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Funmilayo Eniola Olopade,1 Oluwatosin Adekunle Adaramoye,2 Yinusa Raji,3 Abiodun Olubayo Fasola,4 Emiola Oluwabunmi Olapade-Olaopa5 1Department of Anatomy, 2Department of Biochemistry, 3Department of Physiology, 4Department of Oral Pathology, 5Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria Abstract: The College of Medicine of the University of Ibadan recently revised its MBBS and BDS curricula to a competency-based medical education method of instruction. This paper reports the process of revising the methods of instruction and assessment in the core basic medical sciences directed at producing medical and dental graduates with a sound knowledge of the subjects sufficient for medical and dental practice and for future postgraduate efforts in the field or related disciplines. The health needs of the community and views of stakeholders in the Ibadan medical and dental schools were determined, and the “old” curriculum was reviewed. This process was directed at identifying the strengths and weaknesses of the old curricula and the newer competences required for modern-day medical/dental practice. The admission criteria and processes and the learning methods of the students were also studied. At the end of the review, an integrated, system-based, community-oriented, person-centered, and competency-driven curriculum was produced and approved for implementation. Four sets of students have been admitted into the curriculum. There have been challenges to the implementation process, but these have been overcome by continuous faculty development and reorientation programs for the nonteaching staff and students. Two sets of students have crossed over to the clinical school, and the consensus among the clinical teachers is that their knowledge and application of the basic medical sciences are satisfactory. The Ibadan medical and dental schools are implementing their competency-based medical education curricula successfully. The modifications to the teaching and assessment of the core basic medical science subjects have resulted in improved learning and performance at the final examinations. Keywords: competency-based medical education, curriculum revision, basic medical science, integration

Elsie Kiguli-Malwadde,1,2 E Oluwabunmi Olapade-Olaopa,1,3 Sarah Kiguli,2 Candice Chen,4 Nelson K Sewankambo,2 Adesola O Ogunniyi,3 Solome Mukwaya,1 Francis Omaswa11African Centre for Global Health and Social Transformation, Kampala, Uganda; 2Makerere University, College of Health Sciences, Kampala, Uganda; 3College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria; 4School of Public Health and Health Services, The George Washington University, Washington, DC, USA Background: Relatively little has been written on Medical Education in Sub-Saharan Africa, although there are over 170 medical schools in the region. A number of initiatives have been started to support medical education in the region to improve quality and quantity of medical graduates. These initiatives have led to curricular changes in the region, one of which is the introduction of Competency-Based Medical Education (CBME). Institutional reviews: This paper presents two medical schools, Makerere University College of Health Sciences and College of Medicine, University of Ibadan, which successfully implemented CBME. The processes of curriculum revision are described and common themes are highlighted. Both schools used similar processes in developing their CBME curricula, with early and significant stakeholder involvement. Competencies were determined taking into consideration each country's health and education systems. Final competency domains were similar between the two schools. Both schools established medical education departments to support their new curricula. New teaching methodologies and assessment methods were needed to support CBME, requiring investments in faculty training. Both schools received external funding to support CBME development and implementation. Conclusion: CBME has emerged as an important change in medical education in Sub-Saharan Africa with schools adopting it as an approach to transformative medical education. Makerere University and the University of Ibadan have successfully adopted CBME and show that CBME can be implemented even for the low-resourced countries in Africa, supported by external investments to address the human resources gap. Keywords: CBME, medical education, competency domains, competencies, curricular reforms

Africa is currently facing unprecedented growth in its cancer burden. Training an adequate number of skilled physicians is critical to addressing this challenge. We examine African oncology faculty's professional development (PD) activities, associated barriers, enablers, satisfaction levels, and highlight the implications for improving the quality of the oncology faculty workforce in SSA. We surveyed oncology faculty (n = 69) through the African Organization for Research and Training in Cancer listserv and conducted semi-structured interviews with nine (n = 9) faculty involved in African oncology training programs to ascertain their views on PD activities including, method of delivery, curriculum development, teaching, learning, and mentorship. Descriptive, inferential, and thematic analytical techniques were used to analyze the data. Ninety-two percent of African oncology faculty have participated in a PD activity and about 34% were dissatisfied with their overall PD. Access to curriculum development opportunities (OR = 2.10, p < 0.05), mentorship opportunities (OR = 3.12, p < 0.001), and a longer duration of practice (OR = 8.66, p < 0.001) were significantly associated with better overall satisfaction with PD. Barriers cited for PD included the competitive nature of PD courses and programs, limited online learning opportunities, poor internet access, time constraints, language barriers, and high costs associated with PD activities. Enablers for improving PD include improving institutional culture of learning and ensuring greater access to local institutional support. African oncologists are faced with many professional development challenges. Addressing these challenges may improve faculty satisfaction levels, remove barriers, and improve expected outcomes., Competing Interests: Declarations. Competing Interests: The authors declare no competing interests., (© 2025. The Author(s) under exclusive licence to American Association for Cancer Education.)

Background: Data regarding the features and outcomes of hospitalized COVID-19 patients in Africa are increasingly available., Objectives: To describe socio-demographic, clinical and laboratory characteristics and outcomes of COVID-19 patients., Methods: A cross-sectional study of 86 adult patients hospitalized with COVID-19 between March and November 2020. Characteristics were described in survivors and non-survivors., Results: Mean age was 60.9±16.1 years, 53(61.6%) were male. Co-morbidities were found in 77(89.5%) patients. On severity, 6(7%) were mild, 23(26.7%) moderate, 51(59.3%) severe and 6(7%) critical. Oxygen saturation and respiratory rate were 71±22% and 38±11/minute in non-survivors and 90±7% and 31±7/minute in survivors respectively (p<0.001, p<0.001)). Overall mortality was 47.7% with no death among patients with mild disease and deaths in all patients with critical disease. Duration of hospitalization was 2.0(1.0-4.5) days in those who died and 12(7.0-15.0) days in those who survived (p<0.001). Of the 42 patients that received dexamethasone, 11(26.2%) died, while 31(73.8%) survived (p=<0.001)., Conclusion: Most of the patients had co-morbidities and there was high mortality in patients with severe and critical COVID-19. Mean oxygen saturation was low and respiratory rate high overall. Factors associated with mortality included: Significantly greater hypoxia and tachypnea, less dexamethasone use and shorter hospitalization., Competing Interests: The authors declare that there are no relationships or support which might be perceived as constituting a conflict of interest., (© 2023 Adekanmbi O et al.)

The healthcare workforce plays a pivotal role in cancer care delivery, leadership, policy, education, and research in complex cancer systems. To ensure quality and relevance, health professionals must have the necessary competencies to deliver patient-centered and efficient care, coupled with the ability to work in teams and manage health resources wisely. This paper aims to review the concept of competency-based medical education (CBME) in the context of oncology to provide insights and guidance for those interested in adopting or adapting competency-based education in training programs. The results of a scoping review of CBME in oncology are presented here to describe the current status of CBME in oncology. The literature describing the implementation and evaluation of CBME in oncology training programs for medical professionals internationally is summarized and key themes identified to provide practical guidance for educators. Further, the paper identifies critical competencies for oncology education and training globally and presents recommendations and opportunities for collaboration in competency-based education and training in oncology. The authors argue for increased global collaboration and networking in the realm of CBME to facilitate the establishment of a competent global cancer care workforce.

Objective  Technetium-99m labeled prostate-specific membrane antigen (PSMA) single-photon emission computed tomography/computed tomography (SPECT/CT) is a suitable alternative to prostate-specific membrane antigen-positron emission tomography (PSMA-PET) imaging. However, the availability of SPECT/CT in many developing countries is limited. Materials and Methods  To evaluate the utility of planar 99m Tc-PSMA in the absence of SPECT/CT, we compared planar 99m Tc-PSMA and routine bone scan imaging in low-, intermediate-, and high-risk prostate cancer in five patients with histologically confirmed prostate cancer who had both scans within a period of less than 4 days. The mean age of patients was 66.8 ± 5.24, and the median prostate-specific antigen level was 175 ng/mL (range: 0-778 ng/mL). Results  Planar 99m Tc-PSMA scan provided no additional benefit over bone scans in the low-risk prostate cancer cases. In the cases with intermediate-risk prostate cancers, planar 99m Tc-PSMA indicated complete and partial response to treatment in oligometastatic and widespread metastatic disease, respectively. In one patient with high-risk prostate cancer, planar 99m Tc-PSMA detected additional skeletal lesions that were not seen on bone scan. Conclusion  In the absence of SPECT/CT, planar 99m Tc-PSMA was useful for confirming extent of disease in treated intermediate- and high-risk prostate cancer. It showed little value in low-risk prostate cancer, especially when bone scan is normal. It was particularly useful for treatment response assessment in oligometastatic disease, and its utility should be further explored., Competing Interests: Conflict of Interest None declared., (World Association of Radiopharmaceutical and Molecular Therapy (WARMTH). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Objective: There is a paucity of information on bone scanning for prostate cancer from low-resource countries. This study evaluated the role of bone scan in the primary staging of newly diagnosed prostate cancer in one such setting., Methods: A retrospective analysis of 126 men with newly diagnosed prostate cancer undergoing an initial staging bone scan between January 2017 and December 2020 was carried out at a regional nuclear medicine center in Nigeria. Bone scan results were analyzed according to age, serum level of baseline prostate-specific antigen (PSA), and Gleason score. Equivocal scans and patients with no Gleason score or baseline PSA were excluded from the analysis. p  < 0.05 was said to be significant statistically., Results: Of 111 patients (aged 38-84 years, median 66 years), who met the inclusion criteria, 26 (23%) men had evidence of bony metastases as shown by a positive bone scan. Higher PSA levels and Gleason scores were associated with an increased risk of a positive bone scan, p  < 0.001. No patient with a PSA level < 20 ng/mL and a Gleason score of < 7 had a positive bone scan., Conclusion: The role of bone scanning in staging newly diagnosed prostate cancer patients in Nigeria is consistent with global reports. Our study confirms that a bone scan finding is well associated with the risk classification using PSA and Gleason score in our population., Competing Interests: Conflict of InterestAkintunde Orunmuyi, Sikiru Adebayo, Olayinka Ilesanmi, Augustine Takure, and E.Oluwabunmi Olapade-Olaopa declare that they have no conflict of interest., (© The Author(s), under exclusive licence to Korean Society of Nuclear Medicine 2021.)

Objectives: The aim of this study was to investigate the effects of diet reversal to standard chow on diet-induced changes in structure and function of normal and obstructed bladders in male Wistar rats., Methods: Eighty animals were equally divided into sham-surgery and bladder outlet obstruction (BOO) dietary groups and fed standard chow (control), high-carbohydrate, high-fat, and high-protein diets. BOO groups had surgically induced BOO, whereas sham surgery was performed on sham groups at the end of week 8. Animals were continued on the treatment diets for 4 wk after surgery, then the diets were all changed to standard chow for the remainder of the study period. Bladder weight, detrusor contractility, Rho-associated protein kinase (Rho-kinase), and myosin light chain kinase were determined. Polymerase chain reaction was used to assay for transforming growth factor-β, connecting tissue growth factor, hypoxia-inducible factor-1α, and platelet-derived growth factor subunit A levels in the bladder. C-reactive protein, insulin-like growth factor-1, nerve growth factor, and C-X-C motif chemokine ligand 12 concentrations were determined by enzyme-linked immunosorbent assay. The collagen content of the bladder was estimated by liquid chromatography/mass spectrometry., Results: Reversal of diet to standard chow resulted in reversal of diet-induced changes in all variables measured in obstructed bladders. High-fat-diet-induced alterations in normal bladders were also reversed., Conclusion: The results suggested that in obstructed bladders of animals, reversal of the diet could reverse all diet-associated changes that increase inflammation and fibrosis in obstructed bladders. This is especially important in changes related to high consumption of fatty diets and associated lower urinary tract symptoms., (Copyright © 2021 Elsevier Inc. All rights reserved.)

High mortality rates of prostate cancer (PCa) are associated with metastatic castration-resistant prostate cancer (CRPC) due to the maintenance of androgen receptor (AR) signaling despite androgen deprivation therapies (ADTs). The 8q24 chromosomal locus is a region of very high PCa susceptibility that carries genetic variants associated with high risk of PCa incidence. This region also carries frequent amplifications of the PVT1 gene, a non-protein coding gene that encodes a cluster of microRNAs including, microRNA-1205 (miR-1205), which are largely understudied. Herein, we demonstrate that miR-1205 is underexpressed in PCa cells and tissues and suppresses CRPC tumors in vivo . To characterize the molecular pathway, we identified and validated fry-like (FRYL) as a direct molecular target of miR-1205 and observed its overexpression in PCa cells and tissues. FRYL is predicted to regulate dendritic branching, which led to the investigation of FRYL in neuroendocrine PCa (NEPC). Resistance toward ADT leads to the progression of treatment related NEPC often characterized by PCa neuroendocrine differentiation (NED), however, this mechanism is poorly understood. Underexpression of miR-1205 is observed when NED is induced in vitro and inhibition of miR-1205 leads to increased expression of NED markers. However, while FRYL is overexpressed during NED, FRYL knockdown did not reduce NED, therefore revealing that miR-1205 induces NED independently of FRYL., Competing Interests: OOO was Co-Founder of NucleoBio, Inc., a City University of New York start-up biotechnology company. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Naidoo, Levine, Gillot, Orunmuyi, Olapade-Olaopa, Ali, Krampis, Pan, Dorsaint, Sboner and Ogunwobi.)

Genetic variation in susceptibility to complex diseases, such as cancer, is well-established. Enrichment of disease associated alleles in specific populations could have implications for disease incidence and prevalence. Prostate cancer (PCa) is a disease with well-established higher incidence, prevalence, and worse outcomes among men of African ancestry in comparison to other populations. PCa is a multi-factorial, complex disease, but the exact mechanisms for its development and progression are unclear. The gene desert located on chromosome 8q24 is associated with aggressiveness of PCa. Interestingly, the non-protein coding gene locus Plasmacytoma Variant Translocation (PVT1) is present at chromosome 8q24 and is overexpressed in PCa. PVT1 gives rise to multiple transcripts with potentially different molecular and cellular functions. In an analysis of the PVT1 locus using data from the 1000 Genomes Project, we found the chromosomal region spanning PVT1 exons 4A and 4B to be highly differentiated between African and non-African populations. We further investigated levels of gene expression of PVT1 exons 4A and 4B and observed significant overexpression of these exons in PCa tissues relative to benign prostatic hyperplasia and to normal prostate tissues obtained from men of African ancestry. These results indicate that PVT1 exons 4A and 4B may have clinical implications in PCa a conclusion supported by the observation that transient and stable overexpression of PVT1 exons 4A and 4B significantly induce greater prostate epithelial cell migration and proliferation. We anticipate that further exploration of the role of PVT1 exons 4A and 4B may lead to the development of diagnostic, therapeutic, and other clinical applications in PCa., (Copyright © 2020 Pal et al.)

Prostate cancer (PCa) is the most common non-cutaneous cancer and second leading cause of cancer-related death for men in the United States. The nonprotein coding gene locus plasmacytoma variant translocation 1 (PVT1) is located at 8q24 and is dysregulated in different cancers. PVT1 gives rise to several alternatively spliced transcripts and microRNAs. There are at least twelve exons of PVT1, which make separate transcripts, and likely have different functions. Here, we demonstrate that PVT1 exon 9 is significantly overexpressed in PCa tissues in comparison to normal prostate tissues. Both transient and stable overexpression of PVT1 exon 9 significantly induced greater prostate epithelial cell migration, as well as increased proliferation and corresponding proliferating cell nuclear antigen (PCNA) expression. Notably, implantation into mice of a non-tumorigenic prostate epithelial cell line stably overexpressing PVT1 exon 9 resulted in the formation of malignant tumors. Furthermore, PVT1 exon 9 overexpression significantly induced castration resistance. Consequently, PVT1 exon 9 expression is important for PCa initiation and progression, and holds promise as a therapeutic target in PCa., Competing Interests: Olorunseun O. Ogunwobi is Co-Founder of NucleoBio, Inc., a City University of New York start-up biotechnology company. The other authors declare no competing interests.

There is increasing evidence that PVT1 has oncogenic properties and regulates proliferation and growth of many cancers. Themolecular mechanisms of action of PVT1 are mediated, in part, by microRNAs (miRNAs). However, some well-established transcription factors involved in cancer cell proliferation share a common thread of microRNA associations with PVT1. Furthermore, these microRNAs are also involved in mechanisms that lead to the development of drug resistance in cancer cells. While several microRNAs have been implicated directly in PVT1-mediated tumorigenesis, significant steps need to be taken to elucidate these important relationships. We synthesize the current knowledge of the miRNAs and associated genes by which PVT1 contributes to tumorigenesis. Overall, the trend suggests a negative correlation of microRNA expression with PVT1. It is clear that future studies involving PVT1 should be carried out in conjunction with microRNA analysis and should include large scale lncRNA-miRNA-mRNA network analysis. Likewise, the relationship between established transcription factors such as p53 and MYC , and processes like epithelial-mesenchymal transition may offer valuable insight into the yet unknown mechanisms of PVTI-mediated cancer progression via microRNA-dependent signaling networks.

Background: Dietary intake is implicated in the pathogenesis of non-communicable diseases, especially those affecting metabolism. Many non-communicable diseases are mediated by alterations in antioxidant activity and chronic inflammation with its resultant effects. Developmental programming causes offspring of parents with particular metabolic phenotypes to adopt predisposition to these phenotypes during development., Objective: This study investigated the effects of maternal macronutrient consumption in two generations of rats (F0 and F1) on programming of antioxidant activity and inflammatory status in F2 offspring., Methods: The F0 and F1 animals were fed on different macronutrient diets (control, HCD, HFD, HPD) for nine weeks and mated, however F2 animals were fed on standard chow. Glutathione (GSH), Glutathione disulphide (GSSG), lipid peroxidation, Interleukin-6 (IL-6), and Transforming Growth Factor- β (TGF-β) were then determined in F0, F1 and F2 generations using standard methods., Results: In all test groups, the F2 offspring reflected similar changes in measured variables as observed in F0 and F1 animals., Conclusion: The results of the study suggest that dietary macronutrient intake in parent generations, could have an effect on developmental programming of antioxidant activity and inflammatory status in offspring., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: To investigate the effects of various diets on structure and function of the bladder in both normal and obstructed bladders of male Wistar rats., Methods: Sham-operated rats and rats with experimentally-induced bladder outlet obstruction (BOO) were fed with standard rats' feed (control), High-carbohydrate (HCD), High-fat (HFD) and High-protein (HPD) diets. Feeding was continued for 4 weeks after BOO surgery. Bladder weight, detrusor contractility, Rho-Kinase (ROK) and Myosin Light Chain Kinase (MLCK) expressions were determined using standard methods., Results: In comparison with control, bladder weight was increased in HFD (164 ± 9 mg), BOO (437 ± 21 mg), HFD-BOO (523 ± 19 mg) and HPD-BOO (268 ± 18 mg). Detrusor contractility was reduced in BOO and HFD-BOO. The ROK- I and II expressions were high in HCD-BOO and low in HPD-BOO but ROK-I was also elevated in BOO. However, MLCK increased only in HCD-BOO., Conclusion: The results of the study reveal that diets with varying macronutrient compositions have variable effects on the bladder with and without obstruction. High-fat diets especially, affect detrusor morphology and function in both obstructed and unobstructed bladders., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Aims: To investigate the effects of diets on factors and markers of inflammation and fibrosis in unobstructed and obstructed bladders of male Wistar rats., Materials and Methods: Partial BOO was surgically induced in twelve-week old rats after feeding on different diets for eight (8) weeks. Feeding continued for 4 weeks after surgery. Rats were divided into sham-operated and BOO groups as follow: control, high-carbohydrate (HCD), high-fat (HFD) and high-protein (HPD). After the feeding period, bladder weight, CRP, nerve growth factor (NGF), tissue growth factor-β (TGF-β), connective tissue growth factor (CTGF), hypoxia inducible factor-1α (HIF-1 α), platelet-derived growth factor-A (PDGF-A) and CXCL12 were all determined., Key Findings: In both unobstructed and obstructed bladders, CRP was increased in animals fed on the HFD (P < 0.05). NGF was increased in animals fed on HFD and HPD but decreased only in HCD-BOO. CXCL12 was increased in animals fed on HFD and HPD (P < 0.05) and decreased in HCD. The HCD-BOO group exhibited a decrease in CXCL12, while CXCL12 increased in HFD-BOO. TGF-β was elevated in HFD and all the dietary-BOO groups, but animals with obstructed bladders fed on the HPD and HCD had significant reduction in TGF-β expression. CTGF was increased in HFD- and HPD-fed animals. HIF-1α, PDGF-A and collagen were increased in both HFD dietary groups and HPD-BOO., Significance: Feeding on a high fat diet results in increased activity of factors and mediators of inflammation and fibrosis in both unobstructed and obstructed rat bladders. This might increase predisposition to or further worsen symptoms in BOO., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Urethral steinstrasse is rare. Only a few cases of spontaneous or postinterventional urethral steinstrasse have been reported in pediatric and adult patients. We report a case of a 52-year-old Nigerian man with a secondary urethral steinstrasse, and the treatment options possible, as day case procedures, under caudal anesthesia.

Background: Surgery is the most common source of acute pain., Aim: To determine the intensity of acute pain following day case surgery and evaluate the effectiveness of the prescribed analgesics., Methods: A descriptive observational study carried out at the main operating and the Urology Outpatient theatre suites of the University College Hospital, Ibadan. Seventy consecutive adult patients presenting for day case surgeries between July and September 2013 were recruited. The procedures were stratified as follows: peripheral, groin/perineal, urologic/endoscopy or orthopedic/plastic surgeries. The prescribed postoperative oral analgesics were paracetamol alone or in combination with diclofenac, tramadol or both. Postoperative pain intensity was assessed on arrival in the recovery room and at 6, 12, 24, 48, & 72 hours using the Verbal Intensity Pain Scale (VIPS). The pain scores were presented as mean±SD at different time intervals for each stratified surgical procedures and analgesics using tables and frequency bar charts. A mean pain score of less than 2 for each category of surgical procedures or analgesics group was considered as satisfactory pain control and thus effective analgesia., Result: The overall prevalence of moderate to worst possible pain after surgery in this study was 54.3% on arrival in the recovery room. The mean pain score was greater than 2 at 6 hours postoperative in all surgical categories except in patients who had peripheral surgeries irrespective of single or combination analgesic therapy., Conclusion: A high proportion of patients arrived in the recovery room with a high pain score; measures to improve intraoperative analgesia should be employed., Competing Interests: There are no conflicts of interest

Background: Phytotherapy is becoming a treatment option in management of diseases including benign prostatic hyperplasia (BPH). We have shown previously that methyl jasmonate (MeJA) ameliorated BPH, however the underlying mechanism of action remains unknown. This study was designed to investigate in mechanistic terms the protective role of MeJA in BPH., Methods: BPH was induced by daily injections of testosterone propionate (TP) (3mg/kg) for 28 days., Results: The weight and organo-somatic weight of prostate in BPH rats were 6.8 and 5.1 times higher than castrated-control group, respectively. Inflammatory markers; prostatic myeloperoxidase and total nitric oxide were significantly increased in BPH group. The activity of aniline hydroxylase (Phase I drug metabolizing enzyme) was significantly increased in BPH rats by 22%. In BPH group, immuno-histochemistry revealed strong expression of prostatic inducible nitric oxide synthase, cyclooxygenase-2 and Bcl 2 , while mild expression of p53 and Bax were seen. Serum triglyceride and total cholesterol were significantly increased, while HDL-c was decreased in BPH. Interestingly, MeJA and finasteride (singly or combination) attenuated inflammatory indices and induced apoptotic parameters in BPH rats., Conclusion: MeJA protects against TP-induced BPH via mechanisms that involve anti-inflammation, induction of apoptosis and inhibition of phase I drug metabolizing enzyme., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Background: Urethrocutaneous fistula could be a distressing condition to the child and parents alike. Its management could be challenging and requires adequate expertise., Aim: To review the characteristics and aetiology of urethrocutaneous fistula managed in our division over a ten-year period., Methodology: All children with urethrocutaneous fistulae from July 2006 to June 2015 were subject of this review. The demography, aetiology, type of fistula, operation performed and the outcome were retrieved from the division operation book and case notes of the patients. The data was analyzed using SPSS Inc. version 20 and odd ratio., Results: Thirty-five children were managed over a period of ten tears. The age ranged from 6 months to 13 years with a mean of 4±1.9years. Seventy one percent of urethrocutaneous fistulae resulted from complication of childhood male circumcision procedures performed in private hospitals and by nurses. One child (3%) had isolated perineal urethrocutaneous fistula while 26% complicated hypospadias repair at these locations: glandular in 1% case, subcoronal in 3% cases, penile in 2% cases, and penoscrotal in 3% cases. Ten (29%) children with abnormal haemoglobin AC was noted in 3 (9%) patients and haemoglobin AS in 7 (20%) patients. The odd ratio between abnormal haemoglobin and normal haemoglobin was 3.8. The surgical repair of post-circumcision urethrocutaneous fistulae and post-hypospadias had a recurrent fistulae in 4 (16%) and 3 (33%) respectively. Majority of the fistulae were repaired by simple closure in 80% post-circumcision and in 44% post-hypospadias repair. in the more difficult cases, penile degloving with urethral mobilization was done in 16% post-circumcision fistula and 22% post-hypospadias fistula with no recurrence., Conclusion: in this study, post-circumcision urethrocutaneous fistula was the commonest cause of childhood urethrocutaneous fistula, the severe ones could require penile degloving to achieve repair without tension; recurrence was a major complication.

Male circumcision is one of the most commonly performed procedures in Africa, with a wide variation between the different regions on the practice. This is because circumcision is often done for religious and cultural or traditional reasons, which includes being part of rituals or rite of passage to adulthood. There had been few medical indications for the procedure until the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) pandemic, which is prevalent in many of the countries in the region. Evidence from randomized controlled trials conducted in the continent had shown that male circumcision could be instrumental to reducing the transmission of HIV/AIDS in heterosexual couples in high disease prevalent and low circumcision prevalent areas. This had led to the roll-out of large population-based adult male circumcisions as well as the development of tools to facilitate the procedure. Circumcision, however, is not without complications and the incidence appears related to the age of the patient, where the procedure was done, technique used and level of proficiency of the practitioners. This article reviews the practice of circumcision in Africa and highlights the impact of the procedure on the continent., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Recent proposals for re-defining the roles Africa's health workforce are a continuation of the discussions that have been held since colonial times. The proposals have centred on basing the continent's healthcare delivery on non-physician clinicians (NPCs) who can be quickly trained and widely distributed to treat majority of the common diseases. Whilst seemingly logical, the success of these proposals will depend on the development of clearly defined professional duties for each cadre of healthcare workers (HCW) taking the peculiarities of each country into consideration. As such the continent-wide efforts aimed at health-professional curriculum reforms, more effective utilisation of task-shifting as well as the intra - and inter-disciplinary collaborations must be encouraged. Since physicians play a major role in the training mentoring and supervision of physician and non-physician health-workers alike, the maintenance of the standards of university medical education is central to the success of all health system models. It must also be recognized that, efforts at improving Africa's health systems can only succeed if the necessary socio-economic, educational, and technological infrastructure are in place., (© 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

BACKGROUND - Globally, human resources for health are being optimized to address the increasing health burden and concomitant increased demands on health professionals. These demands are even more exacting in Sub-SaharanAfrica considering the shortage of health care workers, especially physicians. The noteworthy efforts at deploying task-shifting to address this situation not-withstanding, the situation also signals the need to re-define the objectives of medical instruction to ensure effective and contemporary medical practice in a mostly physician-led health workforce across the sub-continent. In this regard, medical and dental graduates must be educated to perform certain minimum essential professional duties competently. Essential Professional Duties are locally relevant professional activities of international standard that represent identifiable outcomes against which the effectiveness of physicians in a specific community can be measured to ensure social accountability. PROCEDURE AND PRODUCT - The Association of Medical Schools of Africa has developed the 'Essential Professional Duties for sub-Saharan medical and dental graduates' to ensure these physicians provide safe and effective contemporary medical/dental practice on the sub-continent. The duties have been grouped into those required for basic patient care, basic administrative skills, basic emergency care, communication, inter-professional relationships, self-directed learning and social responsibilities. Their relevance and suitability have been evaluated prior to their adoption by the Association. CONCLUSION; These Essential Physician Duties have been developed to serve as targets for health professionals training instruments and thus give direction to health system strategies. It is hoped that they will be adopted by medical and dental schools across sub-,. Saharan Africa.

Background: Erectile dysfunction is becoming a public health issue with high incidences reported in community studies., Objective: To evaluate the characteristics and outcome of treatment in men with erectile dysfunction in a tertiary center in Ibadan southwestern Nigeria., Methods: Data of men with erectile dysfunction was retrieved between July 2004 and June 2014 and analyzed using SPSS version 16 statistical software., Results: Eighty-nine men with erectile dysfunction were managed which constituted 2% of all urological cases seen during the study period. Their median and mean ages were 39 years and 39.6 ± 1.2SD (range 19-76 years). The peak age incidence at 30-44 years was 41.6% and reduced with increasing age after 65 years to 4.5%. The etiologies were psychogenic in 55%, organic in 27%, idiopathic in 17% and 1% was familial. 67.5%, 31.5% and 3.4% were married, single and separated respectively. Seventy percent neither smoked cigarette nor drank alcohol, 21.3% drank alcohol and 9% took both alcohol and smoked cigarette. Seventy seven and half percent of men presented within 5 years of their symptom. The treatments offered were PDE type 5 inhibitors alone or in combination with psychotherapy or modification of medications. The outcome of these treatments ranged from 89% to 91% success rate., Conclusion: The number of men with erectile dysfunction managed in the tertiary hospital is very low though the outcome of treatment is within acceptable range. Increase public enlightenment may encourage increase hospital patronage and access to the available treatments for erectile dysfunction.

Background: The epidemiology of lower urinary tract symptoms in adult men in Nigeria is presently not well known., Aim: To evaluate a screened population of men for lower urinary tract symptoms and their impact on the participants' quality of life., Methods: A cohort study was conducted among men aged 40 years and older from 3 selected centres in Ibadan, Southwestern Nigeria. The presence of lower urinary tract symptoms and their impact was determined using the International Prostate Symptom Score (IPSS) administered via standardized questionnaires., Results: Six hundred and fifty-five men participated in the study. The median age was 56 years with a range of 40 - 92 years. Eight percent (8%) of respondents were asymptomatic, whilst 66%, 20% and 6% had mild, moderate and severe symptoms respectively. Nocturia was the most common symptom and the second most troublesome. Overall storage (irritative) symptoms occurred with the similar frequency to voiding (obstructive) symptoms (91% v 92%), but voiding symptoms were more likely to be severe and thus more troublesome (p = <0.000.1). The severity of the individual symptoms as well as the overall score also increased significantly with age [p = 0.001]. There was a high correlation between IPSS and Quality of Life (QoL) scores (correlation coefficient 'r' = 0.75 [p = <0.0001]. Despite this, 72% of QoL respondents were satisfied with their quality of life., Conclusion: The frequency of non-troublesome lower urinary tract symptoms was high in adult men in this cohort of men in Southwestern Nigeria and that severity was age-related. In addition, whilst storage and voiding symptoms occurred with similar frequency, voiding symptoms were the more severe and troublesome., Competing Interests: The authors have declared that no competing interests exist.

Background: A study from the University College Hospital, Ibadan, Southwest, Nigeria on bladder cancers had described an increase in the frequency of urothelial carcinoma compared to the earlier reported preponderance of squamous-cell carcinoma., Aim: To provide an update on the histopathologic pattern of bladder cancers in our community and to explore its implications for future health system policies., Methods: The records of the Ibadan Cancer Registry from January 1997 to December 2014 were reviewed and the data analyzed for the histologic subtypes of bladder cancers diagnosed in the hospital., Results: Two hundred and sixteen bladder tumours were recorded during this period with a male to female ratio of 3.2:1. Complete information was available in 195 cases of which 181 (96.8%) were bladder carcinomas whilst 14 were sarcomas. Of the bladder carcinomas, 68.5%, 19.9% and 11.6% were urothelial carcinomas, squamous cell carcinomas, and adenocarcinomas (AC) respectively. Urothelial carcinoma was more common in all age groups and its peak age of occurrence was in the 51-60 year age group. The peak age for squamous cell carcinoma was in the 41-50 year age group. Mean and median age of occurrence was significantly lower in females in the urothelial and squamous cell carcinomas, but lowest in squamous cell carcinoma [P = < 0.0001]., Conclusion: This population study has confirmed urothelial carcinoma as the predominant histotype of bladder cancer in Ibadan, Southwest Nigeria currently and that both urothelial and squamous cell carcinomas occur earlier in women., Competing Interests: The authors have declared that no competing interests exist.

A major goal of the Medical Education Partnership Initiative (MEPI) is to improve local health systems by strengthening medical education in Sub-Saharan Africa. A new approach to collaboration was intended to overcome the one-sided nature of many partnerships that often provide more rewards to institutions from wealthy countries than to their Sub-Saharan African counterparts. The benefits of this MEPI approach are reflected in at least five positive outcomes. First, effective partnerships have been developed across a diverse group of MEPI stakeholders. Second, a "community of practice" has been established to continue strengthening medical education in Sub-Saharan Africa. Third, links have been strengthened among MEPI health science schools in Sub-Saharan Africa, their communities, and ministries of both health and education. Fourth, respect among partners in the United States for a culture of ownership and self-determinism among their African counterparts committed to improving education has been enhanced. And finally, performance metrics for strengthening of health science education in Sub-Saharan Africa have been advanced. Meanwhile, partner medical schools in the United States have witnessed the benefits of collaborating across traditional disciplinary boundaries, such as physicians working within highly functioning community-based health care teams with many of the participating schools in Sub-Saharan Africa. MEPI demonstrates that North-South as well as South-South partnerships, with an explicit focus on improving local health systems through better education, can be designed to empower partners in the South with support from collaborators in the North.

Background: Physician tracking systems are critical for health workforce planning as well as for activities to ensure quality health care - such as physician regulation, education, and emergency response. However, information on current systems for physician tracking in sub-Saharan Africa is limited. The objective of this study is to provide information on the current state of physician tracking systems in the region, highlighting emerging themes and innovative practices., Methods: This study included a review of the literature, an online search for physician licensing systems, and a document review of publicly available physician registration forms for sub-Saharan African countries. Primary data on physician tracking activities was collected as part of the Medical Education Partnership Initiative (MEPI) - through two rounds over two years of annual surveys to 13 medical schools in 12 sub-Saharan countries. Two innovations were identified during two MEPI school site visits in Uganda and Ghana., Results: Out of twelve countries, nine had existing frameworks for physician tracking through licensing requirements. Most countries collected basic demographic information: name, address, date of birth, nationality/citizenship, and training institution. Practice information was less frequently collected. The most frequently collected practice fields were specialty/degree and current title/position. Location of employment and name and sector of current employer were less frequently collected. Many medical schools are taking steps to implement graduate tracking systems. We also highlight two innovative practices: mobile technology access to physician registries in Uganda and MDNet, a public-private partnership providing free mobile-to-mobile voice and text messages to all doctors registered with the Ghana Medical Association., Conclusion: While physician tracking systems vary widely between countries and a number of challenges remain, there appears to be increasing interest in developing these systems and many innovative developments in the area. Opportunities exist to expand these systems in a more coordinated manner that will ultimately lead to better workforce planning, implementation of the workforce, and better health.

A 43-year-old woman presented with 20-year history of leakage of urine per vaginam. She had one failed repair attempt. Pelvic examination with dye test showed leakage of clear urine suggestive of ureterovaginal fistula. The preoperative intravenous urogram revealed duplex ureter and cystoscopy showed normally cited ureteric orifices with two other ectopic ureteric openings and bladder diverticula. The definitive surgery performed was ureteric reimplantation (ureteroneocystostomy) of the two distal ureteric to 2 cm superiolateral to the two normal orifices and diverticuloplasty. There was resolution of urinary incontinence after surgery. Three months after surgery, she had urodynamic testing done (cystometry), which showed 220 mLs with no signs of instability or leakage during filling phase but leaked on coughing at maximal bladder capacity. This is to showcase some diagnostic dilemma that could arise with obstetric fistula, which is generally diagnosed by clinical assessment.

Background: Carcinoma of the prostate is now the most commonly diagnosed male cancer worldwide. However, knowledge and perception of Nigerian men about the disease has not been fully investigated., Aim: To determine the level of awareness about prostate cancer among men 40 years and older in Ibadan, Southwestern Nigeria., Method: Four focus group discussions were used to obtain information from 29 randomly- selected Nigerian men, aged 40 years and above, about their knowledge of the common causes of morbidity and mortality among men of their age group as well as prostatic diseases and their perceived causes. In-depth interviews were then conducted among 656 participants using questionnaires., Results: Generally, the respondents and discussants were unaware of the prostate gland and its diseases; whilst relatively few knew about carcinoma of the prostate and most were ignorant of the symptoms of the disease. Among discussants and respondents who knew about the gland, most thought that benign and malignant prostatic diseases were long-term complications of promiscuity and sexually transmitted infections. All the participants were interested in receiving information about all aspects of carcinoma of the prostate., Conclusion: . These results indicate that a large proportion of adult Nigerian men are ignorant of the prostate gland and its diseases in general, and carcinoma of the prostate in particular. There is therefore the need for community awareness programs on prostatic diseases in our locality.

Background: Prostate cancer is the most common male malignancy in Nigeria and most patients present with advanced and metastatic disease. Cutaneous metastasis from prostate cancer is rare worldwide and to our knowledge has not been previously reported in a native African. We hereby report a case in a 62-year-old Nigerian. CASE PRESENTATION AND MANAGEMENT: A 62-yr-old Nigeria man presented with 6 months history of lower urinary tract symptoms that culminated in urinary retention for which he was catheterized. He noticed multiple painless skin nodules about the same time on the neck and trunk. On examination, he had multiple cutaneous nodules on his neck, limbs and trunk. His prostate gland was enlarged, hard and irregular. Prostate biopsy revealed adenocarcinoma of the prostate. He had bilateral orchidectomy with progressive regression of the skin nodules. He had successful trial of voiding without a catheter 3 weeks after bilateral total orchidectomy., Conclusion: Cutaneous metastasis from prostate cancer is rare in native Africans despite the high incidence of the disease in this population. To our knowledge, this index case is the first report in a native African in the English literature.

Background: Sub-Saharan Africa suffers a disproportionate share of the world's burden of disease while having some of the world's greatest health care workforce shortages. Doctors are an important component of any high functioning health care system. However, efforts to strengthen the doctor workforce in the region have been limited by a small number of medical schools with limited enrolments, international migration of graduates, poor geographic distribution of doctors, and insufficient data on medical schools. The goal of the Sub-Saharan African Medical Schools Study (SAMSS) is to increase the level of understanding and expand the baseline data on medical schools in the region., Methods: The SAMSS survey is a descriptive survey study of Sub-Saharan African medical schools. The survey instrument included quantitative and qualitative questions focused on institutional characteristics, student profiles, curricula, post-graduate medical education, teaching staff, resources, barriers to capacity expansion, educational innovations, and external relationships with government and non-governmental organizations. Surveys were sent via e-mail to medical school deans or officials designated by the dean. Analysis is both descriptive and multivariable., Results: Surveys were distributed to 146 medical schools in 40 of 48 Sub-Saharan African countries. One hundred and five responses were received (72% response rate). An additional 23 schools were identified after the close of the survey period. Fifty-eight respondents have been founded since 1990, including 22 private schools. Enrolments for medical schools range from 2 to 1800 and graduates range from 4 to 384. Seventy-three percent of respondents (n = 64) increased first year enrolments in the past five years. On average, 26% of respondents' graduates were reported to migrate out of the country within five years of graduation (n = 68). The most significant reported barriers to increasing the number of graduates, and improving quality, related to infrastructure and faculty limitations, respectively. Significant correlations were seen between schools implementing increased faculty salaries and bonuses, and lower percentage loss of faculty over the previous five years (P = 0.018); strengthened institutional research tools (P = 0.00015) and funded faculty research time (P = 0.045) and greater faculty involvement in research; and country compulsory service requirements (P = 0.039), a moderate number (1-5) of post-graduate medical education programs (P = 0.016) and francophone schools (P = 0.016) and greater rural general practice after graduation., Conclusions: The results of the SAMSS survey increases the level of data and understanding of medical schools in Sub-Saharan Africa. This data serves as a baseline for future research, policies and investment in the health care workforce in the region which will be necessary for improving health.

Objectives: This review synthesises research published in the traditional and 'grey' literature to promote a broader understanding of the history and current status of medical education in sub-Saharan Africa (SSA)., Methods: We performed an extensive review and analysis of existing literature on medical education in SSA. Relevant literature was identified through searches of five traditional medical databases and three non-traditional or grey literature databases featuring many African journals not indexed by the traditional databases. We focused our inquiry upon three themes of importance to educators and policymakers: innovation; capacity building, and workforce retention., Results: Despite the tremendous heterogeneity of languages and institutions in the region, the available literature is published predominantly in English in journals based in South Africa, the UK and the USA. In addition, first authors usually come from those countries. Several topics are thoroughly described in this literature: (i) human resources planning priorities; (ii) curricular innovations such as problem-based and community-based learning, and (iii) the 'brain drain' and internal drain. Other important topics are largely neglected, including: (i) solution implementation; (ii) programme outcomes, and (iii) the development of medical education as a specialised field of inquiry., Conclusions: Medical education in SSA has undergone dramatic changes over the last 50 years, which are recorded within both the traditionally indexed literature and the non-traditional, grey literature. Greater diversity in perspectives and experiences in medical education, as well as focused inquiry into neglected topics, is needed to advance medical education in the region. Lessons learned from this review may be relevant to other regions afflicted by doctor shortages and inequities in health care resulting from inadequate capacity in medical education; the findings from this study might be used to inform specific efforts to address these issues., (© Blackwell Publishing Ltd 2011.)

Small numbers of graduates from few medical schools, and emigration of graduates to other countries, contribute to low physician presence in sub-Saharan Africa. The Sub-Saharan African Medical School Study examined the challenges, innovations, and emerging trends in medical education in the region. We identified 168 medical schools; of the 146 surveyed, 105 (72%) responded. Findings from the study showed that countries are prioritising medical education scale-up as part of health-system strengthening, and we identified many innovations in premedical preparation, team-based education, and creative use of scarce research support. The study also drew attention to ubiquitous faculty shortages in basic and clinical sciences, weak physical infrastructure, and little use of external accreditation. Patterns recorded include the growth of private medical schools, community-based education, and international partnerships, and the benefit of research for faculty development. Ten recommendations provide guidance for efforts to strengthen medical education in sub-Saharan Africa., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objective: Transrectal prostate biopsy is a potentially painful procedure. Our service has significant experience with caudal anesthesia for perianal procedures. This study is aimed to determine the effectiveness of caudal anesthesia for transrectal prostate biopsy., Patients and Methods: Seventy consecutive patients undergoing transrectal prostate biopsy were entered into the study. The patients were requested to complete a questionnaire structured to assess the pain felt during the procedure using the visual analog score (VAS). The effectiveness of the caudal anesthesia was determined by the anesthesia of the perineum and the laxity of the anal sphincter. Complications from the procedures were recorded., Results: All the patients completed and returned the questionnaire. The average age of the respondents is 65.8 years. Among the 34 patients with caudal block, effective anesthesia was achieved in 28 patients and ineffective in six patients. However, the mean VAS for the pain from transrectal prostate biopsy was 1.49 +/- 1.93 SD (range 0-6.0) for the patients with effective caudal anesthesia and 8.02 +/- 1.79 SD (range 5.0-10.0) for patients with no caudal anesthesia. There was a reduced requirement for analgesics after prostate biopsy for patients with effective caudal anesthesia. Three patients (8.8%) had minor complications (transient dizziness) following the injection of the anesthetic into the caudal epidural space., Conclusion: Satisfactory analgesia for transrectal prostate biopsy can be achieved with the use of CA and it results in better cooperation of the patient during the procedure.

Background: Carcinoma of the prostate (CaP) is the most common male malignancy in developed and developing countries and has been termed the "malignant epidemic of blacks." Despite this, clinicians managing men with advanced CaP in Africa have to contend with significant limitations in the healthcare systems. This article reviews the current and future options for the management of these patients on the African continent., Methods: We searched PubMed and Google for articles on CaP with an emphasis on those focusing on subpopulation differences. Information was also obtained from ongoing studies and interviews with urologists and other specialists and executives in hospitals in our locality., Results: In Africa, most patients with CaP present with advanced disease, and surgical castration is the most common treatment option, as most modern treatment strategies for the disease are unavailable or unaffordable. Unfortunately, a significant proportion of these men progress to hormone-resistant disease shortly after first-line hormonal treatment, and a majority die within 2 years. Problems that are peculiar to the African continent include poor health facilities, scarcity of expert care, high cost of treatment, lack of data, low level of awareness of the disease, absence of early detection and treatment programs, cultural limitations, and the prominence of alternative medical practice., Conclusion: Most Africans with CaP present with advanced disease, and treatment is mostly limited to bilateral orchiectomy, but the results are poor. The care of these patients can be improved by increased funding of healthcare institutions and projects directed at prevention, early detection, and treatment.

Prostatic specific antigen (PSA) immunoreactivity is the most commonly used histological marker to identify epithelial cells of prostate origin. Unlike tissues from white men in which grade-related variability has been reported, the pattern of PSA immunoreactivity in prostatic tissues from black African men is presently unknown. This study was done to evaluate the pattern of PSA staining in sections of normal, benign hyperplastic and malignant prostatic glands from men from this sub-population. PSA immunostaining was done on 4-microm serial sections from archival specimens of benign prostatic hyperplasia (BPH) and carcinoma of the prostate (CaP) obtained from black African men using standard immunoperoxidase techniques. The intensity of PSA immunoreactivity of the glands was scored using a semi-quantitative method. PSA expression decreased with increasing de-differentiation of the tissue histotype with poorly differentiated tumours staining least. PSA immunoreactivity was strong in 100% of normal glands and 84% of BPH glands and moderate in the rest. In contrast, PSA immunopositivity was strong in 32% of CaP glands, moderate in 26%, weak in 34% and absent in 8%. Statistical comparison revealed that PSA expression was significantly higher in benign tissues (normal/ atrophic and BPH) than in CaP glands [p = < 0.0001]. Our findings show that PSA immunoreactivity is grade-related in prostatic tissues from black men and this has implications for clinical diagnosis and research. It also confirms the limitations of PSA-testing in diagnosing CaP, and indicates that newer immunohistochemical tests for malignant prostatic cells should be acquired by Sub-Saharan laboratories.

Background and Objective: Anti-epidermal growth factor receptor strategies are now established in cancer treatment We have recently described the presence of EGFRvIII (a variant EGFR) in prostatic tumours from UK white men and this is now a target for anti-prostate cancer treatments. However, there has been no report on the expression of this abnormal protein in black men., Materials and Methods: We determined EGFRvIII expression in sections of normal, benign hyperplastic (BPH) and carcinomatous (CaP) prostatic archival tissues from Nigerian men and UK white men using streptavidin immunohistochemical techniques. The EGFRvIII immunoreactivity was scored visually using a semi-quantitative method and the results compared statistically., Results: EGFRvIII expression increased with increasing malignancy in both study populations (CaP > BPH > Normal p, <0.0001). Furthermore, EGFRvIII expression was similar in both BPH and CaP tissues in black and white men (p, 0.86 and 0.31 respectively)., Conclusion: These results demonstrate that EGFRvIII immunoreactivity in prostatic tumours in black men is similar to that in white men. Anti-cancer treatments directed at the EGFRvIII should be equally effective in men from both subpopulations.

Students adopt several learning approaches towards achieving the perceived goal of passing their prescribed examinations. This study was carried out to determine the study processes being used by medical students of the College of Medicine, University of Ibadan on arrival at the Faculty of Clinical Sciences. One hundred and sixty five first year clinical students were studied using the modified 'Biggs' Study Process Questionnaire. Additional questions to identify local factors that would contribute to the learning were also included. There were 143 respondents (87% of the study population). The predominant study pattern among the students was the deep approach (63%). The achieving and superficial approaches were used by 8% and 29% of the students respectively. Additional analysis showed that 68%, 31% and 1% had 'good', 'average' and poor learning capacities respectively. Self interest was the principal reason why the students chose medicine as a career. Most students (76%) preferred lectures to tutorials, and only 30% found out extra information about topics taught frequently. Thirty-nine percent of the study cohort saw their teachers as role models, and 76% intended to travel abroad after graduation. Majority of 1st year clinical students of the College of Medicine, University of Ibadan adopted a deep approach to learning and have a good capacity to learn. However, most do not employ self-directed learning strategies and do not see their teachers as role models. The majority intend to travel abroad upon graduation.

Human Immunodeficiency Virus and Acquired Immunodeficiency Disease (HIV/AIDS) are one of the most difficult challenges facing practicing surgeons worldwide. The challenge is more acute in sub-Saharan Africa as it currently has the highest prevalence of HIV infection in the world. Surgeons are at risk of occupationally acquired infection as a result of intimate contact with the blood and other body fluids of HIV patients requiring surgery. Patients also risk being infected by surgeons and other health care workers during surgical or dental procedures. The seropositive status of the majority of HIV positive patients may be unsuspected by the attending medical personnel who may not practice universal precautions against infection. The non-availability of relevant devices is however the most important factor militating against the use of universal precautions, especially in developing countries. There is therefore a need to increase the awareness about universal precautions and to provide the necessary devices to promote constant adherence to these procedures in order to reduce the risk of nosocomial HIV infection.