Impact of ultrasound scanning on pregnant Women's compliance with attendance at antenatal care visits and supervised delivery at primary healthcare centres in northern Nigeria: Initial experiences.

INTRODUCTION: The world health organisation (WHO) recommends at least one ultrasound scan amidst eight antenatal care visits, however, most pregnant women in low and middle-income countries do not achieve this. This study aims to assess the impact of limited obstetrics ultrasound (LOUS) within primary healthcare centres in northern Nigeria. METHODS: A cross sectional study was conducted across selected primary healthcare centres in Bauchi and Kano States (northern Nigeria). The study protocol was approved by the Ministry of Health in each State. Within each State a total of nine primary healthcare centres were randomly selected. Information on all complete antenatal care (ANC) records of women who used the primary healthcare facility for 12 months prior to introduction of ultrasound (January 2016 to December 2016) and 12 months after (January 2018 to December 2018) were collected. Study data were analysed using descriptive (mean, standard deviations) and inferential statistics. Independent sample t-test were used to find out if there was a statistical difference between the pre and post-intervention data on women compliance to ANC visits, facility based delivery, maternal and child mortality. Data were analysed using the Statistical Package for Social Sciences and significance was set at p ≤ 0.05. RESULTS: There was a significant increase in the number of ANC visits and supervised facility delivery after introduction of ultrasound services (LOUS) in the primary healthcare centres. The number of ANC visits in Kano State was 2637.6 ± 972.0 before and 3793.0 ± 517.5 after the introduction of ultrasound services. The number of ANC visits in Bauchi State was 1866.6 ± 488.3 before and 2854.0 ± 631.3 after the introduction of ultrasound services. The number of supervised facility deliveries in Kano state was 520.1 ± 128.7 before and 1021.1 ± 217.0 after the introduction of LOUS. The number of supervised facility deliveries for Bauchi state was 553.1 ± 309.9 before and 1056.3 ± 295.4 after introduction of LOUS. A total of 2486 (11.0%) women were referred for further imaging due to equivocal ultrasound findings. A total of 2185 (9.7%) pregnant women were referred for appropriate care due to multiple gestations. CONCLUSION: This study found that LOUS, in resource scarce settings, has the potential of improving ANC visits, facility delivery rates and reduce maternal and child mortality. It also leads to change in patient management plans resulting in referrals for appropriate care. IMPLICATION FOR PRACTICE: Technological interventions using ultrasound have the potential to motivate pregnant women to attend ANC, give birth in a healthcare facility and thus reduce maternal and child morbidity and mortality. This is in line with the global drive to reduce maternal and child death by 2030 to less than 70 maternal deaths in 100,000 live births and neonatal mortality reduction to 12 in 1000 live births and under 5 mortality reduction to 25 in 1000 live births.

Renal doppler indices and their correlation with laboratory indices of human immunodeficiency virus sero-positive adult individuals.

INTRODUCTION: Renal Doppler resistive index (RI) and pulsatility index (PI) values are potentially more sensitive at detecting renal abnormalities when compared to standard laboratory indices in patients with HIV/AIDS. To the best of our knowledge, there are no published research articles on renal Doppler indices and their correlation with laboratory indices of HIV sero-positive adult individuals. This study aimed to assess the renal function of HIV-sero-positive adults using RI and PI, and correlating these indices against laboratory values. METHODS: A prospective cross-sectional study was conducted from July 2019 to April 2020. A purposive sampling method was employed and included 396 HIV sero-positive adult individuals. Sampling for the renal RI and PI was performed at the level of the inter-lober arteries, in between the medullary pyramids. An RI value above 0.70 and a PI value above 1.56 were consider abnormal. Serum creatine and urea together with evidence of proteinuria were recorded at the time of scanning. RESULTS: Forty-three (10.9%) men had an abnormal RI, 32 (8.1%) had abnormal PI, five (2.5%) had abnormal creatinine, two (1%) abnormal urea and eight (4.1%) with proteinuria. In women, 29 (7.3%) had abnormal RI, 22 (5.6%) abnormal PI, four (2%) abnormal creatinine and urea and six (3%) had proteinuria. There was a statistically significant weak positive correlation between RI and PI and serum creatinine and urea (r > 0.2, P < 0.05). CONCLUSION: The proportion of patients with abnormal RI and PI was higher than the proportion of participants with abnormal serum urea, creatinine and proteinuria. Renal Doppler indices could be used be used in the early assessment of renal function in HIV sero-positive adults individuals. IMPLICATIONS FOR PRACTICE: Serum creatinine and urea are routinely used to evaluate renal function in patients with HIV/AIDS. Findings from this initial study show that RI and PI could be used detecting early renal abnormalities when compared to standard laboratory values.

Measuring wall shear stress distribution in the carotid artery in an African population: Computational fluid dynamics versus ultrasound doppler velocimetry.

INTRODUCTION: Computational fluid dynamics (CFD) and ultrasound Doppler velocimetry are diagnostic tools useful for determining carotid artery segments susceptible to atheromatous plaque development. This study computes and compares the difference in Wall Shear Stress (WSS) measurements between these two methods. METHODS: The carotid artery of 204 volunteers selected using simple random sampling were scanned using standard carotid doppler protocols. Four segments of the carotid artery - the common, internal, external carotid, and the carotid bulb were sonographically assessed. The intima-media thickness, diameter, peak systolic velocity, and end-diastolic velocity were measured at a point 2 cm away from the carotid bifurcation for the three segments, while the carotid bulb was measured at the bifurcation. A 2D incompressible Navier-Stokes Equation for modelling Newtonian, pulsatile, and laminar flow in a viscoelastic pipe was applied to model velocity flow across the carotid artery using COMSOL software. WSS values were computed for experimental and CFD measurements and the results were compared. RESULTS: The WSS values generated by the model had respectively peak and average values of 19.81 N/cm2 and 15.76 ± 1.81 N/cm2 for the common carotid, 10.77 N/cm2 and 7.57 ± 1.66 N/cm2 for the internal carotid, 11.51 N/cm2 and 8.05 ± 1.65 N/cm2 for the external carotid, 37.55 N/cm2 and 26.55 ± 6.62 N/cm2 for the carotid bifurcation, 1.39 N/cm2 and 3.13 ± 1.34 N/cm2 for the carotid bulb. The model measurements matched doppler velocimetry measurements with <15% variation. CONCLUSION: Model based WSS values were higher but comparable with doppler velocimetry measurements. The carotid bulb had low WSS and is therefore the segment highly disposed to atheromatous plaque formation. IMPLICATIONS FOR PRACTICE: Subject-specific mathematical models could be incorporated during cardiovascular scan work up for accurate WSS distribution and early prediction of possible atherosclerotic sites.

Achieving universal access to obstetric ultrasound in resource constrained settings: A narrative review.

OBJECTIVES: The potential benefits and challenges of achieving universal access to obstetric ultrasound services in resource constrained settings were reviewed, with a view to making some recommendations to address the huge burden of avoidable maternal and child morbidity and mortality. KEY FINDINGS: In most resource-poor settings of the world, antenatal ultrasound is available only to a privileged few in urban centres, while the majority of the population living in rural areas have little or no access to diagnostic imaging services. There is also the extreme shortage of sonographers and doctors with specialist training in sonography. A comprehensive regulation must be put in place to achieve maximum benefits and to ensure quality assurance; appropriate use and application of ethics and training must be comprehensive. CONCLUSION: Ultrasound service provision, in resource-scarce settings, has the potential to improve access and quality of health care services in areas like the point of care ultrasound service provision and in the fields of obstetrics and gynaecology. A comprehensive regulation must be put in place to achieve maximum benefits and to ensure quality assurance. IMPLICATIONS FOR PRACTICE: Making ultrasound technology available and affordable in resource scare settings has the potential to improve access to diagnostic imaging services and reduce avoidable maternal and child death in resource constrained settings.

Awareness of information, expectations and experiences among women for obstetric sonography in a south east Nigeria population.

BACKGROUND: The role of obstetric sonography in the development of diagnostic ultrasound technology has remained invaluable in obstetric and gynaecological investigation. OBJECTIVES: This work investigated the awareness of information, expectations and experiences of pregnant women coming for obstetric sonography. METHODS: One hundred and ten (110) pregnant women in Anambra State of Nigeria were prospectively studied during prenatal ultrasound scan. RESULTS: The mean age of the studied population was 30.5 +/- 14.5 years. Majority (85%) of the subjects were already aware of obstetric ultrasound scan. Most of the subjects were between the ages of 26-35. 73% got their information from antenatal centre. Over 20% were interested in the lies and presentation of their foetus. During the scan, about 69% subjects interested with the sonographers, and more than half of the population (51%) saw their babies. CONCLUSION: The role of prenatal a-sonography in obstetric care should be promoted by creating awareness campaign in antenatal centres, and initiating mother/sonographers interaction are necessary.

Entrance surface dose of the common radiological investigations in Abuth, Zaria.

The entrance surface Dose (ESD) was determined among patients who presented for routine radiological examinations using thermoluminescent dosimeter (TLD) chips placed on averagely built adult [(30 cm) chest width, 60-90kg weight and 20-40years)] by multiplying the incident dose/entrances dose by the back scattered factor [BSF] gotten from an experiment. The values obtained from ESD measurements are as follows 8.03 mGy for Abdomen, 0.13 mGy for chest AP, 0.69 mGy for chest lateral, 0.5 mGy for cervical spine; AP: 0.38 mGy for cervical spine lateral; 4.75 mGy for hip AP: 12.83 mGy for hip lateral: 5.74mGy for lumbar spine, AP lumbar spine lateral is 15.15 mGy. 1.38m Gy is for pelvis AP. 2.93mGy for skull AP/PA 1.2mGy for skull lateral, 5.46mGy for thorax AP, while the lateral is 14.90m Gy. The average dose value is 9.28mGy Range 0.13-14.90mGy (Percentage standard error; +/- 1.45). From this studies Radiation doses delivered for routine investigations are generally lower than IAEA reference doses. Using these values for optimization of radiation protection practices for patient should be ensured since it does not rule out options for stochastic radiation.

Antihypertensive properties of Allium sativum (garlic) on normotensive and two kidney one clip hypertensive rats.

Allium sativum (garlic) is reported to act as an antihypertensive amidst an inconsistency of evidence. In this study, we investigated the cardiovascular effects of aqueous garlic extracts (AGE) on normotensive and hypertensive rats using the two-kidney one-clip (2K1C) model. Mean arterial blood pressure (MAP) and heart rate (HR) were measured in normotensive and 2K1C rat models anesthetized with thiopentone sodium (50 mg/kg body weight i.p.) through the left common carotid artery connected to a recording apparatus. The jugular vein was cannulated for administration of drugs. Intravenous injection of AGE (5-20 mg/kg) caused a significant (p<0.05) decrease in both MAP and HR in a dose-dependent manner in both the normotensive and 2K1C models, with more effects on normotensive than 2K1C rat model. The dose of 20mg/kg of AGE significantly (p<0.05) reduced systolic (16.7 ± 2.0%), diastolic (26.7 ± 5.2%), MAP (23.1 ± 3.6%) and HR (38.4 ± 4.3%) in normotensive rats. In 2K1C group, it significantly reduced systolic (22.2 ± 2.1 %), diastolic (30.6 ± 3.2%), MAP (28.2 ± 3.1%) and HR (45.2 ± 3.5%) from basal levels. Pulse pressure was significantly elevated (33.3 ±5.1%) in the 2K1C group. Pretreatment of the animals with muscarinic receptor antagonist, atropine (2 mg/kg, i.v.), did not affect the hypotensive and the negative chronotropic activities of the extract. AGE caused a decrease in blood pressure and bradycardia by direct mechanism not involving the cholinergic pathway in both normotensive and 2K1C rats, suggesting a likely involvement of peripheral mechanism for hypotension.

Global climate change and body functions.

The following text is an excerpt of the Keynote Address delivered by Professor (Sir) A.C. Ugwu, of the University of Benin, at the Annual National Conference of the Physiological Society of Nigeria at Lagos, on Thursday, the 26th of August, 2010.In 1896, a Swedish Chemist, Savante Arrhenius, predicted Global Warming. Global Climate or Global W arming, is a gradual process that threatens sea level elevations, crop failure and famine, global rainfall patterns, changes to plant and animal populations and serious health effects....

Influence of age on blood pressure recovery after maximal effort ergometer exercise in non-athletic adult males.

This study investigated whether age influences blood pressure recovery after maximal exercise in adult males. Forty healthy, non-athletic adult males (20 young, aged 22 +/- 3.46 years and 20 older, aged 48 +/- 6.91 years) participated in the study. Subjects performed a maximal-effort ergometer exercise test. Peak oxygen uptake (VO2max) was measured during the exercise protocol; heart rate (HR) and blood pressure (BP) were measured before exercise, during exercise (at 2-min intervals), and at the first minute of post-exercise recovery and subsequently at 2-min intervals until the recovery of BP. Results indicated that young adults had lower systolic blood pressure (SBP) recovery ratio (P < 0.05), lower SBP recovery time (P < 0.001), higher SBP% decline in 1, and 3 min (P < 0.001), and higher DBP% decline in 1, and 3 min (P < 0.05, <0.001) than the older adults, thus indicating faster BP recovery in young than older adults. A bivariate correlation test, revealed significant associations (P < 0.001, <0.01) between age and BP recovery parameters: percentage SBP decline in 1 and 3 min (27 and 39%), percentage DBP decline in 1 and 3 min (14 and 26%), third minute SBP ratio (22%), and SBP recovery time (72%). After controlling for factors affecting BP recovery such as resting SBP, percentage HR decline, VO2max and delta SBP, the observed correlations reduced in SBP recovery time (29%; P < 0.002) but disappeared (P > 0.01) in the other BP recovery parameters. These data indicate the need to take into account, factors affecting BP recovery when interpreting the effect of age on BP responses after exercise in future investigations.

Bayes' theorem: a paradigm research tool in biomedical sciences.

One of the most interesting applications of the results of probability theory involves estimating unknown probability and making decisions on the basis of new (sample) information. Biomedical scientists often use the Bayesian decision theory for the purposes of computing diagnostic values such as sensitivity and specificity for a certain diagnostic test and from which positive or negative predictive values are obtained in other to make decisions concerning the well-being of the patient. Often times error rates are encountered and estimated from the results of trials of the screening test with a view to calculating the overall case rate for which an accurate estimate is rarely available. The concept of conditional probability takes into account information about the occurrence of one event to predict the probability of another event. It is on this premise that this article presents Bayes' theorem as a vital tool. A brief intuitive development of this theorem and its application in diagnosis is given with minimum proof and examples.

Randomized controlled trials: the most powerful tool in modern clinical research.

Randomized controlled trial (RCT) can be said to be one of the simplest but most powerful tool of research. It is the most rigorous way of determining whether a cause-effect relation exists between treatment and outcome and for assessing the cost effectiveness of a treatment. Through the randomization, bias will be avoided by distributing the characteristics of patients that may influence outcome randomly between treatment groups so that any difference in outcome can be explained only by treatment. These characteristics might be demographic in nature in the form of age or prognostic factors such as clinical history or disease severity. For instance, menopausal status may influence outcome of treatment for breast cancer. This article is aimed at reviewing the general principles, importance of RCT and the reason for its importance in clinical research.

Occupational Stress among Radiographers: Impact of Sonography Responsability

Role extension in any occupation can affect both psychosocial and biomechanical stress levels and thus; have some consequences on efficiency in service delivery. The study was aimed to determine the impact of role extension of medical radiographers into sonography. 50 self-administered questionnaires were distributed to radiographers and to sonographers (radiographers with sonography responsibility). The questionnaires included questions seeking information on the demographic profile of the radiographer and sonographer; anatomical regions of biomechanical symptoms/stress and visual analogue scale (VAS); which rated job satisfaction and anxiety levels. 96of the questionnaires were returned and analyzed statistically using SPSS 11.0 software with P 0.05 indicating level of significance. Sonographers had more prevalence of biomechanical stress symptoms than the radiographers. Job satisfaction for sonographers (58.75) was lower than that for radiographers (64.29). Anxiety level was higher among sonographers even though this was not statistically significant. Sonography responsibility on radiographers did not have any significant effect on psychosocial stress. A balance in the extended role could aid efficiency in service delivery while improving the social strength of the individual

Uterine Roundness Index: Model Formulation and Nomogram for a Nigerian Population

This study was aimed to establish a nomogram for uterine roundness index (UTRI) for a Nigerian population. Seven hundred Nigerian girls and women in the premenarche; nulliparous; multiparous and postmenopausal groups with normal uteri were evaluated by pelvic ultrasound. The length; anteroposterior and transverse diameters of the uterus were measured and the UTRI calculated as the ratio of anteroposterior diameter to the length. The age; height; and parity of the subject were recorded. The mean UTRI +SD were 0.44457+0.0629 for premenarche; 0.5880+0.1118 for nulliparous; 0.6005+0.1046 for multiparous and 0.5269+0.1037 for postmenopausal. Pearson's correlation analysis showed significant correlation between UTRI and age; height and weight in premenarche group and weight in the nulliparous; multiparous and postmenopausal groups (p 0.05). Significant negative correlation between UTRI and age occurred only in the postmenopausal group (p 0.05). The study has established a nomogram for UTRI in a Nigeria population which will be of gynaecological importance to sonographers and referring clinicians in assessing the normality of uterine shapes and contour

Sonographic Evaluation of Cervical Length Changes during Normal Pregnancy

This study was aimed to establish reference values of cervical length in normal pregnancy. We studied a cross-sectional sample of 144 pregnant women by transabdominal sonography. The inclusion criteria were sonographic confirmation of gestational age; the absence of any risk factors for preterm birth; and uncomplicated pregnancy. Cervical length was measured in a straight line. Height; age and weight of patients were also obtained. There was a relationship between gestational age and cervical length; which could be described with a linear regression (R = 0.44; P0.05). Our study shows an increase in cervical length with gestational age. Reference ranges constructed for the whole gestational period could be more clinically applicable and useful than a single cut off value for more efficient prevention and management of preterm birth

Maternal Perspectives of Prenatal Sonogram in a North-Eastern Population in Nigeria

Limited information exists on maternal perspectives of prenatal sonogram in north-eastern Nigeria. This study was aimed at documenting the views and expectations of pregnant women concerning prenatal sonogram as well as their level of awareness of its purpose; limitations and safety in a predominantly Moslem society. A survey was carried out on a convenience sample of 150 patients referred from ante-natal clinics for prenatal sonogram; by administering semi-structured questionnaires. The results show that 61.3of the women had prenatal sonogram; with little or no information about the purpose; capabilities and limitations of the procedure. 24.7had neither formal western nor Islamic educational background that may have influenced their perceptions. Most of the women (81.3) were sponsored by either government or their husbands; 72.7perceived sonogram to be affordable and 63.4viewed sonographic results as reliable. The perceived main reasons for having a prenatal sonogram were to determine the expected date of delivery and foetal well-being; and to obtain reassurance of maternal health. Sex determination and number of foetuses were the least considered reasons. The study indicates that providing pregnant women with adequate information and sensitising them to the purpose and limitations of sonograms is necessary to guarantee its rational utilisation. Improving patient care; enhancing the skill of sonographers and providing more facilities would improve the services and patients' perspectives of prenatal sonography

The Effect of Moderate Alcohol Intake on Gallblader Motility: a Milk Ultrasonographic Study

Objectives: To assess the effect of periodic and moderate alcohol intake on gallbladder motility. Methods: The ultrasonographic ellipsoid method was used in 21 healthy male subjects: 12 non-alcohol and 9 alcohol drinkers. The stimulus for gallbladder contraction was 165 ml of half cream milk. Gallbladder dynamics were studied for 20 minutes following the ingestion of the milk. The mean percentage change in gallbladder volume after 10 and 20 minutes gave indications of gallbladder motility. Results: Moderate and periodic alcohol intake did not stimulate rapid postprandial gallbladder emptying. Conclusion: The protective effect of alcohol against biliary cholesterol cholelithiasis could not be due to stimulation of gallbladder emptying

Perceptions of Medical Students Undergoing Cadaveric Training: a Sociocognitive Perspective

The emotional and sociocognitive aspects of human dissection are important aspects of professionalism in medical training and so should be critically evaluated in the present day changing society. Medical students of Ebonyi State University; Nigeria completed 390 questionnaires. The questionnaires included questions seeking demographic information; open-ended questions on their first experience of dissection and suggestions on improvements in training. The Visual analogue scale (VAS) was used to assess anxiety and satisfaction levels. The questionnaires were analyzed statistically with P0.05 indicating level of significance. Majority (35.7) of the students was excited/fulfilled after their first experience and 41.5were of the opinion that life in humans is more appreciated by dissection. Their mean anxiety level was 3.42 while satisfaction rating was 7.13 on a scale of 1-10. A greater number of students suggested that conducive learning environment and improved preservation techniques would improve satisfaction (30.3and 33.1respectively). A Conducive environment and better preservation of cadavers are the major factors that improve satisfaction. Psychosocial factors should be assessed constantly to ascertain attitudinal changes of students; which will be helpful in quality of professional formation

Grades of gallbladder diseases using gallbladder contraction index: a pilot study.

The aim of this study was to develop a pilot model for the assessment of the severity of gallbladder diseases based on gallbladder contraction index, clinical and sonographic appearances of the gallbladder. The gallbladder contraction index (GBCI) was obtained as the average of the first ten and the first 20 minutes contraction indices. A range of 5% to 77% previously obtained in normal subjects was adopted in this study. Gallbladder contraction index in combination with other variables: sonographic appearances and clinical presentations were used for the grading of gallbladder diseases in the present study. This pilot model may have a good diagnostic performance but a clinical prospective evaluation is needed to confirm its actual value.

Incidence of occupational stress among medical radiographers: a population based zonal survey.

Biomechanical and psychosocial stresses are capable of destabilizing any health care professional. The current health sector reform in Nigeria, which lays emphasis on service delivery on a background of very few radiographers, may lead to an increase in stress level. This study investigated the incidence of occupational stress among radiographers in southeastern Nigeria. 50 self-completion questionnaires were delivered to radiographers in the southeastern Nigeria. The questionnaires included questions seeking information on the demographic profile of the radiographer, anatomical regions of biomechanical systems/stress and Visual Analogue Scale (VAS), which rated job satisfaction and anxiety levels. 32 questionnaires were returned and analyzed statistically. Biomechanical stress was observed in all anatomical regions studied. Job satisfaction rating was 61.3% and anxiety level was 45.3%. This study has provided a baseline stress level and prevalence among radiographers with which future studies in view of the on going health sector reform in Nigeria could be compared.

Vascular smooth muscle sensitivity to varying oxygen tensions, Bay K 8644 and nifedipine.

With the suggestion that while high oxygen levels may alter the response beyond the receptor, with wrong information about excitation-contraction coupling; it was observed that levels of oxygen affect both the calcium channel blockers and facilitators with net reduction of influx or utilisation of external calcium. In this our study, using rat tail artery activated by noradrenaline and potassium chloride in the presence of Bay K. 8644 and nifedipine at different oxygen levels, we showed that desensitisation of the responses of the vascular smooth muscle occurred. It was evident that the underlying basis of vascular responses observed with different oxygen levels was apparently due to shifting of the control curves. Hence, drugs which modify calcium channels functions may in vitro, be altered qualitatively and quantitatively by hyperoxic conditions, in receptor or voltage sensitive calcium channels, since oxygen appears to exert facilitatory effects on calcium channels.