Severity and Predictors of Outcome of Motorcycle-Associated Head Injury: An Experience from a Regional Neurosurgery Centre in Northern Nigeria.

BACKGROUND: Motorcycle-associated head injury is one of the leading causes of disability and deaths, with its main victims being the motorcyclists, passengers, and pedestrians in their young productive age group. This study determines the role of severity and some predictive factors on survival and mortality of motorcycle-associated head injury. METHODS: This is a cross-sectional study using data of patients managed for motorcycle-associated head injuries between December 2014 and November 2016. The patients' biodata, clinical findings, and management outcomes were analyzed using Statistical Packages for the Social Sciences version 20. RESULTS: A total of 184 patients were analyzed, most of whom (81%) were aged ≤40 years and with a male dominance of 6.7:1. Pupillary abnormality was seen in 43.5% of the patients, and severe head injury occurred in 34.2% of the patients. Hemorrhagic contusion was the most common computed tomography (CT) finding (16.3%). Among 20.8% of the patients who died, 63.2% had severe head injury. CONCLUSIONS: Motorcycle-associated head injury predominantly occurred among young men who used a motorcycle for commercial purposes. The survival rate was higher among patients who had brain CT scan performed, extra-axial clots, and operative treatment. However, high mortality was seen among patients who could not afford brain CT scan, and who had bilateral pupillary dilatation, CT findings of abnormalities that are not surgically amenable, and severe head injury.

Childhood Hydrocephalus in Sokoto: Experience with 401 Series.

BACKGROUND: Hydrocephalus is a complex and multifactorial neurological disorders. Childhood hydrocephalus like other chronic childhood illness is a major contributor to poor quality of life and huge financial burden to the affected family and nation. Epidemiological factors tend to vary with geographical location. Unlike in developed countries, most data from developing countries showed infection as the most common etiology. This study was conducted to analyze our epidemiological features of childhood hydrocephalus in Sokoto with a review of the literature. AIMS: The aims of this study were to determine the frequency of causes of hydrocephalus in Sokoto and to determine the short-term outcomes of treatment and compare results with the literatures. MATERIALS AND METHODS: This was a retrospective study with patients' data from the theatre records, patients' case notes, and radiological records. Outcomes were based on complications and changes in the occipitofrontal circumferences. Criteria for statistical significant was P < 0.05. RESULTS: One hundred and thirty-eight patients satisfied inclusion criteria. No sex preponderance was found with a mean age of 16.41 months. Maternal illiteracy rate was 60% with 49.3% of the parents at lower socioeconomic class. Infection was the most frequent etiology (45.7%). Myelomeningocele associated hydrocephalus was also common (16.7%). However, post-hemorrhagic hydrocephalus was rare (2.9%). Mean preoperative and postoperative occipitofrontal circumferences were 54.22 cm and 47.92 cm, respectively, with P = 0.001. CONCLUSION: Poverty and illiteracy were strongly associated with childhood hydrocephalus in our patients. Infection was predominantly associated with morbidity with large number of patients being lost to follow-up.

Necrotizing fasciitis: a comparative analysis of 56 cases.

BACKGROUND: The term necrotizing fasciitis (NF) is now used in a generic sense to include all diffuse necrotizing soft-tissue infections except gas gangrene. It is a synergistic, polymicrobial soft-tissue infection associated with rapid progression, extensive necrosis, profound systemic toxemia, considerable morbidity and a high mortality rate. Although the disease is no respecter of age and affects a wide age group, adults are known to be more commonly affected than children. AIMS: To highlight the differences and similarities in the modes of presentation and results of intervention of NF in children and adults. PATIENTS AND METHODS: A four-year prospective descriptive analysis of all consecutive patients with NF (excluding cancrum oris and Fournier's gangrene) treated at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, from January 2001 to December 2004. RESULTS: A total of 56 patients were treated of which 32 (57.1%) were children < or = 15 years, while the remaining 24 (42.9%) were adults aged >15 years. There were 31 males and 25 females, giving the male-to-female ratio of 1.2:1; the corresponding ratios for children and adults were 1.7:1 and 1.1:2, respectively. The age ranged from six days to 70 years (mean 19.9 years). Trauma and minor skin infections were the main precipitating factors. The total body surface area (BSA) involved ranged from 1-16% (children 2-16%, adults 1-7%) with a mean of 4.3% (children 5.9%, adults 2.7%). The trunk was the most commonly involved anatomical region of the body (50.0%) in children, while in adults it was the lower limb (54.2%). In both children and adults, infection was mainly polymicrobial. The most common mode of wound resurfacing was by second intention in children (46.9%) and split-thickness skin grafting (STSG) in adults (37.5%). Septicemia was a common complication in both age groups. Mortality was 9.4% and 16.7% among children and adults, respectively. CONCLUSION: NF is more common in children than adults in northwestern Nigeria. Early recognition, aggressive surgical treatment and supportive therapy remain the essential keys to success.