Aim: To review the disease pattern and outcome for neurological patients admitted to the intensive care unit (1CU) of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria was undertaken. Patients and Methods: The hospital records (case notes ICU records) were reviewed retrospectively for five years and the necessary data were extracted. Neurosurgical patients excluded. Results: There was a total of six hundred and sixty-seven admission to the ICU and twenty-three of these were neurological patients. Cerebrovascular accident (CVA) or stroke was the commonest indication for admission to the IUC at 48% followed by Guillain-Barre syndrome (17%), myasthenia gravis (17%), or neurone disease (13%) and cerebral malaria (4%). Six patients (26%) received mechanical ventilation, while another six (26%) received oxygen via an intranasal catheter or variable performance facemask. Ten patient received pressor agents for organ support. The mortality rate was 43.5% with ten deaths. The deaths were as follows, cerebrovascular accidents (5), Guillain-Barre syndrome (2), myasthenia gravis (2) and motor neurone disease (1). Conclusion: This study showed that while the disease spectrum and pattern of admission was similar to that in the developed nations, the outcome was worse. Provision of modern facilities, including a neuro-intensive care unit may improve outcome in these patients.

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Aim: To determine the sero-prevalence of hepatitis B surface antigen (HBsAg), in sexually transmitted diseases(STD) patients and to determine the sex-related risk factors associated with HBsAg Patients and Methods: A descriptive study was performed at the University of Benin Teaching Hospital, on 155 (79 males and 76 females) between the ages of 24 and 63 years (mean age 35±2.4 years ).Patients were consecutively selected from all adults attending the STD clinic. A questionnaire was administered to each patient, in order to ascertain the possible risk factors, for the transmission of HBsAg, with STDs as the main risk factor. The sex-related factors included a history of multiple partners in the past 6 months, a history of a number of episodes of STDs, history of heterosexual exposure to partners at risk, for example prostitutes; a history of symptoms of an STD at the commencement of the study. Sera were screened for HBsAg, using a rapid chromatographic iminuno-assay. Results: The number of HBsAg positives was 14.1%(males 5.1% and females 9%).The sex-related risk factors identified were a history of exposure to partners at risk; a history of HIV antibody; a history of clinical symptoms of an STD at the commencement of the study. Conclusion: The HBsAg sero-prevalence rate of 14.1% is high. The study showed that exposure to sex-related risk factors are liable for the high prevalence of HBsAg observed. In order to curb the further spread of the hepatitis B virus, we recommend prompt treatment of STDs; avoidance of people at risk of STDs; cost effective HBsAg screening and public health education based on the epidemiology of sex-related HBsAg acquisition .

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Background: Pleurodesis is an effective treatment for malignant pleural effusion but the ideal agent that will combine efficacy with safety and ease of administration remains under debate. Injectable tetracycline used to be the preferred agent for sclerosis for many clinicians but it has been withdrawn from the market. There is thus an ongoing search for suitable and better alternatives. In a third world environment, cost is a major determinant of use of some agents. Some patients have already been heavily pretrcated with systemic cytotoxic drugs while some are too weak for agents with cytotoxic activity. All these limit the choice of agents available to us. Patients and Methods: Capsules of tetracycline were dissolved in sterile water and this was injected through a thoracostomy tube in patients with malignant pleural effusion from breast cancer. The efficacy was measured by its ability to the control effusion for at least 30 days as evidenced by non recurrence of clinical xsfeatures of effusion necessitating re-treatment and/or chest radiology showing more than 50% fluid re-accumulation. Results: Twelve pleural effusions were treated with capsule tetracycline pleurodesis. Eleven effusions satisfied evaluation criteria. Eight of eleven evaluable pleural effusions (72.7%) were controlled for at least 30 days or until patient's death or loss to follow up. The reactions following the use of the agent were minimal comprising only of mild to moderate chest pain, an episode of fever, body aches and vomiting. All the symptoms were controlled by simple measure like analgesics. Conclusion: Capsule tetracycline has shown good promise as a sclerosing agent for pleurodesis. A prospective randomized trial comparing it with other known agents is warranted.

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Aim: To determine any relationship between Malaria infections and Widal agglutinin level. Patients and Methods: Three hundred and thirty adult patients attending various clinics at University Of Nigeria Teaching Hospital between September 2000 and May 2001 first confirmed of malaria parasitaemia also had Widal agglutinin levels checked. Similar thing was done for 200 healthy individuals who have not suffered malaria or any pyrexial illness in the past two months used as control. The level of malaria parasitaemia was determined by microscopy of Giemsa stained thick and thin blood films, while Widal agglutinin titres were determined by using both slide and tube dilution methods. Results: In the study population, 134 (41%) with malaria parasitaemia had Widal agglutinin above 1:80 and females (57%) were more affected. The study showed that 313 (95%) of the patients had parasitic load of 1+ and 2+ occurring frequently while 13 (4%) had parasitaemia of 3+. In the control group 96 (48%) had Widal agglutinin of 1:80 and none exceeded this level, while only 10 had parasitaemia of 1+. Conclusions: There exist an influence of malaria on Widal agglutinin level χ² = 110.6, P<0.0001), but the levels were not necessarily dependent on parasitic load of plasmodia in the blood. Malaria must first be properly treated even in cases of high agglutinin levels, while in suspected enteric fever, bacteriologic proof must be sought through blood, urine or stool cultures.

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Background: Abdominal emergency surgery consists a significant number of paediatric emergencies done in our environment. Paucity of paediatric surgeons has led to majority of these cases being done by general surgeons. Aim: To compare results obtained by the general surgeons with that of the paediatric surgeons at Nnewi. Patients and Methods: A retrospective study comparing results within two periods each of 4 years duration. The first period spanning from 1^st May 1995 to 30^th April 1999 in which the paediatric abdominal emergencies were managed by general surgeons, the second period being from 1st May 1999 to 30^th April 2003 in which the emergencies were managed by a paediatric surgical team all at Nnamdi Azikiwe University Teaching Hospital Nnewi. Results: Sixty cases were done in the first period. There were 6 post operative complications and 3 deaths. Seventy four cases were done in the second period with one post operative complication and no death. Conclusion: General surgeons still have a role to play in the management of paediatric abdominal surgical emergencies in our environment. However to improve morbidity/mortality, regular update paediatric surgical courses/workshop should be organized for general surgeons undertaking paediatric surgical emergencies. More paediatric surgeons should be trained and more paediatric surgical units should established in the country.

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Background: Anastomotic false aneurysm is rare in Nigeria although it is the commonest cause of false aneurysm presently in developed countries. Method: A case is presented and the aetiopathogenesis is reviewed. The treatment modalities are highlighted. Conclusion: With increasing vascular reconstructive procedures, this type of false aneurysm will become common in our environment. It is therefore pertinent that this lesion is readily recognized so that appropriate treatment is given.

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Aim: To study the lead content of well water in Enugu, Southeast Nigeria. Method: Wells (101) were located using the multistage sampling procedure and samples were collected into clean plastic containers. Analysis was done using atomic absorption spectrophotometer. Result: The means lead content of well water samples was 4.44± 0.61μmol/L representing a 1758.5 percentage increase over the World Health Organization tolerable limit for lead in drinking water (0.24μmol/L). There was no significant difference between the means of samples from different locations (p>0.005). Conclusion: Lead contamination of well water was widespread in the city. This underscores the necessity for government of Enugu state to provide portable water for the populace. Studies to monitor toxicity among consumers are suggested.

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Aim: To evaluate the effectiveness of the German model of community psychiatry at the Medical University of Hanover. Patients and Methods: Three hundred and thirteen (313) patients treated over a period of ten years (1987-1996) at the Social Psychiatry Department of the University of Hanover were anonymously grouped on basis of their score on a Psychosocial Risk Score (PSR). Those admitted to the study were between 18 and 60 and excluded addictions and psycho-organic disorders. Results: There was a highly significant correlation between psychosocial risks (indicators of the chronicity and severity of psychiatric disorder, the psychiatric first diagnosis, the age of onset of disease and duration since onset of disease) at the first therapeutic contact and future Long Stay Hospitalization (LSH). The highest coefficient was found for the criterion of the situation of employment, followed by primary income living situation, duration since onset of disease, type of initial diagnosis and age at onset of disease. Conclusion: The simple sum core (PRS) allows calculating the risk of LSH on the basis of a small number of characteristics drawn from usually registered psychiatric base data and can help psychiatric services to concentrate on high risk patients.

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Aim: To assess the therapeutic benefits of Maximum Androgen Blockade and the Tolerability of Bicalutamide, an oral non-steroidal anti-androgen in patients with advanced prostate cancer. Patients and Methods: A total of forty-nine(49) male patients aged between 42 and 84 years with tumour grades T₂, T₃ and T₄ were enrolled in a multi-centre clinical trial to receive bicatutamide 50mg daily following surgical castration. Patients were assessed for disease status, adverse events and quality of life. Results: Thirty-three (33) patients completed the study and had therapy for 48 weeks, 90.9% of whom had complete response while the quality of life due to urinary symptoms was also markedly improved. The profile of adverse events was mild. Conclusion: Bicalutamide given as a daily dose of 50mg in combination with surgical castration is a well tolerated therapy and has therapeutic benefits in African patients with advanced prostate cancer.

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Aim: To determine the frequency of mental (psychiatricO disorders among antenatal women seen at Nnamdi Azikiwe University Teaching Hospital Nnewi, (NAUTH) Method: An alternate women seen at NAUTH antenatal clinic between January 1998 to December 1999 formed the base population study. The symptom check list of the 10^th Revision of the International Classification of Mental Disorders (ICD-10 SCL), the self-reporting questionnaire (SRQ) and the Health Questionnaire (HQ) were used to assess the subjects. Subjects who screened positive as possible cases of mental disorders were further evaluated with the Composite International Diagnostic Interview Schedule CIDl). Results: A total of 1160 subjects were screened. The mental morbidity rate was 5.5%. Depression constituted the commonest identified mental disorder (3.6%), followed by neurotic stress-related and somatoform disorders (1.8%) and psychotic disorders, not otherwise specified (0.1%) Conclusion: The mental morbidity rate among the studied subjects was low. Depression was the commonest of the mental disorders.

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Objective: To determine and compare the in vivo efficacy of the trial drugs chloroquine and sulphadoxine-pyrimethamine in the treatment of uncomplicated malaria in under 5 children. Study Design and Methods: This was a comparative clinical trial conducted at Ugwuogo Nike, a rural community, in South east Nigeria. Patients were selected by convenience method and allotted to trial drugs by randomization. Fifty-five patients were allocated to each treatment group (chloroquine and sulphadoxine-pyrimethamine). Patients were enrolled after informed consents were obtained. Historical, physical and laboratory data were obtained to determine the baseline characteristics: age, sex, place of domicile, clinical status of the children. The haematocrit and parasite density were also determined for each patient and repeated on Days I, 2, 3, 7, 14. Drugs were administered by direct observation methods. Data obtained were analysed with parametric and nonparametric tests to determine significance and associations. Results: The study was conducted from July 29^th to September 8^th 2002, and one hundred and ten (110) children aged to 59 months with malaria were recruited. The baseline characteristics of the enrolled patients in the two treatment groups were similar except for the mean weights. Fever clearance time for both drugs; chloroquine and sulphadoxine- pyrimethamine, respectively was 32.29 hours (± 17.42). There were 26 cases of early treatment failure in the chloroquine group and 17 in the S-P group (p > 0.05). The proportions of late parasitological failure was 43.6% for each of the treatment groups. Only two and seven cases in the respective groups had adequate clinical and parasitological response (p > 0.05), however clinical efficacy was 56.3% for SP and 47.2% for chloroquine. Conclusion: The number of early treatment failures in both treatment groups exceeds the acceptable limit of 25%. It is therefore recommended that combination therapy regimens with cheaper and easily available drugs should be adopted rather than monotherapy.

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Aims: To determine if free eye screening can improve clinic attendance, bed occupancy and detect previously unrecognized diseases in tertiary hospitals. Methods: A free eye screening programme was conducted at the University of Benin Teaching Hospital over 5 days. The demographic data of the subjects were obtained, their eyes were examined and the findings recorded. The number of patients attending clinic and bed occupancy at one week, one month and three months after screening were determined. Results: There were 188 subjects comprising 123 males and 65 females. The most common conditions seen were refractive errors (44.1%), cataract (26.1%), allergic conjunctivitis (10.6%), glaucoma (9%) and pterygium (7.4%). There was a considerable increase in daily clinic attendance and bed occupancy over the next three months. Conclusions: Free eye screening programmes are useful for identification and treatment of potentially blinding eye conditions. They also, help in providing awareness and improved utilization of hospital services. Clinic attendance and bed occupancy are considerably improved after such events.

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Aim: To audit the services of the neonatal Unit since its inception and determine the causes of morbidity and mortality among the neonates. Methods: This was a retrospective study. Case notes of all babies admitted into the neonatal Unit for the three-year study period were retrieved from the medical records department of the hospital and reviewed. The data reviewed included sex, gestational age, and mode of delivery, birth weight, in-born and out-born, maternal booking status and associated factors, indications for admission, diagnosis and outcome. Results: A total of 536 neonates made up of 425 in-borns (79.3%) and 111 out-borns (20.7%) was admitted into the Unit, 186 (34.7%) were of low birth weight (LBW) and 139 (25.9%) preterms. There was an increase in the yearly admissions from 63 to 367. Major indications for admission included septicaemia (26.9%), prematurity and LBW (22.9%), birth asphyxia (20.9%), unconjugated hyperbilirubinaemia (11.4%), neonatal malaria (4.1%) and congenital malformation (3.2%). Two hundred and thirty-nine of the 536 babies (44.6%) were babies born to un-booked mothers. There were 80 deaths, giving an overall mortality of 14.9%. LBW contributed to 55.0% of the overall mortality. Others were birth asphyxia (18.7%), septicaemia (11.2%) and congenital malformation (7.5%). A total of 45/80 (56.3%) of the mortality cases was in-born but 58/80 (72.5%) of the deaths was delivered to unbooked mothers. Conclusion: Preventable conditions are the main causes of morbidity and mortality in our centre. Identifiable causes included lack of antenatal care, low standard of available services and lack of essential equipment like ventilators and overcrowding in the unit. Measures that are needed to improve the care of newborns are highlighted.

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