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Introduction: Over 80% of cardiovascular deaths take place in low and middle incomecountries. These cardiovascular deaths are caused by modifiable risk factors. Evidenceis emerging that some of these factors maybe even more prevalent in rural areas whichare generally underserved.Aim: The aim of this study was to record risk factors for cardiovascular disease inrural communities in south southern Nigeria and review some related literature.Methods: A cross sectional study during clinical outreach activities that took placein 2016 to 2018 in several rural and few urban communities in Cross River State,Nigeria. Participating individuals gave full consent and ethical clearance obtained.Socio-demographic data, Anthropometric data and Blood sugar measurements wereobtained. Data extracted was transferred into EXCEL thereafter analysis was doneusing SPSS version 21. p values less than 0.05 were deemed statistically significant.Tests of significance included Anova, chi square and student t- tests.Results: Total population investigated over the 3 year period was 504. (2016-33.1%),(2017 -37.9%), (2018 – 28%) with a Female: Male distribution of 1:1.Most participants tended to be overweight across the years 59.7%, 59.1%, 73.7%,2016, 2017, and 2018 respectively. The prevalence of Hypertension was 10.71%. Nosignificant gender difference in the prevalence of Hypertension (6.94% males to 3.77%females, p=0.097). The prevalence of Diabetes Mellitus was 10.67%. There was nosignificant gender prevalence (6.67% males to 4.00% females, p =0.431)Conclusion: Cardiovascular disease remains relatively uncommon in Sub-SaharanAfrica, despite an increasing prevalence of risk factors, but it’s incidence is rising.Steps should be taken in Sub-Saharan Africa to prevent an epidemic. This involvesdetailed and regular screening for cardiovascular risk factors in rural communities.Key words: RISK FACTORS, Cardio vascular disease, South South Nigeria.

Objective: The objective of this study was to define the injury types found intracranially when head trauma occurs and possibly predict the type of injury seen with the different mechanisms of injury. Methods: We prospectively studied ninety-one patients presenting at the University of Calabar Teaching Hospital (UCTH) over twenty-four months (February 2011 to February 2013) with head injury. Their socio-demographics and clinical data as well as the CT findings were collected. Statistical analysis was done using stata 10, stat corp, Texas USA, 2007. Frequency tables, bar chats, histograms and chi-square were used to analyse the data. Results: Ninety-one patients with head injury were seen. The age group of 20-29 and 40-49years were the commonest, median being twenty-nine years, interquartile range, 22-42years. Sixty four (70.3%) males, twenty seven (29.7%) females. The commonest mechanism of injury was RTA. Diffuse cerebral oedema, cerebral haemorrhage were the commonest brain events. No normal scan was seen. Skull fractures, especially comminuted ones were the commonest. CT findings in each case could not be predicted from the mechanism of injury. Conclusion: This study reveals that a typical head injured patient in our locality is a male aged 20 – 29 years, involved in an RTA. Since it is impossible to predict the CT scan findings using the mechanism of injury, CT scans should be made available in all hospitals so as to appropriately manage these types of patients. DOI: http://dx.doi.org/10.3126/ajms.v5i2.8754 Asian Journal of Medical Science, Volume-5(2) 2014: 73-79

Aim: This retrospective analysis documents the features and factors that potentially affect outcomes in septic arthritis in the Cross River Basin area of south-south Nigeria. Patients and Methods: A retrospective analysis of 43 patients who presented with septic arthritis in 45 joints between September 2007 and August 2010. All patients with pain, fever, joint swelling and non-weight bearing/refusal to move the limb and had a joint aspiration productive of a turbid and/or purulent aspirate were included in the analysis. Patients whose joint aspiration produced frank blood or a clear exudate were excluded. Results: There were 24 males and 19 females (M:F = 1.3:1). Forty patients were children while three were adults. Thirty-three patients were urban dwellers, 8 were semi-urban dwellers and 2 were rural dwellers. Twenty-five children were first seen by a Paediatrician. Only 5 patients were first seen by an Orthopaedic surgeon. Definitive treatment was conservative in 28 children and arthrotomy/washout in 12 children and 3 adults. Staphylococcus aureus was the commonest isolated pathogen in both age groups. Conclusion: Injudicious interventions in musculoskeletal conditions consist not only of traditional bone setting and other unorthodox practices, but also sub-optimal orthodox medical practices. Healthcare outcomes in Africa are a function of the skewed distribution of the healthcare workforce and a weak referral chain. The near absence of follow-up culture underscores the need for education on injudicious antibiotic therapy to be directed at patients and physicians. Judicious interventions in musculoskeletal sepsis at first contact and a strengthening of the referral chain are important.

Background: Peripheral limb vascular diseases form one of the most common diseases that affect the middle‑aged and the elderly. Duplex ultrasound has revolutionized medicare and is an important modality for investigating them. Unfortunately, this modality is still not popular in our environment and in Calabar was used for the 1st time 4 years ago. This work is, therefore, to report our findings and hopefully increase the awareness of its benefits thereby improving and hastening the diagnosis of vascular pathologies in our environment.Methods: A prospective study that took place in the University of Calabar Teaching Hospital, Calabar between March 2011 and August 2014. The study included patients with pain, swelling, ulceration, as well as outright gangrene of the upper or lower limbs. Others were stroke or transient ischemic attack (TIA) patients, and patients with renal grafts. The scans were carried out in Radiology Department using a digital color Doppler ultrasound.Results: Seventy‑six patients were scanned during this period. They were more males (67%) than females (33%). The indications were mainly leg swelling and pain 25 (33%), stroke/TIA 10 (13%), and deep venous thrombosis (DVT) 10 (13%) The most common scan done was peripheral limb Doppler, 49 (64.5%).The majority of the scans showed no abnormality followed by chronic venous insufficiency 13 (17.1%) and lower limb arteriosclerosis 7 (9.2%) which was noted to be common among diabetics and hypertensive. DVT was another common finding and 4 out of 10 patients in whom DVT was suspected clinically showed sonographic evidence of the condition.Conclusion: Duplex ultrasound has been shown to diagnose varied vascular pathologies even in a locale where it is a relatively new technique. It is recommended that timely referrals be made, and mobile Doppler units be acquired to save more lives and limbs in the developing world.Keywords: Calabar, deep venous thrombosis, duplex ultrasound, peripheral lower limbs

Background: Road traffic injury remains a major source of blunt abdominal trauma (BAT). Road traffic injury and other forms of trauma have become a major health problem throughout the world especially in low and middle-income countries. In a previous study (2005-2007), abdominal trauma constituted 79 (4.8%) of trauma cases; BAT, 40 (53%) and penetrating abdominal trauma (PAT), 39 (47%). Effective policies on road safety should be developed based on local research and not on adapted models. We present this study to highlight the possible effect of legislation on the ban of the use of motorcycles on blunt abdominal trauma. Methods: Patients that presented to the University of Calabar Teaching Hospital, Calabar with BAT from 2008-2010 were prospectively studied based on a questionnaire following the legislation prohibiting the use of motorcycles. Results: A total of 12,083 patients presented during the study period, trauma patients totaled 4942 (41%), of this, 48 (1%) suffered abdominal trauma: BAT 19 (40%), penetrating abdominal trauma (PAT) 29 (60%). The age range of the patients was from 5 to 48 years (mean 26.6 years) with a M:F = 5.3:1. Road traffic accident (RTA) 17 (90%) [Motorvehicle 7 (37%), motorcycles 10 (53%)] was the commonest cause of trauma. The spleen was the commonest injured organ 14 (74%). Conclusion: Road traffic injury constitutes a public health challenge and the hallmark is prevention. Legislation prohibiting the use of motorcycles may have been responsible for the reduction in BAT.

Background: Blunt abdominal trauma (BAT) usually results from motor vehicle accidents, assaults, and recreational accidents or falls. This communication is a 3-year report of an ongoing study aimed at providing the current BAT prevalence in our center. It is hoped that this would assist in a better design of prevention and emergency trauma response systems to cope with this epidemic. Methods: All of the patients admitted to the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria, from February 2005 to January 2008 were prospectively studied based on a questionnaire. Hemodynamic stability and sonography formed the basis for selecting patients for non-operative management (NOM); others were offered laparotomy. Results: In total, 4,391 emergencies were seen during the study period, of which 1,654 (38%) were due to trauma. Seventy-nine patients with abdominal trauma accounted for 4.8% of trauma cases. Forty-two (53%) patients suffered BAT and their ages ranged from 14 and 56 years (mean 28.4 years), with a male:female ratio of 2.5:1. Road traffic accidents accounted for 13 (87%) and 26 (96%) patients in the NOM and laparotomy groups, respectively. The most commonly injured organ was the spleen in both groups: 8 (50%) and 15 (56%) in the NOM and laparotomy groups, respectively. Fifteen (36%) patients were managed successfully in the NOM group. Conclusion: Trauma was mainly due to road traffic injuries. Hemodynamic stability and ultrasonography effectively selected patients for NOM. The establishment of trauma systems, provision of ancillary diagnostic and monitoring facilities, well-designed roads and traffic infrastructure, and health education on road safety would reduce injury, morbidity, and mortality.

AIM: This is to report a case of Klippel Trenauay Weber syndrome in a fifteen year old Nigerian boy. This is a rare syndrome and it is the first case to be reported in UCTH Calabar.CASE PRESENTATION: Product of a full term uneventful pregnancy, delivered to non-consanguineous apparently healthy parents. At birth was noted to gradually develop swelling on the right leg, worse at the right foot. There was crossed hemi-hypertrophy with right leg bigger than the left. As child grew symptoms worsened, parents separated and eventually he was abandoned to the streets. He presented at University of Calabar Teaching Hospital for medical care at the age of fifteen years with lymphatic obstruction, persistent foul smelling drainage, lipodermatosclerosis of right foot as well psycho-social and financial constraints. The diagnosis was made with x-rays and Doppler studies of the lower limb vessels. He is currently being managed conservatively with compression dressings on the affected limbs, Antibiotics for the infection and analgesics. De-bulking surgery is being anticipated at this time.CONCLUSION: This is a case of KTWS presenting in adolescence and due to its rarity in Nigeria, this report is to increase awareness.

Background: Women between 12 and 50 years are in the reproductive age. The likelihood of or actual presence of pregnancy should be ruled out before they are exposed to medical ionizing radiation. Fetal exposure to ionizing radiation can either induce malformation (teratogenic) or cancer. They should be exposed only when it is safe for the fetus or when the benefit far outweighs the risk in urgent medical conditions. The radiation dose in medical imaging is generally below the threshold to induce malformation (100 mGy) in the fetus, but there is indeed no safe level as the risk of cancer induction later in life can occur at any dose. The referring physician must obtain the last menstrual period (LMP) and sometimes carry out pregnancy test before sending their patients for examinations using ionizing radiation. However, there are circumstances in which these rules are waived. Objective: The purpose of the study is to evaluate the role of the referring physician in the radiation protection of the fetus using the LMP. Subjects and Methods: This is a prospective study over a 2-month period. All the request forms of menstruating women aged 12-50 years sent for conventional radiography are included in the study. Results: One percent provided the LMP in the request forms. 0.6% (one) of our subjects was sure she is pregnant, but 13.7% (25) had an overdue menstruation. Conclusion: The level of compliance of the physicians with the referral guidelines for women of reproductive age is poor.

Neonatal intestinal obstruction is the most common surgical emergency in the newborn period. Prompt diagnosis and urgent management improve the chances of a favorable outcome. Aetiology and outcome may vary in different parts of the same country. Objective: To evaluate the aetiology and factors associated with mortality in neonates presenting with intestinal obstruction in University of Calabar Teaching Hospital, Calabar, Nigeria. Method: This was a retrospective study of clinical records of neonates presenting with features of intestinal obstruction over an eight year period. The biodata, diagnosis, management and outcome for the neonates were documented. Result : Forty neonates; 26(65%) males and 14(35.5%) females were studied. Imperforate anus was seen in 40% of subjects while Hirschsprung’s disease and intestinal atresia each were seen in 10%. Aetiology could not be determined in about a fifth of the cases. Age less than one week at presentation was significantly associated with a poor outcome. No case had surgical intervention within twenty-four hours of presentation. The overall mortality was 30%, most of these 9 (75%) was due to anorectal malformations. Conclusion: The management and outcome of neonatal intestinal obstruction in our setting is poor. There is urgent need to upgrade our neonatal intensive care services to improve outcome in affected neonates. More Paediatric surgeons are required to reduce the gross inadequacy of expert as this would improve on the surgical intervention time as reported in this study. Key Words : Neonatal intestinal obstruction Hirschprung’s disease

Objective: To assess the degree of utilization of the radiology request form (RRF), the extent of completion each form, the frequency of filling the fields in all the forms, and its effectiveness as a communication tool between the referring clinicians and radiologists. Materials and Methods: All the RRFs for conventional radiographic examinations were audited over a 3-month period. A database containing all the fields in the form, type of request paper used, and legibility of the physician′s handwriting was created. A few resident radiologists in the plain film reporting unit were recruited to join in collecting the data daily. We used simple statistical methods to analyze the extent of completion of each form, frequency of completion of the fields in all the request forms, frequency of use of the appropriate form, and frequency of legibility of the physician′s handwriting. The results are expressed in percentages. Results: Five hundred eighty (580) requests were analyzed, consisting of 180 for males and 400 for females. The most-completed request form was 86.67% filled, while the least-completed was 26.67%. The most frequently filled field was the requested examination (99.66%). Of the clinicians, 28% did not use the RRF for their referrals, while 7.37% had illegible handwriting. Conclusion: A significant number of the referring clinicians did not make the best use of the radiology department by not using the institution′s approved RRF as an effective means of communication with the radiologists, mainly due to the inadequate completion of the forms.

Background: Computerized Tomography (CT) findings of Cerebrovascular Accidents (CVA) in patients in Calabar, Nigeria, have not been previously reported. The aim is to document the CT findings and the pattern and demographic features of the condition. Materials and Methods: We prospectively studied 87 consecutive patients, presenting over a 12-month period with diagnosis of stroke. The sociodemographic and clinical data as well as the CT findings were collected. Statistical analysis was done using the computer software STATA 10 corp., Texas, USA. Results: There were 49 males and 37 females with a median age of 56 years (45.75-67). The ischemic type of CVA predominated, (81.4%), with no significant gender difference (P = 0.99). The peak age of stroke was in those less than 50 years (33.7%). The individuals with hemorrhagic stroke were younger than those with ischemic stroke (median of 48 and 59 years, respectively). Conclusion: Stroke incidence in Calabar has evolved so much, as to affect a much younger age group and the female to male ratio is fast approaching equality. The hemorrhagic type tends to affect younger males. It is recommended that young people presenting with stroke in the Calabar area, particularly where a CT scan is not available, must be suspected to have a hemorrhagic stroke.