Qualitative health care is a fundamental right of all citizens of a given country. How this health care is delivered depends significantly on the economy, dedication, and quality of the health-care providers and the political will of the government of the country. Health care may be public run or organized by private health-care providers. We can also have an intercalated program where there is public–private partnership. Whichever way this basic fundamental human right is delivered, sustainability, affordability, and accessibility are vital to its success. The Nigerian health-care delivery can be broadly classified into two; the hitherto existing traditional medicine and the modern orthodox medicine which came to our shores with the arrival of the European colonialists. The traditional system is still patronized by most Nigerians and is known by different linguistic terminologies such as the “Wanzami” or Barber in Hausa and the “Babalawo” in Yoruba language. Traditional birth attendants also exist in all communities in Nigeria complemented by herbalist and spiritualists of different shades and callings. It is our aim to give a brief account of our observations on the Nigerian health-care system with a view to correcting the challenges by the government and the public in general.

Introduction: In patients with acute scrotal pain, differentiating acute epididymitis from testicular torsion should be made promptly and accurately, to treat the underlying cause correctly. Acute epididymitis is treated with a simple course of antibiotics while testicular torsion requires emergency surgical exploration to salvage the testis. The assessment of patients with acute scrotal pain is done mainly using color Doppler ultrasonography, which, however, requires skills and has limitations of being highly operator-dependent and uncomfortable to patients with scrotal pains because it may take too long to perform and often involves probe compression. Scrotal scintigraphy using ^99m Tc-pertechnetate may provide an alternative reproducible, quick noninvasive and reliable nuclear medicine functional imaging technique that could be used in the evaluation of patients with acute scrotal pain. The aim of this study is to document our clinical experiences with the use of scrotal scintigraphy in differentiating acute epididymitis from testicular torsion in patients with acute scrotal pain. Material and Method: All scrotal scintigraphy performed in our institution between 2007 and 2015 were included in this study. Scrotal scintigraphy was performed after intravenous administration of ^99m Tc-pertechnetate radiotracer and images were acquired using MEDISO dual-headed gamma camera. Acute epididymitis is diagnosed when there is increased blood flow on dynamic images and increased uptake around the region of the epididymis, while testicular torsion as decreased blood flow and photopenic area in the testis on dynamic and static images, respectively. The final diagnosis was documented based on relief of symptoms after a course of antibiotics or surgical exploration. Results: All patients were examined by urologist and only patients in whom the differentiation between acute epididymitis and torsion could not be made clinically were include in this study. A total of 21 patients were studied. There were 16 patients diagnosed with acute epididymitis and five patients with testicular torsion. Conclusion: Our study demonstrates that scrotal scintigraphy is a simple, accurate, and effective functional imaging technique that can differentiate acute epididymitis from testicular torsion in selected patients presenting with acute scrotal pain.

Introduction: Breast cancer is a major global public health problem accounting for massive morbidity and significant mortality worldwide. Factors contributing to breast cancer mortality have been a topic of intense research and discussion in the scientific world. There is, however, a dearth of information on the incidence of breast cancer mortality in most resource-poor countries including Nigeria. Available data from most African workers on breast cancer focused on incidence, risk factors, and complications rather than mortality. The unique ethnic heterogeneity of Abuja and its peculiar lifestyle (as compared to other Nigerian cities) provides added impetus for assessing breast cancer mortality in one of the Nigeria's fastest growing cities. This study is carried out in a 400-bedded public tertiary hospital in Abuja, the capital of Nigeria. Materials and Methods: A retrospective review of all breast samples in the department of histopathology over a decade is performed supported by clinical information from the medical record archives. Results: Of 2292 breast samples received in the department, 35.3% (n = 810) are malignant out of which 10.6% (n = 86) died. Breast cancer incidence increased from 29 in 2005 to 141 by 2013 while mortality declined from 11 to 9 over the same period. A crude fatality rate of 3.7% is observed. The ages of the decedents ranged from 20 to 90 years with a mean of 43.5 years. Infiltrative ductal carcinoma accounts for the largest mortality with 87.4%. Conclusion: Breast cancer is an important cause of mortality among females and efforts at early detection and treatment should be intensified.

Background: Sleep hygiene may be defined as a set of habits and guidelines that promote consistently restful and sufficient sleep at night, consequently leading to alertness during the day. The study was aimed at determining the pattern of sleep hygiene and factors contributing to poor sleep among children attending children outpatient clinic in Federal Teaching Hospital Abakaliki (FETHA). Materials and Methods: In this cross-sectional descriptive study, data were collected from May 2012 to September 2012. Structured questionnaire was administered to parents of children aged 2–16 years. Participants were recruited from the children's outpatient clinic of FETHA. Results: A total of 354 children were recruited, of which 60.8% do not have a regular bedtime and wake time. A total of 56 children (15.8%) had bedtime problems (problems going to bed and problems falling asleep), 10.7% experienced daytime sleepiness, 15% had frequent night waking, and snoring was noted in 30 (8.5%) children. More females had a regular bedtime and wake time 40.0% than males 28.7%. Problems with going to bed, falling asleep, frequent night waking, and daytime sleepiness were more prevalent in children aged 6–10 years. Children less than 6 years had the highest prevalence of daytime naps, regular bedtime, and wake time. Watching television before bedtime was significantly associated with frequent night waking, problems with falling asleep, and daytime sleepiness (P = 0.000, P = 0.001, and P = 0.002, respectively). Conclusion: Findings from this study showed that poor sleep hygiene is common among children in this environment. Health education to parents and their children aged 7 years and above on the importance of good sleep hygiene is, therefore, necessary.

Background: Hypertension and diabetes are among the leading noncommunicable diseases (NCDs) in the world. The etiology and prognosis of these diseases are markedly influenced by environmental stress and lifestyle choices. Prevention and effective control of these conditions largely depend on patients' cooperation and commitment to lifestyle modification. Materials and Methods: A cross-sectional descriptive study was carried out among 51 patients with hypertension only, 27 patients with diabetes only, and 27 patients with both hypertension and diabetes attending specialist clinics at Aminu Kano Teaching Hospital and Murtala Muhammad Specialist Hospital both in Kano, using a semi-structured interviewer-administered questionnaire after selection of patients by systematic sampling. The data were analyzed with Minitab statistical software version 12 (Minitab Inc. Pennsylvania, US), qualitative and quantitative variables were summarized using percentages and means, respectively, while associations between categorical variables were assessed using Chi-squared test at a significance level of ≤0.05. Results: About 86.3% of the patients with hypertension only, 88.9% of patients with diabetes only, and 74% of patients with both hypertension and diabetes were aware of the various components of nonpharmacological therapy for NCDs; this ranged from the knowledge of the diseases and knowledge about lifestyle modifications. About 13.8% of the respondents with hypertension only had good knowledge of hypertension prevention, whereas 62.8% had fair knowledge and 23.5% had poor knowledge of hypertension prevention, respectively. Although majority (74.5%) of our hypertensive patients and 77.8% of patients with both hypertension and diabetes, had a positive attitude toward nonpharmacological therapy. Conclusion: This study showed that a great percentage of our patients with NCDs had very poor knowledge of the different components of nonpharmacological therapies.

Background: In many African settings, infant and child care practices are dictated by long-established social norms and cultural values, some of which may be disastrous to the health of the baby. To determine how maternal education is related with child health and rearing practices in Kano. Materials and Methods: Using a descriptive cross-sectional design, 386 randomly selected mothers of under-five children and their babies were examined. Data were analyzed using IBM SPSS Statistics for Windows, version 22 (IBM Corp., Armonk, NY, USA). Children's weight-for-height, height-for-age, and weight-for-age Z-scores were obtained. Infant and child care, feeding and weaning practices were assessed and scored based on a system adapted from past study. Results: The mean ± standard deviation of the mothers was 27.3 ± 5.2 years, 69.7% had at least secondary school education. The mothers had 4 ± 2 children, and 79.3% were ≥12 months old. More than half of the children (58.2%) had suffered one or more of the common childhood diseases within the previous month, 60.3% had a form of malnutrition and less than half (42.5%) were fully immunized for age. Varying infant and child care, feeding and weaning practices were observed. Overall, half (49.2%) of the mothers had good care practices, 42.2% had good feeding practices and 57.6% had good weaning practices. Interestingly, neither the mothers' care practices nor the feeding practices were statistically associated with their educational status. However, the proportion of the mothers with good weaning practices was higher among those with no secondary education (59.7%). Conclusion: The finding suggests that cultural beliefs are specific areas of focus in campaigns for improving infant and child care and rearing practices of mothers, and eventually for reducing the high infant and child morbidity and mortality in the Northern Nigeria.

Introduction: The demand for radiological examination has increased tremendously despite paucity of referring clinicians' knowledge on radiation protection. Reasons to justify these referrals vary. Consequently, the aim of this study is to evaluate the relationship between clinicians' knowledge of radiological imaging dosage to their referral justification and guideline. Materials and Methods: Structured questionnaires were developed with four sections (Section 1, sociodemographic data; Section 2, justification for imaging referral; Section 3, knowledge of radiation dose to patients; Section 4, effect of irradiation). The questionnaires were administered at a previous Nigerian Medical Association National Conference, which took place at Lagos in 2013. Sections 3 and 4 were scored and rated. Results: The respondents gave plausible reasons to refer patients for radiological evaluation despite the observation that majority of them were unaware of the existence of referral guidelines and had poor knowledge on radiation. Only 16 (12.2%) of the respondents had a fair score on knowledge about radiation dose to patients while 110 (84.0%) had poor score. Five (3.8%) of the respondents had good score. Similarly, on identifying effect of radiation, 10 (7.6%) had good score, 4 (3.1%) fair score, and 117 (89.3%) poor score. Conclusion: Most of the referrals of patients for radiological evaluation by the respondents were not based on the standard guidelines. Therefore, it is pertinent that referral guidelines should be developed and implemented and clinicians should be educated and trained on radiation protection.

Background: The choice of reconstruction options for maxillectomy defects varies significantly. Factors affecting it range from the type of defect to the surgeon's expertise. This study aims to evaluate the practice of Nigerian Oral and Maxillofacial surgeons in the reconstruction of post-maxillectomy defects. Materials and Methods: The survey was conducted by use of questionnaires administered at the annual scientific meeting of the oral and maxillofacial surgeons of Nigeria in Ibadan 2012. Results: A response rate of 66.7% was achieved. All of our respondents are consultant oral and maxillofacial surgeons, 80% of whom practice in a teaching hospital. All but one of them perform maxillectomies, however only 25% of them offer surgical reconstruction of the resulting defects to patients. Flaps have been used by 25% of the respondents, while none of them has employed microvascular reconstruction. Prosthetic rehabilitation of patients is pervasive among the respondents. Conclusion: Maxillectomy defects have far-reaching consequences on patients' quality of life and attempts should be made to reconstruct such defects. Although maxillectomy is a commonly performed procedure among oral and maxillofacial surgeons in Nigeria, especially for malignancies of the oral and paranasal sinuses, surgical reconstruction of resulting defects is not so frequently done. Microvascular surgery, which is becoming a frequently utilized option among surgeons in developed nations, is still infrequently used in our environment. There is a need for oral and maxillofacial surgeons in our climes to improve their skills so as to increase the range of reconstructive options offered.

Accessory breast and the diseases affecting these aberrant breast tissues are relatively uncommon, and with variable prevalence among different populations. These are commonly located in the axilla, chest wall, and vulva. The most common disease in these tissues is carcinoma; however, other benign neoplastic and nonneoplastic lesions do occur. In this review, we present a clinicopathologic analysis of all the consecutive cases seen in a major referral teaching hospital over a period spanning 10 years (2006–2015).

Ruptured ectopic pregnancy is not an uncommon diagnosis in gynecological emergency admissions, but spontaneous tubal abortion with an intact live fetus is a rare event which can be diagnosed preoperatively with ultrasound. The aim of this study is to report a case of spontaneous live tubal abortion following ectopic gestation that was diagnosed ultrasonographically and confirmed intraoperatively.