Introduction: The cerebrospinal fluid within the ventricles could be in excess or markedly reduced, and these could be the only sign of an intracranial or intraventricular disease. The linear dimensions of the 3 ^rd and 4 ^th cerebral ventricles are key to some of these findings. The practice of using the reviewer's experience or observing a change in the shape of the ventricles can be very subjective, hence the need for normal values. Objective: To establish linear dimensions of the 3 ^rd and 4 ^th cerebral ventricles among normal adults in Zaria using computer tomography. Materials and Methods: Axial computerized tomographic brain scans of the 488 normal subjects reviewed were acquired during a 3 year period (2009-2012) using a multi-slice GE Sigma excite scanner in our department, and the images were reviewed retrospectively. We obtained the widest linear dimensions of the 3 ^rd and 4 ^th cerebral ventricles using the in-built linear calipers of the computer tomography (CT) scan machine for each patient. Statistical analysis was performed using Sigmastat 2.0 for Windows (Statsoft, San Rafael, CA). The following statistical tests employed: students t-test and analysis of variance, and a probability level of <0.001 taken as statistically significant. Results: The 488 brain CT scans analyzed for this study comprised of 319 (65.36%) males and 169 (34.63%) females. The ages ranged from 18 to 84 years with a mean age of 37.26 years. The age difference between males and females were statistically significant. The mean 3 ^rd ventricular widths were 4.23 ± 1.25 and 3.81 ± 0.87 in males and females respectively, whereas the mean 4 ^th ventricular widths were, 7.87 ± 1.30 and 7.54 ± 1.33, in males and females, respectively. Conclusion: In this study, we have established normal linear values for the 3 ^rd and 4 ^th cerebral ventricles in Zaria using computed tomography. These values could serve as a quick reference for radiologists and neurosurgeons, obviating the need for advanced software packages, which may not be readily available.

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Introduction: Perinatal asphyxia is a global neonatal problem which significantly contributes to both morbidity and mortality. It is the fifth largest cause of under-five mortality. This study was aimed to determine the prevalence, risk factors and outcome of perinatal asphyxia in newborns seen in the Special Care Baby Unit. Materials and Methods: A retrospective study of newborns managed for perinatal asphyxia over a 1-year period. All inborn babies with Apgar scores <6 at 5 min and out born babies with no Apgar score but with features of asphyxia were studied. Case files of the patients were retrieved and relevant information was obtained. Results: Of the 223 neonates admitted during the study period, 67 (30.1%) newborns had perinatal asphyxia from our record; but only 47 (70.1%) case files with complete data were retrieved, giving a prevalence of 21.1%. Twenty five (53.2%) of the mothers were primiparous, 31 (66.0%) had no antenatal care and 25 (53.2%) presented with prolonged obstructed labor. Twenty-eight (59.6%) of the newborns were females; 41 (87.2%) were term, 27 (57.4%) of normal birth weight, 42 (89.4%) delivered in the hospital and mostly through an emergency caesarean section. Thirty (63.9%) of the newborns were discharged; while 12 newborns died, giving a case fatality rate of 25.5%. Conclusion: Perinatal asphyxia is a significant cause of morbidity and mortality in Gusau. Health education of pregnant mothers on antenatal care for early detection of high-risk pregnancy is highly recommended in order to reduce the high incidence of this preventable condition.

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Background: Cervical spondylosis (CS) has received little attention in the Nigerian medical literature even in the present era of magnetic resonance imaging (MRI). Unfortunately, cervical spondylotic myelopathy (CSM) is the most common form of functional debility from spinal cord disease in older adults. Objective: We sought to describe the clinico radiologic findings in CS and CSM with the hope of familiarizing clinicians with this prevalent and potentially devastating disorder. Materials and Methods: This study was a retrospective analysis of 76 patients who underwent cervical MRI examination on account of CS, associated with either radiculopathy, myelopathy, or myelo radiculopathy. The patients comprised of 54 (71.1%) males and 22 (28.9%) females, their ages ranged from 26 to 78 years. Each patient was also scored clinically using the Nurick's classification for cervical myelopathy and scores compared with their MRI examination findings. Results: The condition was commoner in males than females (M:F = 2.5:1). Multi-level disease was seen in almost all patients and the commonest disc levels affected in spondylosis were C4/5, followed by C5/6; while for spondylotic myelopathy, it was C3-4 level. The prevalence of CSM in this study was 42.10%. The patients' clinical scores compared well with their MRI findings. Conclusion: CS should not be dismissed as a mere consequence of aging 'but a disease with possible debilitating outcome and early prevalence due to an interplay of environmental and genetic factors'. On the strength of this, we have presented the MRI and clinical findings in CS and spondylotic myelopathy; and also reviewed previous reports in the light of the current findings in the literature.

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Background: Despite the safety, affordability and widespread use of ultrasound; there is a paucity of literature on ultrasonographic assessment of the portal vein (PV) diameter in adult patients in our local environment. Aims and Objective: The aim of this study was to determine the mean and range of PV diameter in chronic liver disease (CLD) patients in our local environment. Materials and Methods: This cross-sectional prospective study was carried out at the University of Maiduguri Teaching Hospital between January and June, 2013. Two hundred and fifty adult male and female CLD patients and equal number of age and sex matched controls aged 18 years and above had abdominal ultrasonography for measurement of their main, right and left PV diameter in both inspiration and expiration. Transverse and longitudinal measurements were obtained, and the averages of the two measurements were used to determine their final diameter. Results: There were 187 (74.8%) male and 63 (25.2%) female CLD patients aged between 19 and 77 years (mean ± standard deviation [SD], 43.78 ± 12.97 years). The mean diameter of the main PV (±SD) in CLD was 18.68 ± 2.59 mm which is higher than that of the control (10.87 ± 0.81 mm). The mean diameter of the right and left PVs in CLD were 9.04 ± 1.26 mm and 8.58 ± 1.23 mm respectively, which were higher than the respective values of 4.35 ± 0.52 mm and 4.12 ± 0.52 mm in the control. The PV diameter correlated with age and respiratory phases in both CLD and the control group (P < 0.05). There was statistically significant difference in PV diameter between males and females (P < 0.05) with values higher in females. Conclusion: The mean value and range of PV diameter in CLD patients in this environment were statistically and significantly higher than controls. The diameter correlated with age and showed significant difference between the two sexes and respiratory phases.

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Introduction: Pneumococcal infection is a leading cause of morbidity and mortality worldwide. There is a paucity of data on pneumococcal infection in Nigeria. We aimed to determine the epidemiology and clinical outcome of pneumococcal infection in a Tertiary Referral Center in Northwestern Nigeria. Materials and Methods: We conducted a prospective, hospital-based study on patients with community acquired pneumococcal infections. All studied subjects had clinical evaluation and relevant laboratory investigations. The outcome was defined as mortality. Analysis was carried out using descriptive statistics with differences and relationships determined using Student's t-test, Chi-squared and Fisher's exact tests as appropriate, with P < 0.05 regarded as significant. Result: Three hundred and two cases of bacteriologically proven community acquired pneumonia (241/302), bacteremia (38/302) and meningitis (23/302) were screened, out of which 125/241 (51.7%), 7/23 (30.4%) and 8/38 (21.1%) were pneumococcal pneumonia, pneumococcal meningitis and pneumococcal bacteremia, respectively. Most of the patients, 87/140 (69.3%) had comorbidity conditions. The overall mortality rate was 12.9%. Chronic heart disease (odds ratio [OR] = 1.143; 95% confidence interval [CI] = 0.032-0.638), human immunodeficiency virus infection (OR = 2.309; 95% CI = 1.258-4.241), age ≥65 years (OR = 6.397; 95% CI = 2.181-18.746), and infection with multi-drug resistant Pneumococcus (OR = 4.089; 95% CI = 1.274-13.125) were identified as independent risk factors for mortality. Conclusion: The Pneumococcus is a common cause of community acquired infections among adults in northwestern Nigeria, with associated high mortality.

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Adult-onset Still's disease (AOSD) is a rare auto-inflammatory syndrome. In Zambia, like most parts of Africa, fever is usually caused by infections (e.g., tuberculosis) and infestations (e.g., malaria). AOSD represents one of the few febrile conditions that are not due to microbial infections or parasitic infestations. It therefore cannot be managed with antibiotics or antihelminthics. Generally, patients are <35-year-old, febrile, have arthralgias, and an evanescent maculopapular rash. Treatment of AOSD requires the use of immunosuppressant drugs. This is the first report of a patient with AOSD in Zambia. It is one of the very few cases to be reported in Africa.

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We report here a case of bilateral pelviureteric junction stones in a 2 months old baby who presented with acute onset anuria and sepsis. The baby was diagnosed to have acute postrenal failure due to obstructive bilateral ureteric stones based on the findings of ultrasound scan. This was a rare case of drug-induced hypercalcemia resulting from inappropriate iatrogenic supplementation of calcium and Vitamin D. Baby later developed hydrocephalus as sequelae to meningitis. Magnetic resonance imaging of brain showed periventricular calcification probably a sequelae to hypercalcemia. Our case emphasizes the need for considering iatrogenic hypercalcemia as a cause of urolithiasis and other forms of calcification in infants.

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Background: Left ventricular hypertrophy (LVH) is present in 67-70% of patients on chronic dialysis and in up to 40-60% of kidney transplant recipients (KTRs) and is associated with graft dysfunction. We determined the prevalence of LVH and its association with graft function among KTRs in a South African transplant center. Materials and Methods: Adult recipients of kidney transplant at the Charlotte Maxeke Johannesburg Academic Hospital between January 2005 and December 2009 were recruited. Patients' records were assessed for information on their posttransplant follow-up. All patients had transthoracic echocardiography and carotid Doppler done for assessment of cardiac status and carotid intima-media thickness (CIMT) respectively. Graft dysfunction was defined as estimated glomerular filtration rate of <60 ml/min/1.73 m ² based on the modification of diet in renal disease formula. Inferential and modeling statistics were applied as appropriate using SPSS, and P ≤ 0.05 considered significant. Results: One hundred KTRs underwent echocardiography. There were 63% males, and the mean age of the study population was 42.2 ± 12.42 with a range of 19-70 years. The mean duration posttransplant was 59.28 ± 18.59 months with a range of 36-84 months. LVH was present in 76% of the study population; 51% had concentric LVH, and 25% had eccentric LVH. Graft dysfunction was found in 52%. Risk factors for LVH were longer duration on dialysis P = 0.017, cigarette smoking P = 0.032, increased CIMT P = 0.05, higher cumulative steroid dose P < 0.0001 and increased waist circumference P = 0.03. LVH was associated with graft dysfunction, χ² = 9.22, P = 0.008. Conclusion: LVH is prevalent in our KTRs and is associated with graft dysfunction.

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Purpose: To determine the retinal nerve fiber layer (RNFL) measurements in normal eyes in Zaria and to investigate the effect of age and axial length on RNFL thickness. Materials and Methods Forty eyes of 40 healthy subjects aged between 18 and 73 underwent peripapillary RNFL thickness measurement by a series of three circular scans with a 3.4 mm diameter (Stratus optical coherence tomography, RNFL thickness 3.4 acquisition protocol). The mean RNFL values were correlated with age and axial length. The statistical analysis used was Pearson's coefficient of correlation, linear regression, and paired t-test with the analyse-it^® software for Excel. Results: The mean age of the subjects was 35 years, range18.0-73.0 years. Mean RNFL thickness global average was 107.055 μm standard deviation (SD 9.219 μm) with the RNFL in the superior quadrant being the thickest (mean: 139.0 mm SD 15.0 mm), there was no significant correlation with axial length in this study (P = 0.56) but there was a negative correlation between global RNFL average and age (r = ­0.56 P = 0.0002). Conclusion: This study provides normative RNFL values for normal eyes in Zaria locality. It can be used as a reference for the normal measurements of RNFL in this environment. Age demonstrates a significant negative correlation with RNFL thickness.

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This is a case report of a 27-year-old multipara with human immunodeficiency virus (HIV) infection in pregnancy. She was commenced on antiretroviral drugs: Nevirapine, Zidovudine, Lamivudine antiretroviral therapy, and co-trimoxazole but developed generalized maculopapular rash and eye lesions on the 6 ^th day of treatment. Toxic epidermal necrolysis was suspected. She was managed by a multi-disciplinary team of physicians and in a high dependency care setting and she recovered fully. This case is presented to highlight the possible occurrence of this condition among HIV-positive patients, the challenges of care and the importance for teamwork in such cases.

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