Pattern of duplex doppler ultrasound scans in Jos University Teaching Hospital.

INTRODUCTION: Doppler ultrasound scan is a non invasive diagnostic tool used in the evaluation of vascular and perivascular lesions. It is gaining a wider acceptance over other methods of vascular evaluation which are expensive and invasive. We aimed at evaluating the indications and findings of duplex doppler ultrasound scans performed in this centre. METHODOLOGY: This was a retrospective study of all consecutive patients that had doppler ultrasound scans from January 2000 to December 2004. RESULTS: One Hundred and sixty five (165) Doppler ultra sound scans were performed on 115 patients. Thirty nine patients had a double scan while 19 had repeated scans. The study population was aged between 2-90 years with a mean age of 44.5 +/- 17.5 years. There were 86 (52.1%) males and 79 (47.9%) females giving a male to female ratio of 1:1.67 (41%) of the doppler scans were for deep vein thrombosis while peripheral vascular disease and vascular aneurysm accounted for 24 (14.5%) and 23 (13.9%) respectively, see Table 1. Reduction in vascular blood flow was the most common doppler finding seen in 34 (20.6%) patients followed by visible thrombi in 14 (8.5%) patients. CONCLUSION: Deep vein thrombosis is the most common indication for doppler ultrasound scan in our practice.

Digitally recycled incubators: better economic alternatives to modern systems in low-income countries.

UNLABELLED: The need to maintain a neutral thermal environment is critical to newborn care. AIM: To investigate reasons for the insufficiency of functional incubators and develop a cost-effective technique for using electronic digital components to recycle obsolete incubators in Nigeria. METHODS: Following interview of 84 clinicians and administrators in Nigerian hospitals, it was identified that inadequate funding was the main reason for lack of functional incubators. Two groups of incubator units were then created and their performance compared. Sixteen units of modern (group A) and 19 units of obsolete (group B) incubators were obtained from six hospitals. An assembly design applying independent generic components for recycling systems was specified and produced. These were sourced through the internet at competitive cost and fitted into the reconstructed panels of the obsolete systems. The functional performance of each recycled system was rigorously monitored for 6 months and graded using ten performance indices. The same indices were used to quantify group A systems. RESULTS: The performance of the recycled incubators (group B) was found to be similar to those of modern incubators. Group B's cost index was found to be 25% of that of group A's. CONCLUSION: Appropriate incubator recycling is a cost-effective method of re-equipping hospitals in low-income countries.

Diabetes co-existing with chronic liver disease: clinical features and response to therapy.

BACKGROUND AND OBJECTIVES: Diabetes mellitus (DM) and chronic liver disease (cirrhosis) may co-exist in the same individual. Diabetes may cause non-alcoholic steatohepatitis with necroinflammatory changes and granuloma formation leading to hepatic fibrosis. Cirrhosis of the liver from alcohol and hepatitis C infection, on the other hand, may give rise to insulin resistance or may result in progressive impairment of insulin secretion leading to DM. We studied the clinical features and response to therapy of diabetic patients with the two conditions to determine if there are differences in the clinical features and effects of the chronic liver disease (CLD) on the management of DM. METHODS: This was a prospective study conducted at the Diabetes Clinic at the Jos University Teaching Hospital (JUTH) over a period of two years. Newly diagnosed diabetics with features of CLD (cirrhosis) were enrolled into the study after obtaining a consent. Age, sex, body mass index (BMI), family history of diabetes were recorded, as well as symptoms and signs of DM or CLD. Serum fasting blood glucose (FBS), prothrombin time ratio (PTR), and serum fasting lipids (serum lipoproteins and serum triglycerides) were measured. Urinalysis was done. The responses to therapy were classified as very rapid, rapid and gradual based on our previous unpublished observations that diabetic patients with CLD responded briskly to antidiabetes therapy. RESULTS: 26 patients(19 men, and 7 women) were seen with both diseases agreed to participate in the study This accounted for 8.6% of the diabetic population attending the diabetes clinic. The mean age of the patients was 54.6 (9.2) years spanning a range of 34-75 years. Mean BMI was 21.6 (6.0) kg/m2. The mean serum albumin concentration was 25.5 (8.5) g/l, mean FBS was 15.5 ( 3.4) mmol/l and PTR was 1.6 (0.43). Urinalysis showed glycosuriain all patients with only one patient showing trace of ketonuria. Clinical features of DM and CLD were few each. There was a brisk response to insulin therapy so that one needs to be cautious with insulin administration. CONCLUSION: Diabetes in patients with CLD has similar but fewer features compared to patients with type2 DM. CLD affects the response to therapy, particularly insulin therapy and calls for caution, as these patients may be sensitive to therapy.

Diabetes Co-existing with Chronic Liver Disease : Clinical Features and Reponse to Therapy

Background and objectives : Diabetes mellitus (DM) and chronic liver disease (cirrhosis) may co-exist in the same individual. Diabetes may cause non-alcoholic steatohepatitis with necroinflammatory changes and granuloma formation leading to hepatic fibrosis. Cirrhosis of the liver from alcohol and hepatitis C infection; on the other hand; may give rise to insulin resistance or may result in progressive impairment of insulin secretion leading to DM. We studied the clinical features and response to therapy of diabetic patients with the two conditions to determine if there are differences in the clinical features and effects of the chronic liver disease (CLD) on the management of DM. Methods: This was a prospective study conducted at the Diabetes Clinic at the Jos University Teaching Hospital (JUTH) over a period of two years. Newly diagnosed diabetics with features of CLD (cirrhosis) were enrolled into the study after obtaining a consent. Age; sex; body mass index (BMI); family history of diabetes were recorded; as well as symptoms and signs of DM or CLD. Serum fasting blood glucose (FBS); prothrombin time ratio (PTR); and serum fasting lipids (serum lipoproteins and serum triglycerides) were measured. Urinalysis was done. The responses to therapy were classified as very rapid; rapid and gradual based on our previous unpublished observations that diabetic patients with CLD responded briskly to antidiabetes therapy. Result : 26 patients (19 men; and 7 women) were seen with both diseases agreed to participate in the study. This accounted for 8.6of the diabetic population attending the diabetes clinic. The mean age of the patients was 54.6 (9.2 ) years spanning a range of 34-75 years. Mean BMI was 21.6 (6) kg/m2. The mean serum albumin concentration was 25.5 (8.5) g/l; mean FBS was 15.5 (3.4) mmol/l and PTR was 1.6 (0.43). Urinalysis showed glycosuriain all patients with only one patient showing trace of ketonuria. Clinical features of DM and CLD were few each. There was a brisk response to insulin therapy so that one needs to be cautious with insulin administration.Conclusion : Diabetes in patients with CLD has similar but fewer features compared to patients with type 2 DM. CLD affects the response to therapy; particularly insulintherapy and calls for caution; as these patients may be sensitive to therapy

Familial polycystic kidney disease in Nigeria: a report of two cases.

A case of familial polycystic kidney disease is reported. Although isolated cases of adult polycystic kidney disease have been reported in our environment, no case to our knowledge has been reported with a familial link. Polycystic kidney disease is said to be rare in Africans. Although it commonly terminates in chronic renal failure, it hardly features in the aetiopathogenesis of end stage renal disease requiring some form of renal replacement therapy in African series. This, some workers believe may be due to misdiagnosis and under reporting. This report is to show that it may not be as rare as suspected, and that the familial link shown in the advanced countries is also applicable here. Case 1 was diagnosed in the course of evaluation of her clinical disease. Case 2, an aunt of Case 1, was diagnosed following investigation of a casual complaint of a painless abdominal mass in the wake of her senior brother's death from haemorrhagic stroke.

Sonographic diagnosis of congenital brain malformations: the Ilorin experience.

A retrospective study was done to determine the incidence of congenital malformation of the brain among African infants over a 5 year period. Transfontanelle ultrasound (US) was performed on 98 infants consisting of 45 males and 53 females. The mean age was 2.6 months (range 1-11 months). Congenital malformation was present in 25.5% of the 98 cases studied, most of which were associated with hydrocephalus. Cerebral aqueduct stenosis was the commonest congenital anomaly encountered and was found in 24% of case. This study shows that transfontanelle US is a useful tool for diagnosis of congenital brain malformations in infants.

Familial polycystic kidney disease in Nigeria: A report of two cases

A case of familial polycystic kidney disease is reported. Although isolated cases of adult polycystic kidney disease have been reported in our environment; no case to our knowledge has been reported with a familial link. Polycystic kidney disease is said to be rare in Africans. Although it commonly terminates in chronic renal failure; it hardly features in the aetiopathogenesis of end stage renal disease requiring some form of renal replacement therapy in African series. This; some workers believe may be due to misdiagnosis and under reporting. This report is to show that it may not be as rare as suspected; and that the familial link shown in the advanced countries is also applicable here. Case 1 was diagnosed in the course of evaluation of her clinical disease. Case 2; an aunt of Case 1; was diagnosed following investigation of a casual complaint of a painless abdominal mass in the wake of her senior brother's death from haemorrhagic stroke

A review of the radiological diagnosis of small bowel obstruction using various imaging modalities.

Radiological investigation is an important tool in the diagnosis of small bowel obstruction (SBO). While plain abdominal radiograph remains the commonest investigation done in SBO, contrast gastrointestinal radiography, ultrasonography (US), computerised tomography (CT) scan -- with or without contrast enhancement are increasingly being advocated particularly in equivocal cases of SBO. We conducted manual, medicine and internet search for relevant literature on diagnosis of SBO using radiological investigations. Plain abdominal radiograph has a diagnostic accuracy for SBO that varies widely from 50 - 92% . Contrast gastrointestinal radiograph in equivocal cases of adhesive SBO can readily differentiate between complete and partial obstruction. Abdominal ultrasound is cheap and readily available. Accuracy of as high as 89% has been reported in experienced hands. CT scan has an added advantage of predicting the site and cause of obstruction. In developing countries like ours, plain abdominal radiography still remains an important diagnostic tool. The role of abdominal ultrasonography needs further evaluation since it is safe, readily available and affordable.

Transfontanelle ultrasonography: an invaluable tool in the assessment of the infant brain.

Transfontanelle (cranial) ultrasonography was carried out in 98 Nigerian infants over a period of 5 years. Of the infants, 38 (38.8%) had hydrocephalus from various causes while 26 (25.5%) had congenital anomalies. As ultrasound equipment is becoming a more readily available and affordable tool in the developing countries, it should become much easier for medical staff in these countries to arrive at the correct diagnosis of intracranial diseases in infants.

Current aetiology of neonatal sepsis in Jos University Teaching Hospital.

BACKGROUND: Periodic bacteriologic surveillance in neonatal units is a necessity. OBJECTIVE: To determine the currently prevalent pathogens of neonatal sepsis in the Special Care Baby Unit of Jos University Teaching Hospital, and their antibiotic susceptibility profiles. METHODOLOGY: One hundred and twenty two neonates with clinical suspicion of sepsis underwent bacteriologic screening over a 4 month period. RESULTS: One hundred and fourteen bacteria were isolated from 66 (54.1%) of the infants. Forty two (36.8%) isolates were gram positive (predominantly Staphylococcus aureus), while 72 (63.2%) were gram negative (predominantly Escherichia coli). Gentamicin was most useful antibiotic, though effective against only 67% of both gram positive and gram negative bacteria. The susceptibilities of both gram positive and gram negative bacteria to the third generation cephalosporins were particularly poor (less than 10%). CONCLUSION: Our data show a change in the predominant gram negative bacterial pathogen compared with an earlier report from our unit, and an alarming overall decline in the susceptibilities of both gram positive and gram negative pathogens to the commonly used antibiotics.

Intestinal atresia: management problems in a developing country.

Over a 13-year period, 24 children with intestinal atresia were managed at the Jos University Teaching Hospital, Jos, Nigeria. Intestinal atresia ranks as the second most common cause of neonatal intestinal obstruction (after anorectal malformation) in our hospital. Five children had duodenal obstruction (two atresia, two duodenal webs, one annular pancreas), 17 had jejunoileal atresia, and two had colonic atresia. Fourteen were boys, and 10 were girls (M:F: 1.17:1). The median age at presentation to the surgeon was 6 days (range: 1 day-12 years). The most common presenting features were bilious vomiting and abdominal distension. Six patients did not pass meconium within the first 24 h of birth. The median weight at presentation was 2.6 kg (range: 1.1 kg-5.0 kg). Seven patients (four with jejunoileal atresia and three with duodenal obstruction) had associated congenital anomalies. Diagnostic investigation was plain abdominal x-ray, showing double-bubble gas shadows in duodenal atresia and varying degrees of air-fluid levels in jejunoileal and colonic atresias. An upper gastrointestinal series was done in three patients and a barium enema in one. Retrocolic duodenojejunostomy was done for all patients with duodenal atresia and annular pancreas, duodenotomy and web excision for those with duodenal webs, and resection with end-to-end anastomosis for those with jejunoileal atresia. One child with atresia involving the whole ileum and the colon had a jejunorectal anastomosis, while the other child with colonic atresia had caecostomy followed later by ileorectal anastomosis. Ten neonates died, giving a mortality rate of 41.7%. Mortality from intestinal atresia is still high in our environment, due mainly to lack of neonatal intensive care facilities.

Amodiaquine treatment of uncomplicated malaria in children, in an area of chloroquine-resistant Plasmodium falciparum in north-central Nigeria.

The efficacy of amodiaquine against Plasmodium falciparum malaria was assessed in an area of confirmed chloroquine resistance in the cool, north-central plateau of Nigeria, using a 14-day protocol. The patients were all children aged <5 years of age. The drug proved highly efficacious, giving a cure 'rate' of 100% on day 14 and mean fever- and parasite-clearance times of 1.11 and 3.11 days, respectively. It was also well tolerated. Following treatment, packed-cell volumes (PCV) generally increased (65% of patients) but remained constant (12%) or even decreased (23%) in some patients; the overall improvement in PCV was not statistically significant (P >0.05). The results justify the use of amodiaquine to treat P. falciparum malaria in those who have failed treatment with chloroquine and the second-line drugs (e.g. sulfadoxine-pyrimethamine) currently used in Nigeria. As the amodiaquine would be better employed as one part of a combination than on its own, there is a need to identify suitable partner compounds.

Clinical pattern and outcome in children with acute severe falciparum malaria at Jos University Teaching Hospital, Nigeria.

A prospective study was undertaken to determine the clinical pattern and outcome among children admitted with acute severe malaria into the emergency paediatric unit (EPU) at the Jos University Teaching Hospital (JUTH) over a 15-month period (between August 1991-October 1992). Five hundred and one (25%) children were admitted with acute severe malaria, out of a total of 2008 admissions into the EPU during the study period. Blood smears for malaria parasites were positive in 287 (57.7%) of the children and P. falciparum was the only species identified in the study. Seventy one percent of the children admitted were aged 5 years and below. Febrile convulsions was the commonest manifestation of acute severe malaria, accounting for 49.7% of the cases. Majority (97.8%) of the children responded satisfactorily to chloroquine therapy with clearance of parasitaemia. Associated bacteraemia was documented in 35 (7%) of the 501 children. Sixteen out of the 501 children died, giving a mortality of 3.2%. Cerebral malaria, which accounted for only 17.6% of the admissions, was responsible for 56.3% of all the deaths. Mortality was also associated with hypoglycaemia, severe anaemia, shock and repeated, prolonged seizures.