Background: Bleeding from an enlarged prostate gland is a major complication of benign prostatic enlargement (BPH). This review details our management over a 10-year period. Materials and Methods: A retrospective review of patients who presented with bleeding BPH between January 2001 and December 2010 was carried out to determine the outcome of management. Results: Forty-two patients with bleeding prostates treated by open prostatectomy were analyzed. The peak incidence was in the age group of 60-69 years. The main associated co-morbidities were hypertension in 17 (40.48%) and diabetes in seven (16.67) patients. Urine culture was positive in 24 (57.14%) patients, with E. coli in 13 (54.17%) and Pseudomonas in four (16.67%) patients as the main isolates. Most patients (37; 88.08%) received blood transfusions ranging from two to four units. Operative techniques were transvesical in 30 (76.92%) and retropubic in nine (23.08%) patients. Isolated median lobe enlargement of the prostate was seen in 18 (46.15%) and whole organ enlargement in 21 (53.85%) patients. The weight of the prostates ranged from 47 to 403 g (mean, 127 g). Incidental carcinoma was seen in one patient (2.56%). The mean hospital stay was 11 days (range 9-21), and the mean follow-up was 21 months (range 3-26). There was one (2.38%) mortality. Conclusion: BPH with massive hematuria invariably has an enlarged median lobe and is managed by open prostatectomy, without risk of re-bleeding.

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Background: Dengue fever is a serious public health problem in terms of its morbidity and mortality. It reports from almost all countries and it is endemic in the tropical countries. Aim: The present hospital study aims to describe  the frequency , distribution and case fatality of dengue fever based on the variables such as age, sex and year. Settings and Design: It is a hospital-based retrospective study of 5 years in tertiary care and teaching hospital in South India. Materials and Methods: The data were collected from the medical records department of the hospital and analyzed by using Microsoft excel. Result: Out of 341 reported cases of dengue, 60.70% were males and 39.29% were females. In both males and females, the high proportion of cases were reported in adult age groups (>20 years). Case fatality rate of dengue fever is 1.2%, with 0.97% in males and 1.49% in females. Out of 341 cases, 333 (97.65%) were Classical Dengue Fever and remaining 8 cases (2.34%) were dengue hemorrhagic fever. Conclusion: More cases of dengue fever were reported in the adult age group (20 years and above) and in males compared to low age groups (<20 years) and females. It highlights the involvement of work component in the occurrence of disease. Community-based action program is required for source reduction activities in the outdoor area for arresting the breeding and multiplication of Aedes mosquitoes and thereby to reduce the morbidity and mortality of dengue fever.

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Background: Morbidity and mortality pattern is a reflection of disease burden. The aim of this study is to provide a comprehensive report of the causes of death in a tertiary hospital in Nigeria, a developing tropical nation. Methods and Material: We carried out a retrospective descriptive cross-sectional study of all records of deaths from January 2004 to December 2008 in Federal Medical Centre Umuahia, Abia, State in Southeast Nigeria. Results: Of a total of 18,107 patients were admitted during the study period, 2;172 deaths representing 12% mortality rate and comprising 1;230 (56.6%) males and 942 (43.4%) females were recorded. The age of patients ranged from birth to 100 years with a mean of 41.41 ± 26.30 years and 25-44 years age group being the most affected (n = 587, 27.1%). The overall leading cause of death was the infections group, which accounted for 837 (37.6%) deaths. Other major causes were cardiovascular system -related deaths 534 (24.7%), neonatal causes 173 (8.0%), trauma 155 (7.1%), diabetes mellitus complications 144 (6.6%) and neoplasia 76 (3.5%). Conclusion: Majority of the leading causes of mortality in this study are preventable. Our data reflects the effects of double disease burden of infections and non- communicable communicable diseases in a developing nation.

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Background: Oral health has been demonstrated to be an integral component of general health, with a serious impact on the quality of life and the overall well-being. Dental care utilization is an indispensable facilitator of oral health. Reports from the African continent highlight poor utilization of dental services across urban and rural populations. Hence, this study aims to determine the use of dental services by patients attending the dental clinic of Federal Medical Centre, Katsina between January 2011 and December 2012. Materials and Methods: The patients' records were retrieved and analyzed for demographic data, diagnosis, and treatment. Results: During the 2-year study period, a total of 2021 patients [1083 (53.6%) males and 938 (46.4%) females] were treated. The age of the patients ranged from 4 months to 94 years [mean ± standard deviation (SD) =28.6 years ± 16.2; median 28 years]. Approximately 80% of the patients were below the age of 40 years, with 21-30 years age group recording the highest frequency (28%). Most of the patients had caries and its sequelae, followed by periodontal disease (n = 352, 17.4%). Restorative and surgical procedures (n = 808, 40%) were the major treatment utilized by this cohort, with periodontal procedure trailing (n = 3951, 8.6%). Tooth extraction (n = 755, 37.3%) was the primary treatment accessed, followed by amalgam filling (n = 651, 32.2%) and scaling/polishing (n = 355, 17.6%). Conclusion: Our data demonstrate preponderance of male gender and young age group in the utilization of dental services among the study population. Tooth extraction was the most frequently provided dental treatment. We recommend preventive oral care as a means of reducing dental burden in the center.

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We present an unusual case of a middle aged female without other known co-morbidities presenting clinically with isolated prolonged fever and a radiological evidence of persisting focal lung opacity mimicking neoplasm. She was subsequently diagnosed to have nonspecific interstitial pneumonia on video-assisted thoracoscopic surgery guided lung biopsy. She responded excellently to oral corticosteroids both clinically and radiologically. This case illustrated the need to think beyond infective and neoplastic etiologies in a patient with persistent lung nodule.

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Background: Sikkim is declared as a goitre endemic state with an estimated prevalence of 54%. The spectrums of diseases include simple goitre, thyroiditis, adenoma, carcinoma, multinodular goitre and Graves' disease. The present study aims to determine the pattern of thyroid swelling in a hospital setup at Sikkim. Materials and Methods: This study is a retrospective analysis of records of all patients presenting with thyroid swelling in a tertiary care hospital at Gangtok, Sikkim during the period of 4 years between 1 ^st January 2008 and 31 ^st December 2011. Patients were diagnosed by clinical examination, FNAC, USG, CT scan and hormone estimation. Histopatholgical confirmation was done in surgical cases. Clinic opathological and demographic data of 166 such patients were obtained and analyzed for the present study. Results: The most common goitrous disease was simple goitre (69.27%) followed by thyroiditis (10.24%), toxic goitre (7.83%) and malignancy (12.65%). Papillary variant was the commonest carcinoma. Overall female:male ratio was 4.9:1. The prevalence goitrous lesion was highest in the middle age group between 30-39 years, while the extremes of age (below 10 years and above 70 years) were rarely involved. Conclusions: The prevalence of goitre in Sikkim is still very high despite iodisation programs by the Government. There is urgent need for more data on autoimmunity and goitrogens status to explain the high prevalence of goitre in this population.

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Background: There is a paucity of population-based data on ocular morbidity globally. The objectives of the current study were to estimate the prevalence and magnitude of eye disorders and to determine the ophthalmic subspecialty requirements for the population of Sokoto state, Nigeria. The information generated may provide baseline data for planning of a comprehensive eye health services in the state. Materials and Methods: During an all-ages population based blindness survey in December 2005, persons selected through a multi-stage random sampling were examined for any ocular disorder using a magnifying loupe, penlight and a direct ophthalmoscope. Data was entered and analyzed by a statistician. Statistical tests were carried out using Epi info 6 software (Centre for disease control [CDC] Atlanta, Georgia). Results: A total of 4848 persons were examined which gave a response rate of 91%. A total of 943 persons of the sample had an eye disorder in at least 1 eye, giving an ocular morbidity prevalence of 19%. Children aged 0-9 years constituted the highest proportion (37.5%) of the examined subjects. About 57% of the study population were males. Disorders affecting the lens (9.34%) were the most common followed by conjunctival lesions (5.49%). The most common diagnosis was lens opacity (8.1%) followed by conjunctivitis (5.2%). The most common subspecialty requirements in the population are cataract microsurgery (41.7%), and cornea/anterior segment (33%). Conclusion: Our data demonstrates high burden of ocular diseases most of which are either preventable or treatable in the study population. We recommend provision of human resource and technology requirements to meet these demands.

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Background: Severe organophosphorus (OPC) poisoning is one of the serious problems in developing world, taking great toll on life. Though Atropine is used as an antidote, there are no clear guidelines. We conducted an open label randomized controlled clinical study to compare the efficacy of continuous infusion of atropine to that of intermittent bolus dose in the treatment of OPC poisoning. Methods and Material: Patients aged above 12 years with clinical evidence of OPC poisoning were studied. Both the groups received initial bolus of 1to3 mg of atropine. Then, Group-A received intermittent bolus and group-B, continuous infusion, until adequately atropinized. Results: Out of 743 patients (group-A: 356 and group-B: 387), females were 54%. 83% had suicidal intent. Mean atropine dose was 126.6mg in group-A and 78mg in group-B (P < 0.0001) . 21.07% (group-A) and 12.92% (group-B) developed intermediate syndrome (P = 0.003) , mortality was 27.25%(97) in group-A v/s 13%(50) in group-B (P < 0.0001) . Ventilator support needed in 36%(group-A) against 17% in group-B (P < 0.0001) and duration of ventilation was 1.5 days lesser in group B (P < 0.0001) . 23.03% had atropine toxicity in group-A as compared to 8% in group-B (P < 0.0001) . Hospital stay was 1.67 (P < 0.0001) days shorter for group-B. Conclusion: Continuous atropine infusion should be standard of care in treating OPC poisoning.

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Background: Pregnancy and childbirth are thought to be associated with development of lower urinary tract symptoms (LUTS). The study aimed at ascertaining prevalence rates of LUTS before and during pregnancy, the determinants and perceived effects of these symptoms on the life of the women. Materials and Methods: Questionnaires in which LUTS were defined according to recommendations of International Continence Society was administered on consecutive women who delivered at ≥37 weeks' gestation to ascertain the presence or absence of LUTS before and during pregnancy and perceived effects on their life. Data was also collected on their socio-demographic and obstetric features. Descriptive statistics and relationship between LUTS and other variables were analyzed using SPSS version 16. Results: Prevalence rates of LUTS before and during pregnancy were 52.9% and 89.2%, respectively, and mostly included nocturia and stress urinary incontinence. Women were more likely to develop LUTS during pregnancy (P = 0.002, OR 4.99, 95% CI 1.793 - 13.906). Only 14.4% and 41.7% reported any burden on their daily life before and during pregnancy, respectively. Previous vaginal delivery (P = 0.01, OR 3.12, 95% CI 2.91-5.62), grand-multiparity (P = 0.04, OR 4.15, 95% CI 3.82-7.24) were associated with LUTS prior to pregnancy while presence of LUTS before pregnancy (P = 0.001, OR 10.80, 95% CI 4.24-27.52), previous vaginal delivery (P = 0.002, OR 6.38, 95% CI 4.25-12.43) and moderate maternal obesity (P = 0.03, OR 2.56, 95% CI 1.82-3.47) were predictive of LUTS during pregnancy. Conclusion: LUTS are common among women both before and during pregnancy but most of them were not bothered by the LUTS. Those with previous vaginal delivery and are grand-multiparous are more likely to develop LUTS prior to pregnancy while the presence of LUTS before pregnancy, vaginal delivery and maternal obesity are determinants of LUTS during pregnancy.

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Structural variations of the kidney and its abnormal vascular architecture make the kidney unsuitable for transplantation. We report here a case of malrotated left kidney with cratered hilum and presence of an accessory renal artery. A lumbar vein was seen to loop under the accessory renal artery on the way of its termination into the left renal vein. The kidney appeared to have failed to rotate from its fetal position. Thus, the hilum was placed ventrally. The hilum was crater-like in shape, wide, and allowed passage of the hilar structures. The shape of the kidney itself had undergone slight modification as it appeared more ovoid than its typical bean shape. The poles, but not the surface or borders were distinguishable. The variations described in the current observation are of a unique pattern of congenital malformation having surgical, urological, and radiological implications.

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