Although breast self-examination (BSE) is a well known concept, its historical development is poorly appreciated. Therefore, this paper traces it to the 17th Century and shows that, in all probability, if the cure of breast cancer were to rest on a Simple remedy, BSE would inherently become readily practised.

Objective: To investigate leucocyte mobilization, acid phosphatase and acetylcholinesterase activities during ivermectin therapy for onchocerciasis, to shed light on the mechanism underlying the involvement of the host's immune system. Method: A single oral dose of ivermectin (300 g/kg) was administered to 78 subjects (42 patients and 36 non-infected) aged between 14 and 40 years. Blood samples were collected from the subjects prior to the administration of the drug at 3, 7 and 14 days post-treatment. Results: There was no significant increase (P>0.05) in all the blood cell types throughout the study period. Significant increases (P<0.05) were observed in mean neutrophil and eosinophil counts on day 3 and days 0, 3, 7, and 14, respectively in the patients than in the controls. Mean lymphocyte counts were also significantly decreased (p<0.05) on days 3, 7 and 14 in the patients than in the controls. Both acid phosphatase and acetylcholinesterase activities were not significantly altered (p>0.05) throughout the study period. Conclusion: Killing of microfilariae by radicals generated from neutrophils; and the enhancement of eosinophils against Onchocerca volvulus after treatment with ivermectin is hereby suggested.

Background: Aneurysmal subarachnoid haemorrhage remains a significant cause of morbidity and mortality from stroke in Africans. In many parts of Nigeria it is largely underdiagnosed. Literature is scanty for this condition in the South East of Nigeria especially for the last two decades. Aims: To determine the case spectrum of subarachnoid haemorrhage, particularly of the aneurysmal type, in Enugu, South East Nigeria. Methods: A retrospective study was done of patients admitted into the medical wards of the University of Nigeria Teaching Hospital Enugu Nigeria with a clinical diagnosis of stroke between January 1980 and December 1999, a twenty year period. Case records of suspected and confirmed subarachnoid haemorrhage cases were identified and relevant data obtained. Results: Out of a total of 450 patients admitted with stroke, only 38 were clearly identified to have haemorrhagic stroke. Of these, 22 patients were managed as subarachnoid haemorrhage representing 58% of the haemorrhagic stroke patients and 4.9% of the total stroke patients. Most of the stroke patients, 337 in all (74.9%), were not classified as being either ischaemic or haemorrhagic in nature. There were more female than male patients with subarachnoid haemorrhage and the ages ranged from the second decade to the ninth decade of life. Only 5 of the 22 patients with subarachnoid haemorrhage had proven ruptured aneurysms as the cause. Systemic hypertension was a significant finding in 59% of the patients with subarachnoid haemorrhage. Conclusion: There is clear evidence that majority of cases of subarachnoid haemorrhage remain unrecognized in Nigeria. Non recognition may mean unnecessarily high disability and deaths from a condition which with modern neurological care maybe significantly ameliorated resulting in improved quality of life for the affected patients.

Background: Epilepsy is the most common chronic neurological disease encountered among school children in Nigeria. Studies in developed countries show conflicting reports on it's effect on academic performance. There is also a dearth of information on the academic performance of Nigerian children with epilepsy. Aim: To determine the academic performance of children with epilepsy, hoping that our findings will help in formulating policies that will be used in their educational programme. Method: The academic performance of 50 consecutively recruited epileptic children aged between 5-14years attending normal Primary school in Enugu and presenting at the Paediatric Neurology clinic of UNTH Enugu, was compared with those of non-epileptic classmates who were matched for age, sex and socio-economic status. The academic performance was assessed using the overall scores achieved in the terminal examination in the 2001/2002 academic years, as well as the scores in individual subjects. Results: There were 36 males and 14 Females (Male: Female ratio was 2:1). The most common seizure type among the epileptic children was generalized tonic-clonic seizure seen in 58% of the children. Twenty six percent of the epileptic children had a low overall score, and therefore poor academic performance, compared to 16% of the controls. (P=0.35). The difference was not statistically significant. However, the Mean score of the epileptic children was significantly lower than that of the controls in certain subjects, viz: English (P=0.02), Sciences (P=0.02) and Social studies (P=0.02). Conclusion: It is concluded that the overall academic performance of epileptic children without other chronic disorders attending normal schools is not different from that of normal children in the same setting, though they are under-achieving in some subjects.

Aim: To determine the usefulness of fecal leucocyte count in predicting the need for antibacterial agents in the management of childhood diarrhea in southeast Nigeria. Methods: A two-year prospective study (Jan 1998-Decl999 inclusive) of 211 patients with non-bloody diarrhea was done in a private children specialist hospital in southeast of Nigeria. The stool of each of these patients was subjected to macroscopic and microscopic analysis and the findings documented. The patients were put on oral rehydration solution (ORS) and seen subsequently every two days. During the visits, the progression or otherwise of their diarrhea determined further intervention with antibacterial agents. At resolution, the result of the stool macroscopy and microscopy of each patient taken at the visit when the decision to either give antibacterial agents (worsening) or not (improving) was taken and subsequently patient improved, was correlated with the decision taken on such a patient. The results were subjected to X² analysis and the critical values determined. Also the means and standard deviations where relevant were calculated. Results: The results showed that a total of 86 out of 211 of the cases needed antibacterial agents; 67 as single therapy and the rest as combination therapy with other drugs for other conditions diagnosed. Additionally, for the samples that had >8wbc/hpf, 31 out of 36 of them required antibacterial agents, while for those that had <2wbc/hpf, 70 out of 75 did not. [X² = 81.02 X² _3,005 = 7.815 (P<0.05)]. Conclusion: These results show that in non-bloody diarrhoeas in children in this environment, the fecal leucocyte count could be used to determine those that will need antibacterial agents.

Aim: To investigate the incidence of self-medication among University academicians and to determine whether there are age and sex differences. Subjects and Methods: The population of the study was the academicians in the eleven faculties of University of Benin. A random sampling method was used to select the five faculties, which participated in the study. A stratified sampling method was used to select ten lecturers (five males and five females) from each participating faculty. A total of eighty lecturers participated in the study. The data was collected with the questionnaire titled Self-Medication Inventory (SMI). Experts in the field validated it. The questionnaire was tested on thirty respondents who were excluded from the main study. The Pearson Product Moment Correlation method was 0.76 and the final Spearman-Brown formula yielded 0.86, which showed that the instrument was reliable. The Z-test, ANOVA and common percentage wee the statistics used. Results: All respondents were found to indulge in self-medication with consequent adverse effects and there were no differences in gender or age. Conclusion: Since most lecturers self-medicate irrespective of gender or age, it is recommended that programmes should be mounted in the universities, to enlighten all irrespective of gender or age on the dangers of this dangerous habits on self-medication.

Background: In exercising freedom to determine their own future without external restraints, patients admitted to hospital sometimes opt to leave against medical advice. This retrospective study was designed to determine the incidence of discharge against medical advice among medical patients and to highlight procedural pitfalls in its handling at the University of Nigeria Teaching Hospital Enugu Nigeria. Methods: Case notes of all medical patients who left hospital against medical advice in the medical wards of the University of Nigeria Teaching Hospital over a period of 4 years and 6 months were examined and information relating to patient's age, gender, diagnosis, duration of stay and reasons for leaving the hospital against medical advice extracted. Results: One hundred and fifteen medical patients left hospital against medical advice (82 males and 33 females) and 92 of them (80%) were admitted through the accidents and emergency department of the hospital. The discharge forms were signed by the patients' relatives in 72 cases (64.3%) and by the patients concerned in 27 cases (23.5%). The reason for leaving against medical advice was not stated in 98 cases (85.2%). Neurological lesions (31.3%) and gastrointestinal/hepatobiliary diseases (27.1%) topped the list of working diagnoses. Most of the patients (62.6%) left within the first week of admission. No follow-up arrangement was made for any of the patients. Conclusion: Discharge against medical advice is frequent among medical patients especially those admitted as emergencies. The procedure adopted by medical staff in dealing with this very sensitive medical issue with high potential for serious ethical and legal breaches needs radical reforms

Osteosarcoma of the jaw is rare constituting about 4% of all the primary malignant neoplasm in the jaw. Radiologically, it presents with radiopacity of the affected jaw often described as ‘sunray’ in appearance. However, at early stage, the commonest radiological presentation is characterized by widening of periodontal ligament space in a plain radiograph. At this stage without proper radiological evaluation, it could easily be misdiagnosed as a suppurative process or as a benign neoplasm. The problem of misdiagnosis of osteosarcoma and other jaw tumours in our environment is strongly associated with the radiological misinterpretation. We have experienced several cases of Osteosarcoma wrongly diagnosed as periodontal disease or dentoaveolar abscess due to wrong radiological interpretations and extraction done with dire consequences. The purpose of this article is to emphasize the need for proper radiological interpretation in the diagnosis of osteosarcoma before treatment and to illustrate the dilemma of two young adolescent Nigerians that were the victims of radiological misinterpretation.

Aim: To evaluate the management of post thymectomy myasthenia gravis (MG) patient in our centre; to highlight those aspects of patient care that could improve outcome and to serve as a bench mark for developing a standardized protocol for management. Method: A retrospective study of 5 cases of post thymectomy MG patients managed in the intensive care unit [ICU] of University of Nigeria Teaching Hospital, Enugu, Nigeria between 1995 and 2001 was carried Out. Diagnosis of MG was done clinically and with positive edrophonium or neostigmine test. Data concerning demographic and clinical characteristics were obtained from the case records. Results: The patients spent 10 - 36 days in the ICU. They were between the ages of 20 and 36 years; 4 females and 1 male. Seven episodes of cholinergic crisis and 4 episodes of myasthenic crisis were recorded with no mortality. Conclusion:The use of standard protocols for management of post thymectomy MG would produce better results in terms of the number of cholinergic and myasthenic crises, and duration of respiratory support.

Aim: To ascertain the prevalence and nature of psychoactive drug use amongst taxi drivers in Nigeria. Materials and Method: A total of 192 taxi drivers in Enugu, South East Nigeria was studied using a questionnaire. Information obtained from the questionnaire included socio-demographic characteristics of the drivers, pattern and reasons for drug use and factors associated with it's use, awareness of danger posed by drugs as well as accident rates amongst the drivers. Result: The prevalence of psychoactive drug use amongst the drivers was 85.4% . The commonest drugs used were alcohol, tobacco and central nervous system stimulants such as coffee and kolanut. Drivers who were single, of younger age group, of low literacy level and who had been in the profession for more than 5 years had higher prevalence of drug use. The commonest reason for using drugs was to remain strong and alert while religious conviction was a major consideration for not using psychoactive drugs. Conclusion: There is a high prevalence of psychoactive drug use amongst taxi drivers in Nigeria. A drug rehabilitation program for taxi drivers in Nigeria is advocated. Religious leaders should be integrated into the program. A health education programme to create awareness on dangers of these substances as well as stress coping mechanisms is advocated.

Background: Congenital neurodevelopmental anomalies by nature are in most cases apparent at birth or present shortly after in childhood. The abnormalities at the cranio- cervical junction are not exempt. The Chiari malformations (types 1 4) are a group of such disorders. Though with variable components, they are known to present either at birth / early life or in adulthood. It is important that early diagnosis be made because of the severe and frequently life threatening nature of the anomalies. Aim: This paper presents the unusual case of a 43 year old Nigerian man, a twin, presenting to the clinic with Chiari type 1 malformation the features of which were made manifest only in middle age and had been managed as a chronic headache syndrome. Materials and method: The clinical features of the patient are presented together with relevant results of investigations including magnetic resonance imaging. Careful literature search was made using library and internet sources. Results: A 43 year old Nigerian male, a stadium manager, presented to the medical clinic with four years history of headache, paresthesias, dysphagia, vertigo and gait instability with an episode of syncope. He had received medical attention from various centres without relief. A past medical history of bronchial asthma and gastro-oesophageal reflux disease was elicited. He had an unremarkable childhood history though his twin brother died few months after birth of an unknown cause. Physical examination revealed an alert and well nourished man with normal cognition. There was no nuchal rigidity and the cranial nerves were intact. No papilloedema on fundoscopy. His motor system examination was unremarkable except for areflexia in the upper limbs. Sensations were grossly intact but he had a sensory ataxia on standing. Other systems were normal. Plain radiographs of the neck were equivocal for cervical spondylosis. Brain CT scan was normal as was the EEG while a brain and spinal MRI study revealed a Chiari type 1 malformation with hydromyelia. Symptomatic treatment was offered to the patient till decompressive surgery was successfully done. Conclusion: This case report highlights the need for comprehensive neurological evaluation of patients presenting with chronic head and neck pain. The availability of and access to modern neuroimaging modalities will go a long way in detecting hitherto underdiagnosed neurodevelopmental disorders especially in Africa.

A 45-year-old Igbo man presented with a subcutaneous nodule in the lateral aspect of his left thigh. Following its excision, the lesion turned out on microscopy to be due to the unique juxtaposition of onchocerca nodule and tumoural calcinosis. Such selectivity in disease localization is deemed to be worthy of documentation, especially with reference to the two seemingly disparate fields of onchocerca parasitism and calcium metabolism.