Background: Postoperative pain remains one of the greatest concerns during and after cesarean section (CS). Various regimens have been used for post-cesarean pain control including opioids but unfortunately, the intolerability and addictive tendencies of opioids have reduced their acceptability necessitating other more effective and well tolerated alternative. Objective: To determine the effectiveness of diclofenac sodium combined with pentazocine versus pentazocine alone in reducing post-operative pain after CS. Methods: This was an open-label, quasi-randomized clinical trial of 67 women that underwent CS and received either duplet (administration of diclofenac sodium tablets rectally every 12 hours and pentazocine intramuscularly every 6 hours) or single (pentazocine alone) pain treatment, all for 48 hours. Primary outcome measure was visual analogue pain score. Secondary outcome measures were women's satisfaction, commencement of oral sips, mobilization, breastfeeding and return of bowel function including maternal adverse effects. Statistical analysis involved descriptive and inferential statistics at 95% level of confidence using the Epi Info 2008 version 3.5.1. P ≤ 0.05 was considered statistically significant. Analysis was by intention-to-treat. Results: Women receiving duplet treatment, as compared to pentazocine only, experienced less pain (p < 0.001; OR=15.56; 95% CI=4.03 to 64.94), greater good patient' satisfaction (p<0.001; OR=21.54; 95% CI=5.29 to 96.43), and mobilization at less than 24 hours of surgery (p<0.001; OR=116.25; 95% CI=16.52 to1125.66). No significant difference was seen in initiation of oral sips, breastfeeding, return of bowel function and maternal adverse effects (p>0.05). Conclusion: Diclofenac combined with pentazocine significantly reduced pain, increased patient' satisfaction and earlier mobilization during post-cesarean period compared to pentazocine alone.

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Objectives: This study aims to determine the prevalence and factors associated with susceptibility to stress-related illnesses among medical students in a Nigerian medical school. Methods: A total of 379 medical students were enrolled by simple random sampling. A selfadministered ‘International Stress Management Association’(ISMA) STRESS questionnaire was used to evaluate susceptibility to stress-related illnessesamong the subjects. Statistical analysis was done with the Statistical Package for Social Sciences (SPPS) version 19 (Chicago IL). Results: Among the medical students studied, 21.1% (80/379) are susceptible to stress-related illnesses and could be prone to many traits or characteristics that are creating un-healthy behaviours. Females 15.7% (26/379) are more susceptible to stress related illness when compared to males 25.4% (54/379) and it is statistically significant (p<0.05).Those from upper class are more susceptible to stress related illness when compared to other classes, though this is not statistically significant. (p= 0.45). Conclusions: A relatively high number of medical students are susceptible to stress-related illnesses with a female predominance.

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Background: Lumbar canal stenosis often associated with chronic low back pain describes abnormal narrowing of the lumbar spinal canal, likely resulting in compression of neural elements within the spinal canal and the lateral recesses. This study seeks to determine the proportion of cases of lumbar canal stenosis among adult patients presenting with chronic low back pain and the pattern of findings seen on MRI of the lumbosacral spine at Memfys hospital for Neurosurgery, Enugu. Methods: Retrospective study of MRI images for 300 adult patients of both sexes presenting with chronic low back pain between January 1st and December 31st 2013. Statistical analysis done using Statistical Package for the Social Sciences IBM – SPSS for windows version 21.0 (2012). Results: Out of 300 patients with chronic low back pain, 134 (44.7%) showed MRI features of canal stenosis. Mean and median ages were 57.3 and 58.0 years respectively. There were more females (57.5%) than males (42.5%). Commonest and least affected sites were L4/5 and T12/l1 respectively. Pattern of lumbosacral MRI findings was as follows, postero-lateral disc herniation (92.5%), ligamentumflavum hypertrophy (53.7%), kyphosis (26.1%), facet hypertrophy (25.4%), retrolisthesis (18.7%), vertebral degenerative changes (17.9%), vertebral fracture (11.9%), spinal mass (9.7%), vertebral mass (9.0%) and scoliosis (7.5%). Conclusion: More than two in five adult patients presenting with chronic low back pain may also have lumbar canal stenosis. MRI of the lumbosacral spine shows various osseous and soft tissue anomalies among this group of patients.

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Background: Sulfonamides represent a large class of antibiotics that have multiple clinical uses. However, therapeutic abuse in the treatment of multiple anti-malarial drug resistant Plamodium falciparum calls for immediate attention. Aim: This study is to investigate possible histological alteration of the liver and kidney of Plasmodium-infested mice exposed to indiscriminate consumption of sulfonamide based drugs. Methods: Thirty infested mice of both sexes, with average mean weight of 19.98g were randomly grouped as (A, B, C, D and a control group E). Graded dose of Laridox^(SP) were orally administered to the mice in order of 0.1, 0.2, 0.3 and 0.4mg/kg body weight respectively with respect to 1.8mg/kg LD₅₀ (oral). Commercially purchased drinking water, standard top feed^(R) was given ad libitum, for 10 days. The mice were weighed before and after drug administration while the animals were sacrificed by cervical dislocation on day 11. Grossing was done and was fixed in 10% buffered neutral formalin. Cut tissue at 3-5mm was processed according to paraffin embedding technique while section was cut at 3- 5microns for light microscopy. Results: Grossly, the organs of animals in group C and D showed variation in colour while empirical measurement revealed weight loss in both test and control. Histopathology findings showed inflammatory cells infiltration, congestive glomerulus, and haematoma, thickening of the interstitial cells with tubular necrosis, distortion and vacuolation of the portal vein. Conclusion: This study showed that therapeutic abuse of sulfonamide based drugs may have such cellular deleterious effect on humans in a similar circumstance.

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Abdominal Pregnancy often constitutesa life-threatening obstetric emergency. The associated maternal morbidity and mortality are very high especially in advanced cases. We present an intriguing case of long lasting (four years duration) of advanced abdominal pregnancy in a 32-year- old retroviral disease positive G₂P₁ ⁺⁰ woman with no living child. Following initial evaluations and diagnosis at different peripheral hospitals, she declined consent for surgery despite counselling because of erroneous believes that her problem was ‘spiritual’. However, her illness persisted and she eventually presented at the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu where she finally consented to exploratory laparotomy. An organized 26weeks size thick-walled mass, containing necrotic fetal parts with easily identifiable skull and long bones was delivered. There was also an adjourning sterile abscess collection that was evacuated. Her post-operative recovery was uneventful. The delay in carrying out exploratory laparotomy on this women caused by her initial refusal to give consent brings up controversies surrounding ethical principle of personal autonomy which were also highlighted in this case report.

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