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Background: Diabetic peripheral neuropathy (DPN) is a common and debilitating complication of type 2 diabetes mellitus (T2DM). Early detection and prompt institution of appropriate therapy could prevent undesirable outcomes such as paresthesia, pain, and amputation. Although the gold standard for diagnosing DPN is nerve conduction studies, high-resolution peripheral nerve ultrasonography may serve as a noninvasive and low-cost alternative for diagnosing and staging DPN. This study investigated the clinical utility of sonographic posterior tibial nerve cross-sectional area (PTN CSA) for diagnosing DPN in individuals with T2DM., Methods: Eighty consecutive adults with T2DM and 80 age-/sex-matched controls were recruited. Clinical information was obtained, including symptoms, disease duration, Toronto clinical neuropathy score (TCNS), and biochemical parameters. The left PTN CSA at 1 cm, 3 cm, and 5 cm above the medial malleolus (MM) was measured with a high-frequency ultrasound transducer and compared to the detection of DPN using the TCNS., Results: Based on the TCNS, 58 (72.5%) of the T2DM group had DPN. Of these, 14 (24.1%), 16 (27.6%), and 28 (48.3%) participants had mild, moderate, and severe DPN, respectively. All the mean PTN CSA (aggregate, 1 cm, 3 cm, and 5 cm above MM) of the participants with T2DM and DPN (T2DM-DPN) were significantly higher than those of T2DM without DPN (WDPN) and controls. All the PTN CSA increased significantly with increasing severity of DPN. The PTN CSA at 3 and 5 cm levels correlated weakly but significantly with fasting plasma glucose and glycated hemoglobin levels., Conclusion: The PTN CSA is significantly larger in T2DM-DPN than in T2DM-WDPN and healthy controls. PTN ultrasonography can be an additional tool for screening DPN in patients with T2DM., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Medical Ultrasound.)

Context: COVID-19 came suddenly, bringing to the fore the challenges inherent in the health system. In a developing country, such as Nigeria, which already had myriad problems with funds and equipment in the health sector., Aims: This study aims to examine the challenges encountered by the staff in Radiology facilities and how they combated the challenges., Settings and Design: A descriptive cross-sectional study of radiology facilities in Nigeria., Subjects and Methods: Radiologists from nine government and four private facilities who attended to COVID-19 patients were asked to fill questionnaires on challenges faced and their coping strategies. Responses were sent through E-mail., Statistical Analysis Used: Data from the responses were analyzed using Microsoft excel for Mac 2011 and presented as figures and tables., Results: Majority of the government 7 (77.8%) and private facilities 4 (100%) had no equipment dedicated only to COVID-19 patients. Seven (77.8%) government facilities complained of inadequate staff, poor availability of personal protective equipment (PPEs) 8 (88.9%), and lack of technology for remote viewing 7 (77.8%). Fear of cross-infection was a challenge in one of the facilities 1 (11.1%). Coping strategies adopted include ensuring less traffic in the department by discouraging walk-in patients and canceling non-emergent cases, booking suspected/confirmed cases for lighter times, using old film for face shields and cloth for facemasks, staff education on COVID-19 and preventive measures, and sending reports to physicians through E-mail., Conclusions: There were a lot of challenges during the COVID-19 crisis, with government hospitals experiencing more challenges than private facilities. The challenges included among others inadequate staff strength and lack of technology for remote viewing. Some were overcome using education and by production of facemasks/shields production using recycled materials., Competing Interests: None

Background: Keloid is a fibroproliferative disorder of dermal origin, common and severe in the dark-skinned individuals. The patients suffer from pain and pruritus with poor body image., Aims: We compared the efficacy and side effects of intra-lesional verapamil and triamcinolone in patients with keloids. As most treatments are cumbersome, recurrence is a major problem despite the many treatment modalities. There is need for effective monotherapy with minimal complications., Materials and Method: This is a prospective, randomized study of intralesional injection of verapamil and triamcinolone in keloids conducted in the Burns and Plastic unit of a tertiary hospital. There were two groups; triamcinolone treatment group (TTG) and verapamil treatment group (VTG). A total of 115 patients with keloids <10 cm were diagnosed, 37 (32.2%) were excluded, and 78 were included into the study. There were 40 patients in the TTG and 38 patients in the VTG. Eventually, 70 patients completed the study. Triamcinolone 40 mg and 2.5 mg of verapamil were used for TTG and VTG respectively. The changes in the dimensions of keloids were measured using an electronic caliper. The symptoms were assessed using the visual analog score for pain and the pruritus score was adapted from the 5-D pruritus score., Results: Triamcinolone completely resolved pain and pruritus in 6 and 12 weeks, respectively, while there was no complete resolution among VTG patients. However, verapamil injection was comparably effective to triamcinolone for small-size keloids., Conclusion: Verapamil as monotherapy is less efficaceous in the resolution of symptoms of keloids but is comparable to triamcinolone in reducing the size of small-sized keloids., Competing Interests: None

We describe the advent of pediatric radiology in Nigeria and the challenges associated with establishing the subspecialty. Nigeria has very few radiologists with a special interest in pediatric radiology caring for more than 82 million children. One major challenge is the lack of interest in the subspecialty owing to the lack of remuneration when compared with others like interventional radiology. The majority of the radiologists also do not have specialized training in pediatric radiology. With very few children's hospitals, where to work after graduation is also a deterrent for pediatric radiologists. Put simply, Nigeria needs help. We also suggest ways to overcome these challenges.

Emphysematous pyelonephritis (EPN) is a rare, severe necrotising infection of the renal parenchyma and surrounding tissues. It is usually life-threatening and should be promptly treated. Here, we report a clinical case of a 54-year-old male who presented with the left flank pains of 3-week duration. The flank pain was described as dull, constant with associated fever. He was diagnosed with diabetes mellitus (DM) while on admission. A clinical diagnosis of the left pyelonephritis was made. The abdominopelvic computed tomography scan confirmed bilateral EPN by showing a thin film of perinephric fluid (13.2 ml) in the left lower pole. He was managed conservatively with fluid therapy, adequate glycaemic control and intravenous antibiotics with no percutaneous drainage done. This highlights the importance of early initiation of appropriate medical treatment to avoid interventional urological procedures of nephrectomy. It also highlights the importance of clinical suspicion of EPN in patients presenting with symptoms of urinary tract infection and DM., Competing Interests: None

Background: Prior studies on Hysterosalpingography (HSG) have shown that pelvic inflammatory disease (PID) related tubal adhesions accounted for 30 - 50% of female infertility, with as high as 80% reported in some studies. With improved access to contraceptives, antibiotics and promotion of safe practices, the abnormal findings in HSG may have reduced or altered., Objective: To document the imaging findings in the HSG of participants and to compare current findings with prior studies done nationally and internationally., Method: A retrospective evaluation of 974 HSGs done at the tertiary diagnostic center over a 7-year period was conducted and analyzed using diagnostic accuracy tables., Results: Tubal pathologies were the most common abnormality in this study, (35.1% of the cases), comprising tubal blockage and hydrosalpinges; followed by uterine masses seen in 223 (22.9%) of the clients. Tubal occlusion was higher in clients with multiple abnormal findings; while normal sized and large uterine cavities had a higher percentage of bilateral tubal patency., Conclusion: Tubal factors remain the most common abnormality seen in the HSGs of infertile women in this study, though with lower prevalence compared with prior older studies. Forty seven (47%) of the cases of female factor infertility had normal HSGs with bilateral tubal patency., (© 2019 Omidiji et al.)

Background: Breast cancer is the commonest female cancer in Nigeria. Despite its increased awareness, affordability of available screening tools is a bane. Mammography, the goal standard for screening is costly and not widely available in terms of infrastructure, technical/personnel capabilities. Ultrasound is accessible and affordable., Objectives: This study compared the use of ultrasound and mammography as breast cancer screening tools in women in South West Nigeria by characterizing and comparing the prevalent breast parenchyma, breast cancer features and the independent sensitivity of ultrasound and mammography., Methods: This cross sectional comparative descriptive study used both ultrasound and mammography as screening tools in 300 consenting women aged 30 to 60 years who attended a free breast cancer screening campaign in a tertiary hospital in Lagos. Categorical variables were presented in tables and Chi squares for associations P-value set at ± 0.1., Results: Mean age was 41.01 + 6.5years with majority in the 30 - 39 year age group 139 (55%). Fatty (BIRADS A and B) parenchyma predominated {ultrasound 237 (79%); mammography 233 (77.7%)} in all age groups. 7 (2.3%) were confirmed malignant by histology with (6) in the 30-39 age group and (1) in the 40-49 age group. Ultrasound detected all the confirmed cases 7(100%), whereas mammography detected 6 (85%). Sensitivity was higher using ultrasound (100%) than mammography (85.7%)., Conclusion: Ultrasound can be utilized as a first line of screening especially in remote/rural areas in developing world., Funding: Part funding from Run for Cure governmental organization.