Background : Cancer of the cervix is the most common cancer of the female genital tract and accounts for about two hundred and fifty thousand deaths yearly most of which occur in the developing countries. It has assumed greater prominence with the decrease in deaths due to infective causes and the increase in the incidence of HIV/AIDS which is a predisposing factor. A significant drop in its incidence has been recorded in the developed countries as a result of intensive program of cervical screening. This study determines the level of awareness and uptake of cervical screening in Owerri, South Eastern part of Nigeria. Method : This is a cross sectional study in which self administered questionnaires returned by eight hundred and forty six respondents were analysed using simple percentages. Results : The level of awareness of cervical screening was 52.8 %( 447), while 7.1 %( 60) had ever done the test. The major sources of information about cervical smear were hospital /health facilities (31.3%) and friends (30.9%).The most common reasons given for not doing the test were lack of awareness 390(46.1%),no need for it 106( 12.5%) and fear of a bad result 98(11.6%). Conclusion : The level of awareness of cervical screening is low and worse still, is the level of uptake at the present level of uptake no significant impact will be made on the incidence of cervical cancer which needs to be reduced. A national cervical smear screening policy is advocated but in the interim, greater public education and the greater use of opportunistic screening by physicians should be vigorously pursued.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Background / Objectives : Expenditures due to irrational use of drugs have been a strain on the meagre health budgets of several developing countries and inappropriate prescribing has been identified in many health facilities in developing countries. This study examines the prescription pattern in a secondary health facility. Method : A descriptive cross-sectional survey was used in this study. Three hundred and three randomly selected prescriptions issued to patients attending out-patients' clinics in the facility over a period of three months were examined. Data obtained was analyzed using EPI-INFO 2000 computer software. Results : Mean number of drugs per prescription in the health facility is 3.99 ± 1.55. At least 4 drugs were prescribed in 61.6% of the prescriptions. Generic prescribing was generally low. Out of a total of 1219 drugs prescribed 511 (41.9%) were prescribed in generic names. Analgesics, antimalarials, antibiotics and antihypertensives accounted for 19.7%, 10.2%, 13.0% and 4.9% of the drugs prescribed respectively. Only 124 (40.9%) of the prescriptions had all drugs prescribed available in the health facility. Conclusion : This study found practice of polypharmacy prevalent as found in other studies in developing countries among prescribers and prescription in generic names is low. Regular orientation and re-orientation of prescribers on rational drug prescription and prescription in generic names in conformity with national drug policies is necessary.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Background : Despite the growing research interest in self-medication, little information has been available about its major determinants especially in developing countries. This informed the conduct of this study to determine the major factors that influence the pattern of self medication in a population of market women in Ifako-Ijaiye area of Lagos, Nigeria. Methods : Interviewer administered pretested semistructured questionnaire was used to collect data from 205 market women selected by multistage sampling technique. Results : The patent medicine dealers were the commonest source of information on medications (31.4%) and where they were obtained (52.2%). The exceptions were the educated (62.5%) respondents who obtained theirs from hospitals and pharmacies. Trade and generic names (61.1%) were common means of drug recognition especially among the educated respondents (P<.05). Education of the respondents was the major factor influencing the practice of self-medication though the pattern was descriptively associated with the marital status and educational level of the respondents (P<.05). Benefits of the practice includes in the order: curing of ailments (58.0%), saving time and money (32.0%) and independence of care (7.0%). Conclusion : Literacy and public health education were the major factors influencing the pattern of self-medication among market women. Recommendations on the role of education of market women, patent medicine dealers and the importance of community pharmacy were suggested.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Background : Intestinal parasites are very common in developing countries including Nigeria. There are diverse ways of their transmission; the study attempts to determine the level of intestinal parasitic contamination on vegetables sold in Jos. Methods : Sample of 200 each of Tomatoes (Lycopersium sativus), Letus (Loctus satival) Carrot (Davcus carota L) Cabbage (Brassica Denceal) and Green leafy vegetables were analyzed using standardized Centrifugal-floatation technique methods. Results : Of the 1250 samples of vegetables examined, 450 (36.0%) were positive for intestinal parasites, cabbage recorded the highest prevalence of 64% while tomatoes had the least prevalence of 20%. Conclusion : Vegetables in Jos are heavily contaminated with intestinal parasites and there is need for public enlightenment campaign on the danger of consuming inadequately washed and prepared vegetables.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Rhabdomyosarcoma is relatively seen in the pediatric age group with the head and neck region as the commonest site. To the best of our knowledge, few cases of laryngeal involvement in adult have been described in the literature. Biologically, rhabdomyosarcoma is different from squamous cell carcinoma, which is the commonest tumor of the larynx. A previously healthy non-smoker 77-year-old lady presented to the ENT outpatient with a six weeks history of intermittent alteration of voice quality. She had no history of sore throat, or any symptoms suggesting laryngo-pharyngeal reflux. Examination showed asymmetry of the left arytenoid cartilage and aryepiglottic fold. She subsequently had a direct laryngoscopy and biopsy. Histology and immunohistochemistry examination suggested the diagnosis of mesenchymal neoplasm. Following discussion at MDT she subsequently had a total laryngectomy. Histology confirmed a completely excised laryngeal rhabdomyosarcoma. Rhabdomyosarcoma of larynx in adult is a rare disease. Surgical treatment with or without adjuvant radiotherapy is currently the treatment of choice for this disease.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Background : Tuberculosis (TB) is an important cause of mortality and morbidity in human immunodeficiency virus (HIV) infection in Africa. The interaction between TB and HIV infections is reviewed. Methods : Literature on TB, HIV and their co-infection, especially in sub-Saharan Africa, including Nigeria, is reviewed. Results : Burden of TB is fueled by the HIV epidemic, and clinical presentation of TB may be atypical with co-infection. Recommendations on drugs and timing of antiretroviral therapy (ART) initiation are discussed. Use of cotrimoxazole prophylaxis (CPT) in co-infected patients reduces morbidity and mortality, while the principles of TB prevention in HIV infection can be summarized with the three I's: intensive TB case finding and surveillance, isoniazid preventive therapy (IPT) and infection-control measures; to these can be added a fourth 'I,' viz., instituting ART. Clinical complications like drug resistance, toxicity and drug interactions; and immune reconstitution inflammatory syndrome (IRIS) with CPT, IPT and ART are highlighted. Emergence of drug-resistant- and nosocomial- TB in HIV infection poses serious challenges and potential consequences in Africa, and appropriate measures are recommended. Conclusions : Many barriers exist for optimizing the care of the two diseases, but the aim should be strengthening capacities, collaborations, linkages and eventually integrating the services. Interventions for TB prevention in HIV infection should be widely implemented.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Background : To assess the level of parasite burden in a village community and the predisposing factors. Methods : Two hundred subjects each were recruited from three communities- Tyogbenda, Jato-Aka and Adikpo during an episode of free medical outreach. A simple random sampling method was adopted and a questionnaire was interviewer administered on relevant aspects of basic hygiene such as- sources of water supply, methods of domestic sewage disposal and frequency of hand washing. Stool samples were collected and tested and findings analysed using appropriate statistical methods, p values < 0.05 were considered significant. Results : The prevalence of intestinal parasites in Tyogbenda, Jato-Aka and Adikpo communities was found to be 71.5%, 65.5% and 40.5% respectively. Ascaris lumbricoides was the commonest parasite in the three centres (34.5%, 28.5% and 19.0% respectively for Tyogbenda, Jato-Aka and Adikpo communities). Other parasites identified were- Entamoeba histolytica, Entamoeba coli, Hookworm, Enterobius vermicularis, Strongyloides stercoralis, Schistosoma mansoni and Trichuris trichura. Multiple parasitic infestation was common in the communities where quality of water supply and methods of sewage disposal facilities were below standard. Conclusion : The prevalence of intestinal parasitism is still high in Nigerian rural communities. The present resolve by the federal ministry of water resources to supply potable water to all Nigerian rural communities should be sustained. Furthermore, a health education program should be properly constituted and integrated into the present primary health care policy for the country.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Background / objective : To document the premenstrual and menstrual symptoms of Muslim women, with a view to providing adequate and sensitive care. Methods : Two hundred Muslim women were interviewed at Ahmadu Bello University Teaching Hospital and Muslim Specialist Hospital, both in Zaria between August and October 2003. Results : Premenstrual symptoms were present in 23.8% of the women and breast pain was the commonest symptom (50%). Self-medication was practiced by those who needed medication for the premenstrual symptoms (29.8%). Premenstrual symptoms were significantly associated with lower parity (p = 0.02), previous (p = 0.03) and current (p = 0.01) contraceptive use and dysmenorrhoea (p = <0.001). Dysmenorrhoea was present in 36.4% and was significantly associated with lower age (p = 0.03), and lower parity (p = 0.01). Conclusions : Health care workers and the general public need to be aware of premenstrual symptoms and dysmenorrhoea in order to provide adequate care and support that is sensitive to Muslim women's needs. Health care providers should also be aware that premenstrual symptoms are more likely to coexist with dysmenorrhoea and provide therapies that can cater for both problems whenever possible.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

The use of fundal pressure to assist a woman in labor is a controversial procedure. Its benefits are yet to be scientifically confirmed and it is associated with complications such as perineal lacerations, uterine rupture and uterine inversion. A case is reported of a 28year old Gravida 5 Para 4 + 0 (3 Alive) who presented to Aminu Kano Teaching Hospital, (AKTH) Kano, Nigeria with uterine prolapse following fundal pressure done in the first stage of labor in a peripheral hospital. She was delivered by Cesarean section and the prolapse successfully reduced under general anesthesia. Health workers need education on the risks associated with fundal pressure. Alternative methods of aiding women in labor should be promoted.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Background : Seasonal variation in hospitalization for cardiovascular disease has been described in the temperate regions of the world as well as in Northern Nigeria. Increase admission rates during the cold seasons have been reported in these areas. No studies have been done in Southern Nigeria. This study is thus aimed at describing the seasonal variation in admissions for heart failure, uncontrolled hypertension and hypertension related-stroke in Southern Nigeria. Methods : Hospital records of patients admitted to the medical wards of the University of Uyo Hospital (UUTH) with heart failure of all causes, uncontrolled hypertension and hypertension&#8211; related stroke (Cerebrovascular accident) between January 1998 and December 2001 were used. Epi-Info 2002 software was used to analyze data. Results : Of the 3500 patients admitted during the study period 542 (15.3%) were on account of heart failure, uncontrolled hypertension and hypertension related cerebrovascular accident (CVA). The mean age of patients was 52±12.8 years. The average monthly admission was eleven (11). More admissions were recorded in the rainy (cold) season than in the dry (hot) season. The observed difference was however statistically significant only for heart failure and uncontrolled hypertension (P<.05). Conclusion : Admissions for heart failure and uncontrolled hypertension are therefore more during the wet (cold) season in southern Nigeria. This may be attributed to the high default rate to follow up visit in this season when agricultural activity is intense and less attention given to medical care. This leads to poor compliance to medications and clinical deterioration. The already bad road network both in rural and urban centers also become worse at this time making access to medical care difficult. Facilities and measures should thus be put in place to provide adequate medical care for these patients during that period of the year.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Background : Tetanus remains one of the major public health hazards of the developing world. Previous studies in Nigeria indicate that mortality ranged from 26% to 60%. Mortality is much lower in the developed world because of the availability of facilities for intensive care of cases, unlike in most developing countries. Aim : To report our experience with the management of adult tetanus at the University of Port Harcourt Teaching Hospital over the past 10 years (1996-2005). Methods : Data of all patients aged 16 years and above managed for tetanus in the medical wards between January 1996 and December 2005 were retrieved from their case records and analyzed. Results : Eighty-six patients were managed for tetanus (50 males and 36 females), constituting about 1% of all medical admissions over the 10-year period. Students, civil servants and commercial motorcyclists formed the major groups at risk. The commonest portal of entry was lower limb injuries (54%). Case fatality rate (CFR) was 42.9%, with a statistically significant higher CFR found among patients above 40 years of age (P= .000), patients with incubation period shorter than 7 days (P= .04), those with a shorter duration of hospitalization (P= .000) and those administered higher average daily diazepam doses (P= .044). Complications such as aspiration pneumonitis, laryngospasm and respiratory failure were major causes of mortality. Conclusion : Case fatality rate of tetanus has remained consistently high at our center. Factors that were significantly associated with high mortality included older age, age above 40 years , incubation period of less than 7 days and higher degree of sedation with diazepam. It is recommended that preventive immunization against tetanus be given to all Nigerians with secondary vaccination at adulthood.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Objective: To look at the trends in maternal mortality in our institution over 5 years. Methods: Records of 112 maternal deaths were retrospectively reviewed to determine the trends and the likely direct cause of each death over the study period. Results: There were a total of 112 maternal deaths, while 3931 deliveries were conducted over the 5-year period. The maternal mortality ratio (MMR) was 2849/100,000 deliveries. The highest MMR of 6234/100,000 was observed in 2003, with remarkable decline to 1837/100,000 in 2007. Eclampsia consistently remained the leading cause, accounting for 46.4% of the maternal deaths, followed by sepsis and postpartum hemorrhage (PPH) contributing 17% and 14.3%, respectively. There were no statistically significant differences in the corresponding percentages of maternal deaths between various age groups (χ²=6.68; P =0.083). Grandmultiparas accounted for a significant proportion of maternal deaths as compared to low parity, with χ²=10.43; P =0.00054. Lack of seeking antenatal care (unbooked) and illiteracy were observed to be significant determinants of maternal mortality (χ²=64.69, P =0.00000; and χ²=18.52, P =0.0000168, respectively). Conclusion: In spite of decrease in the maternal mortality ratio over the years, it still remains high, with eclampsia persistently contributing most significantly. Community enlightenment on the need to avail of antenatal care and hospital delivery services, and improvement in the quality of skilled maternity care will, among other factors, drastically curtail these preventable causes of maternal death and reduce MMR.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Background / Objective : To determine the pattern of eclampsia and its contribution to maternal mortality at the Federal Medical Centre, Birnin Kudu, Jigawa State in Northern Nigeria. Method : A 4-year retrospective review of the case records of all women who presented with eclampsia at the center. All the case records were retrieved from the medical record department and analyzed. Results : There were 207 cases of eclampsia out of 2197 deliveries during the period giving an incidence of 9.42%. 171(82.6%) of the patients were unbooked. Majority (58.5%) of the patients were aged less than 20 years. The highest frequency (78.3%) was recorded in the primigravida. Delay before reaching the hospital was established in 116(56%) of patients. The condition was antepartum in 68(32.9%), intrapartum in 112(54.1%) and postpartum in 27(13%). 107(51.7%) of the patients were delivered by cesarean section. Twenty two (10.6%) of the mothers died. Eclampsia was the commonest cause of maternal mortality and contributed 43.1% of all maternal deaths. 180(87%) of the babies were delivered alive while 27(13%) died. Conclusion : Eclampsia is a major cause of maternal mortality. There is need for health education on the need for patients to avail themselves of antenatal care.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Background : Dermatofibrosarcoma protuberance (DFSP) is a relatively uncommon soft tissue neoplasm with intermediate to low grade malignancy, rarely metastasizing to regional lymph node or distant site but with proclivity for local recurrence due to inadequate resection. Methods : We evaluated the clinical histories and treatment outcomes of five consecutive patients who had histologic diagnosis of DFSP in the University of Calabar Teaching Hospital between 2000 and 2004. Results :The five cases reported had histologic diagnosis, sought for after excision. The male: female ratio was 2:3 with an age range of 17-35 years (mean, 26.6 years). Two of the lesions involved the neck and the other three sites involved were the anterior chest wall, groin and proximal thigh. Three of the lesions were recurrent. Conclusion : DFSP is an uncommon tumour, painless, cutaneous and multilobulated lesions should arouse the suspicion of this tumour. Early presentation, pre-operative histologic diagnosis and postoperative evaluation of resection margins would enhance the goal of ensuring adequate excision for improved outcome.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Background : Ophthalmic involvement in lymphoma is a relatively rare condition that can result from a primary intraocular lymphoma or an intraocular manifestation of systemic lymphoma. This report reviews the ophthalmic manifestations of lymphoma. Methods : Review of relevant information from journal articles and Internet search. Results : Almost all the structures in the orbit, adnexiae and eye can be involved in lymphoma. Lymphoma of the eye and adnexiae are most frequently of B lineage. Most of the ocular manifestations frequently masquerade as other more benign intraocular conditions including allergic or infectious conjunctivitis, uveitis, multiple evanescent white dot syndrome, acute retinal necrosis or herpetic retinitis. Correct diagnosis thus depends on a high index of suspicion and frequently requires radiologic imaging, histologic analysis, particularly vitreous biopsy or flow cytometry, subretinal aspiration and retinal biopsy. Diagnosis is often delayed and may lead to a fatal outcome. Recognition of its modes of presentation facilitates early diagnosis and treatment that may improve prognosis. Conclusions : It is important to review the ocular manifestations of lymphoma to assist the ophthalmologist to play a pivotal role in the prompt diagnosis and treatment of ocular lymphoma, and the haematologist/oncologist to recognize the need for a complete ophthalmic evaluation in the diagnosis, follow-up and management of lymphoma patients.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Background: Use of modern contraceptive methods has been shown to reduce unwanted pregnancy, high parity and maternal mortality. Intrauterine contraceptive devices which are among the safest and most effective reversible contraceptives available, are particularly suitable for women in developing countries as they are affordable, convenient to use, do not require re-supply visits and are very cost-effective. The aim of this study is to determine the socio-demographic characteristics of intrauterine contraceptive device acceptors, the pattern of insertions and complications at the University of Uyo Teaching hospital, Uyo. Method: The record cards of all clients who had intrauterine contraceptive device inserted at the family planning clinic over a six-year period were reviewed. Results: During the study period, there were 852 new contraceptive acceptors out of which 39.7% accepted the intrauterine contraceptive device. The modal age group of the clients was 25-29 years (32.5%). Acceptance of intrauterine contraceptive device was most common among multiparous clients (65.1%). Majority of the acceptors were married (90.0%), Christians (98.8%) and 72.8% had at least secondary school education. Clinic personnel (65.7%) and friends/relatives (21.3%) were the most common sources of information on contraception. Most (93.5%) of the clients had their intrauterine contraceptive devices inserted within 7 days of menstruation. Lower abdominal pain (5.5%) and vulval/vaginal itching (5.3%) were the most common complications. Conclusion: The acceptors of intrauterine contraceptive devices in our center were young, multiparous and educated women. Increasing mass media involvement in the dissemination of accurate information about intrauterine contraceptive devices to the general populace, the introduction of postpartum and post-abortal intrauterine contraceptive device insertions and the encouragement of our grandmultiparous women to accept intrauterine contraceptive device would lead to an increase in its acceptance and use.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Background : Pre-eclampsia and eclampsia are important causes of maternal and perinatal morbidity and mortality in the developing countries. There is need to provide the most effective management to pre-eclamptic and eclamptic patients. There is now evidence that magnesium sulphate is the most effective anticonvulsant. Method : In this article , a literature review was made on the contribution of pre-eclampsia and eclampsia to maternal mortality and how it can be curtailed by the use of magnesium sulphate. Results : The drug is administered by the Pritchard or Zuspan regimen, although modifications in the two protocols have been reported. Conclusion : A Nigerian national protocol has been developed on its use. There is need for further training of health workers on how to use this important drug.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Objective : To determine the incidence of maternal mortality associated with eclampsia and to determine how socio-demographic and clinical characteristics of the women influence the deaths. Methodology : Records of 52 eclampsia-related mortalities from January 2003 to December 2007 were reviewed, retrospectively. Their social demography, mode and place of delivery, time of eclampsia, and fetal outcome were extracted for analysis. Results : Eclampsia accounted for 52 (46.4%) of the 112 total maternal deaths recorded within the 5-year period, with case fatality of 22.33%. Age group <20, 20-29 and above 30 all had similar case fatality rate of 22.1%, 23.8% and 26.7%, respectively. Those who were experiencing their first deliveries have the worst deaths recording 42.5% of the case fatality in that category. As expected, unbooked had higher case fatality of 24.0% compared to 15% among booked cases, while those with no formal education also had more death (22.3% case fatality) as compared to 3.3% among those who had some form of formal education. Antepartum eclampsia was the cause in 50% of the death, 11(21.2%) of the pregnancies were not delivered before their death, while 18 (34.6%) were stillbirth. Conclusion : Eclampsia still remains the major cause of maternal mortality in this region resulting from unsupervised pregnancies and deliveries. There is need to educate and encourage the general public for antenatal care and hospital delivery.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Aim: With increasing urbanization of lifestyle, cardiovascular morbidity and mortality have been on the increase in Africans. Studies on cardiovascular risk factors in rural communities in South East Nigeria are scarce. This study focused on hypertension and obesity in adult Nigerians dwelling in a rural setting in Eastern Nigeria. Materials and Methods: A total of 218 participants from the rural community were recruited into the study. A questionnaire was used to assess prior knowledge of their weight and blood pressure status as well as drug history for those found to have hypertension. Each participant's blood pressure was measured and any value ≥140/90 mmHg was regarded as high blood pressure (HBP). Their heights and weights were measured and their body mass indices (BMI) calculated using the standard formula of BMI = Weight in Kg/Height in m ² ; BMI ≥30 Kg/m ² was referred to as global obesity. Their waist circumferences (WC) were also measured and any value ≥102 cm for males and ≥88 cm for females was regarded as abdominal obesity. Results: The general prevalence of HBP in the rural community was 44.5%. The prevalence of HBP increased as age increased and awareness about HBP was low (15.2%). Females were more aware than the males. The prevalence of HBP was higher in males (49.3%) compared with their female counterparts (42.3%), whereas the females had a higher prevalence of all forms of obesity (abdominal: 36.2%, global: 14.8%) compared with the males (abdominal: 14.5%, global: 10.1%). Higher BMI was associated with higher systolic and diastolic BP values. Hypertensive participants had higher BMI and WC than those who had normal BP. Conclusion: The prevalence of both hypertension and obesity seems to be increasing in rural communities in Nigeria and thus, the available prevalence documented in previous studies for rural communities may no longer represent the current trend. Awareness of the participants about these major cardiovascular risk factors is still very low. Higher BMI was associated with higher values of both systolic and diastolic BP.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Background : Chronic kidney disease is an important component of chronic non&#8211; communicable diseases that are now of pandemic proportions and are the major cause of morbidity and mortality worldwide. Patients with reduced renal function represent a population not only at risk for progression of kidney disease and development of end stage renal disease (ESRD), but also at a greater risk of cardiovascular disease and mortality. Unfortunately, chronic kidney disease is under diagnosed and undetected resulting in lost opportunities for improving the clinical outcome. Early diagnosis with appropriate interventions will improve the quality of care of patients and prevent or delay progression to end stage renal disease. Our objective is to review existing recommendations and examine their adaptation to improving the quality of care for patients with chronic kidney disease in our environment. Method : Hand searches of published articles and electronic data were the primary sources. Only articles published in the English language were consulted excluding case reports, letters and conference abstracts. Articles of original data were searched from 1980 while review articles and expert committee reports were from 2000. Results : Early diagnosis of chronic kidney disease is crucial to improving the clinical outcome and reducing the incidence of end stage renal disease. Certain individuals with specific socio demographic and clinical factors are at increased risk of chronic renal disease. All individuals should be assessed as part of routine health encounter, to determine whether they are at increased risk of developing chronic kidney disease based on clinical and socio demographic factors. Individuals at increased risk of developing chronic kidney disease should undergo testing for markers of kidney damage, and to estimate the level of GFR.Individuals found to have chronic kidney disease should be evaluated and treated appropriately. A clinical action plan should be developed for each patient based on the type and stage of renal disease, co-morbid conditions, complications of the disease and risk factors for progression of renal disease or development of cardiovascular disease. Conclusion : Individuals at increased risk, but found not to have chronic kidney disease, should be advised to follow of risk factor reduction, if appropriate, and undergo repeat periodic evaluation.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Transverse facial clefts are rare deformities, these mostly occur as part of syndromes such as facial dysostosis and branchial arch syndrome. This is a report of a case of isolated, asyndromic bilateral facial cleft seen at a semi-urban specialist hospital. Congenital facial defects remain sources of mental and social stress to the families. Infanticide, perhaps a thing of the past in the developed world may still be practiced in cases of congenital deformities in the developing countries, hence the need for early involvement of social workers and clinical psychologist in management.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Background: Malaria accounts for 1 million deaths among children under five annually. It has been shown that improving home treatment and preventing delays in seeking treatment, by teaching women to respond promptly when their children have fever, can decrease malaria related complications and mortality. This study looks at the impact of health education on knowledge of malaria: its recognition, treatment and prevention among caregivers of children under five in Jengre, North Central Nigeria. Methods: The study was a community based intervention study conducted in three stages: A pre- intervention stage, where 150 caregivers, were selected through a multistage sampling technique from the households containing children under five. Information for the baseline was collected through an interviewer administered semi-structured questionnaire. The intervention consisted of a series of health education sessions designed based on findings from the pre-intervention stage. The post-intervention impact assessment was conducted using a modified version of the questionnaire used in the pre intervention stage. Results: Malaria was recognized as one of the diseases that cause fever in community by all the respondents. Sixty-one (40.6%) had adequate knowledge concerning malaria causation, transmission, prevention and treatment. Twenty eight (56%) of respondents reported Self-treatment. There was a statistically significant relationship between years of formal education and first line treatment option (P=.012). Thirty-four (68%) mothers acted within eight hours of onset of fever. The intervention had an effect on perception (P<.001), knowledge (P<.001), malaria prevention practice (P=.001), first line treatment option (P=.031) and the type of treatment given to the children with fever (P=.048). Conclusion: Health education impacted positively caregivers' knowledge of malaria and their willingness to access antimalarial treatment when their children have fever. Malaria information should be made available to caregivers visiting child welfare clinics. Caregivers should also be integrated into malaria control activities at community level.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

A 10-year-old girl presented with an episode of seizure following osteomyelitis of the frontal bone and subperiosteal abscess due to frontal sinusitis. CT scan confirmed osteomeyelitis of the frontal bone and subperiosteal abscess. At surgery, the subperiosteal abscess and contiguous subdural abscess was drained and sequestrectomy of the affected frontal bone done. Broad spectrum antibiotics and anticonvulsant were given for 4 weeks. The patient recovered without residual problems and has remained well at 5 years of follow up. Pott's puffy tumor is now relatively uncommon and associated seizure is unusual. Early diagnosis and prompt treatment is necessary to avoid severe neurological complications and sequelae.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Background: Achalasia is an infrequent primary motility disorder of the esophagus. Because of uncertain etiology, treatment is only palliative and is directed at decreasing lower esophageal sphincter pressure, improving esophageal emptying and relieving the symptoms of achalasia. Current treatment options include pharmacological, endoscopic and surgical. We undertook a systematic literature review of the management strategies currently available for achalasia. Method: A Medline, PubMed and Cochrane database search was conducted using reference manager 11. Original articles and reviews published in the English literature on the management of achalasia were reviewed. Emphasis was placed on articles published in the last ten years on randomized controlled trials comparing the various forms of treatment. Results: Esophageal manometry is the standard diagnostic evaluation for achalasia. Accurate diagnosis can also be made based on clinical findings and barium esophagogram. Medical treatment with nitrates or calcium channel blockers has variable results in alleviating the symptoms of achalasia but long-term results are disappointing because of tolerance and side effects. Intrasphincteric injection of botulinum toxin, pneumatic dilatation and surgical myotomy are variably effective at controlling the symptoms of achalasia but each modality has specific strength and weaknesses which make their choice suitable in a particular group of patients. While pneumatic dilatation is superior to botulinum toxin injection surgical myotomy provides the best long-term control of symptoms in patients with achalasia. Conclusion: Laparoscopic myotomy should be the initial treatment for most patients with achalasia. Pneumatic dilatation is the most cost-effective alternative but its long-term efficacy is less than that of surgical myotomy. Endoscopic botulinum toxin injection can be considered when other forms of treatment are contraindicated.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

An up-to-date review on human paragonimiasis in Africa was carried out to determine the current geographical distribution of human cases and analyze the animal reservoir, snails and crustaceans which intervene in the local life cycle of Paragonimus species. Two countries, i.e., Cameroon and Nigeria, were mainly affected by this disease, while the distribution of human cases in the other eight states of the intertropical zone was scattered. Infected patients were currently few in number and two Paragonimus species: P. africanus and P. uterobilateralis, were found. The animal reservoir is mainly constituted by crab-eating mammals. The identity of the host snail remains doubtful and was either a prosobranch, or a land snail. Seven crab species belonging to Callinectes, Liberonautes and Sudanonautes genera are able to harbour paragonimid metacercariae. Due to the current low prevalence of human paragonimiasis recorded in Africa and the high cost of wide-scale screenings for this disease, training of technicians in anti-tuberculosis centers would be the most realistic attitude to detect mycobacteria and/or Paragonimus eggs during the same sputum examination.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]