Burden, Severity and Characteristic Pattern of Coronary Artery Disease using 160-Slice Computed Tomographic Angiography: Earliest Report from Northern Nigeria.

BACKGROUND: Coronary computed tomography angiography (CCTA) allows for non-invasive visualization of the coronary arteries which is promising in diagnosing coronary artery disease. OBJECTIVES: To determine the prevalence, morphology, anatomic distribution pattern and correlates of CAD in our environment. METHODS: This cross-sectional study was conducted on the first cohort of patients referred for CCTA in our hospital. The patients were examined with 160-slice Toshiba® CT scanner. Their demographic data, relevant clinical information as well as the findings on CCTA were extracted and documented. The data were analysed using the R programming software version 4.0.4. RESULTS: Out of a total of 153 patients who presented for CCTA within the study period, 133 (84.7%) were eligible for analysis. Their age ranged from 22-78 years with a mean ± SD of 55.8 ± 11.7 years. A total of 33 (24.8%) had normal CCTA, while 100 (75.2%) had either stenosis or total occlusion. There was a significantly higher (p-value of 0.00001) calcium score among those with stenosis compared to those with normal CCTA. The severity of the stenotic lesion was associated with the calcium score. The logistic regression analyses showed a statistically significant (P = 0.0415, OR = 1.0569, 97.5% CI =1.078152-1.123240) association between age and the presence of coronary stenosis. In addition, most of the stenotic lesions were in the left anterior descending artery (LAD). CONCLUSION: Majority of the patients had coronary artery disease of variable severity and the LAD was the most involved artery. There was no significant association between sex and severity of the disease; however, old age and higher number of lesions were associated with severe disease.

CONTEXTE: L'angiographie coronaire par tomodensitométrie (ATCC) permet une visualisation non invasive des artères coronaires, ce qui est prometteur pour le diagnostic de la maladie coronarienne. OBJECTIFS: Déterminer la prévalence, la morphologie, le modèle de distribution anatomique et les corrélats de la maladie coronarienne dans notre environnement. MÉTHODES: Cette étude transversale a été menée sur la première cohorte de patients envoyés pour un CCTA dans notre hôpital. Les patients ont été examinés à l'aide d'un tomodensitomètre Toshiba® à 160 coupes. Leurs données démographiques, les informations cliniques pertinentes ainsi que les résultats de l'ACTC ont été extraits et documentés. Les données ont été analysées à l'aide du logiciel de programmation R version 4.0.4. RÉSULTATS: Sur un total de 153 patients qui se sont présentés pour une ACTC pendant la période de l'étude, 133 (84,7 %) étaientéligibles pour l'analyse. Leur âge était compris entre 22 et 78 ans,avec une moyenne + écart-type de 55,8 + 11,7 ans. Au total, 33 (24,8%) avaient une CCTA normale, tandis que 100 (75,2 %) présentaient une sténose ou une occlusion totale. Le score calcique était significativement plus élevé (valeur p de 0,00001) chez les patients présentant une sténose que chez ceux dont l'ACTC était normale. La gravité de la lésion sténosée était associée au score calcique. Les analyses de régression logistique ont montré une association significative (P=0,0415, OR= 1,0569, 97,5% CI=1,078152-1,123240) entre l'âge et la présence d'une sténose coronaire. En outre, la plupart des lésions sténosées se trouvaient dans l'artère descendante antérieure gauche (LAD). CONCLUSION: La majorité des patients présentaient une maladie coronarienne de gravité variable et l'artère LAD était l'artère la plus touchée. Il n'y avait pas d'association significative entre le sexe et la sévérité de la maladie ; cependant, l'âge avancé et le nombre plus élevé de lésions étaient associés à la sévérité de la maladie. Mots-clés: Angiographie, Tomodensitométrie, Artères Coronaires, Stenose.

INFERIOR VENA CAVA FILTER PLACEMENT FOR PREVENTION OF PULMONARY THROMBOEMBOLISM: CASE SERIES FROM NORTHWESTERN NIGERIA.

Background: Inferior vena cava (IVC) filter placement is an image-guided procedure aimed at primarily preventing pulmonary thromboembolism in patients with lower limb venous thromboembolic (VTE) disease. In Northern Nigeria with a relatively high incidence of thromboembolic disease such as Deep vein thrombosis, reports on IVC filter placement are largely low. We report the feasibility of IVC filter placement on eight patients for the first time in a typical low-resource setting in Northern Nigeria. Case Presentations: We had an equal number of males and females of the eight patients. Their ages ranged from 20 to 80 years. Five patients presented with bilateral lower limbs Deep vein thrombosis (DVT) of which one had a pulmonary embolism. Two other patients had extensive left femoral DVT and one had extensive IVC, iliac, femoral, and popliteal veins thrombosis. The medical records of seven patients, who had IVC filter placement in our department, were reviewed. The IVC filter was deployed with the aid of a C-arm fluoroscopic unit. In a single case, access was secured via an indwelling dialysis catheter. Conclusions: All the patients had successful deployment with satisfactory postprocedure conditions. The intended benefit of pulmonary embolism prevention was achieved in the series of procedures that were performed. Indicating the value of IVC filter even in resource-poor settings and effort should be made towards exploring such intervention.

Factors associated with intraventricular hemorrhage among preterm neonates in Aminu Kano teaching hospital.

BACKGROUND: Intraventricular hemorrhage (IVH) is a severe complication among preterm neonates which can result in hydrocephalus, cerebral palsy, behavioural disorders, learning disabilities, or death. It is important to identify the factors associated with IVH in order to prevent these neurological consequences and reduce the resultant burden of neurological disease. Aim: To determine the factors associated with IVH among preterm neonates. DESIGN: The study was prospective cross-sectional in design. SUBJECTS AND METHODS: Ninety-nine preterm neonates who were < 37 completed weeks of gestation were recruited consecutively from the Special Care Baby Unit of a Tertiary Hospital. Transfontanelle ultrasonography was used to detect IVH and the factors associated with IVH were classified into: neonatal, maternal (prenatal), and clinical factors. Data were analyzed using SPSS version 16.0 for windows. Chi-squared test and Fisher's exact probability test were used as appropriate. The level of significance was set at P < 0.05. The association between these factors and IVH was evaluated by univariate and multivariate logistic regression analyses. RESULTS: Among the 99 preterm neonates studied, 36 (36.4%) of them were between 28 and 31 weeks of gestation, whereas 63 (63.6%) were between 32 and 36 weeks of gestation. In univariate analysis, the factors found to be associated with IVH were lower gestational age <32 weeks gestation, low Apgar score of <3 in 1 and 5 min, respectively, outborn status of neonates, lower social class, need for respiratory support, and blood transfusion. However, the lower gestational age (odds ratio [OR]: 10.9, 95% confidence interval [CI]:1.95-61.04) and respiratory support (continuous positive airway pressure (CPAP)) [OR: 52.24; CI: 3.40-721.84] were retained as significant predictors of IVH in the multivariate logistic regression model. CONCLUSION: The lower gestational age and respiratory support (CPAP) are independent predictors for IVH. Prevention of preterm delivery and improvement in interventions of neonatal care (CPAP) are necessary to prevent the risk for IVH especially in the early preterm neonates.

Doppler sonographic evaluation of venogenic extremity swellings: Analysis of 170 patients from Kano, Nigeria.

INTRODUCTION: Deep venous thrombosis (DVT) is a serious problem that can potentially lead to many complications including life-threatening pulmonary arterial thrombosis. Screening and confirmation of the diagnosis are critical in the care of this condition. OBJECTIVES: The objective of this study was to evaluate the role of Doppler sonography in diagnosing DVT and to illustrate the pattern in 170 suspected cases from our local environment. MATERIALS AND METHODS: This study was conducted at our department over 18 months. A total of 170 patients with clinical suspicion of limb DVT were recruited. The characteristics of the patients, risk factor for DVT, and the site of the lesion were documented. Sonographic examination was done using 7.5 MHz linear and 3.5 MHz convex transducers. RESULTS: Out of the 170 patients, there are 89 (52.35%) males and 81 (47.65%) females. Their mean age was 50.6 years (+17.9 years). The common risk factors for DVT include chronic medical illness (28.8%), long distance travel (15.3%), previous DVT (8.8%), stroke/paralysis (5.3%), neoplasms (5.9%), pregnancy (5.9%), and trauma/surgery (5.9%). About 55.8% (95) of them were confirmed to have DVT on ultrasound while 44.2% (75) had normal ultrasound findings. There was a female preponderance among the 95 cases of DVT, 58.9% of them were females while 41.1% of them were males. It was found that contiguous femoro-popliteal and ilio-femoro-popliteal segments were most commonly thrombosed. These lesions were predominantly left sided (59.5%). CONCLUSION: There was a predominance of females and femoro-popliteal segments in DVT. Doppler ultrasound is very useful in the evaluation of extremity DVT. All clinically suspected cases should be evaluated with this modality due to limited sensitivity of clinical evaluation in the diagnosis of DVT. Further correlative studies in comparison to venography and hematologic indices are also recommended.

Dynamic and morphologic evaluation of erectile dysfunction on penile doppler sonography and contrast cavernosography.

BACKGROUND: Penile erection is a complex phenomenon that involves coordinated interaction of the psychologic, hormonal, nervous, arterial, venous, and sinusoidal systems. Erectile dysfunction (ED) is the persistent inability to attain or maintain penile erection sufficient for sexual intercourse. This study aims to determine the real-time morphologic vascular abnormalities in men with ED using penile Doppler sonography in Kano, Nigeria. MATERIALS AND METHODS: Twenty-one patients who were referred from urology clinics on account of suspected vasculogenic ED were reviewed. The cavernorsal arteries were examined with 7.5 MHz linear transducer in gray scale and duplex Doppler modes before and after intracavernosal injection of 60 mg papevarine. Serial peak systolic velocity (PSV), end diastolic velocity (EDV), and diameter measurements were performed at 5-min intervals for 30 min. RESULTS: The mean age of the patients was 43.14 ± 9.84 years. Out of the 21 patients examined, 5 showed normal findings while 10 had evidence of venous leakage. Five patients had arterial insufficiency; out of which 3 patients showed calcifications of the tunica albuginea, suggesting Peyronie's disease. Interestingly, 1 patient showed combining features of arterial insufficiency and of venous leakage. Those with arterial insufficiency were relatively older than other patients. They also had compounding medical conditions of diabetes and hypertension. CONCLUSION: Vascular etiologies are important contributors of ED in our setting. Papavarine-induced Doppler sonography and cavernosography shows promise in accurate assessment and overall care of these patients.

Computed tomography dose index for head CT in northern Nigeria.

Computed tomography dose index w and dose length product were recorded for the purpose of developing diagnostic reference levels (DRLs) for radiation dose optimisation. The study was conducted in three radiology departments with CT centres in Northern Nigeria. Data were collected from 54 consenting adult participants (weighing 70 kg ± 3) that had head CT scans. Analysis was done using SPSS version statistical software. A combined dose for the three centres was calculated and compared with the reported data from the international communities where there are established DRLs. Third quartile values of CTDIw and DLP were determined as 77 mGy and 985 mGy cm, respectively. Local DRLs that are significantly higher than most of the reported data in the literature have been established.

Plain radiographic evaluation of the nasopharynx: do raters agree?

BACKGROUND: Subjective plain radiographic evaluation of the nasopharynx has been a widely adopted technique. Although it has its own limitations, its ease of interpretation and simplicity are some of its advantages. AIM: To investigate the reliability, using kappa, in subjectively reporting plain nasopharyngeal radiographs in children with symptoms suggestive of enlarged adenoids. METHODS: This was a retrospective study of the clinical records, and plain X-rays of the nasopharynx of paediatric patients with clinical features of adenoid hypertrophy in a Nigerian Tertiary Health Institution from January 2008 to December 2008. RESULTS: Fifty-one children with a mean age of 3.4 years; standard deviation of 2.772 was studied. They had an age range of 2 months to 12 years. Most (66.6%) of the children studied were in the age bracket 0-4 years. The inter-rater reliability between the two Otolaryngologists, and that between an Otolaryngologist and a Radiologist using kappa statistics were 0.6696, 95% CI (0.5035-0.8357; p<0.05) and 0.8182, 95% CI (0.7073-0.9291; p<0.05) respectively. While the kappa intra-rater reliabilities for the two Otolaryngologists were 0.6931, 95% CI (0.5473-0.8389) and 0.9591, 95% CI (0.9033-1.000). CONCLUSION: There was a high level of agreement among trained raters, in subjectively interpreting plain nasopharyngeal radiographs in children with suspected adenoidal obstruction.

Experience on Transfontanelle Neurosonography in Kano, Nigeria: a preliminary report.

OBJECTIVE: To retrospectively audit and analyse all the Transfontanelle Neurosonographic scans performed at the Aminu Kano Teaching Hospital (AKTH), between January to September, 2004. METHODS: Information on the gray scale appearance of the ventricles, cerebral and cerebellar parenchyma, extra axial fluid spaces, status of the sulci and gyri and the echogenic internal outline of the bony skull vault was extracted from the records of all the Transfontanelle neurosonographic scans performed at the specialist Ultrasound clinic of the AKTH, between January to September, 2004. RESULTS: Eighteen infants were scanned, and 8 (44.4%) of them were neonates. Meningitis (9 patients) and increasing head size (7 patients) were the commonest clinical indication for referral. Communicating hydrocephalus was the only known complication seen in 4(44.4%) of the post meningitic patients. While in the increasing head size group, congenital malformations such as Aqueductal stenosis and Arachnoid cyst of the quadrigeminal cistern as well as hydrocephalus predominates (4 out of 7 patients). The last 2 patients referred on account of severe birth asphyxia and swollen occiput showed no abnormality and occipital meningocoele respectively. CONCLUSION: This study confirms the earlier notion of the pre-eminence of infection as compared to congenital malformation as the leading cause of infant morbidity in developing nations. It also emphasises the value of Transfontanelle neurosonography as an excellent, non-invasive, inexpensive, rapid and safe imaging modality for the evaluation of the pathologic conditions of infants' brain.

Broad ligament pregnancy: a report of two cases.

Broad ligament pregnancy is a rare event and diagnosis is often late in our setting. Two multiparous women in early thirties presented for routine antenatal care. Routine ultrasonography revealed midtrimester abdominal pregnancies. Broad ligament pregnancy was diagnosed in both cases at laparotomy and both had excision of pregnancy and salpingo-ophorectomy with satisfactory recovery. Ultrasonography is a useful tool in the early diagnosis of abdominal pregnancy in our environment. Routine ultrasonography in pregnancy is advocated in our setting.