iosr-JDMS   Volume-13 ~ Issue-10 ~ October-2014

Abstract: Background: Acute clinical episode of uncomplicated malaria induces several pathophysiological biochemical disturbances in its host. We examined and compared these biochemical alterations in children pre- and post- treatment with ACTs up to day 14 and how the ACTs affect these biochemical parameters during recovery. Aim: To determine and compare the alterations in selected biochemical indices pre- and post-treatment of uncomplicated P. falciparum malaria with artemether-lumefantrine (AL) and artesunate-amodiaquine (AA) in under-five children up toDay 14 day. Method: Data on 111 children aged 6 to 60 months who were enrolled into a drug therapeutic efficacy testing (DTET) of AL (20/120mg) with AA (25mg/67.5mg or 50/135mg) in the treatment of uncomplicated falciparum malaria, were analysed. Inclusion criteria were: history of fever in the last 24hrs and /or measured axillary temperature  37.5oC, P. falciparum infection with parasitaemia> 1000 to < 250,000 parasites/μL, HIV seronegative status, and a written informed consent from parents/ guardians.Enrolees were randomized into one of two treatment arms, and their biochemical indices (ALT, AST, Bilirubin and creatinine) were measured longitudinally on D0, D7 and D14 and analyzed

Key words: Children, uncomplicated Plasmodium falciparum malaria, biochemical indices, ACTs

[1]. Bidaki ZM, Dalimi AH: Biochemical and haematological alteration in vivax malaria in Kahnouj City. J Rafsanjani Univ Med Sci1994; 3(1): 17-24
[2]. Adeosum OG, Oduola T, Akanji BO et al; Biochemical alteration in Nigerian children with acute falciparum malaria. Afri J Biotechnol 2007; 6 (7); 881-885.
[3]. Udosen EO: Malaria treatment using oral Melkafin; Changes in biochemical and haematological parameters in Nigerian children with uncomplicated falciparum malaria; Orient J Med 15(12)
[4]. Rajpurkar MM: Renal involvement in malaria. J Postgrad Med 40: 134-4
[5]. Ahmed SH, Danish T, Faridi MMA, Ahmen AJ, Fakhir S and Khan AS. Renal Function in Acute malaria in Children. J. Trop Pediatr (1989) 35(6) 291-294. http://tropej.oxfordjournals.org/content/35/6/291.

Abstract: HGPPS is a rare congenital disorder resulting from cranial nuclear maldevelopment and characterized by absence of conjugate horizontal eye movements, preservation of vertical gaze & convergence, progressive scoliosis developing in childhood and hypoplasia of dorsomedial brainstem structures associated with sagittal cleft of pons and medulla. We present a 19 years old male, with restriction of eye movements, reduced visual acuity & had clinical and imaging findings of HGPPS. The patient revealed bilateral horizontal gaze palsy with normal vertical eye movements and normal convergence. Best corrected visual acuity was 6/24 in right eye & 6/36 in left eye.PA view X-ray spine show thoraco-lumbar scoliotic deformity. MRI revealed split pons sign associated with hypoplasia of pons & medulla. Hypoplasia of the dorsomedial brainstem structures leads to defect of the abducens nucleus and MLF which leads to horizontal gaze palsy whereas scoliosis could be due to chronic muscle tone abnormalities resulting from primary brainstem anomaly.
Keywords: congenital, horizontal gaze palsy, scoliosis, split pons sign.

[1] Gutowski NJ, Bosley T, Engle E. The Congenital Cranial Dysinnervation Disorders (CCDDs). Neuromuscular Disorders 2003;13:573-8.
[2] Jen, J., Coulin, C. J., Bosley, T. M., Salih, M. A. M., Sabatti, C., Nelson, S. F., Baloh, R. W. Familial horizontal gaze palsy with progressive scoliosis maps to chromosome 11q23-25. Neurology 59: 432-435, 2002.
[3] Crisfield RJ. Scoliosis with progressive external ophthalmoplegia in four siblings. J Bone Joint Surg 1974;56B:484–489.
[4] Dretakis EK, Kondoyannis PN. Congenital scoliosis associated with encephalopathy in five children of two families. J Bone Joint Surg 1974;56A:1747–1750.
[5] Sharpe JA, Silversides JL, Blair RD. Familial paralysis of horizontal gaze: associated with pendular nystagmus, progressive scoliosis, and facial contraction with myokymia. Neurology 1975;25:1035–1040 .
[6] Thomsen M, Steffen H, Sabo D, Niethard FU. Juvenile progressive scoliosis and congenital horizontal gaze palsy. J Pediatr Orthop B 1996;5:185–189 .

Abstract: Mercury is among the heavy metals that have been reported to cause devastating health problems worldwide. The present work was aimed at investigating the effects of mercury chloride and Vitamin C administration on the cyto-architecture of the liver and some liver parameters. Thirty adult Wistar Rats of average weight of 200g were randomly divided into six groups of five rats per group. The animals were administered with different concentrations of mercury chloride orally for three weeks. Group one was the Control and was administered with normal saline, Groups two and three were administered with 52mg/kg body weight and 26.25mg/kg body weight of mercury chloride respectively while Groups four and five were administered with 52mg/kg of mercury chloride +5mg/kg of ascorbic acid and 26.25mg/kg of mercury chloride+5mg/kg of ascorbic acid respectively and Group 6 was administered 5mg/kg of ascorbic acid only. After three weeks of administration, the animals were sacrificed humanely, blood and tissue samples were collected for analysis. The results showed there was significant increase in liver biochemical parameters such as AST, ALT and ALP levels in the serum of treated animals (p<0.05). The result showed that the administration of ascorbic acid resulted in ameliorative effects on biochemical parameters and the effect was most pronounced on the liver of treated rats at higher concentrations of mercuric chloride which was dose dependent.

Keywords: Mercuric Chloride, ascorbic acid, liver, Vitamin C, hepatocytes, Wistar rats.

[1]. Agarwal R, Raisuddin S, Tewari S, Goel SK, Raizada RB, Behari JR. (2010). Evaluation of comparative effect of pre- and post-treatment of selenium on mercury-induced oxidative stress, histological alterations, and metallothionein mRNA expression in rats. J. Biochem. Mol. Toxicol. 24(2):123-35.
[2]. ATSDR (Agency for Toxic Substances and Disease Registration) (2011). Draft technology profile for mercury. US department of health and human services, Atlanta, Georgia, USA. Pp102-225.
[3]. Bjornberg A, Vahter M, Berglund B, Niklasson B, Blennow M, and Sandborgh-Englund G (2011). Transport of methylmercury and inorganic mercury to the fetus and breast-fed infant," Environmental Health Perspectives, 113(10):113–118.

[4]. Burger J, Jeitner C, Gochfeld M. (2011). Locational differences in mercury and selenium levels in 19 species of saltwater fish from New Jersey. J. Toxicol Environ Health.74(13):863-874.

[5]. Ellman, GL. (1959) Tissue sulfhydryl groups. Arch. Biochem. Biophys. 82, 70-72

Abstract: Seizure is a rare neurological manifestation of Takayasu's arteritis (TA). This report is about a 15 year old female patient, admitted with loss of consciousness, generalised seizures and hypertension. The patient had asymmetric peripheral pulses and unequal blood pressure in the arms. Doppler study showed diminished blood flow predominantly in left upper limb, while fluorescent aortogram revealed left subclavian artery stenosis. MRI was suggestive of posterior reversible encephalopathy syndrome (PRES). Electroencephalogram (EEG) report was consistent with cerebral dysrhythmia. The patient had coexistent ostium secundum atrial septal defect. Previous case reports attribute seizures to ischemia (caused by involvement of the carotid and vertebral arteries) and PRES in patients of TA. The presence of cerebral dysrhythmia after clinical improvement made the cause of seizure difficult to ascertain in our patient. The presence of atrial septal defect (ASD) was possibly coincidental.
Keywords: Atrial septal defect, cerebral dysrhythmia, Posterior reversible encephalopathy syndrome, Seizure, Takayasu's arteritis.

[1]. Johnston SL, Lock RJ, Gompels MM, Takayasu arteritis: Review, Journal of Clinical Pathology, 55(7), 2002, 481–486.
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[6]. Zaki SA, Chavan V, Shanbag P. Unusual presentation of Takayasu's arteritis as posterior reversible encephalopathy syndrome, Annals of Indian Academy of Neurology, 14(3), 2011, 214-216

Abstract: Root canal therapy is mainly used to prevent and treat periradicular inflammation by the elimination of microorganisms from the root canal system. The most commonly used methods for microbial control include instrumentation, antimicrobial irrigation, intracanaldressing , adequate filling and coronal restoration. The root-canal system is usually obturated with gutta-percha combined with a sealer. The long-lasting seal of a root-canal filling, which is of clinical importance, depends largely on the sealing ability of the sealer used because gutta-percha is considered to be impermeable. Leakage of sealers has often been studied by means of dye penetration, a method in which the specimen has to be destroyed and cannot be used for longitudinal sectioning. An endodontic sealer plays an important role in successful endodontic treatment. It provides an impervious seal, fills the irregularities and minor discrepancies between the root canal wall and core filling material, and assists in microbial control if microorganisms were left on the root canal walls or in the tubules. Ideally, a thin layer of the sealer should be evenly applied to canal walls prior to the placement of the core filling material. The thickness of the endodontic sealer layer is very influential in the quality of the root canal filling.

[1]. Lai CC, Huang FM, Yang HW, Chan Y, Huang MS, Chou MY, et al.Antimicrobial activity of four root canal sealers against endodonticpathogens. Clin Oral Investig 2001;5:236-9.
[2]. Gomes BP, Pedroso JA, Jacinto RC, Vianna ME, Ferraz CC, Zaia AA,et al. In vitro evaluation of the antimicrobial activity of five root canalsealers. Braz Dent J 2004;15:30-5.
[3]. Baumgartner G, Zehnder M, Paque F. Enterococcus faecalis type strainleakage through root canals filled with gutta-percha/AH Plus or Resilon/Epiphany. J Endod 2007;33:45-7.
[4]. Yucel A, Guler E, Guler A. Bacterial penetration after obturation with fourdifferent root canal sealers. J Endod 2006;32:890-3.
[5]. Miglani R, Shankar, Indira R, Ramachandran S. An in vitro evaluation of calcium hydroxide root canal sealers and its effect on six microorganisms. J Conserv Dent 2007;10:99-103.

Abstract: Background:Head traumais a major health problem which is becoming increasingly a burden on the already stressed accident and emergency services of hospitals in Nigeria especially in the Northcentral part of Nigeria due to heightened insurgent activities. It is associated with significant long term morbidity and mortality. The aim of the study was to characterize and establish patternof computed tomographic features in patients with head trauma in Jos metropolis. Methods: We prospectively evaluated CT findings in 110 patients between the ages of one and eighty years who were sent to the Radiology department of JUTH for CTbrain with history of head trauma. Results: There were 81 males and 29 females with a mean age of 33.4years (SD26.5).Cerebral contusion, fractures, and Intracranial haemorrhage, were the commonest CT features in subjects and accounted for 21.8% , 19.3%and13.7.8%,for cerebral contusion, fractures and intracranial haemorrhage respectively. The age ranges of 21 to 40 years were mostly affected accounting for 45.4% of cases with 37.3% male subjects. 16.4% of the subjects were children under the age of ten. Conclusions: this study has clearly demonstratedthat cerebral contusion,intracranial haemorrhage and fracture are the commonest computed tomographic features seen in this region among head injured patients and these involve men mostly in their reproductive and sexually active ages.

Key Words: Computerized tomography (CT), Magnetic resonance imaging (MRI) Head trauma,Findings, Incidence,Jos. Northeast

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[2] Davis p.,LavitaA.,Farina M.L., VecahG.Prognosis of severe head injuries. Journal of Neurosurgery2010;57:779-783

[3] Heegaard WG, Biros MH. Head. In: Marx J. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. St. Louis, Mo: Mosby; 2006: chap. 38.

[4] Selwyn taylor, head injury,surgical management. William Heinemann medical books ltd,London:745
[5] Anderson T, Heitger M, Macleod A.D ."Concussion and Mild Head Injury".Practical Neurology 2006; 6: 342–357. Retrieved 2008-01-23.
[6] McCaffrey RJ "Special Issues in the Evaluation of Mild Traumatic Brain Injury". The Practice of Forensic Neuropsychology1997: Meeting Challenges in the Courtroom. New York: Plenum Press. pp. 71-75.

Abstract: The exposure of motor mechanics to petrol and crude oil products daily basis in the course of their job could be dangerous. Thirty adult males were used in this study. Their average weight is 70-75kg. they were grouped into two groups. Group X (15) are the control subjects and Group Y (15) are the test subjects. The test subjects were monitored on daily basis in the use of petrol in their daily job. At the end of 28 days, blood samples were collected from them and from the apparently healthy control subjects. Haematological tests carried out revealed decrease in haemoglobin concentration, packed cell volume and the biochemical indices did not reveal much effect in the liver function test. There was absence of streptococci pyogenes and candida alicaus in their oral cavity showing that their exposure to petrochemical products discorage the growth of bacteria in their oral cavity. It coud be deduced from this study that daily exposure to petrol gradually causes reduction in blood levels and sterility of the oral cavity.

Key Words: Petrol, haemoglobin, liver function test, roadside mechanics, gastrointestinal system, bacteria

[1]. BAKER F.J, SILVERTON (1998). "Plate cultural methods. Introduction to Medical Laboratory Technology 7th Edition pg 276. Butterworth- Heinemann publication. Linacre House, Jordan Hill, Oxford OX28DP. 225 Wildwood Avenues, Woburn MA 01801-2041.
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[5]. ITA S.O and UDOFIA U.A (2011). Comparative studies of some haematological parameters in Rats following Ingestion of Crude oil (Nigerian Bonny Light),, Petrol, Kerosene and Diesel. Asian Journal of Biological Sciences 4: 498-505.

Abstract: Periodontitis is a multifactorial and a polymicrobial infectious disease primarily associated with gram negative bacterias. Bdellovibrio and like organism (BALOs) are small, fast, flagellate, deltaproteobacteria that prey on other gram negative pathogens. It utilizes the cell content, including DNA and RNA for its growth. This significant activity has been the focus of research for many years, with useful practical applications in both dental and medical fields. Bdellovibrio has potential as a bio control agents or living antibiotics. This review article focuses on the life cycle of bdellovibrio and its use against the elimination of harmful and pathogenic bacteria, highlighting its future role and implication in periodontal diseases.

Keywords: Bdellovibrio, Periodontal disease, Periodontitis, Predator, Prey

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Abstract: Introduction: Rape is a serious and obnoxious crime constituting a violation of the right and freedom of women with adverse effects on its victims.Objective: The study is aimed to analyze the demographic parameters of perpetrators of rape, the instruments of abuse and the environment of the assault.Methodology: this is a descriptive study conducted over a period of 6 months at the central hospital, Benin City. Data was obtained using a structured questionnaire and analyzed using spss version 16. Results: A total of 100 cases were documented during the study period. The mean age of the assailants was 20 years with peak age range of 21-30 years. Neighbours were the highest culprits and majority of abuse were carried out during the day in the homes of assailants.Conclusion: Adolescents and young adults are the commonest perpetrators of rape in Benin City. They are familiar with their victims in majority of cases, using unsuspected instruments to perpetrate their crime.

Keywords: Perpetrators, Rape, Benin City

[1]. Sarkar sc, lalwani s, rautji r, bhardwaj dn and dogra td. Prospective study of victims and offender of sexual offences. The malaysian journal of forensic pathology and science, june 2008; 3(2):10 – 47
[2]. Shrikant ss, manish bs medico-legal examination of accused of alleged rape cases a prospective study.. J indian acad forensic med. 2013, vol. 35, no. 4
[3]. Chattoraj n. Sex related offences and their preventive and control measures: an indian perspective; guest paper in resource material series72 at 133rd international training course by unafei; 2006; p 82-99
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Abstract: Neck space infections affect fascial compartments of head ,neck and their contents. In this study we aimed at study of different aspects of neck space abscesses in scenario of rural population.In present study 54 patients were studied who were presented to ENT OPD and diagnosed as having neck space abscesses. Most commonly involved space was peritonsillar space. Male predominance was noted. Most common organism found on pus culture was coagulase positive staphylococcus (29.62%) ,sensitivity was highest for aminoglycosides and cephalosporins 78.57% and 71.42% respectively.Resistance was highest for erythromycin and ciprofloxacin.

Key words; neck space abscesses, peritonsillar abscess,incision and drainage, antibiotic sensitivity

[1]. Kaluskar S, Bajaj P, Bane P. Deep space infections of neck. Indian J Otolaryngol Head Neck Surg. 2007 Mar;59(1):45-8.
[2]. Coticchia JM, Getnick GS, Yun RD, Arnold JE. Age-, site-, and time-specific differences in pediatric deep neck abscesses. Arch Otolaryngol Head Neck Surg. 2004 Feb;130(2):201-7.
[3]. Khaled Al-Noury, Alsaid Lotfy. Deep Neck spaces Radiology And review Of Deep Neck Infections At King Abdulaziz University hospital. Egyptian Journal Of Ear, Nose, Throat And Allied sciences. 2010 Dec; 11: 69-7
[4]. Ridder GJ, Technau-Ihling K, Sander A, Boedeker CC. Spectrum and management of deep neck space infections: an 8-year experience of 234 cases. Otolaryngol Head Neck Surg. 2005 Nov;133(5):709-14.
[5]. Tan P, Chan LY, Huang YC. Deep Neck Infections In Children. J Microbiol Immunol Infect. 2001; 34:287-292
[6]. Boscolo-Rizzo P, Stellin M, Muzzi E, Mantovani M, Fuson R, Lupato V, Trabalzini F, Da Mosto MC. Deep neck infections: a study of 365 cases highlighting recommendations for management and treatment. Eur Arch Otorhinolaryngol. 2012 Apr;269(4):1241-9.

Abstract: Background: The beneficial effects of two central neuraxial blocks in combined form are well acceptable and well tolerable by patients. Beneficial effects of both components are utilized, minimizing their drawbacks. Aims: Our study is designed to evaluate the use of peripheral ( popliteal fossa block ) and central nerve block (spinal) in combined form for below knee surgical procedures. Methods: 30 patients of 60-90 years old with ASA physical status of classification II and III were selected for below knee surgical procedures undergoing popliteal fossa block 20 minutes before sacral spinal anesthesia. The popliteal fossa block was achieved with 30 ml of o.375% injection bupivacaine through lateral approach at the level of upper broader of patella with help of nerve stimulator needle. Sacral spinal anesthesia was introduced through second dorsal foramen of sacrum by intrathecal administration of three ml of 0.5% injection bupivacaine. Results: The hemodynamic stability along with profound and prolonged analgesia before, during and after surgical procedure is the most interesting characteristic feature of this study. Preoperative popliteal fossa block induces analgesic effect at the fracture site and contributes comforts to patients at the time of positioning the patient for administration of sacral spinal anesthesia. It acts as an adjuvant to spinal anesthesia like intrathecal administration of fentanyl or clonidine with the central depression. Conclusion: It provides analgesia before spinal as preoperative medication without central depression, cardiovascular stability during surgical procedures under spinal anesthesia and prolonged analgesia after surgery.

Keywords: sacral spinal; popliteal fossa; below knee surgery; combined block

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[2]. Mcleod GA, Dell K, Smith C, Wildsmith J.A.W. Measuring the quality of epidural block for abdominal surgery. Br J Anesth 2006; 96:633-9.
[3]. Paria R, Surroy S, Majumder M, Paria A, Paria B, Das G. Sacral spinal anesthesia. Indian J Anesth. 2014; 58(1) : 80-2
[4]. Paria R, Surroy S, Majumder M, Paria B, Sengupta S, Paria A. Sacral Saddle Block IOSR-JDMS 2014; 13(4) 39-40.
[5]. Paria R, Surroy S, Majumder M, Paria B, Sengupta S, Paria A. Sacral Epidural Anesthesia IOSR-JD MS 2014; 13(5) 10-11
[6]. Hansen,E, Eshelman,M.R, Cracchiolo, A.3rd . Popliteal fossa neural blockade as the sole anesthetic technique for outpatient foot and ankle surgery. Foot Ankle Int.21:38, 2000.

Abstract: A 40 (forty) year old male patient with Ankylosing Spondylitis was admitted for total replacement of left hip joint. Fusion of the axial skeleton, immobility of cervical spines and restricted movement of temporo-mandibular joint lead to anticipate difficulty in intubation and failure of central neuraxial blockade for total hip replacement. Above factors also compelled to discard the attempts for spinal or epidural or general anesthesia (G.A.) in the conventional way. Last of all, it was decided to operate under caudal anesthesia. But it was difficult to administer caudal anesthesia through calcified sacral hiatus. After through discussion with surgeons, decision was taken to drill the calcified membrane over the sacral hiatus. Through the drilling hole, nerve stimulator needle was introduced and 30 ml of local anesthetic was injected in sacral epidural space after electing dorsiflexion moment of great toe. Satisfied anesthesia developed within 5 minutes. At last, an epidural catheter was inserted within sacral epidural space and kept it left in the sacral epidural space. Operation was completed smoothly without any disturbance from patient's side. No hemodynamic instability was noted.

Keywords: axial skeleton, cervical spines, blind nasal intubation, awake fiber optic intubation, peripheral nerve block, psoas compartment, nerve stimulator

[1]. Paria R, Surroy S, Majumder M, Paria A, Paria B, Das G. Sacral spinal anesthesia. Indian J Anesth. 2014; 58(1) : 80-2
[2]. Paria R, Surroy S, Majumder M, Paria B, Sengupta S, Paria A. Sacral Epidural Anesthesia IOSR-JDMS 2014; 13(5) 10-11.
[3]. Tsui, B.C., Tarkkila, P., Gupta, S., Kearney, R. Confirmation of caudal needle placement using nerve stimulation. Anesthesiology 91: 374; 1999
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Abstract: A review of the literature on operating dental auxiliaries and their utilization in the dental workforce is presented, and their role is examined in the light of broader issues relating to changing disease patterns and service delivery. A strategy for adopting a team approach in the delivery of dental services is mentioned, which would necessitate the dentist taking on the role of team leader and maintaining responsibility for overall treatment planning and quality assurance. Dental auxiliaries could provide basic preventive and restorative dental services, allowing dentists to concentrate on providing more complex high technology treatment. Implications for the future training of dental auxiliaries are presented.

Key words: Dental auxiliaries, dental manpower, operating auxiliary.

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Abstract: Ascariasis is caused by the nematode, Ascaris lumbricoides, commonly found in the tropics. These parasites are transmitted via the faecal oral route. Their eggs hatch in the small intestines and the larvae migrate through the gut wall into the bloodstream and to the alveoli. They subsequently move up the respiratory tract to the trachea and are swallowed. The larvae mature in the small intestines, deriving nutrients from ingested food. Most infections are asymptomatic. Common manifestations include malnutrition or Loeffler's pneumonia (fever, cough and eosinophilia due to a heavy larvae burden). There are, however, reports of ascariasis in the biliary and pancreatic ducts that cause complications.(1-6).

[1]. Misra SP, Dwivedi M. Clinical features and management of biliary ascariasis in a non-endemic area. Postgrad Med J2000; 76:29-32.
[2]. Agaoglu N, Arslan MK. Recurrent attacks of acute pancreatitis from Ascaris in the common bile duct. J Am CollSurg2006; 203:580-1.
[3]. Clinch CR, Stephens MB. Case description of Ascariasis.Arch Fam Med2000; 9:1193-4.
[4]. Sandouk F, Haffar S, Zada M, Graham DY, Anand BS. Pancreatic-biliary ascariasis: experience of 300 cases. Am J Gastroenterol1997; 92:2264-7.
[5]. Khan BA, Shadan A, Suhail M, et al. Magnetic resonance cholangiography in biliary ascariasis. JK Pract2005; 12:205-6.

Abstract: White matter injury of prematurity (WMIP) was formerly called as Periventricular leukomalacia (PVL) even though it effects gray matter. It represents end stage of WMIP. This article emphasizes role of Neurosonogram in detection & grading of periventricular leukomalacia and its drawbacks.

Keywords: Periventricular leukomalacia (PVL), Neurosonogram, Grading.

[1] Barkovich AJ. Brain and spine injuries in infancy and childhood. In: Barkovich AJ, ed. Pediatric neuroimaging. 4th ed. Philadelphia, Pa: LippincottWilliams & Wilkins, 2005; 190–290.

[2] Dr Yuranga Weerakkody and Dr Bruno Di Muzio et al, Radiopedia.org.

[3] Christine P. Chao, MD et al. Neonatal Hypoxic-Ischemic Encephalopathy:Multimodality Imaging Findings , RadioGraphics 2006; 26:S159–S172.

Abstract: Background: Miraa, qat, chat, cat, ghat or khat (Catha edulis), is a shrub indigenous to Eastern Africa and Arabic countries. It is cultivated in most Africa countries. Chewed miraa has sympathomimetic and euphoric effects and its chewing is a popular habit among some populations in Kenya. Habitual miraa chewing has been associated with oral lesions including oral cancer. It has also been associated with various toxic effects on the central nervous system, cardiovascular and reproductive system. In Kenya no data exists among the population that chew miraa of oral mucosal changes associated with miraa chewing. Study Objective: To describe cytological changes of the oral mucosa among habitual miraa chewers in Meru Kenya. Setting: Recruitment was done in miraa selling and chewing kiosks in Meru town. Sample collection and specimen processing was done at Meru level V hospital and KNH/UON cytology laboratory respectively. Subjects: Two hundred and nineteen (219) consenting participants aged 18 years and above with a history of chewing miraa for more than three years were recruited. Design and method: This is a cross-sectional study. A total of 219 consenting adults who met the inclusion criteria were recruited. Snowball sampling technique was also used to hasten enrolment. Buccal smears were collected using cytobrush and examined to determine oral mucosal cytological changes while face to face interviews was used to collect social demographic data as well as risk factors for oral mucosal disease. Data management and statistical analysis: Frequency and percentages were used to describe the patterns of oral mucosal cytology including the occurrence of neoplastic lesions. All statistical analyses were performed using STATA version 12.

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Abstract: This paper is our recent review of literatures on lower limb amputation in Nigeria. There is no national data on the incidence of amputation in Nigeria. Its management remain a major health problem in our society. Amputee in Nigeria is often confronted with the physical reality of mutilation and the stigma attached to it, making it difficult for patients to accept the therapeutic value of amputation unless they perceive an obvious threat to life. The pattern of indications vary from place to place and seems to be changing. Rehabilitation of amputees is a major problem in Nigeria. It is multidisciplinary and should begin from the time the decision is made. This should be co-ordinated in a well organized amputee clinic. Most of the amputees do not have access to prosthesis so they hop around with the aid of sticks, crutches and join the colony of beggars and destitute in our streets. Efforts should be channelled towards preventing limb losses and reducing the burden on amputees through the initiation of new and enforcement of existing health policies in Nigeria.

Keywords: Lower Limb, Amputation, Major, Review, Nigeria.

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