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This study investigates into the adverse impacts of heavy metal concentration on human health, particularly when present in water used in palm oil production in selected industries in Ondo State, Nigeria. Through wet-digestive analysis, the levels of heavy metals including Copper (Cu), Lead (Pb), Manganese (Mn), Zinc (Zn), and Cadmium (Cd) were assessed in both water samples and palm oil products. The results revealed concentrations of heavy metals in water samples and control ranging from Copper (0.167 - 0.297 and 0.143 mg/L), Lead (0.047 - 0.100 mg/L), Manganese (0.250 - 0.327 mg/L), and Zinc (0.0417 - 0.547 mg/L), while palm oil concentrations ranged from Cu (0.327 - 0.100 mg/L), Ni (0.045 - 0.010 mg/L), Pb (0.207 - 0.100 mg/L), Mn (0.390 - 0.183 mg/L), and Zn (0.697 - 0.453 mg/L). Comparison with World Health Organization (WHO) standards indicated that Pb concentrations in water exceeded permissible limits, suggesting potential contamination in palm oil samples. Additionally, a significant positive correlation (p<0.05) was observed between Pb levels in water and palm oil samples, indicating the transfer of lead contaminants into the palm oil during production. These findings underscore the importance of monitoring and regulating heavy metal concentrations in water sources used in palm oil production to safeguard public health. [ABSTRACT FROM AUTHOR]

The study was carried out to evaluate the radioactivity concentrations of 40K, 232Th and 238U in five maize samples collected from maize farms within Ekiti State, Nigeria. The activity concentration measurements were determined using n -- type co-axial HPGe detectors for the state. The activity concentrations were found to vary from 994.67 - 2457.01 Bq Kg-1 for 40K, 32.84 - 91.88 Bq kg-1 for 232Th and 43.21 - 97.77 Bq kg-1 for 238U respectively. The annual effective dose to individuals from the consumption of the Maize was estimated on the basis of the measured radionuclides content in the food crop which ranged between 0.41 and 1.51 m Svy-1 respectively. The value 1.04 m Svy-1 were obtained for the state as the mean total annual effective dose. The mean excess life time cancer risk was also calculated to be 2.06x10-9. The value was compared with the internationally acceptable limits and found to be far less to the maximum permissible dose of 1.0 x10-3 recommended for the public by the United Nations Scientific Committee on the Effects of Atomic Radiation. Hence, the maize was found to be safe for human consumption. [ABSTRACT FROM AUTHOR]

Background: Age-based formulas (ABFs) are commonly used in paediatric anaesthesia to determine the correct size of an endotracheal tube (ETT). However, these formulas often predict an incorrect size. The aim of this study was to determine if the tracheal internal diameter as determined on axial ultrasound images better predicts paediatric ETT size than Cole's ABF. Methods: This study is a prospective observational study that involved 106 paediatric patients aged 1-10 years classified as ASA I and ASA II according to the American Society of Anesthesiologists Classification of Physical Status. These paediatric patients were scheduled for elective surgery and required general anaesthesia. They were randomly allocated to one of two groups by blind balloting. There were 53 participants in each group: the ultrasound-predicted endotracheal tube size (UPE) group and the (agebased) formula-predicted endotracheal tube size (FPE) group. For both groups, the actual ETT size used for intubation was noted and compared to the predicted size. Results: The two groups (UPE and FPE) were comparable with respect to demographic and clinical variables. Airway ultrasound scans predicted the appropriate ETT size in 52 out of the 53 participants in the UPE group. This is a better prediction than the Cole's ABF, which accurately predicted appropriate ETT size in 35 out of the 53 participants in the FPE group (p < 0.001). Conclusion: Data from this study shows that an airway ultrasound scan predicted the ETT size more accurately than Cole's ABF in paediatric patients. [ABSTRACT FROM AUTHOR]

Traumatic diaphragmatic rupture is not a common injury in children. It is an important cause of morbidity and mortality, though diagnosis may be missed or delayed with atypical clinical presentation and confounding radiological features. A 4-year-old male presented with periumbilical abdominal pain, bilious vomiting, fever and progressive difficulty in breathing for two days. He had complained of vague left-side chest pain on return from the swimming pool about 6 weeks earlier. An initial chest radiograph showed a non-outlined left hemidiaphragm, a left pneumothorax, rightward mediastinal shift and suspected bowel in the chest. He could not afford a CT scan, hence a repeat chest radiograph was performed, which outlined the stomach with an air-fluid level in the left hemithorax.

Objective: High cereal fiber and low-glycemic index (GI) diets are associated with reduced cardiovascular disease (CVD) risk in cohort studies. Clinical trial evidence on event incidence is lacking. Therefore, to make trial outcomes more directly relevant to CVD, we compared the effect on carotid plaque development in diabetes of a low-GI diet versus a whole-grain wheat-fiber diet., Research Design and Methods: The study randomized 169 men and women with well-controlled type 2 diabetes to counseling on a low GI-diet or whole-grain wheat-fiber diet for 3 years. Change in carotid vessel wall volume (VWV) (prespecified primary end point) was assessed by MRI as an indication of arterial damage., Results: Of 169 randomized participants, 134 completed the study. No treatment differences were seen in VWV. However, on the whole-grain wheat-fiber diet, VWV increased significantly from baseline, 23 mm3 (95% CI 4, 41; P = 0.016), but not on the low-GI diet, 8 mm3 (95% CI -10, 26; P = 0.381). The low-GI diet resulted in preservation of renal function, as estimated glomerular filtration rate, compared with the reduction following the wheat-fiber diet. HbA1c was modestly reduced over the first 9 months in the intention-to-treat analysis and extended with greater compliance to 15 months in the per-protocol analysis., Conclusions: Since the low-GI diet was similar to the whole-grain wheat-fiber diet recommended for cardiovascular risk reduction, the low-GI diet may also be effective for CVD risk reduction., (© 2022 by the American Diabetes Association.)

Background: Perinatal asphyxia, more appropriately known as hypoxic-ischemic encephalopathy (HIE), is a condition characterized by clinical and laboratory evidence of acute or sub-acute brain injury resulting from systemic hypoxemia and/or reduced cerebral blood flow. HIE is a common and devastating clinical condition in resource-poor countries with poor treatment outcome. This paper describes the protocol for an ongoing study that aims to evaluate the neuroprotective effects of Erythropoietin (EPO) as compared to routine care in the management of moderate to severe HIE among term infants., Methods: This study is a double-blind randomized controlled trial that will be conducted in the neonatal wards of the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria, over a two-year period after ethical approvals and consents. One hundred and twenty-eight term newborns (≥ 37 weeks gestation) diagnosed with moderate/ severe HIE at admission will be allocated by randomization to receive either EPO or normal saline. All the participants will be offered standard care according to the unit protocol for HIE. Baseline investigations and close monitoring of the babies are done until discharge. Participants are followed up for 2 years to monitor their outcome (death or neurological development) using standard instruments., Discussion: Previous trials had shown that EPO confers neuroprotective benefits and improve neurological and behavioral outcome in infants with HIE both singly or as an adjuvant to therapeutic hypothermia. This study hypothesized that administering EPO to newborns with moderate /severe HIE can positively influence their clinical and neurological outcomes and will provide evidence to either support or disprove the usefulness of Erythropoietin as a sole agent in the treatment of HIE, especially in resource-limited environment with the highest burden of the disease., Trial Registration: The study has been registered with the Pan African Clinical trials registry on the 2nd of December 2018, with registration number PACTR201812814507775.

Background: Increased photoprotection by natural melanin allows for African-Americans to be less impacted by photoaging than Caucasians. However, less is known about chronological aging in this population., Objective: To create a photonumeric scale for African-Americans to evaluate chronological skin aging and to explore contributing elements to intrinsic aging., Methods: Standardized photographs of the upper inner arm were taken from 75 African-American participants. Five participants were chosen as standards to create a 9-point photonumeric scale (0 = none, 8 = most severe). The scale was utilized by three blinded dermatologists to independently rate participants' photographs., Results: The interrater agreements were 0.768 (95% CI: 0.671-0.834) for trial 1 and 0.725 (0.608-0.794) for trial 2. The intrarater agreements were 0.757 (0.596-0.875), 0.850 (0.771-0.903), and 0.790 (0.686-0.855) for the three raters. Averaged chronological aging scores were correlated with participants' survey responses, which revealed age as a significant predictor (r = 0.72, p < 0.001)., Limitation: Our study was limited by the sample size, although the number of study participants was similar on a investigation in Caucasians., Conclusion: This study created the first reliable photonumeric scale for chronologic skin aging in African-Americans and found increased age and greater BMI as contributors to intrinsic skin aging phenotype in this population., (Copyright © 2018 National Medical Association. Published by Elsevier Inc. All rights reserved.)

Background: African-Americans are less affected by photoaging than lighter skin individuals. Although scales for photoaging have been developed for Caucasians and Asians, no scale exists for African-Americans., Aim: To develop a photonumeric scale for photoaging and to determine factors that contribute to photoaging in African-Americans., Methods: Five participants' photographs were selected as standards to create a 9-point photonumeric scale (0 = none, 8 = most severe). Three blinded dermatologists used the scale to grade the remaining participants' photographs., Results: Interrater reliabilities were 0.775 (95% CI: 0.635, 0.880) for trial 1 and 0.832 (0.747, 0.883) for trial 2. Intrarater reliabilities, assessed over a 1 week interval, were 0.863 (0.727, 0.940), 0.928 (0.890, 0.954), and 0.866 (0.739, 0.935) for the three graders, indicating strong agreement. Photoaging scores were then correlated with participants' survey on lifestyle factors, which yielded age as a significant predictor (r = 0.91, p < 0.001). Furthermore, multiple regression model to predict facial photoaging (adjusted R 2  = 0.849) selected age (b 1  = 0.111, p < 0.001), sun exposure (b 2  = 0.206, p = 0.014), and gender (b 2  = -0.388, p = 0.063) as the most important variables., Conclusions: A reliable photonumeric scale for photoaging in African Americans was developed. Age, sun exposure, and male gender were found to be contributory factors to photoaging., (Copyright © 2018 National Medical Association. Published by Elsevier Inc. All rights reserved.)

Objective: To assess associations between dietary intake and carotid intima media thickness (CIMT) by carotid ultrasound (CUS), a surrogate marker of cardiovascular disease (CVD) risk, in those with type 2 diabetes., Design: Cross-sectional analysis of baseline data from 325 participants from three randomised controlled trials collected in the same way., Setting: Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada., Participants: 325 participants with type 2 diabetes, taking oral antidiabetic agents, with an HbA1c between 6.5% and 8.0% at screening, without a recent cardiovascular event., Main Outcome Measures: CIMT by CUS and associations with dietary intake from 7-day food records, as well as anthropometric measures and fasting serum samples., Results: CIMT was significantly inversely associated with dietary pulse intake (β=-0.019, p=0.009), available carbohydrate (β=-0.004, p=0.008), glycaemic load (β=-0.001, p=0.007) and starch (β=-0.126, p=0.010), and directly associated with total (β=0.004, p=0.028) and saturated (β=0.012, p=0.006) fat intake in multivariate regression models adjusted for age, smoking, previous CVD event, blood pressure medication, antidiabetic medication and ultrasonographer., Conclusions: Lower CIMT was significantly associated with greater consumption of dietary pulses and carbohydrates and lower total and saturated fat intake, suggesting a potential role for diet in CVD risk management in type 2 diabetes. Randomised controlled trials are anticipated to explore these associations further., Trial Registration Number: NCT01063374., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objective: Bipolar disorder (BD) is associated with increased rates of cardiovascular disease (CVD). Brain-derived neurotrophic factor (BDNF) and inflammatory markers are leading biomarkers in BD. We examined whether these biomarkers underlie the link between BD and CVD proxies among adolescents with bipolar spectrum disorders., Methods: Subjects were 60 adolescents, 13-19 years old (40 with BD and 20 healthy controls [HCs]). Semistructured interviews determined diagnoses based on DSM-IV. Serum was assayed for BDNF, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). Carotid intima media thickness (cIMT) and flow-mediated dilation were assessed using ultrasound. Procedures were conducted at a subspecialty clinic (January 2011-May 2014)., Results: Adolescents with BD had significantly greater waist circumference (BD: 81.72 cm [11.67 cm], HC: 75.64 cm [8.63 cm]; U = 547.5, P = .021), body mass index (BMI) (BD: 25.50 kg/m²undefined[5.29 kg/m²], HC: 21.76 kg/m² [3.43 kg/m²]; U = 608.5, P < .0001), pulse pressure (BD: 42.31 mm Hg [10.57 mm Hg], HC: 33.84 mm Hg [6.69 mm Hg]; U = 561.5, P < .001), and IL-6 (BD: 8.93 pg/mL [7.71 pg/mL], HC: 4.96 pg/mL [6.38 pg/mL]; U = 516.0, P < .0001) than HC adolescents. Subjects with BD-I (n = 14) and BD-II (n = 16) had greater IL-6 versus HCs (F₃,₅₁ = 5.29, P = .003). Controlling for BMI and age did not alter these findings. IL-6 was higher in symptomatic (n = 19) and asymptomatic BD (n = 21) versus that found in HCs (F₂,₅₂ = 7.96, P = .001). In symptomatic BD, lower BDNF was associated with greater mean cIMT (ρ = -0.507, P = .037)., Conclusions: This study found evidence of increased inflammation among adolescents with BD. While present findings suggest a potential interplay between symptomatic status, biomarkers, and atherosclerosis proxies, there were no significant differences in cIMT or flow-mediated dilation in adolescents with BD compared to HCs. This may indicate that there is potential opportunity for CVD prevention strategies in adolescents with BD., (© Copyright 2017 Physicians Postgraduate Press, Inc.)

Introduction: Type 2 diabetes (T2DM) produces macrovascular and microvascular damage, significantly increasing the risk of cardiovascular disease (CVD), renal failure and blindness. As rates of T2DM rise, the need for effective dietary and other lifestyle changes to improve diabetes management become more urgent. Low-glycaemic index (GI) diets may improve glycaemic control in diabetes in the short term; however, there is a lack of evidence on the long-term adherence to low-GI diets, as well as on the association with surrogate markers of CVD beyond traditional risk factors. Recently, advances have been made in measures of subclinical arterial disease through the use of MRI, which, along with standard measures from carotid ultrasound (CUS) scanning, have been associated with CVD events. We therefore designed a randomised, controlled, clinical trial to assess whether low-GI dietary advice can significantly improve surrogate markers of CVD and long-term glycaemic control in T2DM., Methods and Analysis: 169 otherwise healthy individuals with T2DM were recruited to receive intensive counselling on a low-GI or high-cereal fibre diet for 3 years. To assess macrovascular disease, MRI and CUS are used, and to assess microvascular disease, retinal photography and 24-hour urinary collections are taken at baseline and years 1 and 3. Risk factors for CVD are assessed every 3 months., Ethics and Dissemination: The study protocol and consent form have been approved by the research ethics board of St. Michael's Hospital. If the study shows a benefit, these data will support the use of low-GI and/or high-fibre foods in the management of T2DM and its complications., Trial Registration Number: NCT01063374; Pre-results., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Introduction: In the field of bipolar disorder (BD) research there is an absence of validated biomarkers and limited understanding of the biology underlying excessive and premature cardiovascular disease (CVD). Oxidative stress is a potential biomarker in both BD and CVD., Objective: To examine psychiatric and cardiovascular characteristics associated with peripheral oxidative stress markers among adolescents with BD, who are at high risk for CVD., Methods: Participants were 30 adolescents, 13-19years old, with BD and without CVD. Ultrasonography was used to evaluate vascular function and structure. Traditional CVD risk factors were also measured. Psychiatric assessments were conducted via semi-structured interview. Serum levels of oxidative stress (lipid hydroperoxides (LPH) and protein carbonylation (PC)) were assayed., Results: Compared to published data on adults with BD, adolescents had significantly lower levels of LPH and PC (t52(11.34), p<0.0001; t58(29.68), p<0.0001, respectively). Thicker mean and maximum carotid intima media thickness was associated with greater levels of LPH (r=.455, p=.015; r=.620, p<0.0001, respectively). LPH was associated with diastolic blood pressure (r=-.488, p=0.008) and pulse pressure (r=.543, p=0.003). Mood symptoms and medication were not significantly associated with oxidative stress., Conclusion: Adolescents with BD have lower levels of oxidative stress compared to adults with BD, supporting prevailing illness staging theories for BD. Oxidative stress is robustly associated with a proxy measure of atherosclerosis and may explain in part the increased risk of CVD in BD., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Cardiovascular disease (CVD) is exceedingly prevalent among adults with bipolar disorder (BD), implicating BD adolescents as a high-risk group for CVD. Non-invasive ultrasound measures of vascular structure (via carotid intima media thickness [cIMT]) and function (via flow-mediated dilation [FMD]) predict future CVD, and are associated with traditional CVD risk factors among adolescents without mood disorders. This study examined, for the first time, the association of cIMT and FMD with CVD risk factors among adolescents with BD. The presence of multiple potential confounds among adolescents with BD, including various medications and mood states, informs the need to demonstrate whether cIMT and FMD are associated with CVD risk factors in this population specifically. Participants were 30 adolescents, 13-19 years old, with BD, without CVD. High-resolution ultrasonography was used to evaluate vascular structure (cIMT) and function (FMD). Analyses examined associations of cIMT and FMD with traditional CVD risk factors. cIMT was significantly positively associated with systolic blood pressure and waist circumference. FMD was significantly negatively associated with waist circumference, body mass index, triglycerides, and glucose, and positively associated with high-density lipoprotein. cIMT and FMD are associated with traditional CVD risk factors among adolescents with BD. Irrespective of numerous potential confounds, non-invasive vascular ultrasound approaches may be used as CVD risk proxies among adolescents with BD as they are for other adolescents.

Background: This study explored the outcome of children with patent anterior fontanelles who were treated with trans-fontanelle ultrasound scan (TFUSS), which is more affordable and available than CT scan and MRI in the diagnosis of childhood intracranial pathologies and treatment of subdural empyema, in developing countries., Patients and Methods: Seventeen infants with post-meningitic subdural empyema, diagnosed using trans-fontanelle ultrasound alone and treated with subdural tapping over a 31-months period, were studied., Results: Eleven patients presented with grades II and III Bannister and William grading for level of consciousness in intracranial subdural empyema. Aspirate from 7 (41.2%) patients were sterile. The most common organisms isolated were Streptococcus faecalis 3 (17.6%), Haemophilus Influenza 2 (11.8) and Staphylococcus aureus 2 (11.8), multiple organisms were isolated in three of the patients. Ninety-four percent (94%) of the patients had good outcome. Five subjects developed hydrocephalus, one patient had a recurrence of subdural empyema, four patients had residual hemiparesis, two of the four patients had speech difficulties, while one patient (~6%) died., Conclusion: While CT and MRI remain the gold standard for investigating intracranial lesions, transfontanelle ultrasonography is adequate for diagnosis of infantile subdural empyema in resource-challenged areas. Percutaneous subdural tap is an affordable and effective therapy in such patients with financial challenges.

Purpose: To evaluate the computed tomography (CT) findings of intracranial hemorrhage among patients with head trauma in Lagos, Nigeria., Methods: In this retrospective, cross-sectional study, a convenience sample of 500 patients with head trauma who had diagnostic cranial CT scans was selected. All the radiological reports and CT scans of patients with head trauma were retrieved in the hospitals selected as study sites. The reports were sorted into 2 groups - normal findings and intracranial bleeding. The reports of intracranial bleeding were sorted again into different classes of intracranial bleeding as identified by the radiologist who reported it. All data were analyzed using the Epi Info public domain software package. The chi-square test was used to measure the statistical significance of study results at P < .05., Results: Most of the study subjects (68%) were men. Traffic accidents accounted for 44% of all the head traumas found in the study, and 58% of the head traumas resulted in intracranial bleeding. Among the hemorrhages found, 37% were intracerebral, 25% were subdural, 16% were intraventricular, 15% were subarachnoid, and 7% were epidural., Discussion: Intracranial hemorrhage was a common consequence of acute head trauma sustained from traffic accidents in the population studied, with intracerebral hemorrhage being the most prevalent type., Conclusion: Traffic accidents are the main cause of acute head trauma in Lagos, Nigeria. The use of CT for early diagnosis of intracranial hemorrhage appears justifiable.

Objectives: To highlight the usefulness of duplex ultrasonography in assessing patients with clinical features suggestive of DVT in this environment., Patients and Methods: A total of seventy patients (44 males and 26 females, aged 15-85 years) with a clinical diagnosis of deep venous thrombosis (DVT) were seen between September 2005 and September 2007 in the Radiodiagnosis Department of the Lagos University Teaching Hospital, and a private Multi-specialist hospital both in Lagos, Nigeria. They had bilateral lower extremity venous duplex ultrasonographic examination performed on them. The common femoral vein, superficial femoral vein, proximal deep femoral vein, proximal greater saphenous vein, popliteal vein and posterior tibial veins were evaluated with compression sonography in the transverse plane. Grey scale, colour and pulsed Doppler imaging of the venous segments were observed., Results: The sonographic abnormalities observed included frozen valves, venous reflux, venous dilatation with echogenic thrombus, absence of Doppler signals and narrowed, thick walled veins. It was observed that 30 (42.3%) patients had acute DVT, 11 (15.7%) had chronic venous disease (CVD), while 10 (14.3%) had incompetence of the superficial venous system. Acute DVT was the commonest pathology observed., Conclusion: Duplex ultrasonography should be performed on all patients with a clinical diagnosis of DVT in order to rule out other differential diagnoses.

Objective: To highlight the usefulness of duplex ultrasonography in assessing the degree of limb ischaemia in patients with peripheral arterial occlusive disease (PAOD)., Methodology: Duplex ultrasonography (B mode, Color flow and spectral Doppler analysis) was used to evaluate the degree of limb ischaemia in an elderly Nigerian woman with diabetes who had clinical features of severe PAOD RESULTS: The patient was found to have moderate and severe limb ischaemia in the right and left lower limbs respectively. She subsequently had a below the knee amputation of the left lower limb., Conclusion: Duplex ultrasound is advised as part of the pre-operative evaluation of patients with PAOD, in order to adequately localise the diseased arterial segment and degree of limb ischaemia. However, segmental Doppler pressures with ankle brachial analysis should be utilised as a screening tool in symptomatic patients.

Craniopharyngiomas are usually benign tumours, commonly seen in children. They may be locally aggressive and tend to recur after excision. The most common symptoms are headache and visual difficulties. Calcifications may be seen on computed tomography. This is a case of craniopharyngioma resulting in visual loss in an adult.

Missing Intrauterine contraceptive devices can migrate to various regions intra-abdominally. Plain radiography usually confirms that the devise is still within the abdominal cavity, while other specific studies may define its relationship with the organ imaged. This is a case of a Migrated IUCD resulting in urinary symptoms.