Background: The management of stroke had a radical change in the last decade. This revolution followed the finding that carefully selected patient with acute ischemic stroke can benefit from thrombolytic therapy. The drug has to be given within 3 hours of the stroke to be of benefit. Administration of the drug later than this does not have much impact on the outcome. We, therefore, undertook this study to determine the time of presentation of our patients with stroke. This will establish the practicality of thrombolytic therapy in our practice. Objective: The aim of this study was to observe the time of presentation of stroke patients in a tertiary hospital in Nigeria. Materials and Methods: The time of presentation of 128 stroke patients admitted into the medical wards of Jos University Teaching Hospital was recorded. Results: There were only 13 (10.1%) patients who presented within the stipulated 3 hours for acute intervention. The median time and mode was 'after 3 hours but within the first day.' Conclusion: We found that our stroke patients presented late to the hospital. Most of our patients will not benefit from the recent modalities of management even if available. There is need for public education and enlightenment on stroke, risk factors, symptoms, and the need for early presentation after a stroke.

Objectives: To determine the seroprevalence of rubella infection in pregnancy. Materials and Methods: A cross-sectional survey of 345 consecutive and consenting antenatal attendees at Aba, Southeastern Nigeria over the period 1 June - 1 September, 2012. A structured pretested questionnaire was used to collect and record data on the socio-demographic characteristics of the subjects. Blood samples were collected from the subjects and tested for rubella IgG antibodies using the QikTech ^TM One-Step Rubella Test (LuSys Laboratories, USA). Results: Sixteen (4.6%) of the 345 subjects were found to have rubella IgG antibodies in their blood. None of the subjects had been vaccinated against rubella. Maternal age, parity, educational level attained, and marital status did not show any association with rubella IgG antibodies seropositivity. Conclusion: Our findings imply immunity to rubella in 4.6% of the subjects. Thus, 95.4% of the subjects were seronegative and non-immune. This large pool of seronegative and non-immune population will benefit from education on the availability of vaccination, prevention, and consequences of congenital rubella.

Background: Suicide is becoming a major public health problem. Objective: To determine the pattern of suicide cases with respect to age, sex, and methods employed. Design: A 10-year retrospective study of suicide cases reported to the Coroner in Rivers and Abia states of Nigeria. Materials and Methods: Data on the age, sex, circumstances, and methods of all suicide cases handled by the authors were extracted and analyzed. Results: There were 32 cases (0.9%) of suicides out of a total of 3,555 medico-legal autopsies reviewed over the period. Of the 32 cases, 28 (87.5%) were males and 4 (12.5%) were females, giving a male to female ratio of 7:1. The age distribution showed a peak incidence in the third decade. The commonest method of committing suicide in this environment is by hanging. The range and mean of the ages is 16 - 64 yrs and 31 yrs, respectively. Conclusion: This review shows that the choice of how to die often depends on the most available and most convenient means at hand. Women chose less violent means of suicide such as drowning or poisoning, while males often chose violent methods such as hanging or firearms.

Background: The rising prevalence and the attendant morbidity and mortality arising from macrosomic births require a good understanding and good management protocol. Objective: To determine the prevalence and associated factors of macrosomia. Design: Retrospective study Setting: The labor ward, isolation ward and main theatre of the University of PortHarcourt Teaching Hospital ( UPTH ). Subjects: Four hundred and sixty babies with macrosomia delivered at UPTH. Patients and Method: Data including the birth weight, gestational age, sex, and mode of delivery, Apgar score, morbidity in the newborn, duration of admission, outcome of management, maternal age, parity, pregnancy and labor complications relating to the subjects were extracted and analyzed. Results: The prevalence of macrosomia was 7.4% (490/6642). It was highest in multiparous parturients (77.8%) (358/460) aged 30-34 years (42%) (193/460). Significantly more males 302(65.7%) (302/460) than females 158(34.3%) (158/460) were macrosomic p<0.001. Ninety five (20.6%) (95/460) had moderate to severe birth asphyxia while 2% (9/460) were still births. Among the pregnancy and labor complications respectively noted in the parturients, gestational diabetes mellitus (18.2%) (28/154) and cephalopelvic disproportion (43%) were the most frequent. Majority, 299 (65.2%) (299/460) had spontaneous vertex delivery, while 150 (32.6%) (150/460) were delivered by Caesarean section. Birth asphyxia (20.6%) (95/460) and prematurity (8.5%) (39/460) were the leading fetal complications. Conclusion: Multiparous expectant women aged 30-34 years and those with gestational diabetes mellitus are prone to delivering macrosomic babies in this community. They should therefore be properly supervised with the fetus monitored for growth and size and appropriate mode of delivery and neonatal resuscitation determined prenatally to reduce the incidence of adverse perinatal outcome.

Background: Since uptake of family planning methods is influenced by poor knowledge of modern contraceptive methods and by cultural beliefs and community opinions, there may be benefit in having the counseling on offer from someone who lives within the community he/she serves, and who is cognizant of the nature of local concerns. Objective: To assess the impact of collaboration between a private health care facility, a non-governmental organization, and community health care workers on the uptake of modern methods of contraception by women in the rural community of Ekeakpara in Osisioma Ngwa LGA of Abia State, Nigeria. Design: A cross-sectional study. Setting: A health care facility. Subjects: All acceptors of modern methods of contraception at the facility from January 2004 to December 2006, and from June 2010 to May 2012. Materials and Methods: Contraceptive uptake between two periods (January 2004 - December 2006 and June 2010 - May 2012) was compared. Qualitative data on acceptors of contraception between June 2010 and May 2012 were collected using in-depth interviews. Results: Mean age of the women was 33.4 years. Majority (38%) of the women had only primary education. Their parities ranged from 1 to 10 with a mean parity of 5.1. With community mobilization, the women acceptance and attitude to modern methods of contraception was better than previously. Prior to community mobilization, 13 out of 30 women in need of permanent limitation of their family size chose injectable contraceptives. With community mobilization, majority of the women (120 out of 122) in need of permanent limitation of their family size opted for either the long-acting reversible contraceptive methods or bilateral tubal ligation. Conclusion: The positive impact of community mobilization in collaboration with an NGO as exemplified in this study suggests the need to encourage donors, governments, and the private sector to increase resources to fund family planning in rural communities in Nigeria.

Background: Caregivers of pediatric patients undergoing surgery are likely to suffer from mental and physical exhaustion leading to stress. This is important in view of the prevailing socio-economic as well as the healthcare system available in a developing country like India. Therefore the present study is designed to measure heart rate variability among this special group of population who give care to pediatric patients undergoing surgery. Materials and Methods: 15 female subjects were enrolled from among attendants of patients admitted with an immediate indication of surgery, who required constant care. They were free from any type of physical and mental health issues, non smokers and non addicts. Each care giver was subjected to HRV analysis on three occasions: The first record was performed on the first day of their arrival in the hospital as caregivers. The second observation was recorded after 3 days of care giving. The final HRV analysis was done after 1 month of care giving. Two types of parameters were analyzed: Time domain and frequency domain.Statistical analysis was done using paired t-test. Results: Both the HRV parameters - time and frequency domain, showed decreased values during the third day and one month recording as compared to the first day recording. The decrease is much more during the one month recording as compared to the third day recording. Statistically significant decrease is observed in mean RR interval, heart rate, VLF and LF only when the first day recording is compared with the third day recording but when the first day recording was compared with the one month recording significant decrease was found in mean RR interval and heart rate. Conclusion: Subjects involved in taking care of pediatric patients are likely to undergo a lot of physical and mental stress, thus affecting their autonomic status. HRV analysis using short term ECG recording was used to detect changes consequent to this stress. It was found that almost all HRV parameters measuring heart rate complexity were decreased in the period of care giving.

Background: Motorcycle accidents are very common and cause major injuries. The Abia State government banned commercial motorcyclists from operating in the major cities of the state in July, 2009. Objectives: To determine the influence of this ban on the cause and pattern of injuries due to road traffic accidents. Design: The study is retrospective. Setting: The Accident and Emergency Department of the Federal Medical Centre, Umuahia. Subjects: All patients involved in road traffic accidents that were brought to the Accident and Emergency Department of the Federal Medical Centre, Umuahia in 2009. Materials and Methods: Data obtained from patients' case notes were subjected to statistical analysis. Results: In the six months before the ban, a significant number of motorcycle accidents occurred compared to the other six months after the ban. More of the injuries were major, more of the patients were males, and the median age of occurrence for most of the injuries was 25.5years. Conclusion: The ban on commercial motorcycle operatives significantly reduced the incidence of road traffic accidents and major injuries.

Background: Member of Aba Spots club including some of the family members were screened for the prevalence of Hepatitis B and C infection. Testing members of the Aba Spots club along with their family members is a strategy to identify undiagnosed hepatitis B and C virus infections in Aba, Nigeria. We also assessed how the social life of members of Aba Spots Club may influence the acquisition of Hepatitis B and C infections. Materials and Methods: Demorgraphic information of members was collected as blood samples were analyzed for each member using commercially procured test strips. Proportions of those tested for Hepatitis B and C infections were determined. Results: Among the 470 members, 211; comprising 139 club members and 72 family members, were accessible for Hepatitis B and C infection survey. Prevalence of Hepatitis B and C infection was 3(1.4%) and that of Hepatitis C was 2 (0.95%), with an overall prevalence of 5 (2.4%). No past results of infection and immunization were noted among the subjects. Conclusion: This study offers opportunity to capture, identify and educate infected and unaffected members of the society on the health hazards associated with Hepatitis B and C infections. Those with known positive hepatitis status also received treatment and those considered susceptible were educated on how to initiate preventive action (e.g. vaccination).

Background: The role of estrogen on pulmonary function test (PFT) was well known in the normal course of the menstrual cycle. Significant increase in both progesterone (37%) and estradiol (13.5%), whereas no change in plasma follicle stimulating hormone (FSH) & leutinizing hormone [LH] was observed in exercising women in previous studies. Therefore, this study was intended to see the limitations of the pulmonary system in adaptability to exercise in proliferative phase of menstrual cycle in obese and non obese women. Materials and Methods: Healthy young adult females between 19-25 years in proliferative phase of menstrual cycle leading a sedentary life style were considered in the study group.10 subjects in each group were studied based on the body mass index (BMI), were made to undergo treadmill exercise testing and computerized spirometry to assess dynamic lung functions. Results: It was observed that exercise per se does not cause a statistically significant change in dynamic lung function parameters maximum mid expiratory flow [MMEF], peak expiratory flow rate (PEFR), mid expiratory flow (MEF) 25% to 75% in either of the groups. Conclusion: This finding supports the hypothesis that the respiratory system is not normally the most limiting factor in the delivery of oxygen even under the predominant influence of estrogen in proliferative phase which is further accentuated by exercise and obesity, at least borderline does not have much influence on respiratory system adaptability.

Background: Government channel for distributing free insecticidal nets stop at the health centers. About 70% of rural women who do not access this health facility fail to collect the free nets. Alternative channel for reaching these women is hereby advocated. Materials and Methods: An interventional study was carried out in eight randomly selected villages of Abia South. Experimental and control groups were assigned four villages each. Sample size for each group was 200 households systematically selected. Questionnaire and interview guide were instruments for data collection. Data were analyzed quantitatively. Chi-square statistic was used in testing for statistical significance. Results: Before intervention, ownership and utilization of treated nets in experimental group were 36.5% and 28.8%, respectively, while in the control group, it was 38% and 30.0%, respectively. Ownership and utilization of treated nets in experimental group increased by 54.5% and 46.5%, respectively, after intervention. In the control group, where there were no interventional activities carried out, ownership and utilization of treated nets showed no significant increase. Conclusion: Health promotion intervention, fixed-install mental payment-basis for net cost, and home-based net distribution channel scaled up net ownership and utilization by 54.5% and 46.5%, respectively, in the study area.

Objective: To appraise operational environments and facilities of petroleum refining and distribution industry in Nigeria with a view to establishing the potential hazards/health risks Design: A prospective study. Setting: The Operational environments- facilities and activities of PHRC and PPMC, Eleme near Port Harcourt, Nigeria. Materials and Methods: Personal walk-through of the operational sites and facilities using checklist, participation in the various units' activities, and oral interviews of staff concerning the health hazards/risks of their workplace. Results: Five main occupational hazard categories were revealed- physical, chemical, biological, psychosocial, and ergonomic hazards. Sundry job exposures to these workplace hazards are suspected to be responsible for the accidents, injuries morbidities, and mortalities recorded in this industry. Conclusion: Current state of facilities and activities at the operational units of petroleum refining and distribution industry in Nigeria are fraught with several hazards, categorizable into five main hazard types, a situation that disposes staff to sundry health risks. Facility upgrade and industrial health services updates are thus warranted for abatement of hazards/associated health risks, and securing safer facilities and healthier work environment.

Background: Onychomycosis, although a common problem in all age groups, is often misdiagnosed and consequently under-treated. There is need for improved awareness and proper laboratory diagnosis to ensure effective therapy. Objective: To review the etiology, diagnosis, and treatment of onychomycosis. Design: Data sources from internet searches on AJOL and Pubmed conducted using the keywords "onychomycosis," fungal nail infections. Setting: Abia State University Teaching Hospital (ABSUTH), Aba, in South Eastern Nigeria. Subjects: A total of 38 articles and laboratory manuals. Materials and Methods: A total of 38 articles including laboratory manuals, published between 1974 and 2009, were selected and reviewed. Results: Onychomycosis is gradually increasing in the general population. The etiological agents differ from person to person and from place to place. Conclusion: There is need for proper laboratory diagnosis prior to institution of therapy. Effective therapy is with the use of systemic drugs with or without topical agents.

Prolactinoma is an intra-sellar benign adenoma. It could be micro- or macro-adenoma. The commoner micro-adenoma is an endocrine active. The distant effect of Prolactinaemia is on reproductive system and breast as seen in our Para-2 45 year old woman with pituitary micro adenoma, dense breasts and right breast abscess.