Assessment of shoulder joint derangements with magnetic resonance imaging in adult Nigerians.

Objectives: Shoulder pain secondary to various aetiologies is a common musculoskeletal complaint worldwide, and Magnetic Resonance Imaging (MRI) is the most accurate imaging method for evaluating shoulder pain in all age groups. While the patterns of shoulder MRI abnormalities in various demographics have been reported, data on sub-Sahara African populations are still sparse. This study aims to describe the imaging features and spectrum of shoulder joint pathologies on MRI in adult Nigerians. Materials and Methods: This was a retrospective review of the shoulder MRI of 100 adult Nigerians (with and without trauma) from September 2020 to December 2021. Their clinical data and shoulder MRI findings were extracted and analysed. Statistical significance was set at P ≤ 0.05. Results: There were 64 males and 36 females aged 18-82 years. Right shoulder MRI was done in 53 subjects (53%), while the left shoulder was studied in 47 (47%). Supraspinatus tendinopathy (73%), acromioclavicular joint arthropathy (68%), and subacromial-subdeltoid (SASD) bursitis (64%) were the most frequently detected pathologies. Other demonstrated derangements include glenohumeral joint effusion (24%), long head of biceps tendon sheath effusion (18%), labral abnormalities (16%), subcoracoid bursitis (4%), Hill Sach's deformity (3%), anterior glenohumeral dislocation (2%), fatty degeneration of the supraspinatus/infraspinatus muscles (2%), adhesive capsulitis (1%), and other bony abnormalities (contusion, erosion, subchondral cysts). There was no significant difference in the frequency of shoulder abnormalities between the male and female subjects. Conclusion: Acromioclavicular joint arthropathy, SASD bursitis, and rotator cuff disorders were the dominant pathologies in the participants' shoulders.

Flow-mediated Dilation of the Brachial Artery in Women with Hypertensive Disorders of Pregnancy.

Background: Hypertensive disorder of pregnancy (HDP) comprise chronic hypertension, gestational hypertension, preeclampsia/eclampsia, and preeclampsia superimposed on chronic hypertension. HDP complicate up to 10% of pregnancies worldwide and carry significant risks of maternal and perinatal morbidity and mortality. The aim of this study was to evaluate the derangement and characteristics of brachial artery flow-mediated dilation (BAFMD) in women with HDP. Methods: The BAFMD of the right brachial artery of 80 women with HDP (pregnant HDP), 80 normotensive pregnant women (pregnant non-HDP), and 80 healthy nonpregnant women (nonpregnant controls) was evaluated with B-mode ultrasound. The age, blood pressure, body mass index (BMI), brachial artery diameter, and BAFMD of the participants were compared. P ≤ 0.05 was statistically significant. Results: The pregnant HDP group had significantly lower mean BAFMD compared to pregnant non-HDP and nonpregnant controls (6.9% ± 2.53% vs. 8.32% ± 3.4% vs. 9.4% ± 2.68%; P < 0.001). There was no significant difference between the mean BAFMD of the pregnant HDP subgroups: preeclampsia (5.81% ± 1.7%) versus gestational hypertension (6.43% ± 3.02%); P = 0.57. BAFMD diminished with advancing gestational age in both the pregnant HDP and pregnant non-HDP groups. On regression analysis, BAFMD was a poor marker for HDP, while BMI was an independent predictor for HDP. Conclusion: Even though HDP were associated with significantly diminished BAFMD, it was not a good marker for HDP.

Correlation of Doppler ultrasound resistive index in the prostatic gland with severity of male lower urinary tract symptoms, prostate volume, and concomitant diabetes mellitus.

Introduction: Benign prostatic enlargement (BPE) and type 2 diabetes mellitus (T2DM) are common in elderly men. This study aimed to correlate the Doppler resistive indices of prostatic arteries with the severity of lower urinary tract symptoms (LUTS) and prostate volume in men with concomitant BPE and T2DM. Material and methods: Fifty men with T2DM and BPE (BPE-DM) as cases and 50 age-matched men with BPE but no T2DM (BPE-ND) as controls were enrolled. B-mode and power Doppler ultrasonography of the prostate gland were done for both groups. Results: The mean total prostatic volume of the BPE-DM was 79.18 ±8.9 ml, while that of BPE-ND was 60.73 ±10.6 ml (p <0.0001). The mean prostatic resistive index (PRI) was significantly higher among BPE-DM than BPE-ND (0.74 ±0.02 vs 0.68 ±0.09 for right capsular artery; 0.77 ±0.04 vs 0.71 ±0.02 for left capsular artery; and 0.76 ±0.04 vs 0.70 ±0.02 for the urethral artery). BPE-DM with higher glycated haemoglobin, fasting plasma glucose, and longer duration of T2DM experienced more severe lower urinary tract symptoms and had higher PRI. Conclusions: In conclusion, the BPE-DM group presented larger prostate glands and more bothersome LUTS, which correlated with higher PRI. Strict glycaemic control is necessary in men with co-existing BPE and T2DM.

Ultrasonographic Intravesical Prostatic Protrusion in Men with Benign Prostatic Hyperplasia in Southwest Nigeria.

Objectives: To study the relationship between sonographically measured intravesical prostate protrusion and international prostate symptoms score (IPSS), as well as prostate volume, in men with benign prostatic hyperplasia at a single health facility. Materials and Methods: This was a cross-sectional observational study of one hundred men (age >40 years) diagnosed with benign prostatic hyperplasia. Their International Prostate Symptoms Score (IPSS) was assessed using the standardised IPSS instrument. Abdominal ultrasound was done to measure the intravesical prostatic protrusion (IPP), while prostate volume was estimated transabdominally and transrectally. Correlations between parameters were quantified with Spearman's correlation test. P ≤ 0.05 was statistically significant. Results: The mean age was 62.84 ± 9.0 years (Range =42-79 years). The mean IPSS was 20.99 ± 6.42 (range of 5-30). Seventy-three percent of the men in this study had intravesical prostatic protrusion on ultrasound. The mean IPP was 13.0 ± 4.0 mm. Of the 73 men with IPP, 17 (23.3%), 29 (39.7%), and 27 (37%) had grade I, grade II and grade III IPP, respectively. The mean transabdominal prostate volume (TPVA) and transrectal prostate volume (TPVT) were 71 ± 14 ml and 69 ± 13 ml, respectively. IPP had a statistically significant positive correlation with all the other parameters. The strongest correlation (very high correlation) was with the TPVA (r=0.797, P < 0.0001), followed by a moderate correlation with the IPSS (r =0.513, P < 0.0001). TPVT, transition zone volume, transition zone index, presumed circle area ratio, and quality of life score yielded slightly weaker moderate correlation with IPP, while IPP correlated weakly with age. Conclusion: IPP correlated well with multiple clinical and sonographic parameters. It correlated better with TPVA than TPVT.

Magnetic Resonance Imaging of Internal Derangements and Other Knee Pathologies in Adult Nigerians.

Background: Knee joint pathologies/injuries are one of the most common musculoskeletal complaints in adults worldwide. The aetiologies of knee joint disorders are diverse. Magnetic resonance imaging (MRI) is a sophisticated method of detecting and characterizing knee pathologies. This study was conducted to document the clinical presentation and MRI patterns of knee joint abnormalities in a group of adults in Lagos, Nigeria, and to juxtapose it with reports from other climes. Methodology: A retrospective hospital-based analysis of the knee MRI of 158 adult Nigerians was conducted in a single health facility. The clinical history and knee MRI findings were extracted, analyzed, and documented. Statistical significance was established at P≤0.05. Results: There were 158 participants comprising 92 males (58.2%) and 66 females (41.8%) between the ages of 18 and 79. The mean age of the males was 44.75 ± 14.41 years, while that of the females was 47.76 ± 13.72 years (P = 0.19). A history of previous trauma was elicited in 135 (85.4%) participants. Eighty-two right knees (51.9%) and 76 left knees (48.1%) were examined. The dominant joint pathologies detected include effusion (77.2%), medial meniscopathy (48.1%), tibial abnormalities (46.2%), femoral abnormalities (46.2%), patella abnormalities (46.2%), anterior cruciate ligament disorders (37.3%), lateral meniscopathy (27.2%), medial collateral ligament disorders (22.2%), and popliteal (Baker's) cysts (15.8%). ACL abnormalities were significantly more prevalent in male subjects. Knees with ruptured sACL had significantly more joint effusion and injuries to the medial meniscus, lateral meniscus, posterior cruciate ligament (PCL), medial retinacular ligament (MRL), femur, tibia, and fibula. There was no significant difference in the frequency of abnormalities between the right and left knees. Conclusion: Joint effusion, medial meniscopathy, osseous abnormalities (tibia, femur, patella), ACL abnormalities, lateral meniscopathy, and MCL abnormalities, in decreasing order, were the most frequent pathologies in the knee joints evaluated.

Ultrasonographic characterisation of obstructive uropathy in Nigerian women with uterine fibroids.

OBJECTIVES: The objective of this study was to determine the prevalence of upper renal tract obstructive changes in women with uterine fibroids using ultrasonography (USG). METHODS: We enrolled 140 women with uterine fibroids and performed USG of the uterus and upper renal tract with full and empty urinary bladders, respectively. The number of fibroid nodules and the uterine volume were determined. The presence of hydronephrosis was graded and documented. Uterine volumes >200 cm3 were denoted as large and vice versa. Statistical analysis was done using Chi-square and non-parametric tests. RESULTS: The median uterine volume was 556 cm3. Application of a 200 cm3 cut-off value yielded 126 (90%) large uterine volumes and 14 (10%) small uterine volumes. Of the 140 women enrolled, 52 (37.1%) had renal backpressure changes. Of these 52 patients, 51 (98.1%) had uterine volumes >200 cm3. Both kidneys were affected in the vast majority (36 out of 52 = 69.2%) of those with renal backpressure changes, and 23 (44.2%) of the 52 women with renal backpressure changes had mild (Grade 1) hydronephrosis, while 25 (48.1%) had moderate (Grade 2) hydronephrosis. When unilateral, however, backpressure changes were significantly more common on the right side. CONCLUSION: Approximately one in three women with fibroids had renal backpressure changes in this study. Large uterine volume is a key predisposing factor. Routine sonographic assessment of fibroids should include a focused/targeted evaluation of the kidneys.