Post-partum haemorrhage (PPH) is a life-threatening obstetric complication and the leading cause of maternal death. Any bleeding that results in or could result in haemodynamic instability, if untreated, must be considered as PPH. There is no controversy about the need for prevention and treatment of PPH. The keystone of management of PPH entails first, non-invasive and nonsurgical methods and then invasive and surgical methods. However, mortality remains high. Therefore, new advancements in the treatment are most crucial. One such advancement has been the use of recombinant activated factor VII (rFVIIa) in PPH. First used 12 years back in PPH, this universal haemostatic agent has been effectively used in controlling PPH. The best available indicator of rFVIIa efficacy is the arrest of haemorrhage, which is judged by visual evidence and haemodynamic stabilization. It also reduces costs of therapy and the use of blood components in massive PPH. In cases of intractable PPH with no other obvious indications for hysterectomy, administration of rFVIIa should be considered before surgery. We share our experience in a series of cases of PPH, successfully managed using rFVIIa.

Background: Osteoporosis is one of the major extra-pulmonary manifestations of chronic obstructive pulmonary disease (COPD), which limits the physical activity. The present study was undertaken to study the bone mineral density (BMD) and osteoporosis in the elderly COPD patients. Materials and Methods: This was a cross-sectional study carried out among elderly COPD patients. After a detailed clinical history spirometry was done to stage the severity of COPD. DEXA scan of the lumbar spine was performed using bone densitometer to determine osteoporosis. Statistical analysis was based on Chi-square test. Risk factors were identified by univariate and multivariate logistic regression analysis. Results: A total of 70 elderly COPD patients were included. Fourty-six patients (65.7%) had osteoporosis and 13 (18.6%) had osteopenia. Majority of the osteoporosis patients had stage III or stage IV COPD disease (77.2%). As the severity grade of COPD increased, the risk of osteoporosis also increased. Also, with the increasing severity of COPD, BMD decreased. Patients with lower body mass index (BMI) had higher prevalence of osteoporosis (45.7%). Using multivariate regression analysis, stage IV COPD, number of acute exacerbations >3 and steroid cumulative dose >1000 mg were independent risk factors for osteoporosis in elderly COPD patients. Conclusions: The prevalence of osteoporosis was 65.7%, and 18.6% had osteopenia. Stage III and IV patients had significantly lower BMI in elderly COPD patients. High clinical suspicion and early diagnosis and treatment are required in the evaluation of osteoporosis in elderly COPD patients.

Background: This study was carried out to assess the relationship between thevarious assessment parameters, viz. continuous assessment (CA), multiple choice questions (MCQ), essay, practical, oral with the overall performance in the first professional examination in Physiology. Materials and Methods: The results of all 244 students that sat for the examination over 4 years were used. The CA, MCQ, essay, practical, oral and overall performance scores were obtained. All the scores were rounded up to 100% to give each parameter equal weighting. Results: Analysis showed that the average overall performance was 50.8 ± 5.3. The best average performance was in practical (55.5 ± 9.1), while the least was in MCQ (44.1 ± 7.8). In the study, 81.1% of students passed orals, 80.3% passed practical, 72.5% passed CA, 58.6% passed essay, 22.5% passed MCQ and 71.7% of students passed on the overall performance. All assessment parameters significantly correlated with overall performance. Continuous assessment had the best correlation (r = 0.801, P = 0.000), while oral had the least correlation (r = 0.277, P = 0.000) with overall performance. Essay was the best predictor of overall performance (β = 0.421, P = 000), followed by MCQ (β = 0.356, P = 000), while practical was the least predictor of performance (β = 0.162, P = 000). Conclusion: We suggest that the department should uphold the principle of continuous assessment and more effort be made in the design of MCQ so that performance can improve.

Background: The maintenance of balance is an essential requirement for the performance of daily tasks and sporting activities and muscular fatigue is a factor to impair postural control, so this study was done to compare the effect of selected muscle groups fatigue on postural control during bipedal stance in healthy subjects. Materials and Methods: Fifteen healthy female students (24.3 ± 2.6 years) completed three testing session with a break period of at least 2 days. During each session, postural control was assessed during two 30-s trials of bipedal stance with eyes close before and after the fatigue protocol. Fatigue protocols were performed by 60% of their unfatigued Maximum Voluntary Contraction of unilateral ankle plantar flexors, bilateral lumbar extensors and bilateral neck extensors. One of the three fatigue protocols was performed on each session. Results: The result showed that fatigue had a significant effect on COP velocity and it increase COP velocity but there was not found any difference in postural sway between muscle groups. Conclusion: Localized muscle fatigue caused deficits in postural control regardless of the location of fatigue. Authors suggest the possibility of the contributions of central mechanisms to postural deficits due to fatigue and it seems that difference was not between muscle groups due to central fatigue.

Background: Albendazole is used as an anthelmintic in the treatment of some parasitic infections. This study determined how the effects of albendazole on liver enzymes are influenced by diet. Materials and Method: Thirty adult male Wistar rats of mean weight 304.12 ± 11.34 g were randomly grouped into five: Group A: Control, was given rat pellets and water only; Group B received 15 mg/kg/d of albendazole while fasting; Group C received 15 mg/kg/d of albendazole with fatty meal; Group D received 15 mg/kg/d of albendazole with normal diet (rat pellets); and, Group E received 30 mg/kg/d of albendazole with normal diet (rat pellets); they were given orally for 3 consecutive days. The animals were sacrificed thereafter and blood samples obtained for quantitative study of the serum activities of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP). Results: Significant elevation in the serum levels of the transaminases especially in animals which were on their normal diet (rat pellets), while ALP was either reduced or increased based on dietary factors. Conclusions: Oral administration of albendazole before meal or with a fatty diet could help limit severe elevation of liver enzymes associated with its use, while still ensuring optimal efficacy.

Background: Anogenital warts are a common cause of morbidity affecting mainly the productive age group of the economy. Paucity of data in Nigeria necessitated this study. Materials and Methods: The pathology records of anogenital warts diagnosed in the Department of Pathology, Ahmadu Bello University Zaria between 1 ^st January 2000 and 31 ^st December 2009 were reviewed. Results: A total of 68 warts were diagnosed within the study period with anogenital warts constituting 39.7%. Majority of cases (62%) were in the 20-39 years age group (range: 5-50 years) and vulva was the most common site affected. Conclusion: Genital warts are common in our environment, biopsy of suspicious lesions is recommended for diagnostic yield.

Background: Cervical cancer is the most common genital cancer and one of the leading causes of death among female population. Fortunately, this cancer is preventable by screening for premalignant lesions but this is rarely provided and hardly utilised. We assessed the knowledge, attitude and utilisation of cervical cancer screening among market women in Sabon Gari, Zaria. Materials and Methods: This was a cross-sectional study to evaluate the knowledge, attitude and practice of cervical cancer screening among market women. A total of 260 women were administered with questionnaires which were both self and interviewer administered. These were analysed using SPSS version 11. Results: Respondents exhibited a fair knowledge of cervical cancer and cervical cancer screening (43.5%); however, their knowledge of risk factors was poor. There was generally good attitude to cervical cancer screening (80.4%), but their level of practice was low (15.4%). Conclusions: There was a fair knowledge of cervical cancer and cervical cancer screening among Nigerian market women in this study, their practice of cervical cancer screening was poor.

Background: To determine the structural findings in brain sonography of African infants with complicated sporadic bacterial meningitis. Materials and Methods: Retrospective assessment of medical records of patients who underwent brain sonography on account of complicated bacterial meningitis. The brain sonography was carried out over a 4-year period (between September 15, 2004 and September 14, 2008). Result : A total of 86 infants were studied (40 boys and 46 girls in a ratio of 1:1.1); more than 70% of the patients were aged below 6 months. Presenting complaint included convulsion with fever in 34 (39.53%), persistent fever 20 (23.26%), bulging fontanelles 8 (9.30%), coma 7 (8.14%) and sepsis with convulsion 6 (6.98%), among others. Patients' place of previous treatment included specialist hospitals 33 (38.37%), private hospitals 21 (24.42%), herbal home centres 12 (13.95%), nursing homes 8 (9.30%), patent medicine stores 7 (8.14%) and other non-doctor attended clinics 5 (5.81%) infants. The sonographic findings included hydrocephalus 36 (41.86%), cerebral infarction 12 (13.95%), encephalocoele 9 (10.49%) and intracerebral abscess 7 (8.14%) infants. Cerebritis 5 (5.81%), intracerebral hemorrhage 3 (3.49%), porocephalic cysts 2 (2.33%), cerebral oedema 2 (2.33%), intraventricular haemorrhage 1 (1.16%) and subdural collection 1 (1.16%) infants; 8 patients (9.30%) had normal findings. Conclusion: Hydrocephalus, cerebral infarction and intracerebral abscess were the most common complications elicited by sonography in this study. Early and adequate treatment with antibiotics in patients with persistent fever and convulsion with fever will reduce the complications of meningitis and its long-term neurological sequelae.

Background: Iron deficiency anaemia is the most common nutritional anaemia among children. Lead toxicity is a serious health threat, especially in developing countries due to environmental pollution. It was thus aimed to investigate correlation between blood lead concentration and iron deficiency in children of Mashhad, Iran. Materials and Methods: This cross sectional study was performed on children between 1 year and 10 years, in Imam Reza teaching hospital of Mashhad, Iran, in 2010. Indeed during complete blood count (CBC), we measured iron and total iron binding capacity (TIBC) by colorimetric methods, ferritin by radioimmune assay and blood lead concentration by atomic absorption method. Results were analysed by Statistical Package for Social Sciences (SPSS) (version 11.5), using statistical tests including independent sample t-test, Mann-Whitney U test, Spearman's test and analysis of variance (ANOVA) and Pearson's or Spearman's correlation coefficient. P value ≤ 0.05 was considered as a significant level. Results: We studied 223 cases including 98 control children and 125 patients. All children had lead intoxication. Mean (±SD) blood lead concentration in the control group was 57.1 ± 25.3 (ranged 20-212) μg/dl and in the patient group was 57 ± 20.4 (ranged 10.9-159) μg/dl with no significant difference (P value = 0.713). We also did not find any correlation between blood lead concentration and haemoglobin, ferritin, iron, TIBC, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), white blood cells (WBC) and platelets. Conclusion: Based on these results, no correlation was found between blood lead concentration and iron deficiency in the children. Because all children had lead intoxication, further studies in highly polluted and a comparison with a low polluted area are necessary to make a general conclusion.

Background: Supracondylar fractures are the commonest elbow injury in children. Most displaced Supracondylar fractures are manipulated and held with a medial/lateral entry or two lateral Kirschner wires. It was the purpose of this study to investigate the treatment of this injury in this unique patient population. Materials and Methods: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2005 to July 2010. One hundred seventy patients were recruited from Emergency and outpatient department having closed displaced Supracondylar fractures of humerus in children. They were treated either with medial-lateral pin fixation (n = 85) or with 2-lateral pin fixation (n = 85). All patients were operated under general anaesthesia. All patients were followed for 6 months. Results were analysed using Flynn's criteria. Statistical Analysis Used: Chi Square Test. Chi Square calculator was used as a software. Results: All children achieved union in a mean time of 4 weeks (range: 3-6 weeks). Post-operatively, eight patients (4.70%) got ulnar nerve injury and six (3.52%) patients got pin tract infection. Comparison between two groups such as cross K-wire group (85) and lateral K-wire group (n = 85) by using the Chi Square Test showed that in case of 8 weeks with (P-values = 0.89), in 16 weeks (P = 0.91) and 24 weeks (P = 0.85) with respective excellent, good, fair and poor categories were not found statistically significant. Conclusion: The lateral percutaneous pinning technique of displaced Supracondylar fractures of the humerus offers a viable alternative to the crossed pinning group as it offers the same stability without the incipient risk of iatrogenic ulnar nerve injury.

Background: To evaluate the effect of various combination of post-extraction regimen administered to patients who had intra-alveolar molar tooth extraction. Patients and Methods: One year prospective study involving 76 consenting patients who came for 1-week post-extraction review. The patients were placed on warm saline mouth rinse with (verbal instruction) or without antibiotic and or analgesic therapy (written prescription), after intra-alveolar molar tooth extraction. Information was obtained from the patients through questionnaire and clinical examination. Results: The patients were placed on warm saline mouth rinse (n = 29, 38.2%) only, warm saline rinse, antibiotics (Amoxicillin and metronidazole) and Paracetamol (n = 31, 40.8%), Paracetamol and warm saline rinse (n = 12, 15.8%) and antibiotics (Amoxicillin and metronidazole) and Paracetamol (n = 4, 5.3%). A total of 63 (82.9%) patients complied with the post-extraction regimen, giving a significant high compliance to the post-extraction instructions (P = 0.001). There were 10 (13.2%) cases of post-extraction localised alveolar osteitis, with predilection for the lower molar teeth (n = 6, 7.9%) and a significant predilection for females (n = 8, 10.5%) [P = 0.005]. Overall, there were five (6.6%) cases each of localised alveolar osteitis in the compliant patients (n = 63, 82.9%) and non-compliant patients (n = 13, 17.1%), giving a ratio of 1:13 and 1:3, respectively. There was significant association of compliance with post-extraction instruction and the reduced incidence of localized alveolar osteitis (P = 0.015). Conclusion: This study showed a significant patients' compliance with post-extraction warm saline rinse, prophylactic antibiotics and analgesic and a corresponding significant reduction in the incidence of localised alveolar osteitis following intra-alveolar molar tooth extraction. This study emphasises the need to properly educate patients on the effect of compliance to various combination of post-extraction regimen.

Background: The pattern of distribution of surgically treated symptomatic prolapsed lumbar and sacral intervertebral discs has been published, though scantily, especially in males. We decided to look at our own series, compare and contrast ours with some of those published. Materials and Methods: We treated 88 locations of this lesion in 68 males. The clinical features were those of lower back pains, with or without radiation into the lower extremities, sensory loss and paresis of the limbs. There was a case of loss of urinary bladder and ano-rectal control. All lesions were confirmed through cauda-equinograms and treated under general anaesthesia in knee-chest position (MECCA position). The patients were followed up for 3-6 months post-operatively. Results: There were 88 locations in 68 males of 21-70 years of age, with 29 prolapses occurring during the age range 31-40 years, while 54 locations were on the left and 48 at L4/5. The procedures were well tolerated by all patients and there were no post-operative complications. Conclusion: This lesion in our series occurred mostly on the left, at the L4/5 level and peaked at 31-40 years age range. The predictability of occurrence of this disease, using side, level and age is still not feasible in males from our series.

Background: Preeclampsia is of major complications of pregnancy that is associated with maternal morbidity and mortality. Therefore, prediction and early diagnosis of preeclampsia would be helpful for better controlling of related complications. Our study aimed to investigate risk factors helping to predict and early diagnose of preeclampsia. Materials and Methods: A total of 739 nulliparous women at their 24-28 ^th weeks of the first pregnancy were enrolled in this multi-center cohort study. Incidence or absence of preeclampsia in this population was evaluated up to the end of pregnancy period. For each case, a record sheet was assigned that contained information about haematocrit level in weeks 24-28 ^th of pregnancy, blood pressure, result of roll-over test in weeks 24-28 ^th of pregnancy and the presence of disease up to end of the study. Diagnosis of preeclampsia was made based on gold standard. Results : Overall, 3.9 % of all cases developed preeclampsia. The mean maternal age, body mass index (BMI), years of education and positive roll-over test were significantly higher in preeclampsia group (P < 0.001). However, the mean gestational age and changes in the levels of haematocrit were significantly higher in normotensive cases (P < 0.001). Our combined model could predict preeclampsia with a sensitivity of 93% and a specificity of 80%. Conclusion: Simple combined model of demographic characteristics including maternal age, BMI, years of education and positive roll-over tests can predict preeclampsia without any cost for the patients.

Demodex folliculorum and Demodex brevis are obligatory parasites that live in sebaceous glands and follicles. When immune system becomes suppressed by any reason, patients become vulnerable to obligatory parasites like D. folliculorum and D. brevis. Immune system becomes suppressed in cancer patients who undergo chemotherapy, and as a result these patients become vulnerable to infestations. In our case, a 45 year-old female has been admitted to oncology clinic for a medical treatment of breast cancer. Her systematic physical examination was normal, except redness on her cheeks and forehead. There was no abnormality in biochemical and haematological laboratory values. We have decided to apply chemotherapy of Adriamycin, cyclophosphamide and 5-fluorouracil. Due to the itchy redness on her cheeks and forehead, we had performed an examination for demodex before chemotherapy; and we have identified 20 mites/cm² on her right and left cheeks, and 15 mites/cm² on her forehead. When our patient had came our clinic with increasing complaint of itchy rash, after the first course of chemotherapy we have reexamined demodex. The result of microscopic examination revealed large amount of demodex of 50 mites/cm² on her right and left cheeks and 30 mites/cm² on her forehead, which were nearly 2.5-times higher than the previous examination. This increase probably was associated with immune suppression of chemotherapy.

Simultaneous occurrence of papillary and follicular thyroid cancer, known as differentiated thyroid cancer, has been reported with various presentations, but presence of an anaplastic cancer, as an undifferentiated cancer, in addition to differentiated thyroid cancer is rarely reported. We here report a 40-year-old man with papillary thyroid cancer on his right thyroid lobe and metastasized to the right posterior triangle of the neck. Survey on the mass in the right posterior triangle revealed presence of simultaneous papillary, follicular, and anaplastic thyroid cancer. The patient underwent right thyroid lobectomy and he received adjuvant radiotherapy in combination with chemotherapy.

Spontaneous bilateral femoral neck facture in a renal disease patient is not common. We report a case of 47-year-old female patient with chronic renal failure and on regular hemodialysis for the past 5 years who sustained bilateral impacted femoral neck fracture without history of trauma and injury and refused any surgical intervention. The patient was mobilised on wheel chair one year after the fractures. The cause of the fracture and the literature review of the bilateral femoral neck fracture in renal disease are discussed.

Background: Fractures of the humeral shaft are uncommon, representing less than 10 percent of all fractures in children. Humeral shaft fractures in children can be treated by immobilisation alone. A small number of fractures are unable to be reduced adequately or maintained in adequate alignment, and these should be treated surgically. In the present study, Kirschner wires (K-wire) were used to achieve a closed intramedullary fixation of humeral shaft fractures. The objective of this study was to evaluate the efficacy of intramedullary K-wires for the treatment of humeral shaft fracture in children. Patients and Methods: This prospective study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from June 2005 to June 2010. Sixty-eight children with a mean age of 7.7 years (range, 2-14 years) were recruited from Emergency and out patient department having closed fracture of humerus shaft. All patients were operated under general anaesthesia. All patients were followed for 12 months. Results: Out of 68 patients, 64 patients underwent union in 42-70 days with a mean of 56 days. Complications found in four patients who had insignificant delayed union which were united next 3 weeks. Intramedullary K-wires were removed after an average of 5 months without any complications. The results were excellent in 94.11% and good in 5% children. Conclusion: This technique is simple, quick to perform, safe and reliable and avoids prolonged hospitalization with good results and is economical.