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   Table of Contents - Current issue
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July-December 2019
Volume 26 | Issue 2
Page Nos. 59-137

Online since Thursday, July 18, 2019

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ORIGINAL ARTICLES  

Assessment of ultrasound flow-mediated dilation of brachial artery in regular blood donors in a Nigerian Tertiary Hospital p. 59
Ozoemena Sebastine Oboke, Adekunle Ayokunle Olakunle Adeyomoye, Alani S Akanmu, Olubukola Abeni Omidiji, Olubusayo Abimbola Agbaje
DOI:10.4103/wajr.wajr_6_18  
Background: Iron is a pro-oxidant cofactor that may be linked to cardiovascular disease (CVD) progression and reduction of body iron stores have been hypothesized to reduce the risk of CV disease. Aim: The aim of this study is to assess reduction in CVD risk susceptibility among regular blood donors compared with nondonors using ultrasound brachial artery flow-mediated dilation (BAFMD). Settings and Design: A prospective comparative study designed to establish the difference between mean flow-mediated dilatation (FMD) in the patients who are regular blood donors compared with nondonors recruited from a Teaching Hospital donor clinic. Materials and Methods: Data were collected over 7 months from December 2014 to June 2015. 100 eligible regular male blood donors, aged 21–50 years, were selected from a Teaching Hospital blood donor records and their BAFMD assessed. 50 nondonors/ first time donors, of equivalent age group, consecutively were assessed for comparison. Serum markers of iron stores, markers of oxidative stress and other related cardiac risk factors were also assessed in all patients. Results: BAFMD was significantly greater in regular blood donors when compared with nondonors (13.95% ± 7.02% vs. 8.20% ± 4.19%, P = 0.000). Serum ferritin was significantly decreased in regular blood donors when compared with nondonors (mean value 41.92 ng/ml ± 23.12 ng/ml vs. 61.97 ± 30.19 ng/ml, P = 0.000), but Hb did not differ between the groups. High FMD was significantly associated with high C-high-density lipoprotein and low C-LDL (r = −0.215*, P = 0.032, r = 0.188, P = 0.031, r = 0.193, P = 0.027, r = 0.0279, P = 0.002, r = 0.139, P = 0.084). LDL was decreased in regular blood donors compared with nondonors. Conclusion: The study provides prognostic information for assessing ultrasound BAFMD as a cardiac risk marker. Regular blood donors have enhanced cardiovascular function with increased flow-mediated dilation, decreased body iron stores, and decreased oxidative stress compared with nondonors.
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Roles of contrast-enhanced ultrasound and diffusion-weighted magnetic resonance imaging and their comparison in solid space-occupying lesions of the liver – Microbubbles and micromovements in imaging p. 69
Santosh PV Rai, Teja Reddy, Sandeep Gopal, Suresh Shenoy
DOI:10.4103/wajr.wajr_18_18  
Aims: This study aims to establish the role of contrast-enhanced ultrasound (CEUS) and diffusion-weighted (DW) magnetic resonance imaging (MRI) in the characterization of solid liver lesions. Settings and Design: An analysis of 22 patients undergoing CEUS and DW MRI following identification of 1 or more solid liver lesions on conventional ultrasonography. Subjects and Methods: The study is carried in a standard Doppler ultrasound machine with contrast ultrasound capabilities and 1.5T MRI machine over a period of 2 years from July 2015 to June 2017. After baseline US examination, a bolus of 1.0–2.4 ml of ultrasound contrast agent was administered intravenously followed by 10 ml of saline flush. CEUS images were obtained during arterial, portal venous, and delayed phases. After CEUS, patient is transferred to MRI scanning room where the DW imaging (DWI) sequence is taken. The CEUS and DW MRI diagnosis were compared to other imaging modalities, histopathology, and/or clinical follow-up after 12 months. Statistical Analysis Used: Sensitivity, specificity, positive predictive value, negative predictive value, accuracy rate and receiver operating characteristic analysis curve was performed using Statistical Package – SPSS ver. 17.0. Statistical evaluation of qualitative analysis between benign and malignant lesions was performed using the Fisher's exact test. Results: CEUS correctly identified malignant liver lesions in 13 out of 14 cases, with the final diagnosis confirmed by histopathology in 6 cases, by other imaging modalities in 7 cases and follow-up in 1 case. Eight patients were correctly identified as benign liver lesions on CEUS imaging, with all these cases confirmed on other imaging modalities and/or follow-up and two cases by histopathology. In the detection of malignancy, the sensitivity is 86.7% and specificity is 100%. On the DW images the Mean apparent diffusion coefficient (ADC) value for benign lesions is 1.5 and mean ADC value for malignant lesions is 0.7. The ADC was significantly higher in benign lesions than in malignant lesions (P < 0.01). Conclusions: In our experience, CEUS and DWI with ADC values are highly accurate in confirming benign lesions, early detection of malignant lesions, and metastases in known primary malignancy patients. Other advantage of CEUS and DW MRI is that it is also cost-effective as compared to simultaneously performing individual investigations and can be performed in renal insufficiency patients. Hence, we conclude that CEUS and DW MRI sequence should be used in routine practice.
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Role of cine phase-contrast magnetic resonance imaging in the management of normal pressure hydrocephalus p. 80
Maneet Kaur, Paramdeep Singh, Kavita Saggar, Rakesh Kumar Kaushal, Rajinder Kumar Bansal
DOI:10.4103/wajr.wajr_2_18  
Background and Aim: There are several unanswered queries related to normal pressure hydrocephalus (NPH) regarding the diagnostic criteria and selection of appropriate patients for shunt surgery. This study aimed to evaluate the utility of cine phase-contrast (CPC) magnetic resonance imaging (MRI) in the management of patients with NPH. Patients and Methods: In this prospective study, MRI analysis was done on 1.5 Tesla scanner in 20 patients who presented with clinical features and routine MRI findings which were suggestive of NPH. CPC MRI and clinical assessment were performed before and after a high-volume cerebrospinal fluid (CSF) tap by lumbar puncture. Out of these twenty participants, ten underwent ventriculoperitoneal (VP) shunting. Clinical assessment was also done after VP shunting. CSF flow through the aqueduct was also evaluated in twenty age- and sex-matched controls. Results: There was a statistically significant difference between aqueductal flow void score in cases and controls. However, no significant difference in flow void was seen after the tap or after the shunt. There was also a statistically significant difference between the values of stroke volume (SV) in cases and controls. Very high SVs (>50 μL) correlated with marked clinical improvement after the tap and after the shunt. Mildly elevated SV did not help in making any interpretation regarding the usefulness of shunt. There was also a statistically significant difference between the values of peak velocity (PV) in cases and controls. Patients with PV >10 cm/s and with a fall of ≥2 cm/s after tap significantly correlated with clinical improvement. Conclusions: CPC MRI is a useful adjunctive technique to support the diagnosis of NPH as well as in predicting a favorable response to shunt surgery in these patients.
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Determination of X-ray shielding thickness in two tertiary hospitals in Kano metropolis, Nigeria p. 90
Aminu Abubakar Abubakar, Mohammed Sidi
DOI:10.4103/wajr.wajr_28_18  
Background: Radiation dose depends on the total workload (Wtot) which is affected by the number of patients, tube potential, and tube current. Despite the increment in patients visiting the X-ray units under study and X-ray tube revolutions, changes have not been made in the shielding material to suit the current situation. Aims: This study aims to evaluate the thickness of X-ray shielding barriers in two tertiary hospitals in Kano Metropolis using XRAYBAR software. Materials and Methods: This was a prospective, cross-sectional study and was undertaken from March 2017 to October 2017. A purposive sampling technique was employed to select two hospitals out of five. The two were named A and B, respectively. The minimum required thickness in each barrier was determined by XRAYBAR software. Results: The Wtot (workload) for room I, II and III was found to be 199.9, 146, and 149.1 mA-min per week. The shielding barrier thickness required to reduce the unshielded radiation dose to the design dose limit for wall 1, 2, 3, 4, and operating console of the Room I was found to be 17.5, 5.5, 0.2, 0.00, 3.3 cm, that of wall 1, 2, 3, and 4 of room II was found to be 9.1, 3.4, 0.02, 2.3 cm, while for the wall 1, 2, 3, 4, and operating console of room III was found to be 12.3, 4.8, 3.8, 3.2, and 26.5 cm, respectively. Conclusion: The calculated shielding barrier thickness from XRAYBARR code when compared to the design barrier thickness was found to be adequate.
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Role of computed tomography scan in assessment of skull fracture patterns among motorcycle road traffic accident patients in South Western Nigeria p. 94
Omolola M Akinwunmi, Omolola Mojisola Atalabi, Ademola Joseph Adekanmi
DOI:10.4103/wajr.wajr_56_17  
Background: Commercial motorcycling is a common means of transportation in Nigeria, and motorcycle road traffic accidents (MCRTAs) are commonly associated with multiple skull fractures. Cranial computed tomography (CT) scan is the standard imaging modality of patients with head injury. Aim: The aim of this study is to describe the pattern of skull fractures on cranial CT scan in patients with head injury following MCRTA. Patients and Methods: This was a descriptive cross-sectional study conducted at the University College Hospital, Ibadan, between June and October 2016. Noncontrast cranial CT scan was performed on 190 patients who presented with head injury following MCRTAs. Results: Over half (n = 59.8%) of the patients were within the ages of 20–39 years with a mean age of 33 ± 14.37 years. A total of 183 patients did not use crash helmet at the time of accident, out of which 168 (n = 88.4%) sustained skull fractures. Six different skull fracture patterns were identified on cranial CT scan of these patients. The most common fracture pattern seen was the combined calvarial, facial, and base of skull fractures representing 22.1% while the least fracture pattern was the base of skull fracture (n = 4.7%). Most of the patients with calvarial fractures were without helmet at the time of injury (n = 98.3%) compared to 1.7% of patients who wore helmet at the time of injury. This was statistically significant (P = 0.040). Conclusion: This study further underscores the usefulness of cranial CT scan in identifying and evaluating patients with skull fractures following MCRTA in our environment, thus guiding proper medical and surgical management of such patients in a low-resource setting.
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Profile of computed tomography scan findings of patients diagnosed with pancreatic neoplasm at Dr. George Mukhari Academic Hospital, Ga-Rankuwa, Pretoria, South Africa p. 100
John Osi Ozoh, Magenthran Govender, Olakunle Adewunmi Towobola, Gboyega Adebola Ogunbanjo
DOI:10.4103/wajr.wajr_55_17  
Background: The aim of this study is to determine the profile of abdominal computed tomography (CT) scan findings of patients diagnosed with pancreatic adenocarcinoma and other pancreatic neoplasm that simulates pancreatic adenocarcinoma, which constitute the majority of pancreatic neoplasm at Dr. George Mukhari Academic Hospital, Ga-Rankuwa, Pretoria, South Africa. Materials and Methods: A prospective study of abdominal CT scans of 67 patients, aged 12 years and older, with histologically confirmed pancreatic neoplasms, including their medical records and laboratory results, from November 1, 2013 to June 30, 2017, was conducted. CT scan images were acquired with 128 slices, Philips, and GE CT scanners. Statistical analysis was made using a Statistical Program for the Social Sciences software SPSS (version 22.0). Results: There were 36 females (53.7%) and 31 males (46.3%) in this series and four demised. The ages of the patients ranged from 12 to 90 years. The most common clinical presentation was obstructive jaundice (86.6%). The predominant histological diagnosis was adenocarcinoma (74.6%), followed by primary lymphoma of the pancreas (13.4%) and 65.7% of the pancreatic neoplasms were unresectable, while most of the other pancreatic neoplasms based on their CT scan findings masqueraded as pancreatic adenocarcinoma. Pancreatic adenocarcinoma demonstrated both typical and atypical CT scan findings. Conclusion: Accurate diagnosis and appropriate management of pancreatic neoplasms are important because of their high morbidity and mortality. The majority of the pancreatic neoplasms were unresectable at the time of their presentation. A multidisciplinary management team is recommended since pancreatic neoplasms still remain a serious clinical challenge.
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Comparison of the diagnostic performance of ultrasonography with fine-needle aspiration cytology in thyroid nodules p. 110
Grace Oluyemisi Bayewu, Ayotunde O Ogunseyinde, Omolola Mojisola Atalabi, Gabriel Olabiyi Ogun, Adesoji Ebenezer Adetona
DOI:10.4103/wajr.wajr_30_18  
Objective: The aim of the study was to correlate the sonographic (ultrasound [US]) and color flow Doppler findings with the results of US-guided fine-needle aspiration biopsy. Materials and Methods: This is a cross-sectional study conducted in the ultrasound suite of our hospital, South Western, Nigeria. It is a cross-sectional study on 110 adult patients with clinically palpable thyroid nodule(s) in our hospital. Sonographic scans of 110 thyroid nodules in 110 patients were performed, and characteristics of thyroid nodules that were studied included microcalcifications, an irregular or microlobulated margins, marked hypoechogenicity/hypoechogenicity, a shape that was taller than it was wide, and color flow pattern in Color Doppler ultrasound. The presence and absence of characteristics of nodules were classified as having positive or negative findings, respectively. Results: Among 110 solid thyroid nodules, 23 lesions were classified as positive considering the sonographic characteristics and 9 of them were proved to be malignant on histopathology. Of 87 lesions which were classified as negative, none was proved to be malignant. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value based on our sonographic classification method were 100%, 86%, 36%, and 100%, respectively. Conclusion: This study showed that ultrasound can be sensitive and specific for thyroid nodules but the PPV is low.
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Congenital sensorineural hearing loss in consanguineous marriages – Does the cochlear length vary p. 117
Rohit Aggarwal, Kavitha Yellur, Upendra Kumar Joish, Raju Augustine George, Himanshu Swami, Sabarigirish Kanjully
DOI:10.4103/wajr.wajr_40_17  
Objective: There is an increased prevalence of congenital sensorineural hearing loss (SNHL) among children born out of consanguineous wedlocks, and congenital deafness is associated with increased prevalence of structural inner-ear malformations. This study is done to evaluate whether consanguinity affects the cochlear length, which in turn will influence the type of cochlear implant and depth of electrode insertion during surgery in these patients. Methods: Children presenting with congenital SNHL and born out of consanguineous marriages (Group A) were compared with children presenting with SNHL and born out of nonconsanguineous marriages (Group B). Patients in both groups were evaluated with magnetic resonance imaging as a routine pretreatment workup. A high-resolution three-dimensional T2-weighted sampling perfection with application-optimized contrasts using different flip-angle evolution imaging of the inner ears was performed. Curved multiplanar reconstruction module was used to deconvolute the membranous cochlea and measure its length. The cochlear lengths among both the groups were compared using analysis of variance test. Results: A total of seven patients were included in both Groups A and B each. The mean length of membranous cochlea in Group A was 22.6 mm and Group B was 22.5 mm. There was no statistically significant variation in the cochlear lengths of both the groups. Conclusion: Consanguinity is unlikely to produce any significant variation in the length of the cochlea.
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Knowledge, perception, and attitude of health-care professionals toward obstetrics ultrasonography in selected internally displaced persons' camps in North-east Nigeria p. 121
Fati Dauda Malgwi, Wiam Elshami Elshami, Joseph Dlama Zira, Akanegbu Ubaka Edwin, Moi Silas Alhamdu, Shem Samuel Laushugno, Ameh Prince Ogenyi, Mohammed Sani Umar, Ginikanwa Njoku Augusta
DOI:10.4103/wajr.wajr_20_18  
Background: Ultrasound is the frontline diagnostic tool of choice for perinatal care. It is usually provided in ideal settings by experts. Objectives: The objective of this study is to determine the knowledge, perception, and attitude of health-care professionals toward obstetric ultrasound in internally displaced persons (IDPs) camps in Maiduguri, Borno state, North-east Nigeria. Materials and Methods: A prospective survey was conducted in three selected IDPs camps in Maiduguri from January to May 2017. Healthcare personnel from the antenatal clinics of the selected IDPs camps were enrolled in the study. A 26-item structured questionnaire was used to elicit responses on demography, knowledge, perception, and attitude. Data collected were analyzed using the Statistical Package for Social Sciences version 21 and descriptive statistics were generated for the data. Results: Out of the fifty questionnaires distributed, forty-five were filled and returned appropriately; given a returned rate of 90.0%. The respondents consisted of community health extension worker (37.8%, n = 17), nurses (24.4%, n = 11), midwives (24.4%, n = 11), and doctors (13.3%, n = 6). Respondents had average knowledge about obstetric ultrasound (59%); however, their levels of perception and attitude toward obstetric ultrasound were high, 84% and 69%, respectively. Nevertheless, 31.1% of the respondents believed ultrasound to be harmful to the baby, 3.8% believed it can lead to cancer or can be painful, and 2.2% felt that there is no need for ultrasound scan during pregnancy. Doctors had the highest level of knowledge, right perception, and positive attitude toward obstetric ultrasound (100%). Conclusion: A good number of the respondents had the right perception and attitude toward obstetric ultrasound, but generally most respondents had inadequate knowledge.
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Influence of induced abortion on tubal findings in hysterosalpingography among women with infertility in Calabar, Nigeria p. 127
Ofonime Nkechinyere Ukweh, Chibuike Mcsteve Okeke, Afiong Oboko Oku
DOI:10.4103/wajr.wajr_37_18  
Background/Aim: Induced abortion is a major cause of infertility in our environment, with postabortal complications commonly occurring, especially when done by untrained medical personnel, and in unsafe environments. Imaging plays a very important role in the assessment of tubal factors as a possible cause of infertility; hence, the choice of hysterosalpingography (HSG) as a vital initial tool in the diagnostic evaluation of these patients. The aim of the study was to determine the relationship between induced abortions and HSG tubal findings in the management of females with infertility. Materials and Methods: This was a cross-sectional descriptive study of 87 HSG's of women being managed for infertility in a private specialist hospital over 2 years from November 2015 to October 2017. Results: The overall mean age of the respondents was 34.09 ± 4.82 years. Most of the respondents were between 30 and 39 years (60.9%) of age, 70 (80.5%) respondents were nulliparous, and 71 (81.6%) had a previous history of induced abortion. Tubal findings were found to be normal in over a third of the respondents (35.6%). The most common abnormal findings were tubal blockage and hydrosalpinx (50.6%). The abnormal tubal findings were significantly associated with a history of more than one induced abortion and nulliparity (P < 0.05). Hydrosalpinx (86.4%) was commonly linked with a previous history of induced abortion, although the difference was not statistically significant (P ≥ 0.05). Conclusions: The study demonstrated that abnormal tubal findings in HSG are more common among women with a history of induced abortion; however, the prevalence of tubal damage had mild correlation with the number of induced abortions.
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CASE REPORTS Top

A rare case report of internal jugular vein aneurysm p. 131
Shrishail Adke, Pramod Shaha, Kulamani Sahoo, Prakash Patil
DOI:10.4103/wajr.wajr_9_18  
Vascular aneurysms are common in the arteries and rare in the veins. Internal jugular vein (IJV) aneurysm is a relatively rare condition. The patient presented with a painless swelling on the right side of the neck that appears while coughing, straining, and bending. Detection of a soft and compressible swelling in the course of IJV, superficial to the sternocleidomastoid muscle, which resolves on compression and becomes prominent on Valsalva maneuver supports the clinical diagnosis of IJV aneurysm. Imaging diagnosis was done by color Doppler ultrasound, and precise delineation of the lesion was done with multidetector computed tomography. There was no thrombus within aneurysm.
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Endovascular retrieval of fractured chemoport at the superior vena cava-right atrial junction in 3 years old p. 135
Punit Pushkar Mahajan, Krantikumar Rathod
DOI:10.4103/wajr.wajr_38_18  
A 3-year-old female child, a case of lymphoid leukemia successfully completed her last cycle of chemotherapy. While retrieving the chemoport, the distal part of the port was fractured and migrated distally in the superior vena cava which was seen on the chest radiograph and later confirmed on computed tomography (scan). We present an interesting case where removal of such a fractured port segment was done in toto by means of endovascular intervention through the common femoral vein under fluoroscopy guidance.
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