Sonographic estimation of gestational age from 20 to 40 weeks by fetal kidney lengths' measurements among pregnant women in Portharcourt, Nigeria.

BACKGROUND: Ultrasonography has become an indispensible tool in the management of obstetric patients. Accurate determination of fetal gestational age (FGA) has posed great challenge to patient management as the accuracy of traditional biometric parameters decreases with advance in gestation age. Accuracy of fetal kidney length (FKL) in the determination of FGA at third trimester has been documented in other population. This study is aimed to create baseline reference values of fetal kidney lengths in a Nigerian population as previous studies show population specific variations. METHODS: This prospective cross sectional study was carried out on 534 pregnant women between 20 and 40 weeks of gestation who met the inclusion criteria at Diamond Biomedical Services Ltd. A pilot study was conducted on 20 patients to determine the reproducibility and reliability of ultrasound measurement of FKL. Fetal kidney lengths were calculated as mean of three separate measurements. The 5th, 50th and 95th percentiles were calculated using least squared regression analysis. Third polynomial regression models were used to establish the relationship between right and left FKL and FGA. RESULTS: Both FKL measurements are highly reproducible with excellent correlation and agreement within and between sonographers. It correlates strongly with gestational age while the relationships between right and left kidney lengths with gestational age were established using the following regression equations: RKL = - 11.18 + 1.193 × FGA - 0.0350 × FGA2 + 0.00037 × FGA3 and LKL = - 12.57 + 1.332 × FGA - 0.0390 × FGA2 + 0.00040 × FGA3 for right and left kidneys respectively. CONCLUSION: Nigerian population specific baseline reference values of FKLs for the estimation of FGA should be adopted rather than relying on the Caucasians values as universal patterns.

Sonographic Evaluation of Some Abdominal Organs in Sickle Cell Disease Patients in a Tertiary Health Institution in Northeastern Nigeria.

BACKGROUND: Sonographic evaluation of abdominal organs is an important work up in managing sickle cell disease (SCD) patients. This study aimed at evaluating abdominal organs by sonography among SCD patients. METHODOLOGY: A cross-sectional study was carried out in Maiduguri, Nigeria from April 2014 to July 2015. Two hundred and fifty-two patients participated in the study, with 126 controls and 126 SCD patients. There were 131 (52%) males, and 121 (48%) females, with age range 3-38 years. Measurements were done using ultrasound machine with probe frequencies ranging from 1-4MHz and 4-9MHz in supine, right and left oblique positions for optimum visualization of the abdominal organs. RESULTS: Participants within the age range of 10-15 years had the highest frequency with 88 (34.9%), followed by those within the age group of 17-23 years with 86 (34.1%), and the least were those within the age group of 30 years and above with 8 (3.2%). Hepatomegaly was found in 53 (75.7%), and increased echogenicity of the liver was found in 50 (94.3%) of the SCD patients, P = 0.000. Gallstones were found in 45 (17.9%), gallbladder sludge was found in 51 (21.4%) and thickened gallbladder wall was found in 84 (33.3%) of the SCD patients, P = 0.000. Autosplenectomy was found in 45 (17.9%), splenomegaly in 63 (24.9%), and calcified spleen in 18 (8.7%) of the SCD patients, P = 0.000. Enlarged kidneys in SCD patients were found in 61 (98.4%) and 63 (98.4%) on the right and left kidneys, respectively. Shrunken kidneys were found in 5 (2.0%) and 4 (1.6%) of the SCD patients on the right and left kidneys, respectively, P = 0.000. CONCLUSION: Abdominal sonography in SCD patients revealed varied remarkable changes in the size, echotexture, intraluminal deposits and wall thickness in the liver, gallbladder, kidneys, and spleen.

Sonographic evaluation of kidney echogenicity and morphology among HIV sero-positive adults at Lagos University Teaching Hospital.

AIM: To evaluate the role of kidney echogenicity and morphology in the diagnosis of human immunodeficiency virus-associated nephropathy (HIVAN). SUBJECTS AND METHODS: In the cross-sectional study, a sample of 340 anti-retroviral therapy (ART)-naïve AIDS patients underwent laboratory CD4+ count, serum creatinine determination and sonographic renal echogenicity grading and size measurement. Rounded kidneys were described as bulbous while bean-shaped kidneys were described as reniform; echogenicity was categorized into grades 0, 1, 2 and 3. Kidney length, width, thickness and volume were measured in HIVAN and control groups. RESULTS: Mean age of the population was 42.7 ± 9.4 years; 87.4% had HIVAN. Mean CD4+ count, serum creatinine and GFR for HIVAN patients were 153.1 ± 103.2 cells/mm3, 218.4 ± 147.4 mmol/L and 50.1 ± 23.6 mL/min/1.73 m2 for males and 121.9 ± 91.0 cells/mm3, and 222.0 ± 150.4 mmol/L and 39.3 ± 20.6 mL/min/1.73 m2 for females, respectively; control subjects and non-HIVAN patients had grade 0 renal echogenicity; 56.9% of HIVAN patients had echogenicity grade 3; 5.3% had kidney length < 10 cm; 73.9% had bulbous kidneys; the kidney was significantly wider and thicker in HIVAN (p < 0.05). CONCLUSION: Sonographic evaluation of renal echogenicity and morphology can reliably predict HIVAN diagnosis. Apathy to screening and late presentation were high while HIV/AIDS remains an important public health problem in the city of Lagos. Unilateral reduction in kidney size could be a major sequela of AIDS while sonographic measurement of absolute kidney length appears inadequate in the evaluation of AIDS patients with nephropathy.

Sonographic correlation of foetal neck circumference and area with gestational age among pregnant women in Port Harcourt, Nigeria.

The purpose of this study was to create a reference range nomogram of foetal neck circumference (FNC) and foetal neck area (FNA) in a Nigerian population using polynomial regression models. This cross-sectional study involved 723 pregnant women between 14 and 40 weeks of gestation. Axial measurements of the FNC and FNA were obtained in three measurements and the mean taken as the final value and the 5th, 50th and 95th percentiles for each foetal gestational age (FGA) were calculated. FNC and FNA correlated strongly with FGA, biparietal diameter, abdominal circumference, head circumference, and femoral length. Cubic models fitted the FNC vs FGA, and FNA vs. FGA values, and the mathematical relationships are given as: [Formula: see text] [Formula: see text] [Formula: see text]. Nomograms of FNC and FNA are thus generated. Impact statement The foetal neck circumference (FNC) and foetal neck area (FNA) can serve as predictors of foetal gestational age (FGA) since they correlate strongly and positively with FGA and known biometric parameters. The measurements obtained vary with the population studied. This study provides a nomogram of the FNA and FNC for an African population. The values correlate with that of the Caucasian population up to 32 weeks FGA. Interestingly, FNA and FNC measurements demonstrate high correlation but poor agreement in measurements between sonographers. Even though FNA and FNC could be used as predictors of foetal gestational age, the measurements vary significantly between sonographers. This is attributable to the difficulty in obtaining a satisfactory axial view of foetal neck, which is dependent on foetal presentation.

Patients' reaction to the ethical conduct of radiographers and staff services as predictors of radiological experience satisfaction: a cross-sectional study.

BACKGROUND: Patients' satisfaction arises from their appraisal of experience in hospital services and measuring patients' satisfaction in hospital has become a global phenomenon. To improve on patients' satisfaction, radiographers have to imbibe the right ethical attitude in their conduct while discharging duties to patients during radiological examination. The objective of this study is to understand from the patients' perspective the ethical conduct of radiographers and radiology nurses that constitute factors in patient satisfaction during routine radiological examination. The rationale of the study is to use the findings to improve radiological service delivery and improve on patient satisfaction. METHODS: This is a cross-sectional descriptive study in which 300 respondents (outpatients) in two hospitals were surveyed to ascertain their satisfaction with the ethical conduct of radiographers and services provided by radiology nurses in the department. The data was analyzed using descriptive statistics at 95 % confidence interval for mean scores and Z-values. RESULTS: Three hundred patients responded to the survey which comprised of 145 patients from the public hospital and 155 patients from the private hospital. Radiographers fell short in some ethical/professional conduct as in informed consent before treatment (mean = 2.95); radiographers' not explaining his/her experience, expectation, knowledge and equipment procedure (mean = 2.98). However, they did well in some aspects including observation of professional boundaries with patients during treatment and equity in treatment for the patients during the radiological examination (mean score = 1.43). Some services provided by staff members in the department also fell short of patients' expectation and satisfaction including explanation of what to expect during the exam (mean = 3.30), whereas they did well in their level of courtesy to patients (mean score = 4.09). There was a significant difference in the satisfaction level experienced by patients at both hospitals in favour of the private hospital. CONCLUSIONS: There is an urgent need for improved ethical/professional conduct of radiographers and general service delivery in the radiology departments of the hospitals where this investigation was carried out to enhance patient satisfaction. Government has to improve the curricular of service providers in radiology service in the university to include ethical/professional conduct and patient/provider relationship.

Validity of common ultrasound methods of fetal weight estimation in late pregnancy among women in Kwale, Niger Delta region, Nigeria.

BACKGROUND: Accuracy of some ultrasound equations used in our locality for fetal weight estimation is doubtful. OBJECTIVE: To assess the accuracy of common ultrasound equations used for fetal weight estimation. SUBJECTS AND METHODS: A longitudinal study was conducted on selected Nigerian obstetric population at Central Hospital, Kwale between March, 2009 and January, 2011. Sonography was performed on 412 women with advanced singleton cyesis and measurements of BPD, HC, AC, and FL were obtained and figured into 12 common ultrasound equations for the estimation of fetal weight. The actual birth weight at delivery was recorded. RESULTS: The highest intraclass correlation coefficient was generated by the Hadlock 5 and Hsieh 2 equations. The least mean absolute percent error was obtained with Hsieh 2 equation, followed by Woo 3, and Hadlock 5. These equations also had the least percentage error and the least range of limits of agreement in the same order with no significant difference between their mean fetal weight estimates and that of the actual birth weight (p > 0.05). All twelve equations had strong positive correlation with the actual birth weight with Nzeh 2 equation the least. CONCLUSION: Hsieh 2 equation has the best accuracy in fetal weight estimation studied.

Sonographic evaluation of the spleen among sickle cell disease patients in a teaching hospital in Nigeria.

BACKGROUND: Regional variations in size and parenchyma echo-texture of the spleen among sickle cell disease (SCD) patients have been documented in various publications. The objectives of this study were to assess the size and parenchyma echo-texture of the spleen of SCD patients and ascertain the relationship of age, height and weight with the spleen sizes. METHODS: This was a cross sectional study involving 103 each of SCD and age matched control subjects. Aloka ST- 550 -3500 ultrasound machine with 3.5 and 5 MHz convex transducers was used to scan the subjects over a 15 months period (September, 2012 to November, 2013). The age, height and weight of each subject were recorded. RESULTS: The spleen sizes of SCD patients were generally larger than those of the controls (p < 0.05). Abnormal spleen parenchyma of varied appearances was found among the SCD subjects. There were negative correlations between mean spleen sizes and height, weight and age in SCD patients but positive correlations were found between them in the controls. CONCLUSION: Routine sonographic assessment of spleen size and echo-texture is useful in the management of SCD patients.

Ultrasonographic kidney sizes among children in Benin, Nigeria: correlation with age and BMI.

PURPOSE: To determine kidney sizes among Nigerian children using ultrasonography to provide local reference data that could be compared with renal growth charts when assessing kidneys of Nigerian children for growth or pathology. METHODS: The study design was cross-sectional and a convenience sampling technique was used to select a sample. Consent was obtained from participants and ethical approval was obtained from the local ethics committee. A DP-1100 sector scanner with a 3.5 MHz probe was used for the study. Sonographers measured kidney length, width, and thickness and calculated renal volume. Renal sizes were correlated with somatometric parameters. Regression equations were derived for each pair of variables. RESULTS: No statistically significant difference was found in kidney sizes between male and female participants or between length, width, or volume of right and left kidneys. A strong correlation was found between kidney length and volume and the participant's age and body mass index. CONCLUSION: This study has provided values of kidney sizes in a normal Nigerian pediatric population. Regression equations also were derived for easy computation of kidney sizes.