Introduction: Several international studies suggest that medical school training is associated with high levels of stress. Although stress is peculiar to the medical profession, it is rarely given the desired attention, especially in resource-constrained settings. This study was therefore conducted to determine the prevalence of stress stressors, coping strategies of medical students in the University of Calabar, Nigeria. Materials and Methods: A cross-sectional descriptive survey of 451 medical students was conducted on available classes during the study period. A semi-structured self-administered questionnaire was used to elicit information from respondents. Data were summarized using proportions, and Chi-square test was used to explore associations between categorical variables. Level of significance was set at P < 0.05. Results: Majority (94.2%), of undergraduate medical trainees perceived the training as stressful. The major stressors identified were excessive academic work load (82.3%), inadequate holidays (76.4%), and insufficient time for recreation (76.2%). Feeling depressed, sleeping problems and anxiety were the most common effects of stress reported by the respondents. The coping strategies adopted by the students were mainly positive. Perceived stress was significantly associated with being in the clinical level of study, residing on campus and a higher monthly allowance (P < 0.05). Conclusion: Majority of the students interviewed perceived their training as stressful. There is, therefore, an urgent need for medical educators to introduce of stress management courses or programs into the curriculum.

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Background: Teething is an important developmental milestone in young children. Mothers attribute several symptoms to teething and their beliefs in turn affect their behavior towards the healthcare of children during the period of tooth eruption. This study assessed maternal beliefs and behaviors towards teething in young children in Benin City, Nigeria. Methods: A descriptive cross-sectional study was carried out among mothers who brought their babies to Well Baby Clinics in three health facilities in Benin City, Nigeria. The tool for data collection was a structured researcher-administered questionnaire. Data were analyzed using SPSS version 16.0. Results: Mothers of 420 children (mean age 16.2 ± 8.6 months) participated in the study. Over two-third 302 (71.7%) believed that infant teething is associated with various symptoms. The commonest symptoms reported were fever 258 (85.7%) and diarrhea 241 (80.0%) while the least was redness of the gums, 2 (0.7%). A greater proportion of respondents, 224 (74.4%), 186 (61.8%) and 184 (61.1%) managed teething discomfort with teething syrups, tepid sponging and teething toys respectively. More than half of the respondents 263 (54.3%) and 162 (56.3%) gave analgesics to relieve fever and oral rehydration solution (ORS) for diarrhea attributed to the teething process respectively. Conclusion: Mothers' beliefs encourage the use of "teething" as a ready explanation for childhood diseases. They utilize analgesics, ORS, teething syrup and herbal medications to relieve perceived teething symptoms. The misconception about teething can be corrected through health education of mothers when they access health facilities. The mass media may also be employed to reach a larger audience.

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Aim: To assess the knowledge of cardiopulmonary resuscitation (CPR) among clinical medical students of the University of Port-Harcourt. Materials and Methods: A cross-sectional study on the knowledge of CPR among clinical medical students (4 ^th -6 ^th year classes) of the University of Port Harcourt. The data collected were analyzed using the Epi info version 7 statistical packages and Chi-square test was used to compare proportions with P < 0.05 considered significant. Results: Two hundred and forty-five questionnaires were distributed with 177 (72.2%) duly filled. The male to female ratio was 1.5:1, the age range was 19-40 years with a mean of 24.50 ΁ 2.79 years. The 6 ^th year class had 109 (61.6%) respondents, 5 ^th year had 49 (27.7%) and 4 ^th year had 19 (10.7%). Forty-six (26.0%) of students had some form of CPR training and 11 (6.2%) admitted having performed CPR. Of the 46 students that had CPR training, 39 (84.8%) did so because it was given to them at some point in their medical training, while 7 (15.5%) acquired the training due to personal interest. One hundred and two (74.6%) students scored <50%, while 45 (25.4%) scored >50%. The number of students scoring >50% increased with increasing class level (P < 0.001). Students with some prior training in CPR (50.0%) scored above average compared to the students without CPR training (16.8%) (P < 0.001). Conclusion: There is a need to periodically and constantly organize CPR for the medical students and incorporating the training in their medical curriculum to enhance better understanding of the procedure.

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Background: Cesarean delivery is associated with increased risk of hemorrhage, and this necessitated the practice of routine hematocrit testing to detect anemia and the need for blood transfusion. Objectives: To ascertain the necessity of this routine investigation and to identify factors predictive of anemia following uncomplicated cesarean delivery at this clinical setting. Materials and Methods: A prospective observational study of 236 women who had uneventful cesarean delivery at term over a 12-month period. Relevant sociodemographic and obstetric data were extracted, and clinical assessment of the women including postoperative hematocrit was done on second postoperative day. Data were analyzed using SPSS version 16 for Windows. Multivariate logistic regression analysis was done to identify independent risk factors predictive of anemia postcesarean section. Results: Average age and parity of the women were 29.8 ± 4.9 years and 2.2 ± 1.5 respectively. Mean pre and postcesarean hematocrit was 35.2% ± 3.4% and 30.7% ± 4.0% respectively with an average drop of 4.6% ± 3.3%. Only 5.9% had hematocrit decline of >10% and none was transfused. Preoperative hematocrit ≤35% (P < 0.0001, OR: 4.43, 95% confidence intervals (CI): 2.00-9.80), fatigue (P = 0.04, OR: 3.92, 95% CI: 1.07-14.39), and conjunctival pallor (P = 0.02, OR: 5.01, 95% CI: 1.32-19.02) were independent factors predictive of anemia postcesarean delivery. Conclusion: This study suggests that routine postcesarean hematocrit testing is unnecessary following uncomplicated procedure but may be indicated in women with preoperative hematocrit ≤35%, postoperative fatigue, and conjunctival pallor.

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Background: Encopresis is a disabling condition that causes psychological problems in children and disharmony among family members and places a heavy burden on the well-being of the child and nation. Objectives: Objectives of this study were to determine the prevalence of encopresis in children aged 5-12 years attending government primary schools in southeast Nigeria and associated factors. Materials and Methods: We enrolled 245 children in this study. The study was carried out among children in four government primary schools who were within the age range of 5-12 in Enugu and Ebonyi states of Nigeria. The instrument employed for data collection was a structured questionnaire (enuresis and encopresis questionnaire). The families were assigned socioeconomic classes (SEC) using Oyedeji's method of social classification. Data were analyzed with Statistical package for social sciences (SPSS) software, version 17. Data presentation was in the form of tables and charts. Frequencies, proportions, and percentages were calculated for categorical variables. Results: We obtained a prevalence of 10.5%. Encopresis was highest in lower SEC. Encopresis was more in females 27.8% compared to males 25.4% though not statistically significant. One hundred and fifty-three (75%) of children achieved bowel control after the age of 4. About 72% of the children with stool soiling problem have no enuresis while 27% have enuresis. Conclusion: The prevalence of encopresis among school pupil in southeastern Nigeria is 10.5%. Encopresis is more common in children from a low SEC.

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L-asparaginase, a chemotherapeutic agent, is commonly used in the treatment of acute lymphoblastic leukemia patients. L-asparaginase therapy is associated with low fibrinogen levels and thrombosis. Cerebral venous thrombosis is the dreaded form of thrombosis in such patients. Management in such situation is not standardized owing to its rarity in the literature. We present here management of such a case with a brief review of the literature.

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Background: Prolonged stay in the Intensive Care Unit (ICU) defined ≥14 days stay in the ICU is associated with increased cost, resource utilization, and could contribute to patients' morbidity and mortality. Objective: This study was designed to determine the factors that contributed to prolonged stay in ICU and its impact on patients' outcome. Materials and Methods: We conducted an 11-year retrospective, case-control study of all admissions into the ICU with emphasis on prolonged stay. Data on indications for ICU admission, clinical course, and intervention in terms of blood transfusion and mechanical ventilation were obtained and analyzed. Others were duration of stay in the ICU and patients' outcome. Results: A total of 1,661 patients were admitted into the ICU during the study period, out of which only 90 patients had prolonged stay constituting 5.4%. Mortality rate among patients with prolonged stay was 37.8%. Neurosurgery and cardiothoracic units had more patients with prolonged stay, 38.6% and 18.2% patients, respectively. Blood transfusion and the indication for ICU admission contributed significantly to prolonged stay. Conclusion: The ICU exerts great physical, material, psychological, and social toll on the patients, institution, and society. Indication for ICU admission/severity of illness and blood transfusion were identified factors associated with prolonged stay in the ICU. Age, sex, and mechanical ventilation did not have any significant impact on duration stay.

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Objective: The aim was to study the incidence, microbiological profile and early outcomes in elderly (age >60 years) patients of ventilator associated pneumonia (VAP) admitted to Intensive Care Unit (ICU) of a Tertiary Care Hospital in Uttarakhand. Materials and Methods: Elderly patients (age >60 years) admitted to ICU who developed VAP were enrolled in the study from December 2011 to December 2012 .Their endotracheal secretions were collected and processed as per standard microbiological methods, and the results analyzed along with the early outcomes in terms of in ICU mortality of the patients. Retrospective analysis of records was also done during this period of one year to find out the incidence of VAP among elderly patients. Results: Incidence of VAP was 45.21% among elderly patients on mechanical ventilation (MV) and Gram-negative organisms were the most common etiological organisms. Mortality among elderly patients with VAP was similar to that in young. Conclusions: A higher incidence of VAP was seen among elderly patients subjected to MV though larger studies are needed. Microbiological profile of VAP among elderly and young is similar.

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Background: The overwhelming impact the Human Immunodeficiency Virus (HIV) has on the world is undeniable. With the introduction of highly active antiretroviral therapy (HAART), HIV/AIDS has changed from a killer disease to a treatable chronic infection. However, HAART may be associated with some blood changes. Objectives: The aim of this study is to evaluate the effect of HAART on some haematological and haemorrheological indices in HIV infected pregnant women at different trimesters. Methods: This study was carried out at the ante-natal clinic of the University of Benin Teaching Hospital from April 2013 to February, 2014. Ethical approval was obtained from the ethics and research committee of the University of Benin Teaching Hospital. Fifty (50) HIV-seropositive pregnant women on HAART and 50 HIV-seropositive pregnant women not on HAART as controls were recruited. The mean age of these women was 29 years. Blood was sampled from both test and control subjects for whole blood viscosity (WBV) by Reid and Ugwu method, platelet, while blood cell count, haemoglobin estimation and erythrocyte sedimentation rate were done by methods described by Dacie and Lewis. Results: In the first trimester there were no significant changes in Hb, WBC and WBV (P > 0.05) between test and control subjects, while in the second trimester there was a significant decrease in platelet counts (<0.001), in the control subjects and WBV did not show any significant difference (P > 0.05). In the third trimester of gestation WBC also increased significantly (P < 0.001), though these increases were within normal ranges. Conclusion: Haematological and haemorheological activity differs in pregnancy and the introduction of HAART further predisposes these women to bleeding episodes.

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Background: Neonatal tetanus is a lethal disease which has remained an important public health problem in developing countries. The global efforts at eliminating neonatal tetanus have resulted in many nations having less than one case of neonatal tetanus per 1,000 live births per district- a goal that Nigeria is striving to achieve. Objective: To evaluate the contribution of neonatal tetanus to morbidity and mortality in the neonatal unit of Stella Obasanjo Hospital (SOH), Benin City, Nigeria. Methods: A retrospective study in which records of admissions over a six-year period (June 2008 to May 2014) were obtained from the neonatal unit records paying particular attention to cases of tetanus. Information retrieved included age, sex, duration of stay in the unit and outcome. Results: A total of 2,324 patients were admitted into the neonatal unit during the study period. Of these, 23 had tetanus, giving an overall prevalence of 1.0% and an annual incidence of four cases. All the cases were out-born. Nine (39.1%) were males while 14 (60.9%) were females giving a M: F ratio of 1: 1.6. The median and modal age at presentation was seven days (range being 2-21 days). Ten (43.8%) patients were discharged home, four (17.4%) discharged against medical advice while nine died; giving a case fatality rate of 39.1% and contributing 3.1% out of the overall mortality of 286 neonates. Conclusion: Neonatal tetanus contribute significantly to morbidity and mortality. The global efforts for disease elimination should be unrelenting. To be counted among nations that have successfully eliminated the disease, we must pay particular attention to public enlightenment.

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Background: Dental amalgam has been in use for a very long time in the field of restorative dentistry as an intracoronal restorative material. Despite its long usage, there have been reports about adverse health effects arising from the exposure to minute mercury released from amalgam to the dentists if not properly handled. Aim: The aim was to find out the compliance of Nigerian dentists with recommendations on mercury hygiene practices. Materials and Methods: A cross-sectional study using self-administered questionnaire consisting of three parts was conducted among registered dentists. The first part of the questionnaire sought demographic characteristics of respondents while second part assessed measures taken by the caregiver himself while working with amalgam and the last part assessed measures taken to control and prevent mercury contamination within the clinical setup. Result: There was total compliance with the use of gloves when working with amalgam among the participants. However, the house officers had the highest tendency of always wearing face mask and protective clothing followed by specialist in training. There was a statistically significant difference in the tendency to always wear face mask (χ² = 21.37, P = 0.00) and protective clothing (χ² = 24.77, P = 0.00) as against occasional and never wearing them, among the different categories of dentists. Compliance with the use of rubber dam and alternative source of air was found to be generally poor among the professionals studied. More than two-third of all dentists studied never used the two preventive measures. About 78% never used rubber dam when working with amalgam. The method of handling excess mercury was found to be more appropriate among the respondents in the teaching hospitals and poorest among those in private set-up. Furthermore, a great majority (87.5%) of those working in private clinics had never heard of mercury vapor monitoring. Conclusion: It was noted that some of the standard mercury hygiene practices such as the use of rubber dam, high volume suction, and water cooling when removing or polishing amalgam restorations were not followed properly.

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Context: Fracture of the proximal humerus had been recorded as the second most common fracture of the upper extremity, following distal forearm fracture. Aims: This study was aimed at investigating some possible demographic risk factors associated with proximal humeral fractures among Nigerians. Settings and Design: The study was carried out at the National Orthopedic Hospital, Igbobi, Lagos State, Nigeria. Materials and Methods: Plain films of X-ray from a total number of 162 patients between 0 and 100 years, comprising 86 males and 76 females were used for the study. They were grouped into children (0-17 years), young (18-39 years), middle age (40-65 years), and elderly (above 65 years). Statistical Analysis Used: The analyses were done using Statistical Package for Social Sciences version 16.0 and presented in bar charts. Results: The results showed that there was no statistically significant difference (P = 0.432) between the frequencies of proximal humeral fracture in males and females. There was also no statistically significant difference (P = 0.432) found between the occurrence on the right and left sides. Whereas the major causes of proximal humeral fractures from this study were falls and road traffic accidents (RTAs), there was no statistically significant difference (P = 0.619) found between them. The highest frequency of proximal humeral fractures was among the children in males and the elderly in females. Conclusions: In conclusion, the major causes of proximal humeral fractures from this study were falls and RTAs.

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Introduction: This is a 20-year retrospective audit of salivary gland cancers (SGC) in University of Benin Teaching Hospital (UBTH) Benin City, Nigeria, and is aimed at determining the epidemiological profile of these tumors. Materials: The materials for this study consisted of available slides and paraffin-embedded tissue blocks of all SGC received during the study period. Results and Conclusion: SGC are rare, accounting for 0.5% of all tumors seen in the study centre. The mean age of patients with SGC was 49.1± 17.1 years, and the peak age was in the 6th decade. A male to female ratio of 0.77 was observed in the study. A changing frequency from mucoepidemoid to adenoid cystic carcinoma as the most common SGC was also demonstrated in this study. The commonest site for SGC in this study was parotid gland, while the palate was the commonest site for minor malignant salivary gland tumors.

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Background: Self-reporting though thought to be unreliable, is often used to assess medication adherence in clinical practice. The aim of this study was to determine self-reported medication adherence and blood pressure control rates in patients with chronic kidney disease (CKD). Patients and Methods: This was a cross-sectional survey of patients with CKD attending a nephrology out-patient clinic in Lagos. Recruited patients had been attending the clinic for >1 year and had >4 clinic visits. CKD was defined as glomerular filtration rate <60 ml/min/1.73 m ² , medication adherence was assessed according to the simplified medication adherence questionnaire, while target blood pressure was defined as a sitting recording <130/80 mmHg. Results: A total of 91 patients (50.5% female) were studied. The mean age (years) of the study population was 49.5 ΁ 13 (range 22-78). The mean glomerular filtration rate (ml/min/1.73 m ² ) was 23.5 ΁ 16.0 (range 4-59). Overall, 61 (67%) patients were adherent while 23 (25.3%) had their blood pressures controlled to target. Control rates were similar regardless of adherence status (P = 0.19). Adherent patients had significantly lower mean systolic blood pressures (P < 0.01) and were more likely to achieve systolic blood pressures <130 mmHg (P = 0.02). Conclusion: Medication adherence rates and blood pressure control rates reported here are similar to previous studies. Adherent patients were more likely to achieve systolic blood pressure targets <130 mmHg, but not diastolic blood pressure targets of <80 mmHg.

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A 7-year-old male child presented to a private clinic in Abakaliki, with a complaint of straining at micturition, poor urinary stream and painful micturation all of 2 months prior to presentation. Examination showed a suprapubic tenderness and fullness with a firm and exquisitely tender mass in the urethra in the region of the corona of the penis, protruding at the urethral meatus as a whitish, firm, sharp substance. Conclusion: Urolithiasis though not a common condition in this age group especially in our environment can still be seen as demonstrated in this patient.

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