Consensus statement from the international consensus meeting on post-traumatic cranioplasty.

BACKGROUND: Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach. METHODS: The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP. RESULTS: The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations. CONCLUSIONS: This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.

Prevalence of Pre-Diabetes, Diabetes and Associated Cardiovascular Risk Amongst Healthcare Workers in Ahmadu Bello University Teaching Hospital (ABUTH), Zaria using Glycated Haemoglobin.

BACKGROUND: There is a global rise in the prevalence of diabetes mellitus and pre-diabetes is a fore-runner to type-2 diabetes. Pre-diabetes is reversible, therefore, measures should be taken to halt or slow down its progression to frank diabetes. AIM: The study aimed to evaluate the prevalence of pre-diabetes and diabetes amongst staff of ABUTH, Zaria and identify some cardiovascular risks associated with them. METHODS: A cross-sectional analytical study carried out on 377 healthcare workers who presented at the Medical out-patient department of ABUTH, Zaria in response to an invitation for the 2017 World Diabetes Day free medical screening. HbA1c was assessed via Immunofluorescence method. The difference in HbA1c amongst healthcare workers was determined by One-way Analysis of Variance with Post-hoc Bonferroni test. Cardiovascular risk associations were assessed via Multiple Binary Logistic Regression. RESULTS: Pre-diabetes and diabetes prevalence were 19.4% and 6.5% respectively. There were 28.6% undiagnosed diabetic healthcare workers. There was no significant (p=0.35) difference in HbA1c between different categories of healthcare workers, however, random blood glucose was significantly (p=0.042) higher in other healthcare workers than doctors. There was a significant (p<0.01) association between systolic hypertension and risk of developing pre-diabetes and diabetes (OR, 4.11, CI 0.98-17.30). CONCLUSION: There is a high prevalence of pre-diabetes and diabetes amongst healthcare workers in Zaria. The odds of hypertensive healthcare workers developing pre-diabetes and diabetes is high. Efforts should be geared at intensifying health education, increased work physical activity and proper diet.

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.

PATTERN OF REFERRALS OF HEAD INJURY TO THE UNIVERSITY COLLEGE HOSPITAL, IBADAN.

BACKGROUND: Although there are now many neurosurgical units in Nigeria, cases of head injury (HI) continue to present in the University College Hospital, UCH, Ibadan, from hospitals all over the country. OBJECTIVE: This report aims to highlight the contemporary patterns of referrals of cases of head injury for neurosurgery in Ibadan. METHOD: The study emanated from an analysis of registry of cases of head injury managed in our practice covering a 7-year period at the UCH Ibadan. The clinical/ trauma-demography of cases of head injury referred were analyzed quantitatively and then compared with head injury cases that presented primarily to UCH Ibadan during the same period. An alpha value of <0.05 was considered significant for associations for pattern of referrals. RESULTS: Of the 1034 cases of head injuries in the registry, 23.6% presented primarily to UCH, Ibadan; 423 (40.1%) were from outside Ibadan/Oyo state. Most of the cases were earlier seen in other health facilities in four out of Nigeria's six geopolitical zones including other teaching hospitals with practicing neurosurgeons. The reasons for these inter-hospital, inter-state referrals included absence of neurosurgical expertise (67%) or lack of other logistics like neuroimaging, bed space and intensive care unit services. Head Injury was caused by road accidents in more than 85% of the cases. The patients referred inter-state had more severe injuries, more delayed attainment of critical milestones in their trauma care, and higher frequency of neurosurgical operative interventions. They also had worse in-hospital outcome and longer length of stay. CONCLUSION: The University College Hospital, Ibadan continues to play a pivotal role in the management of head injury in Nigeria. The results support an urgent need for stakeholders in the health sector to provide all that is required to uphold the status of the Hospital as a center of excellence in neurosurgery and neurosciences.

Utilization of isolated marine mussel cells as an in vitro model to assess xenobiotics induced genotoxicity.

Freshly isolated cells are used as an ideal experimental model in in vitro toxicology analysis, especially the detection of diverse xenobiotics induced genotoxic effects. In present study, heavy metals (Zn, Cu, Cd, Pb) and PCBs were selected as representative xenobiotics to verify the ability of in vitro model in assessing genotoxic effects in cells of marine mussels (Mytilus galloprovincialis). DNA damage and chromosome aberration were assessed in freshly isolated cells from haemolymph, gill and digestive gland by single cell gel electrophoresis and micronucleus assay respectively. Gill cells showed more sensitive to Zn exposure among three types of cells, indicating tissue-specific genotoxicity. Significantly higher DNA aberrations were induced by Cu in haemocytes compared to Cd and Pb, indicating chemical-specific genotoxicity. An additive effect was detected after combined heavy metals and PCBs exposure, suggesting the interaction of selected xenobiotics. To our knowledge, this is the first attempt to study the complex effects of organic and/or inorganic contaminants using freshly isolated cells from marine mussels. Genetic responses are proved to occur and maintained in vitro in relation to short-term xenobiotics induced stresses. The utilization of the in vitro model could provide a rapid tool to investigate the comprehensive toxic effects in marine invertebrates and monitor environmental health.

Constraints in the neurosurgical management of pituitary tumours in an African developing country: a 5-year observational study from Benin Republic.

INTRODUCTION: Benin Republic, a very low-income-sub- Saharan African developing country, has a severely resource-constrained health system. There is hardly any data available on the pattern of pituitary tumour in this country METHODS: A single surgeon, hospital-based retrospective analysis of the pattern, presentation and clinical / surgical course of7a prospective cohort of pituitary tumours seen over a 5-year period is presented RESULTS: There were 38 cases, 20 (52.6%) female; 27% of all brain tumours seen. They were macroadenomas in 97. 4%, and greater than 4cm in 63.2%. They occurred mainly (86.8%) in people aged 15 to 59 years. Delayed neurosurgical presentation, mean 5.16years (range 1-23years) was the rule in 94.7%%; and, visual and endocrinological dysfunction the two most prominent symptomatology. Due to severe logistic constraints, neuroimaging evaluation was possible with cranial CT only in about 90% of the cases. Also only 9 cases (23.7%) did eventually receive the planned neurosurgical operative treatment, in 5 cases of which even this surgical treatment Was only facilitated by some foreign neurosurgical missions. CONCLUSIONS: Pituitary adenomas represent a sizeable proportion of brain tumours in Benin Republic. National health care resources in this low income African country for their optimal clinical / radiological evaluation, and surgical treatment, are grossly inadequate; indeed, almost non-existent.

2-(2-nitrovinyl)furan promotes oxidation of cellular proteins, lipids, and DNA of male rat liver and kidney.

The effect of 2-(2-nitrovinyl)furan on the redox status of male rat liver and kidney was evaluated. Twenty male rats were randomized into four groups; group A received olive oil and groups B, C, and D rats received 12.5, 25, and 50 mg/kg bodyweight of 2-(2-nitrovinyl)furan intraperitoneally, daily at 24 h interval, respectively, for 14 days. 2-(2-Nitrovinyl)furan significantly reduced (P < 0.05) alkaline phosphatase, alanine, and aspartate aminotransferase activities in male rat liver and kidney with a corresponding increase in serum. The activities of superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, and levels of reduced glutathione/glutathione disulfide (GSSG) ratio in the liver and kidney of 2-(2-nitrovinyl)furan-treated rats decreased significantly (P < 0.05). In contrast, GSSG, protein carbonyl, conjugated dienes, lipid hydroperoxides, malondialdehyde, and fragmented DNA (%) in 2-(2-nitrovinyl)furan-treated rats increased significantly (P < 0.05). Overall, data from this study revealed that 2-(2-nitrovinyl)furan exhibited its toxic effect by suppressing or depleting the antioxidant systems.

Blighia sapida leaves halt elevated blood glucose, dyslipidemia and oxidative stress in alloxan-induced diabetic rats.

ETHNOPHARMACOLOGICAL RELEVANCE: Blighia sapida leaves are used in the management of diabetes in Nigeria. Thus the antidiabetic activity of methanolic Blighia sapida leaf extract and its capability to halt oxidative stress and dyslipidemia in alloxan-induced diabetic rats were investigated. METHODS: In vitro antioxidant activity of the extract (0.2-1.0mg/mL) was investigated using 2,2-diphenyl-1-1picrylhydrazyl (DPPH) radical, superoxide ion, hydrogen peroxide, and hydroxyl radical and ferric ion reducing system. Antidiabetic was evaluated in alloxan-induced diabetic rats. RESULTS: The methanolic extract of Blighia sapida leaves at 1.0mg/mL scavenged DPPH, superoxide ion, hydrogen peroxide, and hydroxyl radical at 80.34%, 57.39%, 72.36% and 77.0% respectively, while ferric ion was significantly reduced. Single oral dose of the extract significantly reduced blood glucose level in a dose dependent manner with highest dose producing 18.6% reduction after 240min. Similar reduction was produced after 28 days of extract administration with the highest dose producing 65.65% reduction which compared significantly (P<0.05) with the control group and glibenclamide treated groups. Alloxan-induced diabetic mediated alterations in liver and serum cholesterol, triacylglycerides, high-density lipoprotein cholesterol (HDLc), low density lipoprotein (LDL) cholesterol and very low-density lipoprotein cholesterol (VLDLc) were significantly (P<0.05) restored by the extract. Methanolic extract of Blighia sapida leaves significantly attenuated the decrease in the activities of reactive oxygen species detoxifying enzymes (superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase and glucose 6-phosphate dehydrogenase) in the liver and pancreas of alloxan-induced diabetic rats. Elevation in the concentrations of malondialdehyde, conjugated dienes, lipid hydroperoxides, protein carbonyl, and fragmented DNA was significantly (P<0.05) lowered by Blighia sapida leaves extract. CONCLUSION: Overall, methanolic extract of Blighia sapida leaves at all doses used reduced blood glucose level and prevented oxidative stress and dyslipidemia in alloxan-induced diabetic rats.

Bridelia ferruginea promotes reactive oxygen species detoxification in N-nitrosodiethylamine-treated rats.

This study was aimed at investigating the in vitro and in vivo reactive oxygen species (ROS) scavenging and detoxification potentials of aqueous extract of Bridelia ferruginea (B. ferruginea). Reactive oxygen species scavenging potentials of the aqueous leaf extract of B. ferruginea (0.2-1.0 mg/ml) was investigated using 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical, superoxide ion, hydrogen peroxide, hydroxyl radical, and ferric ion reducing system. The detoxification of ROS was evaluated in N-nitrosodiethylamine-induced redox imbalance in the liver of rats. B. ferruginea extract at 1.0 mg/ml scavenged the DPPH, superoxide ion, hydrogen peroxide, and hydroxyl radical at 87%, 83%, 92%, and 86%, respectively, it also reduced ferric ion significantly. ROS detoxifying enzymes (superoxide dismutase (SOD), catalase, glutathione peroxidase, glutathione reductase, and glucose 6-phosphate dehydrogenase) activities were significantly (p < .05) induced by B. ferruginea. These inductions significantly (p < .05) attenuated the N-nitrosodiethylamine-mediated decrease in ROS detoxifying enzymes and compared favorably with Vitamin C. N-nitrosodiethylamine-mediated elevation in the concentrations of malondialdehyde, conjugated dienes, lipid hydroperoxides, protein carbonyl, and percentage DNA fragmentation were significantly (p < .05) lowered by B. ferruginea extract. Overall, the results of this study show that B. ferruginea leaf extract possess ROS scavenging and detoxification potentials.

Is breaking of bad news indeed unacceptable to native Africans? A cross-sectional survey of patients in a Nigerian neurosurgical service.

OBJECTIVES: Breaking of bad news is anecdotally deemed to be culturally unacceptable, even intolerable, to native Africans. We sought whether this hypothesis could be formulated among a cohort of patients who had difficult diagnoses given them in a Nigerian neurosurgical service. MATERIALS AND METHODS: A semi-structured, interviewer-administered questionnaire was used in a cross-sectional survey among a consecutive cohort of patients on their opinion and preferences regarding the full disclosure of the grave prognoses of their difficult neurosurgical diagnoses. RESULTS: A total of 109 patients, 74 (67.9%) males, were sampled over a one-and-half-year period. They were mainly young adults, mean age of 40.2 (SD 14.2) years; more than half of them, 56%, had only basic literacy education, but the majority, 99.1%, declared themselves to have serious religious commitments. Less than 3% of the study participants chose not to receive their medical bad news whilst the majority who preferred to have the full disclosure of their medical diagnosis wanted their relations around during the process in 88%, and indeed, 91% would not be happy to be kept in the dark by their knowing relations. Finally, whilst the majority (98%) did not see the prospects of getting any governmental support, hope in God (88%) and family support (40%) were the means by which they expected to cope with the realities of their new futures. CONCLUSIONS: This data-driven study showed that contrary to anecdotal belief breaking bad news was not intolerable to a cohort of native Nigerian-African patients in a neurosurgical practice.

Recurrent nasal polyp and pansinus mucopyocele associated with bilateral blindness: a case report.

A 39 year old female with 24-month history of recurrent mucoid rhinorhea associated with progressive bilateral nasal blockage, headache, anosmia and bilateral impaired vision is reported. There was a past history of sinus surgery. The neuro-ophthalmic examination revealed left non-axial proptosis and visual acuity of nil light perception in both eyes at 3 meters. CT scan of the paranasal sinuses and brain showed markedly expanded left frontal sinus with sclerotic walls and expanded mixed density lesion in all the sinuses. She had surgery via trans-nasal, external and skull base approaches for effective clearance of the polypoidal masses and drainage of the sinus mucopyocele. Histological examination confirmed chronic inflammatory polyp. She remains stable to date although visual impairment and anosmia remained persistent. Patients with nasal polyposis require frequent follow-up even after surgical treatment for the early detection and management of complications to avoid consequences such as visual loss.

Orbital solitary fibrous tumor. Another rare case from Africa.

Solitary fibrous tumor (SFT) of the orbit, initially thought to be rare, is being increasingly documented in the medical literature. We here present the case of a 37-year-old Nigerian man who presented with left sided painless, vision-sparing proptosis. Cranial computed tomography scan showed a globular, left medial, orbital extraconal mass. The mass was excised, en bloc, via a medial orbitotomy procedure aided by left ethmoidectomy. Surgery was uncomplicated and histology of the excised tissue was reported as compatible with SFT. There was also a strong and diffuse immunostaining with CD 34. At 6-month follow-up, the left-sided proptosis has completely regressed. To the best of our knowledge, this is the second case of orbital SFT to be reported in an African.

Adult sacrococcygeal teratoma: a case report.

Sacrococcygeal teratomas are extremely rare in adults. We present an adult female with a sacrococcygeal teratoma managed in our hospital.

Clinicoepidemiological profiles and outcomes during first hospital admission of head injury patients in Ikeja, Nigeria. A prospective cohort study.

BACKGROUND: Although head injury (HI) is a major public health problem in Nigeria and other low and middle income countries of the world, there is a paucity of data from these societies. This is largely due to under-reporting. We carried out a prospective study of the clinicoepidemiological profiles and outcomes following the first hospitalization of a cohort of head-injured patients in Ikeja, Nigeria, a metropolitan African city. METHODS: In an 8-month period from May until December 2005, data from all HI cases seen in our neurosurgical unit were prospectively recorded for subsequent analysis. These include demographics, mechanism of injury, pre-neurosurgical care received, severity of injury using the Glasgow Coma Scale, presence of hemodynamic instability, pupillary anomalies and associated systemic injuries, cranial computed tomography (CT) findings and the number of surgical interventions, as well as outcomes after the first hospital admission using the Glasgow Outcome Scale. Determinants of outcome were explored using the chi(2) test and the level of significance was put at p = 0.05. RESULTS: There were 143 cases of HI, which is about one fifth of our total workload, including 122 males and 21 females aged 0.5-85 years (mean age 29.15). The majority (88%) were either school children or low income earners. Road accidents accounted for 75% of the cases; three quarter of the cases had some initial care in other health facilities before the arrival in our unit, at an average of 33 h. Mild, moderate and severe HI accounted for 60, 18 and 22%, respectively. About a quarter of the patients sustained other systemic injuries. Cranial CT scanning was obtainable in 40 patients (28%); 9 of these revealed surgical mass lesions, of whom 5 had life-saving operations. Many well-known determinants of a poor outcome of HI were prevalent in this study group and found to have a significantly adverse effect on patient outcome. CONCLUSIONS: HI is a major public health problem in Nigeria, taking up at least one fifth of the neurosurgical workload. The prehospital emergency medical service is poorly organized. Determinants of a poor outcome of HI are highly prevalent, including poor accessibility to cranial CT scanning, absence or inadequacy of logistics for neurocritical care and an inadequate number of neurosurgeons.

An unusual faciocerebellar arrow injury: successful surgical removal in a peasant Nigerian: a case report.

INTRODUCTION: Reports of penetrating injuries of the cranium have been mainly craniocerebral or faciocerebral, craniocerebellar projectiles are few. CASE: We present a case of a 23 year old Nigerian with a craniofacial penetrating injury by a hunting arrow. The trajectory of the arrow through the facial skeleton across the craniocervical junction into the posterior fossa makes this unique in the literature. Successful operative retrieval by a joint team of neurosurgeons and otorhinolaryngologists, problems of delayed presentation and inadequate diagnostic facilities are highlighted. CONCLUSION: The morbidity-free outcome of surgical removal despite the delay in presentation and management in our practice setting with limited facilities are the salient points of this presentation.

Arrow injury to the skull base.

An unsual case of penetrating nasal injury with middle skull base involvement, from fired arrow is reported. The arrow was surgically removed and the patient remains well with no sequelae. We therefore present this case because of its rarity. The anatomical principles underlying the surgical management of the lesions are discussed.