[Rare association of subperiosteal hematoma of the orbit with frontal extradural hematoma: a case report]. / Association rare d'un hématome sous-périosté de l'orbite et d'un hématome extradural frontal: à propos d'un cas.

Subperiosteal haematoma of the orbit associated with frontal extradural hematoma is very rare. We here report a case treated in our Department with a literature review. The study involved a 15-year-old boy, victim of head injury from white weapon, a week before his admission to the emergency room. He had inflammatory and painful exophthalmos on the left side, associated with left ophthalmoplegia and blindness. Brain scanner showed left frontal extradural hematoma associated with subperiosteal hematoma of the ipsilateral orbit. Frontal craniotomy associated with fracture orbitotomy allowed evacuation of the extradural hematoma, and then, of the subperiosteal hematoma. Patient´s outcome was favorable. Simultaneous occurrence of frontal extradural hematoma and subperiosteal hematoma of the orbit is extremely rare. Generally, attention is drawn by exophthalmos and visual disturbances. Emergency brain scan without contrast agent injection can be used to make a diagnosis. Prognosis depends on visual function, then adequate management helps to safeguard the eye and vision.

Delays in a traumatic brain injury: A case report.

We present a case highlighting bottlenecks on the care chain for a victim of an open traumatic brain injury. Risks of severe complications, infectious in particular, escalate with every hour.

Needs of Young African Neurosurgeons and Residents: A Cross-Sectional Study.

Introduction: Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice. Methods: African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018. The survey link was distributed via social media platforms and through professional society mailing lists. Univariate and bivariate data analyses were run and a P-value < 0.05 was considered to be statistically significant. Results: 112 respondents from 20 countries participated in this study. 98 (87.5%) were male, 63 (56.3%) were from sub-Saharan Africa, and 52 (46.4%) were residents. 39 (34.8%) had regular journal club sessions at their hospital, 100 (89.3%) did not have access to cadaver dissection labs, and 62 (55.4%) had never attended a WFNS-endorsed conference. 67.0% of respondents reported limited research opportunities and 58.9% reported limited education opportunities. Lack of mentorship (P = 0.023, Phi = 0.26), lack of access to journals (P = 0.002, Phi = 0.332), and limited access to conferences (P = 0.019, Phi = 0.369) were associated with the country income category. Conclusion: This survey identified barriers to education, research, and practice among African trainees and young neurosurgeons. The findings of this study should inform future initiatives aimed at reducing the barriers faced by this group.

The Impact of COVID-19 on Neurosurgical Services in Africa.

INTRODUCTION: COVID-19 has affected the global provision of neurosurgical services. We sought to review the impact of COVID-19 on the neurosurgical services in Africa. METHODS: A cross-sectional survey was distributed to African neurosurgeons seeking to review demographics, national and neurosurgical preparedness, and change in clinical services in April 2020. RESULTS: A total of 316 responses from 42 countries were received. Of these, 81.6% of respondents were male and 79.11% were under the age of 45 years. In our sample, 123 (38.92%) respondents were in training. Most (94.3%) respondents stated they had COVID-19 cases reported in their country as of April 2020. Only 31 (41.50%) had received training on managing COVID-19. A total of 173 (54.70%) respondents were not performing elective surgery. There was a deficit in the provision of personal protective equipment (PPE): surgical masks (90.80%), gloves (84.80%), N95 masks (50.80%), and shoe covers (49.10%). Health ministry (80.40%), World Health Organization (74.50%), and journal papers (41.40%) were the most common sources of information on COVID-19. A total of 43.60% had a neurosurgeon in the COVID-19 preparedness team; 59.8% were concerned they may contract COVID-19 at work with a further 25.90% worried they may infect their family. Mental stress as a result of COVID-19 was reported by 14.20% of respondents. As of April 2020, 73.40% had no change in their income. CONCLUSIONS: Most African countries have a national COVID-19 policy response plan that is not always fully suited to the local neurosurgery services. There is an ongoing need for PPE and training for COVID-19 preparedness. There has been a reduction in clinical activities both in clinic and surgeries undertaken.

A Continental Survey on the Impact of COVID-19 on Neurosurgical Training in Africa.

BACKGROUND: Containment measures for COVID-19 have affected surgical training globally. We sought to assess how neurosurgical training has been affected across Africa in April 2020. METHODS: A cross-sectional survey was distributed to African Neurosurgical trainees seeking to review demographics and effects of COVID on training. RESULTS: A total of 123 neurosurgery trainees responded from 23 African countries and a further 6 were abroad. A total of 91.80% were men, and 96.70% were training in public institutions. Only 41% had received training in COVID-19 with 61.79% worried that they would contract COVID-19 while performing their clinical duties. There was a marked reduction in clinical activities including a median reduction of elective surgery (-80%), clinics (-83%), and emergency surgery (-38.50%). A total of 23.58% of residents did not receive a formal salary, with 50% on less than $1000 USD gross per month. CONCLUSIONS: This is the first continental survey of neurosurgery trainees in Africa. COVID-19 has significantly affected clinical and learning opportunities. There are concerns of the long-term effects on their training activities for an uncertain period of time during this pandemic. Although there has been a global increase in e-learning, there is need to evaluate if this is accessible to all trainees.

Knowledge, Attitudes, and Practices with Respect to Epilepsy among Nurses in the City of Niamey, Niger.

Objective The aim of this study is to evaluate knowledge, attitudes, and practices about epilepsy among nurses in the city of Niamey, Niger, to identify existing gaps in their knowledge concerning epilepsy to formulate recommendations to improve the quality of care for people with epilepsy. Materials and Methods We conducted a descriptive cross-sectional survey on epilepsy knowledge among nurses in the city of Niamey, using a self-administered questionnaire including questions related to knowledge about epilepsy. Results A total of 98 nurses (29 men and 69 women) were included in the survey. The mean age of the participants was of 32.88 ± 10.87 years (range: 17-58 years). The sample consisted of 10.2% of student nurses, 64.3% of college patent, and 25.5% of bachelor nurses. Only 22.4% of participants reported having heard about epilepsy during their training programs. Among the respondents, 43.9% of them had already attended at least one epileptic seizure. Epilepsy is considered as a psychiatric illness and contagious disease by 11.2 and 19.4% of respondents, respectively. The main transmission routes reported were physical contact with an epileptic person (14.3%) and contact with saliva (4.1%). Epilepsy was considered as an incurable disease by 5.1% of respondents. When someone has an epileptic seizure, 10.2% of respondents think that physical contact with this person should be avoided to prevent from contamination. Only 6.1% of respondents had appropriate attitudes when someone has an epileptic seizure such as lying the patient on his side, clearing the airway if necessary, and diazepam injection. Conclusion Considering that people with epilepsy are largely cared out by nurses in Niger, the results of the study justify the need to train nurses with respect to epilepsy to improve their knowledge about epilepsy and the care of people with epilepsy.

Knowledge, attitudes, and practices with respect to epilepsy among primary and secondary school teachers in the city of Niamey, Niger.

OBJECTIVE: We aimed firstly to evaluate knowledge, attitudes, and practices about epilepsy among primary and secondary school teachers in the city of Niamey and secondly to formulate targeted sensitization messages for these teachers. MATERIALS AND METHODS: A descriptive cross-sectional survey was carried out among primary and secondary school teachers in the city of Niamey, capital of Niger, using a self-administered questionnaire including questions related to knowledge, attitudes, and practices about epilepsy. RESULTS: One hundred and forty-five (145) teachers aged 27-69 (mean age: 39.57 ± 8.304 years) had answered the questionnaire (52 men and 93 women). In 62.1% of cases, respondents had a bachelor degree in education signifying a high level of education. Sixty-one respondents (42.1%) considered epilepsy as a brain disease, whereas it was considered as a psychiatric illness by 15.9% of respondents and as an impurity by 38.9%. Sixteen respondents (11%) considered it as a hereditary disease. Epilepsy was considered as a contagious disease by 46.2% of teachers, and the main transmission routes reported were contact with places of crisis (26.2%), physical contact with an epileptic person (16.6%), and contact with saliva (6.9%). It was considered as an incurable disease by 6.9% of teachers. Of the 115 respondents (79.3%) who considered epilepsy as a treatable condition, 46 of them believe that epilepsy is treated by traditional medicine. When someone has an epileptic seizure, 28.3% of respondents think that physical contact with him should be avoided and that the places of the crisis should be avoided. CONCLUSION: Considering that epilepsy is common in school-age, the study results suggest the need to train teachers with respect to epilepsy to change misconceptions about epilepsy and to promote positive attitudes toward epileptic people to avoid the rejection of these people by the society responsible for problems of social integration.

Clinical and etiological characteristics of epilepsy in people from Niger: a hospital-based study from a tertiary care referral center of Niamey, Niger.

OBJECTIVES: Epilepsy constitutes a major public health concern in the world particularly in developing countries, especially in sub-Saharan African countries. We designed this study to evaluate epilepsy management at a tertiary referral center in Niger to obtain a comprehensive understanding to determine the intrahospital deficiencies to improve and to make recommendations in terms to improve epilepsy management in Niger. METHODS: We conducted a retrospective study at the Neurology Outpatient Clinic of the National Hospital of Niamey (Niger) between May 2013 and May 2018 (5 years), collecting all cases of patients diagnosed with epilepsy by the neurologists. From the registers of consultation, we collected for each patient the demographic, clinical, etiological, and therapeutic data, as well as the outcomes during follow-up visits. RESULTS: Of the 4576 patients seen during the period of the study, 1350 patients consulted for epilepsy with a hospital frequency of 29.5%. The mean age of the patients was 18.55 ± 17.15 years (range: 3 months to 83 years) with a predominance of the male sex (sex ratio at 1.5). Patients younger than 20 years were the most represented (61.6%). All patients underwent EEG. Only 463 patients (35.2%) underwent brain imaging. Generalized tonic-clonic seizures were the most frequent (50%) followed by typical absences seizures (11.8%). Cerebrovascular disease, central nervous system infections, and head injuries were the main etiologies. First-generation AEDs were the most prescribed (99%). The proportion of patients with drug-resistance was 9.6%. SIGNIFICANCE: Our study shows limited access to newer generation AEDs and diagnostic tests of epilepsy in Niger. Considerable efforts should be made to facilitate for people living with epilepsy the accessibility to diagnostic tests and newer generation AEDs in order to improve the quality of epilepsy management in Niger.

Rural Surgery in Niger: A Multicentric Study in 21 District Hospitals.

The purpose of the study was to evaluate the qualitative aspect and global impact of surgery in a district hospital (DH) since the launching of the surgery at the district level. Surgical care was provided by general practitioners (GP) who received 12-month training in surgery, certified by a "Capacity of District Surgery" (CDS) diploma. It was a prospective study during 4 years from 2007 to 2010. Of the 34 DHs, only 21 were functional and included in this study. Most of the DHs had two or more CDS (n = 15). The majority of the DHs had one nurse surgical aid (n = 16) and one nurse anesthetist (n = 17). The total number of surgical operations was 18,441 cases; emergency cases represented 51.8 % and elective surgery 48.2 %. Regarding emergency surgery, cesarean sections revealed the most common surgical procedure (37.21 %), followed by wound debridement (19.42 %). In elective surgery, hernia repair and hydrocelectomy were the most common surgical procedures (69.60 %), followed by gynecologic procedures in 12.74 % of the cases. The global complication rate was 4.34 %. The global mortality rate was 1.04 % (n = 192), 102 deaths following cesarean section (2.87 %). No death was encountered in elective surgery. Nine hundred and fifty-five patients (5.17 %) were transferred to a higher-level facility of whom 598 patients (62.61 %) were admitted for fracture treatment. The concept of district surgery has proven to be an effective tool to counter skilled medical manpower shortage to perform emergency and elective basic surgery at the rural level and could be adopted by developing countries facing similar health challenges.

Management of postoperative pain: experience of the Niamey National Hospital, Niger.

OBJECTIVE: The aim of this study was to evaluate the management of postoperative pain at the Niamey National Hospital. METHODS: A prospective study was conducted in the Department of Anesthesiology and Intensive Care at the Niamey National Hospital from March to June, 2009. Data collected included age, sex, literacy, American Society of Anesthesiologists (ASA) physical status classification, type of anesthesia, type of surgery, postoperative analgesics used, and the cost of analgesics. Three types of pain assessment scale were used depending on the patient's ability to describe his or her pain: the verbal rating scale (VRS), the numerical rating scale (NRS), or the visual analog scale (VAS). Patients were evaluated during the first 48 hours following surgery. RESULTS: The sample included 553 patients. The VRS was used for the evaluation of 72% of patients, the NRS for 14.4%, and the VAS for 13.6%. Of the VRS group, 33.9%, 8.3%, and 2.1% rated their pain as 3 or 4 out of 4 at 12, 24, and 48 hours postoperatively, respectively. For the NRS group, 33.8%, 8.8%, and 2.5% rated their pain as greater than 7 out of 10 at 12, 24, and 48 hours postoperatively, respectively. For the VAS group, 29.3%, 5.4%, and 0% rated their pain as greater than 7 out of 10 at 12, 24, and 48 hours postoperatively, respectively. CONCLUSION: Postoperative pain assessment and management in developing countries has not been well described. Poverty, illiteracy, and inadequate training of physicians and other health personnel contribute to the underutilization of postoperative analgesia. Analysis of the results gathered at the Niamey National Hospital gives baseline data that can be the impetus to increase training in pain management and to establish standardized protocols.

Using 'Catheter à Fentes' for Management of Childhood Hydrocephalus: A Prospective Study of Ninety-six Cases.

OBJECTIVE: To evaluate the management of childhood hydrocephalus using the 'catheter à fentes' as a ventriculoperitoneal shunt. MATERIALS AND METHODS: A prospective study from January 2003 to January 2004 was carried out in the Neurosurgery Department of the National Hospital Niamey (Niger-Republic). Ninety-six infants with hydrocephalus, between the ages of 1 to 22 months were treated with 'catheter à fentes' as a ventriculoperitoneal shunt. RESULTS: Ninety-six infants with hydrocephalus, between the ages of 1 and 22 months were included in this study, over a period of 31 months; 53% of the infants were females. The symptoms evolved over three months in 89.55% of the cases (n = 85). Hydrocephalus was post-infective in 51% of the cases, associated with spina bifida in 32% of the cases, neonatal bleeding in 7.2% of the cases; brain abnormalities were found in 6.2%, and tumor in 3.1% of the cases. The head circumference was greater than 2SD in all cases; 87.53% of the infants had psychomotor retardation (less than 80 QD according to the Lezine score). Ventricular dilation was triventricular in 17.70% and tetra ventricular in 82.29% of the cases. 'Catheter à fentes' models of high pressure, medium pressure, and low pressure were used. Hydrodynamic complications (hyperdrainage, obstruction, underdrainage) occurred in 7.9% of the cases, and these were handled with simple observation in follow-up clinics. The average regression of head circumference three months postoperatively, for all the three models of 'catheter à fentes,' was 3.73 cm. CONCLUSION: This study shows that the usage of 'catheter à fentes' for treatment of childhood hydrocephalus gives satisfactory results.

Rachipagus: a report of two cases - thoracic and lumbar.

We present two cases of rachipagus in two male infants and review the literature on this anomaly. These infants were from consanguineous marriages and cases of twins were reported in their families. In the first case it was a limb attached to the lower lumbar region with a rudimentary posterior arch. At the junction there was a lipomeningocele. Anatomical dissection of the limb identified the bones of the lower limb. In the second case, the parasites were joints of the upper limb that were attached to the chest by rudimentary posterior arches. In both cases there was only one spinal canal and a single spinal cord. Except the spina bifida in the first case no other malformation was diagnosed. The parasites were successfully excised. The two patients are well at one year of follow-up. Rachipagus is a rare embryogenic malformation with a good prognosis in the absence of associated congenital anomalies.