Diabetic Nephropathy is a frequent cause of end-stage renal disease (ESRD) all over the world. The aim of this study is to determine the prevalence of diabetic nephropathy in the treated population of patients with end-stage renal disease. Two hundred and five patients (124 male, 81 female) with ESRD seen at the Renal Unit of University of Nigeria Teaching Hospital, Enugu over a five-year period (Jan 1993 -Dec 1997) were reviewed. Thirty-four patients (24 males, 10 females) had diabetic nephropathy i.e prevalence of 16.59%. Diabetic nephropathy was the third most common cause of ESRD, while ESRD of unknown etiology and glomerulonephritis were first and second with prevalence rates of 28.78% and 21.46% respectively. The male to female ratio was 2.4:1 and the age range of patients was 30 - 84 years with a mean of 56.24+11.65. The mean duration of diabetes mellitus was 12.88+5.37 (range 4 - 30 years). Twenty seven patients (79.41%) had non insulin dependent diabetes while 7 (20.59%) were insulin dependent diabetics. The prevalence of hypertension in these patients with diabetic nephropathy was 82.35%. The mean number of haemodialysis sessions was 4.9 sessions. It is concluded therefore that diabetic nephropathy is a common cause of end stage renal disease in Nigeria.

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A retrospective study of the sociodemographic characteristics of the contraceptive acceptors at the University of Nigeria Teaching Hospital from January to December 1992 is presented. All the 1115 acceptors were married women aged 18 - 55 years. The highest acceptors were those aged 26 - 40 years 894 (80%), while teenagers below the age of 20 years formed only 1 (2%) of all the clients. A greater proportion of the women 805 (72%) had formal education and 871 (78%), had 4 -10 living children. Child spacing was given as the most important reason for attending the family planning clinic by 721 (65%) women. The IUD was the most popular method of contraception adopted by 861 (77%) women, followed by injectables 177 (16%) and then oral contraceptives 36 (3%). It is recommended that the promotion of the child spacing benefits of contraception, the availability of the barrier and natural family planning methods be used to improve the patronage of family planning services especially among the men, young females, and illiterate women.

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We reviewed pre-operatively 200 adult patients (age 27 -76 years) presented for various surgical procedures at the University of Nigeria Teaching Hospital Enugu, to determine the incidence and nature of co-existing medical conditions that may influence the course of anaesthesia which were hitherto undetected by the primary physicians. Nineteen percent of the patients had features of intercurrent disease. Previously undetected hypertension was most prevalent with an incidence of 8%. Others were, difficult airway 2%, chronic obstructive airway disease 2%, anaemia 2%, morbid obesity 1% and alcoholism 1%. We recommend that in view of the above findings anaesthesiologists should view the pre-operative visit as a sine-qua-non for safe anaesthesia.

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Two hundred mothers were interviewed at two health facilities in Enugu, the capital of Enugu State in Nigeria, between May and July 1995, to determine their knowledge, attitude and practice in relation to exclusive breastfeeding. All the mothers had breastfed their babies but only 3% would breastfeed exclusively. This practice was attributed to the erroneous belief that breastmilk alone was not sufficent and that early supplementation with water and artificial milk was necessary. There was a delay in initiating breastfeeding especially by less literate women and giving colostrum to babies was viewed with scepticism. Literate mothers with seondary and post-secondary education were more likely to breastfed for shorter duration than those with primary and no formal education. (p ≤ 0.05). The needs for appropriate health education of mothers and retraining of health care providers on lactation management are discussed.

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This is a rare case of false aneurysm of the internal maxillary artery which followed fracture of the mandible. Some time in March, 1995 a youngman was involved in a motor cycle accident. He sustained injuries including fracture of the mandible (most certainty subcondylar). He was admitted in a hospital where the fracture was reduced and wired. After a few days in the hospital he was discharged. About 3 months after discharge he started to experience left sided, occasionally heavy epistaxis. He was treated in various hospitals, but when the bleeding continued to get worse he was referred to U.N.T.H. On admission x-ray of the sinuses was done and complete opacity of the left antrum was revealed. A decision to explore the antrum was made. At surgery the left maxillary sinus was filled with large, cystic, haemangiomatous, friable mass which destroyed totally the lateral wall of the antrum. Apparently in the process of mandibular fracture, the internal maxillary artery which lies close to the fracture site also got damaged. False aneurysm of the artery developed. The aneurysmal sac gradually increased in size and herniated through the damaged antral wall into the antrum. The sac continued to increase in size until the antrum was completely filled. It bled intermittently. The condition was successfully treated through Caldwell-luc operation.

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The efficacy of pressure therapy in the prevention of deep vein thrombosis (DVT) in stroke patients was evaluated in a prospective randomised clinical trial involving thirty five patients who either received pressure stockings or not. The interface pressure applied by the stocking was measured using a purpose designed electro-pneumatic pressure sensor while diagnosis of DVT was made using radio-active iodine labelled fibrinogen test. Twenty five percent (5/20) of control group as against 15.4% (2/13) of treatment group developed DVT which was not statistically significant. The reduction in the incidence of DVT in the treatment group is a reflection of tue protective effect of correctly fitted stocking applying effective interface pressure. This necessitates clinical interface pressure measurement in order to optimize prophylatic efficacy of these simple physical devices in stroke patients.

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The role of low density lipoproteins (LDL) in the pathogensis of atherosclerosis has been gaining increasing importance. It is well accepted that LDL in their modified (i.e. oxidised) forms are no longer recognised by LDL-receptors, but are taken up by arterial wall cells, especially by macrophages, in a non-regulated manner through the so-called scavenger-receptor pathway. This process leads to the formation of foam cells, the hallmark of the atherosclerotic lesion. The oxidation can be induced in-vitro by incubating LDL with cultured cells of the arterial wall like endotherial cells, smooth muscle cells or monocytes/macrophages. A standardised oxidation can be achieved by incubating LDL with divalent metal ions like copper or iron. LDL modified by this method was found to have comparable physicochemical properties; and the copper-induced invitro oxidation of LDL has become a well established frequently used method. The kinetics of copper-induced LDL-oxidation can be monitored continuously by measuring the increase of the 234nm absorption of the developing conjugated dienes. The degree of oxidation can also be quantified by measuring the thiobarbituric acid reactive substances(TBARS) or by electrophoresis. LDL modified by this method was shown to be good tool for further in-vitro and also in-vivo investigations.

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Although an association between goitre and pregnancy has been reported in some studies, this observation could not be confirmed by others. It is thought that differences in the level of iodine intake of different populations is responsible for the conflicts in reported findings. The current study was aimed at determining the extent of the problem of goitre in pregnancy in Enugu metropolis as an indirect assessment of the status of iodine intake among the population. In this controlled study, 213 consecutively selected, apparently healthy pregnant women attending a busy non-referral maternity hospital in Enugu and 276 apparently healthy, non-pregnant female subjects of similar age, parity and social class were studied. The prevalence rate of clinical goitre was significantly higher among the pregnant subjects compared with the controls (52.6% vs 10.9%) respectively; x² = 101.42; P< 0.0001). Although a majority of the women in both groups had palpable goiters (grade 1A and grade IB), 18.2% and 2.5% respectively of the pregnant subjects and the controls had goiters that were clearly visible (grade 2 and grade 3). The difference in the visible goitre rates between the two comparison groups was statistically very highly significant (P< 0.001). The goitre frequency increased progressively from the 37.3% in the first quarter of pregnancy through to 69.8% in the last quarter. Independently, high parity and advanced gestational age were associated with high goitre frequency among the pregnant women (P< 0.01 for each). It is concluded that pregnancy has a goitrogenic effect in Enugu. Although this may be indicative of sub-optimal iodine intake among the residents of the town, this needs further confirmation.

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In a cross-sectional study of the blood pressure distribution of 542 healthy non-pregnant Nigerian women, the mean +2SD of the measured casual blood pressure was 133/90mmHg. The prevalence of hypertension amongst these women was 8.5%. The epidemiological determinants of blood pressure were found to be similar to those of other populations. Comparatively, 478 healthy unmatched pregnant women were longitudinally studied from booking before 13 weeks gestation to 6 weeks postpartum. The incidence of hypertension from booking till one hour postpartum period was 21.6%. At 6 weeks postpartum, the prevalence of hypertension was 7.3%, this most probably representing undiagnosed essential hypertension. It was concluded that the baseline blood pressures of Nigerian women of reproductive age appear to have risen resulting in an increased incidence of essential hypertension amongst the women.

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An epidemiological survey of onchocerciasis and its transmission was undertaken at Achi in the forest-savannah mosaic area of South-Eastern Nigeria. Out of a total registered population of 14608, of whom 2282 were examined, 20.3% (462) had onchodermatitis and 22.4% (510) had nodules in non-lymph node areas. The prevalence of onchodermatitis and nodules showed an overall rise with age, peak between ages 30 and 39 years. The prevalence of skin microfilarial load was 45% and the community microfilarial load was 3.1mf/mg skin. These parameters also rose with age. Visual acuity was impaired in 35.4% of subjects while 3.9% were blind. In 16.5%, visual impairment was attributable to cataract. Transmission studies showed that simuiium damnosum was the dominant vector species. Biting by the vector was mostly between February and April during the afternoon. This study and many others reveal the serious health problem posed by river blindness in West African countries not covered by the Onchocerciasis Vector Control Programme. The socio-economic burden is considerable and justifies integrated control strategies including mass ivermectin distribution.

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Thirty male patients who presented with bladder outflow obstruction of various causes at the University of Nigeria Teaching Hospital Enugu, during a period of eight years (Jannuary 1990 to December 1997), were included in this prospective study. The objectives of the study were to establish the degree of renal impairment association with chronic bladder outflow obstruction, to monitor the rate of recovery after relieving such obstruction, and to assess their responses to definitice treatment of the obstruction. It was found out that all the patients had full recovery of the biochemical renal functions with urinary diversion and eventually had successful definitive suurgery. It is recommended that such patients should have initial urinary diversion followed by full recovery of biochemical renal functions before a definite surgery is planned for the obstruction.

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