Background: With increasing use of diagnostic X-ray machines across Lagos, South-West Nigeria, relevant international bodies have proposed the use of reference dose levels (RDLs) to help manage radiation dose to patients without compromising image quality. Objectives: The purpose of this study was to determine the entrance surface dose (ESD) at third quartile (75 ^th percentile) in Lagos metropolis for normal adult radiographic examinations and to compare them with national and international established reference dose guidelines. Materials and Methods: One dedicated X-ray unit in each diagnostic center was used for this study denoted as H1-H10. A noninvasive Unfors ThinX RAD kilovoltage (kVp) meter which served as the phantom (mimicked patient) was used for measurements. The ESDs were determined by placing the Unfors ThinX RAD kVp meter on the patient's table bucky at a source to image distance (SID) of 100 cm and at the erect bucky at a SID of 180 cm. The peak tube kVp was varied at different milliampere seconds (mAs). Results : The mean ESD for adult postero-anterior (PA) chest, antero-posterior (AP) Abdomen and (AP) lumbar spine X-ray examination were 0.603, 2.57, and 2.57 mGy, respectively. While the ESD for the third quartile for adult (PA) chest, (AP) abdomen, and (AP) lumbar spine X-ray examination among the ten X-ray centers were 0.93, 2.74, and 2.47 mGy, respectively. Conclusion: Third quartile ESD which translate to RDL for adult (PA) chest examination for this study was higher compared to other national and international RDLs but adult (AP) abdomen and lumbar spine examinations were within accepted national and international range.

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Background: Achilles tendinopathy (AT) is the most frequently reported injury related to the ankle and foot in different sports activities. Much attention has been paid to elite athletes in competitive sports, but there is paucity of data on its prevalence in recreational sports. Aims: This study investigated the prevalence of AT and its association with selected physical characteristics in a population of recreational sports participants in Lagos, Nigeria. Settings and Design: Cross-sectional analytical study. Materials and Methods: This study involved 302 recreational sports participants in various sports centers in Lagos State. The Royal London test was used to assess for the presence of AT, while the Victorian Institute of Sports Assessment - Achilles questionnaire was used to evaluate the severity of AT among the participants. Statistical Analysis: Data collected were summarized using descriptive statistics and analyzed using Pearson Chi-square. The level of significance was set at P ≤ 0.05. Results: Our findings show that 21% of the participants had AT. Gender, height, and weight showed no significant association with AT; however, the age of the participants showed a significant association with AT. Conclusion: AT is common among recreational sports individuals in Lagos, Nigeria, age being a contributing factor while other physical characteristics had no impact.

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Background: The prevalence of diabetes mellitus (DM), a noncommunicable disease (NCD) in adolescents, is on the rise worldwide; therefore, knowledge which facilitates prevention and early detection is important. The objective of this study was to determine the knowledge of DM and self-reported risk factors among adolescents in a senior secondary school, in Surulere, Lagos State. Methodology: This was a cross-sectional descriptive study of 144 male and 106 female senior secondary students with a mean age of 15.2 ΁ 1.3 years. Respondents were selected through multistage sampling technique. A structured pretested questionnaire was used to collect data. Epi Info 7.1.5 was used for data analysis and the level of statistical significance was set at 5%. Results obtained were presented with the use of frequency tables. Results: Two out of three respondents had heard of DM. Among those who were aware of the condition, 64.9% knew it referred to abnormally high blood glucose. Only (10.9%) knew it was a lifelong condition and less than a third (26.7%) knew the measurement of blood glucose with a device for the screening test. Less than 30% considered obesity, family history, diet, and physical inactivity as risk factors. Their main source of information was the mass media. Overall, 46% of respondents had good knowledge of DM. As regards the presence of lifestyle behavior/risk factor for DM/NCDs in the respondents, 8.4% of the respondents had a family history of DM, had consumed alcohol (28.8%), smoked tobacco (4.8%), and were overweight/obese (5.2%). Conclusion: Two-thirds were aware of DM, of which over half had inadequate knowledge of DM despite the existence of some risk factors. There should, therefore, be an inclusion of NCD education in the curriculum of secondary school students.

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Background: Urinalysis is a simple and cheap method of screening for systemic diseases including kidney disease and may open a window of opportunity for prevention/early treatments especially in resource-constrained settings like Nigeria. We therefore studied the pattern of urinary abnormalities among an apparently healthy urban population. Methods: Mid-stream clean catch urine samples were collected from 1048 apparently healthy subjects and tested for urinary abnormalities using the dipstick method following a health promotional talk in Idi-araba, a Lagos slum. Results: A total of 1048 randomly selected subjects with a mean age of 38.7 ΁ 14.5 years (age range 18-85 years) were screened. This consisted of 597 (57%) females and 451 (43%) males. Protenuria, hematuria, leucocyturia, nitrituria, and glucosuria were present in 18.9%, 1.7%, 9.2%, 1.8% and 2% of the subjects respectively. Proteinuria and haematuria was more prevalent in subjects aged ≥40 years (P < 0.05). The prevalence of leucocyturia, nitrituria, and glucosuria were independent of age (P < 0.05). There were no gender differences in the prevalence of urinary abnormalities (P < 0.05). Four hundred and forty-four (42.3%) of the cohort had hypertension (HTN). Proteinuria and leucocyturia were more prevalent in hypertensive subjects (P < 0.05) while hematuria, nitrituria, and glucosuria was independent of hypertensive status of subjects (P < 0.05). Conclusion: Urinary abnormalities are common among apparently healthy adults in Lagos. It is therefore recommended that it should be routinely done as a cheap screening tool and further evaluation conducted where necessary. This may result in cheaper treatment and better outcomes.

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Introduction: Congenital adrenal hyperplasia (CAH) encompasses a group of autosomal recessive disorders, each of which involves a deficiency of an enzyme involved in the synthesis of cortisol, aldosterone, or both. More than 90% of CAH are caused by 21-hydroxylase deficiency (21HD), found in 1:10,000 to 1:15,000 live births. Early diagnosis of CAH is important because newborn babies with salt-losing forms of CAH die within days or weeks if not treated. In a resource-constrained setting, lack of awareness, poor health facilities, inadequate laboratory support, and expensive and erratic availability of drugs make most children with CAH vulnerable. Objectives: To describe characteristics of the children with CAH attending the Pediatric Endocrinology Clinic of Lagos University Teaching Hospital over a 10 years period. Subjects and Methods: Case records of patients with CAH attending the clinic from February 2005 to January 2015 were reviewed and data extracted from them for further statistical analysis using Microsoft Excel 2010. Results: Twenty eight patients (14 males and 14 females) were seen constituting 34% of the patients with ambiguous genitalia. The median (range) age of the patients was 7 (0.33-  21) years, and the median (range) age at presentation was 3 (0.01-15) years. These include within the neonatal period (25.0%), before 1 year (17.9%), before 5 years (25.0%), and beyond 5 years (32.1%). Modes of presentation included ambiguous genitalia, precocious puberty, salt loss, and discovery on screening because of an affected sibling. Presumed enzyme deficiencies are 21 hydroxylase (78.5% of which 18.2% salt-losing), 11-beta-hydroxylase (14.3%), 17α-hydroxylase (3.6%), and P450 oxidoreductase (3.6%), respectively. Six patients (21.4%) had associated hypertension. Other comorbidities include Blount's disease and pelvi-ureteric junction obstruction. Three male patients were also managed for subsequent associated central precocious puberty. Two siblings were affected in 3 nonconsanguineous families. One patient had contracted HIV/Acquired Immune Deficiency Syndrome from blood transfusion after clitoridectomy. Challenges in management include unavailability and unaffordability of investigations and drugs for treatment. Conclusions: CAH is an important cause of ambiguous genitalia and precocious puberty. Careful examination of the newborn genitalia is important, and a high index of suspicion maintained for salt-losing forms. Increased awareness should be created nationwide for prompt diagnosis and referral when applicable. Treatment is life-long and expensive.

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Background: Blood is routinely grouped and cross matched for elective adenoidectomy and, or, tonsillectomy at our institution. This practice has led to unnecessary delay and cancellation of surgery. Materials and Methods: This was a prospective study conducted in children aged one and half to nine years scheduled for adenoidectomy and, or, tonsillectomy from January, 2012 to April 2013. We investigated the need for routine preoperative grouping and cross matching of blood, and the immediate complications following adenotonsillectomy. Data collected included the number of blood cross matched and transfused, pre- and postoperative haemoglobin, estimated blood loss, duration of delay in commencing surgery due to lack of blood and the immediate complications following adenoidectomy and tonsillectomy. Results: A total of 129 patients were studied, adenotonsillectomy was performed in 88.37%, adenoidectomy in 7.75%, and tonsillectomy in 3.88%. The median estimated blood loss was 100 IQR (60-100 ml), 145 pints of blood were requested in all, one pint in 77.93% and two pints in 22.07%. The Cross-match to Transfusion Ratio, Transfusion Index and Blood ordering quotient were zero (0) respectively. The median duration of delay before surgery commenced on account of lack of blood was 84 IQR (27.5-119.5) mls. Primary haemorrhage was observed in 4 (3.1%), accidental extubation in 13 (10.07%), hypoxia 5 (3.88%) and cardiac arrest in one patient (0.78%). Conclusion: The cross-match to transfusion ratio, transfusion index and blood ordering quotient were zero, which suggest that cross-matched blood is unlikely to be required, and there was low blood usage. Therefore, the routine practice of preoperative grouping and cross matching of blood seems unnecessary adenoidectomy and, or, tonsillectomy. It is recommended that group and save should be encouraged because of shortage of blood in our country.

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Background and Objective: Advances in laparoscopy are making the service accessible even in resource-poor countries where adaptations are made to meet local challenges. We report our experience in the provision of laparoscopy service to children at a tertiary health center in North-central Nigeria. Methods: A team of pediatric surgeons, anesthetists, and nurses collaborated to provide service and train other personnel. A prospective collection of data on biodata, diagnoses, procedure, and outcome over an effective period of 36 months of laparoscopy intervention of the 54 months between September 2009 and February 2014 was done. Consent, which also included the possibility of conversion to open was obtained from the parents of the patients. Results: A total of 73 patients aged 2 weeks to 16 years with a male: female ratio of 3 to 1 had laparoscopy done during the period. Fifty-two (71.2%) procedures were therapeutic, and 21 (28.8%) cases were done as emergency. Laparoscopic appendectomy was the most commonly performed procedure 25 (34.3%), followed by laparoscopic orchidopexy 17 (23. 3%), and diagnostic laparoscopy for disorders of sexual differentiation in 13 (17.8%). The length of stay in hospital postoperative was 1-3 days with a mean of 1.34 ΁ 0.45 days. The complications recorded included hemorrhage, in a case of infantile hypertrophic pyloric stenosis due to failed electrocautery, one port site burns injury from diathermy dissection, and two periport pain postoperation. There was no mortality recorded. Conclusion: Pediatric laparoscopic service is gaining recognition in our practice in spite of poor resources, incessant industrial actions, and apathy from support staff. The outcomes are encouraging as the patients had minimal morbidities. Skills are improved through practice and retraining and manpower, and instruments are being expanded through our collaboration and training.

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Background: The content of physicians' referral (PR) for physiotherapy is very crucial with respect to physical diagnosis and treatment decisions. It is an indicator of the level of clinical decision making required for proper physiotherapy management of patients. Objectives: To investigate the contents of the PRs to the Department of Physiotherapy of a Teaching Hospital. Materials and Methods: A total of 326 PR for physiotherapy received from four Medical Departments (63 Medicine, 90 Orthopaedics, 81 Paediatrics, and 92 Surgery) of the Teaching Hospital over a period of 3 months were analyzed using a structured data selection sheet. Clinical information such as patient's name and age, diagnosis, brief summary of pathology, prescribed modality, referring unit, date of referral, name, and signature of referring physicians were extracted. Data are presented using frequency distribution and percentages. Chi-square was used to determine the association between variables with significance set at P < 0.05. Results: In the majority of the PR, a brief summary of the pathology of the patients (230, 70.6%) and the referring units (259, 79.4%) were included. The majority (239, 73.3%) of the PR included diagnosis in their referral; (212, 65.0%) and (142, 43.6%) of the PR contained physiotherapy prescription and physicians' name, respectively. Conclusion: Most of the PR did not contain adequate or complete information based on a standard referral format, and most physicians use physiotherapy on "prescription basis" rather than on "consultation basis." A detailed PR for physiotherapy may encourage the use of physiotherapy on a consultation basis.

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