Spectrum of Brain Magnetic Resonance Imaging Findings in Children with Non-febrile Seizures at Ahmadu Bello University Teaching Hospital, Northwest Nigeria

The objectives were to determine the frequency of abnormal magnetic resonance imaging findings in patients with postpartum headache and related factors. A total of 102 patients with postpartum headache underwent brain magnetic resonance imaging study. The images were examined by a blinded radiologist. The related demographic, obstetric and headache-related factors were recorded. The multiple logistic regression model was used to determine the predictive factors. Abnormal magnetic resonance imaging findings were observed in 42 of 102 patients (41.2%, 95% confidence interval = 31.6 to 50.7%). The most common finding was sinusitis (10 of 42 patients, 23.8%, 95% confidence interval = 15.5 to 32%). Then, posterior reversible encephalopathy syndrome (six of 42 cases, 14.2%, 95% confidence interval = 7.4 to 20.9%), cerebral venous thrombosis (four of 42 cases, 9.5%, 95% confidence interval = 3.8 to 15.1%), and subarachnoid hemorrhage (four of 42 cases, 9.5%, 95% confidence interval = 3.8 to 15.1%) were most prevalent findings. Convulsions (odds ratio of 3.39) and initiation of headache earlier than 5 days postpartum (odds ratio of 0.29) were significant predictive factors. Abnormal brain magnetic resonance imaging findings were seen in a considerable number of patients with postpartum headache. When headache starts in the first 5 days postpartum and accompanied by convulsions, there are likely to be abnormal magnetic resonance imaging findings.

Purpose: To describe the brain magnetic resonance imaging (MRI) findings in children with syndromic mitochondrial diseases (MDs).Methods: From 1988 to July 2008, brain MRI of 30 patients diagnosed as syndromic MDs were reviewed. Definite diagnosis of syndromic MDs was made based on the modified diagnostic criteria of mitochondrial diseases.Results: Among the 30 recruited patients, 14 had Leigh syndrome, five exhibited mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes syndrome, three manifested mitochondrial cardiomyopathy, two had Kearns-Sayre syndrome, one exhibited fatal infantile mitochondrial myopathy, one manifested myoclonic epilepsy with ragged red fibers, one had Leber hereditary optic neuropathy, one exhibited deafness dystonia syndrome, one manifested chronic progressive external ophthalmoplegia, and one had Pearson syndrome.One patient with mitochondrial cardiomyopathy did not perform brain MRI and five cases (two mitochondrial cardiomyopathies, one fatal infantile mitochondrial myopathy, one chronic progressive external ophthalmoplegia, and one Pearson syndrome) had initially normal brain MRI findings. Initial brain MRI abnormalities were found in 24 out of 29 patients (83%). The most common signal changes on the initial brain MRI were abnormal signal intensity over the basal ganglia, gray matter, and brainstem in 17 (71%), 10 (42%), and 9 (38%) patients, respectively. 14 out of 15 cases (14/15; 93%) were found to have evolutionary changes on the follow-up brain MRI.Conclusions: Brain MRI is a useful tool helping to make the diagnosis of syndromic MDs in children, especially abnormal signal intensity over the basal ganglia. Follow-up brain MRI is important for assessing clinical evolution of the disease.

A subset of patients experience persistent symptoms after pediatric concussion, and magnetic resonance imaging (MRI) is commonly used to evaluate for pathology. The utility of this practice is unclear. We conducted a retrospective cohort study to describe the MRI findings in children with concussion. A registry of all patients seen at our institution from January 2010 through March 2016 with pediatric sports-related concussion was cross-referenced with a database of radiographical studies. Radiology reports were reviewed for abnormal findings. Patients with abnormal computed tomographies or MRI scans ordered for reasons other than concussion were excluded. Among 3338 children identified with concussion, 427 underwent MRI. Only 2 (0.5%) had findings compatible with traumatic injury, consisting in both of microhemorrhage. Sixty-one patients (14.3%) had abnormal findings unrelated to trauma, including 24 nonspecific T2 changes, 15 pineal cysts, eight Chiari I malformations, and five arachnoid cysts. One child underwent craniotomy for a cerebellar hemangioblastoma after presenting with ataxia; another had cortical dysplasia resected after seizure. The 2 patients with microhemorrhage each had three previous concussions, significantly more than patients whose scans were normal (median, 1) or abnormal without injury (median, 1.5; p = 0.048). MRI rarely revealed intracranial injuries in children post-concussion, and the clinical relevance of these uncommon findings remains unclear. Abnormalities unrelated to trauma are usually benign. However, MRI should be thoughtfully considered in children who present with concerning or atypical symptoms.

BackgroundCoronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging disease. The consequences of SARS-CoV-2 exposure in infants remain unknown. Therefore, this study aims to investigate whether neonates born to mothers with COVID-19 have adverse brain development.MethodsThis multicenter observational study was conducted at two designated maternal and children’s hospitals in Hubei Province, mainland China from February 1, 2020 to May 15, 2020. Neonates born to mothers with COVID-19 were enrolled. Brain magnetic resonance imaging (MRI) findings, and volumes of grey and white matters, and physical growth parameters were observed at 44 weeks corrected gestational age.ResultsOf 72 neonates born to mothers with COVID-19, 8 (11%) were diagnosed with COVID-19, 8 (11%) were critically ill, and no deaths were reported. Among the eight neonates that underwent brain MRI at corrected gestational age of 44 weeks, five neonates were diagnosed with COVID-19. Among these five neonates, three presented abnormal MRI findings including abnormal signal in white matter and delayed myelination in newborn 2, delayed myelination and brain dysplasia in newborn 3, and abnormal signal in the bilateral periventricular in newborn 5. The other three neonates without COVID-19 presented no significantly changes of brain MRI findings and the volumes of grey matter and white matter compared to those of healthy newborns at the equivalent age (P > 0.05). Physical growth parameters for weight, length, and head circumference at gestational age of 44 weeks were all above the 3rd percentile for all neonates.ConclusionsSome of the neonates born to mothers with COVID-19 had abnormal brain MRI findings but these neonates did not appear to have poor physical growth. These findings may provide the information on the follow-up schedule on the neonates exposed to SARS-CoV-2, but further study is required to evaluate the association between the abnormal MRI findings and the exposure to SARS-CoV-2.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12519-021-00426-z.

Background: Seizure is the most common neurological disorder in children and an important cause of paediatric hospital admission with the highest prevalence in the under-five age group. Magnetic Resonance Imaging (MRI) is the neuro-imaging technique of choice in the initial evaluation of children with epilepsy. High-field MRI is the ideal imaging modality for evaluating seizures but this is not readily available in developing countries. Objective: To analyse the spectrum of MRI findings in children presenting with seizures using a low-field (0.36T) MRI. Methods: Children aged ≤18years with seizures, with cranial MRI at the University College Hospital (UCH), Nigeria between January 2013 and June 2015 were retrospectively reviewed. Results: There were a total of 134 patients with 53% as adolescents and most of them (85; 63.4%) had abnormal cranial MRI findings. More male children had abnormal findings (52; 61.2%) and most abnormal findings (42; 49.4%) were reported among adolescents. The most frequent abnormality was hydrocephalus (23.5%) from various causes followed by cerebral tumours (14.1%) and ischaemic cerebral infarcts (11.8%). In the adolescents, intracranial tumours (21.4%) were the most frequent abnormal findings, while hydrocephalus was commoner in children aged less than 10 years, accounting for 33.3% and 36.0% among the 1-5 years and 6-11 years age groups respectively. Conclusion: Low-field MRI, which is more readily available, can provide substantial preliminary findings to aid the management of children with epilepsies. Improved access to high-field MRI through cost reduction and early MR imaging evaluation in the course of illness are desirable.

Background: To assess the patients’ perception of quality of services (PPQS) offered by the haematology laboratory of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. A cross-sectional descriptive study was conducted among 125 outpatients of the haematology laboratory in ABUTH, Zaria. A stratified sampling with subsequent systematic random sampling was utilized. This study was conducted in the haematology laboratory of ABUTH, Zaria, Nigeria from 25th April to 3rd August 2016. Participants and Methods: Five-point Likert scales were used to rate 10 categories in addition to overall satisfaction. The most important service categories were also assessed. Percentage satisfaction and scores (on a scale of 1–5) were computed. Data were analyzed using the Statistical Package for the Social Sciences version 20.0 software. Data were presented using tables. Medians and interquartile ranges were used to summarize ordinal data. Mann–Whitney U or Kruskal–Wallis tests were used as applicable. The level of significance was set at P Results: The mean age of participants was 32.04 ± 10.97 years, and females constituted 71 (56.79%). The service category with the highest satisfaction was cleanliness of phlebotomy area (85.60%) followed by information on how to receive results (80.00%). Staff courtesy had the highest satisfaction score (4.25) followed by ease of phlebotomy (3.97). The least was cleanliness of toilets (3.12). Privacy during phlebotomy, ease of phlebotomy and comfort of chairs were the most important categories, with respective scores/values of 26 (20.80%), 23 (18.40%) and 22 (17.60%). Overall satisfaction was 81.60% (score of 3.94). The distribution of overall satisfaction ratings did not differ across socio-economic groups. Conclusion: The PPQS of the haematology laboratory of ABUTH, Zaria reveals a high level of overall satisfaction. Satisfaction with waiting time and cleanliness of toilets are low. All metrics should be considered as opportunities for improvement.

PP15.11 – 3031: Brain magnetic resonance imaging findings in children with recurrent headache

FRI0327 Brain mri findings in patients with diffuse psychiatric/neuropsychological syndromes in systemic lupus erythematosus

Introduction: Sickle cell anemia (SCA) is a chronic disease presenting with acute and painful exacerbations with multi-organ affectation. An alteration in the components of hemostasis such as the fibrinolytic system is observed among patients with SCA. Routine care of patients with SCA rarely involves the investigation of this component, and little attention is paid to the role of this system in the evaluation of patients with vaso-occlusive crisis. Objectives: To determine the D-dimer levels and some hematological parameters of adult patients with sickle cell anemia in steady state attending the hematology clinic of Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Nigeria. Materials and Methods: We conducted a case-control study involving 50 patients with SCA (HbSS) in steady state and 25 healthy volunteers with normal hemoglobin (HbAA) as controls. Steady state refers to absence of acute painful crisis or any changes due to therapy for at least four consecutive weeks after a previous painful crisis. Hemoglobin concentration (Hb), white blood cell count (WBC), and platelet count were determined by hematology analyzer. D-dimer levels were determined by ELISA method using Microplate Reader (Rayto RT-2100C), calibrated to a wavelength of 450 nm. Results were summarized as frequencies, proportions, and median with interquartile range (IQR) where appropriate and the level of significance was set at ≤0.05. Results: The mean age of the patients was 23.80 ± 7.46 years while that of the controls was 24.28 ± 4.8 years (P = 0.76), respectively. The mean hematological parameters of both groups were Hb (8.57 ± 1.33 vs 13. ± 1.29 g/dL, P value <0.0001), WBC (10.63 ± 3.19 vs 5. 76 ± 1.21 × 109/L, P value <0.0001), platelet count (494.38 ± 213.88 vs 220.83 ± 75.26 × 109/L, P value <0.0001), respectively. The median and IQR of D-dimer levels of the patients and the controls was 1730.25 ng/mL (12359.2–36.2 ng/mL) and 324.00 ng/mL (1034.0–127.8 ng/mL), respectively. Conclusion: Marked increase in D-dimer levels in patients with sickle cell anemia in this study suggested that multiple sites were involved in thrombi formation and this requires extensive fibrinolytic activity to dissolve these thrombi.

Objective : In 1985, the WHO recommended an optimum Cesarean section (CS) rate of 10–15% and stated that there was no justification for any region to have higher rates. The global increase in CS rate is causing concern and it is a major public health issue. Our objective is to appraise the CS intervention, observe trend, and proffer solutions. Materials and Methods : All relevant clinical data from the patients delivery records in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria over the period 2010–2014 were pooled and used to analyze the clinical information. Results : There were a total of 9,388 deliveries during the period out of which 2,254 were CS, giving a rate of 24.5%. The mean age and parity of the study groups were 30.6 ± 4.8 years and 1.9 ± 1.6, respectively. A total of 288 (12%) of them were done as elective. Most of the CS was done due to previous scar, pre‑eclamsia/eclampsia. The maternal mortality rate (MMR) during this period was 870/100000 live births, the CS‑related mortality was 339/100,000, and the perinatal mortality (PM) was 43.9/1000 live births. Conclusion : The CS rate, the MMR, and PM are all high and the indications show that alternative interventions can be used to reverse the ugly trend but there is a need for training. Key words : Cesarean section; rate; maternal mortality; perinatal mortality; indications; trend and training.

Background: Protein energy malnutrition (PEM) is a major public health problem in the tropical and subtropical regions of the world and often arises during protein and/or energy deficits due to nutritional inadequacy, poor socio-economic and environmental conditions and infections. Vitamin A deficiency (VAD) is an important health concern in severe malnutrition and has been found to be associated with significant morbidity and mortality. Children with PEM have greater deficiency of total protein and albumin and in severe cases the total protein may be reduced to about 50 per-cent. The objective of this study was to determine the serum vitamin A, total protein and albumin in malnourished children aged 6-59 months at Institute of Child Health Zaria.&#x0D; Methods: This study was a case control health- based descriptive study to determine the relationship between serum vitamin A, protein and albumin levels among children with Protein Energy Malnutrition and their controls at Institute of Child Health, Ahmadu Bello University Teaching Hospital (ABUTH) Zaria. Using systematic sampling method, a total of 132 children (cases and controls) between 6 and 59 months of age were selected for assessment of their serum vitamin A, protein and albumin. Serum vitamin A level was analyzed by high performance liquid chromatography while the total serum protein and albumin levels were analyzed on the Boerhringer Mannheim Automated Hitachi system 704 using the Biuret and colour change methods respectively.&#x0D; Results: The highest mean serum vitamin A (60.28±11.03μg/dl) and mean protein (61.24±10.12g/dl) among malnourished group were seen in marasmic –kwashiokor. For the controls, the mean serum protein is 62.96±5.99g/dl while the mean serum vitamin A is 59.44±13.90μg/dl. The overall mean serum protein for study group and controls were 50.2 4 ± 12.33μg/dl and 62.96±5.99g/dl respectively and the difference between them was statistically significant (p&lt;0.01) The highest mean retinol (60.28±11.03) and albumin (38.43±30.14g/dl) were recorded among the marasmic-kwashiorkor malnutrition, while for the controls, the mean retinol was 50.44±13.90μg/dl and the mean serum albumin was 37.62±40.98g/dl. The overall mean serum albumin for both study group and controls were37.17±12.22g/dl and 37.62±40.98g/dl respectively and the difference between them was statistically significant (p&lt;0.04).&#x0D; Conclusion: The serumprotein and albumin showed positive correlation with serum vitamin A levels. The highest mean serum vitamin A, protein and albumin was seen in marasmic-kwashiorkor among under-nourished children

The present study looked into the possibility of impact of age on HbA1c level of diabetic patients attending Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Nigeria, as there have been reports of correlation between age and HbA1c in some other parts of the world. Three hundred and fifty (350) diabetic patients were initially recruited over a period of 10 months, from March 2018 to December 2018. Subjects consisted of 200 female and 150 male diabetic patients. After 10-12 hours fast, 5mL of blood was drawn from volunteer patients. About 3mL was centrifuged in order to separate the serum after which the serum was then analysed for glucose. Two hundred and fifteen (215) subjects, comprising of 110 female and 105 male diabetic patients, with ages between 46 years and 84 years (mean age = 65±19 years) and mean blood glucose of 200±20 mg/dL were then selected for the study. The remaining 2mL whole blood was analysed immediately for HbA1c. Information about patient’s age was obtained via a well-designed questionnaire and matched with hospital record. There was no significant difference in the mean HbA1c levels of male and female participants. For the given blood glucose range, the HbA1c level increased by 0.2%, proportionally, with every decade (10 years) increase in age. It was concluded that HbA1c increases consistently – independent of blood glucose and gender – with increase in age of diabetic patients.

The present study looked into the possibility of impact of age on HbA1c level of diabetic patients attending Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Nigeria, as there have been reports of correlation between age and HbA1c in some other parts of the world. Three hundred and fifty (350) diabetic patients were initially recruited over a period of 10 months, from March 2018 to December 2018. Subjects consisted of 200 female and 150 male diabetic patients. After 10-12 hours fast, 5mL of blood was drawn from volunteer patients. About 3mL was centrifuged in order to separate the serum after which the serum was then analysed for glucose. Two hundred and fifteen (215) subjects, comprising of 110 female and 105 male diabetic patients, with ages between 46 years and 84 years (mean age = 65±19 years) and mean blood glucose of 200±20 mg/dL were then selected for the study. The remaining 2mL whole blood was analysed immediately for HbA1c. Information about patient’s age was obtained via a well-designed questionnaire and matched with hospital record. There was no significant difference in the mean HbA1c levels of male and female participants. For the given blood glucose range, the HbA1c level increased by 0.2%, proportionally, with every decade (10 years) increase in age. It was concluded that HbA1c increases consistently – independent of blood glucose and gender – with increase in age of diabetic patients.

Background Hospital acquired infection (HAI) is a major problem in healthcare delivery worldwide despite medical advances. A low HH compliance rate of 17.1% was found among surgical health workers at Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Nigeria. Although hand hygiene (HH) is a proven low-cost means to curtail HAI, low HH compliance is a global reality. The WHO multimodal strategy attempts to address low HH compliance within the frame of contextual realities. Methods This was an interventional study utilizing action research through a mixed method approach to investigate the effectiveness of employing a contextualized multimodal strategy to enhance the HH compliance rate of doctors at ABUTH Zaria. The study was from August to October 2022. A behavioural change campaign (BCC) HH workshop was carried out on doctors, and data collection followed immediately in the surgical wards (i.e. clusters) that had received environmental modification through the provision HH posters and nurses for visual and verbal reminders, respectively. The four clusters were: visual reminders only, verbal reminders only, visual and verbal reminders combined and neither visual nor verbal reminders (i.e. control). All clusters received an uninterrupted supply of alcohol-based hand rubs (ABHR) throughout the study period. The HH observation proforma for ‘five moments of HH’ template was used to collect the quantitative data through direct observation while qualitative data were by one-on-one interviews on doctors in surgical wards at ABUTH Zaria. Results The cumulative HH compliance rate by doctors was 69% (N = 1774). This was significantly different from the baseline HH compliance rate of 17.1% before this study’s intervention (P &amp;lt; 0.0001, C. I. 45.5% to 57.7%). HH was observed from doctors most in wards with both visual and verbal reminders (78%) while lowest (59%) where visual and verbal reminders were not provided, i.e. C4 (n = 444). Compared with the baseline HH compliance, all interventions were significant. However, compared with C4, visual reminders only (C1) had insignificant effect on influencing the HH practice of doctors while visual and verbal reminders combined. Verbal reminders only (C2) were found to be as effective as when combined with visual reminders (78%) as the difference was statistically insignificant (P = 0.4791, CI −3.5% to 7.5%, χ2 = 0.5). However, all doctors reported being motivated to perform HH by the presence of ABHR which was similar to the significance found even in the ward where no verbal or visual reminders (59%, n = 444) were used compared with the baseline (17%, n = 286) before this intervention study (P &amp;lt; 0.0001, CI 35% to 48%, χ2 = 125). All respondents reported hearing about the HH behavioural change workshop even though only one attended. Conclusions Continuous workshop on HH is necessary to sustain awareness of health workers on the importance of hand hygiene. The presence of ABHRs alone was enough motivation for doctors to perform HH but verbal reminders were significant in sustaining this positive attitude towards HH. A scaling of this intervention is needed in other departments so that staff can have changes made to their values towards healthcare delivery as well at ABUTH Zaria. Contextualizing the WHO multimodal strategy is an efficient and acceptable means of addressing the problem of low HH compliance.

MRI utilization and rates of abnormal pretreatment MRI findings in early-onset scoliosis: review of a global cohort.