AIM: To determine the prevalence of oral habits and assess the effects of these habits on the occlusion in a group of Nigerian schoolchildren. METHOD: A cross-sectional study of 928 children aged 4-15 years from Eti -Osa local government area in Lagos, Nigeria. The sample population was selected from 2 private and 3 public schools. RESULTS: Three hundred and sixteen children (34.1%) of total children examined, exhibited one form of oral habit or another. The most common habit observed was digit sucking which was observed in 17% of the children. Increased overjet was observed in 33% of the habit children. This was significantly higher than findings in children without the habit who recorded an increased overjet of 25.3%. Anterior open bite was observed in 12.5% of habit children and 3.1% of non-habit children. Statistically significant differences in the occurrence of upper incisor proclination, lower incisor retroclination and lip incompetence were also observed occurring more frequently in the oral habit group. Posterior crossbite was observed in 1.9% of the habit group and 1.5% of the non-habit group. This difference was not statistically significant. CONCLUSION: This study shows an increased prevalence of oral habits when compared to previous studies in this region. Increased overjet and anterior open bite were the most commonly occurring occlusal anomalies associated with oral habits. There is a need to reduce the occurrence of permanent occlusal deformation due to the persistent form of these habits through dental health education among Nigerian children.

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OBJECTIVES: To highlight the usefulness of duplex ultrasonography in assessing patients with clinical features suggestive of DVT in this environment. PATIENTS AND METHODS: A total of seventy patients (44 males and 26 females, aged 15-85 years) with a clinical diagnosis of deep venous thrombosis (DVT) were seen between September 2005 and September 2007 in the Radiodiagnosis Department of the Lagos University Teaching Hospital, and a private Multi-specialist hospital both in Lagos, Nigeria. They had bilateral lower extremity venous duplex ultrasonographic examination performed on them. The common femoral vein, superficial femoral vein, proximal deep femoral vein, proximal greater saphenous vein, popliteal vein and posterior tibial veins were evaluated with compression sonography in the transverse plane. Grey scale, colour and pulsed Doppler imaging of the venous segments were observed. RESULTS: The sonographic abnormalities observed included frozen valves, venous reflux, venous dilatation with echogenic thrombus, absence of Doppler signals and narrowed, thick walled veins. It was observed that 30 (42.3%) patients had acute DVT, 11 (15.7%) had chronic venous disease (CVD), while 10 (14.3%) had incompetence of the superficial venous system. Acute DVT was the commonest pathology observed. CONCLUSION: Duplex ultrasonography should be performed on all patients with a clinical diagnosis of DVT in order to rule out other differential diagnoses.

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BACKGROUND: Cervical cancer is the commonest cancer in northern Nigeria. There are only two radiotherapy centers in the north and four centres in the south, each with only one megavoltage machine for a population of over 140 million. The number of patients requiring radiotherapy for various malignancies is beyond the available facilities and expertise leading to long waiting time and disease progression with its attendant sequelae. This is the basis of using other orthodox treatment modalities as first line. PATIENTS AND METHODS: Between January 2006 and December 2007, 116 patients with histologically confirmed cervical cancer with vaginal bleeding as the predominant symptom were treated. Patients presenting with torrential haemorrhage were excluded from this study as they constitute oncologic emergencies. Patients were interviewed with a structured pro forma on a 3-weekly basis during chemotherapy schedules to assess and evaluate per vaginal bleeding and discharge. Dose of chemotherapy was 70 mg/m΂ every 3 weeks. Results were analysed using Epi Info soft ware Version 3.4.1; 2007 Edition. RESULTS: The median age was 49 years (27-80 yrs). 62 patients were having per vagina bleeding for more than 6 months before commencement of chemotherapy (range 1-60 months). 49 patients had blood transfusion before chemotherapy, average of 2.7 pints of blood transfused per patient. 84 had at least FIGO stage IIIA disease. Squamous cell carcinoma is the commonest histology type followed by adenocarcinoma with 95 and 16 patients respectively. 81 patients had complete cessation of per vagina bleeding with 69 having complete cessation on or before 4th course of chemotherapy (9th week) and complete cessation of per vagina discharges was seen in 52 patients. 115 patients had a performance status KPS of below 80 prior to chemotherapy, and after completing 6 cycles, 100 patients had KPS of 80 and above. CONCLUSION: In resource-poor setting, Cisplatin based chemotherapy can be used by medical, gynaecological oncologists and general practitioners to control vaginal bleeding and improve the quality of life of patients pending radiotherapy. For optimal treatment with chemoradiotherapy, government and non-governmental agencies must do all it takes to remedy the problems of shortage of resources.

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BACKGROUND: Toxoplasma gondii (T.gondii), an obligate intracellular parasite found in many species throughout the world, causes a variety of clinical syndromes in humans and animals. It is also associated with morbidity and mortality in pregnancy. Hence the need to determine the seroprevalence of antibody to toxoplasmosis gondii amongst pregnant women. SUBJECTS AND METHODS: A cross- sectional study was carried out using patients attending the ante-natal clinic of Lagos State University Teaching Hospital Ikeja. All consenting newly registered ante-natal patients were recruited consecutively into the study within a time frame of six weeks during which a total of 179 pregnant participants were recruited. Literate participants filled self administered questionnaires whilst the non-literate participants were interviewed by research assistants. Five milliliters of blood was collected from each participant after obtaining patient's consent. Sera were assayed for antitoxoplasmosis IgG antibody by enzyme linked immunosorbent assay. (ELISA.) RESULTS: A total of 179 pregnant women were studied. Almost 50.8% were between the ages of 25-30 years, 70.8% of the patients studied, had tertiary education. An assessment of the patients' status to anti-toxoplasmosis IgG showed 40.8% were positive while 59.2% were negative. Pet-keeping was a practice amongst only 6.1% of patients whilst 90.5% did not keep pets. Out of those who kept pets, 63.6% were positive while 39.5% were negative. Amongst those who did not keep pets, 39.5% were positive while 60.5% were negative. This difference was not statistically significant. (P=0.261) CONCLUSION: It appears that seroprevalence of toxoplasmosis IgG antibody amongst the pregnant women in this study population is high. Therefore, it is valuable to follow up the IgMantibody status of their off springs as its presence indicates recent exposure.

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BACKGROUND: It was not clear for a while, which of the definitions of metabolic syndrome best predicted those at risk of cardiovascular disease and diabetes but recent studies have confirmed the predictive ability of various definitions of metabolic syndrome and have reported that the International Diabetes Federation definition, although more sensitive is associated with a higher false positive predictive rate. OBJECTIVES: To determine the prevalence of metabolic syndrome, using the International Diabetes Federation and Adult Treatment Panel III definitions among adult Nigerians attending Family Medicine Clinics at two hospitals in Rivers State Nigeria. METHODS: Adult subjects attending family medicine clinics at an urban and a sub-urban hospital in Rivers State, Nigeria were bled after an overnight fast, and venous blood obtained for lipid studies and fasting plasma glucose estimations. Measurements were made to determine height, weight, waist circumference and blood pressure. The data obtained was analysed using SPSS for Windows software version 12 and Epi info version 6.04D RESULTS: The prevalence of metabolic syndrome was 19.81% (ATP III) and 23.19% (IDF) at one centre and 34.17% (ATP III) and 35.42% (IDF) at the other centre. CONCLUSION: The prevalence of metabolic syndrome by the two definitions was significantly higher at the second centre. The difference in the prevalence rates by the two definitions was also much smaller in the second centre perhaps because the second centre had more women and the mean age of the subjects was significantly higher.

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BACKGROUND: Few studies documenting the echocardiographic findings of patients with sickle cell anaemia have been reported from Africa despite the high prevalence of the disease on the continent. AIMS AND OBJECTIVES: The present study aimed to determine echocardiographic cardiac dimensions and haemodynamic parameters of children with homozygous sickle cell anaemia (SCA), in steady state at the Lagos University Teaching Hospital (LUTH). MATERIALS AND METHODS: Sixty children with SCA and sixty age and sex matched controls with ages ranging from 1-15 years were studied. Their cardiovascular functions were determined by echocardiographic examination. RESULTS: Mean age of SCA patients and controls were 95.41 ± 49.06 months and 95.45 ± 50.9 months respectively (p = 0.97). Mean left atrial dimension (LA), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular posterior wall thickness (LVPW), Interventricular septal thickness (IVS) and left ventricular mass (LVM) in SCA patients were significantly larger than those of controls (p < 0.001 for each parameter). Left ventricular fractional shortening (FS) and ejection fraction (EF) were within acceptable normal limits although significantly lower in SCA patients (p < 0.001). The mean haemoglobin concentration in the subjects (77.23 ± 12.88) was significantly lower than in the controls (121 ± 16.09) (p < 0.001). Each direct echocardiographic parameter (LAD, AO, LVEDD, LVESD, IVS, LVPW and LVM) correlated significantly with age in both groups while left ventricular functional parameters (FS and EF) did not in both groups. Chamber dimensions, LVPW, FS and EF were inversely correlated with haemoglobin concentration in the subjects.

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OBJECTIVES: To assess knowledge, attitude and management practices on intimate partner violence (IPV) in primary care practice and determine barriers to screening, safety concerns and prior training of health workers. METHODS: Self administered questionnaire interview of 298 health workers from 104 health facilities in the 33 local government areas of Oyo state. RESULTS: Health workers underestimated IPV, 80% estimated that less than 10% of women in their practice experience violence. Only 35% (105) screened routinely for IPV, while 43% (129) had ever identified a victim. Response of health workers when they found oppressed women were often (64.5%) limited to treatment of injuries. Many (66.1%) believed it was an intrusion into patient's private life to inquire about violence. Ninety per cent (270) expressed concern for their personal safety if they were to discuss with the oppressed or perpetrators. Many (74.8%) believed that they could assist men who perpetrate violence, while 92.3% believed they could assist abused women. Only 18.8% (56) had ever received training on violence. Health workers with previous training on IPV were three times more likely to screen (AOR 2.66; 95%CI: 1.52-4.63), while the more senior cadre were more likely (AOR 1.62; 95% CI: 1.13-2.81) to have identified an oppressed woman. Although not significant, females had better knowledge and attitudes than men (OR 0.67; 0.96-2.94 and 0.78; 0.44-1.40). CONCLUSIONS: Health workers were willing to discuss IPV, but lacked fundamental knowledge on IPV. Training efforts that focus on screening and comprehensive management are urgently required.

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AIM: To report the case of Junctional Epidermolysis bullosa seen in the University of Calabar Teaching Hospital, Calabar and to draw attention to the existence of this condition among Nigerians. SUBJECT AND METHODS: A Nigerian female infant, normal at birth, developed extensive blistering skin eruptions from the age of ten days. The lesions involved the face, neck, shoulders, upper trunk and the buccal mucosa of the lower lip sparing the limbs. The cornea were cloudy. The history, type and distribution of the lesions were consistent with Junctional Epidermolysis bullosa (EB). This was confirmed by skin biopsy and histology. Various medications including systemic and topical steroids, antibiotics and other topical creams only produce transient relief with frequent relapses. The Junctional EB type is known to be autosomal recessive in inheritance though there was no positive family history. Avoidance of heat, warm bath and trauma and genetic counseling can be helpful in reducing frequent relapses of the condition that has no specific treatment. CONCLUSION: This appears to be the first case of Epidermolysis bullosa to be reported from Calabar, south eastern Nigeria. This case report shows that this rare condition does affect people in the tropics. Efforts should always be made to reach a definitive diagnosis whenever unusual conditions are encountered in clinical practice.

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BACKGROUND: Adverse cutaneous drug eruptions are dreaded complication of drug use and this is more so when it occurs in the setting of human immune virus (HIV) infection and acquired immune deficiency syndrome (AIDS). AIMS AND OBJECTIVES: This study aims to look at the prevalence of cutaneous drug eruptions in adult Nigerians with HIV/AIDS and find out the etiological agents, outcome, and prognosis of such occurrence in Irrua Specialist Teaching Hospital, Irrua Edo State Nigeria. SUBJECTS AND METHODS: A retrospective study of cutaneous drug eruptions in patients with HIV/AIDS managed in this centre over the past five years (between January 2001 and December 2005 prior to initiation of antiretroviral therapy) was carried out. RESULTS: A total of 900 patients with HIV/AIDS were managed during this period (antiretroviral treatment was not available during this period). Twenty five of these patients (2.8%) not had cutaneous drug eruptions (2.8%). Erythema multiforme major or Steven Johnson Syndrome (SJS)-40% and Toxic epidermal necrolysis (TEN)-20% were the most frequent types of adverse cutaneous drug events found while combination antituberculosis agent of Isoniazid/Thiacethazone (64%) and anti malarial Sulphadoxine/Pyrimethamine (20%) were the notable culprit drugs found to be responsible for these. There was a 20% fatality rate. CONCLUSIONS: Treatment of tuberculosis which is the most common AIDS presenting illness with anti tuberculosis regimen that includes thiacethazone and the ready availability of anti malarials over the counter without prescription are responsible for the findings of this study. Avoiding drugs such as those found to be culprit agents in this study in patients with HIV/AIDS; right prescription practice by health practitioners as well as more intense health education of the public on the hazards of self prescription will all go a long way in minimising the occurrence of these events.

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BACKGROUND: There is an increasing popularity of fine needle aspiration cytologic diagnosis of palpable tumours over histologic diagnosis despite the accuracy of histologic diagnosis. OBJECTIVE: To compare cytologic and histologic diagnosis of palpable tumours in Rivers State. DESIGN AND SETTING: A prospective descriptive study at the University of Port Harcourt Teaching Hospital (UPTH) Port Harcourt. METHODS: Using the methods previously described, tumour aspirates were obtained and stained with Giemsa Hematoxylin and Eosin or pap as appropriate and covered with a cover slip. RESULTS: One hundred and sixty seven (167) FNAC specimens from patients aged 3-74 years were studied. Most of the biopsies (81.6%) were obtained from patients below 50 years with the highest frequency in the age group 40-49 years (20.4%). Females predominated with a ratio of 5.2:1. The commonest tissue aspirated was the breast (51.5%) while the least was the salivary gland (1.2%). Out of the histologically confirmed cases, the FNAC was 85.6% accurate. CONCLUSION: FNAC diagnosis of palpable tumors is accurate and reliable as histologic diagnosis if handled by an experienced pathologist.

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This is to illustrate the case of a 14 year old male student of a secondary school who fell off the top of an unguarded bunk bed in his hostel while sleeping and sustained a fracture of the left orbital margin, severe periorbital echymosis and conjunctivitis. He was managed conservatively. Two weeks post injury; the swelling resolved. At 2 months post injury, he improved tremendously and his visual acuity in the affected eye was 6/6. The swelling resolved and his anterior and posterior segments were normal. The patient was lucky to have had an intact eyeball. If it had been a penetrating eye injury, it could have been disastrous. Blinding eye injuries may be irreversible.Unguarded bunk beds may be dangerous to the eye. A recommendation of minimal standard for bunk-beds for children or no bunks at all in schools is suggested.

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OBJECTIVES: Often the public cannot differentiate among eye care providers with adverse effect on ocular health. This is to ascertain awareness and knowledge of Nigerian public workers about eye care providers. METHODS: Structured self administered questionnaire on respondents' socio-demography, awareness and knowledge about eye care providers was distributed to 500 consenting public workers in Ilorin, Nigeria. RESULTS: Four hundred and fifty one respondents, aged 20 to 57 years comprising 213 (50.8%) men and 206 (49.2%) women participated. Majority 348 (87.9%) had tertiary education while the remaining had at least primary education. Most respondents 392 (88.9%) were aware of the availability of eye care providers while 49 (11.1%) were unaware. Based on their knowledge of the eye care providers, three categories of respondents emerged: majority had correct perception, some had wrong perception and some knew nothing about eye care providers. The level of education was found to be significantly associated with the level of awareness and knowledge of the respondents (p< 0.05) while gender was not (p>0.05). CONCLUSION: Despite the majority of the respondents having good perception of eye care providers, the respondents who had wrong perception and those who were oblivious of eye care providers could be draw backs to eye health care.

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BACKGROUND: Brain tumours and head trauma are two pathological entities that may involve the central nervous system to produce similar clinical neurologic signs and symptoms. There has been a long-term debate in the literature on association between these two clinical conditions following observations over time of development of intracranial tumours in individuals who previously sustained head injury. In this teaching centre, there were in succession, two cases of head injury which, at brain CT scanning, turned out to be brain tumours. These findings stimulated the need to review the literature. OBJECTIVE: To examine the literature for evidence of the role of brain tumour as a factor in development of falls and subsequent head injury and thus raise awareness of their association. METHODS: Related literature materials on brain tumours and head injury were reviewed. RESULTS: Some reports in the medical literature established only weak evidence in support of head injury as an aetiologic agent for brain tumour occurrence; others found no association between them. CT and MRI are useful investigative modalities. CONCLUSION: Head trauma may only have caused small and preexisting quiescent tumour to grow as a result of predisposition to fall by musculoskeletal incoordination caused by the tumour itself.

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AIMS AND OBJECTIVES: Alcohol abuse is a major public health problem and one of the leading causes of preventable death. Data on the frequency of biochemical abnormalities among alcoholics in the Niger Delta region is unavailable. We therefore conducted this pilot study to determine the type of biochemical abnormalities amongst a group of chronic alcoholics in Port Harcourt, Nigeria. SUBJECTS AND METHODS: Thirty (30) subjects aged 40 50 years with a daily alcohol consumption of more than 100g formed the study group. Thirty (30) aged matched controls from the same locality who were non-alcoholics were also recruited. Ten mls (10mls) of venous blood was collected from both subjects and controls from the antecubital fossa after obtaining informed consent into lithium heparin bottles. The plasma was harvested and stored at -20 degrees C until assayed. Plasma bilirubin, aspartate transaminase, alanine transaminase, alkaline phosphatase, gamma glutamyl transferase, glucose, total protein, albumin, magnesium, calcium and inorganic phosphorus were estimated using standard kit methods while plasma potassium was determined by flame photometry. Routine laboratory accuracy and precision controls were utilised. RESULTS: Alcohol abuse was associated with a significantly lower body weight, body mass index and percentage body fat. The plasma sodium, inorganic phosphate, gamma glutamyl transferase were significantly higher in chronic alcohol abuse when compared with normal subjects. On the other hand, the plasma magnesium, potassium, calcium, total protein, albumin and glucose were significantly reduced in the study subjects. CONCLUSION: Biochemical abnormalities are common among chronic alcoholics in this region. They include hypernatraemia, hypoglycaemia, hypocalcaemia, hypomagnesaemia, hypokalaemia, hypoalbuminaemia and hyperphosphataemia. Aspartate transaminase and gamma glutamyl transferase are usually elevated and suggests alcoholic liver damage. Efforts should be made to identify these abnormalities and treat them as it may go a long way towards improving morbidity and mortality of alcohol related diseases.

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AIM: To present the clinical features of arteriovenous malformations of the occipital lobe in order to assist in making a diagnosis prior to intracerebral haemorrhage. METHODS: A Sixty one year old Nigerian male patient complained of constant frontal headache for five years with associated gradual visual loss. Six months before presentation he suffered two episodes of severe headache associated with dizziness and profound visual loss. On examination his visual acuity was Hand Movement in each eye, the pupils were active and both optic discs were normal. Neurological examination was normal. A Computed Tomography was normal. He suddenly fell down and died within one week of presentation. Autopsy report revealed arteriovenous malformations of both occipital lobes and left parietal lobe. CONCLUSION: Visual loss may be the only clinical sign in occipital lobe lesions. A visual field test is helpful in the diagnosis. Computed tomography has limitations in the diagnosis of intracranial lesions especially suspected vascular lesions. Early presentation, visual field analysis and angiographic studies are essential.

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