Background: Rural Igbo women frequently perceive disorders of menstruation in the context of their inability to achieve pregnancy, and may otherwise not volunteer information on such abnormalities in the gynaecological clinic. This study determined the prevalence and pattern of menstrual disorders in rural Igbo women of Ebonyi State, South East Nigeria. Materials and Methods: Data was collected from 1500 women in randomly selected communities in rural Ebonyi State by trained research assistants using pre tested questionnaires in a cross sectional study that spanned three months, March to May 2005. Information obtained related to their socio demographic variables, menstrual characteristics and disorders. Data obtained was analyzed using the epi info statistical programme. Results: One thousand, four hundred and sixty-three questionnaires were analyzed. The mean cycle length and mean menstrual flow duration in our study population were 29.6 days and 4.4 days respectively. Eight hundred and twenty-nine (56.7%) of the respondents had one or a combination of menstrual disorders. Dysmenorrhoea occurred in 51.3% of the women and was the commonest menstrual disorder noted. Intermenstrual bleeding, found in forty-five (3.1%) respondents was the least common. Short cycle length (<21 days), long cycle length (>35 days), menstrual flow duration lasting more than 7 days and heavy menstrual loss were significantly more prevalent among the adolescents than other age groups. Conclusion: Menstrual complaints which are important indices of women's well being are commonly encountered in Igbo women of Southeast Nigeria, and may indicate underlying gynaecological pathology.

Study Design: An open randomised, controlled, parallel group, single blind comparison of Ramipril with Amlodipine. Subject and Methods: Fifty-five intent to treat hypertensive subjects were sequentially recruited for the study from the medical out-patient Clinics of the University of Nigeria Teaching Hospital, Enugu. All had systolic blood pressure (SBP) of 140 179 mmHg and Diastolic Blood Pressure (DBP) of 90 109 mm Hg. Thirty-three subjects (17 males and 16 females completed the study. They were aged 34 80 years with mean age of 53.1 ± 33.7 years. There were 14 patients in the Ramipril group (mean age 48.4 ± 7.8 years) and 19 in the Amlodipine group (mean age: 56.05± 10.9). They were treated for 12 weeks. Dose titration from 5mg daily to 10 mg daily was done for both groups at 6 weeks of treatment. Results: At the end of the treatment period (12 weeks), the mean SBP in the Ramipril group reduced from 152.5 ± 10.1 mmHg to 135.1 ± 21.3 mmHg and in the Amlodipine-treated group from 152.0 ± 12.2 mmHg to 132.1 mmHg. There was no significant change in the pulse rates and body mass indices in both groups before and after treatment. Both haematological and biochemical indices were not significantly affected by treatment with both drugs. There were also no significant adverse effects in all subjects who completed the study although discontinuation rate was higher in the amlodipine treated group (7 vs 4). Conclusion: Ramipril at 5-10 mg daily and Amlodipine at 5 10 mg daily have been shown to produce satisfactory blood pressure control in majority of patients. The study also shows that Ramipril is effective as monotherapy at the doses used in the study for Nigerians with mild to moderate hypertension.

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Aim: Lessons are sought regarding the patterns of utilization of a central biopsy service by patients living in the same area but patronizing two surgeons who served them three decades apart. Methods: During the roughly 3-year periods between 9.10.71 and 25.9.71 on the one hand and between 9.10.2001 and 25.9.2004 on the other hand, two surgeons submitted biopsies from different Umuahia hospitals to a Reference Laboratory in Enugu. The accumulated data were analyzed as to the variability of the organs involved. Results: The 1970s featured 28 cases with a relatively wide scatter of organs, whereas in the 2000s the 101 cases showed mammary preponderance. Conclusion: In keeping with the world pattern, there appears to be an increasing incidence of breast cancer in Igboland. Perhaps, by keeping the eye open for a chance observation regarding health service utilization patterns, lasting light may dawn on the enigma of mammary masses.

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Aim: To characterize the effect of malaria infection on serum HDL levels with respect to age and sex distribution in an endemic population. Patients and Methods: A total of sixty subjects within the age range of 10 to 60 years were selected by stratified random sampling from patients attending the general out-patient department of a district hospital in Enugu. Serum HDL fractions were determined in both malaria patients and healthy control subjects. Data obtained was statistically analyzed using ANOVA, assuming P<0.05 as significant and presented in tabular form. Results: The study revealed a consistent age-related decline in serum HDL values in both malaria patients and control. However, the mean HDL values were noted to be significantly elevated in malaria patients relative to control, (P<0.05). Conclusion: The serum HDL fraction may be implicated in the pathogenesis of malaria infection especially in the disease endemic zones.

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Ludwig's angina is a serious infection of the oral cavity and other soft tissues above the hyoid bone. It is associated with brawny indurations of the soft tissues, upward displacement of the tongue to the roof of the palate, and potential compromise of the upper airway. Carious or infected mandibular molars, virulent microorganisms and altered / compromised immunity such as occurs in pregnancy and puerperium, are risk factors. Antibiotics therapy, incision and drainage and in many cases creation of artificial airways are the corner stone in the treatment protocol of Ludwig's angina. In this report, we present a case of Ludwig's angina in a puerperant which was treated without creating artificial airway.

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Background: A prospective study on the relationship between the weighted revised trauma score and patient outcome (mortality) was carried out at National hospital, Abuja, Nigeria from April to December 2005. Methods: The patients' demographics were collected. The duration of stay in the intensive care unit was also noted. The weighted RTS was used in this study. The sum of coded values of Glasgow coma scale (GCS) score, systolic blood pressure(SBP) and respiratory rate(RR) were calculated and documented. These parameters were recorded at the accident and emergency department and calculated in the ICU. Results: The records of 38 head injured trauma patients admitted to the general ICU of National Hospital, Abuja, Nigeria over a nine-month period (April -December 2005) were analyzed. The average age of the patients was 36.18 years (range 4-65 yr.) There were thirty-four males amongst the patients. The average duration of stay in the ICU was 9.05 days (range 1-43 days). Three patients (8%) had surgical intervention. Only one patient with RTS of less than 5.6 survived (4.093). Twelve patients survived (31.6%). Five patients (13.1%) with RTS greater than 5.6 died (complicated by cervical spine injury in two patients and basal skull fracture in three others). Conclusion: The results in this study revealed that though the weighted RTS was effective in determining mortality outcome in head injured patients, the mortality rate in this study was high because of delayed transfer of patients due to poor ambulance services, associated cervical spine injuries and gunshot injuries to the head. Improvement of referral and ambulance services may help reduce this high rate. This study reemphasized the fact that the weighted score of the RTS is a good predictor of both severity of head injury (and thus the need for ICU admission) and mortality.

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Background: Ectopic pregnancy is a common life threatening gynaecological emergency in our environment. In developed centers, diagnosis is made before rupture occurs, however, most cases in our environment still present late with severe intraperitoneal haemorrhage. Apart from the late presentation; most of our institutions lack the necessary technology and man power to make early diagnosis Aims and objective: The aim of this article is to review the current trends in the diagnosis and management of ectopic pregnancy, evaluate our peculiar socioeconomic circumstances and determine how best to circumvent mortalities and morbidities. Study design and Methodology: Extensive search was made on medline, Pub med and African journal on line using the key words ectopic pregnancy and extra uterine pregnancy. Additional information was obtained from text books in the medical library of University of Nigeria. Results: Ectopic pregnancy is common. Most risk factors tend to interfere with tubal structure and function. Mortalities and morbidities are low when diagnosis is made before rupture occurs. Absense of cross matched blood should not be a deterrent to exploratory laparotomy. Conclusion: Despite apparent lack of facilities, our clinicians should exhibit the highest degree of clinical acumen and make diagnosis before rupture occurs, as some patients may desire conservation of their reproductive and menstrual functions.

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Background/Aim: Hepatitis C Virus(HCV) is a leading cause of chronic liver disease worldwide. In developing countries, blood transfusion is still a major route of its transmission. The aim of this study was to determine the seroprevalence of HCV infection among blood donors and to determine some of the risk factors for the acquisition of this infection. Method: This was a cross sectional study of consecutive blood donors at the University of Nigeria Teaching Hospital (UNTH) Enugu between September 1 2004 and December 312005. HCV antibody test was carried out using a 3^rd generation enzyme-linked immunosorbent assay (EIA-3). Results: Two hundred and sixty eight (268) blood donors participated in the study (246 males and 22 females). The seroprevalence of HCV antibody was 3.7%. Previous history of blood transfusion was more prevalent in HCV antibody positive blood donors than HCV antibody negative blood donors. Conclusion: The seroprevalence of HCV antibody in blood donors in Enugu is 3.7%. Previous blood transfusion is a risk factor for acquiring the infection.

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Aim: There is need to resolve the continuing difficult question regarding the possible relationship between mammary dysplasia and breast cancer. Method: This is a 30-year study of the incidences of both mammary dysplasia and breast cancer occurring among the Igbos, a major ethnic group in Nigeria, West Africa. Results: Out of 1304 cases of breast cancer Found in a personal histopathology data pool, 8 (0.6%) had previously presented with mammary dysplasia. This figure falls within the 0.2 % 7% range published in the literature. Conclusion: It is hypothesized that the true relationship will be discovered through simply promoting thorough doctor-patient communications worldwide.

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Pain, swelling and trismus are the most common causes of discomfort and postoperative morbidity after the surgical removal of impacted lower third molars under local anesthesia. A review of literature shows that the existence of these postoperative variables after the surgical removal of impacted lower third molar are well known and could lead to a reduction in the postoperative quality of life of patients. Reducing or minimizing these postoperative variables seems a laudable goal especially if wound healing is not compromised. Several studies carried out have not pointed on any systemic or local agent used without any adverse effect. Oral surgeons have used drains after the surgical removal of mandibular impacted third molars to minimize postoperative morbidity with varying degrees of success. The use of a drain in association with primary suture after the surgical removal of the impacted lower third molars allows the patient to experience a more comfortable postoperative period in relation to pain, swelling and trismus, because it permits the drainage of fluids located in the tissue spaces. The purpose of this study is to review the effects of drains after the surgical removal of impacted lower third molar so that oral surgeons carrying out lower third molar extraction may be properly informed to consider the use of drains to minimize the postoperative discomfort

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Background: Dental practitioners experience high levels of stress within their working lives, which may be associated with significant distress that could affect patients' treatment outcome. The aim of this study was to undertake a questionnaire-based survey to establish the level of occupational stress among dental professionals in eastern Nigeria. Subjects and methods: A total of 62 questionnaires were randomly distributed to practicing dental surgeon in eastern Nigeria. The information collected included: years of practical experience; causes of stress during clinical practice; signs of onset of stress; reactions of individual practitioner during stress condition; and patient's management during practitioner's stressful moment. Fifty-seven were returned anonymously representing 92% response rate, which were used in the data analysis Results: All the 57 respondents agreed they have been under stress occasionally during practice. Forty-one (72%) indicated patients' management while 43 (75.4%) indicated the type of clinical procedures as the main causes of their stress. Twenty-three (40.4%) respondents were of the opinion that staff and practice management were the main cause of their stress. Twenty-seven (47.4%) and 28 (49.1%) were affected by time pressure and environmental factor respectively. All the respondents were of the opinion that more years of practice has reduction effect and better management of stress during clinical practice. Conclusion: The findings of this research confirm that dental surgeons appreciate the co-existence of stress in dental practice and every practitioner is affected. Surgeons should be able to identify their own stress adaptation methods to provide an efficient and effective way to proper patients' management and job satisfaction. This paper will hopefully stimulate dental surgeons to consider further research in areas of stress management during clinical practice.

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