Anas Ismail

Speciality choices of final year medical students: A 10-year follow-up

Introduction: The preference of medical specialties by medical graduates may play a role in determining the pattern of the future workforce in the healthcare system. This was a longitudinal study over a 10-year period (2004-14) to determine what progress the graduates have made regarding their specialty choices at the graduation level. Materials and Methods: Structured self-administered questionnaires were administered to 40 final year medical students to determine their preferences for medical specialisation at graduation in 2004. Follow-up interviews were conducted after a10-year period (in 2014) to determine to what extent they were able to realise their objectives. Results: Out of the 40 medical students involved in this study, 24 were males (60%) and 16 were females (40%). Their mean age at graduation level was 27.3 ± 1.97 years. There was a high preference for Obstetrics and Gynaecology (O and G) and Paediatrics at graduation. At 10 yearspost graduation, 5 students had reached the level of Consultants, 20 were at the level of Senior Registrars while 15 were at the level of Registrars and Medical officers. At 10 years post-graduation, there was a preference for Family Medicine, Internal Medicine, Radiology, and Community Medicine; despite the predominance of Paediatrics and O and G at graduation. Whenthe age at graduation of these students was compared with their current status, those at the rank of consultants showed a younger age at graduation level of 26.4 ± 0.55 years, compared with Senior Registrars (27.45 ± 1.54 years), and medical officers/others (27.60 ± 2.50 years). However, these differences were not of statistical significance [one-way analysis of variance (ANOVA) F = 0.778, P = 0.467]. Pursuing the preferred area of specialisation at the graduation (P = 0.04) was associated with more progress in post-graduate training. Conclusion: Specialty choices are determined by availability of training posts, with choice of specialty at the level of graduation, giving way to what is pragmatically available and feasible. However, pursuing preferred area of specialisation at graduation is associated with more progress in career. Furtherstudies are required to determine the contribution of other factors in determining career progress and sticking to preferred area of specialisation at graduation.

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.

Partial corpus callosal agenesis with ventriculomegaly and sulcal anomaly in a 10-year-old child

Agenesis of the corpus callosum is a heterogeneous, congenital neurodevelopmental condition that can be observed either in isolation or in combination with other brain abnormalities. Patients often present early with characteristic neurologic and physical manifestations. This case discusses a 10-year-old boy who presented to a tertiary health facility in Northern Nigeria with 6-month history of seizure disorder, cognitive impairment and urinary incontinence and had classical magnetic resonance imaging (MRI) findings consistent with partial corpus callosum agenesis in combination with other brain abnormalities. He was placed on daily oral carbamazepine and has done well with supportive care from family.

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.

Diagnostic anatomy of the maxillofacial region on orthopantomograph

The purpose of the present article was to review the physics and radiation factor of the orthopantomograph and to describe the diagnostic anatomy visualised on the imaging modality. Literature search was done via PubMed, EMBASE, Cochrane electronic databases and Google Scholar. The keywords for the search were orthopantomograph, anatomy, maxillofacial region and physics. The search was restricted to articles written in English Language and published within the years 1940–2016. The search was further limited to review, free full-text articles. The available literature was reviewed, and the physics and radiation exposure of patients undergoing orthopantomograph imaging were discussed. The radiation exposure was compared to the complete mouth series intra-oral periapical radiographs. Furthermore, the diagnostic anatomy of the maxillofacial region, as visualised on the orthopantomograph, was reviewed. The clinical relevance of the various anatomic structures was also discussed. The knowledge of maxillofacial anatomy on the orthopantomograph can be challenging due to distortion and superimposition of anatomic structures. However, a good understanding of the normal enables the clinician to identify the abnormal.

Pictorial essay: A retrospective review of male breast diseases in Maiduguri and Kano, Nigeria

Introduction: Breast diseases in men are not as common as those in women and though male breast cancer is seen rarely, thus the lack of screening guidelines worldwide, benign breast diseases such as gynecomastia present fairly commonly in both primary and tertiary care setting. There is a paucity of information about the pattern, protocols, and imaging features of male breast diseases in Nigeria. Objective: To review the variety of presentations and radiological features of male breast diseases encountered in Aminu Kano Teaching Hospital (AKTH) and University of Maiduguri Teaching Hospital (UMTH). We wish to discuss the departmental protocols and highlight the role of mammography and sonomammography in the evaluation of male breast diseases. Materials and Methods: A 5-year retrospective review was performed on the imaging findings of a total number of 27 male patients who presented with symptoms of breast disease to the radiology departments of AKTH (12) and UMTH (15) in Nigeria. All patients had mammography and sonomammography or sonomammography alone performed by a senior radiology resident and consultant radiologist. Selected cases had ultrasound guided biopsy and histology. Results: Twenty-seven male patients were reviewed from both centers with an age range of 0.06-69 years (mean of 33.11 ± 18.10 years). The majority of patients (88.9%) presented with breast enlargement only. Concerning laterality of disease, bilateral involvement was more common (59.3%). In unilateral disease, 33.3% of patients presented with left-sided lesions while only 7.4% had right-sided involvement. Gynecomastia was seen in twenty (20) patients and was the most common breast disease seen in male patients presenting for imaging in both centers. Breast abscesses were the second most common. We saw one case of bilateral male breast cancer. Overall, bilateral disease was far more common than unilateral. Conclusion: Mammography is the most important first-line imaging modality employed in the diagnosis of male breast diseases in our environment; sonomammography is an important and radiological modality of investigation used to differentiate gynecomastia from male breast cancer and breast abscess. Gynecomastia remains the most common occurring male breast disease in our study.

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.

Computed tomographic angiography: An alternative to catheter-angiography in the evaluation of a scalp arterio-venous malformation

Arterio-venous malformation (AVM) is an uncommon abnormality, characterized by abnormally dilated pathologic vessels resulting in shunting of blood from arteries to veins without intermediary capillaries. The management of AVM is challenging because of high shunt flow and complex vascular anatomy. A 28-year-old female patient presented with a pulsatile occipital swelling. Sonographic findings of the AVM were confirmed on computed tomographic angiography, showing dilated, and tortuous vessels in the occipital region with feeders from the vertebral arteries and the right external carotid, which drained to the right internal jugular vein. She was treated by ligating the feeders.

Pattern of fetal arterial blood flow in selected vessels in patients with pregnancy induced hypertension in Aminu Kano Teaching Hospital Kano, Nigeria

Background: Doppler velocimetry of fetal arterial blood flow in pregnancy induced hypertension (PIH) determines fetal hemodynamic adjustment. Objective: This study was aimed to determine the pattern of fetal arterial blood flow of selected vessels in patients with PIH. Materials and Methods: A total of 34 pregnant women with PIH at a gestational age of 24-37 weeks were prospectively examined with Doppler ultrasound of the fetal middle cerebral artery (MCA), umbilical artery and placental blood flow (uterine artery). Results: The mean peak systolic velocity (PSV) of the fetal MCA was 8.23±3.96, resistance index (RI) was 0.763±0.07 and systolic diastolic (S/D) ratio was 4.558±1.36. The mean PSV of umbilical artery was 72.28±26.585, RI was 0.62±0.19 and S/D was 2.63±0.75. The mean placental blood flow (uterine artery) PSV was 141.34±70.58, RI was 0.59 and S/D was 2.42±1.07. Uterine artery PSV was normal in only six patients. Uterine artery was also not sonographically demonstrated in two patients. Conclusion: Doppler velocimetry of arterial blood vessels in pregnancy complicated with PIH reveals abnormal pattern; its application in PIH would be useful for further management.