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This study investigates how Nigerian librarians are mitigating the infodemic caused by the COVID-19 pandemic. The descriptive survey design was adopted for the study. The entire population of Nigerian librarians in major social media platforms of the Nigerian Library Association and its sections were used for the study. An online survey administered through Google forms was used. A total of 186 librarians responded to the survey. The data was analysed with percentages and presented in charts. The findings show that: the majority (80%) agreed that there is infodemic in Nigeria. The major roles played by the librarians in mitigating the infodemic are: correction of misconceptions online (54.8%), posting of official information online(47.8%), and provision of authentic sources to COVID-19 guidelines (39.8%);the majority (91.1%) of the librarians played these roles as personal initiatives;majority (79%) of them believe their roles have been effective;and the major challenges facing their efforts are the issue of low bandwidth (59.1%), distrust for official information (31%) and regard for myths (29%). The implication of these findings is that most of the efforts made by Nigerian librarians to curb the spread of fake news associated with the corona virus were mainly personal initiatives. This further implies that a majority of Nigerian libraries do not have plans and policies in place to ensure service delivery in emergency situations. It was recommended, among others, that Nigerian librarians should go beyond online efforts to use traditional methods in order to reach a larger part of the populace without access to the internet. © 2021, The International Academic Forum (IAFOR). All rights reserved.

Background: Anti-failure therapy is vital to the reduction of morbidity and mortality associated with heart failure (HF). Medication nonadherence (MNA) has been identified as a major limiting factor for the attainment of therapeutic goals. This study aimed to determine the prevalence and characteristics of MNA in HF patients attending Lagos University Teaching Hospital (LUTH), Lagos. Methods: This was a descriptive cross-sectional study involving 202 previously diagnosed HF patients attending an outpatient clinic in LUTH. Data were obtained from patient's medical records and the use of an interviewer-administered questionnaire. Medication Adherence Report Scale 5-items was used to determine MNA. Results: Of the 202 HF subjects, 68% (n = 128) were aged 31–60 years, 65% (n = 132) were females, 58%, (n = 116) were taking ≤4 pills/day, 54.5% were taking pills twice daily, and 72.3% (n = 146) had comorbid conditions. The overall prevalence of MNA was 69.3% with ACE inhibitors having the highest MNA of 73.2% and angiotensin receptor blocker/neprilysin inhibitor having the least MNA of 0%. MNA was independent of age, gender, educational status, pill burden, duration of HF, history of HF admission, functional status, and specific comorbidities (P < 0.05). However, the presence of three comorbidities was associated with lower MNA (P < 0.05). Conclusion: There is a high prevalence of MNA in Nigerian HF patients. Measures aimed at improving adherence are imperative to improve outcomes in these patients.

Background: Rape remains a controversial issue with a few victims reporting experience because of the myriad of societal perception, prolonged steps in pursuing a case to logical conclusion of securing conviction, as well as psychological and physical residuals of the experience. Data in Nigeria is therefore hard to come by as it is diminished and often not available. Objectives: To assess the pattern and trend of rape cases in a State in Nigeria. Methods: A descriptive and retrospective study where data records on socio-demographics and case specifics was collected on victims of sexual assault that reported to DFID/ PATHS 2 supported Tamar Sexual Assault Centre between 2014 and 2016 after which it was analysed and presented in bar charts. Results: The yearly prevalence varied for the different age groups studied with the highest prevalence noted for 13 years and above (175,200,255) over the 3 years of 2014, 2015 and 2016 studied. The reported cases also improved over the studied years with rates of 0.47, 0.96 and 0.5 respectively. Conclusion: The yearly comparison and baseline data show that the centre's establishment caused an improvement in rape case reporting and follow-up. Keywords: Rape; trends; Nigerian; State.

Background: Categorization of endometrial carcinomas as type I and II provides useful insights into their different risk factors, pathogenesis and biologic behaviours. Aim: To determine the immunohistochemical classifications of endometrial carcinomas in Nigerian women. Design: A retrospective review of histopathologic slides of cases of endometrial carcinomas seen at the Lagos University Teaching Hospital (LUTH) over a 5-year period. The slides were reviewed, and the diagnoses made according to the WHO nomenclature. The classification of endometrial carcinomas into Type I and II was made by immunohistochemistry using antibodies to ER, PR, p53 and Ki-67. Results: Eight cases of endometrial adenocarcinoma were reported accounting for 53.3% of all endometrial malignancies. Of these, only 1 case showed the classic type I immunophenotype while type II staining pattern was seen in 4 cases. The remaining 3 cases had equivocal immunophenotypes: one was p53+ but showed ER+, PR+ and high Ki-67 index; the second was p53-, ER+, PR+ but had a high Ki-67 expression; while the last was p53-, but ER-, PR- and had high Ki-67 expression. Conclusion: Endometrial carcinomas in Nigerian women are more likely to be type II carcinomas. A reasonable proportion of the cases were equivocal thus requiring further categorization with molecular studies. Keywords: Endometrial carcinomas, immunohistochemistry, LUTH, Nigerian.

BACKGROUND Most occurrences of type 1 diabetes cases in any population are sporadic rather than familial. Hence, type 1 diabetes among siblings is a rare occurrence. Even more rare is for three or more siblings to develop type 1 diabetes. In this report, we describe a case of a Nigerian family in which type 1 diabetes occurred in three siblings among four children with neither parent having diabetes. All three siblings are positive for glutamic acid decarboxylase and anti-islet cell antibodies. CASE SUMMARY There were four siblings (three males and one female) born to a couple without a diagnosis of diabetes. The eldest child (male) was diagnosed with diabetes at the age of 15, the second child (female) was diagnosed at the age of 11 and the fourth child (male) was diagnosed at the age of 9. All the siblings presented with similar osmotic symptoms and were diagnosed of diabetic ketoacidosis. All of them had markedly reduced serum C-peptide levels with high levels of glutamic acid decarboxylase and insulinoma-associated protein-2 antibodies. We could not perform genetic analysis of HLA-DR, DQ and CTLA4 in the siblings as well as the parents; hence haplotypes could not be characterized. Both parents of the probands have no prior history of diabetes, and their blood glucose and glycated hemoglobin levels were within normal ranges. The third child (male) has no history suggestive of diabetes, and his blood glucose and glycated hemoglobin have remained within normal ranges. CONCLUSION Although the occurrence of type 1 diabetes in proband siblings is uncommon, screening for diabetes among siblings especially with islet autoantibodies should be encouraged.

Background: The prospect of EEG as a potential biomarker for detecting a cognitive decline in those living with epilepsy has not been extensively studied. Objective: To determine the relationship between electroencephalographic (EEG) changes and cognitive functions in Women with Epilepsy (WWE). Methods: The study involved 100 adult WWE aged between 16 and 40 years on Levetiracetam (LEV) or Carbamazepine (CAB) monotherapy. Zung Self-Reporting Depression Scale (ZSRDS) was used to assess the mood of participants while the Community Screening Interview for Dementia (CSID) was used to assess various cognition domains. Results: The frequency of Periodic Epileptiform Discharges (PED) (p = 0.008), delta waves and theta waves (p = 0.004) were higher in WWE with Cognitive Impairment (CI) compared to those without CI. Lower cognitive scores were seen among those with delta wave across the domains of cognition with statistical significance for language fluency (p = 0.039), language comprehension (p = 0.000), and total CSID (p = 0.000). WWE with PED had a lower mean total CSID score compared to those without PED (p = 0.019). The absence of alpha wave (p = 0.027), presence of delta wave (p = 0.013), slow frequency (p = 0.015) and PED (p = 0.031) were EEG predictors of cognitive impairment. Medication type (p = 0.016) and depression (p = 0.001) were the clinical predictors of cognitive impairment in WWE. Conclusion: The frequencies of PED and slow waves were higher in WWE with CI while the absence of alpha wave, presence of delta wave and PED were EEG predictors of CI.

Citrobacter infection is an uncommon but serious, difficult to treat infection associated with high mortality. Accumulation of pus or fluid in a pericardial space causes restriction of cardiac filling and consequent decrease in cardiac output. We herein report Citrobacter freundii, a rare infectious cause of this uncommon disorder. Our patient is a 10yr old male referred with complaints of cough productive of mucoid sputum and associated chest pain of two weeks duration, difficulty in breathing and orthopnoea for one week. He was acutely ill looking in respiratory distress with tachypnoea and tachycardia. Blood pressure was normal with pulsus alternans, there was increased jugular venous pressure, diffused apex beat and distant heart sounds with pericardial rub. Retroviral screening and gene Xpert for Mycobacterium tuberculosis were negative. Chest radiograph showed enlarged heart of “water bottle” appearance with cardiothoracic ratio of 0.77 and right sided pleural effusion which was drained. Transthoracic Echocardiogram confirm pyopericardium with multiples echoes in cardiac temponade. Echo-guided percutaneous pericardiocentesis yielded 600mls of purulent aspirates. Citrobacter freundii Sensitive to gentamycin, co-amoxiclav but resistant to cefuroxime and cefixime was cultured from pericardial aspirates and sputum. Patient recovered fully after pericardiocentesis and intravenous antibiotics. In this case report, we describe Citrobacter freundii causing cardiac temponade and empyema in a Nigerian immunocompetent child which to our knowledge has thus far not been reported. Pyopericardium may follow rare causes as Citrobacter freundii which require high index of suspicion.

Highlights • The current case presented late with complication of gangrene and perforation because it was first managed as a case of gastroenteritis. • Gastroenteritis is among the various differential diagnosis of intussusception a high index of suspicion is required for timely diagnosis. • Being available, cheap and free of radiation, using ultrasound more often in infants can aid diagnosis., Introduction Intussusception is the process of invagination of a bowel segment into the adjoining intestinal lumen which may cause bowel obstruction and gangrene. It commonly occurs in infants at a mean age of 9-months with male preponderance. The condition has excellent prognosis if diagnosis is made early and appropriate treatment commenced and mortality rate from intussusception in children can be less than 1%. However, if diagnosis or treatments are delayed it can be fatal in a few days. Presentation of case We present a case of Ileo-colic perforated ileum due to delayed diagnosis. It was initially misdiagnosed as gastroenteritis at another hospital. The infant was resuscitated with intravenous fluid and had laparotomy. A signed consent was obtained before the surgery and media consent was signed for publication. A gangrenous terminal ileum was resected and ileo-colic anastomosis was done. Post-operative course was uncomplicated and the patient was discharged after 5days. Discussion The index case presented late with complication of gangrene and perforation because it was first managed as a case of gastroenteritis. Gastroenteritis is among the various differential diagnosis of intussusception. Complications have been reported to increase numbers of surgical treatment and sometimes mortality, but rarely occur with good diagnostic acumen. Conclusion We conclude that high clinical suspicion, interaction with senior surgeons and regular use of ultrasound in infants with gastrointestinal symptoms will aid diagnosis. Although surgery was performed in the index case, non-surgical reduction is a very efficient treatment modality in uncomplicated cases.

Background: In children, toothbrushing with fluoride toothpaste is the method of choice for preventing dental caries and it is influenced mainly by their mothers.Objective: To provide descriptive information about toothpaste utilization profiles of 6 to 8-year-old Nigerian children.Materials and methods: A cross-section of 130 mothers of 6-8 year-old Nigerians provided information on sociodemographic characteristics, knowledge of toothpaste use, tooth brushing habits and criteria for selecting toothpaste for their child. Their 6-8 year-old children who attended the Dental Centre of the University of Maiduguri Teaching Hospital North-Eastern Nigeria were examined for presence of dental caries and fluorosis. Data analysis included both descriptive and inferential statistics at p0.05). Females (54.2%) and children of mothers who had no formal education (65.6%) had more fluorosis than their counterparts (p

Battered child syndrome (BCS) is a form of physical abuse that is characterised by multiple injuries and potentially fatal outcome. Despite the high prevalence of physical abuse in developing countries, BCS is rarely reported. Hence, this report highlighted a four-year-old Nigerian boy who suffered multiple injuries (scalp haematoma, bruises, right clavicular fracture, and burns) from the paternal uncle's wife. This case report is discussed along the line of public health approach for curbing the social menace.

Summary Background Traditional cardiovascular risk factors (CVRFs), which include age, gender, hypertension, diabetes mellitus, dyslipidaemia, smoking, alcohol consumption, chronic kidney disease and obesity, have been shown to be associated with atherosclerosis. We aimed to evaluate the impact of traditional CVRFs on carotid atherosclerosis (CA) in a sample of Nigerian adults. Methods We examined 162 subjects with traditional CVRFs in a cross-sectional study. Demographic and clinical data, including history of hypertension, diabetes mellitus, smoking, alcohol intake and chronic kidney disease, as well as systolic and diastolic blood pressure, weight and height were collected. Serum creatinine, fasting blood glucose and lipid profiles were also determined. Carotid intima–media thickness (CIMT) and presence of carotid plaque (CP) were evaluated by high-frequency B-mode ultrasound. Chi-squared and regression analyses were carried out to determine associations between variables of CIMT and CVRF. Results Increased CIMT was associated with all CVRFs (p < 0.05) except gender (p > 0.05), while CP was associated with older age, obesity, hypertension and dyslipidaemia (p < 0.05). We found prevalence of increased CIMT was 53.7%, while that of CP was 16.1%. The prevalence of CA (increased CIMT and CP) also increased with increasing number of CVRFs in the subjects. Age ≥ 50 years, hypertension, dyslipidaemia, obesity and alcohol intake explained 78.7% of variance in CIMT, while age ≥ 50 years and hypertension explained 38.0% of variance in CP. Conclusions CA was associated with presence and increasing number of traditional CVRFs. A significant percentage of variance in CA was, however, unexplained by traditional CVRFs.

CNPq Background: Comparative studies of patients in different sociogeographic/ecological zones may unravel potential environmental and nutritional factors influencing disease phenotype. In sickle cell disease (SCD), differential access to comprehensive care may influence their growth and nutritional status. Methods: From June 2015 to February 2016, steady-state nutritional parameters of 109 Brazilian and 95 Nigerian children with SCD attending routine clinic visits at Universidade Federal de Sao Paulo, Brazil and Obafemi Awolowo University Teaching Hospital, Ile-Ife (Ilesa unit), respectively, were compared. Results: A relatively high proportion of the children in both centres (23.5%) were wasted [body-mass index (BMI)-for-age z-score

Background: The reported health and socioeconomic consequences of ear piercing, especially in modern day society, underscore the need to further research into this subject. In this study, we determine the trends and complications of ear piercing among selected Nigerian population. Aim and Objectives: The aim and objective of this study was to draw attention to the trends and complications of ear piercing with a view to prevent its associated complications. Methodology: It is a descriptive cross-sectional study carried out between February and May 2015 among selected Nigerian population from two of its six geo-political zones. A self-administered semi-structured questionnaire which had been pretested was used to collect data from 458 respondents who consented using multistage sampling technique. Results: Of 480 respondents enumerated, 458 completed the questionnaires and gave their biodata. The male:female ratio was 1:6.2. Their ages ranged from 18 to 75 years with a mean of 35.56 ± 10.16. About 35.4% of the respondents were within the age group of 31–40 years. Majority of the respondents, i.e.,79.3% practiced ear piercing on their children. Most of them (86.8%) preferred single piercing. Ear piercing was performed within the 1st week of birth in 37.2% of the respondents. Large percentage (93.2%) of the respondents will not encourage ear piercing in male children. Nearly 20.5% of the respondents observed complications. Conclusion: Ear piercing remained a common practice in Nigeria, with respondents preferring it on females. Majority of the piercings are done in childhood and by untrained personnel. Keloid formation was the notable complication observed by the respondents. There is a need to increase awareness about the hazards of ear piercings and to enact laws that regulate ear piercings particularly in children which is hereby stretched.

Background Obsessive compulsive symptoms (OCS) have not been studied among Nigerian adolescents, despite studies in developed countries reporting that almost 90% of affected adolescents do not receive any treatment. The availability of a psychometrically valid and reliable instrument will serve as an initial step towards the diagnosis and subsequent treatment of Nigerian adolescent obsessive compulsive disorder (OCD). Aims The aim of this study was to examine the psychometric characteristics as well as correlates of the Obsessive Compulsive Inventory – Child Version (OCI-CV) in a non-clinical sample of Nigerian adolescents. Methods This was a cross-sectional study involving 1017 adolescents who completed the Obsessive Compulsive Inventory-Child Version (OCI-CV), the Hospital Anxiety and Depression Scale (HADS), General Health Questionnaire-12 (GHQ-12) and Rosenberg’s Self-Esteem Scale (RSES). The model fit of the OCI-CV 6 factors was examined through confirmatory factor analysis. Reliability was determined by calculating the McDonald’s Omega hierarchical (ωh) values while its concurrent validity was examined through correlational analyses. Results The overall internal consistency of the OCI-CV was 0.96. The indices of fitness obtained on subjecting the 21 items of the OCI-CV to CFA indicated modestly acceptable indices of fitness despite satisfactory item loading on the 6 subscales. Statistically significant correlations were observed between OCI-CV and the other study measures. OCS was reported by 37.8%. Conclusion The OCI-CV has exhibited satisfactory psychometric properties among Nigerian adolescen

Background: Despite the poor doctor–patient ratio in Nigeria, which is far below the World Health Organization's recommendation, Nigerian doctors are known to contribute a significant proportion of the medical workforce in other countries, especially in the United Kingdom (UK) and the United States of America (USA). Aim: This study aimed to assess Nigerian medical doctors' willingness to practice in foreign countries, as well as the possible push and pull factors contributing to this brain drain. Methodology: A cross-sectional survey was conducted, and 329 medical doctors were selected from a list of doctors who were attending the Annual Delegates Meeting of the Nigerian Medical Association, using a systematic random sampling technique. A semistructured self-administered questionnaire was used to obtain the information from the selected respondents. Results: All selected respondents agreed to participate in the study. The mean age of the participants was 41.4 ± 6.3 years, 85.9% of them being males and 75.7% being Christians. About 36% of the respondents had medical fellowship, 31.6% were resident doctors, and 16.4% had only an MBBS degree. The median duration of practice was 12 years, and the median monthly income was ₦420,000.000. About 72.9% of the respondents were willing to practice in foreign countries if given the opportunity, 29.2% of whom preferred the USA, 25.1% preferred the UK, and 15.7 preferred Australia. Among those not willing to practice in foreign countries, 48.3% preferred working in Nigeria despite all the challenges and 32.2% was due to family and other personal reasons. Among those willing to practice in foreign countries, about 66.3% was due to poor financial incentives/working environment, 46.5% due to insecurity, and 38% due to inter-professional rivalry in the health sector. The following factors were found to be independent (intrinsic) determinants of willingness to practice in a foreign country: Geopolitical zone of origin, highest educational qualifications, duration of practice, and average monthly income. Conclusion: It is a big threat to the Nigerian health system for the majority of its doctors to be willing to leave the country. Hence, the need for governments at all levels to, as a matter of urgency, address the factors responsible for this drive.

The poem appearing in the epilogue of the book of Proverbs (Prov 31:10-31) is classically a paean poem that eulogises the outstanding qualities of the female figure assumedly portrayed as an epitome of womanhood. This article seeks to address the unbalanced portrayal of the couple in the paean by inviting readers to pay close attention to the mention of the male figure in vv. 11, 23, 28-29 and to discover his salient role often glossed over or overlooked by interpreters. It draws attention to the civilised and humane personality of this male figure who, suggestively, is to be seen to serve as the architect of the achievements and public praise of his wife, given the patrilocal and patriarchal context of ancient Israel. In view of this, it is argued, he also deserves to elicit praise. By implication, it also invites the contemporary African male figure, particularly the Nigerian one, to follow the legacy of this husband by exhibiting the characteristics of responsible African manhood as he functions as husband and father.

We promote awareness of the features of emails that propose advanced fee fraud schemes. These are commonly known as 419 emails (after Section 419 of the Nigerian Penal Code). We outline the structural features of 419 emails and conduct a preliminary study of their distinctive linguistic features, using word frequency counts and DICTION text analysis software. We find that the incidence of first person singular pronouns is seven times greater in 419 emails than non-419 emails. We suggest elements of a future research agenda that can build on our preliminary results to help reduce advanced fee fraud.

Objective: To report an unusual case of orbital hydatid cyst successfully managed by surgical excision.Case report: A 33-year-old female presented with gradual protrusion of the left eye associated with poor vision, cosmetic embarrassment and watering. She had excision biopsy of an encapsulated cystic lesion with cheesy tissue and serous content. Orbital hydatid cyst due to echinococcosis was confirmed at histopathological examination of the excised tissue. She subsequently became pregnant hence, could not undergo post-operative antihelminthic treatment, but was managed conservatively with no recurrence after five years of regular follow-up.Conclusion: Orbital hydatid cyst should be considered as a differential in a young patient presenting with unilateral proptosisFunding: NoneKeywords: Echinococcosis, Hydatid cyst, Orbit, Nigerian, Proptosis

Objective: To evaluate the relevance of Electroencephalography (EEG) in the management of various neuropsychiatric conditions in University of Ilorin Teaching Hospital (UITH), Ilorin. Background: EEG is still relevant in the diagnosis and management of patients with seizure disorders and extends to other neuropsychiatric conditions. However, very few studies have examined the use of EEG in developing countries, including Nigeria. Methods: The EEG records of 154 patients between January 2012 and December 2012 were reviewed. EEG unit’s records, including EEG request forms and EEG reports were examined. Socio demographic data, clinical data and the neurologist’s comments on the EEG recordings were extracted and recorded on the proforma form. Results: A total of 142(92.2%) of the patients out of 154 had complete records and were studied. Majority (84.5%) of the patients were below the age of 30 years. Various types of seizure disorders accounted for 80% of the provisional diagnosis. The EEG diagnosis based on the interpretation of the EEG records showed that 96 (67.6%) of the patients had normal records. Conclusion: EEG still plays a very important role in the investigation of neuropsychiatric conditions especially epilepsy in developing countries. EEG facilities should be readily available. Keywords: Electroencephalography, investigations, neuropsychiatric, Nigerian, Teaching Hospital

Background Biopsies are often essential for definitive diagnosis of oro-facial lesions and are a part of oral diagnostic procedures carried out in histopathology laboratories. At present, there is paucity of literature on the audit of oral histopathology services in Nigeria. The objectives of this study were to determine the prevalence of biopsied oral lesions in a Nigerian tertiary institution. Also to profile the usage of oral pathology service and to identify challenges that may be present in an oral histodiagnostic service. Methods This was a retrospective study performed at the Oral Pathology Department of the University of Ibadan/ University College Hospital, Ibadan, Nigeria. Reports of all biopsies submitted at the Oral Pathology laboratory, for the period 1990-2014, were reviewed and data extracted. Descriptive analysis was done using SPSS software, version 20. Results The total number of reports was 1,998; invalid reports constituting 220(11%) were subsequently excluded leaving 1,778(89%) valid reports. The mean age of patients was 36.70±19.79, while the peak age of presentation was in the 3rd decade. Male to female ratio was 1:1.1, and the mandible was the most common site of lesions 619(34.8%). These services were mainly utilized by oral surgeons (83.9%) and ameloblastoma (11.5%) was the most frequently diagnosed lesion. CD45 (16.7%) was the most frequently requested immuno-diagnostic test. Conclusion Biopsied oral lesions were more prevalent in females, while oral and maxillofacial surgeons utilized these services the most. Inadequate biopsy specimens or unrepresentative specimens and deficient documentation were challenges identified in this study.

Background Juvenile delinquency has become a significant global problem. Conduct disorder (CD), among other psychiatric disorders, has assumed prominence in its association with juvenile offending as well as criminality in adulthood. Despite this knowledge, little attention is given to this problem especially as it affects adjudicated adolescent offenders in developing countries. Aim To examine the prevalence and correlates of CD among incarcerated adolescents in a Nigerian Borstal Institution and to investigate its independent predictors. Methods A cross-sectional descriptive study was conducted among 147 inmates of a Borstal Institution in Abeokuta, South Western Nigeria. A self-administered questionnaire and interviewer administered MINI-KID were used. The associations between conduct disorder and socio demographic as well as forensic variables were investigated using Chi square statistics while logistic regression was used to predict CD. Results Out of 147 respondents, 83 (56.5 %) met the criteria for CD with a mean age 17.1 ± 1.1. Of the socio-demographic and forensic variables investigated, number of siblings (OR 4. 630; p = 0.010; 95 % CI 1.433–14.964) and previous history of incarceration (OR 4. 99; p = 0.043; 95 % CI 1.048–23.846) emerged as independent predictors of CD. Conclusions This study recorded a high prevalence of conduct disorder among a sample of incarcerated juvenile offenders. The association of conduct disorder with large family size and recidivism highlights the need for comprehensive early interventions focused on improving parental supervision in large families as well as other re-training programs aimed at reducing juvenile re-offending.

Background Pregnancy is a physiological process associated with an increased hemodynamic load and cardiac structural remodeling. Limited echocardiographic information exists on cardiac chambers, left ventricular (LV) systolic and diastolic functions, and LV mass during trimesters of normal pregnancy among African women. Materials and Methods Echocardiography was done at the beginning of the second trimester, beginning of the third trimester, and middle of the third trimester for 100 normal pregnant women and at one visit for age-matched 100 nonpregnant women. The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 17 software. Analysis of variance was used to compare within trimesters, and a P value of Results The mean (SD) ages of the patients and controls were 28.20 (±5.91) and 28.35 (±6.06) years, respectively (age range = 19-44 years, P = 0.86). Cardiac chambers, LV systolic function, and LV mass and its index increased significantly during pregnancy. A significant increase in A-wave velocity but slight increase in E-wave velocity and a reduction in tissue e′ velocity at the septal margin but a progressive increase in a′ velocity were also observed ( P < 0.05). Conclusion Cardiac chamber dimensions, LV wall thickness, and mass, most indices of LV systolic and diastolic function, though within normal range, were significantly higher in pregnant than in nonpregnant Nigerian women.

Introduction: Serum prostate specific antigen (PSA) levels increase with age and varies among different races and communities. The study was aimed at defining the age-specific reference ranges of serum PSA in our environment. Methods: We evaluated the relationship between age and serum PSA levels and the age-specific reference ranges of serum PSA among civil servants in Lagos, who underwent routine medical checkups. Criteria for inclusion were men who have no lower urinary tract symptoms, normal digital rectal examination and serum PSA ≤ 20 ng/ml. SPSS Statistic 21 was used for data evaluation and the mean, median, 95th percentile PSA levels were estimated. Pearson's correlation was used to examine the relationship, and P < 0.05 was considered significant. Results: 4032 men met the criteria for inclusion in the evaluation. The mean age was 51.6 (range 40–70) years, and there was a strong correlation between serum PSA levels and age (r = 0.097, P < 0.001). PSA ranges of 0–2.5, >2.5–4.0, >4.0–10, and >10 ng/ml were found in 3218 (80%), 481 (12%), 284 (7%), and 52 (1%) men, respectively. The mean, median and the 95th percentile PSA for the overall group were 1.84, 1.33, and 5.2 ng/ml respectively. However the 95th percentile PSA levels for men aged 40–49, 50–59, and 60–70 years were 4.78, 5.47, and 8.93 ng/ml respectively. Conclusion: The age-specific PSA levels among Nigerian men for each age group is higher than what was described for men in the Western world. These reference ranges of serum PSA should be considered for men aged ≥40 years in our environment.Keywords: Age, cancer, Nigerian, prostate specific antigen, reference

Best macular dystrophy is reported to be rare in Africans. It is a hereditary disease that starts in childhood and progresses through some stages before visual symptoms occur. This case report presents a 43-year-old Nigerian with the disease and stresses the importance of regular eye exams of patients and relatives to detect changes such as choroidal neovascular membrane amenable to treatment.

Background: Chronic psychosocial stress and serum uric acid (SUA) level have been implicated in the etiology and cardiovascular events risk factors in hypertension. Studies have reported significant benefit of exercise in the overall management of hypertension. However, studies on the effect of exercise on psychosocial stress and SUA in the management of hypertension seem scanty. Aim: The aim of this study was to determine the effect of continuous training program on SUA and psychosocial status of black African (Nigerian) population with hypertension. Subjects and Methods: Age.matched randomized controlled trial was used; subjects with diagnosis of hypertension attending the hypertensive clinic of Murtala Muhammed Specialist Hospital (MMSH), Kano, Nigeria form the population for the study. Two hundred and seventeen subjects with mild to moderate (systolic blood pressure (SBP) between 140 and 180 and diastolic blood pressure (DBP) between 90 and 109 mmHg) essential hypertension were grouped into continuous (112) and control groups (105). The continuous group involved in an 8 weeks continuous training (60%-79% HR max) of between 45 and 60 min, 3 times per week, while the controls group remain sedentary. SBP, DBP, SUA, VO2 max and psychosocial status were assessed. Student t.test and Pearson correlation test were used in data analysis. Results: The study revealed significant beneficial effect of continuous training programs on VO2 max, SBP, DBP, SUA, and psychosocial status (P < 0.05). Psychosocial status and SUA was significantly and positively and negatively correlated respectively with VO2 max at P < 0.01. Conclusions: This study concludes and supports the recommendations of moderate intensity (continuous) training program in blood pressure reduction, SUA and psychosocial stress management in hypertension. Keywords: African, Blood pressure, Hypertension, Nigerian, Psychosocial stress, Serum uric acid

BackgroundThe epidemiology of fractures of the humeral shaft has received little attention in Nigeria. This study was aimed at investigating the possible risk factors associated with diaphyseal humeral fractures among Nigerians.MethodsThe study was carried out retrospectively at the Department of Medical Records, National Orthopaedic Hospital, Igbobi, Lagos State, Nigeria, between 2007 and 2012. Case notes and plain films of X-ray from a total number of 206 patients of ages from birth to one hundred years (0–100 years), comprising of 140 males and 66 females, were used for the study. The analyses were done using Statistical Package for Social Sciences (SPSS) version 16.0 and presented in bar charts. The frequencies were reported as percentages. The differences in frequencies were compared using chi-square test.ResultsThe results showed that the percentage frequency of diaphyseal humeral fractures was significantly higher (P ConclusionsThe major causes of diaphyseal humeral fractures are road traffic accidents and falls. Since diaphyseal humeral fracture is an issue of harsh economic consequences, adequate measures should be taken by all the parties involved, especially government agencies, to address this menace in term of road maintenance and general well-being of the citizens. Furthermore, since it was observed that different regions of the bones of interest present diverse characteristics with respect to associated risk factors, it is recommended that such studies as this should be region-based rather than whole-bone based.

Background: Retinoblastoma is the most common intraocular childhood malignancy. Its management is, however, not without challenges especially in a developing country like Nigeria. This study sought to present the clinical profile and treatment outcome of patients with retinoblastoma managed in a Nigerian tertiary eye care facility highlighting the challenges with a view to improving the management of the disease. Materials and Methods: A retrospective, single-institution, and institutional review board-approved review of all patients diagnosed with retinoblastoma between January 2012 and December 2015 was done. Data obtained from case files of patients include demographic characteristics, presenting complaint, laterality of disease, tumor stage using the International Intraocular Retinoblastoma Classification, treatment, and outcome. Information obtained from phone calls to the caregivers were also summarized. Results: The review included 54 eyes of 41 patients between the ages of 2 months and 5 years. The mean age at presentation was 24.4 ± 11.4 months. There were 18 males (43.9%). Duration of symptoms before presentation ranged from 2 weeks to 2 years. Tumor was bilateral in 13 (31.7%) patients. Leukocoria was the most common presenting complaint observed in 32 (59.2%) eyes. Groups D and E were the most common intraocular tumor stage documented in 16 (29.7%) and 15 (27.8%) eyes, respectively. Most patients (29, 70.7%) defaulted from treatment after the first or second presentation. Only 6 (21.4%) of 28 patients offered enucleation or modified exenteration either at presentation (Class E) or after chemoreduction (orbital disease) consented. Conclusion: Late presentation, high default rate, and noncompletion of treatment were the major challenges facing retinoblastoma management in this center.

Background: Breast cancer markers are becoming increasingly important in breast cancer research due to their impact on prognosis, treatment and survival. The present retrospective study was carried out to quantify the proportion of estrogen (ER), progesterone (PR), and human epithelial receptor 2 (HER2) expressions and their association with tumour grade, age, and tumour size in breast cancer patients in Nigeria. Materials and methods: The paraffin embedded tissue sections were analysed for breast cancer markers using monoclonal antibody SP1 for ER and SP2 for PR and polyclonal antibody ErbB2 for HER2. Results: A total of 286 breast cancer paraffin wax tissue sections were analysed for ER, PR and HER2 expression. Of all the tissue samples examined, 20 (7%) were ER-positive, 6 (2.1%) were PR-positive, 11 (3.8%) were HER2-positive whereas 248 (87%) were triple-negative breast carcinoma. ER- and PR-positivity was associated with early grade I and II tumours (P < 0.010-0.009) and tumour sizes of < 50mm (p < 0.001). HER2-positivity was positively (P < 0.009) associated with grade II tumours and negatively (P < 0.0001) associated with grade III tumours. Triple-negative breast cancer was associated with grade III tumours (P < 0.0001) and larger tumour sizes of > 50mm (P < 0.0001). Conclusion: A small proportion of Nigerian women with breast cancer are ER/PR-positive which are associated with less aggressive, better prognosis and benefit from endocrine therapy. An even smaller proportion of patients with aggressive tumors were HER2-posivite but responsive to Herceptin treatment. Unfortunately, a very high proportion of cases were triple-negative which is associated with very aggressive tumours and no targeted treatment, which may explain the high mortality rates from breast cancer in Nigeria.

Urinary tract infections (UTI) in children with sickle cell anemia (SCA) may result in long term renal dysfunction. The prevalence, potential risk factors, and clinical significance of asymptomatic bacteriuria (ASB) were investigated in 196 Nigerian children with SCA in stable state. These children had clinical evaluation and assessment of their mid-stream urine (MSU) for pyuria, culture, and sensitivity tests; urinalysis for proteinuria, and estimated glomerular filtration rate (eGFR), hematocrit, serum creatinine and uric acid estimation. Children with confirmed ASB were compared with those without ASB. Those with confirmed ASB were monitored for 6 months for persistence of significant growth, development of symptomatic UTI, and evaluation of renal functions. The prevalence of probable and confirmed ASB in this cohort of SCA children were 12.2% and 6.6%, respectively. Confirmed ASB was more prevalent among older ( P = 0.046) and female ( P = 0.003) SCA children, particularly those with pyuria (odd Ratio, OR = 5.4, 95% confidence interval, CI = 2.7-11.0, P < 0.001) and proteinuria (OR = 1.4, 95% CI = 3.9-8.7, P = 0.006). Previous symptomatic UTI was not associated with ASB. Also, the mean eGFR, serum creatinine, and uric acid were not different in the group with ASB and those without ASB ( P > 0.05). At the end of 6 month follow-up, two (15.4%) of the 13 children with ASB had persistence of significant growth, but none develop symptomatic UTI. Also, none of the two with persistent ASB had hypertension or deranged renal function. ASB is a significant problem in older age female SCA children, although renal functions were not different among those with and without ASB. A large scale randomized placebo-controlled trial of conventional treatment for ASB in SCA is advocated to define its long-term clinical significance.

Background Ulcerative colitis (UC) is uncommon in the tropics and sub-tropics. We report a case of UC in a 7 year old girl whose parents were both Nigerians. This report is to alert healthcare professionals in sub-Saharan Africa that UC is not a rare health problem, especially in children. Case presentation The patient presented with frequent passage of blood stained stool, abdominal pain and significant weight loss. The diagnosis was entertained after she was investigated for common causes of chronic diarrhea in our setting and the findings were negative. The patient symptoms abated after she was commenced on steroid therapy. Conclusion Under-diagnosis and misdiagnosis may account for a dearth of information on UC in African children.

Pheochromocytomas are rare tumors that present a diagnostic challenge in developing countries. They occur in the adrenal gland and as paragangliomas along the sympathetic chain. Clinical features are usually those of sustained or paroxysmal hypertension and complications thereof. Surgical extirpation remains the mainstay of treatment and is greatly facilitated by accurate pre-operative tumor localization. Pre-operative medical management with antihypertensive medication has led to significant reductions in peri-operative mortality. Determination of malignancy is difficult in the absence of obvious metastases. We present a case of left adrenal phechromocytoma that was stabilized. Adrenalectomy had a good outcome and the patient has so far been followed up for a year.

Background Some studies have suggested that breast cancer in black women is more aggressive than in white women. This study's aim was to look for evidence of differences in tumour biology between the two cohorts. Methods This study compared the stage, grade and pathological expression of five immunohistochemical markers (oestrogen receptor [ER], progesterone receptor [PR], ERBB2, P53 and cyclin D1 [CCND1]) in tumour biopsies from age-matched cohorts of patients from Nigeria and England. Sixty-eight suitable samples from Nigerian (n = 34) and British (n = 34) breast cancer patients were retrieved from histology tissue banks. Results There were significant differences between the two cohorts in the expression of ER and CCND1; and stark differences in the clinical stage at presentation. But no significant differences were observed for tumour grade. Conclusion There was a significantly, low ER expression in the Nigerian cases which also predicts a poor response to hormonal therapy as well as a poorer prognosis. Differences in clinical stage at presentation will most likely influence prognosis between Nigerian and British women with breast cancer.

Hypoglycemia has been reported to present as a stroke mimic with hemiparesis or even hemiplegia. Earlier reports have suggested a possible right hemispheric predilection. Even though most cases occur in the elderly, cases of hypoglycemic hemiparesis have been reported amongst insulin-treated children with diabetes mellitus. The pathophysiology of hypoglycemic-hemiparesis is hinged on metabolic injury to selected vulnerable cerebral neurons. It is also conceived that presenilin-1 mutation as well as magnesium deficiency may be contributory. Blood glucose should be checked in all patients with altered states of consciousness. Hypoglycemia should be considered in all DM patients presenting with hemiparesis Keywords : Hypoglycemia; hemiparesis; Diabetes mellitus; pathogenesis; Nigerian Nigerian Medical Practitioner Vol. 50 (2) 2006: pp 36-38

Spindle cell hemangioma (SCH) is an uncommon tumor that usually presents as subcutaneous or deep dermal nodule affecting the extremities and is typically

Three cases of genital injuries caused by self-amputation, dog bite and cassava grating machine are presented. Accidental partial amputation of the penis through dog bite and de-gloving by cassava grating machine and unusual and, to our knowledge, have never been reported before. A previous report from this center showed that approximately 21% of all genito-urinary injuries specifically affect the genital organs, mostly as complications of circumcision2. As with one of our patients, victims of genital self-amputation usually have an antecedent history of serious psychosexual problems. Surgical management is usually aimed at restoring cosmesis and preserving erectile and ejaculatory capacities and function. It may sometimes be extensive. Attempt at re-anastomosis should be made when an amputated stump is available and viable. De-gloving and crush injury to the phallus is a very severe form of injury for which primary repair is unlikely to produce the best results. Non-viable tissue usually forms the basis for wound infection, which would result in breakdown. Delayed repair is likely to produce better results. Key Words: Unusual; causes; genital injuries; management; Nigerian Mary Slessor Journal of Medicine Vol.4(1) 2004: 93-98

Background Intensive insulin therapy is essential in the maintenance of strict glycemic control among insulin requiring patients with diabetes. However this presents a challenge in the face of the complexities associated with insulin use and also taking into consideration the potential dangers associated with inappropriate use. Insufficient knowledge of insulin use can result in preventable complications, adverse patient outcome, poor adherence to therapy and invariably poor glycemic control. Methods Insulin requiring diabetes patients (n = 54) attending the 2012 world diabetes day celebration in a Nigerian community were surveyed using a two part questionnaire. Section A elicited information on their demographics characteristics and participation in update courses, and exercise, while section B assessed knowledge of insulin use using the Michigan Diabetes Research and Training Centre's Brief Diabetes Knowledge Test. All participants who had a good grasp of English language or who could understand the contents of the questionnaire when it was explained to them, and were willing to participate in the study were assessed. Descriptive statistics of percentages was computed for the sociodemographic variables, previous education, satisfaction with education, involvement in regular exercise, knowledge of benefit of exercise and correct response to each question in section B. Analysis of variance (ANOVA) and independent t-test was used to determine the influence of sociodemographic variables on insulin use knowledge. Results Knowledge of insulin use is poor among insulin requiring patients with diabetes, with majority not conversant with such terms as ketoacidosis, insulin reaction and low blood sugar. Furthermore, they did not know how to modify their insulin dosage in relation to diet, exercise and infections (e.g. flu). Better knowledge of insulin use was associated with age, employment status, level of education attained, how frequent one reads/attends update courses and satisfaction with education received. Conclusion Poor knowledge of the causes and prevention of the ketoacidosis, insulin reaction and hypoglycemia increases their risk of developing them, which will invariably lead to poor adherence to insulin therapy. Therefore this study suggests a methodical, continuous and up-to-date tutelage if proper self management in terms of good glycemic control is to be achieved.

Paratesticular liposarcomas are rare tumors and are usually seen in patients in middle age or older. Optimal treatment is radical orchidectomy. Radiotherapy or chemotherapy is added for advanced disease or recurrences. These practice guidelines often vary from the experience in developing countries. We present a 23-year old man who presented with paratesticular myxoid liposarcoma, after transscrotal orchidectomy for ‘testicular tumor’ without histology. He was subsequently managed by neoadjuvant chemotherapy and complete tumor excision. A case of paratesticular myxoid liposarcoma in a young man is highlighted. Also noted is the fact that complete extirpation at primary surgery reduces the risk of local recurrence. The practice of transscrotal orchidectomy and non-submission of surgical specimens is highlighted and condemned.

Introduction Intravascular papillary endothelial hyperplasia is a reactive proliferative lesion of endothelial cells in blood vessels. It typically presents as a painless, reddish purple lesion in the sites affected. The orbit remains an uncommon site of affectation of this relatively common disease. It is noteworthy that this is the first reported case, to the best of our knowledge, of orbital intravascular papillary endothelial hyperplasia in a Nigerian child. Case presentation The case reported here is an orbital intravascular papillary endothelial hyperplasia causing non-axial proptosis and loss of vision in a 14-year-old Nigerian boy. We describe the clinical and histological findings of intravascular papillary endothelial hyperplasia in the orbit of this 14-year-old boy. The key distinguishing features are discussed and relevant literature is reviewed. Conclusion Although unusual in presentation, intravascular papillary endothelial proliferation should be considered in the list of differentials of proptosis due to mass lesion in young Nigerians and, possibly, Africans.

Introduction Dextrocardia with situs inversus is a rare congenital disease. In patients with this condition, the heart is presented as a mirror image of itself with its apex pointing to the right. The pulmonary and abdominal anatomies are reversed. Dextrocardia with situs inversus occurs at birth but its diagnosis may be in adulthood. This case advances knowledge by graphically describing the unusual electrocardiographic features of dextrocardia in a young adult. Case presentation We report a case of a 22-year-old Nigerian man of Yoruba ethnicity who presented himself for preadmission medical test. He had a standard 12-lead electrocardiogram which revealed uncommon features: inversion of P waves in leads I, aVL and aVR; dominantly negative QRS waves in leads I, V1 to V6; reverse R wave progression in chest leads; low voltage in V4 to V6; extreme QRS axis; flattened T waves in V4 to V6 and aVR; and inverted T waves in lead I and aVL. An electrocardiogram diagnosis of dextrocardia was made. The differential diagnosis considered was right ventricular hypertrophy. A cardiovascular examination showed pulse rate of 70 beats per minute, blood pressure of 119/62mmHg, visible cardiac impulse at right precordium, apex beat was located at his fifth right intercostal space mid-clavicular line. A chest X-ray (posterior anterior view) including upper abdomen showed dextrocardia; his aortic arch was located on the right. His stomach bubble was located below his right hemidiaphragm. His trachea was slightly deviated to the left. The findings in his lung fields were not remarkable. Abdominopelvic ultrasonography showed that right-sided intra-abdominal organs (liver, gallbladder) were located on the left while left-sided organs (stomach, spleen) were located on the right. His abdominal aorta was on the right while his inferior vena cava was located on the left. A diagnosis of dextrocardia with situs inversus was made ultrasonographically. Conclusions A properly interpreted electrocardiogram was useful in suspecting the diagnosis of dextrocardia with situs inversus. So, an analysis of a relatively simple and non-invasive diagnostic tool such as an electrocardiogram allows for suspicion of a cardiovascular anomaly in a setting of scarce diagnostic resources.