Background: Congenital diaphragmatic hernias (CDHs) are uncommonly seen anomalies of the diaphragm in our environment. They present late posing great difficulty in diagnosing and management. Objective: To review our experience in the management of CDH and to draw attention to misdiagnosis and mismanagement of cases. Methodology: A prospective study on all patients with CDH from August 2008 to June 2014. Protocols and questionnaire were designed for diagnosis, management, and follow-up of the cases. Results: Eight patients (five males and three females) with age between 15 days and 8 years (median = 5 months) were recruited. Seven (87.5%) cases had hernia of Bochdalek hernia (BH) (one on the right and six on the left) and one had Morgagni hernia (MH). All patients were underweight with a median of 10.7 kg (range = 3.0–17.6 kg). Five (62.5%) cases had recurrent cough, respiratory distress, and postprandrial vomiting; one patient (12.5%) presented with chronic constipation raising the suspicion of Hirschsprung's disease. Diagnosis was confirmed with plain chest X-ray in six patients; upper gastrointestinal contrast in three cases (37.5%) while the patient with chronic constipation and anterior CDH had barium enema, and two patients had chest ultrasound to confirm diagnosis. One patient underwent laparoscopic repair of an MH, and seven patients had open transabdominal repair of BH. The median age at surgery was 7 months (36 days – 96 months). The diaphragmatic defect dimension ranged from 3 cm to 11 cm. Only one patient had 24 h Intensive Care Unit care postsurgery, and median length of stay was 11.8 days (range = 5–27 days) in the open group and only 4 days in the laparoscopic case. Conclusions: CDHs were uncommon and presented late in our practice. Modalities of management require meticulous and structured professional care. We recommend that postmortem should be done in stillborn and infants' deaths to determine true incidence of CDH and confirm possible high hidden mortality.

Background: Psychoactive substance use by vehicle drivers is a global problem. The identification of factors associated with their use among long-distance commercial drivers will provide information valuable to the interventions aimed at the control of this pattern of behavior. Objective: To determine the sociodemographic factors associated with the use of psychoactive substances among long distance commercial vehicle drivers in Kaduna, a city in Northwest Nigeria. Materials and Methods: Long distance drivers from selected motor parks in Kaduna metropolis were recruited. They were interviewed using a sociodemographic and a brief drug use questionnaire, two screening instruments which included the Alcohol Use Disorder Identification Test and the Drug Abuse Screening Test. Results: All 274 subjects were males, with a mean age of 43.4 ± 10.2 years. 94.9% of the subjects were married, 78.5% of them were Muslims, and 67.5% had received a formal education of at least primary school level. Younger drivers were more likely to use cannabis, P < 0.0001, and tobacco P < 0.028, while those who had no spouse used more cannabis. A significant proportion of alcohol users was Christians with formal education, while Muslims were more likely to use cannabis and caffeinated substances. Significant predictors of alcohol use were being a Christian, odds ratio (OR) = 30.6, P < 0.0001 and above 45 years of age, OR = 3.3, P = 0.007, while significant predictors of cannabis use were not having a spouse, OR = 6.6, P = 0.004, and below 45 years of age, OR = 5.5, P = 0.03. Conclusion: Sociodemographic factors influence substance use among long distance drivers, and these characteristics can be explored as the focus in directing drug use control intervention.

Background and Purpose: Most of the available intravenous (IV) induction agents produce hypotension except ketamine. However, its use is limited due to cardiovascular stimulation. We therefore investigated the effects of oral clonidine premedication on ketamine-induced cardiostimulation. Methodology: This was a prospective, double-blind, randomized controlled study of 156 patients scheduled for general anesthesia. The patients were randomized into three Groups A, B, and C of 52 patients each and all the patients received 10mg diazepam the night before the surgery and 90 minutes before induction of anaesthesia. In addition, patients in Groups A and B received 0.1 mg and 0.3 mg oral clonidine, respectively, at the time of premedication while no clonidine was administered to patients in Group C. Anesthesia was induced with IV ketamine 2 mg/kg and 100% oxygen 8 L/min via the Bain's circuit. The pulse rate (PR), systolic blood pressure, diastolic blood pressure, and mean arterial pressure were measured noninvasively and recorded every minute for 10 min before induction of anesthesia. Results: The peak values of PR in the 0.1 mg and 0.3 mg clonidine groups were significantly lower than the corresponding value in the control (C) group (86 ± 5 bpm and 83 ± 7 bpm vs. 118 ± 14 bpm, P < 0.05). However, the peak mean blood pressure in the Group B was significantly reduced when compared with the corresponding values in the Groups A and C (97 ± 9 mmHg vs. 117 ± 7 mmHg and 115 ± 14 mmHg, respectively P < 0.05). Conclusion: Preanesthetic oral clonidine reduced cardiostimulation following ketamine-induction in spontaneously breathing patients.

Background: Ginseng is a well-known Chinese herb with many confi rmed clinical advantages. Ginseng formulation in combination with other chemicals is very interesting. The combination between ginseng and amino acid such as arginine is interesting. There are extremely limited reports on such ginseng-amino acid combination. Method: The present ontology study is to assess the ginseng-arginine combination. Results: In this study, a standard ontology study was used for assessing the resulted effect as an outcome of combination between ginseng and arginine. Conclusion: Based on this study, there is no new addition effect but some concurrent effects between ginseng and arginine can be identified.

Background: The National Health Insurance Scheme (NHIS) in Nigeria was introduced in 2005 to remove financial barriers to access of care and to improve quality of care. However, since introduction of the scheme, there has not been any documented study to assess whether there has any improvement in quality of care in the participating facilities as a result of its introduction. Objectives: This study was undertaken to determine and compare the quality of care before and after introduction of NHIS in health facilities in Zaria, Kaduna State, Northwestern Nigeria. Materials and Methods: The study was cross-sectional, descriptive, and comparative in design. Using stratified sampling one public and two private NHIS accredited secondary health facilities were selected. Adherence to Federal Ministry of Health performance standards for emergency obstetric care was used as proxy for quality. A retrospective analysis of a total of 320 case notes of female patients that were managed in these facilities for five maternal complications was undertaken, 160 before and 160 after introduction of NHIS. Results: Results showed that quality of care, represented by levels of adherence to standard treatment guidelines, was generally poor (42%). The mean adherence to standards of care levels at facility level of 37.9% before and 46.3% after introduction of NHIS was observed; this difference was statistically significant (P = 0.005), with the public facility performing significantly better, with an adherence level of 59% compared to 30% for private facilities (P = 0.001). Conclusion: The study demonstrated improvement in quality of care following introduction of NHIS in the facilities. Integrating supportive supervision and rapid expansion of the scheme are recommended to widely spread its quality-related benefits.

Background: Self-monitoring of blood glucose (SMBG) is considered one of the cornerstones of diabetes care and is an important component of modern therapy for diabetes mellitus. Methods: This was a descriptive cross-sectional study carried out at the diabetes clinic of Jos University Teaching Hospital (JUTH) and a private specialist clinic in Jos, North central Nigeria. One hundred and eighty patients on treatment for diabetes aged 18 years and above diagnosed to have diabetes but not less than six months were recruited consecutively. Patients on dietary management and patients with Gestational Diabetes Mellitus (GDM) were excluded from the study. Data was obtained using a questionnaire. Results: Ninety six (53.3%) were males. The mean age was 56 ± 11 years. The median (range) duration of diabetes was 9.0 (3.0 - 12.5). One hundred and eighteen (65.5%) had either secondary or tertiary education with one hundred and three (57.2%) earning less than N500,000 yearly. The prevalence of self monitoring of blood glucose (SMBG) was only 47.8 % with more than 50% not practicing SMBG as recommended by the American Diabetes Association. Factors associated with SMBG include high level of education, high income (>N 1.5 million yearly), long duration of diabetes (≥10 years) and male sex. Conclusion: The practice of SMBG in our environment is suboptimal with those practicing it not doing it as recommended. Hence, increased awareness and education of patients with diabetes should be promoted among those who do not practice SMBG and those who do not practice it as recommended.

Background: The study evaluated compliance with warm saline rinse instruction, the factors militating against it and its association with postoperative complications after dental extractions. Materials and Methods: A prospective study of all consecutive patients 16 years and above who had dental extraction at the dental clinic of our institution over a 1-year period was undertaken. The patients were reviewed at day 3, 7, 11, 15, and 30 postextractions to evaluate for compliance with warm saline rinse instructions. The information obtained included sociodemographics, compliance, reasons for noncompliance, and complications. The collected data were analyzed using Statistical Package for Social Sciences (SPSS) version 13. The results were presented as frequencies, percentages, mean and standard deviations (SD), and cross tabulations as appropriate. Statistical significance was set at P < 0.05. Results: Of the 220 patients who met the inclusion criteria, male accounted for 127 (57.7%) while female were represented by 93 (42.3%) giving a male to female ratio of 1.4:1. The ages ranged from 18 to 73 years, mean (SD) 32.2 (9.84) years. Less than half (n = 103; 46.8%) of them complied fully with the instructions. The majority of the noncompliant subjects were able to gargle twice daily (n = 84; 71.8%) and the most frequent number days gargled was 5 days (n = 48; 41%). The most commonly observed reason for noncompliance was the participants' nature of work (n = 36; 30.8%). A total of 17 (7.7%) subjects developed alveolar osteitis and this was significantly more in the noncompliant subjects (χ² = 9.09; P = 0.003). Those who gargled twice or thrice daily had significantly less alveolar osteitis compared to those that gargled at lower frequencies (χ² = 23.88; P = 0.0001). Conclusion: Patients' nature of the occupation, educational activities, and too high a dosing frequency are some of the factors militating against compliance with warm saline rinse instructions.

Background: Attempts being made to unravel the relationship between blood antigens, hemoglobin (Hb) genotypes and increased susceptibility to certain diseases are ongoing. Objective: The study was carried out to provide data on the distribution of ABO, Rh D, and Hb variants among pregnant women receiving antenatal care at Federal Medical Centre, Yola, Nigeria. Materials and Methods: Medical records of these subjects (n = 2226) were sorted out and analyzed according to their ABO blood group phenotypes and Hb variants. Results: Blood group O was the most prevalent (47.7%) among our subjects, followed by A (26.6%), B (22.2%), and AB (3.5%). The Rh D antigen was positive in 97.1% and negative in 2.9% of the study population. There were five Hb genotypes AA (81.94%), AC (0.34%), AS (17.57%), SC (0.05%), and SS (0.14%). The occurrence of different ABO, Rh D blood groups and Hb variants varied significantly (P < 0.05) among pregnant women studied. Conclusion: The frequency of ABO and Rh D blood groups will assist in the formulation of genetic counseling policies.

Background: Teenage pregnancy is generally considered to be a high-risk event. Teenage mothers are physically and psychologically ill-prepared for reproduction. Low socioeconomic status and lack of prenatal care are among the factors influencing pregnancy outcome in these patients. Objective: To assess the obstetric outcome of teenage pregnancy, its current trends, sociodemographic determinants, and incidence in Aminu Kano Teaching Hospital. Materials and Methods: A retrospective study of 540 teenage primigravidae who delivered in Aminu Kano Teaching Hospital between 1^st of January 2009 and 31^st of December 2011. Results: The incidence of teenage pregnancy over the study period was 5.8% (58/1000 deliveries). Majority of the patients (78.9%) belonged to low socioeconomic class. Pregnancy complications prevalent in these patients included anemia (33.5%), low birth weight (17.8%), preeclampsia/eclampsia (12.4%), preterm labor (11.5%), and stillbirth (2.5%). Cesarean section rate among them was 18.9%. Conclusion: Teenage pregnancy is a high-risk pregnancy because of the associated pregnancy complications which are more prevalent in the unbooked patients. Access to health care services, girl-child education, and improvement of the socioeconomic status of the patients will reduce its incidence.

Both tuberculosis (TB) and Crohn's disease can affect any part of the gastrointestinal tract, but the terminal ileum and ileocecal region are mostly affected. Colonoscopic features of erythema, mucosal nodules, ulcers, strictures, and a deformed ileocecal valve occur in TB are nonspecific and can also occur in Crohn's disease. This is a case of a Nigerian with ileocecal TB, which mimicked Crohn's disease at colonoscopy. The patient is a 23-year-old man who presented to the clinic on account of recurrent abdominal pain and weight loss of 7 months duration. There was history of nonmucoid, nonbloody, and nonfoul smelling bowel motions. He had progressive weight loss was progressive with history of nausea, bloating, and anorexia but no vomiting. Colonoscopy revealed polypoid lesions in the cecum, deformed and polypoid ileocecal valve, and cobblestone appearance in the ileum. The histology of the ileal and colonic biopsies showed diffuse transmural infiltration by lymphocytic cells. Because of the extent of cecal and ileal involvement together with severe abdominal pain the patient was experiencing, he was taken for surgery where a right hemicolectomy with ileotransverse anastomosis was performed. The histology of the resected bowel then revealed features consistent with TB.

1,1′-dimethyl-4,4′-bipyridinium dichloride (paraquat) is a very rare cause of acute toxic nephropathy in Nigeria unlike in Asia-Pacific region. It is one of the most commonly used herbicides which are highly toxic to humans especially when ingested. Paraquat poisoning is associated with high case fatality of up to 52% with pulmonary and renal complications as the major causes of mortality. We reviewed the case notes of a 23-year-old female who was managed for acute kidney injury (AKI) following paraquat poisoning. We present a case of a 23-year-old female who developed nonoliguric AKI that was diagnosed 3 days following paraquat poisoning. She was managed with hemodialysis and had complete renal recovery. Patients with paraquat poisoning have a high risk of developing AKI which may be delayed; hence, renal function should be closely and continuously monitored in them. Early diagnosis and prompt treatment is key to reducing the associated morbidity and mortality.