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Aim of the study: To determine the sensitivity and specificity of ultrasound for detecting the causes of obstructive jaundice. Materials and methods: Eighty adult patients with clinical and biochemical features of obstructive jaundice were enrolled in this study. The causes, degrees and levels of ductal obstruction were evaluated sonographically via the transabdominal route. The ultrasonographic diagnoses were correlated with surgical findings and histopathological diagnoses. Results: The age range was 16 to 82 years, with a mean of 51.06 ± 14.95 years. The peak age group was the sixth decade with 23 (28.8%) patients. There were nearly twice as many females as males, with 28 (35%) males and 52 (65%) females, giving a male to female ratio of 1:1.9. On ultrasound, pancreatic carcinoma (28.0%) and choledocholithiasis (21.3%) were the most common malignant and benign causes of obstructive jaundice, respectively. Hepatocellular carcinoma (1.3%) was the least common etiology. There was a strong correlation between the definitive diagnosis and the sonographic level of obstruction. The overall sensitivity of ultrasound for detecting the cause of obstruction was 76.6%, while the specificity was 98%. Conclusion: Ultrasonography is a reliable imaging modality for diagnosing the cause and level of obstruction in surgical jaundice. The sensitivity is adequate to aid the early institution of surgical intervention, thereby preventing morbidity and mortality that may accompany late interventions in our setting.

Semen analysis has been used for a long time to assess male fertility due to its limitations sperm DNA fragmentation index (DFI), which describes the sperm DNA's condition, is an appropriate criterion for assessing male fertility. This study evaluated the pattern and value of DFI of infertile men in the South West of Nigeria. This is a cross-sectional and descriptive study that recruited two hundred and eighty-seven (287) patients from two fertility centers in Lagos, Nigeria. The Sperm DFI was determined using the Sperm chromatin structure assay (SCSA) test. The descriptive and inferential statistics of the study were carried out using R packages (R version 4.2.0) with the help of R functions using compiled code. The result showed that the mean age sperm concentration, total motility morphology, and DFI were as follows 42.96±7.09years, 40.18±4.19×10 6 per ml, 49%±19%, 56±17%, and 15.78±8.52 respectively. There is a significant negative correlation between sperm concentration and DFI at a P-value of 0.0018 with a regression model of Coefficient of determination is 0.305. The DFI value of infertile men negatively correlates with sperm concentration, thus increase sperm production may improve sperm quality., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Palpation of the seventh cervical vertebra (C7) is an important landmark for counting vertebrae for vertebral spine surgical instrumentation. However, studies have shown that the spinous process of C7 displays an anatomical deviation among individuals, which may mislead a surgeon who is not aware of this, and there have been no such studies among southwest Nigerians. The present study aimed to examine the incidence of bifidity in the C7 spinous process and their variation among 48 subjects with the aid of a three-dimensional (3D) computed tomography. The 48 subjects who had undergone cervical spine computed tomography studies comprised the pooled data of ages between 12 and 55 years of black race in southwest Nigeria from the radiology department of the Trauma and Surgical Centre, Ondo State, Nigeria. A series of multivariate and discriminant statistical tests were performed on the measurement data to determine the occurrence of bifid spinous processes at C7 in southwestern Nigeria. The results show about 10% bifidity in the C-7 vertebra and no bifidity in the first cervical vertebra and the highest rate in the C-6 vertebra in the study population. The incidence in this study is significantly higher than findings in previous works. Thus, there is a need for clinicians to pay more attention to this variation when using C7 as a landmark especially in the studied population., (© 2024. The Author(s).)

Background: The determinant of the spermiogram of semen varies in different populations based on several factors ranging, from age to the pathological state of an individual to environmental factors. The aim of the study is to determine the spermiogram of patients that attend fertility clinics in southwest Nigeria and the relationship between the parameters., Methodology: This is a cross-sectional study that recruited two hundred and ninety seven (297) patients from two fertility centers in Lagos, Nigeria for the period of January 2021 to November 2022. The sperm samples were collected following WHO standards. The spermiogram was analyzed using an automated sperm analyzer and the descriptive and inference statistics of the study were carried out using R packages (R version 4.2.0)., Results: The result showed the mean age of 43.12±6.95years with median age of 42years. The mean of sperm count and concentration were 114×10 6 sperm cells and 42×10 6 per mL with the mean volume of the semen produced by the patients was 2.69mL and average motility (progressive and non-progressive) of the sperm is 47%±19%, 42%±17% has normal morphology. The distributions of the observed variables (seminal fluid parameters) were different from normal distributions in the studied population, such that almost all of them are skewed to the right. The degree of relationship between the sperm parameter were very weak. Nevertheless, specifically, there is a negative correlation between age and sperm count, age and motility, age and volume, and a positive correlation between age and abnormal morphology. The results showed that sperm morphology has a significant effect on motility while sperm morphology significantly depend on sperm count., Conclusion: An increase in sperm volume and concentration improves the sperm morphology and boost the sperm motility, this may increasing the chance of fertility., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: Hypertensive disorder of pregnancy (HDP) comprise chronic hypertension, gestational hypertension, preeclampsia/eclampsia, and preeclampsia superimposed on chronic hypertension. HDP complicate up to 10% of pregnancies worldwide and carry significant risks of maternal and perinatal morbidity and mortality. The aim of this study was to evaluate the derangement and characteristics of brachial artery flow-mediated dilation (BAFMD) in women with HDP., Methods: The BAFMD of the right brachial artery of 80 women with HDP (pregnant HDP), 80 normotensive pregnant women (pregnant non-HDP), and 80 healthy nonpregnant women (nonpregnant controls) was evaluated with B-mode ultrasound. The age, blood pressure, body mass index (BMI), brachial artery diameter, and BAFMD of the participants were compared. P ≤ 0.05 was statistically significant., Results: The pregnant HDP group had significantly lower mean BAFMD compared to pregnant non-HDP and nonpregnant controls (6.9% ± 2.53% vs. 8.32% ± 3.4% vs. 9.4% ± 2.68%; P < 0.001). There was no significant difference between the mean BAFMD of the pregnant HDP subgroups: preeclampsia (5.81% ± 1.7%) versus gestational hypertension (6.43% ± 3.02%); P = 0.57. BAFMD diminished with advancing gestational age in both the pregnant HDP and pregnant non-HDP groups. On regression analysis, BAFMD was a poor marker for HDP, while BMI was an independent predictor for HDP., Conclusion: Even though HDP were associated with significantly diminished BAFMD, it was not a good marker for HDP., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Medical Ultrasound.)

Objective: To assess the accuracy of hysterosalpingography in diagnosis of uterine and/or tubal factor infertility, using hysterolaparoscopy with dye test as the gold standard with an implication for which test should be the first-line investigation., Methods: A prospective cross-sectional study of 96 women who underwent hysterosalpingography and hysterolaparoscopy with dye test. All women within reproductive age group with utero-tubal infertility who underwent both hysterosalpingography and hysterolaparoscopy with dye-test procedure were included. The outcome measures were proportions of tubal blockage and intrauterine pathology. Individual and overall mean accuracy were calculated for hysterosalpingography, using hysterolaparoscopy with dye test as the gold standard. Patient had procedure of hysterosalpingography first and both laparoscopic surgeons and patients were blinded to the outcome of hysterolaparoscopy with dye test until analysis. Statistical significance was set at p < 0.05., Results: Overall, 128 women were assessed for eligibility while 96 women finally completed the study. Hysterosalpingography demonstrated diagnostic accuracy of 77.8% (p < 0.001), 76.3% (p < 0.001) and 78.3% (p < 0.001) for right, left and bilateral tubal blockage, respectively. Overall accuracy of hysterosalpingography tubal factor assessment was 77.4 ± 0.8% (95% confidence interval = 76.5% to 78.4%). Hysterosalpingography showed an accuracy of 85.7%, 86.6% and 76.7% for right, left and bilateral hydrosalpinx, respectively, given overall diagnostic accuracy of 83.0 ± 5.1% (95% confidence interval = 77.9% to 88.1%). Overall accuracy of hysterosalpingography in diagnosing intrauterine pathology was 68.5 ± 9.8% (95% confidence interval = 53.9% to 83.1%)., Conclusion: Hysterosalpingography detects tubal blockade and intrauterine pathology poorly compared to hysterolaparoscopy with dye test. Hysterosalpingography may face unpredictable clinical situations biased by technological error, leading to unsuccessful evaluation and uncertain diagnosis. Although the cost-effectiveness, risk of surgery or anaesthesia flaws hysterolaparoscopy with dye test. Hysterosalpingography should not be the first-line utero-tubal assessment tool rather hysterolaparoscopy with dye test., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© The Author(s) 2022.)

Background: This study aims to determine the relationship(s) of fetal liver length (FLL) to the gestational age, biometric parameters (BPD, FL, AC, HC), and fetal weight in third trimester pregnancies., Methodology: This was a hospital-based cross-sectional study of 400 fetuses in normal third trimester pregnancies recruited from the Obstetrics and Gynaecology department of OAUTHC, Ile-Ife, Nigeria. The participants were between 20-45 years of age and their gestational ages ranged from 27-40weeks. The FLL, liver thickness and transverse diameter were measured on B-mode ultrasound. Fetal liver volume (FLV) was calculated using the ellipsoid formula. The expected gestational age (EGA) was determined from the date of the last menstrual period (LMP), early first-trimester crown-rump length (CRL), or early second-trimester biparietal diameter (BPD) ultrasound. The estimated gestational age (EGA) and EFW were calculated using computer-assisted analysis of ultrasound fetal biometrics., Results: The mean height, weight, and body mass index (BMI) of the participants were 1.62±0.08m, 72.07±13.26kg and 27±4.70kg/m2 respectively. FLL had a linear relationship and a positive correlation with EGA and EFW. There was also a positive correlation between FLL and fetal biometrics, maternal weight, and BMI. Percentile distribution of FLL and FLV for the GA 27-40weeks was developed., Conclusion: FLL could be used to predict GA in normal pregnancies especially when LMP is uncertain., (Copyright © 2021 Nigerian Medical Association.)

Objective: To investigate the effects of essential hypertension on the luminal diameter (caliber) and Doppler velocimetric indices of the abdominal aorta (AA) in adult patients with systemic hypertension., Materials and Methods: This was a prospective descriptive comparative study of 254 participants (127 with essential hypertension and 127 age/sex-matched controls). Their anthropometric parameters, fasting blood pressure, lipid profile, fasting blood sugar, and triplex sonography of the suprarenal and infrarenal abdominal aorta (Peak systolic velocity, PSV; End-diastolic velocity, EDV; Resistive Index, RI; and luminal diameter) were evaluated., Results: The mean age of the male subjects was 64.02 ± 10.02 years, while the mean age of the male controls was 63.14 ± 10.52 years ( P > 0.05). The mean age of female subjects was 61.23 ± 10.09 years, while the mean age of the female controls was 61.76 ± 10.26 years ( P > 0.05). The age group 60 - 69 years had the highest number of subjects and controls. The mean duration of hypertension in the subjects was 12.5 ± 5.2 years. The suprarenal and infrarenal abdominal aortic diameters (AAD) were higher in males than age-matched female counterparts. AAD increased with age mostly in hypertensive male subjects. PSV (in males) and RI (in both sexes) were elevated in hypertensive subjects compared to controls, while EDV (in both sexes) was significantly lower in subjects than controls. Multivariate linear regression showed that age and diastolic blood pressure were significant independent predictors for both suprarenal and infrarenal AADs., Conclusion: Systemic hypertension causes structural and hemodynamic changes in the abdominal aorta which are detectable on triplex sonography., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of the West African College of Surgeons.)

Studies have shown that severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) is a highly infectious disease, with global deaths rising to about 360,438 as of 28 May 2020. Different countries have used various approaches such as lockdown, social distancing, maintenance of personal hygiene, and increased establishment of testing and isolation centers to manage the pandemic. Poor biomedical waste (BMW) management, treatment, and disposal techniques, especially SARS-CoV-2 infected BMW, may threaten the environmental and public health in most developing countries and, by extension, impact the economic status of individuals and the nation at large. This may increase the potential for the transmission of air/blood body fluid-borne pathogens, increase the growth of microorganisms, risk of mutagenesis, and upsurge of more virulent strain. In contrast, uncontrolled substandard burning could increase the potential spread of nosocomial infection and environmental exposure to toxic organic compounds, heavy metals, radioactive, and genotoxic bio-aerosols which might be present in the gaseous, liquid, and solid by-products. The paucity of understanding of pathophysiology and management of the SARS-CoV-2 pandemic has also necessitated the need to put in place appropriate disposal techniques to cater for the sudden increase in the global demand for personal protective equipment (PPE) and pharmaceutical drugs to manage the pandemic and to reduce the risk of preventable infection by the waste. Therefore, there is a need for adequate sensitization, awareness, and environmental monitoring of the impacts of improper handling of SARS-CoV-2 infected BMWs. Hence, this review aimed to address the issues relating to the improper management of increased SARS-CoV-2 infected BMW in low middle-income countries (LMICs)., (© 2021 Walter de Gruyter GmbH, Berlin/Boston.)

Purpose: This study aims to describe the mammographic findings in a population of Nigerian women and to explore the relationships between abnormal mammographic findings, breast malignancy, and breast composition., Methodology: This was a retrospective study of consecutive mammograms carried out at Union Diagnostics and Clinical Services in Lagos, Nigeria from 2016 to 2018. Demographic information, indications for and findings on mammographic evaluation were obtained. A logistic regression fit model was used to establish the correlation between mammographic findings, breast density, and suspicion for breast malignancy (higher BIRADS scores). P ≤ 0.05 represented a statistically significant result., Results: A total of 304 patients were involved in this study (age range 20-80 years, mean age 49.0 ± 10.5 years). The patients between 40 and 49 years formed the largest age group with 128 patients (42.4%). Most patients were referred for a breast mass/lump (115/304-38.6%); 56 patients (18.8%) presenting for routine screening. The most common finding on the mammograms was BIRADS 4 in both breasts in 96 patients (31.6%). Most patients had heterogeneous breast density (195 patients - 64.1%). Multivariate logistic regression analysis showed a significant correlation between history of mass, poorly defined margins, and suspicion of malignancy. There was no statistically significant association between abnormal mammographic findings and higher breast density., Conclusion: Poorly defined margins were positively correlated with BIRADS ratings suspicious for malignancy. The presence of a breast mass was positively correlated with a higher BIRADS score when other possible cofounding variables were not accounted for. Patient age did not correlate with breast density in this study., (Copyright © 2020 National Medical Association. Published by Elsevier Inc. All rights reserved.)

This study was done to investigate the effects of common food additives such as sodium benzoate (SB) and ascorbic acid (AA) on haematological parameters of male Wistar rats. Forty-eight (48) male albino rats with an average weight of 105 g were grouped into twelve (n = 4) of Basal Control and other 11 groups orally administered 1 mg of SB, 10 mg of SB, 10 mg of AA, 0.2 mg of AA + 0.5 mg of SB, 0.2 mg of AA + 1 mg of SB, 0.2 mg of AA + 10 mg of SB, 0.2 mg of SB + 0.1 mg of AA, 0.2 mg of SB + 0.5 mg of AA, carbonated soft drinks (CSD)+ 0.1 mg of AA, CSD + 1 mg of AA and CSD + 10 mg of AA, respectively for 21 non-consecutive days. At the end of the experiment, blood samples were collected in EDTA anticoagulant tubes, haematological parameters were evaluated, and data were analyzed. There was a dose-dependent increase (p < 0.05) in White Blood Cell counts of SB treated rats compared with the control group. The lymphocyte exhibited significant reduction (p < 0.05) in the groups treated with 1mg SB and 10mg SB/kg bodyweight of 67 ± 2.96 and 58 ± 4.18%, respectively. The mean corpuscular haemoglobin showed no significant difference at 95% confidence interval. However, mean corpuscular haemoglobin concentration, haematocrit and platelet were affected by an increase in the concentrations of SB. High SB concentrations increased the destruction of erythrocytes, which directly increased the catabolism of haemoglobin. However, AA administration mitigated the adverse effects of SB on the haematological parameters of the animal., (© 2020 The Authors.)

Severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) that causes COVID-19 infections penetrates body cells by binding to angiotensin-converting enzyme-2 (ACE2) receptors. Evidence shows that SARS-CoV-2 can also affect the urogenital tract. Hence, it should be given serious attention when treating COVID-19-infected male patients of reproductive age group. Other viruses like HIV, mumps, papilloma and Epstein-Barr can induce viral orchitis, germ cell apoptosis, inflammation and germ cell destruction with attending infertility and tumors. The blood-testis barrier (BTB) and blood-epididymis barrier (BEB) are essential physical barricades in the male reproductive tract located between the blood vessel and seminiferous tubules in the testes. Despite the significant role of these barriers in male reproductive function, studies have shown that a wide range of viruses can still penetrate the barriers and induce testicular dysfunctions. Therefore, this mini-review highlights the role of ACE2 receptors in promoting SARS-CoV-2-induced blood-testis/epididymal barrier infiltration and testicular dysfunction.

Purpose: This study aims to explore the relationships between abnormal hysterosalpingography (HSG) findings and all types of infertility., Material and Methods: This retrospective study was carried out at a private radiodiagnostic centre in Lagos, Nigeria. The radiologist reports of all consecutive patients who had HSG evaluation from 2016 to 2018 were analysed. Biodemographic information and indications for HSG evaluation were also documented. Logistic regression was used to test correlations between the explanatory and outcome variables. P ≤ 0.05 represented a statistically significant result., Results: A total of 450 patients were involved in this study, with ages ranging from 21 to 51 years and a mean age of 34.6 ± 5.56 years. The age group 31-35 years had the highest frequency of infertility. There were 299 patients referred for infertility. Secondary infertility was seen in 211 patients (46.9%), primary infertility was seen in 79 patients (17.6%), and subfertility was seen in nine patients (2%). There were 49 patients (10.9%) with cornual tubal blockage, while 57 patients (12.7%) had perifimbrial adhesion and/or blockage. There were 56 patients (12.4%) with hydrosalpinx and nine patients (2.0%) with tubal occlusion. Multivariate logistic regression analysis showed women with hydrosalpinx were 2.11 times more likely to be infertile than those without hydrosalpinx (95% CI: 1.02-4.36, p = 0.042)., Conclusions: The presence of hydrosalpinx was a significant risk factor in developing all types of infertility. Understanding the HSG patterns and their correlations with infertility will help physicians across the world when evaluating infertility in patients of similar background to our patient population., Competing Interests: The authors report no conflict of interest., (Copyright © Polish Medical Society of Radiology 2020.)

Background: The purposes of this study are to sonographically measure the placental thickness (PT) in normal fetuses; to correlate it with gestational age (GA), fetal growth parameters, and estimated fetal weight (EFW); and to design a nomogram for the derived PT measurements., Methods: This was a hospital-based cross-sectional study on 400 women with apparently normal pregnancy within the age range of 18-45 years recruited from the Antenatal Clinic of our hospital. The fetal GA was estimated by the last menstrual period (LMP). The fetal growth parameters were determined using standard sonographic methods while the PT was measured at the level of the umbilical cord insertion site. PT was then correlated with GA, fetal growth parameters, and the EFW., Results: The mean PT (mean ± standard deviation) in the 1 st , 2 nd , 3 rd trimesters and the whole duration of pregnancy were 14.5 ± 0.3 mm, 24.6 ± 3.9 mm, 34.8 ± 2.8 mm, and 29.6 ± 7.1 mm, respectively. PT ranged from 13.5 ± 1.9 mm at 11 weeks to 39.1 ± 0.6 mm at 40 weeks. PT (in mm) had a linear relationship and a statistically significant positive correlation with GA (in weeks) in all the trimesters, with most significant correlation recorded in the 2 nd trimester ( r = 0.79). There was also a statistically significant positive correlation between PT and the fetal growth parameters (biparietal diameter, head circumference, abdominal circumference, femur length and crown-rump length), and EFW. PT nomogram was developed from 11 to 40 weeks of gestation using a scatter plot with 95% confidence interval for our locality., Conclusion: PT has a linear relationship with GA, fetal growth parameters, and EFW and it can be used along with other fetal growth parameters to increase the accuracy for predicting GA in normal pregnancies, especially when the subject is not sure of or does not know her LMP., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Journal of Medical Ultrasound.)

Objective: To determine the strength of association between fetal kidney measurements and gestational age (GA) in third-trimester pregnancies., Methods: In a cross-sectional study in Ile-Ife, Nigeria, women in the third trimester of a singleton pregnancy who were sure of the date of their last menstrual period or had an early pregnancy scan were recruited consecutively in 2012. Standard biometric measurements were taken, along with fetal kidney length (FKL), anteroposterior diameter (FKAPD), and transverse diameter (FKTD). Fetal kidney volume (FKV) was calculated via the ellipsoid formula. Data were analyzed by Pearson correlation and multivariate linear regression., Results: In total, 470 women were recruited. Compared with standard biometric parameters, renal parameters showed better correlation with GA. Among the standard parameters, femur length showed the strongest correlation with GA. FKL and FKV showed stronger positive correlation with GA as compared with FKTD and FKAPD. In multivariate linear regression modeling, FKL alone predicted GA with accuracy of ±10.1 days, whereas a combination of standard and kidney parameters predicted GA with better accuracy of ±8.0 days., Conclusions: Compared with standard biometric parameters, fetal renal parameters correlated better with GA in the third trimester. Among the renal parameters, FKL correlated most strongly with GA., (© 2019 International Federation of Gynecology and Obstetrics.)

Objectives: The objective of this study was to determine the prevalence of upper renal tract obstructive changes in women with uterine fibroids using ultrasonography (USG)., Methods: We enrolled 140 women with uterine fibroids and performed USG of the uterus and upper renal tract with full and empty urinary bladders, respectively. The number of fibroid nodules and the uterine volume were determined. The presence of hydronephrosis was graded and documented. Uterine volumes >200 cm 3 were denoted as large and vice versa. Statistical analysis was done using Chi-square and non-parametric tests., Results: The median uterine volume was 556 cm 3 . Application of a 200 cm 3 cut-off value yielded 126 (90%) large uterine volumes and 14 (10%) small uterine volumes. Of the 140 women enrolled, 52 (37.1%) had renal backpressure changes. Of these 52 patients, 51 (98.1%) had uterine volumes >200 cm 3 . Both kidneys were affected in the vast majority (36 out of 52 = 69.2%) of those with renal backpressure changes, and 23 (44.2%) of the 52 women with renal backpressure changes had mild (Grade 1) hydronephrosis, while 25 (48.1%) had moderate (Grade 2) hydronephrosis. When unilateral, however, backpressure changes were significantly more common on the right side., Conclusion: Approximately one in three women with fibroids had renal backpressure changes in this study. Large uterine volume is a key predisposing factor. Routine sonographic assessment of fibroids should include a focused/targeted evaluation of the kidneys., Competing Interests: None

Background: The use of electrocardiogram for sex verification in adults is an emerging concept in medicine. It is feasible through the utilization of Ogunlade Sex Determination Electrocardiographic Score. The aim of this study was to use an electrocardiogram to verify the sex of a woman with primary amenorrhea., Case Presentation: We report a case of a 36-year-old woman of Yoruba ethnicity who presented with primary amenorrhea. A physical examination revealed a woman with a feminine appearance characterized by long plaited hair and well-developed breasts. As part of the investigations to unravel the sex status, she had a resting standard 12-lead electrocardiogram which revealed a masculine electrocardiogram pattern with Ogunlade Sex Determination Electrocardiographic Score of 9 (T-wave pattern in lead V 1 , 3; ST segment in lead V 2 or V 3 , 3; QRS rotation, 2; heart rate of 79, 1). An abdominopelvic ultrasonography done by a radiologist showed absence of uterus, fallopian tubes, and ovaries. When our patient was considered for transvaginal scan, she declined but embraced translabial ultrasound as she claimed to be a virgin. Translabial ultrasonography revealed the presence of undescended hypoplastic testes with associated testicular microlithiasis at the external inguinal rings bilaterally. Karyotyping using a blood sample revealed 46,XY and a sex-determining region Y report showed that the blood sample was positive for the SRY gene confirming the status as male. This synchronized with the initial electrocardiogram evaluation. The testes were later removed., Conclusion: This report concluded that an electrocardiogram as a cheap, readily available and non-invasive test has a role in sex verification in young adults with primary amenorrhea.

Objectives: Diabetic nephropathy is a common complication of diabetes mellitus due to microangiopathy leading to end stage renal disease. This study determined the relationship between renal resistivity index and pulsatility index with biochemical indices of renal function in patients with type 2 diabetes mellitus methods: This study involved 80 adults with type 2 diabetes mellitus. Urinary albumin excretion rate (UAER) and serum creatinine levels were measured, and the estimated glomerular filtration rate (eGFR) was calculated. Right renal resistivity index (RI) and pulsatility index (PI) values were determined., Results: Mean renal resistivity index was 0.72±0.06 while the pulsatility index was 1.36 ± 0.24. Resistivity index was positively correlated with albuminuria (r = 0.426; p <0.001) and serum creatinine (r = 0.458; p <0.001), but negatively correlated with eGFR (r = -0.399; p <0.001). There was positive correlation between pulsatility index and albuminuria (r = 0.341; p = 0.002), and serum creatinine (r = 0.478; p = <0.001); and negative correlation between PI and eGFR (r = - 0.359; p = 0.001)., Conclusions: Renal resistivity index and pulsatility index may provide valuable non-invasive estimate of predicting the presence and severity of renal dysfunction in patients with type 2 diabetes.

Purpose: The purpose of this study was to evaluate the correlations of ultrasonographically estimated volumes of pleural fluid with the actual effusion volume in order to determine the most reliable formula., Methods: In 32 consecutive patients with clinically diagnosed pleural effusion, an ultrasound estimation was made of the volume of effusion using four different formulae, including two in the erect position and two in the supine position. Closed-tube thoracostomy drainage using a 28-Fr chest tube was performed. The total drainage was calculated after confirmation of full lung re-expansion and complete drainage by plain chest radiographs and ultrasound. The ultrasonographically estimated volume was compared to the actual total volume drained as the gold standard., Results: There were 14 female and 18 male subjects. The mean age of all subjects was 41.56±18.34 years. Fifty percent of the effusions were in the left hemithorax. Metastatic disease accounted for the plurality of effusions (31.2%). The mean total volume drained for all the subjects was 2,770±1,841 mL. The ultrasonographically estimated volumes for the erect 1, erect 2, supine 1, and supine 2 formulae were 1,816±753 mL, 1,520±690 mL, 2,491±1,855 mL, and 1,393±787 mL, respectively. The Pearson correlation coefficients (r) for the estimate of each formula were 0.75, 0.81, 0.62, and 0.63, respectively., Conclusion: Although both erect formulae showed similar correlations, the erect 2 formula (Goecke 2) was most closely correlated with the actual volume drained.

Background: Metabolic risk factors associated with non-alcoholic fatty liver disease (NAFLD) include Type 2 diabetes mellitus (T2DM), obesity and dyslipidaemia. Prevention or management of these risk factors with glycaemic control, weight reduction and low serum lipid levels respectively have been reported to reduce the risk of NAFLD or slow its progression. Since ultrasound (USS) is a safe and reliable method of identifying fatty changes in the liver, this study was done to determine the relationship between glycaemic control and ultrasound diagnosed NAFLD in T2DM., Methodology: Demographic data, anthropometric measurements and laboratory tests including glycated haemoglobin (HbA1c), fasting blood glucose (FBG) and serum lipids of 80 T2DM subjects aged 40-80 years were taken. Their livers were evaluated using B-mode ultrasound, and the data obtained were statistically analysed using SPSS version 20., Results: Fifty-five of all participants (68.8%) were diagnosed with NAFLD sonographic grades 1, 2 and 3 made up of 13 (16.3%), 26 (32.5%) and 16 (20.0%), respectively while 25 (37.2%) had grade 0. The prevalence of NAFLD in T2DM varied significantly with BMI (p = 0.001) and glycaemic control (p = 0.048) while the USS grades of NAFLD varied significantly with age (p = 0.043) and BMI (p = 0.006). The independent strong predictors of NAFLD were overweight (r = 0.409, p = 0.012, OR = 6.626) and obesity (r = 0.411 p = 0.009, OR = 11.508), while poor glycaemic control (r = 0.270, p = 0.015, OR = 3.473) was a moderate independent predictor., Conclusion: The prevalence of NAFLD increases with increasing BMI and HBA1c in T2DM, while its ultrasound grade varies with BMI. Overweight, obesity and poor glycaemic control are independent predictors of NAFLD., (Copyright © 2017 National Medical Association. Published by Elsevier Inc. All rights reserved.)

Objective: To sonographically evaluate the dominant fibroid nodule vascularity and flow velocity pattern of perifibroid and intrafibroid arteries., Methods: We recruited 140 women with uterine fibroids. Their uteri were scanned to determine the vascularity of fibroid nodules and the Doppler indices of the fibroid arteries., Results: The median volume of the dominant leiomyoma nodule was 133 cm 3 (range=1.5-2,575 cm 3 ). Eighty-three subjects (59.3%) had a dominant leiomyoma nodule volume of ≤200.0 cm 3 while the volume of the dominant leiomyoma nodule was >200.0 cm 3 in 57 (40.7%) subjects. The dominant fibroid nodule was vascular in 137 (97.9%) subjects and avascular in 3 (2.1%). All the perifibroid artery indices (except the end-diastolic velocity [EDV] and diastolic average ratio [DAR]) are significantly higher than those of the intrafibroid artery. The mean Doppler indices of perifibroid vs. intrafibroid arteries as follows: peak systolic velocity (PSV; 52.1 vs. 45.4 cm/s); EDV (21.1 vs. 22.4 cm/s); time-averaged maximum velocity (TAMX; 31.5 vs. 30.4 cm/s); time- averaged mean velocity (T mean ; 14.3 vs. 13.8 cm/s); pulsatility index (PI; 1.1 vs. 0.8); resistive index (RI; 0.6 vs. 0.5); systolic-diastolic ratio (SDR; 2.7 vs. 2.1); impedance index (ImI; 2.7 vs. 2.1); and DAR (0.66 vs. 0.74); P <0.001 for all indices., Conclusion: The predominant pattern of fibroid vascularity is peripheral vascularity and the perifibroid artery indices (except EDV and DAR) are significantly higher than those of the intrafibroid artery. Recurrent fibroids in women with previous myomectomy had significantly higher intrafibroid PI, RI, SDR, and ImI than those without previous myomectomy., Competing Interests: Conflict of interest: No potential conflict of interest relevant to this article was reported.

Background: The air spaces of the nasal cavity and the sphenoid sinus (SS) constitute a convenient corridor to access lesions of the skull base using the endoscopic endonasal transsphenoidal approach (EETA). Safe EETA depends on the SS and skull base anatomy of the patient. Individual variations exist in the degree and pattern of SS pneumatization. This study aims to examine the variations in SS pneumatization, the inter-sphenoid septum (ISS), and their relationship with the internal carotid artery (ICA) among adult Nigerians., Materials and Methods: We reviewed computerized tomography (CT) images of 320 adult patients that had imaging for various indications. This excluded those with traumatic, inflammatory, or neoplastic process that may alter anatomical landmarks. The images were evaluated for the types of SS pneumatization, number and insertion of ISS, and the protrusion of ICA into the sinus cavity., Results: Prevalence of SS pneumatization types: 1.9% conchal, 1.2% presellar, 56.6% sellar, and 40.2% postsellar. The lateral extension of SS occurred into the pterygoid in 138 patients (45.1%), greater wing 112 (35%), lesser wing 37 (11.6%), the full lateral type was seen in 97 (30.3%) patients. One ISS occurred in 150 (46.9%) patients, 162 (50.6%) had multiple, and 8 (2.5%) had none. ISS insertion into ICA bony covering occurred in 101 (31.6%) patients, whereas protrusion of ICA into SS cavity occurred in 110 (34.4%) patients., Conclusion: Variations of the SS, ISS, and ICA anatomy are present among native Africans. Detailed imaging evaluation of each patient is considered for EETA is mandatory., Competing Interests: There are no conflicts of interest.

Objective  To describe the blood flow velocities and impedance indices changes in the uterine arteries of leiomyomatous uteri using Doppler sonography. Methods  This was a prospective, case-control study conducted on 140 premenopausal women with sonographic diagnosis of uterine leiomyoma and 140 premenopausal controls without leiomyomas. Pelvic sonography was performed to diagnose and characterize the leiomyomas. The hemodynamics of the ascending branches of both main uterine arteries was assessed by Doppler interrogation. Statistical analysis was performed mainly using non-parametric tests. Results  The median uterine volume of the subjects was 556 cm 3 , while that of the controls was 90.5 cm 3 ( p  < 0.001). The mean peak systolic velocity (PSV), end-diastolic velocity (EDV), time-averaged maximum velocity (TAMX), time-averaged mean velocity (Tmean), acceleration time (AT), acceleration index (AI), diastolic/systolic ratio (DSR), diastolic average ratio (DAR), and inverse pulsatility index (PI) were significantly higher in the subjects (94.2 cm/s, 29.7 cm/s, 49.1 cm/s, 25.5 cm/s, 118 ms, 0.8, 0.3, 0.6, and 0.8 respectively) compared with the controls (54.2 cm/s, 7.7 cm/s, 20.0 cm/s, 10.0 cm/s, 92.0 ms, 0.6, 0.1, 0.4, and 0.4 respectively); p  < 0.001 for all values. Conversely, the mean PI, resistivity index (RI), systolic/diastolic ratio (SDR) and impedance index (ImI) of the subjects (1.52, 0.70, 3.81, and 3.81 respectively) were significantly lower than those of the controls (2.38, 0.86, 7.23, and 7.24 respectively); p  < 0.001 for all values. Conclusion  There is a significantly increased perfusion of leiomyomatous uteri that is most likely due to uterine enlargement., Competing Interests: Conflicts of Interest: None to declare., (Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.)

Objectives: Brachial artery flow-mediated dilatation on sonography is used to evaluate endothelial dysfunction, which is a key event in the development of atherosclerosis and predates structural atherosclerotic lesions by many years. Atherosclerosis has been implicated in the pathophysiologic mechanisms of ischemic stroke. The aim of this study was to determine the association between brachial flow-mediated dilatation, the presence of cardiovascular risk factors, and acute stroke., Methods: We evaluated right brachial arteries of 150 participants (50 stroke patients, 50 patients with cardiovascular risk factors, and 50 healthy control individuals) with B-mode sonography before and 5 minutes after sphygmomanometer cuff application to their forearms. Analysis of variance for multiple comparisons was used between each group., Results: Mean ages of the stroke, risk factor, and control groups ± SD were 57.5 ± 14.8, 52.4 ± 16.0, and 56.1 ± 14.9 years, respectively (P = .235). Flow-mediated dilatation rates were 4.37% ± 1.50%, 5.62% ± 1.23%, and 10.33% ± 1.96% in the stroke, risk factor, and control groups (P ≤ .001). Dilatation was 3.79% ± 0.92% in ischemic stroke compared with 6.02% ± 1.62% in intracerebral hemorrhage (P < .001), but there was no significant difference in dilatation between ischemic stroke subtypes according to the Trial of ORG 10172 in Acute Stroke Treatment classification (P = .301)., Conclusions: Brachial flow-mediated dilatation was significantly lower in patients with acute stroke compared with controls matched for vascular risk factors and healthy controls. Decreased vascular endothelial function in stroke patients was particularly related to cerebral infarction compared with intracerebral hemorrhage. Brachial flow-mediated dilatation did not differentiate ischemic stroke subtypes by the Trial of ORG 10172 in Acute Stroke Treatment classification. Flow-mediated dilatation was therefore found to be a marker of cardiovascular risk and a probable reactant in the acute phase of stroke., (© 2016 by the American Institute of Ultrasound in Medicine.)

Objective: To determine the prevalence of gallstone disease and its complications among pregnant women in a semi-urban Nigerian setting., Methods: Consecutive consenting pregnant women presenting at the prenatal clinic of a Nigerian tertiary hospital were recruited over an 18-month period. During routine obstetric ultrasound, the presence of gallstones and/or associated sequelae was investigated. Patients' sociodemographic data and hemoglobin genotype were documented., Results: Overall, 1283 pregnant women (14-43 years of age) were included in the study. Thirty-seven (2.9%) had sonographic evidence of gallstones, 26 (2%) had biliary sludge, and 2 (0.2%) had gallbladder polyps. Twenty-one (56.8%) of the 37 women with gallstones were 30 years of age or younger. Only 1 (1.2%) of 85 selected women in the first trimester of pregnancy with no gallstones who were followed throughout pregnancy developed gallstones in the third trimester. Overall, 3 (0.2%) women had clinical and radiologic evidence of acute calculous cholecystitis, 2 of whom underwent laparoscopic cholecystectomy after delivery., Conclusion: The present study demonstrated a low prevalence of gallstone disease and its acute complications among pregnant Nigerian women in a semi-urban setting., (Copyright © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

An intrauterine contraceptive device (IUCD) is one of the most common forms of contraception in use worldwide today. It is associated with a myriad of problems and complications, one of which is the missing IUCD. It is a known fact that IUCDs can perforate the uterus resulting in its subsequent relocation in other organs within the pelvis and the abdomen. This study showed that more than 50% of clinically diagnosed cases of a missing IUCD are still located within the endometrial cavity. It is therefore being proposed that a clinical diagnosis of 'missing string' be made until adequate radiological investigations, such as ultrasonography, plain X-rays and computerized tomography, have been carried out.

Background: Benign breast diseases are common and Ultrasound is a very useful tool in examining benign breast diseases especially in distinguishing solid from cystic masses. This study aims to determine the sonographic pattern of benign breast diseases in a Nigerian population and to compare this pattern with that which has been previously reported in other environments., Methods: This a prospective study of Ninety-four patients with breast disease scanned between 1997 and 2001 on request from the breast clinic of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. A total of forty-four patients with histologicaly confirmed benign breast diseases were selected for this study. Their ultrasonographic features were evaluated and compared with those previously described., Result: Fibroadenoma was the commonest disease, occurring in 62.2% of the patients, with a mean age of 29.1 years, an age higher than that previously reported. Other diseases which were expected to occur commonly (breast abscess, cyst) were rarely seen., Conclusion: While it was discovered that the sonographic pattern of most of the diseases in this study conformed to that already described in literature despite late presentation, only one sonographic appearance of galactocele, out of the three reported, was noted in this study. In addition, despite the nonspecificity of ultrasound appearances in fibrocystic disease, an attempt has been made to match these appearances with the different histological types already described in literature.