Aims and Objectives: The study was set to detect Candida species in female genital discharge and validate the associated risk factors. Materials and Methods: A prospective study of female genital swabs collected from women with abnormal vaginal discharge (test group) and a control group who were attending gynaecology, family planning, antenatal care or HIV/STI clinics of Aminu Kano Teaching Hospital, Kano Nigeria and analysed for microscopy and culture in microbiology laboratory from December 2008 to December 2009. Data on epidemiologic indices were collected from the patients, using structured interviewer- administered questionnaires. Results: Candida species were detected in the test group in 60% (n=600/1000) cases of infective vaginal discharge while 12%(120/1000) in the control group . The isolation rate of Candida albicans was 69% more than the non- albicans. Distribution of vaginal candidiasis in the test group, was prevalent in young adults age group of 21 to 30 years with 50% (n=300/600), in patients with pregnancy 38% (n=225/600) and patients with chronically debilitating illnesses 26%(n=157/600). Conclusion: The result shows that vaginal candidiasis is quite common and Candida albicans is the most prevalent species. We therefore recommend early diagnosis and prompt treatment of vaginal candidiasis in all women clinics especially among the patients with chronic debilitating illness, pregnancy and young adults in order to avert the complications of vaginal candidiasis and reduce HIV transmission.

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Aims and Objectives: The objective of this study is to describe the ocular features of Marfan's Syndrome in Benin City, Nigeria and highlight problems associated with their management Materials and Methods : A study of all consecutive patients with a diagnosis of Marfan's syndrome at the eye clinic of the University of Benin Teaching Hospital, Benin City, Nigeria was done between June 1st 2009 and December 31st 2010. Results : There were 13 patients (8 males and 5 females). The age range was 10 to 50 years with a mean age of 23+ 10.1 years. The duration of symptoms was 1year to 22 years with a mean of 7.9 years. The ocular features were ectopia lentis in 92.3% of the patients, cataract in 69.2%, glaucoma and myopia in 30.8% each. Others were strabismus (7.7%), unilateral corneal opacities from the use of traditional eye medication (15.4%), phthisis bulbi and retinal detachment in 7.7% each. Three (23%) patients were bilaterally blind while 7(53.8%) had unilateral blindness. The best corrected visual acuity in 4 out of 5 patients who had cataract extraction at 8weeks post op. was 6/60 to 6/12. There was no improvement in 1 patient. Conclusion: Patients with Marfan's syndrome in Benin City, Nigeria have visual impairment and blindness due to delay in presentation and the use of traditional eye medications. Health education and early presentation to hospital is recommended. This will help in reducing avoidable visual impairment and blindness and thus improve survival and quality of life in these patients.

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Aims and objectives: This study explored relationship between post-stroke functional recovery and QoL among Nigeria SSv with first-ever stroke. Patients, materials and methods: This Study involved 65 (33 males and 32 females) individuals diagnosed of first-ever episode of stroke in the University College Hospital, Ibadan, Nigeria. The National Stroke Severity scale was used to assess their stroke sequeles. Their functional performance and QoL was assessed using the combination of the standard values of Barthel Index and Frenchay Activities Index, and the Stroke-Specific QoL questionnaire respectively. They were assessed at 14 days and fortnightly for 12 months post-stroke. Data were analysed using the Pearson's Moment Correlation and paired t-test at p = 0.05. Results: Fifty-five (84.61%) out of the 65 SSv completed this study while 10 (15.39%) died. Participants' age was 58.1±15.7 years with majority (90.6%) of them between 40 years and 79 years. Mean QoL score increased significantly at day 14-day through 6-month and non-significantly through 12-month post-stroke. Mean functional performance significantly increased from 3.2±2.1 at day 14 to 66.3±14.2 at 6-month but non-significantly from 6-month to 76.14±12.1 at 12month post-stroke. Their functional recovery had direct positive relationship with their QoL scores during the 12 months follow-up. Conclusion: Stroke has negative impact on both the functional performance and quality of life of stroke survivors. Quality of life of stroke survivors increases with improvement in functional recovery.

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Summary Aims and Objectives The Glasgow coma scale (GCS) form the basis for important management decisions by the attending physicians or other health personnel in the care of comatose patients. Inaccurate reporting may result in unnecessary treatment and diagnostic tests. The purpose of this study is to assess the knowledge of GCS among physicians in different specialties of training in a tertiary centre in Nigeria. Materials and Methods The study was a descriptive survey conducted among doctors at the University of Ilorin Teaching Hospital (UITH) Ilorin, in North Central Nigeria. Physicians from different specialties and all levels of training were surveyed. Questionnaires were administered simultaneously within a department without prior notification. Participants were instructed not to use any reference materials while completing the questionnaire. Results Majority of the physicians could indicate correctly what GCS stands for (97%) and identify each category correctly. However, only 37% could score all the categories correctly. There was a positive impact in theoretical knowledge and recall among respondents who has had training in GCS. The level of training of respondents correlated well with recall of GCS with Residents and interns faring better than fellows and medical officers. Recall of GCS scoring was least among Physicians in family medicine compared to physicians in other specialties. Conclusion Improved training with retention strategies in the use of the GCS and retraining of all physicians involved in the management of the comatose patients should be the focus of future strategic plans.

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Aims and objectives: To evaluate the effect of ageing on the level of antioxidants and lipid Peroxidationin healthy individual of various age groups. Subjects and methods: A total number of 162 healthy males and females volunteer between the ages of 18-80years were divided into three groups. These volunteers were divided into group i(18-30yr), group ii (31-60yrs) and group iii (60-80yr). Plasma concentration of total bilirubin, uric acid, ascorbic acid, á-tocopherol, retinol, total antioxidant status(TAS), malondialdehyde (MDA), glutathione (GSH) and ceruloplasmin measured. Erythrocyte antioxidantenzyme activities of superoxide dismutase(SOD), catalase(CAT), glutathione and peroxidase(GSH-Px) were measured using standard methods. Results: Erythrocyte antioxidant enzymes(GSH-Px and SOD) activities and GSH level were significantly reduced among group iii(p<0.01) and group ii (p<0.05) age group subjects compared to the younger age groupi. Conversely,MDA showed a significant increase in group iii (p<0.01) and group ii (p<0.01) compared to younger age group i. CAT activity and TAS level were reduced significantly (p<0.05) in both groups iii and ii compared to younger age group i.Ascorbic acid, á-tocopherol and retinol levels were significantly reduced among group iii (p<0.05) compared to group i. Conclusion: Ageing was associated with increased lipid peroxidation and lower antioxidant defenses. Changes that occur during ageing cannot be avoided but may be delayed and controlled to some extent. To counter these changes, dietary supplementation of a variety of antioxidants might be beneficial.

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Aims and Objectives: To evaluate the Clinico-pathologic Characteristics of Metastatic prostate cancer patients seen in the Radiotherapy and Oncology Department, Ahmadu Bello University Teaching Hospital, Nigeria. Materials and Methods : Between January 2006 and December 2009, a period of 4 years, 72 new patients with prostate cancers were seen of which 43 patients had distant metastases. Only patients with histologic confirmation of prostate cancer and having metastases were included in the study irrespective of age, co-morbidity and performance status. Patients' folders were reviewed retrospectively with a structured pro forma. Information retrieved from patient's folder included age, histology, Gleason score, co-morbidities, interval between diagnosis and referral to oncology unit, interval between referral and presentation at oncology unit, PSA at diagnosis and presentation at oncology unit, sites of metastases, bones sites involved in bone metastases, types of treatment received and follow up status. Results were analysed using Epi Info soft ware Version 3.4.1; 2007 Edition. Results : 43 patients had distant metastases from prostate cancer during initial evaluation at presentation in the radiotherapy and oncology centre. The mean age was 66.2 years (range, 47 – 82 years, median age 66 years and modal age group was 65 – 69 years). Co-morbidity was seen in 18 patients, with hypertension being the commonest (HT = 14, DM = 2 and HIV 2 patients). No morbidity seen in 25 patients. The range of duration from diagnosis to referral was 1 – 84 months. Only 20 patients presented at radiotherapy and oncology centre within 6 months of diagnosis and 18 patients presented after 12 months of diagnosis. 33 patients presented within 1 month of being referred for further management. 6 patients reported within 2 months and 2 patients within 3 months and another 2 patients within 4 months. Only 27 patients had PSA done at diagnosis. No PSA was done in 16 patients. The PSA range at diagnosis was 10.0 – 232 ng/ml, mean PSA was 67.46 ng/ml while only 40 patients did PSA on presentation for further management with a range of 1 – 245 ng/ml and a mean of 57.95 ng/ml. The histology report revealed adenocarcinoma and transitional carcinoma in 42 and 1 patients respectively. The Gleason score range was 6 – 10, with a mean score of 7.8. The Gleason score was not reported in 3 patients. Multiple organs involvement by metastases was seen in 16 patients. Bone metastases was the commonest (35), followed by lungs (8), liver (7), Virchow's lymph nodes (6), brain (5), and soft tissue (5). The lumbar vertebrae was the commonest site of bone metastases (32) followed by the sacrum (17), pelvis (11), and long bones (7). 3 patients had metastases to the ribs and 2 patients each to the skull, sternum and cervical spines. All the patients received hormonal therapy, 30 patients received palliative radiotherapy, 29 patients had surgical castration, 25 patients had radical radiotherapy to pelvis, 18 patients had systemic chemotherapy and definitive surgery was done in 16 patients. Only 6 patients received Ibandronate due to cost. 13 patients are alive and attending follow up, 11 confirmed dead and 19 lost to follow up. Conclusion : The patients were referred for management late after surgery. Bones, predominantly the lumbosacral spines was the commonest organ involved in metastases. Skeletal survey with bone scan and plain x-rays especially lumbosacral spines should be part of the staging investigation for all patients with advanced stage. There is need for more awareness on other treatment modalities emphasising the multidiscipline and multimodality management of prostate cancer.

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Aims and objectives: This study aimed at reviewing cases of myocardial infarction managed between January 2006 and June 2009. Materials and Methods: Records of all patients managed for acute MI during the period were studied. Diagnosis was based on presence of ischemic type of chest discomfort, serial electrocardiographic (ECG) changes compatible with MI, a rise in troponin I level and echocardiographic abnormalities. Results: Fourteen patients consisting of 13 (92.9%) males and 1 (7.1%) female had MI. They were all Nigerians, their ages ranged from 40 to 82 years with a mean of 55.6 ±12.7 years; and 85.7% of them belonged to social class 1. MI accounted for 0.21% of the total 6647 admissions during the period. Present hospital incidence (0.21%) is significantly higher (Chi2=6.8, p=0.01) than previously reported incidence of 0.075%. Twelve patients had systemic hypertension, 8 had high body mass index, 6 had dyslipidaemia, 5 smoked cigarette and 2 had diabetes mellitus. Three patients died giving a case fatality rate of 21.4% and another 3 developed chronic left ventricular systolic failure. Conclusion: Incidence of MI is increasing among hospital admissions in Ilorin and there is an urgent need for community interventions targeted at early detection and treatment of hypertension, diabetes mellitus, dyslipidaemia and obesity. Campaigns against cigarette smoking should be sustained.

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Objectives: To determine the prevalent age of symptomatic benign prostate hyperplasia (BPH), the average BPH volume, and the association between BPH volumes and the age, and anthropometrics in our immediate black community. Patients, Materials and Method: Selected patients with lower urinary tract symptoms (LUTS) due to BPH with tissue diagnosis, and adult men of similar age group with no irritative or obstructive LUTS were prospectively studied from July 2003 to June 2009. The age, height and weight were recorded, prostate volumes determined with ultrasound, body mass index (bmi) calculated, and correlations determined between the prostate volume and the age, and anthropometrics. Results: 105 patients aged 43-88yrs (mean=64.4, 8.88SD) managed for BPH were studied with 93 asymptomatic men aged 43-80yrs (mean=56.15, 9.89SD). The mean(SD) prostate volume, height, weight and bmi were 83.8(37.7)ml, 1.67(0.07)m, 63.6(9.32)kg and 22.8(3.03)kg/m2, and 24.5(9.2)ml, 1.69(0.06)m, 68.9(10.6)kg and 24.2(3.44)kg/m2 respectively for symptomatic and asymptomatic groups. In the symptomatic group, BPH volume showed significant positive correlation with the age (p=0.030), but no correlation with the weight (p=0.550), height (p=0.375) and bmi (p=0.840). In the asymptomatic group, prostate volume also showed significant positive correlation with the age (p=0.041), but no correlation with the weight (p=0.434), height (p= 0.394), and bmi (p=0.203). Conclusion: The prevalent age of symptomatic BPH in our community is 43- 88years with 83.79(37.66)ml mean(SD) volume in symptomatic patients and 24.45(9.21)ml in asymptomatic men. BPH volume correlates with age but not with anthropometrics. Lack of correlation with BPH volume suggests that anthropometrics may not be risk factors for development of BPH in our community.

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Chronic Kidney Disease (CKD) is defined as the presence of markers of kidney damage or of estimated glomerular filtration rate (eGFR) <60 mL • min^{– 1} • (1.73 m²) [<1 mL^{– 1} • (1.73 m²)¹ for three months or more. CKD is associated with poor outcomes and high cost, disproportionately affecting the elderly, the Black race and the middle aged in Nigeria. Thus, new public health campaigns focus on early detection of CKD. To facilitate early detection of CKD, many national and international organisations now recommend routine reporting of estimated glomerular filtration rate (eGFR) whenever serum creatinine is measured. The formulae/equations provide a quick estimate (eGFR) of the GFR without need for urine collection in clinical practice. Current guidelines advocate the use of prediction equations, such as the Cockcroft-Gault (CG) formula and the Modification of Diet in Renal Disease (MDRD) study-derived equations. Laboratories in African should commence routine reporting of eGFR for a number of reasons; ¹. The sensitivity of serum creatinine (Scr) in identifying CKD is low.². In Nigeria, a representative country; screening for Chronic Kidney Disease (CKD) is hardly considered in the routine practice of the primary and secondary care medical officers.³ Studies have shown that routine reporting of eGFR improved the documentation and identification of CKD by almost 50%.⁴ There is the possibility of reversing CKD if picked earlier.⁵. The high cost of treating CKD patients in advanced stages and the low per capital income status of the populace in Sub-Saharan Africa.⁶. Poor health infrastructure to manage advanced CKD patients in the continent.⁷. Several studies, now show lack of awareness of CKD among non-nephrologists that is related, at least in part, to difficulty in interpreting serum creatinine concentrations (the reciprocal, non-linear relationship between GFR and serum creatinine).⁸ Mathematical estimates of GFR [ as in eGFR] that incorporate creatinine concentration, as well as factors affecting creatinine production rates, such as size, gender, age and ethnic background, are more sensitive to changes in renal function than serum creatinine value alone.⁹ Recent guidelines define "action plans" for CKD according to the GFR, including referral to nephrologists at GFRs <30 mL • min^{– 1} • (1.73 m²).

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Aims and Objectives: The objective of this article is to report a case of unrecognised missed guide wire diagnosed two months after right internal jugular cannulation and which was successfully retrieved from the right femoral vein. Patient and Methods: The case record of a patient that had retained intravenous guide wire was reviewed with relevant literature. Result: A 40-yr-old female had an emergency left thoracotomy on account of haemorrhagic pleural effusion. A right internal jugular central venous catheter (CVC) insertion was performed for resuscitation and haemodynamic monitoring before induction of anaesthesia. A follow-up thoraco-abdominal Computed tomography (CT) scan taken after 8 weeks showed a pigtail intravascular metallic foreign body traversing the distal superior vena cava, right atrium, inferior vena cava, and ending at the right femoral vein. The guide wire was successfully removed via a right femoral venotomy under local anaesthesia. Conclusion: Intravascular loss of a guide wire is a rare complication of CVC insertion. If basic precautionary measures were taken, the loss of guide wire would have been avoided.

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Aims and Objectives: To present a case of skeletal metastasis from a gallbladder malignancy, a rare occurrence. Case report: A 75 year old Nigerian woman presented in the surgical outpatient clinic of the University of Port Harcourt Teaching Hospital with a two month history of right hypochondrial pain and three weeks swelling on the forehead. Physical examination revealed an ill looking, emaciated elderly woman in mild painful distress. She was pale, afebrile and anicteric. Skull x-ray revealed a well circumscribed soft tissue mass over a lytic bone defect in the frontal region. Abdominal ultrasound scan showed an enlarged gallbladder with a thickened wall and intraluminal echogenic mass, surrounding lymphadenopathy and intrahepatic metastasis. Radiological diagnosis of advanced gallbladder carcinoma with both local and distant metastases was made. Conclusion: Carcinoma of the gallbladder with skeletal metastasis is a rare finding. However, in any patient with gallbladder malignancy distant metastasis with skeletal involvement should be sought.

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Aims and Objectives: To determine the common aetiolog of acute bacterial meningitis in children and their antibiotic susceptibility pattern. Materials and Methods: A retrospective study with a review of cerebrospinal fluid culture reports of paediatric patients aged 0-15 years, suspected of acute meningitis in the Medical Microbiology Department of Aminu Kano Teaching Hospital, Kano, Nigeria from October 2006 to October 2009 from October 2006 to October 2009. Results: A positive culture bacterial isolation rate of 3.3% (n=50/1500) with prevalence of Streptococcus pneumoniae (24%), Neisseria meningitidis(22%), Escherichia coli(16%), Haemophilus influenzae (14%), Group B streptococci(8%) and Enterococci(8%) which were susceptible to ceftriaxone(96%), cefotaxime(95%) and ciprofloxacin(93%) across the bacterial isolates. Neonates were 55% (n=6.8/12.4) most at risk. Conclusion: Neonates are the most at risk of acute bacterial meningitis. In the absence of antibiotic susceptibility report, ceftriaxone should be considered as a first choice reliable antibiotic for empirical treatment of meningitis in children, in this environment.

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Aims and Objectives: To explore the concerns, experiences and satisfaction of women who had induction of labour at term. Materials and Methods: A cross-sectional study conducted in Nigeria, among 252 pregnant women who had induction of labour at term using a two part pre and post induction questionnaire. Results: Concerns expressed by the women prior to labour induction were the fear of caesarean delivery (16.6%), labour pains (15.1%) and an adverse foetal or maternal outcome (4.8%). Overall, 180 women (71.4%) expressed satisfaction with the induction process while 72 (28.6%) were dissatisfied. Comparatively, a higher mean age and shorter induction-delivery interval (470 ± 180 vs 660 ± 370, p<0.001) was significantly associated with maternal satisfaction with induced labour. It was also associated with significantly lower caesarean section rates (13.3% vs 61.1%, p=0.001) and composite maternal or foetal morbidities. The common reasons for dissatisfaction with induced labour included caesarean delivery (13.4%), painful labour (8.7%) while 2.4% felt the duration of the procedure was too long. Conclusion: This study suggests that a substantial number of pregnant women who had induction of labour had unsatisfactory experience. The reasons for dissatisfaction should be addressed by physicians in order to promote a positive psycho-emotional experience of pregnancy and childbirth.

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Aims and Objectives: The study was aimed at identifying the pattern of skeletal trauma in the paediatric age group as it relates to the causes. Materials and Methods: A retrospective analysis of the records on the request cards, case notes, radiographs and reports (where available) of all children aged one day to 15years who were referred to the radiology department of Olabisi Onabanjo University Teaching Hospital, Sagamu was carried out. Fractures were analysed with respect to sex, age, causes, type and location of fracture. Results: The analysis spanned a period of twenty-eight months during which a total of three hundred and twenty eight radiographs were analysed. The mean ages of male and female patients were 5.4΁4.6 and 5.1΁4.6 years, respectively, with a range of 0.2-15years. Normal radiographs were found in 124 (37.80%) patients, 53.1 (16.1%) had 55 fractures, and 39 (11.9%) had soft tissue swelling. Fractures were found most commonly in male children and in the age range 4-6 years. Fractures occur three times more in the upper limbs, and the bones most frequently affected are the humerus, radius, and the ulna in descending order. Most of the fractures were due to Road Traffic Injury (RTI) seen in 18.9%, falls seen in 18.9%, and birth trauma, which was responsible for 7.5%. The most frequently involved bone in fractures is the humerus followed by the femur bone. Skull fractures occur mostly in the parietal bone. Conclusions: Fractures are still mostly investigated with plain radiographs. Fractures are more frequent in male children and in the 4-6 year age range; it is seen more in the upper limb bones especially in the humerus. Skull fractures are relatively rare. Half of the fractures occur in the distal and mid portions of long bones. This study has also high lighted the importance of road traffic injury and falls as aetiological factors in fracture occurring in children. Effort should be made to ease deliveries in order to reduce the incidence of birth trauma.

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