Clinical Presentation and Outcome of Impalement Craniocerebral Injuries - A CASE SERIES.

Non-missile, low-velocity penetrating craniocerebral injuries are uncommon among civilians and unlike missile injuries, are associated with localized brain injury and subsequent good outcome if managed appropriately. Penetrating injuries to the brain caused by a retained, relatively blunt or sharp object that perforate the brain along its longitudinal axis producing a wound track corresponding to its length of penetration, are called impalement injuries. Most of the impalement craniocerebral injuries are accidental and varying objects have been reported. We report our experience with the management of seven cases of impalement craniocerebral injuries. Five of the patients were adult male while two female children were involved. One case was from assault, others resulted from accidental injury. Left side of the cranium was more commonly involved. The impaled objects in this study included a lead pencil, a screw driver, a branch of a tree, and other metallic objects. Most of the patients had craniectomy and water tight dura repair during remover of the impaled object. All patients made good recovery following surgical intervention. Management principles entail early recognition, deliberate and careful debridement, and judicious antibiotic therapy. The surgical approach to these injuries varies, depending on the route of entry.

INTRAMEDULLARY TUBERCULOMA OF THORACIC SPINAL CORD IN AN APPARENTLY HEALTHY NIGERIAN: CASE REPORT.

Spinal intramedullary is an uncommon form of tuberculosis causing spinal cord injury in this environment. We report a case of thoracic intramedullary tuberculoma in an immunocompetent male Nigerian with negative screening for tuberculosis. He presented with 8 months history of back pain and 2 months history of progressive weakness in both lower limbs. Physical examination revealed a well-nourished man with spastic paraplegia. Chest radiograph and CT scan were normal but Magnetic resonance imaging (MRI) of the thoracolumbar region showed cord oedema and circumscribed intramedullary lesions at D12 and L1 levels with target sign. The patient was promptly prepared and had D12 and L1 laminectomy and posterior myelotomy with excision of the intramedullary lesion. Histology showed granulomatous lesion with central caseation in keeping with a tuberculoma. He was treated with a 4-drug antituberculous regimen with physiotherapy and he made complete neurological recovery 8 months post-operatively. Intramedullary tuberculoma should be considered in differential diagnosis of intramedullary tumors in this environment. Treatment with antituberculous drugs results in good outcome.

Outcomes of intensive care management of traumatic brain injury in a resource-challenged tertiary health centre.

BACKGROUND: Improved surgical care and protocol-driven intensive care interventions for head injured patients have contributed to the overall reduction in mortality in developed countries. The aim of this study is to highlight the clinical outcomes of patients with severe traumatic brain injury managed in the multispecialty ICU of our institution. STUDY DESIGN: The medical records of all patients with severe TBI managed in our 3-bedded non-dedicated ICU over a 24-month period were reviewed. Data on demographic characteristics, mechanism of injury, neuroimaging and interventions were obtained and the primary outcome measure was the mortality. RESULTS: Fifty one patients, age ranged from 2-75 years and median age of 30 years were studied. The male sex was more involved (M;F of 12;1) and motorcycle crashes caused the majority of the injury (19,{37%}). None of the patients received pre-hospital care and about half (25 {49 %}) presented six hours post trauma. Cranial CT scan showed intracranial haemorrhage in 7 of the 21 patients stabled for neuroimaging. Overall mortality was 70%, with highest mortality recorded in those who did not have post injury brain CT scan (58% vs 82%, p = 0.066). CONCLUSION: Mortality from severe TBI is very high in our environment where routine pre-hospital care and prompt transfer to neurosurgical centres are not practiced. Lack of facilities for monitoring intracranial pressure and arterial blood gases in our ICU also contributed to the high mortality.

Complications of unsafe abortion in South West Nigeria: a review of 96 cases.

BACKGROUND: Induced abortion is common and largely performed under clandestine and unsafe conditions in Nigeria. Complications from such procedures contribute significantly to maternal morbidity and mortality in the country. OBJECTIVE: To determine the sociodemographic characteristics and pattern of complications present in patients managed for unsafe abortion. SETTING: The patients studied were treated in Federal Medical Centre, Ido Ekiti, a tertiary health institution located in a rural town and a main referral hospital in Ekiti State, South West Nigeria. METHODOLOGY: The records of patients admitted for complications of unsafe abortion over a 5-year period were analyzed with regard to sociodemographic characteristics, gestational age at termination of pregnancy, the providers, methods used and the complications they develop. RESULTS: A total of 102 patients were treated for complications of unsafe abortion during the period under review constituting 7.4% of total gynaecological admission. Majority (60.4%) of the patients were less than 25 years old, 74.0% were students while 81.3% were unmarried. Only 9.4% of the women had ever used contraceptives. Of all the cases, 21 (21.9%) were performed within 8 weeks of gestation while 47.9% were performed in the second trimester. Surgical uterine evacuation was the method used in 67.7% of the patients and 65.6% of the abortions were performed by non physicians. Sepsis was the commonest complication in the patients (79.2%) while uterine perforation was present in 12.5% of the women. The case fatality rate was 16.6% and unsafe abortion accounted for 30.8% of all maternal mortality during the period. CONCLUSION: As young single nulliparous students are the principal sufferers of complications of unsafe abortion in this study, young persons, especially in-school adolescents, should be targeted for the provision of comprehensive reproductive health services.

Patterns of presentations at a free eye clinic in an urban state hospital.

BACKGROUND: Provision of affordable eye care is one of the cardinal programs of the Osun State Government of Nigeria. OBJECTIVE: The objective of this study was to assess the pattern of eye diseases presenting in a secondary health care facility based at Osogbo the State Capital. MATERIALS AND METHODS: We reviewed the hospital records of all patients that were cared for at the eye clinic of the State Hospital, Osogbo, Osun State, Nigeria from January 2009 to December 2010. RESULTS: A total of 1018 patients were attended to at the eye clinic during the period of review. Mean age of these patients was 49.4 ± 23.2 years. There were 408 (40.1%) males and 610 (59.9%) females with a female-male ratio of 1.5 : 1. Most of them were traders (28.1%) and married (32.1%). Vernal conjunctivitis (21.1%), cataract (14%), glaucoma (11.1%), and refractive errors (20.7%) were the main eye diagnoses. CONCLUSION: Preventable causes of blindness were quite common among the patients. There is a need for community education to reduce the prevalence of these diseases in the general population.

Sexual assault against women at Osogbo southwestern Nigeria.

BACKGROUND: Sexual assault against women is common all over the world. However, reliable data on the subject in developing countries including Nigeria is not available. OBJECTIVE: To review the patterns of sexual violence against women treated at the hospital over a 7-year period. MATERIALS AND METHODS: Review of hospital records of victims of sexual assault who presented at the hospital from 1 January 2003 to 31 December 2009. Data obtained were analyzed using descriptive statistics and Chi squire test. RESULTS: Sexual assault cases constituted 2.1% of female consultation outside pregnancy during the period under study while proportion of cases increased over the years under review. Mean age of the victims was 15.8 (SD 8.1) years ranging from 5 to 48 years. Most (73.7%) were less than 18 years while 93.2% were single (never married). About 81% of the victims less than 18 years were sexually abused in the day time. Majority (79.6%) knew their assailant. About 40% of the victims presented within 24 h of sexual abuse but none had postexposure prophylaxis. CONCLUSION: Sexual assault among women is an important health problem in this environment. There is need for hospital based management protocol.