An Elastin-like Polypeptide-fusion peptide targeting capsid-tegument interface as an antiviral against cytomegalovirus infection.

The tegument protein pp150 of Human Cytomegalovirus (HCMV) is known to be essential for the final stages of virus maturation and mediates its functions by interacting with capsid proteins. Our laboratory has previously identified the critical regions in pp150 important for pp150-capsid interactions and designed peptides similar in sequence to these regions, with a goal to competitively inhibit capsid maturation. Treatment with a specific peptide (PepCR2 or P10) targeted to pp150 conserved region 2 led to a significant reduction in murine CMV (MCMV) growth in cell culture, paving the way for in vivo testing in a mouse model of CMV infection. However, the general pharmacokinetic parameters of peptides, including rapid degradation and limited tissue and cell membrane permeability, pose a challenge to their successful use in vivo. Therefore, we designed a biopolymer-stabilized elastin-like polypeptide (ELP) fusion construct (ELP-P10) to enhance the bioavailability of P10. Antiviral efficacy and cytotoxic effects of ELP-P10 were studied in cell culture, and pharmacokinetics, biodistribution, and antiviral efficacy were studied in a mouse model of CMV infection. ELP-P10 maintained significant antiviral activity in cell culture, and this conjugation significantly enhanced P10 bioavailability in mouse tissues. The fluorescently labeled ELP-P10 accumulated to higher levels in mouse liver and kidneys as compared to the unconjugated P10. Moreover, viral titers from vital organs of MCMV-infected mice indicated a significant reduction of virus load upon ELP-P10 treatment. Therefore, ELP-P10 has the potential to be developed into an effective antiviral against CMV infection.

Novel approach to determine unbalanced current circuit on Nigerian 330kV transmission grid for reliability and security enhancement.

The present Nigerian transmission network is faced with the difficulty of evacuating and dispatching reliable and quality electricity supply and simultaneously maintaining an operational standard of security to prevent any collapses. Therefore, this study developed a novel technique to optimize electrical current flow to provide in-depth research and analysis of current flowing in the transmission network circuit prone to danger during short-circuit faults. The research methodology involved the generation of unbalanced short-circuit calculations at every single node of the three-phase network using the symmetrical component method. Numerical simulation of different types of unbalanced short-circuit fault into the entire 330kV transmission network using unbalanced fault algorithms written in a flexible MATLAB program environment is also performed on every bus. The influence of these short-circuit faults is examined on the generated spectrum of line current magnitude. This study then generates a series of unbalanced current circuit and line losses analysis that unveils the different scenarios regarding existing network performance. The method adopted is promising. It established the most critical lines (about 20) with high unbalanced current magnitudes and high line losses during the disturbance. Based on the result analysis, four (quad) bundles of conductors is designed as a proposed modification to the upgrade of all critical double circuit lines and the conversion of single critical lines on the 330kV transmission network to improve the power transfer capability and also meet the future transmission network development plan. Furthermore, recommendations that are considered desirable in this study are proffered to ensure acceptable power quality and security in the network.

Development and practice of laparoscopic surgery in a Nigerian tertiary hospital.

BACKGROUND: For the benefits of less postoperative pain, early recovery and discharge, and better cosmesis, laparoscopic surgery is rapidly gaining acceptance amongst surgeons as a better alternative to traditional open procedures. In January 2015, bookings for laparoscopic surgery became a more regular feature on our operation list. AIMS: We reported the indications, management outcome, and challenges in patients who had laparoscopic surgery in our institution. This is to document the trends in our surgical practice. METHODOLOGY: This is a descriptive study of 137 patients who had laparoscopic surgery for general surgical indications in our institution over a period of 5 years. Patients data as collected from the records department were evaluated for demographic characteristics, medical comorbidities, type of procedures done, and perioperative outcome. Data analysis was performed using Statistical Package for Social Sciences (SPSS). RESULTS: A total of 137 Patients had laparoscopic general surgery between January 2015 and December 2019. There were 48 males and 89 females with a male-to-female ratio of 1:1.9. The mean age of the patients was 38.8 ± 3.4 years (range 16-87 years). Laparoscopic cholecystectomy (35%) and laparoscopic appendicectomy (29.9%) were the most common procedures performed. Five (3.7%) cases were converted to open surgery. Superficial surgical site infection (5.8%) following laparoscopic appendicectomy was the most common postoperative complication. There was no 30-day postoperative mortality. CONCLUSION: Laparoscopic surgery is safe and can be applied to wide variety of general surgical conditions in developing countries. Minimal postoperative morbidity of laparoscopy is a major benefit to the patients.

Critical assessment of refugees' needs in post-emergency context: the case of Malian war refugees settled in Northern Burkina Faso.

BACKGROUND: Empirically assessing the needs of refugees in camps is critical to the improvement of existing policies and programs that aim at enhancing their well-being. By neglecting the needs of refugees, interventions may fail to capture the complex patterns of refugees' daily lives within camps. This paper provides a comprehensive assessment of the needs of encamped Malian refugees in Northern Burkina Faso following the 2012-armed conflict. In addition to assessing the needs of Malian refugees, the study aimed to critically assess from an upstream perspective the degree of their involvement in policies and practices that are targeted towards improving their livelihood. METHODS: We took an "upstream" view on the lives of Malian refugees to identify their unmet needs. A purposive sampling strategy was employed to collect data from various media sources, including data aggregated from the website of the United Nations High Commissioner for Refugees (UNHCR). The most populous refugee camp (Mentao) was visited in September 2012 and in-depth group discussion and interviews were conducted with key informants, including nine camp representatives and four officials from the central and decentralized administrations. RESULTS: Media canvass combined with the UNHCR level 2 census revealed a flawed headcount of refugees, which was 205.4% higher than the real number in Burkina Faso. Although refugees live harmoniously with the natives and their security has been assured, they strongly complained about the number of unused food items distributed. Camps were distributed among humanitarian organizations leading to differential advantage and resources from one camp to another. Additionally, idleness, lack of classrooms facilities for pre-school children and lack of continuous healthcare services were major concerns raised. Further, refugees expressed limited involvement in the planning and implementation of programs that are related to their welfare. CONCLUSION: This study revealed that refugees' voices were not taken into consideration in making tailor-made programs. This calls for more comprehensive surge capacity to deal with refugees' basic needs. Further, a strong leadership from hoststate should be encouraged to offer equal opportunities to refugees regardless of their camps. Finally, an innovative strategy is needed to build a reliable database that could enhance the design, implementation, monitoring and evaluation of policies and programs.

Mechanisms of resistance to three mite growth inhibitors of Tetranychus urticae in hops.

Mite growth inhibitors (MGIs), such as etoxazole and hexythiazox, are valuable IPM tools for Tetranychus urticae control in hops due to their unique mode of action and selectivity. Hence, it is necessary to standardize bioassay methods to evaluate the efficacy of MGIs, monitor resistance, and identify mechanisms underlying MGI resistance in the field. Here, we developed a three-tiered approach for evaluating ovicidal toxicity of MGIs to T. urticae, which simulated different MGI exposure scenarios in the field. The most effective bioassay method was direct exposure of T. urticae eggs to MGIs. With this method, four field-collected T. urticae populations showed low-to-moderate resistance to MGIs. Cross-resistance among MGIs and from MGIs to bifenazate and bifenthrin was detected. Besides target site insensitivity, enhanced cytochrome P450 and esterase activities also contribute to the MGI resistance in hop yard-collected T. urticae populations. Low-to-moderate MGI resistance in T. urticae populations may be mediated by multiple mechanisms. Positive selection pressure on the I1017F mutation is moderate in field-collected T. urticae populations. Further studies are required to identify metabolic detoxification genes that confer resistance to MGIs for precise resistance monitoring.

Socioeconomic differential in self-assessment of health and happiness in 5 African countries: Finding from World Value Survey.

OBJECTIVE: Factors that contribute to wealth related inequalities in self-rated health (SRH) and happiness remains unclear most especially in sub-Saharan countries (SSA). This study aims to explore and compare socioeconomic differentials in SRH and happiness in five SSA countries. METHODS: Using the 2010/2014 World Values Survey (WVS), we obtained a sample of 9,869 participants of age 16 and above from five SSA countries (Nigeria, Ghana, South Africa, Rwanda and Zimbabwe). Socioeconomic inequalities were quantified using the concentration index. The contribution of each predictor to concentration index's magnitude was obtained by means of regression based decomposition analysis. RESULTS: Poor SRH ranges from approximately 9% in Nigeria to 20% in Zimbabwe, whereas unhappiness was lower in Rwanda (9.5%) and higher in South Africa (23.3%). Concentration index was negative for both outcomes in all countries, which implies that poor SRH and unhappiness are excessively concentrated among the poorest socioeconomic strata. Although magnitudes differ across countries, however, the major contributor to wealth-related inequality in poor SRH is satisfaction with financial situation whereas for unhappiness the major contributors are level of income and satisfaction with financial situation. CONCLUSIONS: This study underscores an association between wealth related inequalities and poor SRH and unhappiness in the context of SSA. Improving equity in health, as suggested by the commission of social determinants of health may be useful in fighting against the unfair distribution of resources. Thus, knowledge about the self-rating of health and happiness can serve as proxy estimates for understanding the distribution of health care access and economic resources needed for well-being in resident countries.

Modulation of social space by dopamine in Drosophila melanogaster, but no effect on the avoidance of the Drosophila stress odorant.

Appropriate response to others is necessary for social interactions. Yet little is known about how neurotransmitters regulate attractive and repulsive social cues. Using genetic and pharmacological manipulations in Drosophila melanogaster, we show that dopamine is contributing the response to others in a social group, specifically, social spacing, but not the avoidance of odours released by stressed flies (dSO). Interestingly, this dopamine-mediated behaviour is prominent only in the day-time, and its effect varies depending on tissue, sex and type of manipulation. Furthermore, alteration of dopamine levels has no effect on dSO avoidance regardless of sex, which suggests that a different neurotransmitter regulates this response.

An Obstructing Small Bowel Phytobezoar in an Elderly Female Nigerian: A Case Report and Literature Review.

Small bowel obstruction secondary to phytobezoars is an unusual presentation in surgery. We present a case of an elderly female patient with an insidious onset of abdominal pain, abdominal distension, and bilious vomiting diagnosed radiologically to be small bowel obstruction. Exploratory laparotomy revealed a trapped mass of vegetable matter in the distal ileum. She had enterotomy with primary closure for removal of obstructing ileal phytobezoars. Her postoperative recovery was uneventful.

A COMPARISON OF THE OBJECTIVE STRUCTURED CLINICAL EXAMINATION AND THE TRADITIONAL ORAL CLINICAL EXAMINATION IN A NIGERIAN UNIVERSITY.

BACKGROUND: Assessment of clinical skills is essential in medical education. Ideally marks should be based on the student's competence alone. The limitations of the traditional long case examinations such as the patient and examiner variability are well known. The objective structured clinical examination (OSCE) was designed to overcome these limitations. Studies comparing the OSCE and the traditional long case examination in the same group of students are very sparse. AIM: To compare the objective structured clinical examination (OSCE) and the traditional long case examination by determining their correlations with other forms of assessment in undergraduate surgery. SETTING: This study was carried out at the College of Medicine, University of Lagos, Nigeria. METHODOLOGY: The results of 612 undergraduate students in our medical school of the University of Lagos, Nigeria over a period of 4 years (2012-2015) were analysed. The scores in the long case examination , objective structured clinical examination (OSCE) , multiple choice questions and Essays were analysed and compared using the Pearson's Correlation co-efficient. SPSS version 17 software was used and a P-value < 0.01 was regarded as statistically significant. RESULTS: Overall, there was a statistical significant positive correlation among most forms of assessment. The OSCE and the long case examination had a correlation of 0.374. Compared with the long case examination, the OSCE had a higher correlation with all other forms of assessment. The total clinical score (the sum of all long case examination and OSCE) however performed better than the OSCE or the long case examination alone as it had the highest correlation with all other forms of assessment. CONCLUSION: The OSCE has been shown to be better than the long case examination as an indicator of the student overall knowledge of surgery as it had a superior correlation with other forms of assessments. The total clinical score was however the best indicator of the student overall knowledge in Surgery as it had the best correlation with other forms of assessment. We recommend and encourage institutions that presently combine the OSCE and the long case examination to carry out similar analysis such as ours to determine the desirability of combining LCE and OSCE rather than outright replacement of LCE with OSCE.

Conditions Affecting Social Space in Drosophila melanogaster.

The social space assay described here can be used to quantify social interactions of Drosophila melanogaster - or other small insects - in a straightforward manner. As we previously demonstrated (1), in a two-dimensional chamber, we first force the flies to form a tight group, subsequently allowing them to take their preferred distance from each other. After the flies have settled, we measure the distance to the closest neighbor (or social space), processing a static picture with free online software (ImageJ). The analysis of the distance to the closest neighbor allows researchers to determine the effects of genetic and environmental factors on social interaction, while controlling for potential confounding factors. Diverse factors such as climbing ability, time of day, sex, and number of flies, can modify social spacing of flies. We thus propose a series of experimental controls to mitigate these confounding effects. This assay can be used for at least two purposes. First, researchers can determine how their favorite environmental shift (such as isolation, temperature, stress or toxins) will impact social spacing (1,2). Second, researchers can dissect the genetic and neural underpinnings of this basic form of social behavior (1,3). Specifically, we used it as a diagnostic tool to study the role of orthologous genes thought to be involved in social behavior in other organisms, such as candidate genes for autism in humans (4).

An evaluation of usefulness of prostate specific antigen and digital rectal examination in the diagnosis of prostate cancer in an unscreened population:experience in a Nigerian teaching hospital.

OBJECTIVE: To evaluate the usefulness of prostate specific antigen (PSA) and digital rectal examination (DRE) in the diagnosis of cancer of the prostate (CaP) amongst unscreened patients. PATIENTS, MATERIALS AND METHODS: A prospective study 168 unscreened men who were referred for evaluation for CaP. They all had a 10-core extended transrectal prostatic needle biopsy using size 16 Tru Cut needle for either an elevated serum total PSA of > 4 ng/ml or abnormal DRE findings or both. Overall cancer detection rate was determined and detection rates were determined separately for patients with elevated PSA with normal DRE, abnormal DRE with normal PSA and those with both indications. The performances of each indication were determined separately and in combination in terms of their sensitivity, specificity, predictive values and accuracy. The results were compared amongst patients with different indications for biopsy. RESULTS: The overall cancer detection rate was 44.0%. Detection rates in patients with elevated PSA with normal DRE and abnormal DRE with normal PSA were 30.0% and 17.4% respectively. There was statistically significant increased detection of 61.2% amongst patients with both indications. The overall sensitivities of PSA, DRE and combination of both were 94.6%, 75.7% and 70.3% respectively while the specificities were 20.2%, 44.7% and 64.9% respectively. The accuracies of PSA, DRE and combination of both indications were 53%, 58% and 67.3% respectively while the PPVs were 48.3%, 51.9% and 61.2% respectively. Mean Gleason score was 6.82 while the overall complication rate was 23.2% CONCLUSION: Neither PSA nor DRE is sensitive, specific, predictive or accurate enough on its own to be an ideal screening or diagnostic test for CaP. Therefore, optimal evaluation of patients with suspected CaP is best achieved with both even in unscreened populations.

Removal of orthopaedic implants from patients at the University College Hospital, Ibadan.

BACKGROUND: Removal of orthopaedic implants is often done after complete healing of fractures. Orthopaedic implants are removed for a variety of reasons such as patients' request after fracture union, implant failure and other complications arising from the use of implants. AIMS AND OBJECTIVES: To determine the indications and complications of removal of orthopaedic implants in our hospital. METHODS: A retrospective study of medical records of all patients who underwent removal of orthopaedic implants used for fracture fixation at a Nigeria teaching hospital during the five year period between 2007 and 2011. Information about age, sex, indications for fracture fixation, indications for removal of implant, types of implants removed, complications of implant removal and its treatment were studied. RESULTS: Thirty patients whose orthopaedic implants had been in place for a mean duration of 12 months before removal were included in the study. 80% of the implants were removed from the femur. Implant failure is the commonest indication for implant removal accounting for 60% of cases. CONCLUSION: Healed fractures and implant failure are the commonest indications for removal of orthopaedic implants in our centre. Implant removal should be advocated when they have failed or become symptomatic. However, appropriate patient selection and adequate surgical technique should be employed to achieve satisfactory outcome.

KRAS and BRAF mutations in Nigerian colorectal cancers.

PURPOSE: Activation of the KRAS oncogene is implicated in colorectal carcinogenesis and mutations have been reported in 30-50% of cases. BRAF mutation, though less common, is also reported and importantly associated with shorter progression-free interval. This study aims to determine the KRAS and BRAF mutation statuses of Nigerian colorectal cancers (CRC). METHODS: Mutation analysis was carried out on archival paraffin-embedded blocks of CRC tissues. KRAS codons 12, 13 and 61 and BRAF V600E were assessed by pyrosequencing after DNA extraction from 200 cases at the Leeds Institute of Molecular Medicine, St. James's University Hospital, UK. Mutation rates and the spectra were determined. RESULTS: Pyrosequencing was successful in 112 of 200 cases. KRAS mutation in codons 12 and 13 was demonstrated in 23 of 112 cases (21%); none in codon 61. BRAF mutation in codon 600 was demonstrated in 4.5%. CONCLUSION: This study shows that 21% of Nigerian CRC patients carry a KRAS mutation; half the rate in Caucasians; and that BRAF mutation also occurs in Nigerian CRC cancers.

Dysplasia epiphysealis hemimelica: a case report.

AIMS AND OBJECTIVES: To report the clinical presentation, course, management and associated pathology of DEH seen at the National Orthopaedic Hospital Lagos. PATIENT AND METHODS: Case review was employed to report the association of an incidental radiologic finding of asymptomatic DEH with Blount disease. RESULTS: This case is an 11-year-old girl with asymptomatic DEH of both ankles associated with right unilateral Blount disease. The incidental pathology is conservatively managed following the surgical treatment of the Blount disease which is the symptomatic pathology. CONCLUSION: DEH is an uncommon pathology usually an incidental radiologic finding which may or may not be associated with other skeletal pathologies. The management is essentially conservative but surgery is an option when symptomatic.

Acute appendicitis in Lagos: a review of 250 cases.

OBJECTIVES: Acute appendicitis is common. This prospective study of 250 cases of acute appendicitis was performed to critically analyse the pattern of presentation, management, operative findings and treatment outcome. The effect of length and position of the appendix in relationship to acute inflammation was also determined. PATIENTS AND METHODS: Two hundred and fifty cases of acute appendicitis were studied, including those found to have appendicitis at surgery despite other preoperative diagnosis. Patient biodata, clinical signs and symptoms were recorded. Haematological and biochemical parameters were determined after which all patients with a diagnosis of acute appendicitis had appendicectomy under general anaesthesia. All relevant peri-operative data were recorded. Excised appendices were sent for histological examination. RESULTS: There were 133 males and 117 females giving a gender ratio of 1.2:1. The mean age was 25.7 +/- 10.3 years, with majority of cases (42.8%) occurring in the third decade of life. Abdominal pain (100%), fever (48.4%), anorexia (48.0%), vomiting (47.8%) were the common symptoms. Commonly elicited signs included right iliac fossa direct tenderness (74.4%), rebound tenderness (59.2%), localised guarding (42.8%) and right rectal wall tenderness (43.2%). The mean white cell count was not significantly elevated (mean 8538 +/- 4166 per mm3, P > 0.05). Sixty three percent (156/245) of all appendices were retrocaecal in position. Mean length of the appendices was 10.4 +/- 2.9 cm. The length and position of appendices were not significantly different between those who had acutely inflamed and normal appendices (P = 0.923) Two hundred and forty five patients (98%) with a diagnosis of acute appendicitis had appendicectomy. The commonest postoperative complication was wound infection (8%), overall complication rate was 13.5% and negative appendicectomy rate was 13.4%. CONCLUSION: The presentation, management and treatment outcome of acute appendicitis in our centre are similar to those of other centres in our sub-region. Complication rates were low.

Chronic renal failure from the English-speaking Caribbean: 2007 data / Fallo renal crónico en el Caribe anglófono: datos del 2007

AIM: Development of the renal registry to include patients at different stages of chronic kidney disease (CKD). BACKGROUND: The 2007 renal registry include cases at different stages of CKD based on the current guidelines according to the National Kidney Foundation (NKF) Kidney Disease Outcome Initiative (K/DOQI) staging. There was an increase in the number of participating countries, with the addition of Antigua and Barbuda, St Lucia and Turks and Caicos. METHODS: Data were collected using a questionnaire form. Data were stored and analysed in Words Excel for Windows or SPSS 12.0. RESULTS: Data were available for Antigua and Barbuda (n = 43), British Virgin Islands (n = 69), Cayman Islands (n = 45), Trinidad and Tobago (n = 564), Jamaica (n = 920), Turks and Caicos (n = 64), St Lucia (n = 51) and Bahamas (n = 121). The registry identified hypertension, diabetes mellitus and Chronic Glomerulonephritis (CGN) as the commonest causes of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in these countries. The leading cause of death reported was listed as ischaemic heart disease/heart failure, sepsis and cerebrovascular accident. CONCLUSIONS: The majority of patients with CKD and ESRD had hypertension, diabetes mellitus and CGN as the major causes. Collection of data for patients with CKD at different stages was met with some challenges, and resulted in underestimation of the true number of persons with CKD across these Caribbean countries. More emphasis will continue to be placed on improving data collection so the true incidence, prevalence and healthcare burden of CKD is known in the Caribbean. A web based programme is being developed to improve data collection.

OBJETIVO: Desarrollar el registro renal incluyendo pacientes en diferentes etapas de la enfermedad crónica del riñón (ECR). ANTECEDENTES: El registro renal 2007 incluye casos en diferentes etapas de la ECR, sobre la base de los lineamientos actuales de la estadificación según la iniciativa para los resultados de la enfermedad crónica renal (K/DOQI) propuesta por la Fundación Nacional del Riñón (NKF). Hubo un aumento en el número de países participantes, al añadirse Antigua y Barbuda, Santa Lucia e Islas Turcas y Caicos. MÉTODOS: Los datos fueron recogidos utilizando un cuestionario. Luego fueron almacenados y analizados usando Excel para Windows, o mediante SPSS 12.0. RESULTADOS: Hubo a disposición datos para Antigua y Barbuda (n = 43), Islas Vírgenes Británicas (n = 69), Islas Cayman (n = 45), Trinidad y Tobago (n = 564), Jamaica (n = 920), Islas Turcas y Caicos (n = 64), Santa Lucia (n = 51) y Bahamas (n = 121). El registro identificó la hipertensión, la diabetes mellitus y la glomerulonefritis crónica (GNC) como las causas más comunes de la enfermedad crónica del riñón (ECR) y la enfermedad renal terminal (ERT) en estos países. La principal causa de muerte según los reportes, fueron la cardiopatía isquémica/fallo cardíaco, la sepsis y el accidente cardiovascular. CONCLUSIONES: La mayoría de los pacientes con ECR y ERT sufrían de hipertensión, diabetes mellitus y GNC como causas mayores. La recogida de datos para los pacientes con ECR tuvo algunas dificultades, por lo que se subestimó el número real de personas con ECR en todos estos países caribeños. Se seguiría haciendo un mayor énfasis en mejorar la recogida de datos, de modo que la verdadera incidencia, prevalencia y carga de atención a la salud de la ECR sea conocida en el Caribe. Se halla en curso el desarrollo de un programa en la red de Internet, a fin de mejorar la recogida de datos.

The new pattern of urethral stricture disease in Lagos, Nigeria.

OBJECTIVES: The study is a follow up to two separate studies done in this centre 42 and 20 years ago on the changing pattern of urethral stricture disease(USD). It assesses the aetiology,the general pattern and treatment outcome in our centre. PATIENTS AND METHODS: This is an 8 year review of all cases of USD managed at the Lagos University Teaching Hospital between January 1998 to December 2005. Diagnosis was confirmed mainly by urethrographic studies and occasionally by endoscopy. Data collected included age, sex, aetiology, site and length of stricture, treatment and outcome. RESULTS: Eighty four patients (83 males and 1 female) with USD were seen within the period with a mean age of 43.1 years. Trauma was responsible for 60 (72.3%) cases, with road traffic accident topping the list with 29 (34.9%), with iatrogenic trauma now accounting for 17 (20.5%) of all cases of USD. Indwelling urethral catheter was responsible for 13 (76.5%) of iatrogenic cases. Purulent Urethritis was responsible for 22 (26.5%) of cases. Fifty (60.2%) cases were located in the anterior urethral while twenty three (39.8%) were in the posterior. Fifty seven patients had urethroplasty with a recurrence of 14% and 8 patients had urethral dilatation with 50% 1 year recurrence. CONCLUSION: Trauma is now the undisputed leading cause of USD in our environment. The incidence of post catheterisation strictures has also risen rapidly. Increased safety on our roads, improvement in medical education and quality of urethral catheters are suggested by this study in order to reduce the incidence of USD.

Penile fasciocutaneous flap urethroplasty: recent experience and challenges in a sub-Saharan African teaching hospital.

OBJECTIVE: To evaluate penile fasciocutaneous flap urethroplasty for complex anterior urethral strictures in circumcised West African men. METHODS: Between January 2002 and December 2006, 26 patients with anterior urethral strictures underwent penile fasciocutaneous flap urethroplasty (PFU), using a modification of the technique described by Quartey (Quartey JKM. J Urol. 1985;134:474-475). Of these patients, 21 had dorsal onlay patches and 5 had tubularize patches. Average follow-up was 19 months. RESULTS: There was a 100% immediate success rate with the dorsal onlay group. No recurrence was seen in all patients available for follow-up at 30 months. The tubularized flap had an immediate success of 80% but at 30 months it was only 40%. Troublesome postvoid dribbling was completely eliminated and complications were minor and few, which included 1 case of distal superficial dorsal penile skin loss, 1 case of urethrocutaneous fistula, and 2 cases of postvoid dribbling all of which were managed conservatively. CONCLUSIONS: PFU when used as a dorsal onlay gives excellent results at least in the immediate and intermediate periods in black West African population. A multiracial study to compare the effect of skin color on the short- and long-term outcome of PFU is also suggested.

Medical audit of diagnostic mammographic examination at the lagos university teaching hospital (luth), Nigeria.

PURPOSE: We studied the performance of diagnostic mammography in predicting malignancy among patients presenting with signs and symptoms of malignancy. MATERIALS AND METHODS: 310 patients who presented to the surgical out-patients of the Lagos University Teaching Hospital with signs and symptoms of breast cancer, between January 2002 and December 2003 had mammographic evaluation with a dedicated mammography unit. The mammographic appearances were prospectively classified using the BI-RADS assessment categorisation, and histological confirmation following surgical excision was correlated with mammography. RESULTS: The overall sensitivity of mammography in the study was 82.8% (CI 78.6 - 87%) while specificity, Positive predictive value (PPV) and accuracy were 90.7% (CI 87.5-93.9%), 69.97% (CI 46.6 - 74.8%), and 89% (CI 85.5-92.5%) respectively. Multivariate analysis showed that sensitivity and specificity generally declined as breast density increased. CONCLUSION: Diagnostic mammography is useful in characterising breast lesions. This study analyses the performance of mammography and shows that the resultant specificity is high, however it may have to be used in conjunction with needle biopsy to achieve improve sensitivity and avoid unnecessary benign surgical biopsies.

Complex Ebstein's anomaly in a 80 year old Nigerian woman.

There is a gradually growing interest in the subject of congenital heart diseases as many children born with them are now growing into adulthood. The reasons are twofold: increasing awareness among clinicians as well as major advances in the diagnosis and treatment of congenital heart diseases in children. A case of Ebstein's anomaly (EA), one of the most important congenital diseases of the tricuspid valve, in an 80 year old woman referred to the cardiology clinic of the University of Benin Teaching Hospital in Benin City, Nigeria, is hereby reported. It is a rare condition. The features demonstrated in this case report tend to suggest that there may be several adult survivors of congenital heart diseases. These may coexist with other systemic illnesses such as systemic hypertension.