CONTEXT: Contraception with Depot Medroxyprogesterone Acetate (Depo provera®) is quite effective though not without side effects that may cause discontinuation amongst acceptors. OBJECTIVE: To evaluate client characteristics, their experiences and acceptability of Depo provera in Enugu and compare these with previous experiences elsewhere. MATERIALS AND METHOD: A review of the family planning records of new acceptors who used Depo provera between 1^st January 2000 and 31^st December 2005 at the family planning clinic of University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu. RESULTS: Within the study period, 684 new clients accepted Depo provera, accounting for 21.4% of all new acceptors for various forms of contraception. The mean [± SD] age and parity of the 590 acceptors whose records were available were 34.40 ± 6.03 years and 5.52 ± 2.02 respectively. Seventy percent (70%) of the clients had 5 or more children. Most (51.6%) had primary education. Seventy percent of clients with 5 or more children wanted no more children while 30% of those gainfully employed use of Depo provera for child spacing. Fifty seven percent of clients accepted Depo provera within a year following confinement and 80.2% of them were breast feeding. Complications occurred in 54.2% of all acceptors, with menstrual abnormalities occurring in 94.4% of them. Secondary amenorrhoea was the commonest menstrual anomaly occurring in 81.1% of clients with menstrual problems. Discontinuation in use of Depo provera was 51.5% after the first one year. Irregular injection schedules and default were common with a continuation rate of 25.6% at the end of the observation period. However, the complaints of side effects appeared to wane beyond the second year of use. Three accidental pregnancies (0.5%) occurred during the study period. CONCLUSION: Depot medroxyprogesterone acetate injectable contraceptive is an effective method of contraception in Enugu.It is accepted mainly by clients that have completed their family and are breast feeding. Awareness of its side effects obviously enhances continuation.

BACKGROUND: Youths are the most vulnerable group affected by the HIV pandemic and its spread is most rapid amongst them. Their knowledge and awareness about this disease could transform to positive habits which could stem the tide of the pandemic. This study therefore set out to find out about the knowledge and awareness of HIV/AIDS and sexual behaviour amongst pre-clinical medical student in a Nigerian University. MATERIAL AND METHOD: This was a cross sectional descriptive study carried out in the University of Uyo Medical School. Structured questionnaire was administered to consenting students to gather relevant information about socio-demographic characteristic, HIV/AIDS awareness, sexual behaviour, willingness to screen for HIV/AIDS amongst others RESULT: One hundred and fourteen students completed the questionnaire. Majority (82) were males, with most of them aged between 16-24 years. All of them (100%) had heard about HIV/IADS, before, and majority heard it from the first time through the electronic media. Majority (83.9%) could identify all the routes of transmission of HIV/AIDS while all respondents identified HIV virus as being. Ninety five percent agreed there is no cure for the disease. Thirty seven percent of then were sexually active with the mean age of sexual debut being 17.2 ± 3.95 years. Only 70% of the sexually active respondent admitted using a condom during sexual intercourse. Majority (94.3%) agreed to undergo voluntary counselling and testing with 73% saying they will seek medical attention if infected. Only 40.2% of the respondent agreed to disclose their status if they test positive to the virus. CONCLUSION: Awareness and knowledge among certain aspects of HIV/AIDS amongst pre-clinical medical students in Uyo is high. However certain risky behaviour like no consistent use of condom during sexual intercourse still persist with many students not readily accepting to disclose their HIV status if they test positive to the virus. We advocate increased awareness, sensitization and education of the entire populace about HIV/AIDS. Government should also legislate laws to prevent discrimination, stigmatization and victimization of those affectedby the virus.

OBJECTIVE: Little information is available about prevalence of psychiatric morbidity among adult patients who suffered from cancrum oris in Nigeria. The objective of this paper was to assess the prevalence of psychiatric morbidity among patients of cancrum oris in Nigeria. METHOD: A cross sectional controlled study was conducted in 2005 comprising 200 adult patients of cancrum oris. Data was collected through self administered questionnaire from the patients. Psychiatric morbidity was assessed using General Health Questionnaire (GHQ) 28. RESULTS: Prevalence of psychiatric morbidity was 37% which was about three times that of the control. Psychiatric morbidity was more prevalent among female patients. Other factors associated with high prevalence of psychiatric morbidity include being never married, no formal education and unemployed status CONCLUSION: Psychiatric morbidity is prevalent among cancrum oris patients with differences between both sexes. Being never married, no formal education and unemployed status were other associated factors.

BACKGROUND: The Millennium Development Goal 5(MDG-5) aims at reducing Maternal Mortality Ratio (MMR) by 75% by the year 2015 as compared with the 1990 estimates. There is paucity of recent information on the pattern of maternal mortality in the north central Nigeria. OBJECTIVE: This study aims to document the trend and causes of maternal deaths at the Federal Medical Centre, (FMC), Lokoja and to suggest ways of improving safe motherhood services at the centre and in Nigeria. METHOD: This is a review of case records of 44 aternal deaths that occurred between 1^st January 2005 and 31^st December 2009 at FMC, Lokoja, north central Nigeria. RESULTS: Forty four maternal deaths occurred and 9496 live births were recorded, giving a Maternal Mortality Ratio (MMR) of 463 per 100,000 live births. The annual MMR decreased from 779/100,000 live births in 2005 to 392/100,000 live births in 2009. The unbooked patients constituted about 68.2% of maternal deaths and about half (56.9%) of women that died were within the age range of 25-29 years. Hypertensive disorders (31.8%), abortion complications (18.2%), obstructed labour/uterine rupture (9.1%) and hemorrhage (9.1%) were the leading causes of death. CONCLUSION: We observed a decreasing trend in annual maternal mortality at the hospital but more commitment is needed to achieve the MDG-5.

OBJECTIVE: To determine the relationship between prostate volume and international prostate symptom score (IPSS) in Africans with benign prostatic hyperplasia (BPH). PATIENTS AND METHOD: This was a prospective study of 120 men aged between 45 to 85years, who were referred to the urology outpatient facility for treatment of clinical BPH between July 2007 and October 2008 in Jos University Teaching Hospital. These patients were properly evaluated; a digital rectal examination was done to estimate the prostate size. The pre-treatment IPSS of the patient was also obtained. The prostate volume of each patient was then estimated by transabdominal ultrasound. RESULTS: The mean prostate volume was 72.79±44.38cm³. The mean values for the different diameters of the prostate were 5.63±1.17cm (longitudinal diameter), 4.48± 0.95cm (anterior posterior diameter), 4.97±1.06cm (transverse diameter). The Pearson’s correlation between pre-treatment International prostate symptom score and prostate volume was -0.0035 (P>0.05). CONCLUSION: This study has shown that there is no significant relationship between international prostate symptom score and prostate volume in Africans. This is same with similar studies done in other parts of the world.

INTRODUCTION: Previous reports on free surgeries have tended to focus on the numbers of patients treated. Little has been documented on the impact on training hence this report. Such grants should positively impact training, patient outcome and volume of patients. METHODS: A retrospective review of all cleft surgeries carried out two years before and after the commencement of free surgical treatment at the hospital (from November 2004 to October 2008) was undertaken. The demographics were studied for both primary and revisionai surgeries. The primary surgeons were also noted. Excluded from the study are procedures to remove sutures. Simple arithmetic analysis was used. RESULTS: Seventy-three cleft procedures had been carried out before, while 168 procedures were carried out after October 2006. Eight patients aged over 15 years had lip repairs before while 42 patients over 15 years had lip repair after commencement. Fourteen procedures were carried out by three trainee surgeons before; while 29 procedures were carried out by nine trainees after October 2006. In 2005 an average of four procedures a month were undertaken; this increased by 2008 to eight. CONCLUSION: Free treatment positively impacts patient turnout and training, and are encouraged to improve the quality of healthcare in the country.

BACKGROUND: Malignant renal tumour is the third commonest urological tumour after prostate and bladder cancer. It is however the urological tumour with the highest mortality/ incidence ratio. OBJECTIVE: To review the frequency, mode of presentation and histological pattern of patients with malignant renal tumours in Nnamdi Azikiwe University Teaching Hospital. METHOD: A 7 year retrospective review of all our renal tumour folders in the institution. RESULTS: 19 patients qualified for the study with a male/female ratio of 1:2.8 and a mean age of 52.6 + 15.8 years. The peak age was in the seventh decade. Most patient present late (78.9%).Renal cell cancer was the commonest tumour type with the commonest mode of presentation being abdominal mass and pain. CONCLUSION: Malignant renal tumours present very late in our environment and patients hesitate in accepting available treatment option which is surgery. There is need for increased patient awareness and high index of suspicion by the clinician, particularly during imaging procedures, as this would significantly enhance the early detection of these patients.

BACKGROUND: Episiotomy is the most commonly performed obstetric procedure. The indications and efficacy are poorly established and its practice has remained controversial. OBJECTIVE: To determine the rate and the determinants of episiotomy in the parturients at the UNTH, Enugu. METHODS: A five year retrospective review of episiotomy at UNTH Enugu between 1^st January ,2000 and 31^st December,2004. RESULTS: Out of 3032 vaginal deliveries, 1201 women had episiotomy during vaginal delivery, giving a rate of 39.6%. The rate fluctuated between 38.7% in 2000 to 32.7% in 2004.The risk of receiving episiotomy is significantly higher among Primigravidae than multigravidae [OR=10.92,(95%CI=8.98,13.28]. Similarly, macrosomia(birth weight>4kg) significantly increases the risk of episiotomy[OR=0.096, (95%CI=0.06,0.15]. Women who had instrumental or destructive vaginal delivery are significantly more likely to receive episiotomy than those who had spontaneous vaginal delivery[OR=0.13 (95%CI=0.07,0.26]. The postpartum blood loss is significantly higher among women that received episiotomy than those who did not[t=42.161,P>0.0001], CONCLUSIONS: The rate of episiotomy in UNTH, Enugu is high. Primigravidity, macrosomia and instrumental deliveries are factors associated with increased risk of episiotomy. Knowledge of these risk factors will guide in predicting episiotomy among paturients in labour ward.

BACKGROUND: Fractures of the zygomatic complex occur worldwide and are a component part of injuries that can be sustained in the maxillofacial region. The objective was to analyze the clinical presentation and management of zygomatic complex fractures. Methods: This was a prospective study carried out over a period of five years at the University of Calabar Teaching Hospital, Nigeria. Data documented were patients’ age, gender, time of presentation, cause and type of fracture, associated head and maxillofacial injuries, clinical features, types of plain radiographs, treatment methods, duration of follow-up and complications. RESULTS: Majority of the patients (n=81, 63.3%) were in their third and fourth decades of life while the male to female ratio was 20.3:1. Road traffic accident (n=lll, 86.7%) was the most common cause of fracture. Fractures of the zygomatic complex alone (n=105, 82.0%) were more common than isolated fractures of the arch (n=13, 10.2%) and combined fractures of the zygomatic complex and arch (n=10,7.8%). CONCLUSION: While multi-disciplinary approach to treatment is important, majority of the fractures were treated by simple elevation and transosseous wire osteosynthesis. Delay in presentation, associated injuries and non-availability of mini-plating technique contributed to the development of complications.

BACKGROUND: Eclampsia contributes significantly to maternal and perinatal mortalities globally. The objective of this study is to review the pattern of Eclampsia in Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria. METHOD: A retrospective study that reviewed records from labour ward and the Medical Records Department, of cases of Eclampsia managed at NAUTH over a ten year period 1^st January-31^st December, 2009. RESULTS: There were 57 cases of Eclampsia out of a total of 6,262 deliveries within the study period, giving a prevalence of 0.91%. The highest prevalence of 0.24% occurred in 2009. It was most common, 14 (30.4%), in the 25-29 years age group. The nulliparous women, 28 (61%) were more commonly affected. The prevalence was higher in the un-booked patients (89%), and antepartum Eclampsia was the commonest type (76%). Twenty one (45.7%) patients had three or more convulsions prior to the institution of therapy. Headache, oedema, and blurring of vision were the commonest symptoms, 74%, 71%, and 65% respectively. CONCLUSION: Eclampsia occurred mainly in unbooked and primigravid patients in this study. Early registration of pregnant women, especially primigravid, in health facilities for effective antenatal care and supervised hospital delivery will significantly reduce the prevalence and complications of Eclampsia.

BACKGROUND: Neurological disorders are a significant cause of morbidity and mortality worldwide. Urban hospital -based studies give some perspectives on the burden of neurological disease but there are no community- based studies from South East Nigeria. AIM: This study sought to screen for the scope and pattern of neurological dysfunction affecting inhabitants of two semi-urban communities in Enugu, South East Nigeria. METHODS: A descriptive, cross- sectional, questionnaire- based study of inhabitants living in Alfred Camp and Udi Siding communities in Enugu was carried out in March 2008. Using a structured questionnaire, house- to- house interview of the residents was conducted by doctors trained for this purpose. Residents’ knowledge and experience of clinical features that suggest neurological dysfunction were ascertained. Informed consent was obtained and ethical approval obtained from the Ethics Committee of the University of Nigeria Teaching Hospital Enugu. Data obtained was analyzed using SPSS version 13.5. RESULTS: Completed questionnaires were 239 in number. There were 138 males and 101 females with age range of 18 -75 years. Most respondents, 127 (53.1%), were aged 21 -30 years. Pain syndromes were most common with headache, low back pain and neuropathic pain accounting for the top 3 neurological disorders. CONCLUSION: This study has suggested that pain syndromes affect large numbers of people ordinarily resident in semi-urban communities in Enugu, South East Nigeria. These syndromes have an effect on quality of life. There is need for further large scale studies as well as increased public health strategies for addressing neurological diseases including pain disorders.

BACKGROUND: The relevance of dyslipidaemia in the management of cardiovascular diseases especially hypertension is an important health care challenge that is increasing worldwide. Of great concern in Nigeria is that most geriatric hypertensives with dylipidaemia are not routinely diagnosed and therefore do not receive appropriate treatment. OBJECTIVE: This study is aimed at describing the magnitude (prevalence and pattern) of atherogenic dyslipidaemia among geriatric Nigerians with systemic hypertension in a rural hospital in Eastern Nigeria. METHODS: A descriptive hospital-based study was carried out from June 2008 to June 2011 on 122 consecutive geriatric patients with systemic hypertension who met the selection criteria at St Vincent De Paul hospital, Amurie-Omanze, a rural Mission General Hospital in Imo state. The fasting lipid profile was determined by enzymatic method. Dyslipidaemia was defined using the third report of National Cholesterol Education Panel in adult (ATP III). The data collected included age and sex. RESULTS: Fifty-four(44.3%) out of 122 patients had at least one dyslipidaemia. The age of the patients ranged from 65 years to 91 years with mean age of 69±2.10 years. There were 51(41.8%) males and 71(58.2) females with male to female ratio of 1: 1.4. The commonest lipid abnormality was low high density lipoprotein-cholesterol (38.5%). Others included high low density cholesterol (23.8%), high total cholesterol (17.2%) and high triglyceride (14.8%). CONCLUSION: This study has shown that dyslipidaemia exist among geriatric hypertensives in the study area with low HDL-C being the most frequent lipid abnormality suggesting that low HDL may be the major form of dyslipidaemia and a marker of dyslipidaemic cardiometabolic risk among them. Screening for dyslipidaemia should therefore form an important part of clinical care of geriatric hypertensives and those with dyslipidaemia should become target for lipid lowering treatment in addition to lifestyle modification.

BACKGROUND: Hysterectomy is one of the most commonly performed major gynaecological procedures in women. Total abdominal hysterectomy (TAH) for benign disorders is commonly performed in Jos University Teaching Hospital and this study aimed at ascertaining its frequency in relation to other major gynaecological operations, demographic features of the patients, indications and safety of the procedure in this institution. MATERIALS AND METHODS: A retrospective descriptive study of consecutive patients who had elective total abdominal hysterectomy performed for various benign indications during the study period from January 2001 to December 2008 was conducted. Data extracted from the case files included age, parity, presenting symptoms, indications for the surgery, intraoperative findings and post-operative complications. Data was analysed with 2008 EPI-info version 3.5.1. RESULTS: Total abdominal hysterectomy accounted for 18.2% of all major gynaecological operations. Majority of the women were in their fifth decade of life (65.9%) and parity of five and above (46.4%).The most common indications were uterine fibroid with or without menorrhagia (60.6%) and cervical intraepithelial neoplasia (27.0%). Post-operative morbidity was recorded in 40 (17.7%) of cases. Post-operative wound infection (52.5%) and fever (30.0%) accounted for the majority of the complications. There was no mortality. CONCLUSION: Total abdominal hysterectomy for benign conditions is relatively common and safe in this centre. The review of the antibiotic regimes for chemoprophylaxis may help in reducing the postoperative infection rate associated with the operation.

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 withmany of these diseases.

BACKGROUND: Eye diseases constitute one of the common health problems presenting to the general practice clinic and could have significant socioeconomic consequences. OBJECTIVES: To determine the pattern of eye diseases presenting to the eye clinic of Ahmadu Bello University Sick Bay, Samaru, Zaria. METHODS: A prospective study of both new and old consecutive patients presenting to the eye clinic of Ahmadu Bello University Sick Bay between March 2009 and May 2010 was conducted. A screening format designed by the authors was used to extract information on biodata,presenting complaint,visual acuityanterior and posterior segment examination,investigations and diagnosis.The data was analysed using Analyse-it V2.22(2010) statistical soft ware. RESULTS: There were 1448 patients comprising 856 males and 592 females who were aged 24.3 years ±11.7SD with an age range of 0 to 60years.The majority(63.5%) were students. The common eye diseases seen were infective conjunctivitis (40.3%), allergic conjunctivitis, (32.7%), refractive errors (17.3%), glaucoma (1.9%) and cataract (1.8%). CONCLUSION: Eye diseases were found to be common within the community of Ahmadu Bello University which is made up of students predominantly. This implies that avoidable (preventable and treatable) ocular disorders are still common among Nigerian students. Early detection (through periodic eye screening) and prompt treatment will significantly reduce visual impairment and needless blindness from these avoidable causes.

INTRODUCTION: HIV infection and AIDS is a public health problem worldwide, particularly affecting the populace in resource constrained settings like in sub- Saharan Africa. Women of reproductive age are most affected and infected with the disease. METHODOLOGY: A descriptive study of pregnant women presenting for the first time at the obstetrics booking clinic of ESUTTH, Parklane from 1st April, 2009 to 31^st March, 2010. Socio-demographic characteristics, sexual behavior, pregnancy history and STI related symptoms were obtained using already prepared proforma. HIV Screening test was conducted in a serial two step approach using Determine HIV test kits and Stat- Pak HIV kits after obtaining an informed consent. Discordant results were subjected to Western blot for confirmation. Data were entered and analyzed using Epi-info statistical software. P Value <0.05 were assessed as statistically significant at 95% confidence interval. RESULT: A total of 1306 women were recruited, 66 women were HIV positive, giving a prevalence rate of 5.1%. Their mean age was 28.79 ± 5.06 years. Majority of them were married (9%).The mean gestational age at booking was 26.2 ± 6.8 weeks. Alcohol intake, history of 3 or more sexual partner in the last 5 years, abnormal vaginal discharge in the last 12 months, history of genital ulcer in last 12 month, had a statistically significant association with prevalence of HIV infection (p value<0.005) CONCLUSION: HIV infection prevalence rate in among antenatal attendants in Enugu is still high. A multi-sectoral approach is required for effective prevention and control of the disease to ensure achievement of Millennium development Goals 5&6

BACKGROUND: Despite well known risks associated with unprotected premarital sex, this phenomenon has not been well explored among young men in rural northern Nigeria. We studied the predictors of premarital sex and preferred sources of sexual and reproductive health information among young unmarried men in Kumbotso, northern Nigeria. METHOD: A cross section of 400 young men were interviewed using structured questionnaires with mostly closed ended questions. RESULTS: Of the 385 respondents, 39 (10.1%) were sexually experienced. Less than half of respondents (48.7%) used a condom at sexual debut, and an equal proportion reported having multiple sex partners. Only 41.0% of sexually experienced respondents reported subsequent consistent condom use Age (adjusted odds ratio [AOR] = 4.12; 95% confidence interval (CI): 2.245.20) and educational attainment [AOR=3.57; 95%CI (1.49-9.10)] were significant predictors of sexual experience. The current versus preferred sources of sexual and reproductive health information included friends (51.3% vs. 93.3%), Islamic school teachers (41.0% vs. 72.7%) and school teachers (8.8% vs. 15.1%). CONCLUSION: Although the prevalence of premarital sex among young men in this community in northern Nigeria was low, those that did engage in such activity were likely to not use condoms and to have multiple partners. Preferred and trusted sources of information included peers and religious leaders. The findings in this study could be used to develop innovative strategies for reaching young men with accurate sexual and reproductive health information.

BACKGROUND: Umbilical hernias are common in children but many resolve spontaneously within the first five years of life .Most umbilical herniorrhaphies in our environment are due to symptomatic hernias which constitute a small percentage of all umbilical hernias. PATIENTS AND METHODS : Aretrospective review of all pediatric patients with UH treated at Federal Medical Centre Umuahia ,Abia State from February 2001 to February 2011. RESULTS: There were 22 patients but only 20 of the folders were found and analyzed .They were made up of 1 lmales and 9females with a mean age of 6.19±0.83years and median age of 6years.Nine(7 males and 2 females) had acute incarcerations ,nine(3 males and 6 females) had recurrent umbilical pains without incarceration and two(1 male and 1 female) had recurrent incarcerations .Age range for acute incarceration was 2- 8years(mean:4.69years,median :4years);recurrent umbilical pains was 4months-15 years(mean:7.7years,median:8years) and for recurrent incarceration 2-10years(mean:6years).All had standard umbilical hernia repairs except one whose parents declined surgery after reduction of acute incarceration .One patient with acute incarceration had gangrenous bowel with hernia sac abscess and was offered bowel resection with end-to-end anastomosis .On short-term follow-up ,the symptoms resolved in all the patients following surgery .Fivepatients had six complications:! exuberant granulation tissue,2 stitch reactions,2 superficial wound dehiscence and one superficial wound infection .There were no mortalities and no recurrence on short-term follow-up .Only one patient(5%)registered under the National Health Insurance Scheme(NHIS). CONCLUSIONS: Active observation of all umbilical hernias at all ages will ensure early detection of complications and prompt treatment .Elective repair of umbilical hernias in patients above five years with fascia defect greater than 1.5cm is encouraged .Comprehensive NHIS will ensure early presentation and reduced complications.

BACKGROUND: Tetanus is an infection that can be associated with a high mortality especially in developing countries. Critical care which may include artificial control of respiration is crucial in survival, but cardiovascular complications from autonomic instability remains an important cause of death. The objective of this report is to highlight this important cause of mortality despite artificial control of ventilation to prevent respiratory arrest. METHOD: The medical record of the patient and relevant literature were reviewed. RESULT: A 29-year old male following a wound on the lower limb presented with clinical features suggestive of tetanus. Incubation period was short and immunization history was uncertain. Basic treatment directed at removing source of infection and neutralisation of unbound toxin was however commenced. Following signs of imminent respiratory failure due to severe uncontrollable spasms, controlled mechanical ventilation was instituted in the critical care unit(CCU). However, the patient succumbed to cardiac arrest as a result of severe autonomic instability, despite aggressive cardiopulmonary resuscitation. CONCLUSION: Cardiovascular arrest from severe autonomic instability remains an important cause of mortality in tetanus despite artificial ventilation. Early management with appropriate therapy is advisable to prevent its occurrence.

Vulvar lipomas are rare and few cases have been reported in the world literature. We document a case of large soft vulvar mass following episiotomy in a 23-year-old primipara. The mass was excised and histologic examination confirmed lipoma.

Retained placental membranes and tissues are responsible for 5% to 10% of postpartum hemorrhage. Placenta acereta occurs in approximately 1 in 2500 pregnancies of which placenta percreta constitutes about 5% of placenta acereta. This portends the rarity of placenta percreta especially in a 32 year old woman with minimal risk factors. Our patient was a G₄P₃⁺⁰ woman with 2 living male children who presented at 39 weeks plus 2 days gestation in latent phase of labour and transverse lie. She had emergency caesarean hysterectomy due to primary postpartum haemorrhage secondary to placenta percreta. There should be a high index of suspicion of placenta percreta in women with the risk factors and whoever does caesarean section should have the skills for hysterectomy in case of any encounter with placenta percreta not amenable to conservative management.

This study is derived from retrospective data from the management of a fire disaster involving nine students managed in the institution following a fire disaster at the female students’ hostel. The average length of stay was 19 days. The total cost was $47.74 per day per patient.