Validation of the role of retrograde urethrogram in the management of urethral strictures Nasir Oyelowo, Muhammed Ahmed, Ahmad Bello, Lawal A Tijani, Maitama H. Y. L Bola Bilyaminu, Musliu A Tolani, Adetola M Tolani, Sudi Abdullahi, Awaisu Mudi, Jemila Olagunju Sub-Saharan African Journal of Medicine 2018 5(4):107-110 Introduction: Urethral stricture is a common cause of lower urinary tract symptoms in the middle aged and elderly men in our environment. Its diagnosis and management is hinged mainly on a retrograde urethrogram (RUG) that is associated with variable lengths and sites with that found intraoperatively due to difference in magnification (source patient as well as source image distance), penile stretch, and positioning during the procedure. We hereby sort to validate this tool in defining urethral strictures. Materials and Methods: Adult patients with lower urinary tract symptoms suspected to be due to urethral strictures who presented to the outpatient department and emergency departments of the hospital between January 2016 to December 2016 were recruited into the study. This was followed by obtaining an informed consent from the patient and ethical clearance from the institution. Patients who were not fit or not willing to have a urethroplasty were excluded from the study. The recruited patients had RUG to characterize the strictures. The intraoperative findings at urethroplasty were compared with that found on RUG. Data were collected and analyzed using SPSS version 23 to determine sensitivity specificity of the test. Results: A total of 84 patients were studied during the period. The mean age of the patients was 44.1 years. Bulbar strictures accounted for 65% of the strictures. Most of the strictures were single (72%) and long segment (52%). Sensitivity and specificity of RUG in determination of the length of stricture were 76.9% and 74.6%, respectively, whereas the sensitivity and specificity of RUG in determination of site of stricture were 92.9% and 96.4%, respectively. The determination of number of stricture on RUG has a sensitivity of 94.2% and specificity of 90.8%. Conclusion: RUG is a valuable tool in the management of urethral strictures with a higher sensitivity and specificity for the determination of site and number of strictures as compared to length of stricture that is more affected by magnification and techniques in contrast administration. This should be considered during procedure as well as during interpretation of images.

Value of computed tomography scan in evaluation of adult onset seizures in north-central Nigeria Itanyi Ukamaka D., Uduma Felix U., Aiyekomogbon J. O. Sub-Saharan African Journal of Medicine 2018 5(4):111-116 Background: Seizure is a sudden onset of paroxysmal event from abnormal excessive neuronal activity in the brain. Computed tomography (CT) is a veritable tool for evaluation of seizures in view of the relationship between the age of onset, clinical presentation, and radiologic findings. Aim: This article highlights common brain computed tomographic findings among patients with adult-onset seizures in Abuja, Nigeria. Methods: This was a retrospective study of the imaging records of 115 patients referred to the Radiology Department of University of Abuja Teaching Hospital for brain CT on account of adult-onset seizures from January 2014 to June 2017. Results: The mean age of the 115 adult patients studied was 41.2 ± 19.4 years with male-to-female ratio of 1.1:1. Sixty-five (56.5%) patients were less than 40 years whereas 50 patients (43.5%) were above 40 years. Majority (56.5%) of the patients had abnormalities in their cranial CT with 50 cases (43.5%) reported as normal. Patients with abnormal CT scan findings were older (49.9 ± 20.4 years) than those with normal CT scan (29.9 ± 9.9 years) with a higher incidence of abnormal CT findings in males (63.95%). Abnormal CT scan was seen in 21 (32.3%) of cases in <40-year age group increasing to 44 (88.0%) in >40-year age group. The most common structural abnormalities were brain atrophy (13.9%), intracranial tumors (12.2%), and brain infarction (10.4%). Conclusion: A single institutional study in Abuja, Nigeria, showed a high frequency of structural abnormalities on brain-computed tomograms of patients with adult-onset seizures with a significant increase with age.

Platelet indices in healthy pregnant and nonpregnant Nigerian women Ochuwa Adiketu Babah, Ayodeji A Oluwole, Lemchukwu Chukwunonye Amaeshi Sub-Saharan African Journal of Medicine 2018 5(4):117-122 Background: Though hematological changes occur in pregnancy, changes in platelet indices have not been widely studied, and we do not have reference ranges for use in pregnancy. Objective: To assess effect of pregnancy on platelet indices and establish reference values for these parameters in pregnancy. Methodology: A prospective descriptive study involving 161 consenting healthy HIV seronegative women: 80 pregnant and 81 nonpregnant. Information on their sociodemographic characteristics, obstetric, and past medical histories were obtained. Full blood count was determined by Mindray BC3200-automated hematological analyzer, and their platelet count (PLT), mean platelet volume, plateletcrit, and platelet distribution width (PDW) were retrieved. Data were analyzed using Epi Info version 3.5.1. Results: Platelet count that is most commonly used in clinical practice has a mean (±SD) value of 217.32 × 109 (± 64,990) cells/L in nonpregnant women and 205.48 × 109 (±57,226) cells/L in pregnant women. Only PDW showed statistically significant increase across the three trimesters as pregnancy advances (p = 0.02). The population reference ranges for PLT was 85.74–348.90 × 109 cells/L in nonpregnant women and 90.31–320.65 × 109 cells/L in pregnant women. Conclusion: Platelet indices are affected by pregnancy, and there is a need to redefine thrombocytopenia in pregnancy in our setting in order to minimize the risk of unnecessary interventions or denial of necessary treatment.

Lip lesions: A 10-year retrospective analysis from a Nigerian tertiary healthcare institution Benjamin Fomete, Rowland Agbara, Ezekiel T Adebayo, Davis S Adeola Sub-Saharan African Journal of Medicine 2018 5(4):123-128 Introduction: Lip lesions can be acquired or congenital, benign, or malignant. They can also form as a result of systemic manifestation or infection such as cancrum oris or gangrenous stomatitis. Lesion can affect the upper, lower, or both lips together. Patients and Methods: A retrospective study of patients attending the oral and maxillofacial clinic of a tertiary health institution between January 2006 and December 2015 was undertaken. Results: The majority of the patients were from 2nd to 5th decades of life with a ratio of 1.54:1. The age ranged from 1.5 to 78 years. The lower lip (64%) was the most affected, and the unspecified represented 7.8%. The upper-to-lower lip ratio was 1:2.85. Conclusion: Acquired lesions formed the bulk of the lesions seen.

Hepatoprotective Effects of Aqueous Extract of Watermelon (Citrullus lanatus) Seeds on Ethanol-Induced Oxidative Damage in Wister Rats Sebastine Anthony Bazabang, Nwankwo Monday, Sunday Samuel Adebisi, Wusa Makena, Ibrahim Abdullahi Iliya Sub-Saharan African Journal of Medicine 2018 5(4):129-137 Background: Watermelon (Citrullus lanatus) is a roundish or ovoid fruit rich in antioxidant supplements that prevent oxidative stress in hepatic tissues due to generation of reactive oxygen species following exposure to alcohol. The present study aimed to investigate the protective effects of watermelon seed on ethanol-induced oxidative damage in liver of Wister rats. Methods: Twenty-five adult Wister rats of both sexes were randomly divided into five groups of five rats each. Rats in group I were administered distilled water for 8 days. Group II were administered distilled water for 7 days followed by 20 mL/kg body weight of 40% ethanol per body weight on day 8. Groups III and IV were administered 200 and 400 mg/kg, respectively, of the extract for 7 days followed by 20 mL/kg of 40% ethanol on day 8. Group V received 100 mg/kg body weight of silymarin for 7 days followed by 20 mg/kg of 40% ethanol on day 8. Animals were sacrificed on day 8. Liver was excised and then processed for histopathological examination. Biochemical assay for the following hepatic marker enzymes was carried out: alanine amino-transferase (ALT), aspartate amino-transferase (AST), alkaline phosphates (ALP), and protein concentration. Results: The results showed that watermelon treatment leads to increase in body weight. Furthermore, pretreatment with watermelon seed extract lead to significant decrease (P < 0.05) in plasma AST, ALT, ALP, and protein concentration, compared to ethanol treatment group. Conclusion: Watermelon seed extract demonstrates hepatoprotective effect in ethanol-induced oxidation in the liver of Wister rats, which might be linked to various antioxidant phytochemical content present in the extract.

Giant Congenital Melanocytic Nevi: Case Report and Review of Literature Yakubu Abubakar, Hafsat Rufai Ahmad, Jamilu Abdullahi Faruk Sub-Saharan African Journal of Medicine 2018 5(4):138-141 Background: Giant congenital melanocytic nevus is defined as a melanocytic lesion present at birth that reaches a diameter of more than 20 cm in adulthood. Its incidence is estimated as below 1:500,000 newborns. These lesions have a major psychosocial impact on the patient and the family because of its unsightly appearance in addition to neurological complications and high risk of malignant transformation into a melanoma. Case: A 6-month-old girl presented with hyperpigmented skin lesions over the back, gluteal regions, perineum, thighs, and scalp since birth with a progressive increase in number and sizes of satellite lesions all over the body. A clinical diagnosis of giant cell melanocytic nevi was made because of the sizes, location, and color of the lesions. Although she was planned to have a thorough neurological assessment due to the number and sizes of the lesions, she was lost to follow-up because of financial constraints and the perception that no medical/surgical intervention could be offered to her. Conclusions: Giant congenital melanocytic nevi are rarely seen or reported. It is however worthy to note that adequate investigation, proper and effective communications between physicians and the parents/patient, and monitoring for neurological complications are essential in ensuring satisfaction in the quality of life of these patients.

Systemic lupus erythematosus presenting with vasculitic breast ulcer: a case report Umar Abdul'Aziz, Maryam Ahmed Shehu Sub-Saharan African Journal of Medicine 2018 5(4):142-145 Background Systemic lupus erythematosus (SLE) is a multisystem inflammatory autoimmune disease characterized by myriads of clinical manifestations and presentation, ranging from benign to organ-threatening presentation. Secondary vasculitis resulting from inflammation of the blood vessel linings in SLE have been described and can affect any vessel of any size and site, often portending poor prognosis due to attendant risk of ischemic target organ damage. Vasculitis affecting the mammary gland is particularly rare and could present as a diagnostic challenge. This case report with literature review highlights the importance of considering vasculitis as a cause of breast ulcer in SLE patients. Case History A 36-year-old poorly managed SLE patient presented with a 3-week history of a painful nodule on the upper outer quadrant of her right breast that ulcerated spontaneously after a week resulting in an expanding deep ulcer of the upper outer quadrant of the right breast despite usage of broad-spectrum antibiotics therapy and wound care. Wound microscopy, culture and sensitivity, and acid fast bacilli test were negative. Punch biopsy findings showed features consistent with vasculitis. The breast ulcer responded to initiation of azathioprine and prednisolone, and the patient ultimately had skin grafting. Conclusion Systemic lupus erythematosus vasculitis can affect the breast, presenting with features akin to breast cancer such as breast induration, nodules, or poorly healing ulcer. High index of suspicion is required to attain the diagnosis and patients usually show good response to immunomodulatory therapy.

Nigerian healthcare organization: A mirror to Africa’s conundrum? Uchenna Kelvin Omeje, Joshua Boloroduro Adeoye Sub-Saharan African Journal of Medicine 2018 5(4):146-147