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   Table of Contents - Current issue
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July-December 2021
Volume 2 | Issue 2
Page Nos. 43-85

Online since Tuesday, November 30, 2021

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REVIEW ARTICLES  

Setting up a sustainable interventional radiology practice in a resource-limited environment: Steps to note, challenges, and strategies p. 43
Omodele A Olowoyeye, Kofo O Soyebi, Olubukola Omidiji, Adekunle Adeyomoye, Nicholas Kayode Irurhe, Hammed Ninalowo
DOI:10.4103/jrmt.jrmt_11_21  
Interventional radiology (IR) is a developing sub-specialty in Nigeria. Although IR equipment and consumables are expensive, the benefit to patients on the long run compensates for the financial costs. There are various measures that should be put in place to ensure a safe IR practice. There are associated challenges that may be peculiar to different types of hospitals in our environment. This paper focuses on the steps to consider when setting up an IR practice in a resource-limited teaching hospital setting. It also highlights possible challenges and strategies to overcome such challenges.
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Systemic complications and imaging challenges of sickle cell disease in sub-saharan Africa p. 48
Grace B Inah, Emmanuel E Ekanem, Christiana I Obiora, Godwin I Ogbole
DOI:10.4103/jrmt.jrmt_12_21  
With improved life expectancy of people living with sickle cell disease (SCD) as a result of modern interventions, chronic problems such as pulmonary, abdominal, cardiovascular, musculoskeletal, and obstetric challenges are more often encountered. The need for radiological examination is, therefore, growing for the early diagnosis of these complications and improved prognosis. The emphasis, therefore, should be toward safer diagnostic options such as ultrasonography, transcranial Doppler ultrasound, and echocardiography as repeated radiation is counterproductive. This review is aimed at highlighting the imaging challenges encountered in the management of SCD in sub-Saharan Africa and possible ways of mitigating them. We reviewed available electronic literature in the last 20 years, especially articles from Google Scholar and PubMed with search keywords of imaging challenges, sickle cell disease, and sub-Saharan Africa. The challenges identified in this review include lack of institutional infrastructure, poor equipment availability, weak health and imaging personnel capacity, treatment affordability, service accessibility, and poor research and training facilities. With the increasing longevity of SCD individuals in sub-Saharan Africa, imaging requirements are rising. Repeated exposure to radiation should be minimized as much as possible. Engagement of the private sector through public-private partnership in equipping health institutions with radiological equipment, as well as training of appropriate personnel for their deployment is strongly recommended to enhance care, prevent complications, and improve outcomes for SCD in sub-Saharan Africa.
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ORIGINAL ARTICLES Top

Plain chest radiographic findings among COVID-19 patients in sub-saharan Africa p. 55
Donald Amasike Nzeh, Hadijat Oluseyi Kolade-Yunusa, Ibrahim Shalangwa, Bisallah Ahmed Ekele, Felicia Anumah, Udugh Isaac, Paul Ogbonyomi, Thairu Yunusa, Vivian Gga Kwaghe, Zaiyad Habib, Alexander Agada Akor, Anthony Bawa, Francis Adebayo, Godwin Idoko, Olusegun Akintola
DOI:10.4103/jrmt.jrmt_4_21  
Background: Coronavirus disease (COVID-19) is a pandemic that is ravaging the world. Chest imaging plays an important role in the diagnosis and management of patients with COVID-19-related chest infections. This study determined the pattern of chest radiographic features among confirmed COVID-19 patients in Abuja, Nigeria. Materials and Methods: Chest radiographs (CXR) of COVID-19 patients were reviewed, and the radiological features of the lesions were recorded based on the type of opacities, pattern of distribution in the lung fields, side of lesions, and severity of pulmonary abnormalities. Results: The radiographs of 77 patients were analyzed. Their age range was 15–88 years with a mean of 47.4 years and peak age group of 51–60 years. Gender distribution of the patients was 58 (75.3%) males and 19 (24.7%) females giving a male-to-female ratio of 3.1: 1. Fifty-five (71.4%) of the patients had normal CXRs, whereas 22 (28.6%) patients had abnormal pulmonary appearances. Seven (58.3%) out of 12 patients with mild interstitial pneumonia had unilateral disease, whereas 5 (41.7%) had bilateral disease. Combined total of ten patients with moderate and severe interstitial pneumonia all had bilateral disease. Conclusion: Plain CXR gives reliable diagnosis about the presence and degree of interstitial pneumonia in COVID-19 patients. CXR should be routinely done as a baseline diagnostic tool in patients positive for reverse-transcription polymerase chain reaction test. The findings in the CXRs of COVID-19 patients in sub-Saharan Africa are similar to those reported from the other parts of the world.
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The role of computed tomography in the management of patients with suspected COVID-19 – A Nigerian study p. 61
Olubukola Khadija Ajiboye, Ohiole Ayeni, Oludolapo Sherifat Katibi, Ummi Musa Umar, Chiedozie Osuoji, Said Ajibola Agboola, Evelyn Ogedegbe, Felix Ogedegbe
DOI:10.4103/jrmt.jrmt_17_21  
Background: Computed tomography (CT) of the chest is a useful diagnostic adjunct in the management of COVID-19. It has proven useful in areas where ready access to real-time reverse transcriptase polymerase chain reaction (PCR) is not readily available. Objectives: This study sought to evaluate the chest CT findings of patients suspected with having COVID-19 on presenting at the emergency room. Materials and Methods: This is a retrospective study done in Cedarcrest Hospitals, Abuja, with patient information pooled from patients' electronic medical records from April to December 2020. Patients were selected based on suspicion of COVID-19 infection. Suspicion was stratified into high, moderate, and low using an in-house clinical suspicion score called the Cedarcrest Emergency COVID-19 Risk Assessment Tool. Patients with background pulmonary pathology or chest trauma were excluded. Plain chest CT scans were performed to evaluate for COVID-19 pneumonia. Results: CT imaging increased the clinical suspicion of COVID-19. However, no statistically significant relationship was found between the positive CT findings and the PCR results. Conclusion: Chest CT should be correlated with clinical findings and laboratory results for patient evaluation.
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Experience with percutaneous drainage of body fluids in a tertiary center in Benin City p. 66
Blessing O Igbinedion, Festus Ehigiamusoe, Esongboriaimen Mabel Agbebaku
DOI:10.4103/jrmt.jrmt_13_21  
Background: Percutaneous drainage is the evacuation of body fluids either using needle aspiration or by catheter placement under imaging guidance. Abnormal collections in the body which may be idiopathic, postinfectious, posttraumatic, or postsurgical (iatrogenic) can be free (e.g., ascites) or loculated (e.g. cysts and abscesses). Most cases of significant fluid accumulation require evacuation. Interventional radiology offers treatment and even cure to such patients who may be too ill to withstand surgery or not able to afford the cost of open surgery. The aim of this article is to review the common percutaneous drainage procedures done in the Radiology department of the University of Benin teaching hospital. Materials and Methods: A retrospective analysis of percutaneous drainage requests to the department of radiology of the hospital from January 2017 to march 2020 was performed. Data on age, gender, clinical diagnosis, the radiologic findings, procedures, and instrumentation utilized were retrieved and analyzed using IBM SPSS version 23. Results: A total of 49 patients' data were recruited for this study; 40 (81.6%) were female. The most common indication for intervention was liver abscess (14.3%), followed by liver cyst, endometriosis, obstructive jaundice, and pelvic abscess. The IV cannula/sheath was the most widely used instrument, followed by the pigtail catheter. All patients had their procedures done under antibiotic cover and the cases of hepatic cysts had albendazole added to their drug regimen. Conclusion: Despite the limited availability of resources for interventional radiology, basic procedures like cyst and abscess drainages can be successfully carried out using available materials and catheters.
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Diagnostic value of ultrasonographic portal venous index in the assessment of liver fibrosis in chronic viral hepatitis in Lagos, Nigeria p. 72
Kofo O Soyebi, Ajibola S Agboola, Ganiyat K Oyeleke
DOI:10.4103/jrmt.jrmt_14_21  
Background: Delayed intervention in chronic viral hepatitis results in progression to fibrosis and hepatocellular carcinoma. Determining the degree of liver fibrosis is invaluable in the initiation of clinical interventions, prevention of progression, and prognostication of end-stage liver disease. Considering the risks of liver biopsy (the standard for assessing fibrosis), safer methods are necessitated. Aim: The aim of this study was to determine the reliability of ultrasonographic Portal Venous Index (PVI) in assessing liver fibrosis. Subjects and Methods: Doppler Ultrasonography-determined Aspartate-Platelet Ratio Index (APRI) Score. Results: The mean age for the subjects was 35.79 ± 10.75 years and controls was 36.51 ± 11.31 years. They were sex matched. HBV was more common, with a 99:3 HBV: HCV ratio. HBV immunization compliance in both the groups was poor. The median PVI of the subjects and controls was 0.36 and 0.42, respectively, which was statistically significant (P = 0.025). There was no significant difference in median PVI between subjects with and without significant fibrosis as determined by APRI score. There was an inverse but moderate correlation between PVI and APRI score (r = −0.57, P = 0.569). The area under the receiver operating characteristic curve was 0.524 (95% confidence interval: 0.36–0.69). The cutoff for PVI was 0.34 with a sensitivity of 57.1% and a specificity of 57.4%. Conclusion: PVI is useful in distinguishing healthy individuals from virus-induced chronic liver diseases but could not adequately determine the degree of liver fibrosis.
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Umbilical artery doppler reference indices in normal pregnancy p. 79
Owoicho Daniel Okochi, Aliyu Yabagi Isah, Hadijat Oluseyi Kolade-Yunusa, Habiba Ibrahim Abdullahi
DOI:10.4103/jrmt.jrmt_10_21  
Background: Umbilical artery Doppler (UAD) studies offer a noninvasive method of indirectly assessing the fetal and uteroplacental circulation. However, the umbilical artery (UA) velocimetry reference currently in use was established in developed countries and derived from pregnant women that are likely to have had different biophysical characteristics. There is a need to develop an UA index nomogram for the indigenous pregnant population. Aim: The aim of this study was to determine the UAD reference indices among women with normal singleton pregnancy. Materials and Methods: This was a cross-sectional descriptive study of 422 women with uncomplicated pregnancies who attended the antenatal clinic of the University of Abuja Teaching Hospital with pregnancy ages between 28 and 40 weeks' gestation. The systolic and diastolic (S/D) ratio, the resistance index (RI), and the pulsatility index (PI) of the UA were obtained. Results: The mean UAD showed a progressive decrease with increasing fetal gestational age with S/D ratio, PI, and RI being 3.05 ± 0.28, 1.07 ± 0.1, and 0.68 ± 0.05 at 28 weeks and 2.10 ± 0.17, 0.73 ± 0.09, and 0.52 ± 0.04 at 40 weeks, respectively. Estimated reference values for relatively normal singleton fetuses S/D ratio, PI, and RI were 2.98, 1.03, and 0.67 and 2.07, 0.72, and 0.52 at 28 and 40 weeks of gestation, respectively. The S/D ratio (r = ‒0.741, P ≤ 0.002), PI (r = ‒0.694, P ≤ 0.001), and RI (r = ‒0.366, P ≤ 0.001) were significantly different from the existing reference value of 3.02 (S/D ratio), 1.05 (PI), and 0.62 (RI) and 2.18 (S/D ratio), 0.82 (PI), and 0.52 (RI). The respective existing values were at 28 weeks and 40 weeks of gestation. Conclusion: The UA index nomogram obtained from this study showed significantly lower values compared with the existing values, and therefore, it is advocated for use among African pregnant population.
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