Aim: To study premier parameters of mammary masses in Nigerian nuns. Methods: A prospective study was undertaken by one of us, a nun, as regards the occurrence of breast lumps in fellow members of religious orders living among the Igbos, a populous Nigerian ethnic group. The coauthor helped in respect of both direction of the research and examination of the breast biopsies. Results: Of the total 1017 nuns examined, 107 were found to have breast diseases of which 101 were benign and two malignant. Their ages ranged from 20 to 68 years. The commonest lesion was benign dysplasia (67%), followed by fibroadenoma (36.2%). Their respective mean ages of 33.3 ± 22.6 years and 28.1 ± 12.6 years were statistically significant. The mode of presentation was generally that of a painless lump. Nuns in Igboland are generally young, and their breast diseases commonly benign. Most of them claimed not to know about breast cancer (73.8%) while only 8.4% did regular breast self-examination. Conclusion: Nuns constitute a subset of the population that is very suitable for confirmatory or negatory researches on the etiologic link between benign dysplasia and malignant disease of the breast.

Adenocarcinoma of the vermiform appendix is rare constituting less than 0.5% of all gastrointestinal tumours. It is most commonly seen after the fifth decade of life with a slight male preponderance. It stains positive for cytokeratin 20 which is utilized in immunohistochemical diagnosis. The commonest clinical presentation is that of acute appendicitis but the diagnosis of adenocarcinoma is usually made after histologic analysis of the specimen. It may also manifest with evidence of local or distant spread. The staging system used is commonly Duke's and the prognosis is dependent on the stage and grade of tumour. The primary aim of this article is to emphasize the need to subject all appendicectomy specimens for histologic analysis and to offer the patient with adenocarcinoma right hemicolectomy which may be curative in early cases. Patients should be followed up with surveillance for a long time due to the high incidence of synchronous and metachronous tumours especially of the gastrointestinal tract.

Background: The surgical removal of impacted lower third molar is one of the most frequently performed procedures in oral and maxillofacial surgery and represents a standard operation. Patients' complaints of pain, swelling and limitation in mouth opening associated with inflammatory response following lower third molar surgical extraction is an important factor affecting their daily life. The type of molar impaction has been associated with the increased postoperative morbidity following surgical removal. Objectives: The aim of this study is to compare the effect of different molar impactions according to George Winter on postoperative pain, swelling and trismus, which occur after lower third molar surgery. Patients and methods: A comparative study of the effect of different lower third molar impactions on postoperative pain, swelling and trismus was carried out among 100 patients of both gender attending the oral and maxillofacial surgery unit of University of Nigeria Teaching Hospital, Enugu between January 2004 and February 2005. The molar impactions were mesioangular; 35, vertical; 26, horizontal; 23 and distoangular; 16. There were 40 (40%) males and 60 (60%) females all between the ages of 18-40 years. Pain, swelling and trismus were evaluated at 24 hours, 72 hours and 5 days postoperatively. The measurements obtained were recorded and converted to relative values, which provided numerical data for the comparative analysis. Results: The result of the study showed that mesioangular impaction had the highest reduction in all the postoperative variables followed by the horizontal impaction at all the evaluation periods while distoangular impaction had the least.Conclusion: The type of impaction according to Winter is associated with postoperative morbidity after lower third molar surgery. Distoangular impaction tends to have high rate of postoperative morbidity than others. This calls for adoption of extra measures in minimizing these postoperative variables by oral surgeons carrying out third molar surgery especially during distoangular disimpaction.

Aim: To investigate the prevalence and pattern of occurrence of traumatic anterior dental injuries in the 6 to 12 year olds, attending public schools in the urban city of Enugu, South - Eastern Nigeria. Subjects and Methods: A total of 2000 subjects were selected from 8 primary schools in Enugu, through a 2 stage sampling method. Examination was done out of hospital environment. Results: Traumatic injuries to the anterior teeth occurred in 11.6% (Females, 4.9%; males, 6.7%) of the studied population. The injuries were seen most frequently in the 6 years olds (25.9%). Falls (78.4%) and luxation/enamel fracture (31.9%) accounted for the majority of the injuries. Upper jaw (86.6%) and upper central incisors (75.5%) suffered traumatic anterior injuries most often. Conclusion: Within the limitations of the study, traumatic dental injuries were fairly common and it is suggested that preventive programme and early medical attention should be adopted by clinicians so that complications are prevented or reduced.

Aim: A recent Saudi Arabian series on prostate carcinoma directed attention to the urgent need for worldwide comparative studies and accumulation of data on this disease. This necessitated comparing of my West African data with those of that Middle Eastern population. Method: A 30-year retrospective study was carried out as regards surgical specimens of prostate carcinoma received by me on a referral basis. Thereafter, findings were compared as regards Nigeria and Saudi Arabia. Results: Much as Saudi doctors are yet to grasp the urgency of the problems of prostate carcinoma, Igbo doctors appreciate it greatly. Although the ethnic origins of the different Saudi communities could not be characterized, the present paper deals specifically with the Igbos. The Saudis and Igbos were averagely aged as close as 68.8 years and 66 years respectively. In contrast, the respective incidences of haematuria were 2% and 11.8%. Conclusions: Whereas the wind of change is scarcely blowing among Saudi urologists, their Igbo counterparts are showing increasing activities in the 1970s, 1980s, and 1990s. The problem of genetic predisposition may be solved by asking specific questions regarding the hometowns of patients and any involvement of their family members. With regard to worldwide future horizons in prostate research, there is need, among other environmental determinants, to pursue studies on ethnicity.

The earliest feature and hallmark of adolescence is sexual maturation which is seen as the development of secondary sexual characteristics, general increase in body size, change in body configuration and progressive sexual urge. Innate hormonal template in these adolescents and environmental influences predispose them to and encourage sexual activities. This calls for deliberate effort to forestall the numerous deleterious consequences of careless or illicit sexual activities. The ease at obtaining criminal abortion with its numerous complications in developing countries like Nigeria, despite the restrictive abortion law, at best compounds the picture rather than solve the problem. Poor value system, goal-setting, decision-making, parental supervision, and quite importantly, poor knowledge (ignorance in sexual issues) ill-equip them. A typical case of today's adolescent in Nigeria is reported, illustrating the plight of these young adolescents in their state of unpreparedness for this cardinal milestone; little or absent supervision, inadequate informed decision-making capability for both parents/guardians and the adolescents themselves. Deliberate effort to provide preventive services for these adolescents to forestall avoidable self damage, vicious cycle of poverty and provide appropriate intervention measures is recommended.

Background: To highlight the burden of measles infection in Abakaliki and to join in the call for review of vaccination strategies in Nigeria. Methods: Case files of patients admitted with measles into Ebonyi state university teaching hospital, Abakaliki, from January 2001 to December 2005 were reviewed and relevant data collected and analyzed. Results: A total of 2,530 patients were admitted during the period of study, out of which 62 had measles giving a period prevalence of 24 per thousand. Age range was 6 months to 12 years. Prevaccination age group (<9 months) and children above 60 months each constituted 23.0% of the study group. Majority of the patients (61.0%) did not receive measles vaccine while 36.0% had vaccine failure. Bronchopneumonia was the commonest complication encountered (67.0%). Case fatality rate was 12.9%. Conclusion: Morbidity and mortality from measles is still a significant health problem in Abakaliki. Prevaccination age group and children above 5 years are increasingly infected. There is urgent need to increase vaccine coverage and effectiveness if measles control will ever be a reality in Nigeria. A 2-dose measles vaccine policy may help realize this dream.

Background: HIV policy in the Department of Surgery of NAUTH is unit dependent. Because the paediatric surgery unit is a new one, we conducted this study to have a scientific basis on which to formulate a policy guiding management of paediatric surgical patients vis-avis HIV infection. Aim: To help establish a policy on our HIV infected paediatric surgical patients. Patient and Methods: All registered patients within the 4yr period whose parents gave consent were screened. Before 2003 our screening was by ELISA method and confirmation was by Western blot but from early 2003 screening / confirmation was by the rapid kit method. Results: One thousand two hundred and twenty eight (1228) gave consent and were screened out of 1549 registered patients. Seven tested positive. Three of these were from a ‘single’ mother, 2 from another with infertility who tried a few sexual partners before getting pregnant, one from a 14yr old sickler who has had 2 previous blood transfusions and one in a two year old girl with a hernia and severe cachexia. Conclusion: Prevalence of HIV seropositivity is very low among paediatric surgical patients at NAUTH. Routine screening of patients is not necessary and should not form part of the policy. We recommend routine counselling of parents and provision of facilities for precautionary measures as the policy for now. Screening should be highly selective.

Objectives: (1)To determine the level of electrolyte in TB patients (2) To see if these are significantly different from those of control-match for age and sex (3) To calculate the anion gap levels in TB patient and (4) to see if the anion gap levels could be used in the management of patient with tuberculosis. Patients and Methods: Anion gap level was studied in thirty adult patients with tuberculosis. Plasma concentration of sodium, potassium, chloride and bicarbonate were estimated and anion gap calculated in the patients and twenty five apparently healthy adults. Results: Results obtained were compared statistically and it was found that sodium, potassium bicabonate total protein albumin and globulin were significantly different while their anion gap and chloride levels were found not to be statistically significantly different. Conclusion: It does appear that anion gap calculation could not be used as diagnostic or prognostic parameter in patient with tuberculosis.

Background: A complex relationship seems to exist between adenosine deaminase (ADA) and insulin in obesity. Through its effect on adenosine, the enzyme can modulate the action of insulin and affect blood glucose while the administration of insulin is said to decrease the activities of the enzyme. Aim: To investigate the relationship between ADA and fasting blood glucose, (FBG) in obesity and determine whether assay of the enzyme activities could be used to monitor glycaemic control in obesity. Materials and Methods: Thirty-four obese, otherwise apparently healthy subjects (males=19, females=15) aged 17-70 years and 48 apparently healthy, non-obese individuals (male=34, females=14) aged 21-60 years served as control. Their FBG and serum ADA activity were determined using appropriate methods. Results: There were significant differences between the BMI, 20.0 ± 3.1kg/m²; FBG, 5.0 ± 0.77mmol/l; ADA, 7.26 ± 0.95U/I of control and corresponding values; 35.05± 4.24kg/m²; 5.49 ± 1.32 mmol/l and 8.72 ± 1.14 U/l of the test subjects (p=0.0001, 0.001, >0.05 respectively) The FBG and ADA of the control correlated positively with the BMI (range 21-28) showing metabolic derangement in excess weight. The correlation was completely lost in the obese subjects with BMI in excess of 30 .There was no correlation between ADA and FBG. Conclusion: The result shows that serum ADA may influence FBG yet it may not serve as an index of glycaemia in obesity. The rise in ADA activities in obesity may be due to insulin resistance or increased secretion of adenosine.

Objective: To ascertain the existence and prevalence of depressive symptoms amongst Pulmonary Tuberculosis patients. Materials and Methods: A consecutive recruitment of 105 patients affected by tuberculosis seen at the chest clinic of University of Nigeria Teaching Hospital (U.N.T.H) over a six-week period was done. Pre-tested structured questionnaires as well as the Zung Self rating depression scale were used to collected information from these patients. Results: The age of respondents ranged from 15-80 years with a mean of 36.7 ±14.4 years. Forty-four (41.9%) patients studied had depressive symptoms. Being widowed or single, increasing age, unemployment, duration of illness , duration of treatment and being accompanied to hospital increased the prevalence of depressive symptoms amongst TB patients. However unemployment, being accompanied to hospital and duration of treatment significantly increased prevalence of depression in affected patients. Conclusion: Depressive symptoms do occur amongst TB patients. A high index of suspicion should be maintained by medical practitioners who manage TB patients for easy detection and prompt treatment of depressive symptoms.

Aim: To assess of the knowledge, treatment preferences and attitudes of Primary Health Care (PHC) workers' towards the mentally ill. Method: A descriptive study of all PHC workers in Igbo-Etiti LGA of Enugu State, Nigeria. Data was collected using a pre-tested, self-administered questionnaire. A 5-point Likert scale ranging from “totally disagree = 1” to “totally agree = 5” was used to score their attitudes. Data was analysed using Statistical Package for Social Sciences and Programme for Epidemiologist software. Results: Out of the 100 PHC workers studied, 41% on the average had incorrect knowledge of the causes of mental illness while 54% had correct knowledge. Evil spirit possession and native charm/juju were incorrectly mentioned by half of the respondents as causes of mental illness while alcohol/drug abuse, emotional problems and marijuana smoking were correctly implicated by more than 70% of respondents. Although 90% of the primary health care workers preferred hospital doctors/psychiatrists to treat the mentally ill, 49% and 47% would also recommend native/traditional healers and deliverance/prayer houses respectively. Their attitudes towards these patients in the order of decreasing negativity were mostly stereotypic, separatism, stigmatisation, pessimistic prediction, restrictiveness and least likely benevolence. Conclusion: The PHC workers demonstrated a poor knowledge of the aetiology of mental disorders and a high negative attitude towards the mentally ill. It is recommended that these health workers should be retrained urgently in the interest of the mentally ill in their environment.

Aim: The study aims at finding out the pattern of substance use among secondary school adolescents in Enugu. Method: A total of 300 secondary school students (150 males and 150 females) aged between 10 and 18 years (adolescents) were randomly selected using simple random sampling technique from five secondary schools in Enugu metropolis. The schools reflected the type of secondary schools in Enugu metropolis. That is public, mission, private, day and boarding schools. The subjects were selected from junior secondary one to senior secondary three classes after permission was obtained from the school authorities concerned. Data was collected using pre-tested, semi-structured questionnaire containing information on socio-demographic variables as well as data on substance use. Results: Out of 300 adolescents who participated in the study, 272 (141 males and 131 females) completed and returned their questionnaires properly while 28 (9 males and 19 females) did not complete their questionnaires properly and were therefore discarded. This gives a proper response rate of 90.7%. Out of the 272 properly completed questionnaires 77 (28.3%), (12 males and 65 females), were found not to be involved in substance use and were therefore regarded as non “cases”, while 195 (71.1%), (129 males and 66 females), who were involved in substance use were regarded as “cases”. Further analysis on the cases revealed some of the following: (1) A substance use prevalence rate of 71.7%, (2) 81.5% of the adolescents substance users were males as against 18.4% who were females, giving a male -female ratio of approximately 4:1' The average age of the adolescents was 12.3 years. 66.7% came from monogamous homes while 33.3% came from polygamous homes. Beer was the major substance taken by the adolescents (35.9%) with 18.9% taking it at least once a day. Bar/restaurants were the most preferred place for taking these substances, while in the company of other adolescents. The substances were taken mainly to facilitate social activities, relieve worry and anxiety and to facilitate reading. Conclusion: In view of the high involvement of adolescents in substance use and giving the danger arising there-from it is concluded that government should ban under aged youths and adolescents from consuming alcohol and enforce the smoking edict. They should also be banned from purchasing alcohol and other psychotropic substances from the shops or market. Furthermore there should be regular psychological counseling in schools to help adolescents be aware of the dangers arising from substance abuse.

Objective: The relationship between stroke and subsequent handedness of limb weakness has been the subject of several studies. Handedness has been associated with several factors including quality of life and post stroke depression amongst others. The aim of this paper is to examine the pattern of stroke and handedness at a tertiary hospital in Enugu South East Nigeria and if possible examine the relationship between handedness and other factors present in the patients. Methods: A retrospective study of patients admitted with a clinical diagnosis of stroke between January 1980 and December 1999 was done. Relevant data were retrieved from the patients' case records. Results: A total of 450 cases of stroke were identified within the time frame. There were more males than females (ratio 1.27:1). The mean age was 53.46 years. Most of the stroke cases were considered ischaemic in nature. There was an almost equal distribution of patients with left hemiparesis relative to those with right hemiparesis. Eight percent of the patients had tetraparesis. No significant relationship was found between handedness and sex of the patients. These findings agree with the results from other centres. It was not possible to examine the relationship with other factors as these were not documented in the folders. More studies are recommended to elucidate fully the relationship between stroke, handedness and other factors including gender. Conclusion: The relationship between stroke, handedness and other patients' factors as seen in Nigeria will require more studies in other centres to be conducted in order to generate greater clarity of the issues involved.