Telemedicine and biomedical care in Africa: Prospects and challenges.

The use of information and communication technology for health care delivery, particularly in poor settings where access to medical services is inadequate, holds promise in expanding health care access. In rural or impoverished environment, where disease is prevalent, doctors are scarce, and health care infrastructure is inadequate, telemedicine holds a good prospect in improving the health conditions of the people. However, telemedical practice in Africa cannot be without challenges because some aspects are often difficult to implement in underdeveloped settings where ignorance and poverty are rife. Apart from nonavailability of facilities and poor communication, most Africans have different understanding of ailments, which often affect the health system. Considering the increasing disease burden in Africa and the need for tremendous progress in achieving the health component of the millennium development goals, telemedicine should be of concern to health policy makers. This paper critically examines the prospects and challenges of telemedical practice in Africa through a systematic review of 31 relevant publications which, in addition to the authors' knowledge and experience in biomedical care in Africa, supported the information as presented.

A comparative analysis of the level of cortisol and the number of teeth extracted among patients undergoing routine dental extraction.

BACKGROUND AND OBJECTIVE: A postextraction comparative (cohort) study was carried out to determine whether the number of teeth extracted has an effect on salivary cortisol and by extension on stress. SUBJECTS AND METHODS: Sixty-three consecutive patients comprising 27 males (42.9%) and 36 females (57.1%) with a male: female ratio of 1:1.3, divided into two groups of A and B with a mean age of 25.8 ± 4.9 years, and age range of 18-37 years took part in the study. Fifty (79.4%) of them in group A (22 males and 28 females) each had a tooth extracted while 13 (20.6%) in group B (5 males and 8 females) had two teeth removed. One ml of resting saliva was collected from each patient 10 minutes after the procedure and analyzed for cortisol. All extractions and sample collections were done between 10 am and 2 pm to standardize the study and control for the diurnal variation of cortisol. Statistical analysis of the generated data was performed by using Student's t-test on SPSS version 17.0. The level of significance was set at 0.05 with P< 0.05 regarded significant. RESULT: The result showed mean salivary cortisol level of 12.914 ± 2.4684 ng/ml for group A and 12.108 ± 1.7192 ng/ml for group B though not statistically significant (P > 0.05). Females had more extractions in the two groups when compared with males. Male gender had a statistical significance difference (P < 0.05). CONCLUSION: This study shows that the number of teeth extracted did not have effect on mean salivary cortisol, as a result two teeth extraction does not impart more stress to the patient when compared with one, and as such no additional adjuvant stress relieving measures are needed in two teeth extractions.

Clinical characteristics and presentation of ameloblastomas: an 8-year retrospective study of 240 cases in Eastern Nigeria.

Our aim was to summarise the clinical characteristics and presentation of ameloblastomas in eastern Nigeria. We organised a retrospective study of 240 patients who presented with ameloblastomas to the Oral and Maxillofacial Surgery units of five specialist hospitals in the eastern states of Nigeria over an eight-year period (2004-2011). We analysed the casenotes, and categorised the cases by site of tumour, age, sex, and time of presentation. There were 117 men (49%) (mean (SD) age 43 (6.2) years) and 123 women (51%) (mean (SD) age 32 (4.7) years), a male:female ratio of 1:1.1. The largest age group was 20-39 years (n=102, 43%), and the most common site was the anterior mandible (n=140, 58%). Most of the patients presented late. Our results show that the most common site of ameloblastomas in Eastern Nigeria is the anterior mandible and that women are affected more than men, which is at variance with the results of most other studies.

Ethics of palliative care in late-stage cancer management and end-of-life issues in a depressed economy.

The Hippocratic Oath has often been referred to as the ethical foundation of medical practice with the key restriction "cause no harm" which is also the principle of benevolence in bioethics. In medical profession, the Oath still exemplifies the key virtues of a doctor in its emphasis on the obligations toward the well-being of the individual patient. In management of end-stage cancer in a depressed economy such as Nigeria, we frequently encounter a wide range of ethical issues that arise in the provision of palliative care mostly due to the prevailing economic situation and cultural setting. Since most of these patients came from a lower economic class of the society, with little or no formal education and lived at a subsistence level, they often find it difficult to provide the medications needed. In a poor setting where health inequity is rife, and ignorance and poverty are commonplace, a good understanding of medical ethics with a good model of health care system will contribute to the health professional's decision-making that will be in the best interest of the patients. Physicians must protect the lives of their patients and should never hasten their death. In end-stage cancer management, we have to relieve suffering and pains, promote palliative care, and give psychological support but never abandoning the patient or initiate terminating their life. This presentation is a clinical analysis of the ethical issues regarding the management of end-stage cancer patients in a poor economy with a critical overview of end-of-life issues in African perspective.

Medical incidents in developing countries: A few case studies from Nigeria.

The moral worth of a clinician's, action in patients' management depends exclusively on the moral acceptability of the rule of obligation to duty on which the clinician acts. Since every rational being thinks of him or herself as an end, all people must act in such a way that they treat humanity, whether in their own person or in the person of another, always as an end and never simply as a means. A duty of care is, therefore, paramount in the relationship between clinician and patient. While litigation in healthcare system is rapidly increasing globally, which affords individual explanation and compensation for perceived wrong diagnosis and treatment; it is still rudimentary in Nigeria. This default position has made most health care providers indifferent in the presence of gross clinical negligence and medical errors. Though most Nigerians may be aware of their rights to institute legal action in situations such as, negligence with serious harm or death, but, the socioeconomic factors, cultural, and religious notions among other reasons within the society often makes litigation impossible for an individual. Attributing every medical adverse event in the course of treatment as "God's Will" and the saying "It's God's Time" for every death among most African people has also become a great impediment to curbing clinical negligence in our environment. This paper presents a few case studies from author's experience and complaints from patients during clinical practice.

Clinical Evaluation of the Efficacy of Arthocare Forte, a Chondro-Protective and Anti-Arthritic Drug in the Management of Bacterial Plaque-Induced Chronic Periodontitis.

BACKGROUND: Arthocare forte medication is made up of different constituents and the advantages offered by this disposition have not been explored in the management of chronic periodontitis. AIM: The aim was to assess the clinical response of bacterial plaque-induced generalized chronic periodontitis to arthocare medication, and the relationship of age and gender to the prevalence of chronic periodontal disease. SUBJECTS AND METHODS: This study was done at the Dental Surgery Clinic of the University of Calabar Teaching Hospital, Nigeria. It was a Prospective randomized controlled trial evaluating the effect of arthocare treatment on 81/162 patients with teeth mobility over a period of 5 years. All the patients (162) underwent root planing, and 81/162 (50%) were treated with arthocare for comparative analysis. The variables recorded were patient's age, gender, and degree of tooth mobility, periodontal pocket, and bleeding from the pocket after treatment. Statistical analysis was done using EPI INFO 7. RESULTS: Majority of the patients were between 46 and 75 years in both control (n = 59/81, 72.8%) and experimental groups (n = 52/81, 64.2%). There were 86/162 (53.1%) males and 76/162 (46.9%) females, giving a male-to-female ratio of 1.1:1. Seventy-seven patients (95.1%) in the experimental group had total remission in comparison to 32/81 (39.5%) in control group which was statistically significant (P < 0.001). CONCLUSION: The arthocare administered to patients in the experimental group speeds up the regenerative capacity and stability of the periodontium when compared with the control. Multicentre clinical trials are recommended to validate the use of arthocare forte in the treatment of generalized chronic periodontitis.

Evaluation of cortisol concentrations in saliva as a measure of stress in patients having routine dental extractions.

We measured changes in the salivary concentrations of cortisol as an index of stress, and to find out if patients were stressed during routine intra-alveolar dental extractions. A total of 126 patients (63 experimental and 63 controls) matched for age and sex with a mean (SD) age of 26 (5) years (range 18-40) were recruited. Samples of saliva from patients whose glands had not been stimulated were collected twice from the study group (30minutes before, and 10minutes after, the procedure) and once from the control subjects. All samples were collected between 10.00 and 14.00hours to standardise the method and control for the diurnal variation of cortisol. There was a slight but not significant increase in the mean salivary concentration of cortisol between the preoperative samples (mean (SD) 12.3 (1.5)ng/ml and the postoperative samples 12.8 (2.3)ng/ml in the study group) and the control 8.7 (1.0)ng/ml. However, there was no difference between the sexes. The study highlights a simple but effective way of evaluating stress in patients having intra-alveolar dental extraction, and emphasises the invaluable role of salivary cortisol in the evaluation of stress (particularly in our environment).

Knowledge and utilization of computer-software for statistics among Nigerian dentists.

BACKGROUND: The use of computer soft ware for generation of statistic analysis has transformed health information and data to simplest form in the areas of access, storage, retrieval and analysis in the field of research. This survey therefore was carried out to assess the level of knowledge and utilization of computer software for statistical analysis among dental researchers in eastern Nigeria. METHOD: Questionnaires on the use of computer software for statistical analysis were randomly distributed to 65 practicing dental surgeons of above 5 years experience in the tertiary academic hospitals in eastern Nigeria. The focus was on: years of clinical experience; research work experience; knowledge and application of computer generated software for data processing and stastistical analysis. RESULT: Sixty-two (62/65; 95.4%) of these questionnaires were returned anonymously, which were used in our data analysis. Twenty-nine (29/62; 46.8%) respondents fall within those with 5-10 years of clinical experience out of which none has completed the specialist training programme. Practitioners with above 10 years clinical experiences were 33 (33/62; 53.2%) out of which 15 (15/33; 45.5%) are specialists representing 24.2% (15/62) of the total number of respondents. All the 15 specialists are actively involved in research activities and only five (5/15; 33.3%) can utilize software statistical analysis unaided. CONCLUSION: This study has i dentified poor utilization of computer software for statistic analysis among dental researchers in eastern Nigeria. This is strongly associated with lack of exposure on the use of these software early enough especially during the undergraduate training. This call for introduction of computer training programme in dental curriculum to enable practitioners develops the attitude of using computer software for their research.

Prognosis of teeth in the line of mandibular fracture: 5-year clinical and radiological follow-up.

OBJECTIVE: The purpose of this article is to highlight our experience with the prognosis of teeth retained in the line of mandibular fracture after treatment of the fracture. PATIENTS AND METHODS: A prospective evaluation of 62 patients with 200 teeth in the line of mandibular fracture seen and treated at the Dental and Maxillofacial Clinic, University of Calabar Teaching Hospital, Calabar south-south Nigeria between 2005 and 2009 was carried out. The focus was on 96 teeth in the line of mandibular fracture retained after reduction and immobilization of the fracture by closed reduction technique. The clinical and radiological follow-up period of patients ranged between six months and 3.5 years. RESULTS: Majority of the patients 33 (53.2%) were in their third decade of life. The age of patients' ranged, from seven to 48 years with a mean of 24 +/- 2.3 years, There were 48 (77.4%) males and 14 (22.5%) females giving a male-to-female ratio of 3.4:1. One hundred and four teeth (52%) out of the 200 were extracted during treatment of the fracture. Of the remaining 96 teeth, 25 (26.0%) were anterior teeth while 71 (73.9%) were posterior. Twenty-four (25.0%) of the teeth in the line of fracture developed complications. Of those teeth involved with complications 10 (41.7%) were incisors and canine while 14 (58.3%) premolars and molars. Hypersensitivity and discolouration were the predominant complications. CONCLUSION: Appropriate case selection and thorough clinical and radiological assessment is required to reduce the rate of complications of teeth left in-situ in the mandibular fracture line after treatment. The various complications in this study were managed successfully.

Culture and biomedical care in Africa: the influence of culture on biomedical care in a traditional African society, Nigeria, West Africa.

BACKGROUND: Biomedical Care in Africa and the influence of culture on the health-seeking behaviour of Africans can not be underestimated; many African cultures have different understanding of the causes of disease which more often affect our public health system, policy, planning and implementations. The traditional African healer unlike a doctor trained in western biomedicine, looks for the cause of the patient's ailments as misfortune in relationship between the patient and the social, natural and spiritual environments. The complexity of African society with different cultural and religious practices also reflects on the people's attitude and understanding of their health matters. This paper is an overview of the cultural influence on biomedical care in a traditional African society, Nigeria, West Africa. METHODS: A research on the patients' health seeking behaviour and Primary Health Care service organization in 10 health centres in the five eastern states of the Federal Republic of Nigeria was carried out using a multistage cross-sectional study. A semi-structured questionnaire was administered to the health care providers and patients while an in-depth semi- structured interview was also conducted. RESULT: We observed there is underutilization of health care services at the primary level because most people do not accept the model of health care system provided for them. Most people believe diseases are caused by supernatural beings, the handiwork of neighbours or vengeance from an offended god as a result of transgressions committed in the past by an individual or parents. This group of people therefore prefers seeking traditional medicine to seeking orthodox medicine and often ends up in the hands of witch doctors who claim to have cure to almost all the diseases. CONCLUSION: Biomedical care in Africa is influence by culture because of different understanding of what ailment is and also due to limited knowledge of health matters, poverty and ignorance. There is a need therefore to focus on health out-reach programme, communication and enlightment campaign in Africa especially in the rural areas that are more vulnerable and are burdened with many of these diseases.

Attendance pattern amongst patients at the Dental Clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria.

OBJECTIVE: Dental clinic attendance is one of the indicators of health behaviour which will ultimately impact on the oral health. This study aimed at determining the patients' attendance pattern and the reasons for attendance at the Dental clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu. METHODS: A retrospective study was done using the record book of the Oral Diagnosis unit of the Dental clinic in UNTH. Data on patients' age, gender, presenting complaint(s) at first visit were obtained from these books. Patients with incomplete records were omitted. The data were analysed statistically using Statistical Package for Social Sciences (version 15); frequencies of all relevant variables were generated and Chi-square test was used to compare categorical variablesatp < 0.05. RESULTS: Data of 1663 patients with mean age of 33.2 +/- 18 years were obtained. Six hundred and eighty six (41.3%) were males while 977 (58.7%) were females; a statistically significant difference was found in the quarterly attendances of males and females (p < 0.05). The 20-29 and the 0-9 years age groups had 36.1% and 6.5% records respectively. Eight hundred and twenty five (49.2%) visited clinic because of pain, 7.6% for swellings in the mouth and 5.7% were without symptom but attended for routine check ups cum professional tooth cleaning. CONCLUSION: Asymptomatic dental clinic attendance was not common in this report; attendances were mostly prompted by pain. More females than males attended clinic and the second quarter of the year witnessed the highest turn out of patients.

Maxillofacial injuries in Calabar south-south, Nigeria: a 5 year study of jawbone fractures.

OBJECTIVES: The aim of this study is to highlight the overall uniqueness of the pattern of presentation of maxillofacial injuries seen at the Department of Oral and Maxillofacial Surgery of the University of Calabar Teaching Hospital, Calabar south-south Nigeria between January 2000 and December 2004 and to share our experience in terms of occurrence, seasonal fluctuations and the adequacy of treatment methods in our environment. MATERIALS AND METHODS: Case notes of all. the 200 maxillofacial trauma patients were retrieved, examined and analyzed with regards to age, gender and cause of injury, socio-demographic data, diagnosis, pattern of presentation, distribution and treatment. RESULTS: A male-to-female ratio of 3.65:1 was obtained. Out of the 200 patients the highest incidence of injury was in the 20-30 year age group 85 (n=85; 42.5%). The major causes of injuries were motorcycle (n=74; 37%), vehicle (n=62; 31.5%) and assault (n=40; 20%). Six (3%) river-related or boat accidents were recorded. Industrial and sports related accidents contributed the least (n=5; 2.5%). CONCLUSION: Road traffic accident had the highest proportion of the entire maxillofacial injuries with more males affected than females. Seasonal distribution showed a bimodal peak variation of May-June and September-January. This paper calls for the reinforcement of measures for the prevention of automobile accident and the establishment of more maxillofacial specialist centers with modern equipment for effective management of maxillofacial injuries.

Enrolment and retention of African women in biomedical research: the challenges.

BACKGROUND: In Africa, women have had minimal participation in biomedical research especially in clinical trials despite the epidemiologic realities of the trends and burden of diseases in the continent. The purpose of this paper is to critically examine the challenges as well as suggesting ways of over-coming them in recruiting and retaining African women in biomedical research. METHODS: Relevant biomedical research literatures on Human Research Participants from Scirus, Pubmed and Medline computerized search were critically evaluated and highlighted Information was also obtained from research ethics training as well as texts and journals in the medical libraries of the research ethics departments of the Universities of Pretoria, Kwazulu-Natal, Johns Hopkins Berman Institute of Bioethics Baltimore and Kennedy Institute of Bioethics Georgetown University, Washington DC. RESULTS: Studies reviewed have shown that African women have an unfair participation in biomedical research. Efforts in enrolling and retaining women in biomedical research are hampered by chain reactions of events viz: gender perception, cultural barriers, ignorance and fear of adverse event, limited autonomy to give consent, lack of confidentiality especially in sensitive trials, and improper research design. CONCLUSION: Women need to participate in clinical trials because of their different biological and physiological make-up which require proper information about the effects of drugs on their bodies. A variety of harm may therefore ensue from failure to include adequate numbers of women in biomedical research such as exposure to ineffective treatment, occurrence of unexpected side-effects and delayed diagnosis and early treatment of disease.

Surgical challenges in the treatment of advanced cases of ameloblastoma in the developing world: The authors' experience.

Total mandibulectomy was carried out in 32 patients with extensive oro-facial lesions histologically diagnosed as ameloblastoma in four specialist centres in south-eastern Nigeria from January 2001 to December 2006. All the patients presented at an advanced stage with the whole mandible affected so the treatment of choice was total mandibulectomy. The patients gave informed consent for surgery. The standard surgical procedure was the same in all cases and was performed by the same surgeons. Of the 32 mandibles removed, there were 13 male (41%) and 19 female (59%) patients, giving a male-to-female ratio of 1:1.6. Three (9%) patients died due to problems relating to anaesthesia while five (16%) had postsurgical-related psychosomatic problems. Generally, the postoperative recovery was characterized by reduction in the quality of life of these patients because immediate jaw reconstruction was not feasible. This article highlights the challenges in the surgical management of advanced cases of ameloblastoma in the developing world and proposes a middle ground for professional interactions and exchange programmes among oral and maxillofacial surgeons across the world to assist poorer countries in the management of these advanced cases of oro-facial tumours.

Surgical excision of intra-oral dermoid cyst under local anaesthesia: a review of nine cases.

OBJECTIVE: The purpose of this article is to highlight the effectiveness of local anaesthesia in the surgical excision of intral-oral dermoid cyst in the absence of available modern and efficient general anaesthetic options as experienced in our environment. PATIENTS AND METHODS: A retrospective review of nine patients with intra-oral dermoid cysts seen at the oral and maxillofacial surgery units of three specialist hospitals in eastern Nigeria was carried out between 1996 and 2007. We used simple clinical findings and the aspiration technique for our provisional diagnosis and treated our patients by using local anaesthesia, which contains 2% lignocaine hydrochloride in 1: 80,000 adrenaline. RESULTS: Out of the nine cases seen, the male-to-female ratio was 2:1, representing six male and three female. The age range was 13-22 years, with a mean age of 19 years. The use of local anaesthesia was uneventful and despite the limited options of treatment and the absence of advanced imaging techniques we achieved total success and good results in all nine patients. CONCLUSION: The anaesthetic difficulties and uncertainties associated with the management of intral-oral dermoid cysts especially in an environment that lack modern general anaesthetic options can be avoided by the use of local anaesthesia. This may, therefore, be an effective alternative to difficult and sometime expensive general anaesthetic methods used in developed countries and could be emulated by oral and maxillofacial surgeons in poorer countries.

Enrolment and Retention of African Women in Biomedical Research: the Challenges

Background : In Africa; women have had minimal participation in biomedical research especially in clinical trials despite the epidemiologic realities of the trends andburden of diseases in the continent. The purpose of this paper is to critically examine the challenges as well as suggesting ways of over-coming them in recruiting andretaining African women in biomedical research. Methods:Relevant biomedical research literatures on Human Research Participants from Scirus; Pubmed and Medline computerized search were critically evaluated and highlighted. Information was also obtained from research ethics training as well as texts and journals in the medical libraries of the research ethics departments of the Universities of Pretoria; Kwazulu-Natal; Johns Hopkins Berman Institute of Bioethics Baltimore and Kennedy Institute of Bioethics Georgetown University; Washington DC. Results: Studies reviewed have shown that African women have an unfair participation in biomedical research. Efforts in enrolling and retaining women in biomedical research are hampered by chain reactions of events viz: gender perception; cultural barriers; ignorance and fear of adverse event; limited autonomy to give consent; lack of confidentiality especially in sensitive trials; and improper research design. Conclusion:Women need to participate in clinical trials because of their different biological and physiological make-up which require proper information about the effects of drugs on their bodies. A variety of harm may therefore ensue from failure to include adequate numbers of women in biomedical research such as exposure to ineffective treatment; occurrence of unexpected sideeffects and delayed diagnosis and early treatment of disease

Enrolment and Retention of African Women in Biomedical Research: The Challenges

In Africa; women have had minimal participation in biomedical research especially in clinical trials despite the epidemiologic realities of the trends and burden of diseases in the continent. The purpose of this paper is to critically examine the challenges as well as suggesting ways of over-coming them in recruiting and retaining African women in biomedical research. Relevant biomedical research literatures on Human Research Participants from Scirus; Pubmed and Medline computerized search were critically evaluated and highlighted. Information was also obtained from research ethics training as well as texts and journals in the medical libraries of the research ethics departments of the Universities of Pretoria; Kwazulu-Natal; Johns Hopkins Berman Institute of Bioethics Baltimore and Kennedy Institute of Bioethics Georgetown University; Washington DC. Studies reviewed have shown that African women have an unfair participation in biomedical research. Efforts in enrolling and retaining women in biomedical research are hampered by chain reactions of events viz: gender perception; cultural barriers; ignorance and fear of adverse event; limited autonomy to give consent; lack of confidentiality especially in sensitive trials; and improper research design. Women need to participate in clinical trials because of their different biological and physiological make-up which require proper information about the effects of drugs on their bodies. A variety of harm may therefore ensue from failure to include adequate numbers of women in biomedical research such as exposure to ineffective treatment; occurrence of unexpected sideeffects and delayed diagnosis and early treatment of disease

Civilian gunshot injuries to the oro-facial region in Calabar, south-south Nigeria, 2002-2006.

BACKGROUND: This article reviews 16 cases of civilian gunshot injuries of the oro-facial region seen at University of Calabar Teaching Hospital, Calabar over a 5-year period and highlights the rising trend in the occurrence of gun shot injuries to the orofacial region as experienced in the south-south region of Nigeria. METHODOLOGY: Records of 16 patients with different types of gunshot injuries to the oro-facial region seen and treated at the University of Calabar Teaching Hospital, Calabar between 2002 and 2006 were reviewed. The focus was on the patient's age, gender, type of weapons used, the surrounding circumstances (accidental or intentional), the time of occurrence and management. RESULTS: Out of 16 patients seen, 14 (87.5%) were males and 2 (12.5%) were females, giving a male to female ratio of 7:1, with the age range from 18 to 50 years. Thirteen (81.3%) of the patients were injured by low velocity missile while 3 (18.7%) by high velocity missile. Violence was responsible for 14 cases (81.7%), and 2 cases (18.3%) was due to the accidental discharge. CONCLUSION: This study has shown an increasing occurrence of gunshot injuries to the oro-facial region in our environment with males more affected than females. With the changing political situation, social advancement and urbanization, there is a need to regulate the influx of deadly weapons in the country by the relevant agencies. Maxillofacial surgeons should also brace up to the new development as this poses a new kind of challenge to our knowledge of trauma management.

Civilian Gunshot injuries to the Oro-facial region in Calabar, South-South Nigeria, 2002-2006

This article reviews 16 cases of civilian gunshot injuries of the oro-facial region seen at University of Calabar Teaching Hospital, Calabar over a 5-year period and highlights the rising trend in the occurrence of gun shot injuries to the orofacial region as experienced in the south-south region of Nigeria. Records of 16 patients with different types of gunshot injuries to the oro-facial region seen and treated at the University of Calabar Teaching Hospital, Calabar between 2002 and 2006 were reviewed. The focus was on the patient's age, gender, type of weapons used, the surrounding circumstances (accidental or intentional), the time of occurrence and management. Out of 16 patients seen, 14 (87.5%) were males and 2 (12.5%) were females, giving a male to female ratio of 7:1, with the age range from 18 to 50 years. Thirteen (81.3%) of the patients were injured by low velocity missile while 3 (18.7%) by high velocity missile. Violence was responsible for 14 cases (81.7%), and 2 cases (18.3%) was due to the accidental discharge. This study has shown an increasing occurrence of gunshot injuries to the oro-facial region in our environment with males more affected than females. With the changing political situation, social advancement and urbanization, there is a need to regulate the influx of deadly weapons in the country by the relevant agencies. Maxillofacial surgeons should also brace up to the new development as this poses a new kind of challenge to our knowledge of trauma management

Oral cancer in Enugu, Nigeria, 1998-2003.

Cancers of the oral cavity make up 3-4% of all cancers, being in eighth place in men and eleventh in women when the cancer is caused by smoking and alcohol misuse. In this study we recorded all oral cancers in Enugu, eastern Nigeria over the 6-year period from 1998 to 2003. We reviewed all patients who had a diagnosis of invasive oral cancer during this period from notes kept in the Records Department of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Carcinoma-in-situ, lymphoma, and leukaemia were not included. All cases were categorised by the site of the tumour and the age and sex of the patient. Eighty one cases of oral cancer were recorded during that period, accounting for 2.7% of all cancers. Forty-eight men and thirty-three women were affected, and the most common site was other sites of the oral cavity (28, 35%), followed by the tongue (24, 30%), floor of the mouth (17, 21%) and finally the lip (12, 15%). They were all advanced at the time of presentation. The patients gave no history of alcohol or tobacco misuse, and their conditions should be seen in terms of chronic illnesses, malnutrition, poverty, and ignorance. We need an urgent awareness campaign, and programmes for the prevention and early detection of oral cancer, in Nigeria.