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Objectives: The integration of ultrasound into routine obstetric workup has transformed antenatal care in resource-poor and remote communities in Africa. The present study aims to investigate the utilization of obstetric ultrasound at a cottage hospital in suburban Nigeria. Material and Methods: This retrospective study was conducted at Obio Cottage Hospital, Port Harcourt, Rivers State, South-South Nigeria. Ethical approval was obtained before commencement of the study from the Health Research Ethics Committee of University of Calabar Teaching Hospital with reference number UCTH/HREC/33/533. Reports were retrieved from the records of the radiology unit of the study facility, and data including biometric data and radiological diagnosis were transferred to Microsoft Excel spreadsheet for data analysis. Simple proportions and percentages were used to analyze the data. All statistical analyses were conducted using Statistical Package for the Social Science version 21.0, IBM Inc., Chicago, Illinois, USA. Statistical significance was set at P ≤ 0.05. Results: The total ANC visits at Obio Cottage Hospital was 28,072, with 27% (7689) utilization of ultrasound scan. The mean age and range of parity of attendees were 32 ± 2.3 and 1–5, respectively. Of the total scans performed, 99.93% was routine, while 0.07% (5) was clinical-based (targeted). Normal findings were 7520 (97.8%) of antenatal scans recorded, while abnormal cases, multiple gestation, and uncertain diagnosis accounted for 121 (1.57%), 44 (0.57%), and 4 (0.06%), respectively. Conclusion: The present study has shown a considerable volume of obstetric ultrasound scan in this cottage hospital, albeit, with low utilization compared to the number of antenatal registration. Findings were mainly normal with minimal need for referral for advance care.

Introduction: Urinary tract infection is a major reason for hospital visits and a common clinical condition encountered by clinicians. The causative agents of urinary tract infection and their resistant pattern vary globally. The aim of this study was to highlight the profile of pathogens associated with urinary tract infections in our locality. The objective was to investigate the resistant pattern of these microbial isolates from patients with urinary tract infection and offer recommendations for effective treatment. Materials and methods: We retrospectively analyzed the urine culture and antimicrobial sensitivity reports of patients with suspected urinary tract infection at the University of Calabar Teaching Hospital, Calabar, Nigeria, from September 2019 to August 2020. Methicillin resistance was detected by disk diffusion method using 30 µg cefoxitin disk. Production of Extended spectrum beta lactamases was detected by the Combination disk and the double-disk synergy method. Results: Of 979 urine culture and sensitivity reports, 306 (31.26%) were positive for microbial growth. Two microbial isolates each were recovered from urine samples of 5 patients giving a total number of 311 isolates from 306 patients. 45.75% of positive results were in males. The predominant isolate was Escherichia coli (n=97, 31.19%). Extended Spectrum Beta Lactamases (ESBL) producing strains comprised 10.08% (10/238) of Gram-negative group of organisms, while 47.39% (145/306) of all bacterial isolates in our study were multi drug resistant (MDR). 14.29% (6/42) of S. aureus isolates were methicillin resistant S. aureus, while 33.33% (2/6) of methicillin resistant S. aureus (MRSA) were multi drug resistant. Conclusion: Urinary tract infection caused by antimicrobial resistant organisms is common among studied patients. This emphasizes the need for urine culture and sensitivity tests in the management of urinary tract infection.

Risk factors for carotid intima-media thickness (cIMT) and carotid plaque (CP) differ by ethnicity; however, this is not well understood in some ethnic populations. This work examines the risk factors for cIMT and CP in an indigenous Nigerian population.We assessed cIMT and CP in 122 participants and then performed biochemical analysis: fasting blood glucose (FBG), hemoglobin A1c, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), and total cholesterol (TC). The clinical history and anthropometric characteristics of participants were recorded. Linear models were used to assess the factors associated with cIMT and CP, and stepwise multivariate regression analyses were conducted to assess the predictors of cIMT and CP.The cIMT thickness varied from .5 mm to 1.3 mm. Family history of heart disease (FHHDx), physical activity, FBG, HDL-C, TG, TC, body mass index (BMI), systolic pressure, and waist circumference were significantly associated with cIMT (P ≤ .01). High systolic (β = .008) and diastolic (β = .17) pressure, FHHDx (β = .24), age (β = .004), physical activity (β = -.09), and waist circumference (β = -.017) significantly predicted 85% of the variation in cIMT (P.001 for all). Family history of hypertension (FHH), LDL-C, and high blood pressure were significantly associated with CP (P ≤ .05). The significant predictors of CP were FHH (β = .145, P = .03), smoking (β = .167, P = .01), HDL-C (β = .283, P.001), weight (β = .150, P = .04), and BMI (β = .183, P = .01), explaining most of the 43.2% variation in CP.Some of the risk factors differ from those of other ethnicities, suggesting a need for population-specific approach to risk assessment and early detection of subclinical disease.

Background: Congestion of patient waiting areas at commencement of work is the usual scenario in Nigeria's public hospitals. This strains the personnel and facilities. Patients are dissatisfied and lose faith in the system. This study aims to audit the booking system, patient waiting time, and causes of congestion in an ultrasound unit. Materials and Methods: This is a prospective, descriptive study involving 350 patients referred from general outpatient and specialist clinics to the ultrasound unit, twice weekly for 6 weeks. Patients were grouped into two: those with scheduled appointments and the unbooked. The time of scheduled appointment and arrival in the unit and the time of commencement and conclusion of the examination were recorded. Results: Three hundred and eighteen patients had scheduled appointments, while 32 were unbooked. Half of the later were emergencies and the other half were walk-ins. There was no consistency in number of slots and block size. Large blocks of over 20 patients were observed on 33.3% of the days and 51.26% of the patients were given 8:00 am appointments. The average patient waiting time is 132.11 minutes but range from 62 to 220 minutes daily. The radiologists resumed work between 8:17 and 9:29 am each scan day. The average waiting time is shorter for patients who arrived after 11:00 am. Conclusion: Ineffective booking of appointments and Sonologist's tardiness are major predisposition to congestion. Appointments in small blocks at 30 minutes intervals will eliminate congestion, reduce patient waiting time, and improve satisfaction. Point-of-care ultrasound should be introduced in outpatient clinics.

Background: Hypertension and diabetes rank high among cardiovascular risk factors, and in Africa, many affected persons are undiagnosed. Urban market traders are constrained from regular clinic visits by the fear of revenue loss occasioned by their absence from the stores, contributing to the reportedly high rates of undiagnosed and poorly treated cardiovascular conditions. This study determined the rate of undiagnosed hypertension and diabetes among traders in an urban market in Calabar, Nigeria. Methods: In this cross-sectional study, we used an interviewer-administered questionnaire to collect data from 105 traders at Marian market Calabar, including information on demographic characteristics and self-reported statuses regarding hypertension and diabetes. Subsequently, blood pressure and random blood sugar values were measured. Results: Forty-three (41.0%) of the respondents correctly reported their statuses regarding hypertension and 93.3% of the respondents correctly reported their statuses regarding diabetes. 62 (59%) and 7 (6.7%) of them had hitherto undiagnosed hypertension and diabetes, respectively. Only two (9.5%) out of those with a self-reported history of hypertension had normal blood pressure values. There was no agreement between the self-reported and actual profiles of hypertension among the respondents (kappa = 0.000, P = 0.008), and a weak level of agreement between the self-reported and actual profiles of diabetes among the respondents (kappa = 0.559, P < 0.001). Educational level was the identified predictor of correct self-report of status regarding hypertension (P = 0.031); Conclusion: There was a high rate of undiagnosed hypertension and, to a lesser extent, diabetes among this set of urban market traders.

Background: The global burden of cardiovascular diseases (CVDs) is mainly driven by modifiable risk factors, with sub-Saharan Africa as the region to bear the brunt of the increasing burden. Emphasis has been on hypertension while side-lining the others to variable extents. Furthermore, the work environment, which plays an important role in the social life of adults has received less attention. This study aimed to identify nonhypertensive modifiable cardiovascular risk factors among traders in an urban market in Calabar metropolis, Nigeria. Materials and Methods: In this cross-sectional study, we collected data on demographic characteristics and cardiovascular risk profile from eligible traders at Marian market, using a structured interviewer-administered questionnaire. The anthropometric and blood sugar measurements of the participants were duly obtained. Results: A hundred and fifty-one traders comprising 97 (64.2%) females and 54 (35.8%) participated in the study. Physical inactivity (58.3%), obesity (33.1%), risky alcohol consumption (17.9%), diabetes (9.9%), and cigarette smoking (2%) were the identified modifiable cardiovascular risk factors. A greater proportion of the females was obese compared to the males (P = 0.009), whereas the males had greater proportions with physical inactivity (P = 0.003), risky alcohol consumption (P = 0.026), and cigarette smoking (P = 0.022). Conclusion: The proportion of nonhypertensive cardiovascular risk factors was high in the traders, with physical inactivity, obesity, and risky alcohol consumption identified as the most prevalent. Preventive measures to mitigate the increasing burden of CVDs should be extended to traders.

Objective: The influence of cultural and traditional beliefs on key maternal and child health practices in the developing nations cannot be overemphasized. This study was carried out to determine the influence of cultural and traditional beliefs on key maternal and child health practices among rural and urban mothers in Cross River State. Materials and Methods: The study design was a comparative analytical cross-sectional study among mothers with under-five children in rural and urban households in Cross River State and the study populations comprised mothers of under-five children and traditional birth attendants in Cross River State. Sampling technique used to select respondents in the rural and urban sites was multistage sampling method and the sample size was determined using standard method of comparing two independent groups. For focus group discussion (FGD), the purposive sampling method was employed in both study sites. The study instrument was a semi-structured questionnaire and data obtained were analyzed using SPSS version 21.0. Results: Statistical analysis showed that the age of mother, husband, and marriage of women from the rural communities were significantly higher (P > 0.05) than that of women from the urban communities. Knowledge of the cultural beliefs of their people concerning maternal and child health is significantly higher in the rural communities than in the urban communities (P < 0.0001). Similarly, there was significant difference in the cultural dispositions of the rural and urban communities to maternal and child health practices (P < 0.05). The results of this study suggest that traditional beliefs influence maternal and child health-care practices in Cross River State, Nigeria. Conclusions: It is therefore concluded that cultural and traditional influences on maternal and child health practices are predominant in rural settings, with positive or indifferent cultural disposition to recommended practice being commonly associated with such practice. Maternal health education as well as education and engagement of traditional leaders are highly recommended. This should be focused at corrective reorientation toward the preference of recommended best practices that they currently do not support while sustaining the effort at encouraging other best practices.

This study aimed to characterize knee meniscus signal-intensity using magnetic resonance imaging. Our research included knee MR images of 138 subjects from multi-centres in Nigeria, between September 2016 and December 2017. Knee images were retrieved from patients' folder of MRI scanners and transfered to a DICOM workstation (Onis 2.6) for image analysis. Knee meniscus was characterized into 0, 1, 2 & 3 grades using Crue’s grading approach. Our research revealed 58% incidence of meniscal lesion. Study yielded a significant relationship between meniscal lesion and gender (p

Background: Ultrasound is operator-dependent, and its value and efficacy in fetal morphology assessment in a low-resource setting is poorly understood. We assessed the value and efficacy of fetal morphology ultrasound assessment in a Nigerian setting. Materials and Methods: We surveyed fetal morphology ultrasound performed across five facilities and followed-up each fetus to ascertain the outcome. Fetuses were surveyed in the second trimester (18th&ndash, 22nd weeks) using the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guideline. Clinical and surgical reports were used as references to assess the diagnostic efficacy of ultrasound in livebirths, and autopsy reports to confirm anomalies in terminated pregnancies, spontaneous abortions, intrauterine fetal deaths, and still births. We calculated sensitivity, specificity, positive and negative predictive values, Area under the curve (AUC), Youden index, likelihood ratios, and post-test probabilities. Results: In total, 6520 fetuses of women aged 15&ndash, 46 years (mean = 31.7 years) were surveyed. The overall sensitivity, specificity, and AUC were 77.1 (95% CI: 68&ndash, 84.6), 99.5 (95% CI: 99.3&ndash, 99.7), and 88.3 (95% CI: 83.7&ndash, 92.2), respectively. Other performance metrics were: positive predictive value, 72.4 (95% CI: 64.7&ndash, 79.0), negative predictive value, 99.6 (95% CI: 99.5&ndash, 99.7), and Youden index (77.1%). Abnormality prevalence was 1.67% (95% CI: 1.37&ndash, 2.01), and the positive and negative likelihood ratios were 254 (95% CI: 107.7&ndash, 221.4) and 0.23 (95% CI: 0.16&ndash, 0.33), respectively. The post-test probability for positive test was 72% (95% CI: 65&ndash, 79). Conclusion: Fetal morphology assessment is valuable in a poor economics setting, however, the variation in the diagnostic efficacy across facilities and the limitations associated with the detection of circulatory system anomalies need to be addressed.

Background: The presence of breast lump(s) is one of the most common reasons for hospital visits by women especially those of reproductive age. Despite the heightened anxiety associated with the discovery of breast lump often erroneously thought to be breast cancer, majority of these lumps are usually found to be benign histologically. The aim of this study is to determine the prevalence of benign breast diseases in Calabar , Nigeria and to profile their histologic patterns. Method: A descriptive retrospective review over a period of 5 years (January 2012 – December 2017) of laboratory request forms and histopathology records of all patients whose specimens were received in the Department of Histopathology, University of Calabar Teaching Hospital, Calabar, Nigeria were analysed for clinical findings, histopathology reports and demographic data like age, sex etc. Results: Of the 380 reports retrieved 8(2.1%) were male and 372(97.9%) were females. The mean age of the patients was 25.4 ± 9.9 years with majority of the patients in the 2 and 3 decade of life. Gynaecomastia (62.5%) was the commonest benign breast lesion found in males. Fibroadenoma (59.3%) was most frequently found among the females followed by fibrocystic disease and fibrocystic changes (16.4%). Atypical ductal hyperplasia (0.8%) was less commonly found. Conclusion: Benign breast diseases are common amongst young female patients within the 2 and 3 decades of life in Calabar, Nigeria with fibroadenoma being the commonest histologic type. Keywords: Breast, Benign, Histopathology, Calabar

Observation has shown a preponderance of irrelevant, unjustified and perhaps unnecessary radiological requests in the study area. The consequences of this on the patients' doses and population collective dose may be dire.To assess Clinicians/Referrers' knowledge of radiation doses of patients undergoing radiological examinations.A prospective, non-experimental, cross-sectional survey of clinicians (except radiologists) in various hospitals in Calabar metropolis, Cross River State, Nigeria, was conducted. A pretested and validated questionnaire was designed to extract responses on rating of effective doses for commonly requested imaging examinations, using the value for the posterior-anterior (PA) chest x-ray as reference. Questions on radiosensitivity of different organs, imaging modalities that use ionizing radiation and considerations for the choice of ionizing radiation (IR) based examinations were included. Participants were also asked for their preferred methods of filling any knowledge gap on IR issues. Responses were presented in simple percentages.A total of 104 respondents, made up of 63.5% males and 36.5% females participated in the study. At least 70% and 42% of the respondents, respectively, were aware that Ultrasound and Magnetic Resonance Imaging were not IR based modalities. About 67.3% of the respondents did not know the doses of commonly requested radiological examinations. This result was not dependent on clinicians' demography. A total of 61.5% of the respondents referred patients for IR examinations even when the result was unlikely to alter their diagnosis or treatment; but to reassure the patient (98.8% ), meet expectations of patients (35%) or to give the patient the feeling of being taken seriously (75%).Participating Clinicians in this study have showed poor knowledge of radiation doses of commonly requested radiological examinations. Most participants suggested improvement of their knowledge of radiation doses through continuous medical education and by the provision of referral guidelines.

Background/Aim: Induced abortion is a major cause of infertility in our environment, with postabortal complications commonly occurring, especially when done by untrained medical personnel, and in unsafe environments. Imaging plays a very important role in the assessment of tubal factors as a possible cause of infertility; hence, the choice of hysterosalpingography (HSG) as a vital initial tool in the diagnostic evaluation of these patients. The aim of the study was to determine the relationship between induced abortions and HSG tubal findings in the management of females with infertility. Materials and Methods: This was a cross-sectional descriptive study of 87 HSG's of women being managed for infertility in a private specialist hospital over 2 years from November 2015 to October 2017. Results: The overall mean age of the respondents was 34.09 ± 4.82 years. Most of the respondents were between 30 and 39 years (60.9%) of age, 70 (80.5%) respondents were nulliparous, and 71 (81.6%) had a previous history of induced abortion. Tubal findings were found to be normal in over a third of the respondents (35.6%). The most common abnormal findings were tubal blockage and hydrosalpinx (50.6%). The abnormal tubal findings were significantly associated with a history of more than one induced abortion and nulliparity (P < 0.05). Hydrosalpinx (86.4%) was commonly linked with a previous history of induced abortion, although the difference was not statistically significant (P ≥ 0.05). Conclusions: The study demonstrated that abnormal tubal findings in HSG are more common among women with a history of induced abortion; however, the prevalence of tubal damage had mild correlation with the number of induced abortions.

Background: Observation has shown a preponderance of irrelevant, unjustified and perhaps unnecessary radiological requests in the study area. The consequences of this on the patients' doses and population collective dose may be dire.Objective: To assess Clinicians/Referrers' knowledge of radiation doses of patients undergoing radiological examinations.Methodology: A prospective, non-experimental, cross-sectional survey of clinicians (except radiologists) in various hospitals in Calabar metropolis, Cross River State, Nigeria, was conducted. A pretested and validated questionnaire was designed to extract responses on rating of effective doses for commonly requested imaging examinations, using the value for the posterior-anterior (PA) chest x-ray as reference. Questions on radiosensitivity of different organs, imaging modalities that use ionizing radiation and considerations for the choice of ionizing radiation (IR) based examinations were included. Participants were also asked for their preferred methods of filling any knowledge gap on IR issues. Responses were presented in simple percentages.Results: A total of 104 respondents, made up of 63.5% males and 36.5% females participated in the study. At least 70% and 42% of the respondents, respectively, were aware that Ultrasound and Magnetic Resonance Imaging were not IR based modalities. About 67.3% of the respondents did not know the doses of commonly requested radiological examinations. This result was not dependent on clinicians' demography. A total of 61.5% of the respondents referred patients for IR examinations even when the result was unlikely to alter their diagnosis or treatment; but to reassure the patient (98.8% ), meet expectations of patients (35%) or to give the patient the feeling of being taken seriously (75%).Conclusion: Participating Clinicians in this study have showed poor knowledge of radiation doses of commonly requested radiological examinations. Most participants suggested improvement of their knowledge of radiation doses through continuous medical education and by the provision of referral guidelines.Keywords: Clinicians, Ionizing radiation, radiology, practitioners, knowledge.

Background: Peripheral limb vascular diseases form one of the most common diseases that affect the middle‑aged and the elderly. Duplex ultrasound has revolutionized medicare and is an important modality for investigating them. Unfortunately, this modality is still not popular in our environment and in Calabar was used for the 1st time 4 years ago. This work is, therefore, to report our findings and hopefully increase the awareness of its benefits thereby improving and hastening the diagnosis of vascular pathologies in our environment.Methods: A prospective study that took place in the University of Calabar Teaching Hospital, Calabar between March 2011 and August 2014. The study included patients with pain, swelling, ulceration, as well as outright gangrene of the upper or lower limbs. Others were stroke or transient ischemic attack (TIA) patients, and patients with renal grafts. The scans were carried out in Radiology Department using a digital color Doppler ultrasound.Results: Seventy‑six patients were scanned during this period. They were more males (67%) than females (33%). The indications were mainly leg swelling and pain 25 (33%), stroke/TIA 10 (13%), and deep venous thrombosis (DVT) 10 (13%) The most common scan done was peripheral limb Doppler, 49 (64.5%).The majority of the scans showed no abnormality followed by chronic venous insufficiency 13 (17.1%) and lower limb arteriosclerosis 7 (9.2%) which was noted to be common among diabetics and hypertensive. DVT was another common finding and 4 out of 10 patients in whom DVT was suspected clinically showed sonographic evidence of the condition.Conclusion: Duplex ultrasound has been shown to diagnose varied vascular pathologies even in a locale where it is a relatively new technique. It is recommended that timely referrals be made, and mobile Doppler units be acquired to save more lives and limbs in the developing world.Keywords: Calabar, deep venous thrombosis, duplex ultrasound, peripheral lower limbs