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Accidental poisoning in children, though underreported in our environment, is common and could prove fatal. It is important to identify the primary chemical agent that is responsible for the poisoning. We present a case of accidental ingestion of fish poisoned with aluminum phosphide (AlP) used as rat poisoning by a 14-month-old girl. At presentation, the actual chemical content of the poison was not available and clinical features were suggestive of organophosphate poisoning. She was commenced on atropine together with other treatment, on which she made remarkable improvement. The atropine was continued with complete resolution of symptoms on the third day of admission. We, therefore, report a serendipitous use of atropine in the management of AlP poisoning with successful outcome.

Background: Doppler echocardiography is a reliable and non-invasive method of detecting valvar regurgitation. The aim of this study was to determine the prevalence of valvar regurgitation in children with structurally normal hearts and explore its relationship with age, gender and anthropometry. Methods: This was a descriptive cross-sectional study conducted in four tertiary hospitals in Nigeria. Two hundred and thirty-three children (124 males and 109 females), from birth to 18 years were recruited prospectively. Using transthoracic echocardiography, the presence of valvar regurgitation was assessed across the four cardiac valves using Color Doppler interrogation after structural abnormalities were ruled out. Data was analyzed using the Statistical Package for Social Sciences (SPSS) software, version 22. Results: Valvar regurgitation was found in 158/233 children giving a prevalence of 67.8%. They consisted of 87 males and 71 females with a male: female ratio of 1.2:1. Of these, 82 (35.2%) had a single valvar regurgitation, 72 (30.9%) had regurgitation at two valves while 4 (1.7%) had regurgitation at three valves. Pulmonary regurgitation was the most common in 52.8% of cases while aortic regurgitation was seen in only two children (0.9%). There was a non-significant negative correlation of age and body surface area with presence of tricuspid regurgitation (ρ -0.79, p=0.22 and ρ -0.12, p=0.08) and mitral regurgitation (ρ -0.04, p=0.56 and ρ -0.02, p=0.83) but positive correlation with pulmonary regurgitation (ρ 0.11, p= 0.11 and ρ 0.12, p= 0.08). The presence of valvar regurgitation was not associated with gender (p=.>0.05). Conclusion: The prevalence of valvar regurgitation in apparently healthy Nigerian children is 67.8%. The presence of valvar regurgitation especially of the right sided valves could be a physiologic finding in apparently healthy children with structurally normal hearts. Regurgitation of the left sided valves is rare.

Background Pulmonary hypertension (PH), a complication of sickle cell anaemia (SCA), results in considerable morbidity. This study aims to determine the prevalence and associations of echocardiography-suggested PH in children with SCA. Methods We performed a cross-sectional comparative study involving 100 systematically sampled SCA subjects 3–14 y of age in their steady state with matched haemoglobin AA phenotype controls. Clinical, laboratory and echocardiography data (including tricuspid regurgitation velocity [TRV], mean pulmonary arterial pressure [mPAP] and tricuspid annular plane systolic excursion [TAPSE]) were obtained from all patients. Statistical analyses were performed using SPSS version 22 (IBM, Armonk, NY, USA). A p-value Results Of the 100 SCA subjects studied, 22 (22%) had echocardiographic findings suggestive of PH compared with none in the controls. The median TAPSE was significantly lower in the PH group (2.55 cm [interquartile range {IQR} 2.2–2.8]) compared with the no PH group (2.77 cm [IQR 2.4–3.2]) (p=0.03). No significant correlation existed between mPAP and age, nor any laboratory parameters studied. The odds ratio (OR) suggested PH significantly increased with an increase in the frequency of hospitalizations for vaso-occlusive crises within a 12-month period (OR 15.15 [95% CI 1.57 to 146.35], p=0.02) and a lifetime history of blood transfusion (OR 5.44 [95% CI 1.09 to 27.24], p=0.04). Conclusions Echocardiography-suggested PH is common in children with SCA and is associated with poorer right ventricular function, frequent vaso-occlusive crises and blood transfusions.

Objective: To determine if there was any difference in SpO2 readings during exchange blood transfusion (EBT). Methods: A prospective cross-sectional study of neonates with severe neonatal jaundice requiring EBT was conducted. Oxygen saturation was recorded before, immediately and 15 minutes after EBT by using a pulse oximeter. Results: This study included 30 neonates with 20 males and 10 females. The age ranged from 1 to 12 days with a mean of (5.4 ±2.9) days. Pre-EBT SpO2 ranged from 90% to 98% with a mean value of (94.3 ± 2.2)%; SpO2 in the end of EBT ranged from 85% to 99% with a mean value of (94.1 ± 3.2)%; SpO2 at 15 minutes after EBT ranged from 77% to 99% with a mean value of (94.8 ± 4.1)%. There was no significant difference between SpO2 values at onset of EBT and either immediately or 15 minutes after EBT (P=0.770 and 0.422, respectively). SpO2 showed no significant difference between neonates who were infused with blood of different storage times (0.999) and 15 minutes after EBT (P=0.887). Besides, SpO2 values were compariable in neonates with hematocrit

Elevated mean pulmonary artery pressure (mPAP) and right heart failure increase mortality in patients with chronic kidney disease (CKD).The objective of this study is to determine the prevalence of elevated mPAP in children with CKD compared with matched controls and to ascertain the relationship between elevated mPAP with right ventricular dysfunction and history of hemodialysis.A cross-sectional comparative study of mPAP and tricuspid annular plane systolic excursion of 21 children with CKD and age- and sex-matched controls asymptomatic for cardiac disease was conducted.Median mPAP was 27.69 (18.3-36.1) mmHg in CKD patients compared with 14.55 (13.5-17.1) mmHg in controls (Elevated mPAP is significantly more common in children with CKD compared with controls. CKD population with mPAP elevation is more likely to have impaired RV function. The occurrence of elevated mPAP was more common in those who were never dialyzed.

Background:Congenital heart defects (CHDs) are common birth defects with significant impact on morbidity and mortality. We aimed to compare regional patterns of CHDs in Nigeria using a registry-based approach.Methods:Children with echocardiography-confirmed CHDs at 17 medical centers across the country were enrolled in a pilot National Pediatric Cardiac Registry from January to December 2014.Results:A total of 1,296 children (52.9% male; median age 0.9 years) with CHDs were enrolled. Patients enrolled in Northern Nigeria constituted 34.6% of the study population and were older compared to those enrolled from Southern Nigeria (2.9 ± 3.6 vs 2.4 ± 3.5 years; P = .02). Ventricular septal defects were significantly more prevalent in the North (37.4%) compared with the South (18.5%; P < .0001), while severe CHDs were more prevalent in the South ( P = .004). Of the 208 (16.0%) children who received corrective cardiac intervention, only 43 (20.7%) of them had the intervention done in country. More patients in the South received intervention compared to the North (19.02% vs 10.5%; P < .0001).Conclusion:This is the first prospective, registry-based, multicenter study of CHDs in Nigerian children. We demonstrate important differences between the Northern and the Southern geographical regions of the country in terms of age at diagnosis, type, and severity of lesion as well as access to cardiac surgery. The findings demonstrate the utility of a national CHDs registry for understanding clinical epidemiology of CHDs in low- and middle-income countries and its potential to serve as a basis for research and planning.

Background: Chronic kidney disease (CKD) affects multiple organs and is an established risk factor for cardiovascular disease and mortality. Impaired systolic function of the left ventricle is common in adult CKD patients. Objective: The main objective of the study is to determine the prevalence of left ventricular systolic dysfunction (LVSD) in children with CKD and its association with age, stage of disease, and history of dialysis. Subjects and Methods: This was a comparative cross-sectional descriptive study. Twenty-one children with CKD aged 3–14 years and an equal number of age- and gender-matched apparently healthy controls were recruited. Outcome Measures: LVSD was considered present when ejection fraction (EF)

Infants of diabetic mothers are prone to cardiac malformations due to teratogenicity of diabetes mellitus (DM). We present here the case of a macrosomic neonate who had marked difficulty with breathing. He had severe hypertrophic cardiomyopathy with patent ductus arteriosus and cor triatriatum dexter, and although his mother had obstetric and a family history suggestive of DM, this diagnosis was not made as her antenatal fasting plasma glucose assay was normal. The need for adequate diagnosis using oral glucose tolerance test or hemoglobin A1c is hereby emphasized.

Introduction: Chronic heart disease in children imposes a great burden in most developing countries, especially among those with congenital heart disease where early surgical intervention is difficult because of limited medical facilities. Most of our patients survive on long-time oral medications, some of which are sweetened. Therefore, there is a heightened risk of dental caries. This study sought to determine if there were more caries in children with chronic heart disease than those without heart disease.Materials and Methods: This study was cross-sectional, and oral examinations were done using mouth mirror. A convenient sampling method was adopted. Children were recruited over an 8-month period (May–December 2017). Results: This study compared 130 children with varied forms of cardiac defect with 130 children who had no chronic morbidity or any cardiac lesion. Their ages ranged from 1 to 14 years, with a mean of 5.85 +/- 3.30. The prevalence of dental caries was generally low in this report; dental caries was identified in 20.8% of all the children. Among those with cardiac defect, 30 (25.2%) had dental caries. Furthermore, caries was observed more frequently among cardiac patients on chronic medication when compared with the control, and this observation was statistically significant (X2 = 18.846, df = 1,P= 0.00). The mean decayed, missing, and filled teeth (dmft, 2.03 +/- 0.85) and (DMFT, 1.22 +/- 0.44) for primary and permanent dentition were higher among those with cardiac defect; those without cardiac lesion had a mean dmft of 1.31 +/- 0.48 and DMFT of 1.00 +/- 0.00. Conclusion: Dental caries was low in this study though most cases were reported among patients with cardiac disease.

Background: The teething process is part of normal development of the skeletal system; however, different tribes and ethnic groups seem to have a list of symptoms they believe are linked to teething. Could it be that health professionals also hold to these false believes concerning teething? This is important to find out because when systemic problem is misdiagnosed as teething and nothing is done, it may result in death. This study aims to assess the level of knowledge of infants' teething and associated myths among health professionals, to ascertain the attitude of health professionals toward teething in infants, and to identify practices by health professional toward “teething problems.” Materials and Methods: This study was cross-sectional study, conducted from August to September 2016, and multistage sampling method was adopted. Results: Four hundred and fifty health workers participated in the study; however, 427 of them correctly completed the questionnaire giving a response rate of 94.9%. There were 213 (49.9%) males and 214 (50.1%) females with m:f ratio of 1:1. Most respondents (322; 77.8%) believed teething was associated with significant systemic symptoms, 92 (21.5%) did not associate teething with any significant systemic complaint, while only 3 (0.7%) of them were not sure if teething causes systemic illness. Fever and loss of appetite were the most common symptoms associated with teething followed by stooling while skin rash was the least common complaint associated with teething. Conclusion: Teething myths are still prevalent among health-care workers; common illnesses attributed to teething included fever, loss of appetite, excessive salivation, and diarrhea.

Background: Excessive left ventricular mass (LVM) and diastolic dysfunction are associated with higher morbidity and mortality among patients with chronic kidney disease (CKD). Objective: The objective of the following study is to determine the prevalence of increased LVM index (LVMI), pattern of abnormal LV geometry, and diastolic dysfunction in Nigerian CKD children and to establish a relationship of these with estimated glomerular filtration rate (eGFR). Subjects and Methods: Cross-sectional comparative study of LV structure and diastolic function of 21 children with CKD age- and sex-matched and controls asymptomatic for cardiac disease. Results: The median LVMI was 62.19 (34.7) g/m2 in CKD patients compared with 52.89 (30.2) g/m2 in controls (P = 0.04). Excessive LVMI was present in 3 (14.3%) individuals compared with none (0%) of the controls P < 0.001. The prediction equation for LVMI using eGFR is: LVMI = 123.11+ (−0.48) × eGFR ml/m2/min. Abnormal LV geometry was present in 19.05% of the CKD patients and none of the controls (P = 0.04). CKD stages differed significantly with respect to the presence of abnormality with LV geometry (P = 0.04). LV diastolic dysfunction was present in 4 (19.1%) individuals (2 each had impaired relaxation and restrictive patterns) compared with 1 (4.8%) control (restrictive pattern)-P

Background: Reports have identified a rising prevalence of bronchial asthma, with the highest pediatric burden in the 6–11 years old. Aim: This study aimed at determining the epidemiology of asthma among primary school pupils, aged 6–11 years in Kano metropolis. Settings and Design: This study was prospective, descriptive, cross-sectional study carried out among 811 primary school pupils in Kano metropolis from October 2012 to December 2013. Materials and Methods: Information was obtained using pretested questionnaires, and enlisted pupils had their spirometric values recorded. Diagnosis of asthma was based on two or more of the following: recurrent cough, especially nocturnal, recurrent wheeze, recurrent difficulty in breathing with a response to a bronchodilator, and spirometric features of airway obstruction. Statistical Analysis: The data were analyzed with SPSS version 16 using percentages, mean values, standard deviation, Chi-square test, Student's t-test, and multiple logistic regression. P value was significant at ≤0.05. Results: Asthma prevalence was 12.5%. The disease prevalence was comparable across ethnic groups and socioeconomic classes. Neither weight nor height differed significantly between the asthmatic and nonasthmatic pupils. Family history of asthma and physical stigmata of cutaneous atopy were significantly associated with the disease. Conclusions: The prevalence of bronchial asthma among the pupils studied suggests a current local disease burden that is comparable to those of communities in the industrialized countries. There is a need for improved health education and campaigns about the disease not only for Nigerians but also for other countries with the high prevalence.

In pyopericardium, pus accumulates in the pericardial space as a result of infection by pyogenic organisms, most common of which are Staphylococcus aureus and Mycobacterium tuberculosis. These patients are at risk of cardiac tamponade. Apart from pericardiocentesis in the management of these patients, definitive drug treatment may pose a formidable challenge in a setting of coinfection as in patients with tuberculosis who are predisposed to secondary bacterial infections. This was the case of our patient. We here highlight the challenges faced with etiologic diagnosis in resource-limited settings.

Background: The pattern of congenital heart diseases (CHD) varies from region to region even in the same country. Echocardiography has been available in Aminu Kano Teaching Hospital for about 10 years now but problems then were non.available of appropriate probes for children making it difficult to make some specific diagnosis. This study was undertaken to determine the types and the relative frequencies of congenital heart defects seen among children at the Aminu Kano Teaching Hospital, Kano, Nigeria.Materials and Methods: This is a retrospective study of the echocardiographic data collected over 24 monthfs period, between October 2009 and September 2011. Information obtained from the records included age, gender, clinical diagnosis, and echocardiographic findings. Data was analyzed and expressed in frequency tables and percentages.Results: A total of 506 children were seen. The age range was between 5 days and 15 years with a mean age of 3.29 } 2.56. A total of 173 (34.2%) had CHD. There were 104 boys and 69 girls giving a M: F ratio of 3:2. 48.6% of the children were 1 year and younger. In order of frequencies, the common CHD are ventricular septal defect (30.6%), tetralogy of fallot (16.7%), atrial septal defect (12.1%), patent ductus arteriosus (10.9%), endocardial cushion defect (8.8%), tricuspid atresia (4.6%) and truncusarteriosus (2.3%).Conclusions: Echocardiographic screening of the children revealed a wide variety of CHDs. VSD and TOF are the most common, accounting for about half of the cases with CHDs. There is an urgent need for government and non.government organizations to establish well.equipped cardiothoracic surgical centes across the country to cater for children with CHDs.

In the Western world, cases of purulent pericarditis have become almost nonexistent with progress and advent of new immunizations against many causative organisms. We report Klebsiella pneumoniae pericarditis, a rare cause of this uncommon disease, hitherto unreported in Nigeria. K. pneumoniae, which is a rod-shaped, Gram-negative, facultative anaerobe, produces extended-spectrum beta-lactamases; hence, it is usually resistant to a lot of antibiotics and is associated with a significant case fatality rate. Our 13-year-old male patient had septic arthritis of the right hip joint came with a 3 weeks complaint of difficulty with breathing. He had respiratory distress, tachypnea, and tachycardia. Although blood pressure was normal, he had pulsus paradoxus, elevated jugular venous pressure, diffuse apex beat, and heart sounds were distant. Chest radiograph revealed an increased cardiothoracic ratio (0.86) with “water bottle” appearance. Transthoracic echocardiography confirmed pericardial effusion with cardiac tamponade. Echo-guided pericardiocentesis was done, and 340 ml of foul-smelling and creamy pus with greenish tinge was aspirated and this grew K. pneumoniae sensitive to ciprofloxacin and gentamycin but resistant to other conventional antibiotics. Recovery was complete after a week of pericardial tube drainage and 3 weeks of treatment. To the best of our knowledge, this is the first case of Klebsiella - induced pyopericardium and with successful management in a Nigerian child. Pyopericardium may follow rare causes such as K. pneumoniae infection with its unique antibiogram.

Background: The academic and psychological demands of undergraduate medical education may result in high-stress levels among students. High stress has been associated with poor academic performance, negative impact on physical and mental health. This study aims to determine the prevalence of stress among undergraduate clinical students of Bayero University Kano Medical School. Materials and Methods: This was a cross sectional study conducted among 224 clinical medical students from levels 400–600. The Cohen's Perceived stress scale (PSS-10) was used to assess the severity of among the students. The Chi-square test was used to determine associations and a significant association was considered at P Results: A prevalence of high stress of 59.8% was observed with a mean PSS score of 20.76 ± 5.58. The highest mean score of 22.29 ± 5.58 was observed among 400 level clinical students. There was no significant difference between both genders. A significantly higher proportion of students undergoing medicine, pathology, paediatrics and surgery postings were observed to be experiencing a higher level of perceived stress compared to those in Obstetrics and Gynaecology, ( χ 2 = 1617, df = 4, P χ 2 = 5.54, df = 1, P Conclusion: Further studies to determine the causes of stress need to be carried out. This will assist the students and teachers to appropriately manage stress.

Background: The high prevalence of hypertension in developing countries has stimulated a lot of research, one of which is tracking of childhood blood pressure (BP). To the authors' knowledge, the point prevalence of elevated BP among primary school children in Kano Metropolis, Kano State, Nigeria has not been documented. Objective: To determine the BP levels and the point prevalence of elevated BP among primary school children in Kano Metropolis, Nigeria. Materials and Methods: A multistage sampling technique was used to select 2000 pupils from 66 primary schools in Kano aged 6–14 years. Data were collected using a standardized pretested questionnaires completed by the parents/guardians. BP was measured with a mercury sphygmomanometer. Average of three readings was recorded for each pupil as his/her BP. Weight and height were also recorded using standard techniques. Elevated BP was defined using the criteria by the 4th task force, according to age, gender, and height. Results: A total of 2000 pupils were studied with 1058 females and 942 boys with a ratio of 1.1:1. The mean systolic blood pressures (SBP) among males and females were 93.17 ± 8.70 and 94.28 ± 9.06 mm Hg while the mean diastolic blood pressures (DBP) were 59.1 ± 6.9 and 60.3 ± 6.9 mm Hg, respectively. Overall, there was a significant positive correlation between SBP (r = 0.44) and DBP (r = 0.38) with body mass index (BMI). Using criteria by the 4th report, 3% of pupils had elevated BP in this study. Conclusion: There is a positive correlation between SBP/DBP and BMI, the overall prevalence rate of elevated BP among the study population was 3%.

Background: Lectures are essential parts of undergraduate medical education for the transfer of information to students. The traditional method of lecture delivery is widely practiced while some lecturers prefer the use of multimedia powerpoint. Objectives: This study intends to find out the preference and views on lecture delivery methods among the clinical students of Bayero University Medical School. Materials and Methods: This is a descriptive cross-sectional study involving the 400, 500 and 600 levels students. Self-administered pretested questionnaires were administered. Data were analysed by the use of frequencies and percentages. The difference between the various classes was analysed using one-way ANOVA with a P < 0.05 considered to be significant. Results: The age range is between 20 and 41 years with a mean age of 24.9 ± 2.91. There are 171 males and 90 females with a male: female ratio of 1.9:1. The predominant method of lecture delivery by teachers is the use of multimedia powerpoint, 215 (82.4%). Most of the students, 185 (70.9%) prefer a combination of the traditional and powerpoint methods, whereas 13 (12.6%) prefer the use of powerpoint while a minority 33 (5%), the traditional method. Majority, 181 (69.3%) are of the view that the duration of lectures should not exceed 1 h. Conclusion: A combination of the traditional method and multimedia powerpoint is the preferred lecture delivery method of Bayero University clinical students and they opined that lectures should not exceed an hour.

Background: The prevalence of congenital heart defects (CHD) in children with cleft lips (CLs) and palate (CP) is reportedly higher than the general population. Several studies have described diverse rate of CHD in different localities. Aims and Objectives: To the authors' knowledge, the frequency and pattern of CHD among children with CLs and CP has not described in this geopolitical zone. Materials and Methods: This is a retrospective study of the echocardiographic records of all cases of CL and CP seen over a 4 years period, between November, 2010 and October, 2013. Data were analyzed and expressed using frequency tables and percentages. Results: A total 30 children were referred for echocardiographic screening (ECGS) during the period. There were 17 males and 13 females, giving a male:female of about 1:1. The age range was between 15 days and 12 years with a median age of 4 months. There were 6 (20%) cases of CHDs. Conclusions: The relatively high rate of CHD among children with oral clefts in this study justifies the need for ECGS for these categories of children.

Goldenhar syndrome is a rare congenital malformation characterized by ocular, auricular and vertebral abnormalities of varying severity. It occurs world-wide with no racial or sex predilection. Although its etiology remains unclear, maternal exposure to viruses, chemicals and abnormalities of the vascular supply to the first arch have been implicated. We, therefore, report a case of a 2-year-old child with Goldenhar syndrome whose mother had a history of repeated falls and vaginal bleeding during pregnancy

Bedside teaching remains the most effective way of imparting competency in clinical skills in undergraduate medical education but there has been a noticeable decline in the practice of bedside teaching worldwide. This paper aims to emphasise the importance of bedside teaching, highlights the possible barriers to effective bedside teaching and equip medical teachers with the effective ways of achieving the intended goals of bedside teaching by emphasising the techniques recommended by experts in the field of medical education. Developed countries have employed the use of clinical skill centres to cushion the effect of the decline in bedside teaching, but in resource-limited countries it remains the only viable option. The advantages of bedside teaching include; learning in context, impartation of clinical skills, nurturing and development of clinical reasoning. In addition, bedside teaching provides opportunity for role modelling, professional thinking, observation of communication skills, team work and integration of communication skills, clinical skills and ethical issues in the process of patient care. Several hindrances to effective bedside teaching have been identified. These include a large student: teacher ratio, crowded lectures, improper use of logbooks, lack of preparedness and interest, increasing administrative and research works among medical teachers. The strategies recommended by experts can be categorised into three; based on the timing as; before, during and after bedside teaching. These emphasise the need for adequate preparation, setting of clear objectives before teaching, active participation, gentle correction during teaching, feedback and discussion of sensitive issues away from the patient.

Hepatic encephalopathy is a serious life-threatening complication of liver disease. It is often associated with hypoglycemia in majority of cases. However, we report the case of a 3-year-old boy with hepatitis-B-virus-related chronic liver disease who presented with hepatic encephalopathy stage-three precipitated by malaria, who developed hyperglycemia while on admission. He was hepatitis B surface antigen positive and had two pluses (++) of Plasmodium falciparum malaria parasitaemia on peripheral film with deranged liver function tests and elevated serum lipase. He was managed conservatively; later, after recovering completely he was discharged home.

Background: The association between Down syndrome (DS) and congenital heart disease (CHD) was first recognised by Garrod in 1894. Several studies have reported about 40-60% prevalence of CHD in DS and a predominance of left to right shunts like atrioventricular septal defects (AVSDs), ventricular septal defect, patent ductus arteriosus and atrial septal defect. Objectives: This study was carried out to find out the prevalence and types of CHD among children with DS. Materials and Methods: This was a retrospective study of the echocardiographic data collected over a 24-month period, between October 2009 and September 2011. The echocardiographic diagnosis of all children with DS referred was reviewed. Results: A total of 35 cases of DS were seen. The age ranged from 0.5-30 months. About 60% of the children with DS were aged 6 months and below. There were 19 males and 8 females giving a M: F ratio of about 2:1. A total of 77.1% of the children with DS had CHD. The most common CHD is AVSD (40%), followed by atrial septal defect (22.25%). A total of 22.25% had normal echocardiographic study. Conclusion: Early referral and screening of all babies born with the clinical phenotype of DS should be encouraged due to the high prevalence of CHD.

Assessment in medical education is very vital because of its far reaching implications not only for the students and their teachers but for the communities and world at large. This article attempts to review the assessment methods used in undergraduate medical schools, highlight their limitations while proffering solutions as recommended by experts in medical education. Assessment methods that are used in the undergraduate medical education can be broadly subdivided into two; assessment of knowledge and its application (Multiple choice questions, essay and viva voce) and assessment of clinical competence (long case, short case and objective structured clinical examination [OSCE]). There are five major criteria for determining the usefulness of a particular method of assessment: Reliability, Validity, Educational impact, Cost effectiveness and Acceptability. The major drawback of the long and short case examinations is the poor reliability or reproducibility due to case specificity, inter examiner and clinical case scenario variability. In 1975, Harden et al., introduced the OSCE to avoid the disadvantages of long case but acceptability may be an issue because of inadequate exposure to its principles and resistance to change by some teachers. Another objective version of the long case is the objective structured long examination records. Objective structured practical examination is also preferred to the traditional practical examinations in laboratory based courses. All assessment methods have their strengths and limitations. It is important that teachers in medical schools are aware of the limitations of the traditional assessment tools and embrace newer and more reliable methods of assessment.