Outcome of Nonoperative Management of Selected Cases of Acute Traumatic Intracranial Hematomas in a Rural Neurosurgical Service of a Developing Country.

OBJECTIVE: In resource-limited settings, the standard of care prescribed in developed countries for either operative or nonoperative management of traumatic intracranial hematomas (TICHs) frequently has to be adapted to the economic and infrastructural realities. This study aims to present the outcome of selected cases of TICHs managed nonoperatively without routine intensive care unit admission, repeated cranial computed tomography (CT) scan or intracranial pressure monitoring at a rural neurosurgical service in a developing country. METHODS: This was a retrospective analysis of a cohort of our patients with cranial CT-confirmed TICHs selected for nonoperative treatment from our prospective head injury (HI) register over a 42-month period. RESULTS: There were 67 patients (51 males) in this study with a mean age of 38.6 (standard deviation, 17.6) years, having mild HI in >half, (55.2%, 37/67) and anisocoria in 22.4% (15/67). Road traffic accident was the most common (50/67, 74.7%) trauma etiology. Isolated acute-subdural hematoma, intracerebral hemorrhage, and epidural hematoma occurred in 29.9%, 25.4%, and 22.4% of the patients respectively. Only 2 of 8 patients in whom intensive care unit admission was deemed necessary could afford admission. Repeat cranial CT scan was requested in 8 patients (8/67, 11.9%); only 5 of these could afford the investigation. The outcome of care was good in 82.1% patients (55/67). Increasing severity of the HI (P < 0.01) and presence of pupillary abnormality (P = 0.03) were significant predictors of poor outcome. CONCLUSIONS: In a Nigerian rural neurosurgery practice, nonoperative management of a well-selected cohort of TICHs was attended by acceptable level of favorable outcome.

Stretched penile length and total serum testosterone in term male neonates.

INTRODUCTION: the reference values of stretched penile length vary with different ethnic group. There is paucity of data on the reference range of total serum testosterone in neonates especially in Africa. This study therefore was to determine the normal stretched penile length, total serum testosterone levels in term male newborns and to correlate them with anthropometric parameters. METHODS: this was a prospective cross-sectional study. One hundred and twenty-four consecutive healthy term male neonates were recruited in the first 72 hours of postnatal life. The stretched penile length (SPL) was measured with a rigid metric ruler. Weight, length and occipitofrontal circumference were also measured. Total serum testosterone level was determined using Enzyme Linked Immunoassay. Data were analysed using the Statistical Package for Social Sciences for Windows version 20. RESULTS: a total of 124 term male neonates were recruited. The postnatal age of recruited neonates was one to 70 hours with a mean of 22.8 ± 17.6 hours and the mean of estimated gestation age was 38.5 ± 1.3 weeks. The range of stretched penile length was from 2.1 to 3.9 cm with a mean of 3.2 ± 0.4 cm and SPL less than 2.2 cm was considered as micropenis. The mean total serum testosterone level was 357.4 ± 241.7 ng/dl. The SPL had a positive correlation with the birth weight, length and total serum testosterone. The total serum testosterone and birth length were predictors of stretched penile length. CONCLUSION: among the studied population the mean stretched penile length was 3.2 cm and mean total serum testosterone was 357.4 ng/dL.

Disclosure to sexual partner and condom use among HIV positive clients attending ART clinic at a tertiary health facility in South West Nigeria.

INTRODUCTION: Condom use and disclosure of HIV status increase the safety of sexual activity. Its extent will determine the need for appropriate interventions. The objective of this study was to identify determinants of condom use and disclosure to sexual partners among individuals receiving Antiretroviral Therapy at a tertiary health facility in South West Nigeria. METHODS: A cross-sectional study of 578 clients enrolled in the ART program of Federal Medical Centre Owo, Ondo State Nigeria, was conducted. RESULTS: The mean age of respondents was 38.6+9.6 years, more than half (66.6%) were females and 7% were currently married. Three-quarter were sexually active out of which 324(75.9%) used condom consistently and correctly and 323(75.6%) disclosed their status to their sexual partner. Use of condom was by 81% of those with tertiary education (p=0.002), and 84.5% of singles utilized condom (p<0.001). Determinant of condom use were, male (OR: 2; CI: 1.1- 3.3; p=0.013), secondary and tertiary education (OR: 3.69; CI: 1.48 - 9.19; p=0.005) and (OR: 4.79; CI: 1.84 - 12.44; p=0.001) respectively. Determinant of disclosure was being married (OR: 11.8; CI- 5.5-25.7; p<0.001). No significant association exist between disclosure and condom use. CONCLUSION: Most of the people living with HIV accessing ART were sexually active. A good proportion of them used condom consistently and correctly. Disclosure did not have significant effect on condom use. More health education intervention to increase disclosure rate and safe sexual behaviour among HIV positive clients is needed.