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   Table of Contents - Current issue
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July-December 2020
Volume 27 | Issue 2
Page Nos. 75-165

Online since Thursday, September 24, 2020

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ORIGINAL ARTICLES  

Sonographic evaluation of the optic nerve sheath diameter and anterior chamber depth of the eye among apparently healthy adults in Kano, Nigeria p. 75
Mohammed Sidi, Muzammil Aminu
DOI:10.4103/wajr.wajr_3_20  
Background: Measurement of optic nerve sheath diameter (ONSD) and anterior chamber depth (ACD) by ultrasound is increasingly used as a marker to detect raised intracranial pressure and other eye pathologies. Knowledge of normal ONSD and ACD in a healthy population is essential in the interpretation of pathological conditions. Aim: The study aimed at evaluating the ONSD and ACD of the eye in apparently healthy adults in Kano State. Materials and Methods: This was a prospective and cross-sectional study conducted among apparently healthy adults in Kano State from April 2019 to October 2019. Using convenience sampling method, 384 adults participated in the study. An ethical approval was obtained from the Human Research and Ethics Committee of the Kano State Ministry of Health, and informed consent was obtained from all the selected participants. A portable digital ultrasound machine, Nortek CS 3 with a 7.5 MHz linear transducer, was used to obtain ACD and ONSD at 3 mm behind the globe, and the values were recorded in data capture sheet. The obtained data were analyzed using SPSS version 23.0. Results: The mean and standard deviation of the right and left ONSDs for males was 4.42 ± 1.38 mm and 4.44 ± 1.41 mm and for the females was 4.39 ± 1.31 mm and 4.41 ± 1.31, respectively. The mean and standard deviation of the right and left ACDs for males was 3.16 ± 0.37 mm and 3.14 ± 0.35 mm and for females was 3.12 ± 0.40 mm and 3.11 ± 1.39 mm, respectively. Conclusion: The study has established normative values for the ONSD and ACD of the eye in Kano State, Nigeria.
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Cranial tomographic angiographic evaluation of suspected intracranial vascular abnormalities among a Nigerian cohort p. 81
Ademola Joseph Adekanmi, James Ayotunde Balogun, Peter Taiwo Adenigba
DOI:10.4103/wajr.wajr_10_20  
Background: Lately, there has been an increased utilization of computed tomography angiography (CTA) as the preferred first-line modality for the evaluation and diagnosis of most cerebral vascular lesions. Objective: The objective of this study was to evaluate suspected intracranial vascular cases, using CTA at a major referral tertiary hospital in South West Nigeria. Materials and Methods: This was a hospital-based retrospective study of suspected intracranial vascular cases in all ages and both sexes that had CTA from January 2011 to December 2018. Data were analyzed with IBM SPSS version 23.0, and P < 0.005 was considered statistically significant. Results: A total of 128 patients were studied, the mean age was 44.1 ± 17.7 years, and male: female ratio was 1:1.06. The leading clinical diagnoses were as follows: intracranial aneurysms (34/128), subarachnoid hemorrhage (27/128), intracranial vascular tumors (26/128), brain hemorrhage from vascular abnormality (19/128), and arteriovenous malformations (AVMs) (10/128). At CTA, 61 patients had vascular abnormalities: intracranial aneurysm was seen in 63.9% with a peak age range of 41–60 years, and the leading location of aneurysms was posterior cerebral artery (18.8%), followed by posterior communicating artery (16.7%) and the cavernous segment of the internal carotid artery (16.7%). AVMs were more common in patients aged 40 years and below (91.7%) in males (66.7%) and in the parietal lobe. Intracranial aneurysms were 3.25 times as common as brain AVMs. Conclusion: Intracranial aneurysms are the predominant vascular lesions, occurring mostly in the older age group. AVMs occurred mostly in younger people, more in males, and predominantly in the parietal lobes. The hospital incidence of aneurysms to AVMs was 3.25:1.
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Normal ultrasonographic dimensions of the gallbladder and common bile duct in neonates p. 89
Adejumoke I Ayede, Richard B Olatunji, Atinuke M Agunloye
DOI:10.4103/wajr.wajr_22_20  
Background: Ultrasound (US) is the first choice of imaging in neonates presenting with persistent jaundice to exclude surgically correctable causes and differentiate obstructive from nonobstructive causes. Previous studies on normal dimensions of gallbladder (GB) and common bile duct (CBD) recruited adults and children spread across a wide age group. Aims: This study aimed to determine GB and CBD normal dimensions in a large homogeneous neonatal population as well as guide decision regarding pre-US fasting in neonates who require GB evaluation. Materials and Methods: Five hundred and twenty-eight healthy newborns were recruited between May 2009 and May 2011. The widest intraluminal anterior-posterior diameters of GB and CBD were measured. Neonatal age in days, sex, birth weight, weight and height, gestational age at delivery, and time interval since last feed recorded. Results: The mean age was 9.56 ± 7.66 days, and 50.6% were males. The mean CBD diameter was 1.16 ± 1.61 mm while the mean GB diameter was 4.42 ± 2.16 mm. GB and CBD were clearly seen and measurable in 297 (55.8%) neonates and 237 (44.38%) neonates, respectively. There was a significant correlation between CBD diameter and GB diameter (P = 0.04) but no correlation with any demographic parameter. GB visualization was not dependent on time interval from last feed. Conclusion: Mean neonatal values for CBD and GB were established, but neonates have a wider range of GB diameters compared with older children, so GB diameter may not be a reliable parameter for neonatal GB pathologies. GB visualization was not dependent on time interval from last feed; hence, a recent feed should not delay emergency scans, especially in ill neonates
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Ultrasound derived-parameters and symptom severity scores as noninvasive predictors of bladder outlet obstruction in patients with benign prostatic enlargement p. 95
Oseremen Aisuodionoe-Shadrach, Hadijat Oluseyi Kolade-Yunusa, Abu Sadiq
DOI:10.4103/wajr.wajr_25_19  
Introduction: Benign prostatic hyperplasia (BPH) is common in men over 50 years and causes lower urinary tract (LUT) symptoms. There is an emerging need to explore the value of utilizing ultrasound (US)-derived parameters of the LUT as noninvasive predictors of the degree of bladder outlet obstruction (BOO) from BPH and determine if they correlate with the symptom severity observed in these patients. This study aimed to determine the utility of US-derived parameters of the LUT (prostate volume [PV], bladder wall thickness [BWT], and postvoid residual volume [PVR]) in predicting severity of BOO and correlating them with the symptom severity scores – International Prostate Symptom Score (IPSS) and quality of life (QoL) – in patients with BPH in our practice. Methodology: We prospectively studied 100 newly diagnosed patients with symptomatic BPH who presented to the urology outpatient clinic and were referred to the radiology department for transabdominal scan of the urinary bladder and prostate. The patients' age, IPSS, and QoL and their BWT1 (full bladder), BWT2 (empty bladder), PV, and PVR were measured using transabdominal US scan. Correlation was done using Pearson's correlation coefficient, and P < 0.05 was considered statistically significant. Results: The mean age of the participants was 60 years. The mean BTW1 and BTW2 were 4.66 mm and 25.80 mm, respectively. The mean IPSS was 16, with a majority (42%) having severe symptoms. There is a negative insignificant correlation between PVR and BTW2 (r = −0.053, P = 0.603). There is a weak but statistically insignificant correlation between QoL and BWT. There is a weak but insignificant correlation between PV and IPSS (r = 0.193, P = 0.055). There is a weak but insignificant correlation between IPSS and BWT. There is a moderate and statistically significant correlation between IPSS and PVR (r = 0.350, P < 0.001). Conclusion: In our patients, we found that BWT had an insignificant correlation with QoL and a negative correlation with PVR, respectively. We could show, however, that in them, PVR and IPSS were significantly correlated.
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Preoperative dual imaging evaluation of profound sensorineural hearing loss in patients for cochlear implantation p. 100
Ankur Malhotra, Lalit Kumar, Rajul Rastogi, Vijai Pratap
DOI:10.4103/wajr.wajr_14_19  
Background: Profound sensorineural hearing loss (SNHL) may be the result of major inner ear structural malformations, and cochlear implantation remains the only viable treatment option. High-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) are indispensable for optimum preoperative implant workup and thus play a vital role in patient selection, pre-implantation counseling, and surgical management. Aim and Objectives: The aim of this study is to evaluate patients with profound SNHL for cochlear implantation preoperatively on both HRCT and MRI and to compare imaging findings in both modalities. Materials and Methods: This longitudinal prospective study was conducted in the Department of Radiology of a tertiary care-based hospital in North India. A total of 45 patients (90 temporal bones) with clinically diagnosed bilateral profound SNHL were included in the study. Patients with a previous history of temporal bone injury were excluded from the study. All cases were evaluated on both 128 slice Philips computed tomography (CT) machine and 1.5 Tesla Siemens Magnetom MRI scanner. Each temporal bone was systematically analyzed for anatomical and structural abnormalities. Results: Both high-resolution CT and MRI played vital roles in the workup of patients with profound SNHL for cochlear implantation and allowed accurate assessment of critical inner ear abnormalities. Cochlear malformations (30%) were responsible for the majority of structural abnormalities in this study with Type II incomplete partition (8.9%) being the most common. Cochlear nerve deficiency was seen in 20 cases (22.2%) and was diagnosed only on MRI. Similarly, early fibrosis and abnormal signal intensity were also detected only on MRI, which were missed on CT. Conclusions: Both high-resolution CT and high magnet MRI complement each other and reduce the chances of missing critical findings, which are crucial for surgical management and planning. Thus, it is advisable to perform dual imaging with both modalities wherever and whenever possible, to offer maximum information to treating surgeon preoperatively.
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Clinical neonatal hypoxic ischemic injury: Cranial ultrasound spectrum of findings in neonates admitted to a Newborn Unit in Nairobi, Kenya p. 108
Lewis Bosire Bundi, Gladys Mwango, Vincent Otieno Oliver, Beatrice Mulama
DOI:10.4103/wajr.wajr_17_19  
Introduction: Birth asphyxia causes significant neurologic injury and neurodevelopmental delay in children. Cranial ultrasound (CUS) can be used for the diagnosis, early intervention, and prognostication of birth asphyxia. We determined the CUS findings among term neonates with clinical birth asphyxia and correlated sonographic findings with the modified Sarnat clinical grade. Materials and Methods: We conducted a prospective cross-sectional analytical study in Kenyatta National Hospital New Born Unit (KNH NBU) between June 2018 and October 2018. Term babies, older than 24 h with clinical birth asphyxia, were recruited and CUS was performed. Statistical analysis was done using proportions, means, and frequencies. Chi-square tests were used to assess correlation between imaging findings and the clinical Sarnat grading of asphyxia. Results: Periventricular deep white matter echogenicity and thalamus and/or basal ganglia deep gray matter was reported in 56.4% and 31.1%, respectively. Only 4.4% had cortical gray matter. Normal CUS findings were reported in 40.0% of the neonates. Prolonged labor and meconium-stained liquor were the predominant risk factors for perinatal asphyxia, seen in 58% of the neonates. Prolonged labor was independently reported in 43% of the neonates. Moderate and severe Sarnat grades correlated with abnormal sonographic changes of hypoxic ischemic encephalopathy (HIE) (Grades 2–8) (P = 0.038). There was a trend toward HIE severity with worsening Sarnat stages (trend test P= 0.039). Abnormal resistive indices (<0.5 and >0.8) were strongly associated with the presence of HIE brain changes (P = 0.003). Conclusion: The correlation between birth asphyxia severity and CUS was more robust in Doppler evaluation of the deep cerebral arteries.
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The impact of playing wind musical instruments on the masseter muscles in a West African population p. 114
Tope Emmanuel Adeyemi, Olayinka Donald Otuyemi, Babatunde Olamide Bamgbose, Suwaid Abba Muhammad
DOI:10.4103/wajr.wajr_4_20  
Aim: The morphological dimension of the masseter muscle is largely influenced by physical and habitual activities, which may impact directly on its performance. This study assessed the effects of playing wind musical instruments on the masseter muscle thickness in a male Nigerian adult population. Materials and Methods: Equal numbers of male wind instrument players (WIP) were recruited and compared with nonwind instrument players (non-WIP) of the same age. Information on the sociodemographic characteristics, history, and type of wind instrument played was obtained. The masseter muscle thickness and fractional shortening were determined during relaxation and contraction using a linear probe of 7.5 MHz on ultrasound machine (Biosound Esaote MyLab40 Ultrasound machine; 2012; Italy, Rome). Reliability test demonstrated an excellent intrarater correlation (Cronbach's alpha; 0.98). Data were analyzed using SPSS version 17. Statistical significance was set at P < 0.05. Results: The overall mean thickness of the masseter muscle at relaxation, contraction, and fractional shortening in WIP group was 9.21 ± 1.43 mm, 14.22 ± 1.95 mm, and 35.06% ± 5.07%, respectively, while 8.92 ± 1.12 mm, 13.97 ± 1.44 mm, and 36.08% ± 4.48%, respectively, in non-WIP group. No statistically significant differences were observed between the groups (P > 0.05). Type of instrument played, duration, and frequency of play did not significantly affect the muscle thickness except for the number of years of play. There was also a significant right/left side dichotomy in each group. Conclusions: Playing a wind instrument showed no significant effect on the thickness of the masseter muscle, however there was a significant increase in the muscle thickness with increasing years of play of wind instruments.
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Relationship between renal dimensions using ultrasonography and body mass index in apparently healthy school children in Port Harcourt, Nigeria p. 121
Tochi Ada Uchenwa, Ifeoma Comfort Anochie, Henrietta Uche Okafor, Obinna Cecils Maduforo
DOI:10.4103/wajr.wajr_7_20  
Background: Renal size is an important parameter in evaluation and management of a child with kidney disease. Establishing the normal limits of renal sizes standardized against somatometric parameters will be a useful tool in detecting probable renal diseases in children. Aim: To determine renal sizes in relation to body mass index (BMI) in apparently healthy primary school children in Port Harcourt. Materials and Methods: This was a cross-sectional and multi-staged study involving 450 children aged 6-12 years. Renal ultrasonography was carried out using a portable DP 1100 PLUS real time ultrasound machine fitted with 3.5MHz probe. The length, width and anteroposterior diameter of the kidneys were measured, and renal volume calculated. The BMI percentile for age and sex were obtained. The renal sizes were correlated with somatometric parameters and regression equations derived. Results: The mean renal length and volume percentiles increased from 77.7 ± 5.6 and 49.2 ± 13.7 at 6years to 85.9 ± 5.9 and 60.4 ± 18.4 at 12years respectively. There were no significant differences in the length and volume between the right and left kidneys, and dimensions of the kidneys were not statistically different in males and females. There was a significant positive correlation between BMI and renal dimensions. The renal length and volume increased at a rate of 1.372mm and 1.951cm3 per year and at a rate of 0.067mm and 0.176cm3 per one percentile increase in BMI respectively. The regression model derived for predicting renal length in mm =65.731 + (1.372 Age X) + (0.067 BMI percentile X) while that for renal volume in cm3 =26.386 + (1.951 Age X) + (0.176 BMI percentile X), (Where X is the independent variables: age in years and BMI in percentile). Conclusion: BMI has a significant positive linear relationship with renal dimensions. This study has provided prediction models for deriving renal length and volume from subject's BMI and age.
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Perspectives of Nigerian doctors on the practice of rebates, fee-splitting, and kickbacks p. 128
Bukunmi Michael Idowu, Mayowa Abimbola Soneye, Tolulope Adebayo Okedere, Stephen Olaoluwa Onigbinde, Aderemi Ishola
DOI:10.4103/wajr.wajr_19_19  
Background: Fee splitting is a global pandemic in the health-care industry, whereby financial and nonfinancial inducements are offered to health-care practitioners in exchange for guaranteed patient referral, continuous patronage, or preferential usage/prescription of the payer's products. Methods: We surveyed 280 medical doctors from August 2017 to October 2017 to assess their knowledge, perception, and attitude toward fee-splitting using self-administered questionnaires. Results: The majority (89%) of our respondents indicated that they were aware of the existence of fee-splitting in the Nigerian health-care industry. About 34% accept rebates, while 70% admitted to knowing other colleagues who accept rebates. The amount received as rebates was ≤20% of the cost of an investigation. More than half of the respondents (52%) opined that the practice is a nationwide phenomenon. An astonishing 78% of respondents either did not know (61%) or asserted wrongly (17%) that the practice is not a violation Nigerian Medical Council rules. Only 46% affirmed that the practice is unethical. Compared to private hospitals, fee-splitting is less in public hospitals. Sixty-one percent noted that other health-care workers (besides physicians) are also involved. The primary allures of fee-splitting were a quest for an extra source of income (64%), poor/irregular salaries (60%), ignorance of its illegality (56%), and greed (47%). The identified deleterious consequences were unnecessary investigations/procedures, inflated health-care cost, quackery, delayed treatment/prolonged hospital stay, beclouded clinical judgment, and negative public perception. Conclusion: Stricter regulatory enforcement and continuous ethics education are needed to disrupt the widespread fee-splitting culture.
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Socio-demographic and clinico-pathologic pattern of patients with colorectal cancers seen in Ahmadu Bello University Teaching Hospital, Zaria p. 136
Hadiza Theyra-Enias, Sunday Adeyemi Adewuyi, Adewumi Alabi, Desiree Jimeta Jummai, Ismail Hadi Zubairu
DOI:10.4103/wajr.wajr_27_19  
Introduction: Colorectal cancer is a major cause of morbidity and mortality in the world. It accounts for 10.2% of cancer incidence globally, with a mortality of 9.2%. It ranks third in terms of incidence but second in terms of mortality. Colorectal cancer is not uniformly common throughout the world. Its incidence is increasing in developing countries, probably due to the acquisition of western lifestyle. Aim: The aim of this study was to determine the sociodemographic and clinicopathological pattern of patients with colorectal cancer seen in the Department of Surgery, Radiotherapy, and Oncology Centre, Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, over a 10-year period. Materials and Methods: In this retrospective study, data were collected from the case files and treatment cards of 122 patients with colorectal cancer managed at the Surgical, Radiotherapy, and Oncology Department of ABUTH, Zaria, from January 2006 to December 2015. Data items analyzed included age, sex, residential area, occupation, duration of symptoms, presenting complaints, subsite, histological type, grade, and stage. All analyses were performed by SPSS version 20. Results: An annual incidence of 12.2 cases/annum was seen. Seventy (57.4%) were male and 52 (42.6%) were female. Male:female ratio was 1.3:1 and the age range was between 12 years and 78 years, majority were between 31 and 40 years (24.6%), with a mean age of 42.4 years and median age of 41 years. It was found to be more common among the urban dwellers, with the public/civil servants being the most affected (36.0%). The duration of presenting complain ranged from 3 weeks to 10 years, most patients presenting at 7–10 months with more than one symptom. Bleeding per rectum was the most common symptom seen in 20%. Adenocarcinoma was the predominant histology seen in 73% (n = 89) and 28.7% were well differentiated. The rectum was the most common subsite, while left-sided lesions (20%) were more common than right-sided lesions (17%). About 18% (n = 22) had distant metastasis. Conclusion: The study showed that colorectal cancer was more common among the younger age group, with a slight male preponderance. They were mostly urban dwellers and civil/public servants. The most common presenting symptom was bleeding per rectum and majority of the cases presented at an advanced stage. Early detection through public health education, screening programs, affordable and effective treatment, and follow-up will help reverse this trend. Conclusion: The study showed that colorectal cancer was more common among the younger age group, with a slight male preponderance. They were mostly urban dwellers and civil/public servants. Bleeding per rectum being the most common complaint, majority of the cases presented at an advanced stage. Early detection through public health education, screening programs, affordable and effective treatment, and follow-up will help reverse this trend.
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Public–private partnerships in Nigerian teaching hospitals: Potential and challenges p. 143
Faosat Olayiwola Jinadu, Atinuke Monsurat Agunloye, Adekunle A Adeyomoye, Abiola Omobonike Adekoya, Gbolahan Oladele Obajimi
DOI:10.4103/wajr.wajr_28_19  
Background: Public–private partnership (PPP) has become a popular model used by public sector organizations that are usually under-funded by their respective governments to render services in fulfillment of their egalitarian responsibilities and goals. Lately, the health sector has been a recipient of such initiatives and the trend is growing. However, the successful delivery of services to patients is sometimes hampered because of difficulties encountered in both the development and interpretation of clauses contained in agreements including Memoranda of Understanding between the parties. The anticipated outcomes and impact often remain elusive due to the tensions encountered during implementation. Aim and Objective: The aim of this study was to determine the current operational status as well as explore potential benefits and challenges of the use of the PPP model in radiology departments of selected teaching hospitals within three South-Western States of Nigeria (Lagos, Ogun, and Oyo). It is hoped that the study findings would provide useful data needed for improvement of the PPP model as it is being currently practiced. Materials and Methods: This was a qualitative study in which 138 closed- and open-ended questionnaires were administered to all cadres of staff in radiology departments of the selected hospitals teaching hospitals within three South-Western States of Nigeria (Lagos, Ogun, and Oyo). Results: There was a 100% response from the participants. The age range of the participants was 25–65 years. Study findings showed that almost all radiological equipment can be acquired through PPP. There was improved service delivery and residency training with PPP. Jurisdictional conflict was the greatest challenge. Conclusion: PPP is a viable option that should be encouraged by government for the purchase of equipment in hospitals.
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COVID radiology preparedness in Nigeria: How ready are we? p. 150
Olubukola A Omidiji, Nicholas K Irurhe, Adekunle O Adeyomoye, Omodele A Olowoyeye, Oluyemisi O Toyobo, Elizabeth A Idowu, Aderemi Ishola, Sidikat A Ayodele, Mayomi A Onuwaje, Kenneth C Eze, Ngozi R Dim, Adaobi C Ilo, Feyisayo Y Daji, Kamaldeen O Jimoh, Abdulsalam M Yidi, Olubukola K Ajiboye, Ismail Anas, Muhammadu S Ahmadu, Ogechi A Ihekuna, Rachael S Akinola, Rasheed A Arogundade, Omolola M Atalabi
DOI:10.4103/wajr.wajr_19_20  
The novel human coronavirus (COVID-19) began in Wuhan China as an interstitial pneumonia of unidentifiable origin in December 2019 and thereafter spread its tentacles all over the world. There is a need for radiology departments in both government and private facilities to be prepared to meet this crisis. Their efforts should be geared not only toward diagnosis, but also to preventing patient-to-patient, staff-to-patient, and staff-to-staff transmission of infection by utilizing social distancing measures and personal protective equipment (PPE). Aim: To evaluate the preparedness of radiologic departments of government hospitals and private centers, by assessing the outlay of the facility and likelihood to attend to COVID patients, type of equipment in the centers, and plans in place for protection of staff and the public. Materials and Methods: The radiology departments of government and private facilities in each geopolitical zone of the country were randomly selected to discuss radiology preparedness in Nigeria using preset guidelines which were sent to radiologists at the facilities. Written informed consent was obtained from the radiologists at the participating centers. Ethical approval was also obtained from the Lagos University Teaching Hospital Health Research Ethics Committee. Results: A total of twelve centers were included in the study, comprising eight government and four private centers. All had plans in place to attend to COVID patients; majority were in the process of developing standard operating procedures (SOPs). Majority of the government facilities lacked mobile equipment and adequate PPEs, with only one computed tomography machine and no holding area in some of the facilities for symptomatic patients unlike the private facilities. They, however, had infection control teams in place. Conclusion: Private radiological centers appear better prepared and more equipped to cope with the crisis than government hospitals. Adequate PPEs, mobile equipment, and isolation rooms need to be provided for the government facilities. Radiology information systems should be installed for remote viewing. Training and retraining on COVID management and decontamination should be conducted periodically. SOPs should be drafted universally and modified for each facility.
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CASE REPORTS Top

Fahr's disease: Clinicoradiological findings of a rare disease in an adult Nigerian p. 155
Ademola Joseph Adekanmi, Ayotunde Ibrahim Bisi, Rufus Akinyemi
DOI:10.4103/wajr.wajr_5_20  
Fahr's disease is a rare genetic or sporadic neurodegenerative disorder characterized by abnormal deposition of calcium in areas of the brain that control movements, including the basal ganglia and cerebral cortex. The continuous development, as well as widespread use of brain imaging, has contributed to the increased detection rates of such cases. We describe a sixty-six-year-old male Nigerian who presented with recurrent loss of consciousness, urinary incontinence, and an incidental radiological finding characteristic of Fahr's disease. This article discusses the clinical features, radiological features, diagnostic criteria, and management of Fahr's disease.
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Rare case of central neurocytoma in a middle-aged Nigerian woman presenting with chronic headache and visual impairment p. 159
Austine Abebe Osawe, Ayinde Babatunde Junaid, Abubakar Otaru Aliyu, Mohammed Kabir Saleh
DOI:10.4103/wajr.wajr_32_19  
Central neurocytomas (CNs) are rare benign neuroepithelial neoplasms occurring in young- and middle-aged adults. They most commonly arise within the body of the lateral ventricle, adjacent to the septum pellucidum and foramen of Monro. Patients may be asymptomatic or may present with headache and signs of raised intracranial pressure due to hydrocephalus. Preoperative diagnosis of CN by neuroimaging, electron microscopy, and immunohistochemical methods helps in planning therapy. This case describes CN in a 42-year-old female with signs and symptoms of raised intracranial pressure, neuroimaging (magnetic resonance imaging) findings, and the management.
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Congenital absence of the left circumflex artery p. 163
Nirav Ramesh Thaker, Rasika Rajanikant Gosavi, Sunila Jaggi, Inder Raj Talwar
DOI:10.4103/wajr.wajr_34_19  
Congenital absence of the left circumflex artery is a rare coronary anomaly with few reported cases in literature. These patients are usually diagnosed incidentally when they undergo either a conventional or a computed tomography (CT) coronary angiography to rule out an underlying coronary artery disease. Coronary CT angiography is a useful noninvasive imaging modality which can be used to diagnose and confirm coronary anomalies reliably. In this article, we report a case of a 55-year-old female who was incidentally found to have a congenitally absent left circumflex artery after a workup was initiated for nonspecific chest pain.
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