Radiotherapy services in low resource settings: The situation in Nigeria.

Objective: About 50%-60% of all cancer cases will require radiotherapy during their treatment. Nonetheless, radiotherapy facilities are limited in low- and middle-income countries and despite high cancer burden in these regions of the world, only 5% have access to radiation therapy. This study identified the location of radiotherapy centers, the types of radiotherapy machines available and the personnel available in each radiotherapy center in Nigeria. Methods: A cross-sectional questionnaire-based study conducted across the six geopolitical zones of Nigeria from May 2020 to April 2021. A questionnaire having sections on facility profile, status of facility, and human resources, was used to elucidate information for the study. Descriptive statistics (frequency and proportion) were used to describe facilities' characteristics, status, and human resources available. Results: Out of nine radiotherapy centers evaluated, the majority 33.3% (n = 3) were found in the southwest geopolitical zone of Nigeria. Out of 10 equipment and accessories evaluated for availability, Ahmadu Bello University Teaching Hospital and University of Benin Teaching Hospital had the highest number of available equipment and accessories 90% (n = 9) each respectively. Out of the nine centers evaluated, only four centers had at least one functional equipment. The highest number 64.3% (n = 9) out of the 14 required number of staff in each center was found at University College Hospital. Out of 31 medical physicists identified, the majority 22.6% (n = 7) was found at University of Nigeria Teaching Hospital. Conclusion: A high percentage of radiotherapy centers in Nigeria lacks the equipment and manpower to function optimally and is located within the southwest geopolitical zone of Nigeria. Therefore, proper investment in the radiotherapy service through private-public partnership, staff training, and equipment upgrade and maintenance could substantially improve the state of cancer care.

Sensitivity of uterine artery Doppler pulsatility index in screening for adverse pregnancy outcome in first and second trimesters.

PURPOSE: In a poor resource country where screening for adverse pregnancy outcomes using maternal biomarkers seems unattainable, there is a need to search for credible alternatives. This study is, therefore, aimed at determining the sensitivity of uterine artery Doppler pulsatility index (UtAD-PI) in predicting pregnancy outcomes in the first and second trimesters and to establish any statistical difference in mean UtAD-PI in first and second trimesters screening of women with normal and abnormal pregnancy outcomes respectively. METHODS: This clinical-based, longitudinal, and unpaired cohort study involved 500 pregnant women, who were screened for adverse outcomes using UtAD-PI and delivered in the hospital. These were divided into two groups, each having a training set and a test set. The training set was used to generate the receiver operator characteristic curve and cut-off point while the test set was used to test for sensitivity and specificity of the Ut-ADI in each trimester. RESULTS: The sensitivity and specificity of UtAD-PI in first-trimester screening are 97% and 76.5% while second-trimester gave sensitivity and specificity of 57.5% and 63.3% respectively. The uterine artery Doppler pulsatility index shows statistically significant differences between normal pregnancy and pregnancy with adverse outcomes (p-value = 0.000). CONCLUSION: The uterine artery Doppler pulsatility index is a good screening tool for adverse pregnancy outcomes. First-trimester screening of patients for adverse outcomes is more sensitive than the second-trimester screening using UtAD-PI. There is also a statistically significant difference between mean UtAD-PI between normal pregnancy and pregnancy with adverse pregnancy outcomes.

Sonographic measurement of ear length among normal fetuses of pregnant Igbo women in port Harcourt, Nigeria.

BACKGROUND: Fetal ear length measurement has been associated with some clinical values: sonographic marker for chromosomal aneuploidy and for biometric estimation of fetal gestational age. OBJECTIVES: To establish a baseline reference value for fetal ear length and to assess relationship between fetal ear length and gestational age. METHODS: Ear length measurements were obtained prospectively from fetuses in 551 normal singleton pregnancies of 15 to 41 weeks gestation. Normal cases were defined as normal sonographic findings during examination plus normal infant post-delivery. The relationship between gestational age (GA) in weeks and fetal ear length (FEL) in millimeters were analyzed by simple linear regression. Correlation of FEL measurements with GA, biparietal diameter (BPD), Head circumference (HC), Abdominal Circumference (AC), Femur Length (FL) and maternal age (MA) were also obtained. RESULTS: Linear relationships were found between FEL and GA (FEL=0.872GA-2.972). There was a high correlation between FEL and GA (r = 0.837; P = .001). Good linear relationship and strong positive correlation were demonstrated between FEL and BPD, AC, HC, and FL (p<0.05). CONCLUSION: The result of this study provides normal baseline reference value for FEL. The study also showed good linear relationship and good correlation between FEL and fetal biometric measurements.

Renal echotextural changes in Nigerian workers chronically exposed to petroleum-based liquid fuels.

Background: Exposure to hydrocarbon is associated with an increased risk of development of chronic kidney disease. Ultrasound, which is a non-invasive imaging modality, provides very important information about kidney morphology. Objective: The aim of this study was to evaluate the effects of chronic exposure to some petroleum products on the kidney of exposed workers using sonography. Materials and methods: This was a prospective cross-sectional study involving 415 workers with chronic workplace exposure to petroleum fuel in Enugu metropolis. The study population comprised 164 petrol station attendants, 175 automobile mechanics and 76 petrol tanker drivers aged between 20 and 65 years. Abdominal ultrasound was performed, as well as serum urea and creatinine were measured to assess the kidneys of these workers chronically exposed to petroleum fuels, and the findings were compared to findings in an aged-matched, non-exposed control group. Results: Increased echogenicity of the kidneys was observed in 21 subjects from the study group and this differed significantly (p <0.05) from the findings in the control group. Conclusions: The study has shown that chronic exposure to petroleum fuel affects renal echotexture and that ultrasound may serve as a useful non-invasive tool for routine use in the assessment of petroleum-induced nephropathy.Background: Exposure to hydrocarbon is associated with an increased risk of development of chronic kidney disease. Ultrasound, which is a non-invasive imaging modality, provides very important information about kidney morphology. Objective: The aim of this study was to evaluate the effects of chronic exposure to some petroleum products on the kidney of exposed workers using sonography. Materials and methods: This was a prospective cross-sectional study involving 415 workers with chronic workplace exposure to petroleum fuel in Enugu metropolis. The study population comprised 164 petrol station attendants, 175 automobile mechanics and 76 petrol tanker drivers aged between 20 and 65 years. Abdominal ultrasound was performed, as well as serum urea and creatinine were measured to assess the kidneys of these workers chronically exposed to petroleum fuels, and the findings were compared to findings in an aged-matched, non-exposed control group. Results: Increased echogenicity of the kidneys was observed in 21 subjects from the study group and this differed significantly (p <0.05) from the findings in the control group. Conclusions: The study has shown that chronic exposure to petroleum fuel affects renal echotexture and that ultrasound may serve as a useful non-invasive tool for routine use in the assessment of petroleum-induced nephropathy.

Bone mineral density in an urban and a rural children population-A comparative, population-based study in Enugu State, Nigeria.

INTRODUCTION: Osteoporosis is one of the non-communicable diseases linked to urbanisation. The foundation of osteoporotic fractures stems from childhood. Therefore, studies that promote maximising peak bone mass are strongly advocated. Studies have shown that there are differences in the incidence of osteoporotic fractures in rural and urban communities. No study has investigated urban-rural differences in BMD of Nigerian children. This study, therefore, aimed to investigate urban-rural differences in BMD of Nigerian children and the association with physical activity, demographic and anthropometric variables. METHODS: In a cross-sectional, study in Enugu, Nigeria, estimated bone mineral density (eBMD) was measured at the calcaneum using the QUS densitometer, Hologic Sahara, in 457 urban (Enugu metropolis) and 559 rural (Nsukka community) children aged 6-14 years. Height, weight and physical activity were measured. Independent sample t-test was used for comparative analysis while Pearson correlation coefficients and multiple regression models were used to examine the relationship between the eBMD and the other parameters. RESULTS: The mean (S.D) eBMD of the urban children [0.52(0.09) g/cm2] were significantly higher (p < 0.05) than their age- and gender-matched counterparts in the rural areas [0.51(0.08) g/cm2]. Age and weight predicted (p < 0.05) the eBMD in the urban subjects while only age was the predictor (p < 0.05) in the rural subjects. The physical activity pattern had no relationship with eBMD in both urban and rural children in Enugu, Nigeria. CONCLUSIONS: The eBMD of rural children is lower than that of their age- and gender-matched urban counterparts.

Calcaneal Broadband Ultrasound Attenuation and Speed of Sound Measurements in a Population of Nigerian Children: Reference Data and the Influence of Sociodemographic Variables.

OBJECTIVES: The aim of our study was to establish a reference database of calcaneal broadband ultrasound attenuation (BUA) and the speed of sound (SOS) in a healthy Nigerian population of children aged 6 to 14 years and also to investigate the influence of sociodemographic and anthropometric variables on them. METHODS: The BUA and SOS of 1016 healthy children were measured by quantitative ultrasound densitometry. Height and weight were measured with a stadiometer and weighing balance, respectively, whereas the sociodemographic parameters of the participants were collected on a semistructured questionnaire. A multiple regression model using stepwise selection and Pearson correlation coefficients were used to examine the relationship between the ultrasound parameters and sociodemographic and anthropometric parameters. Comparisons between various age groups were made by analysis of variance. RESULTS: The mean BUA and SOS ± SD of the participants were 60.57 ± 16.21 dB/MHz and 1563.48 ± 21.74 m/s, respectively, for boys and 58.18 ± 15.16 dB/MHz and 1560.03 ± 22.32 m/s for girls. The BUA in both sexes was positively influenced by age and weight (P < .05), whereas only the father's educational status was its predictor (P < .05) in the boys. For the girls, the family size and mother's educational status were predictors of the BUA (P < .05). The SOS was marginally influenced by age and family size in the boys (P < .05), whereas the father's educational status was the predictor in the girls. CONCLUSIONS: The established BUA and SOS values in this study are baseline values, and further study, which would also involve data from a large number of Nigerian children, would be needed to support their effectiveness as reference values.

Sonographic assessment of petroleum-induced hepatotoxicity in Nigerians: does biochemical assessment underestimate liver damage?

BACKGROUND: Exposure to petroleum products has been shown to have significant adverse effects on the liver which can manifest either as morphological or physiological changes. OBJECTIVES: The aim of the study was to assess the effects of chronic exposure to some petroleum products on the liver of exposed workers using sonography and to determine whether biochemical assessments underestimated hepatotoxicity. METHODS: Abdominal ultrasound was performed on 415 exposed workers in order to evaluate liver echogenicity and size. Also, biochemical assessment of the liver was done to evaluate its function. RESULTS: Statistically significant increase in the liver parenchymal echogenicity and the liver size was seen in the exposed workers compared with control (p ≤ 0.05). These increased as the exposure duration increased. It was also noted that out of 16.87% (N=70) exposed workers with abnormal liver echopattern, only 2.65% (N=11) had alanine aminotransferase above the reference range. CONCLUSION: The study revealed evidence of ultrasound detectable hepatotoxicity among the exposed subjects. Sonography appeared to detect petroleum products-induced hepatic toxicity more than biochemical assays suggesting that biochemical assessment may have underestimated toxicity.

Assessment of natural radioactivity in phosphate ore, phosphogypsum and soil samples around a phosphate fertilizer plant in Nigeria.

The radionuclides present in phosphate ore, phosphogypsum and soil samples in the vicinity of a phosphate fertilizer plants in Nigeria were identified and their activity concentration determined to assess the potential radiation impact on the environment due to fertilizer production. The mean activity concentration of (238)U, (232)Th, and (40)K radionuclides in phosphate ore samples were 616 ± 38.6, BDL (Below Detection Level) and 323.7 ± 57.5 Bq kg(-1) respectively. For the phosphogypsum, 334.8 ± 8.8, 4.0 ± 1.4, and 199.9 ± 9.3 Bq kg(-1) respectively and for soil samples range from 20.5 ± 7.3 to 175.7 ± 10.5 Bq kg(-1) for (226)Ra, 15.5 ± 1.5 to 50.4 ± 0.6 Bq kg(-1) for (232)Th and 89.5 ± 8.1 to 316.1 ± 41.3 Bq kg(-1) for (40)K respectively. The mean absorbed dose rate was 71.4 nGy h(-1). The mean annual effective dose was 86 µSv.

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