Aim: To study a group of 5 Ibo nurses who were suffering from breast cancer but showed such extreme denial of it that they totally rejected mastectomy even unto death. Methods: During a period of 16 years, mastectomy was carried out agreeably by the same surgeon on 102 Ibo women. Results: Among this cohort, five women stood out because not only were they nurses but also they totally rejected mastectomy. Their grounds centred principally on concern about self-worth, presumed incurability of cancer, mutilation implicit in surgery, doubt of correctness of biopsy report, the sufficiency of prayers, and even fear of reincarnating with one breast. Conclusion: Extreme maladaptive response may follow the diagnosis of breast cancer and the proposal of mastectomy. This requires both epidemiological and psychosocial researches.

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Aim: To study the prescription pattern of different cadres of doctors, with the possible influencing factors, at the initial visit of hypertensive patients to the outpatient cardiology clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Method: A five-year retrospective study (from September 1989 to August 1994) of all the antihypertensive prescriptions at the patients' initial visits, using their case notes, was carried out. Results: Out of the 421 patients selected for the study, 233 (55%) were males and 188 (45%) females, giving a malerfemale ratio of 1.2:1. Two hundred and thirteen (51%) of the patients had severe hypertension and 27 (6.5%) were mildly hypertensive. Monotherapy was observed in 156 (41%) of the patients and Polytherapy in 59%. Regroton was the most commonly prescribed drug (20%), and Minizide, the least prescribed (0.7%). The 51-60 year age group had the highest incidence of both mono and polytherapies respectively, and the >80 years age group the least. Though there was statistical difference with regards to age of patients (P = 0.005), there was none in prescription patterns of mono or polytherapies (P = 0.075), or status of the prescribing doctor (P > 0.22). Conclusion: Findings highly suggest that the prescription pattern for antihypertensive drugs reflected the grade (severity) of hypertension in the presenting patients, the experience of the prescriber, and the knowledge of the available drugs at the time of prescription, in this teaching hospital.

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Background: Pregnant Nigerian women are usually anxious about the gender of their fetuses. As a sole indication or an addition to other indications, many women presenting for ultrasonography often demand gender determination. Objective: To determine 1.the proportion of pregnant Nigerian women presenting for ultrasonography who request for gender determination 2. the accuracy of ultrasonography in determination of gender. Results: During the period of study (September 2004 to March 2006), 1153 women had obstetric ultrasound examination in the two centres. Three hundred and sixty-four (31.6%) of the women requested for gender determination of their fetuses and had this carried out, all for social reasons. The gestational ages at ultrasound examination ranged from 18 to 38 weeks with a mean of 28.5 ± 5.0 weeks. By 31^st of March 2006, 71 of the women had delivered. The genders of 59 (83.1%) fetuses - 33 males and 26 females - were accurately diagnosed. Out of the 42 male fetuses delivered, the gender of 33 (78.6% was accurately diagnosed while out of 39 female fetuses delivered, the gender of 26 (89.7%) was accurately diagnosed. In other words, more male fetuses were diagnosed as females than was the reverse. Gestational age had no significant effect on the overall accuracy of gender determination (p > 0.05). Conclusion: Ultrasonography is not 100% accurate in determining gender. Because of its medico-legal implications, pregnant women seeking for sonographic gender determination ought to be adequately counselled about this.

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Objective: To assess Knowledge and perception of the Nigerian clergy about HIV/AIDS and their role in fighting the scourge. Method: One hundred and fourteen priests from various Christian denominations were interviewed using self - administered structured questionnaires. The survey instrument was a questionnaire with questions pertaining to various aspects of HIV/AIDS including knowledge of cause, transmission and prevention of HIV/AIDS as well as care of people living with HIV/AIDS. Results: All the priests had heard of HIV/AIDS and the electronic and print media were the commonest sources of information. Sixty five (57.0%) had correct knowledge of the different modes of transmission of HIV/AIDS while 36 (31.6%) knew the cause of the disease. Some priests still attributed the illness to a divine punishment from God and to the activities of demonic and spiritual forces. Abstinence was both the commonest method of prevention identified and approved by the priests while use of condom was the least. Seventy one priests (62.3%) claimed their congregations were well informed about HIV/AIDS. Reasons for poor information of some congregations were chiefly failure of the church to pay attention to their need for information and lack of appropriate personnel to disseminate the information. Premarital screening for intending couples was carried out by majority (93.8%) of the priests while only 46 (40.4%) ran a welfare programme for people living with and affected by HIV/AIDS. Conclusion: Awareness of HIV/AIDS is high amongst the clergy but misconceptions still abound on the cause and modes of transmission of the disease. Majority of the priests conduct premarital screening but only a few run a welfare programme for PLWHA. The clergy is still quite opposed to the use of condom as a method of prevention of HIV/AIDS. However the church has other strong potentials that can be harnessed to carry out effective campaigns for the control of HIV/AIDS as well as providing care and support for PLWHA and those affected by AIDS.

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Aim: To highlight the persistence of couching as a treatment for cataract in our community and its attendant complications. Materials and Methods: Retrospective study, using hospital records of 9 patients who had undergone couching and presented at the eye clinic, University of Nigeria Teaching Hospital, Enugu between November 2004 and April 2005. Information was obtained on the following: - Biodata, period between couching and presentation, type of coucher patronized, reasons for undergoing couching, presenting complaints, visual acuity status on presentation and after treatment, and complications following couching. Results: Eight eyes (80%) out of the ten eyes in these 9 patients were noted to be blind, on presentation at our centre. The commonest complication was lens dislocation into the anterior chamber with vitreous in the anterior chamber. Conclusion: Couching as a treatment for cataract is potentially dangerous and remains a significant cause of low vision and blindness in our community, if the practice is left unchecked.

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Background: Community-associated methicillin-resistant Staphylococcus aureus is increasingly reported. This study investigated its prevalence in urine of healthy women and resistance pattern to other antibiotics. Methods: Urine samples collected from healthy women volunteers in Federal Capital Territory were cultured and screened for Staphylococcus aureus using standard microbiological procedures. The isolates were then subjected to antibiotic susceptibility testing using disc diffusion technique. Results: A total of 60 (40%) Staphylococcus aureus isolates were isolated from 150 urine samples collected. The prevalence rate from married and single women were 41% and 38% respectively. Of the Staphylococcus aureus isolated 43 (71.7%) were methicillin resistant. The difference in the proportion of isolates that were MRSA observed in the two women groups is not statistically significantly (P>0.05). The MRSA isolates had 100%, 90.7% and 83.7% resistance to ampicillin, clindamycin and vancomycin respectively. They also showed 93-95% susceptibility to gentamicin, ciprofloxacin, ofloxacin, pefloxacin and sparfloxacin. Conclusion: Methicillin resistant Staphylococcus aureus is highly prevalent in the urine of healthy women investigated in Federal Capital Territory. Their resistance to vancomycin, a glycopeptide that is rarely used in this environment calls for further investigations into the clinical significance of the observed resistance on the chemotherapy and outcomes of Staphylococcal infections.

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Background: Postoperative haemoglobin oxygen saturation (SPO₂) may decrease after even minor surgical procedures. Aim: To evaluate the incidence of postoperative hypoxaemia in children randomized to receive either halothane-nitrous oxide (N₂O) or propofol- nitrous oxide, during a standardized anaesthetic technique for superficial surgery. Method: All patients had standard anaesthesia with either of the two drugs. Oxygen saturation was monitored with a pulse oximeter. After tracheal extubation, all the patients received 100% oxygen for at least 3 minutes and then were transferred to the recovery room (RR) in the left lateral position. The SPO2 values were monitored in the Recovery Room and supplemental oxygen was administered to all patients with SPO₂ less than 90%. Results: There were no significant differences in demographic characteristics or in the times to tracheal extubation and transfer to the RR between the two groups. While SPO₂ values decreased in both groups during transfer to the RR, they did not differ significantly at any time in the RR. Conclusion: The use of propofol does not decrease the incidence of postoperative hypoxaemia in the patient population studied.

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Chronic Hepatitis B virus (HBV) infection, is endemic in Nigeria . Efforts to curtail the spread by way of prevention ,diagnosis and treatment, have been inadequate and the disease has continued to pose great challenge to the third world as evidenced by its endemicity in Nigeria. The current review highlights the clinical manifestations, diagnosis and treatment strategies.

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Background: Traditional methods of examining medical students are still important. Manual collation of examination marks (with the use of calculators to obtain results) is tedious and time-consuming. This paper illustrates the use of Epi-Info research software by applying it to the processing of student registration and examination results. Methods: Students' registration details are entered into the Epi-Info record file provided. Specially designed programs then generate files for entry of examination marks, computation of final results and printing out of marks and results for vetting and cross-checking at examiners' meetings. Results: Sample print-outs of collated examination marks and the computed final results are provided. Conclusion: Computerisation eases the work load posed by the processing of registration details and examination results. However the importance of maintaining data confidentiality and cross-checking computer outputs with original records of marks cannot by overemphasized.

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Nigeria and other developing countries of Africa, south of Saharan are currently facing one of the most dehumanizing social and public health problems, human trafficking (HT). This can be termed modern slavery in which victims of HT are adopted, forced or coerced into labour and sexual exploitation, especially young girls exported into Europe. Some are trafficked or smuggled through torturous land routes, like the Saharan desert to Europe, and passing through the Mediterranean Sea in small boats. In Course of these, some of the victims never get to their destination - either because they are abandoned en-route or are drowned in the Mediterranean Sea. The present study uses available information to create a better understanding of the causes, the psychological, social and public health problems of this dehumanizing activity in Nigeria - which is adjudged the center of the regional child trafficking market. This work brings to focus the government efforts to combat HT in Nigeria.

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Background: Tropical pyomyositis is endemic in this environment yet a good number of patients with this condition are not detected on time.^[1],[5],[19] Clinical diagnostic criteria are often misleading and recourse to imaging techniques would appear mandatory if morbidity and mortality must be controlled. Aim: To identify the clinical and sonographic features of pyomyositis which could facilitate diagnosis. Materials and Methods: The demographic, clinical and sonographic findings in 48 consecutive patients aged between six months and 78 years who initially presented with palpable masses of the neck, abdomen, chest and limbs, 46 of which eventually proved to be pyomyositis were retrospectively compiled and analysed Results: The most affected age group was the (1-20 years) age groups. More males than females, as well as more rural .than urban subjects were affected. All referring physicians except 12 missed the diagnosis. The diagnosis of pyomyositis was correctly established with the aid of sonography in forty-six cases while two cases proved to be false positive. The most common causative organism was staphylococcus aureus. Two categories of lesions were identified sonographically namely:(l) The small ovoid solid hypoechoic lesion showing discrete swollen linear muscle fibres seen in the early part of the disease process. (2) The large partly solid partly fluid inhomogenously hypoechoic lesion demonstrating areas of partial myonecrosis usually seen in the later stages of the disease. The most frequently affected muscles in this series were those of the anterior abdominal wall. Conclusion: Ultrasound is effective in both diagnosis and therapy. It could enable a precise diagnosis to be made so long as the ultrasonic findings are evaluated in conjunction with the clinical features and laboratory findings such as ESR, WBC and culture/sensitivity of infected muscle aspirates. False-positives of pyomyositis are not uncommon and histological analysis of muscle biopsy specimens may occasionally be mandatory to arrive at a definite diagnosis. Sonography offers good guidance at both needle aspiration and muscle biopsy. It is easily available, cheap and radiation free.

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Acute chest syndrome in patients with sickle cell disease is a medical emergency. It remains one of the leading causes of morbidity and mortality in these patients. It is multifactorial in origin with main causes including infection, infarction and pulmonary embolism. In most instances, it is difficult to differentiate between these various aetiological factors. Practically therefore, management of these patients should be aggressive, bearing in mind all these possible aetiologic mechanisms. Early recognition, immediate administration of oxygen therapy, antibiotics, anticoagulation, intravenous fluids, adequate pain control and treatment of the underlying cause are required in ensuring that the patient responds well to therapy.

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