Omolola M. Atalabi

Cranial Magnetic Resonance Imaging Findings in Kwashiorkor

ABSTRACT Protein energy malnutrition (PEM) is an important public health problem in the developing countries, although it is becoming uncommon in South West Nigeria. Cerebral changes have been associated with severe PEM. This study evaluated the neurological changes using Magnetic Resonance Imaging (MRI) in Ibadan south west Nigeria. The 5 children evaluated had a median age of 16 months and all the children had brain changes compatible with cerebral atrophy. In addition two of the children had periventricular white matter changes, while one these two had mega cisterna magna in addition. Though this study did not re-evaluate the brains of these children after nutritional rehabilitation, it is possible that changes are reversible as demonstrated in earlier studies

Pregnancy Outcomes and Ethanol Cook stove intervention: A randomized-controlled trial in Ibadan, Nigeria.

BACKGROUND Household air pollution (HAP) exposure has been linked to adverse pregnancy outcomes. OBJECTIVES A randomized controlled trial was undertaken in Ibadan, Nigeria to determine the impact of cooking with ethanol on pregnancy outcomes. METHODS Three-hundred-twenty-four pregnant women were randomized to either the control (continued cooking using kerosene/firewood stove, n=162) or intervention group (received ethanol stove, n=162). Primary outcome variables were birthweight, preterm delivery, intrauterine growth restriction (IUGR), and occurrence of miscarriage/stillbirth. RESULTS Mean birthweights for ethanol and controls were 3076 and 2988g, respectively; the difference, 88g, (95% confidence interval: -18g to 194g), was not statistically significant (p=0.10). After adjusting for covariates, the difference reached significance (p=0.020). Rates of preterm delivery were 6.7% (ethanol) and 11.0% (control), (p=0.22). Number of miscarriages was 1(ethanol) vs. 4 (control) and stillbirths was 3 (ethanol) vs. 7 (control) (both non-significant). Average gestational age at delivery was significantly (p=0.015) higher in ethanol-users (39.2weeks) compared to controls (38.2weeks). Perinatal mortality (stillbirths and neonatal deaths) was twice as high in controls compared to ethanol-users (7.9% vs. 3.9%; p=0.045, after adjustment for covariates). We did not detect significant differences in exposure levels between the two treatment arms, perhaps due to large seasonal effects and high ambient air pollution levels. CONCLUSIONS Transition from traditional biomass/kerosene fuel to ethanol reduced adverse pregnancy outcomes. However, the difference in birthweight was statistically significant only after covariate adjustment and the other significant differences were in tertiary endpoints. Our results are suggestive of a beneficial effect of ethanol use. Larger trials are required to validate these findings.

Bilateral tardus-parvus waveform in kidneys secondary to mid-aortic syndrome in a hypertensive child.

A 10-year-old girl who presented with hypertension and anelevated renin level underwent a renal US examination thatdemonstrated abnormal Doppler waveforms in bothkidneys, characterized by the tardus-parvus pattern withprolonged acceleration time, decreased peak systolic veloc-ity and elevated diastolic flow (Fig. 1). The child wasfurther evaluated with conventional angiography thatdemonstrated marked narrowing of the abdominal aortastarting just below the level of the superior mesentericartery (Fig. 2, short arrows) consistent with mid-aorticsyndrome. In addition, narrowing of the superior mesentericartery was seen (Fig. 2, long arrow) as well as mildnarrowing of both proximal bilateral renal arteries.Although hypertension is typically essential (primary) inolder children and adolescents, in approximately 10% ofchildrenitisduetounderlyingrenovasculardisease[1]. Whentardus-parvus waveforms are present in bilateral kidneys,however, aortic coarctation or mid-aortic syndrome should beconsidered in addition to bilateral renal artery stenosis [1, 2].References

Transvaginal ultrasonography: a survey of the acceptability and its predictors among a native African women population

Objective To determine the acceptability of transvaginal ultrasonography (TVU) and associated factors among Nigerian women. Method A cross-sectional survey was conducted among 3137 women who presented for transabdominal ultrasound scan between August and November 2010 in two referral hospitals in Nigeria. Data were obtained using a questionnaire. Descriptive and multivariate analysis was performed applying logistic regression analysis; predictors of willingness of participants regarding transvaginal ultrasound were identified using SPSS Statistics (SPSS Inc, Chicago, IL) version 17 software. Results The mean age of the women was 33.8 years (standard deviation = 7.9), with 88.8% currently married. About 84% were willing to have TVU, while 54.2% were indifferent about the gender of the sonologist. About 17.3% believed that the procedure is painful. Significant predictors of willingness to have TVU were previous sexual experience and douching, prior painful vaginal examination, and vaginal surgery. Conclusion The majority of Nigerian women expressed a willingness to have the TVU procedure without necessarily opting for any gender preference of the operator. Women should be adequately counseled on the operations of the procedure so as to be able to psychologically prepare for them.

Abdominal paraganglioma in a pediatric patient

A9-year-oldboypresentedwithabdominalpain.AbdominalUS showed a large cystic mass measuring 13.4×6.8 cmassociated with several peripheral solid nodules (M) (Fig. 1,arrows). CTconfirmed the large cystic abdominal mass (M)(Fig. 2) with an enhancing nodular periphery (arrows).Surgical pathology showed cystic paraganglioma.Paraganglioma is a rare neuroendocrine neoplasm arisingfrom the paraganglionic cells found in various anatomiclocations [1, 2]. As a result of excess secretion of catechol-amine, patients with a functioning paraganglioma commonlypresent with palpitations, headache, sweating, and hyperten-sion [1, 2]. In contrast, patients with a nonfunctioningparaganglioma typically present with an enlarging palpablemass or associated pain, as in this patient [ 2]. Althoughcomplete surgical resection usually results in a cure, approx-imately 20–42% of paragangliomas can metastasize toregional lymph nodes, bone, liver, and lungs [ 1, 2]. Onimaging, paragangliomas are usually large (>3 cm) andhypervascular, and they often demonstrate extensive internalcystic degeneration [1, 2].References

The state of radiology subspecialty training in the west african subregion: The residents' perspective

Background/Aim: Radiology residency was initiated nearly 30 years ago in the West African subregion, but accompanying formal subspecialty training has been developed within the 30 year time span. In contrast, subspecialization has evolved over the past 25 years in developed countries. The aim of this study was to determine residents′ perspective about radiology subspecialization training in West Africa. Materials and Methods: Semi-structured, self-administered electronic questionnaires were sent to residents at different levels of training via E-mail and during update courses. Data analysis was performed using SPSS version 15.0 (IBM) package. Quantitative variables were expressed using summary statistics including means and medians. Descriptive analysis was performed for the qualitative variables using frequencies, proportions, and charts. Statistical significance was set at the 5% level using two tailed P values. Results: There were 117 respondents 85 (72.6%) males and 32 (27.4%) females. A total of 110 (94%) were aware of the various subspecialties in radiology with neuroradiology being identified by all as separate subspecialty. Interventional radiology topped the choice of subspecialty with 61 (52.1%) respondents, and 67 (57.3%) would prefer that subspecialties be introduced in phases. Ultrasound, basic X-ray, mamography equipment, and computed tomography scanners are available in many of the training centers. 116 (99.1%) of the residents believed that there is a need for subspecialization in the subregion. Conclusion: Our study demonstrates the need for subspecialization in West Africa. To achieve this goal, collaboration and support from well-established radiology residency and fellowship training programs based in developed countries is necessary.

Evaluation of renal blood flow using Doppler sonography in children with acute Falciparum malaria in south-western Nigeria.

Background: Renal blood flow evaluation during malaria illness is rarely done despite the high incidence of kidney injury from malaria and availability of Doppler ultrasound scanners in malaria endemic areas. Aims: This study is to evaluate the renal blood flow changes using Doppler ultrasonography among uncomplicated and complicated malaria subsets of pediatric patient with laboratory Original Research Article Adekanmi et al.; BJMMR, 8(6): 503-515, 2015; Article no.BJMMR.2015.473 504 evidence of malaria parasitemia and without background clinical and laboratory evidence of renal impairment. And to compare these with parameters of age matched healthy pediatric control. Study Design: This was a prospective case control study of renal Doppler indices in children with acute malaria. Place of Study: The study was conducted among pediatric patients presenting at the children outpatient clinics, emergency and pediatric wards of the University College Hospital (UCH), Ibadan Nigeria. Methodology: Doppler indices of 602 kidneys were evaluated among 85 uncomplicated (UM), 85 complicated malaria (CM) children that presented within 24 hours and follow up scans on days 3 and 5 of their illness. These were compared with that of 131 healthy children (control). Results: The main renal artery diameter of the CM group was 0.41±0.07 mm, UM=0.48±0.09 mm and 0.53±0.11 mm (p=<0.001) in the control group. The main renal vein diameter were 0.59±0.11 mm and 0.48±0.10 mm and 0.63±0.15 mm (P=<0.000) among the CM, UM and the control group respectively. The PSV and EDV were slightly lower in the malaria groups than in the control group. PSV=49.01±18.21 cm/s in the UM and CM=50.71±19.68 cm/s. The control group PSV was 56.95±15.47 cm/s. AT was however significantly lower in the two malaria subgroups than in the control. (UM=47.70±18.28 cm/s, CM=52.33±21.06 cm/s and control=75.20±27.66 cm/s respectively (p=<0.000). The Intrarenal S/D in UM was 2.73±0.49 and the CM group S/D was 3.05±0.65 and control=2.62±0.47 (P=0.04). Slightly lower but statistically insignificant mean values were seen in the RI and PI. Conclusion: The main renal arterial and vein diameters and the intra renal vessel AT are significantly reduced during acute falciparum malaria illness. The intra-renal PSV and EDV are likely to be lower in acute falciparum malaria than in the normal healthy children. The intra-renal S/D are significantly higher in the UM and CM. Also, the PI and RI are likely to be higher in the malaria groups. The AT and S/D both showed inverse and direct relationship respectively as malaria severity worsens. We propose that renal Doppler ultrasound can be used to monitor renal status and should be included in the management of children with acute malaria infection more so in malaria endemic area.

Baseline chest radiographic features among antiretroviral therapy naïve human immuno-deficiency virus positive children in a pediatric care program

Background: Pulmonary diseases are commonly seen in children with HIV infection, and their etiology is often unclear. The radiological appearances of these conditions are often non-specific. Conventional radiographs play an important role in the management of chest conditions especially in resource poor settings. Objective: This retrospective study was carried out to determine the chest radiographic pattern in children with HIV infection. Materials and Methods: The baseline chest X-ray of 150 HIV-positive but antiretroviral drug naïve children were analyzed between July 2008 and December 2009 at the University College Hospital in Ibadan, south-west Nigeria. All children were screened for tuberculosis (TB) by one or combination of mantoux, acid-fast Bacilli (AFB) sputum, and erythrocyte sedimentation rate. The CD4 count was also taken as part of baseline laboratory test. Chi-squared test was used to determine association between the pattern of chest X-ray findings, and sex, age, and CD4 counts. Results: The mean age of the study group was 51.6 months, with children older than 5 years dominating and there was no statistical difference in the sex distribution. A total of 115 children (76.7%) had abnormal chest X-ray, with lymphadenopathy accounting for 45.3% followed by parenchymal lesions with 37.3%, miliary shadows, and cavities accounted for 6.7% and 2.6%, respectively. Cavities were found to be common in patient who tested positive to AFB than AFB-negative patients. Other findings like reticulonodular or diffuse patterns, lymphadenopathy, pleural effusion, or soft tissue swelling were also commoner in the AFB-positive patients. The CD4 count was available for 42% of the patient and there was no significant association between the chest radiographic changes and the CD4 count. Conclusion: Definitive diagnosis of pulmonary disease might be difficult based on chest X-ray alone, however, chest X-ray is a basic radiological test and almost the easiest to perform in both resource poor or rich setting and it is still recommended that routine chest X-ray should remain part of investigation of HIV-positive children to serve as adjunct to other investigations in early detection of TB.