BACKGROUND: The burden of tuberculosis in Nigeria is the highest in Africa. Therefore, improved knowledge of health workers on the current issues concerning the disease, including the National guideline, is important for effective disease control. METHODS: An in-depth search of relevant literature on the subject area. This includes texts and operational documents of the Nigerian national tuberculosis programme, as well as online searches using Pubmed, African journal online (Ajol), and Google scholar. RESULTS: About one third of the world population is infected with tuberculous bacilli with up to 10% lifetime risk of developing the disease. Pulmonary tuberculosis (PTB) especially the reactivated latent infection is the major source of the infection in communities. In an effort to increase case detection, a single acid fast bacillus in at least one of two sputum smears is currently adequate to diagnose PTB. Furthermore, there is a global effort to eliminate the disease by the year 2050 and these efforts are coordinated in Nigeria by the National tuberculosis control programme. CONCLUSION: Tuberculosis is an impediment to human development in developing countries, especially in this era of HIV pandemic. Continuing education of health professional on tuberculosis and its accessible treatment, will improve patients’ education, proper management and appropriate referral.

BACKGROUND: Endometriosis is a common mysterious and fascinating gynaecological condition with diverse clinical manifestations, highly variable and unpredictable clinical course with decreased quality of life. Despite extensive research, endometriosis is fraught with controversies. METHODS: Review of pertinent literature on endometriosis, selected references, internet services through gynaecological search which have been critical in the understanding of this puzzling gynaecologic condition were included in the review. RESULTS: Endometriosis most commonly afflict women in there late 20s and 30s. The classic symptom complex include dysmenorrhoea, dyspareunia, menorrhagia and infertility. About 30% of the patients are asymptomatic. The incidence of infertility amongst women suffering from endometriosis ranges from 30%-40%. The factors implicated in causing endometriosis-associated infertility are multiple and its management is shrouded in controversy, complex and imperfectly understood. CONCLUSION: Inspite of diverse clinical manifestations, variable and unpredictable clinical course, there is a chance to improve pregnancy rates with improvement in assisted reproductive technology.

BACKGROUND: Neural tube defects are major cause of infant mortality and disability. Their occurrence has been linked to folate deficiency during pregnancy. Periconceptional use of folate has been shown to significantly reduce their incidence. Awareness of this relationship is key to adopting appropriate measures to prevent them. This study was carried out to assess the level of this awareness among reproductive-age female employees in a tertiary hospital. METHODOLOGY: Questionnaires designed to assess respondents’ knowledge about neural tube defects and folic acid were completed by women of child-bearing age working in various departments of the University of Port Harcourt Teaching Hospital. Data were collated and analysed by a third party who had no knowledge of the respondents. RESULTS: 94.4% of the respondents had some knowledge about folic acid. 29.6% knew something about neural tube defects. 24.1% were aware that folate has a beneficial role in their prevention. 70.4% said they would not take it daily if they were not pregnant. CONCLUSION: The level of awareness about the role of folate in prevention of neural tube defects among respondents in this study is low; and thus there is poor response to suggestions regarding its periconceptional use. There is need to enhance this awareness to ensure that populations at risk benefit from research on the subject. RUNNING HEAD: “Folic acid prevention of neural tube defects”

OBJECTIVE: To study the seroprevalence of Hepatitis B viral (HBV), infection among patients attending Aminu Kano Teaching Hospital in Kano metropolis. PATIENTS AND METHOD: This is a retrospective study in which patients tested for hepatitis B virus using hepatitis B surface antigen (HBsAg) as a marker were reviewed over 3 years. A total of 6,395 patients comprising of 4,040 males and 2,355 females including adults and children were tested for HBsAg from January 2004 to December 2006. Over this period, 1,509 sera were tested in 2004,2,322 in 2005 and 2,564 in 2006. RESULTS: Among the 6,395 patients, 703(11.4%) comprising of 240 (10.2%) females and 490 (12.1%) males were positive for HBsAg. The highest prevalence was seen at the extremes of life in which 19.4% and 16.9% were seen among patients below 10 years and above 50 years respectively. The yearly trend of HBV surface antigenemia was 220 (14.6%) in 2004, 235 (10.1%) in 2005 and 275 (10.7%) in 2006. CONCLUSION: We conclude that the prevalence of HBsAg among patients attending Aminu Kano Teaching Hospital, Kano is high and highest prevalence is seen at the extremes of life.

OBJECTIVES: To describe the importance of craniofacial approach in extensive tumours of the nose and paranasal sinuses with intracranial extension. MATERIALS AND METHODS: This is a retrospective study and descriptive analysis of craniofacial approaches to extensive tumors of the nose and paranasal sinuses that were carried at Usmanu Danfodiyo university teaching Hospital Sokoto Nigeria over a nine year period(July 1999 to June 2008). RESULTS: Out of 111 patients seen with tumours of the nose and paranasal sinuses during the period, 29(26.1%) were radiologically reported through computerised tomographic scan to have intracranial extension. Twenty-four(82.8%) were males while 5(17.2%) were females. Twentyfive(86.2%) patients underwent transfacial approach (modified lateral rhinotomy). Intraoperative findings in these cases only warranted the repair of dural tear in 6 cases through the transfacial approach who had anterior skull base invovlement while 4 had combined transcranial and transfacial approaches (anterior craniofacial resection). Therefore only 10(34.5%) patients of all the radiologically reported cases of intracranial extension were confirmed intraoperatively to have intracranial extension(5males, 5females) with an age range of 1 ½ Vz to 60years and mean age of 34.1 years. One patient had orbital exenteration also carried out. Four out of 10 patients are alive after a minimum period of 2 years follow up due to extensive intracranial spread and late presentation of the patient. CONCLUSION: Extensive tumours of the nose and paranasal sinuses with suspected intracranial extension requires not only computerized tomographic scans to assess the extent of the tumour but also a combined transfacial and transcranial approach to successfully resect the tumour.

BACKGROUND: Anaesthesia in spinal cord injured (SCI) can be hazardous. In complete injuries above T6, the abnormal state of the respiratory and the cardiovascular systems pose special problems. The objective of this study therefore was to evaluate the anaesthetic requirements in patients with complete SCI undergoing operation below the level of the cord lesion. PATIENTS AND METHOD: The medical records and the operation notes of all patients with complete SCI who underwent surgical operations between January 2001 and December 2005 were reviewed. Information about their demographics, level of injury, indications for operation, type of operation done and the type anaesthesia used were collated. The choice anaesthesia was guarded by the proximity of operation site to the level of cord transaction and by patient’s preference. The pre-operative and intra-operative blood pressure, pulse rate and respiratory rate were used to monitor cardiovascular and respiratory responses. RESULTS: They were twenty-eight, all male except one. The age range was 13-67 years with an average of 32 years. The level of cord lesion varied. The thoracic spine was most involved followed by the cervical spine. The most common indication for operation was pressure sore. The anesthetic requirement varied, and ranged from general anesthesia (GA) to no anaesthesia at all. Three broad groups were observed: no anaesthesia; sedation with diazepam; and general anaesthesia. There was no remarkable change in the blood pressure readings in the three groups. However, three patients who had GA and whose operation sites were in the twilight zone had remarkable changes in the pulse and respiratory rates. CONCLUSION: Even though spinal patients are insensate below the level of their injury, significant proportions that need operation below the level of cord lesion require anaesthesia.

BACKGROUND: Uterine fibroid is the commonest female genital tumour occurring within the reproductive age group, and abdominal myomectomy is the most offered surgical treatment in our environment. There is need to audit this practice in our centre so as to observe the practice pattern and outcome of myomectomies in Enugu, Nigeria. OBJECTIVE: To audit myomectomies, the practice pattern and outcome at the University of Nigeria Teaching Hospital Enugu-Nigeria. METHODS: A 5-year retrospective study of myomectomies performed in UNTH Enugu between January 1,2004 and December 31,2008. Data relating to socio-demographic characteristics, indication for surgery, intraoperative haemostatic measures, estimated blood loss, use of drain, duration of hospital stay and complications were abstracted and analyzed. RESULT: A total of 122 abdominal myomectomies were performed and 70.5% of the patients were aged 30 39 years and 80% were nullipara. Lower abdominal swelling and discomfort were the commonest presentation and indication for the surgery. Tourniquet was used for haemostasis in 57.4% while postoperative drain was inserted in 52.6%. 24.6% received blood transfusion and the average duration of hospital stay was 8.6 days. Complications were mild, with pyrexia as the commonest complication (28.7%). There was no mortality. CONCLUSION: Though myomectomy is safe and tolerated in our centre, a consensus practice pattern through a prospective study is required to further improve outcome.

BACKGROUND: The quality of information shared with health care professionals depends on their ability to keep it confidential especially in this information technology age when unguided access is imminent. In view of this, the study described knowledge, attitude and practice of confidentiality of patients’ health records amongst health care professionals at Federal Medical Centre Bida, Nigeria METHODS: A semi-structured self-administered questionnaire on the subject was administered to 313 health professionals chosen by stratified random sampling in the hospital. RESULTS: Majority (161, 66.8%) of the participants were less than ten years in practice. Virtually, all (232, 96.3%) have heard about confidentiality mostly from schools (134, 55.6%), on-the-job (61, 25.3%) and from multiple sources (18,7.5%). On responsibility for confidentiality; only 35 (14.5%) knew it is the responsibility of every health professional, while the majority; 117 (48.5%) felt it was exclusively meant for health information management professionals. Responses to issues on confidentiality range from 58.1% (revelation of documented next of kin to relatives of dead patients by staff) to 94.2% (employing the service of untrained interpreter). Very few (28, 11.6%) argued that confidentiality and privacy are not synonymous. Recommendations given to improve the practice of confidentiality include among others, observance of good health records practice by all professionals/stakeholders, continuing sensitisation of all staff and sanction against erring staff. CONCLUSIONS: Although, most professionals were aware of confidentiality, there appears a gap of in-depth knowledge and lack of awareness of respective responsibility towards it. However, they will do better if given the enabling environment and continuing education on the subject.

BACKGROUND: Halitosis is a recognized problem in dental practice. Some individuals have the belief that they have offensive mouth odour which neither the dental clinician nor any other person can perceive. This condition is known as delusional halitosis. Delusional halitosis can be classified as either Pseudo halitosis or Halitophobia depending on the response to initial treatment. Halitophobia is an olfactory reference syndrome and is a psychological condition that the dental surgeon is ill equipped to treat alone. This study aimed to analyse patients diagnosed with delusional halitosis, highlight our experiences and make suggestions for improved management of such patients. METHODOLOGY: All patients who presented at the dental clinics of University of Nigeria Teaching Hospital between January 2005 and December 2009 with a primary complaint of oral malodour were examined organoleptically. Those with obvious halitosis and known psychological conditions were excluded from the study. Once a diagnosis of delusional halitosis was made, each patient was educated on the nature of halitosis, its causes and prevention. They then received oral prophylaxis and oral hygiene instructions. They were then recalled at one week, four week and six week intervals to establish a definitive classification. RESULT: 18 out of the 25 patients who presented were diagnosed with delusional halitosis. 61% of them male and 39% of them female with an average age of 30 yrs. Pseudo halitosis comprised a majority of the cases seen(13). Halitophobia was seen in the minority (5). Reasons sited for believing that they had mouth odour by the patients studied included, peoples reaction when they were in close proximity and how people tended to avoid them (94.4%), ability to self perceive the foul odour from their mouths (55%) and 27.8 % said they had been told by another person that they had bad breath. All the patients had very good oral hygiene, with a tendency to over indulge on oral care products and tended to use mouthwash, breath mints and sweets in an attempt to mask the perceived odour with a few having excessive tooth brushing habits. Most had visited 2 or more other physicians within the year of presentation at the clinic with the same complaint. The patients were embarrassed (55.6 %) frustrated (27.6 %), self conscious (11.1 %) or felt helpless (5.6 %) by their perceived foul mouth odour, but none claimed to have suicidal thoughts. CONCLUSION: In all cases of delusional halitosis, there is usually an underlying psychosomatic problem, which can range from an over valued belief to a frank delusional disorder where the individual can hardly be dissuaded from their belief of mouth odour. A multidisciplinary approach to treatment between the dental surgeons and the psychological specialists may present the best approach for the patients.

BACKGROUND: Mob action is posing an undue social and public health problems in Niger Delta region of Nigeria; as victims who were said to have committed crime were violently killed without fair trial by law. There is need to research into the pattern, cause and frequency of deaths from mob action. AIM: To study the pattern cause and frequency of death from mob action. SETTING: Niger Delta Region of Nigeria. DESIGN: A ten (1999-2008) consecutive autopsy on victims of mob action. METHODOLOGY: A thorough autopsy was performed on all the victims following standard method after being severed with the coroner’s inquest form by police. Variables considered were the ages and sex, yearly frequency, methods applied in the killing and reasons that motivated the killing. These were obtained from the coroner’s inquest forms, police, relations and eye witnesses. RESULT: A total of thirty eight bodies were examined. Thirty four (89.5%) were males and four (10.5%) females; giving a male to female ratio of 8.5:1. The youngest was 16 years old male while the oldest 72 years old male. Majority 30 (78.9%) of deaths occurred below the age of 50 years. Youths of the age group 20 29 were most involved and the highest frequency 12(21.1%) of death was recorded in 2004. Beating 14(36.8%) was the most common method applied for the killing while political violence 15(39.5%) was the most common circumstances for the killing. CONCLUSION: Killing by mob action is a social, legal and public health problem in the Niger Delta region of Nigeria that requires a swift government intervention to reduce the carnage associated with it. Problems of economic inequality, youth unemployment and corruption should be adequately addressed by the Nigerian Government.

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

AIM: To outline the outcome of the first eye camp of the eye care program in Rivers state which was established only in 2008 to reduce the burden of blindness in the state as revealed by the Nigerian national blindness and visual impairment survey results released in 2008 as much as possible to the lowest before the year 2020. METHODOLOGY: A descriptive analysis of the activities of the Prevention of blindness committee, Rivers established in 2008 by the Ministry of health, Rivers state, Nigeria. An analysis of the first eye camp held at the Rumuigbo health center, Rumuigbo, Port Harcourt is also presented from the records made at the time of the camp. The activities were partly sponsored by the Ministry of Health, Rivers state. Data analysis was with the help of a statistician using SPSS version 11. RESULTS: The recently released Nigerian National Survey on Blindness and Visual Impairment revealed that about 15,000 people are blind from cataract in Rivers state, Nigeria. Over a 3 day period to mark World Sight Day 2010, a total of 455 persons were screened for cataract surgery at the above venue. The mean age was 46.2 years (SD± 17.55) with an age range of 1 and half to 99 years. The male female ratio was 1:1. A total of 125 patients (27.5%) had cataract of which 83 were mature. Refractive error also affected 125 people (27.5%). Sixty-five people (14.3%) were suspected to have glaucoma while 13(2.9%) and 45 people (9.9%) presented with corneal opacities and allergic conjunctivitides respectively. Other conditions seen include conjunctival degenerations, inflammatory conditions, staphylomata etc. Cataract surgery was performed on 51 people (40.8% of those with all diagnosed with cataract and 61.4% of those with mature cataract. Other conditions that could not be treated on location were referred to the teaching hospital and the state hospital nearby. The postoperative cases were also referred to the same hospitals for follow- up. Follow up showed that majority(n=38, 74.5 %) attained 6/24 to 6/60 VA range by the end of the first week with improvement to the 6/12 to 6/18 range by the end of the first month in 30 (58.8 %) of the patients. CONCLUSION: It is highly desirable for periodic eye camps to take place in Rivers state as it was an eye opener that even within the township, most people who are avoidably blind are within easy reach of secondary and tertiary health facilities that can offer eye care. Satisfactory visual outcome was obtained in the majority of cases operated upon. Government is within their rights to fund subsequent programs adequately as their input is necessary for sustainability. This will help reduce the burden of the cataract blind in the state though it is not likely that V2020 will be achieved at the current rate.

A total of eighty patients with various malignancies seen between September 2008 and April 2009 at the University of Nigeria Teaching Hospital, (UNTH) Ituku-Ozalla Enugu Nigeria had their haemogram values done at Days 0 and 12 of the first cycle of their various chemotherapeutic regimens. They were adult patients who had been diagnosed of various malignancies, consisting of Breast cancer 36 patients (45%), Non-Hodgkin’s lymphoma 8 (10%), Hodgkin’s lymphoma 13 (16.25%), Colorectal carcinoma 6 (7.5%), Multiple myeloma 7 (8.75%), Cervical carcinoma 1 (1.25%) and other malignancies 9 (11.25%). Haematological indices evaluated include: packed cell volume, haemoglobin concentration, total white blood cell count, platelet count and erythrocyte sedimentation rate. The socio demographic data of the patients were assessed from a questionnaire. There were 27 males (33.75%) and 53 females (66.25%). The age of the patients ranged from 18 80 years with a median of 45 years. Haematological parameters which were found to be significantly reduced include: haemoglobin concentration, packed cell volume and total white cell count.

BACKGROUND: Postpartum Care is necessary to monitor and ensure return to normal of some physiological changes that occurred during pregnancy and delivery, and any abnormalities detected should be treated. The aim of this study is to describe the perception of and care seeking behaviour for maternal morbidity following childbirth among mothers in Enugu, Nigeria and determine if they depend on the socio-demographic characteristics of mothers METHODS: A cross-sectional survey of women who had recent deliveries was done. Quantitative and qualitative methods of data collection were used. Data analysis was by descriptive and inferential statistics at 95% level of confidence and manual content analysis. RESULTS: Three hundred and seventy-one respondents who had, at least, one self-reported morbidity following childbirth were studied. Only approximately 43.1% perceived their symptoms as abnormal and 39.5% soughtmedical attention for their symptoms. Inaccurate perception was influenced by the severity of symptoms as well as cultural beliefs on what constitutes abnormal symptoms following childbirth. Correct perception of morbidity was dependent on maternal age (p=0.002) and educational status (p=0.004) whereas positive care seeking behaviour was dependent on area of residence (p=0.03). A greater proportion of mothers aged 30 years or below had accurate perception compared to older mothers (p=0.02). A greater proportion of rural dwellers sought medical attention for their symptoms compared to urban dwellers. CONCLUSION: Inaccurate perception of, and poor care seeking behaviour for postpartum morbidity were common among a sample of women with recent deliveries in Enugu due largely to cultural beliefs about morbidity following childbirth. Correct perception and positive care seeking behaviour were not enhanced by older age, greater educational attainment of mothers or residence in urban areas.

BACKGROUND: Gynaecological cancers are among the leading causes of cancer related deaths worldwide. The objective of this study was to determine the pattern and relative frequencies of gynecological cancers as seen at the University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu, SoutheasternNigeria. METHODS: An analysis of retrospective clinical data from the ward admissions and discharge books and the operating theatre record books. RESULTS: During the 10-year period under study (2000-2009), 407 cases of gynaecological cancers were admitted into the hospital. The age range of these women was 21-80 years with mean age of 54.6 ± 14.2 years. The commonest gynaecological cancers in women less than 30 years of age were choriocarcinoma (36.1%) and ovarian cancer (33.3%). After 30 years, cervical cancer became the commonest cancer. Overall, cervical cancer was by far the commonest gynecological cancer constituting 78% of all the cases, followed by ovarian cancer (8.9%), choriocarcinoma (4.3%), endometrial cancer (4.1%), vulva cancer (4.0%) and leiomyosarcoma (0.5%). There was no case of vaginal cancer during the study period. Anaemia was the commonest sequelae, complicating 55% of the cases, followed by genital fistulae (12%), infertility (3%), renal failure (3%), and pulmonary complications (2%). CONCLUSION: Cervical cancer is by far the commonest gynaecological cancer in Enugu and there is high incidence of this cancer even in young women below the age of 30 years. The commonest gynaecological cancer in women less than 30 years is choriocarcinoma, and anaemia is the commonest sequelae of all gynaecological cancers.

BACKGROUND: The reproductive health hazards of unwanted pregnancies and unsafe abortions have been reduced with modern contraceptive use. The purpose of this review is to highlight the acceptability and side effects of Jadelle; a modern subdermal contraceptive implant in Port Harcourt METHODS: Case files of acceptors of Jadelle^® subdermal implants between 4^th January 2008 and 30th June 2010 were retrieved. Information obtained were sociodemographic characteristics, insertion and post insertion complications. Data analysis was done with Microsoft Excel and EPI info statistical software 14.0. RESULTS: Of the seven thousand, eight hundred and eighty four (7884) clients who accepted contraceptive during the study period; 75 chose Jadelle constituting 0.95% of acceptors. The mean age and parity of acceptors were 33,1 years and 4.05 respectfully. Majority of the clients (89.33%) were married while 10.67% were single mothers. Similarly most of the acceptors had secondary and tertiary education, 26.67% and 69.33% respectively. Prevalent side effects were amenorrhoea (41.33%), intermenstrual bleeding (6.67%), intermenstrual spotting (4.00%). None of the acceptors discontinued the method. There was no accidental pregnancy. CONCLUSION: Jadelle^® appears to have been accepted in our centre. About two third of the clients switched from their other methods to Jadelle; with a zero percent discontinuations rate among acceptors.

BACKGROUND: Tear gas is a noxious vapour used in quelling civil disturbances. The law enforcement agents who usually handle this are well trained and rarely injured by the use of this weapon especially during peace times. METHODS: We report injuries sustained by two policemen handling tear gas as a result of accidents. Case notes of the patients were the source of information. RESULTS: Two policemen were injured while handling tear gas. The equipment accidentally dropped and exploded on attempting to pick them. The mechanisms of injuries and parts of the body injured were similar ie the hands and face with traumatic cataract of an eye in one patient. CONCLUSION: We conclude that proper training of the law enforcement agents will go a long way in reducing these types of morbidity from tear gas use.

BACKGROUND: Severe isolated facial injuries arising from the explosion of dry cell battery in children is extremely rare. The management of the resultant tissue devastation in a scarce resource economy can be quite challenging. METHOD: We report a case of 12 year old boy who sustained extensive oral and facial blast injuries caused by shattering of a locally assembled fan as result of an explosion of four 1.5 Volts dry cell batteries. He had multiple lacerations and avulsion of facial soft tissues as well avulsion and fractures of the mandible and maxilla. There was associated oronasal communication and avulsion of the anterior teeth in the upper and lower jaws. RESULTS: Serial debridement and minimal repair of soft tissue injuries as well as splinting of the mandible was done under local anaeasthesia. Fourteen months after the injuries there was complete healing of mandibular fracture and closure of the oronasal communication. However patient had perioral hypertrophic scar, microstomia and edentulism. CONCLUSION: Extensive life threatening injuries can be caused by a simple device such as a 1.5v dry cell battery. Early surgical intervention offers the best hope for full recovery.

PREAMBLE Concurrent clinical presentation of ischaemic and haemorrrhagic strokes can only be revealed convincingly with neuroimaging studies. Clinically at presentation, which pathological type (ischaemia or haemmorhagic) precedes the other was appreciated clinically in case I; queried at presentation for case II; was not entertained for case III.

We present a 72-year-old man and a known hypertensive with poor drug compliance seen here on 22-03-06,with a 4-year history of progressive dyspnoea, associated with cough and a wheeze. On examination he was chronically ill looking with altered state of consciousness, pale, centrally cyanosed, febrile (T-38°C), in respiratory distress (RR-33pm). Significant chest radiological findings include marked aortic unfolding and cardiomegaly, with biventricular involvement. Numerous nodular opacities in both lung fields especially the Right side with right apical opacification/thickening. Treatment as appropriate was instituted but unfortunately the patient succumbed after thirty days on admission and an autopsy carried out revealed multiple pulmonary infarcts with pulmonary thrombo-embolism.

BACKGROUND: Idiopathic intracranial hypertension is a rare neurologic disorder which is largely self limiting and occurs as a result of increased intracranial pressure. Papilledema is the most significant finding and may progress to visual loss. CASE REPORT: The case of a 45 year old obese female, who presented with a 9 month old history of headache and on examination was found to have papilledema is presented here. The patient received no medical or surgical intervention and presented 5 months later with resolution of the symptoms. CONCLUSION: Idiopathic intracranial hypertension is a sight threatening disease in which raised intracranial pressure is associated with increased body mass index. Proper assessment and close monitoring of patients who present with these features is essential in preventing visual loss.

BACKGROUND: Perforated Peptic Ulcer (PPU) is extremely rare in pregnancy. We report a case of perforated peptic ulcer in pregnancy during Ramadan fasting. PATIENT AND METHODS: The patient is a 16 years old primigravida who presented with features of peritonitis at 28 weeks of gestation while fasting during Ramadan. Ultrasound scan reported a singleton live fetus at 28 weeks gestation. At laparotomy via upper midline incision; a 1cm roundish perforation located on the duodenum anteriorly was found with about a litre of gastric juice mixed with blood and food particles in the peritoneal cavity. The perforation was close transversely with omental patch (Modified Graham’s patch) and peritoneal lavage done with warm saline. She had a preterm delivery of a 1kg baby 3 days post-operatively by a spontaneous vaginal delivery, but the baby died 3 days later. CONCLUSIONS: Perforated Peptic Ulcer(PPU) though rare in pregnancy can occur and fasting can be a risk factor.