Incidental finding of autosomal dominant polycystic kidney disease in a 52-year-old man: a case report.

Autosomal dominant polycystic kidney disease (ADPKD) also known as Adult Polycystic Kidney Disease (APKD) is one of the most common systemic hereditary diseases. The disease usually presents between 20 to 39 years of age, although milder forms may not present until over 60 years and absence of renal failure has been rarely observed in some patients up to 80 years of age. Three distinct gene defects have been implicated in the pathogenesis of APKD designated as PKD1, PKD2, and PKD3. Patients with APKD may be asymptomatic, or may usually present with hypertension (in 50-70% of cases), renal insufficiency, and the complications of multiple cysts (haematuria, pain and infection) or as an abdominal mass discovered on incidental clinical or imaging examination. APKD is said to be rare in Africans. Case report: We report a case of an incidental finding of autosomal dominant polycystic kidney disease (ADPKD) in a 52-year-old normotensive man with a normal renal function test. Haematuria, dysuria and low-grade fever were the presenting complaints. The role of radiology in the diagnosis and management of ADPKD was highlighted. Conclusion: Although APKD is rare in Africans, a high index of suspicion for the disease is essential for the diagnosis of the disease especially in elderly patients with a family history of APKD who present with haematuria associated with multiple renal cysts

Sebaceous Carcinoma of Submandibular Gland Presenting with Upper Airway Obstruction: A Case Report and Review of the Literature

Sebaceous carcinoma (SC) of the salivary gland is a very rare tumor occurring more in the parotid gland. It is extremely rare in the submandibular gland. Only four cases of submandibular gland SC have been reported worldwide in English literature. We present the first case of submandibular gland SC in our environment and the fifth to be reported in English literature. A 55‑year‑old male farmer presented to our facility with a 10-year history of progressive, painless left submandibular mass, which worsened 4 months before presentation, associated with dysphagia to solid, muffled voice, weight loss, and upper airway obstruction. He had emergency tracheostomy and biopsy of the left submandibular mass. Histopathological examination of the mass confirmed SC. He was referred for radiotherapy but said to have died few weeks later while still preparing to travel for the radiation therapy. The rarity of these cases made the clinicopathologic pattern to be poorly understood thus making the choice of treatment option difficult. More cases need to be reported in other to develop the best treatment modalities

Ultrasonographic Splenic Indices Among Paediatric and Adults with Sickle Cell Disease in Nigeria

Background Ultrasonography is an established and reliable method for assessing the spleen. Because of variation due to genetic and other environmental factors including malaria endemicity, interpretation of splenic sizes requires a knowledge of the normal reference range for a given population. The aim of this study was to determine spleen size in different age groups among healthy people in North-Eastern Nigeria and use this as a reference to determine spleen size amongst sickle cell disease (SCD) patients. Methods Using a cross-sectional study design, spleen size was measured in healthy people of different age groups, and steady-state SCD patients (children and adults) using abdominal ultrasonography. Using the age-group specific reference values obtained from the controls, spleens were classified into small, normal size, or enlarged among the SCD patients. Results Abdominal ultrasonography was performed for 313 participants, comprising 109 (34.8%) healthy controls and 204 (65.2%) steady-state SCD patients. The spleen was visualized in all the controls. However, 97(47.6%) of the SCD patients had no visible spleen. Small, normal, and enlarged spleens were observed in 16.7% (n=18/107), 63.6% (n=68/107) and 19.6% (n=21/107) SCD patients, respectively. Compared to the control group, splenic length was three-fold higher in the first two years of life in SCD patients, followed by a progressive age-related decline in size. Enlarged spleens were detected among 5(2.4%) SCD patients by manual palpation method compared to 21 (19.6%) using ultrasonography. Conclusion Model-based age-specific reference ranges and percentile curves for splenic dimensions based on ultrasonography among normal controls in North-Eastern Nigeria were established and may be of value in assessing spleen sizes among SCD patients living in malaria-endemic regions of Africa. Regular spleen scans to assess changes in size can help identify SCD patients at risk of splenomegaly complications including subclinical acute sequestration and hypersplenism, and those who are developing splenic atrophy

Ultrasonographic assessment of spleen size and pattern of change among sickle cell disease patients and healthy controls in North-Eastern Nigeria

Background: Ultrasonography is an established and reliable method for assessing the spleen. Because of variation due to genetic and other environmental factors including malaria endemicity, interpretation of spleen sizes requires a knowledge of the normal reference range for a given population. This study aimed to identify spleen size reference ranges across age groups of healthy controls to serve as a baseline to assess changes in spleen size in patients with sickle cell disease. Methods: Using a cross-sectional study design, spleen size was measured in healthy people of different age groups and steady-state sickle cell disease patients (children and adults) using abdominal ultrasonography. Using the age-group-specific reference values obtained from the controls, spleens were classified into small, normal size or enlarged among the sickle cell disease patients. Results: The study consisted of 109 (34.8%) healthy controls and 204 (65.2%) steady-state sickle cell disease patients. The spleen was visualised in all the controls ( n = 109) and in 107 (52.4%) sickle cell disease patients. Using cut-off values for spleen length among the controls across age groups (< 5 years (5.0–7.0 cm); 5–9 years (5.5–8.5 cm); 10–14 years (6.0–11.0 cm) and ⩾ 15 years (7.0–12.5 cm)), spleen size was classified as small ( n = 18/204; 8.87%), normal ( n = 68/204; 33.3%) and enlarged ( n = 21/204; 10.3%) among the sickle cell disease patients. Conclusion: Model-based age-group reference ranges and percentile curves for splenic dimensions based on ultrasonography among normal controls in North-Eastern Nigeria were established and may be of value in assessing spleen sizes among sickle cell disease patients living in malaria-endemic regions of Africa

Determinants of splenic preservation among patients with sickle cell disease in North‐Eastern Nigeria

Objective: In patients with sickle cell disease (SCD), the spleen commonly enlarges during early childhood, but undergoes reduction in size and fibrosis from repeated episodes of vaso‐occlusion and infarction. The rate of progression of this process varies markedly among these patients. The aim of current study was to explore clinical and laboratory factors associated with the preservation of the spleen among these patients. Methods: Two hundred four patients with SCD (103 females; age 1–45 years) underwent abdominal ultrasonography at the University of Maiduguri Teaching Hospital, Nigeria between October 2020 and November 2021 to assess for splenic visualisation and echotexture. Steady‐state clinical parameters and blood samples for full blood count, serum chemistry, high‐performance liquid chromatography and malaria parasitemia were obtained from all the patients. Results: The spleen was visualised in 107 (52.4%; 95% confidence interval [CI], 46%–59%) patients with SCD on ultrasonography. While the spleen was visualised in all children less than 5 years of age, it was visualised in only 23.5% of those aged 15 years and older. Visualisation of the spleen was significantly associated with low mean corpuscular haemoglobin concentration and high haemoglobin F (HbF) in those younger than 10 years. The odds of visualisation of the spleen on ultrasonography increased by a factor of 1.17% for every 1% increase in HbF level. Only 32 (15%) patients were on regular hydroxyurea therapy. The HbF level was significantly higher among patients on hydroxyurea (median 12.7 vs. 7.4; p < 0.0001). Conclusion: In patients with SCD, failure to visualise the spleen was not found in children less than 5 years old. Patients with visualised spleens had a higher level of HbF than those with non‐visualised spleens. HbF was significantly associated with visualisation of the spleen before 10 years of age. Since early administration of hydroxyurea will increase HbF level, we expect that it would help to preserve the spleen

Bacteraemia Among Patients with Sickle Cell Disease in Nigeria: Association with Spleen Size and Function

In Sub-Saharan Africa, infections are a leading cause of morbidity among individuals with sickle cell disease (SCD). The causes of the increased risk of infection are poorly documented, but the loss of splenic function is important. Previous studies have documented increased susceptibility to bacterial infections among SCD patients, evidenced by increasing markers of splenic dysfunction (1, 2); however, there are no data on the association between bacterial infections and splenic function among the SCD population in Sub-Saharan Africa, partly because most of the techniques required to assess splenic function are not readily available (3). We recently employed the presence of two red cell containing inclusions - Howell-Jolly bodies (HJB) and argyrophilic (silver staining) inclusion (AI) red cells - to assess splenic dysfunction among our SCD patients (4). In the present study, we aimed to determine the prevalence and pattern of organisms causing bacteraemia among our acutely-ill SCD patients and to describe any association between bacteraemia with splenic status on ultrasound and two markers of splenic dysfunction (i.e HJB and AI red cells

Evaluation of hypofunctioning thyroid nodules with technetium-99m MIBI and ultrasonography

Background: Fine needle aspiration cytology (FNAC) cannot reliably differentiate follicular adenoma from follicular carcinoma (FC), which requires histological evidence of capsular or vascular invasion. FC is the most predominant thyroid cancer in our loco-regional environment, indicating the need for improvement in preoperative diagnostic accuracy of thyroid nodules to ensure appropriate and timely interventions. Objective: The purpose of this study was to assess the role of technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy and ultrasonography (USG) in the differential diagnosis of thyroid nodules. Methods: Forty-two patients with hypofunctioning thyroid nodules were prospectively studied with 99mTc-MIBI scintigraphy and USG to differentiate benign from malignant nodules. An injection of 740 MBq of 99mTc-MIBI was intravenously administered, followed by semiquantitative analysis of dual-phase scans using a 4-point (0 to 3) scoring system. USG was subsequently performed and interpretation was based on some sonographic criteria for malignancy. In the following days and weeks, patients underwent FNAC followed by surgery and histopathologic examination. Results: All malignant nodules were positive on 99mTc-MIBI and all but two malignant nodules were positive on USG. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy are, respectively, 100%, 70%, 65%, 100%, and 81% for 99mTc-MIBI scintigraphy; 87%, 78%, 68%, 91% and 81% for USG; and 83%, 100%, 100%, 96% and 64% for FNAC. There was no statistically significant difference between 99mTc-MIBI scintigraphy and USG performance for both benign (p = 0.317) and malignant (p = 0.573) nodules. Conclusion: 99mTc-MIBI scintigraphy and USG are important imaging modalities in the evaluation of thyroid nodules, particularly follicular neoplasms which are frequently associated with non-diagnostic cytology

Cardiovascular disturbances in COVID-19 : an updated review of the pathophysiology and clinical evidence of cardiovascular damage induced by SARS-CoV-2

Severe acute respiratory coronavirus-2 (SARS-Co-2) is the causative agent of coronavirus disease-2019 (COVID-19). COVID-19 is a disease with highly variable phenotypes, being asymptomatic in most patients. In symptomatic patients, disease manifestation is variable, ranging from mild disease to severe and critical illness requiring treatment in the intensive care unit. The presence of underlying cardiovascular morbidities was identified early in the evolution of the disease to be a critical determinant of the severe disease phenotype. SARS-CoV-2, though a primarily respiratory virus, also causes severe damage to the cardiovascular system, contributing significantly to morbidity and mortality seen in COVID-19. Evidence on the impact of cardiovascular disorders in disease manifestation and outcome of treatment is rapidly emerging. The cardiovascular system expresses the angiotensin-converting enzyme-2, the receptor used by SARS-CoV-2 for binding, making it vulnerable to infection by the virus. Systemic perturbations including the so-called cytokine storm also impact on the normal functioning of the cardiovascular system. Imaging plays a prominent role not only in the detection of cardiovascular damage induced by SARS-CoV-2 infection but in the follow-up of patients' clinical progress while on treatment and in identifying long-term sequelae of the disease.http://www.biomedcentral.com/bmccardiovascdisordNuclear Medicin

A Review of Arrow Shot Injuries to the Head and Neck in Northeastern Nigeria

Background: Arrow shot injuries remained rampant in developing countries. Involvement of the head and neck region is not uncommon and poses a significant management challenge due to the presence of so many vital structures within a relatively small anatomic region. Objective: To review the pattern of arrow shot injuries to the head and neck region that presented to the University of Maiduguri Teaching Hospital (UMTH) in Northeastern Nigeria. Method: This is a retrospective review of patients who presented with arrow shot injuries involving the head and neck region, to the University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria between January 2009 and December 2019. Result: All the thirty patients studied were males. The mean age was 32.2±SD14.4 (range 8-60 years), the peak age group affected was 11-20 years. The majority (83.4%) are 40 years and below. The main reasons for the attacks were terrorism due to Boko haram (40%), cattle rustling (30%), and herdsmen/farmers clashes (20%). Affected sites were the neck (46.7%), the orbit (20%), and the nose (10%). Patient had wound exploration and arrow extraction, debridement, evisceration of the globe, fronto-ethmoidectomy, medial maxillectomy, and vascular repair as the case may be. Conclusion: Arrow shot injuries still exist in our society and may involve the head and neck region leading to significant management challenges. Priority should be given to adequate resuscitation and airway management especially in unstable patients. Appropriate and timely intervention is necessary for a good outcome