Pattern and value of Sperm DNA Fragmentation Index and its correlation with spermiogram in infertile South West Nigerian Men

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±4.19×106 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.

The spermiogram and correlation of seminal fluid parameters in patient attending fertility centre in Lagos, South West Nigeria

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 114×106 sperm cells and 42×106 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.

Relationship between Mammographic Findings and Breast Abnormalities in a Nigerian Population

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.

Diagnostic accuracy of ultrasonography in adults with obstructive jaundice

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.

Ultrasonic determination of gestational age by assessment of fetal kidney size in the third trimester in southwest Nigeria

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.

The role of electrocardiogram in sex verification in a young adult with primary amenorrhea: a case report

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 V1, 3; ST segment in lead V2 or V3, 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.

Relationship between Renal Doppler Indices and Biochemical indices of Renal Function in Type 2 Diabetes Mellitus

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.

Variations of renal vascular anatomy in a nigerian population: A computerized tomography studys

Background

A broad spectrum of renal vascular variations has been reported by anatomists and radiologists. The prevalence of these variations is extremely divergent in different populations. Therefore, radiologists and surgeons in different climes must be knowledgeable about the type and prevalence of the variants in their area of practice to avoid diagnostic pitfalls and for optimization of surgical techniques.

Objective

The objective of this study is to describe the types and prevalence of renal vascular variations among patients undergoing contrast-enhanced computerized tomography (CECT) of the abdomen in a Nigerian population, as well as provide a concise review of literature on the embryological basis and clinical significance of the identified variations.

Materials and Methods

This study was a retrospective review of 200 CECT of the abdomen to identify variations of arterial (accessory, early branching, and precaval) and venous (multiple, retroaortic, and circumaortic) anatomy of the kidneys.

Results

We studied 200 patients, 102 (51%) females and 98 (49%) males. Age range is 18-90 years (mean = 53.08 ± 17.01). Prevalence of any renal vascular variations was 50%, arterial variations were 37%, and venous variations were 13%. Variations were significantly more common in males, P = 0.000075. The most common arterial variant was the accessory renal artery (23%) seen in 10% (right) and 13.0% (left); early branching was seen in 4.0% (right) and 0.5% (left) as well as precaval right renal artery seen in 4.5%. Venous variants were late confluence 3.0% (right) and 2.5% (left); multiple veins was seen in 2.5% (right) and 2.5% (left) as well as retroaortic left renal vein seen in 2.0%. The inferior polar accessory artery was the most prevalent accessory artery. Early arterial bifurcation was significantly more common on the right (P = 0.016) while other vascular variants showed no statistically significant association with laterality.

Conclusion

Variation of renal vascular anatomy is a frequent finding among Nigerians. Radiologists and surgeons must be aware of these variants for optimization of surgical techniques.

Sphenoid Sinus Pneumatization, Septation, and the Internal Carotid Artery: A Computed Tomography Study

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.

Radiation dose and radiation protection principle awareness: a survey among Nigerian paediatricians

AIMS AND OBJECTIVES

This study is aimed at determining the knowledge of Paediatricians in Nigeria about the basic principle of radiation protection ALARA (As Low As Reasonably Achievable) and their knowledge of the radiation doses that children receive during some common radiological procedures.

MATERIALS AND METHODS

Two hundred and fifty questionnaires were circulated among paediatricians at the 2012 annual Paediatricians' Association of Nigeria Conference. The questionnaires contain 10 questions designed to asses the pediatricians' general knowledge on : ionising radiation and the risks, doses children receive during some common radiological procedures and awareness of the radiation protection principle, ALARA ( As Low As Reasonably Achievable).

RESULTS

Of the 162 Paediatricians that participated, 69% named at least one non medical source of ionising radiation, 54.9% would not recommend CXR to screen an apparently healthy child for tuberculosis and 87% believe that children are at greater risk of adverse effects of ionising radiation. For dose estimation, 51.9% and 51.2% of the paediatricians underestimated doses received during Cranial and abdominal computerised tomography respectively while 13.6% and 37% respectively erroneously believed that abdominal ultrasound and brain magnetic resonance imaging utilise ionising radiation. 13.6% gave the correct meaning of the Acronym ALARA.

CONCLUSIONS

The Paediatricians' knowledge about the basic principle of radiation protection ALARA and the doses that children receive during some common radiological procedures is poor. There is need to ensure adequate training on radiation hazards and protection at all levels of medical education.

Prevalence and complications of gallstone disease among pregnant women in a Nigerian hospital

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.

What is the fate of the missing intrauterine contraceptive device?

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.

Neglected massive intracerebral abscess: an unusual cause of bilateral visual loss

BACKGROUND

Bilateral visual loss following chronically raised intracranial pressure is not uncommon especially in developing countries. However, this calls for concern when the cause of the raised intracranial pressure is neglected pyogenic cerebral abscess.

CASE SUMMARY

A sixteen year old male student presented to our unit with eight months history of recurrent headache associated with early morning vomiting. He developed bilateral visual loss a month prior to presentation. He had sought treatment at several herbal homes and orthodox hospitals before presentation. His cranial computed tomographic scan (CT) showed a massive peripheral contrast enhancing lesion in the frontal lobes with gross midline shift and other evidence of mass effect. He subsequently had craniotomy and excision of the mass. Intraoperative and laboratory findings confirmed the lesions to be abscess. He had ciprofloxacin and metronidazole for four weeks. He had uneventful postoperative period though his visual loss has persisted. He is being followed up in the clinic.

CONCLUSION

This patient illustrates that untreated frontal lobe abscess could cause bilateral visual loss from chronically elevated intracranial pressure (ICP). Even though this should be rare in contemporary neurosurgical practice, ignorance and poverty which are rife in developing countries will be important contributory factors. Physicians working in developing countries should be aware of the symptomatology of cerebral abscess and raised ICP. They should encourage patients to do cranial CT when the features are suggestive of space occupying lesions.

The appearances of benign breast diseases on ultrasound

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.