Background: Vitamin A is a naturally occurring fat - soluble vitamin, whose main physiologic role is that of maintenance of integrity of epithelial cells of the body. This study reviews the functions, sources and varying clinical uses of vitamin A. Methods: Data were collected from MEDLINE searches, Cochrane Controlled Trials and other relevant journals. References are cited. Results: Vitamin A has utility value in virtually all branches of medicine Ophathalmology, Immunology, Paediatrics, Obstetrics, Dermatology, Cardiology, Oncology and therapy of infectious diseases. Conclusions: Attention is drawn to the need for vitamin A supplementation and fortification of foods to avert deficiency.

Aim: To determine the plasma ascorbic acid concentration, haematocrit, reticulocyte count and blood cell morphology in homozygous sickle cell disease in Enugu metropolis. Materals and Methods: Forty known sickle cell anaemia patients (HbSS) and ten non-sicklers (HbAA) were used as tests and controls respectively. In both cases, whole blood samples were collected in EDTA bottles. Plasma ascorbic acid concentration was determined by Roe and Kenther method while haematological parameters were by the method of Dacie and Lewis. Results: The mean results obtained in sicklers were: ascorbic acid 0.60± 0.13mmol/L; reticulocyte 5.7 ±2.3%; haemotocrit 0.19 ±0.33L/L. In steady state, the following results were obtained: ascorbic acid 0.32 ± 0.14 mmol/L; reticulocytes 6.5 ± 2.2%, haematocrit 0.21 ±0.05 L/L. The mean results for vasoocclusive crisis state were: ascorbic acid 0.35 ±0.15mmol/L; reticulocyte 6.0±3.0%; haematocrit 0.39 ± 0.14 L/L. The results for the control subjects were ascorbic acid 1.42 ±0.70mmol/L; reticulocyte 21.±1.7%; haematocrit 0.39±0.14L/L. The blood cell morphology in sicklers showed moderate to marked anisocytosis, poikilocytosis, hypochromia, polychromasia, target cells and normoblastosis. The blood cells in control were normocytic and normochromic. Ascorbic acid, Reticulocyte and Haematocrit levels showed significant difference (p<0.05) each, when sicklers were compared with controls. However, steady and crisis states showed no significant difference (p>0.05) Conclusion: The results suggest that ascorbic acid concentration in plasma of sicklers in Enugu metropolis is lower than normal subjects, while vaso-occulsive sickling crisis does not appear to change the concentration in sickle cell disease. The results also show that haematological changes occur in sickle cell disease.

Aims: To determine the rate of nasopharyngeal colonization of Streptococcus pneumoniae among nursery school children in Enugu urban and to determine their antibiotic susceptibility pattern particularly the penicillin resistant strains. Methods: Specimens were collected from the nasopharynx of 385 apparently healthy children aged between 12 to 36months with cotton tipped flexible metal applicator. The swabs were immediately inoculated on to blood agar plates. The plates were incubated at 37°C for 24-48 hours under 5% carbon dioxide. Organisms were identified and confirmed as S. pneumoniae according to Facklam and Washington technique. Antibiogram was carried out with penicillin by the oxacillin disc diffusion method and also to erythromycin chloramphenicol and cephalosporin using Muellur -Hinton agar. Results: S. Pneumoniae was isolated from 64 (16.6%) children; 29% colonization rate observed in 141 malnourished children was significantly greater (p<0.05) than the rate of 9.5% from the 244 children that were well nourished. Nine (14%) of the 64 isolates of S. Pneumoniae were resistant to penicillin and 2 of these were also found to be resistant to erythromycin, chloramphenicol and cephalosporin. Conclusion: A good proportion of apparently healthy children in Enugu are nasopharyngeal carriers of beta -lactam drug resistant strains of S. Pneumoniae especially in the malnourished group and mainly in the age group 12-24 months. This observation calls for a careful re-evaluation of the management of infections due to this organism that hitherto was well managed with penicillin and related drugs. There is need for constant monitoring of the antibiotic sensitivity patterns of S. Pneumoniae strains from patients in this community.

Objective: To determine the prevalence of enterohaemorrhagic Escherichia coli (EHEC), the pathogenicity of other strains of Escherichia coli and other organisms in children presenting with and without diarrhoea in the hospital. Subjects and Methods: A total of 247 stool samples collected from children aged 1 month to 7 years, made up of children with diarrlhoea (90) and children without diarrhoea (157), were screened for the presence of enterohaemorrhagic Escherichia coli (EHEC). Microscopy, culture and biochemical tests were done on all stool samples for the presence of EHEC and other enteric pathogens and for the presence of parasites. Results: Out of the 247 stools tested, 103 (41.7%) were infected with pathogenic organisms. No protozoan parasite was isolated. Out of the 90 children with diarrhoea and the 157 children without diarrhoea, 64 (71.1%) and 39 (24.8%) (X² = 2.462; P<0.05) were infected with pathogenic organisms, respectively. The pathogenic organisms which included other strains of Escherichia coli which were not typed had the highest prevalence (87.4%) as against staphylococcus aureus (11.7%) and Candida species (0.9%). (X² 3.342; P<0.05). However No EHEC, shigellae and salmonella species were isolated. A moderately significant association was found between the ages of children and E coli. Infection, with children below 4 years of age, having the highest prevalence (X² 2.632, P< 0.05). There was an inverse relationship, the younger children had more pathogenic infections than the older children. No statistical significance was found between the sexes and E Coli infection (X² =0.432; P>0.05) and also between the sources of water supply and E. coil infection (X² = 0.502; P>0.05) Conclusion: This study which was specifically carried out to determine the prevalence of EHEC in diarrhoea children recorded a zero prevalence. However in the course of the study other strains of E. coli and other organisms were isolated as reported in the study. This suggests therefore that EHEC is not a common cause of watery diarrhoea in children. We suggest that further work be done using bloody stool samples and stool samples from children with renal failure. Perhaps its prevalence may be higher as EHEC is thought to be strongly associated with bloody diarrhoea and children with haemolytic uraemia syndrome.

Aim: To asses the prevalence of HIV/AIDS among E.N.T. patients at U.N.T.H. Enugu. Patients and Methods: Records of 224 patients who attended the E.N.T. Clinic for surgery between May 1995 and April 1998 were retrospectively evaluated. The prevalence, spectrum, and characteristics of head and neck complications of the AIDS patients were evaluated. Results: Out of 224 patients, 12 (5.4%) were HIV seropositive, with a male/female ratio of 1:0.7. They were aged between the second and fifth decade with highest incidence in the age group 21 – 30 years. Transmission was by heterosexual relationships. Patients were neither drug abusers nor homosexuals and there were equal numbers of single and married patients. Businessmen were the highest occupational group (50%), followed by students, civil servant and hoteliers at 16.6% each. Patients presented with varied multiple symptomatology; productive cough 5 (50%), neoplasm 5(42%), catarrh 4 (33.3%), fever 3 (25%), sore – throat 3 (25%), cervical lymphadenopathy 3 (25%), dysphonia 3 (25%). Conclusion: Although the above symptoms are common in everyday otolaryngology practice, there should be awareness that AIDS could present in a similar way.

Aim: To examine the rate of awareness of HIV/AIDS among post-primary school students in Edo State of Nigeria, Method: A stratified random sample of 4000 students participated in the study. The instrument used in collecting the data titled HIV/AIDS Awareness Inventory (HAAI) was tested and the Pearson product moment correlation was 0,73. The final Spearman-Brown formula yielded 0.85, which showed that the instrument was reliable. The z-test and ANOVA were the statistical methods used. Results: The major findings were that: 68% of male students as opposed to 81% of female students agreed that disease could be transmitted only through sexual intercourse, 97% of the students agreed that the disease carrier could easily be identified by sickly lean look, 93% of the female students who have had sexual intercourse agreed that their partners did not use condom and 72% of the students have never had sexual intercourse while 87% were found not to be sexually active. conclusion: The awareness of HIV/AIDS is very low inspite of all the efforts already put in by both the government and non-governmental agencies. The parents, teachers, politicians, community and religious leaders and the mass media, should intensify the awareness of the disease at the grass root level.

Presented, is a case report of a long and slender steel wire penetrating and embedding in the upper aerodigestive tract of a 65-year-old man in a rare home accident. The upturned end of the wire in the pharynx prevented it from being pulled out, despite the fact that about 50cm of it was protruding from the mouth to the outside. The challenging task of removing it was made simple and safe by using an open surgical approach that directly accessed the upturned end of the wire. The rarity of such event, the age of the patient, the type of the foreign body, the injuries suffered and the challenges it posed in its management were discussed.

Many prophylactic and therapeutic devices used in orthopaedics and rehabilitation medicine apply both static and dynamic pressure on the skin of the body. Oftentimes, the pressure applied by these devices may not be ascertained and when the external compressing pressure is known, the actual or interface pressure may not be a reflection of the externally applied pressure. This transducer can be routinely used clinically to ensure that various devices in clinical practice apply adequate and safe pressures.

Aim: To determine the knowledge, beliefs and practices towards malaria amongst pregnant women in Enugu. Method: A cross sectional survey of 300 consecutive pregnant women attending the antenatal clinics of University of Nigeria Teaching Hospital Enugu was carried out. The survey instrument was a questionnaire with questions covering various aspects of malaria including causes, prevention and treatment practices. Results: One hundred and thirty two (53.1%) of the pregnant women had correct knowledge of the aetiology of malaria while 103 (41.3%) still attributed the aetiology of malaria to other factors including excessive ingestion of oil, overexposure to sunlight, bite of cockroach, witches and poisoned food. Knowledge of the causes of malaria was directly proportional to the educational attainment of the women. Most respondents showed correct knowledge concerning symptoms of malaria and fever was the most acknowledged symptom; 234 (94.0%) believed malaria could be prevented and knowledge and practice of malaria preventive measures were also high. The major determinants of choice of preventive measures adopted by the women were perceived reliability 178 (71.2%) and ease of administration 76 (30.4). Treatment choices of malaria amongst the women were oral drugs 123 (49.4%), injections 116 (46.6%) herbs 5 (2.0%) and unspecified 5(2.0%). In the event of an attack of malaria 160 (64.3%) of the pregnant women would visit a doctor, 44.7 (17.7%) would engage in home treatment with drugs mainly analgesics and antimalarials, while the rest would resort to either treatment with herbs, visit to chemists or resorted to prayers. Conclusion: The study has demonstrated a fair knowledge of causes of malaria and its preventive measures. However a few grey areas have been identified. The belief in other causes of malaria apart from mosquitoes as widely held by the women could cause a diversion of attention to preventive measures from mosquito bites. Sustained health education especially to less educated women is strongly advocated to enhance to knowledge of malaria and practice of preventive measures.

Background: Chronic residual neuralgia may occur after operation in the lower abdomen as a result of surgical handling or suture compression of the sensory nerves. Pain in the inguinal region is the usual mode of presentation and if the pain persists, accurate identification of the nerve involved, and treatment is recommended. Materials and Methods: Experience with 8 patients in the last 3 years with chronic residual neuralgia after appendectomy and herniorrhaphy is presented. Six of the patients had Ilioinguinal and 2 had genitofemoral neuralgia. The six patients with ilioinguinal neuralgia had neurectomy. Results: Five of the six patients who underwent neurectomy for ilioinguinal neuralgia had complete pain relief while one of them required a further genitofemoral blockage for coexisting genitofemoral neuralgia. Conclusions: Nerve entrapment is a rare complications of operations in the lower abdomen. When the diagnosis is made by a multidisciplinary approach, a neurectomy is frequently successful in relieving severe pain and paresthesia without serious morbidity.

Primary malignant neoplasms have been of great interest for a long time. A historical review mentioned the commoner combinations of organs and exemplified with primary cancer of the urinary bladder being associated with that of the uterine cervix, bowel, pharynx or prostate. The present study reports its association with the gall bladder. The rarity value of this combination is enhanced by the vesical growth being an adenocarcinoma which is itself a rare type in this organ.

Aim: An analysis of orbito -ocular tumours in Enugu, Nigeria. Patients and Methods: This is a retrospective analysis of patients seen at the University of Nigeria Teaching Hospital, Enugu, between January 1990 and December 1999. The information sought included demographic data, presenting symptoms, diagnosis, mode of treatment and histological pattern. Results: Of the 134 patients enrolled for the study, 51 of them (38.1%) had retinoblastoma. This was considered the highest presenting orbito-ocular tumour in children. Other conditions included neurofibromatosis, dermolipoma, chalazion, haemangioma, rhabdom- yosarcoma, pseudotumour, dermoid cyst, Burkitt's lymphoma, liposarcoma, lipoma and onchocercal nodule. About 70% of the patients presented at five years and below. Patients with intraocular tumours were 38.0% of total, followed by orbital tumours (34.0%), eye lid tumours (18.%) and conjunctival tumours (10.0%). Intraocular tumours ranged highest because retinoblastoma contributed to the highest number of cases and is primarily intraocular. Conclusion: This study has brought to light the many aspect of orbito-ocular tumours in Nigerian children and also highlighted the many problems caused by inadequate facilities for diagnosis and management.

Aim: A cross -sectional study carried out in Awka, Anambra State, Nigeria to determine the perception of adolescents to teenage pregnancy. Subject and Method: Four secondary schools were randomly selected for the conduct of the survey. One hundred and thirty (130) students in the senior secondary classes were randomly selected in each of the chosen school giving a total of 520 subjects. Trained interviewers were used to administer structured questionnaires to the students. Results: The result revealed a high level of awareness of teenage pregnancy amongst the adolescents (71.8%); 5.1% (16) of the girls and 8.1% (15) of the boys reported having been involved in teenage pregnancy. Over 92% (444) of the respondents showed disapproval to it while 4.4% (21) were indifferent and 3.5 (17) consider it acceptable. Substantial proportions of the students 29.8% (143) do not know how to avoid teenage pregnancy. Contraception is not the favoured option but rather abstinence. Abortion is low on the line of action subjects will take if they fall victim to unintended pregnancy. Conclusion: It is advocated that an urgent action be taken by policy makers to reduce the prevalence of teenage pregnancy to save the youths from undue hardship imposed on them by unintended pregnancy and also check the spread of AIDS. Adolescents should be encouraged to use contraceptives if they cannot abstain from sex before marriage.

Objective: To determine the disposition of medical personnel to contraception in Enugu, Eastern Nigeria. Methods: A questionnaire survey of the contraceptive attitude and practice of 386 male doctors practicing in Enugu and a comparison of these with those of a previous study of the general male population in Enugu. Results: 73% of the male doctors compared to 90% of the general male population in Enugu approved of male contraception. 62.7% of the male doctors compared to 78% of the general male population used a contraceptive method. The main contraceptive methods used by the respondents were condoms (43.9%), periodic abstinence (34.7%) and coitus interruptus (6.5%) while more of the general male population and their consorts used the more effective artificial means of contraception - the intrauterine contraceptive device, hormonal contraceptives and spermicides . The major reasons proffered for the contraceptive choice were prevention of sexually transmitted diseases in the case of condoms and reduced side effects in the case of the natural methods. Although 55.7% of the respondents favoured adolescent contraceptive use, 22.8% of these would not allow their adolescent children access to contraception. 75.6% of the respondents were against legalization of abortion as a back-up for contraceptive failure mainly on religious grounds and because it will increase promiscuity. Conclusion: Although medical personnel in Nigeria have the potential to enhance not only contraceptive knowledge but also its acceptance amongst clients, they themselves are less favourably disposed to contraception than the general population. Family planning programmes in Nigeria and other developing countries need to recognize this limitation. Doctors, therefore, also need to be encouraged to use contraceptives.

Aim: To delineate the problem of the use of psychoactive substances in a rural secondary school. Method: Using a self - report questionnaire a random sample of students of a rural secondary school in Enugu State in Nigeria was studies to find the prevalence and the pattern of use of psychoactive substances. Results: A life time prevalence of the use of substances of 76.3 percent was obtained. Eighty one percent of the boys as against 67.8% of girls have ever used drugs and this was statistically significant (P<0.05). In the daily use of these substances (as also the “ever” use) alcohol topped the list; closely followed by caffeine. Conclusion: It is pertinent to mention the observation of the absence of the use of Amphetamine, Cocaine, Opiodis and Hallucinogens in our study population. However, the need for immediate action to check this level of drug is highlighted and the need for health education in all schools is stressed.

Aim: To determine the pattern of injection use and reasons for its use in formal health facilities. Materials and Methods: This study was carried out in 1999 in Enugu, an urban city in Nigeria. Using a stratified random sampling method 204 patients and 25 prescribers from 20 registered health facilities were selected for the study. Information was collected using both self and interviewer administered questionnaires with verifications from medical records. Results: Parental drugs were prescribed for 106(52.0%) patients and injectables prescribed significantly more for patients in the health centers 42(93.3%) N=45 followed by private hospitals 56(51.4%) N=109 and least in tertiary/secondary health facilities 8(16.0%) N=50. (X²=56.8, DF=2, p-value=0.00) When the patients' were disaggregated by the preservers' qualifications the injection habit of specialists (N=58) and general practitioners (N=92) were the same (approx. 38% each) while that of primary health workers remained significantly high at (90.7%, N=54). (X²=44.3, DF=2, p=0.00) And out of a total of 769 drugs prescribed, 207(26.9%) were injectables. Of the 207 injectables prescribed; analgesics were 54(26.1%) with dipyrone 47; antimalarials were 44(21.3%)and all were chloroquine; vitamins/haematinics were 41(19.8%) with Vitamin B complex 35 and antibiotics were 38(18.4%) with penicillins 21. The major reasons given by the prescribers for the injections were to, quicken the onset of drug action 51(48.1%), satisfy patients 21(19.8%) and when other formulations are not available 16(15.1%). The indications for the injections were justified for only 20( 9.6%) drugs. Only 26(12.7%) patients requested an injection. Most patients 154(75.5 %) did not make any specific drug request because 108 patients felt that it was the prescribers' duty. About 141(69.1%) patients knew that injection can cause an adverse effect while 27 (13.2%) patients believe injections have no Disadvantages. Conclusion: The rate of unjustified injection use within the formal health sector in Enugu is very high though patients demand for injections is low. Educational interventions aimed at primary health care providers and private medical practitioners should be organized urgently in this setting to curb the rate of injection use.

Aim: To determine whether unbooked admissions were predictable, or whether there were any preventable anaesthetic factors responsible for intensive care unit (ICU) admission. Materials and Methods: The admissions to the Intensive Care Unit (ICU) of the University of Nigeria Teaching Hospital, Enugu for the period June, 1998 to end of August 1999 were reviewed. Data were collected from medical records, especially anaesthetic records. The anaesthetic chart records the source of the admission, whether post-operative admissions are booked or unbooked, patient age, mortality, details of therapies (including medications, monitoring lines, management of fluids) airway problems, cardiac disease, respiratory failure renal impairment and infection. Result: Three thousand operations were performed during the study period. There were 150 admissions to the ICU from the operating theatre, with 9(6%) unbooked. Of the unbooked admissions, 6(67%) were considered predictable and 4 (44%) had preventable features. Conclusion: There were predictable and unpredictable admissions with or without preventable features.

Objective: To determine the association between low and very low birth weight infants and perinatal mortality at the University of Nigeria Teaching Hospital, Enugu. Methods: A retrospective study of the hospital records in the labour ward and the Newborn Special Care Unit (N.B.S.C.U), of the UNTH was carried out for the years 1992 - 1997. The babies enlisted in the study were those that weighed under 2.5kg, subdivided into the low birth weight (LBW) infants, weighing 1.5-2. 49kg; and very low birth weight (VLBW) infants, weighing 0.5- 1.499kg. The birth weights among these age groups were then compared with the general figures for all the births. Figures obtained were analysed by simple statistical methods. Results: A total of 6376 babies were delivered in the UNTH during the period under study. Out of this number 784 (12.296%), weighed below 2.5kg. Of this number 283 were VLBW and 501 LBW. The perinatal mortality rate (PMR), for the LBW ranged from 294.8 per 1000 to 397 per 1000, the highest mortality rate being recorded for the year 1995. The annual PMR for the VLBW ranged between 516.6 per 1000 to 878.7 per 1000, the highest mortality rate being recorded for the year 1997. Although the 784 total number obtained for the LBW and VLBW babies was only 12.29% of the total births in the hospital, the mortality rate among this age group is very high especially in the VLBW infants (717.3/1000) Conclusion: The contribution of LBW and VLBW babies to the PMR in UNTH is high. When considered separately, the PMR among them is extremely high. Delivery, monitoring and treatment procedures of pre-term infants need to be improved.

Aim: To identify, review and highlight the contributions of some species of Compositae to health care of the Nigerian populace, especially in rural setting. Methods: Information is derived mainly from ethno botanical surveys conducted over time by the author, in Southeastern Nigeria. The information is corroborated by experienced traditional medicine practitioners who are members of the Association for Scientific Identification, Conservation and Utilization of Medicinal Plants of Nigeria (ASICUMPON) Enugu. Reference is made also to Useful Plants of West Tropical Africa. Results: Twenty-two species are discussed, indicating their medical value in treating several ailments and conditions. The spectrum of ailments is indeed wide including diabetes, insomnia, skin problems, fertility and impotence, malaria, ulcer, sexually transmitted diseases, cough, worms, sores, poison antidote, among others. Method of preparation and administration include infusions, decoctions, maceration and pounding, drying and steam baths. Conclusions: The abundance of species and variety of ailments treated justify further research on the contributions of Compositae in Nigeria.