors and living conditions are thought to be responsible for the observed increased prevalence of this infection. OBJECTIVES: The aim of this study is to evaluate the effect of living conditions, using certain selected demographic parameters, on CMV seropositivity, among blood donors in Jos. PATIENTS AND METHODS: A total of 200 prospective blood donors who presented for bleeding were recruited consecutively into the study. Questionnaire was used to obtain the personal, educational, social and demographic data of donors. Screening for CMV antibodies was performed on each serum sample using ELISA kit ("DIALAB", Austria) (www.dialab.at). RESULTS: The relationship between the extent of crowding and CMV status of donors was statistically significant, p<0.05. Other studied donor demographic parameters (source of drinking water, place of abode and type of toilet facility) did not statistically influence donor CMV status, p>0.05. CONCLUSION: Our study showed that overcrowding was the most significant factor that statistically influenced donor CMV status in Jos, Nigeria. There is, therefore, an urgent need for concerted effort to handle the problem of overcrowding in developing countries and Nigeria in particular.

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OBJECTIVE: To carry out histopathologic analysis of diseases of the prostate gland reported at the department of Anatomical Pathology of the University of Port Harcourt Teaching Hospital between January 1996 and December 2005. PATIENTS AND METHODS: This is a retrospective histologic analysis of prostate samples seen at the University of Port Harcourt Teaching Hospital. Where necessary, new slides were prepared from blocks of the samples. The request cards of the patients were also retrieved and scrutinized for age, presenting symptoms and clinical diagnosis. RESULTS: Prostate biopsies constituted 8.8% of all surgical specimens and 30.9% of all male specimens received during this study period. Only 529 (7.6%) of all prostate specimens where included for the review because the slides or blocks of the rest could not be traced. Of the 529 specimens reviewed, 301 (56.9%) were needle biopsies while 228 (43.1%) were prostatectomies. Three hundred and thirty one (62.6%) of the cases were nodular hyperplasia and 198 (37.4%) were invasive adenocarcinomas, thirty-four (17.2%) of the invasive adenocarcinomas were incidental carcinomas. There was prostatic intraepithelial neoplasia (PIN) in 79 (14.9%) cases. Prostatitis was found in 223 cases (42.2%) of the entire specimen studied. All cases of prostatitis occurred in association with nodular hyperplasia, invasive carcinoma or prostatic intraepithelial neoplasia (PIN). CONCLUSION: The burden of prostate diseases among adult males in Port Harcourt is high and malignant neoplastic diseases in the form of clinical and incidental carcinomas as well as premalignant diseases in the form of prostatic intraepithelial neoplasia (PIN) were quite common.

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AIM: This study was intended to assess the clinical reliability of the Pederson index as an instrument for preoperative determination of surgical difficulty in third molar surgery. METHODS: Pederson index was used to predict the difficulty of 79 cases of impacted mandibular third molar extractions. The predictions were compared with actual surgical difficulty determined by operation time. The reproducibility as well as the reliability of the index was determined. RESULTS: The index was found to be highly reproducible (P=0.00). The sensitivity and specificity were 94.9% and 45% respectively. The Positive predictive value (PPV) was 67.2% and the negative predictive value was 90% while the accuracy was 69.6%. CONCLUSION: The Pederson index though reproducible is not a reliable instrument for predicting surgical difficulty of third molar surgery when compared with actual surgical difficulty as determined by the operation time. There is a definite need to derive an index that could be used for preoperative prediction of difficulty; however it is much more important that any index so employed should provide accurate information as the consequence of wrong judgments could be quite deleterious to the patients and embarrassing to the surgeon. While it is not completely unimportant, the Pederson index should not be employed as a sole instrument for preoperative assessment of difficulty in third molar surgery.

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Pyogenic liver abscess [PLA] is a rare and life-threatening disease in children. Appendicitis was the leading source of PLA in the pre-antibiotic era, but it essentially has been eliminated in recent times. Most patients with persistent fever after exploratory laparatomy for perforated appendicitis are often found to have residual abdominal collection. We report a 12-year old girl with PLA after laparotomy for perforated appendix. She developed persistent fever and respiratory distress post operatively. Physicians had an impression of pneumonia but abdominal ultrasound showed cystic mass with mobile internal echoes within the right lobe of the liver suggesting an abscess. Patient was successfully managed by percutaneous drainage under ultrasound guidance. Culture of the pus yielded no growth. She was discharged after 7 weeks of hospital stay. Aetiology, evaluation and treatment modalities were reviewed.

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OBJECTIVES: To determine the incidence, review the management as well as the maternal and perinatal outcome of singleton breech presentation at term at the Lagos University Teaching Hospital (LUTH). METHOD: A review of the 108 singleton term breech deliveries that took place at the Lagos University Teaching Hospital over 30 months from 1st January 2005 to 30th June 2007. RESULTS: The incidence of singleton term breech delivery was 3.4% and eighty seven per cent of the delivery was by caesarean section. Babies delivered by caesarean section were more likely to have first and fifth minute Apgar Scores greater than 7 compared to those delivered vaginally (p < 0.001). The perinatal mortality rate was more than four times higher in singleton term breech deliveries when compared to singleton term cephalic deliveries. The mean estimated blood loss following caesarean delivery was 775.5 + 441.6 ml while that following assisted breech delivery was 253.6 + 217.9 ml and this was statistically significant (p < 0.001). The mean hospital stay of mothers following caesarean birth was 6.6 + 1.8 days while it was 3.1 + 1.5 days for those that had assisted breech delivery. This was also statistically significant (p < 0.001). However all the six women with puerperal complications occurred in women that had caesarean section. CONCLUSION: Babies delivered by caesarean section had better perinatal outcome compared with assisted vaginal breech delivery. Maternal morbidity occurring in the caesarean section group was not fatal.

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AIM: To assess the prevalence, presentation, treatment and outcome of management of male breast cancer (MBC) in Osogbo, Nigeria. METHODS: A review of all cases of MBC seen at LAUTECH Teaching Hospital Osogbo between January 2004 and December 2006 was done. The age, presenting symptoms and signs, stage, histology, associated co-morbid illnesses, treatment and outcome of care were all retrieved and analysed. RESULTS: Seven (8.86%) out of seventy nine cases of breast cancers seen are males. Ages ranged between 38 and 80 years (mean 60.5 median 65 years). They all presented with advanced lesions after a 6 -36 months delay (mean-11.57 months). All were invasive ductal carcinoma. All the four with significant co-morbid illnesses died of them within one week to seven months. Only one patient had mastectomy. CONCLUSION: MBC constitutes 8.86% of all breast cancer, all presented late with advanced lesions and co-morbid illnesses contributed significantly to mortality.

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BACKGROUND: Routine admission of all post-thyroidectomy patients into intensive care unit (ICU) within the first 24-48 hours is advocated and practised in some hospitals. However, clinicians today are faced with the need to improve patient outcome at minimal costs. AIMS: To determine the incidence of life-threatening complications necessitating (ICU) admission following thyroidectomy; and to identify any pre-operative risk factors for ICU admission in patients with goitre. SETTING: University of Ilorin Teaching Hospital, Ilorin, Nigeria. DESIGN: Retrospective study. METHODOLOGY: A retrospective study of all patients who were admitted to the ICU following thyroidectomy, over a period of 10 years (January 1993- December 2002), was carried out. Their records were analysed for indication for admission, therapeutic intervention instituted and outcome. RESULTS: A total of 196 case notes out of the 210 thyroidectomies performed within the study period could be retrieved for analysis. Twenty patients (10.2%) required ICU admission for various indications. Sixteen of the admissions were elective based on recognition of the need immediately after extubation in the theatre, while the remaining 4 patients were emergency admissions transferred from the post-surgical ward at variable periods within the first 24-hours post-operatively. The most common reason for ICU admission was recurrent laryngeal nerve (RLN) palsy, which occurred in 13 patients (6.6%). There was one mortality in the elective admissions and no mortality in emergency admissions. No patient died or suffered disability on account of failure to get admitted to ICU. CONCLUSION: It is safe to discharge the majority of patients back to post-surgical ward for nursing care immediately after thyroidectomy. Most of our patients were discharged to the post-surgical ward without any life-threatening complication.

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BACKGROUND: The provision of prenatal care and the promotion of institutional childbirth have the potential to reduce maternal and neonatal morbidity and mortality. Despite this, high maternal and infant mortality is still being recorded in the developing countries and researchers still report low utilisation of maternal health care services in different communities in Nigeria. OBJECTIVE: This study examined the current level of utilisation of maternal health care in some rural and peri-urban communities of Olorunda Local Government Areas of Osun State in South Western Nigeria. METHODS: A cross-sectional descriptive study was carried out. Researchers conducted a house-to-house survey using a semi-structured questionnaire to interview adult women who are either pregnant or already had a child before. Information was collected on demographic characteristics and utilisation of maternal health care services. RESULTS: Most of the respondents (94.8%) delivered in health care facilities with the supervision of trained health personnel. The study showed a strong influence of mother's education and economic status of the family respectively (p<0.05) on the use of maternal health care services. CONCLUSION: This study revealed a higher level of utilisation of maternal health care services in the communities under study than earlier reported in Southwestern Nigeria. Continuous and sustained community education and mobilisation is essential so that women and their families learn about the need for special care during pregnancy and childbirth under trained health personnel.

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To determine the Sociodemographic characteristics, infant feeding choices and outcome of HIV exposed neonates attending the paediatric infectious disease clinic (IDC) of Aminu Kano Teaching Hospital Kano. PATIENTS AND METHODS: The records of all HIV exposed babies were reviewed. One hundred and ninety HIV exposed babies were seen between October 2003-December 2005. Of these 121 were part of the PMTCT programme while 69 were not. A total of 179(94.2%) babies were delivered at term while 11(5.8%) were delivered prematurely, with M: F ratio of 1.2:1. RESULTS: A substantial number of mothers in the non PMTCT group were diagnosed antenataly or even prior to conception yet they did not avail themselves of the interventions in the PMTCT programme. Reasons given were ignorance, inaccessibility to PMTCT centres and fear of stigmatisation. Breast milk substitute, was the leading choice of mothers in the PMTCT group while breast milk and mixed feeding was practised more in the non-PMTCT group. CONCLUSION: PMTCT remains the best way of preventing paediatric HIV infection and infant feeding counselling should be family oriented. Provision of free infant formula, PCR machines to enable early diagnosis, waiving of fees, and home visits would greatly improve infant follow up.

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OBJECTIVE: To evaluate the haemostatic function and menstrual pattern of Norplant acceptors after 36 months of use. METHOD: This was a prospective longitudinal study that involved fifty five healthy, non-breastfeeding, sexually active informed volunteers recruited from our family planning clinic, between September and December 2002. Blood samples were collected at pre-insertion, 12, 24 and 36 months follow up for packed cell volume, platelet count, prothrombin time and activated partial thromboplastin time. Statistical analysis was with paired t-test. The level of significance was set at p<0.05. Each acceptor received a menstrual calendar to chart all bleeding events. RESULTS: The mean age and weight of the 29 acceptors who had complete records at 36 months of study were 33.7 +/- 5.9 years, 64.1 +/- 9.9 kg respectively. The mean packed cell volume (PCV) was 34.3 +/- 2.5% at pre-insertion. This rose to significant mean +/- SD values of 37.6 +/- 3.5%; p < 0.0002, 37.4 +/- 3.2%: p < 0.0001 and 38.0 +/- 2.6%; p < 0.0001 at 12, 24 and 36 months respectively. The mean platelet count at pre-insertion was (239,724 +/- 85,886 per microl). There were significant reductions in the mean concentration at 12 months (p <0.04; 198,310 +/- 78,476 per microl) and at 36 months (p<0.0002; 154,241+/- 45,207 per microl). The prothrombin and the partial thromboplastin time at 12, 24 and 36 months did not show significant change over their pre-insertion mean values of 11.9 +/- 1.1 seconds and 36.9 +/- 3.0 seconds respectively. At 24 and 36 months 75.9% (22) and 72.4% (21) of the users reported abnormal menstrual patterns respectively. Only 24.2% (7) and 27.6% (8) had normal menstrual patterns at the respective months. Continuation rates at the end of 24 and 36 months of studies were 85.5% (47) and 80% (44) respectively. Reasons for discontinuation were planning for another baby, menorrhagia, lump in the breast and elevated blood pressure CONCLUSION: Acceptors of Norplant had mainly reduced bleeding patterns, which did not predispose them to anaemia neither did they have an adverse effect as a result of the reduced but normal platelet count.

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OBJECTIVE: To highlight the usefulness of duplex ultrasonography in assessing the degree of limb ischaemia in patients with peripheral arterial occlusive disease (PAOD). METHODOLOGY: Duplex ultrasonography (B mode, Color flow and spectral Doppler analysis) was used to evaluate the degree of limb ischaemia in an elderly Nigerian woman with diabetes who had clinical features of severe PAOD RESULTS: The patient was found to have moderate and severe limb ischaemia in the right and left lower limbs respectively. She subsequently had a below the knee amputation of the left lower limb. CONCLUSION: Duplex ultrasound is advised as part of the pre-operative evaluation of patients with PAOD, in order to adequately localise the diseased arterial segment and degree of limb ischaemia. However, segmental Doppler pressures with ankle brachial analysis should be utilised as a screening tool in symptomatic patients.

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