Sclerosing encapsulating peritonitis: A rare cause of intestinal obstruction in 2 patients.

Sclerosing encapsulating peritonitis is a very rare cause of intestinal obstruction. It usually follows peritoneal dialysis. The idiopathic form is also called abdominal cocoon and is more common in tropical and subtropical regions. We hereby present the clinical histories and imaging findings of 2 confirmed cases of sclerosing encapsulating peritonitis who presented with chronic symptoms of bowel obstruction.

Cystic Fibrosis in an Adolescent: A "Miranda Warning" Against Blaming TB-A Case-Based Scholarly Update.

Cystic fibrosis (CF) is a multisystem disorder that occurs as a result of autosomal recessive congenital transmission of CF transmembrane conductance regulator (CFTR) gene mutation on chromosome 7. Because it is considered a disease of the Caucasian pediatric population or due to lack of awareness, it is rarely considered in developing countries like ours. This case report presents the first case of cystic fibrosis ever reported in Ethiopia and possibly East Africa, that of a 17-year-old female diagnosed with the disease following a CT scan of her abdomen and chest. She was initially misdiagnosed and treated for tuberculosis (TB) as she was a chronic cougher. Perhaps due to epidemiological evidence, there is an obstinate tendency of blaming tuberculosis (TB) for almost every case of chronic cough with fibro-bronchiectatic lung parenchymal changes in Ethiopia. Once a diagnosis of TB is posted on such patients, their diagnosis remains in the circle of TB reinfection, relapse or resistance, followed by multiple phases of anti-mycobacterial drugs. This could lead to hazardous implications, including unnecessary prolonged anti-mycobacterial treatments, possibility of developing drug resistance, and mismanagement-related patient morbidity. This patient's chest and abdominal CT findings, including bronchiectasis, hepatic steatosis, pancreatic lipomatosis, micro-gallbladder and proximal colonic wall thickening, led to the diagnosis of CF. This article, presenting the first documented case of CF in the region, is meant to be a helpful reminder for clinicians and radiologists to also consider presumably "rare" illnesses like CF rather than blaming TB for every chronic cough and highlights the importance of abdominal CT features in the diagnosis of CF.

High Magnitude Advanced Colorectal Cancer at Diagnosis in Ethiopian Patients: Imaging Pattern and Associated Factors.

Background: Colorectal cancer (CRC) is one of the most prevalent and incident cancers worldwide with an Increasing prevalence in a younger age in developing countries. The aim of the study was to determine the staging and imaging pattern of CRC at diagnosis. Methods: This is a descriptive cross-sectional study including all consecutive cases of CRC found in the departments of radiology and oncology during the study period from March 2016 - February 2017. Results: A total of 132 CRC cases were studied with M: F = 2.4:1, mean age of 46yrs and 67.4%

Bone quality in fluoride-exposed populations: A novel application of the ultrasonic method.

BACKGROUND: Various studies, mostly with animals, have provided evidence of adverse impacts of fluoride (F-) on bone density, collagen and microstructure, yet its effects on overall bone quality (strength) has not been clearly or extensively characterized in human populations. OBJECTIVE: In this observational study, we assessed variation in an integrated measures of bone quality in a population exposed to wide-ranging F- levels (0.3 to 15.5 mg/L) in drinking water, using a novel application of non-ionizing ultrasonic method. METHOD: We collected 871 speed of sound (SOS) measurements from 341 subjects residing in 25 communities, aged 10-70 years (188 males and 153 females). All subjects received scans of the cortical radius and tibia, and adults over the age of 19 received an additional scan of the phalanx. Associations between F- in drinking water and 24-h urine samples, and SOS as a measure of bone quality, were evaluated in bivariate and multivariable regressions adjusting for age, sex, BMI, smoking, and toothpaste use. RESULTS: We found negative associations between F- exposure and bone quality at all three bones. Adult tibial SOS showed the strongest inverse association with F- exposure, which accounted for 20% of the variance in SOS measures (r = 0.45; n = 199; p < 0.0001). In adjusted analysis, a 1 mg/L increase in F- in drinking water was related to a reduction of 15.8 m/s (95% CI: -21.3 to -10.3), whereas a 1 mg/L increase in 24-h urinary F- (range: 0.04-39.5 mg/L) was linked to a reduction of 8.4 m/s (95% CI: -12.7, -4.12) of adult tibial SOS. Among adolescents, in contrast, weaker and non-significant inverse associations between F- exposure and SOS were found, while age, gender, and BMI were more significant predictors than in adults. CONCLUSIONS: These results are indicative of a fluoride-induced deterioration of bone quality in humans, likely reflecting a combination of factors related to SOS: net bone loss, abnormal mineralization and collagen formation, or altered microarchitecture. The portable and low-cost ultrasound technique appears potentially useful for assessment of bone quality, and should be tested in other locations and for other bone-related disorders, to assess the feasibility of its more extensive diagnostic use in hard-to-reach rural regions.

Vitamin D3 Status and the Association with Human Cathelicidin Expression in Patients with Different Clinical Forms of Active Tuberculosis.

Low vitamin D (vitD3) is one of the most common nutritional deficiencies in the world known to be associated with numerous medical conditions including infections such as tuberculosis (TB). In this study, vitD3 status and its association with the antimicrobial peptide, human cathelicidin (LL-37), was investigated in Ethiopian patients with different clinical forms of TB. Patients with active TB (n = 77) and non-TB controls (n = 78) were enrolled in Ethiopia, while another group of non-TB controls (n = 62) was from Sweden. Active TB included pulmonary TB (n = 32), pleural TB (n = 20), and lymph node TB (n = 25). Concentrations of 25-hydroxyvitamin D3 (25(OH)D3) were assessed in plasma, while LL-37 mRNA was measured in peripheral blood and in samples obtained from the site of infection. Median 25(OH)D3 plasma levels in active TB patients were similar to Ethiopian non-TB controls (38.5 versus 35.0 nmol/L) and vitD3 deficiency (.

LATENT TUBERCULOSIS AMONG ADULT ETHIOPIAN PATIENTS AT CHEST CLINIC, TIKURANBESSA SPECIALIZED HOSPITAL, ADDIS ABABA, ETHIOPIA.

Background: One-third of the world population is infected with Mycobacterium tuberculosis. Most people exposed to M. tuberculosis showed no evidence of active disease. About 5-10% of people with latent tuberculosis infection (LTBI) without HIV will progress to develop active tuberculosis (TB) in their lifetimes. This study was conducted to determine the magnitude of latent TB among the adult population at a teaching and referral Hospital in Ethiopia. Methods: This study was conducted at the Chest clinic of Tikur Anbessa Specialized Hospital during 2010-2013. The study was a cross-sectional study conducted among healthy adults after informed consent was obtained from each individual. Tuberculin skin test (TST) and Interferon Gamma whole blood assay (Quantiferon-Tuberculosis- Gold) was performed using enzyme linked immuno-sorbent assay. Average CD4, CD8, CD3 and CD4:CD8 ratio was determined for all study participants. Results: From a total of 70 healthy adults tested for LTBI using Quantiferon Gold, 45(64%) tested positive and 25 (36%) were negative for latent tuberculosis infection. From the 66 healthy individuals who were tested using TST for LTBI, 42 (62%) individuals were TST positive and 25 (38%) individuals were TST negative. Average CD4, CD8, CD3 and CD4:CD8 ratio was 748, 598, 1401 and 1.4, respectively. Conclusions: The magnitude of latent tuberculosis infection was high in this study, which reflects existing high prevalence of TB. TST and Quantiferon-Tuberculosis-Gold assay show similar efficacy for the diagnosis of LTBI in healthy Ethiopian adults. The absolute CD4 T-cell counts of healthy HIV- negative Ethiopians are considerably lower than CD4 T cell counts in other countries.

REVIEW OF THE CLINICAL, COMPUTERIZED TOMOGRAPHY SCAN AND/OR MAGNETIC RESONANCE IMAGING FINDINGS OF INTRACRANIAL TUBERCULOMA IN AN ETHIOPIAN TEACHING HOSPITAL.

ackground: Ethiopia is one of the countries that has high burden of all forms of tuberculosis and there is no published report on computerized tomography scan and/or magnetic resonance imaging of intracranial tuberculomas. Objective : to review the clinical, computerized tomography and/or magnetic resonance imaging features of intracranial tuberculoma. Methods: retrospective review of patient's medical records of patients operated for intracranial mass that had computerized tomography and/or magnetic resonance imaging brain scans and had histopathological diagnoses, at Tikur Anbessa Specialized Hospital between January 2009 and June 2013. Results: Of 222 operated cases of intracranial mass subjected to histopathological test 29 (14.6%) were found to have tuberculomas, 28 (14.1%) had caseous necrosis and one was a tuberculous abscess, in 25 cases imaging was available for review and were included in the study . There were 15 males and 10 females with age range being 2 to 65 years and with the Median age being 13 years. Twenty patients had computerized tomography and five patients had magnetic resonance imaging. Seizure 15/25 (60%) and headache 11/25 (44%) were the commonest presentation. Solitary or confluent large lesions were seen in 12/25 (48%) of patients. 14/25 (56%) of the lesions had their size between 2 cm and 5 cm. Majority of the lesions 15/25 (60%) were in the frontal and parietal lobes. The lesions were isodense on CT in 18/25 (72%) of the pre-contrast studies and 21/25 (84%) showed ring or rim enhancement after intravenous administration of the contrast medium. Conclusion: Tuberculoma, more frequently, presented with non-specific clinical findings and chronic seizure disorder and comonly occurred in young patients and often seen infratentorialy. It is often complicated with hydrocephalus in the pediatric age group. Computerized tomography scan and/or magnetic resonance imaging features are not different from reports from other countries.

Review of the clinical, computerized tomography scan and/or magnetic resonance imaging findings of intracranial tuberculoma in an Ethiopian teaching hospital

Background: Ethiopia is one of the countries that has high burden of all forms of tuberculosis and there is no published report on computerized tomography scan and/or magnetic resonance imaging of intracranial tuberculomas. Objective : to review the clinical, computerized tomography and/or magnetic resonance imaging features of intracranial tuberculoma. Methods: A retrospective review of patient's medical records of patients operated for intracranial mass that had computerized tomography and/or magnetic resonance imaging brain scans and had histopathological diagnoses, at Tikur Anbessa Specialized Hospital between January 2009 and June 2013.Results: Of 222 operated cases of intracranial mass subjected to histopathological test 29 (14.6%) were found to have tuberculomas, 28 (14.1%) had caseous necrosis and one was a tuberculous abscess, in 25 cases imaging was available for review and were included in the study . There were 15 males and 10 females with age range being 2 to 65 years and with the Median age being 13 years. Twenty patients had computerized tomography and five patients had magnetic resonance imaging. Seizure 15/25 (60%) and headache 11/25 (44%) were the commonest presentation. Solitary or confluent large lesions were seen in 12/25 (48%) of patients. 14/25 (56%) of the lesions had their size between 2 cm and 5 cm. Majority of the lesions 15/25 (60%) were in the frontal and parietal lobes. The lesions were isodense on CT in 18/25 (72%) of the pre-contrast studies and 21/25 (84%) showed ring or rim enhancement after intravenous administration of the contrast medium.Conclusion: Tuberculoma, more frequently, presented with non-specific clinical findings and chronic seizure disorder and commonly occurred in young patients and often seen infratentorialy. It is often complicated with hydrocephalus in the pediatric age group. Computerized tomography scan and/or magnetic resonance imaging features are not different from reports from other countries

Latent tuberculosis among adult Ethiopian patients at chest clinic, Tikuranbessa specialized hospital, Addis Ababa, Ethiopia

Background: One-third of the world population is infected with mycobacterium tuberculosis. Most people exposed to mycobacterium tuberculosis showed no evidence of active disease. About 5-10% of latent tuberculosis infection without HIV will progress to developed active tuberculosis in their lifetimes. This study was conducted to determine the magnitude of Latent TB among the adult population at a teaching and referral Hospital in Ethiopia.Methods: This study was conducted at the Chest clinic of Tikur Anbessa Specialized Hospital during 2010-2013.The study was a cross-sectional study conducted among healthy adults after informed consent was obtained from each individual. Tuberculin skin test and Interferon Gamma whole blood assay (Quantiferon-Tuberculosis-Gold) was performed using Enzyme linked Immuno-sorbent Assay. Average CD4, CD8, CD3 and CD4:CD8 ratio was determined for all study participants. Results:From a total of 70 healthy adults tested for latent tuberculosis infection using Quantiferon Gold,45(64%) tested positive and 25 (36%) were negative for latent tuberculosis infection. From the sixty six healthy individuals who were tested using tuberculin skin test for latent tuberculosis infection, 42 (62%) individuals were Tuberculin skin test positive and 25 (38%) individuals were Tuberculin skin test negative. Average CD4, CD8, CD3 and CD4:CD8 ratio was 748, 598, 1401 and 1.4, respectively. Conclusions: The magnitude of latent tuberculosis infection was high in this study, which reflects existing high prevalence of tuberculosis.Tuberculin skin test and Quantiferon-Tuberculosis-Goldassay show similar efficacy for the diagnosis of latent tuberculosis infection in healthy Ethiopian adults. The absolute CD4 T-cell counts of healthy HIV-negative Ethiopian's are considerably lower than other countries

EVALUATING THE VALIDITY AND RELIABILITY OF CHEST RADIOGRAPHY IN THE DIAGNOSIS OF TUBERCULOSIS AMONG SMEAR NEGATIVE PULMONARY TUBERCULOSIS PATIENTS.

BACKGROUND: Tuberculosis (TB) is a mycobacterial infection mainly affecting the lungs. Early and correct diagnosis of sputum smear negative patients by chest radiography (CXR) is challenging since it depends on reader's ability to detect abnormal findings and to interpret it correctly. OBJECTIVES: To evaluate the validity and reliability of CXR the diagnosis of TB among smear negative pulmonary tuberculosis (PTB). METHODS: An institutional based cross-sectional study was conducted at seven selected health facilities from October 2011 to September 2012 on 159 adults aged 18 years and above who were newly diagnosed smear negative for PTB patients diagnosed using Chest X-ray (CXR). Morning sputum was collected and cultured from each patient using Lowenstein Jensen media. All the CXRs were revised by senior radiologists in conjunction with the principal investigator. A structured questionnaire was used to collect socio-demographic, clinical and radiological data. Sensitivity and specificity measures of the CXR findings were calculated in comparison to the gold standard sputum culture results. RESULTS: The mean (SD) age of patients involved in the study was 37.1 (16.7), ranging from 18 to 87 years. Of the total 159 smear negative PTB patients, the most common CXR finding was consolidation (40.3%) followed by cavitations (23.9%) and nodular lesions (17.0%). Sputum culture results showed that, 47 (29.6%) were culture positive, 103 (64.7%) were culture negative and 9 (5.6%) were contaminated. About 14% (22/159) of the study subjects were HIV positive. The sensitivity and specificity of CXR findings were 77.1% (37/48) and 36.9% (41/111), respectively. The positive and negative predictive values were 34.6% (3 7/107) and 78.8% (41/52), respectively. CONCLUSION: CXR can be used as supportive investigative modality to diagnose smear negative Pulmonary TB in conditions where TB culture is no more feasible.

Current Efavirenz (EFV) or ritonavir-boosted lopinavir (LPV/r) use correlates with elevate markers of atherosclerosis in HIV-infected subjects in Addis Ababa, Ethiopia.

BACKGROUND: HIV patients on antiretroviral therapy have shown elevated incidence of dyslipidemia, lipodystrophy, and cardiovascular disease (CVD). Most studies, however, focus on cohorts from developed countries, with less data available for these co-morbidities in Ethiopia and sub-Saharan Africa. METHODS: Adult HIV-negative (n = 36), treatment naïve (n = 51), efavirenz (EFV)-treated (n = 91), nevirapine (NVP)-treated (n = 95), or ritonavir-boosted lopinavir (LPV/r)-treated (n=44) subjects were recruited from Black Lion Hospital in Addis Ababa, Ethiopia. Aortic pressure, augmentation pressure, and pulse wave velocity (PWV) were measured via applanation tonometry and carotid intima-media thickness (cIMT) and carotid arterial stiffness, and brachial artery flow-mediated dilation (FMD) were measured via non-invasive ultrasound. Body mass index, waist-to-hip circumference ratio (WHR), skinfold thickness, and self-reported fat redistribution were used to quantify lipodystrophy. CD4+ cell count, plasma HIV RNA levels, fasting glucose, total-, HDL-, and LDL-cholesterol, triglycerides, hsCRP, sVCAM-1, sICAM-1, leptin and complete blood count were measured. RESULTS: PWV and normalized cIMT were elevate and FMD impaired in EFV- and LPV/r-treated subjects compared to NVP-treated subjects; normalized cIMT was also elevated and FMD impaired in the EFV- and LPV/r-treated subjects compared to treatment-naïve subjects. cIMT was not statistically different across groups. Treated subjects exhibited elevated markers of dyslipidemia, inflammation, and lipodystrophy. PWV was associated with age, current EFV and LPV/r used, heart rate, blood pressure, triglycerides, LDL, and hsCRP, FMD with age, HIV duration, WHR, and glucose, and cIMT with age, current EFV use, skinfold thickness, and blood pressure. CONCLUSIONS: Current EFV- or LPV/r-treatment, but not NVP-treatment, correlated with elevated markers of atherosclerosis, which may involve mechanisms distinct from traditional risk factors.

Epidural and para spinal thoracic hydatidosis presenting with progressive paraparesis and paraplegia: a case report.

We report a 16 year old male patient from rural Ethiopia with pathologically and intraoperatively proven thoracic para spinal and epidural hydatidosis, a very rare involvement, who presented with progresive both lower limb weakness, loss of pain, touch and properioception and double incontinence of two weeks prior to hospital admission. The pathological, radiological (MRI and plain x-ray) and the intra operative findings are briefly discussed with literature review.

ABDOMINAL LYMPHOMA: IMAGING WORK UP CHALLENGES AND RECOMMENDATIONS IN RESOURCE LIMITED SETUP.

Lymphoma management begins with an accurate diagnosis & staging. Major advances in imaging techniques, make cross sectional imaging and nuclear medicine technique an excellent tool for patient work up. However, limited access to modern imaging modality in resource limited set up and luck of standardized imaging work up challenged patient's management. Assess the local lymphoma imaging work up and management challenges in patients with lymphoma and develop local imaging and reporting guideline. A semistructured qualitative interview to six conveniently selected physicians (hematologists, oncologists & pathologists) who primarily takes care of lymphoma patient and literature review on the role of various imaging modalities, recommendation and experience of other countries were used as a methodology Conventional and basic imaging modalities are used in the work up of patient in our set up. The imaging recommendation for these patients requires at least CT of the chest, abdomen and pelvis for initial diagnosis and FDG-PET and/or PET-CTfor follow up and recurrence. Due to the comparable diagnostic potentials of US and its wide spread availability, makes US still the primary imaging modality. Luck of required information's and inconsistency in the radiologists report found to challenge physicians in their patient management. The study concluded that US should still stay as the most important imaging modality in the initial treatment, staging and follow up patients in resource limited set up. It also recommended the general imaging work up and reporting framework.

Diagnostic performance of transvesical ultrasound in clinically suspected ectopic pregnancy in a public and tertiary hospital setup.

BACKGROUND: Ectopic pregnancy consists 1.2 to 1.4% of all reported pregnancies and an increasing accordance has been documented in many parts of the world OBJECTIVE: To evaluate the performance of transvesical ultrasound (TVS) in the diagnosis of ectopic pregnancy in the public hospital setup. METHODS: Review of medical records of 117 patients who were admitted to St Paul's Hospital with the diagnosis of ectopic pregnancy between the years 2005 and 2008 was made. Data on demographic & clinical information, and laboratory investigations done and transvesical ultrasound records were collected. Outcomes after Laparatomy were used as confirmations or gold standard for final diagnosis. RESULTS: Of the 117 admitted patients for ectopic pregnancy, 99 (84.6%) had transvesical ultrasound done & in 65 (65.9%) of those 99 patients, it suggested diagnosis of ectopic pregnancy. Sixty-four (55%) had pervaginal bleeding and lower abdominal pain as presenting complaint. Documentation of uterine, adnexal & cul-de-sac findings fall the three diagnostic variables) was noted in 71/99 (71.7%) two of the three and only one of the three diagnostic variables were seen 20.2% and 8.1% of the sonographic studies respectively. Of patients whose ultrasound report suggested ectopic pregnancy, in 46 (70.8%) a complex adnexal mass and in 33 (50.8%) moderate to large amount of cul-de-sac fluid, and in 9 (19.8%) patients fluid in the uterine cavity were detected The overall sensitivity and specificity of transvesical ultrasound study in the diagnosis of ectopic pregnancy were 83.3% and 33.3% respectively, with positive & negative predictive values of 73.5% and 47.4% respectively and accuracy of 68%. CONCLUSION: About 83.3% of admitted patients were diagnosed sonographically to have ectopic gestation prior to surgery. Quality of the ultrasound report with respect to completeness in number of sonographic diagnostic variables has a statistically significant (P < 0.05) role in enhancing the accuracy of transvesical ultrasonography in the diagnosis and exclusion of ectopic pregnancy.

A case report of left sided IVC with retroaortic right renal vein and hemiazygos continuation.

A case report of a left sided IVC with hemiazygos continuation and retro aortic right renal vein in a 45 year old female is described here with discussion of embryogenesis of this anomaly and its clinical importance. The anomaly was first observed on computer tomographic images performed for a different purpose. Doppler ultrasound done afterwards then showed absence of hepatic segment of the IVC and a retro aortic right renal vein. As far as our search is concerned this is the first report of its kind in Ethiopia.

CT and color Doppler diagnosis of the vein of Galen malformations with hydrocephalus: a case series report of rare intracranial vascular malformations.

Arteriovenous malformations are uncommonly occurring congenital conditions and great vein of Galen malformations are rare form of arteriovenous malformations. Aneurysmal dilatation of the median prosencephalic vein of Markowski is responsible for the clinical presentation of patients and most children manifest the disease during infancy. We present three cases of great vein of Galen malformations, presenting to Tikur Anbessa hospital, one with thrombosis and communicating hydrocephalus; the other two with obstructive hydrocephalus and no thrombosis. All patients have markedly dilated intracranial veins with vascular enhancement pattern in venous phase of brain CT scan. Physicians should be aware of different radiological presentations of vein of Galen malformations and different clinical presentation of these cases. Very rarely the vein of Galen malformation can have thromboses and obliteration of itself The clinicians should also know that CT scan and MRI are the corner stones for the diagnosis of vein of Galen malformations but more fetuses are diagnosed with VGM in the uterus by ultrasound during ANC.

A 52-year-old lady with post operative reversible blindness and hemiparesis.

A 52-year-old lady developed cortical blindness followed by left sided hemiparesis after cholecystectomy, both of which resolved remarkably. A diagnosis of posterior reversible encephalopathy syndrome (PRES) was made based on characteristic clinical and MRI features.

Epidemiology of skeletal fluorosis in Wonji Shoa Sugar Estate, Wonji, Ethiopia: a community based survey.

INTRODUCTION: Endemic skeletal fluorosis is a form of chronic fluoride intoxication resulting from ingestion of excessive quantities of fluoride through drinking water. It is an important public health problem in parts of several developing countries including Ethiopia. OBJECTIVE: The aim of this study is assess the magnitude of the problem at the community level. MATERIALS AND METHODS: This community based, cross-sectional study was undertaken in Wonji-Shoa Sugar Estate. (WSSE). A base line census of the adult population of WSSE was carried out at the beginning of the study. A total of 578 subjects were selected by simple random sampling using a sampling frame which was prepared from the census results. For each study participant, information on socio-demographic characteristics, possible risk factors gathered and X-ray of the forearm PA and Lateral were taken using standard x-ray techniques. RESULTS: The overall prevalence of skeletal fluorosis is 65.7%, with male to female prevalence ratio of 79.3% vs. 53%. The crude analysis of factors associated with skeletal fluorosis shows that, males than females and manual workers than others had significantly higher risk (Crude OR = 3.39, 95% CI = 2.31-4.95 and OR = 3.22, 95% CI = 2.20-4.72 respectively). On logistic regression, only sex, age and camp of residence remained significantly associated with skeletal fluorosis. Adjusted for other factors, males were more likely (about 2.5 times to be at risk than females and older people of age 55 years and above had about 20 times higher risk than young adults of age 15-24. CONCLUSION: The finding of very high prevalence of radiological skeletal fluorosis (SKF) in this study highlights the importance of endemic SKF as a public health problem. Therefore, prompt measures are required to provide the community with safe drinking water to prevent development of crippling skeletal fluorosis.

Clinical and neuroimaging profile of HIV-1 encephalopathy in infancy and childhood in a sub-Saharan African country.

BACKGROUND: Neurological dysfunction in AIDS is common, occurring in as many as eighty percent of children. Thus, it is important to recognize the central nervous system imaging appearance of HIV, in particular those of HIV encephalopathy, as this is an AIDS defining illness and with distinct neuro-imaging features essential for early diagnosis and timely therapeutic intervention AIM: To identify the clinical features in HIV-1 infection of the central nervous system and their associated neuroradiological correlates. METHODS: Retrospective review of the records of all children with HIV-1 encephalopathy identified among children with neurological and developmental problems and who were on follow up at a child development and neurology clinic in an African city. RESULTS: A total of 22 children (10 male and 12 female) with HIV-1 encephalopathy were identified among 2382 children with various forms of neurological and developmental problems and who were on follow up at a child development and neurology clinic for a little bit over eight years period. All the children acquired the infection vertically. The age range of these children was between 10 months to 14 years. The median age was 5.6 years. The mean duration of symptom was 3.2 years. Global delay or regression in development along with signs of pyramidal tract involvement and seizures were the commonest clinical signs observed in these children. Neuro-behavioral problems were commonly observed among preschool and school aged children. In older children and preadolescents focal seizures with or with out neurologic deficit and neuroradiological findings were common. Nonhemorrhagic stroke was rare and occurred in one child and another child had cortical blindness. Three children had no neurological deficit. Rapid progression of the disease carried grave prognosis. Opportunistic infections and tumors of the central nervous system were also uncommon among these children. Brain volume loss with dilatation of the lateral ventricle, bilateral symmetrical or asymmetrical calcification of the basal ganglia and periventricular involvement of the white matter were the commonest neuro-radiological findings observed in these children. CONCLUSION: Atrophy of the brain with dilatation of the lateral ventricles and calcification of the basal ganglia and peri-ventricular involvement of the white matter were the commonest neuro-radiological findings in children with HIV-1 encephalopathy. Similarly global delay or regression in development along with pyramidal tract signs and seizures were the commonest neurological findings. Behavioral problems were common in preschool and school aged children. Focal seizures were common in older children and preadolescents. Rapid progression of the disease carried grave prognosis.

Basal ganglia calcification with hypoparathyroidism: a case report.

Basal ganglia calcification is rare before forty years. The causes for calcification are too many. If it occurs before forty years of age, it should be considered as pathological unless proved otherwise. In this case report, we will present a seventeen year boy who has pathological calcification in the basal ganglia with hypoparathyroidism.