Vaginal birth after one caesarean section (CS) is considered safe in selected women. However, women with more than one CS in low-income settings are at higher risk of complications with vaginal birth. Thus, abdominal delivery is recommended for women with more than one CS in low-income countries unlike in high-income countries. This study was designed to raise awareness on the remote possibility of safe vaginal delivery after three CS in low-income countries. The records of two women who had vaginal deliveries after three previous CS were retrieved and reviewed. Both women presented in advanced labour and had unplanned but successful vaginal deliveries. There was no uterine rupture. The risks and consequences of uterine rupture may outweigh the benefits of unplanned vaginal birth after more than one CS. These unusual cases suggest the remote possibility of success and the need for further studies on defining safety guidelines for low-resource settings.

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Background: Contraceptives are methods or devices used to prevent pregnancy. In Nigeria, the contraceptive prevalence was reported at 15% in 2013. Aims: This study aimed to determine the pattern of contraceptive use and sociodemographic characteristics of the users of family planning services in a teaching hospital in Lagos. Subjects and Methods: This was a descriptive, retrospective study of women who sought contraceptive services at the family planning clinic over a 3-year period. Relevant information was extracted from the case records of these women. Data were analyzed using Epi Info statistical package for Windows. Results: A total of 594 women opted to use a form of contraception in the study, within an age range of 15–52 years and with mean age of 34.3 ± 4.2 years. Fifty-four percent (54%) of the women users belonged to the Yoruba tribe and 89.4% were of the Christian faith. Married women accounted for 97.6% of the users, with the majority (68.9%) having parity of 2–4. Majority (77.6%) of the women had at least a tertiary level of education, with 46.1% of them involved in a form of skilled occupation. Nurses were the commonest source of referrals (42.9%). A larger proportion of the women (46.3%) preferred Jadelle implant while the least used method is Norplant (0.5%). Conclusion: Equipping medical personnel with the information and skills needed to meet the increasing demand for family planning services is necessary to avert the needless increase in the incidence of unwanted pregnancies, unsafe abortion, and their sequelae.

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Background: Semen analysis has remained an objective, inexpensive and readily available means of assessing male factor infertility. There is a paucity of studies on male factor infertility in Nigeria using the current World Health Organization 2010 human values for semen characteristics. Aim: This study was aimed at determining the socio-demographic and semen characteristics of the male partners of infertile couples in Abakaliki. Materials and Methods: The case files of infertility cases managed at Federal Teaching Hospital from January 2011 to December 2015 were retrieved. Results: Out of 730 semen analysis results analysed, 297 (40.7%) have abnormal parameters ranging from abnormal motility (36.7%), to the combination of low sperm count, abnormal motility and morphology (0.68%). While older age and urban dwelling had significant effect on abnormal sperm motility, rural dwelling and low/or no educational status had a significant effect on low seminal fluid volume and sperm count (P-value ≤ 0.05). Conclusion: There is still a high rate of male factor infertility in this environment.

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Background: Genital Chlamydia trachomatis infection is recognized as the single most common cause of tubal peritoneal damage leading to infertility. Knowledge of the prevalence of Chlamydia antibodies among infertile women will help determine the level of Chlamydial infection and hence its contribution to infertility. Objectives: To determine the prevalence of C. trachomatis immunoglobulin G (IgG) antibody in infertile patients and the sociodemographic characteristics and risk factors associated with infection in Calabar. Materials and Methods: This was a prospective comparative study conducted among 145 women presenting for infertility in UCTH Calabar. Another 145 women with normal pregnancies attending the antenatal clinic were used as controls. The data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 18.0 (SPSS Inc, Chicago, IL, USA). A P-value of less than 0.05 was considered significant. Results: The prevalence of C. trachomatis IgG antibody was 38.6% in the infertile group and 22.8% in the pregnant controls. This difference was statistically significant (P < 0.05). Infertile women aged 30–34 years had the highest positivity rate (36.0%) for C. trachomatis antibody. Thirty-eight (42.7%) of the infertile subjects who tested positive had a history of pelvic inflammatory disease (PID) while 47 (23.4%) who tested negative had a history of PID. The difference was statistically significant (P = 0.001). Chlamydia infection was not found to be associated with any particular type of infertility (P > 0.05). Conclusion: The prevalence of C. trachomatis was higher in infertile women when compared to pregnant controls. This finding lends credence to the call for enzyme immunosorbent assay for Chlamydial IgG antibodies to be incorporated into infertility investigation in this environment.

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Background: Sickle cell disease (SCD) is a chronic disease associated with increased morbidity and mortality. Hemoglobinopathies are the most prevalent genetic disease globally, and SCD is estimated to affect 2–3% of Nigerians. The disease may adversely impact on the quality of life of sickle cell patients. This study aims to evaluate the health-related quality of life (HRQoL) of SCD subjects compared to normal controls living in Benin City, Nigeria. Methodology: The HRQoL of SCD subjects was evaluated using the Medical Outcome Study 36-item survey tool. The outcome was compared with those of a normal non-SCD population. Data were analyzed with Statistical Package for Social Sciences version 16 (Chicago, SPSS Inc.). P value was set at 0.05.Results: Sixty-one SCD subjects and 61 normal respondents (controls) participated in the study. The mean ages of the SCD group and controls were 26.7 ± 9.0 years and 23.70 ± 3.1 years, respectively. Fifty-nine (96.7%) of the SCD respondents were hemoglobin (Hb) SS and 2 (3.3%) were Hb SC. The physical function, limitations due to physical health, general health, and pain scores were significantly lower in the SCD population compared to the controls (P = 0.000, 0.000, 0.000, and 0.002, respectively. The social function and limitation due to the emotional problem do not differ significantly between both groups while the vitality (energy/fatigue) score and emotional well-being were higher in the SCD group, but they were not statistically significant (P = 0.066 and 0.127, respectively). Male gender, employment, clinic attendance, and family support impacted positively on the HRQoL of SCD subjects. Conclusion: The physical and general health functions of SCD subjects are significantly impaired by the disease. There is a need for clinicians in our region to review current management trends to include world best practices such as the universal use of hydroxyurea and stem cell transplantation to change the prevailing trend.

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Acute panmyelosis with myelofibrosis (APMF) is a rare, fatal hematological neoplasm that is characterized by acute onset of cytopenias and fibrosis in the bone marrow in the absence of splenomegaly or fibrosis-related morphological changes in the red blood cells. We report the case of an 80-year-old male who presented with progressive pallor and weakness of 1-month duration. Peripheral smear revealed severe anemia, leukopenia with occasional circulating blasts and a normal platelet count. The marrow was heavily fibrotic, and no aspirate material could be obtained; the biopsy showed extensive infiltration with small to medium size megakaryocytes, dysplastic changes in the erythroid compartment, and focal clusters of blasts. A diagnosis of APMF was made and the patient was started on low dose lenalidomide and supportive transfusions. However, the patient died due to intracranial bleeding. Cases of APMF have a dismal outcome and should be managed aggressively.

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Marfan syndrome (MS) is a disorder of the connective tissues characterized by various phenotypical and genetic manifestations. We present this case to show its rarity and to highlight the need of early diagnosis to avert the numerous complications that follow it. A 7-year-old male, who presented with an abnormal body physique that was noticed at age 2 months, poor vision that was noticed 5 years ago, recurrent chest pain that started 3 years ago, and recurrent easy tiredness that started 3 years ago. He developed poor vision 2 years later. Examination revealed an acutely ill-looking child with dyspnea, grade 4 apical positive surgical margins (PSM), grade 2 diastolic murmur (at the aortic area), multiple skeletal abnormalities with lens subluxation and iridodonesis. Diagnosis of MS was made and he was comanaged with ophthalmologists and orthopedic surgeons.

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Background: Pleomorphic adenoma (PA) of the major salivary glands has been documented to occur in various sizes ranging from 1 cm to 10 cm in their widest diameter; however, they can assume a grotesque proportion as a consequence of uninhibited growth in cases with delayed presentation. Patients and Methods: A retrospective study of all patients with PA of the major salivary glands with sizes >10 cm in its widest dimension and seen over a 10-year period was undertaken by retrieving sociodemographic and clinical data from patients’ case files from the Oral and Maxillofacial Unit of a Nigerian Teaching Hospital. Results: Case files of ten patients (4 males and 6 females) were reviewed over the study period. The ages ranged from 14 to 61 years, mean 33.8 ± 17.97 years. Equal distribution of five cases of PA was noted in the parotid and submandibular glands, respectively. The onset of symptoms ranged from 3 to 20 years and the largest tumor was 27 cm in its largest diameter. Only one case of malignant PA was recorded. Conclusion: Prevalence of giant PA from the study was found to be 13.5%, with a greater occurrence in the female (60%) patients compared to the male (40%) patients and with an equal distribution in both parotid and submandibular glands. PA of major salivary glands can assume a grotesque proportion when timely surgical intervention is not sought. Complete surgical excision in benign lesions can guarantee a cure and restore self-esteem.

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Guillain–Barre syndrome (GBS) complicating pregnancy is a rare event, with documented incidence of 1–3 per 100,000 people annually. Maternal and perinatal mortality rate of >10% is associated with GBS. We present a 28-year-old gravida four para three housewife who developed progressive ascending paralysis during the second trimester of pregnancy. A detailed history and physical examination led to the clinical diagnosis of GBS; she had a preceding gastrointestinal infective episode. She did not consent to lumbar puncture for cerebrospinal fluid analysis, but all investigation results were normal. She was managed supportively as an in-patient with physiotherapy in conjunction with the physiotherapists. Her symptoms improved and she was discharged after 12 days. The rest of the pregnancy progressed uneventfully, and she had a spontaneous vertex delivery of a live female baby that weighed 2.55 kg with good Apgar scores, after 8 h of uncomplicated labour at term. She did not have any postpartum complications, and the neonate was healthy and normal.

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A 45-year-old trader presented to us with 4 weeks history of difficulty in opening his mouth, inability to walk and tonic–clonic seizures with bilateral femoral neck fractures. Three weeks before the onset of problems, the patient had been knocked down by a tricycle and had sustained an open wound over the right medial malleolus; the wound was sutured at a general hospital and the patient discharged home. One week later, the wound started discharging a foul-smelling pus and was dressed at a primary health centre; however, by the second week, the patient started having difficulty in opening his mouth. By the third week, he was bed ridden, developed tonic–clonic seizures and felt a crunching sound associated with severe pain in both hips. He was taken to a traditional bone setter who gave him some herbs, but his symptoms got worse. He was then brought to the Accident and Emergency Department of the University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria where a diagnosis of tetanus was made. Further evaluation revealed Gardener-type IV bilateral femoral neck fractures. He was managed for the tetanus, underwent bilateral bipolar hemiarthroplasty and was discharged home. He spent 10 weeks in the hospital.

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