Background: Several mechanisms have been put forward to explain myocardial dysfunction in sickle cell anaemia. Aims and objectives: This study was aimed at examining the effect of haematocrit parameters on echocardiographic indices of cardiac dimension in adult sickle cell anaemia patients. Methods: A descriptive cross sectional study was done using 60 patients and 60 controls at the adult sickle cell clinic of the University of Nigeria Teaching Hospital Enugu, Nigeria. All the participants had haematocrit estimation, haemoglobin electrophoresis, as well as echocardiographic evaluation. Results: The patients had significantly higher mean values than controls in the estimate of left atrial diameter, posterior wall thickness, left ventricular diameters and volumes, left ventricular mass as well as cardiac index, and right ventricular dimension. Significant correlations were demonstrated in the patient between haematocrit and (1) left atrial dimension {-0.418; p = 0.001}, (2) left ventricular mass index {r = - 0.268; p = 0.038 }. Regression model involving haematocrit accounted for 8.00% and 16.07% respectively of the variations in left ventricular mass (F=5.219; P=0.026), and left atrial dimension (F=11.488; P=0.001). Conclusion: The mechanism of cardiac dysfunction in the sickle cell anaemia is multifactorial with the combined effects of anaemia and sickling playing the major role.

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Background: There is a high prevalence of the S gene in the African population. The economic, social and psychological burden the disease possesses on sufferers and caregivers necessitates fundamental knowledge of the disease. Methods: A total of 500 students (male=340, female=160; mean age, 24±4.5 years) drawn from various faculties and departments and different study levels in University of Benin, Nigeria were studied. This cross-sectional study was conducted between January 2006 and September 2006. Data were collected using a questionnaire containing both open and close ended questions developed by the authors. Data were analyzed descriptively. Results: A majority of the respondents (82.6%) had an appropriate knowledge of the clinical characteristics peculiar to sickle cell anaemia. Respondents attitudes towards positive haemoglobin SS foetus was no termination of pregnancy (45.2%) with religious convictions (32.6%) and right to life (21.2%) as the main reasons given. Avoidance of suffering (50.8%) both to the carrier and caregiver was the main reason given in favor of therapeutic abortion. Conclusions: The need for increased enlightenment cannot be over emphasized. It is recommended that genetic counseling be made a vital aspect of the curriculum irrespective of faculties/departments of admission as a means of controlling the sickle cell disease.

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Background: Surgical audit is a normal part of surgical practice. Earlier reports on the availability of oral and maxillofacial surgical services in Nigeria showed limited number of centres and shortage of specialists. Objective: To determine the pattern of oral and maxillofacial surgical diseases in order to establish the local demographic data base and subsequently structure service delivery on evidence-based disease profile. Materials and methods: A retrospective study using the admission registers and folders of cases treated in the oral and maxillofacial unit in the period of January 2005 to December 2010 in a Nigerian teaching hospital. Results: Within the period, 7948 patients were seen and17.0% needed oral and maxillofacial surgical treatment. Ratio of male to female subjects was 4:1, whereas the age of subjects ranged from one-83 years with mean age at 38.7±10.6 years. Both congenital (0.8%) and acquired (99.2%) cases were recorded. Subjects that had acquired conditions were categorized into traumatic (67.1%) and non-traumatic (32.1%). The commonest aetiological factor (79.1%) causing disease was road traffic accident. The common treatments were intermaxillary fixation (54.8%) and resection (7.5%), whereas the complications were limitation in mouth opening, 22.1% and facial deformity, 19.5%. Conclusion: The commonest indication for consultation was trauma, and since resources for care are scarce in Nigeria, the focus should be to reduce the disease burden by prevention.

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Background: Malaria is a major public health problem in Sudan and causes an enormous burden of morbidity in the country. Malaria is generally controlled in Sudan using five main approaches, which are environmental management, space spraying (SS), insecticide-treated nets (ITNs), larviciding with abate (LWA) and indoor residual house spraying (IRHS). However, it is not clear which options or mix of options present the most economically viable means in terms of financing and delivery, for malaria control. Methods: The study used an interviewer-administered questionnaire administered to malaria control managers at national and sub-national levels, as well as the review of documents to collect information at three levels of service delivery: National, State and Local. Three localities were selected from each state to represent an urban, peri-urban and rural area. Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis is undertaken on the financing and delivery schemes. The respondents assigned scores based on several SWOT indicators, which were: dependability, sustainability, timeliness, equity, sufficiency, and affordability. The scores for the different SWOT indicators were added-up for each vector control mechanism. Findings: The funding for the four strategies was dependable but only the funding for ITNs was rated highest on the sustainability criterion and financing of IRHS and SS were deemed not to be sustainable. Overall, financing of LWA followed by ITNs had the highest SWOT analysis scores on the financing criterion. The delivery strategies of three out of four vector control activities were rated poorly efficient, integrated, and timely. Only the delivery of ITNs and LWA were rated by the control managers as optimally sustainable. Overall, the delivery of LWA, followed by ITNs, was rated highest on the delivery criterion. Conclusion: SWOT analysis revealed critical issues with financing and delivery of the different malaria vector control interventions. These issues need to be resolved for optimal malaria control activities in Sudan.

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Background: Reciprocal pulley exercise is usually recommended for physiotherapy patients undergoing rehabilitation for muscle strengthening exercises or improvement in joint range of motion but, very little is known of its effects on the cardiovascular system. Aims: This study aimed at investigating the blood pressure and pulse rate response to resistive and nonresistive pulley exercises among apparently healthy subjects. Methods: This is an experimental study involving a pretest-posttest randomized groups design. Eighty apparently healthy subjects from the age of 18 to 25 participated in the study. Their informed consent and the hospital ethical approval were duly obtained. They were grouped into two: group A carried out resisted reciprocal pulley exercise while group B carried out free reciprocal pulley exercise, for 50 repetitions while sustaining each stretching for 5 seconds. Their blood pressure and pulse rate was measured before and immediately after the exercises. The data was analysed using t-test. Results: The results showed that the group A subjects recorded a significant increase in systolic BP (p =0.015) and pulse rate (p = 0.0034) but no significant increase in diastolic BP (p = 0.204). The group B subjects recorded significant increase in pulse rate (p= 0.005), systolic (p = 0.035) and diastolic BP (p= 0.003). Conclusion: It is concluded that reciprocal pulley exercise may have significant changes in blood pressure and pulse rate.

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Aim: To study testicular torsion in teenagers in the Igbo community. Method: A retrospective study was carried out as regards requests for pathological examination of specimens received at a Regional Reference Laboratory based in Enugu. Results: Over a period of 30 years, 28 surgical specimens of testicular torsion in Igbo teenagers were received. They were submitted by 18 doctors working in 6 of the numerous towns inhabited by the Ibos or Igbos. The peak age was 16 years. The right testis (64.3%) was involved more often than the left unlike Western reports. Three patients reported within 24 hours of experiencing the usual pain and swelling. Most testes showed advanced necrotic changes. Perhaps, the lesion is uncommon in the community. Certainly, as many as 14 doctors sent but a specimen each. Since the Teaching Hospital at Enugu accounted for fully 16 cases, this suggests that most patients had to travel long distances to obtain treatment. Conclusions: These findings indicate the need for health education as well as the provision of more specialist hospitals for the teeming Igbo communities. We hope that this will be attained through those now springing up in Abakaliki, Orlu, and Aba.

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Background: Diabetes mellitus causes great health complications which include cardiovascular diseases and nerve damage. Aim: To ascertain the participation in blood glucose test, knowledge of diabetes mellitus (DM) and prevalence of hyperglycemia among traders at New market, Enugu State. Methods: The study is a cross-sectional survey involving measurement of random plasma glucose level of the participants using Accu-check glucometer, and collection of data on the knowledge and participation of subjects in blood glucose test using structured questionnaire. The informed consent of the participants was duly obtained after detailed explanation of the objectives and procedures of the study. All the participants had a minimum of senior secondary school education. They were 130 (50 males and 80 females) from the age of 40 years and above. The data collected include participation in blood glucose test, knowledge of diabetes and prevalence of hyperglycemia. The data was analyzed descriptively. Results: The results showed that 53.08% was aware of DM while, 46.92% was unaware; 11.54% of the people have checked their plasma blood glucose level within four years while 88.46% had not; 91.53% had normal plasma blood sugar level while, 8.46% had hyperglycemia; 36.36% of participants with hyperglycemia was aware of their diabetes status while, 63.64% was unaware. Conclusion: There is high percentage of participants who were aware of diabetes mellitus; high percentage of those who have not checked their plasma glucose level within 4 years, low prevalence of hyperglycemia and high percentage of those who were not aware of their diabetes status.

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Background: Transthoracic echocardiography (TTE) is one of the most commonly performed cardiac investigations. It can provide comprehensive information about cardiac structure and function helping to establish a diagnosis and guide therapy, and it is no longer the preserve of the specialist cardiology department. Examinations are frequently requested by doctors in other branches of medicine, and they need to know what question an echocardiogram can answer .The commonest reason for undertaking an echocardiographic examination (echo) is to assess left ventricular function. Previous studies on the indications for echo had documented valvular heart disease, hypertensive heart disease and congenital heart diseases as the commonest indications for echo in Nigeria. Some of these studies were done over a decade ago, and with the changing patterns of cardiovascular disease in our environment, an update is necessary Methodology: We reviewed the echocardiogram records of 608 patients (mean age 46.4 ± 21.4 years) done from July 2009 to October 2011. 56% of the subjects were males, while 44% were females. Results: The commonest indications for echo were hypertensive heart disease, heart failure and valvular heart diseases. The commonest echocardiographic diagnoses were degenerative aortic valve disease, left ventricular diastolic dysfunction and degenerative mitral valve disease. Conclusions: Valvular heart diseases are still the commonest findings in patients presenting for echocardiographic examination in Enugu.

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The frontal sinus is a bilateral asymmetric and pyramidal structure located in the frontal bone. It is absent at birth. The frontal sinus is extremely resilient to injury. However, high velocity impacts such as motor vehicle accidents and assaults can result in frontal sinus fractures. Such high velocity impacts lead to aesthetic deformities. CSF leakage, hypoaesthesia and anaesthesia of the supra-orbital area. Long term complications associated with such injury include sinusitis and mucocoele formation. With Multidisciplinary approach, endotracheal anaesthesia, advent of CT, reconstruction of facial bones along with new surgical techniques has dramatically improved the final outcome and appearance of patients who have sustained bonny injuries to the maxillofacial structures. This reality is completely or wholly the case in most developing countries and Maxillo-Facial centres. Our experience at the maxillofacial unit of Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria, in managing such a case is shared here.

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