Background: Acute sigmoid volvulus is one of the commonest causes of benign large-bowel obstruction. Its incidence varies considerably from one geographic area to another. This study reviews its management in a relatively high-prevalence area. Materials and Methods: All adult patients with acute sigmoid volvulus seen at the Royal Victoria Teaching Hospital (RVTH), Banjul, between September 2000 and January 2005 were retrospectively studied. Demographic data, clinical features, resuscitative measures, results of investigations, findings at surgery and postoperative course, and complications were retrieved from the patients' clinical records and analyzed. Results: A total of 48 patients, 45 (93.8%) males and 3 (6.3%) females, with a male: female ratio of 14.3:1, age range of 19 to 78 years and mean age of 45.8 ± 17.6 years underwent treatment for acute sigmoid volvulus. Twenty-one (43.8%) of the patients were aged 40 to 49 years. Two (4.2%) had rectal tube detortion followed by elective sigmoidectomy and primary anastomosis on the same admission, while 24 (50%) had emergency laparotomy, at which bowel decompression, one-stage resection and primary anastomosis without on-table lavage were done. The rest of the patients, 22 (45.8%), had gangrenous sigmoid colons at laparotomy and consequently underwent resection and Hartmann's procedure. Fourteen (29.1%) patients developed wound infection; and 5 (10.4%) had prolonged ileus, which was managed conservatively. There was no anastomotic leak. The mean hospital stay was 11.1 days. There were 5 deaths, giving a mortality rate of 10.4%. Conclusion: Acute sigmoid volvulus in The Gambia is almost exclusively a male disease. Sigmoid colectomy and primary anastomosis can be carried out safely in those with viable colon without on-table colonic lavage.

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Although Parkinson's disease (PD) is still incurable, a large number of different treatments have become available to improve the quality of life and physical and psychological morbidity, and its early treatment is of prime importance. This article reviews the current situation of PD. This review was based on a search of Medline, the Cochrane Database of Systemic Reviews, and citation lists of relevant publications. The subject headings and keywords used were Parkinson's disease and therapeutic advances. Only articles written in English were included.The management of PD has evolved rapidly over the last 10 years with the advent of new drugs and new classes of drugs, but the currently available treatment methods are all symptomatic ones. However, some of these may have marginal disease-modifying effects. Progress in manufacture of newer drugs has markedly improved the treatment of early PD; however, the management of advanced Parkinson's symptoms remains a challenge. Currently no treatment has been proven to slow the progression of PD. Although symptomatic therapy can provide benefit for many years, PD will eventually result in significant morbidity.

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Background: There is a phobia among doctors for the residency training program, since the establishment of the program over 30 years ago. The reason for establishing the program was mainly to provide the much-needed specialists in medicine. Objectives: To ascertain the perception of the residency training program among residents. Materials and Methods: Structured questionnaires were administered to residents at 3 training institutions in Nigeria. Results: One hundred nineteen (85.5%) questionnaires were returned out of 140. The ages of respondents ranged from 27 to 42 years, the median age being 30 years. There were 110 males and 9 females. One hundred six (89.1%) were junior residents. Ninety (75.6%) were sponsored by the training institutions. Seventy-four (62.25%) felt their consultants were contributing just 50% or less to their training. Sixty-two (52.2%) of the respondents had attended a revision course, conference or seminar within the last 6 months. Majority of the residents would want better remuneration, up-front payment of examination and revision fees, more teaching by the consultants and less emphasis on the provision of services as ways of improving the program. Conclusion: Majority of the residents are sponsored by the training institutions.

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Tuberous sclerosis is a rare neuro-cutaneous syndrome, one of the phakomatosis, characterized by facial angiofibromas (adenoma sebaceum), mental retardation and epilepsy. This classic triad occurs in less than one half of patients, probably in one-third, thus requiring a high index of suspicion to diagnose. Consequently it may easily be misdiagnosed as neurofibromatosis or other medical conditions. This is a case report of tuberous sclerosis in a 13-year-old Nigerian girl that was misdiagnosed as neurofibromatosis because of her cutaneous lesions. This paper discussed the case and reviewed the literature. A comprehensive medical clerkship, thorough physical examination, high index of clinical suspicion and neuroimaging investigations are required to confirm diagnosis.

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Antithyroid drugs have been used for more than 50 years for the management of hyperthyroidism. Most patients tolerate treatment well but some may develop life-threatening side effects such as agranulocytosis, aplastic anemia and cholestatic hepatitis. A 45-year-old female was diagnosed with severe hyperthyroidism. Treatment with Carbimazole 30 mg/day was initiated. Within six weeks following the start of therapy, patient developed potentially life-threatening acute cholestatic hepatitis and agranulocytosis as adverse effects to carbimazole. The patient's symptoms and laboratory abnormalities resolved following withdrawal of offending drug. Agranulocytosis and cholestatic hepatitis together is an extremely rare idiosyncratic side effect of Carbimazole treatment and considered to be dose and age-related. Antithyroid drugs are deceptively easy to use, but because of the variability in the response of patients and the potentially serious side effects, all practitioners who prescribe the drugs need to have a working knowledge of their complex pharmacology.

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Background: Microalbuminuria (MA) has been associated with increased risk of adverse cardiovascular events in nondiabetic hypertensive patients. This may be partly due to increased serum lipid abnormalities in these patients. The objective was to evaluate the association between MA and serum lipid abnormalities in nondiabetic adult Nigerians with hypertension. Materials and Methods: A prospective study which recruited 96 consecutive newly diagnosed adult Nigerian hypertensive met the study criteria. These patients were compared with the same number of age- and sex-matched healthy normotensive individuals. Results: 52 (54.2%) and 44 (45.8%) of patients were males and females, respectively. Mean ± SD ages were 51.2 ± 10.1 and 48.2 ± 8.8 years for male and female patients, respectively. Microalbuminuria was more than five times more prevalent in the patients than in the controls. The means ± SD serum total cholesterol (5.0 ± 0.56 vs. 4.05 ± 0.50 mmol/L, P = 0.04) and low-density lipoprotein cholesterol (3.99 ± 0.49 vs. 2.84 ± 0.58 mmol/L, P = 0.001) were significantly higher, while the mean ± SD for high-density lipoprotein cholesterol was (0.91 ± 0.16 vs. 1.04 ± 0.13 mmol/L, P = 0.03) significantly lower in microalbuminuric patients than in non-microalbuminuric patients. Conclusion: This study has shown that adult nondiabetic Nigerians with MA are significantly more likely to have dyslipidemia than patients without MA. Hence, this subset of hypertensive patients constitutes a high risk group. Screening for MA, and early recognition and prompt treatment of serum lipid abnormalities in these patients may reduce the risk of adverse cardiovascular events.

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Background: The implementation of ICT in the academic curriculum is a part of the e-reform of the undergraduate education currently ongoing at the Moroccan medical school. In order to evaluate the efficiency of such reform, the authors have conducted a survey at the Marrakech school of medicine including 200 students. Materials and Methods: A comparison between the third year medical students and sixth year medical students was performed in our university Hospital. Results: The majority of the students have a personal computer and internet access. Our study shows no significant differences between third year medical students and sixth year medical students. In both students' groups the level of internet and computer access, the internet skills, the opinions on internet use and ICT implementation and the difficulties encountered when using internet for medical purpose were similar. This can be explained by the lack of no implementation of ICT in our university. Conclusion: The learning process is still based on traditional methods. Educational authorities have to train students to improve their internet skills.

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Objective: King Fahd University Hospital, Al-Khobar is a tertiary care center without the facility for in-vitro fertilization (IVF) and embryo transfer, but ovulation induction (OI) is done routinely. The objective of this analysis was to study the obstetric outcome of patients who conceived after IVF and OI. Design: Retrospective analysis. Patients and Methods: One hundred and twenty patients were analysed within the study period of January 1996 and December 2006. Patients were divided into two groups viz; those who became pregnant after IVF and embryo transfer and those who conceived after OI. The obstetric outcome measures analysed include: antenatal and intrapartum complications, the number of babies delivered and the mode of delivery. The data was entered into the database and analysed using SPSS Inc. version 14. Results: The average age was 37.31 ± 4.1 years (range 21-43 years), primary infertility was seen in 74 women and secondary infertility in 46 patients. In 73 (60.8%) of the women, pregnancy occurred after OI and the rest of the patients underwent IVF at other centers. Sixty-nine (57.5%) of women had no previous pregnancy. Antenatal complications were similar in both groups but intrapartum complications were significantly higher in IVF group, P = 0.05. Multiple pregnancies were significantly higher in the IVF group (P = 0.001). Normal vaginal deliveries (NVD) were common in the OI group, and cesarean sections (CS) was significantly higher in IVF group (P = 0.001). Conclusion: This study shows that in pregnancy after IVF and embryo transfer, intrapartum complications were more and CS was the common mode of delivery when compared with those that had only OI.

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Background: Depot medroxyprogesterone acetate is the most studied injectable contraceptive and also one of the most effective methods of contraception currently available. It is reversible, its use is independent of intercourse, and can be provided by trained non-medical staff making it particularly suitable for use in developing countries. The aim of this study is to determine the socio-demographic characteristics of its acceptors, the timing of use and complications at the University of Uyo Teaching Hospital, Uyo. Materials and Methods: The record cards of all clients who accepted medroxyprogesterone acetate injectable contraception over a nine-year period were studied. Results: There were 1065 new contraceptive acceptors out of which 166 (15.1%) accepted depot medroxyprogesterone acetate. The modal age group of the clients was 30-34 years (35.0%). Majority of clients were grandmultiparous (63.9%), married (82.0%), and 50.6% had primary level education. Majority of the clients (84.2%) derived their sources of information on contraception from clinic personnel and friends/relatives. All the clients received their injections within seven days of menstruation. The most common side effects were amenorrhea (12.0%) and spotting of blood per vaginam (10.8%). Conclusion: Depot medroxyprogesterone acetate is a safe form of contraception, which was mostly accepted by grandmultiparous women and those in their thirties. The involvement of the print and electronic media in the propagation of accurate information about depot medroxprogesterone acetate to members of the community and the introduction of post-abortal and puerperal administrations of depot medroxyprogesterone acetate and its new formulation; depo sub-Q provera in all our hospitals are advocated.

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Background: Multiple X-rays required for confirmation and localization of ingested metallic foreign body preoperatively predisposes children to increased radiation exposure. This study aims to highlight the current necessity or otherwise of these X-ray requests. Materials and Methods: This is a retrospective study of patients with ingested metallic foreign bodies over a five-year period in a tertiary health institution. Case notes and X-ray requests were studied. Results: Of 39 cases of foreign body in esophagus, 29 (74.4%) were metallic and the coin accounted for 79.3% of all metallic foreign bodies. There were 20 males to 9 females and 28 children aged 2 months to 11 years to one adult. There were 62 pre-extraction X-rays consisting of 29 (46.8%) initial confirmatory films and 33 (53.2%) repeat films for localization of the foreign body. There were 10 post-extraction films for postoperative complications. Conclusion: More than half of the X-ray films were unnecessary and the radiation exposure was avoidable if alternative methods of localization of the foreign body such as the handheld metal detector were available.

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