Posterior Tibial Nerve Ultrasound Assessment of Peripheral Neuropathy in Adults with Type 2 Diabetes Mellitus.

Background: Diabetic peripheral neuropathy (DPN) is a common and debilitating complication of type 2 diabetes mellitus (T2DM). Early detection and prompt institution of appropriate therapy could prevent undesirable outcomes such as paresthesia, pain, and amputation. Although the gold standard for diagnosing DPN is nerve conduction studies, high-resolution peripheral nerve ultrasonography may serve as a noninvasive and low-cost alternative for diagnosing and staging DPN. This study investigated the clinical utility of sonographic posterior tibial nerve cross-sectional area (PTN CSA) for diagnosing DPN in individuals with T2DM. Methods: Eighty consecutive adults with T2DM and 80 age-/sex-matched controls were recruited. Clinical information was obtained, including symptoms, disease duration, Toronto clinical neuropathy score (TCNS), and biochemical parameters. The left PTN CSA at 1 cm, 3 cm, and 5 cm above the medial malleolus (MM) was measured with a high-frequency ultrasound transducer and compared to the detection of DPN using the TCNS. Results: Based on the TCNS, 58 (72.5%) of the T2DM group had DPN. Of these, 14 (24.1%), 16 (27.6%), and 28 (48.3%) participants had mild, moderate, and severe DPN, respectively. All the mean PTN CSA (aggregate, 1 cm, 3 cm, and 5 cm above MM) of the participants with T2DM and DPN (T2DM-DPN) were significantly higher than those of T2DM without DPN (WDPN) and controls. All the PTN CSA increased significantly with increasing severity of DPN. The PTN CSA at 3 and 5 cm levels correlated weakly but significantly with fasting plasma glucose and glycated hemoglobin levels. Conclusion: The PTN CSA is significantly larger in T2DM-DPN than in T2DM-WDPN and healthy controls. PTN ultrasonography can be an additional tool for screening DPN in patients with T2DM.

The Brain Tumor Segmentation (BraTS) Challenge 2023: Glioma Segmentation in Sub-Saharan Africa Patient Population (BraTS-Africa).

Gliomas are the most common type of primary brain tumors. Although gliomas are relatively rare, they are among the deadliest types of cancer, with a survival rate of less than 2 years after diagnosis. Gliomas are challenging to diagnose, hard to treat and inherently resistant to conventional therapy. Years of extensive research to improve diagnosis and treatment of gliomas have decreased mortality rates across the Global North, while chances of survival among individuals in low- and middle-income countries (LMICs) remain unchanged and are significantly worse in Sub-Saharan Africa (SSA) populations. Long-term survival with glioma is associated with the identification of appropriate pathological features on brain MRI and confirmation by histopathology. Since 2012, the Brain Tumor Segmentation (BraTS) Challenge have evaluated state-of-the-art machine learning methods to detect, characterize, and classify gliomas. However, it is unclear if the state-of-the-art methods can be widely implemented in SSA given the extensive use of lower-quality MRI technology, which produces poor image contrast and resolution and more importantly, the propensity for late presentation of disease at advanced stages as well as the unique characteristics of gliomas in SSA (i.e., suspected higher rates of gliomatosis cerebri). Thus, the BraTS-Africa Challenge provides a unique opportunity to include brain MRI glioma cases from SSA in global efforts through the BraTS Challenge to develop and evaluate computer-aided-diagnostic (CAD) methods for the detection and characterization of glioma in resource-limited settings, where the potential for CAD tools to transform healthcare are more likely.

COVID-19: Challenges and coping strategies in radiology departments in Nigeria.

Context: COVID-19 came suddenly, bringing to the fore the challenges inherent in the health system. In a developing country, such as Nigeria, which already had myriad problems with funds and equipment in the health sector. Aims: This study aims to examine the challenges encountered by the staff in Radiology facilities and how they combated the challenges. Settings and Design: A descriptive cross-sectional study of radiology facilities in Nigeria. Subjects and Methods: Radiologists from nine government and four private facilities who attended to COVID-19 patients were asked to fill questionnaires on challenges faced and their coping strategies. Responses were sent through E-mail. Statistical Analysis Used: Data from the responses were analyzed using Microsoft excel for Mac 2011 and presented as figures and tables. Results: Majority of the government 7 (77.8%) and private facilities 4 (100%) had no equipment dedicated only to COVID-19 patients. Seven (77.8%) government facilities complained of inadequate staff, poor availability of personal protective equipment (PPEs) 8 (88.9%), and lack of technology for remote viewing 7 (77.8%). Fear of cross-infection was a challenge in one of the facilities 1 (11.1%). Coping strategies adopted include ensuring less traffic in the department by discouraging walk-in patients and canceling non-emergent cases, booking suspected/confirmed cases for lighter times, using old film for face shields and cloth for facemasks, staff education on COVID-19 and preventive measures, and sending reports to physicians through E-mail. Conclusions: There were a lot of challenges during the COVID-19 crisis, with government hospitals experiencing more challenges than private facilities. The challenges included among others inadequate staff strength and lack of technology for remote viewing. Some were overcome using education and by production of facemasks/shields production using recycled materials.

RésuméLe contexte: COVID-19 came suddenly, bringing to the fore the challenges inherent in the health system. Dans un pays en développement, comme Le Nigeria, qui avait déjà une myriade de problèmes de fonds et d'équipements dans le secteur de la santé. Objectifs : Cette étude vise à examiner les défis rencontrés par le personnel des établissements de radiologie et comment ils ont relevé les défis. Paramètres et conception: une section descriptive étude des installations de radiologie au Nigeria. Sujets et méthodes: Radiologues de neuf établissements publics et de quatre établissements privés qui ont participé aux patients COVID-19 ont été invités à remplir des questionnaires sur les défis rencontrés et leurs stratégies d'adaptation. Les réponses ont été envoyées par courrier électronique. Analyse statistique utilisée: Les données des réponses ont été analysées à l'aide de Microsoft Excel pour Mac 2011 et présentées sous forme de figures et de tableaux. Résultats: La majorité des établissements publics 7 (77,8 %) et privés 4 (100 %) ne disposaient d'aucun équipement dédié uniquement aux patients COVID-19. Sept (77,8 %) établissements publics se sont plaints d'un personnel inadéquat, d'une faible disponibilité des équipements de protection individuelle (EPI) 8 (88,9 %), et le manque de technologie pour la visualisation à distance 7 (77,8 %). La peur d'une infection croisée était un défi dans l'un des établissements 1 (11,1 %). Faire faceles stratégies adoptées comprennent la réduction de la circulation dans le service en décourageant les patients sans rendez-vous et en annulant les cas non urgents, en réservant les cas suspects/confirmés pour des périodes plus légères, en utilisant un vieux film pour les écrans faciaux et un tissu pour les masques faciaux, la formation du personnel sur COVID-19 et mesures préventives et l'envoi de rapports aux médecins par courrier électronique. Conclusions: Il y a eu beaucoup de défis pendant la COVID-19 crise, les hôpitaux publics étant confrontés à plus de défis que les établissements privés. Les défis comprenaient entre autres l'insuffisance la force du personnel et le manque de technologie pour la visualisation à distance. Certains ont été surmontés grâce à l'éducation et à la production de masques faciaux/boucliers utilisant des matériaux recyclés. Mots-clés: défis, les stratégies d'adaptation, COVID-19, Nigeria.

Pediatric radiology as a subspecialty in Nigeria: to be or not to be?

We describe the advent of pediatric radiology in Nigeria and the challenges associated with establishing the subspecialty. Nigeria has very few radiologists with a special interest in pediatric radiology caring for more than 82 million children. One major challenge is the lack of interest in the subspecialty owing to the lack of remuneration when compared with others like interventional radiology. The majority of the radiologists also do not have specialized training in pediatric radiology. With very few children's hospitals, where to work after graduation is also a deterrent for pediatric radiologists. Put simply, Nigeria needs help. We also suggest ways to overcome these challenges.

My flanks aches: Emphysematous pyelonephritis in a newly diagnosed case of diabetes mellitus.

Emphysematous pyelonephritis (EPN) is a rare, severe necrotising infection of the renal parenchyma and surrounding tissues. It is usually life-threatening and should be promptly treated. Here, we report a clinical case of a 54-year-old male who presented with the left flank pains of 3-week duration. The flank pain was described as dull, constant with associated fever. He was diagnosed with diabetes mellitus (DM) while on admission. A clinical diagnosis of the left pyelonephritis was made. The abdominopelvic computed tomography scan confirmed bilateral EPN by showing a thin film of perinephric fluid (13.2 ml) in the left lower pole. He was managed conservatively with fluid therapy, adequate glycaemic control and intravenous antibiotics with no percutaneous drainage done. This highlights the importance of early initiation of appropriate medical treatment to avoid interventional urological procedures of nephrectomy. It also highlights the importance of clinical suspicion of EPN in patients presenting with symptoms of urinary tract infection and DM.

Hysterosalpingographic findings in infertility - what has changed over the years?

BACKGROUND: Prior studies on Hysterosalpingography (HSG) have shown that pelvic inflammatory disease (PID) related tubal adhesions accounted for 30 - 50% of female infertility, with as high as 80% reported in some studies. With improved access to contraceptives, antibiotics and promotion of safe practices, the abnormal findings in HSG may have reduced or altered. OBJECTIVE: To document the imaging findings in the HSG of participants and to compare current findings with prior studies done nationally and internationally. METHOD: A retrospective evaluation of 974 HSGs done at the tertiary diagnostic center over a 7-year period was conducted and analyzed using diagnostic accuracy tables. RESULTS: Tubal pathologies were the most common abnormality in this study, (35.1% of the cases), comprising tubal blockage and hydrosalpinges; followed by uterine masses seen in 223 (22.9%) of the clients. Tubal occlusion was higher in clients with multiple abnormal findings; while normal sized and large uterine cavities had a higher percentage of bilateral tubal patency. CONCLUSION: Tubal factors remain the most common abnormality seen in the HSGs of infertile women in this study, though with lower prevalence compared with prior older studies. Forty seven (47%) of the cases of female factor infertility had normal HSGs with bilateral tubal patency.

Assessment of ultrasound flow-mediated dilation of brachial artery in regular blood donors in a Nigerian Tertiary Hospital

Background: Iron is a pro-oxidant cofactor that may be linked to cardiovascular disease (CVD) progression and reduction of body iron stores have been hypothesized to reduce the risk of CV disease. Aim: The aim of this study is to assess reduction in CVD risk susceptibility among regular blood donors compared with nondonors using ultrasound brachial artery flow-mediated dilation (BAFMD). Settings and Design: A prospective comparative study designed to establish the difference between mean flow-mediated dilatation (FMD) in the patients who are regular blood donors compared with nondonors recruited from a Teaching Hospital donor clinic. Materials and Methods: Data were collected over 7 months from December 2014 to June 2015. 100 eligible regular male blood donors, aged 21­50 years, were selected from a Teaching Hospital blood donor records and their BAFMD assessed. 50 nondonors/ first time donors, of equivalent age group, consecutively were assessed for comparison. Serum markers of iron stores, markers of oxidative stress and other related cardiac risk factors were also assessed in all patients. Results: BAFMD was significantly greater in regular blood donors when compared with nondonors (13.95% ± 7.02% vs. 8.20% ± 4.19%, P = 0.000). Serum ferritin was significantly decreased in regular blood donors when compared with nondonors (mean value 41.92 ng/ml ± 23.12 ng/ml vs. 61.97 ± 30.19 ng/ml, P = 0.000), but Hb did not differ between the groups. High FMD was significantly associated with high C-high-density lipoprotein and low C-LDL (r = −0.215*, P = 0.032, r = 0.188, P = 0.031, r = 0.193, P = 0.027, r = 0.0279, P = 0.002, r = 0.139, P = 0.084). LDL was decreased in regular blood donors compared with nondonors. Conclusion: The study provides prognostic information for assessing ultrasound BAFMD as a cardiac risk marker. Regular blood donors have enhanced cardiovascular function with increased flow-mediated dilation, decreased body iron stores, and decreased oxidative stress compared with nondonors

Magnetic resonance imaging pattern of congenital brain anomalies in the neurosurgery department of a teaching hospital in Nigeria: An initial experience

Context: Congenital brain anomalies are of diverse types however few are seen in clinical practice. They are associated with high morbidity and mortality; prompt diagnosis and management aid in mitigating some of their adverse effects. Magnetic resonance imaging (MRI) is ideal for imaging these conditions, especially in pediatric cases due to its lack of ionizing radiation and excellent soft-tissue delineation. Not much literature exists for Nigeria due to challenges with statistics and record keeping. Aim: The aim of this study is to document the common congenital brain anomalies encountered using MRI in our environment. Settings and Design: A 5-year retrospective study of all pediatric brain MRI conducted and reviewed in Lagos University Teaching Hospital. 73 pediatric brain MRI scans were reviewed. Materials and Methods: Morphologic evaluation of all pediatric brain MRI conducted in the last 5 years (March 2012­February 2016) was reviewed, retrospectively, by three independent radiologists. Clinical presentations were also documented. Statistical Analysis Used: Descriptive statistics was done using SPSS: PASW Statistics for Windows, Version 18.0 Results: Seventy-three pediatric brain MRI scans were conducted in the last 5 years with congenital brain anomalies seen in 19 (26.0%) of the cases. Their ages ranged from 3 months to 17 years with a mean age of 6.7 ± 6.1 years. There were 9 (47.4%) males and 10 (52.6%) females. The common anomalies are congenital hydrocephalus 7 (35%), of which aqueductal stenosis was 6 (32%), arteriovenous malformations 3 (16%), cerebral atrophy 3 (16%), and arachnoid cysts 2 (11%). Predominant clinical features were delayed developmental milestones, macrocephaly, seizures, headaches, and vomiting. Conclusion: The common congenital brain anomalies in our environment are congenital hydrocephalus, aqueductal stenosis, arteriovenous malformations, cerebral atrophy and arachnoid cysts. MRI is useful in evaluating these anomalies; early diagnosis and prompt intervention can be offered to mitigate adverse effects

Breast cancer screening in a resource poor country: Ultrasound versus mammography.

BACKGROUND: Breast cancer is the commonest female cancer in Nigeria. Despite its increased awareness, affordability of available screening tools is a bane. Mammography, the goal standard for screening is costly and not widely available in terms of infrastructure, technical/personnel capabilities. Ultrasound is accessible and affordable. OBJECTIVES: This study compared the use of ultrasound and mammography as breast cancer screening tools in women in South West Nigeria by characterizing and comparing the prevalent breast parenchyma, breast cancer features and the independent sensitivity of ultrasound and mammography. METHODS: This cross sectional comparative descriptive study used both ultrasound and mammography as screening tools in 300 consenting women aged 30 to 60 years who attended a free breast cancer screening campaign in a tertiary hospital in Lagos. Categorical variables were presented in tables and Chi squares for associations P-value set at ± 0.1. RESULTS: Mean age was 41.01 + 6.5years with majority in the 30 - 39 year age group 139 (55%). Fatty (BIRADS A and B) parenchyma predominated {ultrasound 237 (79%); mammography 233 (77.7%)} in all age groups. 7 (2.3%) were confirmed malignant by histology with (6) in the 30-39 age group and (1) in the 40-49 age group. Ultrasound detected all the confirmed cases 7(100%), whereas mammography detected 6 (85%). Sensitivity was higher using ultrasound (100%) than mammography (85.7%). CONCLUSION: Ultrasound can be utilized as a first line of screening especially in remote/rural areas in developing world. FUNDING: Part funding from Run for Cure governmental organization.

Unusual presentations of child abuse: A report of two cases and the role of imaging.

Insufficient attention has been paid to child abuse in Nigeria, where corporal punishment is still acceptable both at home and in the wider public including schools. This is notlimited to the parents; these punitive measures can also be undertaken by the extended family, caregivers, and neighbors. Mild to extreme force is allowed particularly when the crime involves tarnishing the family image. We hereby report two cases of extreme discipline that can be termed as a form of child abuse to draw the attention of clinicians and radiologists to other possible findings aside from those already reported in literature.