Diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar state are the two most serious acute metabolic complications of diabetes even if managed properly. These disorders can occur in both types 1and 2 diabetes, and remain an important cause of morbidity and mortality in diabetic populations especially, in the developing countries. Intravenous insulin and fluid replacement are the mainstays of therapy, with careful monitoring of potassium levels. Bicarbonate therapy is rarely needed. Infection, omission of insulin, and other precipitating factors should be treated. This review is intended to discuss some of the advances in the management of hyperglycaemic emergencies and also to highlight some of the peculiarities of the management of hyperglycaemic emergency in our setting if we are going to be able to improve outcome significantly.

Background : Patients who recognize their increased risk of stroke are more likely to engage in stroke prevention practices than those who do not. Method : All patients attending medical out-patient clinic of the Federal Medical Center, Ido, Ekiti-State, Nigeria between January 2004-December 2004 were recruited into the screening process following their verbal consent. A set of questionnaire was administered to collect data. Results : A total of 155 patients were studied having satisfied the inclusion criteria. The mean age of the patients was 58.4±18.7 years. Majority of the patients indicated paralysis of one side of the body as the most common symptom of stroke. Patients with higher education p=0.002 and men p=0.004 were more aware of their increased risk factor for stroke than those with low education and women. Conclusion : Perception about stroke among the at risk medical out patients as found out in this study indicates that more health education both at the community and the hospital is very vital to reducing the prevalence, recurrence, disability andmortality of stroke. Health providers are enjoined to communicate information about stroke risk to their patients.

Background : Hepatocellular carcinoma (HCC) is a complication of liver cirrhosis caused by hepatitis B viral infection, fungal infection and genetic factors. This disease though having a silent course is associated with variable morbidity and mortality in this environment. Methods : Previously prepared histologic slides were retrieved and re-evaluated to confirm the diagnosis. Clinical data such as the age, sex, clinical presentations, histologic grading and cause of death were extracted from the case notes, histology request forms and autopsy protocol forms. Results : Seventy five cases were used for the study during the period under review. The youngest was a 14 year old male while the oldest was a 66 years old male. Male to female ratio was 2:1. Majority (28%) occurred in the age group 40-49 years. Upper abdominal mass was the most common clinical presentation (30.7%) and well differentiated hepatocellular carcinoma was the most common (64.0%) histologic grade. Trabecular / sinusoidal pattern (49.3%) was the most common histologic type (pattern) while upper gastro-intestinal bleeding (38.7%) was the most common cause of death at autopsy. Conclusion : Hepatocellular carcinoma is a notable malignancy of the liver associated with variable morbidities and mortality as it has an insidious onset and very aggressive course.

Background : In the last decade the number of elderly citizens in Nigeria has increased and their health needs are becoming popularly recognized. A number of factors have also been recognized to determine health care seeking behaviour in these elderly. Methods : The sample consisted of 756 households that had at least one resident who was aged 60 years and above (35% of 2160 households). Multistage and proportionate sampling techniques were employed to select the study subjects. Structured interview were conducted to elicit information on health needs and determinants of health care seeking behaviour of household members aged 60 years and above. Results : The most frequently reported illnesses were body pain (89.5%), joint pain (86.4%), generalized body weakness and fatigue (81.5%), poor sight (78.2%), fever (71.3%) %), irritability, anger, and nervous tension (70 %), %), listlessness, depression, and headaches (60 %),and decreased mobility (65.8%). More than two-thirds (68.8%) of respondents had never visited health facilities in the last one year even for ordinary medical check-up. Family care/Family consultation was the first choice (44. 6%) of treatment for the most frequently reported illnesses irrespective of age group and sex.Less than one-third (28.7%) of the subjects were aware of their health needs. Receiving treatment when sick was the health needs mentioned by the majority (89.4%) of the elderly. Poverty emerged as a major (50.3%) determinant of health care seeking behaviour followed by nature of illness (28.5%). The odds ratio that elderly from poor households will seek health care from unqualified health care practitioners was 0.7 (95% confidence interval (CI) = 0.38-0.67); while the odds ratio that elderly from poor households will seek health care from qualified health care practitionerswas 0.8 (95% CI = 0.57-0.89). Self treatment had odds ratio of 1.7 (95% CI= 0.38-0.67). After controlling the household's poverty status, there was still a significance difference (P<0.05) in age group and gender in terms of health care seeking behaviour. Conclusion : Socio-economic indicators and nature of illness were the most pervasive determinants of health care seeking behaviour among the elderly, overriding age and sex, and in terms of health-care expenditure, the nature of illness and quality of service provided ranked the major determinants.

Background / Objective : Endocrinologic disorders and infertility are common all over the world; the prevalence of infertility is high in sub-Saharan Africa. Several authors have suggested that the increased incidence of infertility in Africa is due to high prevalence of sexually transmitted diseases. To evaluate the contributions of endocrine abnormalities to infertility in the male in Kano, Northern Nigeria. Methods : A total of five hundred males, aged between 28 and 56 years were evaluated over a period of 4 years (2001 - 2004).The hormones were analyzed using electrochemiluminescene immunoassay technique. Results: Hormonal abnormalities were detected in 22% oligospermic, 40.7% severe oligospermic, and 42.7% azoospermic subjects. Conclusion : Endocrine abnormalities are common in the infertile males. The reason for the observed endocrinopathies is not known, appropriate laboratory investigations are essential for effective patients management. Further study to ascertain the cause(s) of hormonal derangements is suggested.

Background / objective : To document the premenstrual and menstrual symptoms of Muslim women, with a view to providing adequate and sensitive care. Methods : Two hundred Muslim women were interviewed at Ahmadu Bello University Teaching Hospital and Muslim Specialist Hospital, both in Zaria between August and October 2003. Results : Premenstrual symptoms were present in 23.8% of the women and breast pain was the commonest symptom (50%). Self-medication was practiced by those who needed medication for the premenstrual symptoms (29.8%). Premenstrual symptoms were significantly associated with lower parity (p = 0.02), previous (p = 0.03) and current (p = 0.01) contraceptive use and dysmenorrhoea (p = <0.001). Dysmenorrhoea was present in 36.4% and was significantly associated with lower age (p = 0.03), and lower parity (p = 0.01). Conclusions : Health care workers and the general public need to be aware of premenstrual symptoms and dysmenorrhoea in order to provide adequate care and support that is sensitive to Muslim women's needs. Health care providers should also be aware that premenstrual symptoms are more likely to coexist with dysmenorrhoea and provide therapies that can cater for both problems whenever possible.

Background : Neurological diseases account for more than 20% of the world's disease burden with majority of affected people living in Africa. However there is a paucity of literature on neurological disease in Africa. Methods : A retrospective review of 114 children with neurological problem seen at a paediatric neurological clinic in a 2-year. Results : Delayed developmental milestone, convulsion and inability to walk were the 3 most common reasons for referral to our Paediatric neurology clinic. Cerebral palsy (55.3%), Seizure disorder (26.3%) and postmeningitic complications (6.2%) were the common neurological disorder seen at our neurology clinic. The Paediatric outpatient department (POPD) of our hospital was the main source of referral for most cases (83.2%) and 71.1% of all patients resides within Zaria metropolis. The default rate from follow-up was higher among children with cerebral palsy compared to children with seizure disorder (58.7% vs. 13.3%, P< 0.001). Conclusion : Lack of adequate facilities for proper rehabilitation of children with cerebral palsy could have been the main reason for the high default rate from follow-up.

Background : Two hundred and fifty volunteer patients attending 5 major hospitals in Nasarawa town, Nasarawa State, Nigeria were involved in this study to determine the prevalence of Aeromonas spp in persons with diarrhoea. The study population consisted of 133 males and 117 females between the ages of 0-70 years. Methods : Stool samples (148 diarrhoeal and 102 non-diarrhoeal) were analysed for the presence of Aeromonas spp. using standard bacteriological methods. The isolates were also subjected to antimicrobial susceptibility testing using the disc diffusion method. Results : Four (1.60%) of the 250 stool samples were positive for Aeromonas spp. Three (2.03%) of the isolates were recovered from diarrhoeal specimens and 1 (0.98%) from non-diarrhoeal (control) samples. The difference was statistically significant (P<0.05). The highest numbers of isolates 3 (3.66%) were recovered from age group 0-10 years while age group 61-70 years yielded 1 (14.29%). All isolates were found to be Aeromonas hydrophilia. The isolates were all sensitive to tetracycline, gentamicin, chloramphenicol, cotrimoxazole and streptomycin but resistant to penicillin and ampicillin. Other enteropathogens isolated were Shigella spp 5 (2.0%) and Salmonella spp 2(0.8%). Conclusion : This study has shown that a small percentage of gastroenteritis can be attributed to Aeromonas hydrophilia.

Background : Dermatofibrosarcoma protuberance (DFSP) is a relatively uncommon soft tissue neoplasm with intermediate to low grade malignancy, rarely metastasizing to regional lymph node or distant site but with proclivity for local recurrence due to inadequate resection. Methods : We evaluated the clinical histories and treatment outcomes of five consecutive patients who had histologic diagnosis of DFSP in the University of Calabar Teaching Hospital between 2000 and 2004. Results :The five cases reported had histologic diagnosis, sought for after excision. The male: female ratio was 2:3 with an age range of 17-35 years (mean, 26.6 years). Two of the lesions involved the neck and the other three sites involved were the anterior chest wall, groin and proximal thigh. Three of the lesions were recurrent. Conclusion : DFSP is an uncommon tumour, painless, cutaneous and multilobulated lesions should arouse the suspicion of this tumour. Early presentation, pre-operative histologic diagnosis and postoperative evaluation of resection margins would enhance the goal of ensuring adequate excision for improved outcome.