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Aim:To determine patent medicine vendor's awareness and practice of universal precautions. Methodology: This study was a descriptive cross-sectional study carried out in Enugu metropolis, Enugu State, Nigeria in November, 2008. Three hundred and thirty seven patent medicine vendors were studied using semi-structured interviewer administered questionnaires. Information on awareness and practice of universal precautions were obtained. Results: Two hundred and four ( 60. 5%) of the patent medicine vendors had secondary education. Two hundred and sixty three ( 78%) were not aware of the concept of universal precautions. Of the 74 who had heard of the concept, the mass media was the source of information for 38 ( 51. 4%) of them. Most ( 67. 7%) of patent medicine vendors treat open wounds and administer injections. The proportion who take some precaution or the other ( 50. 7%), is similar to those who do not ( 49. 3%). One hundred and forty four ( 42. 7%) of them, dispose of used sharps inappropriately. Two hundred and twenty three ( 66. 2%) of them are aware of the need for appropriate action after a needle prick; i.e., through accessing HIV screening services or consulting a doctor. Conclusion and recommendation: The patent medicine vendor's awareness and practice of universal precautions is poor. Regular training on universal precautions is recommended.

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Objective:To evaluate infant feeding practices and its determinants among HIV positive mothers in Abuja, the Federal Capital Territory of Nigeria. Materials and Methods: This was a cross-sectional descriptive study conducted among sero-positive women diagnosed during pregnancy and had counseling on infant feeding options. The study was conducted in general hospital Asokoro and Gwagwalada specialist Hospital, both of which offer PMTCT services including free breast milk substitutes (infant formula). Results: A total of fifty HIV-positive pregnant mothers participated in the study. Most of the respondents ( 63%) were in age range of 21- 30years, while that of the spouses were 31- 40years respectively. Forty six percent of respondents had secondary education, while 88% were gainfully employed. Majority of respondents ( 84%) notified their partners of their sero-status, while 93% of them were counseled along with their spouse/partners [Table 1]. All the respondents were counseled on different infant feeding options. Forty percent and 46% of respondents respectively chose exclusive breast milk substitute (EB) and exclusive breastfeeding (EBF) for those who opted for replacement feeding. The main reasons given for the choices were: stigma of HIV status, partner support, availability of supply. Infant feeding choices were significantly related to the level of education and awareness of respondents (x² = 32. 8, df = 16, p = 0. 05, x² = 7.4, df = 2, p = 0. 05) Conclusion: Replacement feeding under the present PMTCT programme seems feasible in urban areas of Nigeria. However, public awareness campaigns are needed for its increased acceptability coupled with adequate support that must be provided for mothers who opted for it. Additional training for counseling in HIV and infant feeding options is recommended for health care providers.

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Background: Chronic wounds as a cause of patient morbidity represent a major health burden and drains on resources. There is paucity of information on the actual cost of wound management in Nigeria. Studies have calculated the cost of wounds to the NHS in United Kingdom to be about £ 1bn a year. Objective: This study was conducted to provide data on the point prevalence of wounds in a Nigeria Teaching Hospital, the aetiology and the cost implication of managing the wound. Methods: The study was carried out on a Sunday morning to minimize disruption to patient care. Data on all in patients with chronic wounds were documented in a designed proforma. Results:Two-hundred and six patients were on admission on the day of study out of which sixty-five patients ( 31. 55%) were being managed for one type of wound or the other. There were thirty-six males and twenty-nine females with a male to female ratio of 1. 1: 1. Twenty-four patients ( 36. 9%) had surgical wounds of different aetiology which seventeen patients ( 26. 2%) were being managed for traumatic ulcer. Twenty-nine patients ( 44. 6%) spent between one hundred Naira to five hundred Naira on wound dressing per week. The costs of care of these patients were being settled by their relation in fifty-one patients ( 78. 5%). Conclusion:Wound management is a significant clinical and economic problem. The cost to the health system can be very significant, this is particularly so in a developing country like Nigeria. Our study showed that majority of our patients are petty traders and the cost of wound care was borne mainly by their relatives. The money being spent in a week on wound dressing alone is a bit high for an average Nigerian.

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Background:Hysterectomy is one of the commonest major gynaecological surgeries performed all over the world. This study is the first audit of hysterectomy in a relatively new centre in the North-eastern part of Nigeria. Aim: To determine the indications and outcome of hysterectomy in Gombe. Methods: This is a retrospective study in a tertiary health facility in Gombe, an urban community in north eastern Nigeria. The study is a descriptive analysis of all cases of hysterectomy for benign disease over a 6year period (January 2001-December 2006). Information on socio-demographic characteristics, presenting symptoms, indication for surgery, type of hysterectomy, cadre of surgeon, operative findings, blood transfusion, pre-morbid condition, duration of hospital stay and post-operative morbidity were retrieved and analyzed. Results: Hysterectomy for benign gynaecological conditions accounted for 10.7% of all major gynaecological operations during the study period. The leading indications for hysterectomy were uterine fibroid 36(39.1%), dysfunctional uterine bleeding (DUB) 21(22.8%), and uterovaginal prolapse 19 (20.7%).The mean age and parity were 45.7 + 11.1years and 5.5 + 3.7 respectively. Abdominal hysterectomy with either unilateral or bilateral salpingo-oophorectomy accounted for 73(79.3%) and vaginal hysterectomy contributed 19(20.7%) of cases. The majority of the patients 55(59.8%) were not transfused. Thirty four (37%) were found to be hypertensive. The crude morbidity rate was 29 (31.5%) with wound infection 7(24.1%) being the commonest complication. There was no mortality associated with hysterectomy during the period under review. There was no significant difference in blood transfusion rate between abdominal and vaginal hysterectomies (P= 0.168).The cadre of surgeon (consultant or senior registrar) had no significant influence on morbidity rate (P= 0.132) and overall there was no significant difference between route of hysterectomy (abdominal or vaginal) and morbidity rate (P =0.577).The duration of hospital stay was however significantly lower in those who had vaginal hysterectomy (P=0.019). Conclusion: Hysterectomy appears to be a safe procedure but the high morbidity rate is worrisome. There might therefore be the need to review antibiotic prophylaxis and the policy of asepsis and antisepsis during hysterectomies. The shorter duration of hospital stay following vaginal hysterectomy has an economic appeal and therefore should be resorted to whenever feasible.

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Background: There is at present a high interest in breast cancer but there is still lack of adequate knowledge on male breast cancer. There is no prospective study on male breast cancer, in our environment. Objective: To determine the epidemiology, pathological types, clinical features, management and outcome of male breast cancer in Eastern Nigeria Materials and methods: Folders of all patients with breast cancer, that attended University of Nigeria Teaching Hospital (U.N.T.H.) Enugu, a major referral centre in South Eastern Nigeria from 1995 to 2006 were pooled from the medical record. The number of female and male breast cancer patients were noted. Other relevant facts like age at presentation, duration of illness before presentation, mean age at presentation, pathological types, stage at presentation, treatment received and follow up care were also obtained. Results: Out of 1313 cases of breast cancer that presented over the period, 26 were males giving male percentage to be 2%. The peak incidence of occurrence was between 60- 69 years with a mean of 60. 5 years. The age range of the patients were 25 to 84 years. Invasive ductal carcinoma accounted for 65% of the cases managed. 58% of the cases presented at stage III. Eleven of the patients were followed up for 5 years, only 1 was alive, giving 5 year survival of 9. 1%. Conclusion: Male breast cancer cases contributes to 2% of all breast cancer cases seen at U.N.T.H., Enugu, a major referral centre in Eastern Nigeria . Most of the patients presented late making outcome to be poor. There is need for increased public awareness of this disease.

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Aim:To determine the pattern of presentation of prematurity in Warri Niger Delta. Materials and Method: Retrieval and analysis of casenotes of all the premature babies seen between 2000 and 2007 at General Hospital Warri, a specialist hospital with referrals from surrounding General Hospitals, and GN Children's Clinic, the two major hospitals for children for Warri and its environs. Results: Of the 639 babies seen, 249 were males and 390 females, giving a ration of 1: 1. 6. The youngest in gestational age was 20weeks and five days while the oldest was 36weeks. The lightest in weight was 600g while the heaviest was 2, 400g. Kangaroo nursing was introduced very early in the management. The weight on discharge ranged from 1200g to 2400g, with very good result. The average weight on discharge was 1500g. The overall mortality was 25. 3%, but was 85. 5% in those less than 28weeks of gestation. Mortality was also higher in males at 38. 6% to 16. 9% for females. Respiratory complications are the commonest cause of death, accounting for 30. 8% of the death rate. Conclusion: Prematurity remains a major cause of morbidity and mortality in the newborn period in developing countries. Early maternal handling and introduction of cup and spoon feeding will reduce the time of hospital stay and also the cost of management.

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Background : In spite of enormous investments in Malaria control programme, malaria is still a major cause of morbidity and mortality among under-fives. Objective : The objective of this study was to determine malaria parasitaemia in under-fives and to relate it to household use of Insecticide Treated Bed Nets (ITBNs) in Jos - a malaria endemic setting. Methodology : A cross-sectional study was carried out in a selected settlement in Jos North Local Government Area (LGA) in September 2007 towards the end of the rainy season. All households with children less than 5 years of age in the selected settlement were listed and then 150 of the households were selected using systematic sampling technique. In each selected household one under five was selected and where there were more than one under five only one was selected by balloting. The selected 150 under-fives were then studied using thumb prick blood smear to determine the presence of malaria parasite in their peripheral blood and a semi structured interviewer administered questionnaire to obtain information on household use of ITBNs in the community. Result : Malaria parasitaemia was found in 57 (38.0%) of the children and the highest age specific prevalence of 46.4% was among the 36-47 months age group. The females were more (46.6%) infected than their male counterparts (29.9%) p=0.035. Eighty three (55.3%) mothers owned ITBNs but only 61(40.7%) used them for their children. Children who slept under ITBNs were less likely to have malaria parasites in their blood compared with those who did not (p=0.000..). Mothers' age and education were among other factors that positively influenced the use of ITBNs. Conclusion:Malaria parasitaemia is high in this community and sleeping under ITBN has been found to significantly reduce the prevalence of parasitaemia in the children studied. It is therefore recommended that the ITBNs campaign should be intensified so that the ITBN use can cover all the under-fives.

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Background: Molar gestations are a source of significant morbidity with increased risk of mortality from their complications if not identified and treated early enough. Objective: This study aims at histologically reviewing and analyzing all cases of molar gestations seen in the Histopathology Department of Ahmadu Bello University Zaria between January 1995 and December 2004, and comparing the findings with other studies done elsewhere. Methods : Cases for this study were identified from the departmental bench book. The relevant request forms, slides and in some cases, tissue paraffin blocks for the study period were retrieved. All cases were stained with Haematoxylin and Eosin. The slides were reviewed based on the histological criteria published by Gehrig and Van-Lee. Main findings : Seventy three cases of molar gestations were seen out of which 17 were excluded and 56 were analyzed as follows: Complete hydatidiform mole, 34; Partial hydatidiform mole, 20; Invasive mole, 2. There were 43 cases of choriocarcinoma making 37% of gestational trophoblastic diseases (GTDs) and were exempted from this study. The frequency of Hydatidiform mole was 1: 612 deliveries. The mean age of the patients was 25. 7 years and their leading mode of presentation was vaginal bleeding between 11- 18 weeks of gestation. Conclusions : Hydatidiform mole was found to be a common problem and the complete type occurred more frequently than the partial type.

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Background: The cardiovascular response evoked by laryngoscopy and endotracheal intubation while causing no harm to majority of patients, could result in fatal consequences, or morbidity, in patients at risk. Objective: To evaluate the degree of cardiovascular response evoked by laryngoscopy and endotracheal intubation and compare the effectiveness of repeat-dose propofol and fentanyl premedication in attenuating this cardiovascular response. Methodology: A total of sixty-nine ( 69) patients participated in this double-blind, randomized, prospective study. The change in the cardiovascular parameters following endotracheal intubation were evaluated in three groups of patients; Control(Untreated), Repeat-dose propofol and Fentanyl groups. The parameters considered were Heart rate (HR), Systolic arterial pressure (SAP), Diastolic arterial pressure (DAP),Mean arterial pressure (MAP) and Rate-pressure product (RPP). Results: The untreated group had increase in HR ( 36. 4%), SAP ( 42. 3%), DAP ( 36. 5%), MAP ( 39. 3%), RPP ( 94. 2%) following laryngoscopy and intubation. The fentanyl group had minimal increase in HR ( 11. 6%), SAP ( 11. 64%), DAP ( 11. 42%), MAP ( 11. 35%), RPP ( 24. 6%). Similarly the repeat-dose propofol group had minimal increase in HR ( 13. 6%), SAP ( 16. 63%), DAP ( 19. 5%), MAP ( 17. 2%), RPP ( 32. 8%). Conclusion: Endotracheal intubation in the untreated group was associated with remarkable increases in all the measured cardiovascular parameters whereas patients in the fentanyl group and repeat-dose propofol groups had significantly less increases in the parameters.

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