Background : Obstructed labour, a rare event in developed countries, is a common obstetric problem ki developing countries like Nigeria. It remains one of the leading causes of maternal death in the country. Methods : A retrospective review of all cases of obstructed labour managed at Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto between January 2009 and December 2010 was carried out with the aim of determining the incidence, risk factors, causes, mode of delivery and complications associated with the condition. Results : One hundred and twenty one cases of obstructed labour was managed out of a total of 594V deliveries in the health institution giving an obstructed labour incidence of 2.0% or 1 in 49 deliveries. TrW associated risk factors included illiteracy(98.3%), lack of prenatal care(97.5%), primigravidity(36.3%) and grandmultiparity(26.5%). The leading cause of the condition was cephalopelvic disproportion(78.5%) whibe the commonest mode of delivery was lower segment caesarean section(65.3%). Perinatal death(55.4%>, wound infection(31.4%), puerperal sepsis(26.4%) and ruptured uterus(21.5%) were the most commo® complications. The maternal mortality was 8,264/100000 births. Conclusion : Obstructed labour is relatively common in the health institution and is associated with higy maternal and perinatal mortality. Measures to reduce the its incidence will include health education of th% populace on the importance of prenatal care/ hospital delivery and utilization of available family planning services. In addition, the primary health care providers and traditional birth attendants should be educated on need for prompt referral of abnormal labour.

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Background: Neonatal tetanus (NNT) is a leading cause of neonatal deaths in the developing countries; including Nigeria. Methods: A seven year (2003-2009) retrospective study of routine surveillance data on NNT cases. NNT notifications to the Federal Ministry of Health and the National Demographic Health Survey report of 200& were the data sources. Results: A total of 6,288 NNT cases were reported with 753 deaths, giving an overall 12% case fatality rate (CFR). Most cases, 3,368(54%), occurred in 2005 and 2006 alone but the highest CFR of 98 (24.9%) anc lowest CFR of 143 (8.3%) were in 2009 and 2006 respectively. Proportion of notified cases of 3,42ͳ (54.5%) from south Nigeria was higher than 2,859 (45.5%) from the north. Contrarily, the CFR of 40b. (54.2%) in north Nigeria was higher than the 345 (45.8%) in south. Similarly, all indices for prevention oi NNT were lower in the northern regions when compared to the south: proportion of antenatal care offeree by skilled providers:.65% versus 87%; protection against NNT in the last childbirth: 49% versus 81%; deliveries in a health facility: 41% versus 74%; pregnant women delivered by skilled providers: 43% versus-82%. Conclusion: NNT constitutes a major threat to child survival and utilization of its preventive services may, be poorer in northern Nigeria.

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Background : Hepatitis E virus (HEV) infection remains endemic with occasional epidemics in developing countries, particularly in regions where there is poor sanitation coupled with contaminated water supply. The disease has a poor prognosis in the context of pre-existing chronic liver disease. Aim: In view of the existing dearth of information on the prevalence of HEV infection among children in our setting, this study was thus conducted to provide information on the seroprevalence of HEV among a population of school children in Kaduna, Northern Nigeria. Methods : The study was a cross sectional study involving secondary school children aged 11 years and above, randomly selected by multistage cluster sampling attending public, day secondary schools in three randomly selected local government areas from the three geopolitical zones of Kaduna state, Nigeria. Information was obtained using a questionnaire and blood samples were obtained from the subjects for evaluation for HEV immunoglobulin G (IgG) using a commercial enzyme linked immunoassay kit. Data were summarized as percentages, charts and frequency tables and results computed and analyzed using Epi-info version 3.0. Results : A total of 372 subjects were studied out of which 24 were found to be positive for HEV IgG antibody, which gave a prevalence rate of 6.5%. The age group 16 - 20 years had the highest (9.2%) prevalence for HEV infection compared to other age groups. HEV infection was found to be statistically significantly associated with use of Pit latrine and poor sanitary condition. Conclusion : HEV infection is prevalent among secondary school children in Kaduna state and poor sanitary condition among other predisposing factors was prominent in the community. There is need therefore for collaborative and holistic efforts by all stake holders to ensure provision of clean portable water as well as invigorate health education in order to improve health promoting sanitary conditions to acceptable standards.

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Background: The epidemic of HIV/AIDS has greatly boosted the incidence and prevalence of tuberculosi especially in developing countries of Africa. In Nigeria, data is scanty on the outcome of the management of HIV-TB co-infection. We aimed to evaluate the outcome of tuberculosis (TB) treatment in TB-HIV co-infected patients in North-Central Nigeria. Method: A one-year retrospective review of data obtained from the registry of the Directly Observed Treatment Short-Course (DOTS) centre of the Church of Christ in Nigeria (COCIN) Hospital Mangu, Plateai, State, North-Central Nigeria was undertaken. TB treatment outcome was described as cure, completed therapy, transferred-out, treatment failure, default or death. Results: In all, 273 cases were reviewed with median age at 30years (range 1-70). Only 124(45°/$: patients had HIV screening with 76(27.8%) sero-positives. Sputum smear positive TB was seen /v 108(39.6%) cases with 34 (31.5%) being sero-positive for HIV, and 28(25.9%) not consenting to Hit screening. Of the 273 cases, 55(20.14%) had documented evidence of cure with 122(44.69%) completing treatment for TB; 78(28.57%) patients transferred-out to other TB treatment centers; 1(0.37%) patient haqf treatment failure: 13(4.76%) died; 4(1.47%) defaulted from treatment. There is a statistically significant association between TB/HIV co-infection and dying from TB, p < 0.007, OR 8.81. Conclusion: TB/HIV co-infection is common in our population with substantial number of persons sfrf declining HIV screening. The cure rate for TB in this cohort is poor. Further studies are suggested to trul. address the poor treatment outcome.

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Background: Discharge against medical advice presents ethical dilemma to the medical staff and reflects a failure to reach consensus between the medical personnel and the patient or his/her custodian regarding the need for continued in-patient care. It also presents a challenge for the medical staff in terms of counseling, quality of service as well as legal implications. To determine factors responsible for DAMA in ABUTH this study was conducted. Method: The study was an unmatched retrospective case-control in design involving all patients DAMA between 2005 and 2008. The controls are patients admitted 24 hours before and 24hours after the admission of patient ending up as DAMA; the controls were discharged formally by the attending physician. Relevant information of both DAMA and non-DAMA patients were extracted from their case notes by means of a proforma: age, sex, marital status, religion, occupation, residence, diagnosis and length of stay. The extracted data was entered and analyzed using SPSSv16. Results: There were a total of 21,725 admissions, 16,360 discharges and 2701 deaths during the study period. Of the 21,725 admissions 225 (1.37%) ended up as DAMA. Patient's characteristics that significantly determined DAMA are young age, male patient, admission through ER and a diagnosis of road traffic accident. Conclusion: Discharge against medical advice is prevalent in ABUTH and factors significantly influence DAMA include young age, male gender, admission through ER, involvement in road accident, surgical as well as OBGYdiagnoses.

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Background : Cystic lymphangioma (CL) is a congenital lymphatic malformation that is a rare cause of extratesticular scrotal masses in children, frequently misdiagnosed preoperatively. Complete excision is curative, but recurrence may result following incomplete excision. Aim: This case is presented to alert the medical fraternity on the possibility of CL in a rare site as the scrotum, and to consider same in the differential amongst commoner causes of scrotal masses in children and adults. Methods : A case report, Results : We report a case of cystic lymphangioma of the scrotum in a 7-year-old boy, which had been previously diagnosed as an epididymal cyst. Scrotal ultrasonography and operative findings were consistent with cystic lymphangioma, which was confirmed by histological examination of the excised specimen. The mass was completely excised and the child is free of recurrence at 3 years of follow-up. Conclusion : Scrotal masses may result from unusual causes like cystic lymphangioma, which must be taken into account in the differential diagnosis in such cases. High-resolution ultrasonography, followed by Computerized Tomography (CT) or Magnetic Resonance Imaging (MRI), are useful tools in diagnosis.

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Background: Unlike Chronic Myeloid Leukemia (CML) whose genetic basis (the Philadelphia chromosome), has become a household name, that of Polycythaemia Vera and other non-leukemic myeloproliferative diseases has not equally received wide publicity. Aim: The aim of this paper is to review and highlight the role of JAK2 mutation in Polycythaemia Vera, Primary Myelofibrosis and Essential Thrombocythaemia. Methods: Literature on the subject was reviewed using manual library search, articles in journals, internet search and conference abstracts. Results: JAK2 mutation plays important role in the general pathophysiology of non-leukemic myeloproliferative diseases. Proper understanding of these roles is being utilized in research and development of novel therapeutic agents.

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Background: The control of hypertension is very important because it leads to incidence rats reductions for stroke, ischaemic heart disease and renal failure. It was the objective of this paper tc present experiences encountered in the management of hypertension in Taura health clinic with ar emphasis on drug therapy, as well as to draw lessons for the improvement of the health care system in Nigeria. Method: Case series Results: Nine patients with ages ranging from 26 to 75 years were examined over six month perioc: and all presented with hypertension. The continuous nature of treatment appeared to be an economic: burden on the patients which resulted in poor compliance. Conclusion: Healthcare planners should endeavour to give top priority towards the management oil hypertensive patients either under medication regimen or in any health facility, with the subsidizing, and cheap availability of their drugs

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Background : The clinical diagnosis of diseases and early treatment of patients are tentative pending the outcome of various laboratory investigations. Some clinical diagnosis do not tally with autopsy diagnosis; making autopsy a veritable tool for auditing clinical diagnosis of diseases. Objectives: To determine the accuracy of clinical diagnosis of diseases using autopsy. Design: A twelve year prospective clinico-autopsy study. (1 ^st Jan 1995 - 31 ^st Dec, 2006). Setting: University of Port Harcourt Teaching Hospital (UPTH), and referrals from other hospitals and clinics in Port Harcourt, Nigeria. Methods : The 150 patients who were previously diagnosed of various diseases and treated for variable period of time, and later died were thoroughly autopsied on request to ascertain the cause of death. The medicolegal autopsies were excluded from the study. Results : The autopsies were performed on patients of both sexes of different ages. Ninety (60%) autopsies were males and 60(40%) females, giving a sex ratio of 1.5:1. Out of the 150 clinically diagnosed cases, autopsy accurately confirmed 127 cases (84.6% concordance rate) and varied in 23 (15.4% discordant rate) Conclusion : Autopsy pathology is beneficial to the hospital, clinician, the surviving relatives and medical education. It is a veritable tool for auditing the accuracy of clinical diagnosis and treatment of diseases. It should be incorporated in the patient care and management delivery system in the country.

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Background: Membrane rupture may be integral to labour initiation in paturients with premature rupture of membranes [PROM] and therefore, it may be logical to expect that their labour characteristic and pattern should differ from those with intact membrane undergoing induction of labour. This study compared the 'a'bour characteristics in patients with PROM who had stimulation of uterine contractions with oxytocin with 'tose parturients with intact membranes who underwent induction of labour. Wtethod: This was a retrospective study conducted at the Obstetrics and Gynaecology department of the University of Benin Teaching Hospital (UBTH). The case files of 463 consecutive patients for induction/stimulation of labour from October 2008 to September 2009 were reviewed. Paturients were located into two groups; those with term premature rupture of membranes (PROM) and those with intact membranes who underwent induction of labour. Comparison was made between the labour characteristics of groups, mode of delivery, intrapartum complications and neonatal outcome. Results: During the study period a total of eligible 284 paturients with intact membranes had induction of labour [IOL], while 179 paturients with PROM had stimulation of labour [SOL]. Both groups were comparable in their sociodemographic and clinical characteristics. Majority of the PROM cases were contracting at admission [40.8% to 22.5%], also they had significantly shorter latent period [3.3hrs to 5hrs], required less use of higher oxytocin dose [3.9% to 7.4%] and had shorter labour duration (induction ^f c delivery interval: 6.7hrs to 9.1hrs). There was no difference in their mode of delivery or caesarean section rate. There were no significant differences in intrapartum complications and neonatal outcome measures. Conclusion: The finding of a significant shorter latent period, requirement for less oxytocin dose and overall shorter duration of stimulated labour cases with PROM compared to induction of labour for those with intact membranes suggest that PROM may be a means of labour initiation by some parturients and thus implies that these two groups of paturients are different obstetric entities and should therefore be treated as such in their labour management and research consideration.

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Background: Children are orphaned by AIDS when either or both their parents die from AIDS related 'llnesses. With the National response to combat AIDS orphans and vulnerable children (OVC) situation in Nigeria and in an era of free antiretroviral therapy (ART), we undertook to evaluate the sociodemographic characteristics of AIDS orphans in a tertiary institution. Methods: The sociodemographic characteristics of HIV infected AIDS orphans were compared to their non orphan counterparts using a proforma. Results: Of the 155 HIV infected children, 49(31.6%) were orphans. There were more male orphans 02(65.3 %) and more paternal orphans 24(49.0%). The mean age of the orphans was 7.6 ΁ 4.4(range 1.3 -1.7) years. The majority of the subjects were malnourished irrespective of orphan status. Conclusion: The socio-demographic characteristics of orphans is not significant different from the non orphan. However, there is need to attend to the nutrition of all HIV infected children.

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