Malnutrition is a major contributor to the death of children under 5 years of age in sub-Saharan Africa. Furthermore, poor nutrition causes stunting and underweight in infants and children while at the same time putting at risk normal neurologic and cognitive development. A recent study of rural Fulani infants up to age 2 years in northern Nigeria found that more than one-quarter were stunted and underweight. The nutritional status of these infants was relatively sound at birth but progressively declined over the following 2 years. While insufficient dietary macronutrients such as protein and carbohydrate and micronutrients such as iodine, zinc, vitamin A and iron may well have contributed to their post-natal growth retardation, in this report we raise the possibility that inadequate intake of essential long-chain ω-3 fatty acids, docosahexaenoic acid (DHA) in particular, by infants during the first few years of life may play a role in childhood malnutrition in this part of the world, especially in populations like the Fulani pastoralists who live far-removed from the ocean which would otherwise provide access to DHA-rich seafood. We conclude this piece by suggesting several approaches for improving the DHA status of pregnant and lactating Fulani women and their offspring in Nigeria.

Background/Purpose: Although docosahexaenoic acid (DHA) is critical for the normal development of the central nervous system, especially in utero and during the 1 ^st year of life, the concentration of this important polyunsaturated fatty acid in the milk fat of Nigerian women is low relative to international standards. There is a compelling need to identify dietary sources of DHA for pregnant and lactating women in sub-Saharan Africa and elsewhere in the world where populations live inland far from the sea and therefore lack access to DHA-rich ocean fish. Hen's eggs represent a potentially useful source of DHA. Methodology: Since the DHA content of eggs varies greatly with the hen's diet and knowing from studies elsewhere in the world that free-range (FR) hens produce eggs enriched for DHA, we compared the fatty acid compositions of the yolk of eggs from FR and "commercial" hens in northern Nigeria. Results: The percentage of DHA in the FR eggs was 2.6-fold higher (P < 0.001) compared to commercial eggs. Two FR eggs per day could satisfy about three-fourths of the daily recommended intake of DHA for pregnant and lactating women. The FR eggs also contained 2.8-fold (P < 0.001) more α-linolenic acid, more than 10-fold more eicosapentaenoic acid, and 4.1-fold more of the healthful conjugated linoleic acids than commercial eggs. Conclusion: Eggs produced by FR hens could be useful in improving the fatty acid nutrition of pregnant and lactating women in Nigeria, and ultimately their infants who derive much of their nutrition from breast milk.

Background: This study is aimed at determining the effect of nicotine on male fertility by evaluating some reproductive hormone parameters of male Wistar rat such as serum testosterone, luteinizing hormone (LH), prolactin and follicle stimulating hormone (FSH). Methodology: A total of 20 adult male rats were randomly divided into four groups, the test groups were administered with 0.2 mg/100 g, 0.4/100 g and 0.6/100 g body weight of nicotine base daily for 30 days using a polythene catheter orally while the control were administered with 2 ml 0.9% physiological saline. Results: Nicotine caused a significant reduction (P < 0.05) and (P < 0.01) in the mean values of the hormones of the test group compared with control. Serum testosterone concentration of 4.8 ± 1.30 (P < 0.05), 4.0 ± 2.25 (P < 0.01), 0.6 ± 0.64** were recorded for groups 1, 2 and 3 respectively. For FSH the significant values were 0.26 ± 0.11 (P < 0.05), 0.20 ± 0.12 (P < 0.01) in groups 2 and 3, whilst prolactin showed a significant reduction of 0.08 ± 0.08 (P < 0.05) only in group 3. LH showed a significant reduction in all the test groups with values of 0.48 ± 0.08 (P < 0.01), 0.24 ± 0.11 (P < 0.01) 0.08 ± 0.08 (P < 0.01) for groups 1, 2 and 3 respectively. The results stated are only those that showed a significant reduction at 95% confidence level when compared with the control. Conclusion: It was concluded that nicotine exerted adverse effects on gonadotrophins secreted by the anterior pituitary with concomitant reduction in reproductive potentials of the male rat. Nicotine and nicotine-based products should therefore be taken with caution in cases of infertility.

Background: CD4 T-lymphocyte count has been known to be affected by several factors including ethnic group, region, age, sex and physiological conditions. Studies to evaluate CD4 count in vertically exposed, but human immunodeficiency virus (HIV) negative infants from this region have not been done previously. The aim of this study was to determine the reference values of CD4 counts, percentages and temporal profile in vertically exposed HIV negative infants residing in this environment. Methodology: Blood samples were auto-analyzed using hematology machine made by Point Care Technologies, Inc. (Marlborough, MA, USA). All data were analyzed using statistical package for the social sciences 15.0 for Windows™. Median and 10 ^th and 90 ^th percentiles of CD4 cells were determined and analyzed using Mann-Whitney U test and Kendall's non-parametric correlations. P ≤0.05 values were considered to be significant. Results: The values of CD4 counts in the infants studied were higher compared with adults. The values of CD4 count, %CD4 and their normal ranges were statistically the same for male and female sexes and within all age categories under 1 year. Although absolute CD4 cell count remained fairly constant from birth to the age of 1 year, %CD4 decreased gradually from birth toward the age of one. Conclusions: For the first time in this environment, our study has reported absolute and percentage CD4 count, which were similar to those reported from other African studies. The results support the use of the same reference values for resident male and female infants for clinical decision making.

Background: In Plateau State as well as in most parts of Nigeria, malaria continues to exert a significant burden on the population in terms of morbidity and mortality. Case management of malaria is being used as a major tool in limiting the duration and reduction of mortality associated with the disease. The aim of this study was to assess the knowledge of malaria case management among primary health-care (PHC) workers in Jos, Plateau State. Materials and Methods: A cross-sectional descriptive study design was employed in studying PHC workers involved in treatment of malaria in Jos, Plateau State. 105 PHC workers were selected using a multistage sampling technique and data was collected from them using a semi-structured interviewer administered questionnaire. Data processing and analysis was carried out using STATA 9 statistical software (Stata release 9, statcorp Texas, USA; 2005). Mean and standard deviation were done for quantitative variables while percentages were used to represent qualitative variables. A confidence level of 95% was used and level of statistical significance was set at P ≤ 0.05. Results: Mean of age of the PHC workers was 40 ± 8.1 years and majority of them were females (89%). About 40% of them were senior community health extension workers. Majority of the workers (70%) had not had any recent training on malaria case management. In spite of this, knowledge of malaria was good among the respondents (95% were able to define malaria and 98.1% were able to list the symptoms of malaria respectively). More than half of the respondents (55%) were also able to correctly manage severe malaria. There was a statistically significant association between health worker cadre and correctness of the drug prescriptions (P = 0.001). Conclusion: Despite gaps in malaria case management, primary health-care workers in Jos appeared to be fairly knowledgeable in malaria case management.

Background: Hand washing is a cheap and effective method of limiting the spread of health care associated infections, but compliance has been reported to be low worldwide, especially in developing countries. Objective: To determine the knowledge and practice of hand hygiene among doctors in a tertiary health facility in southern Nigeria. Materials and Methods: This cross-sectional, descriptive study was carried out among all cadres of doctors employed by the hospital. Data were collected using a pretested, semistructured, self-administered questionnaire as well as by direct observation of a subsample of the doctors using an observational checklist. Data analysis was done using the SPSS version 16.0 statistical package and level of significance was set at P < 0.05. Results: A total of 326 doctors participated in the study and one third of these (108) were directly observed. Less than half of the respondents had good knowledge (43.9%) and good practice (48.2%) of hand hygiene. However, on direct observation, the overall compliance rate was 16.7%. Sex and specialty of the respondents were significantly associated with knowledge but not with practice of hand hygiene. The reasons mentioned for noncompliance included: Lack of hand hygiene materials like soap and water (65.0%), forgetfulness (35.0%), too busy/insufficient time (19.3%), inconvenient location of sinks (16.9%), the use of gloves (7.1%), and skin irritation from washing agents (4.6%). Conclusion: This study revealed a very low hand hygiene compliance rate among doctors in a tertiary health facility in the southern part of Nigeria and also highlighted some of the contributory factors. It is recommended that an institution-wide hand hygiene promotion campaign be embarked upon.

Background: Sexually transmitted infections (STIs) are responsible for a variety of health problems especially among the youth who engage in risky sexual behavior. There are few studies that describe STIs among the youths in Northern Nigeria. The objective of the study was to assess knowledge of STIs and risk factors among secondary school youth. Materials and Methods: This was a cross-sectional study in which structured, self-administered questionnaire was used to collect data on socio-demographics, knowledge on STIs, and risk factors. Three senior secondary schools were purposively selected for the study. Results: A total of 1765 youths aged 10-30 years with mean age of 16.9 ± 2.0 years participated in the study. 1371 (77.7%) and 394 (22.3%) were respectively Muslim and Christian. Mean age at first sexual intercourse was 16.7 ± 2.0 years. A majority (67.6%) of them heard about STIs; sources of information of STIs were school lessons 23.6%, mass media 23.3%, and health magazines 19.2%, respectively. Generally, knowledge on STIs was good as 75.4% of respondents knew how the disease is transmitted. This knowledge was significantly associated with class of student, place of treatment, and religious teaching (χ² = 9.6, P = 0.047, χ² = 22.1, P = 0.035 and 42.6, P = 0.001, respectively). Mean knowledge score was 0.698 ± 0.01. A majority of respondents were engaged in risky sexual behavior as only 16.2% use condom as a preventive measure. Eleven percent reported ever having an STI in the past and majority (52.8%) go to government hospital for treatment of acquired STI. 56% of the youth had two or more boy/girl friends and 30% had sexual relationships. Conclusion: It was concluded that secondary school youth had good knowledge about STIs; however, the opposite is true when it comes to preventive practice (use of condom). Interventions such as periodic publicity awareness and school seminars focusing on STI preventions are needed to control the disease among the youth.

Background: Contraceptive widely known in most rural setting as family planning is the planning of when to have children and the use of birth control and other techniques to implement such plans. Socio-cultural status is a determinant of health; it also has an influence on women's knowledge and uptake of contraceptive, the study therefore assessed the family planning uptake rate, prevalence of family planning method and the relationship between the social status and the method used. Methodology: A cross-sectional community survey was conducted among women of reproductive age residing in the community. Epi info version 3.4.3 and statistical package for the social sciences version 16.0 were used for the data entry and analysis respectively. Results: Out of the 362 females studied, (85.4%) were married and (46.4%) had no formal education. Farming was their predominant occupation. Out of all the females respondents; (86.7%) have had deliveries out of which (42.2%) are multiparous and (44.6%) grand multiparous. Contraceptive use was found to be (18.0%); and the most used was injectables (58.5%). A statistically significant association (P = 0.001) was established between contraceptive use and age, religion and marital status. Conclusion: Although contraception use was generally poor among the rural women in the studied community; married women, Christians and younger women were more likely to use a method compared to singles, Muslims and the older women respectively.

Background: Contraception has been identified as an effective means of combating the problem of unwanted pregnancy and unsafe abortion. It is equally an effective means of family planning and fertility control and therefore an important tool in promoting maternal and child health. The contraceptive prevalence in most developing countries remains very low. Objective: To evaluate the trend of contraceptive usage the preferred method and the source of information on contraception among the new clients attending family planning clinic at Aminu Kano Teaching Hospital, Kano. Materials and Methods: Records of the new clients attending family planning clinic of Aminu Kano Teaching Hospital, Kano from January 2005 to December 2009 were reviewed and analyzed. Information extracted included type of contraception, age, parity, and source of information. All information was analyzed using Epi- info 8.0. Results: A total of 3484 new clients accepted various forms of contraceptive methods during the period of study. There was a steady increase in the number of new acceptors of contraceptives over the period of study from 449 (12.9%) in 2005 to 1096 (31.5%) in 2009. The mean age and parity were 28.0±5.8 years and 3.6±2.4, respectively. The most common method of contraception accepted by the clients was injectable 1451 (41.6%), followed by intrauterine device 1124 (32.3%), then oral contraceptive pills which was 749 (21.5%). Bilateral tubal ligation was the least accepted method of contraception, with only 2 (0.6%) women. The predominant source of information on contraceptive methods was through the clinic personnel (97.6%). Conclusion: There was a steady increase in contraceptive acceptability in our center. The injectable methods of contraception were the most commonly accepted method, while bilateral tubal ligation was the least preferred method.

Background: Infertility is a major health problem in Nigeria and commonly results from complications of genital tract infections. Abnormalities of the cervix and its secretions are known significant factors in infertility in women. This study is aimed at determining the pattern of cervical abnormalities detected in cervicograms (CVGs) and assessed the value of the study in evaluation of infertile women in North Central Nigeria. Materials and Methods : Hysterosalpingograms (HSGs) and radiology report of 998 consecutive infertile women who had HSG over 10-year period at Jos University Teaching Hospital, Jos were retrieved and reviewed retrospectively, with particular attention to the cervicohysterograms. The data were analyzed using descriptive statistics with Excel 2010. Results : The women were aged 15-44 years, 4.4% of them were teenagers. Women with secondary infertility were more than those with primary infertility (59% vs. 41%). Cervical abnormalities were seen in 12.6% of the women. Complication rate for HSG was 8.5%. Conclusion : Infection-related cervical disorders were the most common abnormalities seen on the CVGs of women with infertility in this environment. Attention to CVG at HSG, therefore, can give clue to cervical factor in infertility.

Background/Purpose: Neonatal morbidity and mortality contributes significantly to under-five morbidity and mortality in sub-Saharan Africa accounting for 40% of under-five mortality. A substantial reduction in neonatal mortality is therefore necessary to achieve the Millennium Development Goal (MDG) 4 target by 2015. The aim of the study was to assess the pattern of neonatal morbidity and mortality in our environment which will help to identify interventions for better neonatal outcome. Materials and Methods: The study is a review of cases admitted into the neonatal unit of the Jos University Teaching Hospital situated in the North Central part of Nigeria. The unit started operating from the permanent site of the hospital on 1 March 2010 after the relocation of the hospital from the previous site. Data on all neonates admitted into the neonatal unit from 1 March 2010 to 28 February 2011 were obtained from the various registers/records and analyzed. Data extracted included biodata, gestational age, birth weight, main diagnosis, duration of admission, etc., In addition, the outcomes (discharged/died) were documented. All statistical analyses were performed using two-sided tests. A P < 0.05 was considered statistically significant. Results: A total of 572 neonates were admitted, accounting for 54.6% of the 1047 pediatric medical admissions into the hospital. The main causes of admission were neonatal infections (37.1%), prematurity (20.1%), and birth asphyxia (11.5%). Out of the 572 neonates, 111 (19.4%) died. About three quarters (76.5%) of the mortalities occurred in the first week of life with 46.4% of these occurring in the first 24 hours (χ² -20.2, P < 0.001). The common causes of mortality were prematurity (43.2%), , birth asphyxia (18.0%) and neonatal infections (17.1%) Conclusion: There is a high burden for neonatal care at the institution. The three main causes of morbidity and mortality are prematurity, infections, and birth asphyxia. Hence, neonatal care/facilities need to be improved especially to care for the high risk neonate. Also, the importance of infection control cannot be overemphasized.

Background: Bacille Calmette-Guérin (BCG) vaccine has been in use since 1921, yet childhood TB is still very prevalent in Nigeria. Since BCG efficacy depends in part on appropriate vaccine utilization, this study was designed to investigate the current practice of BCG administration through determination of BCG status. Methodology: Consecutive HIV negative children with new diagnosis of tuberculosis disease attending five outpatient clinics in Northern Nigeria were recruited over 2 years. Using a structured questionnaire, information with regards to their BCG status was obtained and each child was examined for the presence of a BCG scar. Logistic regression was performed to identify determinants of BCG status. Results: There were 300 children aged between 1 month and 14 years. More than half of them (mainly residing in rural and semiurban areas) did not receive BCG and only one-third (49/138) of those vaccinated had identifiable BCG scars. Delivery at home was significantly associated with non-receipt of the BCG antigen (OR = 408, z =5.891, P < 0.001). Lack of BCG vaccination was a significant factor for extra pulmonary disease (χ² = 37.34, OR = 11, P = 0.0001); with a four-fold increase in relative risk. Logistic regression showed that lack of a BCG scar correlated significantly with vaccination in non-governmental facilities (P = 0.006), positive tuberculin skin test (TST) values (P < 0.0001) but not with extra pulmonary disease (P = 0.909). Conclusion: Childhood TB is still driven to a large extent by low BCG coverage. In a TB endemic region, the absence of a BCG scar in a symptomatic child is an indicator for TB screening.

Background: The pattern of congenital heart diseases (CHD) varies from region to region even in the same country. Echocardiography has been available in Aminu Kano Teaching Hospitalfor about 10 years now but problems then were non-available of appropriate probes for children making it difficult to make some specific diagnosis. This study was undertaken to determine the types and the relative frequencies of congenital heart defects seen among children at the Aminu Kano Teaching Hospital, Kano, Nigeria. Materials and Methods: This is a retrospective study of the echocardiographic data collected over 24 month's period, between October 2009 and September 2011. Information obtained from the records included age, gender, clinical diagnosis, and echocardiographic findings. Data was analyzed and expressed in frequency tables and percentages. Results: A total of 506 children were seen. The age range was between 5 days and 15 years with a mean age of 3.29 ΁ 2.56. A total of 173 (34.2%) had CHD. There were 104 boys and 69 girls giving a M: F ratio of 3:2. 48.6% of the children were 1 year and younger. In order of frequencies, the common CHD are ventricular septal defect (30.6%), tetralogy of fallot (16.7%), atrial septal defect (12.1%), patent ductus arteriosus (10.9%), endocardial cushion defect (8.8%), tricuspid atresia (4.6%) and truncus arteriosus (2.3%). Conclusions: Echocardiographic screening of the children revealed a wide variety of CHDs. VSD and TOF are the most common, accounting for about half of the cases with CHDs. There is an urgent need for government and non-government organizations to establish well-equipped cardiothoracic surgical centes across the country to cater for children with CHDs.

Background: Upper respiratory tract infections (UTRIs), which may be complicated by acute otitis media (AOM), account for a large number of visits to the primary physician especially in the developed world. Materials and Methods: This study aims to determine the knowledge and treatment outcomes of UTRIs complicated by AOM in health professionals at the Jos University Teaching Hospital. Results: One hundred and forty-one participants aged 25-59 years with a mean age of 42 years (standard deviation (SD= ±12.5) ±12.5) were studied, constituting 94 males and 47 females giving a male to female ratio of 2:1. One hundred and twenty-five (88.7%) participants had experienced an UTRI within the last year of the study of which 37 (26.2%) had spread to the ears. Four (3.2%) participants presented to the otolaryngologist with AOM. None presented to the primary care physician. Thirty-seven (36%) participants used drug combinations, while 66 (64%) used single drug regimens. Eighty-four (81.6%) participants used various antibiotics with seven (6.8%) using a bacteriostatic and bactericidal antibiotic in combination. Four (3.2%) participants obtained prescriptions from the otolaryngologist, 99 (79.2%) got their medications over-the-counter, while 22 (17.6%) had spontaneous resolution of symptoms without the use of medications. All participants had complete resolution of symptoms following treatment. Conclusion: Education of health professionals on the otologic complications of UTRIs is vital to prevent debilitating sequelae.

Background: Tuberculosis (TB) is a global public health problem. Although curable, it is the most common cause of human immunodeficiency virus (HIV) related illness and death. Globally it was estimated that about 12 million people living with HIV/AIDS (PLHIV) are co-infected with tuberculosis (TB). The low immune system resulting from HIV confers the risk known for re-activation of latent or recent TB infection to active TB and increase the rate of recurrence of TB. Materials and Methods: New patients registered with the DOTS clinic meeting TB case definition, diagnosed based on findings suggestive of pulmonary tuberculosis (PTB) on clinical and radiological examination (chest X-ray), and sputum testing for AFB (acid fast bacilli) were offered provider initiated HIV counseling and testing (PICT) using HIV Uni-Gold and Determine test kits. Results: A total of 2, 456 of adult pulmonary tuberculosis (TB) patients were enrolled for 2 years (2007-2009). 462 (18.8%) out of 2,456 were HIV sero-positive. HIV prevalence is higher in female patients (15.9%) than male patients (10.5%) with a statistical difference (P < 0.05). HIV sero-prevalence also varied among the different age group. The peak age prevalence was in the age group 25-34 years accounting for 43.9% and the least with 1.5% in the group 65 and above years old. Conclusion: Diagnosing HIV infection among patients with pulmonary tuberculosis (TB) should be an offortunity for referrals for measure of the prevention and treatment of common HIV related illness, ongoing provision of social and psychological support and anti-retroviral therapy.

Background: Knee osteoarthritis is a chronic medical condition of public health importance in this setting. It is mostly diagnosed when preventive measures are no longer practicable due to reliance on the radiological diagnosis. Objectives: To determine the magnitude and risk factors associated with knee osteoarthritis among adult patients presenting at the University College Hospital, Ibadan, Nigeria. Materials and Methods: This cross-sectional study used a semi-structured questionnaire to interview 400 respondents. Knee osteoarthritis was diagnosed clinically using the American College of Rheumatology (ACR) criteria. Results: The point prevalence of knee osteoarthritis was 11.5%. Increasing age, female gender, marital status, low educational status, financial dependency, poor income, obesity, previous knee injury, epigastric pain, peptic ulcer disease, varus deformity of the knee, and poor health status were significantly associated with knee osteoarthritis. Logistic regression analysis showed increasing age (OR = 2. 874, CI = 1. 294-6.381), history of epigastric pain (OR = 57. 044, CI = 1. 693-192.24) and varus deformity of the left knee (OR = 3. 012, CI = 1. 063-8.547) to be the most significant factors associated with knee osteoarthritis. Conclusion: The magnitude of clinical knee osteoarthritis is high among respondents in this hospital-based study. Doctors in primary care should screen patients at first-contact to detect osteoarthritis early and manage appropriately.

Presbyopia is a refractive error (RE) that causes near visual impairment with advancing age. Uncorrected presbyopia significantly affects near vision-related quality of life of individuals who depend on near work for livelihood, be they literate or illiterate. This study is aimed at finding the prevalence of presbyopia in patients who presented with refractive error in Adoose specialist hospital, Jos. Materials and Methods: Records of all patients who presented at the hospital from 2000 to 2009 with symptoms of functional presbyopia, defined as requiring at least + 0.75 dioptre in order to read the N8 optotype at a distance of 40 cm in the patient's usual visual state were included in the study. The eye with the better presenting visual acuity was used for classifying the patients. Results: There were 912 patients with RE. Of these, there were 482 (52.9%) subjects whose visual acuities improved to N8 optotype at a distance of 40 cm with refraction. There were 265 (55%) males and 217 (45%) females. The mean age of patients at presentation was 47.8 ± 8.2 (range 35-80) years. Most of the patients (77.1%) complained of problems with near visual tasks. Seventy-five (15.7%) subjects presented with glasses of inappropriate corrections that was causing visual strains. Presbyopia showed a significant increase with increasing age. The power ranged from +0.75 to +4.0D (with a mean of 2.08). The most frequent power was +2.0D. The civil servants 257 (53.3%) formed the highest number of subjects seeking presbyopic correction. Plano-presbyopia was the commonest presentation at 51.6% and it showed a significant decrease with increasing age. This was followed by hypermetropia − presbyopia at 32.6% which increased with the increasing age. There were fewer subjects (15.8%) with myopia-presbyopia. Conclusion: This study has shown that presbyopia presents early and is a problem in our society. Economic consequences are likely to be considerable, as uncorrected presbyopia affects people in the working-age group.

Organophosphate poisoning occurs worldwide. Both sexes are equally affected and accidental poisoning is commonest between the ages of 2 and 8 years. The use of organophosphate as homemade insecticide has exposed children to the risk of organophosphate toxicity; furthermore, poor regulation of these hazardous chemicals makes them easily accessible to individuals. The case of three siblings who ate fried fish poisoned with organophosphate meant to serve as bait for rodents in the farm is reported.

Foreign body aspiration or ingestion is common in young children. They may be asymptomatic and pass unnoticed if unwitnessed or may manifest with digestive, respiratory or behavioural problems. Some could be life threatening, therefore in unwitnessed cases, a high index of suspicion should be entertained when young children present with complains suggestive of its occurrence. Key words: Child, foreign body, ingestion, witness

The aim of the report is to re-emphasize how dangerous fish bone impaction in the esophagus could be and that a combination of pointing sign with radiographic features improves the specificity of the diagnosis. A 45-year-old male civil servant presented with 4 days history of fish bone impaction in the throat while taking meal containing fish with accidental ingestion of fish bone. This was associated with odynophagia, dysphagia, drooling of saliva, failed attempted dislodgement with swallowed boluses and positive pointing sign. Neck X-ray showed prevertebral widening and radio-opaque tracheoesophageal penetrating foreign body. He had endoscopy under general anesthesia with retrieval of the fish bone. Laryngo- esophagoscopy showed a laceration in the esophageal mucosal, which penetrated into the laryngeal inlet. This case report re-emphasizes the danger of attempting to dislodge such sharp foreign bodies with boluses of food.

Bilateral Bell's palsy occurring simultaneously is exceedingly rare. We report a case of a 27-year-old Nigerian man with bilateral Bell's palsy, that occurred simultaneously, who had remarkable response to steroid and physiotherapy. We emphasized the importance of considering Bell's palsy and the various differential diagnoses in all cases presenting with bilateral facial muscle paralysis.

Lipomas are the most common benign mesenchymal tumors and can arise in any location where fat is found. They could present as a tiny swelling or as an enormous mass in a body region. When they are more than 10 cm in their widest dimension or greater than 1 kg in weight, they are called giant lipomas. Giant lipomas have been described in the thigh, shoulder and trunk. We present a case of a giant gluteal lipoma in a 62-year-old woman seen in our out-patient clinic.