Rice husk and saw dust as filter loss control agents for water-based muds.

When drilling with water based muds (WBM), significant fluid loss volumes from the mud into the formation can have adverse effects not just on the mud and its properties but also on the stability of the wellbore. Prevention of mud filter loss is one way of assessing the performance of a drilling mud. However, evaluation of the effectiveness or otherwise of a fluid loss control additive can be made by characterizing the mud cake formed. Interestingly, the mud cake characterization is one area that has been somewhat neglected in drilling fluid formulation with agro waste materials. Two cellulosic materials - rice husk and saw dust were chosen for the experimental study. The specie of the rice husk used was the African rice (Oryza glaberrima) while the dust from the saw milling of Oxystigma manni was utilized for this study. To ensure result acceptability, the rice husk and saw dust were ground and the resulting products were sieved to 1.25 × 10-4 m. The filtration characteristics of the formulated mud samples were tested using the American Petroleum Institute (API) filter press and in accordance to the API recommended practice for field testing WBMs. From the filter loss tests, it was observed that the ground rice husk prevented filter loss by an average of 77% compared to ground saw dust filtration control of 63%. In addition, it was observed that at higher concentrations, ground saw dust and rice husk prevented fluid loss to the minimum acceptable API standard. For the filter cake thickness measured in millimetres, ground rice husk exhibited thicker mud cakes when compared with the saw dust by an average amount of 14%. For the mud cake characteristics, the rice husk mud exhibited smooth and slippery cakes while the saw dust mud exhibited rough texture, sticky and firm cakes.

Outcome of management of elevated skull fractures in Enugu, South-East Nigeria.

INTRODUCTION: Elevated skull fractures, previously thought of as a very rare variety of fractures, are no longer very uncommon. They are expectedly gradually finding a slowly growing list of references in neurosurgical literature. They are mostly posttraumatic compound fractures due to the mechanism of injury. Outcome of operative neurosurgical care is generally rewarding. MATERIALS AND METHODS: A 4-year retrospective study of case notes, operation registers, and radiology records of patients diagnosed with elevated skull fractures who had neurosurgical care at the University of Nigeria Teaching Hospital, Enugu, Nigeria, between 2012 and 2015, was done. Only patients with evidence of elevated skull fracture on head computed tomography scan were included. The presenting Glasgow Coma Score and Extended Glasgow Outcome Score (GOSE) at the time of discharge from the hospital and 6 months thereafter were analyzed. RESULTS: Out of 209 patients managed with skull fractures over the study period, eight met the inclusion criteria. Seven (87.5%) were males. The latency to presentation was 6 h in one case and> 8 h in the other cases. All the patients had operative care involving debridement, duroplasty, and bone-fragment realignment (cranioplasty) either primarily or on an interval basis. The GOSE at 6 months was at least 7 in 87.5% of the patients. CONCLUSIONS: Despite the grotesque appearance at presentation, outcome of properly managed elevated skull fractures is good.

Subdural empyema: Clinical presentations and management options for an uncommon neurosurgical emergency in a developing country.

BACKGROUND: Controversy regarding the best management strategy for subdural empyema (SDE) attests to the persisting poor outcomes for this uncommon life threatening intracranial suppurative process. Late presentation confounds the problem in developed countries. While craniotomy is commonly recommended, it is not always possible in late presentation with advanced morbidity. The aim of this study was to identify the pattern of clinical presentation and explore the outcomes following management of SDE using burr hole, aspiration, and drainage (BAAD) in resource poor settings. MATERIALS AND METHODS: This is a retrospective review of prospectively collected data of 18 patients presenting with SDE over a period of 10 years from two neurosurgical centers. Data was abstracted on patients' demographic characteristics, sources of SDE, clinical presentation and site of infection, methods of diagnosis, organisms isolated, treatments received, and outcome. Collected data was entered into the Statistical Package for the Social Sciences version 17 software and subjected to descriptive analysis for all variables. RESULTS: Majority of the patients presented late with Glasgow Coma Scale score GCS of 9/15. Altered sensorium was noted in 14 (77.8%) of the patients, 11 (61.1%) out of the 14 patients had ≤ grade 3 of Bannister and Williams level of consciousness. The mainstay of treatment for all patients was BAAD of abscess and administration of appropriate antibiotics. Fourteen patients (77.8%) were discharged on grade A of H.W. Mauser's grading system. Three mortalities were recorded only in patients who had grade 4 Bannister and Williams grading. CONCLUSION: BAAD is the near approximated option to standard craniotomy management in a limited resource facility and it has a very good clinical outcome. However, more studies are required to draw the final conclusion.

Challenges and outcome of cranial neuroendoscopic surgery in a resource constrained developing African country.

BACKGROUND: Cranial neuroendoscopy has been safely applied to the surgical treatment of different lesions of the brain in our center since its introduction in September 2009. This article summarizes our experience with neuroendoscopy, highlighting the salient challenges and outcome. METHODS: A single institution, retrospective analysis of prospectively acquired cases over a 2.5-year period (September 2010 to February 2013). Challenges experienced during the course of patient care as well as complications and outcomes were recorded and analyzed using SPSS (SPSS Inc. Chicago IL, USA) version 17. Tests of statistical significance were set at 95% level. RESULTS: Of the 291 cranial procedures performed during the study period, 37 (12.7%) were neuroendoscopic interventions. Patients were between the ages of 0.25 years and 25 years with a mean of 5.7 ± 1.5 years (95% confidence interval (CI)). Aqueductal stenosis was the most common indication for endoscopic intervention in 22 (59.5%) patients. Endoscopic third ventriculostomy was the most commonly performed neuroendoscopic procedure in 21 patients (56.7%). Major challenges experienced were patient dependent in 28 ± 1.0 patients (95% CL), learning curve related in 21 ± 0.4 patients, and poor endoscopy support infrastructure in 15 ± 0.5 patients. Complications were significantly more common in the first 6 months of neuroendoscopy (χ2= 7.57, df = 1, P< 0.05). Overall, 30 (81.1%) patients in our study experienced a positive outcome. The permanent morbidity and mortality rates in our series were 2.7% and 8.5%, respectively. CONCLUSION: Highlighted are the myriad obstacles which interface the successful set up of neuroendoscopy service especially in resource-constrained settings. Endoscopic procedures become safer with experience and complications reduce significantly after a steep learning curve.

Skull traction for cervical spinal injury in Enugu: A 5-year retrospective multicenter analysis of the clinical outcomes of patients treated with two common devices.

BACKGROUND: Treatment of cervical spine injury is the most challenging of all the injuries of the spine, and there is yet no agreement on the best method of care. OBJECTIVE: We studied the complications and outcome of two skull traction devices used to treat cases of cervical spine injury in three centers in Enugu, South East Nigeria. PATIENTS AND METHODS: A retrospective analysis of patients with cervical spine injury managed with skull traction as the definitive treatment using either Crutchfield or Gardner-Wells tongs over a 5-year period (April 2008-March 2013). The traction was applied for 6 weeks, and the patient was subsequently mobilized with either hard cervical collar or Minerva jacket for another 6 weeks. RESULTS: One hundred and five patients with complete records out of 127 cervical spinal injured patients treated were studied. Forty-one had the American Spinal Injury Association (ASIA) Grade A whereas 64 had incomplete cord injury of ASIA Grades B-E. Forty-eight had Crutchfield traction whereas 57 had Gardner-Wells traction. At the end of treatment, no patient improved among those with ASIA Grades A and B. All the 12 cases of mortality were recorded as well among ASIA A (n = 9) and B (n = 3) Grades. Over 50% of ASIA Grades C and D patients improved to Grade E. The complication profile varied significantly between the traction subgroups with those treated using Crutchfield tongs experiencing more events (χ2 = 6.5, df = 1, P< 0.05). However, there was no significant statistical difference in the Association Impairment Scale (AIS) outcome (P = 0.55) as well as mortality rates (χ2 = 0.97, DF = 1, P> 0.05) between those treated with Crutchfield and Gardner-Well traction. CONCLUSION: Crutch field tong traction may be associated with more complications when compared with Gardner-Wells traction. However, from our study, the final American Spinal Injury AIS outcome, as well as the overall mortality rates associated with the two traction techniques, did not vary significantly.

Cervical spine injury: a ten-year multicenter analysis of evolution of care and risk factors for poor outcome in southeast Nigeria.

STUDY DESIGN: Retrospective study. OBJECTIVE: To describe the evolution of care and risk factors for poor outcome in patients with cervical spine injury (CSI) treated at three centers in southeast Nigeria. SETTING: Nigeria, southeast. MATERIALS AND METHODS: A 10-year retrospective multicenter analysis of patients with CSI, managed at three centers in southeast Nigeria, from January 2003 to December 2012. RESULTS: Two hundred and seven patients (55%) had CSI out of 377 spinal injury cases in the three study centers, but 195 cases had complete records and were studied. There were 148 males and 47 females. The age range was 3-74 years with a mean of 32.6 (± 1.9) years 95% CI. Most injuries (149 cases) resulted from motor vehicular accidents (MVA). The C5 spinal level was involved in 75 (38%) cases One hundred and seventeen patients (60%) presented with American Spinal Injury Association A (ASIA A) injury. CSI care evolved from the application of a Minerva jacket or cervical traction only to cervical traction and spinal fusion resulting in a reduction in hospital stay (F = 52.5, DF (2, 3) P < 0.05). When compared to 51 patients with incomplete injuries, who improved in neurologic al status at discharge, only three patients with ASIA grade A experienced some improvement. The mortality rate from our series is 16% (32 patients). Those who died were more likely to have a complete injury (25 patients) or a high cervical injury (X² = 61.2, P < 0.05) among other factors. CONCLUSION: The cervical spine is the most commonly injured spinal segment in southeast Nigeria. Although treatment evolution has resulted in reduction of hospital stay, the associated mortality risk still remains high.

Effects of Different Dietary Cadmium Levels on Growth and Tissue Cadmium Content in Juvenile Parrotfish, Oplegnathus fasciatus.

This feeding trial was carried out to evaluate the effects of different dietary cadmium levels on growth and tissue cadmium content in juvenile parrotfish, Oplegnathus fasciatus, using cadmium chloride (CdCl2) as the cadmium source. Fifteen fish averaging 5.5±0.06 g (mean±SD) were randomly distributed into each of twenty one rectangular fiber tanks of 30 L capacity. Each tank was then randomly assigned to one of three replicates of seven diets containing 0.30 (C0), 21.0 (C21), 40.7 (C41), 83.5 (C83), 162 (C162), 1,387 (C1,387) and 2,743 (C2,743) mg cadmium/kg diet. At the end of sixteen weeks of feeding trial, weight gain (WG), specific growth rate (SGR) and feed efficiency (FE) of fish fed C21 were significantly higher than those of fish fed C83, C162, C1,387 and C2,743 (p<0.05). Weight gain, SGR and FE of fish fed C0, C21 and C41 were significantly higher than those of fish fed C162, C1,387 and C2,743. Protein efficiency ratio of fish fed C0, C21 and C41 were significantly higher than those of fish fed C1,387 and C2,743. Average survival of fish fed C0, C21, C41 and C162 were significantly higher than that of fish fed C2,743. Tissue cadmium concentrations increased with cadmium content of diets. Cadmium accumulated the most in liver, followed by gill and then muscle. Muscle, gill and liver cadmium concentrations of fish fed C0, C21, C41 and C83 were significantly lower than those of fish fed C162, C1,387 and C2,743. Based on the ANOVA results of growth performance and tissue cadmium concentrations the safe dietary cadmium level could be lower than 40.7 mg Cd/kg diet while the toxic level could be higher than 162 mg Cd/kg diet.

Neonatal head injury unrelated to birth trauma in South-East Nigeria.

BACKGROUND: Neonatal head trauma resulting from causes other than birth trauma has rarely been the focus of many a research theme in the literature. AIM/OBJECTIVE: To highlight the occurrence of non-birth trauma related neonatal head injury, and evaluate the causes and outcome of treatment. METHODS: A 3 year retrospective review of neonatal patients with head injury from two tertiary hospitals in South-East Nigeria between July 2009 and June 2012 (n-37). Data was collected from patients' birth and medical records. Data was analyzed using the SPSS version 15. RESULT: Among the one hundred and seventy-six cases (11.78)% pediatric head injury cases seen, thirty seven (2.48)% occurred in neonatal patients. The most common cause of head injury was fall 22 cases [59.5%]. Children of mothers with low educational qualification were more likely to sustain falls 22 cases (59.5%). Road traffic accident (n = 15) was associated with more severe injuries and poorer outcome. Operative treatment was associated with increased mortality (two of three cases). The mortality rate in our series is 8.10%. CONCLUSION: Reduction of neonatal head trauma could be achieved through improved maternal education.

Determinants and outcomes of ventriculoperitoneal shunt infections in Enugu, Nigeria.

BACKGROUND: To evaluate the determinants and outcomes of shunt infection (SI). METHODS: One hundred ninety-eight pediatric hydrocephalic patients treated with a ventriculoperitoneal (VP) shunt between January 2008 and August 2012 were retrospectively studied. Patients with SI were compared to those without SI in terms of the occurrence of risk factors and outcomes. Data was analyzed using Statistical Package for the Social Sciences software (version 15). RESULTS: The age range was 2 weeks to 13 years, with a mean age of 3.1 ± 0.19 years for the SI group versus 2.7 ± 0.2 years for those without SI. One hundred and twelve patients were female and 86 were male. SI was recorded in 17 (8.6%) patients. Postinfective hydrocephalus (n = 6) was the most common cause of hydrocephalus in the SI group. Individuals in the SI group, compared to those without infection, were more likely to be underweight (χ2 = 23.4, p < 0.01). The mean interval between VP shunt placement and SI was 1.83 ± 1.25 months. Coagulase-negative Staphylococcus (29.4%) was the most common pathogen. The mortality rate in our series was 21.4% in patients with SI compared to 2.7% in those without SI. CONCLUSION: Coagulase-negative Staphylococcus is currently the most common cause of SI and underweight children appear have a higher risk.

Planners in dark tunnel.

PIP: Augustus Aikhomu, Nigeria's vice-president and a retired admiral, stated in 1991 that accurate population figures were necessary for social and economic planning and policy. Celestine Mezue, assistant director of Bendel state's population commission, stated that non-availability of reliable population statistics was responsible for the failures in national development planning. Two sectors (rural and transportation) have been greatly affected by the lack of data. Educational institutions have been particularly affected by overcrowding or rejection of students due to lack of space and facilities. Over 1 million children must compete for 1000 spaces in primary schools. Complaints at the local level have been directed to insufficient funding for teacher's salaries. About 255,000 students applied for university admission, and only 12% were admitted during 1989-90. Scholarships declined from 1859 awards in 1976 to none in 1984. Post-graduate scholarships declined from 2000 in 1976 to none in 1984. Planning for future health services has also been restricted by lack of accurate statistics. There was a gap between availability of low-income housing and the need for the burgeoning population. Population growth has been estimated at 2.0-3.3%; housing will need to be increased by 2.2-3.5 million more units by 2015. Population growth and congestion in cities has resulted in environmental pollution. The population policy in 1989 recommended 4.0 children per woman. In 1990 a demographic and health survey found fertility to be 6.0 children per woman. Improved data collection and the government support for family planning are needed to reduce population growth in Nigeria.^ieng