Doppler Sonographic Characteristics and Clinical Outcomes of Diabetic Foot Syndrome: A 5-Year Audit from a Tertiary Hospital in Northern Nigeria.

Background: Diabetes foot syndrome is one of the common complications of diabetes. Detailed information on the clinical and vascular characteristics of patients with diabetic foot disease in relation to the outcome of the care provided to these patients will be useful to policymakers and clinicians in early detection and timely interventions for the prevention of disabling complications. Materials and Methods: This is a review of patients with diabetic foot managed in Aminu Kano Teaching Hospital over 5 years (January 2017-May 2022). The sociodemographic characteristics, Wagner classification of the foot, Doppler sonographic characteristics and clinical outcomes, etc., were reviewed. Results: A total of 51 patients were reviewed. Males and females accounted for 56.8% and 43.1%, respectively. Twenty-five patients had Wagner grade 4 ulcers, and fewer patients had Wagner grade 1 and 5-foot ulcers. The mean ± standard deviation Doppler arterial intimal media thickness was 1.53 ± 0.33 (range 0.90-2.40 mm). The majority of DFS patients had Doppler sonographic lesions on the right lower limb 28 (54.9%) only, and 11 (21.6%) of the lesions were bilateral. The posterior tibial artery 11 (21.6%) was the most involved arterial segment with plaques, followed by a combination of popliteal and tibial arterial 10 (19.6%) segments. At 6 months, 45.2% had limb amputation, 17.6% healed ulcers, 17.6% delayed wound healing, and 9.8% died. Conclusion: There is an unacceptably high prevalence of poor treatment outcomes, thus, contributing to a huge burden of care to patients living with diabetes. There is a strong association between severe arterial stenosis detected by Doppler ultrasound and higher rates of amputations.

Auditing the Findings of Computed Tomographic Angiographic Examinations Using 160-Slice Scanner: Analysis of 5-Year Experiences from Northwestern Nigeria.

Background: Computed tomographic angiography (CTA) is a promising tool for the rapid characterisation of the anatomy and structural lesions of the vascular system. Aim/Objectives: The aims/objectives of the study were to determine the frequency and pattern of vascular lesions in northern Nigeria. We also set to determine the agreement between clinical and CTA diagnosis of vascular lesions. Materials and Methods: We study patients that had CTA studies over a 5-year period. In total, 361 patients were referred for CTA, but only the records of 339 of them were retrieved and analysed. The information about patients' characteristics, clinical diagnosis, and the findings on CTA was also retrieved and analysed. The categorical data results were expressed as proportions and percentages. The Cohen's kappa coefficient (κ statistic) was used to determine the agreement between the clinical and CTA findings. A P value of <0.05 was considered statistically significant. Results: The mean (standard deviation) age of the subjects was 49.3 (17.9) years with a range of 1-88 years, consisting of 138 (40.7%) females. Up to 223 patients had various abnormalities on CTA. There were 27 (8.0%) cases of aneurysms, eight (2.4%) cases of arteriovenous malformations, and 99 (29.2%) cases of stenotic atherosclerotic disease. There was a significant agreement between the clinical diagnosis and corresponding findings on CTA showed for intracranial aneurysms (k = 15.0%; P < 0.001), for pulmonary thromboembolism (k = 4.3%; P < 0.001), and for coronary artery disease (k = 34.5%; P < 0.001). Conclusions: The study found that close to 70% of the patients referred for CTA have abnormal findings, out of which stenotic atherosclerosis and aneurysm are the common findings. Our findings highlighted the diagnostic value of CTA variety of clinical conditions and underscored the prevalence of many vascular lesions in our environment, which hitherto were regarded as uncommon.

Changes in opthalmic artery doppler velocimetry in women with preeclampsia in Kano, Nigeria.

Background: Hypertensive disorders in pregnancy are among the most serious complications of pregnancy and represent important contributors to maternal and neonatal morbidity and mortality worldwide. Preeclampsia (PE)-eclampsia syndrome is the most important hypertensive gestational condition. Maternal ophthalmic artery Doppler velocimetry enables the identification of pregnant women with increased cerebral blood flow who are at risk of developing severe PE and eclampsia. Hence the need to determine the changes in ophthalmic artery Doppler velocimetric indices in PE in Kano,Nigeria becomes paramount. Materials and Methods: Ninety-six patients with the clinical diagnosis of PE and 96 normotensive pregnant controls between 20 and 40 weeks' gestational age were recruited for this study. Ophthalmic artery Doppler velocimetric indices of the two groups were measured and documented. Results: The mean velocimetric measurements in the control group were as follows: peak systolic velocity (PSV) = 38.04 ± 13.68 cm/s, End-diastolic volume (EDV) =9.14 ± 3.65 cm/s, resistivity index (RI) = 0.75 ± 0.091, pulsatility index (PI) =1.62 ± 0.55, peak mesodiastolic velocity (PMDV) = 21.02 ± 8.83 cm/s, peak ratio (PR) = 0.56 ± 0.14. The mean velocimetric indices in the PE group were PSV = 44.59 ± 11.54 cm/s, EDV = 12.23 ± 2.66 cm/s, RI = 0.71 ± 0.069, PI = 1.67 ± 0.42, PMDV = 32.27 ± 9.12 and PR = 0.72 ± 0.10. Conclusion: There is a significant difference in the ophthalmic artery Doppler velocimetric indices between women with PE and normal pregnant women. Ophthalmic artery Doppler ultrasound is a useful tool in monitoring the hemodynamic changes in cerebral circulation in PE.

Résumé Contexte: Les troubles hypertensifs de la grossesse font partie des complications les plus graves de la grossesse et représentent des contributeurs importants à la morbidité et à la mortalité maternelles et néonatales dans le monde. Le syndrome de pré-éclampsie-éclampsie est la condition gestationnelle hypertensive la plus importante. La vélocimétrie Doppler de l'artère ophtalmique maternelle permet d'identifier les femmes enceintes présentant un débit sanguin cérébral accru qui risquent de développer une pré-éclampsie et une éclampsie sévères. D'où la nécessité de déterminer par échographie les changements des indices vélocimétriques Doppler de l'artère ophtalmique dans la pré-éclampsie à Kano, au Nigeria. Méthodes: Quatre-vingt-seize patientes présentant un diagnostic clinique de prééclampsie et quatre-vingt-seize témoins enceintes normotendues entre 20 et 40 semaines d'âge gestationnel ont été recrutées pour cette étude. Les indices vélocimétriques Doppler de l'artère ophtalmique des deux groupes ont été mesurés et documentés. Résultats: Les mesures vélocimétriques moyennes dans le groupe témoin étaient les suivantes ; PSV (Vitesse systolique maximale) = 38,04 ± 13,68 cm / s, EDV (volume diastolique final) = 9,14 ± 3,65 cm / s, RI (indice de résistivité) = 0,75 ± 0,091, PI (indice de pulsatilité) = 1,62 ± 0,55, PMDV ( Vitesse méso diastolique maximale) = 21,02 ± 8,83 cm / s, PR (rapport maximal) = 0,56 ± 0,14. Les indices vélocimétriques moyens dans le groupe PE (PE) étaient ; PSV = 44,59 ± 11,54 cm/s, EDV = 12,23 ± 2,66 cm/s, RI = 0,71 ± 0,069, PI = 1,67 ± 0,42, PMDV = 32,27 ± 9,12 et PR = 0,72 ± 0,10. Conclusion: Il existe une différence significative dans les indices vélocimétriques Doppler de l'artère ophtalmique entre les femmes atteintes d'EP et les femmes enceintes normales. L'échographie Doppler artérielle ophtalmique est un outil utile pour surveiller les modifications hémodynamiques de la circulation cérébrale dans la prééclampsie. Mots clés : Doppler, Hypertension, Artère ophtalmique, Prééclampsie.

Scoping review: bladder cancer in Nigeria - what are the gaps in clinical care and research?

OBJECTIVES: There are currently no national guidelines regarding bladder cancer treatment and clinical care pathways in Nigeria. The aim of this scoping review was to identify any gaps in the knowledge of epidemiology, clinical care and translational research in order to aid the development of a defined clinical care pathway and guide future research. METHODS: A scoping review was conducted by searching Medline, Ovid Gateway, The Cochrane library and Open Grey literature using predefined search terms from date of inception to June 2020. Studies were included if they discussed the epidemiology or treatment pathway of bladder cancer. All data were charted and were analysed in a descriptive manner. A consultation phase was also conducted consisting of a multidisciplinary team of clinicians and bladder cancer survivors. RESULTS: A total of 19 studies were deemed suitable for inclusion. The themes included the epidemiology of bladder cancer (high prevalence of schistosomiasis), research surrounding the biology of the disease and translational research including potential biomarkers. The consultation phase highlighted some possible sociocultural and infrastructural issues relating to both the diagnosis and treatment of bladder cancer, with poor knowledge of bladder cancer and its symptoms within the general population identified as a key issue. CONCLUSION: Even though the factors surrounding the relationship between schistosomiasis and the histopathology of bladder cancer remain unclear, there is potential for screening for schistosomiasis in endemic regions of sub-Saharan Africa. Other key areas for future research include the dissemination of information to the general population surrounding bladder cancer and its symptoms to encourage prompt diagnosis.

Doppler velocimetry indices of human immunodeficiency virus-positive pregnant women and their controls at Aminu Kano Teaching Hospital, Kano.

Background: Nigeria is among the countries having a large number of human immunodeficiency virus (HIV)-infected people in Africa with growing number of HIV-positive children, mainly infected by their mothers. Traditional tests diagnose high-risk fetuses very late. Doppler sonography has a potential for detecting high at-risk fetus at a much early stage, so that appropriate measures could be instituted to improve outcomes. This study compared umbilical artery velocimetric parameters among HIV-positive women on highly active antiretroviral therapy (HAART) and their matched controls to determine the possible abnormalities and correlates. Methodology: This was a comparative study that was conducted among HIV-positive pregnant women and their matched controls (HIV-negative pregnant women matched for gestational age and parity) at Aminu Kano Teaching Hospital. History and physical examination, transabdominal ultrasound examination were done on each subject to obtain the basic obstetric parameters. Detailed evaluations of the umbilical arteries on gray scale and duplex Doppler protocols using a 3.5-MHz curvilinear transducer were also done. The data were analyzed using SPSS Version 19.0. Independent samples t-test was used for continuous data. Chi-square test and Fisher's exact test were used for categorical data. P < 0.05 was considered statistically significant. Results: The mean age ± standard deviation (SD) was 30.8 ± 5.50 and 27.6 ± 5.34 for HIV and control groups, respectively. The mean amniotic fluid indices and that of estimated fetal weight for the HIV and control groups showed no statistically significant difference between the two groups. The mean (±SD) umbilical artery diameter of the HIV-infected mothers is wider than their negative controls. Conclusion: The study showed no statistically significant difference between the Doppler indices of HIV-positive pregnant women on HAART and their matched controls.

RésuméContexte: Le Nigéria fait partie des pays ayant un grand nombre de personnes infectées par le virus de l'immunodéficience humaine (VIH) en Afrique avec un nombre croissant d'enfants séropositifs, principalement infectés par leur mère. Les tests traditionnels diagnostiquent très tardivement les fœtus à haut risque. L'échographie Doppler a un potentiel pour détecter les fœtus à haut risque à un stade beaucoup plus précoce, de sorte que des mesures appropriées pourraient être instituées pour améliorer les résultats. Cette étude a comparé les paramètres vélocimétriques de l'artère ombilicale chez les femmes séropositives sous traitement antirétroviral hautement actif (HAART) et leurs témoins appariés pour déterminer les anomalies et les corrélations possibles. Méthodologie: Il s'agit d'une étude comparative menée auprès de femmes enceintes séropositives et de leurs témoins appariés (femmes enceintes séronégatives appariées pour l'âge gestationnel et la parité) à l'hôpital universitaire Aminu Kano. Anamnèse et examen physique, échographie transabdominale ont été réalisés sur chaque sujet pour obtenir les paramètres obstétricaux de base. Des évaluations détaillées des artères ombilicales sur des protocoles d'échelle de gris et Doppler duplex à l'aide d'un transducteur curviligne de 3,5 MHz ont également été effectuées. Les données ont été analysées à l'aide de SPSS version 19.0. Un test t d'échantillons indépendants a été utilisé pour les données continues. Le test du chi carré et le test exact de Fisher ont été utilisés pour les données catégorielles. P <0,05 était considéré comme statistiquement significatif. Résultats: L'âge moyen ± écart type (ET) était de 30,8 ± 5,50 et 27,6 ± 5,34 pour le VIH et les groupes témoins, respectivement. Les indices moyens du liquide amniotique et celui du poids fœtal estimé pour les groupes VIH et contrôle n'ont montré aucune différence statistiquement significative entre les deux groupes. Le diamètre moyen (± ET) de l'artère ombilicale des mères infectées par le VIH est plus large que leurs témoins négatifs. Conclusion: L'étude n'a montré aucune différence statistiquement significative entre les indices Doppler des femmes enceintes séropositives sous HAART et leurs témoins appariés.