Background: Infertility has become a social stigma in our environment because of the erroneous belief that a childless marriage is a failed marriage. This has placed a lot of marriages under pressure. Therefore any solution to infertility is a welcome relief. This is where Assisted Reproduction Techniques (ART) belongs. Aim: To present an overview of ART and review the state of the practice in Nigeria highlighting the benefits, limitations and the future of the ART. Findings: ART has grown from its humble beginning with IUI and IVF & ET in only one centre in Nigeria to more advanced techniques like ICSI and TESE in 3 notable centres. ICSI has enjoyed a better pregnancy rate than even the conventional IVF because of high male infertility in Nigeria. High cost of procedure, lack of skilled personel and poor infrastructures are the major obstacles to the growth of ART in Nigeria. However, the coming of more centres has led to a price reduction and partnership with foreign centres has also provided the needed skill and experience. The joy of an infertile couple having a child of their own remains a driving force for ART is Nigeria and any success is a reduction in the infertility scourge. Conclusion: ART has therefore brought a ray of hope for the infertile couple. It is becoming more available and affordable in Nigeria with improving success rate. It should not be condemned entirely as it can be a last resort for some infertile couple who can afford it.

This short review highlights the beneficial and adverse effects of vegetarian diets in various medical conditions, and the relationships between vegetarian diets and morality. It is becoming increasingly important to recognize that both values and scientific issues come into play in evaluating data on diet. An inverse association has been reported between nut, fruit, vegetable and fibre consumption, and the risk of coronary heart disease. An inverse association between fruit and vegetable consumption and stroke has been suggested. There is an inverse association between dietary fibre intake and incidence of colon and breast cancer as well as prevalence of colonic diverticula and gallstones. There are few adverse effects, mainly increased intestinal gas production and a small risk of vitamin B₁₂ deficiency. The link between food and mood has been established by hundreds of scientific studies. Many of them show that vegetarian diets positively influence depression, anxiety, anger, violence, lethargy, and cravings.

Urolithiasis in not rare in women of childbearing age, however, its occurrence in pregnancy is uncommon. The clinical presentation may not be straightforward, as there are a variety of obstetrical and surgical problems that qualify as part of the differential diagnosis. This can lead to delay in the treatment, which in turn can threaten the pregnancy and lead to renal impairment.

Iron overload constitutes a major health problem worldwide, and deserves attention. This review covers a few of the proliferating literature ranging from mechanisms of its carcinogenesis, iron-withholding defense system and its attendant risks, to suggestions of prevention and control.

Aim: To determine household's practices in utilization of home treatment for childhood malaria and explore their implications for improving prompt appropriate care in communities. Methods: Questionnaires were administered to women from randomly selected households with previous month history of childhood malaria in four villages. Focus groups discussions were also held with groups of men and women in each village. Results: A total of 28/94(29.8%) of the households had drugs in their homes at the time the child had “malaria” and 40 (42.6%) had to buy the drugs from outside. However, 26 (27.7%) first took the child to a health facility for treatment. Only 53.2% cases were confirmed to be malaria, but 47.8% of the treatments given contained anti-malaria and 31.2% drugs like antibiotics. Conclusion: Home treatment can lead to inappropriate drug consumption. It is necessary to compare the cost-effectiveness of alternative means of bringing treatment nearer the home and community -based health workers can help to surmount the problems with home treatment.

Objective: To evaluate the problems of alcohol, other substance and non- prescription drugs use during pregnancy. Methods: The study was carried out at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. Participants who were recruited during the study period, consisted of 1160 alternate pregnant patients who registered at the antenatal clinic from January 1999 to December 2001. They were administered the psychoactive substance screener section of the ICD - 10 symptom checklist (WHO, 1994); the self-reporting questionnaire (SRQ - 24 Harding et al, 1980) and the health questionnaire (Sheila Blume, 1996). Results: Thirty percent of the women admitted to use of non- prescription drugs. Vitamins were the most commonly abused (41.4%) followed by analgesics (33.4%), kola nuts (25.7%), laxatives (10.6%), and antacids (8.9%) Alcohol was consumed by 43.7%. Whereas 16.7% found alcohol not helpful in feeling better or relaxed when they are depressed or nervous, 27.1% found it helpful. The incidence of drinking alcohol was higher (50%) among the 35 and above year age group, followed by the 30-34 year age group with 37.5%. Only 2.9% admitted to using tobacco. Conclusion: Alcohol consumption in pregnancy appears to be higher in the older pregnant Nigerians. The implications of use in early pregnancy and during labour are highlighted.

Aim: To highlight the clinical profile of foreign body aspiration in children seen in a clinic in Enugu and the technique of rigid bronchoscopic removal of these foreign bodies under general anaesthesia. Method: The study was retrospective. The anaesthetic pre-medication was to give intravenous atropine 0.01mg/kg body weight. Anaesthesia was induced with intravenous dose of ketamine 2.0mg/kg and midazolam 0.1mg/kg body weight, and followed with a bolus dose of suxamethonum 1mg/kg. An appropriate sized rigid respiratory bronchoscope assembly was inserted into the trachea. Patient was ventilated manually and bronchoscopic removal of foreign body done. Results: They were 19 males and 11 females, with an average age of 1.6years. Groundnut was the most commonly recovered foreign body in 19(63%) patients. The right main bronchus was the commonest site of impaction in 10(33%) patients. No foreign body was recovered in 4(13.3%) patients. Two patients (6.6%) died from severe acute pulmonary oedema. Conclusion: Foreign body aspiration is a persistent life-threatening problem among Nigerian children. We recommend that children below the age of 4 years should not be fed Whole groundnuts.

Aims: (i) To assess the uptake of cataract surgical services in the Gambia in a simple way, using the incidence of Phacomorphic glaucoma. (ii) To review the cases of phacomophic glaucoma seen in the Gambia over a one-year period. (iii) To update us on the systematic approach to the treatment of early phacomorphic glaucoma. Report: Four cases of phacomorphic glaucoma (with no previous history or signs of trauma, uveitis or any other ocular or systematic pathology that could explain the development of the glaucoma apart from cataract) seen over a one-year period in Royal Victoria Hospital, Banjul, the tertiary unit of the Gambian Eye Care Programme, were identified and analysed for age, sex, symptoms/signs, duration and treatment. There were 3 females and 1 male aged between 50 and 71 years. All but one presented with pain and blurred vision of ≤3 week duration. Visual acuity at presentation was ≤PL in all patients and all remained blind (visual acuity <3/60) even after surgery. Conclusion: i. Generally, the uptake of cataract surgical services in the Gambia is good. ii. In spite of the effectiveness of the cataract surgical services of the Gambian Eye Care Programme, those in dire need of cataract surgery have not come in contact with the available services.

Background: There has been some difficulty distinguishing inverted papilloma (IP) of the nose and paranasal sinuses from other nasal tumors. Confusion exists because IP are uncommon tumors, mimic nasal polyps and nasal malignant growths and also vary in growth from transformation into malignancy. Method: Histologies of a series of inverted papilloma of the nose and paranasal sinuses within a period of 12 years (1985 - 1997), were evaluated. Cases were analysed using the following morphological criteria: clinical finding, localization, bony changes, duration of growth, recurrences and pathologic sections. Results: There were 22 patients, aged between 35 and 80 year (N = 22; 11 Males, 11 females), with histologically proven inverted papilloma Treatment options were simple excision, polypectomy, Lateral Rhinotomy, Caldwell-luc and Hemimaxillectomy. Recurrence was a common feature. Conclusion: Radical aggressive surgery with a close follow up is advocated to avoid recurrence or possible transformation into malignancy.

Aim: To evaluate the significance of sub-chorionic haematoma found in patients with first trimester vaginal bleeding , on pregnancy outcome. Method: This is a prospective study. Five hundred and thirty six patients with first trimester bleeding had abdomino - pelvic ultrasound. Forty-seven patients had sonographic evidence of subchorionic haematoma. The pregnancy was followed up in the forty - seven patients. Result: Spontaneous abortion occurred in 13 patients (27.7%) premature labour in 12 patients (25.5) and spontaneous term vaginal birth in 22 patients (46.8). There was no sonographic evidence of ectopic pregnancy and trophoblastic disease. Conclusion: Majority of the patients who had sub-chorionic haematoma had a normal term pregnancy. However if the subchorionic haematoma was extensive and associated with passage of dark blood clots per vaginam the prognosis for the fetus was poor.

Aim: To evaluate the magnitude of cost involved in treating abdominal wound dehiscence in obstetric patients at the University of Nigeria Teaching Hospital (U.N.T.H) Enugu and estimate the impact of such costs on parturients. Methods: A retrospective case - note based audit was carried out in obstetric patients who developed abdominal wound dehiscence in UNTH Enugu between January 1990 and December 1999. Direct and indirect costs were estimated and their impact analysed. Results: Fifty-six cases of abdominal wound dehiscence occurred in 2460 caesarean sections and 48 laparotomies resulting in a prevalence of 2.2%. Seven (12.5%) complete abdominal wound dehiscence and 49 (87.5%) partial abdominal wound dehiscence were recorded. The mean age of affected women was 27±4.3 years. Their parity ranged from 0-6. Most of the women (69.6%) were is social classes 4 and 5. Their mean duration of hospitalisation was 26.7±11.8 days. In 57.1%, the surgeries were done as emergency and in 30.4%, they were booked. The estimated total cost of treatment in the affected parturients was 1,172,089 Naira. Except for 2 women in social class 1, the rest needed 2-6 times their monthly income to offset the cost of treatment. Treatment costs were significantly higher in unbooked women than their booked counterparts (p<0.05); 73.1 % of direct costs were incurred in women who did not have either pre-or intra -operative antibiotics. Conclusion: Prolonged hospitalisation, high cost of treatment, and prolonged job loss, which might lead to aversion to obstetric operations and hospital delivery, were evident. The consequence is a self- perpetuating cycle of high costs and increased morbidity. It is expected that with the mass mobilization of our parturients to good antenatal care and safe delivery, the cost of obstetric services in our centre will reduce.

Aims: A study was carried out among 136 final year medical students of University of Nigeria Enugu Campus, to verify their attitude to Community Medicine as well as selection of the course for future specialization. Methods: The study was a cross sectional descriptive one involving all final year medical students of the College of Medicine, University of Nigeria Enugu Campus, graduating in the year 2000. Results: The study showed that the students had a fairly good attitude towards Community Medicine. However, only a minority of the students 16(11.8%) ranked it first when compared with the other clinical courses. A total of 24 (17.7%) of the students chose the course as their area of future specialization. There was no statistically significant difference between the male and female students in their opinions. Conclusion: It is recommended that some new innovative methods would be employed to increase the students' interest in the discipline, particularly the aspect of Primary Health Care which is the mainstay of the country's health care delivery system.