Anthonia Ikpeme

A Prospective Study of Blunt Abdominal Trauma at the University of Calabar Teaching Hospital, Nigeria.

Background:Blunt abdominal trauma (BAT) usually results from motor vehicle accidents, assaults, and recreational accidents or falls. This communication is a 3-year report of an ongoing study aimed at providing the current BAT prevalence in our center. It is hoped that this would assist in a better design of prevention and emergency trauma response systems to cope with this epidemic.Methods:All of the patients admitted to the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria, from February 2005 to January 2008 were prospectively studied based on a questionnaire. Hemodynamic stability and sonography formed the basis for selecting patients for non-operative management (NOM); others were offered laparotomy.Results:In total, 4,391 emergencies were seen during the study period, of which 1,654 (38%) were due to trauma. Seventy-nine patients with abdominal trauma accounted for 4.8% of trauma cases. Forty-two (53%) patients suffered BAT and their ages ranged from 14 and 56 years (mean 28.4 years), with a male:female ratio of 2.5:1. Road traffic accidents accounted for 13 (87%) and 26 (96%) patients in the NOM and laparotomy groups, respectively. The most commonly injured organ was the spleen in both groups: 8 (50%) and 15 (56%) in the NOM and laparotomy groups, respectively. Fifteen (36%) patients were managed successfully in the NOM group.Conclusion:Trauma was mainly due to road traffic injuries. Hemodynamic stability and ultrasonography effectively selected patients for NOM. The establishment of trauma systems, provision of ancillary diagnostic and monitoring facilities, well-designed roads and traffic infrastructure, and health education on road safety would reduce injury, morbidity, and mortality.

An audit of the completion of radiology request forms and the request practice.

Objective: To assess the degree of utilization of the radiology request form (RRF), the extent of completion each form, the frequency of filling the fields in all the forms, and its effectiveness as a communication tool between the referring clinicians and radiologists. Materials and Methods: All the RRFs for conventional radiographic examinations were audited over a 3-month period. A database containing all the fields in the form, type of request paper used, and legibility of the physicians handwriting was created. A few resident radiologists in the plain film reporting unit were recruited to join in collecting the data daily. We used simple statistical methods to analyze the extent of completion of each form, frequency of completion of the fields in all the request forms, frequency of use of the appropriate form, and frequency of legibility of the physicians handwriting. The results are expressed in percentages. Results: Five hundred eighty (580) requests were analyzed, consisting of 180 for males and 400 for females. The most-completed request form was 86.67% filled, while the least-completed was 26.67%. The most frequently filled field was the requested examination (99.66%). Of the clinicians, 28% did not use the RRF for their referrals, while 7.37% had illegible handwriting. Conclusion: A significant number of the referring clinicians did not make the best use of the radiology department by not using the institutions approved RRF as an effective means of communication with the radiologists, mainly due to the inadequate completion of the forms.

Breast Evaluation Findings in Calabar, Nigeria

Abstract BACKGROUND: X-ray and sonomammography constitute a significant option in the early detection and management of breast diseases in the developed world. Unfortunately these modalities became available in Nigeria, only in the past few decades. AIM: The aim of this audit is therefore to document the imaging findings, in the past three years in a developing facility in Nigeria relating them with the demograghic features. METHODS: We prospectively studied the x-ray and sonomammography in all patients, presenting over a three year period, for breast evaluation with the hope of discerning the epidemiologic pattern of breast lesions in this environment. RESULTS: One hundred and forty-five females and four males. Median was 38 years (IQR=30-48). The commonest reason for evaluation was screening. Patients that were below 38 years showed no significant difference in frequency and type of lesion compared with patients over 38 years. The commonest breast pattern was fatty replaced. The upper outer quadrant was the commonest site. CONCLUSION: Patients presenting for breast evaluation in Calabar do so for screening mainly. Patients below 38 are nearly equally affected by malignant breast disease as their older counterparts. The commonest breast pattern was fatty replaced. Digital mammography should be available in all tertiary institutions.

Radiation safety of women of the reproductive age: evaluation of the role of referring physicians.

Background: Women between 12 and 50 years are in the reproductive age. The likelihood of or actual presence of pregnancy should be ruled out before they are exposed to medical ionizing radiation. Fetal exposure to ionizing radiation can either induce malformation (teratogenic) or cancer. They should be exposed only when it is safe for the fetus or when the benefit far outweighs the risk in urgent medical conditions. The radiation dose in medical imaging is generally below the threshold to induce malformation (100 mGy) in the fetus, but there is indeed no safe level as the risk of cancer induction later in life can occur at any dose. The referring physician must obtain the last menstrual period (LMP) and sometimes carry out pregnancy test before sending their patients for examinations using ionizing radiation. However, there are circumstances in which these rules are waived. Objective: The purpose of the study is to evaluate the role of the referring physician in the radiation protection of the fetus using the LMP. Subjects and Methods: This is a prospective study over a 2-month period. All the request forms of menstruating women aged 12-50 years sent for conventional radiography are included in the study. Results: One percent provided the LMP in the request forms. 0.6% (one) of our subjects was sure she is pregnant, but 13.7% (25) had an overdue menstruation. Conclusion: The level of compliance of the physicians with the referral guidelines for women of reproductive age is poor.

The Value of Mobile Ultrasound Services in Rural Communities in South-South Nigeria

AIM This paper examines the activities of mobile services units including ultrasound services in rural and urban communities in the Calabar region of South-South, Nigeria. MATERIALS AND METHODS Consenting individuals were invited and attended five medical outreach activities in rural and urban areas of the Calabar region between January and June 2016. Abdomino-pelvic scans were done. Subsequently the results were analyzed. RESULTS Five hundred and seventy-four (574) individuals had Abdomino-pelvic scans done, using a curvilinear probe to assess the abdomino-pelvic organs. The female to male ratio was 1.46:1. The age ranged from 1-78 years with a mean of 40.63 (standard deviation of 17.5). The commonest sonographic finding was uterine fibroids, 21 (8.1%). Fifty-four percent of the scans were normal. The commonest sonographic finding in men was prostatic enlargement. CONCLUSION Medical outreach activities provided by mobile units provide much needed ultrasound services in poor resource settings in Nigeria. Significant clinical pathologies were identified at fairly high rates.

Klippel Trenaunay Syndrome: A Case Report in an Adolescent Nigerian Boy

AIM: This is to report a case of Klippel Trenauay Weber syndrome in a fifteen year old Nigerian boy. This is a rare syndrome and it is the first case to be reported in UCTH Calabar. CASE PRESENTATION: Product of a full term uneventful pregnancy, delivered to non-consanguineous apparently healthy parents. At birth was noted to gradually develop swelling on the right leg, worse at the right foot. There was crossed hemi-hypertrophy with right leg bigger than the left. As child grew symptoms worsened, parents separated and eventually he was abandoned to the streets. He presented at University of Calabar Teaching Hospital for medical care at the age of fifteen years with lymphatic obstruction, persistent foul smelling drainage, lipodermatosclerosis of right foot as well psycho-social and financial constraints. The diagnosis was made with x-rays and Doppler studies of the lower limb vessels. He is currently being managed conservatively with compression dressings on the affected limbs, Antibiotics for the infection and analgesics. De-bulking surgery is being anticipated at this time. CONCLUSION: This is a case of KTWS presenting in adolescence and due to its rarity in Nigeria, this report is to increase awareness.

Computerized tomography findings of cerebrovascular disease in adults in Calabar, Nigeria

Background: Computerized Tomography (CT) findings of Cerebrovascular Accidents (CVA) in patients in Calabar, Nigeria, have not been previously reported. The aim is to document the CT findings and the pattern and demographic features of the condition. Materials and Methods: We prospectively studied 87 consecutive patients, presenting over a 12-month period with diagnosis of stroke. The sociodemographic and clinical data as well as the CT findings were collected. Statistical analysis was done using the computer software STATA 10 corp., Texas, USA. Results: There were 49 males and 37 females with a median age of 56 years (45.75-67). The ischemic type of CVA predominated, (81.4%), with no significant gender difference (P = 0.99). The peak age of stroke was in those less than 50 years (33.7%). The individuals with hemorrhagic stroke were younger than those with ischemic stroke (median of 48 and 59 years, respectively). Conclusion: Stroke incidence in Calabar has evolved so much, as to affect a much younger age group and the female to male ratio is fast approaching equality. The hemorrhagic type tends to affect younger males. It is recommended that young people presenting with stroke in the Calabar area, particularly where a CT scan is not available, must be suspected to have a hemorrhagic stroke.