Carotid doppler ultrasonography in patients with co-existing type 2 diabetes mellitus and hypertension in Nigeria

Background:The co-existence of diabetes mellitus (DM) and hypertension (HTN) has been rising globally with subclinical atherosclerotic complications. These vascular changes can be detected using carotid ultrasonography. Objectives: To determine and compare the carotid arterial structural wall changes and blood flow velocities of adults with co-existing DM and HTN with age-and sex-matched non-diabetic, non-hypertensive controls. Methods: A cross-sectional comparative study of 300 participants comprising 200 adults with co-existing DM and HTN and 100 age-and sex-matched controls was done. Their carotid arteries were examined bilaterally for plaques, carotid intima media thickness (CIMT) and flow velocities ­peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI) and resistive index (RI) using 4­12MHz linear array transducer. Visceral obesity and serum lipids were also assessed. Results: The mean age of the subjects was 56.13 ± 6.93 years; they comprised 38% males and 62% females. The subjects' CIMT was statistically significantly higher (p = 0.001) with a three-fold mean increase (45.5%) compared to the controls (13.7%). Lower flow velocities but higher indices were also observed in the subjects. Strong and significant correlations were observed between EDV and PI r =-0.663, p=>0.001), EDV and RI (r = -0.661, p=>0.001) and PI and RI (r =0.988, p= >0.001)among the subjects. Conclusion: Significant reduction in flow velocities with increased CIMT may be an early indication of subclinical atherosclerosis. Therefore, carotid ultrasonography should be mandatory in individuals at risk for early detection and possible prevention of atherosclerotic complications.

Malrotation of the midgut associated with horseshoe kidney presenting as gastric outlet obstruction in a 15-year-old boy.

Malrotation occurs in approximately 1 in 500 live births. However, the true incidence of malrotation is unknown since many asymptomatic patients fail to present. Approximately 90% of patients with malrotation are diagnosed within the 1st year of life. Eighty per cent of them are diagnosed within the 1st month of life. Nevertheless, there are recent reports of manifestations later in life both as emergency conditions and more chronic gastrointestinal symptoms. The relationship between malrotation and horseshoe kidney has not been fully understood, but few case reports have highlighted their occurrence in the same patient. The mode of presentation of this case and its association with a horseshoe kidney is the reason for this report. This was a case of malrotation associated with horseshoe kidney. He had exploratory laparotomy and Ladd's procedure. Malrotation is associated with horseshoe kidney which presented as gastric outlet obstruction. He responded well to treatment after Ladd's procedure.

Radiographic chest findings and immunological status in HIV-positive patients with tuberculosis coinfection in a sub-urban Nigerian tertiary hospital.

INTRODUCTION: The study was undertaken to assess chest radiographic features and lymphocyte counts among HIV-positive patients with TB coinfection. MATERIALS AND METHOD: We reviewed the chest radiographs of all newly diagnosed, treatment-naïve HIV-positive patients attending the Treatment Centre at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. The radiographs were examined for presence or absence of features of tuberculosis and pneumonia. Those with tuberculosis were further evaluated for presence of cavities and milliary appearance. The demographic characteristics of the patients were recorded. RESULTS: Two hundred and ninety-five radiographs were reviewed, consisting of 192 females, 103 males with mean ages of 33.6±11.65 and 37.85±13.54 years, respectively. Normal radiographs were found in 68.5% patients, features of tuberculosis in 27.8%, and pneumonia in 2.7%. The percentages of males and females with tuberculosis were 35% and 25%, respectively. Patients with milliary TB were from the youngest age group and those with cavities had CD4 cell count below 200cells/mm(3). Cavities occurred most frequently in the lower zones. WBC and counts were highest in patients with pneumonia. CONCLUSION: Normal chest radiographs were associated with mild clinical course. Males were more frequently involved in TB coinfection. Cavities were associated with lowest CD4 cell count and occurred more in lower zones. Patients with HIV/PTB coinfection had the most severe weight loss. There was no statistically significant difference in absolute lymphocyte count between patients with or without tuberculosis. Chest radiograph remains a veritable tool for identifying HIV/AIDS patients with tuberculosis whether sputum is positive or negative.

Pattern of Doppler Ultrasonographic Scan Requests and Findings: A 3-Year Study

Introduction: Doppler ultrasonography is a radiological investigative tool which is relatively new in developing countries, Nigeria inclusive.Objective: To describe the clinical indications, the pattern of requests and findings of Doppler ultrasonographic studies in a tertiary health facility in Sagamu, Nigeria. This is a preliminary report of a spanning June 2007 to July 2010 and highlighting the Methods: This initial report covered the period between June 2007 and July 2010. The subjects consisted of patients who were referred for Doppler Ultrasonography from public and private health facilities in Sagamu. The ultrasound scan was carried out using a Siemens's Sonoline G-40® Ultrasound Machine. The features recorded included the waveforms, peak velocities, pathologic features such as plaques, irregular pools of blood and the relative absence of flow as well as the lack of Doppler signals.Results: There were 42 patients comprising 29 (69%) males and 13 (31%) females, aged 16-78 years, with a mean age of 53 ± 15.5 years. The subjects were matched for age (p = 0.9). The clinical indications for Doppler ultrasound studies included Diabetes Foot Syndrome (DFS), Deep Venous Thrombosis (DVT), peripheral arterial disease, and leg swellings. Minor indications included oedema, gunshot wound, nephritic syndrome, supraclavicular tumour and varicose veins. The Doppler ultrasound findings were confirmatory of the clinical diagnosis of DVT in 5/8 (62.5%) and 5/23 (21.7%) in DFS patients.Conclusion: Doppler ultrasound confirmed a higher proportion of DVT compared to DFS

Radiographic pattern of skeletal trauma in children seen in a tertiary hospital in Sagamu, South West Nigeria.

AIMS AND OBJECTIVES: The study was aimed at identifying the pattern of skeletal trauma in the paediatric age group as it relates to the causes. MATERIALS AND METHODS: A retrospective analysis of the records on the request cards, case notes, radiographs and reports (where available) of all children aged one day to 15 years who were referred to the radiology department of Olabisi Onabanjo University Teaching Hospital, Sagamu was carried out. Fractures were analysed with respect to sex, age, causes, type and location of fracture. RESULTS: The analysis spanned a period of twenty-eight months during which a total of three hundred and twenty eight radiographs were analysed. The mean ages of male and female patients were 5.4±4.6 and 5.1±4.6 years, respectively, with a range of 0.2-15 years. Normal radiographs were found in 124 (37.80%) patients,53.1 (16.1%) had 55 fractures, and 39 (11.9%) had soft tissue swelling. Fractures were found most commonly in male children and in the age range 4-6 years. Fractures occur three times more in the upper limbs, and the bones most frequently affected are the humerus, radius, and the ulna in descending order. Most of the fractures were due to Road Traffic Injury (RTI) seen in 18.9%, falls seen in 18.9%, and birth trauma, which was responsible for 7.5%. The most frequently involved bone in fractures is the humerus followed by the femur bone. Skull fractures occur mostly in the parietal bone. CONCLUSIONS: Fractures are still mostly investigated with plain radiographs. Fractures are more frequent in male children and in the 4-6 year age range; it is seen more in the upper limb bones especially in the humerus. Skull fractures are relatively rare. Half of the fractures occur in the distal and mid portions of long bones. This study has also high lighted the importance of road traffic injury and falls as aetiological factors in fracture occurring in children. Effort should be made to ease deliveries in order to reduce the incidence of birth trauma.

Radiographic pattern of chronic sinusitis in Ilorin, Nigeria.

One hundred and thirteen patients (62 males and 51 females, aged 5-70 years) with chronic sinusitis seen between January 1995 and December 1998 in the Ear, Nose and Throat (ENT) Diseases Clinic of University of Ilorin Teaching Hospital, Ilorin, Nigeria are presented. A provisional diagnosis of chronic sinusitis was made if there were at least two of the following signs and symptoms: nasal blockage, nasal discharge, post nasal drip, excessive sneezing or halitosis. The radiographic abnormalities observed include gross mucosal thickening; haziness; complete opacity and air-fluid level. Seventy-eight (69.0%) showed abnormality in one or both maxillary antra; 39 (34.5%) in the ethmoid; 13 (11.5%) in the frontal; and 1(0.9%) in the sphenoidal sinuses. Thus the maxillary sinus was observed to be the most commonly involved in the disease process, while the sphenoidal sinus is the least commonly involved. This is consistent with findings in most similar studies.

Sludge, stones and sickle cell anaemia.

A total of ninety-seven paediatric and adult patients with sickle cell anaemia and fourty-eight control subjects were investigated with the aim of determining the content of the gallbladder. The patients and control subjects were categorised according to the presence or otherwise of gallbladder stones, and, or sludge. The age last birthday, PCV and number of crises per year were recorded in order to determine their influence on the development of gallbladder stones and sludge. The gallbladder contents were examined using ultrasonographic technique. The age and number of crises per year was determined from the clinical record files and direct questioning of patients. Seventy patients had normal gallbladder content while eighteen had sludge, six had stones, and three had a combination of sludge and stones. None of the control subjects had sludge or stone. The age of patients increased from progressively from those with normal content through those with sludge to those with stones. The PCV and number of crises per year only differentiated between normal and abnormal gallbladder contents. While the prevalence of gallbladder stones in this study falls within the range in previous studies, a high prevalence of sludge was observed. The association between the occurrence of sludge and stones with age, PVC and number of crises per year suggests the need for a larger series and that they may identify a group of patients requiring closer monitoring.

Splenic size determination in sickle cell anaemia: an ultrasonographic study.

OBJECTIVES: To examine the generally accepted concept of autosplenectomy in patients with sickle cell anaemia, and determine the relationship between age, the steady state PCV and splenic size. DESIGN: Case-control study. SETTING: Sickle Cell Clinic, University of Ilorin Teaching Hospital, Ilorin, Nigeria. SUBJECTS: Sickle cell anaemia patients aged three to 47 years, while the controls included age and sex matched patients attending the General Outpatient Department for minor ailments. INTERVENTIONS: Longitudinal and coronal sizes of the spleen were measured antemortem, by ultrasonographic method, in 98 adult sickle cell anaemia patients and 48 control subjects and compared. The splenic size was correlated with age and PCV among sickle cell anaemia patients. MAIN OUTCOME MEASURES: Determination of longitudinal and coronal sizes of the spleen, comparison of mean splenic sizes of patients with those of controls by Student's t test, and correlation of age and PCV with splenic sizes. RESULTS: Both mean longitudinal and coronal diameters, and surface area were found to be higher in the sickle cell anaemia patients compared to the controls. While the longitudinal diameter increased with age continuously, the coronal diameter decreased after the age of 30 years. There were no significant correlations between the splenic sizes and PCV and number of crises per year. CONCLUSION: The general belief that sickle cell anaemia patients suffer anatomical autosplenectomy was not confirmed. This could be due to the effect of malaria and improved clinical care.