Background: Sickle Cell Anemia (SCA) is an inherited disorder which is associated with significant morbidity and mortality. Early recognition as well as prompt and effective management of the morbidities seen in SCA is key to the survival of patients with the disease. Objective: To determine the morbidity profile and outcome of patients with sickle cell anemia (SCA) admitted into an Emergency Pediatric Unit (EPU) of a tertiary health center in Nigeria. Methods: A retrospective study in which records of admissions of children with SCA over a two-year period (June 2011 to May 2013) were obtained from the EPU records. Information retrieved included age, sex, diagnosis and outcome as far as the unit is concerned. Results: One hundred and forty-seven children, 11.9% of the total (1,234 patients) EPU admission, aged between six months and 18 years (mean age being 84.76 ± 57.24 months) were studied. Male: female ratio was 1.3: 1. Vaso-occlusive (53.2%), hyper-hemolytic (37.6%) and acute sequestration crises (9.2%) were noted but no case of aplastic crisis was seen. Among infections, Malaria (56.2%), Sepsis (15.6%) and pneumonia (12.5%) were the major cases documented. Two (50-0%) patients died of acute sequestration crisis, one (25.0%) of meningitis and another (25.0%) of hyper-hemolytic crisis with severe anemia. Mortality rate was 2.7%. Conclusion/ Recommendation: SCA admissions in our EPU are mainly due to vaso-occlusive crises and infections. Acute sequestration crisis was the leading cause of death followed by meningitis and hyper-hemolytic crisis. Prompt and effective transfusion services, the use of pneumococcal conjugate vaccine as well as judicious use of appropriate antibiotics will augment the chances of survival in these children.

Background: Anemia is one of the important clinical significance in sickle cell disease, and a major clinical consequence of glucose-6-phosphate dehydrogenase (G6PD) deficiency is hemolytic anemia. The aim of this study is to compare the enzyme activity in sickle cell patients (SS) and normal hemoglobin (Hb) (AA) individuals. Patients and Methods: A total of 100 hundred samples comprised of 50 sickle cell patients as test subjects and 50 Hb AA individuals were used as controls. Each of the blood sample collected was screened immediately for G6PD deficiency using the methemoglobin reduction test and Randox kit. Results obtained were subjected to statistical analysis using paired t-test. Result: Glucose-6-phosphate dehydrogenase deficiency was found to be significantly higher in test subjects (P < 0.01) when compared with the control subjects. It was also shown that G6PD levels tend to increase with increase in age though this increase was not significant (P > 0.05). There was no significant difference in G6PD levels between males and females sickle cell patients (P > 0.05). Conclusion: These results, therefore, suggests that G6PD enzyme activity is much more reduced in the sickle cell patient who may contribute to making them prone to hemolytic anemia when compared to normal individuals.

Background: In chronic obstructive pulmonary disease (COPD) patients, left ventricular (LV) systolic dysfunction is rare. Objectives: To evaluate the prevalence of LV systolic or diastolic dysfunction in patients with COPD. Materials and Methods: A cross-sectional study was conducted in a tertiary care hospital for a period of 2 years from January 2012 to December 2013. These patients underwent physical examination and standard two-dimensional (2D) echocardiographic views, and peak flow velocity of early diastolic filling [early filling velocity (E-Max)], peak flow velocity of late atrial filling [atrial filling velocity (A-Max)], and early flow velocity peak/late flow velocity peak [early to late (E/A)] ratio were measured according to the criteria of the American Society of Echocardiography. Statistical analysis was carried out using SPSS software. Results: A total of 102 patients diagnosed with COPD as per the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines were enrolled. Of the 102 COPD patients, the maximal A-Max increased and E-Max decreased in 76 patients (74.5%) (P < 0.001). The early flow velocity peak/late flow velocity peak (E/A) ratio also markedly decreased in these 76 patients (P < 0.001) indicating LV dysfunction. The atrial contribution to total left diastolic filling increased in patients with COPD. This was also observed in COPD patients with normal pulmonary artery pressure (PAP) (P < 0.001). Grade IV COPD (P - 0.000), the duration of illness (P < 0.001), and smoking >10 packs for years (P < 0.001) were the risk factors that were associated with the development of LV diastolic dysfunction in COPD patients. Conclusion: The prevalence of LV diastolic dysfunction was 74.5%. As the severity of COPD increased, the risk of LV diastolic dysfunction increased. The screening of severe COPD patients for LV function might improve the outcome.

Background: Carcinoma of the cervix is the most common female genital tract malignancy in Nigeria. Immunosuppression has been linked with acquisition and persistence of human papilloma virus infection, which is known to trigger changes in the cervical epithelium resulting in cancer of the cervix. Objectives: The objective was to determine the prevalence of cervical squamous intraepithelial lesion in human immunodeficiency virus (HIV) positive women receiving care at the Federal Teaching Hospital, Abakaliki in Nigeria, as well as the pattern of abnormal cervical smear in HIV-positive women. Materials and Methods: The study was a prospective cross-sectional study of 206 HIV-positive women attending the HIV clinic at the Federal Teaching Hospital Abakaliki. Papanicolaou smear was collected. Statistical analysis of the results was performed using the SPSS version 16 software package. Results: The prevalence of squamous intraepithelial lesion (SIL) was 6.3% in HIV-positive patient. Of those with abnormal cervical cytology, 35/206 (17%) had inflammatory smear, 16/206 (6.3%) had low-grade SIL, and 4/206 (1.9%) women had Trichomonas vaginalis. Conclusion: The prevalence of low-grade SIL among women infected with HIV in this study was high. The abnormal cervical smear were inflammatory smears, low-grade cervical SILs, and Trichomonas vaginalis infection.

Background: Upper gastrointestinal complaints are common, and the underlying diseases range from simple to very serious pathologies. Upper gastrointestinal endoscopy helps in the proper diagnosis and the appropriate management of the underlying lesions. Aim: To determine the indications for and the findings at upper gastrointestinal endoscopy in a private Tertiary Hospital in South-Eastern, Nigeria. Materials and Methods: A retrospective cohort study of adults who had an upper gastrointestinal endoscopy between March 2011 and August 2012 at the study hospital was carried out. Their medical records were reviewed to evaluate the indications and outcomes of the endoscopy. Results: A total of 211 patients' records were reviewed. Males constituted 49.5% of the patients while females constituted 50.5% giving a male:female ratio of approximately 1:1. Their ages ranged from 18 to 92 years with a mean of 52.5 years. The commonest indications for the procedure were dyspepsia occurring in 129 (61.1%) followed by gastrointestinal bleeding 39 (18.5%). The commonest endoscopic diagnosis was gastritis which was found in 161 (76.3%) patients. Peptic ulcer was diagnosed in 29 patients (13.7%) and gastroesophageal varices in 5 patients (2.4%). Of 39 patients with an indication of upper gastrointestinal bleeding, peptic ulcers occurred in 18 (42.1%) while varices were seen in 5 (12.8%). Conclusion: The commonest indication for upper gastrointestinal endoscopy in the studied Tertiary Hospital in South-Eastern Nigeria is dyspepsia while the commonest endoscopic diagnosis is gastritis. Furthermore, peptic ulcers are seen more commonly than gastro-oesophageal varices in patients presenting with upper gastrointestinal bleeding in this population.

Introduction: Red eye is one of the most common reasons why patients present at the eye clinic. It may be due to a nonvision-threatening ocular condition or vision-threatening one. It may also be a symptom of a life-threatening condition, and improper diagnosis and appropriate management may result in ocular morbidity or mortality. Materials and Methods: A retrospective study was carried out on patients who presented to the eye clinic of the Federal Medical Centre, Birnin Kebbi with complaints and features of the red eye. Patients who presented with red eyes from January 1, 2011 to December 31, 2013 were reviewed. The information retrieved from the patients' records ranged from sociodemographic to causes of red eye. The data were analyzed using the Statistical Package for the Social Sciences version 18. Results: Totally, 2623 patients presented on account of red eye during the 3 years study period. There were 1425 (54.3%) males and 1198 (45.7%) females. The majority of the patients were children age group 0-15 years (39.6%) followed by age group 16-31 years (32.8%). The major causes of red eye in our study were due to ocular allergy 1288 (49.1%), microbial conjunctivitis 293 (11.2%), and ocular trauma 286 (10.9%). Conclusion: Ocular allergy accounts for almost half of cases of red eye seen in this population and majority of cases of red eye were found in children. Priority attention should, therefore, be given to ocular allergy to mitigate school absenteeism that may result from red eye.

Background: Cerebrovascular accident (CVA) or stroke is a leading cause of morbidity and mortality worldwide. The aim of the study is to document the retinal abnormalities in patients with CVA seen in a tertiary hospital. Materials and Methods: The retina of patients aged ≥18 years with CVA occurring within 1 year managed in a tertiary hospital were examined from October to December 2013 and the findings recorded. Patients with prior history of ocular trauma and unconscious stroke patients were excluded. Data were analyzed with Statistical Package for the Social Sciences (SPSS) version 20 and P < 0.05 was taken as significant. Results: A total of 85 patients comprising 61 (71.8%) males and 24 (28.2%) females were seen. The mean age was 66.1 ± 11.0 years (range: 43-88 years), out of which 57 (67.1%) were ≥60 years. There were 67 (78.8%) and 18 (21.2%) cases of ischemic and hemorrhagic stroke, respectively. Hypertension was the most common predisposing factor of stroke in 95.3% of the patients. Abnormalities in the retina background included hemorrhages in 18 (10.6%) eyes, hard exudates and cotton wool spots in 13 (7.8%) and 4 (2.4%) eyes respectively. Retinal vascular abnormalities were documented in 55 (32.4%) eyes. There were more abnormalities in the retina vasculature of patients with hypertension, diabetes mellitus (DM), and hyperlipidemia than in patients without these conditions (P < 0.50). There were also more abnormalities in the background retina of the diabetics when compared to the nondiabetics (P = 0.02). Conclusion: Regular ophthalmic evaluation of patients with predisposing risk factors for CVA with early detection of ocular manifestations/complications of the disease could help modify treatment to prevent or limit more untoward and debilitating effects such as stroke.

Background: Amblyopia causes impairment of visual acuity, depth perception, and contrast sensitivity and this leads to loss of binocular single vision. Objectives: This study was conducted to determine the prevalence and types of amblyopia among primary school pupils in Benin City, Edo State, Nigeria. Materials and Methods: This was a cross-sectional study. A two-stage simple random sampling technique was used to select 2,139 primary school pupils who were examined. Data were obtained using researcher-administered questionnaires and ocular examinations included visual acuity (VA) test, crowding phenomenon, cover test, Hirschberg's test, Maddox wing, and Maddox rod test. Cycloplegic refraction and dilated fundoscopy were performed after the administration of 1% tropicamide. Amblyopia was defined as best corrected VA ≤6/9 in one eye or both the eyes without ocular pathology in either eye. Results: Amblyopia was present in five students (0.23%) - two males and three females - out of whom two had unilateral and three had bilateral amblyopia. There were two cases of mixed amblyopia (both had anisometropia and strabismus with amblyopia). Anisometropic, isometropic, and meridional amblyopia were found in one pupil each. Conclusion: The prevalence of amblyopia among primary schoolchildren in Benin City, Edo State, Nigeria is lower than that reported in previous studies in African, Caucasian, and Asian populations.

Introduction: Umbilical cord prolapse is a dire obstetric emergency that causes a lot of fetal morbidity and mortality and maternal morbidity. The incidence in our Center is not known and the outcome of the cases we have been managing in our Center had never been audited before with a view to finding out how to improve on our management. It is against this back drop that this work is carried out. Material and Method: This is a retrospective study involving all the cases of umbilical cord prolapse managed in Mater Misericordiae Hospital, Afikpo, Ebonyi State, Nigeria from January 1995 to December 2014. The case notes were got from the hospital's Records Department and relevant information were retrieved and analyzed. Results: There were 92 cases of cord prolapse and 22,595 deliveries over the period giving an incidence of cord prolapse of 0.41% or one case of cord prolapse in every 246 deliveries. Twenty one or 22.8% had multiple pregnancy. Fifty two women (56.5%) had mal-presentation and 51 (55.4%) of the women had emergency lower segment caesarean section. Fifty (54.3%) of the babies weighed 2.5 Kg or below. Sixty three (65.6%) of the fetuses were alive while 33 (34.4%) had intra-uterine fetal death giving a perinatal mortality rate of 343.8 per 1000 births. There was no maternal mortality. Of the 63 babies delivered alive, 25(40.3%) had apgar scores of 8 to 10, 22(34.9%) 5 to 7 while16 (25.8%) 1 to 4 in one minute. Conclusion: Umbilical cord prolapse in rural Nigeria is a rare but devastating obstetric emergency with a high perinatal mortality rate and maternal morbidity. Obstetricians must continually update their skills in the management of this condition to help reduce its devastating consequences.

Introduction: Apheresis is widely established in developed centers but only very few centers in Nigeria have this facility. The commencement of hematopoietic stem cell transplantation (HSCT) in our facility in 2011 necessitated the development of an apheresis center with its enormous benefits for both HSCT patients and other patients in the hospital. Materials and Methods: A retrospective study at the University of Benin Teaching Hospital on donor plateletapheresis over a 4-year period (January 2011 to December 31, 2014). Apheresis machine used for the plateletapheresis is Haemonetics MCS+ and donors were selected using the European Guidelines for apheresis selection. Result: A total of 150 plateletapheresis were performed for 50 patients with an average of 34.75 per annum. Donors were mainly males (84.9%) and the general indication was thrombocytopenia secondary to some medical condition. The main medical indication was thrombocytopenia for patients undergoing HSCT (38.2%). Others were hematological malignancies/chemotherapy-related thrombocytopenia (33.3%) and bone marrow aplasia (7.2%). Sixty-five (46.8%) of donors were of blood group O, 48.2% were of blood group A, 2.2% were of blood group B, and 2.9% were of blood group AB. The majority of the donors (98.6%) were Rhesus-positive. The average number of cycles was 6.4 ± 0.2, average yield was 3.6 ± 0.1 × 10 ¹¹ cells, blood volume was 3,135.2 ± 61.0 mL, acid-citrate-dextrose (ACD) was 409.4 ± 25.4 mL, and platelet volume was 243.9 ± 6.1 mL. Conclusion: Plateletapheresis is a new procedure in most developing centers. We have reported the activities in a single center with enormous benefits to patients with thrombocytopenia. There is a need to improve and subsidize these services to make it readily available to patients who require single platelet concentrate.

Background: The prevalence of transfusion-transmissible infections (TTIs) is influenced by certain blood donor characteristics. Aim: To study the epidemiology of TTIs among blood donors in a Nigerian Tertiary Hospital. Materials and Methods: Sociodemographic data and other donor information were retrieved from the donor register. The rapid test results for hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV), syphilis (venereal disease research laboratory), and human immunodeficiency virus (by determine and Stat-Pack test kits) as well as P24 antigen assays were also retrieved from the register. Chi-square statistics was used to compare the prevalence rates of TTIs among donor groups, the level of significance was set at P < 0.05. Results: The highest prevalence of TTIs was recorded for HBsAg and HCV (2.0% (29/1419) and 2.0% (28/1419) respectively), among all donors, it was nil for syphilis (0%). Commercial donors recorded the highest percent prevalence of all TTIs while voluntary donors had the least. Traders and students had a higher prevalence of TTIs among the occupational groups while laborers and the unemployed recorded the least. Blood Group A Rhesus D positive donors recorded the highest prevalence of TTIs while blood Groups A and B Rhesus D negative and AB Rhesus D positive donors recorded the least. There were no significant differences in the prevalence rates of TTIs compared by donor type, gender and occupational groups (P > 0.05). Conclusion: Donor type, occupation and blood group appear to indicate higher TTI carriage rate among our blood donor set.

Background: Oncology nurses are posed with issues that are potential sources of stress to them. Aim: To identify the potential sources of stress in cancer care for Nigerian oncology nurses. Materials and Methods: This was a descriptive cross-sectional study involving nurses working in the oncology units of three selected Nigerian teaching hospitals. Consenting oncology nurses were recruited. The tool for data collection was a self-administered structured questionnaire. Result: Eighty-six (86) nurses participated. High workload (mean = 5.34 ± 0.59), taking care of critically ill patients (mean = 5.12 ± 0.78), strict organizational rules (mean = 5.05 ± 0.66), lack of organizational support (mean = 4.91 ± 0.87), and challenges of caring for dying patients (mean = 4.66 ± 0.97) were the major potential sources of stress perceived by oncology nurses. Conclusion: A number of stress-generating situations have been identified, and appropriate strategies and interventional programs are needed to address them.

Context: Venous thromboembolism is a significant cause of morbidity and mortality in cancer patients. Awareness of patients at risk will enable clinicians proffer thromboprophylaxis promptly and thus reduce morbidity and mortality. Aims: The aim of the study is to evaluate the clinicians' awareness and practice of thromboprophylaxis in cancer patients. Materials and Methods: A descriptive questionnaire-based survey of clinicians in the University of Port Harcourt Teaching Hospital. Statistical analysis used: The Statistical analysis was done using SPSS 17.0. Results: Ninety-four clinicians responded (78.33%). Forty (42.55%) could define Venous thromboembolism (VTE) appropriately. Fifty-seven (60.63%) clinicians saw 1-6 cancer patients monthly and majority; 84 (89.36%) said cancer patients were at higher risk of VTE than noncancer patients. The most commonly cited risk factors for cancer-associated thrombosis (CAT) were the site of the tumor (98.9%), surgery (76%), body mass index (76%). Thirty-seven (39.36%) reported offering some form of thromboprophylaxis to their cancer patients. Low molecular weight heparin was most prescribed; by 24 (64.87%) respondents. Fifty-four (57.45%) of the respondents had no idea of the effect of heparins on tumor progression. Conclusions: The awareness of CAT and the importance of thromboprophylaxis amongst our clinicians is low.

There is a scant report in the literature on conversion disorder in children. These investigators are not aware of any report of this condition among Nigerian children. This could be because this condition is easily missed thus, creating the impression that conversion disorder is rare. This paper presents three cases of Nigerian children who manifested with features consistent with conversion disorder. This communication aims to highlight the need to consider this condition in children, especially those with difficult to explain symptoms.

The evaluation of patients with esophageal complaints starts with barium swallow and/or endoscopy examinations. This report is about a 78-year old female whose barium esophagogram showed evidence of advanced esophageal cancer. The aim of this report is to highlight the need for a high index of suspicion, and early use of barium swallow, in evaluating esophageal complaints in patients of middle age and above, especially in developing countries like Nigeria where endoscopy may not be widely available. An earlier diagnosis may improve the mortality and morbidity from this very lethal tumor which is relatively rare.

A 26-year-old young man came with complaints of abnormally dark skin coloring, particularly in the back of the hands and intertriginous folds between digits, progressively spreading in the last 5 years. There was no family history of the same. He had no personal and family history of skin disease or diabetes mellitus. A clinical diagnosis of drug-induced hyperpigmentation disorder was made. A skin biopsy of 0.3 cm × 0.3 cm which was totally embedded for histopathology reporting was obtained. The section revealed epidermis, dermis, and subcutaneous tissue. Epidermis shows hyperkeratosis, irregular acanthosis with focal filliform down growth of the epidermis. Multiple keratin horn cysts were seen in the down growth. The tips of rete ridges showed pronounced hyperpigmentation. The histopathological impression was Dowling-Degos disease (DDD). DDD is a rare genetic skin condition without a definite cure, although its prevalence is unknown. We report a DDD case in a young man.

Refractory epilepsy is common in practice of neurology. When associated with hemiparesis and hemiatrophy a possibility of Dyke-Davidoff-Masson syndrome (DDMS) could be considered and imaging helps in confirmation. We present a case report of a 10-year-old female who presented with seizures, right-sided hemiparesis, hemiatrophy of the right side of the body, and mental retardation. Magnetic resonance imaging (MRI) brain revealed characteristic features diagnostic of congenital type of cerebral hemiatrophy or DDMS. Few case reports are described in literature highlighting crossed cerebellar diaschisis an imaging finding associated with the syndrome on MRI. The associated MRI findings of the syndrome are described.