The recognition that Helicobacter pylori plays a pivotal role in the pathogenesis of several gastroduodenal pathologies makes its diagnosis necessary in many different circumstances. The incidence of Helicobacter pylori infection in all patients who were referred for Upper Gastrointestinal Endoscopic Examination at the University of Nigeria Teaching Hospital (UNTH) from March 1997 to January 1998 was studied using the Campylobacter - like organisms (CLO) test which is a rapid urease test performed on gastric mucosal biopsies. Out of 152 consecutive patients who were examined during the 11 month period, 86 were females and 66 were males. The endoscopic findings included gastritis which was present in 87 patients, duodenitis 23, gastroesophageal reflux disease 18, duodenal ulcer 11, gastric ulcer 2, significant bile reflux 14 and gastric cancer 1. No abnormality was detected in 46 patients. The CLO test was positive in 99 of the 152 patients (65.13%). Only one duodenal ulcer patient had a negative CLO test. Patients in whom significant bile reflux was observed had a greater tendency to be CLO negative rather than positive. The possible therapeutic implications of these are discussed.

A nine year prospective study was conducted to find out if there are any features in patients with acute urinary retention secondary to BPH, that can fairly accurately predict those who would benefit from trial without catheter. Between July 1989 and June 1998, 108 patienst who presented with acute urinary retention due to clinically diagnosed BPH, in a private urological clinic, were included in this study. To assess which patients that benefit from trial without catheter, the outcome of this practice was analysed against the relevant features of the patients at presentation. On the whole, 33 (30.6%) patients benefited initially from the practice but this was reduced to 25 (23.1%) at the end of six months. Trial without catheter was found to be of value in three groups of patients: (1) Patients in the younger age group (2) Those who have had no significant past urological history and (3) Those recently commenced on drugs like anticholinergics, diuretics and alcohol. The rest of the patients needed definitive treatment. Trial without catheter is justified in those with features detailed above and they should be followed up afterwards. Definitive treatment should be instituted early in the rest of the patients.

The diagnosis of scabies may be very difficult since scabies mimics any pruritic skin condition. In tropical countries like Nigeria, one may have to consider insect bites, infestation of other ectoparasites and ‘Id’ reactions to dermatophyte infection elsewhere on the body; before considering other classical differential diagnosis such as dishydrotic eczema and dermatitis herpertiformis. Following an earlier retrospective study of scabies patients at the University of Nigeria Teaching Hospital skin clinic, over a five year period 1994 - 1998); only 1.8% of cases had correct diagnosis at referral. Initial diagnosis entered by GP's that had seen the cases were incorrect and so were the management of these patients. Nonetheless, identification of a burrow on the skin and isolation of the mite still remains the main pillar of diagnosis. In this review for scabies, the methods for diagnosis and treatment will be presented.

In many societies, women play an important role in promoting health, particuarly in view of their central position in the family. They therefore represent a unique target group for health information and education on the importance of a sanitary environment in health promotion and disease prevention. A systematic sample of 300 women from various parts of Enugu metropolis were interviewed to elicit information on their pattern of household refuse management as well as their perception of refuse management in the city. More people living in bungalows and duplexes (31.7%) were found to be using standard dustbins with cover, compared with 12.4% of those living in either 1 or 2-room apartments (X² = 12.84; df = 1; p < 0.001). Educational level had a positive influence on both the use of standard dustbin with cover as well as the frequency of emptying the household refuse (X² = 14.26; df = 1; P < 0.001). There was a reasonable population access (75.7%) to minicipal refuse dumps. The main reason for dissatisfaction with refuse management in the city was irregular clearing of the municipal council refuse dumps (81.6%). Strategies for improving refuse management in Enugu are discussed.

A retrospective analysis of the treatment outcome of 859 TB patients treated at the Chest Unit of the University of Nigeria Teaching Hospital, Enugu in 1996 and 1997 showed that 276 (32.1%) defaulted. There was no association between defaulting and age of the patients (P>0.1). It was found that 79.7% of the defaulters attended the hospital from a distance of more than one hour as estimated by the time it normally takes by public transport from the patient's residential address to the hospital. Subsequently, 49.3% of them defaulted at the end of the intensive phase of the treatment. Although there was male:female ratio of 1.65:1, no significant association was found between defaulting and gender (P>0.1). The use of short course chemotherapy was also not found to be associated with defaulting (P>0.1). Much needs to be done in terms of continued health education and motivating patients to complete their treatment. Community-based directly observed therapy as well as defaulters tracing will also help to solve the problem of defaulting.

A survey of psychoactive substance abuse based on a random sample of 181 students was carried out using a self-report drug use questionnaire in April 1998. A general life time prevalence of 85.1% was found. However, most were occasional users. Using an operational definition of drug abuse as the daily use of the substance, it was found in the study that the prevalence was much lower. Substances commonly abused were alcohol, caffeine, inhalants and nicotine. Other substances occasionally abused were opiods, amphetamine, cocaine and phencyclidine (PCP). The student population that used alcohol daily amounted to 8.8%, while 16.0% used caffeine on a daily basis. Also 3.9% abused inhalants daily while 2.2% smoked Indian hemp everyday. The authors stressed the need to mount an effective drug prevention programme as well as collaborative and extensive epidemiological surveys.

Road traffic accident is a preventable leading cause of death in Nigeria, and efforts must always be made at prevention of mishaps and better management of victims. The Casualty Department of UNTH Enugu recorded a total of 2399 accident victims between 1st January 1993 and 31st December 1997. There was a seasonal variations with peaks in November, December and January. There was a steady yearly increase in the absolute number of victims for the period, however the last two years recorded relative drops in the usual peak periods. Natural triage occured at the accidents scenes. Many with injuries not compatible with life died at the scene or in transit, and so could not receive any meaningful resuscitation. They were brought in as 'outside corpses'. Head injury alone or in combination with other injuries accounted for about 60% of the cases. Eighty percent of the cases were successfully resucitated, and 8.6% referred to National Orthopaedic Hospital Enugu (NOHE). Mortality rate was 11%. Management of patients was based on established principles related to injuries with modifications in some cases.

A case of undiagnosed acute and fatal meningitis which pesented as eclampsia is presented. The patient presented with features suggestive of eclampsia, such as high blood pressure, proteinuria and fits. The definite diagnosis of meningitis caused by Neisseria Meningitidis was made at postmortem. This is the only case of meningitis in pregnancy reported in the hospital in a period of ten years (1987 - 1996) with 7,300 and 6758 total deliveries and live birth respectively and 86 maternal deaths (11.8 per 1000 births). It is suggested that high index of suspicion for meningitis be entertained for cases of eclampsia who have resided in the Northern part of the country in the past three months.

A five year review of cases in the medical wards of the University of Nigeria Teaching Hospital (UNTH), Enugu, between November, 1993 and November, 1998, revealed that 5538 patients aged between 14 years and 95 years were admitted. Four hundred and nine (409) of the admissions were HIV-related, with male preponderance. The icidence of admission of these HIV cases was highest in the age group 31 - 40 years with 36.2%, 35.7% were in the 21-30 age group and 17.4% in the 41-50 age group. There was no recorded HIV-related case in the age groups above 70 years. These data are consistent with findings in other parts of the country. A well structured programme is urgently recommended on the part of the government and non-governmental agencies at combating the scourge of HIV.

Two thousand six hundred and twenty-seven mothers who delivered during the period of study in the eight Babyfriendly designated hospitals used were recruited for the study. This study was designed to determine the exclusive breastfeeding rate amongst mothers using Babyfriendly hospitals in Benin in view of the increased campaign about breastfeeding. The study showed the mean exclusive breastfeeding rate of 34.53% amongst mothers in Benin City at 6 months post partum. Although this exclusive breastfeeding rate is an improvement on what has been reported in Nigeria (2%) by UNICEF in 1992, there is the need for more aggressive campaign for mothers to imbibe the culture of breastfeeding their babies exclusively.

A case of varicella zoster infection presenting in early infancy is reported. A literature review on aspects of immunity transfer from mother to fetus is done, highlighting the fact that all about immunological competence of a new born derivable from the mother is not fully known. There is need for further research on this in order that this unclear state be fully elucidated.

A case of local tetanus in a 3 year old male child is reported. It involved the left lower limb and was characterised by rigidity and provocative spasms of the affected limb. The suspected portal of entry was through an intramuscular injection given in the left buttock 13 days prior to the onset of symptoms. The child contracted tetanus despite receiving 3 doses of DPT during infancy. To obviate such possible cases of vaccine failure, the reintroduction of booster doses of vaccine in the routine immunisation schedule is suggested.

Tracheostomy is one of the most common surgical procedures, but not always without complications. Its employment in head and neck cancer surgery, for example, remains controversial. This study details those cases in which the life-saving potential of tracheostomy placement was considered to outweigh the disadvantages. It also evaluates the indication for maintaining the airway with the use of tracheostomy following trauma to the facial skeleton. Two hundred and forty consecutive cases of tracheostomy in orofacial and head lesions were assessed and revealed a relatively low complication rate of 5% for all cases. Chest infection was the commonest problem, although none was life threatening and all responded to treatment Indications for tracheostomy as well as the surgical and medical management aimed at reducing tracheostomy complications are discussed.

This paper highlights the clinical and plain radiographic features that assisted in accurate localisation of the radiolucent dental prostheses impacted in the cervical oesophagus of nine patients. These patients presented to the author at the University of Nigeria Teaching Hospital and Balsam Clinics, both in Enugu, Nigeria between February 1994 and January 1998 with history of swallowed and impacted dental protheses in the throat. Localisation of site of impaction was exact in all cases by clinical examination, plain neck radiographs and at rigid oesophagoscopy. The diagnostic radiographic features are widening of retrotrachael region, indentation of trachae and air entrapped in oesophagus. Seven were removed at rigid oesophagoscopy and two by cervical oesophagotomy. It concludes that clinical history, physical examination and plain soft tissue lateral neck radiographs are adequate for full diagnosis. Most dental protheses in unperforated cervical oesophagus could safely be extracted endoscopically, a method that has less morbidity than cervical oesophagotomy.

In West Africa today, accurate information on twinning and related demography is still scanty. Therefore, I report a personal survey carried out among my own kindred during the Nigerian civil war. Being of the harassed Igbo ethnic group, 257 of them had fled back but six of them did not return. These returnees together with those displaced by the advancing federal forces as well as the ordinary residents constituted the survey population of 1,346 persons. Up to 58.7% were aged below 21 years. Of the 40 sets of twins identified, the general incidence was 28.5 per 1000 births. However, individual families reached rates of 31.1 and even 82.2. Some women were examples of the concept that twin-prone individuals are highly fecund. Thus, one pagan woman had 2 sets of twins, which were not allowed to survive, during 10 pregnancies, while a Christian woman achieved 9 pregnancies with 4 sets of twins, the 10th pregnancy being a 5th set born prematurely. Future researches should unravel such intricacies of twinning in all nooks of Nigeria.