Anecdotal reports have attributed persistent splenomegaly in African sickle cell anemia (SS) patients to the effects of malaria. However, no comparative studies of patients in malarial and nonmalarial regions have been conducted, and few studies of malaria antibody titers have been reported. In the present study, age- and sex-matched Nigerian patients (n = 310), while it was found only in 8% of U.S. patients (n = 100) from Georgia. There was significant linear correlation between spleen size and Hb levels and with serum immunoglobulins in the Nigerian group. However, serum complement levels (C3 and C4) were not affected by spleen size. In both groups, patients with splenomegaly had fewer circulating pitted red cells than their counterparts without splenomegaly. The mean +/- SE of IgG-specific malaria antibody titer among the Nigerian patients without palpable spleens was 9,386 +/- 2,036; 9,334 +/- 2,980 in those with spleens between 1 and 5 cm, 16,201 +/- 4,502 in those with spleens between 6 and 10 cm, and 22,445 +/- 8,456 in those with spleens above 10 cm. Coexistent alpha-thalassemia did not influence the prevalence of splenomegaly among the Nigerian SS patients. This study provides additional evidence that malaria plays a significant role in the persistence of splenomegaly in African patients.

This study was conducted to determine the frequency of antenatal intrauterine fetal death (IUFD) and the associated maternal and fetal risk factors in women who presented at a regional tertiary hospital in Saudi Arabia. Over a 5-year period, 191 consecutive cases of IUFD presented and were studied prospectively. Relevant maternal and fetal data were obtained. The stillbirth rate during the period was 10 per 1000 deliveries. In 41% of the cases, the associated causal factors could not be determined. There was a significant (P = 0.00122) linear trend showing an increased risk of IUFD above the age of 20 years and, similarly, a significant (P = 0.00047) linear trend after the first pregnancy. Lack of antenatal care (88.5%), hypertensive diseases in pregnancy (12%) and diabetes mellitus (8%) were associated risk factors while 'major congenital malformation' (14%) was an outstanding fetal factor. The risk factors of antenatal stillbirth in our community seem to be avoidable. Health education to encourage the utilisation of the available antenatal care services, family planning and genetic counselling are being advocated strongly as possible preventive measures.

Background: Rabies is a preventable zoonosis with the highest case fatality of any disease in the world. In the developing world, it is transmitted mainly by dog bites. In parts of southern Nigeria, dog meat is a delicacy. Objective: To highlight trade in stray dogs as a major risk factor for rabies in animals and humans in south-south Nigeria. Method: Patients admitted into the University of Calabar Teaching Hospital (UCTH) with a diagnosis of rabies between July and October 2012 were analysed for risk factors, post exposure prophylaxis (PEP), health seeking behaviour and outcome. Focused group interview were also conducted among traders/ handlers of stray dogs. Results: Ten cases of rabies in subjects aged 3 to 52 years were recorded in these five months period. Eight of the cases were male and apparently got infected directly or indirectly through the trade in stray dogs for human consumption. None had proper PEP and all patients died. Conclusion: Stray dog trade, fuelled by eating of dog meat, is a risk factor for human and animal rabies in Calabar, southern Nigeria. Culling of stray dogs, control of stray dogs' trade and public enlightenment on PEP is recommended.

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The knowledge of and attitude to acquired immunodeficiency syndrome (AIDS) of 738 secondary school youths in Calabar were studied by questionnaire in March 1991. Most (92%) of the adolescents had heard about AIDS, largely through the mass media (79-85%), with parents and teachers contributing in less than 40%. About 30% did not know that AIDS exists in Nigeria. Most of them knew that promiscuity, blood transfusion and sharing injection needles and syringes are the major modes of transmission, but a number still incriminate toilet seats, eating utensils, hand-shaking and kissing. Only 31% were aware that condoms provide protection. For self-protection the youths prefer abstinence (45%) and confinement to one sex partner (19%). Only 3.6% would adopt the use of condoms. To prevent the spread of AIDS, the youths prescribe isolation (37%), treatment (34%), and killing (14%) of diagnosed cases. Most youths (77%) will stop seeing friends and 63% will reject relatives who develop AIDS. The study reveals that while general awareness of AIDS is fairly good, detailed knowledge is riddled with misconceptions and confusion. It is recommended that physicians in the community should assist in disseminating accurate information, with the support of parents, teachers and the youths themselves.

SUMMARY An infant with clinical evidence of prenatal right subclavian arterial occlusion subsequently developed left hemiparesis with cystic infarction of the territory of the right middle cerebral artery. Perinatal limb but elsewhere they were normal. The arm and forearm circumferences, measured at midpoints, were 1-0 cm smaller on the right than on the left. The rest of the physical examination was unremarkable.Plain radiographs of the cervical spine, chest, and right shoulder were normal. A full blood count on day 1 yielded the following results: haemoglobin concentration 223 g/l; packed cell volume 63%; white cell count 20-2x109/l and platelet count 80X109/l. Viral studies were all negative. A splint was applied to the affected limb.On the second day of life the tip of the right ring finger had become dark blue, though the other fingers were viable. Doppler ultrasound scan of the affected limb detected pulsation in the right subclavian artery to the outer border of the first rib, but not beyond. Over the next 72 hours the Doppler pulsation became audible in the axillary artery down to the radial artery and pulses could be felt. The infant remained otherwise well.On discharge at the age of 2 weeks movements in the affected limb had considerably improved and all the pulses were palpable. The range of active movements of the left limbs were within normal limits. Because the improvement was so rapid no further investigations were carried out. The child subsequently failed to attend the follow up clinic.At the age of 7 months the infant was brought back to the clinic the mother complaining that since the age of 4 months the child had had limited use of her left limbs; she had otherwise been well. A full neurological examination showed a left spastic hemiparesis and left hemianopia. The head circumference had dropped to the 10th centile having been on the 25th centile at birth. Her right upper limb was normal, as was her social behaviour. Computed tomography brain scan at the age of 7 months showed a cystic lesion in the area of the right middle cerebral artery with shrinkage of the right hemisphere ( figure). When reviewed at 17 months of age, she could only move about by shuffling on her bottom but she appeared cognitively normal and no seizures had been observed. Discussion

The pattern of faecal excretion of Vibrio cholerae was studied over a duration of eight months among 13 cholera convalescents by two-weekly surveillance cultures. Stools and rectal swabs were cultured on Thiosulphate citrate bile salts sucrose (TCBS) agar for the recovery of vibrio pathogens. Clinical phase and convalescent phase V. cholerae strains were compared for antibiogram profiles. The population of vibrios recovered from faecal inocula was usually scanty (<10(3) vibrios/g). All clinical isolates except three were concordant with convalescent phase strains. Sensitivity to tetracycline was uniform for concordant V. cholerae strains, with minimum inhibitory concentration (MIC) ranging from 0.54-4.0 microg/ml. Nine (69.2%) of the convalescents had positive faecal cultures for periods ranging from two weeks to more than seven months. Two adults whose excretions lasted several months also tested positive for human immuno-deficiency virus (HIV) infections. The significance of stool surveillance cultures for identifying asymptomatic infections among convalescents who may need chemotherapy to abolish excretion is emphasised. However, it could not be established with certainty if vibrios excreted during convalescence were from enteric colonization by the causative strains, or re-infections with the common strains in circulation.