Ultrasonic assessment of the prevalence of gall stones in sickle cell disease children seen at the University of Benin Teaching Hospital, Benin City, Nigeria

Background: Gallstone is a common problem in patients with sickle cell disease. Prevalence of this problem among sickle cell disease (SCD) children may vary with age, and geographic location. Studies on gallstoneprevalence in SCD children are scanty in the South-South zone of Nigeria.Aim: To determine by ultrasonography the prevalence of gallstones among steady state sickle cell disease children attending the Paediatric Outpatient Clinic of the University of Benin Teaching Hospital, Benin-City, south southNigeria.Methodology: The study was a descriptive cross sectional study. The prevalence of gall stones was studied prospectively on 101 sickle cell disease patients who attended the Paediatric Outpatient clinic of the University of Benin Teaching Hospital by means of ultrasonography. They were aged 1-18 years. All except three patients were Haemoglobin (Hb) SSwhile the remaining three were HbSC. Statistical analysis was done by means, percentages and tests of significance was done using students t- test.Results: Five of the 101 children studied had gallstones and one had biliary sludge. The prevalence of gallstone was 5%. All patients with gallstones were HbSS, none with HbSC had stone although only three were studied. Only one child was symptomatic for the presence of gallstones. One patient had biliary sludge. The male: female ratio was 4:1. Prevalenceincreased with age; 2.9% 4.5% and 9.1% in patients aged less than 5,6-10 and 11-18 years respectively. Body weight was significantly associated with the presence of gallstones.Conclusion: Gallstone was found in 5% of the SCD children aged 1- 18years. This value is low compared to those from Europe and North America. It however confirmed the relative low prevalence in the general population of Nigerians. The clinical significance of gallstones in these SCD children is that it may contribute significantly to the morbidity and mortality seen in these children.Recommendation: Routine abdominal scan is recommended for sickle cell disease children to detect gallstone whose presence can mimic abdominal crisis. The option of elective cholecystectomy with reduced morbidity  compared to emergency cholecystectomy can thus be exploited.Key words: Sickle cell disease, gallstones, biliary, sludge, Benin-City, ultrasound

Predictive Accuracy of Transcerebellar Diameter in Comparison with Other Foetal Biometric Parameters for Gestational Age Estimation Among Pregnant Nigerian Women

Objective: To compare the predictive accuracy of foetal trans-cerebellar diameter(TCD) with those of other biometric parameters in the estimation of gestational age (GA).Design: A cross-sectional study.Setting: The University of Benin Teaching Hospital, Nigeria.Subjects: Four hundred and fifty healthy singleton pregnant women, between 14-42 weeks gestation.Main Outcome measures: trans-cerebellar diameter (TCD), biparietal diameter (BPD), femur length (FL), abdominal circumference (AC) values across the gestational age range studied. Correlation and predictive values of TCD compared to those of other biometric parameters.Results: The range of values for TCD was 11.9 -59.7mm (mean =34.2±14.1mm). TCD correlated more significantly with menstrual age compared with other biometric parameters (r=0.984, p=0.000). TCD had a higher predictive accuracy of 96.9%±12 days), BPD (93.8%±14.1days). AC (92.7% ± 15.3days).Conclusion: TCD has a stronger predictive accuracy for gestational age compared to other routinely used foetal biometric parameters among Nigerian Africans

Computerised tomographic patterns in patients with head injury at the University of Benin Teaching Hospital

Background: Head injuries rank high among morbidities due to trauma. Computerised tomography is an important modality in the investigation of these cases. However, literature on this subject in the south.south geopolitical zone of Nigeria is sparse. This study therefore aimed to document the computerized tomographic features of patients with head injury managed at the University of Benin Teaching Hospital (UBTH).Materials and Methods: A prospective study involving patients with head injury referred for CT scan from the Accident and Emergency Unit of UBTH over a 12.month period. A total of 100 patients were studied, using non.enhanced cranial CT scans. Findings were recorded and data analysis using SPSS done.Results: The age group 21.30 years was most frequently involved. Sex preponderance was 4.3:1 (male: female). Twenty.six patients had normal CT scans. The most common abnormal finding was intracerebral hemorrhage 35 cases (33%). This was followed by skull fractures, 23 cases (31%); subdural hemorrhage, 16 cases (21%); cerebral edema, 11 cases (15%). Others included mass effect, nine cases (12%).Conclusion: CT plays a very significant role in management of head injuries, as demonstrated in this study, by making such diagnoses that guided eventual patient management. Intracerebral hemorrhage was the most common abnormal finding in this report. Regular use of CT in moderate to severe cases of head injury is advocated.Key words: Benin City, computerized tomography, head injur

An audit of 3859 preadmission chest radiographs of apparently healthy students in a Nigerian Tertiary Institution

Background: Chest radiographs are routinely requested as part of the medical screening process prior to admission to institutions. Literature on the yield of such an exercise is sparse especially in the Nigerian setting. This study was therefore carried out to assess the usefulness of routine chest radiography for students at the time of admission. Materials and Methods: This was a prospective study of 3859 chest X-rays taken at the department of radiology, University of Benin Teaching Hospital for one admission screening for the 2008/2009 academic year. The age and sex of the subjects were also recorded. The heart, lung fields and bony thorax were examined for any abnormality. Results: Out of the 3859 pre-admission chest radiographs studied, there were 1951 males or 50.56% and 1908 females or 49.44% subjects. The mean age for males was 21.15±3. Conclusion: This study has shown that pre-admission routine chest radiography in asymptomatic patients remains a relevant screening tool for medical fitness during admissions into institutions. However because of dangers of exposure to ionizing radiation, we advise that a detailed medical history and physical examination be done to restrict its use to only those subjects with signs and symptoms suggestive of disease.Key words: Benin city, chest radiographs, preadmissio

Severe pentasomide Armillifer armillatus infestation complicated by hepatic encephalopathy

Background: Diagnosis of Armillifer armillatus infestation is usually incidental, commonly via autopsy or radiography. Affected individual are usually asymptomatic. The case presented here, however, had severe thoracic and abdominal involvement with clinical manifestations.Aim: To report a case of heavy A. armillatus infestation in an adult female Nigerian rural dweller complicated by hepatic parenchyma damage.Setting: Case report from semi-urban southern Nigeria, using clinical records and imaging findings.Materials and Methods: Clinical case records, including laboratory results and radiographic /computed tomography images.Conclusion: Parenchymal damage with organ dysfunction can be seen with severe A. armillatus infestation. Thus, there is a need for regular health education regarding the risk of A. armillatus infestation for individuals who consume snake meat

Contact tracing / pre-employment screening for pulmonary tuberculosis: Should positive mantoux test necessitates routine chest X-ray?

Background: Pulmonary tuberculosis (PTB) remains a scourge in most developing countries. Mantoux skin test andmore commonly chest radiography are some of the methods of diagnosing the disease, especially with regard tocontact tracing and pre-employment screening. Regular use of radiography has both safety and cost implications.This study aimed at establishing if any justification exists in requesting for chest radiographs in asymptomatic subjectswith a positive Mantoux skin test reaction.Methods: 174 adults comprising PTB contacts and newly employed/admitted university staff/students were recruitedinto the study. They were 89 males (51.1%) and 85 females (48.9%). All subjects had Mantoux test (using purifiedprotein derivative, PPD). Patients who had positive Mantoux reaction subsequently were subjected to posteroanteriorchest radiographic examination. Mantoux test and chest radiographic findings were then correlated with each other.Results: 102 subjects (59.2%) had positive Mantoux reactions, while 27 subjects (31.1%) had abnormal chestradiographs. There was no significant correlation between Mantoux readings and chest radiographic findings(P=0.106).Conclusion: It is concluded that other ancillary tests like sputum examination and/or, where available, Interferon andESAT tests should be carried out before chest radiograph is requested in subjects with positive Mantoux reaction

Factors Influencing Patient\'s Access To Diagnostic Imaging Services In Nigeria: Perception Of General Practitioners

Aim: To determine General Practitioner's perceptions of factors influencing patient's access to diagnostic imaging services in Nigeria. Materials and Methods: Self-administered questionnaires were given to general practitioners to complete, in order to identify factors that limit patients' access to diagnostic imaging services, and the perceived impact of this limited access. Contacts were made with the practitioners during conferences, seminars, update courses and meetings, to facilitate administration and retrieval of the questionnaires. Results: General Practitioners identified factors that limit patient's access to diagnostic imaging services in Nigeria and the perceived impact of this limited access. Cost was found to be the main limiting factor, followed by non-availability of some of the imaging modalities. A statistically significant association was found between increasing distance from practitioners' location and availability of some imaging services, regarding limited access. It was the popular view (67% of respondents), that restricted access has significant impact on patient management, by forcing general practitioners to resort to therapeutic trials and ancillary laboratory tests. Conclusion: Diagnostic imaging services remain an important part of patient management in Nigeria. However, access to these services by patients is limited by factors of cost, and non-availability of some modalities, among others. Health insurance and subsidized services as well as training of personnel are suggested for improving access. More interaction between clinicians and radiologists would enhance patient management. KEY WORDS: Access, Diagnostic Imaging Services, and General Practitioners. Nigerian Journal of Clinical Practice Vol.7(2) 2004: 88-9

Computerized tomographic changes as predictors of mortality in hemorrhagic stroke

No Abstract.Tropical Journal of Health Sciences Vol. 14 (2) 2007: pp.13-1

Sonographic Evaluation of Renal Parameters in Individuals with Essential Hypertension and Correlation with Normotensives

Background: Hypertension can secondarily involve the kidneys, and renal sonographic parameters can be used to indirectly assess renal function or status. Ultrasound is an inexpensive and safe modality for evaluating the kidneys. The purpose of this study was to sonographically assess renal parameters in patients with essential hypertension to determine the parameters that may indicate increased risk of renal damage. Materials and Methods: One hundred and fifty individuals (96 females and 54 males) with essential hypertension attending consultant outpatient clinic in University of Benin Teaching Hospital were evaluated. An equal number of nonhypertensive volunteers comprising of 80 females and 70 males were studied as controls. For individuals and controls, the renal length, width, anteroposterior diameters, renal parenchymal volume, cortical thickness, and echogenicity were assessed. Serum creatinine was also obtained. Statistical Package for the Social Sciences (SPSS version 17.0) was used in data analysis. Results: The mean renal parenchymal volume and cortical thickness were 99.1 ± 25.8 cm3 and 1.0 ± 0.2 cm on the right and 113.8 ± 35.8 cm3 and 1.0 ± 0.2 cm on the left for the hypertensive individuals. The values for the normotensives were 100.5 ± 19.8 cm3 and 1.2 ± 0.2 cm on the right and 118.7 ± 27.4 cm3 and 1.3 ± 0.2 cm on the left. The difference in cortical thickness between the two groups was statistically significant. No significant difference was noted between renal parenchymal volume of the right and left kidneys in the individuals and controls. The variation in cortical echogenicity between the hypertensives and controls was statistically significant; 74.0% and 75.3% of hypertensives and 28.0% and 26.0% of normotensives had increased cortical echogenicity on the right and left kidneys, respectively. The serum creatinine value was significantly higher in the hypertensive group. Conclusion: Cortical echogenicity grading was significantly higher among hypertensives than normotensives while renal parenchymal volume and cortical thickness were lower among hypertensives. In the hypertensives and normotensives, renal parenchymal volume, cortical thickness, and renal length were higher in males compared to the females and in the left kidney compared to the right. Hypertension seems to have more effect in the renal cortex than the medulla.Keywords: Cortical thickness, essential hypertension, renal parenchyma, ultrasoun