The diabetic foot is the commonest cause of nontraumatic lower extremity amputation in the developed and developing nations. Several risk factors predispose the diabetic patient to foot ulceration and peripheral neuropathy, with peripheral vascular disease are the commonest risk factors. Clinical examination for these risk factors is often inadequate, reasons for the low performance often hinging on the huge patient turnouts in most diabetic units, the cumbersomeness of and time delays associated with detailed clinical assessments and the subjective and sometimes poorly reproducible results associated with these assessments. Aesthesiometry, Bio-Thesiometry and hand-held Doppler ultrasound techniques are quantitative, non-invasive, rapid, reliable and reproducible methods to detect sensory neuropathy and peripheral vasculopathy. Their objectivity and ease of performance make them ideal for mass screening programs. This article recommends a four model risk selection criteria to target diabetic patients at highest risk for foot complications, such that specific preventive programs focus on this group at highest risk and so reduce rate of loss of limbs to diabetes.

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Aim: To determine safe anaesthesia management techniques for giant goiters at thyroidectomy. Patients and methods: Over a ten year period January 1988 - December 1997, the different anaesthetic techniques used at the University of Nigeria Teaching Hospital Enugu for management of very large goiters at thyroidectomy were studied. Goiters spanning the whole of anterior and lateral triangles of the neck, with minimum dimension 30cm by 30cm (termed ‘giant’ in our unit) were identified on presentation and enrolled for the study. The age and sex of the patients, size of the goiters, their duration, associated symptoms and signs and the reason for presentation to the hospital were documented. The patients were investigated and prepared for thyroidectomy. The airway control techniques employed for thyroidectomy in these patients were also noted. Results: Twelve patients were studied. They all presented with varying degrees of dyspnoea, dysphagia, pressure and pain in the neck and frequent cough and chest pain. Preoperative tracheostomy was carried out on two patients. Four patients were intubated awake following inhalation of nebulized lidocaine. Inhalational induction and intubation after spraying the cords with lidocaine was carried out on six patients. These techniques were respectively related to preoperative stridor at rest, positional stridor and the uncompromised airway. Conclusion: Safe anaesthetic techniques for thyroidectomy in giant goiters are dictated by preoperative airway status. Postoperative complications are related to the extent and finesse of surgery.

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Sub-mucous fibroid is often associated with significant morbidity including prolonged or heavy menstrual bleeding, pelyic pain, prolapse and sometimes, uterine inversion. This substantially affect the quality of life of the individual involved. This case of prolapsed submucous fibroid resulted from prolonged neglect of the fibroid by the patient. Early medical attention could have prevented this complication.

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Aim: To determine the trends in the occurrence of meningococcal meningitis at the University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria, as well as the antibiotic sensitivity pattern. Materials and Methods: The results of all cerebrospinal fluid samples received by the microbiology laboratory (UNTH), Enugu between 1^st January 1992 and 31^st December 2003 were analysed. The case records of the patients were also analysed. Results: Forty - five cases of meningococcal meningitis were studied. From 1992 - 1995, a total of 32 cases, that is an average of 8 cases per year were recorded. Between 1996 and 1997 the numbers started to decrease, with a total of 7 cases for the two years, that is an average of 3.55 cases per year. Between 1998 and 2003, a very remarkable decrease in the number of cases was recorded, with an average of 1 case per year. Sixteen cases (35.56%) occurred in the 0 - 1 year age group. More cases occurred between October and March, that is the dry season months in Nigeria. Mortality was high 13.3% and Neissena Meningitides was completely resistant to sulphonamides and cotrimoxazole. Conclusion: A trend in the decrease of meningococcal meningitis was observed starting from 1996. This is most likely due to the regular availability of meningococcal vaccine coupled with the fact that most of the patients would have used antibiotics before coming to hospital, thus making isolation of the organism difficult

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Background: There is a direct relationship between health and social position, especially between anaemia, level of education and social development. It has been reported that apparently healthy, fully ambulatory individuals could have low haematocrit. In the recent past, there have been attempts at correlating the presence of anaemia with clinical features. Our aim was to determine the prevalence of anaemia in apparently healthy adults, who did not have symptoms or signs of anaemia. Methods: One hundred and seventy apparently healthy HbAA medical students of University of Benin aged 21-35 years were screened for anaemia using an ABBOT analyser DYN 1200. Results: Mean PCV for males was 0.374± 0.032 and for females was 0.326± 0.036.The prevalence of anaemia in the study population was 51.8%; 19.5% in males and 81.8% in females. Among female students 69.4% had hypochromic red cells while all the male students had normochromic red cell; 75.0% of female students had mircrocytic red cells compared with 12.5% of male students. No student had severe anaemia. The higher prevalence of anaemia and hypochromic microcytic red cells in females may be partly due to their higher requirement for iron to replenish stores depleted during the menstrual cycle, though poor nutrition also plays a role. Conclusions: We conclude that clinical examination alone may not be sufficient to exclude the presence of anaemia in adults as a large proportion of them with mild and moderate anaemia may be asymptomatic. Also, anaemia is becoming increasingly prevalent in Nigeria and this is most likely due to the worsening economy.

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Background: Pregnancy, though a physiological process promotes oxidative stress. Ascorbic acid and other antioxidants are used as defense mechanisms against this stress leading to low levels in pregnancy. The degree of reduction in plasma levels has been implicated in the aetiology and severity of many obstetric complications. Objective: To determine the level or degree of reduction in serum ascorbic acid during pregnancy and recommend supplementation strategies. Subjects and Methods: Sixty five (65) pregnant and 65 non pregnant women with age range 20-38 years were recruited. The pregnant women were in their second and third trimesters, attending antenatal clinic at University of Nigeria Teaching Hospital Enugu. Serum levels of ascorbic acid were determined for all the subjects. Results: The serum ascorbic acid levels were significantly lower is pregnant women than in controls. (P < 0.05). There was also a steady decline in the serum levels of ascorbic acid with increasing gestational age. Conclusion: Serum levels of ascorbic acid were reduced in our pregnant women despite our supplementations. Thus increase in the dose during pregnancy and lactation is strongly advocated. The amount to be given is subject to further research.

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Aim: To investigate the prognostic significance of Prostate-Specific Antigen (PSA) rate of change in patients with advanced prostate cancer. Patients and Methods: A total of forty-nine male patients aged between 42 and 84 years with advanced prostate cancer receiving therapy of maximum androgen bloackade were enrolled and had their serum prostate specific antigen value and rate of change assessed over a period of 48 weeks. Results: The rate of change of prostate specific antigen at week 12 of the 40 patients with response (complete/partial) shows that the PSA level at week 12 had changed (reduced) by an average of 122% from the baseline value, while the median rate of change was 97% compared to patients with either no change/progression of disease status whose PSA level at week 12 had changed by only 11.7% and the median rate of change was 0%. Conclusion: It could therefore be concluded that PSA rate of change is of prognostic significance in patients with advanced prostatic cancer.

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Background: Cancer of the cervix, a preventable disease, is the second most common cause of cancer-related morbidity and mortality in women in the developing world. Experience of the disease in Sokoto is lacking in the literature. The aim of this study is to determine the demographic characteristics, clinical features, stage of the disease at presentation and outcome in cases of carcinoma of the cervix in the Usmanu Danfodiyo University Teaching Hospital(UDUTH), Sokoto. Materials and Methods: A descriptive retrospective study of all patients diagnosed with carcinoma of the cervix between January 1998 and December 2003 at UDUTH, Sokoto. Results: There were 100 cases of carcinoma of the cervix during the 6-year study period. The peak age incidence was in the 50-59 year age group(30%), and mean age was 48 years. Parity ranged from 0 to 13. Sixty-seven percent(67%) of patients were Para 5 and above. The main clinical features were irregular vaginal bleeding, postmenopausal bleeding, offensive vaginal discharge and abdominal/pelvic pain. Eighty-nine percent (89%) of patients presented in advanced stages of the disease(Stage IIb to IV). Most patients were not able to receive radiotherapy and were lost to follow-up. Conclusions: Carcinoma of the cervix in Sokoto is a disease of grandmultiparous women who usually present at the advanced stages. Prognosis is poor due to late presentation and inability to afford the cost of radiotherapy. It is recommended that measures to prevent carcinoma of the Cervix must be put in place, chief amongst which is the implementation of a population-based screening programme.

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Aim: To review the occurrence of natural toxicants in plant food and their toxicological implications. Materials and Methods: A search in chemical and CAB abstracts, review of books and available literatures on the subject. Results: While the great importance of plants as a major source of human food is recognized, the inherent limitations associated with plant-derived food stuffs, as a result of the occurrence of various antinutritional factors and toxicants, is reviewed. The quality and safety of food could be threatened by a host of factors, including a diverse range of natural compounds capable of precipitating deleterious effects in animals. The toxicants include, trypsin (protease) inhibitors, tannins and polyphenols, phytohemagglutinins (lectins), oxalate, phytic acid, cyanogenic glycosides, goitrogens, nitrates/nitrites, saponins, alkaloids and mycotoxins. The toxicological implications of these factors were highlighted. Mycotoxins fron fungi that contaminate staple food grains are a danger to humans and animals alike and their economic importance in international trade is considerable. Conclusion: Presence of antinutrients and toxicants in plant derived-food stuffs is a notable disadvantage as regards their utilization if unprocessed. Plant foods for human consumption should therefore be adequately processed such that toxicity is largely eliminated.

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The nervous system manifestations of HIV infection are protean. Initially assumed to be a late feature of HIV infection, neurologic involvement can occur quite early. Recognition and management of this condition can be very challenging. A review of the literature is presented. An extensive search of all materials related to the topic was made using library sources. Current research findings were also included. The pathogenesis of neuro-HIV, components of the syndrome, methods of evaluation and guidelines for management are discussed. The early detection of neurological disease due to HIV infection is of paramount importance to the clinician as there are implications not just for management but also for prognosis.

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Aim: To determine (a) the prevalence of malignancies in children in Abakaliki as well as the outcome of therapy, (b) Compare findings with data from other parts of Nigeria Patients and Methods: A 4-year descriptive retrospective review of childhood malignancies was carried out based on data collected from case notes of patients attending the Paediatrics clinics of Ebonyi State University Teaching Hospital (EBSUTH) and Federal Medical Centre (FMC) Abakaliki. Results: A total of 38,802 cases were reviewed out of which 53 had various types of malignancies, giving a prevalence rate of 0.14%, with a male to female ratio of 2.1:1. The mean age of patients was 8.14 years with a standard deviation of 3.77 years. This constituted 1.7% of the 3088 Ward admissions. Burkitts lymphoma was the commonest malignancy (60.5%) followed in order of frequency by hepatocellular carcinoma (9.2%) and retinoblastoma (7%). Leukemia, rhabdomyosarcoma and Wilm's tumour had a prevalence of 4.7% each. A review of the Burkitts lymphoma cases showed a male dominance with a male to female ratio of 3:1, though this is not statistically significant. There was a preponderance of abdominal tumours. Most of the patients had chemotherapy but outcome was poor. Conclusions: Prevalence of childhood malignancies in Abakaliki is high with a high frequency of Burkitt's lymphoma. Outcome of therapy was poor. Late presentation, absence of proper diagnostic machinery, inadequacy of chemotherapy, poverty and ignorance were some of the factors responsible for the poor outcome of the various malignancies

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Aim: To determine the pattern of clinical presentation and haematological parameters of leukaemias, which had not been documented in this part of Niger Delta region of Nigeria, noted for its petrochemical industries and gas flare sites. Method: All cases of leukaemia that presented to the University of Benin Teaching Hospital, a major referral center in the region from April 1993 to March 2003 were reviewed. Demographic and clinical information including duration of illness before presentation were obtained by oral interview. Diagnosis was established based on the morphological features obtained from well-stained (leishman) peripheral blood smears and bone marrow aspirates. Haematological parameters were done using Automated Coulter Counter. Results: Acute myeloid leukaemia (AML) occurred mainly in adolescent (<19 years) while chronic myeloid leukaemia (CML) occurred predominantly in young adulthood (20-39 years). Granulocytic sarcoma was absent in the leukaemias. Majority of the patients presented in the advanced stage of the disease. The earliest and latest duration of illness before presentation was 2 months and 4 years respectively. At the time of diagnosis, 85% of the patients had haemoglobin level of less than 10g/dl. All the Chronic lymphocytic leukaemia (CLL) patients presented as high-risk group. AML M4 subtype and acute lymphoblastic leukaemia (ALL) L1 and the rare L3 subtypes were the commonest presentations. Conclusion: Many patients presented late in the advanced stage of disease. This was due to poverty, ignorance, illiteracy and other strong limiting factors.

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Aim: To study the geographical pathology of carcinoma of the urinary bladder as regards both its association with endemic schistosomiasis and the variable proportions of its histological types. Methods: A 30-year retrospective analysis was carried out with regard to Igbo patients who inhabit a region of low incidence of schistosomiasis with special reference to the occurrence of urinary carcinoma. Results: Carcinomas manifested in bladder biopsies from 24 patients and in cystectomy specimens from 12 patients. One case alone was associated with schistosomiasis. Conclusion: This lone case is a finding which is in consonance with the theory that the intensity of parasitic infestation is a significant factor in carcinogenesis.

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