Ultrasound as a triaging tool for the diagnosis of malaria and typhoid in a resource constrained setting: A proposed frame-work.

INTRODUCTION: Ultrasound has proven to have great potentials in the diagnosis and work-up of patients affected by tropical diseases. Its role in the diagnosis of malaria and typhoid abounds, but its value as a triaging tool in a resource-constrained settings is indistinct. Our review aimed is aimed at assessing the utility of ultrasound in diagnosis and prognosis of malaria and typhoid. MATERIALS AND METHOD: Extensive literature search was conducted using the PubMed electronic database, for original peer reviewed articles in English language within 1964-2023. Keywords like "malaria", "typhoid", "S. Typhi", "Salmonella Typhi", "enteric fever", "ultrasound", "sonography" and "ultrasonography" were searched, using Boolean operators such as (OR, AND) applying the following filters (English, Human). A systematic synthesis of the literature was done. RESULT: Our initial search yielded 749 potentially relevant references out of which 55 were found to be eligible. Organs assessed include the liver, spleen, kidneys, intestines, mesenteric lymph nodes, among others. For malaria, pathognomonic conditions like splenic enlargement, hepatomegaly, renal abnormalities as well as mesenteric lymph nodes and intestinal wall thickening in patients with typhoid fever. CONCLUSION: Ultrasound by experienced clinicians adds significantly to the diagnosis and work-up of patients with malaria and typhoid fever. However, it is important to note that ultrasound alone may not be sufficient for definitive diagnosis as laboratory tests may still be required for confirmatory diagnosis. IMPLICATION FOR PRACTICE: This study provide information on ultrasound in diagnosis of Malaria and typhoid by evaluating the morphological changes in abdominal and other organs of the body. This can be a guide to clinicians and other healthcare providers for early diagnosis and work-up of patients in endemic areas where resources are scarce.

Attitude towards psychiatric treatment and referral pattern in the University of Maiduguri Teaching Hospital - a preliminary report.

OBJECTIVE: There is a paucity of literature on consultation-liaison psychiatry, in northern Nigeria. This study aimed to determine both the pattern of psychiatric referrals, and the attitudes of doctors toward the treatment of mental disorders in a teaching hospital, in northeast Nigeria. METHOD: In this cross-sectional survey, we used a modified version of the self-rated Kumar 12-item questionnaire and a basic socio-demographic questionnaire to assess a non-random convenient sample of 100 postgraduate resident doctors (with a response rate of 70%) from the University of Maiduguri Teaching Hospital (UMTH). We subjected the data obtained to descriptive statistical analysis, using EPI info (2003), to report averages. RESULTS: A relatively low percentage (57.1%) of doctors acknowledged treating patients with mental disorders in their practice, with a higher proportion acknowledging referral (75%). Nearly one in five (17.6%) of the respondents were unaware that patients with functional illness could have psychological disorders. We found more awareness for psychotherapy (44.1%) than other non-pharmacological treatment interventions, while 10.3% were ignorant of non-pharmacological forms of treatment for psychological problems. CONCLUSION: Although this is a preliminary report, the research reported here demonstrated that doctors in the teaching hospital concerned recognized the need for psychiatric consultation and referral. It is difficult to draw further conclusions because of the limitations of this study.

Epidural steroid injection in patients with lumbosacral radiculopathy in Abuja, Nigeria.

OBJECTIVE: This prospective-controlled observational study looked at well-matched patients with spinal pain and radicular symptoms, caused by lumbar intervertebral disc herniation to compare the short-term clinical outcome of transforaminal and interlaminar epidural steroid injection (ESI) in a resource challenged tertiary institution in Nigeria. MATERIALS AND METHODS: 49 patients with radicular symptoms who were matched for age, symptom duration, magnetic resonance imaging findings, and pre-injection revised Oswentry Disability Index (ODI) score and Visual Analogue Scale (VAS) were assigned into ESI technique. The ODI and VAS score were analyzed immediately after an injection and upon follow-up (average 178.5 days), also with the need for repeated injections and surgical interventions over a 1-year follow-up interval. RESULT: In the transforaminal group (25 patients), there was a statistically significant improvement in the ODI scores from before the injection (ODI mean 62.4) to immediately after the injection (ODI mean 24.4, P < 0.01), and upon follow-up (ODI mean 20.8, P < 0.01). 9 patients (18.4%) required 1 or 2 repeated injections, 3 (6.1%) patients underwent surgery and 2 (4%) patients lost to follow-up. In the interlaminar group (24 patients), there was a statistically significant improvement in the ODI scores from before the injection (ODI mean 60.7) to immediately after the injection (ODI mean 30.1, P < 0.01), but not upon follow-up (ODI mean 43.2, P = 0.09). 11 (22.4%) patients required 1 or 2 repeated injection, 4 (8%) patients underwent surgery and 3 (6.1%) patients were lost to follow-up. There is an average of 2 fold improvement of transforaminal ESI over interlaminar ESI in a 40 point scale of ODI score on follow-up, which was statistically significant (P < 0.01). The VAS showed similar pattern with the ODI scores in the study. CONCLUSION: Transforaminal ESI to treat symptomatic lumbar disc herniation resulted in better short-term pain improvement and fewer long-term surgical interventions compared to interlaminar ESI.

Pelvic types as seen in a tropical setting.

BACKGROUND: Cephalo pelvic disproportion is still the leading indication for caesarean section in many developing countries and the contribution of pelvic typology may play some role in this regard. Our objective is to determine the proportion of pelvic types as seen in a tropical setting. METHOD: A retrospective review of preliminary films of hysterosalpingography of 400 women who underwent the study between January 2000 and December 2007 was reviewed to determine the pelvic typology. RESULT: Of the 400 films reviewed, 361 (90.3%) were gynaecoid, 36 (9%) were androidc and 3 (0.8%) were andropoid. There was no platypelloid pelvis seen in the films reviewed and a mixed type pattern was not observed in this study. CONCLUSION: The proportion of pure gynaecoid pelvis seen in this review is about the highest reported in the literature.

Klippel-Feil syndrome: a case report.

OBJECTIVE: To report the clinical presentation and peculiarity of management of Klippel-Feil syndrome (KFS) at the University of Abuja Teaching Hospital, Gwagwalada. BACKGROUND: KFS is a rare pathology that has not been previously reported on in Nigeria. METHODS: Case review was employed to report this pathology. RESULT: This case is a 10 year old boy with KFS presenting with cosmetic blemish and scoliosis. Surgical treatment of the cosmesis was offered but patient defaulted because of fund due to their low income. CONCLUSION: KFS is an uncommon pathology in the male. The management is essentially conservative but surgery is an option if there was cervical spine instability, scoliosis and cosmetic blemish.

Pelvic Types As Seen in a Tropical Setting

Background: Cephalo pelvic disproportion is still the leading indication for caesarean section in many developing countries and the contribution of pelvic typology may play some role in this regard. Our objective is to determine the proportion of pelvic types as seen in a tropical setting. Method: A retrospective review of preliminary films of hysterosalpingography of 400 women who underwent the study between January 2000 and December 2007 was reviewed to determine the pelvic typology. Result: Of the 400 films reviewed; 361(90.3) were gynaecoid; 36 (9) were android and 3 (0.8) were andropoid. There was no platypelloid pelvis seen in the films reviewed and a mixed type pattern was not observed in this study. Conclusion: The proportion of pure gynaecoid pelvis seen in this review is about the highest reported in the literature

Pedestrian injuries resulting from road traffic accidents: the Azare experience.

BACKGROUND: Road traffic accident (RTA) is a leading cause of serious morbidity and mortality world wide. The pedestrians are not spared from this epidemic. OBJECTIVE: The aim of this study is to identify factors that puts the pedestrian at risk of injuries from RTA and the anatomical regions most commonly involved in our environment and suggest ways of curbing them. METHODS: This was a one-year retrospective study of 122 pedestrian casualties resulting from road traffic accident attending the Accident and Emergency (A/E) Unit of the Federal Medical Centre, Azare. RESULTS: Majority of the patients (72%) were males with a male to female ratio of 2.6:1. Children and adolescents constitute 54.1% of the casualties. Motorcycles were responsible for most of the pedestrian injuries (73%). The head and neck was the most frequently injured anatomical region of the body (43.4%), followed by the extremities (37%). The months of August and January were the peak periods of injuries. CONCLUSION: The safety of pedestrian is seriously threatened by the growing popularity of commercial motorcycles on our roads. Preventive measures are advocated to ensure only licensed cyclists are allowed on the roads. Adequate personnel training to manage head injury in our centers is also advised. More patrol by the road safety agents is advised in the months of January and August.

Pedestrian Injuries Resulting from Road Traffic Accidents : the Azare Experience

BACKGROUND: Road traffic accident (RTA) is a leading cause of serious morbidity and mortality world wide. The pedestrians are not spared from this epidemic. OBJECTIVE: The aim of this study is to identify factors that puts the pedestrian at risk of injuries from RTA and the anatomical regions most commonly involved in our environment and suggest ways of curbing them. METHODS : This was a one-year retrospective study of 122 pedestrian casualties resulting from road traffic accident attending the Accident and Emergency (A/E) Unit of the Federal Medical Centre; Azare. RESULTS : Majority of the patients (72) were males with a male to female ratio of 2.6 :1. Children and adolescents constitute 54;1 of the casualties. Motorcycles were responsible for most of the pedestrian injuries (73). The head and neck was the most frequently injured anatomical region of the body (43.4); followed by the extremities (37). The months of August and January were the peak periods of injuries. CONCLUSION: The safety of pedestrian is seriously threatened by the growing popularity of commercial motorcycles on our roads. Preventive measures are advocated to ensure only licensed cyclists are allowed on the roads. Adequate personnel training to manage head injury in our centers is also advised. More patrol by the road safety agents is advised in the months of January and August

Radiograghic evaluation of lymphadenopathy in pulmonary tuberculosis in Northeastern, Nigeria.

BACKGROUND: There is changing pattern of presentation of tuberculosis in the era of HIV Lymphadenopathy is one of the most important manifestations of tuberculosis, hence the need for the evaluation of its radiologic patterns. METHODS: A multi-centre retrospective study of chest radiographs of 116 adult patients diagnosed bacteriologically (positive sputum smear) as pulmonary tuberculosis was conducted in the University of Maiduguri Teaching Hospital, Maiduguri, and Federal Medical Centre Nguru, in Bomo and Yobe States, Nigeria, respectively between April 2003 and March 2004. Lymphadenopathy was assessed in all the radiographs. RESULTS: Of the one hundred and sixteen radiographs of patients analyzed, there were 83 (71.6%) males and 33 (28.4%) females with mean age of 37.99 +/- 14.11 years. A total of thirty eight patients (32.7%) presented with lymphadenopathy with the highest frequency in the left hilar region (12.9%). Bilateral hilar and paratracheal lymphadenopathy were the lowest with equal percentages (4.3%). Left, right and bilateral hilar enlargement were more common in males than females (p < 0.000) and more patients had left hilar (15) than right hilar (13) enlargement (p = 0.030). Only 3 (2.6%) out of all the patients presented with lymph node calcification. CONCLUSION: In conclusion, there is a rise in the prevalence of lymphadenopathy among pulmonary tuberculosis patients when compared to a previous study done in the pre-HIV era in Nigeria.

Pattern of spinal cord injury in Maiduguri, North Eastern Nigeria.

BACKGROUND: Spinal Cord Injury (SCI) is often associated with lifetime morbidity. There is no data on this injury from this Sub-region. The study examines the pattern of SCI in Maiduguri and its environs with a view to contribute to the emerging national data on the rising incidence of this injury and to highlight the deficiencies in our set up and suggest ways of improving them. METHODS: The case notes of SCI patients managed at the University of Maiduguri Teaching Hospital between 1998 and 2002 were retrospectively analyzed. RESULTS: There were 36 patients, 30 males and 6 females (ratio 5:1) with age range of 13-55 years (mean 34.3 +/- 3 years). Road traffic accident (RTA) accounted for 22 (61.1%), while falls resulted in 9 (25%) of the injuries. The most frequent levels of injury were cervical region 14 (38.9%) and thoracolumbar 10 (27.8%). The commonest complications encountered were urinary tract infections (UTI) and bedsores. All the deaths, 3 (8.3%), occurred in patients with complete cervical spine lesion. CONCLUSION: The high morbidity associated with SCI could be reduced through public enlightment on road safety measures including use of seat belts, prohibition of carrying goods and passengers together in trucks. and establishment of Spinal Centres equipped to function.

Penetrating arrow injuries of the maxillofacial region.

We operated on four civilian patients who had unusual penetrating maxillofacial injuries that resulted from assault with arrows. The patients were fully conscious at the time of presentation. Recovery was uneventful in three, but one died.

The chest radiographic appearance and frequency distribution of cavities in pulmonary tuberculosis among adults in northeastern, Nigeria.

The aim of the study was to assess the radiographic appearance and frequency of distribution of cavitations in the lungs using chest radiographs in Northeastern. Nigeria. A multi-center retrospective study of chest radiographs of 116 adult patients diagnosed bacteriologically as pulmonary tuberculosis was conducted. The age, sex, presence of cavitations, single or multiple. thin walled or thick walled, presence of fluid level or fungal ball in the cavity and the lobar distribution of cavitations in the lungs were assessed. There were 83 (71.6%) males and 33 (28.4%) females with mean age of 37.99 +/- 14.11. A total of 58 patients (50%) presented with cavitations and no sex preponderance observed. There were more cases with multiple (38 patients = 32.8%) than single (20 patients = 17.2%) cavitations (P<0.05). Cavitations were more common in the right (28.23%) and left upper lobes and less common in the left lower and lingula (9.68%) lobes (Table 3). There were more cavitations involving the right lung (57.16%). Thirty four patients (58.62%) presented with only thick walled cavitations compared with 18 cases (31.03%) with only thin walled cavitations (P<0.05). Six patients (10.35) had both thick and thin wall cavitations. Out of the 58 patients with cavitations only 2.32% (4 cases) presented with fluid levels and 1.74% (3 cases) with fungal ball. In conclusion, cavitations are a common finding in pulmonary tuberculosis with no sex preponderance and occur predominantly in the upper lobes. Multiple, thick wall cavitations were the common presentation. Fungal balls and fluid levels were rare.

Fine needle aspiration cytology diagnosis of liver diseases in the University of Maiduguri Teaching Hospital, Maiduguri.

The study is aimed at classifying liver diseases diagnosed by fine needle aspiration cytology (FNAC) in our environment and to emphasize the importance of the procedure for management of our patients. Forty-two patients were referred by the physicians for fine needle aspiration cytology diagnosis in Histopathology Department, University of Maiduguri Teaching Hospital between January 2001 and December 2003. There were 30 males and 12 females (2.5:1) with mean age of 44.7 years. The peak age is in the 5th decade of life. The commonest hepatic disease is primary hepatic malignancy, which accounted for 78.6% (33 patients); 3 suspicious of malignancy, one case each of metastatic carcinoma, amoebic liver abscess; liver storage disease and large cell dysplasia. The technique has gained popularity in our center because it is cheap, convenient, minimally invasive, quick and has high precision in obtaining samples. We therefore recommend this procedure in centers where liver diseases are common as a means of initial investigation.

Production and characterization of a mouse monoclonal antibody specific for lentil lectin.

A murine IgA monoclonal antibody (MoAb) was produced against the widely used glucose/mannose-specific two-chain mitogen from Lens culinaris (lentil) belonging to the Vicieae tribe of the Leguminosae family. The MoAb designated, 98, F-10, was found to be specific for lentil lectin when tested in dot blotting against 22 different native lectins. The antigenic specificity was also tested against subunits of 13 completely sequenced legume lectins separated by sodium dodecyl sulphate-polyacrylamide gel electrophoresis and electrotransferred to nitrocellulose filters. The MoAb showed a strong reaction only against the lentil heavy subunit. Comparison of the amino-acid sequences revealed 13 amino-acid residues which might be involved in the epitope reactive with this antibody. The MoAb did not react with synthetic peptides from the heavy subunit of lentil.