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Folayan, M, Olanrewaju I, Brown B, El Tantawi M, Uzochukwu B, Ezechi O, M. Aly N, Abeldaño G, Ara E, Ayanore M, Ayoola O, Osamika B, Ellakany P, Gaffar B, Idigbe I, Ishabiyi A, Jafer M, Khan A, Khalid Z, Nguyen A.  2021.  Differences in COVID-19 Preventive Behavior and Food Insecurity by HIV Status in Nigeria, 2021/08/13. :3. Abstract

The aim of the study was to assess if there were significant differences in the adoption of COVID-19 risk preventive behaviors and experience of food insecurity by people living with and without HIV in Nigeria. This was a cross-sectional study that recruited a convenience sample of 4471 (20.5% HIV positive) adults in Nigeria. Binary logistic regression analysis was conducted to test the associations between the explanatory variable (HIV positive and non-positive status) and the outcome variables-COVID-19 related behavior changes (physical distancing, isolation/quarantine, working remotely) and food insecurity (hungry but did not eat, cut the size of meals/skip meals) controlling for age, sex at birth, COVID-19 status, and medical status of respondents. Significantly fewer people living with HIV (PLWH) reported a positive COVID-19 test result; and had lower odds of practicing COVID-19 risk preventive behaviors. In comparison with those living without HIV, PLWH had higher odds of cutting meal sizes as a food security measure (AOR: 3.18; 95% CI 2.60-3.88) and lower odds of being hungry and not eating (AOR: 0.24; 95% CI 0.20-0.30). In conclusion, associations between HIV status, COVID-19 preventive behaviors and food security are highly complex and warrant further in-depth to unravel the incongruities identified.

Onwuka, C, Ayoola O, Adekanle O, Famurewa O, Abidoye I.  2021.  Renal arterial resistance index among subjects with liver cirrhosis in a Nigerian population, 2021/02/01. Abstract

Purpose:To describe the relationship between renal artery resistance index (RARI) and liver function based on Child-Pugh system among patients with liver cirrhosis (LC) in Southwest Nigeria.
About 50 patients with LC and 50 controls were consecutively recruited into this prospective comparative case control study. Each LC patient was classed based on Child-Turcotte-Pugh (CTP) system after relevant tests. Subjects underwent abdominal ultrasonography with triplex Doppler examination of the right kidney to obtain RARI.
About 50 cirrhotic and 50 controls completed the study. Age range of cirrhotic subjects was 19-69 years (mean ± SD = 47.5 ± 13.3) while that of controls was 18-69 years (46.9 ± 15.0). RARI was higher (P = <.001) in patients with LC (0.68) than in controls (0.57). RARI was also significantly higher (P = <.001) in cirrhotic subjects in CTP class C (0.72) than in those in classes B (0.66) and A (0.58). Additionally, RARI showed significant correlation with CTP total score (r = .662; P = <.001), serum bilirubin (r = .297; P = .036), serum albumin (r = -.494; P = <.001), serum sodium (r = -.369; P = .008), Model for End Stage Liver Disease (MELD) score (r = .316; P = .026) and MELD-Na score (r = .470; P = .001). RARI showed no significant relationship with serum creatinine (r = .110; P = .445) and blood urea nitrogen (r = .112; P = .437).
Liver cirrhosis is associated with renovascular changes which manifest as increased resistance in the renal arteries. RARI is a useful noninvasive tool for the assessment of these changes and should be done routinely in the evaluation of patients with LC.

Ayoola, O.  2020.  Sickle cell disease: Studying arteries with Doppler ultrasound, 2020/08/19. Abstract

Sickle cell disease is one of the most common genetic diseases worldwide. Occlusion of blood vessels triggers painful crises and leads to various clinical manifestations such as kidney failure, leg ulcers, bowel ischemia, portal hypertension and retinopathy. Many imaging methods allow to observe vaso-occlusion but are limitedby cost and availability issues. In this write-up, the value of Doppler
ultrasonography, a cheap, readily accessible, and noninvasive technique, is illustrated in the evaluation of different vessels in sickle cell disease patients.

Akinlade, F, Asaleye M, Ayoola O, Aremu A.  2020.  Ultrasound assessment of normal liver, spleen, and kidney dimensions in southwest Nigerian children: a bedside formula for sonologists, 2020/08/10. 62:028418512094848. Abstract

BackgroundKnowledge of the normal sizes of the liver, spleen, and kidneys is important to radiologists when assessing for pathology using ultrasound scan. The need for a local determination of a easy-to-use formula for estimating the expected normal sonographic dimensions of these organs in children in order to serve as baseline when assessing them for pathology cannot be over emphasized.
To determine ultrasonographic sizes of the liver, spleen, and kidneys among primary school children in southwestern Nigeria and correlate these with anthropometric measures to provide local reference data and an easy-to-use formula for assessing these organs for pathology in clinical practice.
Material and Methods
This is an observational, cross-sectional study using 1000 public primary school children in Ogbomoso. Sonographic dimensions of their liver, spleen, and both kidneys with anthropometric parameters were obtained and correlated. Data were analyzed using SPSS version 20.
The liver span was higher in boys than in girls ( P = 0.048) while the left lobe of the liver was higher in girls than in boys ( P = 0.003). The spleen length was higher in boys than in girls ( P = 0.011). There was no gender difference in kidney dimensions ( P > 0.05). All anthropometric measures correlated significantly ( P < 0.001) with organ dimensions. Body surface area is the strongest predictor of the liver and kidney sizes ( P < 0.001) and height for spleen size ( P < 0.001).
Nomograms for the liver, spleen, and kidneys and regression equations for estimating the dimensions of these organs were formulated based on the best multivariate correlates.

Ayoola, O, Bolarinwa R, Onwuka C, Idowu B, Aderibigbe A.  2020.  Association between Endothelial Dysfunction, Biomarkers of Renal Function, and Disease Severity in Sickle Cell Disease, 2020/02/27. 1:79-85. Abstract

BackgroundEndothelial dysfunction (ED), as ascertained by brachial artery flow-mediated dilation (FMD), is a known feature of sickle cell disease (SCD), which is present both in crisis and in steady state. The assessment of FMD was introduced to examine the vasodilator function. Our objective was to establish the relationship between ED determined by FMD, biomarkers of renal dysfunction, and biomarkers of disease severity in SCD subjects asymptomatic of renal disease.
We enrolled 44 patients with homozygous SCD in steady state and 33 age- and sex-matched controls between 2013 and 2014 in a tropical tertiary hospital. Ultrasonographic FMD of the right brachial artery, renal arterial Doppler, complete blood count, creatinine, fetal hemoglobin, soluble P-selectin, and cystatin C (Cys-C) levels were determined. Using the median FMD value of the control group, the SCD subjects were further classified into two groups for comparison.
The median FMD in SCD subjects of 3.44 (IQR, 0.00–7.08) was significantly lower than that of controls, which was 5.35 (IQR, 3.60–6.78; P =0.04). There was negative correlation between FMD and Cys-C levels ( r =−0.372; P =0.01) along with renal artery resistivity index (RARI; r =−0.307; P =0.04) in SCD subjects. Additionally, Cys-C level was significantly higher in SCD subjects with FMD<5.35.
Brachial artery FMD was significantly lower in SCD subjects compared with a control group. Cys-C and RARI show a negative correlation with FMD, indicating that renal function is related to ED in SCD.

Anipole, O, Adegbehingbe O, Ayoola O.  2020.  Confirmation of Tenotomy Healing at 3 Weeks Using the Ponseti Protocol, 2020/01/15. 59 Abstract

Percutaneous Achilles tenotomy is an integral key element of the Ponseti method in clubfoot management. The duration of posttenotomy casting has been empirical. Evidence-based duration of healing in Achilles tendon is required to objectively determine the period of posttenotomy casting. This study aims to use clinical and ultrasonographic methods to evaluate the mean duration of Achilles tendon gap (ATG) closure and the weekly percentage of feet that achieved ATG closure after tenotomy. Prospectively, 37 feet of 25 patients <5 years old with idiopathic clubfoot were managed using Ponseti methods. The Achilles tendon was assessed clinically and ultrasonographically before and after tenotomy. The tendon stump gap was created at tenotomy, and posttenotomy assessments were done on a weekly basis until tendon stump gap closure was achieved, with a minimum follow-up of 2 years. The immediate posttenotomy ultrasonographic mean tendon gap area was 5 ± 2.8 mm. The mean duration of the tendon stump gap closure as determined clinically was 1.9 ± 0.8 weeks, whereas it was 2.6 ± 0.9 weeks as assessed ultrasonographically (p < .001). The significant difference between clinical and ultrasound methods of assessing the Achilles tendon gap closure appears to establish casting removal and ambulatory walking at 3 weeks after tenotomy for <5-year-old children with idiopathic clubfoot treated with the Ponseti method. We recommend that the duration of posttenotomy cast should be 3 weeks based on the ultrasonographic findings.

Onigbinde, S, Famurewa O, Ibitoye B, Ameye S, Ayoola O, Asaleye M.  2019.  Sphenoid sinus pneumatization, septation, and the internal carotid artery: A computed tomography study., 2019/12/19. Abstract

Background: The air spaces of the nasal cavity and the sphenoid sinus (SS) constitute a convenient corridor to access lesions of the skull baseusing 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.

Ayoola, O, Bolarinwa RA, Aderibigbe A, Onigbinde S, Oguntade BP.  2019.  Portal Hypertension evolving from Sickled Hepatopathy: Could Hepatic venous Doppler ultrasound be beneficial in its evaluation?, 2019/11/01 135:109450. Abstract

Purpose:Sickle cell intrahepatic cholestasis involves sickling within hepatic sinusoids leading to vascular stasis and localized hypoxia resulting in ballooning of the hepatocytes causing a direct back pressure effect with resultant intracanalicular cholestasis. Vascular stasis may ultimately lead to portal hypertension. We proposed to document findings suggestive of portal hypertension evolving from hepatopathy in steady-state sickle cell disease (SCD) patients using hepatic venous Doppler ultrasound.
This is a prospective case series of 6 SCD subjects in steady-state (median age, 30 years; range, 19-43), comprising of 3 males and 3 females, who underwent a routine Doppler ultrasound evaluation of their hepatic veins and were discovered to have an abnormal biphasic waveform pattern. Venous blood was obtained from all subjects to evaluate for P-selectin, homocysteine, foetal haemoglobin, haematocrit levels, white cell and platelet counts. Doppler ultrasound was also carried out on all subjects to evaluate for the hepatic waveform, right renal artery RI and PI along with the hepatic artery velocities.
All the 6 subjects had reduced haematocrit (median value of 21.5%; range, 18-25%) and some degree of renal dysfunction (plasma cystatin-C ranged from 1.6 to 12.2 mg/L). Elevated white cell count, hyperhomocysteinemia, reduced SpO2(<94.0%) and reduced estimated GFR (eGFR < 90 ml/min) was also noted in 4 subjects (66.7%). Similarly, 4 subjects (66.7%) had elevated RI in the right kidneys while 3 subjects (50.0%) had elevated PI in the right kidney.
Doppler ultrasound Hepatic vein waveform analysis may be a useful examination in the evaluation of patients with SCD as it may elicit feature of portal hypertension. Further studies are suggested to confirm this in a larger population of SCD patients using the gold standard.

Ayoola, O, Bolarinwa R, Onigbinde S, Onakpoya O, Asaleye M, Odedeyi A.  2019.  Intima-media thickness of the common carotid arteries as a marker of retinopathy in sickle cell disease, 2019/07/05. 39 Abstract

Purpose:This study was conducted to test the hypothesis that the carotid intima-media thickness (CIMT) is higher in patients with sickle cell disease (SCD) than in the normal population, and to determine the relationships of the CIMT with central retinal artery (CRA) and renal artery Doppler indices.
Forty-four confirmed steady-state SCD patients aged 16 years and above were recruited consecutively. The Doppler velocimetric indices of their right renal artery and both CRAs were obtained. The CIMT was also measured on each side via B-mode ultrasonography. The subjects were categorized by age and sex. Mean and median values for each group were determined. The Spearman correlation test was used to quantify the relationships between CIMT and the Doppler parameters.
The participants had a median age of 24.50 years (interquartile range, 12.50 to 36.50 years). Twenty-three were men (52.3%) and 21 were women (47.7%). The median CIMT was 0.70 mm (IQR, 0.50 to 0.90 mm). Significant correlations with the CIMT were found for the CRA peak systolic velocity (r=0.312, P=0.003), the renal artery resistivity index (RI) (r=0.284, P=0.007), and the renal artery pulsatility index (PI) (r=0.273, P=0.010). There was no significant relationship between the CIMT and the CRA end-diastolic velocity, CRA RI, or CRA PI.
The CIMT was higher in SCD patients than in the normal population. In addition, the CIMT was significantly correlated with the CRA peak systolic velocity, the renal artery RI, and the renal artery PI.

Lawal, O, Balogun M, Akintomide A, Ayoola O, Mene-Afejuku T, Ogunlade O, Okunola O, Lawal A, Akinsola A.  2019.  Carotid Intima-Media Thickness: A Surrogate Marker for Cardiovascular Disease in Chronic Kidney Disease Patients, 2019/06/01. 13:117954681985294. Abstract

Background:Cardiovascular disease (CVD) is the leading cause of mortality in patients with chronic kidney disease (CKD). Carotid intima-media thickness (CIMT) is a measure of atherosclerotic vascular disease and considered a comprehensive picture of all alterations caused by multiple cardiovascular risk factors over time on the arterial walls. We therefore sought to determine the CIMT of the common carotid artery in patients with CKD and to evaluate the clinical pattern and prevalence of CVD in CKD patients.
A case-control study involving 100 subjects made of 50 patients with CKD stages 2 to 4 and 50 age and sex matched apparently normal individuals. Carotid intima-media thickness of the common carotid artery was considered thickened if it measured greater than 0.8 mm. All subjects had laboratory investigations, 12-lead electrocardiogram, transthoracic echocardiography, and ankle-brachial index.
The mean CIMT was higher in CKD population compared with controls (P < .001). Eighty-four percent of the study population was found to have thickened CIMT compared with 18% of controls (P < .001). Patients with CKD had significantly higher blood pressure and heart rate than controls. Cardiovascular disease was also more prevalent among patients with CKD as compared with controls. Carotid intima-media thickness positively correlated with age, blood pressure, and random blood sugar.
As CIMT was well correlated with many cardiovascular risk factors among CKD patients, it may serve as a surrogate marker for CVD and its early assessment may target patients who may need more aggressive therapy to retard the progression of kidney disease and improve outcome.

Fanimi, OO, Asaleye M, Salako AA, Ayoola O, Adedeji T, Idowu B.  2019.  Transrectal Doppler Sonography of Benign Prostatic Enlargement in Nigerian Men, 2019/05/13. 27 Abstract

Background:Transrectal ultrasonography (TRUS) is the best route for examining the prostate gland because of transducer proximity, elaboration of zonal anatomical details, and Doppler assessment of prostatic arteries' hemodynamics.
Materials and methods:
This was a cross-sectional study of 300 men with benign prostatic enlargement (BPE) and 300 healthy age-matched controls. The resistive index (RI) of the left capsular, right capsular and urethral arteries were assessed by TRUS and correlated with these parameters: maximum urine flow rate (Qmax), total prostatic volume (TPV), transitional zone volume (TZV), transitional zone index (TZI), presumed circle area ratio, and the International Prostatic Symptoms Score (IPSS).
The RI of capsular and urethral arteries correlated significantly with Qmax, TPV, TZV, TZI, and IPSS. Of the three different RIs evaluated, the RI of UA showed the strongest correlation with Qmax (r =- 0.51; P < 0.0001). The RIs were significantly higher in obstructive BOO than the non-obstructive group (Qmax of <15 ml/sec and ≥15 ml/sec, respectively). The mean RI values were 0.73 ± 0.05 vs. 0.63 ± 0.04 for the RCA; 0.73 ± 0.05 vs. 0.62 ± 0.04 for the LCA; and 0.73 ± 0.06 vs. 0.62 ± 0.05 for the UA in the BPE and controls, respectively (P < 0.001). The TPV values were 52.36 ± 28.67 and 18.28 ± 4.26 in BPE and controls, respectively (P < 0.001).
Prostatic artery RIs are elevated in BPE. Increase in RI correlated with increase in TPV, TZV and TZI, urinary symptoms' severity, poor QOL, and the severity of BOO.

Ayoola, O, Bolarinwa R, Onakpoya U, Onwuka C, Adedeji T, Afolabi B, Onigbinde S, Arogundade F.  2019.  Doppler ultrasonographic evaluation of celiac and mesenteric arteries in subjects with sickle cell disease, 2019/05/07. 47 Abstract

Vasculopathy, as occurring in sickle cell disease (SCD), can affect celiac and mesenteric arteries and result in stenosis, with elevated peak systolic velocity (PSV) on Doppler ultrasonography. In six subjects with confirmed SCD in steady state, routine Doppler ultrasonographic examination discovered features of celiac artery (CA) or superior mesenteric artery (SMA) stenosis with CA PSV >200 cm/s (median = 222.8 cm/s; range = 201.5‐427.1 cm/s) and/or SMA PSV >275 cm/s (median 183.2 cm/s; range = 87.8‐289.3 cm/s). Among the six subjects, five had elevated soluble P‐selectin values (median 72.55 ng/mL), while all six (100%) had elevated cystatin C levels (median 4.15 mg/L). Peripheral oxygen saturation was suboptimal in five subjects. All subjects had low hemoglobin concentration levels (median 8.5 g/dL) while four had elevated white blood cell count. Although vaso‐occlusive crises result from microvessel occlusion, these findings at the macrovascular level suggest that SCD patients may also be vulnerable to mesenteric ischemic injury, especially in the setting of anemic heart failure from hemolysis.

Bolarinwa, R, Onakpoya U.  2019.  Evaluation of Renal Arterial Resistivity Index and Some Biochemical Parameters in Sickle Cell Disease: A Preliminary Study for Early Detection of Renal Impairment, 2019/04/27. Abstract

Background: The Doppler Resistive Index (RI)measures intrarenal arterial resistance. It is
increased in a number of kidney diseases and
considered a marker of renal function, which could
serve as an early radiologic predictor of
renovascular changes in sickle cell disease (SCD).
Aims and Objective:
This study evaluated selected biochemical markers
of renal functionand renal Doppler RI in a cohort of
Nigerian adults with SCD and Hb AA controls.
Materials and Methods:
Forty-four Hb SS patients in steady state (M:F =
1.2:1; median age is 24.5) and 22 Hb AA age and
sex-matched controls were recruited consecutively
into the study. All had serum biochemical tests
including serum cystatin-C, serum kidney injury
molecule-1 and serum creatinine while urinary
albumin-creatinine ratio was also evaluated. The
right renal artery Doppler RI was also evaluated in
the segmental/interlobar arteries while relevant nonparametric
tests were used to compare the
biochemical and Doppler parameters between the
subjects and the controls.
Serum creatinine ranged from subnormal to mildly
elevated levels in patients with Hb SS (33-
245μmol/l) and the median (range) renal arterial
Doppler RI was 0.70 (0.49-0.81). The other
parameters evaluated were significantly higher in
patients relative to the controls. Of the biochemical
parameters, urinary albumin- creatinine ratio
showed a weak but statistically significant positive
correlation with renal arterial Doppler RI (r=0.329; p=
0.029), while serum cystatin-C and kidney injury
molecule-1 had no correlation (r = 0.152 and 0.188
respectively; p = 0.324 and 0.22).
Renal arterial Doppler Resistivity Index has a linear
relationship with urinary albumin-creatinine ratio and
could therefore be a potential marker of early renal
impairment in patients with SCD.
Keywords: Sickle cell disease, renal arterial
Doppler resistive index, cystatin-C, serum kidney
injury molecule 1, urinary albumin-creatinine ratio.

Oguntoye, O, Ndububa D, Musah Y, Bolarinwa R, Ayoola O.  2019.  Clinical and Biochemical Manifestations of Severe Sickle Cell Anemia in Adult Patients in Steady State in Ile-Ife, Nigeria, 2019/03/31. 14:52. Abstract

Background: There are documented established markers (indices) of disease severity in patients with sickle cell anemia (SCA) and they determine the course of the disease. This study investigated the pattern and prevalence of some of these markers of disease severity in adult patients with SCA in steady state attending the hematology clinic of a federal tertiary teaching hospital in Ile-Ife, Nigeria.Materials and Methods: This was a descriptive study. Basic demographic data and relevant clinical information was obtained using a well-structured questionnaire and the case files (hospital records) of 50 consecutive SCA (HbSS) patients.
Results: The study group comprised of 21(42%) males and 29(58%) females. The age range was 18–45years with a mean(
SD) of 27.6
7.607. Hepatomegaly(64%), frequent episodes of vaso-occlusive crisis, that is,

3 episodes per year(30%) and Dactylitis in infanthood(26%) were the most common clinical parameters identified in these patients while a high serum total bilirubin of
51µmol/L(26%) was the most common laboratory parameter seen in these patients.
Conclusion: Markers of disease severity were identified in the patients with SCA in this study. The presence of these markers in an SCA patient connotes severe disease and they determine the course of the disease. Therefore, there is a need to pay more attention to these patients by following them up more closely.

Ounsemoyin, A, Idowu B, Ayoola O.  2019.  Sonographic evaluation of post-Cesarean lower uterine segment in pregnant Nigerian women, 2019/01/01. 57:27-34. Abstract

Background: This study was done to determine if there are significant morphological differences between a previously sectioned and non-operated lower uterine segment in a group of Nigerian women.Methods: This was a prospective, descriptive, comparative study of thirty-eight pregnant women with previous Cesarean section (CS) and 45 pregnant women with no previous uterine surgery. They had transabdominal sono-graphic measurement of their lower uterine segment thickness between 35 and 37 weeks gestation. Mann-Whitney U test was used for comparison of means.
Results: The lower uterine segment (LUS) was significantly thinner in women with previous Cesarean group compared to the controls (mean of 4.9 ± 2.5 mm and 3.4 ± 2.2mm versus 6.4 ± 2.8 mm and 4.5 ± 2.2mm for full and myometrial thicknesses, respectively; P= 0.006 and 0.007, respectively). Normal lower uterine segment appearance and thicknesses were seen in the majority of previously sectioned women. The previous scar site was identified in 8 (10.7%) of women with previous scar.
Conclusion: The LUS is thinner in women with previous CS; the more the number of Cesarean sections, the thinner the LUS becomes. Ultrasonography of the LUS could be done to help decide for or against a trial of scar.

Ayoola, O, Bolarinwa R, Onakpoya U, Adedeji T, Onwuka C, Idowu B.  2018.  Intima-media thickness of the common femoral artery as a marker of leg ulceration in sickle cell disease patients, 2018/11/27. 2:3112-3117. Abstract

Leg ulceration is a debilitating chronic complication of sickle cell disease (SCD) the pathogenesis of which is yet to be fully elucidated. We hypothesized that SCD patients with histories of previous leg ulcers would have intima hyperplasia of the common femoral artery (CFA). We enrolled 44 SCD patients and 33 age-matched and sex-matched controls with hemoglobin AA. Anthropometric measurements, biochemical parameters, and sonographic intima-media thickness (IMT) of the CFA were determined. The median CFA IMT in SCD limbs with history of leg ulcers (SWLU) was 1.0 mm, whereas it was 0.7 mm in SCD limbs with no history of leg ulcer (SNLU) and 0.60 mm in controls (P < .001). Among the SNLU, 70.3% had CFA IMT <0.9 mm, whereas only 29.7% had CFA IMT ≥0.9 mm. Conversely, only 20.8% of SWLU had CFA IMT <0.9 mm, whereas the remaining 79.2% had CFA IMT ≥0.9 mm. All the controls had CFA IMT <0.9 mm. Binary logistic regression to determine the odds of having leg ulcer among SCD limbs with CFA IMT of ≥0.9 mm yielded an odds ratio of 9, indicating that SCD limbs with CFA IMT ≥0.9 mm had a 9 times greater risk of having leg ulcer compared with those with CFA IMT <0.9 mm. There is a significant increase in the CFA IMT of SCD limbs with ulcer compared with controls and SCD limbs without ulcer, suggesting that arterial vasculopathy plays a major role in the formation of these ulcers.

Soyoye, O, Otuyemi O, Kolawole K, Ayoola O.  2018.  Relationship between masseter muscle thickness and maxillofacial morphology in pre-orthodontic treatment patients, 2018/10/01. 16 Abstract

This study investigated the relationship between masseter muscle thickness and cephalometric facial parameters in pre-orthodontic treatment patients. Participants were grouped according to their vertical facial patterns into low, normal, and high angle facial patterns using standardised lateral cephalometric radiograph. Associations between the masseter muscle thickness (measured using ultrasonography) and different vertical facial patterns were analysed. Masseter muscle thickness in low angle subjects were significantly higher than the normal and high angle cases during both relaxation and contraction phases (P < 0.001). Masseter muscle thickness correlated positively with Jarabak ratio and ramus thickness (R1/R2) during both phases, and negatively with LAFH, FMA, MMPA and gonial angle.

Soyoye, D, Dawha S, Ayoola O, Ibitoye B, Ikem R, Adedeji T.  2018.  Relationship between Renal Doppler Indices and Biochemical indices of Renal Function in Type 2 Diabetes Mellitus, 2018/09/01. 35:189-194. Abstract

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.
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).
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.

Akinmade, A, Ikem I, Ayoola O, Orimolade A, Adeyeye A.  2018.  Comparing ultrasonography with plain radiography in the diagnosis of paediatric long-bone fractures, 2018/08/30. 43 Abstract

PurposePaediatric long-bone fractures are commonly seen in the emergency department, and diagnosis is usually confirmed by conventional radiographs. This entails exposure to ionizing radiation with its attendant possible carcinogenic and teratogenic effects. Ultrasonography provides a potentially safer diagnostic alternative and may be cheaper, more readily available, and user-friendly. This study aimed to establish the applicability of ultrasound scanning compared with plain radiography in fracture diagnosis.
This prospective observational study documented fracture characteristics using plain radiographs and compared these with findings on ultrasound assessment of same fractures at the time of injury. Scans were repeated at week three and week six to monitor treatment in those whom the mode of treatment did not preclude scanning. Outcome measures were compared for relationships including sensitivity and specificity as well as overall predictive values.
The age range of the 62 subjects enrolled was one to 15 years and the male to female ratio was 1.8:1. Plain radiographs diagnosed 52 fractures and 50 of these were recognized on ultrasound. The two false-negative ultrasound scans were noted in metaphyseal humeral fractures. Overall sensitivity, specificity, and positive and negative predictive values for ultrasonography were 96.2%, 100%, 100%, and 83.3% respectively. Ultrasound scans were also noted to identify callus formation significantly earlier than plain radiographs.
Ultrasound shows potential as a tool in diagnosis of paediatric fractures but may be limited in fractures around metaphyseal bone. Due to the ability to detect callus formation much earlier, ultrasonography may be very useful in monitoring of fracture healing.

Famurewa, O, Asaleye M, Ibitoye B, Ayoola O, Aderibigbe A, Badmus T.  2018.  Variations of renal vascular anatomy in a nigerian population: A computerized tomography studys, 2018/07/01. 21:840-846. Abstract

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.
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.
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.
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.

Olabimpe, S, Otuyemi O, Adebanke K, Ayoola O.  2018.  Relationship between masseter muscle thickness and overbite values in a Nigerian population, 2018/03/12. 16:1-10. Abstract

Objective: This study determined the relationship between masseter muscle thickness and overbite values among Nigerians. Methods: The subjects included 66 consecutive patients (21 males and 45 females) who presented for fixed orthodontic appliance treatment. Overbite values were measured from standard lateral cephalometric radiographs taken for all patients,who were thereafter divided into three groups of reduced overbite (n=22, mean -1.11+ 2.18mm), normal overbite (n=22, mean 2.59+0.50mm) and increased overbite (n=22, mean 5.21+1.39mm). The masseter muscle thickness of each patient was measured bilaterally using ultrasonography. Associations between masseter muscle thickness and different overbite values were analyzed using unpaired t-test, ANOVA and Tukey's multiple comparison analysis. Results: Mean masseter muscle thickness was 11.23 ± 2.40 mm during relaxation and 12.81 ± 2.64 mm during contraction for study participants. The masseter muscle on the habitual side of mastication of participants was generally thicker but the difference was not statistically significant (P > 0.05). There was a progressive increase in masseter muscle thickness from reduced overbite through normal overbite to increased overbite groups and the differences were statistically significant (P < 0.01). Tukey's multiple comparisons showed significant differences between all the three overbite groups (P < 0.05). Conclusion: There was a direct relationship between the muscle thickness and overbite variations.

Afolabi, BI, Ayoola O, Idowu B, Kolawole BA, Omisore A.  2018.  Sonographic Evaluation of the Achilles Tendon and Plantar Fascia of Type 2 Diabetics in Nigeria, 2018/01/01. 27 Abstract

Background:The aim of this study is to compare the Achilles tendon (AT) thickness (ATT) and plantar fascia (PF) thickness (PFT) of diabetics with and without peripheral neuropathy (PN) to that of a control population.
Materials and methods:
B-mode sonography of the AT and PF was done. Correlation analysis was used to determine the relationship between ATT and PFT with demographic data such as body mass index, duration of diabetes, and presence of PN. A multivariate regression was used to construct models for determining the thicknesses.
Eighty type 2 diabetics were recruited and categorized into groups based on the presence or absence of PN (Groups A and B, respectively). Group A constituted 57 participants while there were 23 in Group B. Eighty controls constituted Group C. Mean values of 6.08 ± 0.65, 5.08 ± 0.48, and 4.57 ± 0.57 mm (P < 0.001) of the right ATT were obtained in Groups A to C while values of 1.95 ± 0.35, 1.88 ± 0.39, and 1.44 ± 0.20 mm (P < 0.001) were obtained for the right PFT.
The presence of PN and factors such as diabetes duration can affect the thickness of AT and PF.

Abidoye, I, Ayoola O, Idowu B, Aderibigbe A, Loto O.  2017.  Uterine artery Doppler velocimetry in hypertensive disorder of pregnancy in Nigeria, 2017/12/29. 17 Abstract

Aim of the study: To evaluate the value of uterine artery Doppler indices and waveformpattern in predicting fetuses at risk for intrauterine growth restriction in hypertensive
disorders of pregnancy. Materials and methods: This was a prospective cross-sectional
study including 80 pregnant subjects with hypertensive disorders of pregnancy and two
control groups. Uterine artery Doppler sonography was performed in all study participants.
Uterine artery Doppler indices across the groups were compared using the analysis
of variance (ANOVA) while the presence of prediastolic notch was analyzed with the Chi
Square test. Results: For the hypertensive disorders of pregnancy group, resistivity index
> 0.66 had a sensitivity of 50.0%, specificity of 69.1% and a positive predictive value of
22.2% for predicting intrauterine growth restriction. The odds ratio was 2.2 with a 95%
confidence interval of 0.6–7.8. The presence of prediastolic notching had a sensitivity of
100.0%, specificity of 96.0% and a positive predictive value of 80.0% for predicting intrauterine
growth restriction. The odds ratio was 22.7 with a 95% confidence interval of
7.5–68.5. Conclusion: Uterine artery Doppler sonography is useful for predicting fetuses
at risk for intrauterine growth restriction in hypertensive disorder of pregnancy. Prediastolic
notching is more sensitive and more specific than uterine artery resistivity index in
predicting fetuses at risk of intrauterine growth restriction in established hypertensive
disorder of pregnancy.

Idowu, B, Ayoola O, Adetiloye V, Komolafe M, Afolabi B.  2017.  Sonographic detection of inferior subluxation in post-stroke hemiplegic shoulders, 2017/06/30. 17:106-112. Abstract

Aim of the study:To evaluate the usefulness of ultrasonographic acromion-greater tuberosity distance measurement and Shoulder ratio in detecting post-stroke inferior shoulder subluxation.
Material and methods:
Forty-five hemiplegic stroke patients and 45 controls underwent shoulder sonography to measure their acromion-greater tuberosity distance. Side-to-side acromion-greater tuberosity distance differences and Shoulder ratios were derived from the acromion-greater tuberosity distance values. The long head of biceps tendon, subscapularis tendon, supraspinatus tendon, and the infraspinatus tendon were also evaluated to exclude full thickness tendon tears. Data were analyzed using the Statistical Package for Social Sciences version 20.0 for windows. Normality of data distribution was checked using the Kolmogorov-Smirnov test. Mann-Whitney U test and Chi-square tests were utilized.
Hemiplegic and control shoulders' acromion-greater tuberosity distance values were 2.8 ± 0.6 cm and 2.4 ± 0.4 cm, respectively (p = 0.001). Hemiplegic and control shoulder ratios were 1.3 ± 0.3 and 1.1 ± 0.1, respectively; p < 0.001. Point biserial correlation showed that the presence of subluxation correlated moderately with higher shoulder ratios in all the hemiplegics (rpb = 0.520; p < 0.001).
Our results suggest that acromion-greater tuberosity distance measurement is useful for detecting inferior shoulder subluxation. Shoulder ratio may be of complementary or supplemental value to acromion-greater tuberosity distance difference.