Comparative examination of breast cancer burden in sub-Saharan Africa, 1990-2019: estimates from Global Burden of Disease 2019 study.

OBJECTIVES: In view of the widening gap in survival data between high-income and low-income countries, this study aimed to evaluate the most up-to-date burden of female breast cancer and analyse the leading risk factors in countries and regions in sub-Saharan Africa. DESIGN: An analysis of Global Burden of Disease (GBD) data. SETTING: The data of incidences, deaths, disability-adjusted life years (DALYs) and age-standardised rates (ASR) were retrieved from GBD Results Tool (1 January 1990─31 December 2019) covering 4 sub-Saharan African regions and 44 countries. The burden estimable to the risk factors of breast cancer was also estimated. All estimates were presented as counts and ASR per 100 000 population. PARTICIPANTS: Participants included patients with female breast cancer. MAIN OUTCOMES AND MEASURES: Absolute numbers and ASR/estimates of incidence, deaths and DALY of female breast cancer by location in 1990 and 2019, with their percentage changes from 1990 to 2019. The leading risk factors (eg, alcohol consumption) of breast cancer in sub-Saharan Africa. RESULTS: In sub-Saharan Africa, the incidences of breast cancer increased by 247% in 2019 from 1990, with the highest incidence recorded in Nigeria. The deaths and DALYs of breast cancer increased by 184% and 178%, respectively. From 1990 to 2019, the mortality ASR and DALY ASR increased throughout the region, mostly in Equatorial and Gabon. With varying trends between countries, alcohol consumption and high fasting plasma glucose were noted to be significant contributors to breast cancer deaths between 1990 and 2019. CONCLUSION: The results show the increasing burden of breast cancer in sub-Saharan Africa and provide valuable information on the trends of breast cancer and the risk factors attributable to breast cancer across sociodemographic index, region and country. These findings may inform health policies and improve the rational allocation of health resources.

Ventriculoperitoneal shunt infection rate and other associated complications of VP shunt insertion in Abuja, Nigeria.

Background: Complications associated with ventriculoperitoneal shunt insertion constitute a significant cause of morbidity and mortality among hydrocephalus patients. Despite this, VP shunt placement has remained the mainstay of treatment for hydrocephalus. The aim of this study is to evaluate the complications of VP shunt surgery in our environment and to identify the risk factors associated with it. Methodology: Patients who had VP shunt surgery over a period of two years (Jan 2015-December 2016) were evaluated retrospectively by reviewing their hospital records. The patients' demography, aetiology and clinical presentation of the hydrocephalus, and complications were analysed using SPSS version 26.0. Results were presented in tables and figures. Results: A total of 69 patients who had VP shunt over the study period had complete medical records available for review. Their age ranged between 2days and 68years with a male to female ratio of 1.8:1. Overall complication rate was 30.4%. Shunt malfunction (11.5%) and shunt infection (7.2%) were the commonest complications recorded. Late presentation was the most important risk factor for shunt complications. Conclusion: The rate of shunt complications seen in this study compares fairly with studies in other parts of the world.

Audit of Tracheostomy Care Practices in a Nigerian Tertiary Neurosurgical Intensive Care Unit According to Published Guidelines.

INTRODUCTION: Chest infections are a frequently encountered problem in patients admitted to the intensive care unit (ICU), more so in tracheostomised patients. This study aimed to audit the tracheostomy care practices in patients with neurosurgical pathologies in the ICU of Wellington Clinics Abuja, a tertiary neurosurgical hospital in Nigeria. METHODS: We conducted a closed-loop audit with mixed methods involving analysis of 24 patients who had tracheostomy within the first two weeks of neurosurgical pathology at a tertiary neurosurgical hospital and semi-structured interviews to determine tracheostomy care practices among the primary caregivers - nurses, intensivists, and doctors. RESULTS: Of the 161 ICU admissions in the first cycle, 22 patients received tracheostomy, 16 met the eligibility criteria. At re-audit (second cycle), eight of 40 patients met the criteria. All the patients received open suctioning through a dual cannula-cuffed tracheostomy tube and had independent portable suction units. In the baseline audit (first cycle), suction catheters were reused for 12-24 hours in each patient and were stored in varying combinations of normal saline and Savlon antiseptic (5 mg of cetrimide (0.5% w/w) and 1 mg of chlorhexidine digluconate (0.1% w/w)). The frequency, technique, and assessment of the need for airway suctioning were inconsistent among caregivers interviewed. All 16 patients had at least one episode of pneumonia, 10 patients had a second episode, and two patients had > two episodes. One mortality was recorded directly attributable to the complications of pneumonia. While in the re-audit, with adherence to recommendations, three patients suffered one episode of pneumonia and only one had a second episode. No mortality was recorded. CONCLUSION: A standard practice guideline was necessary for tracheostomy care in our ICU. In low-resource settings, stated recommendations such as single-use suction catheters and improved hygienic practices can reduce rates of pneumonia in tracheostomised patients.

External Cerebrospinal Fluid Drainage in the Management of Nonaneurysmal Subarachnoid Hemorrhage.

Distinguishing the aneurysmal from nonaneurysmal subarachnoid hemorrhage (SAH) may be difficult as acute bleeding in the subarachnoid space is a common denominator. It is believed that toxic effects of breakdown products of acute bleed, including hemoglobin, contribute to the morbidity and mortality of this condition; and that early drainage will potentially reduce them. This series focuses on our local experience with the application of external cerebrospinal fluid (CSF) drainage in the management of a series of cases confirmed to be nonaneurysmal SAH and its effects on the outcome. The objective of this report is to observe the usefulness of external CSF drainage in the management of nonaneurysmal SAH. Five consecutive cases over four years were reviewed and reported as a case series. The main points we focused on were presentation, diagnostic findings on imaging, CSF drainage, and outcome up to six months. All the patients presented with headaches described as sudden, and only one had significant impairment of consciousness Glasgow Coma Scale (GCS) 10/15. Three out of the five patients had a premorbid hypertensive condition of unclear control status. We also observed that three out of the five had a low-pressure pretruncal/perimesencephalic pattern of bleed, whereas two had the typical high-pressure SAH pattern. CT angiography (CTA) was negative in all. Four had lumbar drainage, while one had external ventricular drainage. All were discharged within three weeks and functioned optimally at six months. CSF drainage in managing nonaneurysmal SAH is achievable with minimal access procedures, including lumbar drain (LD) and external ventricular drainage (EVD), which may have further reduced the low morbidity normally associated with this condition.

Fever as a Clinical Presentation of Acute Hydrocephalus: Two Case Reports and a Review of Literature.

Fever is often associated with infectious, traumatic, or allergenic etiologies, a known consequence of the systemic inflammatory response. Its association with a rise in intracranial pressures (ICP) is an uncommon presentation. We herein describe two patients who developed acute hydrocephalus and presented with high-grade fever. This febrile component was resistant to conventional antipyretics and was only relieved by cerebrospinal fluid (CSF) diversion.

Factors Affecting the Outcome of Traumatic Brain Injured Patients with Acute Epidural Haematoma in National Hospital, Abuja.

Objective: The objective is to determine the prognostic factors affecting the surgical outcome of patients surgically treated for acute epidural haematoma. Materials and Methods: A retrospective review of 71 consecutive patients who underwent neurosurgery for acute epidural haematomas over a 5-year period (from January 2015 to December 2019) was conducted. Clinical characteristics and the time intervals were investigated to determine the interactions between all these factors and the outcome. The outcome was graded according to the Glasgow Outcome Scale (GOS) at subsequent follow-up clinic visits. Results: The severity of traumatic brain injury using the Glasgow Coma Scale score (chi-square test, P = 0.033) had a statistically significant relationship with the outcome. The patients' age, gender, and total length of time until surgical intervention (P > 0.05) were of no statistical significance in relation to the outcome. The mortality rate of patients presenting at our centre is 16.9%. Overall, after surgery, 47 of 71 with epidural haematoma had good recovery (GOS 5). Twelve of 71 patients had GOS of 2-4. Twelve patients died. The median duration from injury to presentation was 15 hours with an interquartile range of 15 hours. Conclusion: Our results indicate that the severity of brain injury is an independent risk factor in determining the outcome of epidural haematoma in traumatic brain injury.

The Outcomes of Traumatic Acute Subdural Hematoma in a Tertiary Center in Abuja, Nigeria.

Background Acute traumatic subdural hematoma is life-threatening and is associated with high unfavorable outcomes in developing countries. Objective We aim to identify factors contributing to outcomes after severe traumatic brain injury (TBI) due to acute subdural hematoma (SDH) in patients admitted to National Hospital Abuja, Nigeria. Methods This was a retrospective review of 34 patients who consecutively underwent neurosurgery for acute SDH over five years (from January 2015 to December 2019). Demographic data, clinical characteristics, and the time intervals from injury to surgery were investigated to determine the interactions between all these factors and outcome. Outcome was graded according to the Glasgow outcome scale at the three-month follow-up. Results Out of 34 patients who had surgical evacuation for traumatic acute subdural hematoma, 15 patients died (44.1%). A significant correlation was identified between outcome and the Glasgow coma scale score at admission. No significant correlation was seen between the outcome and the age, gender and the time from injury to surgery (chi2 test, p>0.05). Conclusion The rate of unfavorable outcomes in acute subdural hematoma is high. The Glasgow coma score at admission is an important predictor for outcome in traumatic acute subdural hematoma.