Background: The registration of births and deaths in Nigeria, as with most developing countries continues to remain suboptimal with many births and deaths going unregistered. This has negative consequences for economic planning and development. Objective: The study was undertaken to assess the practice of birth and death registration in South-south Nigeria; and to determine the factors that govern this practice. Subjects and Methods: Using a cross-sectional descriptive study design, a questionnaire was administered to 324 household heads (or their spouses) in an urban local government area in the South-south geo-political zone of Nigeria. Structured interviewer-administered questionnaires were used for data collection. Data were entered into a spreadsheet and analyzed using SPSS version 15. Categorical data were presented as frequency distribution tables, Chi-square test and Fisher's exact were used to examine relationship between demographic characteristics and respondents' knowledge and practice of birth and death registration. Results: Awareness of birth registration was high. Awareness of death registration showed differing views as to where and who should statutorily register a death. Sixty-eight percent of those who recorded a birth in the 10 years preceding the study registered it, whereas 61% of those who recorded a death within their household in the preceding 10 years of the study did not register it. Educational level, marital status, and religion were found to be associated with the practice of birth registration, and educational status alone, with death registration. Conclusion: Much work needs to be done to enlighten the public on vital registration, particularly death registration.

Background: Diode lasers have been used in ophthalmic practice for several years. They are useful in the management of vasoproliferative retinopathies and have been shown to be comparable in efficacy to the argon laser. Aim: To report on the outcome of transpupillary diode laser treatment for retinal diseases. Patients and Methods: A retrospective study carried out using the case files of patients that had retinal diode laser photocoagulation between June 2011 and May 2012 at the Jos University Teaching Hospital, Jos, Nigeria. Information retrieved included patients' age, sex, diagnosis, indication for retinal laser photocoagulation, prelaser and postlaser visual acuity (VA), best corrected VA, and operative complications. Results: A total of 31 eyes of 21 patients had transpupillary retinal laser photocoagulation during the study period. The commonest indication for retinal laser photocoagulation was proliferative diabetic retinopathy (PDR), and this was seen in 16 eyes (52%). Six eyes (19%) had both PDR and clinically significant macular edema (CSMO), while 3 eyes had CSMO only. Other indications were retinal vein occlusion (RVO) with secondary neovascularization (four eyes), proliferative sickle cell retinopathy (one eye), and traumatic retinal tear (one eye). Following laser therapy in those with diabetic retinopathy, VA improved by at least a line in 6 eyes, remained the same in 13 eyes, and deteriorated in 2 eyes. Neovascular regression was observed in 13 eyes and resolution of macular edema in 3 eyes. In the eyes with RVO, neovascular regression was observed in two eyes. Conclusion: Transpupillary diode laser photocoagulation was beneficial in the treatment of retinal diseases. Fibrovascular proliferation with significant fibrous tissue component was, however, associated with poor response to laser treatment in proliferative retinopathies.

Background: Widespread epidemics of yellow fever and cerebrospinal meningitis across the African sub region in the 1990s were largely attributed to poor surveillance systems which were neither able to detect communicable diseases on time nor mount an effective response. Effective communicable disease control relies on effective response systems which are dependent upon effective disease surveillance. Integrated Disease Surveillance and Response strategy (IDSR) was adopted by the AFRO members of the World Health Organization (WHO) to improve surveillance activities. Aim: This study was conducted to assess IDSR implementation in selected Local Government Areas (LGAs) of Kaduna state. Settings and Design: Kaduna state is located in Northern Nigeria. It shares borders with the states of Sokoto, Katsina, Niger, Kano, Bauchi and Plateau. Based on the 2006 census projections, it has a population of 6.63 million. The study was a cross-sectional descriptive study. Materials and Methods: An interviewer administered questionnaire of an adaptation of the World Health Organization Protocol for the Assessment of National Communicable Disease Surveillance and Response systems was used. Data analysis was carried out using Epi Info statistical package version 3.5.1. Results: About a third of the health facilities (38%) did not have any case definition for the priority diseases. About 76% of the health facilities had electricity available from the National Grid. Seventy one percent have standby generators, out of which 67% were functional. Sixty two percent of health facilities had calculators available for data management while 29% had computers and printers available. No form of data analysis was available in 81% of the health facilities, analysis of data were however available in all 3 LGAs studied. A reporting system was available in 57% of health facilities. Thirteen percent of the health facilities reported receiving feedback from the LGAs. There was no feedback from the state to the LGAs, nor was there feedback from the national to the state level. Conclusion: The implementation of IDSR in Kaduna state is poor. Resources are insufficient and although some structures are present on ground like the presence of reporting mechanism, feedback is poor from the higher to lower levels. Standard case definitions are not used in all health facilities for all priority diseases. Standard case definitions should be made available and used in all health facilities.

Background: Orbital and ocular trauma is a major cause of monocular blindness and visual impairment worldwide. The department of ophthalmology of the Ahmadu Bello University Teaching Hospital (ABUTH) only existed at the old Kaduna hospital prior to the full functional take off at the new Shika hospital complex. With the number of orbital/ocular trauma cases and resulting complications on the increase in the eye clinic, a review to determine the incidence, as well as management protocol will lead to improvement in the treatment and visual outcomes of future cases. Aim: To determine the incidence of orbital/ocular trauma in ABUTH, Shika-Zaria. Materials and Methods: A retrospective study involving the analyses of all case files of patients who had orbital trauma and were treated at the eye clinic, ABUTH, Shika-Zaria between January 2006 and December 2007. A detailed protocol was used for data entry. Results: A total of 142 (1.8%) patients with orbital/ocular trauma were seen over a period of 2 years. The male to female ratio was 3:1. The age range was 4 months to 65 years. A unimodal age pattern was observed with peak occurrence in those 16-30 years (33.1%), closely followed by age group 0-15 years (32.4%). Individuals most commonly involved in orbital/ocular trauma were students (32.4%), while the home (42.3%) was the most common location where injury occurred. Mild blunt trauma (49.3%) was the most common diagnosis, followed by severe blunt trauma (30.3%). Severe and mild penetrating injury occurred in (16.2%) and (4.2%) of the patients respectively. Conclusion: An important cause of ocular morbidity presenting at the eye clinic of the ABUTH, Shika-Zaria is orbital/ocular trauma. Factors associated with increased occurrences of orbital/ocular trauma include younger age, male gender, being a student, and domestic and road traffic accidents. More care should be provided at school play grounds, and adequate supervision should be given to vulnerable groups in homes. Road safety rules and guidelines should be enforced on the highways.

Background: Pain is a frequent disturbing symptom of cancer, the prevalence and severity of which depend on the primary tumor, its metastatic sites, and the disease stage. The place of pain management in cancer patients cannot be over emphasized. Proper management results in improved quality of life. Aims: To assess providers' attitude and practice toward cancer pain management in Ahmadu Bello University (ABU) Teaching Hospital, Zaria, Nigeria. Materials and Methods: This was a cross-sectional descriptive pilot study on provider perspectives on pain management in cancer patients. A structured self-administered questionnaire was completed by 79 medical practitioners of various specialties and ranks. Results: Seventy-nine clinicians were recruited for the study. The majority of the respondents, 36 (46%), believe that pain was the commonest symptom in cancer patients. Most, 61 (78%), of the doctors assessed pain using subjective methods and only 30 (29%) of the respondents were conversant with other treatment options for pain. Fifty (64.3%) use analgesia, and their choices were guided mainly by the response of the patients. Forty-eight (61.5%) of those who admit to the use of analgesia, were actually limited by the side effects of the drugs. More than half (57.6%) believed that pain management in our settings is suboptimal, and the commonest limitation to optimal pain management in our settings was availability and affordability of drugs. Conclusion: Professional education needs to focus on the proper assessment of pain, the management of side effects of analgesics, and the use of adjuvant therapies for pain. A better understanding of the pharmacology of opioid analgesics is also needed.

Background: There are reports from many parts of the world on the increased activity of serum total alkaline phosphatase (TALP) in pregnant women, especially during the last half of pregnancy. There is no such documented finding in this environment. There is the need to determine the serum TALP activity in different stages of normal 3 ^rd trimester pregnancy in Zaria to allow for proper interpretation of this analyte at this stage of pregnancy. Subjects and Methods: A cross sectional descriptive study carried out among 100 healthy pregnant women in their 3 ^rd trimester. They were randomly selected from the antenatal clinic of Ahmadu Bello University Teaching Hospital, Zaria. Serum TALP activity was measured using the 4-Nitrophenylphosphate (4-NPP) method. Socio-demographic and obstetrics characteristics were obtained using an administered questionnaire. Microsoft Excel (Microsoft office, 2003) was used for data analysis. Distributions of ALP activities were found to be skewed; hence, non-parametric analyses using percentiles were used in measuring the variation. A P-value of equal to or less than 0.05 (P ≤ 0.05) was considered as statistically significant. Results: The serum TALP activity in normal 3 ^rd trimester pregnancy was found to be higher when compared to the normal population, with a gradual increase with advancing gestational age. Subjects in the gestational age group of 28 to 30 weeks had a serum TALP activity of 46-138 IU/L, with a continuous increase of up to 213 IU/L at 39 weeks of gestation. A sudden drop in activity was observed at the gestational age of 40 weeks and above. The overall serum TALP activity in normal 3 ^rd trimester pregnancy was found to be 41-206 IU/L. Conclusion: A higher serum TALP activity for normal 3 ^rd trimester pregnancy was confirmed for this environment, as has been found elsewhere. There is the need to interpret serum TALP activity in pregnancy with caution.

We report the case of a 65-year-old Nigerian woman with thyrotoxicosis manifesting as choreoathetosis, which misdiagnosed as a seizure disorder. The movement abnormality was characterized by bilateral jerky, purposeless, intermittent, irregular, and sometimes writhing movements, predominantly in the distal joints. Thyroid function test showed elevated total serum triiodothyronine (T3) and thyroxine (T4), and reduced serum thyroid stimulating hormone (TSH). There was complete resolution of choreoathetoid movement after 1 week of propanolol use. The relationship between choreoathetosis and thyrotoxicosis is discussed.

The commonest sites of non-Hodgkin's lymphoma in the head and neck are the cervical nodes, Waldeyer's ring and extra lymphatic organs such as the sinuses, larynx, salivary glands and oral cavity etc. We present the case of a 10 year old with upper airway obstruction secondary to retropharyngeal Burkitt's lymphoma. The presenting features here are very similar to obstructive adenoid enlargement. Emergency tracheotomy, biopsy, and chemotherapy led to resolution and subsequent decanulation. This case is highlighted in relation to the increasing recognition of AIDS related lymphomas globally.

Aneurysms of the Subclavian artery are uncommon, accounting for less than 0.2% of all arterial aneurysms. The most common causes are arteriosclerosis, thoracic outlet obstruction, and trauma. Anomalous branching aortic arrangements are less uncommon, occurring in some 35% of subjects. We report a case of subclavian artery aneurysm in a 62-year- old man presenting with a painless right supraclavicular swelling of approximately 30 years duration. He was a known hypertensive diagnosed 21 years previously and compliant with medication. His serum lipid profile was normal. Doppler Ultrasound of the right subclavian artery showed a thin walled fusiform aneurysmal dilatation located 3.6 cm from its origin with fine internal echoes, and measuring 2.74 cm in diameter. Peak systolic velocity (PSV) within the aneurysm was 33 cm/s, compared with 55 cm/s and 45 cm/s in the right pre-aneurysmal segment and left subclavian arteries respectively. There was turbulent flow and spectral broadening within the aneurysm. Computerized Tomographic (CT) angiography of the aortic arch confirmed a right subclavian aneurysm, and showed an anomalous origin of the left common carotid and subclavian arteries. An anomalous common origin of the left common carotid from the brachiocephalic trunk representing a bovine type variant is a rare condition, its association with subclavian artery aneurysm an even rarer finding.