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Introduction Renal Doppler resistive index (RI) and pulsatility index (PI) values are potentially more sensitive at detecting renal abnormalities when compared to standard laboratory indices in patients with HIV/AIDS. To the best of our knowledge, there are no published research articles on renal Doppler indices and their correlation with laboratory indices of HIV sero-positive adult individuals. This study aimed to assess the renal function of HIV-sero-positive adults using RI and PI, and correlating these indices against laboratory values. Methods A prospective cross-sectional study was conducted from July 2019 to April 2020. A purposive sampling method was employed and included 396 HIV sero-positive adult individuals. Sampling for the renal RI and PI was performed at the level of the inter-lober arteries, in between the medullary pyramids. An RI value above 0.70 and a PI value above 1.56 were consider abnormal. Serum creatine and urea together with evidence of proteinuria were recorded at the time of scanning. Results Forty-three (10.9%) men had an abnormal RI, 32 (8.1%) had abnormal PI, five (2.5%) had abnormal creatinine, two (1%) abnormal urea and eight (4.1%) with proteinuria. In women, 29 (7.3%) had abnormal RI, 22 (5.6%) abnormal PI, four (2%) abnormal creatinine and urea and six (3%) had proteinuria. There was a statistically significant weak positive correlation between RI and PI and serum creatinine and urea (r > 0.2, P Conclusion The proportion of patients with abnormal RI and PI was higher than the proportion of participants with abnormal serum urea, creatinine and proteinuria. Renal Doppler indices could be used be used in the early assessment of renal function in HIV sero-positive adults individuals. Implications for practice Serum creatinine and urea are routinely used to evaluate renal function in patients with HIV/AIDS. Findings from this initial study show that RI and PI could be used detecting early renal abnormalities when compared to standard laboratory values.

We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate a Stroke Prevention Team’s readiness to prevent strokes in children with sickle cell anemia living in northern Nigeria. The NIH sponsored Stroke Prevention Trial in Nigeria included a goal of a sustainable stroke prevention program. The program’s 1-year reach for transcranial Doppler screening was 14.7% (4710/32,000) of which 6.0% (281/4710) had abnormal velocities (≥200 cm/s). All participants with abnormal transcranial Doppler velocities were started on hydroxyurea (effectiveness). The leaders of all 5 hospitals agreed to adopt the program. After 1 year, program-implementation and maintenance rates were 100%, demonstrating the program’s feasibility and short-term sustainability.

(HSG) is a special radiological procedure that is used to assess the patency and the structure of the uterus and Fallopian tubes. The main role of HSG is the study of the Fallopian tubes in infertility. Discomfort, anxiety, and pain that might result of the procedure and may vary depending on the individual’s perception. The patient’s perception of a procedure plays an important role in its acceptance. The study aims at evaluating the perception of patients undergoing HSG examination in Kano metropolis. The study design was prospective and cross-sectional conducted in the Radiology Departments of four hospitals in the Kano metropolis from December 2018 to probability sampling method was employed in the study. An ethical clearance to conduct the study was obtained from the Human Research and Ethics Committee of the Kano State Ministry of Health. A structured questionnaire was used as an instrument for data collection. The questionnaire was validated by experienced sing pilot study the reliability of the measuring tool was tested and the Chronbach reliability coefficient was found to be 0.79. Two hundred and fifty six questionnaires were administered to the selected respondents. An informed consent was obtained from all the selected respondents. The obtained data were analyzed using SPSS version 21.0. Out of the 256 (100%) administered questionnaires, 237 (92.6%) were returned, and 226 (88.3%) were properly filled. In 189 (83.63%) respondents, infertility was found to be be the indication for the procedure. 82 (36.3%) of the respondents believed the procedure was for diagnostic purpose, 78 (34.5%) for therapeutic and 28.3% for diagnostic and therapeutic. Patients undergoing HSG in Kano metropolis had a negative perception towards the procedure.

BACKGROUND: Strokes in children with sickle cell anemia (SCA) are associated with significant morbidity and premature death. Primary stroke prevention in children with SCA involves screening for abnormal transcranial Doppler (TCD) velocity coupled with regular blood transfusion therapy for children with abnormal velocities, for at least one year. However, in Africa, where the majority of children with SCA live, regular blood transfusions are not feasible due to inadequate supply of safe blood, cost, and the reluctance of caregivers to accept transfusion therapy for their children. OBJECTIVES: We describe the Primary Prevention of Stroke in Children with Sickle Cell Disease in Nigeria Trial [Stroke Prevention in Nigeria (SPRING) trial, NCT02560935], a three-center partially-blinded randomized controlled Phase III clinical trial to 1) determine the efficacy of moderate fixed-dose (20 mg/kg/day) versus low fixed-dose (10 mg/kg/day) hydroxyurea therapy for primary stroke prevention; 2) determine the efficacy of moderate fixed-dose hydroxyurea for decreasing the incidence of SCA-related hospitalization (pain, acute chest syndrome, infection, other) compared to low fixed-dose hydroxyurea. DESIGN/METHODS: We will test the primary hypothesis that there will be a 66% relative risk reduction of strokes in children with SCA and abnormal TCD measurements, randomly allocated, for a minimum of three years to receive moderate fixed-dose versus low fixed-dose hydroxyurea (total n=220). RESULTS: The results of this trial will advance the care of children with SCA in Nigeria and sub-Saharan Africa, while improving research capacity for future studies to prevent strokes in children with SCA.

Introduction: In children with sickle cell anemia (SCA) without transcranial Doppler (TCD) screening, the incidence rates of ischemic strokes is approximately the same among children living in low- and high- low-resource settings (Pediatr Neurol. 2019;95:73-78.) with a prevalence of ~ 11%. However, in high-income settings, the standard use of TCD ultrasonography, coupled initially with monthly blood transfusion therapy has dropped the stroke prevalence to < 1%. In a low-income setting, such as Nigeria, where 50% of children in the world with SCA are born (150,000 per year), initial monthly blood transfusion therapy is not practical for most children. In the Stroke Prevention in Nigeria (SPIN) Feasibility Trial (NCT01801423), fixed moderate-dose hydroxyurea was associated with a decreased rate of strokes in children with SCA and abnormal time-averaged mean of the maximum velocity (TAMMV) TCD measurements (≥200cm/sec) when compared to no treatment in the STOP Trial, 0.76 and 10.7 strokes per 100 person-years, repsectively (Am J Hematol. 2020). Based on the success of the SPIN trial, plus the challenges of real-world implementation of a government-supported primary stroke prevention programs for estimated 40,0000 children with SCA in three states in Nigeria, we tested the hypothesis that fixed-moderate dose (~20 mg/kg/day) hydroxyurea therapy for primary stroke prevention results in a 66% relative risk reduction (9 to 3 events per 100 person-years) when compared to fixed low-dose hydroxyurea (~10 mg/kg/day) therapy in a randomized controlled trial (The SPRING Trial; NCT02560935). Methods: In this partial-blind controlled phase III trial, we randomly assigned children between 5 and 12 years of age with SCA and a TCD time-averaged mean of the maximum velocity (TAMMV) ≥ 200 cm/sec measured independently twice or TAMMV ≥220 cm/sec once at study screening to receive fixed low-dose or fixed moderate-dose hydroxyurea. The primary endpoint was a clinical stroke or a transient ischemic attack (TIA). Myelosuppression was assessed with monthly complete blood counts (CBCs). Adherence to hydroxyurea was primarily based on an increase in MCV from baseline and monthly pill count return as a percent of dispensed pills. Hemoglobin F levels were measured at baseline, annually and upon trial exit. To evaluate the safety of hydroxyurea in the trial, children attending the same SCA clinics with TCD (TAMMV) Results: A total of 220 children (mean age: 7.5 years, 51.8% female) were randomly assigned to fixed low- (10 mg/kg/day) or moderate- (20 mg/kg/day) dose hydroxyurea, and were followed for a median of 2.4 years (IQR 2.0-2.8). NINDS Clinical Trials leaders stopped the trial early because of futility for the primary outcome. In the fixed low- and moderate-dose hydroxyurea groups, the incidence rates of strokes per 100 person-years were 1.19 and 1.92 respectively, with an incidence rate ratio of 1.60 (95% CI: 0.31-10.34), p = 0.768. The incidence rate ratio of mortality when comparing the children treated with low- and moderate- fixed-dose hydroxyurea to the non-elevated TCD group (no hydroxyurea therapy, n= 211) was 1.97 (95% CI: 0.64-6.02) and 0.47 (95% CI: 0.05-2.38), p = 0.265 and 0.545, respectively. Returned pills during the trial was 5.4% and 4.8% in the fixed low- and moderate-dose groups, respectively, p= 0.144. MCV from baseline to endpoint increased 1.5fl and 7.2 fl in the fixed low- and moderate-dose groups, respectively, p Conclusions: For primary stroke prevention in children with SCA, fixed low-dose, when compared to fixed moderate-dose hydroxyurea therapy, demonstrated no difference in the incidence rate of strokes. Both fixed low- and moderate -dose hydroxyurea doses are superior to no treatment for primary stroke prevention with abnormal TCD values. In partnership with Katsina, Kano, and Kaduna health department's leaders in Nigeria, 9 distinct SCA and primary stroke prevention clinics have been established, with the provision of free fixed low-dose hydroxyurea therapy (Bond Chemical, Nigeria; $0.15 per 500 mg) for abnormal TCD values, and biannual CBCs as standard care ,for over 40,000 children with SCA. Disclosures DeBaun: Global Blood Therapeutics (GBT): Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees. OffLabel Disclosure: fixed low and moderate dose hydroxyurea for primary stroke prevention in sickle cell

Most cases of liver hemangioma are asymptomatic and discovered incidentally on liver ultrasound or computed tomography scan. Giant cavernous hemangioma (GCH) are however clinically distinct from smaller asymptomatic ones and may be confused with primary or metastatic malignancy. Symptomatic GCH of the liver are rare. The aim of the study was to show the rare case of symptomatic giant cavernous hemangioma of the liver which may be confuse with primary or metastatic malignancy. The patient’s images (abdominal ultrasound and computed tomography scans) and case file were reviewed and summarized. The subject matter of giant cavernous hemangioma was reviewed in the literature. The index case was discussed and compared with literature. We report a 42-year-old man who presented with a 2-year history of right upper abdominal pain and 6-month history of chest pain. No history of jaundice, body swelling or previous history of blood transfusion. No history of smoking or alcohol consumption. The patient is a known diabetic. Abdominal ultrasound scan showed hepatomegaly with a huge well defined oval shaped mixed echogenic mass lesion with lobulated margins occupying 4th and 5th segments of liver, measuring 84.9×111 mm in size suggestive of adenoma. The remaining hepatic parenchyma was normal. No intrahepatic biliary dilatation was seen. Initial histological examination revealed adenoma. Repeat histology done later however revealed hepatitis. Abdominal CT scan was later carried out and showed hepatomegaly but with no discernible mass lesion on precontrast images. Contrast enhanced images however, showed a fairly rounded mass lesion with peripheral enhancement and delayed filling-in at the venous phase, seen in the superior aspect of the right lobe extending to the dome. The intrahepatic vasculature and biliary ducts are not dilated. A diagnosis of cavernous hemangioma was made based on criteria of delayed (centripetal) filling-in. The patient however was lost to follow up. Hepatic hemangioma can be giant and symptomatic and despite its rarity, may still be encountered in practice.

Patients affected with sickle cell disease (SCD) suffer from recurrent vascular occlusions that lead to ischemia and distal tissue infarction in multiple organs. These vascular occlusions manifest as sickle cell pain crises. Abdominal pain is common in sickle cell pain crises. It is attributed to vasoocclusion or infarction in the mesenteric vasculature. Progression to significant ischemic damage of the intestine is rare in sickle cell disease. The objective was to show the rare case of ischemic colitis in SCD patient. The patient’s images (plain abdominal x rays and barium enema images) and case file were reviewed and summarized. The subject matter of ischemic colitis in a known SCD was reviewed in the literature. The index case was discussed and compared with literature. We report an 18-year-old known SCD patient diagnosed since childhood but not regular on medication and follow up. The patient presented to SCD clinic of Aminu Kano Teaching Hospital (AKTH), Kano with 2-year history of recurrent blood stained and watery stool associated with abdominal pain and low-grade fever. There was history of easy fatigability and multiple blood transfusions in the past. Other systemic reviews were unremarkable. This man is the only sickle cell anemic child among 9 other siblings of the family, and on presentation, a second-year student of a junior secondary school. Examination revealed a stunted young man, mild pale with a tinge of jaundice. Abdominal examination revealed hepatomegaly 4 cm below the costal margin. The spleen was not enlarged. Other systemic reviews were unremarkable. Latest hemoglobin was 5.7 g/dL. Renal and the liver function tests were normal. Stool microscopy did not isolate ova, cyst or protozoa. Barium enema was then requested and showed loss of haustration and cobblestone appearance involving the entire colon. Fine mucosal granulations were also noted in the rectum. Diagnosis of colitis most probably ischemic was made. The patient was commenced on analgesics and antibiotics including azithromycin and metronidazole and made significant improvement. Ischemic colitis in SCD may still be encountered in practice despite its rarity.

Context: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) remains a major challenge globally. HIVassociated nephropathy is the third most common cause of endstage renal failure and more prevalent among AfricanAmericans with HIV compared with other races. Aims: This study evaluated sonographic renal changes in drugdependent and drugnaive patients with HIV/AIDS in Kano, Nigeria.Materials and Methods: A prospective and comparative study involving 190 each of drugdependent and drugnaive patients were conducted. Renal sonography was performed using digital ultrasonic diagnostic imaging system, equipped with a 3.5 MHz curvilinear transducer. Statistical analysis used: An independent ttest and Mann–Whitney Utest were used to compare the renal volume and mean rank of the renal parenchymal echogenicity between drugdependent and drugnaive patients. Statistical significance was considered at P

Objective: To describe the computerized tomographic findings in children with head trauma who presented at the Aminu Kano Teaching Hospital, Kano, Nigeria. Methods: It is a retrospective review of patients aged 9 month to 12 years with suspected head injury following head trauma, who presented for CT scan at Aminu Kano Teaching Hospital, Kano, Nigeria from January 2016 to December, 2017. Results: Sixty eight cases were reviewed retrospectively. They ranged from 9 months to 12 years with the mean age of 5 years. Fifty four (79.4%) were males. Fourteen were females (20.6%). Thirty five (51.5%) had head injury secondary to RTA. Twenty four (35.3%) had a history of fall from height. Four (5.9%) had a history of fall into a well. Four (5.9%) had a history of assault. Only one had a history of gun shot (1.5%). Twenty one patients (30.9%) had normal findings. Five (7.4%) of them had a frontal bone fracture. Seven (10.3%) had a parietal bone fracture. Two (2.9%) had fracture of base of the skull. Seventeen (25%) had intracerebral haematoma. Three had brain oedema (4.4%). One had epidural haematoma (1.5%). Eight (11.8%) had subdural haematoma. Six (8%) had combined fracture with cerebral contusion. Conclusion: RTA is a major cause of head injury in the most paediatric age group in our environment with CT scan as a valuable imaging tool in the investigation and management of these patients.

Background: The inferior vena cava (IVC) is thin-walled compliant vessel that adjust the body volume status by changing its diameter depending on the total body fluid volume. sonographic measurement of IVC diameter has been reported as an alternative, rapid and non-invasive method of volume assessment of body fluids. The aim of this study is to determine the normal IVC diameter among healthy adults in Kano, Nigeria. Materials and Methods: Sonographic measurement of IVC of healthy adults with age ranging between 15 and 65 years was done with the subject in the supine position. The intrahepatic portion of its diameter was measured at about 2 cm proximal to the hepatic veins in a longitudinal plane in both inspiratory and expiratory phases of respiration. Three repeated measurements were done to reduce intra-observer variability in this prospective cross-sectional study. Results: A total of 400 adults comprising 173 (43.3%) males and 227 (56.8%) females were recruited using Fisher's statistical formula for sample size determination. The mean age of the subjects was 32.4 ± standard deviation 10.9 years. The mean inspiratory diameter was 10.1 ± 2.7 mm (ranging from 4.8 mm to 18.8 mm). The overall mean IVC expiratory (IVCexp) diameter in this study was 16.7 ± 2.7 mm (range = 10.9–25.4 mm). The mean IVCexp diameter was slightly higher for males than for females (males: 17.1 ± 2.8 mm; females: 16.3 ± 2.7 mm). This difference was statistically significant ( P = 0.0022). There was a gradual decrease in IVC diameter with advancing age. Conclusion: This study was able to generate normal IVC diameter in a sample of Nigerians which may serve as a reference for normal values in Black Africans.

Pleural empyema is an emergency clinical condition characterised by presence of purulent organisms within the pleural fluid. It is associated with significant morbidity and consumption of scarce resources. It is a rare clinical condition but constitute a serious thoracic emergency despite advances in management. Imaging plays an important role in the diagnosis and management of pleural empyema. We present an 11 month old infant with a month history of fever, cough, shortness of breath and weight loss. Clinical diagnosis of bronchopneumonia with pleural effusion was made. Chest radiograph revealed right opaque hemithorax with central mediastinum. Computed tomography (CT) of the chest showed extensive right pleural effusion with compression of viable lung tissue. Ultrasound guided thoracocentesis drained about one litre of pus. Intravenous antibiotics were also administered. Repeat chest radiograph a week after the drainage showed marked reduction in the size of the previously noted opaque right hemithorax with remarkable improvement of the clinical condition.