Objective: To determine the effect of supervised therapy with glibenclamide and metformin on glycaemic control in a selection of patients with poorly controlled type-2 diabetes mellitus in a Nigerian tertiary hospital. Materials and Methods: A prospective uncontrolled open label design was used. Subjects were randomly selected on the basis of poor glycaemic control (Fasting plasma glucose > 150 mg/dl, 2-hour post prandial glucose>180mg/dl, HbA1c >7%) and maximal doses of glibenclamide and metformin (15-20 mg, 2-3g respectively). Patients were seen at regular intervals with analysis of plasma glucose, glycated haemoglobin and supervised treatment (drugs were provided and there was open access to consulting offices and counseling). Results: There was significant reduction in the fasting plasma glucose, 2-hour post prandial plasma glucose and glycated haemoglobin at the end of the study. There were no adverse drug reactions recorded during the study and the drugs were well tolerated. Conclusion: Supervised treatment with Metformin (Gluformin®) and Glibenclamide (Glanil®) significantly improves glycaemic control in patients with type-2 diabetes mellitus.

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Introduction: Hypertension is one of the important risk factors for cardiovascular disease. Although it was initially thought to be rare in rural Africa, several studies have proven otherwise. The prevalence in communities ranges from 5% in Botswana to 33% in Nigeria, South Africa and Kenya. The objectives of this survey were to determine the epidemiological characteristics of hypertensives and the epidemiological characteristics associated with severity of hypertension using the JNC criteria, in a rural Nigerian practice population Methodology: This was a descriptive cross-sectional study involving the use of an intervieweradministered semi-structured questionnaire by trained field workers between July and August 2002 and blood pressure measurements to healthy, non-pregnant respondents aged 15 years and above using standard methods. A multi -stage stratified cluster sampling design was used to select the 350 respondents, 50 from each of the 7 health districts of Ifo Local Government Area of Ogun state Nigeria. Results: The mean systolic Blood Pressure (BP) was 127 (s.d. 26.5). The mean diastolic BP was 79 (sd 16.4). Combining both systolic and diastolic blood pressures 65.4% were not hypertensive while, 34.6% of rural dwellers in the series were considered mild hypertensives using JNI 7 criteria of 140- 159/90-99. The highest percentage of systolic hypertension, 50.7%, was among the 55-60 age group Systolic hypertension was associated with increasing age (p = 0.00). The prevalence of hypertension was highest among respondents whose BMI was greater than 30 (61.5%) .There was no statistically significant association between cigarette smoking and blood pressure. Discussion: The rate of hypertension among rural dwellers of Ifo is high., the national average being 11%. Knowing that there is a continuous relationship between increasing Blood Pressure and stroke, lifestyle modification is advocated for the Ifo rural population.

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Aim: To identify the causes of childhood blindness seen in children 16 years and below in Lagos, Nigeria. Materials and Method: The case notes of children aged 16 years and below seen between November 1994 and June 1998, at the Guinness Eye Centre, L.U.T.H., Lagos were analyzed for age, sex, visual acuity, pregnancy, antenatal, delivery and post-natal history. The feeding pattern, milestones and immunization status were also documented. Result: Out of a total 7,599 new cases, 1,068 (14.1%) were children aged 16 years and below. Sixty-six (6.1%) of these children were blind on presentation and discharge. The causes of bilateral childhood blindness include congenital and developmental cataracts, cortical blindness, congenital glaucoma and complications of measles and harmful traditional eye medications. Trauma related causes of blindness like traumatic cataract, hyphaema and chemical burns were the commonest cause of uni-ocular blindness. Conclusion: Congenital and childhood eye diseases as well as trauma related complications are the common causes of blindness (bilateral and uni-ocular) seen in these children. Recommendation: Prevention of childhood blindness through health education, good nutrition, prompt and adequate treatment of these children on presentation and avoidance of use of harmful traditional eye medications is advocated.

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Background: Cryptorchidism leads to deleterious changes in both the cryptorchid and descended contralateral testis. Higher intra-abdominal temperature is said to be the predominant cause of the ipsilateral testicular damage, but increased lipid peroxidation in both the cryptorchid and descended testis is postulated to also contribute to the bilateral testicular damage. Aim: To assess lipid peroxidation and the effect of an anti-oxidant and broad spectrum free radical scavenger on the cryptorchid and descended testes. Materials and Method: Twenty- eight (4-week old) Sprague-Dawley rats were divided into three groups. The first group (n=8) served as the control. The second and third groups (n=10) had left sided cryptorchidism and the third group in addition had 2mg/kg of melatonin intraperitoneally twice daily. After 12 weeks, animals were sacrificed and blood as collected for serum testosterone and testes removed for malondialdehyde (MDA) estimation, sperm count and motility. Results: Left testicular weight was significantly less in the cryptorchid than other groups (p<0.05), testicular MDA was significantly higher in the cryptorchid and melatonin treated group than in the control (p<0.05). The melatonin treated group also had MDA significantly less than in the cryptorchid only group. The serum testosterone and semen parameters were significantly less in the cryptorchid than control, but the sperm count and motility were significantly higher in the melatonin treated than the cryptorchid only rats. Conclusion: Cryptorchidism induces lipid peroxidation in the cryptorchid and descended testis and this may be attenuated by melatonin.

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Objective: To assess the implementation of the case management guidelines on acute respiratory infections (ARIs) in children by primary health workers in Ibadan Methods: A cross sectional study was carried out from June to December 1999 in Ibadan South East and Lagelu LGAs. Study materials were observation and equipment and supplies checklists, healthworker questionnaires and exit interview questionnaires Results: Twenty-five and 20 health workers were observed to manage 390 children and 386 children in Ibadan South East and Lagelu LGAs respectively. Only 2.1% of the ARI cases were correctly assessed in Ibadan South East LGAs with none in Lagelu LGA. Antibiotics were prescribed for more than two-thirds of ARI cases in each LGA. Most (75.6%) of the health workers in both LGAs were not trained on management of ARIs and none of the health facilities had all essential equipment for management of ARIs. Conclusions: Training programmes on management of ARIs should be organized for health workers in the two LGAs. There should be provision of all equipment and supplies required for standard management of ARI.

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Objective: The study was carried out to review the clinical stage at which cases of Wilms' tumour in children were admitted in Lagos University Teaching Hospital, Lagos, Nigeria, the pathology of the disease, the management employed, the outcome and the effectiveness of the out-patient clinic follow up. Method: The case-notes of all patients managed for Wilms' tumour in the department of Paediatrics, Lagos University Teaching Hospital were reviewed over a period of five years, 1999 to 2003, in a retrospective study. Results: A total of 35 cases were admitted during the study period; comprising 20 males and 15 females. Nineteen of them had nephrectomy, chemotherapy and radiotherapy. Sixteen of these 19 patients were in stages III to V. One patient died three days after nephrectomy. Two out of the patients who had no surgery had chemotherapy and radiotherapy but died before surgery could be performed. The remaining 14 patients had some courses of chemotherapy and radiotherapy but were later discharged against medical advice; also 87.5% of all the cases discharged were lost to follow up. Conclusion: Majority of cases of Wilms' tumour managed in Lagos University Teaching Hospital presented late. There was a high rate of discharge against medical advice. Also there was a high rate of default at the follow-up clinic.

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