Anatomic imaging study of luminal diameter of the circle of Willis in patients with ischemic stroke

Objectives: Stroke or cerebrovascular accident is associated with defects in the circle of Willis; the vascular network that supplies the brain. There is currently lack of literature on the involvement of the circle of Willis in patients with stroke or its association with impending stroke. The objective of the study was to evaluate luminal diameter of arteries that constitute the circle of Willis in patients with stroke using computed tomography angiography (CTA) and magnetic resonance imaging (MRI) scans. Material and Methods: Angiograms of 340 male and female patients aged 15–>75 (40.18 ± 1.1 and 43.68 ± 1.18) years with suspected stroke, referred for either brain CTA or MRI in selected hospitals/diagnostic centers in Nigeria were evaluated using RadiAnt and the MicroDicom viewer software applications. A retrospective descriptive research design was adopted with approval from the federal health research ethics committee. Direct measurement of luminal diameter of major arteries of the circle of Willis was done using SPSS version 25 at P < 0.05. Results: From the 340 images assessed, 256 (75.29%) patients had ischemic stroke with luminal diameter of arteries of the circle of Willis ranged from 1 mm to >3 mm while 84 (24.71%) patients were without stroke with luminal diameter ranged from 1 mm to 2.11 mm (P < 0.05). Conclusion: Patients with stroke have larger luminal diameter of arteries that form the circle of Willis when compared to patients without stroke. The study has established for the 1st time, luminal diameter of circle of Willis that may be an index in the sampled Nigerian population.

Utilization of obstetric ultrasonography and findings in a cottage hospital in Nigeria

Objectives: The integration of ultrasound into routine obstetric workup has transformed antenatal care in resource-poor and remote communities in Africa. The present study aims to investigate the utilization of obstetric ultrasound at a cottage hospital in suburban Nigeria. Material and Methods: This retrospective study was conducted at Obio Cottage Hospital, Port Harcourt, Rivers State, South-South Nigeria. Ethical approval was obtained before commencement of the study from the Health Research Ethics Committee of University of Calabar Teaching Hospital with reference number UCTH/HREC/33/533. Reports were retrieved from the records of the radiology unit of the study facility, and data including biometric data and radiological diagnosis were transferred to Microsoft Excel spreadsheet for data analysis. Simple proportions and percentages were used to analyze the data. All statistical analyses were conducted using Statistical Package for the Social Science version 21.0, IBM Inc., Chicago, Illinois, USA. Statistical significance was set at P ≤ 0.05. Results: The total ANC visits at Obio Cottage Hospital was 28,072, with 27% (7689) utilization of ultrasound scan. The mean age and range of parity of attendees were 32 ± 2.3 and 1–5, respectively. Of the total scans performed, 99.93% was routine, while 0.07% (5) was clinical-based (targeted). Normal findings were 7520 (97.8%) of antenatal scans recorded, while abnormal cases, multiple gestation, and uncertain diagnosis accounted for 121 (1.57%), 44 (0.57%), and 4 (0.06%), respectively. Conclusion: The present study has shown a considerable volume of obstetric ultrasound scan in this cottage hospital, albeit, with low utilization compared to the number of antenatal registration. Findings were mainly normal with minimal need for referral for advance care.

A twisted giant corpus luteum cyst in the third trimester of pregnancy in a multigravida: A case report

Corpus luteum cyst is common in early pregnancy and seldom exceeds 5 cm in diameter; many of which resolve before the end of the first trimester of pregnancy. Giant corpus luteum cyst in third trimester is very rare especially in naturally-conceived pregnancies. We hereby report a rare case of twisted giant corpus luteum cyst in the third trimester in a 33-year-old multigravida. She presented with acute abdominal pain and vomiting at a gestational age of 34 weeks. Ultrasound scan revealed a twisted giant right ovarian cyst. She underwent an emergency cesarean delivery and right oophorectomy. Histology report showed features that were diagnostic of corpus luteum cyst.

A 10-year review of the clinicopathological patterns and prevalence of head and neck lesions in a tertiary health facility in Uyo, South-South Nigeria

Objectives: Head and neck (HN) lesions occur globally, with remarkable morbidity and mortality. However, in our setting, relevant data are lacking to show its clinicopathologic nature. Hence, we aimed to review the clinicopathological patterns and incidence of HN lesions within a 10-year (January 2010 to December 2019) period as well as provide useful data/information to help in better future management of patients with HN lesions. Material and Methods: A retrospective cross-sectional study of HN lesions (with respect to age, gender, site of lesion, and histopathological diagnosis) at the University of Uyo Teaching Hospital Uyo from January 2010 to December 2019. Results: A total of 276 HN lesions were analyzed over a 10-year period, with a prevalence of 0.004. Patients with the highest volume of HN lesions were within the 30–<40 age group. The lesions were more in females (53.6%) with M: F ratio of 1:1.2. There were more neoplastic HN lesions (85.1%) than non-neoplastic HN lesions (14.9%). The benign HN lesions (67.7%) were also more frequent than the malignant HN lesions (32.3%). And the benign neoplastic HN lesions (79.5%) were more than benign non-neoplastic HN lesions (20.5%). Conclusion: The most common HN lesions, respectively, in different subcategories, found in this study were squamous cell carcinoma, nodular goiter, inflammatory nasal polyps, and cystic hygroma. We recommend study of HN lesions’ possible etiologic/risk factors as well as a nationwide survey to determine a national prevalence of HN lesions.

Malignant peripheral nerve sheath tumor of the nose with coincidental HIV infection: Management challenges in limited resource setting

Malignant peripheral nerve sheath tumor (MPNST) is an uncommon soft-tissue sarcoma, with origin from the peripheral nerves or somatic tissues associated with nerve sheath. This tumor rarely affects the nose. The clinicopathological presentations vary from one case to another and depend on cells of origin. Hence, the diagnosis is often difficult. We report a 36-year-old woman who presented in our facility with progressive nasal swelling, facial deformity, and mucopurulent rhinorrhea of 3 years duration. Examination revealed a significant facial disfigurement. She was also found to be seropositive. Computerized tomography scan of paranasal sinuses showed an expansile, subtle enhancing, predominantly low-density mass, with area of air density within it, completely occupying the nasal cavity. No calcific focus, lytic or sclerotic surrounding bones changes seen. Her tumor was resected under general anesthesia with a wide margin, and regional vital structures were preserved. The histological/immunohistochemistry revealed MPNST. She had adjuvant radiotherapy and chemotherapy 2 weeks after surgery. However, a nodule was seen on the floor of the nose few days after completion of radiotherapy, which was biopsied, and histological report was positive for malignancy. The persistence of the malignancy and HIV hampered her facial reconstruction. Also, limited finance hampered procurement of the nasal prosthesis. She was followed up for 1 year before she was lost.

HIV serodiscordant and nondisclosure rates among married women living with HIV in a Southern Nigerian region

Objectives: Intimate sexual partners’ disclosure of HIV positive status is vital in the control of HIV/AIDS pandemic globally. The disclosure rates vary from region to region. The aim of this study was to document the prevalence of HIV serodiscordance and partners disclosure rate; and also determine the associated factors among HIV positive married women living in Calabar region of Nigeria. Material and Methods: A cross-sectional survey was conducted among 260 married women, 18 years and above, receiving HIV care at various health institutions in the region. Data were analyzed using SPSS VERSION 23. Their demographic and health profile were presented in simple proportion and percentages while Chi-square test and logistic regression were used to determine the factors influencing patient’s HIV status disclosure with the level of significance set at 0.05. Results: A total of 254 compiled questionnaires were included in the analysis (response rate-97.7%). The serodiscordant rate was 50%. HIV status disclosure to partner was high, 89.4%. The main determinants of HIV status disclosure were good level of education (AOR = 2.2, 95% CI: = 1.75–2.53, P = 0.007) and long duration of ART use (AOR = 3.23, 95% CI = 2.78–4.15, P = 0.001) while women with high discordant rate were more likely to be divorced/separated (P = 0.012, OR = 1.67). Conclusion: Female education is an important factor in HIV control. Disclosure of HIV status is beneficial to the partner as it promotes safe sex practices and increases adherence to ART.

Assessment of the knowledge of radiology in exiting medical students in University of Calabar

Objectives: Radiology education in the undergraduate level imparts in medical students the basic knowledge to interpret common pathological conditions, know the right imaging requests to make and the right order in which they should be made when they become physicians and the degree of this knowledge is influenced by several factors. The aim of this study was to evaluate the knowledge of radiology in exiting medical students and to identify the challenges of undergraduate radiology education. Material and Methods: This was a prospective cross-sectional observational study that was conducted in a 2-month period in the Radiology Department of the University of Calabar Teaching Hospital. The year 6 medical students of the University of Calabar, who were 79 in number, participated in the study. Relevant questions covering the major areas of radiology were presented to each participant by the use of a pre-test questionnaire. SPSS version 23.0., Pearson’s Chi-square test, and t-tests were used to analyze the data. Results: The medical students had a mean score of 66.5% in radiology knowledge. A significant relationship was observed between diagnostic radiology knowledge and the duration of radiology posting (P = 0.029), radiology teaching methods (P = 0.001), and the quality of learning environment (P = 0.002), respectively. Conclusion: The final year medical students in University of Calabar have an appreciable knowledge of radiology. This can be improved if the duration of radiology education increases by early introduction into the pre-clinical class or other clinical courses, if the radiology teaching methods are updated, and if the quality of the learning environment is improved.

Adjunctive orthodontic management of a missing upper right central incisor in a 12-year-old male using a fixed orthodontic appliance

This article presents a successful orthodontic management of a 12-year-old male using a fixed orthodontic appliance (straight wire technique). His orthodontic treatment was hinged on creating enough space to accept an artificial tooth, correcting the horizontal and vertical relationships of the upper incisors to the lower and the midline shift. Ultimately, an esthetic smile was achieved; function and self-esteem were improved when the artificial tooth was finally fixed.

Awareness and satisfaction with antenatal care services among pregnant women in Lagos state, Nigeria

Objectives: Despite the growing interest and efforts by government to make popular use of antenatal care (ANC) services in Nigeria as recommended by the World Health Organization, high level of infant and maternal mortality remains a major public health challenge facing the country. Dissatisfaction toward ANC services among pregnant women may be attributed to low level of awareness. This study assessed the level of awareness and satisfaction of ANC services among pregnant women in Lagos state, Nigeria. Material and Methods: The study adopted a survey research design. A multistage sampling technique was utilized to recruit participants for this study. A validated questionnaire was used for data collection and data were analyzed using both descriptive and inferential statistics. Ethical approval was obtained from Babcock University Health Research Ethics Committee with approval no: BUHREC543/17. Approval was also obtained from health service commission and in the six general hospitals used for the study. Informed consent was taken and respondents were reassured of the privacy and confidentiality of the information obtained. Results: The results showed that most of the respondents (85.6%) were in their reproductive years, that is, ages 23–37. The results showed that the level of awareness had a significant influence on pregnant women’s satisfaction with the services (β = 0.460, F(1,1313) = 351.499, R2 = 0.211, P < 0.05). The level of awareness of ANC services was high (M = 4.31, SD = 1.01) on a scale of 5. Conclusion: The study concluded that awareness of ANC services positively impacts pregnant women’s satisfaction with the services in Lagos state. Efforts should be made to improve the level of awareness of pregnant mothers to achieve greater satisfaction with ANC services in Lagos state.

Kawasaki disease; rare; or misdiagnosed: A case report in a tertiary hospital in Nigeria

Kawasaki disease (KD) is a self-limiting, acute febrile vasculitis with predilection for children under-5 years. Most reports have emanated from Japan with only a few cases reported in Africa. KD presents a diagnostic dilemma and a high index of suspicion is critical as early treatment reduces the incidence of complications. We describe a 5-month-old male infant who presented with classical clinical features though with delayed diagnosis. Received moderate dose aspirin with limitation of access to intravenous immunoglobulin and who did not develop coronary artery complication. The case report highlights the diagnostic challenges faced by practitioners, made worse by the low index of suspicion inherent in our setting. The fatal complications that may be associated with KD can, therefore, be avoided. It is hoped that pediatricians in particular would become conversant with the diagnostic criteria to facilitate early diagnosis and intervention in children.