Background and Objective: This short -term .....se control study of 70 consecutively recruited HIV-infected and previously antiretroviral nai"ve patients, treated with a combination therapy of stavudine, lamivudine and nevirapine (case) and 30 HIV-infected patients who were yet to start therapy (controls) were studied to evaluate the effect of highly active antiretroviral therapy (HAART) on the haematological parameters of HIV infected individuals. Methodology: Haematological parameters of haemoglobin, total with cell count, platelet count, erythrocyte sedimentation rate and differentia/leucocyte count were determined at baseline for subjects and control patients. Subjects were placed on HAART (stavudine 40 mg, lamivudine 150mg and nevirapine 200mg) twice daily for twelve weeks. of haematological parameters was repeated after 12 weeks of HAART in subjects and untreated controls. Result: The occurrence of anaemia, neutropenia, thrombocytopenia and leucopenia obtained respectively at baseline was 84.3%, 24.3%, 11.4% and 11.4% for subjects but after 12 weeks of HAART these declined respectively to 75.7%, 7.1%, 5.7% and 1.4%. Comparatively, there was an increase from baseline values of 96.7%, 23.3%, 6.7% and 6.7% to 100%, 36.7%, 10% and 36.7% respectively in untreated controls. The difference in mean haematological values of subjects and controls at baseline was not statistically significant (p < O.OS). But after 12 weeks of HAART in subjects and observation in untreated controls, the difference in mean haemaglobin (t = 5.77, p < 0.05), platelet count (I= 2.25, p < 0.05) and erythrocyte sedimentation rate (t = -3.20 p < 0.05) became statistically significant. While the haemoglobin, platelet and erythrocyte sedimentation rate improved in subjects, it declined in untreated controls. Conclusion: This study clearly indicates that highly active antiretroviral therapy of two reverse transcriptase inhibitors (stavudine and lamivudine) and one noll -nucleoside reverse transcriptase inhibitor (nevirapine) may improve cytopenios in HIV-infected Nigerians and may be used in patients with haematologic intolerance to other regimen.

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Direct observation of the procedure of couching of the lens as performed b y two traditional eye couchers in Northern Nigeria was made in February 1998. Following a short prayer, an un-sterilized crude couchi ng needle was introduced through the superior pars-plana into the eye to dislodge the lens downwards and backwards into the vitreous. All patients achieved a visual acuity of counting fingers at 3 meters in the immediate post-operative period, an improvement from perception of light pre-operatively. The sterility of the surgeon, the operated eye, the operating environment and the couching needle was not ensured. The couching needle was also crude· and blunt and the couchers' manipulations were rather rough. The procedure is therefore ad judged to be an unsafe alternative to modern cataract surgery. The provision of easily accessible, affordable, and quality modern cataract surgery would eliminate couching from Northern Nigeria.

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This paper reports a case of pulmonary paragonimiasis in a man resident in Enugu who presented at a chest clinic with haemoptysis: and as initially misdiagnosed a!-zaving pulmonary tuberculosis. It discusses the diagnostic difficulties and the . c n uswn wtth pulmonary tuberculosis, draws attention to the widening endemic foci for pulmonary paragommtasts and the need for an appropriate control programme.

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Background and Aim: Growing concern on the emergence of enterohaemorrhagic Escherichia coli 0157:H7 in the developed countries haue focused our attention on the prevalence of this disease infection in Jos area. · Methodology: From February 2002 to March 2003, 525 faecal specimens from adult and children of both sexes with diarrhoea (425) and without diarrhoea (100) were investigated for the presence of E. coli 0157:H7 enteropathogens. Result: From diarrhoeal patients, 3.5% were infected with enterohaemorrhagic Escherichia coli 0157:H7. No enterohaemorrhagic Escherichia coli 0157:H7 was isolated from control (non - diarrhoeal) patients. From children between the ages 0-5 yrs, 4.0% were infected with E. coli 0157:H7 , while in adults between the ages of 51-60yrs 5.3%. were infected with E. coli 0157:H7. Results from specimens of bloody diarrhoea revealed 11 out of 121 (9.1%) were infected with E. coli 0157.ri7 while E. coli 0157:H7 was detected in only 4 specimens out of 304 (1.3%) of non bloody diarrhoea. Conclusion: Our findings suggest that enterohaemorrhagic E. coli 0157:H7 is one of the bacteria enteropathogens that causes in Jos, Nigeria.

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Background: Bone marrow morphologic changes in patients with HIV!AIDS are frequently reported but none of the changes is termed pathognomonic. The present study is aimed at evaluating the usefulness of bone marrow assessment in Nigerian patients with HIVIAIDS. Materials and Methods: T his is a prospective hospital based study where 96 bone marrow samples of patients infected with HIV/AIDS seen at A.K.T.H., Kana were analyzed using MGG, Perl's stain and/or H&E stains. Indications for marrow study were anaemia (70.9%), Pyrexia of Unknown Origin (20.8%) or lvmphoma (8.3%). Results: Hypercellular marrows were found in 63.3% of patients and the remainder was normocellular or hypocel/ulkar. The major finding of dysplasia was seen in 80% of cases. Erythropoietic and gran ulocytic dysplasia mainly as megaloblastic erythropoiesis accounted for 60.4% and 60.5% of the dysplasia respectivel y. Conclusion: Bone marrow as pi ration in the setting of HIVIAIDS is useful in diagnosing megaloblastic anaemia and staging lymphomas. It may be used or diagnosing infections such as tuberculosis when TB cultures become a vailable or when patients present early.

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Background and Aim: Colostomy is socially unacceptable in many developing countries. Even when performed, morbidity and mortalities are high because most parents are illiterates, colostomy bags are not readily available and there are .no stomal nurses. This prospective study was, therefore, designed to assess the safety of correcting imperforate anus in girls without preliminarily diverting colostomy. Methodology: Twenty-one girls with imperforate anus and recto-vestibular fistula were entered into the study. Traditional large bowel preparations were done for 1 week, followed by Pena's posterior sagittal anorectoplasty. S yringe vents were used to protect the incisions for 10 days. Peri-operative cephalosporin and metronidazole were given. Results: Fourteen girls had intermediate anomalies, 7 had low anomalies. No other major detectable associated congenital anomalies. Washout through the fistula was easy. There were no particular problems with posterior sagittal anorectoplasty in prone positions. 1ucisions in 16 girls healed primarily although 4 patients had minor peri-anal excoriations; 2 girls had superficial wound infection, 2 had anal mucosal prolapse, 1 had recurrence of fistula. Conclusion: This study shows that girls with imperforate anus and recto-vestibular fistula usually sagittal anorectoplasty, protected with venting, without initial defunctioning colostomy. There are several advantages of a single operation, rather than multiples, epecially in developing countries.

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Background and Aim: Eighty-three patients scheduled for caesarean section were prospectively studied to determine the level of difficult laryngoscopic tracheal intubation among anaesthetists of various grades. Methodology: A standardized questionnaire detailing demographics, preoperative airway assessment, laryngoscopic view, the number of attempts and the status of the laryngoscopist was completed for each patient. Results: The overall incidence of difficult laryngoscopic tracheal intubation was 8.4%. the incidence of grade 3 laryngeal view was 15.7%. Oropharyngeal view was found to be a factor for difficult laryngoscopic tracheal intubation · ( p < 0.05, OR = 5.4). Factors such mouth opening, thyromental distance and the grade of anaesthetists were not found to be significantly different in patients who were predicted to be easy or difficult intubation. Conclusion: The incidence of difficult laryngoscopic tracheal intubation is unlikely to be zero especially in training institutions. We suggest that preoperative preparation should emphasize airway examination, especially visualization of oropharyngeal structure as strategy to improving outcome following general anaesthetic caesarean section.

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