Objective: Post operative enterocutaneous fistula, in this environment, continues to excite interest because it runs a distressing course, and it is often associated with high mortality and morbidity. Determining the classification type best suited to suggest the outcome would be helpful in guiding the management of the condition. Setting: Ife Hospital Unit, Obafemi Awolowo Teaching Hospitals Complex, lle - Ife. Outcome Measure: To determine the clinical pattern of post operative external enterocutaneous fistula and the classification method that best predict outcome of the condition. Methodology: Consecutive patients with clinical postoperative external enterocutaneous fistula seen between 1994 and 2006 were studied. The case files were retrieved and information on demographic data, type of initial surgery, source of referral, and characteristic of the fistula in terms of effluent per day and type of intestine involved were retrieved and analyzed. Patient with incomplete clinical information were excluded from the study. Result: There were 30 patients aged 17 to 65 years, mean of 33 years ±SD 12.23 years, with male to female ratio of 2:1. Length of hospital stay ranged from 1 to 43 weeks. Majority 28 (93.3%) were referred after primary operation at the lower cadre hospitals. Enterocutaneous fistula followed intestinal resection in 15 cases (50.0%) and was post appendicectomy in 9 cases (30.06%). Three (11.1%) cases each had burst abdomen and Acquired Immunodeficiency Syndrome (AIDS) in 3 cases (11.1%) additionally. Overall mortality of 12 (40 %) was high. Compared with the other classifications, the current study classification into high and low output highly correlated with the outcome of treatment (logistic regression, p < 0.006 versus p = 0.123 and, p = 0.244, respectively for Sitges - Serra and schein and groups). Conclusion: In this study majority of patients with enterocutaneous fistula were referred from Private and State hospitals set up. This might be a reflection of the generally lower level of technical surgical skills at this level of healthcare facilities. Classification of enterocutaneous fistula into high and low output was still useful in our environment for predicting prognosis and may, therefore, be used to guide management strategies.

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Background: The collection and use of data as an interrelated process requires sufficient knowledge, right attitude and cooperation of health workers at all levels, especially at the primary health care (PHC) level. This study was undertaken to assess the knowledge of primary health care workers regarding the core National Minimum Data sets (cNMDS) to be collected at all levels of health care. It also determined the knowledge as wells as the attitudes of these health workers toward the use of Health Management Information System (HMIS) forms in data collection. Methods: The study was a descriptive cross sectional type with a computed sample size of 107 PHC workers selected from 18 health centers in the 17 Local Government Areas of Enugu State using multistage sampling method. Results: The PHC workers had above 50% knowledge only on 5 out of the 13 core NMDS (38.5%) they are required to collect at their various health centres. On the average, only 25.2% of the PHC workers knew the types and various uses of HMIS forms 000, 001, 002 and 003. The attitudes of the PHC workers towards the use of HMIS forms were largely negative as 60.7% of them expressed no interest in filling the forms while 48.6% saw the exercise as futile and time consuming. Conclusion: There is an urgent need to organize training programme for these PHC workers on the core NMDS they are required to collect, the types of HMIS forms used in recording these data and timely reporting of same to appropriate health authorities.

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Background: Bony problems such as angular deformities and metabolic both; disease are of high frequency in Nigeria. Objective: The aim of this study was to define the pattern of presentation in children with angular deformities of the knee. Methodology: It was an 18-month prospective study involving children aged between birth and 16 years who presented at the consultant orthopaedic outpatient department with angular deformity of the knee. Results: Rickets was found to be the most common aetiology of angular deformity of the knee and bilateral knee affectation was the most common mode of presentation. Genu valgum was the commonest deformity seen and most patients presented before the age of 5years. Conclusion: Rickets is the most common cause of angular deformity of the knee in patients presenting at the orthopaedic clinics in UBTH, but this may not reflect the true prevalence of angular knee deformities in the community.

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Background: The incidence and mortality rate of tuberculosis (TB) has been on the decline until its recent resurgence worldwide, with Nigeria inclusive. Objectives: We, therefore, considered it worthwhile, for this area of the country, evaluating its prevalence/incidence. Furthermore, TB's main clinical features on presentation, variable forms, outcome and associated factors would be ascertained. Methodology: This was a 6-year retrospective study conducted in the Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital (between 1 ^st December 1998 and 30 ^th November 2004). All case files of children aged 3 months -15 years of age with the diagnosis of any form of TB were retrieved from Medical Records Department. The data were analyzed in respect to age, gender, mode of presentation, history of BCG vaccination and evidence of its scar, main clinical findings, and results of investigations, complications, and outcome. Results: Ninety-nine (99) cases of TB were seen over the study period. Total patient on admission was 9,434, giving an overall prevalence rate of 1.1%, that is, about 1,100 per 100,000 populations. The male: female ratio encountered was 1.4:1.0. Of the 99 cases, 45 (45.5%) were in age group 3months- Syears, 32 (32.3%) in >5years- 10years, and 22(22.2%) in >10 - 15.0 year-age-group. The main presenting features were cough, 55(55.5%), fever,53(53.5%) and weight loss 33(33.3%). The most predominant form of TB seen in this series was pulmonary involvement in 46(46.5%) of cases, followed next in rank by disseminated TB, 22(22.2%). The three commonest complications seen in this study were protein energy malnutrition (n= 21), severe anaemia (n=16) and pleural effusion (n=11). Majority of patients had short course anti-TB therapy with current drugs. The case-fatality rate identified was 10.1% (10/99). Fifty-three (53.5%) had complete course of the treatment and were normal thereafter, while 36 (36.5%) cases either signed against medical advice or defaulted from follow-up. Conclusion: Tuberculosis remains one of the major causes of mortality in Nigerian children, and it is, therefore, pertinent improving our socio-economic status, and diligently pursuing BCG vaccination of all children at stipulated periods..

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Introduction: A variety of drugs including single dose (SD) nevirapine, zidovudine and its combination, given to mother in pregnancy and baby postnatally have been used to reduce mother-to-child HIV transmission rate. The experience at the University of Benin Teaching Hospital (UBTH), using highly active antiretroviral therapy (HAART) is reported. Methods: A total of 317 Mothers/ babies pairs recruited at the Prevention of Mother to Child Transmission (PMTCT) programme of UBTH who had HAART, were recruited for the study. HIV status of the infants was determined by deoxyribonucleic acid polymerase chain reaction (DNA PCR). Results: Of the 285 mothers/ infants pairs who adhered to our protocol, the transmission rate was 2.46 %. The babies who had mixed feeding had significantly higher rates than those who were exclusively breast-fed or had replacement feeding. P = <0.0001. Conclusion: In conclusion, the very low mother to child transmission rate in our study can be attributed to the efficacy of HAART regimen.

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Background: Cardiovascular events represent the major cause of death in individuals with diabetes mellitus. The American Diabetes Association has recommended that diabetic adults with addition risk factor for cardiovascular disease be treated with aspirin. We aimed to assess the use of aspirin in diabetic patients. Methods: Case notes of 100 diabetic patients were randomly selected on three occasions (0, 3 and 6 months). Information on risk factors and aspirin use was collected. Following the first review, we raised awareness on this issue. Results: Medical officers were aware of the need for secondary cardiovascular prevention in patients with diabetes mellitus. However, prescription for primary prevention was low. After raising awareness through hospital presentations, aspirin prescription increased. Conclusion: Simple measures of health education, through hospital presentation as part of an audit cycle, have led to a significant improvement in number of aspirin prescriptions. This should translate into a long time improvement in vascular outcome in this patient group.

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Background: The incidence of breast cancer worldwide is increasing. The established risk factors for breast cancer are being used to counsel and enlighten the public to prevent the disease but the incidence is still on the rise. Aims of Study: To search for new risk factors for breast cancer, specifically to determine the relationship of induced abortions and breast cancer. Patients and Methods: Biodata, risk factors, parity and abortion profile of all 145 female breast cancer patients seen in over a three year period were entered into a data sheet and analyzed by simple proportions and percentages. Results: Breast cancer patients who had procured induced abortion were diagnosed with the disease nearly a decade and half earlier than in breast cancer patients who never had induced abortion. Conclusion: Induced abortion, in the presence of same risk factors for breast cancer, caused the disease to be induced at a much earlier age than in the patients who did not procure abortion. We, therefore, advocate that induced abortion be discouraged. Women who must have an abortion should be counseled on increased nsk of breast cancer as part of the informed consent for termination of pregnancy.

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Background: The rise of methicillin resistant Staphylococcus aureus (MRSA) infection has become a serious health issue. The emergence of mutidrug - resistant MRSA strains compounds chemotherapy and has raised public health concern. In this preliminary study, the distribution and antimicrobial susceptibility profile of MRSA to 10 commonly used antimicrobial agents at the University of Calabar Teaching Hospital (UCTH), Nigeria were determined between June 2005 and May 2006. Methods: S. aureus were cultured from various clinical samples using standard bacteriologic technique. Methicillin disc diffusion method for the detection of methicillin resistance and Kirby - Bauer NCCLS modified disc diffusion for antibiotic susceptibility tests were used. Results: The MRSA prevalence rate was 37.5% (33/88) of all S. aureus isolates. Majority of the MRSA strains (15/33) were recovered from blood samples followed by isolates from wound exudates (11/33) and were statistically significant (p<0.05). The rate of MRSA recovery was highest in patients aged 0-9 years (63%) and those aged > 50 years (60%) and were statistically significant (r = - 0.083). The MRSA isolates were resistant to penicillin and ampicillin (97.0%), tetracycline (93.9%,), Cotrimoxazole (90.9%,), Chloramphenicol (78.8%), Cefuroxime (66.7%), Erthromycin (60.6%) and Gentamycin (54.5%). Amoxycillin clavunanic acid and ciprofloxacin were most active with MRSA isolates showing 97% and 93.9% susceptibility to the two drugs respectively. Eighteen (54.5%,) MRSA isolates showed resistance to more than four antibiotic groups: One strain was resistant to all of the antimicrobial agents used. Conclusion: The study affirms the increasing prevalence of multidrug resistant MRSA in Nigeria. There is need for rational chemotherapy, routine detection and regular surveillance of MRSA to limit its spread.

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Background: Twin gestation is known to have a negative influence on birth weight. The mean birth weight of a population changes with time, making its periodic determination necessary. Objective: To determine the mean birth weight of twins in Benin City and examine some factors that may influence it. Methods: The birth weights and sexes of 104 live-born twin pairs delivered over a four-year period in a Nigerian mission hospital were prospectively recorded according to the month and year of delivery and were analyzed. The mean birth weights of twins born during the wet season were compared with those of their counterparts born during the dry season. Results: Combining both sexes, the overall mean birth weight (standard deviation, SD) of twins was 2392(560)g (95% confidence interval, CI = 2316 - 2468). Comparing mean birth weights (SD) of male and female twins it were 2467 (518)g (95% CI = 2367 - 2567) versus 2185 (630)g (95% CI = 2064 - 2306) P<0.01. The mean birth weights (SD) for male twin infants were 2604 (598)g (95% Cl= 2437 - 2771) and 2265 (618)g (95% CI = 2081 -2435) in wet and dry seasons respectively P < 0.02; while for their female counterparts it were 2378 (602)g (95% CI = 2226 - 2530) and 2251 (638)g (95% CI = 2065 - 2437) in wet and dry seasons respectively p > 0.05. Combining both sexes, the mean birth weights (SD) were 2480 (587)g (95% CI = 2362 -2598) and 2259 (606)g (95% CI = 2136 - 2382) in wet and dry seasons respectively P < 0.02. Mean birth weight was significantly higher in multiparous compared to either primiparous or grand multiparous women. Together, mothers in high social class delivered twins with significantly higher mean birth weight than those of mothers in low social class p < 0.01. Conclusion: Overall mean birth weight of twins was 2392 (SD 560)g and it was significantly influenced by maternal parity and social class. Irrespective of gender, twin babies born during the wet season tended to be heavier than their counterparts born during the dry season.

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