The frequency of various indications for plain chest radiography in Nnamdi Azikiwe University Teaching Hospital Nnewi (Nauth)

Background: With soaring advances in the field of medicine, the place of older radiologic imaging modalities is being reduced to basic screening tools. Yet the modern imaging modalities like computerized tomography (CT), magnetic resonance imaging (MRI), ultrasound and nuclear medicine are hardly available.Study Objectives: To study the frequency of various indications of plain chest radiography, remind us of its uses and to enhance the preparedness of the department to maximally accomplish the ideals of this investigation.Methodology: A total of 1476 consecutive patients for chest radiography in the department of radiology, NAUTH, Nnewi from the period of February 2009 and whose request form contain adequate data were recruited for this study. These data were analyzed using SSPS.Results: A total of 1476 patient were included in this study. There was female preponderance with male to female ratio of 1.3:1. Mean Age of the patients is 39.32 years (std19.56). The most frequent indication for chest radiography is certain infections and parasitic diseases (40.9% and the greatest source of referral for this study is General outpatient (GOPD)/family medicine department.Conclusion: The most frequent indications for chest radiography in the study are certain infection and parasitic diseases. Chest Radiography is the most frequent plain radiography study in our environment where infectious diseases are still very rampant. This makes chest radiography an important study for screening patient for possible diagnosis and classifying the need for further radiographic investigation of our patients.Keywords: Frequency, indications, infections, plain chest radiograph, screeningNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Acidosis Activation of the Proton-Sensing GPR4 Receptor Stimulates Vascular Endothelial Cell Inflammatory Responses Revealed by Transcriptome Analysis

Acidic tissue microenvironment commonly exists in inflammatory diseases, tumors, ischemic organs, sickle cell disease, and many other pathological conditions due to hypoxia, glycolytic cell metabolism and deficient blood perfusion. However, the molecular mechanisms by which cells sense and respond to the acidic microenvironment are not well understood. GPR4 is a proton-sensing receptor expressed in endothelial cells and other cell types. The receptor is fully activated by acidic extracellular pH but exhibits lesser activity at the physiological pH 7.4 and minimal activity at more alkaline pH. To delineate the function and signaling pathways of GPR4 activation by acidosis in endothelial cells, we compared the global gene expression of the acidosis response in primary human umbilical vein endothelial cells (HUVEC) with varying level of GPR4. The results demonstrated that acidosis activation of GPR4 in HUVEC substantially increased the expression of a number of inflammatory genes such as chemokines, cytokines, adhesion molecules, NF-κB pathway genes, and prostaglandin-endoperoxidase synthase 2 (PTGS2 or COX-2) and stress response genes such as ATF3 and DDIT3 (CHOP). Similar GPR4-mediated acidosis induction of the inflammatory genes was also noted in other types of endothelial cells including human lung microvascular endothelial cells and pulmonary artery endothelial cells. Further analyses indicated that the NF-κB pathway was important for the acidosis/GPR4-induced inflammatory gene expression. Moreover, acidosis activation of GPR4 increased the adhesion of HUVEC to U937 monocytic cells under a flow condition. Importantly, treatment with a recently identified GPR4 antagonist significantly reduced the acidosis/GPR4-mediated endothelial cell inflammatory response. Taken together, these results show that activation of GPR4 by acidosis stimulates the expression of a wide range of inflammatory genes in endothelial cells. Such inflammatory response can be suppressed by GPR4 small molecule inhibitors and hold potential therapeutic value

Radiological evalution of civilian gunshot injuries in Nauth, Nnewi

This study is meant to evaluate Civilian gunshot injuries in the city of Nnewi with a view of finding the pattern of injuries and background ofaffected individual. It is also aimed to bring to the fore the fact that even our easily available plain radiographic studies will localize the pellets, identify some important damages caused by the pellets and help us in planning for management even in the absence of other complex radiological investigative modalities like computed Tomographic scanners, Magnetic Resonance Imaging (MRI), Angiographic studies and interventional techniques /procedures. All gunshot injuries investigated in the Department of Radiology, Nnamdi Azikiwe University Teaching Hospital, Nnewi (NAUTH) between December 1998 – April 2000 were qualified for this work. The films were reviewed as to location of the pellets to enable the surgeon plan for possible extraction. Twenty-five (25) such patients were reviewed in this study. This showed a male/female ratio of 8.1. The age range of subjects was between 18 – 65 years with a mean age of 35years. The model age involved was 20 – 30 years. The commonest site involved as shown by this study was the lower limb ( from pelvic 5 to the foot). The main source of referral was the Accident & Emergency Unit

Synchronous Retrograde and Micturating Cysto Urethrography A Modification

Background: Retrograde Urethrography (RUG) combined with Micturating cystourethrography (MCUG) is imaging method of choice for studying the urethra and its 1-9 abnormalities . Though there are many modern imaging modalities that are also useful but these are not available in most developing countries. Even the standard method of doing the conventional Urethrography using penile clamp cannot be done in our centre because this is not also available. This led us to this study to help us maximize results by improvising on the available technique. Objective: To demonstrate a local modification of method for synchronous/ combined RUG and MCUG. Method: This is a method in which Foley’s catheter, amputated needle cap, and syringe are used to inject contrast into the lower urinary tract to help define the calibre and outline of these structures during the combined RUG and MCUG. Result: This combined technique demonstrates clearly, the anatomy of the lower urinary tract - urethra and bladder. It shows the length of stricture, where this exists. Conclusion: This method of synchronous RUG and MCUG is cheap, available and readily transferable and helps to demonstrate various pathologies of the lower urinary tract. This is recommended in places where materials for other methods of urethrography are deficient. Key words: Retrograde urethrography, micturating cysto urethrography, modificatio

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease

Azithromycin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatory actions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19. Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospital with COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients were randomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once per day by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatment groups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment and were twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants and local study staff were not masked to the allocated treatment, but all others involved in the trial were masked to the outcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) were eligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was 65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomly allocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall, 561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days (rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median 10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days (rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, no significant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilation or death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24). Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or other prespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restricted to patients in whom there is a clear antimicrobial indication. Funding UK Research and Innovation (Medical Research Council) and National Institute of Health Research