Extramedullary plasmacytoma of the nasal cavity and ethmoidal sinus in human immunodeficiency virus-positive patient.

Extramedullary plasmacytoma (EMP) occurring in the nose and paranasal sinus regions are rare with a male preponderance in the fifth and seventh decades of life. We report a case of EMP of the nasal cavity and ethmoid sinus in a 28-year-old female with human immunodeficiency virus infection.

Epistaxis: The demographics, etiology, management, and predictors of outcome in Jos, North-Central Nigeria.

Background: Epistaxis, though a mere nuisance can have life-threatening consequences. This first study from Jos on epistaxis aims to determine its sociodemographic characteristics, causes, the treatment modalities and the predictors of patient outcome. Study Design: A retrospective chart review. Methods: Health records of patients that met the inclusion criteria for epistaxis at the Jos University Teaching Hospital, Jos, Nigeria, between February 2011 and December 2015 were retrieved manually using standardized codes in the International Classification of Diseases 10th revision and studied for age, gender, associated comorbidities, treatment modalities offered, and outcome of treatment. Results: We managed 154 patients. Records of 92 patients were retrievable aged between 1 and 85 years (Mean = 37.7; standard deviation ± 16.2) with male to female ratio of 2.3:1. Patients in the third decade were the largest group. The most common cause was idiopathic. Anterior nasal bleeding occurred in 51.1%, posterior nasal bleeding in 34.8%. Conservative management was effective in 84.8%. Etiological factors other than chronic liver disease and otolaryngological malignancies showed statistically significant association with good patient outcomes (P = 0.013, P = 0.044, and P = 0.026, respectively). A mortality rate of 5.4% was recorded. Conclusion: Epistaxis of idiopathic origin occurring mostly in young males is the most common with most resolving on conservative management. Early hospital presentation, normal blood pressure at presentation and all management modalities were positive predictors of outcome in our patients.

RésuméContexte: Epistaxis, bien qu'une simple nuisance peut avoir des conséquences mortelles. Cette première étude de Jos sur l'épistaxis vise à déterminer ses caractéristiques sociodémographiques, ses causes, les modalités de traitement et les prédicteurs de l'issue du patient. Conception de l'étude: Une revue rétrospective des dossiers. Méthodes: Les dossiers médicaux des patients répondant aux critères d'inclusion de l'épistaxis au Jos University Teaching Hospital, Jos, Nigéria, entre février 2011 et décembre 2015 ont été récupérés manuellement à l'aide de codes normalisés dans la 10e révision de la Classification internationale des maladies. , les comorbidités associées, les modalités de traitement offertes et les résultats du traitement. Résultats: Nous avons géré 154 patients. Les dossiers de 92 patients étaient récupérables entre 1 et 85 ans (moyenne = 37,7; écart-type = +16,2) avec un ratio hommes / femmes de 2,3: 1. Les patients de la troisième décennie étaient le groupe le plus important. La cause la plus fréquente était idiopathique. Saignement nasal antérieur est survenu chez 51,1%, saignement nasal postérieur chez 34,8%. La gestion conservatrice était efficace dans 84,8%. Des facteurs étiologiques autres que la maladie hépatique chronique et les tumeurs malignes otolaryngologiques ont montré une association statistiquement significative avec de bons résultats pour les patients (P = 0,013, P = 0,044 et P = 0,026, respectivement). Un taux de mortalité de 5,4% a été enregistré. Conclusion: L'épistaxis d'origine idiopathique survenant principalement chez les jeunes hommes est le plus commun avec le plus de résolution sur la gestion conservatrice. La présentation hospitalière précoce, la pression artérielle normale à la présentation et toutes les modalités de prise en charge ont été des prédicteurs positifs des résultats chez nos patients.

The undergraduate medical student's perception of professional mentorship: Results from a developing nation's medical school.

INTRODUCTION: There are no documented formal mentoring programs for medical students in Nigeria. This study aims to determine the perception of undergraduate medical students at the University of Jos on professional mentorship, with a view to informing University authorities on creating and developing a mentoring program. MATERIALS AND METHODS: A cross-sectional study conducted in December 2017 in which self-administered questionnaires were distributed among the sixth-year medical students in a University in North-Central Nigeria, eliciting information regarding biodemographic data, knowledge of and experiences with mentoring, desired benefits of mentoring, and the willingness to participate in a mentoring relationship. Data collected was analyzed with EPI Info statistical software® version 7.2.1 (EPI Info, Center for Disease Control, Atlanta, Georgia, 2017). RESULTS: In a class of 166, the response rate was 83.5%. Mean age = 27.4 years; standard deviation = ±2.6 with a male: female ratio of 1.9:1. Moderate knowledge of mentoring was reported by 47 (44.3%). Attitude toward mentoring was very positive in 23.6%. One hundred and four (98.1%) students agreed mentoring are effective in developing potential. Nearly 95.3% agreed a mentorship program would benefit medical students with 70.8% expressing high willingness to participate. A weak positive statistical correlation between the age of students and those who expressed willingness to participate was recorded (r = 0.04; 95% confidence interval (CI) = 0.6-1.16; and P = 0.05). CONCLUSION: Sixth-year medical students of the University of Jos have a moderate knowledge of and a good attitude toward mentorship. The implementation of a formal mentoring program for medical students at the University of Jos is strongly recommended.

Environmental and Life-Style Related Risk Factors for Sinonasal and Nasopharyngeal Malignancies among a Prospective Cohort in Jos, Nigeria.

BACKGROUND: Worldwide evidence indicates that environmental and life-style related factors are associated with increased risk for cancers in the head and neck region. We aim to study the association between these risk factors and cancers in the sinonasal and nasopharyngeal regions in our environment. METHODS: Longitudinal prospective cohort study at the Jos University Teaching Hospital, Jos, Nigeria. Risk exposures were classified based on the International Agency for the Research on Cancer (IARC) classification of suspected carcinogens. Associations between variables were analyzed using logistic regression. RESULTS: We studied 44 patients with malignancies in nasopharynx (n= 24; 54.5%) and sinonasal regions (n= 20; 45.5%). Male to female ratio is 1.9:1 and mean age is 45.2 years. Alcohol was the commonest risk factor in males (n= 19; 43.2%) while cooking wood fumes were the commonest in females (n= 14; 31.8%) which was associated with increased risk for malignancies for all sites, showing ten times risk in nasal cancers (OR= 9.67; 95% CI 1.87- 9.88; p= 0.01). Tobacco was associated with elevated risk of malignancies in the nasomaxillary and nasal regions. Other risks were herbicides, pesticides, and chemical fertilizers in farmers. CONCLUSION: The significant risk exposures in females were cooking wood fumes and alcohol, tobacco, and exposure to agricultural chemicals in males. Life-style modification and environmental changes to ensure clean air in Nigeria are essential to reduce risks.

The predictive factors of primary head and neck cancer stage at presentation and survival in a developing nation's tertiary hospital.

BACKGROUND: Stage of head and neck cancers at presentation is a strong determinant of outcomes. OBJECTIVE: To evaluate predictors of stage of head and neck cancers at presentation and survival in a Nigerian tertiary hospital. PATIENTS AND METHODS: Health records that met the inclusion criteria for head and neck cancers were retrieved using the International Classification of Diseases, 10th revision and analyzed with associations between variables modeled using logistic regression analysis. RESULTS: From a record of 487 head and neck neoplasms, 129 (26.5%) were malignant of which 122 health records met the criteria for analysis consisting of 83 (68.0%) males and 39 (32.0%) females aged 13-85 years (mean = 51 years; standard deviation = ±16 years). Alcohol (odds ratio = 1.99; 95% confidence interval = 1.08-3.69; p = 0.02) and tobacco exposure (odds ratio = 3.07; 95% confidence interval = 1.32-7.16; p = 0.01) were associated with increased odds for advanced tumor stage at presentation. Stage IV cancer (hazard ratio = 1.44; 95% confidence interval = 1.80-2.59), alcohol (hazard ratio = 2.19; 95% confidence interval = 1.18-4.10) and tobacco use (hazard ratio = 3.40; 95% confidence interval = 1.22-8.74) were associated with increased hazards for death. CONCLUSION: Alcohol, tobacco use and smoke from cooking wood are predictive factors for advanced HNC stage at presentation. Stage IV cancer, alcohol and tobacco use were associated with an increased hazard for death.

The epidemiology, treatment, and determinants of outcome of primary head and neck cancers at the Jos University Teaching Hospital.

INTRODUCTION: This study aims to evaluate the epidemiology, treatment, and factors that determine the outcomes of head and neck cancers (HNC). PATIENTS AND METHODS: Retrospective analytical review of HNC managed at the Jos University Teaching Hospital between May 2007 and April 2017 using the International Classification of Diseases version 10. RESULTS: Of 487 head and neck neoplasms, 129 (26.5%) were malignant and 122 health records met the criteria for analysis consisting of 83 (68.0%) males and 39 (32.0%) females aged 13 years to 85 years (mean = 51 years; standard deviation = ±16.0 years). The most common presenting feature was nasal obstruction (n = 47; 38.5%). The most common tumor site was the nasopharynx (n = 34; 27.9%). Mean duration of symptoms was 13.3 months. Alcohol (P = 0.02), cigarette smoking (P = 0.01), and cooking wood smoke (P = 0.01) were associated with advanced tumor stage. Squamous cell carcinoma was the most common histological type. Posttreatment complication rate was 47.5%. Lost to follow-up rate was 55.7%. The lungs were the most common distant metastatic site. The case fatality rate was 18.0%. CONCLUSION: HNC constitutes almost a quarter of head and neck tumors affecting twice the number of males in their sixth decade with nasopharyngeal cancers being the most common in both genders. Several modifiable variables are noted to target appropriate future cancer education for lifestyle modification, screening for early detection and treatment.

Identifying Risk Factors for Morbidity and Mortality in Patients with Primary Head and Neck Cancers in a Nigerian Population.

BACKGROUND: The risk factors for head and neck cancers (HNC) vary in different parts of the world. OBJECTIVES: To identify the risk factors for HNC and the correlation between these factors and the involved anatomical sites. METHODS: We retrieved and analyzed health records of patients that met the inclusion criteria for HNC managed at our facility in a 10-year period using the International Classification of Diseases (ICD) version 10. RESULTS: We studied 122 patients with a male to female ratio of 2.1:1 aged 13 years to 85 years (mean = 51 years). Alcohol (P = .02), cigarette smoking (P = .01), and cooking wood smoke (P = .01) were associated with advanced tumor stage. CONCLUSIONS: The strongest risk factors for HNC are alcohol, tobacco, HIV, agricultural chemicals, and cooking wood fumes in both sexes in their sixth and seventh decades.

Cost effectiveness of human papilloma virus vaccination in low and middle income countries: a systematic review of literature.

INTRODUCTION: Low and middle income countries (LMICs) bear more than 50% of the current cervical cancer burden over the last decade with linkages to lack of HPV vaccination, high levels of poverty, illiteracy and nonexistent or poor screening programs. Governments of LMICs need enough convincing evidence that HPV vaccination will be more cost-effective in reducing the scourge of cervical cancer. AREAS COVERED: A systematic review to identify suitable studies from MEDLINE(via PubMed), EMBASE and Electronic search through GOOGLE for original and review articles from 2007 to 2014 on cost-effectiveness of human papilloma virus vaccination of pre-adolescent girls in LMICs was conducted. A total of 19 full articles were finally selected and reviewed after screening out those not consistent with the inclusion and exclusion criteria. EXPERT COMMENTARY: Most studies on cost-effectiveness of HPV vaccine in LMICs show that lowering cost of HPV vaccination with or without Pap smear screening is cost-effective in areas with high incidence of cervical cancer.

Otolaryngological Presentations in Times of Terror: Profile from a Tertiary Health Center in North-Central Nigeria.

OBJECTIVES: To report the incidence, socio-demographic characteristics, otorhinolaryngological presentations and outcomes of management of patients at the Jos University Teaching Hospital following terror attacks. METHODS: A prospective descriptive hospital based study of consecutive patients presenting with ear, nose and throat injuries as a result of bomb blasts and ethno-religious crises within a six-year period and managed at the Jos University Teaching Hospital were studied for age, gender, ear, nose and throat presentations, injury mechanism, interventions and outcome of interventions. A designed proforma was used for data collection. RESULTS: There were 107 ear, nose and throat injuries from a total 468 terror-related injuries consisting of 66 (61.7%) males and 41 (38.3%) females (M:F ratio of 1.6:1), aged between 5 and 77 years (mean= 36.7 years; SD= +/- 16.2). Two peak age incidences of injuries in the first and third decades were recorded. The commonest source of injuries was bomb blasts in 47 (44%) patients. Multiple facial fractures with soft tissue injuries were the commonest seen in 78 (72.9%) patients. The commonest associated injuries were head injuries (n= 36). Ninety-four (87.9%) patients presented via the Accident and Emergency department, 16 (15%) received pre-hospital care. Patients with multiple injuries stayed longer in the hospital (p-value= 0.028). Complications were recorded in 19 (17.8%) patients. A case fatality rate of 5.6% was recorded. CONCLUSION: Bomb blasts were the major form of terror attacks in our region. The presence of multiple injuries is a significant negative predictor of patient outcomes.

Pediatric otorhinolaryngology emergencies at the Jos University Teaching Hospital: Study of frequency, management, and outcomes.

BACKGROUND: Studies from Nigeria on pediatric otorhinolaryngology (ORL) emergencies are rare in literature with most focusing on emergencies involving individual systems. OBJECTIVE: The aim of this study is to determine the prevalence of all ORL emergencies among children in our region to provide a baseline data for future health planning. PATIENTS AND METHODS: This is a 1-year retrospective cross-sectional study of patients aged 16 years and below presenting to the Accident and Emergency Department of the Jos University Teaching Hospital, Jos, Nigeria. RESULTS: A total of 203 otolaryngology emergencies were attended of which 129 (63.5%) were pediatric emergencies. Records of 87 patients were retrievable with age range 2 months to 15 years (mean 3.44 years; standard deviation ± 3.35). There were 55 males and 32 females with a male to female ratio of 1.7:1. The majority of cases were aged under 5 years (64; 73.6%). Acute tonsillitis accounted for 32 (36.7%) cases with 6 (6.9%) having peritonsillar abscesses. Acute pharyngitis accounted for 11 (12.6%) presentations followed closely by foreign bodies (FBs) in the ear with 10 (11.5%) presentations. FB in the throat occurred in 4 (4.6%) patients who had removal under general anesthesia. Three (3.4%) cases of maxillofacial injuries occurred as a result of insurgent terror attacks and 3.4% presented following corrosive substance ingestion. Conservative management was commenced in 76 (87.4%) patients, 23 (26.4%) had surgery with 68 (78.2%) admitted and discharged, 18 (20.7%) treated as outpatients, and 1 (1.1%) died on admission. Otolaryngologists attended most (95.4%) patients. CONCLUSION: Pediatric ORL emergencies are common in our region involving a wide range of pathologies. Expansion is required in the ORL training of the emergency room physician to enhance emergency services.

Otorhinolaryngological manifestations in head trauma: A prospective study of the epidemiology, clinical presentations, management, and outcomes.

BACKGROUND: Otorhinolaryngological injuries following head trauma may be missed, overlooked, or forgotten in the acute phase resulting in worsened management outcomes. This study aims to report the epidemiology, clinical presentations, management, and outcomes of otorhinolaryngological injuries in head trauma with a view to creating awareness for early recognition and prompt treatment. PATIENTS AND METHODS: Head injured patients consecutively presenting over a 5-year period were prospectively studied for age, gender, otorhinolaryngological presentations, interventions, and outcome of interventions. Data obtained were statistically analyzed. RESULTS: There were 91 (1.3%) otorhinolaryngological presentations among 7109 head injured patients. Mean age of 34 years, standard deviation = ±15.6 with a male:female ratio of 2.4:1. Severe head injury (Glasgow coma scale <9) occurred in 46 (50.5%) patients. Patients aged 30-39 years were mostly affected (n = 30; 32.9%). Most injuries were from motor vehicular accidents (n = 61; 67%) and assaults (n = 23; 25.3%). The most common otorhinolaryngological presentations were cerebrospinal fluid (CSF) rhinorrhea (n = 26; 28.6%) and CSF otorrhea (n = 25; 27.5%). Conservative management was achieved in 59.3% of patients. Mean time of hospital presentation was 13.8 h. There was no statistical correlation between outcomes and each of etiology and time of presentation (P values 0.18 and 0.9, respectively). Seventy-five (82.4%) were discharged without neurological deficits. A case fatality rate of 6.6% was recorded. CONCLUSION: Frontal skull base and temporal bone fractures with CSF rhinorrhea and otorrhea are the most common injuries occurring mostly in young active males with favorable outcomes following conservative management.

The impact of tinnitus on adult Nigerians: health related Quality of Life assessment of sufferers using the Hospital Anxiety and Depression Scale (HADS) and the RAND-36 item health survey 1.0 questionnaire.

BACKGROUND: Tinnitus is a distressing ailment with limited options for therapy and affecting the quality of life of sufferers. This study aims to investigate the impact of tinnitus on the health related quality of life, the psychological and emotional wellbeing of patients in our environment. PATIENTS AND METHODS: Consecutive patients with tinnitus presenting to the Otorhinolaryngology outpatient clinic of the Jos University Teaching Hospital and The Ear, Nose and Throat Clinic, Jos were assessed and administered the Hospital Anxiety and Depression Scale (HADS) and the RAND-36 item health survey 1.0 questionnaires. RESULTS: We studied 49 patients, age range 22- 79 years (mean = 36.8; median = 35.5; SD = ± 12.7) consisting of 22 (44.9%) males and 27 (55.1%) females, male to female ratio of 1:1.2. Patients in the age range 31 to 40 were in the majority (n = 20; 40.4%). Depressive symptoms were recorded in 14 (28.6%) female patients and 11 (22.4%) male patients. Anxiety symptoms were recorded in 18 (36.7%) female patients and 16 (32.6%) male patients. 34 (69.4%) of our patients scored low on all QoL domains except pain levels irrespective of age or gender with statistically significant positive correlations between all the QoL domains studied for all patients (P-value 0.5). Univariate analysis shows statistically significant inverse correlation between emotional distress (anxiety and depression) scores and each of emotional wellbeing scores. CONCLUSIONS: Our study demonstrates high prevalence of tinnitus amongst the younger population in our region especially females with significant reduction in their HRQoL. This should help in raising the awareness of the impact of tinnitus on the QoL, psychological and emotional wellbeing of patients in our region with a view to improving outcome for tinnitus sufferers. We recommend a further study on a larger sample population to determine the socioeconomic impact of tinnitus on the Nigerian population.

The epidemiology and type of injuries seen at the accident and emergency unit of a Nigerian referral center.

BACKGROUND: A plethora of injuries present at any accident and emergency unit, but the pattern of the injuries varies from region to region especially in ours with the increased ethno-religious clashes and terrorist attacks. This study aims to determine the epidemiology and type of injuries presenting to our center with the possibility of developing injury surveillance initiatives in our center and Nigeria as a whole. MATERIALS AND METHODS: Injured patients consecutively presenting to the accident and emergency department of the Jos University Teaching Hospital within the period February 2011 to January 2012 were prospectively recorded. RESULTS: A total of 720 injured patients admitted with an age range of 8 months to 75 years (mean = 37.9; SD = ±52.4), which consists of 544 males and 176 females giving a male to female ratio of 3.1:1. Patients aged 20-29 years were in the majority (n = 220, 30.6%) with peak incidences in the period of communal clashes. Injuries sustained from motorcycles were the highest (n = 248, 34.4%). Others were 160 (22.2%) in other vehicular and pedestrian injuries, machete (n = 128), gunshots (n = 92), burns (n = 36), bomb blast injuries (n = 16), fall from heights (n = 32) and miscellaneous (n = 8). Injuries sustained in communal clashes and terrorist attacks accounted for 236 (32.8%) presentations. The most common site of injury was the head (n = 30 4, 42.2%). Relatives, passersby and law enforcement agencies brought patients to the hospital with times between injury and presentation ranging from 1 h to 3 weeks. 40 (5.6%) patients were brought in dead. CONCLUSION: A collective effort - on the part of the government and the citizenry is required to ensure better outcomes and a safer society for all.

The Traditionally Amputated Uvula amongst Nigerians: Still an Ongoing Practice.

Traditional healers in Nigeria continue to perform uvulectomy for all throat problems despite the severe complications they present to physicians. It is a hospital-based prospective study done at the outpatient unit of the Department of Otolaryngology, Jos University Teaching Hospital, Jos, Nigeria to determine the prevalence of traditional uvulectomy, highlighting the dangers it portends with suggested ways of providing improved health outcomes for our people. We saw 517 new cases of which 165 (32%) patients aged 2 years to 53 years had their uvulae amputated consisting of 108 (65.5%) males and 57 (34.5%) females giving a male to female ratio of 2 : 1. One hundred and forty two (86.1%) patients had uvulectomy at childhood and 23 (13.9%) in adulthood. The commonest indication was throat pain (n = 36, 21.8%). The commonest complication was hemorrhage (n = 29, 17.6%). Forty six (27.9%) patients required hospital admission.

The Role of Necropsy in Diagnostic Dilemmas as Seen in a Tertiary Hospital in North Central Nigeria

Background. Necropsy (autopsy) has helped medical science and law. It has given rise to numerous diagnostic surprises as it explains cause of death; pathogenesis of diseases; and circumstances of death. It also explains reasons for most therapeutic failures. In spite of its usefulness; the rate has dropped worldwide and Africa is worse hit. This work aims to highlight the role autopsy (Necropsy) plays in demystifying diagnostic dilemmas and to encourage its patronage by medical practitioners; law enforcement agents and society. Methods. This is a retrospective review of autopsy and clinical reports of cases seen by pathologists and physicians in the Jos University Teaching Hospital (JUTH); Jos; North central Nigeria. Results. A total 166 cases were studied out of which 52 had same diagnosis for both attending physician and pathologist; 106 had different diagnoses and in eight cases diagnoses remained unknown even after autopsy was performed. Conclusions. Autopsy remains an important tool for obtaining definitive diagnosis; determining cause of death to explain pathogenesis of diseases; medical auditing and a vital source of data for health statistics and planning

Persistent alveolar soft-part sarcoma with liver metastasis: a case report.

INTRODUCTION: Alveolar soft-part sarcomas are rare, slow-growing tumors that metastasize commonly via vascular routes to the lungs, bones, lymph nodes and brain, causing morbidity and mortality. To the best of our knowledge, this is the first case describing metastasis to the liver reported from Nigeria. CASE PRESENTATION: A 57-year-old man of the Urhobo ethnic group of Nigeria presented with a persistent mass in his left calf. It was initially diagnosed as soft-tissue sarcoma, and its associated systemic effects lead to his death before a histological diagnosis could be obtained. CONCLUSIONS: Alveolar soft-part sarcoma with metastasis to the liver can occur in our region (northeast Africa), and a high index of suspicion is required to make an early diagnosis, followed by prompt surgical excision with clear margins in order to prevent mortality.

Clinico-pathological profile of sinonasal masses: an experience in national ear care center Kaduna, Nigeria.

BACKGROUND: The presence of a mass in the nose and paranasal sinuses may seem to be a simple problem; however it raises many questions about the differential diagnosis. The aim of this study is to evaluate the clinico-pathological profile of sinonasal masses in our environmentThis is a retrospective analytical review of all the patients with sinonasal masses that presented to the national ear care center, Kaduna over a six year (2003-2008) period. Their biodata, clinical profile and histological diagnoses were analyzed. FINDINGS: A total of 76 patients were analyzed, age range 5 to 64 yrs with a mean age of 33.3 yr median and modal age of 35.00 (SD = 13.1 +/- 1.5). Majority of the patients were in the age groups 21-50 yrs. There were 34 male and 42 female with M: F ratio of 1:1.2. The main presenting symptoms are nasal blockage 97.4% and rhinorrhea 94.7%. It was bilateral in 34 (44.7%), left side in 24(31.6%) and right side in 18(23.7%) patients. The commonest clinical diagnoses were simple nasal polyp 47(61.8%) and antrochoanal polyp 10(13.2%). About 59 (77.6%) were benign, 2 (2.6%) were malignant and 15 (19.7%) were lost to follow up. The commonest histological diagnosis is simple inflammatory nasal polyp in 28 (36.8%) patients and the least was nasal capillary hemangioma 2 (2.6%). About 55(72.4%) patients had surgical treatment. CONCLUSIONS: Nasal obstruction and rhinorrhea are the commonest symptoms of presentation, simple inflammatory nasal polyp is still the commonest histological pattern seen in our environment, and surgery is still the best modality of treatment for benign tumor thus the need for advocacy for early recognition and referral to the ENT surgeon.

Management of suicidal cut throat injuries in a developing nation: three case reports.

INTRODUCTION: Suicidal cut throat injuries are either unreported or fortunately rare in our country. The management of these injuries requires a multi-disciplinary approach. CASE PRESENTATIONS: This paper presents our experiences with managing three unemployed adult Nigerian males - two of Hausa ethnicity and one from the Tiv ethnic group presenting with cut throat injuries following suicidal attempts. CONCLUSION: The purpose of these reports is to emphasize that suicidal cut throat injuries do occur in our environment and there is a need for the collaboration of the otorhinolaryngologist, anesthesiologist and psychiatrist in the effective management of these patients. We recommend the socioeconomic improvement of individuals as a way of reducing the incidence of these injuries as unemployment was cited as a motivating factor for suicide in our patients. Ways must also be found to identify the many people in society without mental disorders who are at risk of suicidal behaviors.

Indications and outcome of pediatric tracheostomy: results from a Nigerian tertiary hospital.

BACKGROUND: There is a change in the concept of pediatric tracheostomy. This study investigates the indications and outcomes of pediatric tracheostomy in a Nigerian teaching hospital finding out whether there is also a change in the trend in our environment as compared to other centers. METHODS: A retrospective chart review of 46 patients aged between 2 months and 15 years who presented to our Otorhinolaryngological facility and had tracheostomy between January 2000 and December 2008. RESULTS: The age range was 2 months to 15 years. There were 29 males and 17 females. Thirty two (69.6%) patients were in the age range 6-10 years. Forty tracheostomies (87%) were performed as emergency while 6 (13%) as elective procedures. The commonest indication for tracheostomy was upper airway obstruction (n = 29, 63%). Transverse skin incision was employed in all the cases. No intra-operative complication was recorded. The post-operative complication rate was 15.2%. The duration of tracheostomy ranged from 5 days to 3 months. All the patients were successfully decannulated. The overall mortality was 8 (17.4%). There was no tracheostomy related mortality. CONCLUSIONS: There is no increase in the incidence of tracheostomy in patients under 1 year of age and the commonest indication for the procedure in Nigeria has remained relief of upper airway obstruction. Pediatric tracheostomy is safe when performed in the tertiary hospital setting.

Endobronchial metallic foreign body in a Nigerian child: management difficulties and the need for caution: a case report.

INTRODUCTION: Endobronchial metallic foreign bodies are serious injuries best treated by rigid bronchoscopy as quickly as possible to avoid life threatening respiratory sequelae. CASE PRESENTATION: We report the case of a 13-year-old male Nigerian child of the tangale ethnic group who aspirated a metallic foreign body, highlighting the "difficulties" encountered in managing this patient. CONCLUSIONS: There is a need to adequately equip our hospitals for the management of this otherwise straight forward case and alleviate the sufferings of our people. Parents and guardians should exercise caution in the handling of their children/wards.