Background: Sonographic breast density pattern like mammography is dependent on the relative proportion of connective and glandular tissue. Breast density is a marker for breast cancer risk and has received wide spread interest in many countries in recent times. Aims and Objectives: This paper aims at describing the sonographic breast pattern in women in Ibadan using the American College of Radiology in its breast imaging reporting and data system (ACR-BI-RADS) lexicon. It will also estimate the prevalence of the different sonographic breast patterns and attempt to find any association between the breast patterns and various demographic variables in the women studied. Materials and Methods: A prospective, descriptive study of the sonographic breast pattern in 573 women carried out at the Department of Radiology, University College Hospital, Ibadan. Nigeria. Breasts scans were performed with an Aloka SSD and Logiq P5 machine. Results: A total of 573 women were recruited into the study. Their age ranged between 14 and 74 years (mean = 38.91 ± 12.51 years and median = 38 years). The modal age group was 30-39 years (26.9%). The women attained menopause between 35 and 59 years (mean = 46.2 ± 5.1 years) while the median age for menopause was 47 years. The majority of the women studied were either obese or overweight (66.9%). Sixty-one (10.6%) women had a positive family history of breast cancer with the heterogeneous fibroglandular (60.7%) breast pattern being commonest in this high risk group; and in the entire study population (52.7%). Significant associations between the sonographic breast pattern, age, menopausal status, parity, body mass index (BMI), and waist-hip ratio (WHR) was found. BI-RADS 2 breast pattern appeared to decrease with increasing age while BI-RADS I breast pattern increased with increasing age (P < 0.001). Conclusion: Ultrasonography like mammography, can define the parenchymal breast pattern accurately. Strong correlation exists between parenchymal breast pattern and demographic, parity variables, and breast cancer risk factors.

Background: Long standing hypertension may result in thickening of arterial walls and is reportedly strongly correlated with body mass index (BMI). B-mode ultrasound is a reproducible method for evaluating adaptive vascular changes. The aim of this study is to determine the relationship between body mass index and ultrasound measured carotid intima-media thickness (CIMT) among adults with primary hypertension. Materials and Methods: One hundred and twenty adults of both genders diagnosed with primary hypertension at the University College Hospital (UCH), Ibadan underwent B-mode ultrasound evaluation of the walls of the common and extracranial internal carotid arteries bilaterally. Participants' height and weight were measured and body mass index (BMI) was calculated. Results: Study population had gender distribution of 50 (41.7%) and 70 (58.3%) for males and females, respectively; and a mean age of 50.61 ΁ 10.94 years. Mean height, weight, and BMI were 1.66 m, 69.36 kg, and 24.92 kg/m ² for male subjects and 1.59 m, 65.6 kg, and 25.6 kg/m ² for female subjects, respectively. Normal/underweight and overweight/obese male participants had mean CIMT of 0.744 and 0.820 mm (P < 0.05) on the right side of the neck and 0.740 and 0.816 mm (P < 0.05) on the left side, respectively. However, female participants showed no statistically significant variation in CIMT values for both BMI groups. Conclusion: B-mode ultrasound demonstrates statistically significant variation in CIMT values between normal/underweight and overweight/obese male adults diagnosed with primary hypertension.

Background: The Benin stroke score (BSS) is a validated tool in the diagnosis of intracerebral hemorrhage (ICH) but not in the diagnosis of brain infarct. The aim of this report is to specifically validate the BSS in the clinical diagnosis of acute brain infarct. Materials and Methods: A total of 60 participants with a presumptive diagnosis of acute stroke in a busy tertiary neurologic care centre in Francophone West Africa were evaluated within 48 h of onset of symptoms with the BSS after basic data were obtained, before computed tomography or magnetic resonance imaging scans was used as gold standard. BSS is a three-item tool that scores age, supine diastolic blood pressure, and Glasgow coma scale with a minimum score of 0 and a maximum score of 3.5. A score of 2.5 or less is diagnostic for a brain infarct. Results: The sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratios of BSS in the diagnosis of brain infarct were 83.78%, 69.56%, 81.57%, 72.72%, 2.75, and 0.23, respectively. BSS agreed with neuroimaging in the diagnosis of all stroke subtypes significantly on kappa statistics (k = 0.538, P < 0.001) and interrater and intrarater reliability between two cadres of medical personnel in the use of BSS were significant (r = 0.9. 0.95, 0.95, P < 0.001, <0.001, <0.001), respectively. Conclusion: BSS as a simple clinical tool could be used with appreciable levels of accuracy in the clinical diagnosis of acute brain infarct where neuroimaging may not be available or immediately inaccessible, much the same way it is being used for ICH.

Background: Human immunodeficiency virus (HIV) testing and counseling has remained significantly low in rural communities of Nigeria despite the huge benefits of early case detection and treatment. This study aims at evolving strategies based on the health-seeking attitudes of rural people in order to improve their HIV testing access. Materials and Methods: A cross-sectional study was carried out between May and June 2011 among persons of reproductive ages, that is, 15 years and above for men and 15-49 years for women; normally resident in rural communities of Rivers State, Nigeria, selected using a multistage sampling technique. Results: A total of 267 (42.0%) males and 368 (57.9%) females were interviewed. Most of the respondents (619, 97.5%) had heard about HIV, and 498 (78.4%) were aware of its transmission by sexual route. Condom use was low and non-use with a nonmarital partner 12 months preceding the survey was 33.8% (191). Only 242 (38.1%) had ever tested for HIV: 90 (37.2%) men and 152 (62.8%) women (χ² = 15.14, degree of freedom (df) =1, P = 0.000), while only 33 (13.6%) had tested for HIV based on sexual risk perceptions. The commonest reasons for HIV testing were pregnancy, premarriages, and test for concordance. Reasons for not testing were lack of perception of HIV risk, fear of stigmatization, and discrimination from positive test result. Conclusion: This study highlights the persistence of low HIV testing culture in rural settings in Nigeria and underscores the need that HIV programs should look beyond the healthcare settings and involve the communities, using home and community-based testing approaches in order to expand HIV testing access.

Background: The safety of percutaneous renal biopsy (PRB) has been debated. The primary aim of this study was to review the procedure and secondary aim is to evaluate the safety of PRB in children in a developing nephrology unit in Northern Nigeria. Methods: Renal biopsies carried out in the renal unit of a teaching hospital in northern Nigeria between November 2011 and April 2013 were retrospectively reviewed. All biopsies were carried out electively and under real-time ultrasound guidance using an automatic spring-loaded biopsy gun. Risk factors for complications were analyzed using logistic regression. Results: A total of 24 biopsies were carried out in 20 children with nephrotic syndrome during the period under review. Mean age was 8.3 ΁ 3.0 years. Steroid resistant nephrotic syndrome was the most common indication for biopsy in 11 (55%) cases. Adequate tissue was obtained in 91.7%. Complications occurred in 2 (8.3%) cases. One required hospitalization with blood transfusion. Pre-biopsy hemoglobin concentration of <10 g/dL was found to be a significant predictor for the development of complications (P < 0.05). There was no significant difference in the rate of complications between the in-patient biopsies and day case biopsies. Conclusions: PRB can be safely carried out as an out-patient procedure in children. Low hemologlobin concentration was the major risk factor for complication.

Background: Fournier's gangrene (FG) though a rare condition can be associated with significant mortality. There are few reports in our environment documenting the outcome of management of the condition. The aim of the following study was to describe the clinical characteristics and outcome of management of patients with FG in a tertiary hospital in Southwest Nigeria. Patients and Methods: The clinical records of patients who presented with FG at a tertriary hospital over a 5 year period were reviewed. Results: A total of 11 cases were reviewed and all patients were male. The scrotum alone was the most common site of involvement (54.5%). Late presentation was common with 9.6 days (range 1-21 days) being the average duration between the onset of symptoms and presentation at the hospital. Most of the patients (63.6%) did not have any identifiable systemic predisposing factor. There was no mortality or testicular loss recorded. Conclusion: Patients with FG still present late in our environment. However, appropriate aggressive treatment can help ameliorate the associated mortality and morbidity even in a resource poor setting.

Background: Intrauterine adhesion (IUA) represents scar tissue inside the uterine cavity. Many patients may experience recurrent miscarriages, menstrual dysfunction, and may also be unable to achieve pregnancy. Tubal abnormalities are a significant cause of infertility in women. Hysterosalpingography (HSG) is a useful screening test for the evaluation of the uterine cavity and provides information relating to the assessment of tubal morphology and patency. Materials and Methods: The HSG radiographs of 92 patients with intrauterine adhesions, between November 2008 and October 2011, in the Lagos State University Teaching Hospital, were assessed and analyzed for tubal abnormality. Results: Out of the 92 patients studied, 12 (13.04%) were diagnosed with primary infertility, while the rest of the 80 (86.96%) were referred for secondary infertility. The age range of the patients was between 27 and 42 years, with a mean age of 34.58 ± SD years. The mean infertile period of all the study subjects was 5.78 ± SD years. The prevalence of tubal abnormalities demonstrated in the study was 67.39%. Sixty-six (71.73%) patients presented with minor adhesions, while 26 (28.27%) patients presented with moderate adhesions. Conclusion : The prevalence of tubal abnormalities demonstrated in patients with intrauterine adhesion was 67.39%.

Objective: The aim of the following study was to determine the types of intervention sought by the blind street beggars and assess the barriers to accessing available eye care services. Methods: This cross-sectional study was conducted among consenting blind street beggars in Sokoto, Nigeria between May and June, 2009. A semi-structured interview was conducted to probe issues on historical antecedents of the blindness and the eye heath seeking behavior including the use of traditional eye medications. Assessment of barriers to accessing curative services among the blind persons was explored. Questions were asked and the individual responses were recorded in the questionnaire under the appropriate sections. Results: Two hundred and two of 216 (94.7%) of the examined subjects were found to be blind and included in the analysis. The principal cause of blindness was corneal opacity. Overall 82% of the blindness was due to avoidable causes with majority irreversibly blind. Only 38 subjects (18.8%) sought for intervention in hospitals, others resorted to self-medication (42.1%), medicine store (31.2%) and traditional facility (7.9%). Those that accessed treatment at a hospital did so mainly at a primary health center (50.0%) and General Hospitals (34.2%). The barriers to accessing treatment at the hospital were mainly due to "not taken to any hospital" by the parents/relatives (50.3%) and "services not available" (25.2%). Conclusion: Most respondents resorted to ocular self-medication particularly traditional eye medicines. We advocate for a provision of affordable, accessible and qualitative eye care services with a strong health education component on avoidable causes of blindness.

Background: Regular participation in physical activity (PA) programs is a key concept included in current public health guidelines. Therefore, this study was aimed to determine PA level among adult with type 2 diabetes. Methods: A cross-section of 122 participants selected consecutively were categorized as physically inactive or active using International Physical Activity Questionnaire. Data was assessed using descriptive and inferential statistics. Results: About 31% of the respondents were physically inactive. Residential areas were significantly associated with PA. A high proportion of those who lived in the metropolitan area were physically inactive. Less likely to be physically inactive were married (odds ratios [OR] =0.29, confidence interval [CI] =0.09-0.93) and living in an urban area (OR = 0.19, CI = 0.40-0.87). The degree holders are least physically inactive while the primary school leavers are highest. The median energy expenditure for walking, moderate and vigorous PA was 280.5, 80 and 0 MET-min/week respectively. The sedentary behavior of the respondents was 288 min/day, behavior which increases with age. Conclusion: This study suggests that the prevalence of physical inactivity was high among type 2 diabetics and their sedentary behavior is over 4 h/day. This group of people should be encouraged to participate regularly in PA.

Objective: To determine the pattern and outcome of medical admissions as well as the basic demographic characteristics in medical wards of a tertiary health center located in a rural area. Materials and Methods : A retrospective analysis of medical wards admissions of the Federal Medical Centre, Ido-Ekiti, Ekiti State, southwest Nigeria, between January 2009 and December 2011. Data obtained was analyzed using SPSS Version 16 software. Result: The total number of patients admitted during the period was 1519, age ranged from 16 to 120 years, with a mean of 56.1 + 18.8 years. There were 823 (54.3%) males and 696 (45.7%) females in a ratio of 1.2:1.0; the highest number of age group admitted was the elderly. Disorders of the cardiovascular system topped the admission list (32.1%) in general, and noncommunicable diseases were also predominant (68.4%) on the admission list compared with communicable diseases (31.6%). The most common cause of death was cardiovascular diseases (33.0%). Conclusion: Male gender and elderly aged groups were predominant on admission. Noncommunicable diseases were of higher proportion on admission than communicable diseases. The most common cause of death was cardiovascular diseases of which stroke topped the list.

Background: Low- and middle-income countries bear the mortality burden of head injury compared with high-income countries. Not much has been studied about predictors of poor outcome after head injury in these countries. This study describes and quantifies the effect of demographics and injury causative factors on mortality in a cohort managed in a Nigerian tertiary hospital intensive care. Materials and Methods: A retrospective study was undertaken of all patients admitted into intensive care with severe head injury at the University of Port Harcourt Teaching Hospital, Nigeria between 1 ^st January, 1997 and 31 ^st December, 2006. Logistic regression analysis was performed to examine the effect of age, gender and injury etiology on risk of intensive care unit (ICU) mortality. Results: The number of ICU admission for severe head injury was 231 patients with a male to female ratio of 2.8:1. Patients' mean age and standard deviation was 31.2 ± 15.5 years. The mortality rate was 52.8%. Road traffic injury was the most common etiologic factor (84%). Logistic regression analysis indicated a 56% increase in the risk of ICU mortality between the ages of 21 and 40 years. The effect of age was found to be nonlinear (likelihood ratio P = 0.033). On multivariable analysis, patient's gender (odds ratio 1.07; 95% confidence interval: 0.56-1.97) and etiology of injury were not significantly associated with risk of mortality. Gender was not a modifier of the effect of age (P = 0.218). Conclusion: The study indicated a strong prognostic effect of age. Gender and etiology of injury had no effect on ICU mortality among study cohort.

Background: Mentally ill persons are vulnerable to sexually transmitted infections including hepatitis B and C because of their high level risky behaviors. This study is aimed at establishing the sero-prevalence of hepatitis B and C among the mentally ill individuals (MII) attending Psychiatric clinic of the University of Ilorin Teaching Hospital (UITH), Nigeria since it has not been documented. Methods: A total of 350 MII were recruited. HBsAg testing was by immunoassay test strip (Grand Medical Diagnostic ^R USA) while hepatitis C was tested by commercially prepared kits from ACON, ^R USA. Healthy adults who presented as donors in the Blood Bank of the hospital were used as controls. Results : A total of 700 participants including 350 MII and 350 blood donors (BDs) were recruited for the study. The mean ages of MII and control participants were 36.5 ± 12.3 and 31.4 ± 8.3, respectively.The sero-prevalence of hepatitis B and C among patients with mental illness was 10.0 and 12.6%, respectively, as compared to 10.9% and 1.1% of the blood donors. There was a significant difference in the prevalence of HCV among mentally ill when compared with the blood donors (P = 0.001, χ² = 33.97; OR (CI) =12.44 (5.33-29.03). Conclusion : Mentally ill patients attending UITH were significantly infected with hepatitis C virus. There is need for interventional measures to reduce the prevalence of hepatitis C among the mentally ill population such as health education and early screening of mentally ill in our setting.

Background: Stroke is a common cause of morbidity and mortality worldwide. Therapeutic decision regarding its management requires prompt and accurate diagnosis as well as exclusion of other conditions mimicking this condition. Computerized tomography (CT) scan has been found to be the gold standard in distinguishing primary intracerebral hemorrhage (ICH) from cerebral infarction (CI). Methods: A retrospective review of CT findings in 128 patients who presented in the Radiology Department of Usmanu Danfodiyo University Teaching Hospital with clinical diagnosis of stroke was undertaken over a period of 1 year (from December 2008 to November 2009). The following data were recorded; age, sex, clinical diagnosis, and CT findings. All the CT examinations were performed on a Neusoft C3000 multidetector spiral CT. Evaluation was done by consultant radiologists in the department. Results: Of the 128 patients seen within the period under review, 84 (65.6%) were males while 44 (34.4%) were females. Age range was 4-85 years (mean 49.52, standard deviation (SD) 15.11), while 61 (47.7%) of the patients were in the age group of 41-60 years. Eighty-six patients (67.1%) had cerebral infarction, 38 (29.7%) had intracerebral hemorrhage, while one (0.01%) had subarachnoid hemorrhage. Three patients (0.02%) had normal brain CT findings. Conclusion: Cerebral infarction is the most common form of stroke in this study. CT is essential in establishing the type of stroke, which subsequently determines the type of intervention as well as follow-up evaluation the patient may require.

Background: Hemodialysis (HD) is the readily available modality of renal replacement therapy in Nigeria today. The number of centers for HD continues to increase, but the majority is still located in the big cities and towns. Methods: A retrospective descriptive study in which records of patients on HD from 2004 to 2011 were reviewed. Data in respect of patients' sex, age, occupation and etiology of kidney disease were collected. Data were analyzed using Statistical Package for the Social Sciences statistical software version 16 (SPSS Inc, Chicago IL). Results: A total of 1278 new patients were admitted for HD over the period of review; 60.9% (778) were males and 39.1% (500) females. Mean age of male patients was significantly higher than that of the females (P < 0.01). Those under the age of 40 years constituted 45.4% (580) of the study population, whereas 43.8% (560) were unskilled workers. Nearly 81.1% had CKD while 18.9% (241) had acute kidney injury (AKI). The most common cause of CKD and AKI were chronic glomerulonephritis (CGN) and sepsis respectively. Conclusion: This review showed a preponderance of males in the dialyzed population with males significantly older than the female patients. Patients aged ≤ 40 years and unskilled workers formed a large proportion of the population of HD treated patients. CGN and sepsis were the most common causes of CKD and AKI respectively.

The protrusion of articular soft-tissue from the temporomandibular joint (TMJ) into the external ear in the absence of trauma, neoplasm or inflammation is rare. We present below a Nigerian adult male with retrodiscal herniation of soft-tissues of the TMJ into the external auditory meatus through a persistent foramen of Huschke. We are not aware of any reports of this developmental defect or its prevalence in the Nigerian medical literature. Therefore, this case is presented to heighten the index of suspicion of physicians when managing patients with otorrhea and otalgia; which is often primarily diagnosed or misdiagnosed as otitis externa. This will help avoid complications associated with the anomaly, some of which could be very serious.