IntroductionTongue-tie or ankyloglossia is an anatomic variation in which the lingual frenulum is thick, short or tight. It may be asymptomatic, or present with complications like breast feeding difficulties or speech, dental and cosmetic problems. The treatment of this condition, where indicated, is frenotomy. This procedure usually has few or no complications. However, when it is done by untrained personnel, it may lead to life-threatening complications. This paper highlights complications that could arise from improper treatment of ankyloglossia.Case presentationCase 1 was a one-day-old male neonate, a Nigerian of Igbo ethnicity, who was admitted with bleeding from the mouth and passage of dark stools after clipping of the frenulum by a traditional birth attendant. He was severely pale and in hypovolemic shock, with a severed frenulum which was bleeding actively. His packed cell volume was 15%. He was resuscitated with intravenous fluids and a blood transfusion. The bleeding was controlled using an adrenaline pack. He also received antibiotics. He was discharged five days later.Case 2 was a three-day-old male neonate, a Nigerian of Ikwerre ethnicity, who was admitted with profuse bleeding from a soft tissue injury under the tongue, after clipping of the frenulum by a community health worker. He was severely pale and lethargic. He was resuscitated with intravenous fluids and a blood transfusion. The bleeding vessel was ligated with repair of the soft tissue. He also received antibiotics and was discharged home one week later.ConclusionTreatment of tongue-tie, a benign condition, when done by untrained personnel may result in life-threatening complications. Clinicians should pay more attention to parents' worries about this condition and give adequate counseling or refer them to trained personnel for surgical intervention where clinically indicated.

Introduction: Nigeria is one of the countries where maternal and neonatal tetanus is still prevalent and as such a public health issue. In spite of campaign on maternal tetanus immunization, its safety and protection against tetanus, uptake has remained poor. Aim: This study is aimed to determine the level of Tetanus Toxoid (TT) vaccine uptake among women of child bearing age in Rivers State Nigeria. Methods: Using a cluster sampling method, a descriptive cross-sectional community based study was carried out. The study was carried out in Opiro community in Igbo Agwuru-Asa Clan in Etche Local Government Area of Rivers State. Results: Of the 555 women studied 108(19.5%) of them had received 5 doses of TT while 206 (37.1%) had received at least two doses of TT, giving an overall prevalence of TT utilization among women of childbearing age of 31.7%. Eighty four (31.2%) of women who were ≤ 30 years compared to the 122(42.7%) of the older women had received at least 2 doses of TT vaccine. This was statistically significant (P=0.005, OR 1.67, 95% CI 1.16-2.32), educational level, marital status and occupation also significantly affected Tetanus Toxoid vaccine uptake among the women. Conclusion: This study concludes that utilization of TT immunization among women is low, that younger age, marital status, level of education and occupation of the women can significantly affect the level of TT uptake among women. There is need to strengthen immunization in this community and to create awareness on the need to get optimal Tetanus Toxoid immunization.

Background: Tuberculosis (TB) is a leading cause of death in children but it is underdiagnosed and underreported in children. Objective: To determine the prevalence of pulmonary TB in children among presumptive cases of TB and to compare the diagnostic efficacy of different screening tool for TB in children.  Materials and Methods: This study was a descriptive prospective study carried out over one year in nine general health facilities that can provide diagnosis and treatment for tuberculosis in Rivers State, Nigeria. Children aged 0 – 18 years with presumptive TB were explored. They were explored by carrying out a clinical assessment with chest radiograph, sputum or gastric aspirate for AFB microscopy and XpertMTB/RIF screening. Sociodemographic data and results of the screening tests was retrieved from their case records as well as the National Tuberculosis registers. Ethical approval for the study was obtained from the Rivers state Ministry of Health. Those with confirmed pulmonary TB were commenced on anti TB medications and followed up for at least 6months. Obtained data was analysed by SPSS version 20 and expressed as percentages, proportions and frequencies. A test of significance (chi square and t-test) was conducted between proportions and means as appropriate. In all a p value of less than 0.05 was considered significant.  Results: Nine hundred and sixty three patients aged 0-18 years had presumptive diagnosis of TB,   394 (40.9%) were males while 569 (59.1%) were females. The commonest presenting symptom was chronic cough which occurred in 735 (76.5%) of the patients. The prevalence of pulmonary TB was 19.1%. Significantly more males (60.9%) than female (39.1%) had confirmed tuberculosis (X2= 37.431, p-value <0.001). Significantly more children (54.3%) from the low socioeconomic class had confirmed pulmonary. Seventy two (39.1%) and 29 (15.8%) of the patients were AFB and XpertMTB/RIF positive respectively. Children aged 0-5 years were neither AFB nor XpertMTB/RIF positive. Of the children with confirmed TB, 98 (53.3%) had suggestive clinical features while 86 (46.7%) had suggestive X-ray features. More than a third (33.2%) of the children aged 0-5 years had their TB confirmed by suggestive X-rays and Clinical features. All the patients with TB were commenced on anti TB medications, 40 (21.7%) were lost to follow up (LTFU), 21 (11.4%) were transferred to other centres while 123 (66.8%) completed the treatment.  Conclusion: The prevalence of pulmonary TB among presumptive TB cases in this study was comparable to findings from other studies and clinical diagnosis of Pulmonary TB remains very relevant in its management. Improving the clinical skills of physicians involved in TB care and treatment and the need for community/ facility collaboration to reduce cases of LTFU is advocated.

Data from the case records dary School Class two girl managed at the Department of Paediatrics of the University of Port Harcourt Teaching Hospital were extracted for presentation to highlight vertebral collapse as an uncommon complication of paediatric tetanus and the associated management challenges. The girl presented with complaints of back pains-11 days, inability to open her mouth- 9 days, jerking of the body- 8 days and upper back swelling-6 days following bruises from corporal punishment in her school. She was diagnosed to have tetanus with vertebral collapses of T3-T6. Tuberculosis and other causes of vertebral collapse were excluded. The tetanus was successfully treated but she left against medical advice and defaulted from follow-up for the management of the vertebral collapses. Poverty, ignorance and belief in traditional health care were major obstacles to her management.Key words: Multiple wedge vertebral collapses in tetanus

Introduction: Tuberculosis (TB) is among the top ten leading cause of morbidity and mortality globally, and studies have shown that adherence to a six Month course of Isoniazid Preventive Therapy (IPT) reduces the incidence of TB disease in HIV-negative/positive populations at risk of developing active TB disease. Objective: This study was carried out to identify active TB cases among children aged 0-5 years who are in close contact with adult cases of pulmonary TB (PTB), to determine the adherence rate to IPT among these close contacts that do not have active TB and to identify factors associated with non adherence if any. Methodology: This study was a prospective descriptive study carried out in Rivers state, Nigeria in two health facilities that offers services for TB diagnosis and treatment. Ethical approval for the study was obtained from the Rivers State Ministry of Health while verbal consent was obtained from the parents/caregivers of the children. Children aged 0-5 years who were in close contact with newly diagnosed PTB cases were recruited for the study. They were screened for HIV and evaluated for TB using clinical features and standard laboratory investigations. Those without active TB disease were commenced on isoniazid preventive therapy (IPT) for six months at a daily dose of 5mg/kg after adherence counselling and followed up at the health centres. Obtained data was analysed using Epi Info Version 7.2.3.1 statistical software. Descriptive statistics was used while the test for association between variables was done with chi-square test at p ≤ 0.05 level of significance. Frequency tables were used for presentation of results. Results: A total of Sixty three children were recruited for the study 37 (58.7%) were males while 26 (41.3%) were females. Thirty two (50.8%) were children of index PTB patients while 29 (46.1%) belonged to lower socio-economic class. Their age ranged from 4 months to 4 years with a mean age of 2.84years ±1.27years. Six (16.2%) out of the 37 males and 2 (7.7%) out of the 26 females were confirmed to have active TB, giving a TB prevalence of 12.7%. The gender difference was not statistically significant (p= 0.32). Of the fifty five children that commenced INH in the first Month, only twenty four of them completed the six Month course of INH, giving an IPT adherence rate of 49.6%. Identified reasons for non adherence includes ‘My child is not sick’, ‘No transport Money’, ‘My child is writing exams”. “My child is tired of the drugs”, “the Health workers are not friendly’ and ‘long waiting time before collecting medications”. Conclusion: Early contact tracing is important for early detection of TB cases in children. Adherence to IPT in this study is low and strategies like community tracing of defaulters using trained social workers and community nurses as well as use of well-supervised and convenient ambulatory treatment centres that are manned by trained lower cadre health staff can improve adherence.