Childhood acute bacterial meningitis remains a significant cause of morbidity and mortality especially in developing countries. The pattern of both sporadic and epidemic cases of meningitis has been known to change from place to place even in the same country or geographical region. Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis are the predominant causes of community-acquired bacterial meningitis beyond the neonatal period.

Introduction: Circumcision is the surgical removal of the skin covering the glans penis (prepuce). Circumcision is performed worldwide, among many tribe and races. It is the commonest surgical procedure done in males. It is perform by both trained and non-trained medical personal. Aims and Objective: To compare the outcome of circumcision done by dorsal slit and plastibell methods. Methods and Materials: A prospective study was done over 1 year period. A structured questionnaire was used to collect data. It was a cross-sectional analytical study with sample size of 120 patients divided in to 2 study groups. Group A had dorsal slit while group B had plastibell type of circumcision. Results: The age of circumcision varies between 7days to 10 years. The average duration of the procedure was 12minutes for dorsal slit and 7 minutes, with estimated blood loss of 7mls and 4mls in the two methods. The most common complications observed in our study are surgical site infection, post operative haemorrhage, and delayed separation of the ring. While surgical site infection is more in plastibell method, post operative haemorrhage was found to be commoner in dorsal slit method. Conclusion: Our study showed that plastibell has an obvious advantage of shorter time of procedure, lower risk of post operative bleeding compared to the conventional dorsal slit method of circumcision.

Background/Aims: Ear disease in children is a major public health concern in developing countries. World Health Organization suggests external ear examination for all school entrants in developing countries to identify those with ear discharge and study the extent of ear diseases in the community. The aim of this survey is to screen ears of children attending Ahmadu Bello University staff schools, Zaria and to document the findings. Materials and Methods: This was a cross-sectional survey conducted at four staff schools of Ahmadu Bello University, Zaria between March and May 2013. One thousand and nineteen (1019) consecutive children aged 4–15 years from primary 1 to junior secondary school 3 (JSS 3) were included in this survey. All students were interviewed for the presence or absence of various symptoms of ear diseases followed by ear examination. Results: This survey included 1019 participants, of which 511 (50.1%) and 508 (49.9%) were males and females, respectively. The mean age and standard deviation were 9 and 2.53, respectively. Three hundred and eighty-two (37.5%) of the study population had otologic diseases whereas 637 (62.5%) did not. Impacted wax was the most common otologic disorder observed in 297 (29.1%) followed by otitis media with effusion (tentatively) 43 (4.2%), otomycosis 11 (1.1%), chronic suppurative otitis media 9 (0.9%), preauricular sinus (0.9%), and otitis externa 6 (0.6%). Conclusion: This survey highlights that ear diseases are common among children. Periodic ear examination and health education are essential.

Background: Communication is key to learning. Hearing is an essential part of communication without which acquisition of knowledge is, at best, very difficult. School children require a functioning auditory system for optimal educational development. In hearing impaired children educational development can be stalled should diagnosis not be done in a timely manner. Aim: The aim of the study was to evaluate the hearing threshold and determine the prevalence of hearing loss of a cohort of junior secondary school students attending schools in Kaduna North Local Government Area of Kaduna State, Nigeria. Patients and Methods: This was a cross-sectional prospective study of junior school students aged 10 years to 15 years attending selected secondary schools in Kaduna North Local Government area of Kaduna state, Nigeria. Structured questionnaire was administered to obtain relevant biodata, school type, and auditory health. Otoscopy and Pure tone audiometry were done to determine any associated ear pathology and hearing threshold levels respectively. Data obtained were recorded and analyzed using the Statistical Package for Social Sciences version 16 (SPSS Inc., Chicago, Illinois, USA). The frequency tables were generated showing the distribution of study characteristics. Results: The prevalence rate of hearing loss among junior secondary school students in Kaduna metropolis is 14.7%. Conductive hearing loss was seen in 10.3% of students and sensorineural loss in 4%. Conclusion: There is a high prevalence of hearing loss among students of junior secondary school in Kaduna especially in public schools. Other otologic pathologies like wax and foreign bodies were also noted.

Background: Endotracheal intubation is an integral part of airway management and is key to the practice of safe anesthesia. Prediction of a difficult airway can help reduce the incidence of failed or difficult intubation. We studied the use of “L-E-M-O-N” (Look-Evaluate-Mallampati-Obstruction-Neck mobility) scoring system to predict difficult intubation and determine the prevalence of difficult intubation among adult surgical patients. Materials and Methods: One hundred and sixty (160) consecutive ASA I–III surgical patients between 18 and 65 years of age were recruited from October to December 2011. A variety of airway tests using the “L-E-M-O-N” scoring were done during preoperative assessment; and at induction of anesthesia, airway assessment using Cormack and Lehane was performed and the results were recorded by a standardized record sheet. The variables evaluated were gender, age, weight, height, body mass index (BMI), dentition and a variety of airway tests using the “L-E-M-O-N” scale. SPSS version 17.0 was used for statistical analysis; and a P value <0.05 was considered significant. Results: Prevalence of difficult intubation using Cormack and Lehane score only was found to be 8.1%. The “LOOK” features had sensitivities of 99.1%, 96.6%, and 92.5% for facial trauma, large incisors, and beard or moustache, respectively, and positive predictive values of 0%. Combination of predictors in the “L-E-M-O-N” score showed that, as the mean “L-E-M-O-N” score of the patients increased, the likelihood of difficult visual laryngoscopy also increased. Conclusion: Combination of airway predictors in the “L-E-M-O-N” scoring system significantly improves the ability to predict difficult intubation.

Background: Postoperative nausea and vomiting is a common complication following general anaesthesia for gynaecological laparoscopic procedures. Objective: This prospective study was designed to compare the efficacies of ondansetron and metoclopramide in the prevention of postoperative nausea and vomiting (PONV) after day-case gynaecological laparoscopic surgeries. Materials and Methods: Sixty-six ASA I and II consenting patients aged 18–55 years undergoing day-case gynaecological laparoscopic procedures were recruited and randomly allocated into two groups with each receiving either intravenous ondansetron 4 mg or intravenous metoclopramide 10 mg prior to the induction of anaesthesia. Nausea and vomiting were then assessed over a period of 4 hours before discharge. Results: Nausea occurred in 33.3% and 15.2% of the patients in the metoclopramide and ondansetron groups, respectively (P = 0.001). The incidence of vomiting was 9.1% and 3% (P < 0.0001) for metoclopramide and ondansetron, respectively. Conclusion: Ondansetron offered superior prophylaxis against PONV compared to metoclopramide in patients undergoing day-case gynaecological laparoscopic surgery.

Background: Neck pain is almost as common as low back pain; however, it is under reported especially among Nigerians. Neck pain has a diverse etiology, so it poses a diagnostic dilemma. Objective: To present the pattern of magnetic resonance imaging (MRI) findings in patients with persistent neck pain in resource poor setting. Materials and Methods: A two-year retrospective review of 130 patients (age range 13 to 78 years) who were referred for cervical MRI scan due to neck pain at the radiology department of Ahmadu Bello University Teaching Hospital, Zaria. All the patients were scanned using a single Siemens (Magneto Concerto) MRI scanner. Sagittal T1-weighted and T2-weighted fast spin echo images were acquired, and axial images and contrast-enhanced studies were done only when required. Results: This study included 96 males and 34 females with a mean age, at presentation, of 48.4 (±3.6 years) and modal age group of 41–50 years. Cervical spondylosis constituted the major finding 84 (64.6%). Other causes of neck pain were tuberculosis of the cervical spine (0.8%), vitamin B12 deficiency (0.8%), and spinal neoplasm (1.5%). Cervical cord compression was seen in 69 (53.1%) patients. In a few patients [5 (3.8%)], however, no abnormality was seen on MRI. Conclusion: Cervical spondylosis is the most common cause of neck pain in our environment. MRI obviates the need for a barrage of investigations and threshold should be lowered where the modality is available and in the appropriate clinical setting.

Background: Female circumcision (FC) is still common in many developing countries including Nigeria despite its adverse health consequences. It is performed on women and young girls. This study examined the current awareness and practice of FC in northwestern Nigeria. Patients and Methods: This cross-sectional study was conducted among mothers at a paediatrics department of a tertiary hospital in Kano, northwestern Nigeria. A questionnaire seeking information on the awareness and practice of FC was administered to selected mothers by the researcher. The data was analyzed. Results: Awareness of FC was 93.6% among 234 mothers enrolled in the study. It was practiced by 135 (67.2%) of 201 mothers who had at least one daughter, and only 10.4% of them believed FC was harmful. It was decided by fathers (82.2%), done on babies in the first 7 days (95.6%), by traditional barber (97.0%) and at home (97.8%). Culture was the main reason (69.6%) for performing FC. Conclusion: FC is still commonly practiced. Knowledge of its adverse effects is scanty. More awareness campaigns and effective legislations are needed to curtail this harmful practice.

Context: Neonatal jaundice (NNJ) is a common cause of neonatal morbidity and mortality in sub-Saharan Africa. Fundamental to its successful management is the role of mothers and/caregivers in the care of the newborn. Maternal knowledge about NNJ partly determines the extent to which this role is effectively discharged. To assess the influence of educational instruction about NNJ on recipient mothers' knowledge of and ability to detect NNJ. Settings and Design: This was a postintervention cross-sectional comparative analysis. Patients and Methods: A postintervention cross-sectional comparative study involving mothers accessing immunization services at a tertiary health care facility in northwestern Nigeria was conducted. Two hundred and thirty-nine mothers were interviewed to determine their knowledge of and ability to detect jaundice in newborns. Comparison of knowledge about jaundice was made between categories of mothers who had earlier received educational instructions on NNJ and those who did not. This study was approved by the Health Research and Ethics Committee of the Ahmadu Bello University Teaching Hospital Zaria. Statistical Analysis Used: Information obtained was entered and analyzed using SPSS version 20. Results: The majority (74.1%) of mothers received instruction and education on NNJ during pregnancy all of whom attended antenatal care (ANC) in the tertiary facility. Most respondents (91.6%) were aware of NNJ while only 73.6% gave the appropriate definition of neonatal jaundice of which 82.8% were those who received educational instruction on NNJ during ANC. The degree of knowledge on NNJ was significantly correlated positively with receiving NNJ educational instruction (P = <0.001) and with social class P = 0.001. Conclusions: Receiving educational instruction on NNJ positively influenced mothers' knowledge of causes, signs of severity, identification, treatment, and complications of NNJ.

Background: Facilities for neonatal respiratory support are not available in many centres in developing countries, and hence, there is a need to recognize and prevent the predisposing factors to respiratory distress (RD) among high-risk neonates. This study sets out to determine the prevalence, severity, etiological, and risk factors as well as outcome of babies with RD at the Wesley Guild Hospital (WGH), Ilesa, Nigeria. Materials and Methods: Neonates admitted to the Special Care Baby Unit of the hospital were consecutively recruited into a prospective observational study over a 10-month period. History, examination, and investigation findings were compared among babies with and without RD at presentation. Results: The ages at presentation of the 428 babies ranged from 20 minutes to 25 days [Median (IQR) of 4.0 (1.0–35.0) hours]; male:female 1.4:1 and 32.5% were preterms. Two hundred and fifty (58.4%) had RD, and the major identifiable causes were asphyxia (53.6%), sepsis (24.0%), respiratory distress syndrome (16.4%), and transient tachypnoea of the newborn (10.0%). Lack of antenatal care, low birth weight/preterm delivery, primiparity, and delivery in private hospitals were risk factors to having RD. The presence of RD was associated with hypoxemia, increased mortality (17.2% vs. 4.5%), and length of hospitalization among the babies (P < 0.001). Conclusion: RD is a common presentation among ill neonates and is associated with prolonged hospitalization and death. Many of its predisposing factors are, however, preventable. Making essential obstetric and neonatal care available and affordable will reduce the burden associated with neonatal RD in developing countries.

Aim: To analyze the psychosocial impact of orofacial cleft child on the parents in Kano, North Western Nigeria. Material and Methods: We interviewed 150 parents of patients with orofacial clefts using Interviewer Administered Questionnaire (IAQ) from June to December 2012 for mood state, family stress coping strategy, and impact of cleft on parents using POMS-SF, FSCQ, PICP-Q questionnaire, respectively. Results: Age range of parents was 15–65 years (F: M = 7.3:1); the parents in the 2^nd decade formed the largest group (44.7%) followed by the parents in the 3^rd decade (36.7%). Following POMS-SF rating, 89.3% of the respondent had good mood, 3.3% had fair mood, while 7.3% had poor mood. Most of the parents (97.3%) were able to cope with the stress of caring for a cleft child. Stress among the parents of children having bilateral cleft was higher than unilateral cleft but not statistically significant. Also, the stress felt by the parents having children with severe cleft was higher than mild-moderate cleft though not statistically significant. The mood state of the parent that had children with either unilateral or bilateral clefts were similar, while there was no statistically significant difference in the mood of parents of children that had mild-moderate or severe cleft. Conclusion: Through this study, we corroborated that the psychosocial impact of orofacial cleft is not easy to define and quantify. The most important concern among the parents in all these categories was surgical correction for their wards.

Introduction: Previous studies have shown that medical students globally experience various degrees of psychopathologies such as depression, anxiety, and stress while in medical school. Objective: This study aimed at assessing the symptoms of depression, anxiety, and stress in a sample of Nigerian medical students. Materials and Methods: A cross-sectional and descriptive design was adopted for this study. A total of 240 medical students from the second to sixth years studying at the Lagos State University College of Medicine, Lagos, Nigeria were invited to participate in the study. They completed a proforma form that collected their sociodemographic variables and short version of the Depression Anxiety and Stress Scale. Results: A total of 240 medical students participated in the study. The age range was between 25 and 34 years, (mean 25 years; SD = 4.5); 120 (50%) were females and only 9 (3.75%) were married while a large majority of the participants 229 (95.4%) were single. A small number of the participants 9 (3.8%) and 34 (14.2%) smoked cigarettes and consumed alcohol, respectively. The DASS analysis showed that 15 (6.3%), 23 (9.5%), and 148 (61.6%) experienced symptoms of depression, anxiety, and stress, respectively. Conclusion: The study demonstrated that Nigerian medical students also manifested with various symptoms of psychopathology. Nigerian medical students should be taught stress and change management strategies to assist them to cope with the stressful nature of medical training.

Background: Post stroke depression (PSD) is a common neuropsychiatric mood disorder believed to be under-diagnosed among stroke survivors. Objective: The aim of this study was to determine the prevalence and severity of PSD among stroke survivors in north-eastern Nigeria. Materials and Methods: A purposive sample of stroke survivors (N = 249) in six tertiary health institutions in north-eastern Nigeria completed a three-part survey. Part 1 elicited sociodemographic information and part 2 was a Patient Health Questionnaire-9, utilized to identify the presence of PSD and its severity, while part 3 was Barthel Index utilized to determine the level of independence of participants. Chi-square test was used to determine the difference in prevalence of PSD between gender, different occupational statuses, living conditions, previous history of stroke, and side of hemispheric lesion. Pearson product moment correlation coefficient was used to determine the relationship between depression and age, duration of stroke, and level of independence. Results: An overwhelming majority of the participants (93.6%) were depressed; females tend to be more depressed (P < 0.05) than males. Significant correlation was observed between age and level of independence and PSD (r = −0.157, P = 0.013 and r = 0.345, P < 0.001, respectively). However, there was no significant correlation between the duration of stroke and PSD (r = −0.111, P = 0.079). Conclusion: This study revealed a high prevalence of PSD in the study region with females being more at risk. Further, increase in age and decreased level of independence correlated with PSD.

Introduction: Senna occidentalis is a medicinal plant which is called “rai–rai” or “rai dorai” in Hausa. It is among the most commonly used plants that form the basis of primary healthcare for a majority of people living in rural and remote areas in Nigeria and other third world countries. Hyperlipidemia is a condition which is characterized by elevated levels of serum lipid profile. It is associated with many diseases such as atherosclerosis, cardiovascular diseases, and diabetes. Aims and Objectives: This study was aimed at assessing the effect of oral administration of aqueous leaf extract of S. occidentalis on serum lipid profile in rats. Materials and Methods: Phytochemical screening and effect of aqueous leaf extract of S. occidentalis on lipid profile was conducted. Thirty male albino rats were divided into six groups of 5 rats each. Group I was normal control, group II hyperlipidemic control, groups III, IV, and V were hyperlipidemic rats orally administered with 500 mg/kg, 250 mg/kg, and 166 mg/kg of aqueous leaf extract of S. occidentalis, respectively, for 4 weeks, and group VI were hyperlipidemic rats orally administered with 10 mg/kg of ruvastatin for 4 weeks. At the end of the fourth week, the animals were sacrificed and their serum total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), and low density lipoprotein (LDL) levels were determined. Results: Results of phytochemical screening revealed the presence of tannins, saponins, cardiac glycosides, resins, and flavonoids. Significant (P < 0.05) increase in the serum TC, TG, and LDL-chol were observed in groups II, III, IV, V, and VI when compared with that of the control rats. Significant (P < 0.05) decrease in mean serum TG, TC and LDL-chol levels were found in rats orally administered with 500 mg/kg of aqueous leaf extract of S. occidentalis and those orally administered with 10 mg/kg of rosuvastatin when compared with group II. Rats orally administered with 250 mg/kg of the aqueous leaf extract were found to have significantly lower (P < 0.05) mean serum TC and LDL-chol when compared with that of group II (test control). Conclusion: It could be suggested that aqueous leaf extract of S. occidentalis at 500 mg/kg could cause antihyperlipidemic effect against dietary-induced hyperlipidemia.

Introduction: The pattern of morbidity and mortality varies from region to region and reflects the burden of disease in a particular community. The knowledge of the pattern of diseases and their contribution to mortality in a given country is very important in evaluating its health care delivery system. This study determined the mortality pattern in the medical wards of Murtala Muhammad Specialist Hospital (MMSH), a tertiary health institution in North-western Nigeria. Materials and Methods: This is a retrospective study that reviewed the causes of death in the medical wards of the hospital between January 2013 and December 2015 (3 years). The admission and discharge registers of the medical wards between the stated period were retrieved and relevant data were reviewed and analyzed using Statistical Package for the Social Sciences version 19 software. Results: A total of 4834 patients admitted into the medical wards within the study period were analyzed. Of these, 3465 (71.7%) were discharged, referred, or discharged against medical advice and 1368 patients died, giving an overall mortality rate of 28.3%. The male to female admission ratio was 1.1:1, while the male to female death ratio was 1.5:1. Majority of deaths, 116 (81.7%), occurred after 24 h of admission. The most important causes of death were cerebrovascular disease (34.4%), sepsis (12.1%), congestive heart failure (11.6%), diabetes mellitus-related complications (8.9%), and chronic liver disease (8.6%). Conclusions: Mortality in the medical wards reflects the shift in the disease spectrum burden from communicable to noncommunicable diseases. Public health education, raising the socioeconomic status of our people as well as improving the standards of our health care facilities and personnel would prevent a large proportion of deaths from medical wards.

Background: Pityriasis rosea (PR) is an acute self-limiting papulo-squamous skin disorder commonly observed in otherwise healthy children and young adults. Objective: To describe the clinical pattern of PR in Kano, Northwest Nigeria. Materials and Methods: This was a descriptive cross-sectional study that was carried out between June 2010 and May 2011 among out-patients attending three dermatology clinics in Kano, Nigeria. Patients with rashes that met the clinical diagnostic criteria of PR were recruited and followed up until there was resolution of lesions. The demographic characteristics of the patients were recorded along with the clinical manifestations of the lesions. All the data obtained were analysed using SPSS for Windows. Results: Out of 1,528 patients seen over the 12 months study period, 56 patients had PR out of which 23 (41.1%) were males and 33 (58.9%) were females, giving a male:female ratio of 1:1.4. PR, therefore, accounted for 3.6% of all dermatology out-patient visits in Kano. The patients' ages ranged from 6 years to 55 years with most of them in the age range of 11–20 years. The peak month of incidence was January in which about a quarter (21%) of the patients were seen. Only 5 (8.9%) patients had prodromal symptoms preceding the onset of the rash. Herald patch, which was mainly located on the trunk, was present in 45 (80%) of the studied patients. Secondary eruptions appeared within 7 days after the herald patch in 69% and had a typical Christmas tree pattern of distribution along the line of skin cleavage in 70% of the patients. Approximately three-quarter (73 %) of the patients had complete resolution of the rash by the 4^th week. Recurrence was not reported 24 weeks after the last patient was seen. Conclusion: The pattern of presentation of PR was not different from that observed by other researchers. However, contrary to earlier reports from south Nigeria, our study shows that PR occurs more frequently during the cold dry season.

Background: Although vaccines currently approved for routine childhood immunization are safe and effective, frequent adverse events following immunization (AEFI) often cause ill-health and sometimes loss of public trust in immunization programs. This study assessed the level of knowledge, perception, and reporting attitude of primary healthcare (PHC) workers of AEFI in Sabon Gari local government area of Kaduna state. Materials and Methods: A descriptive cross-sectional survey using simple random sample method was used to select 110 PHC workers. Data were analyzed using IBM Statistical Package for the Social Sciences version 21. Results: Majority (92.2%) knew about AEFI and over 80% of the healthcare workers had been trained on AEFI and knew signs and symptoms of AEFI. More than 50% of respondents had good knowledge on AEFI but only 17.8% had good reporting practices. Sixty-six percent of healthcare workers had encountered an AEFI and 56.7% had ever reported an AEFI. There was a statistically significant relationship between age of healthcare workers (P = 0.001), previous training (P = 0.036), working experience (P = 0.001), and knowledge on AEFIs. Conclusion: The study revealed that PHC workers had good knowledge, perception, and reporting attitude toward AEFI surveillance. There is a need for training and retraining of staff as well as provision of internet access to ease electronic reporting system of AEFI surveillance.

Background: Job satisfaction has been associated with lots of benefits. The provision of health services depends on several factors but the availability and retention of human resources is particularly important. This study aims to determine job satisfaction among healthcare workers in a tertiary hospital in Kano and find if there are any, determining or related factors. Materials and Methods: This was a cross-sectional study conducted between May and June, 2017 on health workers working at a tertiary hospital in Kano, Nigeria. A modified closed-ended self-administered job satisfaction survey questionnaire was used. Data collected were analyzed with IBM Statistical Package for the Social Sciences, version 21 Windows statistical software. Results: The participants' ages ranged from 18 to 62 years with a mean age of 38.94 ± 8.07 years. There were 119 (74.4%) males and 41 (25.4%) females with a male/female (M:F) ratio of 3:1 (χ² = 19.415; P= 0.000). Overall, out of the 157 (98.1%) of the participants that responded to the job satisfaction question, 142 (90.4%) indicated they were satisfied with their jobs and 15 (9.6%) were dissatisfied. Satisfaction based on sociodemographic variables showed that there were no significant associations between them. There were also no significant associations between the professional categories, years in service, monthly salary, job schedule of the participants, and job satisfaction. The main reasons for job satisfaction were monetary and service to humanity. Conclusion: Majority of health workers in Kano were highly satisfied with their jobs because of the need to serve and also for the income.

Introduction: Conjoined twins are abnormalities of twinning in which two individuals are incompletely separated. Conjoined twins can be symmetric or asymmetric and continue to raise significant ethical and legal arguments, resulting in much pressure on the managing teams and hospitals. Patients and Methods: We report 4 cases of conjoined twins, an ischiophagus dipus, pygophagus, thoracoomphalophagus tetrapus, and a parasitic twin tripus. All cases had no prenatal diagnosis and were delivered via spontaneous vaginal delivery. The pygophagus tetrapus was separated and a mortality of 50% was recorded in the immediate post separation period; the surviving twin is 8 years old and doing well. Two were lost due to severe birth trauma, and the last was lost to overwhelming from an infected gluteal congenital defect. Results and Discussion: Conjoined twins are one of the most fascinating congenital malformations not only to the medical practitioners but to communities and general public also. To our knowledge, as of 2012, only 15 cases have been reported from Nigeria. The incidence is 1:50,000–1:100,000 births. Females are affected more frequently than males by a ratio of 3:1. Separation of conjoined twins is a complicated procedure. The importance of a multidisciplinary team approach with several rehearsals of all aspects (surgical, anesthetic intensive care, transfer from the theatre to intensive care unit, and nursing) of the operative procedure cannot be overemphasized. Conclusion: Conjoined twins are one of the most fascinating congenital malformations. Early prenatal diagnosis, antenatal care, choice of mode of delivery, thorough assessment of the extent of shared organs to guide decisions on surgical separation, adequate planning, and rehearsals can reduce morbidity and mortality in these patients. In our series, all pregnancies and deliveries were unsupervised leading to poor outcome.

Background: Otapiapia is a locally prepared insecticide composed of varying strengths of an organophosphate and kerosene. It has been occasionally associated with accidental poisoning. However, there is paucity of data on autopsy findings in pediatric deaths related to organophosphate poisoning, including otapiapia. This report of autopsy findings aims to provide valuable information in these cases and suggest ways to better manage them when they present clinically. Materials and Methods: This is a review of autopsy findings of pediatric cases of accidental poisoning with otapiapia between 2008 and 2016 in a tertiary institution in northwestern Nigeria. Results: Seven cases of otapiapia-related deaths were autopsied during the period reviewed, 4 of which were accidental while infanticide was suspected in the remaining 3. The most common autopsy findings were diffuse alveolar damage followed by cerebral edema and acute tubular necrosis in the kidneys. Conclusion: In cases of otapiapia poisoning that survive to reach medical attention, priority attention should be given to airway and fluid management.

Vesicouterine fistula is a rare urogynecological fistula, usually iatrogenic following lower uterine segment cesarean section. The clinical features of cyclical hematuria, amenorrhea, and urinary continence, Youssef's syndrome, were first reported in the literature in 1957, among patients with vesicouterine fistula. The case reported was a 36-year-old multipara who had two previous lower segment cesarean sections and presented with amenorrhea and menouria. Hysterosalpingography confirmed the diagnosis. The fistula was repaired following the transabdominal surgery. She regained normal vaginal menses.