CT‑guided percutaneous transthoracic lung biopsy: First experience in Ibadan, Nigeria

Percutaneous lung biopsy had been described in the nineteenth century by Leyden, but image- guided needle chest biopsy only gained widespread acceptance in the 1970s. Currently, tissue sampling of a thoracic lesion is indicated when the diagnosis cannot be obtained by the non-invasive techniques and cytological diagnosis will modify the stage of the disease or influence the therapeutic strategy. Cytology obtained by small-gauge needle aspiration biopsy confirms the nature of the lesion in 80 – 95% of cases and carry a low incidence of major complications. The purpose of this report was to provide information on our first experience with CT-guided biopsy and show that with some innovativeness much can be achieve with limited resources and good team work. We performed a CT of the thorax using appropriately placed improvised metal markers, which determined the optimal cutaneous entry point. We then re-checked the location of the lesion scanning intermittently at 5mm slice thickness; we marked the entry point with a pen and cleaned the surface with methylated spirit. A local anaesthetic was subcutaneously injected around marked area. We used a 21G aspiration needle to obtain cytology sample then 18G Trucut biopsy needle to obtain histology specimen. The length of the needle was chosen based on predetermined distance of the target lesion from the skin estimated from the CT images. Our patient was a 51-year-old Nigerian female with a peripherally located nodule in the posterior aspect of the right lung. She had CT-guided biopsy of the nodule. The procedure was well tolerated with no complication of pneumothorax. The histology report provided the basis for treatment regimen. Our experience indicates that percutaneous transthoracic CT-guided needle biopsy is feasible and a safe procedure in our hospital for evaluation of undetermined lung lesions.Keywords: CT‑guided biopsy, pneumothorax, pulmonary noduleNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Pattern of pericardial diseases in HIV positive patients at University College Hospital, Ibadan, Nigeria

Rationale. Pericarditis has been reported as the most common cardiac complication of HIV disease, followed by pericardial effusion. Methods. A retrospective review was conducted of all 68 patients treated for pericardial diseases between August 2003 and July 2008 at University College Hospital, Ibadan, Nigeria. HIV-positive patients (N=42) were compared with those who were HIV negative (N=26). Results. More male than female patients presented with pericardial disease, and the HIV-positive patients were younger than those who were HIV negative. Pericardial effusion was the commonest mode of presentation, accounting for 20 HIV-positive patients (47.7%) and 13 HIV-negative patients (50%). Pericardiostomy was the commonest surgical intervention performed in HIV-positive patients (N=15), while the majority of HIV-negative patients had pericardiocentesis. Conclusion. Pericardial effusion was the commonest cardiac presentation in HIV-positive patients in our setting. We recommend that patients with pericardial effusion be investigated for HIV infection

Relationship between age, radiographic normal heart size and cardio-thoracic ratio in a Nigerian population

Background: Cardio-vascular disease (CVD) is now on the increase. The precise diagnosis of CVD is of immense clinical importance to the cardiac surgeons, pathologist and also for cardiologists. However, information on normal values for various cardio-vascular structures in Nigeria, a country with the highest population of blacks in the world is sparse. In this regard the age-related radiographic sizes of a Nigerian cohort of patients with non-cardiogenic complaints or consultations were therefore assessed.Objectives: To evaluate the limits of normal cardiac size in our environment , determine if there was a relationship between the age and size of the heart and to evaluate the relationship between sex and cardiac size and cardio-thoracic ratio.Design: A cross-sectional study.Setting: The Radiology department of University of Ilorin Teaching Hospital, Ilorin, North Central Nigeria between January to June 2012.Subjects: One Hundred patients were consecutively recruited and their chest radiographs examined after fulfilling the inclusion criteria.Results: Males accounted for 55% of the study population. The age range was 1 month to 73 years, (Mean = 29.3, SD =2.41668). The mean cardiac size was 11.7cm. The average cardiac size for adult males and females, were 11.6cm and 11.5cm respectively while that of thoracic size was 29.0cm and 26.8cm respectively. Correlation between age and cardiac size was 0.66; age and thoracic size was 0.64 and between cardiac size and thoracic size was 0.89. The paired sample t-test for age and cardiac size was less than 0.05 (p value <0.05).Conclusion: knowing the average values of cardiac size for adult males and females (11.6cm and 11.5cm) and thoracic size (29.0cm and 26.8cm) respectively from this study presents a base line for early detection of variation from normal cardiac measurements in this environment

Stroke genetics informs drug discovery and risk prediction across ancestries

Previous genome-wide association studies (GWASs) of stroke - the second leading cause of death worldwide - were conducted predominantly in populations of European ancestry(1,2). Here, in cross-ancestry GWAS meta-analyses of 110,182 patients who have had a stroke (five ancestries, 33% non-European) and 1,503,898 control individuals, we identify association signals for stroke and its subtypes at 89 (61 new) independent loci: 60 in primary inverse-variance-weighted analyses and 29 in secondary meta-regression and multitrait analyses. On the basis of internal cross-ancestry validation and an independent follow-up in 89,084 additional cases of stroke (30% non-European) and 1,013,843 control individuals, 87% of the primary stroke risk loci and 60% of the secondary stroke risk loci were replicated (P < 0.05). Effect sizes were highly correlated across ancestries. Cross-ancestry fine-mapping, in silico mutagenesis analysis(3), and transcriptome-wide and proteome-wide association analyses revealed putative causal genes (such as SH3PXD2A and FURIN) and variants (such as at GRK5 and NOS3). Using a three-pronged approach(4), we provide genetic evidence for putative drug effects, highlighting F11, KLKB1, PROC, GP1BA, LAMC2 and VCAM1 as possible targets, with drugs already under investigation for stroke for F11 and PROC. A polygenic score integrating cross-ancestry and ancestry-specific stroke GWASs with vascular-risk factor GWASs (integrative polygenic scores) strongly predicted ischaemic stroke in populations of European, East Asian and African ancestry(5). Stroke genetic risk scores were predictive of ischaemic stroke independent of clinical risk factors in 52,600 clinical-trial participants with cardiometabolic disease. Our results provide insights to inform biology, reveal potential drug targets and derive genetic risk prediction tools across ancestries.</p

Stroke genetics informs drug discovery and risk prediction across ancestries

Previous genome-wide association studies (GWASs) of stroke — the second leading cause of death worldwide — were conducted predominantly in populations of European ancestry1,2. Here, in cross-ancestry GWAS meta-analyses of 110,182 patients who have had a stroke (five ancestries, 33% non-European) and 1,503,898 control individuals, we identify association signals for stroke and its subtypes at 89 (61 new) independent loci: 60 in primary inverse-variance-weighted analyses and 29 in secondary meta-regression and multitrait analyses. On the basis of internal cross-ancestry validation and an independent follow-up in 89,084 additional cases of stroke (30% non-European) and 1,013,843 control individuals, 87% of the primary stroke risk loci and 60% of the secondary stroke risk loci were replicated (P < 0.05). Effect sizes were highly correlated across ancestries. Cross-ancestry fine-mapping, in silico mutagenesis analysis3, and transcriptome-wide and proteome-wide association analyses revealed putative causal genes (such as SH3PXD2A and FURIN) and variants (such as at GRK5 and NOS3). Using a three-pronged approach4, we provide genetic evidence for putative drug effects, highlighting F11, KLKB1, PROC, GP1BA, LAMC2 and VCAM1 as possible targets, with drugs already under investigation for stroke for F11 and PROC. A polygenic score integrating cross-ancestry and ancestry-specific stroke GWASs with vascular-risk factor GWASs (integrative polygenic scores) strongly predicted ischaemic stroke in populations of European, East Asian and African ancestry5. Stroke genetic risk scores were predictive of ischaemic stroke independent of clinical risk factors in 52,600 clinical-trial participants with cardiometabolic disease. Our results provide insights to inform biology, reveal potential drug targets and derive genetic risk prediction tools across ancestries

Oesophageal perforation: An unusual complication of chest tube insertion

No Abstract

Genital self-mutilation

No Abstract

Peripheral vascular surgical procedures in Ilorin, Nigeria: indications and outcome

Background: Data on peripheral vascular surgical interventions from Nigeria is scanty. Reports form Western and Eastern Nigeria dates back about twodecades. This study therefore analyses the various etiological conditions necessitating intervention, and their outcome. Methods: A retrospective analysis of patients requiring surgical intervention on peripheral vessels from a prospectively collected single surgeon database over a two-year period was conducted. Data were analysed using SPSS version 15.0 windows statistical package. Results: Fourteen peripheral vascular surgical procedures were performed. The age range was 2-70years (24.4±16.3) with five cases (35.7%) in 20-29year group. Trauma accounted for 11 (73.3%) cases. Upper limb involvement occurred in 7 (63.6%) of the traumatic cases whereas all 2 true aneurysm occurred in the lower limb. Direct repair was possible in re-establishing anatomic continuity in about 64% of cases. Of the six morbidities, wound infection accounted for 50% followed by failure of re-vascularizaton (33.3%) and there was one mortality. Conclusion: Trauma is the leading cause of peripheral vascular condition necessitating surgery from our study. Young adults predominate. Though direct repair are often feasible, there is a need for the availability of graft options. Wound infection constitutes the highest post-operative morbidity

Rheumatic valvular heart disease as seen at echocardiography in Ilorin, Nigeria

No Abstrac