Aim: The study assessed the side effects of drugs used in directly observed treatment short course in a newly diagnosed pulmonary tuberculosis patients at the chest unit of University of Nigeria Teaching Hospital in Enugu State, Nigeria Methods: A retrospective study, involving a 3-year review of case files of TB patients diagnosed as new cases was conducted in 2008. A protocol proforma was used to extract data from the folders. Data analysis was done with Epi-info version 3.3.2 software. Results: Various adverse drug reactions were recorded in 160(20.8%) out of the 768 case files reviewed. The adverse reactions in their decreasing order of occurrence were althralgia, 64(40.4%), fever and muscular pains 35(21.9%) each, pruritis 31(19.4%), muscle weakness 16(10.0%), peripheral neuropathy 15(9.4%), nausea & vomiting 13(8.1%),maculopapular rash and headache 9(5.6%) each. Exfoliative dermatitis, jaundice, impaired vision, confusion and renal impairment were 1(0.6%), 2(1.3%), 3(1.9%), 1(0.6%) and 1(0.6%) respectively. Seventy-nine (60.0%) of these reactions were successfully managed within the chest clinic. Six (3.7%) were referred to a special clinic with temporary withdrawal of the anti-tuberculosis drugs in 5(3.1%) and permanent withdrawal of the suspected drug in one (0.6%) of the cases. The treatment outcome of the remaining 58(36.3%) were not documented. A statistically significant difference (p<0.05) in occurrence of adverse reactions was found among TB patients and TB/HIV co-infected patients in 4 (21.1%) out of the 19 adverse reactions recorded. Conclusion: The prevalence of anti-tuberculosis drug reactions at the chest unit of UNTH is low and are mostly minor reactions responded to treatment. However, proper documentation of these reactions including management outcome are necessary

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Aim: To establish the prevalence of pica behaviour during pregnancy; to identify the substances commonly ingested and their prevalence; and to determine the characteristics of women who reported practicing pica. Method: Was descriptive, cross sectional study involving use of questionnaire administered in interview format. Study was conducted at Pumwani Maternity Hospital, Nairobi, Kneya. Participants included a convenience sample of 1071 ante natal women with a mean age of 28.1 (∀7.3) years. Subjects were selected based on availability, accessibility, and willingness to participate in the study. Results: Seven hundred and ninety three (74.0%) participants reported practicing pica regularly on daily basis. Pica prevalence categorised by substances ingested was as follows: soft stones (odowa), 89.8%; soil, 61.2%; and others, 9.6% and no pica, 26.0%. Majority of women who reported practicing pica (62.5%) ingested more than one substance. Most women who practiced pica reported having experienced strong cravings prior to ingestion of pica items, childhood pica, pica before pregnancy, pica in previous pregnancy and a history of pica in family members and significant others in the community. Conclusions: Pica prevalence was significantly high among the subjects indicating that pica in pregnancy might be more common and widespread in Kenya than health care providers assume or observe. There is need to routinely screen pregnant women for pica during antenatal visits as this will provide a more systematic and a less expensive way of establishing its epidemiologic status. A nationwide investigation of pica prevalence is also recommended in order to establish possible health consequences of pica on mother and child.

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Background: Obstructed Labour is a leading cause of operative delivery, maternal and perinatal morbidity, and mortality in developing countries including Nigeria. Aim: To review obstructed labour and its consequences in a district general hospital. Method: A 2-year retrospective study of patients with obstructed labour. Results: During the period of study, 75 patients presented with obstructed labour and were delivered operatively with 3 maternal and 9 perinatal mortality. Conclusion: Health education of the populace on the importance of antenatal care, improvements in the socio-economic conditions, female education, and training of Traditional Birth Attendants, proper supervision during labour and provision of adequate and accessible health care facilities with proper referral are important in preventing and reducing the incidence and complications of obstructed labour.

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Background: Malaria causes about 350 to 500 infections in humans and approximately 1.3 million deaths annually, mainly in the tropics. Sub Saharan Africa accounts for 85% of these fatalities. In many developing countries up to 60% - 80% of the health problems are treated by self medication The disease is often treated in Nigeria by self medication. Objective: To ascertain the prevalence and practice of malaria self medication among the undergraduates of Nigeria tertiary institution. Materials and Methods: A cross sectional descriptive survey was carried out among 250 undergraduates of the University of Nigeria Enugu Campus. A simple random sampling method was used to select the students. Sample size was calculated using a previous prevalence. Instrument of data collection was a self administered questionnaire. Results: Two hundred and forty students 240(96%) suffer from malaria; and 160(67%) practice self medication. One hundred and fifty students (60%) believe self medication should be discouraged and most of them 98(55.4%) believe it encourages drug abuse. Conclusion: The students treat themselves when they believe they have malaria. Most of them believe self medication should be discouraged. I therefore recommend a drug education intervention to curb the menace of self medication for malaria among our undergraduates.

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Background: The rapid improvement in immunization services has resulted in significant decline in infant and childhood mortality and morbidity associated with vaccine preventable disease. However, because these diseases have become less visible, the public tends to be more concerned with adverse events following immunization (AEFI) than with the threat of the disease itself. Aim: To asses the knowledge of AEFI among mothers and also to determining the prevalence, the most common antigen associated with AEFI and mother's responses to the adverse reactions. Method: This is a descriptive cross-sectional study of the mothers who brought their children for immunization in three randomly selected immunization centers in Enugu Urban. A systematic sampling method was used to select 331 mothers. An informed consent was obtained from each participant. Data was collected using a pre-tested, semi-structured, interviewer-administered questionnaire with open and closed ended questions. Data was entered and analyzed using Epi-info version 3.3 software package. Results: Two hundred and seventy-three (82.5%) studied knew that fever is a possible adverse event. Pain and swelling at the site of injection was identified by 77 (23.3%), rash 10.3%, convulsion 3.9% boils 3.0% paralysis / weakness of limbs 2.7% and ulcers 0.6%. Among the 331 mothers, 220 (66.5%) had experienced adverse reactions following immunization of their children. The most commonly reported adverse reaction by these mothers were fever 199 (90.4%), pain / swelling 61 (27.7%), rashes and convulsion 6 (2.7%) each. Ulcer was reported by 2(0.9%) while collapse and paralysis were reported by 1(0.5%) each. Two hundred and five (93.2%) of these reactions out of the reported 220(66.5%) occurred within 24 hours. The antigens responsible as identified by the mothers were DPT 176(80.0%), HBV 37(16.8%), BCG 36(16.4%), OPV 21(9.5%), measles 12(5.5%), yellow fever 10(4.5%) and CSM 7(3.2%). About 190(57.4%) of the mothers responded to these reactions by giving the child paracetamol, 31(21.1%) stopped further immunization temporarily, while 43(19.5%) took the child to hospital. Two (0.9%) of the mother each either took their children to native doctors or gave native mixtures. Sixty-two (88.6%) of those temporarily stopped immunization re-started after a while. Conclusion: The mothers had a fair knowledge of the possible adverse reactions following immunization and actions to take when such occurs. The most reported reactions were associated with DPT and occurred within 24hours of vaccination. Some of the women subsequently did not complete immunization of the affected children. Therefore, health education should be regularly organized for these women on the appropriate actions to be taken when adverse reactions uccur to dispel false rumours, emphasizing the fact that immunization programmes are still one of the safest and most effective health intervention.

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A placebo-controlled clinical trial is a trial where some of the volunteers are given the new drug being tested, and the other volunteers are given a placebo. A placebo looks exactly like the experimental drugs in every respect both in appearance and wrappings which, is prescribed in identical way to the real drug. The experimental group receives the real drugs while the control group receives the placebo. When patients believe that a certain medication will improve their condition, that fact alone can cause certain positive effects when combine with pill, an injection or even a surgical procedure. Researchers can utilize such adventitious effects and more precisely determine the actual therapeutic benefit of a new treatment. However, the use of placebo in clinical trials has been controversial with many stake holders in clinical research expressing different opinions. It is usually not problematic to use a placebo in clinical trials when testing a new treatment in absence of a known treatment. On the other hand, resort to placebo controls becomes ethically controversial when researchers wish to introduce a new treatment as a possible successor or competitor drugs whose use is currently a standard practice. More problematic and controversial is the use of invasive placebo in interventions in surgical trials. This article is therefore, a critical presentation of the ethical issues involved in the protection of human research participants in the presence of placebo controlled clinical trials

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Background: Canarium Schweinfurthii is a tropical plant which has been found useful in the treatment of various ailments such as diabetes mellitus, fever, constipation, malaria,diarrhoea and sexually transmitted diseases. It also possess antioxidant activity and scientific research has shown that medicinal plants with such ability may possess nephroprotective effect. Acetaminophen(paracetamol) is known to be toxic to the kidney especially during starvation, alcohol ingestion and in patients that take drugs that stimulate the P₄₅₀ microsomal oxidase enzymes. Aims and Objectives: This study is aimed at evaluating the protective effects of aqueous and methanol extracts of stem bark of canarium schweinfurthii on the kidney when acetaminophen is used to induce renal injury in rats. Materials and Methods: Twenty-eight male albino rats weighing 150-200g were used for this study. They were divided into seven groups( A-G) of four rats per group. Two cumulative doses of aqueous extract(AE) and methanol extract(ME) were administered to groups A-D prior to oral administration of acetaminophen(500mg/kg). Groups E-G served as acetaminophen, negative(vehicle) and baseline controls respectively. The negative control group was given 3% tween 80 while the baseline control group was given only distilled water. Drug administration lasted for thirty days. Results: Blood urea and serum creatinine levels were significantly higher(p<0.01) in acetaminophen and negative control groups compared to baseline control group and the AE and ME groups. Histopathological examination shows that the extracts preserved the renal histoarchitecture while the acetaminophen and negative control groups showed varying degrees of inflammatory cells infiltration, necrosis,tubular casts, tubular erosion and increased urinary pole. Conclusion: The fall in plasma levels of urea and creatinine in AE and ME treated groups in the presence of acetaminophen suggests an improvement of renal function which is further supported histologically by a well preserved histoarchitecture in these groups.

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Objective: To evaluate needle stick injuries among medical interns in a Nigeria Teaching Hospital. Design: It was a cross-sectional descriptive study. Method: The study was undertaken in May 2004 and included all the 142 medical interns in University of Nigeria Teaching Hospital, Enugu. Data was obtained using semi-structured self administered questionnaires. Results: One hundred and fourteen (80.3%) of medical interns had needle prick injuries within the 12months of internship. Most injuries occurred while setting intravenous fluids. More males significantly had needle stick injuries than females (χ² =33.67, df = 1, p=0.00). Only 39 (20.4%) of cases were reported. A few, 11.3%, did not treat the injury site within 1 hour of injury. Though most had heard of universal precautions only a few, 28(19.7%) were trained on the use of safe devices and safe handling of needles before starting internship. Conclusion: Prevalence of needle stick injuries is high among medical interns and many cases go unreported. Medical interns are not trained safe handling of needles and some are not provided with personal protection.

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Background: Pulmonary arterial hypertension is a recognized complication of sickle cell anaemia particularly in older patients. Doppler Echocardiography is a convenient non-invasive technique for estimating pulmonary arterial systolic blood pressure. Data on this topic are lacking in our environment and the authors therefore set out to determine the frequency of this complication in patients presenting at the adult Haematology clinic of the UNTH Enugu, Nigeria. Materials and methods: The study recruited fifty six adult sickle cell patients in steady state and fifty two age and sex –matched healthy volunteers. Anthropometric measurements were taken for both groups under similar conditions. Echocardiographic techniques were then used to examine the subjects. Results: Pulmonary arterial hypertension was noted in only three out of the fifty six sickle cell patients representing 5% of the study population. Conclusion: Pulmonary arterial hypertension appears to be uncommon in Nigerian adults with sickle cell anaemia in stable state.

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Background: Hibiscus Sabdariffa(HS) is widely consumed in Nigeria and many parts of the world as a refreshing drink. It is equally used in traditional medicine to treat various diseases such as cough, hypertension, stomach disorders, loss of appetite, upper respiratory congestion, nerve and heart disorders and menstrual difficulties. Some of these ethnomedicinal claims have been confirmed by scientific researches. Some of these researches have shown that HS has protective effect on some body organs while others have demonstrated its toxic effect on some organs. Aims and Objectives: The aim of the present study is to show the effect of graded doses of aqueous extract of HS on major excretory organs(Liver and Kidney) of albino Wistar rats. This may be helpful in determining the safety or otherwise of its consumption at different concentrations. Materials and methods: Sixty male albino Wistar rats weighing 150-250mg and aged 2-3 months were used for this study. Normal rat chow (Guinea feed) and distilled water were provided ad libitum. The rats were divided into five groups (A-E). Groups A-D were the test groups and were administered different doses of the HS extract: 20, 40, 80 and 160mg/kg respectively using oral feeder (Gavage). Group E served as control and was given only distilled water. The extract was administered daily for a period of 12 weeks. After 4weeks, four rats were picked at random from each group and sacrificed. The histology of the liver and kidney was investigated. At 8^th and 12^th weeks, the experiments were repeated. Results: There were no significant changes in the histology of the liver throughout the period of HS administration in all the groups. However, there were significant histological changes in the kidney which were more pronounced at higher doses (80 and 160mg/kg). There was shrinkage of glomerular tuft, increase in urinary pole, increase in size of tubular lumen and tubular damage. These effects were more marked as the duration of administration of the extract progressed with greatest effect observed at 12^th week. Conclusion: The results of the present study suggest that aqueous extract of HS has no harmful effect on the liver but when consumed in high doses could be harmful to the kidney. Further research aimed at identifying the chemical composition and potential toxic agent(s) in HS is recommended.

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Background/ Objectives: Many students are daily exposed academic, psychosocial and health related stressors which predispose them to mental depression. This in turn impairs students' behavior, diminish learning and ultimately affect patient care. This study was carried out to ascertain the degrees of mental depression , predisposing factors and coping strategies in medical students. Methods: Study was cross-sectional with sample of 762 drawn by stratified random sampling from third, fourth, fifth and sixth year classes. A self administered questionnaire that incorporated the Becks Depression Inventory BDI-II to assess depression was used. Results: Mean age of respondents was 24.08 ± 2.41. Prevalence of minimal depression was 61.9%, mild depression 27.6%, moderate depression 8.9% and severe depression 1.6%. Statistically significant difference (p<0.05) exist in the prevalence of mild depression in different classes. The factors associated with depression in order of importance were: high failure rates in the MBBS examinations (80.6%), frequent rescheduling of lectures (73.3%), long travel time from hostels to learning areas (75.5%); long stay in medical school (71.7%), inadequate accommodation ( 69.3%). Others are study conditions, lecturers' attitudes, finances, frequent examinations / tests, parental expectations, dual roles and poor relationship with parents. Coping strategies identified: 25% coped passively, 25% talked to friends/ classmates, 23.9% discussed it with their parents/guardians while 17.1% talked to a priest. About 11.5% resorted to alcohol, 4.7% to smoking / use of stimulants. Only 2.1% sought medical advice. Conclusions: The prevalence of mild to moderate depression among medical students is high . Factors related to the academic environment are associated with depression in students and only minimal proportion sought medical advice.

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Background: In Nigeria today measles is the greatest NPI target disease with the greatest impact on child health and ranks as one of the leading causes of childhood morbidity and mortality. Mothers have been known to make most decisions on home treatment of their children. This paper contributes to the knowledge on the perception of the incidence of measles among mothers in a Nigerian rural community Materials and Methods: A community based descriptive survey involving 400 women was conducted with questionnaire administered to the women aged 15-49 years in households. Households were selected by simple random sampling from a frame of Primary Health Care house numbering system. Results: More of the children suffered from measles before than after the launching of the National Programme on Immunization. In 1996 as perceived by the mothers. Conclusions: A reduction in the incidence in the incidence of measles after NPI launch as perceived by the mothers is highly commendable. However efforts need to be sustained to ensure a steady decline in measles incidence

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Background: Preterm Caesarean section may most probably, add further pressure to the already existing poorly developed facilities for intensive perinatal care in low resource countries. Aim: The aim of this study is to determine the perinatal outcome following preterm Caesarean section in a low resource centre, to comparing the perinatal outcome of term and preterm Caesarean sections and identify predictors of adverse perinatal outcome in preterm Caesarean section. Method: A retrospective case controlled study to examine the pattern, outcome and predictors of adverse perinatal outcome in preterm caesarean section. A control of two term to one preterm Caesarean section was selected and their outcome compared. Chisquare test and Odds ratio were used for statistical analysis. P-values of 0.05 or less were considered significant. Result: Of the 3037 deliveries 733 (24.1%) were caesarean sections and 109 (14.9%) of these were preterm Caesarean sections. Maternal medical diseases (28.4%) and poor progress of labor (19.0%) were the commonest indication for preterm caesarean sections. Perinatal mortality was 178/1000 births in preterm Caesarean sections compared to 74/1000 births in the control (p = 0.004; odds ratio 2.7, 95% confidence interval (CI) 1.3-5.8). Birth asphyxia was the commonest cause of perinatal mortality in both groups. Low Apgar score (< 7) was commoner in the preterm group than control (P < 0.001; odds ratio 2.8, CI 1.6-4.8). Conclusion: Preterm Cesarean section constitutes a significant burden in perinatal care. The most important predictor for poor perinatal outcome on multivariate analysis was gestational age. In most indications of preterm Caesarean sections in this study operative deliveries could not be averted easily however planned surgery significantly improved perinatal outcome.

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Objectives: The purpose of this article is to highlight the increasing occurrence of maxillofacial skeletal injuries from boat accidents in our environment and also to present our management modalities as experienced in our center. Materials and Methods: The case notes of the 6 maxillofacial skeletal injuries from boat accident were retrieved from the 200 maxillofacial injuries cases seen and treated at the department of oral and maxillofacial surgery unit of the University of Calabar Teaching Hospital, Calabar between January 2000 and December 2004. Data collected and analyzed include, patients age, occupation, time of presentation, clinical and radiographic findings and management modalities. Results: Out of the 6 patients recorded 4 (66.7%) were males while 2 (33.3%) were females given a male-to-female ratio of 2:1. They were between the ages of 25-40 years and all had multiple facial fractures. Two (33.3%) patients (1 male and 1 female) were unconscious at the time of presentation and despite the multidisciplinary approach to their management, they died after fourteen days of hospitalization in our intensive care unit. Conclusion: Boat accidents though uncommon, are drawing more attention as transportation through water ways is becoming increasingly popular in Nigeria. Since most of the maxillofacial injuries are usually severe and life threatening, the traffic agents in coastal areas should therefore, be prpared for any eventuality while the maxillofacial surgeons should also brace up to the challenges associated with the management of maxillofacial injuries resulting from boat accidents.

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