Hysterosalpingographic findings in infertility – what has changed over the years?

Background: Prior studies on Hysterosalpingography (HSG) have shown that pelvic inflammatory disease (PID) related tubal adhesions accounted for 30 – 50% of female infertility, with as high as 80% reported in some studies. With improved access tocontraceptives, antibiotics and promotion of safe practices, the abnormal findings in HSG may have reduced or altered.Objective: To document the imaging findings in the HSG of participants and to compare current findings with prior studies done nationally and internationally.Method: A retrospective evaluation of 974 HSGs done at the tertiary diagnostic center over a 7-year period was conducted and analyzed using diagnostic accuracy tables.Results: Tubal pathologies were the most common abnormality in this study, (35.1% of the cases), comprising tubal blockage and hydrosalpinges; followed by uterine masses seen in 223 (22.9%) of the clients. Tubal occlusion was higher in clients with multiple abnormal findings; .while normal sized and large uterine cavities had a higher percentage of bilateral tubal patency.Conclusion: Tubal factors remain the most common abnormality seen in the HSGs of infertile women in this study, though with lower prevalence compared with prior older studies. Forty seven (47%) of the cases of female factor infertility had normal HSGs with bilateral tubal patency.Keywords: HSG, infertility, female, Africa, tubal factors, uterine masses

Hysterosalpingographic findings in infertility \u2013 what has changed over the years?

Background: Prior studies on Hysterosalpingography (HSG) have shown that pelvic inflammatory disease (PID) related tubal adhesions accounted for 30 \u2013 50% of female infertility, with as high as 80% reported in some studies. With improved access to contraceptives, antibiotics and promotion of safe practices, the abnormal findings in HSG may have reduced or altered. Objective: To document the imaging findings in the HSG of participants and to compare current findings with prior studies done nationally and internationally. Method: A retrospective evaluation of 974 HSGs done at the tertiary diagnostic center over a 7-year period was conducted and analyzed using diagnostic accuracy tables. Results: Tubal pathologies were the most common abnormality in this study, (35.1% of the cases), comprising tubal blockage and hydrosalpinges; followed by uterine masses seen in 223 (22.9%) of the clients. Tubal occlusion was higher in clients with multiple abnormal findings; .while normal sized and large uterine cavities had a higher percentage of bilateral tubal patency. Conclusion: Tubal factors remain the most common abnormality seen in the HSGs of infertile women in this study, though with lower prevalence compared with prior older studies. Forty seven (47%) of the cases of female factor infertility had normal HSGs with bilateral tubal patency. DOI: https://dx.doi.org/10.4314/ahs.v19i2.9 Cite as: Omidiji OAT, Toyobo OO, Adegbola O, Fatade A, Olowoyeye OA. Hysterosalpingographic findings in infertility \u2013 what has changed over the years? Afri Health Sci.2019;19(2): 1866-1874. https://dx.doi.org/10.4314/ahs.v19i2.

Accuracy of the Siriraj Stroke Score in Differentiating Cerebral Haemorrhage and Infarction in African Nigerians (English)

Background Scoring systems based on discriminant analysis technique and multivariate logistic regression have been developed to distinguish cerebral haemorrhage (CH) from cerebral infarction (CI). This distinction is necessary in the acute management of stroke patients. Objectif The Siriraj stroke score (SSS) was evaluated in Siriraj hospital, Bangkok, and the Western Infirmary, Glasgow, and needs to be validated in an African setting. Methodology The computerised tomography (CT) brain scans of all patients referred with clinical diagnosis of stroke at the University College Hospital (UCH), Ibadan, and RADMED diagnostic centre, Lagos were retrieved and reviewed as well as the case notes of the patients at the referral hospitals. The SSS was computed and the stroke subtype classified. This was compared with the CTscan diagnosis using the latter as the gold standard. Data analysis was performed with Epi-info software and by standard statistical methods. Results Ninety-six patients had complete clinical records and CT scan features consistent with stroke. Of these, 52 had cerebral infarction (CI) and 44 had cerebral haemorrhage (CH). SSS had sensitivity of 50% for CH and 58% for CI with an accuracy of 54.2%. Conclusion In this study, the SSS was not sufficiently sensitive to differentiate between CH and CI in Africans. A prospective study with larger sample size and modification of the discriminant variables is suggested. For now, while efforts must continue to find a simple clinical scoring system to differentiate between CH and CI, we contend that CTscan should remain the investigative technique of choice and should be made affordable and available. Keywords: Africa, cerebral haemorrhage, cerebral infarction, Nigeria, stroke, CT-scan, Accident vasculaire cérébral hemorragique, Accident vasculaire cérébral ischémique, A frique, Nigeria, tomodensitométrie Résumé  Introduction Dans le but d\'agir avec efficacité dans la prise en charge thérapeutique des accidents vasculaires cérébraux un score discriminant à l\'aide de variables multiples a été élaboré afin de distinguer les accidents vasculaires hémorragiques (AVCH) des accidents vasculaires ischémiques (AVCI). Objective Le Siriraj stroke score (SSS) a été évalué au Siriraj hospital, Bangkok et au Western infirmary, Glasgow. Il importait de le valider dans le cadre africain. Méthodologie Les dossiers des malades hospitalisés au Centre Hospitalier Universitaire d\'Ibadan et au centre diagnostic RADMED à Lagos ont été étudiés rétrospectvement de même que les CT-scan. Les données scannographiques ont été comparées au SSS. Les informations ont été analysées grâce au logiciel Epi-info et à l\'aide de différentes méthodes stastistiques. Résultats 96 patitents ont été retenus. 52 malades avaient un infarcissement cérébral et 44 une hémorragie cérébrale. Le SSS avait une sensiblité de 50% pour les AVC hémorragiques et 58% pour les AVCI avec une spécificité de 54,2%. Conclusion Cette étude permet de conclure en l\'absence de spécificité du SSS dans la distinction des AVCH et AVCI chez les Africains. Une étude prospective est préconisée en modifiant certaines variables. Actuellement le CT-scan reste la technique de choix pour différencier les AVCI des AVCH. Af J Neuro Sci: 2002 20(1

ACCURACY OF THE SIRIRAJ STROKE SCORE IN DIFFERENTIATING CEREBRAL HAEMORRAGHE AND INFARCTION IN AFRICAN NIGERIANS

Background: Scoring systems based on discriminant analysis technique and multivariate logistic regression have been developed to distinguish cerebral haemorrhage (CH) from cerebral infarction (CI). This distinction is necessary in the acute management of stroke patients. The Siriraj stroke score (SSS) was evaluated in Siriraj hospital, Bangkok, and the Western Infirmary, Glasgow, and needs to be validated in an African setting. Methodology: The computerised tomography (CT) brain scans of all patients referred with clinical diagnosis of stroke at the University College Hospital (UCH), Ibadan, and RADMED diagnostic centre, Lagos were retrieved and reviewed as well as the case notes of the patients at the referral hospitals. The SSS was computed and the stroke subtype classified. This was compared with the CT scan diagnosis using the latter as the gold standard. Data analysis was performed with Epi-info software and by standard statistical methods. Results: Ninety-six patients had complete clinical records and CT scan features consistent with stroke. Of these, 52 had cerebral infarction (CI) and 44 had cerebral haemorrhage (CH). SSS had sensitivity of 50% for CH and 58% for CI with an accuracy of 54.2%. Conclusion: In this study, the SSS was not sufficiently sensitive to differentiate between CH and CI in Africans. A prospective study with larger sample size and modification of the discriminant variables is suggested. For now, while efforts must continue to find a simple clinical scoring system to differentiate between CH and CI, we contend that CT scan should remain the investigative technique of choice and should be made affordable and available

A framework for advancing sustainable magnetic resonance imaging access in Africa

Magnetic resonance imaging (MRI) technology has profoundly transformed current healthcare systems globally, owing to advances in hardware and software research innovations. Despite these advances, MRI remains largely inaccessible to clinicians, patients, and researchers in low-resource areas, such as Africa. The rapidly growing burden of noncommunicable diseases in Africa underscores the importance of improving access to MRI equipment as well as training and research opportunities on the continent. The Consortium for Advancement of MRI Education and Research in Africa (CAMERA) is a network of African biomedical imaging experts and global partners, implementing novel strategies to advance MRI access and research in Africa. Upon its inception in 2019, CAMERA sets out to identify challenges to MRI usage and provide a framework for addressing MRI needs in the region. To this end, CAMERA conducted a needs assessment survey (NAS) and a series of symposia at international MRI society meetings over a 2-year period. The 68-question NAS was distributed to MRI users in Africa and was completed by 157 clinicians and scientists from across Sub-Saharan Africa (SSA). On average, the number of MRI scanners per million people remained at less than one, of which 39% were obsolete low-field systems but still in use to meet daily clinical needs. The feasibility of coupling stable energy supplies from various sources has contributed to the growing number of higher-field (1.5 T) MRI scanners in the region. However, these systems are underutilized, with only 8% of facilities reporting clinical scans of 15 or more patients per day, per scanner. The most frequently reported MRI scans were neurological and musculoskeletal. The CAMERA NAS combined with the World Health Organization and International Atomic Energy Agency data provides the most up-to-date data on MRI density in Africa and offers a unique insight into Africa\u27s MRI needs. Reported gaps in training, maintenance, and research capacity indicate ongoing challenges in providing sustainable high-value MRI access in SSA. Findings from the NAS and focused discussions at international MRI society meetings provided the basis for the framework presented here for advancing MRI capacity in SSA. While these findings pertain to SSA, the framework provides a model for advancing imaging needs in other low-resource settings

A framework for advancing sustainable magnetic resonance imaging access in Africa

Magnetic resonance imaging (MRI) technology has profoundly transformed current healthcare systems globally, owing to advances in hardware and software research innovations. Despite these advances, MRI remains largely inaccessible to clinicians, patients, and researchers in low-resource areas, such as Africa. The rapidly growing burden of noncommunicable diseases in Africa underscores the importance of improving access to MRI equipment as well as training and research opportunities on the continent. The Consortium for Advancement of MRI Education and Research in Africa (CAMERA) is a network of African biomedical imaging experts and global partners, implementing novel strategies to advance MRI access and research in Africa. Upon its inception in 2019, CAMERA sets out to identify challenges to MRI usage and provide a framework for addressing MRI needs in the region. To this end, CAMERA conducted a needs assessment survey (NAS) and a series of symposia at international MRI society meetings over a 2-year period. The 68-question NAS was distributed to MRI users in Africa and was completed by 157 clinicians and scientists from across Sub-Saharan Africa (SSA). On average, the number of MRI scanners per million people remained at less than one, of which 39% were obsolete low-field systems but still in use to meet daily clinical needs. The feasibility of coupling stable energy supplies from various sources has contributed to the growing number of higher-field (1.5 T) MRI scanners in the region. However, these systems are underutilized, with only 8% of facilities reporting clinical scans of 15 or more patients per day, per scanner. The most frequently reported MRI scans were neurological and musculoskeletal. The CAMERA NAS combined with the World Health Organization and International Atomic Energy Agency data provides the most up-to-date data on MRI density in Africa and offers a unique insight into Africa’s MRI needs. Reported gaps in training, maintenance, and research capacity indicate ongoing challenges in providing sustainable high-value MRI access in SSA. Findings from the NAS and focused discussions at international MRI society meetings provided the basis for the framework presented here for advancing MRI capacity in SSA. While these findings pertain to SSA, the framework provides a model for advancing imaging needs in other low-resource settings.Africa has a massive population with few infrastructural resources and an untapped potential to effect transformative change in healthcare. To advance magnetic resonance imaging (MRI) access across all African countries and improve health and well-being in low-resource settings over the next decade, the MRI community is called to partner with the Consortium for Advancement of MRI Education and Research in Africa (CAMERA) to create enabling clinical and research MRI environments that will utilize the rich intellectual resources in Africa to realize lasting and equitable MRI for all Africans and the world at large.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/175918/1/nbm4846_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/175918/2/nbm4846.pd