The Simple Urine Bag as Wound Drain Post-Craniotomy in a Low-resource Neurosurgical Practice: A Personal 4-year Prospective Cohort Study

Background: In the face of the practical non-availability of custom-made surgical wound drain materials, many other substitutes are used in  developing countries. These substitutes have their draw backs from which the Uribag appears to be free. The main objectives: To present our experience with the use of this cheap and readily-available material as post craniotomy wound drain in a Nigerian neurosurgical unitMethods: A 4-year prospective cohort study of the effectiveness, outcome with use and complications of the Uribag as post craniotomy wound drain in a consecutive cohort of neurosurgical patients. Data analyzed include the patients’ brief demographics; the types of cranial surgery in which drain was used; the drain performance, and any associated untoward drain /wound events.Results: The drain was used for this purpose in 107 patients over 4 years. Nineteen have been excluded from this analysis because they died too soon post op for drain performance to be measured. The 88 patients analyzed included 60 males (68%); age range 11 days to 75 years.Cranial surgery was for trauma in 42% and for brain tumour resection and other cranial procedures in the rest. The drain output ranged from 40mls to 960mls and was in place for an average of 3 days. There was 1 episode (1.1%) of drain dislodgement; 3 of drain blockage (3.4%) and 5 cases (5.7%) of wound complication post drain removal. All wounds healed with primary intention otherwise.Conclusions: The Uribag is an effective, very cheap, and complication-free, closed tube wound drain substitute for cranial surgery.Keywords: postsurgical wound drain substitute, developing country, craniotomy, neurosurgery, Uriba

Evaluation of polybrominated diphenyl ethers in sediment of Lagos Lagoon, Nigeria

Certain pollutants, particularly synthetic organic compounds have given rise to important environmental concerns. New organic pollutants especially polybrominated diphenyl ether (PBDEs) employed in electronic equipment and in some household items as flame retardants are now finding their way into the aquatic environment as components of waste discharge into the water body. These highly hazardous organic pollutants of concern are persistent, can bioaccumulate and biomagnify in aquatic organism especially fish, and there appears to be no clear strategy for managing them. In this study, levels of polybrominated diphenyl ethers were determined in sediments collected from Lagos lagoon with the aim of generating a database which can be employed for management options. Sediment samples were collected using Van Veen grab for a period of one year from randomly selected sites in Lagos lagoon. The samples were soxhlet extracted with dichloromethane to obtain PBDEs extracts which were later cleaned up in a column of silica gel using hexane as eluant. The cleaned extracts were analyzed using gas chromatography coupled with electron capture detector. The total concentrations of PBDEs in sediments ranged from 0.11 to 23.33 mg/kg. In all the studied locations, BDE-28, BDE-153, BDE-154 and BDE 205 were detected in all sediment samples at concentration range of 0.22 to 23.33 mg/kg. Among the PBDEs congeners, sum of tri to hepta BDEs contributed 61.32%, while BDE-205 contributed 38.68% to the total PBDE in the sediment samples. Brominated congeners BDE-47, BDE-153 and BDE-154 (tetra and hepta BDEs) were abundant which contributed 18.31, 12.06 and 34.75%, respectively to the sum of tri to hepta BDE in the sediment. The composition patterns of PBDEs in Lagos Lagoon sediment samples revealed that technical deca-BDE mixture was the major pollutant sources with a minor contribution of penta-BDE mixture.Key words: Gas chromatograph, polybrominated diphenyl ether (PBDEs), sediment, Lagos Lagoon

Relationship of socio-economic status and childhood cancer: an in-hospital cross-sectional study in a developing country

Background: Socioeconomic factors are known to affect health quality, disease occurrence as well as health-seeking behaviors in several ways.Objectives: To determine the influence of socio-economic factors on awareness of cancer, healthseeking behaviors among parents of children with cancer in a developing country and occurrence of cancer using Burkitt lymphoma as index malignancy.Methods: This was a descriptive cross-sectional study that involved children with cancer seen over a 2-year period in a tertiary hospital in Nigeria. Information was obtained by interview through administration of a questionnaire and retrieval of clinical data from patients’ case notes.Results: The caregivers of 91 children (46 boys, 45 girls) were interviewed including 86 biological parents. Majority (84.6%) of the children belonged to the low socio -economic classes 3-5; 45 of 86 parents (52.3%), more likely in parents from higher socioeconomic classes, were aware of cancer but only 7 (8.1%) knew it could occur in children. There was no association between Burkitt lymphoma and socio-economic class. Twenty-eight (30.8%) parents of the 91 children visited alternate sources of health care, most commonly traditional healers, followed by religious centers. There was no association between visits to such centers and the parents’ socio-economic status or with presentation with metastatic disease.Conclusions: Awareness of childhood cancer is low among this cohort of parents; their socioeconomic status seems to impact on this level of awareness but not on their health-seeking behaviors for their affected children. Focused health education is needed to increase childhood cancer awareness and appropriate healthseeking behavior among the population studied.Key words: socio-economic; childhood; cancer; health-seeking; behaviour; awarenes

Intracerebral arteriovenous malformation: Diagnosis of a case with computerized tomography imaging

Cerebral arteriovenous malformations (AVM) are rarely diagnosed and reported from our region of the world possibly due to the paucity (even unavailability) of the necessary imaging modalities especially digital subtraction angiography (DSA). In this report we present the CT features making for the confident diagnosis of a case of cerebral AVM, even in the absence of a DSA. A 26-year-old man presented recently to us with history of headache not associated with any other general clinical or neurological deficits. An initial cranial contrast CT showed a right parietal 5 x 5cm parenchymal mass lesion with features highly suggestive of an AVM. The follow-up CT angiography later confirmed this lesion to be indeed a high grade AVM involving a high flow fistulous communication between the main branches of the right middle cerebral artery and the deep cerebral venous system. Where there is no facility for DSA like in our own practice there are some specific CT scan imaging features that afford fairly accurate diagnosis of cerebral AVMs

The social-economic and family background of the child with a CNS birth defect in a developing country in the current era

Objectives: In much older literature many sociocultural factors militating against the optimal clinical / surgical care of CNS birth defects in the lowmiddle income countries (LMICs) were reported. We set out to interrogate this phenomenon in the current eraMethods: A retrospective crosssectional survey of a prospective data-base of the social-economic and family background of the children with CNS birth defects presenting for surgical care in a busy neurosurgical practice in Nigeria.Results: There were 151 children, 81 males (53.6%), with hydrocephalus and neural tube closure defects (NTDs) seen in the study period; median age at presentation was at 4 weeks of life, the NTDs presenting much earlier than hydrocephalus, p-value< 0.001; each child represented the first of the parents in about a third of cases, and at least the 3rd or higher birth order in 40.4%. The parents were young adults, but the mean age of the fathers, 35.8years, was higher than the mothers’, 30.0years, p-value<0.001; the parents had low level of education and socioeconomic statuses; more than 90% had no knowledge about any preventive measures for CNS birth defects; and, in spite of their already sizeable families each, 56% of mothers, and 62% of the fathers were still gearing up for further pregnancies.Conclusions: Coupled with the region’s well-known harsh health system, the socio-economic and family background of the child with CNS birth defects remain very challenging indeed in this typical developing country. This calls for concerted efforts to promote in the LMICs the adoption of the established measures of preventing CNS birth defects.Keywords: CNS birth defects; social-economic, family background; low-middle income countries

Ultrasound prevalence of gallstone disease in diabetic patients at Ibadan, Nigeria

Background: Gallstones (GS) in the gallbladder (GB) can be responsible for a whole spectrum of disease entities which may lead to a surgical emergency with high mortality. Diabetes mellitus (DM) is a debilitating disease that affects all systems in the body, and literature documents a higher incidence of gallstone disease (GSD) and its complicationsin diabetics than in the non-diabetic population. Most local studies on the association between GS formation and DM have focused on type 2 diabetics. This study was therefore designed to determine the prevalence of GS in both type 1 and type 2 DM and elucidate the demographic and social factors associated with formation of GS in diabetic patients.Materials and Methods: Four hundred diabetic patients aged between 15 and 82 years had abdominal ultrasound to diagnose or exclude the presence of GS.Results: GS was found in 70 (17.5%) of the 400 patients. Positive cases had a male to female ratio of 3:4 and 59 (51.92%) were above the age of 40 years with type 2 DM. Body mass index (BMI) greater than 25 kg/m2 was seen in 56 (48.3%) patients; smoking and alcohol intake were insignificantly implicated. Jaundice was recorded in 8 (11.4%) while abdominal pain was in 24 (34.3%) patients, and 52 (74.3%) patients of those with GSD had had diabetes for more than 4 years.Conclusion: GSD in DM is influenced significantly by age, BMI, and duration of the disease, while gender, social factors, and parity do not influence as strong associated factors.Key words: Diabetes mellitus, gallstones, ultrasoun

Effects of ginger (Zingiber officinale) on cadmium toxicity

Thirty six Winstar rats were divided into six equal groups and investigated for induced cadmium toxicity, and the detoxicating action of ginger on liver-accumulated cadmium. Group 1, the control, werefed with normal rat chow and water for six weeks. Group 2 were fed with normal rat chow and cadmium water (200 ppm Cd in water). Group 3 were fed with rat chow-ginger concentrate (95:5, w/w ratio) andwater, while Group 4 were fed with rat chow-ginger concentrate and cadmium water, all for six weeks. Group 5 were fed with normal rat chow and cadmium water initially for one week, followed by rat chowgingerconcentrate and water for five weeks; while Group 6 were fed with rat chow-ginger concentrate for one week, followed by normal rat chow and cadmium water for five weeks. Cadmium accumulated highly in rat livers without ginger administration, and raised serum glutamate oxaloacetatetransaminase (GOT) and glutamate pyruvate transaminase (GPT), while ginger lowered these parameters. Ginger had better therapeutic than prophylactic detoxication effects on liver cadmium accumulation, especially as further cadmium intake was stopped. It was concluded that cadmium detoxication by ginger was more effective therapeutically, than prophylactically, as further cadmium intake was avoided

Secondary fibrosarcoma of the brain stem treated with cyclophosphamide and Imatinib

Radiation-induced midbrain fibrosarcoma is a rare, highly aggressive tumor, which is associated with poor prognosis. We present the case of a 48-year old man with brainstem fibrosarcoma 20 years following radiation therapy received for a pituitary tumor. We discuss this case in the context of the diagnostic criteria for these tumors, and previous reports of secondary and primary sarcomas of the central nervous system

Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014

BACKGROUND: Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014. METHODS: PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period. RESULTS: We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies. CONCLUSIONS: The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence