Urethral prolapse is the abnormal protrusion of the urethral mucosa through the external urethral meatus. It is a rarely diagnosed condition as most cases will be misdiagnosed as sexual abuse. If diagnosed, however, medical treatment with follow-up will usually suffice. If this fails, or in the presence of complications, surgical management may be employed. The most common presenting feature is urogenital bleeding. Genital bleeding in a pre-pubertal child is alarming to parents. Their first impression is that of a sexual abuse resulting in the suspicion of all adult males in the surrounding environment. The condition is worsened by a scenario in which the child is either too little to give an account or where she points accusing fingers to some adults. We report a case of bleeding from the vulva from urethral prolapse masquerading as suspected sexual abuse from an unknown adult.

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Background: Tympanic membrane (TM) perforation is a recognised cause of hearing loss in our environment. The integrity of the TM can be compromised by varying aetiological factors which are often preventable. TM perforation occurs in different dimensions which tend to influence the degree of hearing loss. Aim: The aim of this study is to determine the aetiological factors and dimensions of TM perforation among adolescents and adults in Benin City. Methods: This was a 1-year prospective study carried out from 1^st July 2014 to 30^th June 2015 at the Ear, Nose and Throat Clinic of University of Benin Teaching Hospital. Consecutive patients with TM perforation were examined using a hand-held otoscope as well as Firefly video otoscope and subsequently had an interviewer administered questionnaire. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20 and ImageJ software. Results: One hundred and forty-eight patients with TM perforation in either or both ears were studied. There were 67 (45.3%) males and 81 (54.7%) females; ratio of 1:1.2. Ages ranged from 10 to 64 years, with a mean age of 34.5 ± 15.7 years. Chronic suppurative otitis media (CSOM) was the major cause of TM perforation in this study, 148 (74.0%). The small perforation was predominant, 54 (55.1%) and 48 (47%) in the right and left ears, respectively while the central anterior perforation, 93 (46.5%) occurred commonly. Conclusion: Central and small perforations were the predominant TM perforation while CSOM was the major cause of TM perforation.

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Background: The high morbidity and mortality associated with malaria especially in sub-Saharan Africa such as Nigeria calls for prompt preventive and curative measures including adherence to standard treatment guideline. Aim: To assess the level of adherence with the five defined WHO prescribing key indicators. Methods: This was a retrospective evaluation of the performance of antimalarial drugs prescribing practice among clinicians from January to December 2014. It was done through a set of drug prescribing indicators developed by WHO and the International Network of Rational Use of Drugs (INRUD). Results: Of the 385 patients prescription randomly generated from the record of 12,477 patients in this descriptive study, a total of 143 (37.1%) had antimalarial prescription(s) with no gender variation. The evaluation of the studied antimalarial drug prescriptions through defined WHO prescribing indicators revealed an average number of drugs per encounter of 3.9, with 37.4% of the prescriptions written in generic names. All the antimalarial drugs were prescribed from the National Drug Formulary, with injectable form constituting 4.7%. Conclusion: This study shows suboptimal compliance with WHO prescribing indicators with respect to average number of antimalarial per encounter and prescription in generic names. The proportion of antimalarials prescription in injectable form falls within the WHO acceptable limit of ≤10%. All antimalarial drug prescriptions in this study were from essential drug list. We, therefore, recommend rational antimalarial drug prescription in conformity with WHO/INRUD core drug prescribing indicators.

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Introduction: The perceived high cost of eye care services has been implicated as one of the reasons for the use of traditional eye medications (TEMs) in the country. Other factors including distance, tradition, ignorance, and failure of medical treatment among others have also been documented as determinants of TEM use. TEMs constitute a wide range of unorthodox therapies utilized for treatment of ocular disorders. They have been reported to have no beneficial effect rather causing more harm than good. Aim: This study sought to determine the prevalence, types, and ocular indications for TEM use in the study population. Methods: This was a cross-sectional study in which a structured questionnaire was used to collect relevant data from consecutive patients attending the eye clinic during the study. Results: At a prevalence of 15.8%, the highest use of TEM was noted among artisans, those in the seventh decade of life, with low level of education, ocular complaints of poor vision, and illness of <1 year duration. Its use though high, was not significantly associated with age, sex, education, occupation and illness duration. Roots and herbs were the most common types of TEM used. Conclusion: There was a high prevalence of use of TEM in this study. The deleterious effect of its use is known and has been reported in literature. Education and enlightenment of the public are needed and highly recommended.

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Background: Patients with chronic kidney disease (CKD) have a high prevalence of cardiovascular risk factors. Cardiovascular disease is the leading cause of death in patients with CKD. Aim: The aim of this study is to determine the prevalence of the various cardiovascular risk factors in CKD patients and compare with that of healthy controls. Methods: A case-controlled study. The study sample included 94 diagnosed CKD patients above the age of 18 years without symptoms of cardiac disease and 70 controls. Fasting plasma glucose, lipid profile, creatinine, albumin, glomerular filtration rate and urinary albumin-creatinine ratio were estimated in participants. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: The cardiovascular risk factors found in CKD patients versus controls were hypertension (62.7% vs. 11.4%), diabetes (13.8% vs. 7.1%), dyslipidaemia (50.0% vs. 31.4%), obesity (14.9% vs. 20.0%), hypoalbuminaemia (19.1% vs. 0%), microalbuminuria (55.3% vs. 20.0%) and macroalbuminuria (21.3% vs. 0%). However, only the prevalences of hypertension (P < 0.001), hypertriglyceridaemia (P = 0.007), low high-density lipoprotein (HDL) (P = 0.050), hypoalbuminaemia (P = 0.007), microalbuminuria (P < 0.001) and macroalbuminuria (P < 0.001) were statistically significant. Patients on maintenance haemodialysis had higher prevalence of hypertension (P = 0.018) and hypoalbuminaemia (P = 0.001) than pre-dialysis patients. Conclusion: Prevalences of hypertension, hypertriglyceridaemia, low HDL, hypoalbuminaemia, microalbuminuria and macroalbuminuria were significantly higher in CKD patients than in controls.

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Background: Chronic periodontal disease is important in the aetiology of various life-threatening systemic diseases. Its surveillance using self-report questionnaire has become necessary due to the disadvantages associated with its surveillance using clinical examination methods. Aim: The aim is to determine the validity of periodontal disease surveillance self-report questionnaire in a Nigerian population. Methods: A representative sample of 250 consecutive adults, attending the dental clinic, University College Hospital, Ibadan, were interviewed and clinically examined using a periodontal disease self-report questionnaire, and community periodontal index of treatment need (CPITN), index as a gold standard. Tooth mobility and gingival recession were also assessed. The data were analysed using SPSS version 15 and OpenEpi module for performance evaluation of a diagnostic test. Validity was determined using receiver operating characteristic curve, the sum of sensitivity and specificity as well as the sum of positive and negative predictive values. Results: The mean age of the study participants was 40.9 ± 16.3 years where the males accounted for 48.9%. It demonstrated low sensitivity, high specificity and low diagnostic accuracy with receiver operating characteristic curve of 0.6. The sum of sensitivity and specificity as well as the sum of positive and negative predictive values were below 120. Only 21.7% reported they had the periodontal disease as compared to 87% diagnosed cases using the clinically based examination method (CPITN index). Conclusion: The periodontal disease self-report questionnaire demonstrated low validity in the study group as many people who had periodontal disease were missed. Development of a questionnaire tool adapted specifically for this environment is hereby recommended.

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Background: The gingival crevicular fluid (GCF) may be a valuable adjunct in the initial diagnosis and assessment of the severity of periodontal disease in patients with hypertension and diabetes. The GCF volume may be used to monitor and plan appropriate dental treatment and prevent progression of disease in adult patients with malocclusion who have hypertension or diabetes. Aim: The aim of this study is to determine the volume and correlation between blood pressure, blood sugar and GCF volume in adult females with malocclusion in Benin City, Nigeria. Methods: A total of 152 fasting women aged 26–65 years were divided into two groups as follows: Group 1: Malocclusion; n = 82 (54%) (crowding - 41, spacing – 39 and anterior open bite - 2) and Group 2: Normal occlusion; n = 70 (46%). Blood pressure and blood sugar values were obtained and the GCF volume measured. Correlations between age, gender, probing depth, malocclusion, blood pressure, blood sugar and GCF volume were determined using the Statistical Package for Social Sciences (version 16) software. Significant values of P < 0.05 were applied. Results: The highest GCF volume in the total sample studied was 2.17 μL in 1.3% and the most prevalent was seen in 0.62 μL in 42.8%. GCF volumes of 0.93 μL were most prevalent in crowding in 14.6% and in 0.62 μL in spacing in 9.9%. Furthermore, a GCF volume of 0.62 μL was highest in blood pressure of 121/89 mmHg in 9.9% and blood sugar levels of 80–120 mg/dl in 25% of subjects, respectively. Malocclusion (crowding, spacing and anterior open bite) exhibited a higher number 45.1% in GCF volume of 0.62 μL. There was, however, no significant relationship between blood pressure, blood sugar and GCF volume (P > 0.05) in both the malocclusion and control groups. There was also a statistically significant difference between GCF volume and pocket depth (P < 0.01). Conclusion: This study revealed that blood pressure and blood sugar levels in adult females with malocclusion do not affect GCF volume. A positive correlation, however, exists between GCF volume, pocket depth and oral hygiene in Benin City.

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Background: Cervical cancer is the second most common cancer in women worldwide. Human immunodeficiency virus (HIV) has been suggested to be a cofactor in the association between human papillomavirus and cervical intraepithelial neoplasia (CIN). Aim: To determine the pattern of cervical cytology changes in women of different HIV status and characterise the sociodemographic factors that confound the changes seen. Methods: This was a cross-sectional comparative study. This study was conducted in Gynaecology Clinic of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Following informed consent, 272 HIV-positive (HIV+) and 275 HIV-negative (HIV−) women had questionnaires administered and Papanicolaou smears were taken. Results: The average age of the respondents was 32.6 ± 6.8 years (range: 15–49 years). Mean parity for HIV+ women was 3.28 and 3.36 for HIV− women while 70.8% of HIV+ women were married comparable with 72.7% in HIV− women. Twenty-nine per cent of HIV+ women had positive smears for CIN compared with 16.4% in those that were HIV−. This was statistically significant (odds ratio = 2.05, P = 0.001). The high-grade lesions (CIN II and CIN III) tended to be higher in the HIV+ women (11.4%) than the HIV− women (0.7%). Conclusion: HIV+ women in Zaria, Northern Nigeria, are at higher risk of severe cervical dysplasia compared with their counterparts who are HIV−. It is recommended that greater effort should be made to have an integrated reproductive healthcare service which includes cervical cytology within the HIV clinics.

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Background: Neurofibromatosis (NF) is a neurocutaneous disorder which involves many organs in the body. There are two types: NF-1 and NF-2. Orbital manifestation is a rarity in NF-1, and it involves dysplasia of the sphenoid bone resulting in herniation of the temporal lobe and subarachnoid space into the orbit culminating in pulsating exophthalmos. Aim: To highlight the clinical presentation and radiological investigation of this rare ocular manifestation of NF-1. Methods: A case report. Results: The case of a 20-year-old male student presenting with a pulsating right eye swelling of about 17-year duration is presented. There was a family history of a first-degree relative with multiple skin swellings. Plain skull radiograph and cranial computed tomography (CT) scan were done and both revealed absence of the right sphenoid bone with herniation of the right temporal lobe and cerebrospinal fluid space into the right orbit. The patient was subsequently lost to follow-up. Conclusion: Pulsating exophthalmos is a complication of sphenoid dysplasia, a rare component of NF-1. Plain skull radiograph and cranial CT scan are two important radiological imaging modalities for investigating patients with such presentation.

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Background: Impacted canines are commonly implicated in malocclusion in the anterior region of the jaws. Aim: To present the surgical and orthodontic management of two cases of bilaterally impacted mandibular canines which resulted in lower anterior segment crowding. Methods: Case report and review of the literature. Results: Two cases of bilateral mandibular canine impaction are presented in this report. The positions of the crown of the canine in both the patients were between the cervical margin and the apices of the roots of the adjacent teeth. There was also transmigration of both bilaterally impacted canines in one patient. The impacted canines were removed surgically to complement orthodontic treatment. Conclusion: The cases reported emphasize the option of surgical extraction as a treatment modality when dealing with impacted mandibular canines. Evaluation of both cases 3 years post-treatment revealed an improved, stable, functional and aesthetic outcome.

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Background: Glandular odontogenic cyst is a rare locally aggressive developmental odontogenic cyst that recurs with conservative management. It has been observed to commonly occur in the mandible with unilocular radiographic presentation. Aim: To improve knowledge of glandular odontogenic cyst among pathologists and clinicians. Methods: A case report and review of literature. Results: We report the only case of recurrent maxillary glandular odontogenic cyst diagnosed in Lagos University Teaching Hospital over a period of 47 years. The progressively growing cyst occurred in a 33-year-old Nigerian male. The lesion recurred 10 months after initial surgical excision. A second surgical excision was performed, and the patient is being closely followed up. Conclusion: Glandular odontogenic cyst is a rare developmental odontogenic cyst that has been reported to have a high recurrent rate. Detailed histopathologic assessment is required to arrive at a definitive diagnosis due to its similarities to other lesions. Segmental or marginal resection with long-term follow-up is advised to prevent recurrence.

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