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Background: The presence of endometrial tissue in the tracheobronchial tree, pleural, and lung is normally referred to as thoracic endometriosis. The association of catamenial pneumothorax, catamenial haemothorax, catamenial haemoptysis and pulmonary nodules is referred to as thoracic endometriosis syndrome (TES). TES is rare but not as rare as it has always been thought of. Case summaries: Case 1: We present EA, a 26-year-old chef/baker who presented to our unit on account of recurrent cyclical right sided chest pain and difficulty in breathing, recurrent haemoptysis and cyclical abdominal pain and swelling with multiple tender umbilical nodules. On general physical examination she was found to be in respiratory distress but not cyanosed with peripheral arterial oxygen saturation 97% on room air. Examination of the chest revealed a right sided chest fullness and reduced movement with breathing. Percussion note was stony dull and absent of breath sound on right hemithorax. Abdominal examination revealed a moderately distended abdomen with positive fluid thrill. Both Pleurocentesis (thoracocentesis) and paracentesis abdominis yielded a haemorrhagic fluid acellular and pleural and lung biopsy demonstrated endometrial stroma and glands. Imaging examination by way of chest X-ray showed a homogenous opacity of the right hemithorax, and pulmonary nodule following drainage. A diagnosis of Thoracic Endometriosis Syndrome was made. She had VAT with lung and pleural biopsy, pleural abrasion and a thoracostomy tube drainage. Case 2: We present IAE, a 29year-old Po+0 who presented to our unit on account of recurrent cyclical right sided chest pain and difficulty in breathing, unproductive cough. On general physical examination she was found to be in moderate respiratory distress but not cyanosed with peripheral arterial oxygen saturation of 98% on room air. Chest examination revealed an apical flattering of anterior chest wall with left trachea deviation. Percussion note was stony dull on the right lower third and hyper resonance middle and upper zones of right hemithorax. Pleurocentesis (thoracocentesis) yielded air and haemorrhagic fluid acellular and pleural and lung biopsies demonstrated endometrial stroma and glands. Imaging examination by way of chest X-ray and chest CT-scan showed air fluid level of the right hemithorax. A diagnosis of TES was made. She had Laparoscopy and VAT at the same sitting with pleural and lung biopsies. She was managed medically after closed thoracostomy tube drainage. She had partial collapse of right lower lobe and thoracotomy with right lower lobectomy was planned but patient declined. She also had Stage IV endometriosis by (rASRM)/ENZIAN systems Case 3: We present JA a 29-year-old lady, a filling station attendant who presented to our unit with a history of gradual onset of right sided chest pain, progressive difficulty in breathing and non-productive cough, and abdominal pain and swelling. On general physical examination she was found to be in respiratory distress but not cyanosed with SPO2 of 98% on room air. Examination of the chest revealed a right apical flattening, reduced ipsilateral chest movement with breathing. Percussion notes were stony dull and absent air entry on the ipsilateral hemithorax. Abdominal examination showed a mildly distended abdomen with a positive shifting dullness. Both Pleurocentesis (thoracocentesis) and paracentesis abdominis yielded a haemorrhagic fluid acellular at cytology and pleural and lung biopsy demonstrated endometrial stroma and gland. Imaging examination by way of chest X-ray showed a homogenous opacity of the right hemithorax. A diagnosis of Familial Thoracic Endometriosis Syndrome (FTES). Had USS guided lung and pleural biopsy and a thoracostomy tube drainage. She had chemical pleurodesis with tetracycline Conclusion: Thoracic endometriosis syndrome is the diagnosis in a lady of reproductive age who present with cyclic or a cyclical recurrent right sided chest pain, cyclical or a cyclical dyspnoea, haemoptysis, cyclical or a cyclical abdominal swelling and peritonitis.

Uterine leiomyomas are common benign gynecological tumors due to the overgrowth of uterine smooth muscle. Pedunculated uterine leiomyoma occurs when the mass is in continuity with the uterus with a stalk and may grow either within the uterine cavity or outside of the uterus and may mimic ovarian neoplasms or intraabdominal tumors. Presented is a 28-year-old woman with a progressive abdominal swelling in the past 9 months seen at the surgical outpatient of our facility. Preoperative CT suggested a diagnosis of an intrabdominal cystic. She had laparotomy and was offered myomectomies on account of a large subserous uterine mass arising from the right side of the uterine fundus, small subserous fundal mass, intramural mass in the left side of the fundus and a cervical mass. Histology confirmed multiple uterine leiomyomas with extensive cystic degenerative changes of the large subserous uterine myoma and adenomyosis of the left fundal mass. Detecting the continuity of an abdominal mass even with extensive degenerative changes mimicking a cyst in continuity with the uterus by a pedicle sign on imaging in the absence of ascites should arouse the diagnosis of pedunculated subserosal leiomyoma. This should be further heightened when it is found in association with cervical myoma. Subserous uterine leiomyoma should be considered in a patient of childbearing age with a grossly distended abdomen without obvious evidence of pregnancy or malignancy. Large subserous uterine leiomyoma in an intraabdominal location may present with diagnostic and surgical challenges that require interdisciplinary cooperation., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: Most neonatal deaths occur in low and middle-income countries (LMICs). These deaths can be prevented through universal access to basic high-quality in-patient health services. Prematurity, neonatal sepsis, and perinatal asphyxia have been reported as the leading causes of in-patient neonatal deaths. This study aimed to assess the trend of neonatal mortality in our hospital, determine the pattern and causes of neonatal mortality, and evaluate the factors associated with neonatal mortality in our facility., Methodology: This was a retrospective cross-sectional descriptive study conducted in the Special Care Babies Unit (SCBU) and Sick Babies Unit (SBU) of the University of Uyo Teaching Hospital, over seven years (2015-2021). Demographic, clinical, and mortality data was extracted from the case record files of patients into a structured proforma and analysed., Results: There was a total of 228 deaths comprising 130 males (57.02%) and 98 (42.98%) females. The median age at demise was 4.00 (IQR = 1.00 - 12.00) days for both genders. The majority (71.50%) of deaths occurred in the Sick Babies Unit. More males died than females (57% vs 43%). The three leading causes of death were: prematurity (38.60%), neonatal sepsis (38.16%), and birth asphyxia (13.60%)., Conclusion: The leading causes of neonatal mortality in our environment are prematurity and neonatal sepsis. There is a need for increased community education on antenatal care, training of traditional birth attendants, improved newborn transportation facilities, and provision of neonatal intensive care facilities., (Copyright © 2024 Nigerian Medical Association.)

Membrane trafficking is a physiological process encompassing different pathways involved in transporting cellular products across cell membranes to specific cell locations via encapsulated vesicles. This process is required for cells to mature and function properly, allowing them to adapt to their surroundings. The retromer complex is a complex composed of nexin proteins and peptides that play a vital role in the endosomal pathway of membrane trafficking. In humans, any interference in normal membrane trafficking or retromer complex can cause profound changes such as those seen in neurodegenerative disorders such as Alzheimer's and Parkinson's. Several studies have explored the potential causative mechanisms in developing both disease processes; however, the role of retromer trafficking in their pathogenesis is becoming increasingly significant with promising therapeutic applications. This manuscript describes the processes involved in membrane transport and the roles of the retromer in the onset and progression of Alzheimer's and Parkinson's. Moreover, we will also explore how these aberrant mechanisms may serve as possible avenues for treatment development in both diseases and the prospect of its future application., (© 2023 Wiley Periodicals LLC.)

There is a paradigm shift towards adopting a multidisciplinary team (MDT) model in the care of cancer patients, with increasing evidence to support its effectiveness. Cancers are biologically distinct, patients present in diverse ways and require, different therapeutic approaches in their management. Patient symptoms and treatment side-effects as well as physical and psychological impact vary according to cancer location and treatment plan. The varied clinical scenarios cancer patients present further buttress the need for MDT practice in hospitals to improve the quality of patient care, in contrast to the outdated concept of holistic treatment offered by a single physician. Unlike Europe, United States of America and Australia which have implemented successful MDT cancer care programs, Nigeria is just coming on board. We present two cases of gastric cancer (seen two months apart) with atypical presentation and the role of MDT in their evaluation and management. These case studies highlight the role of MDT in the management of cancer patients in Nigeria lending credence to the urgent need to implement this model of care in our cancer patients in a bid to improve the quality of care and outcome., Competing Interests: The authors of this case report hereby declare no competing interest., (Copyright: Mbang Kooffreh-Ada et al.)

Background: Community screening for chronic kidney disease has often been based on single measurements of markers of kidney damage worldwide. The evaluation of kidney dysfunction and related risk factors may be facilitated by the deployment of telehealth services such as short message service., Methodology: Cross-sectional study for screening participants for CKD and risk factors during a world kidney event at two communities in Calabar, Cross River State. Short message service (SMS) was used to remind and invite participants to attend a kidney clinic to recheck their kidney functions and subsequently adjust initial point prevalence estimates based on this outcome. Chronic Kidney disease was defined as eGFR less than 60ml/min/1.73m 2 and/or proteinuria., Results: A total of 230 consenting participants were screened with an overall mean age of 36.43 ±11.69 years. 145 (62.7%) were either obese or overweight, while 25 (10.9%), 10 (4.3%) and 1 (0.4%) had a history of hypertension, diabetes, and CKD, respectively. Various degrees of proteinuria were found in 50 (21.74%) participants. Eleven participants had low eGFR <60mL/min. The point prevalence of CKD at the first screening was 24.3% (95%CI 18.9 - 30.4). Of those with either proteinuria or low eGFR, only 12(24%) and 5(45.4%) respectively represented themselves for recheck following the text messages. The adjusted point prevalence was 20.1%., Conclusion: There is a low level of response to recall for rescreening for urinary and blood markers of kidney disease using mobile phone short message service in our population. The determinants and drivers of response will need to be studied., Competing Interests: None, (Copyright © 2023 Nigerian Medical Association.)

Malaria is a severe public health issue in Nigeria, with higher morbidity and mortality rates than any other country. An estimated 100 million malaria cases and over 300,000 deaths are recorded yearly in Nigeria. Vaccination is an effective strategy in combating and eliminating infectious diseases such as malaria, thus, the deployment of a prospective malaria vaccine in Nigeria offers hope to the country's health sector. However, vaccination programmes face challenges, particularly in communities that are difficult to reach geographically or culturally, and these obstacles can only be overcome through continued international, national, and individual commitment. There is a need for expanded and continuous public health information, education, and communication particularly on contemporary health issues such as malaria and vaccination hesitancy. This will enable easier implementation and compliance to strategies for the sustainable control and eventual elimination of malaria. This article highlights some of the lessons learned from previous vaccination programs in Nigeria and how the insight gotten can be pivotal in ensuring the success of a prospective malaria vaccination programme in Nigeria., Competing Interests: No conflicts of interest declared., (© 2022 The Authors.)

The Uttarakhand State, known for its Himalayan Mountains, is a territory in Northern India that is extremely vulnerable to earthquakes, landslides, and floods. Currently, due to the COVID-19 outbreak, India is facing the dual challenge of containing a pandemic and responding to natural disasters. This situation can have a negative impact on the health and the economic development of the region, leading to a long-lasting humanitarian crisis that can disrupt even more, the already overburdened health service. In addition, it can pose serious threats to the wellbeing of the population as it complicates physical distancing and other COVID-19 prevention measures. It is of utmost importance to analyse the impact of floods, landslides, and COVID-19 pandemic on the health system of the Uttarakhand State, and how these crises interact with each other.

Cacao swollen shoot virus (CSSV) is an endemic pathogen causing significant economic losses to cacao ( Theobroma cacao L.) production in West Africa. There is limited updated report on the occurrence, spread, genetic diversity and species of CSSV and its mealybug vectors, especially in Nigeria. Nigeria is presently lagging behind in the search for resistance to CSSV and its vectors in T. cacao L. The present study aimed to map and screen for the presence of CSSV and its natural vectors - female mealybugs (Pseudococcidae: Hemiptera) in cacao plantations in Nigeria. Symptomatic and asymptomatic cacao leaves and whole female mealybug samples were collected from major cacao-growing areas in Nigeria - Abia, Akwa Ibom, Cross River, Edo, Ondo and Oyo States. A total of 2568 cacao leaves from 1052 cacao trees were screened with polymerase chain reaction (PCR) using an open reading frame 1 (ORF 1) CSSV-specific primer pair. PCR screening of the mealybug species was performed using the cytochrome c oxidase subunit I (COI) gene. A combination of scanning electron microscopy (SEM) and histology for morphological identification and DNA barcoding enabled to characterise the female mealybug species. The results revealed that CSSV and its mealybug vectors are present in the major cacaogrowing areas in Nigeria. Although CSSV and its vectors have been previously reported in Cross River, Ondo and Oyo States, our results present the first documented evidence of CSSV emergence and its mealybug vectors in Abia, Akwa Ibom and Edo States. We also present the first report of Pseudococcus jackbeardsleyi (Gimpel and Miller) mealybug species on cacao in Nigeria. In conclusion, it is pertinent to re-establish coordinated routine survey and monitoring of CSSV and its mealybug vector presence in T. cacao L. in Nigeria., (© 2021 Institute of Bioorganic Chemistry, Polish Academy of Sciences.)

COVID-19 being a public health emergency of international concern has emerged in most African countries including Niger. Niger, a landlocked country, is tasked with controlling the pandemic. However, of the big challenges the country faced is the fragility of healthcare system which posed limitations to the fight against the virus. The virus overwhelmed the fragile healthcare system which led to inaccessibility of quality healthcare to the citizens coupled with issues of flooding and economic recession that happened during the pandemic. The healthcare sectored has further been crippled by exposure and infection of the already insufficient healthcare workers. In addition to this, there was the burden of NTDs and other communicable and non-communicable diseases that subverted the country in the depths of difficulties. As per the predictions of World Bank, the poverty curve is likely to escalate due to the outrageous impacts of COVID-19. Adding on to this, the occurrence of natural disasters such as flooding has further stretched the country. It's no coincidence that the country would confront plethora of challenges amidst the second wave. Therefore, timely decision and necessary interventions are needed to strengthen the country's fight against the pandemic. However, this is only feasible when Nigerien government, international allies and other wealthy nations work closely to ensure that the challenges faced by the healthcare system are tackled., (© 2021 The Authors.)

Context: Access to chronic hemodialysis for patients with end-stage kidney disease has improved over the years. However, it is unclear if this has resulted in lower cost and improved dialysis vintage., Aim: We aimed to assess the demographics, cost implication, and sustainability of maintenance hemodialysis in our cohort of end-stage kidney disease (ESKD) patients., Methods: Retrospective descriptive study of ESKD patients on maintenance HD from 2014 to 2018 using hemodialysis records. Time-to-HD discontinuation and reasons for discontinuation were recorded. Using Kaplan-Meier graphs, the time-to-dialysis discontinuation experience of the cohort was shown. Log-rank test was used to compare the experience between both genders. Univariable and multivariable Cox proportional hazard models were built to identify independent associations with time-to-dialysis discontinuation., Results: Over the 5-year period, 702 individuals initiated HD, males were older than females, the complete cohort contributed 65,714 person-days to the study and the median time-to-HD discontinuation was 10 days (interquartile range, 2-42). Females had a shorter time to HD discontinuation (8 days [1-32 days]) compared to males (11 days [2-48 days]). Only 28.5%, 15.3% and 8.3% of the patients had HD beyond 30, 90, and 180 days, respectively. About 128 (18.2%) had thrice-weekly HD. Most sustained the treatment for the 1 st week. Majority (98.4%) of the patients were presumed dead, while 4 (0.65%) were still alive and 6 (0.98%) had renal transplantation. All patients who discontinued dialysis did so for financial reasons. Multivariable Cox proportional hazards model showed that individuals who could afford dialysis more than once a week had reduced hazard of dialysis discontinuation., Conclusion: Most patients cannot sustain HD beyond a few weeks for financial reasons. Several cost containment strategies need to be deployed to bring down the cost of care., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Nigerian Medical Journal.)

Introduction: Haemodialysis (HD) which is a form of renal replacement therapy commonly prescribed for patients with chronic kidney disease (CKD). However, it is not without deleterious haemodynamic responses which may occur either during or immediately after the termination of the procedure. These may include hypotension or hypertension., Methods: This was a retrospective study that reviewed chronic kidney disease (CKD) patients on maintenance haemodialysis at the renal unit of University of Calabar Teaching Hospital, Calabar, Nigeria. In all, 71 patients were reviewed but only 64 patients had complete data for analysis. Socio-demographic, clinical and biochemical data were obtained from the records in the dialysis unit., Results: There were more males 38 (59.4%) than females 26 (40.6%) in the study. The mean age was 51.71±15.43 years and 43.04±14.03years for males and females respectively. The prevalence of intradialysis hypertension 29 (45.3%) was higher than that of intradialysis hypotension 20 (31.3%) and the commonest cause of CKD requiring haemodialysis was diabetic nephropathy. The factors associated with intradialysis hypotension were lower post-dialysis systolic blood pressure (PDSBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and less number of antihypertensive medications; while the factors associated with intradialysis hypertension were higher post-dialysis systolic blood pressure (SBP), MAP, greater number of antihypertensive medications and longer duration of haemodialysis., Conclusion: Our study shows that there are several modifiable factors associated with blood pressure fluctuations among CKD patients on maintenance haemodialysis in the renal unit of the University of Calabar Teaching Hospital, Calabar., Competing Interests: The authors declare no competing interests.

Background: The burden of the people living with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS) is largely borne by communities in Sub-Saharan Africa. The rate of kidney disease is increasing amongst HIV patients and occurs more often in patients with advanced stage of the disease with lower CD 4 counts and associated with a high rate of morbidity and mortality. The objective of this study is to determine the prevalence and predictors of chronic kidney disease (CKD) amongst HIV patients on highly active antiretroviral therapy (HAART) at the University of Calabar Teaching Hospital, Calabar. Materials and methods: This was a cross-sectional study that was carried out over a 4-month period from May to August 2018. In all, a total of 118 patients with HIV on HAART were recruited into the study in a consecutive manner and their serum creatinine measured with the calculation of estimated glomerular filtration rate (eGFR). Other data collected were sex, age, weight, height, body mass index (BMI), waist hip ratio (WHR), packed cell volume, CD4 count etcetera. Data collected were inputted and analyzed with SPSS version 18, and statistical significance was taken to be p <0.05. Results: There were more females (69.5%) amongst the HIV participants and the prevalence of CKD was 15.3%. The risk factors seen to be associated with CKD were lower levels of CD4 count below 200 cells/µl, lower PCV, weight, BMI, and eGFR. Also, higher levels of WHR and creatinine were associated with CKD. Factors directly correlated with CKD were weight, BMI and CD4 count levels, while creatinine level was inversely correlated with CKD. However, a logistic regression model showed only creatinine to be a predictor of CKD. Conclusion: HIV patients on antiretroviral therapy, mainly the highly active antiretroviral therapy (HAART) have a relatively high prevalence of CKD of 15.3% and high level of serum creatinine was predictive of CKD in the logistic regression model in our study., Competing Interests: The authors report no conflicts of interest in this work.

Introduction: Cryptosporidium is an important cause of diarrhea in children and immune-compromised individuals. Recent advances in molecular diagnostics have led to the discovery of subtype families that are thought to be more commonly associated with diarrhea. We aimed to isolate and characterize Cryptosporidium spp among children with diarrhea in Jos, Nigeria., Methods: Stool samples were collected from165 children aged 0-5 years with diarrhea. Cryptosporidium oocysts were examined by wet mount preparation, using formalin ether and a modified acid fast staining method. DNA was extracted from positive samples using QIAamp DNA stool mini kit and PCR-RFLP assay was carried out after quantification. Genotyping and phylogenetic analysis were done to determine the subtype families and their relatedness., Results: From the 165 children studied, 8 (4.8%) were infected with Cryptosporidium. PCR-RFLP assay and genotype characterization found the following Cryptosporidium species: C. hominis 6 (75%) and C. parvum 2 (25.0%), with family subtypes Id-5, Ie-1 and IIa-1, IId-1 respectively.The most common species was C. hominis and the frequent subtype was C. hominis-Id 5 (62.5%)., Conclusion: Cryptosporidium is not an uncommon cause of diarrhea in children, with C. hominis being the dominant species. Also C. hominis Id is the commonest sub-family subtype. Put together, zoonotic species may be an important cause of diarrhea in children aged 0-5 years in Jos, Nigeria., Competing Interests: The authors declare no competing interests.

Background: Majority of chronic kidney disease (CKD) patients are more likely to die of cardiovascular complications before reaching end stage renal disease. The Kidney Disease Outcomes Quality Initiative (K/DOQI) recommends that all CKD patients should be evaluated for dyslipidemia and for treatment to reduce the risk of cardiovascular events., Patients and Methods: A cross-sectional case control study to determine the frequency of occurrence of lipid abnormalities in patients with CKD and compare these abnormalities with that of normal controls. A total of 100 patients and 100 controls were recruited for the study. Demographic and clinical data were obtained using structured questionnaire. Weight, height and waist circumference, body mass index (BMI) and blood pressure were also obtained. Subjects had their fasting lipid profile and fasting plasma glucose assayed after overnight fast of 8-14 hours. Low-density lipoprotein (LDL) was obtained using Friedwald formula., Result: The study revealed that total cholesterol (TC) was elevated above normal levels in 44% of cases compared with 6% in controls (P < 0.001), with the mean (SD) value of 5.82 ± 3.28 mmol/l for cases compared with 3.9 ± 1.0 mmol/l (P < 0.001) in controls. Low density lipoprotein was elevated in 48% of cases compared with 14% in controls (P < 0.001), with the mean (SD) values of 4.15 ± 2.74 mmol/l and 2.57 ± 0.95 mmol/l for cases and controls, respectively, (P < 0.001). Triglyceride (TG) was elevated above normal level in 26% of cases compared with none in the controls (P < 0.001), with the mean (SD) values of 1.41 ± 1.10 mmol/l and 0.64 ± 0.24 mmol/l for cases and controls, respectively (P < 0.001). All Lipid fractions except HDL also correlated significantly with levels of proteinuria TC (r = 0.345, P = 0.001), TG (r = 0.268, P = 0.011) LDL (r = 0.366, P = 0.001)., Conclusion: Dyslipidemia is common among patients with CKD. Regular evaluation of all CKD patients for dyslipidemia and treatment need be instituted.

This study was carried out to evaluate the anti-obesity effect of Vernonia amygdalina Del. (VA) supplemented diet. VA leaf powder was fed at 5% and 15% to diet-induced obese rats for 4 weeks and its effect compared with orlistat (5.14 mg/kg p.o.), an anti-obesity drug. Food intake, body and organ weights, total body fat, some lipid components and amino transaminase activities in serum, hepatocytes and brain; as well as serum glucose, were measured during or at end of the study. Result showed respective decrease of 12.78% and 38.51% in body weight gain, of VA fed rats against 17.45% of orlistat at end of study (P < 0.05); but with no effect on food intake. Total body fat was lowered by 28.04% and 30.02% vs. obese control rats (CDC) (P < 0.05). Furthermore, serum triacylglycerol (TG), serum and brain total cholesterol (TCHOL), were down regulated at 15% VA supplementation (P < 0.05). Serum glucose which increased in obese rats by 46.26% (P < 0.05) vs. NC, indicating intolerance, was restored by VA (38.75% and 34.65%) and orlistat (31.80%) vs. CDC (P < 0.05). VA diet also exerted hepato-protection, via lowering serum alanine amino transaminase (ALT) (41.35% and 27.13%) and aspartate amino transaminase (AST) (17.09% and 43.21%) activities (P < 0.05). Orlistat had no effect on these enzymes. Histology of adipose tissue corroborated the changes on total body fat. We concluded that, diet supplemented with VA can attenuate dietary obesity as well as ameliorates the potential risks of hepato-toxicity and glucose intolerance associated with obesity.

Serum creatine kinase (CK), creatine kinase isoenzyme (CK-MB) and aspartate aminotransferase (AST) are key players in the diagnostic study of cardiac complications. These enzymes are specific diagnostic markers of myocardial infarction and hypertension is a disease condition characterized with a wide range of complications, including myocardial infarction. In this study, we determined the effects of interaction of vitamin A and Rauwolfia vomitoria (RV) root bark extract on marker enzymes of cardiac diseases. CK and CK-MB activities had significant decrease in the group of animals with concomitant administration of vitamin A (40 IU/kg body wt.) and 150 mg/kg body wt. of RV root bark extract. At the interaction of vitamin A with 300 mg/kg body wt. RV root bark extract, CK-MB only showed significant (p ≥ 0.05) decrease while CK decreased insignificantly. Also at the interaction of vitamin A with 300 mg/kg body wt. RV root bark extract, AST increased significantly but decreased significantly at the interaction of vitamin A (40 IU/kg body wt.) and 150 mg/kg body wt. of RV root bark extract. Our findings showed that vitamin A dose did not lower the activities of cardiac marker enzymes. However, concomitant administration of RV root bark extract at 150 mg/kg body wt. with vitamin A shows significant reduction in the activities of CK, CK-MB and AST. These findings suggest that interaction of vitamin A with RV root bark extract would be a meaningful ethno-pharmaceutical approach in the management of myocardial infarction and treatment of hypertension.

The atherogenic potentials of peeled grated cocoyam (Xanthosoma maffafa scot) "ekpang nkukwo", pounded yam (Discorea spp) with plain soup "afia efere", and plantain porridge (Musa paradisiaca) "iwuk ukom" meals were investigated. The three meals were fed to three different groups of albino rats of Wistar strain for a period of twenty eight days. A fourth group which served as control was feed with normal rat pellet. The mean total plasma cholesterol level in the pounded yam with plain soup fed group was significantly lower [P < 0.05] when compared to the control and peeled grated cocoyam fed groups. The mean total plasma triglyceride (MTPTG) level in the pounded yam with plain soup fed group was significantly lower [P < 0.05] when compared to the control group. However the MTPTG level in the peeled grated cocoyam and plantain porridge fed groups were comparable to control. The mean HDL-cholesterol level in the peeled grated cocoyam and plantain fed groups were comparable control. The mean LDL-cholesterol level in the peeled grated cocoyam and plantain porridge fed groups was significantly lower [P < 0.05] than the control group. The LDL-cholesterol and VLDL-cholesterol in the pounded yam with plain soup fed group was significantly lower [P < 0.05] when compared to control. These findings suggest low atherogenic potentials of the pounded yam with plain soup meal compared to the peeled grated cocoyam and plantain porridge meals.

Aqueous extract of the leaf and root ofNauclea latifolia Sm. (Rubiaceae) is used in Nigerian folk medicine for the treatment of hypertension. This work is carried out to investigate the effect ofNauclea latifolia leaf extract on lipid profile and cardiovascular activity of rats. Normal and 10% coconut oil fed rats were treated with the water-soluble fraction of the ethanol extract ofNauclea latifolia leaf for 2 weeks. Forty-eight mature male albino rats of the Wistar strain were divided into two experiments of four groups, each group having 6 animals. Experiment I animals were treated with the water-soluble fraction of the ethanol extract whilst experiment II animals were fed 10% coconut oil meal before treatment with the water-soluble fraction of the ethanol extract. A single oral dose ofNauclea latifolia was 170, 340 and 510 mg/kg body wt/day of the extracts respectively for 2 wks. There was no significant change in the lipid profile of the experimental animals as compared with the controls. There was about 40% relaxation on contracted thoracic aorta that was pre-contracted with 2 μM phenylephrine. The viability of the tissue was tested against 10 μM of acetylcholine. There was no significant (P>0.05) change in Na(+) concentration in the serum. However, the K(+) concentration in the serum of the experimental animals showed a significant increase. The study shows that ethanol extract ofNauclea latifolia has vasodilator action on the aorta and that lipid profiles of experimental rats were not affected. Furthermore, the increase in the K(+) may be contributing to the vasodilator effect ofNauclea latifolia.

Objective: To determine the magnitude of and the reasons for missed opportunities to immunise with tetanus toxoid at a tertiary health institution in Nigeria. The information obtained would be used in developing an intervention strategy for eliminating missed opportunities in the future., Design: Missed opportunity was assessed by using the Revised WHO/EPI protocol (WHO/EPI/MLM/91.7). Exit interviews were carried out on pregnant women visiting the antenatal (prenatal) clinic to register the present pregnancy., Setting: A tertiary health institution in Nigeria., Subjects: Pregnant women who attended the antenatal clinic for the purpose of registering the present pregnancy during the last two booking days in February, 1997 and the first booking day in March, 1997., Main Outcome Measures: Missed opportunities and contributory factors., Results: The prevalence of missed opportunity was 66%. The factors responsible for missed opportunity were poor history taking, lack of knowledge of the current schedule of immunisation, dependence on physician referral for immunisation and inefficient immunisation record keeping system., Conclusion: The findings establish the need for providing physicians in antenatal settings with an update on current immunisation policy and practice and for improved documentation of immunisation histories.

Daily home interviews-examinations were carried out for a period of three months to obtain information on the agent (object) involved, nature (diagnosis) and care provided to children aged zero to 19 years, following accidental injury, in Idikan community, Ibadan. During the study period, 1286 injuries were recorded involving all the 436 children in the study community. Rocky outcrops, chairs, broken bottles, tables, knives and glasses were the major agents of injuries (91.0%). Puncture wounds, lacerations, haematomas, sprains and dislocations constituted most of the nature of injury (96.5%). All injuries were minor injuries (AIS = 1). Relatives-neighbours were responsible for managing majority of the injuries. Only seven (0.6%) injuries were seen by a nurse-physician in a health facility. Specific individual-community health education as well as health service and environmental modification measures are suggested. This study has also shown that community based data on injury provides more precise information required for the development of injury prevention and care programmes at the primary care level.

This study was designed to determine the fluid intake and feeding practices among under five year old children during episodes of diarrhoea. Fluid intake was low. The average amount of salt-sugar solution (SSS) and WHO/UNICEF recommended oral rehydration solution (ORS) formula drank within the preceding 24 hours of diarhoea was 368 mls and 274 mls respectively. Only 54.0% and 43.3% of children received same or more food and fluid respectively as compared with before the diarrhoea. Less than half of the children continued breastfeeding. Targeted health education, with emphasis on these findings, are recommended for improving fluid and food intake in the home management of diarrhoea.

The prevalence of chlamydia trachomatis infection in the population screened, at All Saints Hospital in Chatham between 1988 and 1990, was 6.3%. The main risk factors for cervical chlamydia infections in gynaecological patients were found to be an age less than 25, low socioeconomic status, and exposure to other sexually transmitted diseases. More research is needed to elucidate the factors that contribute to the differences in sociodemographic characteristics of this disease. Meanwhile it is clear that public health intervention is crucial to its control. The disease is frequently asymptomatic and occurs often in a population that is not seen routinely in standard STD outreach efforts. Furthermore, the chlamydia prone population is only moderately successful at referring sexual partners.

The aim of the present Review is to throw some light on the sexual education of young people in the hope that it would provide a panacea for adolescent pregnancy. The source of knowledge, family or school, is not the issue, but information presumably will foster an enlightened mind and perhaps even enlightened behaviour. The availability, or lack of availability, of sex education, contraception and abortion services appears worthy of special consideration. It is often assumed that adolescents, and especially low socio-economic adolescents, begin their pregnancies at young ages because of indifference, or cultural pattern. Too little attention has been paid to the provision of adequate sex education and birth control services, especially in developing countries.

The prevalence of anaemia in pregnant women in a Jewish community in the Western Area of Jerusalem between 1985-1988 was studied. The prevalence of anaemia in this population was 19%. Anaemia was found to increase significantly with maternal age and parity, and had an indirect association with social class.

The health education and medical counselling given by the social health worker to index patients with sexually transmitted disease (STD) attending our clinic were reinforced by a doctor attending a "treatment group" of patients in a randomised controlled trial. Sixty four patients were randomised into two groups of 32. Of the 96 follow up visits required four each group (three per patient), there were 20 defaults in the control group compared with only four in the patients whose health education had been reinforced by the doctor. Four of the control patients had been re-exposed to risk of infection during follow up compared with none in the reinforced group. Also five of the primary and none of the secondary sexual contacts of the control patients came for investigation and treatment (without the need for extra field contact tracing by the social worker) compared with eight primary and two secondary sexual contacts of the reinforced group. The appreciable impact of counselling reinforcement by a doctor shown in this study leads us to emphasise the importance of this practice, especially in developing countries where various infrastructural and cultural factors usually make contact tracing an unrewarding exercise.