The incidence of diabetes globally is reaching an epidemic proportion and with it carries the risk of complications and diabetic foot disease inclusive. The pathophysiology of diabetic foot disease is multifactorial and includes neuropathy, infection, ischaemia and abnormal foot structure and biomechanics. Early recognition of the aetiology of these lesions is important for good functional outcome. Managing the diabetic foot is a complex clinical problem requiring a multidisciplinary collaboration of health care workers to achieve limb salvage. Adequate off-loading, frequent debridement, moist wound care, treatment of infection and revascularisation of ischaemic limbs are the mainstays of treatment. Even with proper management, some of the foot ulcers do not heal and are arrested in a state of chronic inflammation. These wounds can frequently benefit from various adjuvants, such as aggressive debridement, growth factors, bioactive skin equivalents and negative pressure wound therapy. We reviewed current literature including original and review articles obtained through a search of PubMed database, Medline, Google scholar and hand searching of bibliographies of published articles using the keywords: Diabetes, diabetic foot, neuropathy, peripheral arterial disease and ulceration. The enormity of the challenges associated with the management of this important complication of diabetes, coupled with the various progresses being made in this area, and the need to streamline the principles of management, especially in our environment prompted us to review this subject matter.

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Background: The academic and psychological demands of undergraduate medical education may result in high-stress levels among students. High stress has been associated with poor academic performance, negative impact on physical and mental health. This study aims to determine the prevalence of stress among undergraduate clinical students of Bayero University Kano Medical School. Materials and Methods: This was a cross sectional study conducted among 224 clinical medical students from levels 400–600. The Cohen's Perceived stress scale (PSS-10) was used to assess the severity of among the students. The Chi-square test was used to determine associations and a significant association was considered at P < 0.05. Results: A prevalence of high stress of 59.8% was observed with a mean PSS score of 20.76 ± 5.58. The highest mean score of 22.29 ± 5.58 was observed among 400 level clinical students. There was no significant difference between both genders. A significantly higher proportion of students undergoing medicine, pathology, paediatrics and surgery postings were observed to be experiencing a higher level of perceived stress compared to those in Obstetrics and Gynaecology, (χ² = 1617, df = 4, P < 0.05). Similarly, a higher proportion of students whose fathers are educated had a significantly higher stress compared to their counterparts from uneducated backgrounds, (χ² = 5.54, df = 1, P < 0.05). Conclusion: Further studies to determine the causes of stress need to be carried out. This will assist the students and teachers to appropriately manage stress.

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Background: Uterine fibroid is one of the most common pelvic tumours of the female genital tract. Surgery offers long-term relief of symptoms but is associated with complications, hence, the aversion for it in our environment. Therefore, understanding the factors associated with the complications will help to reduce morbidity and mortality. Objective: To determine the surgical options, socio-demographic characteristics, clinical presentations and post-operative complications associated with uterine fibroids at Aminu Kano Teaching Hospital, Kano. Methods: A retrospective review of case notes of 132 surgically managed cases of uterine fibroids at Aminu Kano Teaching Hospital over the study period. Results: Surgical operations for uterine fibroids constituted 21.4% of all gynaecological operations. Most of the cases were seen in 30–39 age group (41.5%) and 51.2% of them were nulliparous. Menorrhagia (53.7%), infertility (26.3%) and abdominal swelling (40.4%) were the common presenting symptoms. Myomectomy was performed in 75.6% of the cases while abdominal hysterectomy accounted for 24.6% of cases. Anaemia was the most common post-operative complication seen in this study (31.7%). Conclusion: Uterine fibroid is common in our environment. The main-stay of management of uterine fibroid is surgery which is associated with post-operative complications. The surgical options used in the management of uterine fibroids in this study were hysterectomy and myomectomy due to lack of requisite skills for the more technical procedures. Improvements in surgical skill will help reduce the frequency and severity of the complications.

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Background/Objectives: Respiratory papillomatosis (RP), which most often affects the larynx, is a relatively rare benign disease that can, however, have an aggressive clinical course. This study aimed to review the outcome of the patients treated for recurrent RP at Aminu Kano Teaching Hospital and the factors associated with the outcome. Materials and Methods: The records of patients managed for laryngeal papillomatosis at the Department of Otorhinolaryngology, Aminu Kano Teaching Hospital, Kano, Nigeria, over a period of 10 years between January 2004 and December 2013 were reviewed. Information obtained from the case files included demographic characteristics and clinical information. The data obtained were analysed using Statistical Package for Social Science version 16. Results: A total of 31 patients with recurrent RP were seen. Among these, 16 (51.6%) were males and 15 (48.4%) were females with sex ratio (M: F) of 1.1:1. The mean age was 11.7 years with standard deviation of ± 1.26. The main presenting symptoms were hoarseness in all patients and difficulty in breathing in 9 (29%). Patients who had the onset of symptoms between 6 and 10 years of age constituted the majority, 17 (54.8%). Only one patient had a solitary lesion on laryngoscopy, the majority had multiple papillomatous lesions, 30 (97.8%). Emergency tracheostomy was performed to relieve upper airway obstruction in 10 (32.3%). Twenty-seven of the patients constituting 87.1% had 1–3 surgical extirpations while 4 (12.9%) had surgery between 4 and 6 times. The voice outcome was mostly poor among the patients post-surgery, 27 (87.1%). Majority of the patients were lost to follow-up, 21 (67.7%), with 1 (3.2%) recorded death and 9 (29%) still on follow-up. Conclusion: There appears to be a limited success in the outcome of our patients managed for recurrent RP. However, early diagnosis and avoidance of tracheostomy where possible are factors that may improve the outcome.

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Introduction: In the last two decades sonography has become the most important imaging modality for the study of the spleen. Different studies have been conducted in different parts of the world so as to determine the normal reference values of splenic dimension using ultrasound scan in healthy adults, and the values obtained have been diverse, thus prompting more work that tends to establish normal values for different regions based on geographic and racial differences. Materials and Methods: A prospective study of normal spleen dimensions using ultrasound in 400 Nigerian adults at Aminu Kano Teaching Hospital was conducted. Sonographic measurement of splenic dimensions was performed with the patient in supine and right lateral decubitus position. Height and weight were measured using the standard anthropometric technique. The data were analysed using computer-based SPSS Version 16.0 software for Windows (SPSS Inc., Chicago, IL, USA). Results: There were 212 males and 188 females, their age ranged between 20 and 70 years. The mean age of the subjects and (±standard deviation) were 33.0 years (±12.0), mean height was 1.64 m (±0.1) and mean weight was 61.4 kg (±11.0). The mean splenic length, width and depth for the subjects studied were 101.6 mm (±13.7), 46.8 mm (±8.2), and 86.8 mm (±12.7), respectively. Conclusion: The mean spleen dimensions obtained in this study were similar to those obtained in other regions of Nigeria but slightly lower than those reported from studies among Caucasians confirming the need for normal values for each region. There was positive correlation between subjects height and weight with splenic length (P < 0.001 and P < 0.001), depth (P < 0.01 and P < 0.001) and width (P < 0.01 and P < 0.001).

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Background: Cancer of the vulva is a rare gynaecological condition and contributes to about 2.6% of gynaecological malignancies seen in our unit. The prevalence is on the increase and late presentation calls for concern. Objectives: To review the epidemiology of cancer of the vulva within the study period in view of the changing pattern. Methodology: This is a retrospective study of histologically diagnosed vulva cancers seen in our unit between March 2005 and February 2015. The records of the patients were retrieved from our Gynea-oncology register, the Health Management Information Department of the Hospital, cancer registry and the histopathology laboratory. Descriptive statistics were used under excel statistical package to analyse the findings using rates, ratio and proportion. Results: We had a total of 1089 gynaecological malignancies and carcinoma of the vulva accounting for 28 (2.6%) patients. Their ages ranged from 13 to 75 years with a mean of 47 years; parity was 0–14 deliveries with a median of 7 and a mean of 4. Most of the patients were of low socioeconomic class. Eight of the nine patients (88.9%) were managed surgically. Majority of the cases had radical/toilet vulvectomy with inguino-femoral lymphadenectomy and adjuvant radiotherapy because they all presented in the advance stage. The complications included one case of inguinal wound disruption and one case of wound sepsis. There were no deaths. The histological types of cancer of the vulva seen were mainly squamous cell cancer accounting for (22) 78.6%. Others include adenocarcinoma accounted for (3) 10.7%, (2) (7.1%) cases of malignant melanoma and embryonal rhabdomyosarcoma (1) 3.6%. Conclusion: What we see may only be the tip of the iceberg since these old women tend to hide their lesions. The treatment of this disease can be highly successful if only our patients present early and would be able to afford the cost of care.

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Background: Diabetes mellitus (DM) patients are often referred to tertiary care centre after prior management in a primary or secondary health centre. Data on newly diagnosed DM are few in our locality. Objective: To determine the clinical and biochemical characteristics of newly diagnosed DM. Subjects and Methods: The present study was a retrospective study of newly diagnosed DM patients seen at a tertiary hospital in Nigeria. Data on patient's age, sex, body mass index (BMI), waist circumference, blood pressure, fasting plasma glucose and fasting lipid profile were retrieved and extracted from their medical records. Results: One hundred and thirty patients with DM were recruited in the study. Seventy-nine (60.8%) diabetic subjects were females. The mean ± standard deviation age of all the diabetic subjects was 55.09 ± 12.56 years. Obesity and hypertension were found in 34 (26.2%) and 50 (38.5%) of the diabetics, respectively. Female diabetic patients had significantly larger mean BMI than that of the male diabetics. High-density lipoprotein cholesterol dyslipidaemia, low-density lipoprotein-cholesterol dyslipidaemia, serum total cholesterol dyslipidaemia and triglyceride dyslipidaemia were found in 38 (29.2%), 35 (26.9%), 17 (13.1%) and 12 (9.2%) of diabetics, respectively. Conclusion: Hypertension, obesity and dyslipidaemia are common features in persons with newly diagnosed DM.

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Background: Quantitative assessment of gallbladder volume (GBV) is an important tool for evaluating many pathologic conditions affecting the gallbladder (GB). Therefore, there is need to establish a baseline sonographic normogram of GBV in our locality for early detection and follow-up of subjects that may develop GB diseases. Objective: To determine the mean and range of fasting GBV and to assess the relationship between GBV and age, sex, and body mass index (BMI). Methodology: The study was a cross-sectional prospective study conducted at the Aminu Kano Teaching Hospital, Kano, North-Western Nigeria. Four hundred healthy adults aged 18–60 years were recruited for the study. Subjects were scanned using Esaote MyLab 40 (Italy) ultrasound and a 3.5 MHz curvilinear transducer after 6–8 h fasting. Scanning was done in supine and right anterior oblique positions. The length, height and width of the GB were obtained and the volume (cm ³) calculated using the ellipsoid formula. The height and weight of the subjects were measured and their respective BMI calculated. Results: There were 238 males (59.5%) and 162 (40.5%) females, with an age range between 18 and 60 years and mean age of 35.6 years (±12.9). The mean fasting GBV was 24.2 cm ³ (±8.4 cm ³), with a volume range of 11.1–50.9 cm ³. The mean BMI was 23.75 Kg/m ² (±8.25). GBV was found to be significantly larger in males compared to females (P = 0.043); larger in older individuals (P = 0.000); and larger in those with higher BMI (P = 0.000). Conclusion: The study has established a mean fasting GBV of 24.2 cm ³ among healthy adults in Kano, North-Western Nigeria. This mean showed positive correlation and variation with age, sex and BMI. The values obtained in this study are comparable with values from other geo-political zones in Nigeria and other parts of the world.

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Objective: The study was aimed at evaluating the body composition of type-2 diabetes mellitus (T2DM) patients using bioelectric impedance analysis (BIA) technique and comparing their findings with age and sex-matched healthy volunteers. Materials and Methods: One hundred T2DM patients and 100 age and sex-matched controls were recruited in the study. Body composition was measured using BIA system (Tanita BC-554 Tanita Corporation, Tokyo, Japan), the data obtained from the body composition analyser included weight, fat %, fat mass, total body water, muscle mass, basal metabolic rate, bone mass, visceral fat (VF), body mass index and physique rating. Results: A total of 100 T2DM patients, who were matched with 100 of the healthy volunteers by age and sex, comprised 58% males and 42% females in each group. Their mean age was 49 years ± 19 years. The average duration of T2DM was 2.32 ± 0.83 years. The median fat composition was 41.1% in diabetic subjects and 30.5% in control (P = 0.0024). The median body water composition was 45.4% in diabetic subjects and 49.3% in control (P = 0.2106). The median muscle composition was 43.0% in diabetic subjects and 44.7% in control (P = 0.8859). The median physique rate was 4 in diabetic subjects and 2 in control (P = 0.0016). The median basal metabolic rate was 1389 in diabetic subjects and 1430 in control (P = 0.8648). The median metabolic age was 45 in diabetic subjects and 48 in control (P = 0.9143). The median bone component was 2.4 in diabetic subjects and 2.4 in control (P = 0.0922). The median VF component was 12% in diabetic subjects and 6% in control (P = 0.0016). Conclusion: Bioimpedance analyses of body composition showed that T2DM patients have significantly higher body fat, VF and physique rate compared with age and sex-matched healthy controls.

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Objective: To evaluate the oral health practices and perception of student nurses in Benin City. Subjects and Methods: A descriptive, cross-sectional survey using a pre-tested self-administered questionnaire with closed-ended questions to collect the data from 1^st-year students of dental nurses, basic and perioperative student nurses in Benin City. Data were analysed using the Statistical Package for the Social Sciences version 16.0 with P < 0.05 was considered significant. Results: One hundred and thirty questionnaires were distributed with 112 returned giving a response rate of 86.1%. The participants consisted of three categories of nurses with age range 18–48 years. The mean age of participants was 28.7 years (standard deviation [SD] ±6.80) with those of dental nurses, basic and perioperative nursing students being 23.5 years (SD ± 2.36), 25.2 years (SD ± 3.36) and 36.6 years (SD ± 4.76), respectively. About 80.4% reported always using a toothbrush and fluoride paste out of which the basic student nurses (43%) reported the highest frequency. More than half of the participants (53.6%) brushed their teeth daily, and 76.8% reported taking snacks occasionally. Furthermore, 55.4% had never visited the dentist, with 18.8% visiting within the last 6 months preceding the study and only about a fifth (19.6%) visited for a check-up and 54.5% for scaling and polishing. Furthermore, 41.1% reported having fair oral hygiene. Conclusions: Oral hygiene practices and dental attendance of the student nurses require improvement. Primary oral health should be emphasised in the nursing curriculum, with training in oral examination.

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Introduction: Patient seeks medical treatment abroad for several reasons. It may be due to lack of expertise or lack of adequate equipment to handle the ailment in the country of abode. However, some may be due to social reasons or due to privileges that come with some social status and position. The study is justified by the need to high light some of the problems encountered by patients after treatment abroad. Materials and Methods: The case notes of three patients seen at the orthopaedic outpatient clinic were retrospectively reviewed. These patients had initially presented with different clinical problems. Data on their clinical history, examinations, investigations and treatment were extracted from their case note. Result: The first patient is a 53-year-old civil servant with clinical and radiological evidence of L4–L5 and L5–S1 disc degeneration with prolapse and neuropathy. He was cancelled for decompression and fusion. He opted to travel abroad for treatment. He represented few months later with the same complaint despite surgical treatment abroad. He had no physical evidence of what procedure was done. A second patient is a 68-year-old man with multilevel disc prolapsed and associated lumbar the canal stenosis. He was given the option of decompression with fusion. He opted to travel abroad, where he had L2–L5 laminectomy with pedicle screw stabilisation spanning three levels using four screws and two rods. His symptoms persisted despite procedure. He had evidence of the wrong choice of procedure. He is presently on conservative management as he does not want surgery. The third patient is a 50-year-old politician who presented with a painful gluteal swelling. She had transforaminal lumbar interbody fusion at L4–L5 with L2–S1 and laminectomy with L2–S1 pedicle screw stabilisation done abroad about 1 year before presentation. The indication being L4–L5 spondylolisthesis with L2–S1 multilevel disc prolapsed. She was found to have dislodged migrated rod. The rod was surgically extracted. Discussions and Conclusion: The First patient had the wrong/suboptimal procedure done to him. As such, he continued to have persistent pain. He cannot afford to go for appropriate procedure abroad. He is being planned for decompression and fusion. The second patient had suboptimal procedure. His pain continued. He could not afford to go for follow-up and re-evaluation. He also does not want any reoperation. He is now conservative management. The second patient had appropriate procedure done. However, she developed a technical complication which was not addressed appropriately. She had surgical extraction of the migrated rod and had done well.

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