A Mixed Method Assessment of the Fertility Preferences of Clients Using Antiretroviral Therapy in Ilorin, Nigeria - A Descriptive Cross-sectional Survey.

INTRODUCTION: The burden of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome in Nigeria remains one of the highest in the world, with the country having the highest number of people living with the infection in the West African subregion. Recent estimates put the HIV prevalence rate in Nigeria at 1.9%. In the early years of the HIV epidemic, attention on the reproductive preferences of people living with HIV was not really considered because of the high risk of mortality and few options to reduce mother-to-child transmission. METHODOLOGY: A descriptive cross-sectional study was carried out in November 2018 using quantitative and qualitative methods. A total of 400 participants were recruited for the quantitative part of the study and 10 respondents for each of the focus group discussion (FGD) sessions. Data were collected using an interviewer-administered questionnaire and a FGD guide. Frequencies and percentages were determined using descriptive analysis. Univariate analysis was used to explore the association between the outcome variables and the independent variables. The independent variables which showed a significant association in the univariate analysis were further subjected to multivariate analysis. RESULTS: The desire to have children since their HIV diagnosis had been mooted by 255 (63.8%) respondents in the past and 64.5% of the respondents admitted to wanting to have children at some point in the future. More than half of the respondents (61%) currently wanted more children while a significant proportion of the respondents who wanted children (68.4%) wanted more than one child. CONCLUSION: The study observed that the desire to have children had largely not been affected by the HIV infection as respondents still had a fairly strong desire to continue to have more children in spite of the risks of transmission involved. The study recommended that government and HIV policymakers need to ensure that HIV prevention messages and programmes adopt cultural and socio-economic considerations when designing and planning HIV prevention programmes.

Vaccine Safety: Assessing the Prevalence and Severity of Adverse Events Following COVID-19 Vaccination amongst Healthcare Workers in Tertiary Health Facilities in Nigeria.

BACKGROUND: Vaccines, including COVID-19 vaccines, are known to be cost-effective interventions for disease prevention and control. However, adverse events following immunisation (AEFI) may challenge the acceptance of these vaccines. This study assessed the prevalence and severity of COVID-19-related AEFI amongst healthcare workers at tertiary health facilities in Nigeria. MATERIALS AND METHODS: This descriptive, cross-sectional study was conducted among healthcare workers who had received the COVID-19 vaccine. A multi-stage sampling technique was used to select participants from six Tertiary Health Facilities in Nigeria. Ethical approval (NHREC/01/01/2007-19/07/2021) was obtained from NHREC. Data were analysed using IBM® SPSS version 25 and categorical variables were presented in tables/charts using frequencies and proportions. RESULTS: A total of 2130 respondents participated in the study, with a mean age of 37.4 ± 9.1 years. Most of the respondents, 1674 (78.6%), had two doses of the vaccine, and the overall prevalence of AEFI was 813 (38.2%). Common among the AEFI reported following the administration of the first dose of the vaccine were fever 649 (30.5%) and pain at the injection site 644 (30.2%), while it was pain at the injection site 216 (10.1%) and fever 173 (8.1%) for second dose. The higher proportions of AEFI were mostly mild to moderate. CONCLUSION: The study observed a relatively low prevalence of AEFI, with the commonly reported ones being fever and injection site pain. It is crucial that countries continuously collect the data on AEFI and establish causality as a way to improve quality and guarantee vaccine safety.

Delayed enterocutaneous fistula after 17 years of gunshot wound injury: a case report.

Enterocutaneous fistula (ECF) is a common complication of abdominal surgery. Postoperatively, it may be the result of a small intestinal injury or an anastomosis leak, and it typically manifests days or weeks following surgery. Case presentation: A 56-year-old man with a history of a gunshot wound injury in the abdomen with colon injury managed for colocolic anastomosis 17 years earlier presented to our hospital's general surgery clinic with the complaint of drainage at the scar area. It was discovered that he had an ECF. The patient underwent a laparotomy. Fistula tract excision and segmental colon resection with colocolic anastomosis were done. Clinical discussion: ECF formation after an extraordinarily long latency due to an anastomotic leak, which has not been previously documented in the literature, is a distinctive aspect of the case. As a result, surgeons should consider ECF in their differentials for patients with a history of abdominal operations. Conclusion: Surgical management is the definitive treatment of ECF after proper resuscitation and stabilization of the patient's condition. Preoperative imaging is crucial for determining the anatomy of the fistula and any associated intra-abdominal pathology.

Clinical observation of laser combined with 5-aminolevulinic acid photodynamic therapy for female vulva condyloma acuminatum.

BACKGROUND: Condylomata acuminata, or genital warts (GW), are exceedingly prevalent, with human papilloma virus infection accounting for 90% of cases. It can be treated in a variety of methods, but the high recurrence rate and cervical scars make it difficult to choose the best treatment option. Hence, the study aims to find the effect of laser combined with 5-aminolevulinic acid (ALA) photodynamic therapy for condyloma acuminata in the vulva, vagina, and cervix. METHODS: A total of 106 female patients with GW of the vulva, vagina, and cervical condyloma acuminata were treated in the Dermatology Department of Subei People's Hospital in Yangzhou from May 2020 to July 2021. All these patients were treated with laser combined with 5-ALA photodynamic therapy to observe the therapeutic effect. RESULTS: About 84.9% of patients responded to the first session of ALA-photodynamic treatment. Five patients relapsed in the 2nd week, two patients relapsed in the 4th week, one relapsed in the 8th week, one relapsed in the 12th week, and the relapsed patients were given 1-3 times of photodynamic therapy again, and no recurrence was seen in the 24th week. After four courses of treatment in 106 patients, the wart clearance rate was 100%. CONCLUSION: Laser combined with 5-ALA photodynamic therapy for female vulva, vagina, and cervix condyloma acuminata has a reliable curative effect, low recurrence rate, few adverse reactions, and less pain. It is worth promoting in female vulva, vagina, and cervical condyloma acuminata.

Return connectedness and multiscale spillovers across clean energy indices and grain commodity markets around COVID-19 crisis.

The aim of this paper is to examine the return connectedness and multiscale spillovers between the Clean Energy Index and the grain commodity market around COVID-19. Using daily data from January 4, 2017 to July 1, 2022, a time-varying parametric vector autoregressive (TVP-VAR) connectedness approach is first used to reveal connectedness patterns before and during COVID-19. We further used Baruník and Krehlík (2018)'s frequency domain spillover method to assess connectedness in different domain horizons. Our results show spillover effects over time and frequency, with COVID-19 significantly affecting the connectedness of the whole system. Dynamic connectedness peaks significantly after sudden bursts of COVID-19, validating the reported uncertainty. We also documented higher spillover levels in the short term than in the medium and long term. In addition, We find that (i) most clean energy indices are positively affected by the COVID-19 outbreak; (ii) the NASDAQ OMX Bio/Clean Fuels Index and NASDAQ OMX Geothermal Index send spillovers to all grain commodities throughout the sample period, while the WilderHill Clean Energy Index and NASDAQ OMX Wind Energy Index indices are the largest recipients of spillovers from other markets regardless of time horizon; (iii) the OMX Bio/Clean Fuels and OMX Geothermal Energy indices dominate spillover shocks to grain commodity markets. This is the first study to analyse the connectedness and time-frequency dynamics of returns in the green energy index and the grain commodity market. These results provide valuable insights to investors and key policymakers, especially at a time of more significant uncertainty.

Determination of optimum number of cycles of induction chemotherapy for locoregionally advanced nasopharyngeal carcinoma: a single-center retrospective study.

BACKGROUND: Induction chemotherapy (IC) followed by concurrent chemo-radiotherapy (CCRT) is the current standard of care for locoregionally advanced nasopharyngeal carcinoma (LA-NPC) patients. However, there is still no consensus on the optimum number of IC cycles. In this study, we aimed to assess the efficacy and toxicities of two or more cycles of IC for LA-NPC patients. METHODS: Data of LA-NPC patients consecutively treated with IC followed by concurrent chemo-radiotherapy (CCRT) in our institute from 2017 to 2022 were retrospectively retrieved and analyzed. Survival outcomes of patients who received two IC cycles were compared with those who received more than two IC cycles. Univariate and multivariate Cox regression analysis were then performed to determine factors that could be independent predictors of survival. Chi-square test and Fisher's exact test were used to compare treatment associated acute toxicities between the two groups. RESULTS: A total of 125 patients were recruited in this study. There were 89 patients who received 2 cycles (IC = 2) of IC and 36 received more than 2 cycles (IC > 2) of IC. The median follow-up time was 26 months [IQR 16-38]. The 3-year overall survival rate was not statistically significant between the two groups (95.50% vs. 86.11%, P = 0.501). Similarly, loco-regional recurrence free survival and progression free survival were not significant (97.75% vs. 97.22%, P = 0.694; and 88.76% vs. 83.33%, P = 0.129), but distant metastasis free survival was significant (88.76% vs. 86.11%, P = 0.049). Multivariate Cox regression analysis showed that IC regimen was an independent prognostic factor. CONCLUSIONS: Two cycles of IC is effective and more than two does not add any additional benefit to the survival outcomes of LA-NPC patients.

Spontaneous expulsion of 10 years retained intrathoracic foreign body (bullet) from left main bronchus: A case report.

A foreign body lodged in the tracheobronchial tree is a serious and common medical emergency that can have serious and perhaps lethal consequences. A few cases have been reported in the literature for the last century with gunshot wounds to the chest that were handled non-operatively and finally expelled the bullet on their own. We present a case of a hemodynamically stable 50-year-old male with a 10-year-old penetrating thoracic gunshot wound, with the bullet found in the left main bronchus on computed tomography (CT) scan upon admission. Further examination found no evident erosive injuries, such as hemoptysis, but he did have empyema and required a thoracotomy for decortication. Shortly after discharge, he coughed out a bullet into the floor, which is why our case is so intriguing. This case demonstrated that a bronchial foreign body is seldom spontaneously expelled.

Dependence and spillover among oil market, China's stock market and exchange rate: new evidence from the Vine-Copula-CoVaR and VAR-BEKK-GARCH frameworks.

We first employ the method of multivariate GARCH models and Vine-Copula-CoVaR to analyse relationships between dependence, systematic risk spillover, and volatility spillover between the USD/CNY exchange rate and the returns on WTI crude oil futures and the Chinese stock market since China's 2005 foreign exchange reform. We utilise daily data from 2005 to 2020. We find a more complex dependence of the USD/CNY exchange rate on stock markets and WTI crude oil prices. All have negative risk spillovers among paired markets, with WTI having the most substantial risk spillover. However, the strength of the systematic risk spillover varies across markets. Based on the results of the VAR(1)-BEKK-GARCH ( 1 , 1 ) and Wald tests confirm that there is a substantial mean spillover from the Chinese stock market and the USD/CNY exchange rate to the WTI crude oil price, whereas there is a more significant spillover from the WTI crude oil price to Chinese stock market volatility. The empirical findings extend the systematic understanding of the international crude oil price shocks to the dependence and transmission mechanism between the Chinese stock market and the USD/CNY exchange rate (USD/CNY). Our findings can help investors and policymakers to manage risk better and develop more sensible market rules.

Psychological and stigma profiles of HIV patients in a North-Central city of Nigeria.

Background: The World Health Organization defines health as a state of complete physical, mental, and social well-being and not merely the absence of infirmity and disease. Researchers and clinicians have mainly focused on health outcomes that are physically or laboratory measured. These, however, do not reflect how the affected individual feels and functions in daily life. This study assessed the psychological and stigma profiles of patients attending HIV clinics in a North-central State of Nigeria. Methods: The study design was descriptive cross-sectional. A total of 384 HIV-positive patients who were systematically recruited at 5 public service delivery sites in Ilorin, Kwara State, North-central Nigeria participated in the study. Data was analyzed using SPSS software version 20.0. Level of significance was pre-determined at P value < 0.05 at a confidence level of 95%. Results: Fifty-nine percent of respondents reported being anxious about their condition and 25.5% felt depressed. Eighty-six percent received adherence counselling and 82.3% received psychological care from support groups. In the psychological domain, majority (74.5%) of the respondents had high health-related quality of life (HRQoL). There was a statistically significant association between employment status and psychological domain of HRQoL. As regards stigma, majority experienced high stereotype stigma (73.7%) and 67.2% experienced high stigma as pertains disclosure. Conclusion: Health workers should promote psychological support of HIV patients, for example, in form of support groups and adherence counseling. Efforts by government and corporate bodies should be geared towards employment empowerment of PLWHA which may help improve quality of life.

Spontaneous pneumorrhachis, pneumomediastinum, pneumopericardium, and subcutaneous emphysema. Rare features of Hamman Syndrome.

INTRODUCTION AND IMPORTANCE: Pneumorrhachis (air within the spinal canal), Pneumomediastinum (abnormal air in the mediastinum), Pneumopericardium (air in the pericardial space), and Subcutaneous emphysema (air trapped under the skin) are rare conditions which are rare features of Hamman Syndrome. Some of pulmonary diseases that relate to pneumorrhachis have been reported in the literature; but Hamman Syndrome with Pneumorrhachis and Pneumopericardium due to violent coughs that triggered by tongue scraping are very rare. CASE PRESENTATION: A 20-year-old male with no previous lung disease or trauma was brought to the emergency department due to acute chest pain, dyspnea, choking, syncope, and neck swelling which started after several self-induced coughs when he was brushing his tongue. Chest CT scan revealed Pneumorrhachis, pneumomediastinum, Pneumopericardium and extensive subcutaneous emphysema associated with lung contusions. CLINICAL DISCUSSION: Barotrauma due to violent coughs that triggered by tongue scraping may lead to lung injury resulting in Hamman Syndrome with rare features of pneumorrhachis and Pneumopericardium. To our knowledge this is the first case report of Hamman syndrome with pneumorrhachis and Pneumopericardium secondary to tongue brushing-induced lung injury in Somalia. CONCLUSION: Violent coughs from tongue scarping can lead to Hamman Syndrome with Pneumorrhachis and Pneumopericardium.

Disclosure Pattern and Its Determinants among Patients Attending Anti-Retroviral Clinics in a North Central Capital City in Nigeria.

Background: It has been observed that contributory factors such as unprotected sexual intercourse and vertical transmission of HIV to the unborn child during childbirth still occur among women living with HIV.HIV status disclosure has also been found to lead to improved access to HIV prevention and treatment programmes. Methodology: The study was a descriptive cross sectional study using quantitative and qualitative data collection tools. Four hundred patients were recruited for the study and systematic sampling was used to select respondents at each treatment centre. Data was collected using a semi-structured interviewer administered questionnaire and a patient focus group discussion (FGD) guide. Results: The age of the respondents ranged from 20 to 70 years and 75.5% of the respondents were females. More than three-quarters of respondents (77%) had disclosed their status to their partners. Status disclosure to sexual partners was higher among respondents who were currently living with their partners (87.1%, p=<0.001). Conclusion: The study recommended that Government, partners and multilateral agencies needs to consider establishing empowerment schemes for women and men living with HIV to enable them live economic viable lives and avoid using economic means as a determinant of status disclosure.

Exploring the significant factors that influence delays in construction projects in Hargeisa.

Over the past decades, construction delays have been perceived as a global challenge that hinders the time delivery, budget, and quality of construction projects. It is the most common, expensive, and risky problem associated with both private and public construction projects. Within this context, the aim of this study is to investigate the significant factors that influence delays in construction projects in Hargeisa, using the road and building projects as a baseline. Through a questionnaire survey with 51 critical delay factors that are categorized into seven major groups, data were collected from 51 construction stakeholders selected based on simple random sampling from the different construction companies. Feedback from the respondents was analyzed using Relative Importance Index (RII) for ranking purposes. Results showed that delay in honoring payment progressively, underestimation or overestimation of the project cost, and delay in the approval of major changes in the work scope were ranked as the three major causes of delays in construction projects in Hargeisa. The implications of these results are vital to future projects as they clearly demonstrate how less attention is given to the application of project management tools such as robust cost, scope and risk management in construction projects. As such, construction stakeholders are recommended to make efforts to use the appropriate project management practices needed to manage the 16 identified critical delay factors, when executing future construction projects. Although, the current study focused on Somaliland construction projects, it expands and improves the understanding of delay factors in the global context, and as such can be applied to other countries and future studies.

Homeostatic Model Assessment of Insulin Activity and Iron Profile among Regular Blood Donors at a Tertiary Health Centre, South-West Nigeria.

CONTEXT: Iron overload has been established to play a role in the etiopathogenesis of Type 2 diabetes mellitus (DM) as evidenced by its high prevalence among patients with hemochromatosis and transfusion-dependent diseases. This is as a result of iron redox reaction which generates free radicals that cause peroxidation of lipid-rich pancreas, leading to reduced insulin sensitivity. AIMS: This study therefore evaluated the impact of regular blood donation, an effective method of reducing iron load, on ß-islet cell functions and level of glycemic control among regular whole blood donors. SETTINGS AND DESIGN: This is a cross-sectional, analytical study. SUBJECTS AND METHODS: Forty-two consenting regular blood donors who had donated whole blood at least twice and not more than thrice in the last 1 year were selected as cases, while 42 age-matched individuals who have never donated blood previously were selected as controls. Samples were obtained and analyzed for fasting plasma glucose, fasting plasma insulin, serum ferritin, transferrin receptor, total iron-binding capacity (TIBC), and serum iron, while Homeostatic Model Assessment (HOMA) of insulin resistance (IR) and beta sensitivity, HOMA-IR, and HOMA-ß-cell function (HOMA-ß%) were calculated for both groups. STATISTICAL ANALYSIS USED: Statistical analysis was done using Microsoft Excel package and the Statistical Package for the Social Sciences (SPSS) version 20.0 (SPSS Inc., Chicago, IL, USA). RESULTS: Iron studies among regular blood donors and nondonors revealed lower serum iron (37.2 ± 7.3 vs. 41.1 ± 7.9 µmol/L, P = 0.180) and lower serum ferritin levels (30.2 ± 26.1 vs. 42.9 ± 38.5 ng/mL, P = 0.117), which were not statistically significant, while there were higher serum transferrin receptor (155.5 ± 22.6 vs. 112.8 ± 43.4 ng/mL, P < 0.001) and higher serum TIBC (42.3 ± 6.4 vs. 37.8 ± 7.4 µmol/L, P < 0.05), among cases than controls. The mean HOMA-IR and HOMA-ß% were also significantly better among donors than nondonors. CONCLUSIONS: Regular blood donation may protect the body from the toxic effects of excessive iron store, which includes improved insulin sensitivity and glycemic control.

Assessment of Health-care Research and Its Challenges among Medical Doctors in Nigeria.

INTRODUCTION: Health-care research in Nigeria has been growing over the years but is constrained by many difficulties. This study aimed to identify the challenges encountered in health-care research and suggest policies to address these problems. MATERIALS AND METHODS: It was a cross-sectional study of medical doctors who have been involved in health-related researches. All participants filled a self-administered online questionnaire comprising 31 questions in five sections. The responses were analyzed using the Google forms and the Statistical Package for the Social Sciences software version 23. RESULTS: The mean age of the study participants was 41.0 ± 8.4 years. Three-quarters of the respondents (75.5%) worked in teaching hospitals. Nearly all (96.6%) carried out their studies using personal funds and only one in 10 had been involved in high-budget projects (≥₦1,000,000). The generation of quality researches was impeded by the restriction of literature review to free online journals (93.2%), incomplete health records (88.0%), limited access to research kits (65.7%), limited use of advanced statistical analysis (29.8%), and challenges with obtaining ethical approval (21.2%). Despite the average online visibility of these researches (52.2%), only 28.5% stated that it has been locally adopted to influence medical practice in their center. CONCLUSION: There is a wide disparity in research capacity among hospital tiers. It is important to leverage on and expand existing partnerships to provide institutional access to premium literature, offer robust, and assessable financial support for the conduct of high-quality researches and provide a framework to bridge the gap in the use of these works to influence practice change in Nigeria.

Management of catheter-associated urethral strictures

Background: Urethral stricture is an abnormal narrowing or loss of distensibility of any segment of the urethra surrounded by corpus spongiosum. In the last two decades, there has been a change in the pattern of aetiology of urethral stricture in urban centres in Nigeria with a shift away from post-infective strictures to the emergence of traumatic and iatrogenic causes.Objective: This study aims to present our observation of the occurrence of long-segment urethral strictures in patients after urethral catheter placement for various indications.Methodology: This is a descriptive, cross sectional report of patients who presented to and were managed at the Urology Unit of a tertiary hospital in North-Western Nigeria. Relevant information were retrieved from patients' case notes and the data was entered into a proforma and analysed using the SPSS 20 software.Results: The mean age of the patients was 45.4 ± 19.4 years, with a range of 11-80 years. Indications for urethral catheterization were acute urine retention 11 (43.8%), intra-operative urine output monitoring 9 (28.1%), following road traffic accident 10(31.2%), unconsciousness secondary to meningitis 1 (3.1%) and after urologic surgery 1 (3.1%). Urethral catheterization was carried out in peripheral hospitals in 19 (56.3%) patients; and from the hospitals operating room in 10 (31.2%), accident and emergency room 2 (6.3%) and trauma centre 1 (3.1%). Strictures were panurethral in 22 (68.75%), in the bulbar urethra in 6 (18.75%) and in the penile urethra 4 (12.5%). The length of strictures ranged from 1 cm to 20 cm. Treatments offered included substitution urethroplasty using oral mucosa grafts (OMG) urethroplasty 30 (93.8%), fasciocutaneous penile flap 1 (3.1%) and direct visual internal urethrotomy (DVIU)1 (3.1%). Satisfactory voiding was recorded in 28 (87.5%), voiding was unsatisfactory in 2 (6.3%), while one patient had stricture recurrence and another one is awaiting second stage repair.Conclusion: Urethral catheterization is an emerging cause of panurethral strictures in our practice and may occur even after relief of acute urine retention but more worrisome following short-term catheterization during surgery. There is need for evaluation of the quality of silicone-coated latex urethral catheters currently available

Comparative diagnosis of pregnancy wastage in cows at slaughter using pregnancy specific protein-B and post slaughter inspection diagnostic procedures.

Slaughter of pregnant animals is a common abattoir practice. This study was designed to compare the diagnostic capacity of pregnancy specific protein-B (PSPB) with post slaughter inspection (PSI) procedures in detecting cows pregnant at slaughter. Blood was collected from cows presenteded for slaughter at an abattoir. The uteri were examined post slaughter for the presence or absence of a foetus. Recovered foetuses were aged using crown-rump length to estimate the stage of pregnancy. Of the 361 cows examined, 72 (19.9 %) were diagnosed pregnant using the PSPB procedure, while 32 (8.9 %) were diagnosed pregnant using PSI diagnosis. Furthermore, with PSI there was a lack of pregnancy diagnosis in 42 (11.6 %) cows detected pregnant using PSPB procedure, and two (0.6 %) cows detected pregnant using PSI were not detected to be pregnant using PSPB diagnosis. Validity of the diagnostic procedures indicated that sensitivity and specificity of the PSPB was 93.8 % and 87.2 %, respectively, while with the PSI diagnosis there was a sensitivity and specificity of 41.7 % and 99.3 %, respectively. The PSPB diagnosis, had an excellent predictive value (AUC - 0.92; p < 0.001; 95 % CI - 0.856 to 0.981). Most of the pregnancy wastage (n = 22; 68.8 %) diagnosed using the PSI method were in the second trimester. The results of this study indicate that PSPB is reliable and a more sensitive diagnostic method than PSI . It is therefore recommended that the PSPB test be incorporated in routine screening for pregnancy status of cows before slaughter.

Significance of radiology in the diagnosis and management of ruptured left gastric artery aneurysm associated with acute pancreatitis: Case report.

RATIONALE: Left gastric artery aneurysms are very rare which progresses into hemorrhagic shock and diagnosis is very challenging particularly in patients with acute pancreatitis and cholecystitis whose vitals become unstable suddenly. PATIENT CONCERNS: A 72-year-old female has presented with severe progressing abdominal pain was treated with total parenteral nutrition for acute pancreatitis based on preliminary work up, but suddenly became unstable with dropping vitals over the ensuing 48 hours. Physical examination has a positive Murphy sign and appeared lethargic. She has no past history of any chronic systemic illness or malignancy. DIAGNOSES: Ruptured left gastric artery aneurysm and left hepatic artery aneurysm with intraperitoneal hemorrhage associated with acute pancreatitis and cholecystitis. INTERVENTIONS: Emergency interventional surgery was performed to embolize both the aneurysms and the giant aneurysmal sac of the left gastric artery was secured with a micrometallic occluding coil which eventually controlled the active hemorrhage. OUTCOMES: The patient became stable and was discharged after 15 days without any recurrence or complications during the 6-month follow-up. LESSONS: This case is a peculiar example of a missed diagnosis of left gastric artery aneurysm associated with acute pancreatitis and cholecystitis with deteriorating clinical condition. Exhaustive radiological investigations are necessary for early diagnosis correlating with presenting clinical situations. Radiologists should be familiar with the challenges in diagnosis and management.

Use of transrectal ultrasound in the management of urologic diseases in a tertiary hospital in North-Western Nigeria.

BACKGROUND: Transrectal ultrasound (TRUS)-guided biopsy of the prostate is considered as a standard of care for diagnosis of prostate cancer. The objective of this study was to document our experience in the use of TRUS in the management of urologic diseases in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto. MATERIALS AND METHODS: This was a retrospective study of patients who had TRUS at UDUTH from December 2009 to November 2017. Relevant data were extracted from the procedure register, and case folders of the patients. Data analysis was performed using IPSS 20.0 version. RESULTS: A total of 844 patients had the procedure within the period of the study. The mean age of the patients was 65.6 ± 10.6 years with a range of 7-98 years. The main clinical diagnoses of the patients were benign prostatic hyperplasia in 528 patients (62.6%), prostate cancer in 285 patients (33.8%) and primary infertility + azoospermia in 17 patients (2.1%). Transrectal ultrasound-guided prostate biopsy was done for 807 patients (96%). TRUS only was done for assessment of seminal vesicle and ejaculatory duct in 17 patients (2.1%), prostate volume assessment in 10 patients (1.1%) and deflation of retained urethral catheter balloon in 9 patients (1%). There was self-limiting rectal bleeding in 600 patients (74.4%) and 3 patients (0.4%) each developed haematuria and postbiopsy infections. CONCLUSION: Prostate biopsy is the most common indication for TRUS in our practice. Other indications were estimation of prostatic volume, evaluation of azoospermia and deflation of retained urethral catheter balloon.

Safety and efficacy of ultrasound-guided percutaneous suprapubic cystostomy in resource-poor setting: A 7-year review.

INTRODUCTION: Percutaneous cystostomy techniques are usually done using disposable sets in developed countries which are not affordable in poor-resource settings. However, the percutaneous technique can be done using reusable trocar or selected big size surgical blades. This is simple, safe, and cost effective in poor-resource setting. The procedure is best done under ultrasound guidance but can also be done blindly in select cases. We present our 7-year experience in ultrasound-guided percutaneous suprapubic cystostomy. MATERIALS AND METHODS: This is a 7-year retrospective review of patients, who had ultrasound-guided percutaneous suprapubic cystostomy at Urology Unit of our institution from January 2010 to December 2016. Disposable cystostomy sets were used for the initial experience, but this was replaced with more cost-effective reusable metallic trocar or selected big size surgical blade methods in the later experience. Data were extracted from procedure register and patients' case notes and entered into pro forma and analyzed using Statistical Package for Social Sciences 20.0 version (2011) for windows (IBM, SPSS Incorporation, Chicago, IL, USA) 20.0 version for Windows. RESULTS: A total number of 135 patients had percutaneous cystostomy, which was ultrasound guided in 134 patients (99.3%). The mean age of the patients was 50.5 ± 23.3 years with a range of 2-90 years. The indications for the procedure include urine retention with failed urethral catheterization in 119 patients (88.1%), urethral injury in 14 patients (10.4%), and urethrocutaneous fistula in 2 patients (1.5%) with spinal cord injury. No major complication was recorded. CONCLUSION: Ultrasound-guided suprapubic cystostomy using reusable trocar or selected surgical blade is simple, safe, effective, and associated with minimal complications in poor-resource setting.

Patient Preference for Management of an Asymptomatic 15 mm Renal Calculus-Avoid Risk or Maximize Success?

INTRODUCTION: We evaluate patient preferences and the underlying factors determining decision making in the management of the asymptomatic 15 mm renal stone. METHODS: A survey was randomly distributed to 106 patients at our multidisciplinary stone clinic. Patients were given a hypothetical scenario of a 15 mm renal stone, and were asked to choose among the 3 treatment options of extracorporeal shock wave lithotripsy, ureteroscopy and percutaneous nephrolithotomy. The success rate, risk and morbidity associated with each treatment were provided to patients. Statistical analysis involved the Fisher exact and Wilcoxon signed rank tests. Analysis was performed using standard computer software with p <0.05 considered statistically significant. RESULTS: A total of 103 patients completed our survey, and 58 (56%) chose ureteroscopy, 26 (25%) chose percutaneous nephrolithotomy and 19 (19%) preferred shock wave lithotripsy as the treatment option. Patients who selected shock wave lithotripsy were increasingly concerned with risk rather than success rate (74% vs 16%, respectively). In contrast, patients who selected percutaneous nephrolithotomy were more concerned with the success rate rather than risk (81% vs 7.5%, respectively). Rates of success and risk were given approximately equal importance by patients selecting ureteroscopy (40% vs 48%, respectively). CONCLUSIONS: Patients who choose percutaneous nephrolithotomy are primarily motivated by a desire to maximize success while the choice of shock wave lithotripsy is primarily motivated by a desire to minimize risks. The majority of patients selected ureteroscopy as a procedure with a balance of moderate risk and moderate success. Understanding the factors driving patient decision making would allow urologists to more effectively manage expectations and provide counseling.