This is a report of a multiparous woman that presented with bleeding per vaginum and life threatening haemorrhage following consensual sexual intercourse. She was resuscitated with intravenous fluids and had blood transfusion. During examination under anaesthesia, a deep spiral right vaginal vault laceration was revealed. The laceration was repaired and she made good recovery

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Background: Individuals with various forms and degrees of limb deformities are common on the streets of Lagos, Nigeria. State-sponsored screening and surgical correction of the deformities were carried out in Lagos between June 2004 and May 2006. A report on the pattern of limb deformities is presented. Methods: This was a prospective study of all the patients that were seen and treated during the various screening programmes and operating sessions. Data was stored electronically and analysed using Microsoft Excel software. Results: A total number of 1,321 patients were screened, and 344 satisfied the inclusion criteria for enrolment. They were aged between 9 months and 64 years but only 20% were aged 5-years and below. Females constituted 58.2% and males 41.8%. A total of 513 limbs were surgically corrected. The most frequent deformity and disease entity were bilateral genu varum (45.1 %) and Blounts disease (48.7%), respectively. Proximal tibial wedge corrective osteotomy was the most frequent surgical procedure performed. Most beneficiaries presented late and were discharged within 48-hours of hospital admission. Conclusions: Improved public awareness about the availability of hospital based resources to solve the problem of limb deformity is advocated.

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Background: The reasons underlying discharge against medical advice by Paediatric patients varies from place to place. Discharge against medical advice is frustrating to the medical personnel and deprives the patient of adequate medical care. This study aims to determine the prevalence and factors associated with discharge against medical advice. Methods: We retrieved and analysed all folders of patients who were discharged against medical advice at the Paediatric ward of Federal Medical Centre Azare, over 18 months period (January 2004 to June 2005). Information obtained included, age, sex, reasons for discharge against medical advice, socio-economic class of parents and duration of hospital stay. Results: The prevalence of discharge against medical advice was 4.3%. Male: Female ratio was 1.5: 1 and the age ranged between 4 hours and 12 years. The commonest reasons for discharge against medical advice were poor financial support and unpreparedness for hospital admissions. Twenty eight (87.5%) of the 32 children whose social class were available came from low social class. Conclusions: Discharge against medical advice is not infrequent in the study population. We recommend health education and free medical care for under-five children and comprehensive implementation of National Health Insurance Scheme as means of reducing the prevalence of discharge against medical advice.

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Background: Measles is still a major cause of childhood morbidity and mortality in Nigeria despite the availability of safe and effective vaccines. The burden of measles using length of hospital stay as a result of complications in hospitalised children with measles is reported. Methods: We carried out a two year retrospective study of children admitted with measles into the department of Paediatrics, University of Maiduguri Teaching Hospital. Results: Three hundred and nine children (11.2% of Paediatric admission) aged 6-90 months (median 13 months) with a male: female ratio of 1.6: 1 were admitted with measles. Forty three (14%) patients were aged less than 9-months. Seventy two per cent (223) of the subjects were not immunised against measles. Length of stay ranged between 4 and 32 days (mean; 8.7 days, median; 16 days) and total bed days were 3561 days. Forty per cent (124) of the measles admissions were for more than 14 days (prolonged hospitalisation). Infants and unvaccinated from low socio-economic class were more likely to have prolonged hospitalization. The most frequent complication associated with prolonged length of stay was bronchopneumonia (70.2%). Two of the children suffered acute measles encephalopathy. Conclusions: Therapy for measles and its complications may be a major drain on medical care resources in this part of Nigeria, especially among young children who are unvaccinated and from low socio-economic class.

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Background: Primary renal cancer accounts for 10 - 20% of all genito-urinary tract malignancies. The present study determined its clinico-pathological pattern and outcome of management. Methods: All patients with malignancies of the kidney seen between January 1999 and December 2007 were included in the study. These patients had surgery alone or in combination with preoperative/postoperative chemotherapy or radiotherapy and all specimens were confirmed malignant on histopathological examination. Results: Forty-nine patients with renal malignancies were seen of which 26(55.1%) were males and 23(44.9%) were females. The adults comprised 30(61.2%) and children 19(38.8%). The mean age was 27.60 +/- 22.12 years (range 7months-70 years). The male: female ratio was 1.1:1 and the mean duration of symptoms was 12.56 months (range 1-48 months). The most frequent clinical features were loin pain, 17 (44.7%), and flank mass, 32(84.2%). Others included haematuria, 13(34.2%), fever, 19(50.0%) and anaemia, 15(39.5%). The main diagnostic investigations were ultrasonography and intravenous urography. Forty-seven (95.9) patients underwent radical unilateral nephrectomy and 2(4.1%) had debulking or lymph node biopsies because of non-resectable tumours. These two had chemotherapy and subsequent nephrectomy. The most frequent renal malignancy was renal cell carcinoma (44.9%) followed by nephroblastoma (38.8%) which accounted for all the childhood renal tumours. All the children with nephroblastoma had postoperative 17(89.5%) or preoperative 2(10.5%) combination chemotherapy. Common postoperative complications included anaemia, fever, and chest and wound infections. There were 3 known deaths (mortality rate of 6.1%). The main cause of death was advanced malignancy. Conclusions: Renal cell carcinoma is the most frequent malignant tumour of the kidney in the study population. Late presentation resulted in in-operable tumours with poor survival despite neo-adjuvant chemotherapy.

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A 2 year old malnourished girl who developed an extensive subcutaneous emphysema complicating measles infection is hereby reported.

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Background: Children are most vulnerable to human immunodeficiency virus infection but in sub-Saharan African countries they are diagnosed late because paediatric human immunodeficiency virus diagnostic facilities are limited. Methods: Prospective study of 400 under-five children with diarrhoea in a hospital sitting. Results: Twenty six children (6.5%) were human immunodeficiency virus positive. Compared to the children who were human immunodeficiency virus negative, those who were positive had higher proportions of patients with acute diarrhoea (77%, p<0.002); recurrent diarrhoea (54%, p<0.001), chronic diarrhoea (p<0.002), caugh (73%, p<0.001); weight loss (18%, p<0.001) and delayed/developmental milestone loss (38%, p<0.001). Conclusions: In resource limited settings cough, wasting or developmental delay associated with chronic diarrhoea may be used as indicators for human immunodeficiency virus screening in under-five children.

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Background: It is not clear if the modality of patient admission into the Intensive Care Unit influences outcome. The Intensive Care Unit was audited to determine the pattern of admission, course of illness and management outcome. Methods: In a retrospective study covering the period January 1, 1994 to December 31, 2003, the master register of the Intensive Care Unit was examined. Parameters studied included demographic characteristics, diagnosis necessitating admission to intensive care unit, management, duration of stay in the unit and outcome. Results: There were 243 (57.6%) unanticipated admissions and 179 (42.4%) elective admissions within the period of study. The unanticipated admissions were more likely to be postsurgical than medical patients, (p < 0.01). There was a significantly higher mortality rate for unanticipated admissions (37%) than for elective admissions (17.3%)(p<0.01). Patients that were electively admitted to the unit were 2.8 times more likely to be discharged than unanticipated admissions (p<0.01). Conclusions: Patients that are electively admitted into the Intensive Care Unit has a better outcome than those whose admission is unanticipated.

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Background: Gastrointestinal perforation in the newborn is common, and often associated with poor outcome in developing countries. We determined the etiology and outcome of neonatal gastrointestinal perforation in an underserved region. Methods: A prospective study of neonates who presented with gastrointestinal perforation at the University of Benin Teaching Hospital, Benin City, and Leadeks Medical Center, both in Edo state, Nigeria, between July 2001 and June 2008. Results: A total of 68 neonates aged between 1 and 28 days (mean 12 ΁ 2.1 days), weighing from 1.5 to 4.1 kg (mean 2.8 ΁ 1.3kg), and comprising 41 males and 27 females (ratio 1.5:1) presented with gastrointestinal perforation. Fifty-one (75%) neonates had perinatal distress, following complicated delivery in 47 (69.1%) and drugs/infections in 4 (5.9%). These factors were the only cause of perforation (primary perforation) in 21 (37.5%) neonates, increased the risk of perforation of gut pathologies (secondary perforation) in 30 (62.5%), while only 17 (25%) neonates with perforation had no perinatal distress. Emergency caesarean delivery, prolonged rupture of membrane, prematurity, pre-partum hemorrhage, drugs, infections and maternal diabetes mellitus were the causes of perinatal distress. Volvulus. 20 (29.4%) anorectal anomaly, 14 (20.6%) necrotizing entero colitis, 11 (16.2%) and Hirschsprung's disease, 2 (2.9%) were causes of secondary perforations. Late presentation of clinically compromised neonates was frequent with attendant 27 (39.7%) deaths. Conclusions: Factors associated with perinatal distress were the leading causes of gastrointestinal perforation in neonates. The mortality was high and antenatal care in hospitals with adequately supervised delivery and early referrals are advocated to improve outcome.

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