Background: Evidence-based medicine (EBM) has been broadly defined as the use of the best available research evidence to guide clinical decision, taking into consideration personal experience and patient values. It is considered the standard of care in clinical practice. All clinicians should be familiar with the basic concepts and practice of EBM. Aim: The aim of this review is to give an overview of the basic principles and practice of EBM, highlight its limitations and suggest how to overcome them. Methods: We searched the PubMed and Cochrane database for English language articles on Evidence-based medicine. We also searched reference list of relevant articles as well as relevant textbooks on EBM. We reviewed these articles and summarized the basics of EBM in this review. The barriers to the practice of EBM especially in developing countries and how to overcome them were also highlighted. Results: There has been a rise in publications on EBM over the last two decades as evidenced by rising PubMed citations on this topic. It is now considered as fundamental to good clinical practice despite its limitations. The practice of EBM involves multiple stages but can be practiced by any clinician by simply resorting to clinical practice guidelines that are usually formulated based on the principles of EBM. Conclusions: Evidence-based medicine is one of the important principles of modern medicine. All clinicians should be con versant with the basic principles of EBM and inculcate it in their clinical practice.

Background: After the delivery of the leading twin, the second twin is at risk of distress from decreased placental perfusion due to premature separation of the placenta, birth trauma from intrauterine manipulations and increase in operative intervention due to mal-presentations. Aim: To evaluate the fetal outcome in cases of retained second twin in tertiary health institution in Sokoto, North-Westem Nigeria. Method: The case notes of patients who were managed for retained second twin at the Usmanu Dan­fodiyo University Teaching Hospital (UDUTH), Sokoto, from January 2005 to December 2009 were retrieved and analysed. The chi-square table was used to analyse some of the results. Results: During the study period, there were 163 twin births out of 10,221 total deliveries, giving a twining incidence of 16 per 1000 births. There were 33 cases where the second twin was retained, representing 3.2 per 1000 births or 1 in 5 twin deliveries. The peri-natal mortality of the second twin (515.2 per 1000 births) was significantly higher than the 151.5 per 1000 births observed for the first twin (p<0.01). The fetal case fatality rate in patients who presented 4hours after delivery of the first twin(61.5%) was significantly higher than that (14.3%) noted in those who presented within 4 hours of delivery (p<0.05). Mal-presentation and uterine atony accounted for (48.2%) and (39.4%) causes of retained twin respectively. Maternal morbidity was encountered in 60.6% of cases, and the commonest maternal complications were postpartum haemorrhage and uterine rupture. Conclusion: Twin pregnancy and delivery require care in institutions with facilities for intervention. Early referral of retained second twin to well-equipped hospitals is associated with better fetal outcome.

Background: Febrile convulsion is one of the commonest presentations at most Paediatric emergency units. Adequate knowledge of relationship between fever and convulsion is needed to lessen the parental anxiety and apprehension associated with febrile convulsion. Febrile convulsion accounts for one third of admissions into most of the emergency paediatric wards with malarial infection being the commonest cause in the tropics. Methods: This was a cross-sectional descriptive study among mothers of under-five children in Garabshi, a rural community in Wamakko local government area of Sokoto State, Nigeria. Using a systematic sampling method, a one in four samples of one hundred and twenty mothers who met the eligibility criteria were recruited into the study. Results; The mothers were aged 18 years to 47 years; majority had Quranic education only, they were all of Islamic faith and were fulltime housewives. One hundred and six (88%) of the mothers were married. 9 (8%) were divorcees and 5 (4%) were widows. Their perceived causes of febrile convulsion Included fever caused by mosquito bite and bad blood; only 4% of the study subjects had adequate knowledge of febrile convulsion with a mean knowledge score of 35.3 ±9.48. Conclusions: The knowledge of febrile convulsion was grossly inadequate amongst the study subjects. There is therefore, the need to institute further measures in form of health education among the study subjects aimed at improving their knowledge and also to remove all misconceptions regarding the cause of febrile convulsion.

Background: Despite poor outcome and increased complications, there is still widespread acceptance of traditional or unorthodox means of treating fractures and other diseases related to musculoskeletal system especially in the developing countries, regardless of social, economic or educational status. We studied characteristics of clients, cost and complications of such treatment among patients attending the trauma clinic at the Federal Medical Centre Katsina and the Ahmadu Bello University Teaching Hospitals, Zaria in northern Nigeria. Method: A prospective study of sixty patients, who presented to the trauma clinic of the two hospitals, was conducted from September 2005 to August 2010 using interviewer administered structured questionnaires. The socio-demographic characteristics of the clients, cost of treatment and pattern of complications were determined. Results: There is a widespread acceptance and patronage of traditional bone setting amongst the people of northern Nigeria. The M: F sex ratio was 4:1, with age range of 1 to 79 years and mean of 34. All patients were Muslims belonging to Hausa 40(66.7%) and Fulani 20(33.3%) ethnic groups. Majority 26(43.3%) had non-formal Qur'anic education while 8(13.3%), 10(16.7%) and 7(11.7%) had primary, secondary and tertiary education respectively. The average cost of treatment was $150. Reasons for patronage of traditional bonesetters principally include pressure from family members, perceived low cost and instant service. The commonest complications were limb-length discrepancy (28.3%), gangrene (15.0%), neglected posterior dislocation of femur (10.0%) and anterior dislocation of the shoulder (10.0%). Others include Volkmann's ischaemic contracture of the forearm (8.3%), fracture non-union (6.7%) andmalunion (5.0%) among others. Conclusion: Traditional bone setting is widely accepted in northern Nigeria despite high complication rates. It is therefore imperative for policymakers, health managers and Orthopaedic Surgeons to engage these practitioners in an unthreatening forum for the development of strategies to tackle this public health tragedy.

Background: Endoscopic services are poorly developed in Nigeria and are limited mainly to diagnostic endoscopy performed in few tertiary health care centres due to lack of facilities, exorbitant cost of equipment and paucity of trained manpower. There is poor correlation between clinical and endoscopic diagnosis of gastrointestinal (GIT) diseases. Aims and Objectives: To document the pattern of GIT diseases in our practice. Design: A retrospective study of all upper gastrointestinal endoscopy reports as entered in the surgical endoscopy register from September 1999 to August 2010. Setting: This study was carried out at the surgery department of the Jos University Teaching Hospital. Materials and Methods: It was a review of all consecutive upper gastrointestinal endoscopy data as entered in the surgical endoscopy register over an 11 year period from September 1999 to August 2010. The patients' biodata, indications for and findings at endoscopy were reviewed. Results: A total of 989 upper gastrointestinal endoscopies were performed. The mean age was 44.5 +/-13.1yrs with a male to female M: F ratio of 3:2. Two hundred and sixty one patients (30.4%) had Non-ulcer dyspepsia, 213 (21.5%) gastritis, 88 (8.9%) duodenitis, 29 (2.9%) oesophagitis and 23 (2.3%) oesophageal candidiasis. Duodenal ulcer was seen in 93 (9.4%), gastric ulcer in 40 (4.0%), combined gastric and duodenal ulcers in 16 (1.6%) and oesophageal ulcer in 1 (0.1%). Seventy-three (7.4%) had oesophageal varices, 67(6.8%) had hiatus hernia and 8(0.8%) had achalasia of the oesophagus. Sixty-six (6.7%) had malignant gastric tumours, 42 (4.2%) oesophageal carcinoma and one had duodenal adenocarcinoma (0.1%). Three patients had oesophageal stricture (0.3%) while one had oesophageal foreign body (0.1 %). Conclusion: It can be concluded that a myriad of pathologies can be seen at upper gastrointestinal endoscopy ranging from non-ulcer dyspepsia, gastritis, peptic ulcer disease, and oesophageal varices to GIT malignancies, candidiasis, oesophageal strictures and hiatus hernia. That most of these pathologies manifest as dyspepsia, meaning that they are more likely to be misdiagnosed and only upper GIT endoscopy can reliably distinguish them.

Background: Serum lipid levels are directly associated with the development and progression of coronary heart disease especially in the elderly and lifestyle factors can modify this association. This study aims to determine the effect of diet and alcohol consumption on lipid profile of elderly subjects in Asaba, Delta state. Method: Elderly subjects attending quarterly medical lectures organized by a non-governmental organization at the Federal Medical Center, Asaba were recruited. Information on diet, alcohol consumption and hypertension were obtained and serum lipids were determined using standard cholesterol/ LDL cholesterol precipitating reagents. Results: They were 110 males and 66 females. The prevalence of hypercholesterolemia was 47%. Elevated total cholesterol and LDL cholesterol was associated with consumption of high fatty diet and absence/high alcohol consumption, although, this was not statistically significant (p=0.3). Conclusion: Dyslipidaemia is prevalent in our elderly population and low dietary fat and moderate alcohol consumption are associated with better lipid parameters

Background: The impact of recent guidelines recommending more aggressive BP control in patients with chronic kidney disease (CKD) is not known in our environment. We evaluated trends and predictors of BP control among our CKD patients with a view to determining factors influencing control in comparison with the results from other studies. Methods: Records of 179 CKD patients (120 males, 59 females) with mean age of 49.05΁15.48 years and male to female ratio of 2:1 were reviewed. Information on sociodemographic data, causes of CKD, blood pressure (BP) control and antihypertensive drug use were sought, categorized and recorded. CKD was defined as CFR less than 60ml/min per 1.73m\ while target treatment goal was taken as systolic and diastolic BP≤130mmHg and ≤80mmHg respectively. Results: Majority had isolated diastolic hypertension (53%) with few systolic hypertension (2%) while 27% had resistant hypertension and only 18% achieved target BP control. Pattern of drug use showed that 58% were compliant and the commonest drug combination (35%) was angiotensin receptor blocker (ARB), angiotensin converting enzyme inhibitor (ACEI), calcium channel blocker (CCB) and Diuretics. The use of multiple drugs including ARB and ACEI was associated with better control of BP. Conclusions: Uncontrolled hypertension was unacceptably high among our CKD patients using the newer control guidelines. Ignorance, poverty, advancing age, lack of treatment and poor compliance to treatment were associated with poor BP control. We recommend aggressive management including the use of three or more drugs at increasing doses especially in those having PKD and chronic glomerulonephritis (CGN) as aetiology. We also advocate health education with emphasis on compliance with medication in order to forestall socioeconomic burden of end stage renal disease.

Background: The quality of clinical case management is significantly determined by the quality of prescription. This informed the rational drug use training and which this survey assesses the impact on health care providers in Catholic Church-owned PHC facilities in Northern Nigeria. Method: This a before-and-after training survey on rational drug prescribing profile among 76 health care workers from 67 Catholic Church-owned PHC facilities in Northern Nigeria using structured self- administered questionnaire to collect information on participants' knowledge and practice of rational drug prescription and audited prescriptions pre and post training. Post-training supportive supervision and on-site mentoring along with work aid were provided participants to re-enforce knowledge and skill taught. ResuIt: Knowledge and practice profile as indicated by their mean scores in both domains significantly improved from 60.2±16.0% to 84.0±11.8% (p<0.0001) and 43.1±12.9% to 65.4±12.7% (p<0.0001) respectively Proportions of participants with improved prescription profile increase significantly with intervention. Disparity in knowledge and practice profile pre-training was eliminated by the intervention. Drugs per prescription dropped from 6 to between 3-5, antibiotics and injections from 78% to 40-60% and 61% to 20-30% respectively. Prescriptions from essential drug list and in generic names increased from 67% to 80-90% and 61% to 75-80% respectively. Conclusion: Training intervention successfully improved the prescription knowledge and practice profile of participants, and is thus a recommended strategy in attaining similar objective.

Background: Maternal mortality is a major cause of death of women in the reproductive age group and its reduction is the focus of Millennium Development Goal 5 (MDG 5). The objective of the study was to determine the causes of death of women in the reproductive age group with emphasis on maternal deaths. Method: Two hundred and forty one cases of death of women in the reproductive age group from 1st December, 2005 to 30th November, 2007 were reviewed for age, tribe, occupation, religion, cause of death, duration of hospital stay and risk factors associated, using the death registers and case files. Result: Of the 241 cases of death recorded within the two year review period among women of the reproductive age group, a total of 234 had their causes of death specified and of these; infectious and parasitic diseases including HIV/AIDS were the commonest cause of death accounting for 32% (75) of deaths, while maternal deaths contributed 19.8%. Other common causes of death were neoplasms (22.3%), diseases of the circulatory system (10.7%). The overall maternal modality ratio was 2,598/100,000 live bidhs with wide variation between the two years studied. The direct causes of maternal modality accounted for 52.4% of cases while the indirect causes accounted for 47.6%. Direct causes of maternal mortality were hypertensive disorders of pregnancy (18.2%), haemorrhage (11.4%), puerperal sepsis including septic abortion (11.4%), and obstructed labour with or without ruptured uterus (11.4%). Conclusion: Infectious and parasitic diseases especially HIV/AIDS and tuberculosis were the leading causes of death of women in the reproductive age group contributing significantly to maternal mortality, which exerts a heavy toll on survival of women in this age group. Strategies to comprehensively address the reproductive health problems of women should be instituted.

Background: Low birth weight is an important determinant of both infant and neonatal mortality rates and is also an indicator of social and economic development. The World Health Organization described any baby with birth weight of less than 2.5kg as low birth weight baby. Objective: To determine the incidence of low birth weight deliveries in Aminu Kano Teaching Hospital, Kano. Study design: A retrospective descriptive study. Results: The overall incidence of low birth weight deliveries over the study period was 11.30%. The incidence dropped yearly from 12.8% in 2007 to 10.90% in 2008 and 10.10% in 2009. Generally, however, incidence peaked in the dry season. The incidence increased in mothers aged 16 years and above to peak between the ages of 21 -25 year and then drop after the age of 30 years. The incidence was also highest among nulliparous women dropping with increasing parity and rising after five consecutive deliveries. Mothers with less than secondary education had the highest delivery rate of low birth weight babies and contrary to other studies, the incidence of low birth weight deliveries was higher among booked mothers 57.8%. Most (84.6%) of the low birth weight babies weighed 1.5kg and above and greater percentage of them were born preterm( 64.2%) meaning that of all the aetiological factors examined, preterm labour (40.7%) was most consistent with low birth weight deliveries and it was followed closely by unknown causes (24.5%), hypertensive disorder of pregnancy (13.1%), twinning (10.5%) and antepartum haemorrhage which accounted for 5.3% of low birth weight. Conclusion: There is a steady decline in the incidence of low birth weight deliveries over the period of study. Most of the babies born with low birth weight were delivered before 37 completed weeks of gestation and preterm labour was the most dorminant risk factor.

Background: Disseminated intravascular coagulation is an acquired acute, subacute or chronic coagulation or thrombohaemorrhagic disorder characterized by formation of microthrombi, consumption of coagulation factors/platelets, activation of fibrinolytic system and haemorrhage. It occurs as a secondary complication to a variety of disorders and infectious diseases but its occurrence in tuberculosis is rare and has not been reported. Objective: The aims of this paper are to present a case of Disseminated Intravascular Coagulation complicated by Acute Renal Failure in a patient with underlying pulmonary tuberculosis and also to review the available literature. Method: A case report. Result: I present a 26-year old student being treated for pulmonary Tuberculosis with history of gum fever, difficulty with breathing, cough, weight loss, seizures, passage of coca-cola coloured urine, reduced urinary output and bleeding from the mouth and gums. His laboratory results showed prolonged coagulation profiles and thrombocytopenia in keeping with Disseminated intravascular coagulation. His Creatinine and Urea estimation results were elevated supportive of Acute Renal Failure. Conclusion: There has been a resurgence of Tuberculosis in developing countries because of HIV/AIDS pandemic; therefore many unusual complications of the disease such as Disseminated Intravascular Coagulation would be expected in our hospitals. Modern laboratory equipments such as coagulometer is needed for full assessment of patients with bleeding disorders. Enlightenment campaign needs to be carried out on the percularities of a teaching hospital to enable the people embrace special procedures.