The impact of normal pregnancy on serum zinc and copper concentrations and on copper/zinc ratio has been determined in a cross-sectional study of eighty-four healthy pregnant Nigerian women. Fifty-seven healthy non-pregnant women served as controls. Serum zinc and copper levels were determined by atomic absorption spectroscopy. Mean serum copper concentration is significantly higher (P < 0.001) in the pregnant group than in controls [19.74(4.65) and 11.87(2.61) micromol/L respectively], while mean zinc level is significantly lower (P< 0.001) than in controls [4.40(1.34) and 5.54(1.04) micromol/L respectively. Copper/Zinc ratio is also significantly higher than (P<0.001) in the test subject [4.87(1.77) and 2.23(0.75) micromol/L respectively]. One-way analysis of variance shows that the mean serum zinc and copper concentrations and copper/zinc ratio differ significantly (P < 0.01, P < 0.05, and P < 0.05 respectively) between any two of the trimester groups. Furthermore, there is a significant positive correlation between gestational age and copper/zinc ratio (r- 0.201; P < 0.05), and a significant negative correlation between gestational age and serum zinc concentration (r = -0.274; P < 0.01). In normal pregnancy, a negative and positive linear relationship exists between gestational age and serum zinc level and copper/zinc ratio respectively. Serum copper does not show any significant trend throughout gestation, though pregnant subjects have higher mean serum copper level than controls.

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Trichomonas vaginalis is the most prevalent, non-viral sexually transmitted infection worldwide and probably the most commonly treatable in Africa and worldwide. The purpose of this study was to determine the prevalence of T. vaginalis among women with vaginal discharge attending a gynaecologic clinic in Lagos and to identify the common characteristics of the vaginal discharge in T Vaginalis. High vaginal swabs were taken from consenting adults with vaginal discharge. The quantity, colour and odour of the discharge were noted. Amine (10% KOH) test and pH were determined. Wet-mount microscopy Giemsa staining and culture in Oxoid (R) Trichomonas Medium were performed on each swab. A total of 200 patients were examined. One hundred and forty-nine (74.5%) had T. vaginalis. There was no statistically significant association between age, marital status, parity, number of sexual partners and prevalence of T vaginalis. The colour of the discharge was white in 104 (69.8%), yellow in 30 (20.1), clear in 15 (10.1%). None was frothy or greenish. The discharge was heavy in 50 (33.6%) and malodorous in 51 (34.2%). The pH range was 4-7 and 42 (28.2%) normal pH of4. In 47 (31.5%) the amine test was negative. The prevalence of T vaginalis among women with vaginal discharge is high. Women complaining of vaginal discharge should be thoroughly screened for T. vaginalis using all available methods

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A prospective study was carried out at the Lagos University Teaching Hospital in Lagos. The aims were to determine the prevalence of otorhinolaryngological disease among patients who were HIV+ and or had clinical AIDS and to correlate the presence of ORL disease with the clinical state of HIV infection. The study was done between October 1998 and September 1999. A total of ninety-eight patients were studied. The age range of the patients was between 15 and 69 years with 83% of them being in the age group of 20-49 years. The results showed that while only 17% of the patients were referred because of ORL diseases, 80% of them actually had O.R.L./head and neck conditions. This difference of proportion is highly significant P = 0.000037. 160.20% of the patients had oral/pharyngeal lesions and 24.5% had identifiable otological disease. Hearing impairment was noted in 30.6% of the patients on pure tone audiometric assessment of which 26.5% were sensorineural. The correlation between O.R.L./head and neck manifestation and the CDC classification of HIV/AIDS infection did not reveal a definite pattern.

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The paper presents patterns of medical admissions into the intensive care unit of the Lagos University Teaching Hospital (LUTH) over an eight-year period from September 1990 to August 1998. Medical admission constituted 15% out of which 1% received surgery for medical complications. Patients with neurological diseases recorded the highest number of admission most of them being for tetanus. The commonest indication for admission was for respiratory insufficiency (33%). All the patients admitted for sub arachnoid haemorrhage, fulminant hepatitis, meningitis and motor neurone disease died. The least mortality was found amongst patients admitted for tetanus who constituted about 44% of the total number of medical admissions. The overall mortality rate was 69% and it was observed that the ages of the patients did not appear to affect the outcome except in patients who were admitted for myocardial infarction and cardiogenic shock. This study emphasizes the need to evolve a system of health evaluation of predicting the survival index of individual patients. There is an urgent need for proper training, motivation of staff and maintenance of equipment used in the ICU.

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Diabetic nephropathy is a common cause of end-stage renal disease. Microalbuminuria, a predictor of diabetic nephropathy, was screened for in newly diagnosed diabetics with the objectives of finding its prevalence and factors associated with its development. The Micral-Test strip was used to screen for microalbuminuria in 66 newly diagnosed diabetics (21 Type 1, 45 Type 2) and 36 non-diabetic controls. Microalbuminuria was present in 50% of diabetics and 8% of controls. Compared with the control group, diabetics had a higher prevalence of smoking, significantly higher mean systolic and diastolic blood pressure and mean arterial pressure. Retinopathy was present in 23% of diabetics and was more frequently encountered in females. From multiple regression analysis smoking, systolic blood pressure, mean arterial pressure and retinopathy were significantly associated with microalbuminuria. In conclusion, microalbuminuria occurs commonly in newly diagnosed diabetics and its development is associated with elevated levels of systolic blood pressure, mean arterial pressure, retinopathy and smoking. Screening for this associated factors of diabetic nephropathy is recommended as a routine in all newly diagnosed diabetics.

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Erratum in Niger Postgrad Med J 2002 Sep;9(3):178-9. One of the contributory factors in the establishment of occlusion is the child's oral habits. A limited amount of information is available on oral habits of pre-school children especially on Nigerian pre-school children. With an increasing interest in the early recognition of mal-occlusion and a corresponding emphasis on preventive procedures, more information on pre-school children may prove to be useful. This study revealed the prevalence of oral habits among 563 Nigerian pre-school children aged 3-5 years at 13.14%: 6.74% for males, 6.4%for females. The acquired data were tested with chi-square(chi2). The results indicate significant gender difference for tongue thrusting/sucking only (P=0.01) using the fisher's exact test. The relationship between digital sucking habit and mal-occlusion was very significant (P<0.01).

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A 29 year old woman was referred from Jos University Teaching Hospital (J. U.TH.) with a provisional diagnosis of phaeochromocytoma. She had presented with recurrent headaches, palpitations, excessive sweating, dizziness, syncope and hypertension. She was treated with phenoxybenzamine and propranolol for six weeks before the drugs were discontinued. This followed conflicting results of investigations done. The return of persistent and severe symptoms led to recommencement of the drugs and surgical intervention after four weeks. A general anaesthetic technique was used. The surgery was complicated by intraoperative hypertension and hypotension. Phentolamine was used to manage intraoperative hypertension. Postoperative complications included shivering, fatigue and paralytic ileus. The report emphasizes the need to take clinical findings into consideration in interpreting results of investigations. It also illustrates the anaesthetic experience for excision of a phaeochromocytoma.

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A comprehensive management plan for cancer pain is yet to be formulated in the West African sub region despite the priority that the World Health Organisation (WHO) has devoted to the problem over the past decade. As a prerequisite to our cancer pain management curriculum development a structured questionnaire on cancer pain management practice was administered to 80 Fellows attending the Annual Scientific Conference of the West African College of Surgeons in 1996. They were asked how often they treated cancer patients, the causes of cancer pain, their methods of assessment and therapeutic measures and complications of management techniques. Forty-four fellows from Nigeria, Ghana, Liberia and Sierra Leone, all consultants and trainers, responded to the questionnaire. About 80% of them treated cancer patients all the time. Specific anti-cancer therapy such as surgery, chemotherapy and hormone therapy were available in the four countries but radiotherapy was only available in two centers in Nigeria. The respondents estimated that 70-90% of their patients had severe pain at presentation. Pain was thought by 52% of respondents to be due to cancer and its treatment while 47% thought it was due to cancer and the fear of dying. Pain assessment was mostly by the verbal rating scale, only 20% included psychological measurement in their schedules. Oral preparations of strong opioids were not available in most countries andfor severe pain, the parenteral route was employed. Only 18% knew about the 'by the clock' dosing schedule. The study revealed that the standard of practice of the respondents falls below accepted practice. There is thus an urgent need for the formal education of personnel involved in the care of these patients.

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A 35-year old man presented with fever, weight loss, drenching night sweats and symptoms of cardiac failure for three months. Examination revealed wasting, peripheral oedema, bilateral pleural effusion and constrictive pericarditis. A diagnosis of constrictive pericarditis with bilateral pleural effusion probably due to tuberculosis was made. Human immunodeficiency virus antibodies and six sputum for acidfast bacilli were negative. Electrocardiograph revealed low voltages globally and echocardiography showed global myocardial hypokinesia. He had pericardiectomy, pericardial and pleural histology was non-specific inflammatory reaction but myocardial histology showed granulomatous changes of tuberculous myocarditis. We suggest that in experienced hands myocardial biopsy could be useful in making the diagnosis.

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We have examined the effects of increasing doses of chloroquine (CQ), on transferrin secretion in primary cultures of immature rat Sertoli cells (SC) grown on a reconstituted basement membrane (Matrigel) in bicameral chambers. SC cells were seeded in serum-free defined medium at a density of 3 x 10(6) cells/0.64cm2/well on Matrigel covered Millicell-HA filters. CQ at concentrations ranging from 0.04-1.0 microM was added to the basal compartment of the bicameral system from day 7 of the culture. The formation of the tight junction was monitored by the measurement of the transepithelial resistance (TER) at 24 hr intervals using an impedance meter TER in untreated controls was 50 Ohms/cm2 on day 1, and increased progressively to 80 Ohms/cm2 by day 7 and plateaued until day 12. On the seventh day of culture, CQ was introduced into the basal chamber During the 4 days of the experiment, the secretion of transferrin decreased with time. Maximal transferrin secretion by SC was detected during the initial 2 day collection period. During the subsequent collection period, CQ (1 microM) decreased significantly transferrin secretion by SC, while 0.04 microM CQ did not affect transferrin secretion. The polarized secretion of transferrin in response to CQ was also studied. During both collection periods there was no significant difference between controls and 0.04 microM CQ cultures in the ratio of apical to basal transferrin secretion. In the 1 microM culture medium, CQ diminished significantly the ratio of apical to basal transferrin secretion. These observations demonstrate the heterogenous effects of lower doses of CQ on immature rat SC in cultures.

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