Before the discovery of specific antibiotics for the treatment of tuberculosis, there was no cure . It took several millennia before the specific organism was uncovered and appropriate drug therapy discovered . initial euphoria of this discovery was dashed by early occurrence of drug resistance . This was overcome , but not completely so, by the use of multi drug therapy. The issue of multi-drug resistant tuberculosis which was a growing concern , even in advanced countries, became more intense by the advent of the Human immun Deficiency Virus (HIV) infection. However, due to growing scientific knowledge , the lessons learnt from the handling of mycobacterium tuberculosis and the disease ca used by it , the war against the HIV and Acquired Immunodeficiency Sydrome (AIDS) which it causes, is being fought in all fronts . The delays experienced with the old disease has been overcome by increased knowledge and interest since the effect of the later on the population has been found to be devastating. co-infection of both diseases or a super-infection of one upon the other presents more complex management problems that have stimulated more intense research. It is hoped that the results of these research works may unearth the solution to the problems of both diseases.

Objective: Caesarean section rate has been on the increase of recent. This study therefore looked at he hospital Caesarean section rate, the indications and the reasons for the high rate . Materials : Caesarean sections performed at the UNTH , Enugu over a two-year period (January 1995 -December 1996) were reviewed. Results: Of the 1 ,641 deliveries, 450 were by caesarean section giving a rate of 27.4%. The commonest indication was two previous caesarean sections. Other major indications were, cephalopelvic disproportion ( 18 .2%), fetal distress ( 17.1%) , pregnancy induced hypertension (16 .1 % ), obstructed labour (14 .0%) . 40.4% of the patients were primigravidae and 26.0% of the cases were unbook e d while 56.7% were emergency procedures. Conclus.ion : The hospital caesarean section rate of 27 .4% represents 1 .5 fold or 66.8% rise over previous study. Some of the indications might not be justified if necessary facilities for fetomaternal monitoring and requisite manpower were available and properly utilized. The importance of education of our women on the need for early booking, regular attendance to antenatal clinics and \..hospital delivery is also emphasized

The prevalence of asymptomatic proteinuria was estimated among 1203 primary school children in the geographic wards of Jos metropolis using dipstick test on early morning urine samples. The prevalence rates of 1.95% and 0.5% using the criteria of .3g / L (+) and :?1 g/ L (++) respectively were lower than those described by previous studies. Also, in contrast to ot her studies, there was no relationship between the prevalence rate and gender at all ages. conclusion, the very low prevalence of proteinuria among asymptomatic children, using early morning urine samples makes it a cheap and reliable tool for the preliminary investigations of suspected renal pathology in clinical practice.

Solid waste management is associated with health hazards. The objective of the study was to describe and quantify the type of parasitic infections among waste handlers using formol-ether concentration technique. Stoll egg count method was adopted in the quantitation of the cysts and eggs. The frequency of parasitic infestation among waste-handlers were as follows: technical staff, (53 .3%) drivers , (81 .8%) refuse-van loaders (69 .3%), street sweepers (63.5%) and barrow-pushers 80.0%. Entamoeba histolytica was found in 18.2% of drivers , 3.5% refuse-van loaders and 10.0% o.f barrow pushers . Giardia Iamblia was detected in 10 .0% of barrow-pushers alone. About 2.3% o.f van-loaders were infected with Balantidium coli. Ascaris lumbricoides eggs were detected in 5 (16 .7%) technical staff, 14 (15 .9%) van-loaders , 3 (15.0%) barrow-pushers, 11(14.9%) street­ sweepers and 3 (13 .6%) drivers. Ancylostoma duodenale infected 7 (31 .8%) drivers, 24 (32.4%) street-sweepers and 6 (30 .0%) barrow- pushers. About 3 (10.0%) technical staff, 9 (10.2%) refuse­ van loaders , 8 (10.8%) street sweepers and 2 (10.0%) barrow-pushers were infected by Schistosoma mansoni respectively Hymenolepis nana infected only 3 (10.0%) of technical staff, while Trichuris trichiura eggs were found in 5 (4.6%) refuse van-loaders, 4 (5.4%) street-sweepers and 1 (5 .4 o/o ) barrow- pushers. Parasite egg intensity was, however, low with Ascaris lumbricoides showing 86 ,226 ΁795 eggs per gram ( epg) ,Ancylostoma duodenale 17 ,352΁156 epg, Trichuris trichiura 1295΁219 epg and Hymenolepis nana 265΁44 epg. Waste d isposal workers are at hiqh risk of infection with different species of intestinal varasites.

Congenital cleft lip deformity represents varying degrees of failure of mesenchymal migration and penetration from maxillary process into the naso-medial process . In Nigeria , and perhaps among other developing countries , the social attitude to congenital deformities has been appalling. It is widely acceptable that the repair of cleft lip should be done in infancy when the child has gained a constant weight of at least 10 pounds (4.5kg) and at least 10 weeks old with an haemoglobin concentration of at least 1 Og!dl. In the last 24 months, our hospital managed 12 cases of unoperated adult cleft lip despite the availability of plastic surgery services in almost all the geo-political zones in Nigeria . These patients during the pre-school and school years has to battle with the stigmas of the typical mid broad lip and flattened nose deformities . Three of our patients dropped out of secondary education because oj social embarrassment and one has returned to school after repair . Although clefts were very wide on presentation, there was adequate well developed soft tissue in adults to achieve cosmetically and functionally acceptable repair. Public enlightenment programme is higiJly needed to help improve early presentation.

Parents often attribute symptoms of some childhood diseases to teething despite little evidence to support this belief. To investigate maternal perception of this milestone, a hospital-based cross­ sectional study was conducted in Enugu. Pre-tested structured questionnaires were administered to two hundred and eighty-nine (289) mothers who met the study criteria. The symptoms more frequently attributed to teething were fever (52% ) , vomiting/diarrhoea (46%) and gun discomfort (33% ) . Regarding knowledge of risk factors for tooth decay and drugs harmful to the teeth, a sizeable number who had primary education (50%), secondary education (47%) and post-secondary education (43%) scored only 2 points. On the whole, maternal knowledge score increased significantly with higher educational status (X 2 = 27.32 p<0.05) . The need to expand the scope of health education at under-five clinics in this locality is evident. It is recommended that information on childhood dentition should be incorporated in health- \..education sessions in order to correct the erroneous perception of mothers on the subject.

A wholly conservative management without interval appendicectomy was instituted for 13 patients diagnosed as having appendix mass between 1998 and 2002 in the University of Benin Teaching Hospital , Benin City, Nigeria . Within three days of admission, one patient developed clinical features of ruptured appendix and three patients those of appendix abscess. The former had exploratory laparotomy and appendicectomy while the latter had surgical drainage without appendicectomy and were followed up with the other patients who responded well to conservative treatment. After being - followed up for between 6 months and 4 years, only one patient had recurrent symptoms. These symptoms occurred two months after discharge and an interval appendicectomy was done for the patient. We surmise that patient should earn appendicectomy after conservative management of appendix mass. Surgery is indicated only if there are recurrent symptoms. This measure will reduce the morbidity and cost of care associated with routine interval appendicectomy.

Many apparently, health Africans present with leuko-neutropenia. The origin of the so-called benign ethnic leuko-neut ropenia remains uncertain. Africans are also, known to have small adrenal cortices. Cortisol is the major secretion of t he adrenal cortex, which profoundly influences leukocyte profile. We investigated the influence of Adrenalectomy (ADX) on the leuk oc yte distribution of albino rats , and correlated the plasma cortisol level of apparently healthy adult male Nigerians (n=20) with their leukocyte distribution . AD X caused a re-d istribution of leukocyte total and difj"erential counts in our animal model of albino rats producing lymphocyte dominance and relative leuko-neutropenia. The plasma cortisol levels of our subjects showed significant negative correlation with lymphoc yte frequency and a significant positive correlation with neutrophil and t otal leukocyte cunts. T hese findings suggest that lymphocyte dominance, relative neutropenia and relative leucopenia , which are common features of some leukopenic Africans can be accounted for by the level of plasma cortisol. We speculate that ethnic leuk o-neutropenia may be due to adrenocortical hypofunction , which reportedly occurs in Africans.

There is scanty literature on paediatric trauma from the developing countries. This study is aimed at contributing information on childhood injuries in North Western Nigeria . We prospectively studied childhood admission for accidental trauma at Usmanu Danfodiyo University Teaching Hospital, Sokoto over a two year period (January 1999 to December 2000). total of 403 children 15 years and below , were seen during the period. The male to female ratio was 1.8:1 . The commonest cause of trauma was road traffic accident (RTA); 35.5% of cases followed by burns; 26.8% and fall; 16.6% of cases. Foreign bodies were responsible for 5.5%, grinding machines for 3.0% and collapsing mud buildings for 1.7% of cases. Pedestrian injuries accounted for 45 .5% of RTA victims. The overall mortality was 6.2%. RTA , with an expressive pedestrian constituent, ranked as the commonest cause of trauma. Socio-economic emancipation, intra-city traffic considerations, abrogation of child labour and provision of adequate water supply should red uce these accidents . Trauma prevention and care programme in developing countries should always address paediatric injuries.

Megalourethra is a rare congenital mesenchymal anomaly causing marked non-obstructive ditatation of the anterior urethra . The sca phoid type involves the spongiosa tissue only. It is managed by Nasbitt's urethroplasty . The fusiform t ype involves both cavernous and spongiosa tissues . It is also associated with other major congenital anomalies especially of the anterior abdominal wall and urinary tract . Operative management is phalloplast y or gender reassignment . We report one case of scaphoid megalourethra successfully managed with urethroplasty, and one case of fusiform megalourethra with multiple anomalies . Approach to diagnosis , investigations and management of this rare condition is discussed .

Mesenteric cysts a re very rare. When they occur, they are usuall y found either incid entally at laparotomy or during investigations for an abdominal mass. Only rarel y d o they present with acut e intestinal obstruction. Abdominal X -ray or ultrasound may not help in confirming the diagnosis. W e present 3 children with proximal bowel obstruction due to mesenteric cysts. All the cysts were congenital in origin. The 3 children needed bowel resection with primary anastomosis. All mad e uneventful recovery. A high index of suspicion is important when managing children with acut e intestinal obstruction as mesenteric cyst may be an uncommon cause.

Prolactinoma is an endocrine abnormality associated with hy perprolactinaemi a of which there is paucity of data in t his environment probably due to under-re porting , under diagnosis and inadequate skill for management . This is a report of a 42 year old Nigerian w ho underwent surgery for pituitary prolactinoma in Western Germa n y and was referred to our hospital for assessment ,of an t erior pituitary reserve on return to Nigeria. Basal values of glucose , cortisol, T3 , 14 , TSH , LH , FSH , and prolactin were measured following which a triple function test was conducted by intravenous administration of a bolus consist ing of ug of ACTH, 200ug TRH and lOOug GnRH . Basal values demonstrated normoglycaemia and euthyroid i sm while responses to TRH and GnRH indicated rest oration of anterior pituitary capacity for synthesis and control of TSH , LH , FSH and prolactin post-operatively .