Background - Despite its central role in modern health care delivery, anaesthesia has failed to attract adequate medical man power in most developing countries. As a result, majority of anaesthetics are performed by non-physician practitioners Objectives - In this study, we examined the factors influencing choice of future career by medical student in Enugu, Nigeria and the implications for anaesthesia Methods - We distributed questionnaires to medical students in the last two years of their training at the University of Nigeria, Enugu, asking them to indicate in order of priorities three specialties they will most likely consider for future career. They were also requested to state fourmost important factors influencing their choice Results - All 195 completed forms were returned; 64% were males and the average age of the respondents was 25.1 years. One hundred and eighty students (93%) agreed to specialise, 1 did not while 12 were undecided. Only 1% of the students chose anaesthesia as their first choice. The other specialties like surgery (29%), paediatrics (14%), public health (14%), obstetrics and gynaecology (12%), radiology (11%), internal medicine (5%) and ophthalmology (5%) were considerably of more interest to them. Ability to pursue other hobbies (40%), academic and research opportunities (23%), availability of training post (10%), career progression (10%), earning potential (9%) and influence of a role model (6%) were the factors affecting career decisions among the students Conclusion - This study has highlighted a very low level of interest for anaesthesia amongst Nigerian undergraduates. It also showed that ability to pursue other hobbies, availability of posts as well as academic and research opportunities are the main influencing factors in the choice of future specialty.We call for urgent measures be put in place tomake anaesthesia more attractive to young medical graduates

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Objectives - To report the occurrence of a severe, blinding and irreversible adverse effect following use of the drug sildenafil citrate (Viagra). Methods - This is a case report of a 60 year old man who presented with unilateral, sudden onset, painless, visual loss following the use of sildenafil citrate 100 mg twice weekly, prescribed for his erectile dysfunction. Examination revealed a visual acuity of 6/6 in the right eye and counting fingers left eye. His left fundus showed marked, diffuse disc edema, extensive retinal hemorrhages in all quadrants, engorged retinal veins and cotton wool spots on the macula. His intraocular pressures were 27mmHg right eye and 25mmHg left eye. Results - Fundus fluoresceine angiography confirmed left ischemic central retinal vein occlusion Conclusion - Central retinal vein occlusion is a possible adverse effect of sildenafil use. Physicians should be vigilant while prescribing thismedication and avoid its use in patients with elevated intraocular pressure

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Objective - To determine contraceptive utilisation and the factors influencing its use among grand multiparas in UMTH,Maiduguri, Nigeria Method - A cross-sectional, descriptive study assessed the pattern of contraceptive utilisation among grand multiparas using a pretested interviewer based questionnaire and analysis was done using SPSS version 13.0 statistical package Results - Four hundred women were interviewed, 55.32% (221/400) of the women had used a contraceptive method for the purpose of spacing their children and 35.5% (141/400) used modern methods of contraception. The most commonly used modern method was the hormonal contraceptives (30.8% used injectable and 14.0% used oral contraceptive pills), followed by intrauterine device in 7.2% while 14.5% of the women relied on Lactational amenorrhea (LAM). Contraceptive use is higher among educated women, Muslim women and those women whose spouses are positively disposed to contraception (p=0.001, p=0.028 and p=0.001 respectively). Conclusion - There is high Contraceptive utilisation among grandmultiparas in UMTH, Maiduguri and the injectable contraceptive is the commonest method

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Background - Gunshot injury (GSI) is a common cause of morbidity and mortality in Nigeria. It is important to study the circumstances and type of injuries for policy formulation to reduce its occurrence. Objective - This is to study the demographic profile of GSI patients to assist policy design and reduce its incidence in Nigeria. Method - This is a two year prospective study of the pattern of GSI to the musculoskeletal system using observer administered questionnaires at a tertiary health centre in Lagos, Nigeria and a review of the outcome of the treatment of these injuries. Results - Fifty four patients with gunshot injury to the musculoskeletal system were studied accounting for (10.3%) of the five hundred and twenty four (524) patients with musculoskeletal injuries treated in the hospital during the period under study. The peak incidencewas in the age group 21-30 years and 41-50 years. The limbs (84.1%) were themost affected parts of the body. Policemen (42.6%) and traders (28.9%) were the most commonly affected people. Violent crime accounted for 85.2% of GSI; Low velocity rifles were the commonest weapon of assault (59.3%). Unfortunately a large number of the patients (44.4%) declined orthodox treatment opting for traditional care. Unintentional shooting occurred in only 11.1% of cases. Conclusion - Majority ofGSI occurred inmale young people especially policemen and traders. The need for local businessmen to use "cashless" transfer of funds needs to be emphasized. Law enforcement officers need more training and better equipment to effectively confront criminal elements.

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Objective - A significant number of unconscious patients who present to the emergency department as a result of Road Traffic Accident (RTA) or fall have a major injury to the Cervical Spine. This case highlights the problems of identification of such injuries in the unconscious Case Report - An unconscious young adult was admitted from the accident and emergency into the intensive care unit with a clinical impression of traumatic head injury. Neck collar was applied and the airway secured with an orotracheal tube. Following positive pressure ventilation for about tenminutes, the patient suddenly woke up to full consciousness and started shaking his head violently and uncontrollably, necessitating his tracheal extubation. He then complained of his inability to use or feel his limbs. Radiological investigation revealed complete dislocation of first (C ) and second (C ) cervical vertebra; a crack in the left temporal skull and a contused left lung.Hewas re-intubated about 20 minutes later when his respiratory efforts began to weaken, and ventilated under propofol sedation. He gradually became ventilator dependent, with collapse of cardiovascular and respiratory systems and died on thirteenth day of admission. Conclusion - Cervical Spine injury should be suspected in all unconscious patients following trauma

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