Objective: The paper aims to review the ‘epidemiologic features of breast lesions in Eastern Nigeria’ using a 10 year data collected from January 1998 to December 2007, and update available literature on the prevalence of common breast lesions in our environment. It simultaneously compares these with previous studies done here. Background: Our population like others in Sub-Saharan Africa is unexplored in terms of reliable health data on breast lesions and it is also a poorly screened population with virtual absence of mammography. Histopathology Departmental records show that the prevalence of breast lesion is increasing, growing from a yearly all time low of 93 specimens in 1999 to 358 biopsies in 2006, a 285% increase. Design: Two thousand two hundred and seven breast specimens were received in our Histopathology Department from January 1998 to December 2007. It is a reference laboratory catering for nearly 30 million people. These were analyzed using simple percentages to update data on breast lesions in our environment. Results: The most common breast lesion is fibroadenoma with n = 674 (30.5%). Its mean age of presentation is 23.8 years Standard Deviation (SD) 7.4 years. All were diagnosed as palpable lumps, the average sizes of these lumps at presentation were 3.2cm x 2.3cm x 1.4cm. Next was fibrocystic change with n = 343 (15.5%), presenting later, average age 34.1 SD 11.8 years. They presented as breast lumps measuring 4.2cm x 2.6cm x 1.6cm larger than the later. Phylloide's tumor (benign variant) n = 87 (3.9%) was seen at a mean of 23.1years SD 7.8 years. Mean size of Phylloide's was 13cm x 10.5cm x 5cm. Carcinomas of the breast had n = 649 (29.4%) with 640 females and 9 males. The average age of male presentation was 57.2years. Female breast cancers constituted 98.6% of cases and generally the mean age of presentation is 41.6years SD 11.4. Forty four % of the malignant samples were mastectomies while 55% were breast lumps whose average sizes were 5.6cmx4cmx2.5cm with 72% lymph node positive at presentation. The rest 450 (12.7%) represented other benign lesions. Conclusions: The most common breast lesion in our environment is fibroadenoma, it is likely to present in a young woman in her early twenties, as a lump of size less than 3.5cm. Large breast lumps measuring more than 6cm in its longest diameter and presenting in girls of same age are likely to be benign Phylloide's. Breast cancer presentation occurs at a mean age of 41.6 years, with 72% of lymph nodes positive at presentation. The relatively large sizes of the breast lumps and absence of lumpless cases are in keeping with a poorly screened population.

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Background and Purpose: Post stroke reactive hyperglycemia has been associated with increased mortality and poor recovery in nondiabetic patients. Few studies have demonstrated the relationship between stress hyperglycemia and stroke outcome in Africans. A prospective study was done to evaluate the prevalence of abnormal glucose metabolism in nondiabetic stroke patients and the risk of poor outcome in such patients. Methods: Fasting plasma glucose was done after admission and patients were followed up for 30 days. Outcome was measured using the Modified Rankin scale based on the last score of each patient. Comprehensive literature search was done on relevant topics. Relative risks was calculated for plasma glucose above and below 140mg/dl. Results: One hundred patients were recruited. Thirty-nine percent had plasma glucose levels below 110mg/dl, 15%-between110-125.9 and 12%-between126-140 while 34% above 140 mg/dl. The percentage with poor outcome corresponding to plasma glucose levels were 53.9%, 46.7%, 58.3%, 72.6% respectively. The risk of death for patients with plasma glucose above 140mg/dl was 1.116 (95% CI, 0.769-1.618), and for patients ≤140 mg/dl was 0.742 (95% CI, 0.253-2.175). A moderate positive correlation was found between Admission plasma glucose and outcome (r = 0.330, p=0.042), indicating that admission plasma glucose moderately affects outcome. Conclusions: There was a high rate of admission hyperglycemia in nondiabetic stroke patients. Post stroke hyperglycemia predicted increased risk of poor recovery in nondiabetic stroke survivors.

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Background: Unilateral renal agenesis (URA) or solitary kidney usually presents as non-ectopic solitary functioning kidney (SFK) with absent contra-lateral kidney. Although it is compatible with normal longevity, recent studies indicate that arterial hypertension, proteinuria, impaired renal function as well as glomerulosclerosis are potential complications. Case Report: We report a male adolescent patient who presented pre-mortem with features of acute renal failure and lobar pneumonia. Post-mortem examination revealed a solitary kidney with light microscopic findings suggesting membranoproliferative glomerulonephritis (MPGN) as the fundamental disease. The short duration of hospitalization and paucity of diagnostic facilities precluded a more accurate confirmation and classification of the glomerular disease. This report however highlights possible pathological scenarios, as well as the handicaps in the practice of Nephrology in this environment.

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Background: It is generally believed that a lactating mother is in a negative nutritional balance and this has often led to all forms of micronutrient supplementation including iron. However the iron status of our lactating mothers has received little or no evaluation. Aim: In this study, we determined the serum iron (SI), total iron binding capacity (TIBC) and percentage transferrin saturation (%TS) in lactating mothers on exclusive breastfeeding. Methods: Seventy (70) apparently healthy female subjects aged between 22-42 years were recruited. Fifty (50) were recruited from lactating mothers on exclusive breast feeding (EBF) attending the post-natal clinic of the University of Nigeria Teaching Hospital (UNTH) and Enugu State University Teaching Hospital(ESUTH), while twenty (20) non-lactating mothers served as control. After a 24 hour dietary recall, SI was determined by atomic absorption spectrometry (model 2380; Perkin Elmer, Walthman, MA),TBIC by Bathophenanthroline method %TS calculated from the TIBC. Results: There were no statistically significant differences in age, parity, estimated caloric and iron intake (p>0.05). The mean values for the lactating mothers on EBF were, serum iron 172.2 ±45.3 μg/100ml, total iron binding capacity 313.7±70.5μg/100ml and percentage transferrin saturation 54.8%. The mean values for the control group were, serum iron 121.2 ± 30.9μg/100ml, TIBC 335.6±88.2μg/100ml and %TS 36.1%.The differences were statistically significant (P<0.001) Conclusion: Exclusive breast feeding does not deplete maternal serum iron, hence does not have any adverse effect on maternal iron metabolism and homeostasis. As a result, Iron supplementation in lactating mothers on EBF, may not confer any advantage especially when maternal nutrition is adequate.

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Background: Strokes account for a large number of medical admissions and neurological admissions in Nigeria. The frequency of the different types of stroke is difficult to ascertain because clinical diagnosis is not always correct. Non-contrast cranial computed tomography (CT) scan reliably distinguishes between ischemic stroke (IS) and hemorrhagic strokes (HS) and will provide a reliable characterization of stroke types in the developing countries. Aims: To examine stroke types based on CT Imaging studies and the differences in stroke types based on age. Methodology: A retrospective study of CT register of Memfys Hospital for Neurosurgery was done covering a period of four and half years. Results: One hundred and six cases which met the criteria were reviewed. Seventy two (67.9%) were males and 34 (32.1%) were females, with a male female ratio of 2.1:1. The proportion of ischemic stroke (IS), Intracerebral hemorrhage (ICH) and Subarachnoid hemorrhage(SAH) was 66.7%, 22.6%, 16.1% respectively. There was a relative preponderance of IS above the 8^th decade and hemorrhagic stroke (ICH and SAH) in the 5^th decade. Conclusion: This study confirms the high proportion of IS and the relative high proportion of ICH and SAH among Nigerian Stroke patients.

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Objective: To determine the prevalence of microalbuminuria among diabetic patients seen in two tertiary hospitals in Enugu, southeast Nigeria and its relationship with the patients' characteristics. Materials and Methods: Ninety three (93) patients, 46 males, aged between 35 and 71 years and registered in the diabetic clinics of the University of Nigeria Teaching Hospital, Ituku/Ozalla and the Parklane Specialist Hospital, both in Enugu Southeast, Nigeria were randomly selected for the study. Results: Fifteen (15) patients (16.1%) had microalbuminuria. The mean (±SD) concentration of microalbumin of the patients was 31.74 (±9.69) mg/dl. The mean (±SD) age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), and duration of diabetes of the patients with microalbuminuria were, 53 (±11) years, 26.1 (±4.7) kg/ m², 147.9 (±22.7) mmHg, 89.7 (±11.9) mmHg, 11.9 (±6.7) mmol/l, 6.0 (±4.0) years respectively. For the whole study population, corresponding values were 57.0(±13.0) years, 26.9 (±5.9) kg/m², 139.2 (±22.8) mmHg, 83.1 (±11.8) mmHg, 9.9 (±5.9) mmol/l, and 6.0 (±5.0) years. The mean BBP and FBG values of patients with microalbuminuria differed significantly form that of patients without microalbuminuria, p< 0.05. Microalbumin concentration did not correlate with any of the parameters but was associated with poorer glycaemic control, higher SBP and longer duration of illness and the male sex. Conclusions: The recorded 16.1% prevalence of microalbuminuria in this study is an indication of high cardiovascular risk and predisposition to severe renal damage. There are drugs for early intervention to delay progression or reverse early glomerular damage. It is recommended that regular check for microalbuminuria be incorporated in the care of Nigeria diabetic patients in order to detect and treat early glomerular damage.

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Aim: To describe the pattern of surgical admissions in University of Nigeria Teaching Hospital, Enugu from 1997 to 1999. Materials and methods: The study was a retrospective study. Data were collected from the theatre registers, ward admissions and casualty admission records at the University of Nigeria Teaching Hospital Enugu, Nigeria. Results: Three thousand four and fifteen surgical patients were operated upon between January1997 and December 1999 in the University of Nigeria Teaching Hospital. This constituted 15.8% of total admissions into the hospital within that time period. The commonest age group that had surgery was 0 – 9 years. The mean age of all surgical patients was 32.7years. Adult to paediatric ratio was 2.5: 1. Hernia (20.0%), intestinal obstruction (12.6%), appendicitis (10.8%), benign prostate hypertrophy (11.4%), cancer of the breast (10.0%) and goiter (8.4%) were the commonest surgical conditions. The digestive system and genitourinary systems were the most commonly affected systems. Emergency admission accounted for 18.1% of all surgical admissions while elective admissions accounted for the rest. Conclusion: More detailed research on the pattern of admissions is important in planning and should be carried out regularly as a management tool. Better record keeping and computerization of the records department is recommended.

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Background: Angio-oedema is a diffuse oedematous swelling of the soft tissues which can be as dramatic as it is brief. It is a subcutaneous extension of urticaria resulting in deep swelling within the subcutaneous sites usually the eyelids and lips. Case Report: The aim of this paper is to report a case of recurrent angio-oedema post consumption of certain food in an adult male patient. In this case, it occurred not only in the upper lip, as was usual with this patient, but also in the lower lip. Patient was effectively managed with an antihistamine drug. It was concluded that angio-oedema associated with food allergy can become more extensive than is usual even in the same patient. Recurrent angio-oedema is the hallmark of various inherited or acquired angio-oedema diseases. Among these diseases, hereditary angio-oedema, or HAE, due to C1 inhibitor, or C1NH, deficiency—HAE type I and type II—has considerable implications for dental health care providers because dental surgery may trigger distressing and even life-threatening oedema of the face, tongue and larynx.

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Background: The body heat exchange, environmental stress and protective clothing becomes stressful in military service too. The use of microporous material and ventilation of garment significantly improve heat exchange, hence reducing physiological strain and improving tolerance to the heat. Moisture absorption, directional radiation, solar radiation, condensation and their interaction with wind may have influence on heat exchange. Aim: To review the role of protective clothing in heat stress stress in military service. Conclusion: Protective clothing serves the purpose of eliminating or reducing the effects of heat stress factors. Protection against chemical and physical agents in most cases implies the use of special fabrics.

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Background: this study was carried out on 12 – 15 year old Nigerian school children to measure and provide baseline data for the gonial angle. Study design: One hundred orthodonticaly untreated subjects were randomly selected by multistage sampling to participate in this study. Lateral cephalometric radiographs of the one hundred, 12-15 years old school children, were taken. Manual tracings of the cephalograms were done and the measurements were recorded, summarized and statistically analyzed. Result: The mean age of the population studied was 12.16years. There were 40 males (40%) and 60 females (60%). The gonial angle for males was found to be 128.04° ±3.69° while that for females was 128.67°±4.99°. No significant difference was noted in the mean value for males and females. (p<0.05). Following a combined data analysis for both males and females, the mean biological gonial angle value obtained was 128.42° ± 5.05°. Conclusion: No significant difference was noted in the values for males and females.

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Aim: A cross-sectional study was conducted in November, 2008 to assess the HIV/AIDS risk perceptions and safe practices among youths in Enugu Metropolis. Materials and Methods: A semi-structured questionnaire was used to collect data from 300 youths who were selected by a multistage sampling technique. Results: Awareness of HIV/AIDS was high. Knowledge of most routes of transmission and some preventive methods were also high. Slightly more than half (54.3%) knew of mother to child transmission. Seventy percent knew that prostitutes are at risk, but knowledge of other people at risk was poor. More than 80% engage in such safe practices as use of safe blood and safe sharp instruments. Knowledge and utilization of PMTCT was slightly above average but referral of rape victims to appropriate centres was very poor (6.3%). Although awareness and attitudes to VCT was high, the percentage of respondents who had ever screened for HIV was low (37.7%). Conclusion & Recommendation: Although knowledge of HIV/AIDS was high, that for people at risk was low and the practice of routine VCT and appropriate management of rape victims were poor and efforts should be made to correct these.

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Aim: Tuberculosis and HIV/AIDS together pose the greatest threat to human health. This study assessed the prevalence and socio-demographic variables of persons affected with TB and TB/HIV co-infections at the chest clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Methods: A retrospective study of 726 patients treated at the chest unit, UNTH from 2003 to 2005 was conducted. A simple random sampling technique was used. Data proforma was used to extract information from the patient's folders, treatment cards and clinic registers. Level of significant was set at 5% confidence level. Results: The prevalence of pulmonary tuberculosis (PTB) and TB/HIV co-infection were 85.7% and 14.3% respectively. The age group 20-39 years had the highest prevalence rate of 51.8% for PTB and 72.2% for TB/HIV co-infection.. Students, traders and civil servants had the highest occupational prevalence of 29.0%, 27.7%, 18.6% respectively for PTB and 22.1%, 35.6% and 15.4% respectively for TB/HIV co-infection. The prevalence of PTB was higher among male patients (59.6%) than female counterparts (40.4%) but the prevalence of TB/HIV co-infection was higher in the females (53.8%) than the males (46.2%). The observed differences in the prevalence rates were statistically significant (p=0.000). Conclusion: There is a corresponding high prevalence of PTB and TB/HIV co-infections among patients attended to in the chest unit of the UNTH for the period 2003 through 2005. Regular and targeted health education intervention on TB and TB/HIV co-infection is recommended for these patients in the future.

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Aim: To ascertain the knowledge of malaria transmission mechanisms, presentations, commonly used control measures and treatment modalities among residents of Enugu urban, Nigeria. Materials and Methods: This was descriptive cross-sectional study. A multistage sampling method was used. A pre-tested semi-structured questionnaire was used for data collection. The questionnaire was interviewer administered to less literate respondents and self administered to the literate ones. Result: The knowledge of the respondents about mosquito, malaria vector, breeding site and the malaria parasite were 197(98.5%), 158(79.0%), 182(91.0%) and 130(65.0%0 respectively. Symptoms of malaria were identified as loss of appetite, 101(50.5%), fever/chills, 70(35.0%), and headache, 64(32.0%). One hundred and seventy-two (86.0%) knew about use of blood test for malaria diagnosis. Environmental cleanliness, 166(83.0%), ITNs, 95(47.5%) and insecticide spray, 81(40.5%) were the control measures mostly used by the respondents to control malaria. Most respondents, 118(59.0%) used orthodox drugs in decreasing order as follows: sulphadoxine-pyrimethamine groups 86(43.0%), quinine based drugs 44(22.0%) and Artemisinin combination therapy by 16(8.0%). The differences observed in the correct and incorrect knowledge of malaria, the use and beliefs about the effectiveness and efficiency of orthodox and unorthodox drugs in malaria treatments among the respondents were statistically significant(p<0.05). Conclusion: Residents of Enugu urban were knowledgeable about malaria and its transmission mechanisms. However, only 47.5% and 8.0% percent of them used the recommended ITNs and Artemisinin based combination therapy for malaria prevention and treatment respectively. Additionally, both the orthodox and unorthodox drugs were freely used for malaria treatment.

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Aim: To measure patients' satisfaction with anaesthesia care and use it as a tool to provide a feedback on the quality of practice of anesthesia in our centre. To examine the validity of this tool as a means of evaluating anaesthetic care. Study design: This is a prospective questionnaire based study. They were standardised postoperative face to-face interviews with open- and close-ended questions. Patients were chosen by simple random sampling. The questionnaires were administered on the second postoperative day. The questionnaire was subdivided into a set of questions. Anaesthesia specific rating of preoperative visit, preparation, and anaesthetic administered were assessed on a 3-point scale. A 5-point scale was used to assess the overall rating of anaesthetic care. Results: A total of 43 patients were interviewed. They were 17 males and 26 females. Anaesthesia specific rating showed that 90.1% of patients were satisfied with the preoperative visit, 95.3% with preparation, and 74.4% with anaesthesia. Study design was rated 40/60 using Patient Satisfaction with Anesthesia Care–Analysis Tool (PSACAT). Conclusion: We conclude that the anaesthetic service offered in our centre is reasonably tolerated and acceptable to patients.

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Background: According to 2006 AIDS epidemic update global summary, the total number of people living with HIV/AIDS world wide is about 39.5 million (34.1-47.7million).¹ In Nigeria about 2.9 million (1.7-4.2 million) people were living with HIV/AIDS in 2005.² The AIDS epidemic continues to spread rapidly among the youth.³ Objectives: To ascertain the perception attitude and practice of voluntary counseling and testing (VCT) for human immune deficiency virus among undergraduates in a Nigerian Tertiary Institution. Methodology: A cross sectional descriptive survey was carried out among 185 undergraduates of the University of Nigeria Enugu Campus using a self administered questionnaire. A total of 200 questionnaires were distributed, fifteen were not returned hence 185 undergraduates were included in the study. Result: The result is from the study carried out in January 2009. Mean age is 22 ± 3.7 SD, 104 (56.3%) males and 80 (43.2%) females. Most 171 (92.4%) were aware of VCT, 177 (95.7%) felt that VCT was important. Inspite of this however a small proportion 48 (25.9%) of the respondents attended VCT services. Most of the respondents gave their reason for non use of VCT as having no knowledge of where to obtain the VCT services. Conclusion and Recommendation: The undergraduates were found to have good knowledge of VCT, access VCT services but low use of the services was discovered. It is therefore recommended that intensive health education and awareness campaign be carried out among the undergraduates to increase their uptake of VCT services.

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