Incomplete vascular ring of the aortic arch presenting with dysphagia in an adult: case report.

Anomalies of the arterial branches of the arch of the aorta are rare, with the aberrant right subclavian artery being the most common of this anomaly. Majority of the anomalies are asymptomatic and often discovered as incidental findings. In the great majority of the symptomatic cases, the presentation may be either with breathlessness or dysphagia or both. This is in addition to the nature of the intrinsic arterial disease of the aberrant vessel, especially in adult patients; and unless borne in mind, the diagnosis is often missed leading to delays and wrong treatment. In this report we present a case of dysphagia in an adult male Nigerian initially diagnosed as œsophageal stricture from herbal potion ingestion but review of his imaging investigations gave a final diagnosis of dysphagia lusoria from an aberrant right subclavian artery. The difficulty in making a diagnosis and the need for a multidisciplinary review of the imaging investigations are highlighted. The patient was successfully treated by a combined trans-thoracic and cervical approach with division and re-implantation of the aberrant vessel unto the right common carotid artery. He has remained symptom-free for 2 years after surgery. Although the great majority of these anomalies are often asymptomatic, it is important they are borne in mind both in imaging investigations as well as in procedures involving structures in the upper visceral mediastinum. Various surgical approaches have been documented in the management of symptomatic ones; it is however recommended that options that ensure revascularization of the affected limb be selected.

Gynaecology, general surgery and urology residents' perspective and exposure to endoscopy training and practice: a cross-sectional study of resident doctors in four residency training centres in Abuja, Nigeria from June to August, 2020.

Introduction: the use of endoscopy in the surgical management of a wide range of ailments has revolutionised the practice of surgery. Endoscopy however has been underutilised in developing nations. Optimal training exposure during the residency training program is considered as very crucial to the improvement of endoscopy practice in this region. The objective of this study was to evaluate the perception and endoscopy training exposure of resident doctors in gynaecology, general surgery and urology in four residency training centres in Abuja. Methods: this was an analytical cross-sectional study of endoscopy exposure of gynaecology, general surgery and urology resident doctors in four residency training centres in Abuja from June through August 2020. Using a structured questionnaire, information was obtained on demography, perception of endoscopy, exposure to and expectations for endoscopy training and practice. Data were analysed with SPSS version 25 (IBM Corp., Armonk, NY, USA). Results: a total of 125 questionnaires were distributed with a 92% response rate. The mean age of the respondents was 36.17±4.62 years with a mean duration of training of 53.91±28.02 months. Eighteen (15.8%) were satisfied with endoscopy practice in their centre and only five respondents (4.4%) had attained competence in operative endoscopy. Twelve trainees (10.5%) reported that they had received formal training in endoscopy outside their workplace and 109 (95.6%) desired to have post-fellowship training. Competence was statistically significantly higher among the senior registrars compared to registrars (Fisher 51.81, P=< 0.001). Lack of funding was the most reported limiting factor to endoscopy training (66.7%) while most (85.1%) desired the incorporation of structured endoscopy training into the residency training curriculum. Conclusion: this study showed poor endoscopy training exposure, a high level of dissatisfaction with the state of endoscopy practice and high expectations of the trainees for improved training facilities and human capacity.

MRI-based morphometric analysis of corpus callosum dimensions of adults in Southeast Nigeria.

The Corpus callosum (CC) is the largest commissural fibre tract, ensuring swift information transfer and integration in both cerebral hemispheres. Variations in morphometry exist. There is a paucity of data on CC dimensions in our subregion, and no standardized reference is available. The study aims to determine the CC dimensions among the adult population in southeast Nigeria. The result will provide reference ranges and form a benchmark for comparisons of CC-related pathologies. A retrospective study of CC morphometric dimensions in normal subjects who had cranial MRI over two years in Memfys Hospital, Enugu, Southeast Nigeria, using a 1.5T GE© 16 channel machine. The CC was segmentalized into seven subregions using the modified Witelson method with special computer software. All measurements were taken twice from the T1 mid-sagittal image, and the mean was used for computation. The results were analyzed using descriptive and inferential statistics. A total of 200 subjects were recruited for the study. The mean length and height of the CC were 75.58 ± 4.52 mm and 24.64 ± 3.40 mm, respectively. The width dimensions of the genu, body, rostrum and splenium were 10.88 ± 1.81 mm, 5.66 ± 1.32 mm, 3.65 ± 1.25 mm, and 10.02 ± 1.70 mm, respectively. No gender variations were noted among the different dimensions of CC (P = 0.90). The length and height of CC increase gradually with age and show a positive correlation. The width dimensions of the genu and splenium increase till middle age and subsequently decreases in line with brain atrophy (p = 0.0000& p = 0.004). Using Pearson's correlation test, no correlation was noted in the dimensions of the body and rostrum of the corpus callosum when related to age and sex. (P = 0.92 & p = 0.66). Reference ranges of CC dimensions in our subregion were presented, and variations exist in its different morphometric dimensions which are affected by brain atrophy. Gender does not influence the dimensions in our subpopulations.

Clinical profile and management challenges of disorders of sex development in Africa: a systematic review.

OBJECTIVES: To review the published literature regarding disorders of sex development (DSD) in Africa which will highlight clinical characteristics, and challenges of evaluation and treatment of DSD. CONTENT: We performed systematic review of articles published on DSD in Africa between January 2001 and December 2020. SUMMARY: Eighteen studies involving 1980 patients from nine countries were analyzed. Overall mean age at presentation was 9.3 years (range 1 day-33 years) with 52.5 and 45.1% reared as females and males, respectively, prior to presentation. Following evaluation however, 64% were assigned female sex, 32.1% were assigned male sex, and 21.8% of the cases required sex reassignment. Only 7 (38.9%) of the publications reported medical treatment of DSD, 4 (22.2%) reported on psychosocial management and 5 (27.8%) documented multidisciplinary team management. Barring regional variations, the documented challenges of management include delayed presentation, loss to follow up, financial challenges, and lack of facilities for care of DSD. Comparison of the cases managed in the last decade (2011-2020) with those managed in the earlier decade (2001-2010) showed a trend towards earlier presentation and reduced rate of sex reassignment in the last decade. However, the challenges persisted. OUTLOOK: Barring regional differences, a high proportion of DSD in Africa may have delayed presentation with inappropriate sex of rearing, inadequate evaluation and need for sex reassignment. Specific efforts to improve time to diagnosis, patient evaluation, improvement of healthcare funding, and collaboration with more developed countries may improve the care of patients with DSD in Africa.

Comparing complications of urethral stricture across various ages: a retrospective analysis of findings from retrograde urethrogram and voiding cysto-urethrogram over 10 years.

OBJECTIVE: To determine the rate and the distribution of the structural defects in the urinary bladder complicating urethral stricture in men, and to compare the complications observed in the younger patients to those observed in the older patients. METHODS: Retrospectively, case files of patients diagnosed of urethral stricture using retrograde urethrogram (RUG) and voiding cysto-urethrogram (VCUG) from February 2009 to August 2018 were analyzed. Stricture characteristics were outlined. In addition, complicating structural defects in the lower urinary tract proximal to the stricture site were documented. The complicating defects identified in the patients were segregated according to age for any observable associations. Logistic regression analysis was used to define the nature of the association of patient age, stricture site, number and length, with distribution of complicating structural defects. Analyses were done using SPSS® version 20. RESULTS: Within the 10-year review period, 257 of 421 suspected cases of urethral stricture were confirmed. Patients are between 1 and 104 years of age (mean: 50.1 ± 19.1 years; median: 51.0 years IQR 35.0-65.0). Bulbar (34.2%); short segment (62.6%); partial (73.9%) strictures are prevalent. Forty-seven (18.3%) of 257 patients presented with 1 or more complications. Bladder diverticulum (8.6%) and urethra-cutaneous fistula (6.6%) are prevalent complications. The distribution of complications does not vary with age, or with stricture characteristics. CONCLUSION: Presentation with complications is not uncommon. The distribution of these complications does not vary with age or with stricture characteristics.

Renal Angiomyolipoma in Pregnancy: Surgical Management with Fetal Preservation - Approach in a Developing Setting.

Renal angiomyolipomas (RAML) are uncommon benign renal tumours that are associated with a tendency to rupture resulting in sometimes-torrential retroperitoneal hemorrhage as the Wunderlich syndrome or as severe potentially exsanguinating hematuria. When hemorrhage from RAML occurs in pregnancy it presents a unique challenge requiring timely and appropriately adapted intervention with the goal of preventing fatality, preserving renal function as well as preventing fetal loss if possible. We report the management of severe bleeding from RAML in pregnancy and highlight the need to adopt a management strategy that suits the practice environment and offers the patient standard and enduring care.

Antiphospholipid syndrome in a young Nigerian girl presenting with gangrenous toes.

We report on a 21-year-old Nigerian girl with toe gangrene, which is one of the most unlikely forms of presentation of antiphospholipid syndrome among Africans. The essence of this case report is to raise awareness that, although antiphospholipid syndrome typically presents in Africans in association with a pregnancy-related event or a neuropathology, it should be considered as a differential diagnosis in all African patients with unexplained vasculitis. A high index of suspicion and early treatment will prevent toe amputations and reduce mortality rates.