Status of Government-Funded Radiotherapy Services in Nigeria.

PURPOSE: Access to radiotherapy (RT) is now one of the stark examples of global cancer inequities. More than 800,000 new cancer cases require potentially curative or palliative RT services in Africa, arguably <15% of these patients currently have access to this important service. For a population of more than 206 million, Nigeria requires a minimum of 280 RT machines for the increasing number of cancer cases. Painfully, the country has only eight Government-funded RT machines. This study aimed to evaluate the status of the eight Government-funded RT services in Nigeria and their ability to deliver effective RT to their patients. METHODS: A survey addressing 10 critical areas was used to assess the eight Government-funded RT services in Nigeria. RESULTS: Unfortunately, six of the eight centers (75%) surveyed have not treated patients with RT because they do not have functioning teletherapy machines in 2021. Only two RT centers have the capability of treating patients using advanced RT techniques. There is no positron emission tomography-computed tomography scan in any of the Government-funded RT centers. The workforce capacity and infrastructure across the eight centers are limited. All of the centers lack residency training programs for medical physicists and radiation therapy technologists resulting in very few well-trained staff. CONCLUSION: As the Nigerian Government plans for the new National Cancer Control Plan, there is an urgent need to scale up access to RT by upgrading the RT equipment, workforce, and infrastructure to meet the current needs of Nigerian patients with cancer. Although the shortfall is apparent from a variety of RT-capacity databases, this detailed analysis provides essential information for an implementation plan involving solutions from within Nigeria and with global partners.

Common and contrast determinants of peripheral artery disease and diabetic peripheral neuropathy in North Central Nigeria.

BACKGROUND: Peripheral artery disease (PAD) and diabetic peripheral neuropathy (DPN) are two of the leading causes of non-traumatic amputation worldwide with tremendous negative effects on the quality of life, psychosocial well-being of persons with diabetes mellitus; and a great burden on health care expenditure. It is therefore imperative, to identify the common and contrast determinants of PAD and DPN in order to ease adoption of common and specific strategies for their early prevention. METHODS: This was a multi-center cross-sectional study which involved the consecutive enrolment of one thousand and forty (1040) participants following consent and waiver of ethical approval. Relevant medical history, anthropometric measurements, other clinical examinations including measurement of ankle-brachial index (ABI) and neurological examinations were undertaken. IBM SPSS version 23 was used for statistical analysis and logistic regression was used to assess for the common and contrast determinants of PAD and DPN. Significance level used was p < 0.05. RESULTS: Multiple stepwise logistic regression showed that common predictors of PAD vs DPN respectively include age, odds ratio (OR) 1.51 vs 1.99, 95 % confidence interval (CI) 1.18-2.34 vs 1.35-2.54, p = 0.033 vs 0.003; duration of DM (OR 1.51 vs 2.01, CI 1.23-1.85 vs 1.00-3.02, p = <.001 vs 0.032); central obesity (OR 9.77 vs 1.12, CI 5.07-18.82 vs 1.08-3.25, p = <.001 vs 0.047); poor SBP control (OR 2.47 vs 1.78, CI 1.26-4.87 vs 1.18-3.31, p = .016 vs 0.001); poor DBP control (OR 2.45 vs 1.45, CI 1.24-4.84 vs 1.13-2.59, p = .010 vs 0.006); poor 2HrPP control (OR 3.43 vs 2.83, CI 1.79-6.56 vs 1.31-4.17, p = <.001 vs 0.001); poor HbA1c control (OR 2.59 vs 2.31, CI 1.50-5.71 vs 1.47-3.69, p = <.001 vs 0.004). Common negative predictors or probable protective factors of PAD and DPN respectively include statins (OR 3.01 vs 2.21, CI 1.99-9.19 vs 1.45-3.26, p = .023 vs 0.004); and antiplatelets (OR 7.14 vs 2.46, CI 3.03-15.61 vs 1.09-5.53, p = .008 vs 0.030). However, only DPN was significantly predicted by female gender (OR 1.94, CI 1.39-2.25, p = 0.023), height (OR 2.02, CI 1.85-2.20, p = 0.001), generalized obesity (OR 2.02, CI 1.58-2.79, p = 0.002), and poor FPG control (OR 2.43, CI 1.50-4.10, p = 0.004) CONCLUSION: Common determinants of PAD and DPN included age, duration of DM, central obesity, and poor control of SBP, DBP, and 2HrPP control. Additionally, the use of antiplatelets and statins use were common inverse determinants of PAD and DPN which means they may help protect against PAD and DPN. However, only DPN was significantly predicted by female gender, height, generalized obesity, and poor control of FPG.

Neuroimaging Findings in Pediatric Chronic Headaches: Is Imaging Always Necessary?

Background: Considering the high cost of Magnetic Resonance Imaging and the high risk of radiation exposure to growing children from Computed tomography scans, we aim to evaluate the neuroimaging findings in children with chronic headaches, determine the frequency of significant remediable pathologies, and establish the need for neuroimaging. Methodology: This is a cross-sectional study of clinical data and neuroimaging findings in 41 children who were imaged in a tertiary hospital and a private diagnostic center in Abuja on account of chronic headaches. Twenty-two children were referred for brain Computed Tomography scan while 19 had brain Magnetic resonance Imaging. Collected data was statistically analyzed using SAS software version 9.3 with the level of significance set at 0.05. Results: The age range of patients was 4 -18years.Thirty-three patients (80.5%) had chronic primary headaches while eight (19.5%) patients had additional "red flag" indications. Normal findings and extracranial lesions accounted for 89.5% of MRI (17/19) and 72.7% (16/22) in CT. Intracranial lesions were seen in 75% of patients with "red flag" and 6.1% of patients with primary headache with significant differences (p=0.0001) between the subsets. The commonest abnormalities were chronic sinusitis (17.1%) and intracranial tumors (9.6%) with no significant difference in the overall neuroimaging findings across the age groups. Chronic sinusitis was found predominantly in adolescent females (85.7%). Conclusions: Neuroimaging has a low yield of significant remediable intracranial lesions in children with chronic headaches without additional "red flag" symptoms thereby necessitating the call to reconsider the use of neuroimaging with a view to imaging gently.

Comparison of waist-height ratio and other obesity indices in the prediction of diabetic peripheral neuropathy.

Background: Waist-height ratio (WHtR) is increasingly being studied as a simple and effective measure of central obesity. Reports have shown that WHtR is a better predictor of hypertension, diabetes, and cardiovascular diseases when compared to traditional obesity indices like body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR). This study is therefore aimed at comparing WHtR with other obesity indices in the prediction of peripheral neuropathy in persons with diabetes mellitus (DM). Methodology: One thousand and forty persons with DM were enrolled following consent. Relevant details of history were obtained, followed by physical examinations. Data were analyzed using IBM-SPSS version 23. Logistic regression was used to compare the odds ratio of obesity indices in the prediction of peripheral neuropathy. The level of significance used was p = 0.05. Results: Logistic regression showed that WHtR had the highest odds ratio (OR) for the prediction of "probable" diabetic peripheral neuropathy (OR 9.11, 95% CI 3.07-47.97, p = 0.002), followed by WC (OR 2.01, 95% CI 1.09-4.05, p = 0.004), and BMI (OR 1.26, 95% CI 1.00-3.99, p = 0.019) after correction for age; systemic hypertension; duration of DM; control of SBP, DBP, HbA1c, FPG, and 2HrPP. Conclusion: WHtR has the highest odds ratio in the prediction of "probable" diabetic peripheral neuropathy in both genders, followed by WC in the males and BMI in the females.

Outcome of mammography examination in asymptomatic women.

Background: Early detection of breast cancer is important in reducing mortality, morbidity, and high socioeconomic burden associated with it. Mammography is currently the primary imaging modality used as a screening tool to detect early breast cancer in women experiencing no symptoms as they are most curable in the early stage with availability of breast conservative therapies. Objective: This study aimed at determining the mammographic breast density patterns and outcome in asymptomatic women who presented for mammographic examination in Abuja. Materials and Methods: This descriptive cross-sectional study comprises of 113 asymptomatic women who presented for mammographic examination at the Radiology Department of University of Abuja Teaching Hospital, Gwagwalada from March 2015 to December 2018. Two basic views (craniocaudal and mediolateral views) of the breast were obtained using EXR-650 mammographic machine. Results: The mean age of study population was 40.72 ± 10.45 years with age range of 35 and 65 years. Base on mammographic breast density, breast imaging, reporting, and data system 1 and 2 were the most prevalent. There was a positive correlation between mammographic breast density and age of respondents. This relationship was statistically significant (Pearson correlation = 0.56, P = 0.000). The mammographic outcome among asymptomatic women who had mammographic examination was negative in 69 (61.1%) women and positive in 44 (38.9%). The positive outcome noted in mammograms of women examined was: benign mass in 18 (15.9%) women; 9 (8.0%) had benign calcification; 7 (6.2%) showed architectural distortion; 5 (4.4%) was inconclusive; focal asymmetry in 3 (2.6%); and suspicious mass in 2 (1.8%). Conclusion: In this study, screening of women reveals various benign and malignant breast pathologies which necessitate early interventions.

RésuméContexte: La détection précoce du cancer du sein est importante pour réduire la mortalité, la morbidité et le fardeau socioéconomique élevé qui en découlent. La mammographie est actuellement la principale modalité d'imagerie utilisée comme outil de dépistage pour détecter le cancer du sein précoce chez les femmes qui ne présentent aucun symptôme, car la maladie est facilement curable au stade précoce avec des thérapies qui favorisent la bonne conservation du sein. Objectif: Cette étude vise à déterminer les modèles de densités mammaires de mammographie et les résultats chez les femmes asymptomatiques qui se sont présentées pour la mammographie à Abuja. Matériels et méthodes: Cette étude transversale descriptive comprend 113 femmes asymptomatiques qui ont subi une mammographie au département Radiologie de l'hôpital universitaire d'Abuja, Gwagwalada de mars 2015 à décembre 2018. Deux type de vues de base (vues cranio-caudale et médio-latérale) ont été obtenues en utilisant deux appareils de mammographie de type EXR 650. Résultats: L'âge moyen de la population étudiée était de 40,72 ± 10,45 ans avec une tranche d'âge de 35 à 65 ans. Sur la base de la densité mammaire de la mammographie, l'image mammaire, les rapports et les systèmes de donnée 1 et 2 étaient les plus répandus. Il y avait une corrélation positive entre la densité mammaire de la mammographie et l'âge des répondantes. Cette relation était statistiquement significative (corrélation de Pearson = 0,56, P = 0,000). Le résultat de la mammographie des femmes asymptomatiques était négatif chez 69 femmes (61,1%) et positif chez 44 (38,9%). Le résultat positif obtenu était comme suit: masse bénigne chez 18 femmes (15,9%); une calcification bénigne chez 9 (8,0%); 7 (6,2%) montraient une distorsion architecturale; 5 (4,4%) n'étaient pas concluants; une asymétrie focale chez 3 (2,6%); et une masse suspecte chez 2 (1,8%) femmes. Conclusion: Cette étude de dépistage chez les femmes révèle diverses pathologies mammaires bénignes et malignes qui nécessitent des interventions précoces.

Atherosclerosis of cavernosal arteries as a cause of erectile dysfunction in an adult: our findings on triplex doppler sonography.

A sixty year old man presented to our health facility with a year history of severe erectile dysfunction (International Index of Erectile Function Score of 5 (IIEF-5)). He was also a known hypertensive and currently being managed for hypertensive heart disease by the Cardiologist. Colour Doppler interrogation of the Cavernosal Arteries showed multiple areas of narrowing in both arteries, giving beaded appearance. The peak systolic velocities of the arteries were less than 25cm/s, and there was persistent diastolic flow in the entire spectral recordings, prompting the diagnosis of arteriogenic erectile dysfunction (ED) secondary to atherosclerosis of the cavernosal arteries. He had medical treatment with PGE5-I, and intracavernosal injection of prostaglandin E1 (Caverjet), but all to no avail. He was counselled for penile implant and he is favourably disposed to that but largely being limited by funds. Funding: None Declared.

Magnetic resonance imaging in chronic headache: our experiences and perspectives.

BACKGROUND: Headache is a common symptomatology necessitating hospital consultations. Despite the prohibitive cost to patients in Nigeria, Magnetic resonance imaging (MRI) has become an evaluating tool for headache. OBJECTIVES: To determine the yield of cranial MRI and frequency of significant intracranial lesions among patients with chronic headache. METHODS: A three-year retrospective analysis of cranial MR images and records of patients referred to Medicaid Diagnostic Centre in Abuja, Nigeria on account of chronic headache was done. Data was analyzed using SAS software version 9.3. RESULTS: 150 patients aged 9 to 73 years (mean= 39.5 years) with chronic headache were studied. There were 54 males and 96 females with a ratio of 1:1.8. 48% and 52% had normal and abnormal MRI findings respectively. Although the number with abnormal MRI was higher than those with normal exams, this difference was not significant (p=0.624). The commonest neoplastic and non-neoplastic abnormalities were pituitary macroadenoma (4%) and sinusitis (21.3%) respectively. CONCLUSION: In our study, MRI had a low diagnostic yield in patients with chronic headache. Therefore, it is expedient that physicians stratify patients with chronic headache based on red flag signs to determine the need for cranial MRI in view of financial burden.

Low-cost antimicrobial fortification of ultrasound coupling gel: An ergonomic innovation to combat sonology-acquired nosocomial infections.

Background: Recent outbreaks of highly contagious diseases have prompted hospital departments to adopt preventive hygiene protocols. Use of shared equipment, including ultrasound transducers and coupling gels, potentially exposes patients to these microbes. Inexpensive means of microbicide fortification of plain/non-sterile ultrasound gel may be useful in interrupting nosocomial infections. The purpose of this study was to evaluate the effectiveness of low-cost antimicrobial fortification of ultrasound coupling gel in preventing nosocomial infections during ultrasound examinations. Methods: Volunteer patients, 20 in number, who presented for an ultrasound scan in a busy radiology clinic in Enugu, Nigeria, were randomly divided into 2 groups of 10 each and were scanned using plain non-sterile gel and gel-fortified with 0.5% chlorhexidine and 70% ethyl alcohol (in a volume ratio of 20:2:1) respectively. Swabs were taken from the patients' skin, gel-laden transducer, and the cleaned transducer and subjected to microbiology analysis. Subsequently, plain and fortified gel samples were allowed to stand in their respective dispensers for 72 hours. The plain and fortified gel samples were subjected to microbiology analysis. Fisher's Exact Test was utilised to compare outcomes in the 2 groups of volunteers. Results: With fortified gel, swab cultures from patients' skin and gel-laden transducer, and from the cleaned transducer, significantly yielded no growth (P= <0.0001 and P= 0.0001 respectively) while swab cultures from the plain gel yielded a total of 19 microbial isolates from 5 micro-organisms. Conclusion: Low-cost fortification of ultrasound coupling gel with 0.5% chlorhexidine and 70% ethyl alcohol renders it hostile to microorganisms encountered at sonology thus preventing nosocomial transmission.