One thousand, one hundred and thirty-five pupils were examined for CSOM in a rural community of Kwara State of Nigeria. The prevalence of CSOM was 73 per 1000 pupils. The highest is seen among the age group of 2-5 years. Unilateral disease was most prevalent (79.5%); 99% of the pupils had tubotympanic disease. Active disease was observed in 27.7% of the cases of CSOM.

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To evaluate the attitudes of primary care physicians to psychiatric referral using a structured questionnaire. Cross-sectional survey of the attitude of 126 (105m, 2lf) consenting doctors working in randomly selected health institutions offering primary care services in Lagos using a structured questionnaire was conducted. Non-recognition of the extent of psychiatric morbidity among patients, stigma, effect of psychiatric referral on self-esteem of patients, not being sure of how rewarding such referral could be, and difficulty in securing psychiatric services seem to affect the referral decisions of most physicians. Equal proportions of physicians (44.4%) agree or disagree with the statement "doctors need to be very careful in referring patients to psychiatrists". Addressing doctors attitudinal dispositions may be a useful step in the design of intervention measures aimed at improving the outcome of psychiatric morbidity presenting in primary care.

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This study seeks to examine the effects of vitamin C supplementation or/and warmth on forearm blood flow (FBF) and forearm vascular resistance (FVR) in sickle cell anaemia (SCA) subjects in the steady state. Sixteen (16) SCA subjects of both sexes (mean age, 23.4+/-1.5 yrs.) were studied. Blood pressure (BP, mm Hg) and FBF (ml/min) measurements were made at rest, with warmth stimulation, after vitamin C supplementation for 6 weeks at 300 mg per day and with warmth stimulation after vitamin C supplementation. Warmth stimulation was induced by immersing the left foot in a bowl of water at a temperature of 40 degrees C for 2 minutes. Forearm blood flow (FBF) [corrected] was measured by means of a forearm plethysmograph. Forearm vascular resistance (FVR, arbitrary units) was calculated by dividing mean arterial pressure (MAP) with FBF. Warmth stimulation at 40 C significantly decreased systolic blood pressure (SBP) (p<0.05), diastolic blood pressure (DBP) (p<0.01), MAP (p<0.01) and FVR (p<0.01) but significantly increased FBF (p<0.01). Vitamin C supplementation also significantly reduced SBP (p<0.001), DBP (p<0.01), MAP (p<0.01) and FVR (p<0.05) but significantly increased FBF (p<0.01). After vitamin C supplementation, warmth stimulation potentiated the reduction in SBP (p<0.001), DBP (p<0.01), FVR (p <0.01) and increase in FBF (p<0.01). In conclusion, warmth stimulation at 40 [corrected] degrees C or vitamin C supplementation caused a decrease in arterial blood pressure, forearm vascular resistance and increase in forearm blood flow in sickle cell anaemia subjects. Pretreatment with vitamin C enhanced the vasodilator effect of warmth.

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This study was undertaken to: (i) determine the prevalence, pattern and outcome of systemic complications of acute glomerulonephritis (AGN), and (ii) evaluate some clinicolaboratory features of the disease in Nigerian children. Clinical and laboratory records of consecutive cases of AGN seen over a period of 3 years in our unit, were prospectively entered into nephrology record forms and later analysed. Some of the analysed data included age, sex, blood pressure, types of systemic complication, haematocrit, plasma electrolytes, urea, creatinine, protein and albumin. Fractional excretion of filtered sodium (FeNa, %) and 24-hours urinary protein concentration data were also analysed. Majority of the patients (18/29) were under 6 years of age, with peak age incidence of 3 years. The hospital incidence of AGN and prevalence of systemic complications were 10 new cases per year and 41.38%, respectively. Heart failure (HF) and acute renal failure (ARF) were sole systemic complications in 7 and 2 AGN patients, respectively. Three patients had double systemic complications: one each of hypertensive encephalopathy (HTE)+HF, HTE+ARF and ARF+HF. Ten of 29 patients (34.48%) had nephrotic range proteinuria. None of the AGN patients except those with ARF had FeNa >1%, plasma bicarbonate <15 mmol/l, urea 225 mmol/l and creatinine 2400 mmol/l. Two of the patients died: one each of ARF and ARF+HF, giving a case fatality and mortality rate of 6.90% and 0.08%, respectively. ARF is clearly the principal risk factor for mortality in our AGN patients. Its early detection and aggressive but purposive management which must include dialysis, will certainly improve outcome in AGN cases complicated by ARF.

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All the isolates of Neisseria gonorrhoeae from patients that attended special treatment Clinic, University College Hospital, Ibadan, Nigeria between 15th January 1997 and 15th December 1999 were studied so as to review the present prevalence rate of penicillinase producing Neisseria gonorrhoeae (PPNG) in Ibadan. Of the 214 patients that had gonococcal infections, 161 were male (75.2%) and 53 (24.8%) were female. Ninety-two (57.1%) of the male and 28(52.8%) of the female were aged between 20- 29 years while 19.9% of the male and 15.1 % of the female were in the age of 40 and above. The sex difference is not statistically significant (chi2=2.19, df=3, p=0.53). The present study revealed that PPNG strains have increased dramatically to 98.6 per cent. This has posed a great threat to the usefulness of penicillin and ampicillin as the drugs of choice in gonococcal therapy in Nigeria.

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Cryptosporidium is the most frequently implicated organism in human immunodeficiency virus (HIV)-related diarrhoea worldwide. Because of the increasing incidence and prevalence of HIV infection in Nigeria and the associated increase in the number of patients presenting with chronic diarrhoea, it has become necessary to determine the prevalence of this organism in HIV-infected patients in Enugu, South Eastern Nigeria. One hundred and eighty nine (189) adult patients with chronic diarrhoea admitted to the University of Nigeria Teaching Hospital (UNTH) Enugu from August 1996 to October 1997 were further evaluated by serological testing for HIV infection. Their stool specimens were examined by light microscopy after staining by a modified cold Ziehl-Neelsen (ZN) method. Out of the 189 patients (117 males and 72 females), 161 had HIV infection (85.19%) whereas 28 (14.81%) were HIV-negative. Neither the HIV-infected nor the HIV-negative patients had cryptosporidium oocysts or any other acid-fast organism in stool. Intestinal cryptosporidiosis is not common in HIV-infected patients with chronic diarrhoea in Enugu. More studies are needed to further confirm this trend.

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Having been developed in a foreign culture, the extent to which items on the Hamilton Depression Rating Scale (HDRS) and the Zung Self-Rating Scale (ZS) reflect the features of depression as obtained in clinical interviews in Nigeria is uncertain. Also, items predictive capabilities for the severity of depression and the extent of concurrence between the two scales in assessing depression need to be ascertained. Seventy- eight patients who met the ICD 10 criteria for major depressive disorder completed the ZS and had the HDRS completed on them. These patients, (in addition to six others) had their case records examined and their symptoms of depression extracted. The predictive values of each item on the scales to the overall severity of depression, the intra-scale and inter-scale items correlations were calculated. Sleeplessness, somatic symptoms and sad mood were the commonest symptoms reported by patients with major depressive disorder. The Zung Scale showed that joylessness, lack of clarity of the mind, and difficulty taking decisions were also very common. The HDRS had better access to somatic symptoms than the Zung Scale, although items on the Zung Scale generally had better predictive value of the overall severity of depression than items on the HDRS. The HDRS had a moderate inter-scale correlation (r=0.43) relative to the Zung Scale, but only three equivalent items (depressed mood, suicide and impaired appetite) on the two scales had moderate and significant correlations. The HDRS and the ZS are very useful rating scales in depression but some modifications and additions will make them more applicable.

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This study assessed the effect of school-based health education on the practice of personal hygiene by children in primary schools in Anambra State, Nigeria. Three hundred and ninety-five (395) and three hundred and ninety-eight (398) primary school pupils randomly recruited as intervention and control groups were rated on five key personal hygiene practices before, immediately after and three months after school-based hygiene health education. Less than 45% were rated clean before health education in both groups. Immediately after health education, more than 65% in the intervention group were rated clean. There was no change in the control group. The difference was statistically significant. However, there was a statistically insignificant decline in those rated clean three months after cessation of health education. The school-based health education improved the personal hygiene practice of the pupils. There is a need for regular reinforcement to sustain the gains.

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The purpose of this report is to highlight the association of behavioural disorder as a tell tale sign of frontal cerebral tumor. A case study of a 27 year old female presenting with a 10 month history of behavioural disorder, associated with gradual to complete loss of vision. The case underlines the significance of behavioural changes as an early sign of intracranial tumor, and the need for early diagnosis with CT scan, irrespective of cost and or adversities.

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Experiments were conducted to investigate the abortifacient potential of aqueous extract of Carica papaya (Linn) seeds in female Sprague-Dawley rats. Oral doses of 100 and 800 mg/kg body weight were administered once a day on days 1-10 post-coitum. No significant differences in total body weight were found in foetuses exposed to these regimes. However, in the group treated with 100 mg/kg body weight, there was a significant increase (p < 0.05) in the implantation sites and foetal weight was significantly decreased (p < 0.05) compared to the controls. No dead or malformed foetuses were found. However, in the group treated with 800 mg/kg body weight, there was obvious vaginal bleeding but no treatment related increase in implantation sites compared with control. There was however, complete resorption of about 30% of the foetuses. The surviving foetuses were stunted when compared with the control but were without any external malformations. The results of the present investigations lead to the clear conclusion that low dose aqueous crude extract of Carica papaya (Linn) seeds does not adversely affect prenatal development. The altered toxicological profile indicates that the abortifacient property is a high dose side effect. The results indicate that Carica papaya toxicity can adversely affect the foetus.

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This is a case of a neonate with a large cervical mass and respiratory distress at birth. Radiological investigations revealed a predominantly solid mass with calcifications and multiple cysts, suggesting a teratoma. Patient died while being prepared for surgery and autopsy confirmed an immature teratoma. The clinical and pathological characteristics of paediatric cervical teratomas are discussed.

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Human immunodeficiency virus (HIV) infection and intestinal helminthiasis are common conditions in Nigeria. Chronic diarrhoea is a common manifestation of acquired immune deficiency syndrome ( AIDS). Helminths such as Strongyloides stercoralis and Trichuris trichiura may cause chronic diarrhoea especially in immunocompromised individuals. In order to determine whether any relationship exists between HIV infection and intestinal helminthiasis, stool samples from all HIV seropositive adults (with or without diarrhoea) admitted to the medical wards of the University of Nigeria Teaching Hospital, Enugu from August 1996 to October 1998 were examined microscopically for helminths. Out of 383 HIV-seropositive patients studied, 181 (47.26%) presented with chronic diarrhoea whereas 202 (52.74%) had no diarrhoea. The overall prevalence rate of gut helminths was 17.74%. The prevalence rate in the patients with chronic diarrhoea was 19.34% and that of those without chronic diarrhoea was 16.34%. The difference was not statistically significant. The helminths identified were Ascaris lumbricoides, Hookworm, Strongyloides stercoralis and Trichuris trichiura but there was no statistically significant difference in the two groups of patients. The study showed that there may be no clearcut relationship between gut helminths and HIV infection.

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A report of three cases of cervico-vaginal fistula (CVF) from induced abortions causing subsequent spontaneous mid-trimester abortions and a literature review is presented. Restrictive abortion laws, low contraceptive usage and increased sexual activity consequent upon adverse socio-economic conditions have led to an increase in the prevalence of illegal abortions in Nigeria over the previous two decades. CVF appears to be an emerging complication of such abortions. Cervical cerclage is preferred to trachelorrhaphy in the management of such cases. However, where vaginally performed cerclage does not succeed, the abdominal route should be used as a last resort. After a previous induced abortion, clinicians managing the subsequent pregnancy need to search carefully for cervico-vaginal fistula, which may compromise that particular pregnancy. Appropriate contraceptive use and safe abortions using modern methods in cases of contraceptive failure will prevent such horrendous complications of induced abortions in Nigeria and other developing countries.

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