Persistent hiccups are hiccups that last for at least 48 h, and may occur following a legion of causes including strokes. They have been described following infarctive and hemorrhagic strokes. Hiccup is a respiratory reflex action that occurs following the sudden contraction of the diaphragmatic and intercostals muscles with closure of the glottis; and putatively believed to be a form of myoclonus (very brief repeated contractions of striated muscles) that occurs from irritation of the medullary mediated reflex arc that has supratentorial inputs. This underpins the association of hiccups with suprabulbar lesions like strokes, apparently following repeated excitatory inputs from the higher centers. Hiccups are ordinarily self-limiting, but persistent hiccups are advisedly treated with pharmacologic agents, of which baclofen, a GABA B agonist muscle relaxant has proven to be remarkably efficient. It is believed that the action of baclofen interrupts the hiccup reflex arc. Nonpharmacologic remedies like vagus nerve stimulation have also been found to be effective and may be complementary. This case series highlights the use of baclofen in persistent hiccups following supratentorial infarcts.

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Background: The profile of patients seen with acute stroke has been sparsely described in north-western Nigeria, even though stroke constitutes an important cause of severe disability in adults. Aims: (1) The primary aim is to determine the clinical and socio-demographic profile of stroke patients seen in a tertiary hospital. (2) The secondary aim is to determine the 30-day case fatality. Patients and Methods: A retrospective study carried out using the case records of patients admitted from January 2007 to December 2009 with the clinical diagnosis of stroke at Usmanu Danfodiyo University Teaching Hospital. Relevant clinical data were extracted using a structured questionnaire designed for the study. Results: A total of 370 case files with the clinical diagnosis of stroke were traced, but only 260 had complete information. The mean age of patients was 55.7 ± 14.3 years; hypertension (74.6%) was the most common modifiable risk factor for stroke followed by diabetes mellitus (8.8%). Stroke constituted 1.2% of all hospital admissions and 8.5% of death in the medical units. The 24-h and 30-day case fatalities were 11.9% and 38.4%, respectively. The mean duration of hospitalization for stroke survivors was 21 days, but the duration of hospitalization prior to death for those that died was 4 days. Conclusion: The 30-day case fatality of acute stroke was high and hypertension was the most common modifiable risk factor for stroke. Prompt and adequate measures should be taken to improve outcome of stroke.

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Introduction: Discharge against medical advice (DAMA) is a worldwide problem with negative health and socioeconomic effects. Factors that have been implicated as causes or contributing to DAMA include financial constraints, lack of health insurance, deteriorating clinical condition of the patient, and problematic doctor-patient relationships. Aims: determine the incidence and profiles ofDAMA on the medical wards, so as to allows for evidence-based interventions to reduce this problem to a minimum. Materials and Methods: This was a case-control study carried out on the medical wards of Federal Medical Center, Ido-Ekiti, South-West Nigeria. The medical records of all patients admitted to the male and female medical wards between January 2008 and April 2011 were reviewed. After being identified through the admission/discharge log, patients who were DAMA and a similar number of patients with regular discharge had their case notes retrieved. Information extracted included bio-data, diagnosis, duration of hospital stay, and reason for discharge. Results: One hundred and thirty-eight patients representing 7.2% were DAMA during the study period. Ninety five cases had complete medical records, and full analysis was carried out on these and 94 other cases with regular discharge as control. The mean age of the DAMA cases was 50.8 ± 18.3 years, with 58 (61.1%) of these patients being male; while the mean age of the control group was 54.1 ± 16.5, of which 54 (57.4%) were male. The mean duration of admission for patients with DAMA was 10.4 ± 9.2 days as against 11.9 ± 10 in the control group, a difference that is not statistically significant. The associations between type of discharge, sex, and duration of admission are shown through odds ratios of 0.883 and 0.833 respectively. Financial problems (48%), lack of clinical improvement (28.8%) and leaving to seek alternative/complimentary medical care (23.1%) were the factors found to be responsible for DAMA in the study. Conclusion: The incidence of discharge against medicine is high in this study. There is a need for all stakeholders to evaluate factors responsible for DAMA, with the aim of reducing this trend.

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Background: Different studies have reported various frequencies of electroencephalographic (EEG) abnormalities in patients with epilepsy. There is, however, a paucity of data on EEG in Nigeria; hence, the need for this study. Objective: The objective of the following study was to evaluate interictal EEG pattern in patients with epilepsy in Kano, Northwestern Nigeria. Subjects and Methods: A cross-sectional study involving the analysis of EEGs of consecutive patients with clinical diagnosis of epilepsy over a 5 year period at two diagnostic centers in Kano, northwestern Nigeria. Information on socio-demographic and seizure characteristics was obtained. The recordings from patients were obtained using the standard methods and interpreted by two of the investigators. The International Federation of Societies for Electroencephalography and Clinical Neurophysiology definition of interictal epileptiform discharges (interictal epileptiform activity [IEA]) was adopted for the study. Result: Out of 2219 patients referred for EEG at the two diagnostic centers during the study period, 2041 (92%) patients had a clinical diagnosis of epilepsy. Their age ranged between 0.04 and 75 years, with a mean age of 22.8 ± 14.9 years. Overall, EEG was abnormal in 1178 (57.7%) and 919 (45.1%) had an epileptiform pattern. A total of 1691 patients had hyperventilation (HV) and response to HV was unremarkable in 1286 (76%) of them. Out of 405 who had remarkable changes on HV; 302 had increase in epileptiform discharges, whereas 103 had abnormal discharges only on HV. Seventeen (89.5%) out of 19 patients with 3 Hz spike and wave complexes had activation by HV. The most common IEA were focal spike/sharp and wave and generalized spike/sharp and slow waves. More antiepileptic drug (AED) naive patients (678) than those that were on AED (500) had EEG abnormality and the difference was statistically significant, P < 0.001. Conclusion: The study showed that the occurrence of interictal EEG abnormality in patients with epilepsy was about 58%. The proportion of interictal epileptiform discharges was 45% in routine first EEG studies. Among those with epileptiform activity, generalized sharp and wave complexes and focal sharp and slow wave complexes were the most common findings.

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Background: Nigerian adolescents constitute about 20% of the total population. Problems associated with menstruation affect 75% of adolescent females in both the developing and the developed world. Objectives: The objective of this study is to establish the age at menarche and menstrual abnormalities among adolescents in secondary schools in Zaria. Materials and Methods: A descriptive cross sectional study in which a self-administered pretested, semi-structured questionnaire in english was administered to 535 female secondary school students in Zaria, northern Nigeria. The students were selected from five schools that were chosen by simple random sampling from a list of schools in Zaria metropolis. Information obtained included age at menarche and menstruation related issues. Results: Of the 535 female secondary school students interviewed, 448 (83.7%) were in senior secondary school. The mean age of the respondents was 15.35 ± 1.48 years. The average age at menarche was 12.53 ± 1.33 years. Most respondents, 369 (69.0%) experienced regular menses. The average duration of menstruation was 5.45 ± 1.81 days in 354 (66.2%) of the respondents. Three hundred and forty-four (64.3%) of the respondents had dysmenorrhea, and it was severe in 229 (66.6%) of them. Only, 137 (25.6%) experienced premenstrual symptoms, the most common symptom being breast tenderness in 62 respondents (45.2%). Conclusion: The age at menarche and the menstrual pattern amongst adolescents in Zaria, northern Nigeria is similar to findings from other parts of Nigeria as well as from other parts of the world. Further studies are however needed to explore the full range of menstrual abnormalities that can occur in the adolescent age group.

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Small bowel volvulus is an occasional cause of mechanical intestinal obstruction in our practice causing diagnostic problems. We report a case of primary small bowel volvulus with gangrene. A 30-year-old farmer who presented with features of acute intestinal obstruction, which at laparotomy revealed a primary small bowel volvulus with a gangrenous loop of ileum. The patient was resuscitated and had exploratory laparotomy; with operative findings of a twisted loop of gangrenous ileum adjoining the ileocecal valve. This was resected and an end to end ileotransverse anastomosis effected. The patient made an uneventful recovery and was discharged on the 7 ^th postoperative day. Primary small bowel volvulus should be suspected in acute intestinal obstruction. It presents as an acute abdomen due to occlusion of bowel lumen alone or with obstruction of its blood supply leading to gangrene. Treatment includes resection and end to end anastomosis, which can help to reduce mortality and morbidity.

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Osteosarcoma (OS) is the most common primary bone tumor of the jaw. It is rare, and the biological behavior differs from other skeletal bone tumors. OS of jaw is characterized by lower incidence of metastasis and better prognosis than OS of long bones. Surgery with adjuvant radiotherapy is the mainstay of treatment. The complicated three-dimensional anatomy of the head and neck region makes it difficult to obtain wide resection margins, leading to higher chances of recurrence. Death is usually caused by the uncontrollable local spread. We present a case of 61-year-old man with diabetes mellitus, who presented with an upper jaw swelling, which was histologically confirmed as OS of the maxilla. He underwent surgery and adjuvant radiation for the same. 1 year later, patient developed recurrence at the base of the skull which was inoperable. He received palliative chemotherapy for the same and is now under follow-up.

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Paget's disease of bone (osteitis deformans) is a condition of unknown etiology, characterized by rapid bone remodeling and formation of new bone that is structurally abnormal. A wide range of clinical manifestations are reported among patients with Paget's disease including bone pain, fractures, secondary osteoarthritis, hearing loss, and syndrome of neurological compression secondary to vascular steal phenomenon. Here we report a rare case of recurrent transient ischemic attacks due to vascular steal syndrome secondary to Paget's disease of bone.

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We describe a male patient who presented with a 2 years history of recurrent ulcers and erythematous plaques on the buttocks. Skin biopsy and tissue culture on Lowenstein Jensen media resulted in the isolation of Mycobacteria, which was further identified as Mycobacterium tuberculosis (MTB) by polymerase chain reaction. The results of drug susceptibility tests showed that the MTB isolated was resistant to isoniazid (INH), rifampicin (RIF), ethambutol (ETH) and rifapentine (RFT). During 7 years of follow-up after discharge from hospital admission, the erythematous plaques and atrophic scars remained confined to the patient's buttocks. This is the first reported case of cutaneous multidrug-resistant tuberculosis (MDR-TB) in China. Given the increasing incidence of MDR-TB in china, our case report calls for heightened clinical awareness and improved facilities to confirm the diagnosis of MDR-TB.

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