Thyroid dose and cancer risk from head and neck computed tomography at two selected centres in Nigeria.

OBJECTIVE: The objective of this study was to evaluate the thyroid glands' radiation dose and the risk of thyroid cancer induction from head or neck computed tomography (CT) examinations. METHODS: In a prospective study, we evaluated all participants of all ages and sex referred for Head or Neck CT Scan at the University College Hospital, Ibadan and Me Cure Healthcare Limited, Ibadan, Oyo State, Nigeria. Thyroid radiation dose was estimated with impact scan calculator, and real-time dose measurement with thermoluminescent badge dosimeters (TLDs). Data were analysed and P < 0.05 was considered statistically significant. RESULTS: One hundred and sixty-three participants (128 adults and 35 children) participated in the study. In most participants (74%), the tube voltage was 120 kVp. The estimated median thyroid gland dose by the imPACT scan calculator was 4.95 mGy (range = 1.20-30.0 mGy) and 4.40 mGy (range = 3.0-5.10 mGy), while the real-time dose measured by the TLD was 4.79 mGy (range = 1.73-96.7 mGy) and 2.33 mGy (range = 1.20-3.73 mGy) at Centre A and B, respectively. The estimated median thyroid cancer risk was 2.88 × 10-6 (maximum range of 52 × 10-6) at centre A and a median value of 3.20 × 10-6 with a cancer risk estimate that may reach 17.9 × 10-6 recorded at centre B, compared to a cumulative thyroid cancer risk of 0.12 × 10-5 among the general Nigerian population. CONCLUSIONS: Scanner specifications and technique may significantly contribute to variations seen in thyroid radiation doses. There may be a need to optimise centre protocols and apply dose reference levels for head and neck CT examinations to reduce thyroid cancer risk in Nigeria.

Uterine and umbilical artery doppler in women with pre-eclampsia and their pregnancy outcomes.

BACKGROUND: Pre-eclampsia (PE) is an important public health menace in both developed and developing countries with high maternal and perinatal morbidity and mortality globally. A major goal towards improving antenatal management of PE is to develop accurate prediction models that identify women at high risk of this disease for appropriate interventions. METHODOLOGY: In a longitudinal cohort study, high-risk singleton pregnant women enroled between April 2015 and February 2016 had uterine and umbilical artery Doppler sonography at 22-24 weeks and 32-34 weeks gestation and had their delivery outcomes documented by the obstetrician and gynaecologist. The peak systolic velocity (PSV), end-diastolic velocity (EDV), Resistivity Index (RI), Pulsatility Index (PI) and the systolic-diastolic ratio (S/D) were recorded. RESULTS: Among the ninety-eight high-risk pregnant women, 61 (62.2%) developed PE and 32 (32.8%) did not have PE. In the PE cases, 15 (24.5%) were mild and 46 (74.5%) were severe PE. The uterine artery PI was significantly associated with PE. A unit increase in uterine PI in high-risk pregnancies, increases the odd of PE by 37.37 times (95% confidence interval; odds ratio = 6.09, 241.9; P < 0.001). The combination of the uterine and umbilical PSV predicted 80.3% of severe PE. All three spontaneous abortions were in women who developed PE, more caesarean section (48.4%) and 69.2% of 45 pre-term deliveries occurred in women with severe PE. CONCLUSION: The findings from this study show significantly lower uterine and umbilical arteries PSV and EDV but higher RI, PI and S/D in cases that developed PE. The uterine artery PI is the best predictor of PE, whereas the combinations of uterine and umbilical arteries PSV best predict severity of PE among high-risk pregnant Nigeria women.

Delleman syndrome: A case report from West Africa - features and the challenges of management.

Delleman syndrome is a rare congenital disorder. We report an 8-month old female with a history of a fleshy mass covering the left eye since birth. Examination revealed poor vision in the left eye, an upper lid coloboma and an epibulbar dermoid with a large area of alopecia and scalp hypoplasia involving the left frontoparietal region. Transfontanelle ultrasound scan did not reveal any intracranial cyst. Cranial computerised tomography subsequently revealed characteristic cerebral malformations of Delleman syndrome. This report demonstrates clinical and computed tomographic features of a case of Delleman syndrome with emphasis on the usefulness of transfontanelle ultrasonography in assessing for life-threatening intracerebral cysts or hydrocephalus, particularly in resource-limited settings, where neuroimaging is not readily available or affordable.

Ultrasonographic renal sizes, cortical thickness and volume in Nigerian children with acute falciparum malaria.

BACKGROUND: Utility of sonographic assessments of renal changes during malaria illness are rarely reported in African children in spite of the high burden of malarial-related kidney damage. METHODS: In this case-control study, renal sizes, cortical thickness and volume of the kidneys of 131 healthy children and 170 with acute falciparum malaria comprising 85 uncomplicated malaria (UM) and 85 complicated malaria (CM) cases, measured within 24 hours of presenting in the hospital were compared. RESULTS: The mean age of children with UM, CM and control groups was 49.7 ± 26.2 months, 50.7 ± 29.3 months and 73.4 ± 25.5 months, respectively (p < 0.001). The mean right kidney length of CM group was higher than control by 0.41cm (95% CI = 0.16, 0.65; p < 0.001) and UM by 0.32 cm (95% CI = 0.02, 0.62; p = 0.030). Similarly, mean left kidney length of CM was higher than control and UM by 0.34 cm (95% CI = 0.09, 0.60; p = 0.005) and 0.41cm (95% CI = 0.09, 0.72; p = 0.006), respectively. Estimated mean renal volume of the CM group was significantly higher than control group by 7.82 cm(3) for right and by 5.79 cm(3) for left kidneys respectively; in the UM group by 9.31cm(3) for right and 8.87 cm(3) for left kidneys respectively. CONCLUSION: There was a marginal increase in renal size of children with Plasmodium falciparum infection, which worsened with increasing severity of malaria morbidity. Ultrasonography provides important information for detecting renal changes in children with acute malaria.

Deploying Artificial Intelligence for Thoracic Imaging Around the World.

PURPOSE: Artificial intelligence (AI) thoracic imaging applications are increasingly being deployed in low- and middle-income countries (LMICs). Radiologists have a critical gatekeeping role to ensure the effective and ethical implementation of AI solutions. RAD-AID International uses a three-pronged implementation strategy to overcome challenges pervasive in LMICs. METHODS: During a similar period, an AI software for chest radiography (CXR) interpretation was deployed at two tertiary hospitals located in Guyana and Nigeria. The three-pronged implementation strategy of clinical education, infrastructure implementation, and phased AI introduction was used. A PACS with a cloud component was installed at each institution. Radiology residents and attending physicians at these institutions completed an introduction-to-AI course to prime them for the use of AI solutions. A phased introduction of the AI software was performed to allow local validation as well as trust building and workflow integration. Local validation processes were used at each site by comparing AI outputs with standardized prospectively generated reports by local radiologists and study team members, allowing for slight differences in the goals of AI software use between sites. RESULTS: The PACS was successfully installed at both institutions. Thirty participants completed the introduction-to-AI course with an average pre-knowledge test score of 75% and an average posttest score of 95%. The focus of the validation process at various sites was reflective of the intended use of the AI software. In Guyana, it revealed an 87% concordance rate between radiologists and the AI model for triaging normal versus abnormal findings on CXR. In Nigeria, an 85% concordance rate between radiologists and the AI model for reporting tuberculosis on CXR was noted. The AI software was successfully deployed and is being used as intended at both institutions. CONCLUSIONS: There are unique barriers to the adoption of AI in LMICs requiring an implementation strategy in collaboration with local institutions and industry partners to ensure success.

Heart failure in Nigeria: protocol for a systematic review and meta-analysis.

Background: Heart failure is now a significant contributor to the burden of non-communicable diseases in developing countries like Nigeria which is experiencing epidemiologic and demographic transition. The epidemiology of heart failure in this country is poorly characterized. The aim of the review is to determine the prevalence of heart failure, the associated risk factors, the aetiology, management, and outcomes of the condition in the country. Methods: Relevant databases such as PubMed /Medline, EMBASE, Web of Science, Google Scholar, African Index Medicus, and African journal online would be searched for articles published in English from January 2000 to December 2021. The analysis will include observational studies conducted among Nigerian adults aged 12 years and above. Article selection shall be conducted by pairs of independent reviewers. Data extraction shall be done by 2 independent reviewers. Results: The primary outcome would be the pooled prevalence of heart failure while the secondary outcomes would be to identify the risk factors and management of heart failure in Nigeria. Conclusion: This will be the first systematic review and meta-analysis of heart failure epidemiology in Nigeria which will hopefully identify gaps for future research and guidance for policy interventions.

Central Retinal and Ophthalmic Artery Doppler Velocimetry among Hypertensives and Normotensive Adults at a Nigerian Tertiary Health Facility.

Background: Haemodynamic alterations of the retrobulbar circulation are sequelae of untreated, long-standing hypertension. Early evaluation of the retrobulbar blood flow is very crucial to prevent irreversible ocular complications. The objective of this study was to evaluate the differences in central retinal artery (CRA) and ophthalmic artery (OA) haemodynamics in adult hypertensive and non-hypertensive subjects. Methodology: This prospective, comparative cross-sectional study was conducted among 63 hypertensives and 75 normotensive controls. Using Doppler ultrasonography, the CRA and OA Doppler velocimetry parameters among cases and controls were evaluated and analysed. Results: The CRA Peak Systolic Velocity (PSV) and End-diastolic velocity (EDV) was 7.54 ± 2.60cm/s and 2.99 ± 1.15cm/s (p<0.001) in hypertensives but 10.8 ± 2.51cm/s and 4.50 ± 1.25cm/s) p<0.001 in controls. The systolic/diastolic ratio (S/D) in cases was 2.64 ± 0.75 and 2.44 ± 0.38 p=0.045 in controls. The CRA's Pulsatility Index (PI) between cases and controls was not statistically significant, p =0.082. Furthermore, the CRA's PSV, PI, Resistivity index (RI) and S/D, were higher among subjects with stage 1 compared to stage 2 hypertension (p=0.004; p=0.027; p<0.001 and p=0.001 respectively). The OA mean EDV in hypertensives was 4.57 ± 1.97 and in controls= 5.31 ± 1.79 (p=0.022), while the OA mean RI and Peak Ratio, p=0.009 and 0.003, respectively, were higher in stage 1 hypertension. Conclusion: The Central retinal and ophthalmic artery blood flow parameters were significantly lower among hypertensive cases. Also, hypertensive stage 2 cases had significantly lower blood flow and vascular impedance parameters in the CRA and both Central retinal and ophthalmic artery, respectively.

Utilization of Uterine and Umbilical Artery Doppler in the Second and Third Trimesters to Predict Adverse Pregnancy Outcomes: A Nigerian Experience.

Objective: To assess the utility of uterine and umbilical artery Doppler in the second and third-trimester in predicting adverse pregnancy outcomes. Methodology: In a prospective longitudinal study, the demographic, clinical, Doppler ultrasound parameters of the uterine and umbilical arteries of 84 consecutive women attending the antenatal clinic at 22-24 weeks and 116 women at 30-34 weeks gestation and pregnancy outcomes were documented and analyzed. Results: Pregnant women with adverse pregnancy outcomes had significantly higher second-trimester mean uterine systolic/diastolic (S/D) ratio (p = 0.001), pulsatility index (PI; p = 0.003), umbilical artery S/D (p = 0.016), and resistivity index (RI; p = 0.041) as well as higher third-trimester uterine S/D and PI. While pregnancies with adverse fetal outcomes showed significantly higher uterine artery S/D and PI at the second trimester, third-trimester uterine showed higher S/D, RI, and PI and umbilical artery PI than in women with normal fetal outcomes. The combination of uterine PI and early diastolic notch were predictors of maternal outcomes and correctly predicted 73% (p < 0.001) in the second trimester. By the third trimester, the uterine PI alone was the best predictor and accurately predicted about 62% of maternal outcomes (p = 0.028). In addition, the second-trimester uterine S/D and early diastolic notch and uterine PI in the third trimester correctly predicted 79% and 78% of fetal outcomes, respectively. Conclusion: Among unselected pregnant women population, the second-trimester Doppler parameters are better predictors of maternal adverse pregnancy outcomes, while adverse fetal outcome prediction by uterine and umbilical Doppler at the second- and the third-trimester parameters are comparable.

Where COVID-19 testing is challenging: a case series highlighting the role of thoracic imaging in resolving management dilemma posed by unusual presentation.

The COVID-19 pandemic remains an evolving disease posing a challenge of incomplete understanding escalated by random atypical clinical presentations. Numerous challenges still exist with accessibility and availability of standard COVID-19 viral testing using real-time Polymerase Chain Reaction (RT-PCR), in low- and middle-income countries, especially in several hospital settings. The clinical information of three select patients at a major health facility in Southwestern Nigeria with unusual COVID-19 clinical presentation and clinical management dilemma related to challenges with COVID-19 viral laboratory testing, were retrospectively reviewed. The medical history in all three cases closely mimicked that of other medical conditions because of assumptions created by red herrings like an acute exacerbation of an underlying non-communicable disease (diaphragmatic eventration) in case 1, re-activation of a previously treated lung condition (tuberculosis) in case 2 and a sequalae of a previously diagnosed but poorly-managed chronic non-communicable disease (decompensated hypertensive heart disease). Also, viral testing was challenging in all cases due to reasons ranging from late turn-around time to inconsistent results. However, thoracic imaging was employed in all cases to heighten suspicion of COVID-19 infection, resolve management dilemma and limit intra-hospital spread. Thoracic imaging can play a major role within hospital settings in low-and middle-income countries in resolving diagnostic challenges of atypical COVID-19 clinical presentations, raising suspicion for early institution of intra-hospital disease containment measures, limiting exposure among hospital staff and guiding clinical case management of COVID-19; especially where challenges with confirmatory viral testing remain persistent.

Case-control study on ocular changes and ophthalmic Doppler velocimetric indices among preeclamptic and normotensive pregnant women in Ibadan, Nigeria.

OBJECTIVE: To compare the ocular changes and Doppler velocimetric indices in preeclamptic and normotensive pregnant women. METHODS AND ANALYSIS: This was a case-control study of 71 preeclamptic women and 72 parity-matched normotensive pregnant women conducted at the University College Hospital, Ibadan, Nigeria. Demographic data were obtained using questionnaires. All participants had visual acuity assessment, funduscopy, intraocular pressure measurement and orbital Doppler ultrasonography. The differences in parameters between the two groups were tested using Student's t-test for quantitative variables and χ2 tests for categorical variables. RESULTS: There were no significant differences between cases and controls with respect to sociodemographic variables. The mean pulsatility index was 1.35±0.46 in cases and 2.1±0.4 in controls (p<0.001); the resistivity index was 0.7±0.18 in cases and 0.83±0.27 among the controls (p=0.01). A similar pattern was observed in the peak systolic velocity (p<0.001) and the peak ratio (p<0.001). There was no significant difference between the groups concerning end-diastolic velocity (p=0.535). Three preeclampsia patients (5.2%) had abnormalities on funduscopy compared with none of the controls. Preeclamptic women had significantly higher intraocular pressures in both eyes at baseline and at 24 hours post delivery. CONCLUSION: This study demonstrated lower Doppler velocimetry and impedance parameters and higher intraocular pressure among preeclampsia cases compared with controls. Abnormal funduscopic findings were observed in a few preeclamptic women and none among the controls. Ophthalmic artery Doppler parameters could be useful in identifying those women who are likely to suffer preeclampsia and its complications.

Intima-media thickness of femoral arteries and carotids among an adult hypertensive Nigerian population: A case-control study to assess their use as surrogate markers of atherosclerosis.

Background: Increased intima-media thickness (IMT) is an established and important surrogate marker for atherosclerosis. Intima-media thickening in the femoral arteries occur earlier and reflect the true extent of generalized atherosclerosis better than in the carotids. Aims: To study the ultrasound-detected morphological changes in the common femoral versus carotid artery wall. Patients and Methods: A case-control study design was used, with 61 adult hypertensive as cases and 61 age-, sex- and BMI-matched normotensive as controls. Variables were participants' characteristics, cardiovascular risk factors, and ultrasonographically evaluated IMT of the carotid and femoral arteries. Results: A total of 122 participants were studied. The mean femoral IMT in hypertensives and controls on the right and left was 0.63 ± 0.07mm vs. 0.52 ± 0.06mm [P < 0.0001] and 0.69 ± 0.0 mm vs. 0.55 ± 0.05mm [P < 0.0001]. Also, the mean carotid IMT among hypertensives and controls on the right =0.80 ±0.15mm vs. 0.64 ± 0.06mm [P < 0.0001], and 0.91 ± 0.22mm vs. 0.65 ± 0.06mm [P < 0.0001] on the left. Significant correlation was observed between IMT and age (B = 0.006, P < 0.001 and B = 0.003, P < 0.001), hypertension (B = 0.205, P < 0.001 and B = 0.122, p< 0.001), and duration of hypertension (B = 0.02, P < 0.001 and B = 0.006, P = 0.02) the femoral and carotid arteries respectively. Conclusion: The femoral and the carotid artery show similar significantly increased IMT in hypertensive adults. The femoral IMT appears to be a good surrogate marker of atherosclerosis among hypertensive Nigerians.

RésuméContexte: L'épaisseur accrue de l'intima-média (IMT) est un marqueur de substitution établi et important de l'athérosclérose. L'épaississement intima-média dans les artères fémorales survient plus tôt et reflète mieux l'étendue réelle de l'athérosclérose généralisée que dans les carotides. Objectifs: étudier les modifications morphologiques détectées par échographie dans la paroi de l'artère fémorale commune par rapport à la carotide. Patients et méthodes: Un schéma d'étude cas-témoins a été utilisé, avec 61 adultes hypertensifs en tant qu'études des cas et 61 normo-tensifs appariés pour l'âge, le sexe et l'IMC en tant que contrôles. Les variables étaient les caractéristiques des participants, les facteurs de risque cardiovasculaires et les TMI évaluées par échographie des artères carotides et fémorales. Résultats: Un total de 122 participants ont été étudiés. Le TMI fémoral moyen chez les hypertensifs et chez les témoins de droite et de gauche était de 0,63 ± 0,07 mm contre 0,52 ± 0,06 mm [P <0,0001] et de 0,69 ± 0,0 mm contre 0,55 ± 0,05 mm [P <0,0001]. En outre, la moyenne IMT carotidienne chez les hypertendus et les contrôles à droite = 0,80 ± 0,15 mm vs 0,64 ± 0,06 mm [P <0,0001] et 0,91 ± 0,22 mm contre 0,65 ± 0,06 mm [p < 0,0001] à gauche. Une corrélation significative a été observée entre les TMI et l'âge (B = 0,006, p < 0,001 et B = 0,003, p < 0,001), l'hypertension (B = 0,205, p <0,001 et B = 0,122, p <0,001) et la durée de l'hypertension (B = 0,02, p < 0,001 et B = 0,006, p = 0,02) respectivement des artères fémorale et carotide. Conclusion: Les artères fémorales et carotide montrent une augmentation similaire du TMI chez les adultes hypertensifs. L'IMT fémoral semble être un bon marqueur de substitution de l'athérosclérose chez les Nigérians hypertensifs.

The Value of Ultrasonography in the Diagnosis of a Rare Congenital Dermoid Cyst of the Anterior Fontanelle in an Infant.

A dermoid cyst is a benign lesion that may occur in different parts of the body. A dermoid cyst of the subgaleal space over the anterior fontanelle is rather uncommon. We present a case of congenital dermoid cyst of the anterior fontanelle in a 3-month-old male infant, underscoring the value of ultrasonography in the diagnosis and highlighting the classical clinical, sonographic, surgical, and pathological findings.

Un kyste dermoïde est une lésion bénigne qui peut survenir dans différentes parties du corps. Un kyste dermoïde de l'espace sous-galéal au-dessus de la fontanelle antérieure est plutôt rare. Nous présentons un cas de kyste dermoïde congénital de la fontanelle antérieure chez un nourrisson de sexe masculin de 3 mois, soulignant l'intérêt de l'échographie dans le diagnostic et mettant en évidence les résultats cliniques, échographiques, chirurgicaux et pathologiques classiques.

Abdominal ultrasonography in HIV/AIDS patients in southwestern Nigeria.

BACKGROUND: Though the major target of the HIV-virus is the immune system, the frequency of abdominal disorders in HIV/AIDS patients has been reported to be second only to pulmonary disease. These abdominal manifestations may be on the increase as the use of antiretroviral therapy has increased life expectancy and improved quality of life. Ultrasonography is an easy to perform, non invasive, inexpensive and safe imaging technique that is invaluable in Africa where AIDS is most prevalent and where sophisticated diagnostic tools are not readily available. PURPOSE: To describe the findings and evaluate the clinical utility of abdominal ultrasonography in HIV/AIDS patients in Ibadan, Nigeria METHODS: A Prospective evaluation of the abdominal ultrasonography of 391 HIV-positive patients as well as 391 age and sex-matched HIV-negative patients were carried out at the University College Hospital, Ibadan. RESULTS: Of the 391 cases studied, 260 (66.5%) were females; the mean age was 38.02 years, (range 15-66 years). The disease was most prevalent in the 4th decade with an incidence of 40.4%. Compared with the HIV-negative individuals, the HIV+ group of patients had a significantly higher proportion of splenomegaly (13.5% vs. 7.7%; p < 0.01), lymphadenopathy (2.0% vs. 1.3%; p < 0.70), and renal abnormalities (8.4% vs. 3.8%; p < 0.02). There were no differences in hepatic and pancreatic abnormalities between the HIV+ and HIV- groups. There were significantly fewer gallstones in the HIV+ group (1.4% vs. 5.1%; p < 0.01). CONCLUSION: AIDS is a multi-systemic disease and its demographic and clinical pattern remains the same globally. Ultrasonography is optimally suited for its clinical management especially in Africa. Its accuracy and sensitivity may be much improved with clinico-pathologic correlation which may not be readily available in developing countries; further studies may provide this much needed diagnostic algorithms.

Intracranial Arterial Calcification in Black Africans with Acute Ischaemic Stroke.

BACKGROUND: Intracranial arterial calcification (IAC), a recognized marker of atherosclerosis on cranial computed tomography (CT), is an independent risk factor for ischaemic stroke. This study aimed to determine the prevalence, distribution, severity, and associations of IAC in adults with acute ischaemic stroke (AIS) at the University College Hospital, Ibadan, Nigeria. METHODS: Cranial CT images of 130 consecutive adults who presented with AIS were acquired on a 64-slice multi-detector Toshiba Aquilion scanner and evaluated for IAC in bone window on Vitrea® software using a semi-quantitative scoring method for extent, thickness, and length of calcifications in the large intracranial arteries. Associations of IAC with clinical and laboratory data were determined by statistical analysis at p < 0.05. RESULTS: There were 71 males (54.6%), and the mean age of all patients was 63.0 ± 13.2 years. Hypertension was the most common risk factor (83.1%). IAC was found in 121 patients (93.1%), predominantly in the carotid siphon (86.1%) followed by the intracranial vertebral arteries (9.3%), middle cerebral arteries (2.4%), basilar artery (1.2%), and the anterior cerebral arteries (1%). The burden of IAC ranged from mild (17.4%) to moderate (52.1%) to severe (30.6%). Age (p < 0.001), diastolic blood pressure (p = 0.037), and alcohol use (0.046) were significantly different among the patients with mild, moderate, and severe degrees of IAC. IAC was associated with age (p < 0.001), hypertension (p = 0.03), diabetes mellitus (p = 0.02), hyperlipidaemia (p = 0.04), and alcohol use (p < 0.001) but not with sex (p = 0.35). CONCLUSIONS: The burden of IAC is very high among native African patients with AIS and preferentially involves proximal inflow arteries. Therefore, the role of large vessel atherosclerosis in ischaemic stroke in native Africans should be explored in future multinational, multimodality studies.

Maternal ophthalmic artery Doppler velocimetry in pre-eclampsia in Southwestern Nigeria.

BACKGROUND: Pre-eclampsia (PE) poses a serious challenge to maternal and fetal health in Africa. It is associated with hemodynamic changes that may affect the internal carotid/ophthalmic artery circulation with consequent neuro-ophthalmic manifestations. Ophthalmic artery Doppler (OAD) ultrasound is an important tool that can be used to detect hemodynamic changes in PE and monitor its severity. In this study, we evaluated hemodynamic changes on OAD ultrasound in the ophthalmic arteries of pre-eclamptic women and compared these with values in healthy pregnant women. METHODS: OAD parameters, such as, peak systolic velocity, peak diastolic velocity, end diastolic velocity, pulsatility index, and peak ratio, were measured on transorbital triplex ultrasound scan with a 7-10 MHz multifrequency linear transducer in 42 consenting pre-eclamptic patients and 41 pregnant controls matched for maternal age, gestational age, and parity at the Department of Radiology, University College Hospital, Ibadan. Univariate, bivariate, and receiver operating characteristic curve data analyses were performed. P<0.05 was considered to be statistically significant. RESULTS: Mean resistivity index, pulsatility index, and peak systolic velocity were significantly lower in pre-eclamptic patients than in the controls. Mean peak diastolic velocity, end diastolic velocity, and peak ratio were significantly higher in the pre-eclamptic group. The receiver operating characteristic curve showed that the resistivity index (sensitivity 75%, specificity 77.8%) could distinguish mild from severe PE while the peak ratio (sensitivity 90.5%, specificity 81.3%) could accurately detect PE. CONCLUSION: OAD ultrasound can be used to monitor patients with PE for early detection of progression to severe forms before cerebral complications develop. OAD screening of patients at high risk for PE can also detect early changes of hemodynamic derangement.

Transvaginal ultrasonography: a survey of the acceptability and its predictors among a native African women population.

OBJECTIVE: To determine the acceptability of transvaginal ultrasonography (TVU) and associated factors among Nigerian women. METHOD: A cross-sectional survey was conducted among 3137 women who presented for transabdominal ultrasound scan between August and November 2010 in two referral hospitals in Nigeria. Data were obtained using a questionnaire. Descriptive and multivariate analysis was performed applying logistic regression analysis; predictors of willingness of participants regarding transvaginal ultrasound were identified using SPSS Statistics (SPSS Inc, Chicago, IL) version 17 software. RESULTS: The mean age of the women was 33.8 years (standard deviation = 7.9), with 88.8% currently married. About 84% were willing to have TVU, while 54.2% were indifferent about the gender of the sonologist. About 17.3% believed that the procedure is painful. Significant predictors of willingness to have TVU were previous sexual experience and douching, prior painful vaginal examination, and vaginal surgery. CONCLUSION: The majority of Nigerian women expressed a willingness to have the TVU procedure without necessarily opting for any gender preference of the operator. Women should be adequately counseled on the operations of the procedure so as to be able to psychologically prepare for them.

Extensive Right Pleural and Chest Wall Malignant Fibrous Histiocytoma at an Unusual Age: Computed Tomography Features.

Aims: To describe a rare case of malignant fibrous histiocytoma at an unusual age of sixteen (16) years. Also to sensitize the medical community to the need for thorough evaluation of an opaque hemithorax and to describe the imaging features of this rare neoplastic disease. Presentation of Case: This was a 16 year old girl who presented with progressive swelling and recurrent right chest pain of 10 months duration and difficult breathing of 6 weeks duration. There was associated weight loss, dry cough and low grade intermittent fever. She had solitary cervical lymphadenopathy, grade II finger clubbing and low hematocrit. Discussion: Malignant fibrous histiocytomas (MFHs) are tumors of adulthood with a mean age of 59 years. It has predilection for the extremities, the abdominal cavity and the retroperitoneum. Primary pleural occurrence is relatively rare. This is a rare case of an extensive malignant fibrous histiocytoma of the right pleura with chest wall involvement presenting at an unusual young age of 16 years, at variance with the ages documented in the literatures. Imaging findings of the histologically proven tumor were also described on high resolution chest Computed Tomography. Conclusion: Malignant fibrous histiocytomas may occur much earlier than the age documented in most literatures. This case showed that not all cases of extensive opaque hemithorax are due to massive pleural effusion and further and better diagnostic imaging will be necessary for prompt and proper management.

Cranial tomographic angiographic evaluation of suspected intracranial vascular abnormalities among a Nigerian cohort

Background: Lately, there has been an increased utilization of computed tomography angiography (CTA) as the preferred first-line modality for the evaluation and diagnosis of most cerebral vascular lesions.Objective: The objective of this study was to evaluate suspected intracranial vascular cases, using CTA at a major referral tertiary hospital in South West Nigeria.Materials and Methods: This was a hospital-based retrospective study of suspected intracranial vascular cases in all ages and both sexes that had CTA from January 2011 to December 2018. Data were analyzed with IBM SPSS version 23.0, and P < 0.005 was considered statistically significant.Results: A total of 128 patients were studied, the mean age was 44.1 ± 17.7 years, and male: female ratio was 1:1.06. The leading clinical diagnoses were as follows: intracranial aneurysms (34/128), subarachnoid hemorrhage (27/128), intracranial vascular tumors (26/128), brain hemorrhage from vascular abnormality (19/128), and arteriovenous malformations (AVMs) (10/128). At CTA, 61 patients had vascular abnormalities: intracranial aneurysm was seen in 63.9% with a peak age range of 41­60 years, and the leading location of aneurysms was posterior cerebral artery (18.8%), followed by posterior communicating artery (16.7%) and the cavernous segment of the internal carotid artery (16.7%). AVMs were more common in patients aged 40 years and below (91.7%) in males (66.7%) and in the parietal lobe. Intracranial aneurysms were 3.25 times as common as brain AVMs.Conclusion: Intracranial aneurysms are the predominant vascular lesions, occurring mostly in the older age group. AVMs occurred mostly in younger people, more in males, and predominantly in the parietal lobes. The hospital incidence of aneurysms to AVMs was 3.25:1

Evaluation of Renal Blood Flow Using Doppler Sonography in Children with Acute Falciparum Malaria in South-Western Nigeria.

Background: Renal blood flow evaluation during malaria illness is rarely done despite the high incidence of kidney injury from malaria and availability of Doppler ultrasound scanners in malaria endemic areas. Aims: This study is to evaluate the renal blood flow changes using Doppler ultrasonography among uncomplicated and complicated malaria subsets of pediatric patient with laboratory evidence of malaria parasitemia and without background clinical and laboratory evidence of renal impairment. And to compare these with parameters of age matched healthy pediatric control. Study Design: This was a prospective case control study of renal Doppler indices in children with acute malaria. Place of Study: The study was conducted among pediatric patients presenting at the children outpatient clinics, emergency and pediatric wards of the University College Hospital (UCH), Ibadan Nigeria. Methodology: Doppler indices of 602 kidneys were evaluated among 85 uncomplicated (UM), 85 complicated malaria (CM) children that presented within 24 hours and follow up scans on days 3 and 5 of their illness. These were compared with that of 131 healthy children (control). Results: The main renal artery diameter of the CM group was 0.41±0.07 mm, UM=0.48±0.09 mm and 0.53±0.11 mm (p=<0.001) in the control group. The main renal vein diameter were 0.59±0.11 mm and 0.48±0.10 mm and 0.63±0.15 mm (P=<0.000) among the CM, UM and the control group respectively. The PSV and EDV were slightly lower in the malaria groups than in the control group. PSV=49.01±18.21 cm/s in the UM and CM=50.71±19.68 cm/s. The control group PSV was 56.95±15.47 cm/s. AT was however significantly lower in the two malaria subgroups than in the control. (UM=47.70±18.28 cm/s, CM=52.33±21.06 cm/s and control=75.20±27.66 cm/s respectively (p=<0.000). The Intrarenal S/D in UM was 2.73±0.49 and the CM group S/D was 3.05±0.65 and control=2.62±0.47 (P=0.04). Slightly lower but statistically insignificant mean values were seen in the RI and PI. Conclusion: The main renal arterial and vein diameters and the intra renal vessel AT are significantly reduced during acute falciparum malaria illness. The intra-renal PSV and EDV are likely to be lower in acute falciparum malaria than in the normal healthy children. The intra-renal S/D are significantly higher in the UM and CM. Also, the PI and RI are likely to be higher in the malaria groups. The AT and S/D both showed inverse and direct relationship respectively as malaria severity worsens. We propose that renal Doppler ultrasound can be used to monitor renal status and should be included in the management of children with acute malaria infection more so in malaria endemic area.

Intima-media thickness of femoral arteries and carotids among an adult hypertensive Nigerian population: a case­control study to assess their use as surrogate markers of atherosclerosis

Background: Increased intima-media thickness (IMT) is an established and important surrogate marker for atherosclerosis. Intima-media thickening in the femoral arteries occur earlier and reflect the true extent of generalized atherosclerosis better than in the carotids. Aims: To study the ultrasound-detected morphological changes in the common femoral versus carotid artery wall. Patients and Methods: A case-control study design was used, with 61 adult hypertensive as cases and 61 age-, sex- and BMI-matched normotensive as controls. Variables were participants' characteristics, cardiovascular risk factors, and ultrasonographically evaluated IMT of the carotid and femoral arteries. Results: A total of 122 participants were studied. The mean femoral IMT in hypertensives and controls on the right and left was 0.63 ± 0.07mm vs. 0.52 ± 0.06mm [P < 0.0001] and 0.69 ± 0.0 mm vs. 0.55 ± 0.05mm [P < 0.0001]. Also, the mean carotid IMT among hypertensives and controls on the right =0.80 ±0.15mm vs. 0.64 ± 0.06mm [P < 0.0001], and 0.91 ± 0.22mm vs. 0.65 ± 0.06mm [P < 0.0001] on the left. Significant correlation was observed between IMT and age (B = 0.006, P < 0.001 and B = 0.003, P < 0.001), hypertension (B = 0.205, P < 0.001 and B = 0.122, p<0.001), and duration of hypertension (B = 0.02, P < 0.001 and B = 0.006, P = 0.02) the femoral and carotid arteries respectively. Conclusion: The femoral and the carotid artery show similar significantly increased IMT in hypertensive adults. The femoral IMT appears to be a good surrogate marker of atherosclerosis among hypertensive Nigerians