Background: Hysteroscopic adhesiolysis is shown to significantly improve the outcome of intrauterine adhesions (IUA). The Minimally Invasive Surgical Unit (MISU) of our Department recently acquired a hysteroscope which is being used for hysteroscopic adhesiolysis among others. Materials and Methods: There were 57 patients diagnosed to have IUA of which 54 case notes were available for analysis, giving a retrieval rate of 95%. The information extracted includes age, parity, and menstrual pattern, predisposing factors, treatment option, outcome, complications and the year of the procedure. The data extracted were analyzed using Epi info Version 3.4.1. Chi squared test (Fisher's exact test) was used to test for statistical difference in the outcome of the modalities of treatment. P value of less than 0.05 was considered significant. Results: There were 57 cases of IUA out of 4160 gynecological patients seen, giving a prevalence of 14/1000. The mean age was 28.9 years (SD 4.5) and mean parity was 1.4 (SD 1.4). Etiologic factors include Dilatation and curettage (D and C) (33.3%), Caesarean section (C/S) (31.5%), manual removal of placenta and Pelvic Inflammatory Disease (PID) (7.4% each), and unexplained (3.7%). Mode of presentation was secondary amenorrhoea (50%), oligomenorrhoea (22.2%), and hypomenorrhoea (10%). As for the management, 68% had blind procedure while 25.9% had hysteroscopic procedure. Lippes loop was used in all except three patients who had pediatric Foleys catheter instead. Upon follow-up 59.3% resumed normal menses, 11.1% had oligomenorrhoea, hypomenorrhoea 13% and amenorrhoea 5.6%. There was no statistical difference in the outcome of treatment between hysteroscopic adhesiolysis and the blind procedure when return to normal menses is considered as the end point, OR=2.27, CI 0.45-12.65, Fisher exact test (one-tailed) P=0.2184818. Conclusion: There was no significant difference between the blind and hysteroscopic procedures. Dilatation and curettage was found to be the commonest cause of IUA.

Background/Objective: Many experts believe that commercial organ transplants continue unabated despite international efforts to curb them. The aim was to determine the trends, outcomes and challenges of commercial living unrelated renal transplants (LURT) as seen in our institution. Materials and Methods: A retrospective study of LURT patients on follow-up at our institution. The list of all LURT patients was obtained from our renal registry. Inclusion criteria for the study were 1) Presentation to our hospital within the first month post transplant; 2) Completion of one-year follow-up OR patient or allograft losses prior to completing one-year follow-up. SPSS 17.0 was used for data analysis. Results: Forty-five patients satisfied the entry criteria; 33 males and 12 females with age range 13-68 years, and mean ΁ SD of 40 + 15 years. The majority (28) of the transplants were carried out in Pakistan, the remaining in Egypt, Philippines, and China. There has been a steady decline in the number of new patients with commercial transplants over a four-year period. Complications encountered included infections in 19 (42.2%) patients, biopsy-proven acute rejections in nine patients (20%), surgical complications in 10 patients (22.2%), post-transplant diabetes in seven (15.6%), delayed graft function in one (2.2%), and chronic allograft nephropathy in one (2.2%) patient. Patient survival at one year was 97.8% and allograft survival was 88.9%. Conclusions: Commercial kidney transplant is on the decline as seen in our center, likely as a result of international efforts to curb it, as well as due to a parallel increase in renal transplants in the country. One-year patient and allograft survivals are good but there is a relatively high rate of infections.

Background: The aim of the study is to determine the pattern of retinopathy seen in diabetic patients attending the outpatient clinic in Aminu Kano Teaching Hospital, Kano, Nigeria. Materials and Methods: Consecutive patients who were attending the diabetic clinic and who consented were examined over a three-month period. Information obtained includes patient's bio data, type and duration of disease, and findings on eye examination. The fundus was examined with direct and indirect ophthalmoscopes, +90 D with slit lamp and fundal photography. Retinopathy was graded using the International Clinical Diabetic Retinopathy Disease Severity Scale (ICDRDSS). Results: A total of 214 patients were examined during the study period. There were 88 males and 126 females (M: F = 1: 1.43). The mean age of the study population was 52.14 ± 13.23 years. The mean age of patients without diabetic retinopathy (DR) was 49.14 ± 13.17 years and the mean age of patients with DR was 58.51 ± 10.94 years. Forty nine patients (23%) had insulin-dependent diabetes mellitus (IDDM) while 165 patients (77%) had non insulin dependent diabetes mellitus (NIDDM). There was statistically significant difference in presence of retinopathy in patients with IDDM compared to those with NIDDM [X² =29.77 {95% CI}, P=0.000]. DR was significantly more common in patients with disease duration of 15 years or more compared with those with disease duration of 14 years or less [X² = 65.85, {95% CI} P= 0.000]. Based on ICDRDSS scale, 136 patients (64%) had no retinopathy and 78 patients (36%) had retinopathy. Some patients were visually impaired and the cause of blindness was DR in 6 patients (2.8%). Cataract and glaucoma were the cause in 6 patients (2.8%). Conclusion: Diabetic retinopathy is common in our environment and is more frequent in IDDM and those with long disease duration. DR is a cause of visual disability although diabetic patients are not exempted from blindness from other eye diseases such as cataract and glaucoma. A screening program needs to be developed to facilitate early detection and prompt treatment.

Background: Community-based lid surgery for trachomatous trichiasis (TT) is provided in 8 local government areas (LGAs) of Sokoto state since 2003 as part of a trachoma control programme. This study aims to assess the impact of community-based lid surgery on the magnitude of TT in 3 LGAs of Sokoto state. Materials and Methods: A population-based survey was conducted in persons aged 15 years and above. A stratified multistage cluster sampling with probability proportional to size was used. Trachoma was assessed using the WHO simplified grading system. Results: Despite high (13%) refusals, 72% of the minimum sample size was examined. The prevalence of blindness ranged from 1.3% to 2.5% in the LGAs while the prevalence of TT in persons aged 15 years and above was 2% in the Silame, 2.7% in the Wamakko and 5.6% in the Kware LGAs, respectively. The prevalence of TT in females 15 years and above was 1.1% in the Silame, 4% in the Wamakko and 6.3% in the Kware LGAs, respectively. The trichiasis surgical coverage is 9.5% in the Kware and 12.5% in the other LGAs respectively. The minimum number of TT lid surgery required to achieve the elimination level is 873 in the Silame LGA, 2611 in the Wamakko LGA and 4672 in the Kware LGA. Conclusion: The burden of TT is high in the study communities while the trichiasis surgical coverage is low. There is a need to strengthen the control programme to meet up with existing need.

Background: Relationship between type 2 DM and cardiovascular disease (CVD) is well known, with CVD being the most common cause of mortality in diabetics. Significant myocardial injury before overt CVD in DM can be identified early using echocardiography. This study therefore aimed at evaluating left ventricular structure and function of patients with type 2 DM. Materials and Methods: One hundred and fifty adult type 2 DM patients were recruited with 150 age- and sex-matched controls. Patients and subjects with systemic hypertension, pregnancy, sickle cell disease and structural heart disease were excluded from the study. Participants were evaluated clinically; had anthropometric parameters and electrocardiogram taken. Echocardiograms were obtained according to the American Society of Echocardiography (ASE) recommendations. Results: Mean age of the patients (55.4±11.6 years) was similar to that of the control (54.2±9.6 years) (P=0.348) and the duration of DM was 4.53 years. Left ventricular (LV) systolic function was normal in both groups but was higher in patients than controls (ejection fraction=70.3±10.7% and 64.4 ± 9.4%, P =0.001 respectively). The prevalence of LV diastolic dysfunction (LVDD) was 72% in the patients compared with 6% in controls (P=0.001). Patients' age, body weight, duration of DM, LV mass index and left atrial dimension were positive correlates of LVDD while patients' age, weight and left atrial dimension were independent predictors of LVDD. Conclusion: There is high prevalence of alterations in LV structure and function in normotensive type 2 DM; and there is a need for early intervention to prevent overt LV dysfunction.

Background: Wire localization for planned surgical treatment in the management of breast cancer is underutilized in our environment. The objective of this study is to assess the role of ultrasound-guided wire localization of breast masses detected on screening mammography and its impact on biopsy and breast conservative surgery in our environment Materials and Methods: A prospective study of 189 women who presented for screening mammography following a health campaign on breast cancer within a six-month period. Wire localization for mammographic detected lesions was done under ultrasound guidance. The lesions excised were sent for specimen radiography and histology. Results: Ten women had wire localization of breast lesions and subsequent excision. Three lesions were on the right and 7 on the left; out of which 3 were malignant. The mean volume of excised tissue was 74.27±30.16 cm ³ . Conclusion: Early detection of breast cancer is possible and practicable in our environment. Wire localization of detectable lesions on mammography will assist in better surgical management and improve prognosis.

Background: Exercise capacity, like some other variables of exercise stress test, is a strong predictor of cardiovascular and overall mortality. Many confounding factors, including gender, have been found to affect exercise capacity. This study evaluated whether exercise capacity differs in age-matched type 2 diabetic Nigerian men and their women counterparts and the hemodynamic variables of exercise treadmill test that correlate with exercise capacity in them. Materials and Methods: A total of 61 type 2 diabetics (male = 34; female = 27) aged 30 to 60 years who were recruited through the Medical Out-patient Department of OAUTHC, Ile Ife, Nigeria, underwent symptom-limited maximal treadmill exercise using Bruce protocol. Result: Patients had comparable clinical and demographic patterns. There was no gender difference in the chronotropic response to exercise. Males had faster heart rate recovery (HRR) than females. Though both sexes had similar resting systolic blood pressure (SBP), males had significantly higher peak SBP than females (216.2 ± 23.7 mmHg vs 203.3 ± 21.7 mmHg; P = 0.03). Exercise capacity was significantly higher in males (7.5 ± 2.0 METs) than females (6.4 ± 1.5 METs); P = 0.01. Significant correlates of exercise capacity in both sexes were fasting plasma glucose, resting diastolic blood pressure, Duke Treadmill Score, and HRR. Majority of the patients were in moderate DUKE risk subgroup and there was no statistically significant difference between males and females in this regard. Conclusion: Gender difference occurs in the exercise capacity of diabetic patients and the factors associated with this disparity may be related to gender differences in resting heart rate and HRR, both reflecting a withdrawal of vagal tone.

Background/Objectives: Menarche, the first menstrual period, is influenced by many factors including socio-economic status and rural or urban dwelling. The aims of the study were to compare the age at menarche between rural and urban girls and evaluate the anthropometric indices at menarche. Materials and Methods: A cross-sectional study of rural secondary school girls and urban school girls. A structured questionnaire was used to obtain information on their age at menarche and other relevant data. Their weights and heights were measured using computerized scales and calibrated walls. Results: Two hundred and twenty eight (228) rural girls and four hundred and eighty (480) urban girls that had attained menarche within a year were studied. Mean age at menarche for all the girls was 15.26 years. Mean menarcheal age for the rural and urban girls were 15.32 years and 15.20 years, respectively. Mean weight and height were 47.6 kg and 156.76 cm, respectively for the rural girls and 48.12 kg and 156.8 cm, respectively for the urban girls. There was no significance difference in age of menarche among the groups (P > 0.05). Conclusion: The mean age at menarche for the school girls is 15.26 years. There was no difference in menarcheal age between the rural and urban school girls. Further longitudinal studies to compare rural school girls and urban school girls in private schools are required

Background: It is widely recognized that rabies is grossly under-reported even though it is a notifiable disease and a lack of accurate figures has rendered rabies a low public health and veterinary priority. This study aimed at determining the incidence of dog bite injuries and clinical rabies in a tertiary health care centre. Materials and Methods: Case records of patients managed at the accident and emergency unit of Ahmadu Bello University Teaching Hospital, Zaria, between June 2000 and May 2010 with diagnosis of dog bite and rabies were retrieved. Relevant clinical data were extracted using a structured questionnaire designed for the study. Results: Eighty-one persons out of 24,683 consultations in the accident and emergency unit presented with dog bite injuries with two clinical cases of human rabies. Mean age of victims of dog bite injuries was 21.1 ± 14.3 years and the majority (55.6%) were children. Males were more affected than females with a male:female ratio of 4.8:1, lower limb/buttock injuries were significantly higher in children than adults, but the adults sustained significantly more severe (type III) injury. The majority of dog bite injuries were washed with soap and irrigated with water or saline and 87.7% of the victim of dog bite received postexposure anti-rabies vaccine. Conclusion: Hospital incidence of dog bite injuries was low, but the use of postexposure prophylaxis was high.

Bilateral tubal ectopic pregnancies are rare occurrences. Two recently managed cases are discussed. The first was a single, sexually active 23-year-old nullipara with family history of twinning who presented with eight weeks amenorrhea, positive pregnancy test, lower abdominal discomfort and other clinical and ultrasound findings suggestive of unruptured left tubal pregnancy. Intra-operatively, unruptured bilateral tubal pregnancies were found and bilateral salpingotomy performed with uneventful recovery. Histology of the specimens confirmed the intra-operative diagnosis. She was appropriately counseled. Case 2, a 30-year-old multiparous housewife who had been on clomid for secondary infertility, presented with signs and symptoms of ruptured tubal ectopic. Intra-operatively, ruptured left and unruptured right tubal pregnancies were found and salpingectomy and salpingotomy were done respectively, with uneventful recovery. The diagnosis was also confirmed histologically and counseling given as in case 1. Bilateral tubal ectopic pregnancies appear to be increasing with twin proneness and use of fertility drugs as risk factors. Whether spontaneous or induced, the hallmarks of good management include early presentation, high index of suspicion, meticulous ultrasound scanning, good case selection, judicious intra-operative inspection of the contralateral tube, histology of specimens and appropriate patient counseling.

Two male siblings aged 10 and 17 years, respectively, presented to our hospital with two days history of being shot in the right eyes with arrows. The patients presented with severe pains, bleeding, swelling, discharge and loss of vision. There was positive history of application of traditional eye medicine and an unsuccessful attempt was made to remove the arrows. Both patients presented with panophthalmitis. X-rays of the orbits and para nasal sinuses indicated the tip of the arrow was lodged to the apex of the orbit in the younger patient, and the arrow vertically traverses the eye/ orbit and lodged in the roof of the maxillary sinus in the other patient with fluid level in the lower third of the sinus. The patients were placed on broad-spectrum systemic antibiotics, had base line investigations and prepared for exploration. The patients had evisceration with removal of the arrows.