HYPOTHESIS: It is held that Krukenberg tumours represent bilateral ovarian involvement from particular growths especially stomach cancers. Hitherto, the route of spread had been controversial. However, on the basis of both animal experimental research and human autopsy work as well as the new frontier in lymph vessel staining techniques, it is hypothesized that the formation of new lymph channels, called lymphangiogenesis, sufficiently explains the peculiar relationship between stomach primaries and ovarian (Krukenberg) secondaries. Furthermore, this conclusion can be tested (a) by strictly avoiding the old fashioned separation of these two organs on the autopsy table and (b) by carefully choosing composite stomach-ovary blocks, staining them appositely, and confirming whether lymph vessels constitute the transportation routes.

Background: Identifying the aetiology of suboptimal care is an integral part of performance improvement, and essentially as suboptimal care has been noted to be a cause of preventable mortality and morbidity. Methods: Using a questionnaire, data was obtained from 101 consecutive multiply injured patients seen at the National Orthopedic Hospital Lagos (NOHL). Parameters of structure and process of care as well as injury severity were obtained. Outcome was measured by trauma injury severity score (TRISS) methodology, and casualty ward length of stay (LOS). Analysis was done with SPSS for windows 11. Results: Trauma resuscitation times averaged 112.73min. Trauma resuscitation time was prolonged in 51.5% of cases and mortality was more likely the longer the TRT (p = 0.044). Care was adjudged inadequate in 39.60% of cases. Bivariate analyses showed that delay in haematological intervention (blood transfusion) and error in treatment, were most strongly associated statistically (p-value 0.051 and 0.006 respectively) and clinically (odds ratio 3 and 5 respectively) with mortality. Unexpected death was 60%. The mean length of stay (LOS) in casualty was 106.85hr. Conclusion: There were deficiencies in the structure and process of trauma care that resulted in less than optimal care of the injured. Mortality and unexpected deaths by the TRISS methodology were used as outcome measures and NOHL faired rather poorly. The standardized mortality ratio >1 confirmed NOHL to be a low-quality performance hospital.

Aim: There is dearth of statistical data and reliable information in our health sector. This study assessed the effectiveness of training in enhancing the knowledge and attitude of primary health care (PHC) workers toward the Health Information Management System (HMIS) in Enugu State, Nigeria. Methods: An experimental study design with an educational intervention involving a control group was conducted in 2004. A two-stage cluster sampling method with block allocation into groups was used in the selection of 57 “study” and 50 “control” respondents. A pre-tested, self administered questionnaire was used for data collection. Data was analysed with Epi-info 3.3.2 software. Results: Both group had similar socio-demographic characteristics and were generally aware of the existence of the HMIS programme at baseline. Pre-intervention, the proportion of the study and control groups identifying the core items of the National Minimum Data Set (NMDS) required to be collected at the PHC level was 80-82% for 1 and 2 items, 50-69% for 4 items each, 25-44% for 3 and 5 items and 7-22% for 5 and 2 items respectively. Post-intervention, the proportion increased significantly in the study group to 80-98% for 8 items, 73% for 1 item, 28-36% for 2 items but remained the same for “in-patient cases” and “in-patient death” unlike the control group which maintained the baseline knowledge. In both groups, the most identified item pre- and post-intervention was “National Programme on Immunization” while the least identified item was “laboratory services”. Attitudes towards data collection for HMIS were largely negative in both groups pre-intervention. But post-intervention, the proportion of the study group who believed that data collection is useful improved from 88% to 100% while the proportion who was not interested in filling the HMIS forms dwindled from 40% to 7% but the control group maintained their baseline negative attitudes. Conclusion: The educational intervention improved the PHC workers' knowledge and attitude towards the HMIS in the study area and is recommended for replication in other parts of Nigeria and Africa where information gathering in the health sector is a problem.

Aim: A cross-sectional study was carried out to compare the knowledge, attitudes and practices of emergency contraception (EC) by women of reproductive age in an urban and a rural community in Enugu State in May, 2005. Materials and method: A structured questionnaire was used to collect data from 383 women who were selected by a multistage sampling technique. Results: Awareness of emergency contraception (EC) was generally high in both communities but significantly higher in the urban community, P=0.0001. However, knowledge of definition, names and timing of its administration was poor in both communities but worse in the rural community (P < 0.05). There was positive attitude towards EC with regards to its increased advertisement in both communities. More people favored the wide availability of EC in the urban women, P=0.002. Nevertheless, the practice of EC in both communities is still low being 36.3% among the urban women and 3.9% in the rural group. Conclusion/recommendation: The knowledge and practice of the women is poor and so there should be increased effort at creating awareness on the use of EC.

Aim: The aim of this study was to assess health data recording, reporting and utilization practices at the primary health care centers in Enugu State, Nigeria. Methods: This is a descriptive, cross-sectional study. A multistage sampling method was used. Survey instruments were observational checklist and structured questionnaire. The study took place at the selected primary health centers located m six Local Government Areas in Enugu State Nigeria. A total of 107 PHC workers and 18 primary health centers were studied. Results: Reportedly, 80(74.8%) of PHC workers used notepads, 52.3% used notebooks whHe only 47.7% used health management information system (HMIS) forms to record data. Eighty-nine (83.2%) sent out recorded data regularly (monthly) to Local Government Authority (LGA). Direct observation of heath centre activities showed that the health information was neither completely nor accurately recorded. Only one (5.6%) of the health centers remitted data timely to the LGA authority, that is on or before two weeks following the month of reporting. Of the eleven (61.1%) of the health facilities that analyze their data, all(100%) used it to access the quantity of vaccine to procure, 45.5% for health education, 27% to monitor clinic attendance and 18.2% to know disease pattern in the service area. Conclusions: Several deficiencies exist in data recording, reporting and utilization practices at the primary health care level in Enugu State, Nigeria. Training programme is advocated to improve the health workers data management skills at the peripheral level.

Aim: To investigate the nature and degree of delay existing in care seeking for treatment amongst patients with pulmonary tuberculosis PTB. Materials and methods: Information was obtained from one hundred and twenty consecutively recruited patients attending for treatment at the chest unit of University of Nigeria Teaching Hospital Enugu, Nigeria using a semi structured questionnaire. Results: Mean age of respondents was 33.2 years±13.6. Treatment sources first visited by the respondents were mostly the patent medicine vendors (PMVs) (40.0%). Perceived non seriousness of illness was the commonest reason for choice of place of initial visit. Mean total delay was 11.3 weeks, mean patient delay was 6.4 weeks and mean health service delay was 4.9weeks. Only 28 (23.3%) of the respondents presented to a recognized (modern) health care facility within three weeks of onset of symptoms. A higher percentage of those who first went to a patent medicine vendor or traditional/spiritual house had delay than those who first went to a private clinic or government facility p< 0.05. Correct knowledge of cause of tuberculosis resulted in early presentation to a health facility. Conclusion: There is still considerable delay in assessing care by TB patients in Nigeria. Early health care seeking, effective and early referral may be improved by integrating private practitioners and PMVs in control programmes and improved community health education on cause of TB.

Background and Objective: The risk of occupational exposure to HIV virus in sub-Saharan Africa is increased by non-adherence to the principles of infection prevention practices. This study assessed the level of awareness and compliance with guideline on occupational exposure to HIV by health care workers (HCW). Materials and Methods: A questionnaire survey of 392 HCW in two tertiary health institutions in southeast Nigeria over a 3-month period. Results: Despite exposure of majority (61.2%) of respondents to patients' body fluid, there was poor compliance with the guidelines on occupational exposure in the hospitals. While 281 (71.7%) respondents were aware of CDC guideline on occupational exposure, only one tenth (n=29) of them knew that such guideline was operational in the hospital. The only content of the guideline known to all the respondents was treatment of the exposed or inoculation site. Most of the exposed respondents refused HIV testing because of fear of testing HIV positive. There was no proper information dissemination to the workers on hospital safety precautions, incident reporting and treatment procedure following occupational exposure. The average time for initiation of chemoprophylaxis following exposure to HIV virus was 55 hours because of logistics. Conclusion: The HCW showed poor knowledge of CDC Guideline on occupational exposure. There is need for hospital authorities to ensure staff education on safety measures, efficient incident reporting system, expeditious source testing, timely evaluation and management of exposed health care worker.

Aim: To compare one-day 2 sputum samples AFB microscopy with standard two-day 3 sputum samples AFB microscopy in a Nigerian rural tuberculosis center. Method: A total of 752 suspected tuberculosis patients were studied between May and July, 2006. Two sputum samples collected “on the spot” and one hour later served as study test procedure while three sputum samples collected in the usual standard sputum microscopy procedure served as control. Results: There was no significant difference in the diagnostic values between the study tests and the control (standard) tests (P=0.57). The study test was also observed to be highly sensitive and specific. Conclusion and Recommendation: One-day 2 sputum sample microscopy for AFB conducted one hour apart should be encouraged to avoid the inconvenience of asking patient to come back the next day. Early morning sputum sample the next day should be reserved for only those who had only one positive sputum result.

Background: Breast cancer is the commonest malignancy affecting women in Nigeria. Regular breast self examination reduces morbidity and mortality from this disease. Objective: To assess the knowledge of breast cancer, breast self-examination and practice amongst secondary school teachers in Enugu, Nigeria. Methods: A cross sectional survey of four hundred and twenty eight teachers drawn from sixteen randomly selected secondary schools in Enugu was done using self-administered questionnaire. Information obtained were socio demographic characteristics of the teachers, knowledge of symptoms and signs of breast cancer, screening methods as well as their knowledge and practice of BSE. Results: Majority (88.8%) of the teachers had heard of breast cancer. Electronic and print media were the major sources of information. Knowledge of symptoms of breast cancer revealed pain in the breast as the commonest (35.4%) followed by a painless lump (24.1%). Only 18.3% knew that there was a genetic predisposition to breast cancer. Three hundred and ninety eight (93.0%) knew breast cancer could be detected early, while 389 teachers identified BSE as a screening test. Only 26.9% of the teachers possessed adequate knowledge of the correct technique for BSE and 41 (9.6%) correctly identified the right time to perform a BSE. Regular practice of BSE was low (47.9%). There was no relationship between age, marital status, educational attainment and regular practice of BSE. Conclusion: There is a critical need to provide adequate information to women on early symptoms and signs of breast cancer as well as improve their knowledge and practice of BSE. Doctors and other health workers should make use of every contact with their female clients to provide these information using appropriate health education tools.

Aim: To determine the prevalence of hypertension and the associated socio-demographic and lifestyle risk factors for hypertension among traders in Enugu, Nigeria. Materials and Methods: The study design was cross sectional and systematic sampling method was used to select the 451 traders studied. Data was collected in February 2006 with a pretested questionnaire and also by direct measurement of respondents' blood pressure, height and weight. Results: The prevalence of hypertension among these traders was 39.5% and it did not vary by gender; 37.9% for females and 40.5% for males. The hypertension rate among respondents increased with increasing age from 13.4% in ≤ 29year olds to 87.5% in ≥ 50 year olds and with decreasing educational attainment from 13.0% in the none-educated to 76.9% in the tertiary educated. Hypertension prevalence was highest in respondents who were separated, divorced or widowed (76.9%) and lowest in the unmarried (19.3%) while a positive family history of hypertension was associated with greater hypertension rate. Hypertension rate was more in tobacco users but did not vary with use of alcohol. Hypertension prevalence decreased with increasing physical activity of traders ranging from 49.8% in sedentary traders to 22.4% in those engaged in adequate physical activity. The hypertension rate was positively correlated with the BMI of respondents ranging from 29.0% for BMI ≤ 24 kgm² to 73.5% for BMI ≥ 30 kgm². Hypertension was positively associated with the number of lifestyle risk factors found in respondents varying from 22.2% in those without risks to 52.4% in traders with all the 4 risks present. Conclusion: The rate of hypertension was high among the study group while the associated risk factors were many. Efforts should be made to reduce the modifiable risk factors present among these traders through health education and other specific health programmes.

Tuberculosis (TB) is an infectious disease with increasing morbidity and mortality particularly because of HIV infection. Drug therapy which is central in the management of TB may be associated with adverse effects. These may be classified as minor or major. The adverse effects may not affect drug therapy and reassurance or symptomatic treatment may suffice. In some cases anti-TB drugs may be changed, temporarily stopped or discontinued if it is major and life threatening. This paper examines some of challenges associated with the management of side effects of anti-TB drugs.

Background: Rabies is a highly contagious viral infection of the nervous system with a still as yet high mortality rate even in advanced settings. Management maybe enhanced with early presentation. The incubation period usually ranges from 7 days to I year with a mean of 1 - 2 months. Method: The case report of a 34 year old Nigerian male presenting with clinical rabies is discussed. The onset of the illness comes 112 days after a dog bite. This incubation period is unusual in this environment. Result: A 34 year old male metal worker of the Igbo tribe and resident in Abakaliki, South East Nigeria was admitted into the medical ward of the University of Nigeria Teaching Hospital Enugu on the 7^th of May 2008 with an 8 day history of headache and a 4 day history of involuntary spasms of facial and pharyngeal muscles associated with pain on drinking water. He also complained of fever. He recalled being bitten about mid- January 2008 by the uncle's dog which had earlier bitten another boy. He sought immediate medical assistance in his locality but did not get any help. Hydrophobia was demonstrable and he exhibited episodes of delirium interspersed with lucid intervals and intermittent generalised muscle rigidity. No focal signs were evident. He died as medical therapy was being instituted. Conclusion: There is a need for the strengthening of public health measures directed at enhancing primary and secondary prevention of rabies in man and animals. This coupled with the prompt presentation of suspected cases and institution of appropriated care may go a long way in reducing the morbidity and mortality rates of rabies in Nigeria.

Objective: To study the rare tuberculous epididymo-orchitis causing infertility. Design: Surgical specimens received at a Reference Laboratory serving the Igbo ethnic group in Nigeria were analyzed as regards tuberculosis during a period of 30 years. Results: One hundred cases involving peripheral lymph nodes, 30 cases of peritoneal disease and 24 cases affecting the genitalia were accessed during the 1970s. Thereafter, only one case was found to be due to sterility. Conclusion: In all probability, if the sexual history can be included routinely as part of the complete medical evaluation, this symptom may be found to be commoner in Nigeria and other areas of the world where TB is a health problem.

Background: Hypercholesterolaemia is a risk factor for cardiovascular diseases. Serum cholesterol is usually determined to know if a subject is at a risk of heart diseases. This lipid is found in most fluids in the body including the odontogenic cyst-fluid. We investigated the concentration of cholesterol in the odontogenic cyst-fluids and sera of the same patients. Aim: The aim of this study was to determine if the cyst-fluid concentration values could be used as alternative measure of the serum cholesterol profile of patients. Patients and method: This was a prospective-study that was carried out in two specialist Health Institutions in Enugu, Nigeria, between January, 2005 and December, 2006. The diagnoses of the cyst-types were made using the clinical, radiographic and histopathologic findings. The cyst-fluids and sera cholesterol values were analized in the Chemical Pathology Laboratory. Result: Eighteen patients with eighteen unilateral cystic lesions met the eligibility criteria for this study. Six radicular cysts, eleven dentigerous cysts and one calcifying odontogenic cyst were analized. In ten of the patients (55.5%) there were no significant statistical differences between the respective cyst-fluid cholesterol concentrations and those of the autologous sera of the patients (p>0.05). Conclusion: Cyst-fluid cholesterol concentration can provide quantitative measure of the patient's serum cholesterol profile.

Background: The muscle diseases are frequently encountered in medical clinics in Nigeria. In many cases however they are not optimally managed. The ion channel diseases, ‘channelopathies’, are a group of muscle disorders that share a lot of clinical similarity. Misdiagnosis can occur especially in resource poor settings with paucity of neurologists and diagnostic tools. Method: A case report of two young Nigerian siblings aged 13 and 15 years who have the clinical features of autosomal recessive myotonia congenita (Becker disease), one of the muscle channelopathies, is presented. The relevant literature is reviewed. Results: A 15 year old Nigerian male presented with a 7 year history of progressive weakness of the legs and a 4 year history of difficulty in lifting heavy loads with the arms. There are no bulbar or cardiac symptoms. He had generalized muscle hypertrophy with percussion and exercise induced myotonia. Available investigations showed no cardiac involvement. The 13 year old younger brother similarly presented with a 4 year history of difficulty in initiating movements with the legs which was within a few weeks by weakness of the upper limbs. He also had no cardiac or bulbar symptoms. The physical findings were similar. The parents could not afford to continue with most investigations but the creatine kinase was elevated in the elder sib. Other members of the family were apparently normal. They were lost to follow up. Conclusion: The pervading poor socioeconomic status of many Nigerians, the dearth of neurologists, the lack of sophisticated diagnostic tools and suboptimal laboratory backup all contribute to the difficulty encountered in managing muscle disease in the country. There is a need for concerted efforts to improve access to affordable and effective medical care to make for proper diagnosis and treatment of cases of muscle diseases.

Acute urinary retention (AUR) is a urological emergency characterized by a sudden and painful inability to pass urine. Early care usually consists of urethral catheterization, or suprapubic catheterization when the urethral approach fails or earlier attempts have resulted in significant urethral trauma. Following these initial steps significant difference had existed in the secondary management of AUR, between the different units regarding issues such as indications for and duration of admission, antibiotic use, alpha adrenergic blocker use and trial without catheter (TWOC). These differences led to a consensus meeting that produced a management protocol for AUR at the University of Nigeria Teaching Hospital, Enugu, that suits our peculiar conditions. This paper reviews the AUR in general and highlights our management protocol.