Background: Kotase® is a combination systemic enzyme therapy that contains bromelain and trypsin. Bromelain is a crude extract of pineapple plant that contains mainly plant proteases. A multitude of actions have been ascribed to it including anti inflammatory properties. Aim: To evaluate the efficacy of bromelain/trypsin combination (Kotase®) in resolution of post laparotomy wound inflammation. Materials and Methods: The study is an open labeled study in which 111 patients were randomized in a 1:1 ratio to receive either Kotase® or no kotase in their post op treatment. All the patients had major laparotomy wounds and were able to resume oral intake within 72 hours of surgery. The two groups of patients received all treatment necessary for their condition except with regards to analgesic and anti-inflammatory treatment. After commencement of oral intake, patients for kotase® treatment had two tablet of kotase® qid added to their post op drugs for a maximum of ten days or until the patient was discharged. Patients were assessed every day for operative wound pain, and inflammatory oedema. Also, the analgesic requirements and wound failure rates were assessed. Results: The two groups were matched with respect to demographic characteristics and case distribution. In the no treatment arm, the average post op inflammatory oedema decreased from 1.969mm on commencement of oral intake to 1.827mm on the 5^th day of measurement and 1.631mm by the time the patients were discharged. In the Kotase® treatment group, the inflammatory oedema decreased from 1.959mm on the first day of drug treatment to 1.389mm by the 5^th day and 1.018mm by the time the patients were discharged. There was significant difference in the size of the oedema of the two groups on the 5^th day and by the time of discharge. The average visual analogue pain score of patients without kotase® decreased from 6.27 on the first day of oral intake to 3.65 by the 5^th day and 1.84 by the time the patients were discharged. The patients that had kotase® had an average pain score of 6.32 on the 1st day and 2.45 on the 5^th day and 0.68 by the time of discharge. Again the drop in pain score was significantly more in the patients that had kotase®. Ten patients in the no kotase® arm needed extra doses of dipyrone in addition to the set down analgesics to control their pain while only one in the kotase® arm needed extra doses of analgesics to control his pain. There were 6 minor wound infections in each treatment arm and one wound breakdown in the no kotase® treatment group. There was no unexpected adverse reaction due to the use of kotase®. Conclusion: The results show the effectiveness of combination of bromelain and trypsin in reducing post operative inflammatory oedema and operation wound pain that accompany major laparotomy wounds.

Background: Hypertension and menopause are independent risk factors for dyslipidaemia. In normotensive subjects, menopause causes significant alteration in lipid levels that may require medical intervention. It is thus expected that this alteration will become more relevant in hypertensive menopausal subjects. In our environment, diverse dietary, socioeconomic, and geographical variables might alter the expected pattern of deraignment. Aims and Objectives: This study aims to compare the total lipid profile and its subfractions in hypertensive premenopausal and hypertensive postmenopausal subjects. Materials and Methods: This is a comparative, cross sectional cohort study involving 116 hypertensive females (67 premenopausal and 49 postmenopausal), consecutively recruited over a two-year period. Serum total cholesterol and its sub fractions, high-density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), and triglyceride, (TG) were estimated using standardized enzymatic and mathematical methods. Significant differences were analysed with student T -test using SPSS version 11 computer software. Results: There were no statistically significant differences in total cholesterol, HDL, LDL, VLDL and HDL/LDL ratio between the two groups (P>0.05). However there were statistically significant differences in triglycerides (P<0.01) and the atherogenic index of plasma (P<0.001). Conclusion: Simultaneous occurrence of menopause and hypertension leads to alteration in lipid profile that favours the use of triglyceride based indices (instead of HDL/LDL ratio) in determining the risk of developing atherosclerosis.

Background: This report describes the unusual presentation and management of an urachal cyst in a 3 1/2 year old Nigerian male child. Before being referred, he had been managed as a bladder rhabdomyosarcoma, and given two courses of cytotoxic therapy. Methodology: Pre-operative diagnosis was inconclusive, including the use of Ultrasonography and micturating cysto-urethrogram (MCUG). Abdomino-inguino-scrotal exploration revealed a pre-peritoneal multi-septate cyst spanning from the umbilicus to the dome of the urinary bladder. In addition there was herniation of this cyst into the right inguino-scrotal space. The cyst yielded 1.7litres of straw coloured fluid. Results: Drainage of the cyst with total excision of the sac in continuity resulted in cure. The patient has remained symptom free at 2years of follow up. Conclusion: This rare presentation of a benign condition stands to caution all practitioners against the irrational use of cytotoxic therapy.

Objective: To determine the knowledge of and attitudes to breastfeeding among preclinical medical students of the Nnamdi Azikiwe University, Nnewi Campus. Methods: Data collection was aided by a pre-tested, self-administered questionnaire from a cross-section of 280 randomly selected students. Results: Two hundred and eighty students, 181 males and 99 females, were interviewed. The mean age of students was 22.3 ± 3.4 years. Eighty-seven percent of them had been breastfed, while 95.7% had observed a breastfeed. Eighty-eight percent of the females expressed intention to breastfeed their babies while 92.8% of the males would encourage their wives to breastfeed. The male students had a more positive attitude to, and were more knowledgeable about breastfeeding, than their female counterparts. Conclusion: This study highlights the need for breastfeeding promotion strategies among female medical students to encourage them, in the future, to breastfeed and also champion the cause of breastfeeding as a child survival strategy.

Aim: To determine the demographic characteristics of people living with HIV/AIDs attending the UNTH treatment center. Patients and Methods: All patients who assess Antiretroviral treatment at the University of Nigeria Teaching Hospital between February 2002 and July 2004 were included. Demographic characteristics such as age, gender, occupation, marital status, number of spouses, past history of STIs, and blood transfusion were obtained from the patients. Sexual preferences including dalliances with commercial sex workers and whether or not they had shared information on their HIV status with others were inquired from them at registration for therapy. Results: The result showed that the commonest route of transmission remains heterosexual contact, but the infection appears to be more common among married couples. People living with HIV/AIDS are more likely to divulge information about their status when they need support of relatives. Condom use is still abhorred. Conclusion: HIV/AIDS appears to have permeated the entire population and can no longer be viewed as a disease of any particular section of the society. Education on preventive measures to reduce the scourge of HIV/AIDs should form greater part of Government's effort to contain the infection.

Background: The need to investigate the perceptions of helpless patients to bed bathing by nurses is a very important aspect of quality assurance in nursing care. Aim: To determine the perceptions of helpless patients to the need for bed bath, the timing of bed bath, nurse's attitude during bed bath and the patient's attitude to being bathed by nurses of the opposite sex. Methods: A descriptive, non-experimental design was used for the study and the main instrument for data collection was researcher-structured questionnaire, which also served as interview guide. Results: The study showed that 96.7% of the respondents have received bed bath in the hospitals studied. Majority of them (94.5%) perceived bed bath as an important need. More than half of the respondents (62.0%) prefer to have their bath early in the morning while (26%) prefer their bath in the evening. Majority of the respondents (91.3%) perceived nurses as careful and (88.0%) perceived nurses as patient. However (5.4%) perceived them as haughty and indifferent. About a quarter of the respondents (27.2%) perceived being bathed by nurses of the opposite sex as violation of their cultural beliefs while (21.7%) perceived it as threat to their self esteem and psychological security. Conclusions: Bed bath remains a significant need of helpless patients in hospitals and nearly all of them perceived it as such. This procedure should be carried out with care, patience and dedication realizing the psychological insecurity experienced by these groups of patients. In a situation where it is practicable, in recognition of the people's culture, helpless patients should receive this special service from nurses of the same sex.

Aim: To examine pattern and perception of onchocerciasis among women in oncho-endemic areas of Imo state; Nigeria. Methods: Clinical examination; questionnaires and focus group discussion were used. Four hundred and twenty (420) women, from 4 endemic communities in Okigwe LGA in Imo State were examined and questionnaires distributed. Focus group discussion was also held with other groups. Results: Illiterate farmers (76.2%) were significantly (P<0.05) more affected than other occupational groups. Fifty five percent of the women with the disease signs and symptoms were disturbed, 30.90% felt normal, while 9.5% and 4.8% felt withdrawn and inferior respectively. Results from focus group discussion confirmed that some villagers feel bad and afraid; some feel sorry while others feel normal when they see women with disease manifestations. A significant (P<0.05) number of the respondents (54.5%) said that men in the communities do not marry girls with the disease manifestations, especially onchodermatitis. Sixty eight percent said onchordermatitis reduces level of interaction with other people. Responses from focus group discussion said that women with severe onchordermatitis are avoided, and a hindrance to sexual relation. According to discussion group, parents do not allow their sons marry girls with onchordermatitis. The villagers believe that genital elephantiasis or oedema and hanging groin are punishment from the gods on the affected women for their infidelity. Abandonment and or divorce were mentioned discussants. A highly significant (P<0.05) number (66.2%) said onchordermatitis affect their concentration at work thus their productivity. They also had diverifised views about treatment and preventive measures. Conclusion: Most of the patients agreed that Mectizan distribution in the communities has improved the health of the people, especially reduction of severe onchordermatitis

Aim: To study the clinical, radiological and histological patterns of bone tumours seen at the National Orthopaedic Hospital Enugu over a period of 13 years (1990-2003). Materials and Methods: The medical records of 56 patients with histologically proven diagnosis of bone tumours during the 13 years period were analysed. Results: Of the 56 cases studied, 31 were malignant and 25 benign. Of these also 35 were male and 21 female giving a male to female ratio of 17 to 1. The average age range was 5 to 76 years. The age range for the benign cases was 5 to 59 years and 10 to 76 years for malignant cases. Altogether 57% of males and 52.4% of females had benign lesions. In the benign group, the main presenting symptom was painless slow growing mass while in the malignant group the symptoms consisted of painful rapid growing tumour with occasional pathological fractures and disruption of function. The commonest benign lesions were ameloblastoma (9) and fibro-osseous lesions (11) while osteosarcoma was the commonest malignant lesion (8). Definitive diagnosis was based on clinical, plain film radiographic findings and biopsy findings. The benign lesions had excision/curettage done, while the malignant cases had ablation or amputations. Those with distant metastases were managed conservatively after tumour ablation. For some cases, recurrence occurred after surgery over a period ranging from 1 year to 22years. The outcome in most of the remaining patients was not verified due to poor patient follow-up. Conclusions: The pattern of bone tumours in South-East Nigeria parallels those in South Western Nigeria and the Western World.

Aim : To determine the incidence of atrial fibrillation (AF) on electrocardiograms (ECG) of patients attending the University of Nigeria Teaching Hospital (UNTH), Enugu. Subjects and Methods : Electrocardiograms done at the UNTH between April and September 2004 were analysed. The patients were mainly in-patients. Further information on the patients were obtained from their medical records. Results : 860 ECGs were studied. 30 of them (3.5%) had atrial fibrillation (AF). Seventeen (56.7%) were males and thirteen (43.3%) females. 66.7% of the cases were aged 50 years and above. In 33.3% of the cases, hypertension was the underlying disease, followed by valvular heart disease (23.3%). Conclusion : The incidence of AF in UNTH was 3.5%. There were more males than females with AF. Most of the cases were in the older age group. Hypertension was the commonest underlying disease.

Aim: To compare the occurrence of male breast carcinoma in Ibos and Hebrews on the basis of their ethnological linkage. Methods: A 30-year retrospective analysis was carried out with regard to Ibo males suffering from breast carcinoma. The literature was searched for such data in Hebrews. Results: Ibo cases numbered 41 while Jerusalem cases came to 42. Similarities were noted in terms of the age bracket with the highest incidence, the average age, the proportion of bilateral disease and the most common presenting symptoms. Dissimilarities occurred as regards the ratio of the incidence of male and female lesions, the laterality of growths, the presence of ulceration and the delay from the first symptom until diagnosis. Conclusion: Ethnicity is a demographic variable worthy of concerted research in the rare field of male breast carcinoma.