Multiple epidermal cysts over the scrotum is a rare condition and requires excision if infected or cosmetically unacceptable. Grossly enlarged or infected cysts require total excision of the scrotal wall followed by the coverage of bare testes. We are reporting a case of multiple epidermal cysts on the scrotum. Total excision of scrotal wall followed by the fascio cutaneous flap coverage was done in this case.

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Background: Our teaching hospitals have different grades of doctors with varied exposure to cardiac arrest settings and their resuscitation skills are often inadequate. Objectives: We investigated whether the grade of a doctor influenced acquisition of knowledge and skill during cardiopulmonary resuscitation (CPR) training in Nigeria. Materials and Methods: Doctors who attended a two-day resuscitation training program between December 2007 and April 2009 were scored on their knowledge of Basic Life Support, Advanced Life Support, and performance at five skill stations. A pass mark was awarded for a post-test score ≥ 75% and a pass in all skill stations. Results: A total of 130 doctors were studied with a mean of 10.99 ± 6.51 years since medical qualification (range, 2-28 years). The mean pre-test score was 54.43 ± 16.10% (range 30.5-91.8%) while the mean post-test score was 88.48 ± 6.8% (range, 54.6-94%), (P < 0.001). Mean post-test scores were not significantly different between grades. Mean scores for questions on Basic Life Support, defibrillator use, and drug therapy and in performance at skill stations were not significantly different between grades. A significant difference however existed in questions on cardiac arrest rhythms (P = 0.031). Sixty-five participants (50%) passed the post-test at first attempt. Consultants, senior registrars, and registrars had pass rates of 59.2%, 53.6%, and 43.5% respectively (P = 0.336). After re-training at performance stations, 124 doctors (95.4%) passed the test with no significant difference in overall pass in the various grades (P = 0.605). Conclusion : Grade of doctor did not affect the acquisition of knowledge and skill during resuscitation training.

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The airway management in prone position secondary to penetrating posterior thoracic injury is challenging to the anesthetist. We described a successful endotracheal intubation under direct laryngoscopy at first attempt in the prone position in a 25-year-old male with a 6-foot hollow metal impacted in the right posterolateral thorax.

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Background: Preeclampsia is a common complication of pregnancy with high maternal and perinatal morbidity and mortality. The new American College of Obstetricians and Gynecologists (ACOG) guideline now includes elevation of liver enzymes as a criterion for the diagnosis of preeclampsia. Objectives: The objectives of this study is to compare liver function tests in preeclampsia and normotensive pregnancy and determine their relationship with systolic and diastolic blood pressure, plasma creatinine, and uric acid levels in Nigerian women with severe preeclampsia. Materials and Methods: This was a case-control study of 46 women with severe preeclampsia and 21 pregnant women as controls. These women attended the Antenatal Clinic at the Lagos University Teaching Hospital, Lagos where women were consecutively recruited. Results: There was a statistically significant difference in the systolic blood pressure (P = 0.002), diastolic blood pressure (P = 0.004), plasma creatinine (P = 0.007), uric acid (P = 0.0001), plasma albumin (P = 0.029), alkaline phosphatase (ALP) (P = 0.0001), aspartate aminotransferase (AST) (P = 0.0001), γ-glutamyl transferase (GGT) (P = 0.035), and unconjugated bilirubin (P = 0.023) between the group with severe preeclampsia and the normotensive pregnancy control group. Alanine aminotransferase (ALT) was however not significantly elevated. AST elevation was the most common anomaly in severe preeclampsia occurring in 54.3% of cases. There was no association between systolic and diastolic blood pressure, plasma creatinine, and uric acid in severe preeclampsia with and without abnormal liver function tests. Conclusion: Elevation of AST, ALP, GGT, and unconjugated bilirubin are common in Nigerian women with severe preeclampsia but may not all be of liver origin. These parameters were also not associated with indices of disease severity. The use of liver enzyme concentrations as adjuncts in preeclampsia diagnosis should be applied with caution in Nigerian women with preeclampsia.

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Background: Open Access (OA) publishing has gained tremendous acceptance in academic publishing over the last decade. This paper reviews the number and trend of OA publishing of research papers originating from College of Medicine University of Lagos (CMUL), Nigeria. Materials and Methods: A computerized literature search of PubMed for all published articles originating from CMUL between 1976 and 2013 was conducted. The search phrase used was "College of Medicine University of Lagos". The search was conducted on March 30, 2013. All articles tagged "Free article" or "Free PubMed article" were selected. Results: A total of 1255 articles appeared in PubMed between 1976 and 2013 (37 years). At the first level of screening, 162 articles were identified as "Open Access". Second level of screening to eliminate articles not originating from CMUL identified 124 articles. Only 15 OA articles were published between 1976 and 2000 (24 years), 11 articles appeared as "Open Access" journals between 2001 and 2005 (5 years), 44 between 2006 and 2010 (5 years), and 54 articles were published between 2011 and 2013. Twenty-four of these articles were published in Nigerian OA Journals, and the remaining articles (100) in foreign journals. Conclusions: OA publishing is becoming popular among researchers at CMUL. This trend has been observed worldwide. Nigerian researchers are advised that while going along with the worldwide trend, they should however, be aware of predatory OA journals and publishers. The criteria for determining predatory OA publishers can be accessed via: www.scholarlyoa.com/publishers.

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Background and Objective: Despite a decent efficacy and safety profile, α₁ - blockers (A1B) and the 5α - reductase inhibitors (5ARI), the conventional drugs used in the treatment of the symptoms of Benign Prostatic Hyperplasia (BPH), are commonly associated with adverse effects including sexual dysfunction and postural hypotension. Phytotherapy for the treatment BPH symptoms has been used for centuries. However, scientific data on their efficacy are sparse. Procin-X and Celloid-S (PC) are powdered plant material products with acclaimed anti- BPH properties. This study assessed their usefulness in the management of BPH. Materials and Methods: This was a single blind, randomized, placebo-controlled study conducted at our hospital involving 80 patients (divided in to 2 equal groups) with the clinical diagnosis of BPH. The study group were given PC while the controls were given multivitamin Capsules daily for a period of 14 weeks. All patients were evaluated at intervals for severity of symptoms, flow rates, prostate size, prostate specific antigen (PSA) and possible adverse effects including erectile function. Test of significance between the means was done using the Students Paired t-test. A P < 0.05 was considered significant. Results: At the end of 14 weeks there was an reduction in symptom score by 5.7 and 1.6 in subjects and controls respectively (P < 0.05) and an increase in flow rate by 4.0mls/s and 1.1mls/s respectively (P < 0.05). There was a 60% and 14% reduction in PSA in the subjects and control respectively. There was also statistically significant increase in the erection score in the subjects. Conclusion: PC appear to be effective and in the management of the symptoms of BPH. The positive effects of PC on erectile function may however give them an advantage over the A1B and 5ARI drugs while the reduction in PSA may also give it a role in chemoprevention of prostate cancer. A large scale cohort study is needed to confirm these findings.

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