Background: Endotracheal intubation is an integral part of airway management and is key to the practice of safe anesthesia. Prediction of a difficult airway can help reduce the incidence of failed or difficult intubation. We studied the use of “L-E-M-O-N” (Look-Evaluate-Mallampati-Obstruction-Neck mobility) scoring system to predict difficult intubation and determine the prevalence of difficult intubation among adult surgical patients. Materials and Methods: One hundred and sixty (160) consecutive ASA I–III surgical patients between 18 and 65 years of age were recruited from October to December 2011. A variety of airway tests using the “L-E-M-O-N” scoring were done during preoperative assessment; and at induction of anesthesia, airway assessment using Cormack and Lehane was performed and the results were recorded by a standardized record sheet. The variables evaluated were gender, age, weight, height, body mass index (BMI), dentition and a variety of airway tests using the “L-E-M-O-N” scale. SPSS version 17.0 was used for statistical analysis; and a P value <0.05 was considered significant. Results: Prevalence of difficult intubation using Cormack and Lehane score only was found to be 8.1%. The “LOOK” features had sensitivities of 99.1%, 96.6%, and 92.5% for facial trauma, large incisors, and beard or moustache, respectively, and positive predictive values of 0%. Combination of predictors in the “L-E-M-O-N” score showed that, as the mean “L-E-M-O-N” score of the patients increased, the likelihood of difficult visual laryngoscopy also increased. Conclusion: Combination of airway predictors in the “L-E-M-O-N” scoring system significantly improves the ability to predict difficult intubation.

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Introduction: Sexual stimulants are preparations used for increasing pleasure during sexual intercourse. The study sought to determine the use and effect of such preparations on women of reproductive age group in Kano, northern Nigeria. Materials and Methods: A self administered questionnaire was used to obtain information from 500 women to determine if they use sexual stimulants and the effects of the drugs on them (if any). Results: There were 423 women that responded. Majority 228 (53.9%) of them use sexual stimulants. Most (47.4%) of them were between the ages of 21 and 30 years, married (85.5%), multiparous (46.9%), and attained tertiary education (58.3%). About 39.9% of the respondents benefited from increased sexual pleasure and satisfaction, 20.2% obtained extra favors from their husbands while 29.9% did not benefit anything from the preparations. About 37.3% developed complications, which included coital laceration (5.9%), copious vaginal discharge (16.5%), vulval itching and rashes (17.5%), lower abdominal pains (14.1%), painful intercourse (16.5%), vaginal dryness (13.0%), and irregular menses (5.9%). Conclusion: A large number of women use sexual stimulants mainly sold by traditional healers. There is need for setting up more orthodox care for sexual dysfunction. There is need for more community health education on female sexual dysfunction.

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Background: The quality of drinking water is an important environmental determinant of health. Widespread production and consumption of inadequately processed or contaminated packaged drinking water can lead to waterborne disease outbreaks. To safeguard public health, it is important that available packaged water is duly registered and regularly analysed. Aim: This study was carried out to determine the bacteriological quality of ten selected brands of sachet water produced and sold in Samaru Zaria metropolis. Materials and Methods: From the brands of sachet water being sold in samaru, ten most popular brands were identified and selected based on patronage by consumers and distributors. A total of 20 samples, two from each of the ten brands of sachet water were bought from water vendors every fortnight for 1 month (may - june 2013). Results: The total coliform count ranged from 2-18+/100 ml. Isolates were identified to be Klebsiella spp., 0[40%] Proteus spp., [30%] Pseudomonas spp. [20%] and Chromobacterium violaceum [10%]. All were negative for thermotolerant coliforms, Salmonella, Shigella and Vibrio cholera. Conclusion: The results of this study showed contamination with micro-organisms found naturally in water, soil or vegetation which indicates a problem with the overall quality of water production but showed no contamination with sewage or animal waste. Microbiological assessment of drinking water quality should be done periodically with the regulatory body National agency for food and drug administration and control (NAFDAC) ensuring good quality assurance and maintenance of internationally defined drinking water standards.

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A 6-month-old boy was referred to the radiology department of the Aminu Kano Teaching Hospital for chest X-ray, from the Emergency Pediatric unit of the Hospital, on account of severe bronchopneumonia in association with diaphragmatic hernia to rule out pulmonary tuberculosis, but for which, chest X-ray and a complimentary urgent Barium meal studies showed a complete left-sided eventration of the hemidiaphragm. He had successful plication of the left hemidiaphragm and the bowel loops, and spleen were carefully freed and fixed back into the abdomen. The paper highlighted on the key role played by the chest X-ray and an immediate complimentary upper gastrointestinal barium studies in making the diagnosis of this life-threatening condition in a resource-poor environment. The relevant literature was also reviewed.

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Accurate estimation of foetal weight is of paramount importance before delivery. Clinical estimation of foetal weight is an important and necessary skill in management of obstetrics patients because of its simplicity; and if it is found to be as accurate as sonographic measurement as some studies suggest, it may be considered for screening of foetal weight especially in low-resource settings where ultrasound is unavailable. The aim of this review is to search for various literatures where clinical methods of foetal weight estimation were used and to examine these methods critically for possible recommendation for their use among obstetrics residents and healthcare practitioners. Electronic search of Medline, Pub Med, Health Internetwork Access to Research Initiative (HINARI) and Google Scholar databases from 1953 to 10th December 2014 was conducted for studies which compared clinical and sonographic foetal weight estimation. Various formulae have been suggested by researchers over the years. The methods however depend on the clinical dexterity of clinicians' and not on specific measurements. No simple and easily applied formula has yet been suggested to transform an external maternal measurement into an estimated foetal weight. Researchers on estimation of foetal weight should work towards a consensus and reproducible formula for clinical foetal weight estimation. Symphysio fundal height (SFH) measurement with a tape-measure seems a simple clinical method because it is cheap, readily available, non-invasive and acceptable to patients. These skills should be practiced by senior obstetricians and taught to midwifes, house officers, medical officers and obstetrics residents. It is however subjected to various degrees of intra-observer and inter-observer errors and studies comparing the different formulae are lacking. Therefore, further researches are needed to improve reliability and reproducibility of these clinical methods. The reliability of other clinical methods other than Dare' method should also be explored.

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Introduction: In the last two decades sonography has become the most important imaging modality for the study of the spleen. Different studies have been conducted in different parts of the world so as to determine the normal reference values of splenic dimension using ultrasound scan in healthy adults, and the values obtained have been diverse, thus prompting more work that tends to establish normal values for different regions based on geographic and racial differences. Materials and Methods: A prospective study of normal spleen dimensions using ultrasound in 400 Nigerian adults at Aminu Kano Teaching Hospital was conducted. Sonographic measurement of splenic dimensions was performed with the patient in supine and right lateral decubitus position. Height and weight were measured using the standard anthropometric technique. The data were analysed using computer-based SPSS Version 16.0 software for Windows (SPSS Inc., Chicago, IL, USA). Results: There were 212 males and 188 females, their age ranged between 20 and 70 years. The mean age of the subjects and (±standard deviation) were 33.0 years (±12.0), mean height was 1.64 m (±0.1) and mean weight was 61.4 kg (±11.0). The mean splenic length, width and depth for the subjects studied were 101.6 mm (±13.7), 46.8 mm (±8.2), and 86.8 mm (±12.7), respectively. Conclusion: The mean spleen dimensions obtained in this study were similar to those obtained in other regions of Nigeria but slightly lower than those reported from studies among Caucasians confirming the need for normal values for each region. There was positive correlation between subjects height and weight with splenic length (P < 0.001 and P < 0.001), depth (P < 0.01 and P < 0.001) and width (P < 0.01 and P < 0.001).

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Bedside teaching remains the most effective way of imparting competency in clinical skills in undergraduate medical education but there has been a noticeable decline in the practice of bedside teaching worldwide. This paper aims to emphasise the importance of bedside teaching, highlights the possible barriers to effective bedside teaching and equip medical teachers with the effective ways of achieving the intended goals of bedside teaching by emphasising the techniques recommended by experts in the field of medical education. Developed countries have employed the use of clinical skill centres to cushion the effect of the decline in bedside teaching, but in resource-limited countries it remains the only viable option. The advantages of bedside teaching include; learning in context, impartation of clinical skills, nurturing and development of clinical reasoning. In addition, bedside teaching provides opportunity for role modelling, professional thinking, observation of communication skills, team work and integration of communication skills, clinical skills and ethical issues in the process of patient care. Several hindrances to effective bedside teaching have been identified. These include a large student: teacher ratio, crowded lectures, improper use of logbooks, lack of preparedness and interest, increasing administrative and research works among medical teachers. The strategies recommended by experts can be categorised into three; based on the timing as; before, during and after bedside teaching. These emphasise the need for adequate preparation, setting of clear objectives before teaching, active participation, gentle correction during teaching, feedback and discussion of sensitive issues away from the patient.

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Inversion of the uterus is a rare clinical problem. Non-puerperal inversion usually results from a tumor arising from the fundus of the uterus. We report two cases of chronic non-puerperal uterine inversion in a 38-year-old and a 54-year-old postmenopausal woman. They both presented with vaginal bleeding, a mass protruding from the vagina and lower abdominal pain. Diagnosis was made based on these clinical features. At first, vaginal myomectomy was performed and after that, a Kustner procedure and vaginal hysterectomy was performed in both cases. Early diagnosis and appropriate surgical treatment of the inverted uterus are important to prevent further complications.

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Background: The incidence of breast cancer is increasing and the presentation is often late in our environment with poor prognosis. Breast self-examination (BSE) remains an important diagnostic tool for the early detection of breast cancer in a resource-limited community. Nurses being in closer contact with patients should be in the forefront in educating the general public on BSE. Objectives: This study investigates the knowledge, attitude and practice of BSE among female nurses in Aminu Kano Teaching Hospital (AKTH) with regard to the number that practice, method and the frequency of BSE. Materials and Methods: The study is a descriptive cross-sectional study of female nurses employed in AKTH using self-administered questionnaire. Respondents were selected by simple random sampling methods from the register of nursing staff at AKTH. The data collected were on socio-demographic profile, knowledge, attitude and practice of BSE. The relationships between these factors were studied. Results: All the nurses studied are aware about BSE, with 91.2% practicing it. There is appallingly poor knowledge of its timing, frequency and method. Only 45 (41.2%) of the respondents practice BSE monthly, and none of the respondents can accurately describe the exact method of BSE. Conclusion: There is universal awareness of the BSE among nurses, with dismal awareness of its purpose, method, timing, and frequency among the female nursing staff studied. However, there is a lot of enthusiasm to encourage others to do it. Therefore, nurses need to be also further trained and educated about the procedure.

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Introduction: Circumcision is the surgical removal of the skin covering the glans penis (prepuce). Circumcision is performed worldwide, among many tribe and races. It is the commonest surgical procedure done in males. It is perform by both trained and non-trained medical personal. Aims and Objective: To compare the outcome of circumcision done by dorsal slit and plastibell methods. Methods and Materials: A prospective study was done over 1 year period. A structured questionnaire was used to collect data. It was a cross-sectional analytical study with sample size of 120 patients divided in to 2 study groups. Group A had dorsal slit while group B had plastibell type of circumcision. Results: The age of circumcision varies between 7days to 10 years. The average duration of the procedure was 12minutes for dorsal slit and 7 minutes, with estimated blood loss of 7mls and 4mls in the two methods. The most common complications observed in our study are surgical site infection, post operative haemorrhage, and delayed separation of the ring. While surgical site infection is more in plastibell method, post operative haemorrhage was found to be commoner in dorsal slit method. Conclusion: Our study showed that plastibell has an obvious advantage of shorter time of procedure, lower risk of post operative bleeding compared to the conventional dorsal slit method of circumcision.

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Assessment in medical education is very vital because of its far reaching implications not only for the students and their teachers but for the communities and world at large. This article attempts to review the assessment methods used in undergraduate medical schools, highlight their limitations while proffering solutions as recommended by experts in medical education. Assessment methods that are used in the undergraduate medical education can be broadly subdivided into two; assessment of knowledge and its application (Multiple choice questions, essay and viva voce) and assessment of clinical competence (long case, short case and objective structured clinical examination [OSCE]). There are five major criteria for determining the usefulness of a particular method of assessment: Reliability, Validity, Educational impact, Cost effectiveness and Acceptability. The major drawback of the long and short case examinations is the poor reliability or reproducibility due to case specificity, inter examiner and clinical case scenario variability. In 1975, Harden et al., introduced the OSCE to avoid the disadvantages of long case but acceptability may be an issue because of inadequate exposure to its principles and resistance to change by some teachers. Another objective version of the long case is the objective structured long examination records. Objective structured practical examination is also preferred to the traditional practical examinations in laboratory based courses. All assessment methods have their strengths and limitations. It is important that teachers in medical schools are aware of the limitations of the traditional assessment tools and embrace newer and more reliable methods of assessment.

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Background: The need for blood and blood products requires an efficient blood transfusion service. This study was undertaken to provide pro data on the distribution of ABO and Rhesus blood groups that would assist in planning and coordinating blood transfusion services for the cosmopolitan city of Kano. Materials and Methods: A total of 5000 consecutive blood donor samples were grouped for ABO and Rhesus 'D' antigen by tile and tube methods at Aminu Kano Teaching Hospital (AKTH) over a one-year period. Results: Blood group O had the highest prevalence of 2860 (57.2%) followed by blood group B of 1035 (20.7%), then A of 1025 (20.5%) and the lowest being AB of 80 (1.6%). A total of 4741 (94.8%) of the study group were Rhesus 'D' positive while 259 (5.2%) were Rhesus 'D' negative. Conclusion: The ABO blood group had blood group O as the most prevalent blood group in the study population while the lowest was AB. The Rhesus blood group positive was 94.8% while Rhesus negative blood group was 5.2%.

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Objective: To determine the prevalence of gingivitis and periodontitis among an adult male population in Benin City, Nigeria. Materials and Methods: The drivers of a private motor transport company whose head office is in Benin City constituted the study participants. Data collection was through an interview-administered questionnaire and periodontal examination. Periodontal disease was assessed using community periodontal index while demographic characteristics, social habits and oral hygiene habits were elicited using interview-administered questionnaire. Results: The prevalence of gingivitis and periodontitis was 75.4% and 15.4% respectively. The prevalence of periodontitis was higher among older participants, those of lower educational attainment and longer driving experience, those that indulged in only once-daily teeth cleaning, tobacco users, regular alcohol and kolanut consumers. Conclusion: The prevalence of gingivitis and periodontitis in this study was similar to previous reports in Nigeria. The prevalence was higher in relation to the risk factors considered in this study thereby necessitating the need for an awareness campaign to enlighten the public about the harmful effects of tobacco, kolanut and alcohol on periodontal health. This study is also recommended among a larger number of people.

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Vitamin C deficiency is a prevalent problem among pregnant women in developing countries. This review is undertaken to evaluate current literature on effect of vitamin C supplementation on the course and outcomes of pregnancy so as to recommend its supplementation or otherwise. Electronic search of Medline, PubMed, Health Internetwork access to Research Initiative (HINARI), and Google Scholar databases was conducted for articles from 1 ^st January, 1993 to 30 ^th November, 2014 using keywords such as "micronutrients", "vitamin C", "ascorbic acid", "vitamin supplementation", and "nutrition in pregnancy". Current evidence from developing countries where vitamin C is deficient among pregnant women has shown that vitamin C may reduce the incidence of some complications of pregnancy and therefore encourage their supplementation in pregnancy. Additional studies, however, are needed in different geographic regions to identify whether vitamin C supplementation in pregnancy results in functional and measurable outcomes for maternal and foetal health. These studies would enable the appropriate intervention strategies to be developed, implemented, and evaluated. Such efforts will require the collaboration and commitment of government agencies, health care providers, nutritionists, research institutions, and the community.

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Introduction: Misoprostol is approved for treatment of incomplete abortion in Nigeria, but subjective evidence suggests that it is seldom used by gynecologists in Nigeria for this indication. The purpose of the study was to determine the rate of utilization of misoprostol for treatment of incomplete abortion by gynecologists in Nigeria and perceived barriers to its use for this indication. Materials and Methods: This was a cross-sectional study of gynecologists who attended the 2017 Society of Gynaecology and Obstetrics of Nigeria, Conference held in Sokoto state, Nigeria as well as a retrospective review of Post abortion care services in three Nigerian tertiary hospitals for a period of one year (1 January-31 December, 2017). Results: Misoprostol was used in the treatment of first trimester abortions in 19/343 (5.5%) compared to manual vacuum aspiration (MVA) 324/343 (94.5%) in the tertiary hospitals. The major perceived barrier in the utilization of misoprostol for treatment of first trimester incomplete abortion was the preference of MVA to misoprostol by the provider (32%) and was followed closely by not being sure of the brand of the misoprostol (31%). Other reasons included that misoprostol was not effective (6%), side effects (8%), high cost (5%), unavailability (1%), not conversant with dosage regimens (1%), and others (16%). Overall, 51% of responders confirmed that they do not have a written onsite protocol for the management of first trimester incomplete abortions in their institutions. Conclusions: There is poor utilization of misoprostol, barriers to its use, and absence of protocols/guidelines for the treatment of first trimester incomplete abortions in most gynecological departments of Nigeria's public health institutions. It is expedient for gynecologists in Nigeria to put in place processes that ensures translation of evidence-based research findings into practice and policies towards improving maternal health in Nigeria.

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Background: Faking and counterfeiting occurs throughout the world with claims that it is more common in some developing countries with weak regulatory programs. It is estimated that more than 10% of drugs worldwide are counterfeit, with up to 50% in some countries. Heightening vigilance and awareness of counterfeiting is one measure for combating faking. Rationale: The aim of this study was to document perceptions of various healthcare providers regarding the problem of drugs faking/counterfeiting including perceived levels, affected drugs, implications, and measures to control; thus, this study aims to provide empirical data on the perception of healthcare providers regarding counterfeit drugs and their effect on public health/safety. Materials and Methods: Ethical approval was obtained and pretested questionnaires were administered to consenting healthcare providers in six local government areas in Lagos. The collected data was sorted and entered into Microsoft Excel, following which analysis was carried out. Results are presented as tables and charts. Results: Respondents believed that the problem of fake/counterfeit drugs is common with a modal faking range of 41–50% of drugs in the country. Anti-infectives, anti-malarials, and analgesics were reported to be the most implicated drugs. Many believed that faking/counterfeiting of drugs can be surmounted by the promulgation and enforcement of appropriate legislation and closure of open drug markets. Conclusions: It can be concluded that respondents are aware of the challenges posed by counterfeit drugs and if empowered can serve as a tool in its eradication. It is recommended that appropriate modalities to review the existing laws and close open drug markets be put in place.

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Background: Condom use during intercourse is perceived as unnecessary in sexual encounters involving a regular partner. The non-use of condom among HIV-positive people has been found to increase the risk of resistance to anti-retroviral therapy. The objective of this study was to determine the pattern of condom use among HIV sero-concordant couples attending a secondary health facility in North-Central Nigeria. Materials and Methods: This is a cross-sectional survey that was carried out among people living with HIV and AIDS (PLWHA) who have been enrolled into care and treatment at General Hospital Abejukolo in Kogi State, Nigeria. The data instrument used was self-/interviewer-administered questionnaire. The data obtained were analysed using EPI-INFO version 3.4.1 software package. Chi-square test was used and P < 0.05 was considered significant for the study. Results: Assessment of knowledge of the respondents on the correct use of condom showed that two-thirds (60; 65.9%) had good knowledge and 70 (79.6%) of them demonstrated positive attitude towards the use of condom during sexual intercourse. About one-third of the respondents (32; 35.2%) would oblige the spouse sexual intercourse without condom mainly because they are both positive, to fulfil marital obligations and to avoid problems in marital relationship. Less than two-thirds (59.3%) of sero-concordant spouse used condom during sexual intercourse for reasons of preventing re-infection and pregnancy. Conclusion: With one-third of respondents not using condom during sexual intercourse, there is a great challenge for spread of HIV infection and risk of drug resistance in HIV care and management. Therefore, stakeholders at various levels should intensify efforts and support research towards behavioural modification in addressing the existing lacunae in HIV control.

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Introduction: Infections from HIV, Hepatitis B and to some extent Hepatitis C viruses constitute a major public health challenge in sub-Saharan Africa, and there are evidences to suggest that there is faster progression of HIV in those co-infected with either HBV or HCV. The aim of this study was to determine the prevalence of HBV and HCV infections among HIV-infected patients, and describe the socio-demographic features and correlates of HIV and HBV/HCV co-infected patients at Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Materials and Methods: This was a cross-sectional study carried out among HIV-positive individuals seen at the adult HIV clinic of AKTH. Four Hundred and forty (440) consecutive HIV-positive adult patients who consented to the study were screened for markers of HBV and HCV using Enzyme-linked Immunosorbent Assay (ELISA) technique. CD ₄ Count and serum ALT were also obtained from the recruited patients. Socio-demographic characteristics and Body Mass Index (BMI) were obtained. Differences and relationships between groups were determined using students t-test and Chi-square test where appropriate, and a P < 0.05 was regarded as significant. Results: Prevalence rates of Hepatitis B and C virus infections obtained were 12.3% and 1.6%, respectively. Individuals who were 40 years or younger were the most affected. HBV co-infection was more common among males than females (16.9% vs 9.2%, respectively, P = 0.0153). Mean serum ALT among participants with HIV alone was 31.6 International Units (IU), but was significantly higher (45.3 IU) for those with HIV/HBV co-infection, P = 0.048. Mean CD ₄ count for HIV/HBV co-infected participants (259.7 c/mm ³ ) was significantly higher than that for participants with HIV alone (240.0 c/mm ³ ), P = 0.0170 whereas the mean BMI was not significantly different between participants with HIV alone (21.3 kg/m ² ) versus HIV/HBV co-infected participants (22.2 kg/m ² ), P = 0.1385. Conclusion: Co-infection with hepatitis B virus is common among HIV-infected patients in our setting and this further reaffirms the need for routine baseline screening for this marker, as it is a major consideration in the initiation and choice of highly active antiretroviral therapy. Furthermore, those found to be negative should be immunized with HBV vaccine to improve the prognosis of their HIV status.

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Background: Hospital-acquired infection is still a major cause of morbidity and mortality in hospitals. Compliance with hand hygiene by healthcare workers is an important preventive measure. However, many healthcare workers do not wash their hands properly or not at all. This cross-sectional study was conducted to assess the practice of hand washing among healthcare workers in a tertiary hospital in Nigeria. Patients and Methods: Healthcare workers were randomly selected and were asked, using a questionnaire, regarding hand hygiene in their working places. Results: A total of 173 healthcare workers who had contact with patients participated in the study. They included doctors, nurses, physiotherapists, laboratory scientists, and technicians. Majority (54.3%) of them were males and 60.1% worked in a health facility for 5 years or less. All participants practiced hand washing at work but only 127 (73.4%) washed their hands correctly. Contact with body fluids was the major (87.3%) reason for washing hands. Soap and water only were used by 58.4% and hands were air dried by 45.1%. The main constraint to hand hygiene was lack of alcohol hand rub, soap, and water. Knowledge of hand washing was from multiple sources. Conclusion: Compliance with hand hygiene was good. Alcohol hand rub, water, and soap should always be available.

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Vulvar edema refers to accumulation of fluid within the interstitial space of the vulvar. It can result from inflammatory conditions, infections, infestations, trauma, pregnancy, tumours and iatrogenic causes. It is an unusual complication of pregnancy and is difficult to determine the cause. It may occur due to underlying systemic pathology and has also been associated with preeclampsia. It has the potential to interfere with vaginal delivery and compromise tissue integrity and has been associated with maternal mortality postpartum. We present a case of huge vulvar edema in a 23 years old primigravida woman that was managed elsewhere as a case of vulvar edema with elevated blood pressure and subsequently discharged home. She presented to us with severe preeclampsia and worsening massive vulvar edema at 32 weeks of gestation. Conservative management failed because of worsening symptoms. Caesarean section was performed with regressing of symptoms within few days. It is important for the clinicians to note that vulvar edema complicating preeclampsia could be a poor prognostic sign.

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The incidence of diabetes globally is reaching an epidemic proportion and with it carries the risk of complications and diabetic foot disease inclusive. The pathophysiology of diabetic foot disease is multifactorial and includes neuropathy, infection, ischaemia and abnormal foot structure and biomechanics. Early recognition of the aetiology of these lesions is important for good functional outcome. Managing the diabetic foot is a complex clinical problem requiring a multidisciplinary collaboration of health care workers to achieve limb salvage. Adequate off-loading, frequent debridement, moist wound care, treatment of infection and revascularisation of ischaemic limbs are the mainstays of treatment. Even with proper management, some of the foot ulcers do not heal and are arrested in a state of chronic inflammation. These wounds can frequently benefit from various adjuvants, such as aggressive debridement, growth factors, bioactive skin equivalents and negative pressure wound therapy. We reviewed current literature including original and review articles obtained through a search of PubMed database, Medline, Google scholar and hand searching of bibliographies of published articles using the keywords: Diabetes, diabetic foot, neuropathy, peripheral arterial disease and ulceration. The enormity of the challenges associated with the management of this important complication of diabetes, coupled with the various progresses being made in this area, and the need to streamline the principles of management, especially in our environment prompted us to review this subject matter.

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Abdominal pregnancy is a rare form of ectopic pregnancy. It is associated with an increase in maternal morbidity and mortality, as well as perinatal mortality rate of up to 85%-95%. A case of abdominal pregnancy in an unbooked primigravida who presented in the third trimester and was successfully managed is hereby described. She came with weight loss and jaundice. The fetus was alive and she was managed conservatively till a laparotomy was eventually performed. The outcome was good for mother and baby.

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Background/Aim: Low birth weight (LBW) is associated with a higher risk of mortality and long term consequences for the survivors. This study determines the incidence and risk factors for LBW babies in Maiduguri. Context/Setting: This study was done in the Departments of Obstetrics and Gynaecology of the University of Maiduguri Teaching Hospital and the State Specialist Hospital, Maiduguri. Materials and Methods: This was a prospective study involving 854 pregnant women and their babies between 2 ^nd February 2009 and 29 ^th July 2009. Socio-demographic, obstetric, medical factors, obstetrics interventions and foetal birth weights were obtained and recorded. Association between variables were examined using student's t-test and Chi-squared test and multivariate logistic regression analysis a P < 0.05 was considered significant. Results: The incidence of LBW was 16.9%. The risk factors for LBW were non-use of haematinics index pregnancy (OR = 13.04; 95% CI = 12-36; P value 0.000); previous history of stillbirth (OR = 8.11; 95% CI = 6-19; P value 0.000); hypertensive disorders of pregnancy (OR = 6.12; 95% CI = 5-14; P value 0.000); ante-partum haemorrhage (OR = 5.85; 95% CI = 4-9; P value 0.000); less than 4 ANC visitsn (OR = 4.94; 95% CI = 3-12; P value 0.000); previous history of premature delivery (OR = 4.39; 95% CI = 4-11; P value 0.000); previous history of LBW (OR = 3.65; 95% CI = 2-21; P value 0.000) and non-use of intermittent preventive therapy in the index pregnancy (OR = 3.24; 95% CI = 1-16; P value 0.001); and teenage mother (OR = 2.75; 95% CI = 2-27; P value 0.006). Conclusion: This study showed high incidence of LBW. Obstetric factors (problems and intervention of the current pregnancy) and previous obstetric performances played crucial role in the occurrence of LBW in our study. Qualitative antenatal care should be made available and provided to pregnant women at all levels of care.

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Sickle cell disease (SCD) is characterized by recurrent vaso-occlusive crisis (VOC). VOC is an important index of disease severity and has been shown to correlate with the risk of multi-organ damage and early death. Although the vulnerability to VOC among patients with SCD may be genetically predetermined on the basis of genotype and haplotype variability, nonetheless, VOC is usually triggered by a wide spectrum of etiologic risk factors, which range from physiological to nonphysiological factors on the one hand, and from psychological to physical factors on the other hand. An understanding of these risk factors and their pathophysiologic mechanisms is important for the hematologist to accurately identify potential etiologic risk factors for VOC. Thus taking preemptive action that will prevent undue exposure of patients to the risk factors and/or prepare the patient to uneventfully withstand the risk factors if exposure is unavoidable. This will ultimately obviate frequent VOC with its attendant risk of organ damage and early death in patients with SCD. Hence, in this study we conducted a broad and comprehensive review (using “sickle cell painful vaso-occlusive crisis” and relevant sub-terms in PubMed, Google Scholar, and other search engines) of various etiologic risk factors for VOC and the pathophysiologic mechanisms through which they trigger pain in patients with SCD.

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Background: Twin pregnancy remains a high risk one, and its incidence varies from one ethnic group to the other. Twin delivery is also associated with increased neonatal and maternal morbidity and mortality. Objective: To det ermine the current incidence and document the complication of twin pregnancy in Kano, northwest Nigeria. Materials and Methods: A retrospective analysis of 231 cases of twin deliveries between 1 ^st January 2007 to 31 ^st December 2009, in Aminu Kano Teaching Hospital (AKTH) Kano was carried out. Results: During this study period, there were 15,233 deliveries and 353 cases of twin deliveries, giving an incidence of 2.3% or 1 in 43 deliveries. The mean maternal age and parity were 29.0 years and 2.6 respectively. The mean gestational age at delivery was 36.9 weeks, with a mean birth weight of 2.4 kg and 2.3 kg for the first and second twin respectively. Male twins constituted 50.3% of twin births. The commonest presentation of twins was Cephalic-cephalic in 52.2%. This was followed by breech-cephalic in 29.6%, cephalic-breech in 12.6% and breech- breech in 5.2%. Mode of delivery was vaginal in 57.4% while 40.0% delivered by Caesarean section. The commonest indication for the Caesarean section was due to breech presentation in the leading twin (75.0%). Hypertensive disorder in pregnancy was the commonest maternal complication accounting for 63.16%, increasing maternal morbidity and mortality, while prematurity was the leading cause of perinatal mortality. Conclusion: This study has shown that the incidence of twin pregnancy is high in Aminu Kano Teaching Hospital, Kano, northwest of Nigeria. It has also shown that twin delivery is associated with prematurity, malpresentations and operative delivery, therefore increased perinatal and maternal morbidity. It is therefore recommended that twin pregnancy should be supervised in a tertiary centre under a specialist care and where facility for neonatal support is available to improve its outcome and reduce perinatal morbidity and mortality.

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