COVID-19 and the Vascular Elderly Subject: Illustration of Therapeutic Management with Corticosteroids in an Elderly Diabetic Patient with COVID-19

Introduction: The severity of Sars-Cov-2 infection is associated with the development of acute respiratory distress syndrome (ARDS). The progression to ARDS appears to be driven by a major inflammatory mechanism potentially sensitive to corticosteroids. Observation: This article describes the case of an elderly patient was admitted to emergency departments for intense asthenia, accompanied by motor diarrhoea, dyspnoea with desaturation in ambient air, in a context of strong suspicion of infection linked to COVID-19. The article also reviews the existing literature on the diagnosis and treatment of this severe form of the disease. Conclusion: Corticosteroids, and in particular dexamethasone, have been shown to be effective in the management of patients with COVID-19, an oxygen-releasing disease.

Prevalence, Awareness and Risk Factors for Hypertension in Adults Attending a Tertiary Hospital in South-East Nigeria

Hypertension, a non-communicable disease, is considered a major public health challenge because of its widespread prevalence globally coupled with its huge morbidity and mortality burden, which is largely preventable if early detection and prompt initiation of management are done. Hypertension prevalence is increasing especially in the developing world, despite this, its awareness among the general population is low. This study aimed at determining the prevalence of hypertension among adult attendees of the General Outpatient Clinic of the Federal University Teaching Hospital (FUTH), Owerri, with an assessment of the proportion of hypertensives who were aware of their hypertensive status, and identifying risk factors of hypertension in the study participants. A cross-sectional analytical study was conducted between October and November 2022 at the General Outpatient Clinic of the FUTH, Owerri. A total of 257 consenting and eligible adult patients made up of 135 males and 122 females, aged 18 years and above, were selected by systematic random sampling method. The overall prevalence of hypertension was 34.6%. The prevalence was higher in females than in males (37.7% vs 31.9%, P = 0.325). Among the hypertensive subjects 56.2% had awareness of their hypertensive status. Following a multiple regression analysis, hypertension was independently associated with age, family history of hypertension, occupation (retirees, traders, farmers and the unemployed), and marital status (being widowed). Hypertension is prevalent in our environment;the prevalence rate from this study is higher than in most studies in our environment, suggesting possibly, a rising burden. The results from the study underscore the need for increased and sustained advocacy for implementation of policies and programs directed at increased detection and management of hypertension in the different population groups such as annual wellness check for employees in the formal sector, largescale dietary and lifestyle adjustments, and know your numbers (an approach to population driven blood pressure check for all adults). Also, health workers should use any opportunity of contact with a patient to screen for hypertension.

Vogt-Koyanagi-Harada (VKH) Disease

Background: Vogt-Koyanagi-Harada (VKH) disease is a rare, multisystem autoimmune disorder characterized by bilateral granulomatous panuveitis, with or without extraocular manifestations. Although its exact etiology and pathogenesis remain unclear, it is hypothesized to involve T-cell dysregulation targeting melanocyte-containing tissues, including the CNS, eye, ear, and skin. VKH predominantly affects pigmented groups, such as Asians, Hispanics, Indians, Native Americans, and Mediterranean ethnicities, accounting for 7-22.4% of uveitis cases. Retrospective analyses indicate a higher incidence among female patients, with most cases occurring in the second and fifth decades of life. Aim: This case report discusses a patient with probable VKH who exhibited ocular, neurologic, and auditory symptoms typical of the prodromal or acute uveitic phase and responded well to prompt management. Case Presentation: A young female in her late 20s presented with low-grade fever, severe headache, neck pain, and neck stiffness. She had received symptomatic treatment at another hospital without relief. She was empirically started on intravenous antibiotics and dexamethasone for suspected pyogenic meningitis and was discharged upon symptom relief. However, she returned two days later due to symptom recurrence. Ophthalmic examination revealed decreased visual acuity bilaterally (6/24), sluggish pupil reaction, optic disc edema, and bilateral macular serous detachments. Mild vitritis with anterior chamber cells and iris pigment on the anterior lens capsule was noted in the left eye. Systemic examination was unremarkable, except for fine crepitations in the bilateral lower lung fields. Management: Considering VKH disease, the patient was started on intravenous methylprednisolone pulse therapy (1 gram/day) for 3 days, followed by oral steroids and topical steroid drops for the eyes. She was discharged with oral prednisolone and prednisolone acetate 1% eye drops. At follow-up, her vision improved, and there was resolution of papillitis and serous retinal detachments. Conclusions: VKH is a significant cause of bilateral vision loss. This case of probable VKH syndrome underscores the importance of early recognition and aggressive treatment in achieving a favorable visual prognosis.

Computed tomography perfusion measurements for definition of lesions in early acute stroke

Background: Perfusion computed tomography (CT) is an evolving technique in the diagnosis of acute stroke. After complex deconvolution algorithms, perfusion color maps-cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT)— are produced, they give visual confirmation of perfusion deficit in ischemic area, but some discrepancies exist regarding this technique in reliability of quantitative detection of tissue viability: penumbra (tissue at risk) that surrounds core (necrosis). Purpose: The purpose of this prospective study was to define brain tissue viability grade on the basis of the perfusion CT parameters in acute stroke patients. Material and Methods: Multimodal CT imaging protocol (unenhanced CT of the brain, CT angiography of head and neck blood vessels, followed by brain perfusion CT and 24 hours follow-up brain CT) was performed. Perfusion deficit was detected first visually, with subsequent manual quantitative and relative measurements in affected and contra-lateral hemisphere in 87 patients. Results: Visual perfusion deficit on perfusion CT images was found in 78 cases (38 female, 40 male;mean age 30 - 84 years): penumbra lesion (n = 49) and core lesion (n = 42). Both lesion types were detected by increased MTT on perfusion CT map, penumbra area showed mean values 202.40% (113% - 345% ± 57.17) and core (41% - 320% ± 64.53) in comparison to contra-lateral hemisphere. CBV mean values in penumbra group were increased up to 113.10% (45% - 276% ± 36.29) and in core decreased till 41.82% (3% - 107% ± 27.09). CBF values were decreased up to 65.63% (31% - 137% ± 22) in penumbra lesion and markedly decreased till 25.94% (4% - 79% ± 17.35) in core. Conclusion: Our study shows that perfusion CT measurements relative threshold values are recommended in definition of penumbra and core lesions in acute stroke patients.

Sonographically guided lymph node biopsy: Complication rates

Purpose: The study investigated the rate of complications associated with sonographically guided lymph node biopsies and assessed potential risk factors. Methods: A total of 536 sonographically guided puncture procedures (283 males, 52.8%;253 females, 47.2%;average age 57.0 ± 16.0 years;range 14 - 87 years) were performed in 469 patients for the work-up of unclear lymphadenopathy. Events, complications and potential risk factors, were prospectively documented. Results: The 469 patients underwent a total of 536 puncture procedures (PP) including 663 punctures and 1485 passes. Lymph node localizations were intraabdominal (55.2%, n = 296), cervical (22.4%, n = 120), inguinal (12.9%, n = 69), axillary (7.8%, n = 42) and other (1.7%, n = 9). No complications were documented during the entire study period. There was no increased risk of complications documented for the potential risk factors number of punctures, the number of passes, the localization, diameter of the lymph node (s), puncture technique, needle gauge, as well as patients’ sex, age and coagulation parameters, and the experience of the examiner. Conclusions: Our findings confirm the safety of percutaneous sonographically guided lymph node biopsies in different regions of the body in patients with adequate coagulation parameters undergoing pre-interventional color Doppler ultrasound examination.

Interval Training and Compensation of Type 2 Diabetes

Introduction: The constant aerobic training is traditionally considered as the best physical activity for diabetic patients. But there is existing problem with adherence (complience) of this type of exercise and toleration of the specific training intensity of exercise for such training time. The advantage of interval training is usage of higher intensity of exercise for very short time alternating with low intensity of exercise. The complex effect of this type of exercise is not mentioned in literature of type 2 diabetes too much. The aim of the study was to find the effect of interval training compound to long term participation of specific exercise program. Methods: 43 obese type 2 diabetes patients treated by diet, oral antidiabetics or insulin were randomized to 2 groups. The control group consisted of 22 patients (12 women, 10 men) with average age 67.4 ± 8.4. 21 patients in main group with average age 65.29 ± 10.67 participated in a controlled exercise program. Before and after the study, both of 2 groups had complex internal investigation including spiroergometry. Results: Fitness parameters improved in this group of diabetics, maximal achieved power in W&middot;kg-1 increased statistically significantly p total cholesterol decreased statistically significantly p < 0.05;average values of LDL-cholesterol decreased about 4.9% and triglycerids about 22.4%;average value of HDL-cholesterol increased about 4.6%;fasting plasma glucose levels decreased about 10.5%. Percentage of body fat p < 0.05 and diastolic blood pressure p < 0.05 decreased based on statistics. BMI tended to decrease but WHR did not change at all. Conclusion: The physical intervention influenced statistically significantly some of the observed parameters. The interval training as a part of physical activities of diabetic patients positively intervenes in complicated system of metabolical processes.

Primary Lymphoma of Bone: Imaging Findings to Improve Diagnosis of a Rarely Considered Disease Prior to Biopsy

Objective: Primary lymphoma of bone (PLB) is a rare malignant bone tumor often presenting in the fifth-sixth decades involving appendicular long bones. Published radiological findings indicate that PLB typically presents as a moth-eaten osteolytic lesion with periosteal reaction, while MRI commonly demonstrates marrow infiltration with extraosseous extension. Given rarity and variable appearances, PLB may not be primarily considered prior to biopsy. Our objective was to evaluate preoperative imaging findings in effort to increase awareness and improve a perceived deficiency in preoperative diagnosis. Materials and Methods: Following IRB approval, retrospective review identified 60 patients with newly diagnosed bone lesions proven to represent PLB in accordance with WHO definition. Preoperative radiographs (n = 46), MRI (n = 33) and PET (n = 37) were independently reviewed by two radiologists. At radiography, lesions were classified: purely lytic, mixed, purely sclerotic, or occult;lytic lesions were graded utilizing Lodwick’s classification. At MRI, lesions were defined as focal or infiltrative and the presence or absence of extraosseous disease was recorded. Extraosseous masses were defined as small (1 cm) and subjectively correlated with degree of cortical destruction. At PET, lesions were recorded as FDG-avid or not. Primary radiograph reports when available (n = 33) were reviewed and exact wording of differential considerations was recorded. Results: Radiographs demonstrated mixed (n = 22), lytic (n = 15), and sclerotic (n = 8) appearances;one radiographically occult lesion was seen by MRI. Lytic lesions were graded: IB (n = 3), IC (n = 5), II (n = 4), and III (n = 3);none were IA. At MRI, 30 lesions were infiltrative and 3 were focal;11 were not associated with extraosseous extension, while 22 showed bony disease with small (n = 7) or large (n = 15) soft tissue mass. Of large masses, 13 demonstrated minimal cortical destruction. At PET, 36 demonstrated FDG uptake;one study was technically limited. Review of reports found that only 5 included “lymphoma” as a diagnostic consideration. Conclusion: Contrary to most published data, we suggest that PLB typically demonstrates some degree of osteosclerosis, often a mixed pattern of sclerosis and lucency;purely lytic lesions may be less common. Similar to existing reports, MRI commonly demonstrates marrow infiltration with extraosseous extension of disease, typically a large soft tissue mass with disproportionate (minimal) cortical destruction. Familiarity with these findings should improve preoperative consideration of PLB in the appropriate clinical scenario when a new osteoblastic lesion is identified.

Antimicrobial Resistance and Genotype Analysis of Extended-Spectrum-β-Lactamase-Producing Proteus Mirabilis

To analyse the genotypes of clinical isolates of Extended-Spectrum-β-Lactamase-Producing (ESBL-producing) Proteus mirabilis (P. mirabilis) and the mechanisms of antimicrobial resistance, to guide reasonable use of antibiotics and to avoid nosocomial outbreak infections by ESBL-producing P. mirabilis. 125 clinical isolates of P. mirabilis were collected from the Drug-Resistant Bacteria Surveillance Center of Anhui Province (from Jan 2009 to May 2010). Searching for the genotypes of ESBLs was perfomed by PCR amplification and DNA sequencing, and performed conjugation test simultaneously. Among ESBL-producing strains, CTX-M was the major genotype (3 CTX-M-13 and 1 CTX-M-3). TEM-1b spectrum β-lactamase was also prevalence in P. mirabilis. The diversity of β-lactamases in P. mirabilis and the emergency of multi-drug-resistance clinical strains will present serious threat to clinical therapy and even will lead to outbreak of nosocomial infections. Our study emphasizes the need for enhanced supervision of ESBL-producing P. mirabilis. Timely and reasonable drug-resistance data are indispensable to clinical therapy.

Bacteriological Profile of Pneumopathies in Chronic Renal Failure at the University Hospital Center of Point-G in Mali

Introduction: Chronic renal failure (CKD) is defined as a glomerular filtration rate (GFR) of less than 60 ml/min/1.73m2 for more than 3 months [1]. Infectious complications are a major source of morbidity in patients with chronic renal failure. In Mali, we have no data on pneumopathies in this population, hence the interest of this study. The objective of this work was to determine the frequency of pneumopathies in patients with chronic renal failure, describe the clinical radio-types, identify the microorganisms involved, and assess the renal prognosis of pneumopathies. Materials and Methods: This was an 18-month prospective and descriptive study from January 1, 2018 to June 30, 2019 conducted in the nephrology and hemodialysis department of the University Hospital of Point G. Included were patients hospitalized during our study period with CKD associated with pneumopathy on a chest X-ray. Not included were all patients hospitalized outside the study period, all CKD cases without pneumonia, patients with incomplete records, and non-consenting patients. Results: We examined 1111 patients, 35 of whom presented an image on chest X-ray related to pneumopathy, a frequency of 3.15% of cases. Twenty-one men (60%) and 14 women (40%) with a sex ratio of 1.5. The mean age was 46.8 ± 13.9 years with extremes of 23 and 76 years. The types of pneumopathy on the chest X-ray were: alveolar pneumopathy: 23 cases (65.7%), pleuropneumopathy: 10 cases (28.6%) and cavitary pneumopathy: 2 cases (5.7%). Cytobacteriological sputum examination was positive in 65.7%;leukocytes (68.6% of cases). The germs found were: Klebsiella pneumoniae (25.7% of cases), Escherica coli (11.4%), Pseudomonas aeruginosa (5.7%), Staphylococcus aureus (5.7%), Citrobacter freundi (5.7%), Enterococus sp. (2.9%), Enterobacter cloacae (2.9%), Candida albicans (5.7%). The search for acid-alcohol-resistant bacilli (BAAR) in sputum was positive in 4 cases (11.4%). There was an association between the results of cytobacteriological examination of sputum and the results of BAAR testing of sputum (p = 0.046).

Intracranial Cryptococcal Infection in HIV Positive Patient

Cryptococcus neoformans is the most common fungal infection of the CNS. The majority of patients with cryptococcosis have preexisting immunodeficiency such as acquired immunodeficiency syndrome (AIDS). CT and/or MRI of the brain only occasionally detects abnormalities specifically related to this infection. We report a case of MR appearance of central nervous system cryptococcosis in a 33-year-old HIV positive man.

Efficacy of high resolution computed tomography for detection of early healing in scaphoid fractures

Background: While plain radiography is commonly used to assess scaphoid fracture, this imaging modality may not accurately demonstrate early bone healing. This investigation evaluates the utility of 64-slice CT in the detection of early fracture healing compared to plain radiographs and magnetic resonance imaging (MRI). Methods: Outpatients attending follow-up visits for scaphoid fractures at Hamilton General Hospital were included in this investigation. Inclusion criteria included outpatients over age of 18 who consented to attend a follow-up visit for the scaphoid fracture at 6 weeks for X-Ray, 64-slice CT and MRI scan to monitor fracture healing. Assessment of healing was independently interpreted by two radiologists specialized in musculoskeletal imaging. A total of 7 adult outpatients were accrued, with each case classified as healing, not healing, or equivocal for plain radiography and 64-slice CT scan. Results: For plain radiographs, the level of interrater agreement for evidence of healing was 57% (4/7) cases. When comparing this to CT scans, there was no discrepancy between radiologists as 100% (7/7) were found to have evidence of healing. The 64-slice CT scan demonstrated evidence of early trabecular continuity in all cases, including radiographs that were interpreted as equivocal. Conclusion: This study can be considered a pilot project for the efficacy of 64-slice CT in the assessment of early healing of scaphoid fractures. For clinicians, the multiplanar reconstruction images allows for more accurate assessment of fractures than plain radiography. CT scans are able to penetrate through bony callus that may obscure visualization of healing in plain radiography, demonstrate trabecular continuity better than plain radiographs, are readily accessible and provide faster imaging acquisition. The observations from this study may have implications in terms of duration and type of casting applied, timing of strengthening exercises, and avoiding unnecessary surgery which affect patient morbidity and cost of care.

Development and evaluation of an ELISA method for the measurement of kallikrein-related peptidase 5 (KLK5) in human serum

Kallikrein-related peptidases (KLKs) have been proposed as potential cancer biomarkers. Kallikrein-related peptidase 5 (KLK5) is a secreted trypsin-like protease of the KLKs. Until now, detection of KLK5 in both biological fluids and tissues has been described frequently due to the potential of being a new cancer biomarker. Our objective was to prepare KLK5 antibodies and establish an ELISA method for KLK5 to study the possible clinical application of KLK5 as a biomarker for malignancies. In this study, recombinant KLK5 protein was produced and purified using a prokaryotic expression system, and then used as immunogen to generate antibodies. High titers of specific antibodies were measured in serum of rabbits after the forth booster injection. And the titer of the antiserum reached 1:106. We have also generated monoclonal antibodies using hybridoma technology and the titer reached 1:105. The activity of KLK5 antibodies was characterized by Western blot and immunohistochemistry. To quantitatively examine KLK5 in serum samples, we established double antibody sandwich ELISA method using mouse mAb as capture and rabbit pAb as tracer antibody. We have detected KLK5 levels in ovarian cancer serum to ensure that our sandwich ELISA measurement to have high sensitivity and specificity. The ranges of linearity reached by the standard curves of the newly developed ELISA were 0.45 ng/mL to 125 ng/mL. The detection limit of the method, defined as the concentration of KLK5 can be distinguished, was 0.20 ng/mL. Median serum KLK5 levels were 3.77 ng/mL and 0.86 ng/mL in ovarian cancer patients and normal female, respectively (P ELISA assay for KLK5. Our preliminary findings prompt that KLK5 may be a new potential biomarker for the diagnosis and prognosis in patients with ovarian.

Determination of <i>Plasmodium</i>Parasite Life Stages and Species in Images of Thin Blood Smears Using Artificial Neural Network

Malaria is a leading cause of deaths globally. Rapid and accurate diagnosis of the disease is key to its effective treatment and management. Identification of plasmodium parasites life stages and species forms part of the diagnosis. In this study, a technique for identifying the parasites life stages and species using microscopic images of thin blood smears stained with Giemsa was developed. The technique entailed designing and training Artificial Neural Network (ANN) classifiers to perform the classification of infected erythrocytes into their respective stages and species. The outputs of the system were compared to the results of expert microscopists. A total of 205 infected erythrocytes images were used to train and test the performance of the system. The system recorded 99.9% in recognizing stages and 96.2% in recognizing plasmodium species.

The characteristics of pulmonary tuberculosis amongst patients attending chest clinic, including age, sex, occupation and hemoglobin concentration in Benin City, Nigeria

Aim: To study characteristics of pulmonary tuberculosis amongst patients attending chest clinics in Benin City. Materials and Methods: A total of 816 subjects comprising of 563 (69%) males and 253 (31%) females were enlisted for this study. Sputum specimen and blood were collected from all subjects. Acid alcohol fast bacilli from sputa were examined using the Ziehl Nelson staning technique. Hemoglobin concentration was determined using the method described by Dacis and Lewis. Result: Pulmonary tuberculosis infection was significantly affected by age among the male and female subjects studied (P - 30 years and 41 - 50 years had the highest risk of acquiring TB amongst the male and female population respectively. Although the unemployed subjects had the highest prevalence of TB (35%), occupation did not significantly affect the prevalence of TB (P > 0.05). Irrespective of gender, anemia was significantly associated with pulmonary tuberculosis infection (P female subjects. Anemia was associated with TB infection. Intervention effort at curbing the prevalence of TB and anemia is advocated.

Efficacy of Magnetic Resonance Imaging in BIRADS 3, 4 and 5 Patients Detected on Full Field Digital Mammography: Our Experience

Aim of the study: To perform Dynamic contrast enhanced MRI of breast in patients with positive findings (BIRADS 3, 4 and 5) detected on screening mammography;to correlate the findings of digital mammography and contrast enhanced MRI of breast with histopathological examinations. Settings and Design: A prospective observation study was conducted at a single centre, i.e. HCG Manavata Cancer Centre. Materials and Methods: Screening mammography was performed on patients with age > 40 years and on patients with age 35 - 40 years having positive family history. The positive mammography was reported and the lesions classified according to BIRADS criteria for mammography. Results: Mammographic examination of the breast lesions yielded an overall sensitivity of 97.67% and a specificity of 85.71%. In our study we combined both morphologic and dynamic parameters and its modification into BIRADS category for lesion classification. The sensitivity of MRI examinations was 97.67% while the specificity was 71.43%. Spiculated margins were encountered only in malignant lesions (p = 0.0006). Statistical correlation was obtained between the pathologically proven benign and malignant lesions regarding their enhancement pattern with p value of Conclusion: As per the results, dynamic contrast MRI had high sensitivity but limited specificity. We did not find any significant difference between FFDM and MRI in terms of diagnostic accuracy. The use of DWI showed high specificity at cut off point of ADC value—0.85 mm2/s. Thus, DWI can be used in addition of morphological and dynamic kinetic characteristics to increase specificity of MRI.

SCNH2 is a novel apelinergic family member acting as a potent mitogenic and chemotactic factor for both endothelial and epithelial cells

The gut hormone apelin is a major therapeutic focus for several diseases involving inflammation and aberrant cell growth. We investigated whether apelin-36 contained alternative bioactive peptides associated with normal physiology or disease. Amino acid sequence analysis of apelin-36 identified an amidation motif consistent with the formation of a secondary bioactive peptide (SCNH2). SCNH2 is proven to be mitogenic and chemotactic in normal/malignant cells and augments angiogenesis via a PTX-resistant/CT-X-sensitive G protein-coupled receptor (GPCR). Notably, SCNH2 is substantially more potent and sensitive than apelin-13 and vascular endothelial growth factor-A. Endogenous SCNH2 is highly expressed in human tumors and placenta and in mouse embryonic tissues. Our findings demonstrate that SCNH2 is a new apelinergic member with critical pluripotent roles in angiogenesis related diseases and embryogenesis via a non-APJ GPCR.

Laboratory Quality Audit in 25 Anti-Retroviral Therapy Facilities in North West of Nigeria

Introduction: A laboratory’s ability to consistently produce high-quality and reliable results hinges on adopting laboratory standards that guide daily practices to ensure steady quality improvement. Although assessment is an extremely rewarding exercise in health care quality improvement processes, it is always considered very time consuming and expensive in developing world settings. A quarterly internal audit was conducted in 25 FHI360 supported Antiretroviral Treatment laboratories in the North West of Nigeria which can surely provide reference for other countries. Methodology: A checklist adapted from the World Health Organization/African Regional Office laboratory accreditation checklist was used to quantitatively evaluate 7 quality essentials (QEs). A team composed of technical staff from FHI360, State Ministry of Health and facility laboratory heads, conducted the audits, developed and monitored intervention plans. Information obtained with the checklist was captured in excel, validated and imported into Grappa Prism software version 5.0 for analysis. Results: Most (92%) facilities were at secondary level with (8%) at tertiary level. The mean total score on all QEs across the facilities was 63.34 ± 9.77 in quarter (Q) 1, 68.8 ± 10.91 in Q2, 72.59 ± 8.02 in Q3 and 72.72 ± 9.16 in Q4 (p ≤ 0.0001). The most improved QE through Q1-Q4 was organization and personnel (32.2%), while signage/bench top reference had an 18.6% point decline. In ranking facilities based on differences of total scores between Q4 and Q1, Kachia General Hospital was the highest with 27 point increase. Considering the mean percentage score for all quarters per facility, 4 had ≥ 80%, 19 had between 60%-80% and 2 had <60%. The total non-conformities cited for QI-Q4 were 185, 100, 78 and 64 respectively with highest recorded in internal and external quality control and the least in facility and safety. Conclusion: We recorded some improvement in most QEs confirming the benefits of internal audits, reviews and follow-up. However, much more is needed in terms of technical assistance, capacity building, mentorship, and commitment at facility and state level to meet minimum acceptable laboratory quality standards.

Imaging Findings in Chest Computed Tomography: Initial Experience in a Developing Country

Background:?High resolution chest computed tomography (HRCT) is an established imaging modality that accurately assesses disease processes that are non-specific on conventional chest radiography. Chest Computed Tomography (CT) has proven invaluable in the evaluation of various diseases of the chest providing precise diagnosis that have great impact on the course of management. In this study, our aim is to evaluate the spectrum of radiological findings in all patients that had chest CTs at a tertiary health Institution in a developing Country. Method: This is a 6-year retrospective study of all patients that had Chest CT from 2009 till 2015. All patient data were retrieved and their Chest CT images reviewed and radiological findings and diagnosis documented. Results: Age range of patients was 1 - 84 years with a mean of 52.36 ± 22.9 years. Ten patients were children (12%). There were more males 53 (63.1%) than females 31 (36.9%) in the study. Referral for imaging was predominantly from internal medicine 33 (47.1%) and Surgery 27 (38.6%) departments. Most of the patients, 53 (63.1%) did not have previous chest radiographs. Consolidative changes were the most common parenchymal finding (77.4%). Few mediastinal masses were found in the study population. CT angiography constituted only 10.7% of all chest CTs done in adults. Conclusion: Few chest CT evaluations are performed compared to CTs of other parts of the body done in the same period. Chest CT is generally under-utilized even in a tertiary institution. There is a need to educate chest physicians on the role and advantages of CT use for the management of their patients.

Perspectives of Continuing Professional Development (CPD) for Kenyan Midwives

Continuing Professional Development (CPD) provides an important strategy for reduction of maternal morbidity and mortality with the aim of attaining Millennium Development goals (MDG) four and five. However, there is lack of information about how Kenyan midwives understand and perceive CPD and how this is situated in the practice and social context. This research aimed to explore Kenyan midwives’ experience and perceptions of CPD. A descriptive explorative approach gathered focus group discussion and questionnaire data on beliefs, opinions, and perceptions, demotivating and motivating factors to CPD of a total of 25 midwives in a level five hospital in Kenya. Questionnaires were piloted and self-administered after cleaning and focus groups taped and transcribed verbatim. Data were analyzed thematically using inductive approach with the aid of SPSS computer program. Results: Four key themes emerged from the data: Midwives’ views of CPD, their motivators for undertaking CPD, the choices they made around CPD, their demotivators for undertaking CPD. Congruence with the issues evident in the literature were: the difficulties with role diversity, the importance of CPD in personal and professional growth, the importance of flexible modes of study and the importance of a supportive culture for ongoing learning. The study findings helped in identifying gaps in the literature about Kenyan midwives’ perspectives on CPD.

Detection of plasmodium parasites from images of thin blood smears

Malaria is the leading cause of morbidity and mortality in tropical and subtropical countries. Conventional microscopy is the Gold standard in the diagnosis of the disease. However, it is prone to some shortcomings which include time consumption and difficultness in reproducing results. Alternative diagnosis techniques which yield superior results are quite expensive and hence inaccessible to developing countries where the disease is prevalent. Thus in this work, an accurate, speedy and affordable system of malaria detection using stained thin blood smear images was developed. The method uses Artificial Neural Network (ANN) to test for the presence of plasmodium parasites in thin blood smear images. Images of infected and non-infected erythrocytes were acquired, pre-processed, relevant features extracted from them and eventually diagnosis was made based on the features extracted from the images. Diagnosis entailed detection of plasmodium parasites. Classification accuracy of 95.0% in detection of infected erythrocyte was achieved with respect to results obtained by expert microscopists. The study revealed that artificial neural network (ANN) classifiers trained with colour features of infected stained thin blood smear images are suitable for detection. It was further shown that ANN classifiers can be trained to perform image segmentation.