Background: Good ventilation is one of the structural designs used to reduce the risk of transmission of airborne infections in hospitals. This is, however, rarely observed in Nigeria as hospital designs used to shut out the inclement weather in temperate countries are copied without much modification. This study assessed the physico-chemical air quality at different areas of the University of Port Harcourt Teaching Hospital, Port Harcourt, to ascertain the level of pollutants in the ambient air. Methods: The study was carried out in July, 2015, in randomly selected inpatient wards, outpatient clinics and clinical laboratories of the hospital, using the appropriate measuring equipment. The study tested for the presence of particulate matter 2.5 (PM_2.5), volatile organic compounds (VOCs) and nitrogen dioxide (NO₂) in the ambient air; as well as the prevailing micrometeorological indices of relative humidity, temperature, wind direction and speed of the study sites. Results: A total of 36 air quality measurements were carried out in nine study sites in the hospital. The assessed pollutants were present in the ambient air of most of the study sites but were within the regulatory limits. The concentration of NO₂in the study sites ranged from 133 μg/m^[3] in the immunisation clinic to 151 μg/m³ in the gynaecology ward, with a mean concentration of 141 μg/m³; while PM_2.5was not detected in the gynaecology and urology wards and present in very low levels in the other study sites. There was, however, greater variability in the levels of VOCs, ranging from 236.57 mg/m³ in the HIV clinic to 530.77 mg/m³ in the male surgical ward. Conclusion: The levels of the assessed pollutants were within regulatory levels, even as there were evidence of poor ventilation in several of the study sites.

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Background: The prevalence of genitourinary malignancies has been found to be increasing in most centres in Nigeria and worldwide. Petroleum and gas explorations have been associated with some genitourinary cancers. Port Harcourt is a major city in the oil and gas exploration zone in Nigeria. Aim: This study aimed to determine the prevalence and pattern of genitourinary malignancies at the University of Port Harcourt Teaching Hospital, Port Harcourt. Methods: A 7-year retrospective study spanning between January 2005 and December 2011 was carried out to document the frequency and pattern of genitourinary malignancies in patients above 16 years of age in the University of Port Harcourt Teaching Hospital. Data were retrieved from patients' case notes, histopathology reports and theatre registers. Information retrieved included gender, age, organ involved and the histologic type. Analysis was done using Statistical Package for Social Sciences version 20.0. Results: A total of 477 cases were isolated. Adenocarcinoma of the prostate was the most common genitourinary malignancy in the region (86.8%), followed by bladder cancer (6.5%) and then malignant renal tumours. The median age for prostate cancer was 67.8 ± 10.3 years, bladder cancer was 58.0 ± 15.6 years and malignant renal tumour was 41.0 ± 19.9 years. Malignant renal tumour had an early peak in the 21–30 years' age range. Transitional cell carcinoma accounted for 83% of bladder cancer. Papillary cell type was the most common renal cell carcinoma seen. Conclusion: There are observed differences in the age of presentation of prostate and renal cancers in this region. The histologic pattern of renal cancer is also different from the pattern observed elsewhere.

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Background: Highly active antiretroviral therapy (HAART) improves immunity and reduces the occurrence of enteroparasitic infections. Aim: This study aimed to determine the prevalence and risk factors of intestinal parasitic infection among human immunodeficiency virus (HIV) patients on HAART in Kogi State, Nigeria. Methods: Blood and stool specimens were collected from 511 subjects including 411 HIV patients on HAART and 100 apparently healthy non-HIV individuals. The blood specimens were used to determine CD4 count and haemoglobin concentration, whereas the stool specimens were processed to detect intestinal parasites using standard techniques. Socio-demographic data were obtained with the aid of a questionnaire. Results: Entamoeba histolytica was the predominant parasites recovered generally and in both genders as well as being the only parasite that was associated with immunodeficiency as measured by CD4 count <200 cell/μL (P = 0.0059) HIV status was a significant risk factor for acquiring intestinal parasitic infection (odds ratio = 8.213 95% confidence interval = 1.971, 34.225; P = 0.0012). Among the other risk factors, CD4 count <200 cell/μL (P < 0.0001) and farming (P = 0.0202) were associated with intestinal parasitic infections among HIV patients on HAART. Conclusion: An overall prevalence of 14.4% of intestinal parasitic infections was observed among HIV patients on HAART in this study. Routine diagnosis of intestinal parasites among HIV patients on HAART is advocated.

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Background: Breast cancer is the most common cancer in women both in the developed and less developed world. Regular self, clinical and mammographic examination of the breast according to internationally acceptable guidelines can result in early detection of cancer in asymptomatic women thereby reducing morbidity and mortality related to the disease. Aim: The aim of this study is to assess the knowledge, practice and attitude of breast examinations and breast cancer amongst medical doctors in Bayelsa State to achieve the desired reduction in mortality. Methods: This is a descriptive cross-sectional study of Doctors in Federal Medical Centre, Yenagoa and Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State carried out between September 1, and October 1, 2015. A structured self-administered questionnaire was designed and used to collect information from 216 medical doctors. The data were processed using SPSS Windows version 20. Summary statistics, sample frequencies and crossed tabulations were then computed. Results: Of the 176 respondents, none had a low level of knowledge; 58 (33.0%) showed moderate level of knowledge, whereas 118 (67.0%) showed a high level of knowledge. Only 55.7% of doctors had performed breast self-examination (BSE), 16.5% clinical breast examination (CBE) and 4% mammography. However, when it was coned-down to only female doctors, it was found that whereas 54 (85.7%) of our female respondents practiced BSE, only 15 (23.8%) had CBE, and only 2 (3.2%) had done screening mammography. Majority (92.6%) believed that breast cancer can be cured if detected early, with 100% opted to seeing a doctor. Conclusion: Convincing majority of medical doctors in our study had excellent knowledge about BSE, CBE and mammography as screening modalities, respectively, for breast cancer. Attitude towards breast cancer treatment was also positive. However, their practice levels were quite poor.

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Background: Comorbidities associated with HIV infection may have profound impact on the future clinical outcomes of infected patients. This study was carried out to assess the prevalence and types of comorbidities in newly diagnosed, highly active anti-retroviral therapy (HAART)-naïve adult HIV patients. Methods: A retrospective study of 501 consecutive newly diagnosed, HAART-naïve HIV-infected patients was carried out between April 2014 and September 2015 at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Demographic characteristics, clinical data and comorbid disease condition at initial presentation were retrieved from the hospital records of study patients. Summary statistics was used to present discrete variables. Medians were calculated for continuous variables (age and CD₄counts). Kruskal–Wallis test was used to compare the medians across the different groups, and the Dunn's post's test was used to compare medians between two groups. Results: One hundred and sixty-one (32.1%) of 501 study patients were identified with comorbid conditions, of which 6 patients had more than one comorbid condition, indicating polypathology. The prevalence of comorbid conditions observed include renal disease (14.4%), hypertension (6.2%), tuberculosis (3.4%), oral thrush (2.4%), malaria (1.6%), urinary tract infection (2.2%), hepatitis-B (1%), diabetes mellitus (0.6%), while oesophageal candidiasis, herpes zoster, hepatitis-C and toxoplasmosis were 0.2% each. Comorbidities of infective origin were found predominantly in patients with WHO clinical class 3 and 4, corresponding with declining CD₄cell counts. Renal disease was present in all four clinical stages of HIV. Conclusion: Renal disease was the most prevalent comorbidity. Comorbidities of infective origin were found almost exclusively in patients with WHO clinical class 3 and 4. Findings highlight the need for detailed evaluation at initial presentation, prior to treatment initiation.

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Background: Blood transfusion is clinically used to treat severe anaemia, but some people refuse it for its adverse effects and religious reasons. Aim: To present two Jehovah's Witness pregnant human immunodeficiency virus (HIV) positive women who were managed successfully without blood at the University of Port Harcourt Teaching Hospital. Methods: Case series - The first case, a 27-year-old Jehovah's Witness woman was found to be retropositive with severe anaemia. She had a packed cell volume (PCV) of 14% in her second trimester in pregnancy. She was treated with oral haematinics, and the PCV rose to 34% before an elective caesarean section. The second case was a 29-year-old Jehovah's Witness woman who was admitted for chronic cough and fever in her second trimester. On further investigation, she was found to have pulmonary tuberculosis, septicaemia and severe anaemia with a PCV of 17%. She declined blood transfusion and was managed with parenteral iron and erythropoietin. Both cases had safe deliveries with good fetomaternal outcome. Conclusion: Pregnant patients who decline blood transfusion can be adequately managed if they register in the first trimester or the early second trimester and such cases need good team management and cooperation between the patient and the teams for a good outcome.

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Background: Acute coronary syndrome (ACS) is a medical emergency and its management must be optimal in all patients. The existing guidelines such as the American College of Cardiology/American Heart Association and the European Society of Cardiology do not capture the peculiar challenges such as the nature of patients, non-availability of required facilities and clinical skills in the management of the spectrum of ACS in many hospitals in low-resource countries. Aim: The aim of this study is to report the challenges in the presentation and management of ACS in a developing country. Case Report: A 75-year-old male, diabetic and hypertensive of 5-year duration with poor drug adherence, presented with a 5-day history of epigastric pain radiating to the back and was managed for gastritis by a close relative who is a retired paramedic. He subsequently developed dyspnoea with profuse diaphoresis a day to presentation to the tertiary hospital. Examination on presentation revealed an elderly male in respiratory distress, pale with cold extremities, pulse 152 bpm and thready and blood pressure was unrecordable. Electrocardiogram (ECG) showed extensive anterior wall myocardial infarction (MI) complicated by ventricular tachycardia (VT). The cardiac troponin I was 27.2 ng/l and troponin T was 54 ng/l. Random blood glucose was 24 mmol/l. A diagnosis of ST elevation MI with VT in cardiogenic shock was made. The patient had oxygen, aspirin, clopidogrel, insulin and serial ECG monitoring but no facilities for cardioversion and the patient died on the same day. Conclusion: Management of ACS in developing countries has peculiar challenges such as atypical presentations, delayed presentation, paucity of facilities and delay in diagnosis and treatment. The hospitals should make ECG mandatory for adults presenting in the emergency rooms and improve on the existing facilities.

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Background: Gastrointestinal stromal tumour are rare gastrointestinal tumour that probably originate from the interstitial cells of Cajal and 95% express a specific molecular marker. They occur most commonly in the stomach (60%) followed by the small intestine (30%) and may present with gastrointestinal bleeding. Case Report: A 40year old man presented with passage of frank blood per rectum with associated haemodynamic instability necessitating several units of blood transfusion. Following adequate resuscitation, lower and upper GI endoscopy done were negative and subsequently had emergency laparotomy for continued gastrointestinal bleeding. We found a bleeding ileal tumour which was resected. Histopathology confirmed gastrointestinal stromal tumour. Conclusion: small bowel stromal tumour rarely and unusually presents with massive lower GI bleeding. Diagnosis may be delayed due to inaccessibility of the small bowel to routine upper and lower GI endoscopy. Mesenteric angiography, radionuclide RBC, capsule endoscopy, push enteroscopy depending on the fitness of the patient, may aid diagnosis. Prompt surgical resection and adjuvant imatinib therapy for malignant variants is the treatment of choice.

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Background: The buccal groove of the lower first molar (LM1) is the reference point in the clinical classification of malocclusion based on Edward Angle's criteria, a classification of great value in orthodontic practice. The groove has been popularly named as the mid-buccal, anterior buccal, or simply as the buccal groove. This variation in nomenclature suggests that the location of the buccal groove differs in different populations. Aim: This study aimed to ascertain the exact location of the buccal groove on mandibular first molars as well as its morphological variations and possible clinical implications in this environment. Methods: The study casts were retrieved from the orthodontic units of University College Hospital, Ibadan, and Military Hospital, Lagos. Sociodemographic variables, the mesiodistal width of the LM1, number of buccal grooves, and location of the buccal groove along the mesiodistal width of the LM1 were ascertained. Data were analysed using the SPSS software version 22. Paired t-test was used to assess the relationships between quantitative variables while the Chi-square test assessed qualitative variables and the level of significance was set at P< 0.05. Results: The mean age of the patients was 15.50 ± 7.09 years. The mean mesiodistal widths of the lower right and left molars were 11.27 ± 0.78 mm and 11.41 ± 0.86 mm, respectively. Paired t-test showed that the left buccal groves were more anteriorly located than the right buccal grooves (P < 0.001). The buccal grooves were more anteriorly placed irrespective of the number of grooves present on the LM1, both left and right (P < 0.001). Conclusion: The most appropriate nomenclature for the buccal groove of the LM1 is the anterior buccal groove. Caution must be exercised in classifying individuals with uncommon buccal groove location in clinical orthodontic practice.

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Background: The spectrum of ocular morbidities seen at a screening programme may be a reflection of diseases in that community. This knowledge would assist in appropriate public eye health planning for that community. Aim: To determine the present spectrum of eye diseases at the Centre for Disease Control (CDC) at the University of Benin Teaching Hospital, Benin City, and to determine if there is any change in the pattern of ocular morbidity seen at the CDC over the past 3 years. Methods: This was a prevalent study conducted at the CDC of the University of Benin Teaching Hospital, Benin City. The records of participants seen at the CDC from August 2010 to October 2014 were retrieved. Data on sociodemographic characteristics and ocular findings were collected and analysed using IBM Statistical Package for Social Sciences version 20. Descriptive analyses were used, and Chi-square test was used to test the association amongst variables. Results: Of the 4653 participants, the analysed sample comprised 4622 (99.3%) participants with complete data. They comprised 1030 males and 3569 females with a mean age of 49 ± 13 standard deviation years (range 9–95 years). Most of the participants (59.9%) were between 40 and 60 years of age. The most common ocular morbidities were refractive error (44.8%), glaucoma (19.4%), cataract (8.1%) and allergic conjunctivitis (4.5%). Conclusions: There has been no change in the pattern of eye disorders over the past 3 years at the CDC of the University of Benin Teaching Hospital. Refractive error, glaucoma, cataract and allergic conjunctivitis were the leading aetiologies of ocular morbidity amongst screening participants seen at the CDC. There is a need to raise awareness of these eye diseases, increase ocular screening uptake and provide eye care resources to control these prevalent eye disorders.

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