Background: Significant carotid artery disease in candidates going for coronary artery bypass graft (CABG) increases the risk of developing peri-operative neurologic events. Therefore, a pre-operative carotid Doppler ultrasonography, which is simple, non-invasive, and cheap may be indispensable. In this study, we report the prevalence of carotid disease in candidates for CABG and assessed the correlates between carotid artery disease and coronary artery disease (CAD). Materials and Methods: Seventy three consecutive patients undergoing elective CABG were recruited over 7 months, January to July 2007. All participants underwent pre-operative carotid Doppler assessment for level of stenosis and site of carotid plaque. Using the criteria defined by the Society of Radiologists in the Ultrasound Consensus, the degree of stenosis was stratified into the categories of normal (no stenosis), 50% non-obstructive carotid disease, 50-69% significant stenosis, 70% critical stenosis to near occlusion, near occlusion, and total occlusion. Patients with previous CABG, congestive cardiac failure, and high-risk surgery were excluded. Results: The mean age of patients was 65.0 ± 7.2 years with male-female ratio of 9:1. Twenty one (28.8%) patients had normal carotid arteries 45 (61.6%) had non-obstructive carotid artery disease 4 (5.5%) had significant carotid stenosis and 3 (4.1%) had critical carotid stenosis. Carotid bulb was the most common site of plaque formation while left internal carotid artery was the commonest site of both significant and critical carotid stenosis. Patients with significant carotid artery disease had 3 times the odd of having severe CAD (left main disease/triple vessel disease). However, this was not statistically significant (OR 2.75, P = 0.284). Conclusion: The high frequency of carotid artery disease in this study underscores the need for routine ultrasonic carotid assessment in candidates for CABG to ensure early detection and prompt management of carotid disease in a candidate of CABG which may prevent untoward peri-operative neurologic events.

Background: About a third of patients with Guillain-Barre Syndrome (GBS) presents with acute respiratory failure requiring invasive mechanical ventilation. We studied the outcome of patients with GBS. Material and Methods: A retrospective data extraction was done on clinical records of 103 patients with diagnosis of GBS admitted in intensive care unit (ICU) over a period of 7 years. All patients requiring ICU admission and mechanical ventilation for more than 48 h were included in the study. Demographic profile, clinical characteristics, treatment given, duration of mechanical ventilation, ICU acquired infections, incidence of pressure sores, and length of ICU stay was noted. Results: Eighty six patients fulfilled the inclusion criteria. The mean age of patients was 32.4 (± 18.12) years. Mean duration of ICU stay was 28.9 (± 26.99) days. Majority (82%) of our patients were male. The most common co-morbidities were diabetes mellitus and hypertension. Axonal neuropathy was the most common (76%) lesion. Autonomic dysfunction was present in 35% of patients. Fifty two percent of patients received immunoglobulin therapy while 64% of required mechanical ventilation for more than 14 days. Tracheostomy was performed in 85% of patients. Ventilator associated pneumonia (VAP) was seen in 33% of patients, blood stream infection in 11% and urinary tract infection in 7%. Forty percent of patients developed bed sore grade 1-2. Seven (8.3%) patients died perhaps due to complications including VAP and sepsis. Conclusions: GBS has a good outcome despite prolonged mechanical ventilation and ICU stay.

Background: Breech delivery is a major issue in obstetric practice mainly because of the high perinatal morbidity and mortality associated with it. The aims of the study are to determine the prevalence management and perinatal outcome of singleton breech deliveries in our center. Materials and Methods: A retrospective study involving 395 singleton breech deliveries out of 24,160 deliveries conducted at the Usmanu Danfodiyo University Teaching Hospital Sokoto, Sokoto, over a 10-year (2001-2010) period. Results: The prevalence rate of singleton breech delivery was 1.7%. Breech deliveries occurred more in the primigravidae. Most babies (69.1%) had vaginal delivery. There was a high caesarean section (CS) rate of 30.9%. Babies delivered by CS had better Apgar scores than those delivered through the vagina (P < 0.05). The perinatal mortality rate in breech deliveries (410/1000) was significantly higher than that (101.5/10000) in their cephalic counterparts (P < 0.05). Similarly, perinatal deaths were more common in unbooked than in booked patients (P < 0.05). Conclusion: Breech delivery was frequent in the study population. Singleton breech delivered by CS had better outcome than those who were delivered through the vagina.

Background : Placenta praevia is one of the most acute life-threatening obstetric emergencies. Its prompt management has been advocated to prevent associated morbidity and mortality. This study determines the incidence, risk factors, presentation, and maternal/fetal morbidity and mortality associated with placenta praevia in Usmanu Danfodiyo University Teaching Hospital, Sokoto. Materials and Methods : In this retrospective study, case notes of patients' that had placenta praevia from January 1, 2003 to December 31, 2007 were retrieved. Relevant data were extracted and analyzed using the Epi-info Version 3.5.1 statistical package. Results : The incidence of placenta praevia was 0.84%. Grand multiparous women (50.0%) were more affected than multiparous women (42.7%). Majority (46.9%) presented with vaginal bleeding after 28 weeks of gestation. The Major type of placenta paevia (77.1%) occurred more than the Minor variety (22.9%). The most common risk factor was previous abortion (18.75%) while anemia (7.3%) was the most common complication. Most (83.3%) were delivered by Caesarean section. There was one (1.0%) maternal mortality and 12 (12.5%) perinatal deaths. Conclusions : Placenta praevia has a low incidence in the study population, is mainly of the Major type with identifiable risk factors and occur mainly in the 21-30 years age group and multiparous women. The major modes of presentations are vaginal bleeding and threatened abortion. Though maternal mortality is low perinatal mortality is high.

Background: We describe the epidemiology, clinical features, management, and outcome of adult patients of scorpion envenomation. Materials and Methods: This is a retrospective study involving a total of 40 patients conducted at Narayana Medical College and Hospital. All the patients had complete blood count, blood glucose, urea, creatinine, liver function test, urine examination, electrocardiography, X-ray chest, and two-dimensional echocardiography as and when indicated. Results: During the study period, a total 40 adult patients were managed for scorpion sting. Mean age was 34.93 ± 12.6 years. Farmers 34 (85%) cases were more commonly bitten by scorpion. Lower limbs (65%) were common site of sting than upper limbs. Stings were more frequent during daytime 27 67.5% vs. 32.5%). Only 12 patients (30%) received first aid before coming to our hospital. Many patients 28 (70%) reached the hospital within 6 h of scorpion sting. Most of the patients 32 (80%) were conscious. There was evidence of pulmonary edema in 15 (37.5%) patients. Eight (20%) patients required elective ventilation and one of the patients had fatal outcome giving an overall mortality of 2.5%. Mean hospital stay was 3.15 ± 1.67 days). Conclusion: Scorpion stings are more frequent in male farmers with most stings occurring in the lower limbs during the daytime in the study population. Local pain was the most common manifestation. Scorpion stings could nonetheless be associated with severe complications with fatal outcome. We recommend public awareness about preventive measures and early management of scorpion sting as measures of reducing scorpion sting related morbidity and mortality.

Background: The dental clinical setting, which is a significant learning environment for undergraduate dental students, may induce anxiety, which may adversely affect the clinical performance. The purpose of this cross-sectional study was to determine the factors provoking clinical anxiety in dental students from the trainers and students perspectives. Materials and Methods: This cross-sectional study was conducted among 6 ^th (final) year dental students of University of Benin and their clinical trainers between January and March 2012 using the 38-item modified Moss and McManus clinical anxiety questionnaire. Results: Of the 67 participants, 32 (47.8%) were 6 ^th year dental students while 35 (52.2%) were clinical trainers. According to the students, the top clinical anxiety provoking situations were inability to meet requirements before exams, inability to pass the final exams, dealing with psychiatric patients, coping with uncooperative children, getting infected by patients, fracturing a tooth during extraction, extracting the wrong tooth, discovering calculus by the supervisor after scaling, accidental pulp exposure, inadvertently hurting patients and using the high speed hand piece. There existed concordance on the top two clinical anxiety provoking situations reported by the students and their clinical trainers. However, measuring blood pressure, taking pulse, presenting in the clinic, handling a syncopal attack, and accidental pulp exposure were statistically significant contrasting clinical anxiety provoking situations from dental students and trainers perspectives. Conclusion: Data from this study revealed that clinical trainers share largely the same perspectives with the dental students on the clinical anxiety provoking situations with slight variations. Fostering a supportive learning environment conducive to dental student learning by strengthen efforts to minimize clinical anxiety is a necessity.

Background: Urbanization is associated with an enormous increase in vehicular traffic emitting exhausts and polluting the atmosphere. Emissions from vehicular traffic constitute the most significant source of ultraparticle in an urban environment. Cab drivers who work near areas located in the vicinity of traffic junctions through which maximum number of vehicles passes are more prone to develop health issues pertaining to the respiratory system. The effect of this occupational hazard in this unorganised workforce is not adequately studied. This study is designed to determine the effect of air pollution on the pulmonary system in cab drivers exposed to automobile exhaust. Materials and Methods: This study was conducted by performing pulmonary function tests (PFTs) on 20 cab drivers who are exposed to automobile exhaust by virtue of their work venue nearer to traffic junctions and comparing them with 20 age, gender-matched, and anthropometric profile cab drivers who work in a rural setting free from vehicular air pollution. PFT by computerized spirometer measuring forced vital capacity (FVC), forced expiratory volume (FEV ₁ ), FEV1/FVC, peak expiratory flow rate (PEFR), and forced expiratory flow (FEF) 25%-75% were measured. Statistical analysis was done by Student's t test (two-tailed, independent) for intergroup analysis. Results: There was a statistically significant decline in dynamic pulmonary function parameters in the study group when compared. FVC, FEV in first second, PEFR, FEV ₁ /FVC, and FEF 25%-75%) were all found to be statistically significantly lower in cab drivers as compared to control group (P < 0.001). Conclusion: This study finds a significant decline in various PFT parameters recorded in the study group as compared with the control group. These suggests a tendency for obstructive lung disease among cab drivers exposed to a polluted urban environment.

Arterial variations in the upper limb are common. These variations are of high clinical and surgical importance. In the right upper-limb of an approximately 60-year-old male cadaver, the brachial artery (BrA) gave an aberrant branch (AdBrA) on its medial side in the middle of the arm, which ran superficially along the basilic vein (BV) in the lower part of the arm. As it reached the roof of the cubital fossa, it ran downwards and laterally along the median cubital vein (MCV) superficial to the bicipital aponeurosis (BA). In the cubital fossa, this artery was joined by the lateral terminal branch (LTB) of BrA forming an arterial loop in front of tendon of biceps brachii. This arterial loop gave a larger branch which continued as radial artery (RA) and a smaller muscular artery. The surgical and clinical significance importance of the case is discussed and literature review is presented.

Though, acute subdural hematoma (ASDH) is one of the most common emergencies in neurological surgery practice, bilateral bifrontal ASDH is uncommon and may constitute diagnostic and therapeutic challenge. Computer tomography and magnetic resonance imaging have important roles in the diagnosis of ASDH. We present a case of bifrontal ASDH that was successfully managed in our institution.

Hydatid disease is an ancient endemic parasitic infestation caused by Echinococcus granulosus, which results in the formation of hydatid cysts in various parts of the body, the liver, and lungs being the most common sites. However, in 15% to 20% of the cases it may occur in unusual sites. We report a 25-year-old male patient who presented with clinical features similar to scrofuloderma in the axillary region but confirmed from histological examination to have hydatid cyst. This case highlights the uncommon site of hydatid cyst and unusual clinical and histopathological features along with the fact that it should be kept in differential diagnosis of nodules and sinuses in the axillary region. The treatment of choice is excision along with combination of albendazole and praziquantel.