Abdulkadir Musa Tabari

Feasibility trial for primary stroke prevention in children with sickle cell anemia in Nigeria (SPIN trial)

The vast majority of children with sickle cell anemia (SCA) live in Africa, where evidence‐based guidelines for primary stroke prevention are lacking. In Kano, Nigeria, we conducted a feasibility trial to determine the acceptability of hydroxyurea therapy for primary stroke prevention in children with abnormal transcranial Doppler (TCD) measurements. Children with SCA and abnormal non‐imaging TCD measurements (≥200 cm/s) received moderate fixed‐dose hydroxyurea therapy (∼20 mg/kg/day). A comparison group of children with TCD measurements <200 cm/s was followed prospectively. Approximately 88% (330 of 375) of families agreed to be screened, while 87% (29 of 33) of those with abnormal TCD measurements, enrolled in the trial. No participant elected to withdraw from the trial. The average mean corpuscular volume increased from 85.7 fl at baseline to 95.5 fl at 24 months (not all of the children who crossed over had a 24 month visit), demonstrating adherence to hydroxyurea. The comparison group consisted of initially 210 children, of which four developed abnormal TCD measurements, and were started on hydroxyurea. None of the monthly research visits were missed (n = total 603 visits). Two and 10 deaths occurred in the treatment and comparison groups, with mortality rates of 2.69 and 1.81 per 100 patient‐years, respectively (P = .67). Our results provide strong evidence, for high family recruitment, retention, and adherence rates, to undertake the first randomized controlled trial with hydroxyurea therapy for primary stroke prevention in children with SCA living in Africa.

Malignant pleural mesothelioma treated as pulmonary tuberculosis

A 45 year old man with malignant pleural mesothelioma had symptoms of prolonged cough, heamoptysis, breathlessness, weight loss and low grade persistent fever. The high prevalence of pulmonary tuberculosis in this environment, coupled with paucity of radiologists in rural areas to competently review his chest radiograph, resulted in making the wrong diagnosis of pulmonary tuberculosis (PTB) as against malignant pleural mesothelioma. He was also wrongly treated for PTB for a period of nine months before referral to a Teaching Hospital. The correct diagnosis was made in a university teaching hospital where adequate specialized manpower was available. Distant metastasis to the liver was already observed at presentation. He was treated with six courses of chemotherapy (Peclitaxel and Cisplastin) and he did well before he was lost to follow-up. Key words: Malignant pleural mesothelioma, PTB, liver metastasis.

Doppler ultrasound velocimetry of middle cerebral arteries of patients with sickle cell disease at Aminu Kano Teaching Hospital: a preliminary report.

Abstract Transcranial Doppler ultrasound scan is a noninvasive method of evaluating the major intracranial vessels. It is becoming an important screening tool for predicting high-risk sickle cell patients for developing cerebrovascular disease. This study evaluates the patients’ characteristics, common indications, and findings on Doppler ultrasound of the middle cerebral arteries of sickle cell patients performed at Aminu Kano Teaching Hospital, Kano, Nigeria. This is a preliminary report of an ongoing review of the transcranial Doppler scans done at Aminu Kano Teaching Hospital. The records of all patients, the indications for Doppler examination, and major findings on the middle cerebral arteries were documented. There are 60 patients, consisting of 22 males and 38 females. Their ages ranged from 1.0 to 41.0 years, with mean of 11.58 ± 7.30 years. About a third of the patients were asymptomatic (38.3%). Those with headache constituted 20.0%, whereas those with past cerebral syndrome constituted 8.3%. Other indications include stroke (11.67%) and transient ischemic attack (3.3%). The mean peak systolic velocity of the middle cerebral artery measured 204.8 cm/s (±80 cm/s) and 208.8 (±79 cm/s) on the respective right and left side. This right-to-left difference was statistically significant (P = 0.046). Symptomatic and female patients showed higher mean peak systolic velocity values when compared with males, although the difference was not statistically significant.

Multisystemic anomalies in conjoined twins: The role of imaging in management

Conjoined twins (CT) represent one of the rarest and most challenging congenital malformations arising as an unfortunate complication of monozygous twinning, with an estimated incidence ranging from 1 in 50,000 to 100,000 pregnancies, with an overall true incidence of about 1 in 200,000 live births with around 60% of them being stillborn. The types of the twins may differ depending on the site of fusion or nonseparation. The most commonly encountered types are thoraco-omphalopagus (28%), thoracopagus (18%), omphalopagus (10%), parasitic twins (10%), pygopagus (6-19%), and craniopagus (6%), with the pygopagus twins having the highest survival rate. Because of the highly variable and complex anatomy and associated malformations, skilled clinical assessments aided by detailed radiological studies, appropriate planning, and teamwork are required for the successful separation of the CT. The role of imaging in the diagnosis and management of missed diagnosed intrauterine case of pygopagus type CT was presented. At delivery, they were found to have sacral fusion on radiography with distal, rectal fusion on limited barium enema. Magnetic resonance imaging demonstrated distal spinal cord fusion with vascular anomaly found on computed tomography angiography. The surgical separation of the patients was successful with satisfactory postoperative lives.

Doppler sonographic evaluation of venogenic extremity swellings: Analysis of 170 patients from Kano, Nigeria

Introduction: Deep venous thrombosis (DVT) is a serious problem that can potentially lead to many complications including life-threatening pulmonary arterial thrombosis. Screening and confirmation of the diagnosis are critical in the care of this condition. Objectives: The objective of this study was to evaluate the role of Doppler sonography in diagnosing DVT and to illustrate the pattern in 170 suspected cases from our local environment. Materials and Methods: This study was conducted at our department over 18 months. A total of 170 patients with clinical suspicion of limb DVT were recruited. The characteristics of the patients, risk factor for DVT, and the site of the lesion were documented. Sonographic examination was done using 7.5 MHz linear and 3.5 MHz convex transducers. Results: Out of the 170 patients, there are 89 (52.35%) males and 81 (47.65%) females. Their mean age was 50.6 years (+17.9 years). The common risk factors for DVT include chronic medical illness (28.8%), long distance travel (15.3%), previous DVT (8.8%), stroke/paralysis (5.3%), neoplasms (5.9%), pregnancy (5.9%), and trauma/surgery (5.9%). About 55.8% (95) of them were confirmed to have DVT on ultrasound while 44.2% (75) had normal ultrasound findings. There was a female preponderance among the 95 cases of DVT, 58.9% of them were females while 41.1% of them were males. It was found that contiguous femoro-popliteal and ilio-femoro-popliteal segments were most commonly thrombosed. These lesions were predominantly left sided (59.5%). Conclusion: There was a predominance of females and femoro-popliteal segments in DVT. Doppler ultrasound is very useful in the evaluation of extremity DVT. All clinically suspected cases should be evaluated with this modality due to limited sensitivity of clinical evaluation in the diagnosis of DVT. Further correlative studies in comparison to venography and hematologic indices are also recommended.

Chest radiographic lateral soft-tissue thickness changes after complete anti-tuberculosis treatment in adults

Background: Pulmonary tuberculosis (PTB) has 95-98% of its mortality in developing countries. It is associated with marked weight loss which can be evident at the lateral soft-tissue thickness on chest radiographs. Objective: To determine the pattern of lateral soft-tissue thickness changes and gender predisposition on chest radiographs in PTB patients and after complete anti-TB treatment. Methodology: This prospective study was conducted over a 6 month period at the Radiology Department of Ahmadu Bello University Teaching Hospital, Zaria. Two hundred adults who were bacteriologically proven to have PTB were consecutively recruited into the study as cases, aged 18-70 years and followed up after 6 months of complete anti-TB treatment and found to be asymptomatic and bacteriologically sputum negative. Their lateral soft-tissue thickness on the chest radiographs was measured. Results: The mean and standard deviation of pretreated and posttreated PTB patients was 12.66 ± 2.63 mm and 21.13 ± 2.56 mm, respectively (P < 0.0001). However, significant increase is noted in lateral soft-tissue thickness after complete anti-TB treatment (P < 0.001) and female sex (P = 0.001). Conclusion: Lateral soft-tissue thickness reduction was seen in PTB patients and significant increase was observed after complete anti-TB treatment.

Scrotal doppler ultrasound evaluation in Zaria, Nigeria

Introduction: The superficial location of the scrotal contents makes them ideally suited for sonographic examination. The development of high-frequency, real-time greyscale scanners along with Doppler facility has enhanced the diagnostic accuracy of scrotal sonographic examinations. Objectives: To determine the pattern and utility of Doppler ultrasound in the assessment of patients with scrotal pathologies in Zaria, Nigeria. Methodology: This retrospective study was carried out over a period of 36 months (February 2012 to January 2015) at the Radiology Department of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, on patients who presented for scrotal sonography on account of scrotal pathology. After a brief examination, colour Doppler ultrasound scan (CDUS) was performed. The clinical diagnosis and final ultrasound diagnosis were compared to determine the sensitivity and specificity of the later. Results: A total of 115 patients were scanned. Nearly 55.6% presented on account of primary infertility. Varicocele (45), hydrocele (31), epididymo-orchitis (8), epididymal cyst (6), microlithiasis (6) and others (6) were frequent Doppler findings. Only 12 cases were normal scan. Overall sensitivity of CDUS in diagnosing varicocele and hydrocele was 100% each, respectively. Conclusion: Doppler ultrasonography is an excellent, safe and reliable method for evaluating patients with scrotal diseases. It is especially important in conditions such as varicocele and hydrocele where accurate diagnosis is required in the management of infertility.

Sonographic measurement of spleen dimensions in healthy adults in North-Western Nigeria

Introduction: In the last two decades sonography has become the most important imaging modality for the study of the spleen. Different studies have been conducted in different parts of the world so as to determine the normal reference values of splenic dimension using ultrasound scan in healthy adults, and the values obtained have been diverse, thus prompting more work that tends to establish normal values for different regions based on geographic and racial differences. Materials and Methods: A prospective study of normal spleen dimensions using ultrasound in 400 Nigerian adults at Aminu Kano Teaching Hospital was conducted. Sonographic measurement of splenic dimensions was performed with the patient in supine and right lateral decubitus position. Height and weight were measured using the standard anthropometric technique. The data were analysed using computer-based SPSS Version 16.0 software for Windows (SPSS Inc., Chicago, IL, USA). Results: There were 212 males and 188 females, their age ranged between 20 and 70 years. The mean age of the subjects and (±standard deviation) were 33.0 years (±12.0), mean height was 1.64 m (±0.1) and mean weight was 61.4 kg (±11.0). The mean splenic length, width and depth for the subjects studied were 101.6 mm (±13.7), 46.8 mm (±8.2), and 86.8 mm (±12.7), respectively. Conclusion: The mean spleen dimensions obtained in this study were similar to those obtained in other regions of Nigeria but slightly lower than those reported from studies among Caucasians confirming the need for normal values for each region. There was positive correlation between subjects height and weight with splenic length (P < 0.001 and P < 0.001), depth (P < 0.01 and P < 0.001) and width (P < 0.01 and P < 0.001).

Magnetic Resonance Imaging of multiple sclerosis: A rare but real disease entity in Africans

Background: Multiple sclerosis (MS) is the most common inflammatory demyelinating disease of the central nervous system in young and middle-aged adults; it also affects older people. There is an important role for magnetic resonance imaging (MRI) in the diagnosis of MS since an MRI can show multiple lesions, some of which can be clinically occult and MRI can show new lesions on follow-up scans. This is aimed to create awareness on the existence of MS in our environment and the role of MRI in the diagnosis of MS. Patients and Methods: Five cases (three females and two males) of MS referred from the medical outpatient clinic and medical ward were seen in the MRI suite at the Department of Radiology, Ahmadu Bello University Teaching Hospital Zaria, Nigeria in the year 2014 whose diagnoses were missed on computed tomography (CT) but clinched on MRI were reviewed. The findings on MRI were correlated with clinical presentation. Results: Titubation and amnesia were the most common mode of clinical presentation in the patients examined. Typical MS lesions involving the corpus callosum, U-fibers, temporal lobes, brainstem, cerebellum, and spinal cord were best depicted on MRI while CT scan did not show any evidence of such lesions. Conclusion: MRI is the imaging modality of choice in the diagnosis of MS. Patients with typical symptoms in Africa should be subjected to MR examination in order to exclude MS.

Clinical and doppler ultrasound evaluation of peripheral arterial diseases in Kano, North-western Nigeria

Aims and Objectives: Doppler ultrasound scan is a non-invasive and cheap tool that complements the roles of computed tomography, magnetic resonance imaging and catheter digital subtraction angiography in the screening, diagnosis and follow up of vascular diseases. In this study, we evaluated and described the findings of the Doppler ultrasound of the peripheral arteries performed at Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Patients and Methods: All the findings of peripheral arterial Doppler ultrasound examinations performed at AKTH during a period of 18 months (from February 2012 to July 2013) were reviewed. All examinations were done using 7.5 MHz linear transducer connected to Mindary Digital Ultrasound Imaging System (Model DC-6; Shenzhen Mindray Biomed Electronics, Shenzhen, China). A 3.5 MHz convex transducer of the same machine was used in obese patients and those with severe subcutaneous oedema. Results: The findings of 50 males and 28 females were reviewed. Their mean age was 55.8 ΁ 17.9 years. Diabetic foot disease, intermittent claudication, gangrene and limb swellings were the most common indications for arterial Doppler examination of the lower limbs, constituting 32.1%, 20.5%, 16.7% and 15.4%, respectively. Significant luminal stenosis, total luminal occlusion and loss of arterial resistance were the most frequent findings, constituting 29%, 26.9% and 7.7%, respectively. Femoro-popliteal and below the knee arteries were commonly involved by these abnormalities. Arrhythmia, increased intimal media thickness and wall calcifications were the common compounding findings while diabetes and hypertension were frequently associated clinical problems of these patients. Conclusion: Doppler ultrasound has a high diagnostic yield in depicting abnormalities in patients with clinical features of peripheral arterial disease.