WHITE CEREBELLUM SIGN AS A DARK PROGNOSTIC INDICATOR OF CEREBRAL INJURY: A CASE REPORT.

Introduction: The white cerebellum sign (WCS) is a classical but rare radiological finding usually associated with irreversible diffuse hypoxic-ischemic cerebral injury. Very few cases exist in the literature globally, especially from the West African region, as a potential hallmark of poor prognostic outcome. We describe the white cerebellum sign in a Nigerian pediatric patient, managed for severe head injury. Case Presentation: A fourteen-year old boy presented to our emergency department with loss of consciousness following a pedestrian road traffic accident. Physical examination revealed a critically ill boy with fever, hypotension, tachycardia, gasping respiration, GCS 3, bilateral dilated unreactive pupils, absent corneal, gag and oculocephalic reflexes. He was thus diagnosed of severe traumatic brain injury and brainstem dysfunction. He had endotracheal intubation, ventilatory and inotropic support. Cranial computerized tomography scan of the patient showed radiological features in keeping with the WCS. His clinical status remained poor until he suffered a cardiac arrest about twelve hours after admission. Conclusion: WCS has been reported in relation to child abuse, anoxic-ischemic brain injury, inflammatory and metabolic brain disorders and trauma. It is a classical radiological description of diffuse cerebral edema alongside relatively normal cerebellar hemispheres and brainstem. Management of this pathology is symptomatic, and aims to ameliorate the associated raised intracranial pressure, control seizures and prevent cerebral infarction. The index patient, who presented 24 hours after severe head injury with associated early post-traumatic seizures, respiratory failure and brainstem dysfunction, had an unfavourable outcome consistent with previous reports of WCS. We have reported the rare but classical white cerebellum sign. It remains a grave prognosticator of cerebral injury and should be sought for in the neuroimaging of patients with acute brain insults.

A dataset for predicting Supreme Court judgments in Nigeria.

It has been widely argued among researchers that the application of big data analytics promises to reduce human bias and provide a scientific and evidence-based approach to the judicial process. In this dataset, historical data consisting of appeal cases presented at the Supreme Court of Nigeria (SCN) were collected from an online repository (Primsol Law Pavillion). A total of 5585 appeal cases brought before the SCN were collected from the archive. The dataset consisted of both criminal and civil appeal cases brought before the SCN. Variables that are related to court case proceedings were identified from related literature, verified by legal experts and used as a basis for generating an electronic structured version of the dataset stored as a spreadsheet file from the unstructured data. From the collected data, thirteen input variables were identified with one output/decision variable. The distribution of the numerical variables was presented as a descriptive statistical summary in terms of the minimum, maximum, mode, mean and standard deviation. The developed dataset can assist researchers to build predictive systems by training their models. Various feature extraction techniques can also be applied on the dataset to remove irrelevant or redundant features for increased performance of such classifiers that are needed to predict the outcome of legal cases.

POST-OPERATIVE INTENSIVE CARE UNIT ADMISSION FOR ELECTIVE BRAIN TUMOUR SURGERIES: A NIGERIAN NEUROSURGICAL UNIT EXPERIENCE.

Background: Patients, post elective brain tumour surgeries, are usually admitted into the Intensive Care Unit (ICU) for quick identification of life-threatening complications or for elective ventilation. The Covid-19 pandemic exerted additional strain on the limited ICU spaces. This study was to probe the need for ICU admission following elective surgery for brain tumour in our environment on the background of enormous constraints. Methods: Data was collected prospectively from patients who had elective brain tumour surgery over 12-months at the University College Hospital, Ibadan. Data included the indications for ICU admission and outcome. Chi-square test and Student t-test were used for analysis at α ≤ 0.05. Results: There were 56 patients with a mean age of 44.6 years and M:F ratio of 1:1. 61.8% of the patients were admitted into the ICU for observation. Patients who had open surgeries were 2 times more likely to be admitted (p<0.01; OR = 2.2, CI: 2.0 - 36.8) than those who had endoscopic surgeries. Awake craniotomy patients did not require ICU care compared with the 63% of the patients who had General Anaesthesia + Endo Tracheal Tube (GA+ETT). Patients with skull base and posterior fossa tumours were more likely to be admitted into the ICU (p=0.036). Of the 34 patients admitted into the ICU, 11(19.6%) had prolonged ICU stay and were 2 times more likely to die compared with those with short admissions (p<0.01; OR = 2.5, CI: 2.29 - 70.02). Conclusion: Observation is the main reason patients are admitted into the ICU. The endoscopic and awake surgery approaches appear to preclude the need for ICU admission, thus capable of cutting costs.

CERVICAL SPINAL CORD INJURY FROM A VEHICULAR ACCIDENTAL NEAR HANGING INJURY AND NECK MANIPULATIONS.

Spinal cord injury is a global problem. It is a devastating life altering condition that is associated with permanent disability and reduced life expectancy. Road traffic accident has been described in global literature as the commonest aetiology and second to it is falls. Identifying these factors have led to development of policies and advocacy to reduce these causes of spinal cord injuries. We present three cases of spinal cord injuries from unusual aetiologies viz-a-viz an accidental hanging which resulted in a C4 traumatic myelopathy Frankel A in a 30-year old artisan, playful neck manipulation in a 23-year old male student, resulting in Brown-Sequard syndrome, which resolved with non-operative spinal cord injury management protocol over six weeks and a C4 traumatic myelopathy Frankel D with a 50% anterior listhesis of C4 on C5 in a 50-year old man who sustained injuries from a choke hold 10 weeks prior to presentation. He recovered fully on non-operative management and discharged home Frankel E.

Assessment of the Holistic Model of Neurosurgical Patient Care at the University College Hospital (UCH), Ibadan.

BACKGROUND: Holistic ward round (HWR) is a polyadic, multiphasic, holistic model of neurosurgical patient care. It is a multidisciplinary ward round where all healthcare providers involved in patients care, the patients, the relations, as well as clergymen (depending on the patients' faith and need) collectively work to review patient's condition and make decisions in the patient's best interest. OBJECTIVES: The study assessed the effectiveness of the holistic model of care and identified the challenges facing this model of healthcare delivery. METHODS: The study was qualitative in design and In-depth Interviews (IDIs) were conducted with eighteen (18) participants who were purposively selected. They include neurosurgeons, nurses, medical social workers and physiotherapists. The data were thematically content analysed with the help of ATLAS.ti (v.7) software. RESULTS: The study found that patients and relations have immensely benefitted from the model of care through psychosocial support. The major challenges facing HWR were logistic, timing and common problems found in the Nigerian healthcare system. CONCLUSION: It was concluded that for HWR to effectively help spinal cord injured patients further, the healthcare providers, patients and their families require support in different forms from outside the hospital.

ENDOSCOPIC ASSISTED, TRANSFONTANELLE EXCISION OF A LARGE THIRD VENTRICULAR ATYPICAL CHOROID PLEXUS PAPILLOMA IN AN INFANT.

Choroid plexus papillomas are rare benign tumours, which are found in both adult and paediatric age groups. The 'atypical' histological subclass is rarer still. The commonest site of occurrence is in the lateral ventricles; rare locations are the cerebellopontine angle and the third ventricle. The goal of care is a gross total excision of the tumour. The histologic subtype determines further adjuvant care given to the patient. The outcome of the care of these patients depends on the histological grade, extent of surgical resection adjuvant care. We present a case of a 12 week-old infant with obstructive hydrocephalus, secondary to a third ventricular atypical choroid plexus papilloma. He had a 'two-staged' resection of the choroid plexus papilloma, using an endoscopic access via the right Kocher's point in the right anterior fontanelle, in the same position as that proposed for access in endoscopic third ventriculostomy because of the observed sutural diastasis. Histology confirmed an atypical choroid plexus papilloma. He made progressive recovery post-surgery but unfortunately there has been default with follow-up clinic visits.

Evaluation of the content validity, internal consistency and stability of an instrument designed to assess the HIV/AIDS knowledge of university students.

OBJECTIVE: This study evaluated the content validity, internal consistency and stability of a questionnaire designed to assess the HIV/AIDS knowledge of young adults. METHODS: The questionnaire was administered on two occasions, within two week intervals, to 219 university students in the USA (n=66), Turkey (n=53) and South Africa (n=100). The psychometric instrument contained demographic information questions and 45 knowledge questions regarding the HIV virus, ways of transmitting it, symptoms of HIV/AIDS infection and methods of prevention. Factor analysis was conducted to assess construct validity; Cronbach alphas and Pearson's product moment correlation (r) were calculated to evaluate internal consistency and stability, respectively. RESULTS: The 45 knowledge questions produced a Kaiser-Meyer-Olkin (measure of sampling adequacy) value of 0.8133 and loaded on three factors with an overall Cronbach's alpha of 0.861. The r for the individual knowledge question was greater than 0.50 and the overall knowledge score was "almost perfect" (0.91; p<.001). For participating students from the USA, Turkey and South Africa, their r for the overall knowledge score was 0.80 (p<.001), 0.83 (p<.001) and 0.93 (p<.001), respectively. CONCLUSIONS: Our findings revealed that the instrument is highly stable and internally consistent. The availability of this instrument may enhance HIV intervention studies internationally.

Bilateral deafness and blindness from a IVth ventricular medulloblastoma.

Delay in diagnosis and management of intra-cranial tumors can be costly if not actually fatal. We present a 16-year-old Nigerian girl with bilateral deafness and blindness from a cerebellar intra-axial medulloblastoma. She has regained some hearing function in both ears 5 months after tumor resection. She remains blind.

Pre-incarceration HIV risk behaviours of male and female inmates.

In most countries, HIV and AIDS rates are higher among inmates than in the general population. As part of a series of studies aimed at examining the plausible links between HIV and incarceration in a State prison system in the United States (US), the present study examined pre-incarceration sexual and injection drug use behaviours of inmates and their demographic correlates. Two-hundred-andsixteen female and 260 male inmates randomly selected from 17 Illinois State prisons completed a structured questionnaire. Findings indicate that the rate of inconsistent condom use with multiple anal and vaginal sexual partners among study participants ranged from 11 to 49%. Fourteen per cent of the women and 25% of the men reported ever injecting drugs, while 13% of the women and 7% of the men had ever shared needles. Demographic correlates of risk behaviours differed between gender and for specific behaviours. The findings indicate that persons entering prison generally exhibit risk behaviours that may increase their chances of acquiring HIV. Comprehensive HIV prevention programmes should be made available to inmates in US prisons and be accessible to them upon release. Studies are needed to examine how individual and structural factors interact to increase HIV and incarceration risk.

Physical and occupational therapy undergraduates' stereotypes of one another.

Literature suggests that increased interaction between physical therapy and occupational therapy students may improve their understanding of each other's profession. This cross-sectional study examined positive and negative stereotypes in an educational setting in which physical and occupational therapy students take over 25% of their curricular courses together. The aim of the study was to assess whether interaction between these students in and out of the classroom positively affected their views of each other, as compared with physical and occupational therapy students in previous studies who did not take classes together. Senior students, 25 physical therapy and 28 occupational therapy, completed two copies of the Health Team Stereotype Scale questionnaire exploring attitudes concerning their own chosen profession and the other participants' profession. They also completed an extracurricular activities survey to indicate how much they participated in activities outside of the classroom with students from the other profession. On the stereotype scale, physical therapy students' self-assessment compared with their assessment of occupational therapy students yielded 28 significantly (p<.05) different adjective pairs; occupational therapy students' self-assessment compared with their assessment of physical therapy students yielded 26 significantly (p<.05) different adjective pairs. The students rarely or never participated in extracurricular activities with each other. When comparing present results with those of previous studies, present subjects selected significantly fewer negative adjective pairs to describe the other profession. The results indicate a more positive view of each other's profession than in the previous studies. The interdisciplinary education model examined in our institution may have fostered positive attitudes among students in these programs.

The effect of professional education on the knowledge and attitudes of physical therapist and occupational therapist students about acquired immunodeficiency syndrome.

BACKGROUND AND PURPOSE: Anxiety and fear about caring for people with acquired immunodeficiency syndrome (AIDS) are concerns expressed by students in health care professions. This study was designed to evaluate the influence of education offered to physical therapist (PT) and occupational therapist (OT) students on their knowledge, attitudes, and willingness to provide services to people with AIDS. SUBJECTS AND METHODS: Twenty-six undergraduate PT students and 23 undergraduate OT students completed a questionnaire at the beginning of their professional education program, following a 5-hour AIDS education seminar, and shortly before their graduation. The questionnaire consisted of 3 subscales designed to evaluate the respondents' knowledge, attitudes, and willingness to treat people with AIDS. RESULTS: At the time of graduation, the students in both disciplines showed improvement in knowledge about AIDS (14.3% for PT students and 13.8% for OT students) and more positive attitudes toward people with AIDS (7.4% for PT students and 5% for OT students). In both disciplines, the students' willingness to provide services for people with AIDS remained unchanged following the AIDS education seminar and at the end of the professional education program. CONCLUSION AND DISCUSSION: The professional education offered to the cohort of students in this study appeared to be beneficial in improving their knowledge and attitudes toward people with AIDS, but it did not affect their willingness to work with this patient group.

The effects of acupuncture, electroneedling and transcutaneous electrical stimulation therapies on peripheral haemodynamic functioning.

For decades, acupuncture and electroneedling treatments have been used, predominately in the Eastern countries, in the management of patients with compromised cardiovascular and digestive functions. Similarly, neuromuscular electrical stimulation is commonly employed in Western countries to modulate pain, augment muscle strength and enhance blood flow in patients with peripheral vascular disease. Many rehabilitation specialists believe that electrical stimulation of acupuncture points with surface electrodes can elicit the same physiological and therapeutic effects as those produced by acupuncture and electroneedling techniques. Electrical stimulation of acupuncture points with surface electrodes is a relatively new and non-invasive treatment with potential clinical application in the management of patients with peripheral vascular disease. Presently, there are controversies in the literature as to the effects of traditional acupuncture, electroneedling and neuromuscular electrical stimulation treatments on peripheral haemodynamic functioning. This paper provides a detailed review of published studies on the above promising therapies. An attempt was made to clarify the pitfalls in the extant literature and delineate the fact from the fiction. Areas for further research were proposed.

Determinants of single limb stance balance performance.

This study was designed to evaluate the effects of gender, physical activity level, age and anthopometric indices on the single limb stance balance performance of asymptomatic subjects. Eighty physically active and 120 sedentary subjects (100 males and 100 females, age ranged, 12-40 years) from Ile-Ife community were recruited for the study. The maximum duration that each subject was able to maintain balance whiled standing on their dominant leg with eyes open and eyes closed were monitored. It was found that: 1. Males had a higher (P < 0.01) balance time than females; 2. The physically active subjects performed better (P < 0.001) on the eyes closed test than sedentrary subjects of comparable age, weight and height; and 3. The balance time, with eyes open or closed, improved with chronological age and increased with height and body weight. The findings in this cross sectional study suggest that exercise programmes could be used to improve balance performance. It was concluded that the single limb stance time testing protocol described in this study could be used: a. As a screening tool in population based studies to identified individuals with a balance dysfunction; and b. In clinical practice to monitor improvement in neuromuscular function of patients with injuries to the lower extremities undergoing rehabilitation.

Effects of high-voltage galvanic stimulation of ST36 and ST37 acupuncture points on peripheral blood flow and skin temperature.

In traditional Chinese medicine, ST36 and ST37 acupuncture points are commonly recommended to enhance peripheral blood circulation and digestive functions; however, there is a paucity of empirical data in support of the above recommendations. This study was designed to evaluate the effects of transcutaneous electrical stimulation of ST36 and ST37 acupuncture points on peripheral haemodynamic functions. Eleven healthy subjects (five men, six women; mean age 28 years), voluntarily participated in the study. A 2 (pulse frequency) x 3(time-frame) experimental design was employed. The subjects' ST36 and ST37 acupuncture points were stimulated, at sensory threshold intensity, with the high-voltage galvanic (HVG) current using two (5 Hz and 120 Hz) different pulse frequencies. Skin temperature and haemodynamic functions (cutaneous blood flow, microvascular volume and erythrocyte velocity), between the first and second metatarsals of the subjects' dominant foot were monitored every 2 min, for 10 min at rest, during 20 min HVG stimulation treatment and 10 min post-stimulation. The results of the repeated-measures analysis of variance revealed no significant F-ratio for pulse frequency and time-frame main effects for any of the dependent variables. Based on our findings we conclude that percutaneously applied HVG stimulation of ST36 and ST37 acupuncture points does not increase peripheral haemodynamic functions in asymptomatic subjects.

Determinants of academic and clinical performance in the physiotherapy education programme at the University of Ibadan, Nigeria.

A retrospective study was conducted to determine the best predictors of academic and clinical performance in the physiotherapy education programme in the University of Ibadan, Nigeria. Reviewing the records of 94 students enrolled in the programme between 1983 and 1987, multiple and stepwise regression analyses revealed that pre-admission requirements were not significantly related to academic and clinical performance. When all the predictor variables were included in the multiple and stepwise regression analyses, the variance accounted for by the predictor variables was dismally low: 33.8% and 21.3% for academic achievement and clinical performance, respectively. We concluded that the pre-admission requirements are not viable predictors of academic and clinical performance in the programme.

Academic performance is not a viable determinant of physical therapy students' burnout.

This study investigated the proposed link between students' academic performance and burnout. We found no significant correlations between students' cumulative grade point average and ratings of emotional exhaustion, depersonalization, and personal accomplishment.

Cardiovascular adjustments and perceived exertion during exercise on the BAPS board.

The Biomechanical Ankle Platform System (BAPS) is widely used in medical rehabilitation; however, the cardiovascular demand and subjective acceptability of the BAPS rehabilitation exercise are presently not documented. The purpose of this study was to evaluate the pattern and magnitude of the cardiovascular adjustments and rating of perceived exertion (RPE) during an acute bout of exercise on the wobble board. Twenty healthy (mean age 24.2 +/- 2.9 years old) subjects exercised for 10 min each on the BAPS board on two different occasions. One test was performed using the small hemisphere board while the other test was performed with the large hemisphere board. The subjects' heart rate (HR), blood pressure (BP), cutaneous blood flow (BF), skin temperature (ST) at the ankle joint, local and overall RPE responses were monitored at specific time periods. Micro-circulation, skin temperature and heart rate were monitored with the LaserFlo Blood Perfusion Monitor, the Physitherm thermocouple and the Cardiotach recorder, respectively. The subjects' rating of perceived effort during exercise was obtained with a 15-point category scale. The result showed significant perturbation of the cardiovascular system during the BAPS exercise. Similarly, both local and overall RPE increased as the duration of exercise increased. The BF and RPE during the large hemisphere exercise session were significantly higher than the small hemisphere session. The subjects' subjective report following the exercise suggests the need for caution in the use of the BAPS board exercise for frail patients and also patients with lower extremity joint pathologies.

Test-retest reliability of a psychometric instrument designed to measure physical therapy students' burnout.

The purpose of this study was to assess the reproducibility of scores on an instrument designed to measure physical therapy students' burnout. Physical therapy students (28 juniors and 28 seniors) completed an adapted educator's version of the Maslach Burnout Inventory on two occasions within a week interval. At each testing session, a separate score was obtained for each student for the three (emotional exhaustion, depersonalization, and personal accomplishment) subscales of the instrument. These scores, analyzed with a two-factor repeated-measures analysis of variance, indicated a significant difference in the personal accomplishment score between the junior and senior students during the two time frames. Scheffé post hoc tests showed that the junior students reported higher personal accomplishment affect at both testing sessions than the senior students. Both junior and senior students reported higher personal accomplishment at retest than at baseline testing. A test-retest reliability coefficient of .850 was obtained for the Depersonalization subscale; .907 and .715 were obtained for the Emotional Exhaustion and Personal Accomplishment subscales, respectively.

Anthropometric indices of male and female Nigerians of different age groups.

The body weight (W), height (H), Quetelet index W/H2), and Ponderosity index (W/H3) of 1,040 healthy (520 male and 520 female) volunteers (age ranged from 6-80 years) from various urban and rural communities in Oyo and Osun States, Nigeria were measured. We observed that the subjects body weight, height and Quetelet index increased with chronological age up until the third decade of life (20-29 years) when they peaked and gradually declined thereafter. The combined mean data for all ages revealed that males were significantly (p < 0.001) taller and heavier than the females. The Quetelet of index of the males were comparable (p > 0.05) to the females, but the Ponderosity index of the females were significantly (p < 0.001) higher than the males. The anthropometric normative data presented in this study will find useful application in bariatric practice in Nigeria. It will serve as a reference to which patients data in Oyo and Osun States can be compared.