To assess the effect of pre-marriage counseling as a tool for sickle cell disease awareness . A structured questionnaire was used to obtain information from 207 mothers attending the infant welfare and antenatal clinics of Nnamdi Azikiwe University Teaching Hospital Nnewi on knowledge of the existence of sick le cell disease , church attended , attendance at marriage counseling sessions , knowledge of own and husband's genotype before marriage . The study population 34 .3% of t he mothers where between the ages of 26 and 30 years, while 60 .4% of the mothers had secondary education. One hundred and fifteen or 55 .5% had knowledge of their genotype and that of their husband s. While 23 .7% and 13.5% of t hem knew their genotypes before courtship and during courtship respectively 34 .3% knew theirs before wedding and onl y 7 .2% knew after wedding . Members of the Roman Catholic faith constituted 48 .8% of the study population with 68.1 % of the study population having attend ed a pre-marriage course before wedding . Ninety two or 65 .2% of the respondents attended a sickle cell counseling session during the course. Sickle cell screening was a pre-condition for wedding in 58.8% of the respondents. This practice of the churches introducing sickle cell trait screening and genetic counseling before marriage needs to be encouraged and strengthened by introducing sickle cell trait screening and genetic counseling in schools in order to cover a wider population and reduce the prevalence of the disease in the society.

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After years of development, microvascular free tissue transfer has been firmly established as the primary method for reconstrutive surgery. The concept of using a reconstructive ladder to repair complex defects has been revolutionized and the tradition of using free flap surgery as the last resort has been challenged. In a developing country like ours , surgeons are still contending with the basic prol;΋lems of microvascular free tissue transplantation . An 18- year old student presented to our hospital with a diagnosis of osteomyelitis of the frontal bone. A radical debrid ement of osteomyelitic bone was done and the defect created was repaired with a microvascular free lattisimus dorsi musculocutaneous flap. The procedure lasted about 16 hours with a long duration of warm ischaemic time , but the flap survived. Institutional support Is highly necessary for making available appropriate microvascular instruments, operating microscope, pharmacologic agents, : allocation of operative time and post operative care, if we must make In the field of fflicrovascular surgery In the West African sub-region .

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Advances in both perinatal and neonatal care over the past two decades mean that increasing numbers of very preterm and very low birthweight (birth weight < 1500g; VLBW) inf ants are surviving. In part this success has itself led to a greater willingness by obstetricians to intervene at earlier gestations with ensuing increases in the numbers of VLBW infants admitted to neonatal intensive care units (NICUs) . In New Zealand, researchers like BA Darlow, AE Cust and DA Donoghue, on behalf of the Australian and New Zealand Neonatal Network (ANZNN), decided from a good study (Arch Dis Child Fetal Neonatal Ed 2003; 88: F23-F28) compare the survival and short term morbidity of all New Zealand very low birthweight (VLBW) infants born in two epochs, 1986 and 1998- 1999. Setting: All level Ill and level II neonatal intensive care units (N I CUs) in New Zealand . Mehods: In 1986, data were prospectively collected for a study of retinopathy of prematurity (ROP). In -1999, prospective data were collected by the Australian and New Zealand Neonatal Network (ANZNN) Both cohorts included all VLBW infants born during the calendar year an d admitted to a NICU. Data were collected from birth until discharge home or death . Results: More VLBW infants were admitted for care in 1998-1999 (n=1084, 0.9% of livebirths) than in (n=413, 0.78% of livebirths; p < O.OOl), including a higher proportion of VLBW infants of < 1000g birth weight (38% v 32% respectively; p < O.OS). Survival to discharge home increased from 81.8% in 1986 to 90.3% in 1998-1999 (p < O.OOl). The 1998-1999 cohort had a higher proportion of infants born in a hos pita l with a level Ill NICU (87% v 72% in 1986; p < O. OOI ) and receiving antenatal corticosteroids (80% v % in 1986: p < O.OOJ). in 1998-1999, the incidence of several morbidities had decreased compared with , including oxygen dependency of 28 days (29% v 39%, respectively; p =O. OOl) and at 36 weeks postmenstrual age (16% v 23%; p=0.002), grade 1 intraventricular haemorrhage (IVH ) (8% v 24%; p < O.OOJ), grade 2/3 IVH (5% v 11%; p < O.OOl ), and stage 3/4 ROP for infants < lOOOg (6% v 13%: p < O.OOl) Conclusions: The outlook for VLBW infants in New Zealand has improved since 1986.

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Pregnancy-associated breast cancer ( PABC) is uncommon. It s management is sometimes controversial and ma y present ethical proble ms . This paper presents cases treated in the University of P ort Harcourt T eaching Hospital from 1990 to 2002 . The case records of patients trea ted for pregn a n cy- as socia t e d breast cancer were retrieved , stu died an d are presented with a limited revie w of th e lite r a tu re o n th e current management of the disease. h ere were 5 nu lliparous young wom e n aged between 26 and 32 years with breast cancer invol ved in 6 pregna ncies . One patient had sequential bilateral mastectomy for carcinoma of the br e ast in pregnancy a t two pregnancies . three had th e cancer affecting one breast in pregnancy and one had th e mas t e ct omy but while on chemotherapy became pregnant and delivered successfully. One patient with advanced disease , refused biopsy and treatment. The diagnosis in 5 instances was in t raducta l carcinoma. The disease is un common but evokes significant emotion in patients and th eir doc t or s . T h e prognosis app e ars similar to that in non -pregnant women . Th e trea t me11t of PABC is similar to that in non-pregnant women except that radiotherapy and chemothe rapy may be co n traindicat ed at certain trimesters .

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Alcoholic preparations is one of the ingredients present in beverage s , drugs o r chemicals in common use even at pregnancy; and this is well acclaimed to be toxic to the concept uses, particularly , the developing skeletal tissues . A thorough literature search at MEDLINE and consultation with local scientific p ublications ,and text books on alcohol and bone development was carried out to compile useful information and to up-date knowledge on this subject . It is of great interest to note that this subject had been, and is yet receiving m uch and globa l attention from experimental, social and health workers ; particularly echoing the hazards of alco h ol abuse on developing tissues. This subject is an area of much and more consideration with the view to unveiling the mystery of the toxicity of alcohol while in search of therapy for its assaults and convincing means of abstinence for the addicts .

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Deaths f rom vaccine-preventable diseases continue to contribute significantly to infant mortality, hence the global d rive against their eradication , especiall y neonatal tetanus and poliomyelitis. T his study set ou t to e valuate the level of awareness and utilization of childhood and maternal tet anus and childhood immunisation programmes at a Primary H ealth Centre, Atelowo in Osogbo, N igeria. The immunisation record was evaluated with regard s to the pattern of maternal tetanus toxoid (TT) administration and childhood immunisation . w ere 209 mothe r-baby pairs and of these, 18 (8.6) had BCG vaccination , 49 (23.4%); DPTl / OPV l, 47 ( 22 .5% ) ; D PT2/0PV2 and 23 ( 11%) ; DPT3/0PV3 . No infant received OPVO . Only (4 .3% ) of 209 babies were immunised against measles . Concerning maternal TT administration, 109 (52.2%) and 74 ( 35 .4 %) had TTl and TT2 , respectivel y . general apath y toward s immunisation was observed, with only 4 .3% of babies bein g available b y nine months of age ; the same tren d was noticed with maternal immunization . T herefore suggest ed is a house-to-house campaign for immunization and a restructuring of t he monit oring systems of t he programmes .

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To evaluate the status of Rhesus-negative In females of reproductive age In the Niger-Delta area of Nigeria , and to briefly discuss some recent ad vances In the molecular biology of the Rhesus blood group, particularly the weak D or D" phenoty pe . Consecutive sampling of a total of 1108 subjects attending the ante-natal and out-patient clinics was done In three health facilities In the Port Harcourt metropolis , Rivers State, Nigeria. [90.5%] of the 1108 subjects were Rh-D positive while 105[9.5%]were Rh- D negative.This find ing of 9 .5% Rh-negatlvlty amongst females of reproductive age In Port Harcourt Is consistent with other published data In Nigeria which recorded a low trend of Rh- D negativity of 1-6%. This finding highlights the high risk of Rh-D Iso-Immunization In this environment and validates the previous position that Rh-D lso-lmm.;nlsatlon is the leading cause of haemolytic disease of the newborn and haemolytic transfusion reactions especially In pregnant mothers. This brings Into focus the need to uplift the care given to Rh-negatlve mothers and the urgent establishment of the National blood transfusion service.

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Anae mia is very com mon in H IV-in fect e d individual s at all stage s of d isease and most often Mar row examin a t ion are not d one to el ucidate some of the ca uses of anaemia .We describe a 42 year old N igerian with H IV -inf ec tion and pul monary tuberculosis on combivir and anti TB therapy (Rifam picin , IN H , Pyra z inamide and e thambutol) with pure re d cell aplasia who responded to steroid t her a py and withdrawal of combivir (lamivu dine + zidovudine ) .

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Sickl e cell disease (SCD) is a generic name for a group of inherited blood conditions th at ha ve two features in com mon: presence of sickle-shaped erythrocy tes (sickle cells) in the blood. and clinical illn ess (disease) ca used by the sickle cells. Literally. SCD is disease caused by sickle ce lls. The disease entities inclu ded 21re homozygo us (HbSS) sickle cell disease or sickle cell anaem ia. and compound heterozygous conditi ons suc h as sick l e cell haemoglobin C (HbSC) disease and sickle cell thalassaemia ( HbS/thal). The ca rrier state sickle cell trait ( HbAS) Js n ot included in the definition of SCD because such heterozygous individuals do not have clinical ill ness clue to the presence of s1ckl e haemoglobin (HbS) in the blood. lheanyi Okpala of St. Thomas Hospital , London in an intriguing article in Blood Reviews 2004; 18: 65-73. reviewed the intriguing co ntri bution of white blood cells to sickle cell disease - a primary red cell disorder. He stated that SCD is characteri zed by a point mutation that replaces aden ine with thymidine in the sixth codon of the 0-globin gene, a unique morphol ogica l abnormality of red blood cells. vasa-occlusion with ischaemic tissue injury. and susceptibil i ty to infections. V < 1scular lumen obstruction in SCD results from interaction of eryt hrocy tes, leukocytes. platelets, plasma proteins. and the vessel wall. The disease phenotype is a product of various genes and enviro nmental factors acting in concert with the protein lesion underlying the red cell anoma ly. The severity of SCD increases w ith leukocy tes count. The biological basis a nd therapeuti c implications of this relationship are discussed. Leukocytes contribu te to sen hy ddllering to blood vessel walls and obstructing the lumen . aggregating w ith oth e r blood cells with effective blockage of the lumen. stimulating the vascular endothelium to increase its express i on of ligands for dGhesion molecules on blood cells, and causing tissue damage and inflammatory reaction which pred i spose to vasocclusion. Patients with impaired ability of leukocytes to kill microbes are more prone to infections; which precipitate sickle cell crisis. Reduction of leukocyte count ameliorates SCD. Similarly, targeted bl ockade or reduced synthesis of specific le ukocyte adhesion molecules and their ligands might con fer clinica l benefit in SCD.

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