Background: Measles, a highly infectious viral disease, is endemic in developing countries with a peak of transmission from October to March. The case fatality rate of measles in the developing countries stands at around 3-5%; this could be as high as 10% during epidemics. Although natural infection with the measles virus confers life-long immunity, those vaccinated with the vaccine could get up to 10 years of protection. In spite of the availability of measles vaccines, there have been sporadic measles outbreaks, especially in developing countries, hence the need to know the underlying cause. Study Design: Systematic review. Method: Relevant literature was reviewed on trend of measles. The literature accessed from the W.H.O and UNICEF sites, and also using Google search include case-series studies, community-based studies on age-specific measles case fatality ratios (CFRs), and cohort analysis of surveillance data. Results: The review shows that lowest measles CFR is seen among the vaccinated children and highest seen among the unvaccinated children. Additionally, the broad range of case and death definitions of measles as well as the study population and geography, clearly highlight the complexities in extrapolating results for global public health planning. Conclusion: The outcome of several studies has shown that measles outbreaks are associated with factors that include: weak measles case-based surveillance in some areas, lack of awareness about the disease among parents, vaccine stock-out, and lack of adequate cold chain equipment to preserve the vaccine in remote hard-to-reach areas.

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Aims: The aim of this study was to determine the prevalence of microalbuminuria (MA) in patients with type 2 diabetes mellitus (T2DM) and to identify the associated risk factors. Settings and Design: The study was a prospective, descriptive, cross-sectional study carried out in the medical outpatient department of the Central Hospital, Warri from March to August 2014 after approval by the hospital's health and ethics committee. Materials and Methods: Two hundred T2DM aged 45-80 years were randomly selected for the study after obtaining their informed consent. Three-morning urine samples collected at 1-month interval were tested for MA using the "MICRAL test" strip. A fasting blood sample was also drawn after 10-12 h overnight fasting for plasma glucose, hemoglobin A1c (HbA1c), lipid profile, and serum creatinine investigations. MA was diagnosed if the urinary albumin excretion ratio was between 30 and 300 mg/24 h from two separate urine samples. Statistical Analysis Used: Data was analyzed using Statistical Package for Social Sciences version 16. Differences at P < 0.05 were considered significant. Results: The prevalence of MA was 58%. The mean age, duration of T2DM, systolic blood pressure, fasting blood glucose, HbA1c level, serum creatinine of type 2 diabetes with MA were significantly higher when compared to T2DM patients without MA while the mean diastolic blood pressure body mass index and age did not differ significantly between the two groups. Conclusions: The overall prevalence of the MA among type 2 diabetes visiting a medical outpatient clinic in Central Hospital, Warri were high and similar to that reported in other studies.

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Introduction: Drug-drug interactions remain a major cause of adverse drug reactions with great consequences such as increased morbidity and increased healthcare cost. In elderly patients with systemic hypertension, there is a tendency for them to be prescribed multiple medications and this may expose them to some drug-drug interactions (DDIs) especially in the context of physiological changes of ageing. The objective of this study was to evaluate potential drug-drug interaction among some Nigerian elderly hypertension. Methods: A cross-sectional study involving elderly hypertensive patients attending the general outpatient clinic of two tertiary healthcare facilities located in Ekiti State, South-West Nigeria. The information collected from the patients' medical records included their ages, gender, diagnosis and list of prescribed anti-hypertensive medications. Potential drug-drug interactions were checked for using the Multi-Drug Interaction Checker (Medscape Reference) and Epocrates Drug Interaction Checker (San Mateo CA, USA). Results: A total of 350 elderly patients attended the clinics during the study period of which 208 (59.4%) hypertensive patients were identified and their records used for analysis. The fixed-dose combination drug Moduretic® (Amiloride /Hydrochlorothiazide)-25.7% was the most commonly prescribed antihypertensive followed by Lisinopril (16.6%), Amlodipine (13.2%) and Nifedipine (12.6%). The anti-platelet Acetyl-salicylic acid (ASA) was prescribed for 100 (48.1%) patients and represented 19.8% of all prescribed medications. A total of 231 potential DDIs were found among the patients giving a mean of 1.3 interactions per patient. The most common identified drug pairs with potential interactions were ACE inhibitors - Amiloride, followed by ACE inhibitors - Hydrochlorothiazide, ACE inhibitors - ASA and ARB - Amiloride. Conclusion: Potential drug-drug interactions, though common in this study comprised mainly of minor and moderate types. Notwithstanding, physicians need to be reminded of the potential for interactions when prescribing for elderly patients

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Objective: To determine the reasons for seeking dental healthcare services in a missionary hospital in Benin City, Nigeria. Materials and Methods: This 14-month retrospective study was conducted in a Pentecostal missionary hospital in Benin City. Data of interest which included age, gender, occupation, primary presenting complaints, and primary diagnosis were collected from the case notes with self-designed proforma. Cases with incomplete data were excluded from this study. The obtained data were subjected to descriptive statistics in the form of frequencies, cross tabulations, and percentages using Statistical Package for the Social Sciences version 17.0. Results: A total of 613 cases were retrieved with the complete information. The majority (56.3%) of the patients were young adults (18-40 years). About one-fifth (21.2%) of the patients were middle-aged adults. Children and elderly constituted 15.8% and 6.7% of the patients, respectively. A total of 332 (54.2%) patients were females. There was diversity in the occupation of the patients with about one-third (37.7%) of the patients being students. The majority of the patients had toothache as their primary presenting complaint (71.1%). Others were tooth deposits (6.0%), fractured teeth (3.8%), hole in teeth (3.1%), missing teeth for replacement (2.3%), routine dental check-up (2.3%), and mouth odor (2.0%). Diagnosis of dental caries and its complications was made in more than half (58.6%) of the patients while one-fifth (20.4%) of the patients were diagnosed with gingivitis. Conclusion: Data from this study revealed that these enormous diverse patients of a Nigerian missionary hospital had toothache as their main primary presenting complaint and dental caries and its complication as their main primary diagnosis.

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Background: Cardiovascular disease (CVD) is the leading cause of hospitalization and death in chronic kidney disease (CKD) patients. Hyperuricemia has emerged as one of the nontraditional cardiovascular risk factors. Studies have shown that hyperuricemia plays a major role in the development of CVD and rapid progression of CKD to end-stage renal disease. Objective: The aim was to determine the prevalence and pattern of hyperuricemia in predialysis CKD patients attending a teaching hospital in Southern Nigeria. Methodology: One hundred and twenty consecutive predialysis CKD patients and 40 control subjects with normal renal function were recruited over 2 years. Data obtained from participants included demographics, body mass index, blood pressure reading, and etiology of CKD. Blood sampling was done for the determination of serum uric acid, creatinine, and fasting serum lipids. P < 0.05 were taken as significant. Results: The mean age of the CKD subjects was 48.8 ± 16.6 years with a male:female ratio of 1.7:1. The prevalence of hyperuricemia in the CKD subjects was 47.5% and this was significantly higher than 15% observed in the control group (P ≤ 0.001). The prevalence of hyperuricemia was highest in CKD stage 3b. Hyperuricemia was more prevalent in younger predialysis CKD subjects and those with hypertensive nephropathy. There was no significant association between hyperuricemia, obesity, gender and dyslipidemia in this study. Conclusion: Hyperuricemia is highly prevalent in young predialysis CKD patients even in the early stages. Measures to reduce hyperuricemia should be put in place especially lifestyle and dietary modification.

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Background: Profiling of stroke types in sub-Saharan Africa until recently has been done in part with the clinical diagnosis, where neuroimaging is not affordable or accessible. Objective: To profile all first-ever stroke using cranial computed tomography (CT) scan. Methods: Three hundred and thirty-four first-ever stroke had demographic data as well as the duration of admission or time to event (outcome), stroke type and severity, volume of hemorrhage in cases of parenchymal hemorrhage captured from the stroke unit register. Operationally outcome was defined as discharge to follow-up or discharge against medical advice (DAMA) or all-cause in-hospital mortality, stroke type was defined by cranial CT as cerebral infarct or intracerebral hemorrhage (ICH) or subarachnoid hemorrhage. Stroke severity was defined by the Canadian Neurological Scale (CNS) and the National Institutes of Health Stroke Score (NIHSS). Data were analyzed as appropriate. Results: Mean age was 62.63 ± 14.90 years, comprising 190 (56.9%) males and 144 (43.1%) females. Mean duration of admission was 12.91 ± 11.38 days. Totally, 251 had cerebral infarct (75.15%), 81 (24.25%) had ICH, 2 (0.60%) had subarachnoid hemorrhage. A total of 177 (51.19%) were discharged to follow-up, 15 (4.50%) were DAMA with acute case fatality of 148 (44.31%). Mean CNS score was 2.85 ± 2.57 and mean NIHSS was 17.29 ± 5.15. Age, time to outcome and NIHSS were the predictors of outcome (survival or discharged to follow-up and all-cause mortality) (odds ratio [OR] =1.043, P = 0.016, OR = 0.923, P = 0.001, OR = 2.467, P < 0.001 respectively) and NIHSS was the only predictor of survival (hazard ratio = 0.872, P < 0.001). Conclusion: This neuroimaging profiling of acute stroke type and outcome is expected to be an improvement over reviews based largely on the presumptive diagnosis.

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Background: Neurologic syndromes like headache may on occasion complicate sexual activity. Though largely benign, the headache may seldom be a symptom of an underlying sinister and life threatening neurologic disorder such as aneurysmal subarachnoid heamorrhage. Method: Relevant published materials on the subject of headache associated with sexual intercourse and their cross references from Pubmed Medline, Cochrane Library, International Headache society, EMBASE and other relevant bibliographic repositories were ferreted since 1980 till date. Result: HAS is mainly a diagnosis of exclusion. The secondary or malignant form has a course that is dictated by its underlying cause. HAS in the primary or benign form is amenable to treatment with drugs including indomethacin, propranolol and calcium channel blockers (nimodipine, verapamil and diltiazem) with excellent prognosis. Conclusion: Early evaluation for underlying cause of HAS and institution of appropriate treatment is recommended.

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Cor triatriatum (CT) otherwise known as a tri atrial heart is a rare congenital heart defect. This report describes a rare case of CT dexter in a 2-year-old girl who presented to our facility with cough and difficulty in breathing of a year duration and body swelling of 3 months duration. She was also found to be in heart failure. Transthoracic echocardiography revealed a membrane separating the right atrium into two chambers, with features of pulmonary hypertension. Although the patient was scheduled for follow-up, she however, died 2 days later. Early diagnosis and prompt referral of patients with this rare defect are mandatory to prevent mortality from this defect that is amenable to simple corrective surgery.

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Primary extra osseous osteogenic sarcoma is one of the rarest forms of malignant tumor of the breast. It can arise as a result of osseous metaplasia of a preexisting neoplasm or from a none-phylloides sarcoma of a previously normal breast. Due to its rarity, natural history and optimal treatment methods remain unclear. A 60-year-old patient presented to the surgical casualty with large breast abscess. Abscess wall histology revealed an osteosarcoma of the breast. Left total mastectomy with axillary clearance was performed. Histology and subsequent imunohistochemical studies confirmed the diagnosis of osteogenic sarcoma without lymph nodal metastasis. The patient was referred to the oncologist for further management. Rare types of breast tumors can be presented as breast abscess. Incision and drainage together with wall biopsy help to exclude associated sinister pathologies. Diagnosis of primary osteosarcoma of the breast was made using histological and immunohistochemical findings once the possible primary from the sternum and ribs were excluded. Treatment is as for sarcomas affecting other locations and should comprise a multidisciplinary approach.

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Aims: To compare the diagnostic yield of digital rectal examination (DRE), transrectal ultrasound (TRUS) scan, and prostate-specific antigen (PSA) in diagnostic evaluation of advanced carcinoma of the prostate (CAP). Subjects and Methods: A comparative study of sensitivity and specificity of DRE, TRUS, and PSA in the evaluation of advanced CAP. This was done over a 3-year period (January 2010 to December 2012) in a tertiary health institution in Sub-Saharan Africa. All patients presenting with symptoms of prostatic enlargement were recruited, DRE, TRUS, and PSA findings were compared to the histological diagnosis. Statistical Analysis Used: SPSS version 16.0. Results: One hundred and eight cases were analyzed. Histological diagnosis revealed that 52 (48.1%) were CAP whereas 56 (51.9%) were benign. All the patients presented with lower urinary tract symptoms. Surprisingly, some patients with advanced CAP had PSA values in the normal range (0-4 ng/ml) while some with the benign disease also had PSA values above 50 ng/ml. PSA was noted to have the highest sensitivity but lowest specificity. Conclusions: Limitations of PSA are not only seen in screening for early disease, but also in the diagnosis of advanced CAP, and no value of PSA can be considered safe to declare a patient CAP free.

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