Background: Twin pregnancy remains a high risk one, and its incidence varies from one ethnic group to the other. Twin delivery is also associated with increased neonatal and maternal morbidity and mortality. Objective: To det ermine the current incidence and document the complication of twin pregnancy in Kano, northwest Nigeria. Materials and Methods: A retrospective analysis of 231 cases of twin deliveries between 1 ^st January 2007 to 31 ^st December 2009, in Aminu Kano Teaching Hospital (AKTH) Kano was carried out. Results: During this study period, there were 15,233 deliveries and 353 cases of twin deliveries, giving an incidence of 2.3% or 1 in 43 deliveries. The mean maternal age and parity were 29.0 years and 2.6 respectively. The mean gestational age at delivery was 36.9 weeks, with a mean birth weight of 2.4 kg and 2.3 kg for the first and second twin respectively. Male twins constituted 50.3% of twin births. The commonest presentation of twins was Cephalic-cephalic in 52.2%. This was followed by breech-cephalic in 29.6%, cephalic-breech in 12.6% and breech- breech in 5.2%. Mode of delivery was vaginal in 57.4% while 40.0% delivered by Caesarean section. The commonest indication for the Caesarean section was due to breech presentation in the leading twin (75.0%). Hypertensive disorder in pregnancy was the commonest maternal complication accounting for 63.16%, increasing maternal morbidity and mortality, while prematurity was the leading cause of perinatal mortality. Conclusion: This study has shown that the incidence of twin pregnancy is high in Aminu Kano Teaching Hospital, Kano, northwest of Nigeria. It has also shown that twin delivery is associated with prematurity, malpresentations and operative delivery, therefore increased perinatal and maternal morbidity. It is therefore recommended that twin pregnancy should be supervised in a tertiary centre under a specialist care and where facility for neonatal support is available to improve its outcome and reduce perinatal morbidity and mortality.

Background/Aim: Foetal weight cannot be measured directly in utero, but it can be estimated or predicted from foetal and maternal anatomical characteristics. This study was undertaken to examine the relationship between birth weights and certain maternal anthropometric measurements (weight, height and BMI). Context/Setting: This study was done in Aminu Kano Teaching Hospital (AKTH), North-West, Nigeria. Aminu Kano Teaching Hospital is a 500-bed tertiary hospital located in Kano, the most populous state in Nigeria. Materials and Methods: This was a prospective study. Interviewer-administered questionnaires were used to retrieve sociodemographic and obstetrics information. Two-hundred (88.9%) pregnant women responded completely. The weight, height and BMI of the women were measured. Unclothed newborns were weighed immediately after delivery. The data obtained was analysed using SPSS version 16.0 statistical software. The accuracy of maternal weight, height and body mass index in predicting birth weight was compared using Student's t-test, Chi-square test and Pearson's Coefficient of Correlation and P < 0.05 was considered statistically significant. Results: The mean maternal age was 28.2 ± 5.7 years. The mean parity was 3 ± 2. The mean gestational age at delivery was 38.5 ± 2 years. The mean actual birth weight was 3.27 ± 0.53 kg. The mean maternal weight was 72.03 ± 11 kg. Maternal weight showed a strong positive correlation with birth weight ( r = 0.48) and this was statistically significant ( P < 0.001). The mean maternal height was 1.64 ± 0.55 m. The mean maternal BMI was 27.9 ± 4.33. Maternal BMI showed a weak positive correlation with birth weight ( r = 0.28) and this was statistically significant ( P < 0.001). Maternal weight and BMI are better predictors of birth weight than maternal height. Conclusion: Maternal weight and BMI are good predictors of birth weight and can be recommended for use as screening test in poor resource setting.

Background and Objective: Several studies across the world have revealed that liver dysfunction is a common finding in children with sickle cell anaemia (SCA). The situation in hospitals in Nigeria is not known. The few studies carried out in Nigeria were on adult subjects. The overall objective of the study was to evaluate the liver function test (LFT) profile of children with SCA, aged 1-14 years, with a view to improve the routine investigation and management of this group of subjects. Materials and Methods: LFT profile of 60 SCA subjects and 60 age- and sex-matched apparently healthy subjects (controls) was evaluated in the present study in the departments of chemical pathology and paediatrics of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, northern region of Nigeria. Results: The results of serum LFTs of the SCA subjects and age- and sex-matched control subjects showed that the concentrations of serum total bilirubin (TB), conjugated bilirubin (CB), unconjugated bilirubin (UCB), alkaline phosphatase (ALP), and aspartate transaminase/alanine transaminase (AST/ALT) ratio were significantly higher (P < 0.001), while the levels of total protein (TP) were significantly lower (P < 0.001) in SCA subjects compared with the control subjects. Serum levels of ALT, AST and albumin (ALB) among SCA and control subjects were not statistically different (P > 0.05). The results of serum LFTs also showed that there were no significant age differences (P > 0.05) in both SCA subjects and control subjects. There were no correlations between all the LFT analytes and the frequency of crisis (FOC) among SCA subjects (P > 0.05). Conclusion: It could be concluded from the findings of the present study that there are mild LFT abnormalities in children with SCA even in steady state, and that the extent of some of the abnormalities decreases with advancing age of the subjects.

Background: Juvenile polyps are a common cause of low volume painless rectal bleeding in children. Most of these polyps are located within the sigmoid colon and the rectum. Objective: The aim of this study was to describe the clinical characteristics of children presenting with colorectal polyp in Kano, Nigeria and to document the challenges faced in their management. Materials and Methods: We undertook a retrospective review of the clinical records of all children aged 13 years or less who presented to our hospital with a colorectal polyp between January 2008 and December 2008, and also prospectively enrolled all those presenting between January 2009 and December 2010. Demographic, clinical and laboratory data were collected. Data were analysed using SPSS 15.0 (SPSS Inc, Chicago, IL). Results: There were 16 patients in all, with their ages ranging between 2.5 years and 9 years (mean 6.03 years). There were 8 boys and 8 girls (M: F = 1:1). Haematochezia was the most common presenting symptom, followed by a prolapsing rectal mass and rectal prolapse. In 13 of the patients, there was a solitary polyp, while 3 patients had 2 polyps each. All the polyps were located in the rectum within 7 cm of the anal verge. Only one patient had a sessile polyp, while all the others were pedunculated. Histopathology reported juvenile polyp without evidence of adenomatous change in all of them. Conclusion: A careful digital rectal examination is recommended for all children presenting with a bloody stool to rule out juvenile polyp.

Background: Thinness in older children has been associated with delayed pubertal maturation, reduced muscular strength and work capacity. There is paucity of studies on thinness among adolescents in Nigeria. Objectives: The aim of this study was to determine the prevalence of thinness among adolescents in Kano, Northwestern Nigeria . Materials and Methods: In this descriptive cross-sectional survey, we used a multi-staged random sampling technique to select 718 students from six secondary schools in Kano metropolis. A pretested questionnaire was used to collect socio-demographic data. Physical measurements for weight and height were carried out using standard procedures. Results: The overall prevalence of thinness was 60.6%, with a higher prevalence among boys (63.0%) compared with girls (58.7%). Grades-I, II and III thinness were found in 26.0%, 15.5% and 19.1% of the studied subjects respectively. The prevalence of grade III thinness was higher among boys (19.4%) compared with girls (18.8%). The rate of thinness was observed to increase with age up to 16 years after which it starts to fall. Older age was also found to be independently associated with thinness among our subjects. Conclusion: The prevalence of thinness among adolescents in Kano is high, with a slightly higher rate in boys than girls. There is need for concerted effort by policy makers to come up with programmes aimed at reducing the burden of undernutrition among school children in our setting.

Background: Hernia is a common surgical condition in our environment and constitutes a serious problem in male farmers in northern Nigeria. Complications are frequently seen, especially during the rainy season, due to increased physical activity as a result of farm work; many of these are Life threatening. Elective repair is often delayed due to long waiting time and the cost of operation is not readily affordable to many in the general public. Approach: The government of Kano State decided to embark upon a free campaign to electively treat 1000 patients with hernia across the state in order to decrease the morbidity and mortality associated with its complications and also to increase the capacity of the hospitals by retaining procured equipments used for the campaign for further use. Following public enlightenment, the campaign was carried out over a period of 3 weeks between 4 and 25 December 2006 in six selected hospitals using mobile surgical teams. A protocol and a questionnaire were designed for use during the campaign. Achievements: A total of 2824 patients with hernia and/or hydrocoele were screened during the campaign, out of which 1155 stable patients were successfully operated at no cost. Equipment, surgical outfits, patient drapes including remaining drugs and consumables were left for use in the centers. No untoward event was reported. Conclusion: It is feasible to conduct a mass hernia campaign to decrease the morbidity and mortality associated with its complications and emergency repair. Mass hernia campaigns require adequate organization, trained staff, necessary equipments and enough supply of consumables. The mass turnout of patients demands a regular/scheduled campaign to further alleviate this problem. There is need for participation of non-governmental organizations, professional associations and corporate bodies to be more involved in health care delivery in our society.

Background and Objective: Fine needle aspiration cytology has assumed a great importance in the pre-operative diagnosis of palpable breast lesions in several hospital and clinical settings worldwide. This study aims to audit its diagnostic utility and validity in a tertiary hospital, and to review some of the diagnostic pitfalls in interpretation of breast cytology. Materials and Methods: The study comprised of breast cytology reports and their subsequent tissue biopsy diagnoses recorded over a 5-year period from January 2008 to December 2012. Results: A total of 1162 breast cytology reports were made over the review period out of which 200 had histological confirmation. Out of the 200 cases, 109 (54.5%) were benign (C2), 20 (10.0%) cases were suspicious probably benign (C3), 27 (13.5%) cases were suspicious probably malignant (C4) and 44 (22.0%) were malignant (C5). The cytology reports were correlated with subsequent histological diagnoses. Of the 109 benign C2 reports, 99 were confirmed on tissue histology as truly benign (true negatives) and the remaining 10 cases were malignant (false negatives). Forty-three of the 44 malignant (C5) cytology reports initially made were confirmed as malignant on tissue histology (true positives). The remaining malignant (C5) cytology case was, however, revealed to be benign (false positive). The overall suspicious rate (C3 and C4) was 23.5%. The absolute sensitivity was 81.0%, specificity was 99.0%, positive predictive value (PPV) (C5) of 97.7%, negative predictive value (NPV) (C2) of 90.8%. The false positive rate (FPR), false negative rate (FNR) and suspicious rates (SR) were 1.2%, 12.0% and 23.5%, respectively. Conclusion: Fine needle aspiration cytology of the breast has recorded high absolute sensitivity and specificity in our centre with a marginally high false positive rate. It has thus continued to have relevance as an important pre-operative diagnostic tool in the management of palpable breast lesions in our hospital.

Post-ictal psychosis occurring with super refractory epilepticus is an uncommon neuropsychiatric phenomenon. The purpose of this article is to describe the clinical management in an adult male of a protracted post-ictal psychotic disorder, which complicated a super-refractory status epilepticus in a resource poor country. The case describes the clinical presentation of a young man on an anti epileptic drug, diagnosed with secondarily generalized complex partial seizure disorder following a head injury. The index episode, which the patient presented days later for orthodox care, manifested after some days with post-ictal psychotic mental disturbances. Despite the cautious use of antipsychotic and antiepileptic drugs, super-refractory status epilepticus complicated seizure. On admission to the ICU, intravenous midazolam was given to the patient, but could not be maintained due to unavailability and substituted with magnesium sulphate infusion.The magnesium sulphate infusion was maintained due to break through seizures on return of patient to the psychiatric ward. The psychosis and refractory seizures were controlled after 8 weeks by joint magnesium titration, intravenous diazepam, high dose oral anti epileptics, and atypical antipsychotic drugs. A combined therapy of magnesium, benzodiazepine, and atypical antipsychotics might be an effective treatment option in post-ictal psychosis with super- refractory status epilepticus.

The mandible plays a major role in definition of lower facial contour, airway protection and support for the tongue, dentition and the muscles of the floor of the mouth. Interruption of mandibular continuity, therefore, produces both cosmetic and functional derangements. The restoration of a patient, therefore, into acceptable cosmetics and satisfactory function after surgical ablation is a challenge for the oral and maxillofacial surgeon. This was a case of composite post-ablative defect which was reconstructed with a non-biological material (alloplast). The alloplast got exteriorised intraorally within a period of 1 year with resultant infection and had to be removed. It was concluded that alloplasts served only as temporary stabilisation in delayed reconstructtion of mandibular continuity defects. The reasons for delay may, however, vary. Resource development is necessary to facilitate surgical skills acquisition in free microvascular techniques of reconstruction which offers better and sustainable outcomes.