Background: Malaria is prevalent in Nigeria, and artemether + lumefantrine (artemisinin-based combination therapy [ACT]) is drug of choice in treatment of uncomplicated cases. ACT is contraindicated in early pregnancy. They release-free radicals that can compromise female fertility. Infertility and its associated complications such as miscarriages, abnormal gestation, and unstable marriages seem to be on the increase. This study aims at evaluating the effect of ACT on female fertility. The significance of this research is to draw the attention of fertility care givers to this possible cause of infertility and fertility challenges. Subjects and Methods: Creighton Model FertilityCare System and NaProTECHNOLOGY are simply technologies that can be used to assess female fertility. They are used in this study to assess the effect of ACT administered at different stages of menstrual cycles of three selected fertile adult females. The results are interpreted on the background of standard Creighton model chart. Results: This study has shown that ACT has a significant fertility deteriorating effect on the women. It caused ovulation defect and diagnosed as partial rupture syndrome in the very cycle of use and in the first cycle after use. It also significantly reduced cervical mucus production and significantly reduced luteal phase progesterone production with an associated significant increase of luteal phase estrogen production. Conclusion: ACT use as antimalarial may be a possible cause of infertility and fertility challenges in women.

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Background: Referral system is any process in which healthcare providers at lower levels of the health system seek the assistance of providers who are better equipped or specially trained to guide them in managing or to take over responsibility for a particular episode of a clinical condition in a patient. Objective: To evaluate the profile and outcome of referrals from primary healthcare levels. Materials and Methods: This was a descriptive cross-sectional study undertaken with the aid of a structured questionnaire administered to all referred pregnant mothers and parents of children at three General Hospitals and one tertiary hospital. Results: Nearly all the participants were informed about the reason for their referral. Four-fifths of the participants were not accompanied by a health worker, whereas 90% were not expected on arrival. About 80% of the participants went to the referred hospital on the same day. The most common mode for transporting referred patients was public bus followed private vehicle. Conclusion: Although there are good practices with regard to referred patients being informed about the reason for their referral, work is still pending to ensure that the referral systems are effectively functioning in the referring of patients from primary health facilities.

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Lipomas can be found in any region of the body and are the most common benign tumors of the adipose tissue. Giant lipomas have been reported to be any lipoma more than 10 cm in size along its widest diameter or more than 10 g in weight. Here we present two case reports of otherwise healthy patients who presented with unusually large tumors at different points in the same facility. Hence, it was needed to report our findings: A 27-year-old man with a 3-year history of a huge right gluteal swelling; A 56-year-old man with a 30-year history of a right lower limb mass. Physical examination and relevant radiological investigations were conducted to characterize and ascertain the extent of the two masses. They were excised surgically and underwent histology to confirm diagnosis. Despite the availability of improved health services, giant lipomas still exist.

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The subcutaneous position of the extensor tendons makes it possible for the tendon/s to be lacerated in many cases of sharp object cuts on the dorsum of hand. The lack of insight and the poor patients' assessment cause the primary clinician to secure hemostasis and repair the obvious skin wound only. This unrecognized tendon injury would later become obvious because of persistent deformity and loss of function. This is a case series of patients with delayed diagnosis of extensor tendon injuries to the fingers as seen in a level II surgical specialty from January 2006 to December 2016.These extensor tendon injuries presented late after healing of skin wounds. Tenolysis, tenorrhaphy and physiotherapy were successful but the delay caused loss of man hours and added cost to treatment.

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The salivary fluid has an old history of study, but its physiological importance has only been recognized recently. In the past 50 years, the pace of salivary research has accelerated with the advent of new techniques that illuminated the biochemical and physicochemical properties of saliva. The interest in saliva increased, further, with the finding that saliva is filled with hundreds of components that might serve to detect systemic diseases and/or act as an evidence of exposure to various harmful substances as well as provide biomarkers of health and disease. The role of saliva in the diagnosis as well as monitoring of glycemic control has, also, been attracting attention of clinical researchers in recent times although results have been conflicting. To conclude, saliva is a whole, diverse fluid, that serves various purposes discussed in detail in the literature. The recent introduction of molecular biology opens up, once again, new vistas and a new search of the role of salivary fluid as a potential diagnostic tool which has an added advantage of being noninvasive. This review presents such insight into the possible use of salivary fluid for the monitoring of serum glucose levels and in the detection of glycemic control in diabetic patients.

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Stress is a complex phenomenon difficult to define but occurs every day and medical practitioners are not left out. There are many sources of stress for medical doctors including hectic work schedule, lack of sleep and food because of calls and emergencies and these give rise to adverse effects on the health of the doctor who is to care for the health of the populace. This is a review article after searching different online search engines including PubMed, Google and other literature on the topic and studies carried on stress at the workplace especially how it affects medical doctors. There is need to incorporate stress management programs amongst doctors to prevent burnout and medical errors which can lead to litigation.

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