Characteristics and Outcome of Paediatric Traumatic Brain Injuries: An Analysis of 163 Patients in Enugu

Background: As with most ailments common to adult and paediatric age groups, studies that describe and characterize paediatric traumatic brain injuries (TBIs) lag those of their adult counterparts. This is more so in the developing countries where national data are not well developed. The development of local clinical  guidelines has been shown to positively impact outcomes of paediatric TBI. Data on the characteristics and outcomes of TBI among paediatric age groups will provide a framework for the development of an  all‑encompassing management guideline. Methods: In this study, a retrospective review of demography, mechanism of injury, pattern of presentation, nature of treatment, duration of hospital admission, and outcome of children aged 0–17 years managed for traumatic TBI at the University of Nigeria Teaching Hospital, Enugu‑Nigeria was performed. Data were analyzed using SPSS version 21. Relevant test statistics were used to test for associations. AP = 0.05 was considered  statistically significant. Results: Atotal of 163 patients’ medical records were retrieved and analyzed. Of these, 117 (71.8%) were males and 46 (28.2%) were females. Their ages ranged from 6 weeks to 17 years with a mean age of 7.66 ± 5.1 years and peaked at 3–5 years. No difference in mean age between gender (P = 0.427). Pedestrian motor vehicular accident was the most common cause of injury. Fall from fruit trees and assault were peculiar to children from suburban/rural areas. TBI severity on admission was mild (44.2%), moderate (38.7%), and severe (17.2%). Other systemic injuries were present in 33.7%, of which long bone fractures were the most common (23/55). Abnormal brain computed tomography findings were seen in 83.2% with skull fracture being the most common finding. Operative procedures were carried out on 19.6% of patients. Conservative measures were the mainstay of management. The mean  duration of hospital admission was 14.01 ± 11.8 days was significantly associated with admission Glasgow Coma Scale (GCS) Score (P < 0.0001) and Glasgow Outcome Score (GOS) at discharge (P = 0.03). The overall outcome was good (GOS 4 and 5) in 92.0% and has a significant association with GCS on admission (P < 0.0001). Long‑term (Extended GOS) was 8 in 98.2% of those followed up. Conclusion: Paediatric TBI is mainly mild to moderate in severity with a male predilection. The main cause is road traffic accidents with most victims being pedestrians. Management is mainly non-operative and the outcome at discharge is good even in a middle‑income country and significantly determined by GCS on admission

Comprehensive Axillary Management of Clinically Node-Positive (cN plus ) Breast Cancer Patients: A Narrative Review on Neoadjuvant Chemotherapy

Simple Summary Axillary management in breast cancer has undergone significant changes over the past decades, especially with the introduction of neoadjuvant chemotherapy (NACT). NACT aims to shrink tumors before surgery, allowing for less invasive axillary approaches such as sentinel lymph node biopsy (SLNB) and targeted axillary dissection (TAD). These techniques help reduce the need for axillary lymph node dissection (ALND), which is associated with higher risks of complications like lymphedema. However, patient selection for these procedures depends on factors such as tumor biology, response to NACT, and the extent of nodal disease. This review discusses the latest evidence supporting de-escalation strategies in axillary surgery and highlights ongoing research that aims to further refine the selection criteria for these approaches. Multidisciplinary collaboration remains key to implementing personalized treatments that optimize patient outcomes while minimizing surgical morbidity.Abstract Background. In breast cancer (BC) patients, axillary management has undergone major improvements over the last few years, and efforts to identify the optimal strategy for the management of axillary surgery are still ongoing. Methods. In current clinical practice, women with clinically node-positive (cN+) BC usually receive neoadjuvant chemotherapy (NACT) with the aim of reducing the extent of primary disease and, thus, allowing for axillary-conservative surgery. Remarkably, after NACT, up to one out of three patients achieves an axillary pathologic complete response, which, in turn, is associated with a more favorable prognosis than residual axillary disease. However, NACT is not without drawbacks, as NACT-associated inflammation can damage lymphatic vessels. Furthermore, varying degrees of response may occur in the axillary lymph nodes, increasing the false negative rate for sentinel biopsy. Results. At present, there is no consensus on the optimal approach in patients with cN+ BC undergoing NACT, although multidisciplinary management seems to be recommended. Conclusions. This narrative review provides a comprehensive overview of axillary management in cN+ BC patients undergoing NACT. It uses a multidisciplinary approach that encompasses the oncological management perspectives, as well as surgical and chemotherapeutic viewpoints

Preliminary Findings on Metastatic Brain Tumors in Enugu, Southeast Nigeria

Background: Metastatic brain tumors (MBTs) are the most common brain neoplasms seen clinically and are often associated with poor outcomes. This study highlights the demographic, clinical, and radiological profiles as well as outcomes of MBTs managed in a tertiary hospital in Southeast Nigeria. Methods: This was a 1-year prospective observational study of patients with MBT who presented to the neurosurgery unit of the University of Nigeria Teaching Hospital, Enugu, from December 2018 to November 2019. Data on the demography, clinical and radiological features, treatment, and outcomes were collected and analyzed. Results: Of the 31 patients with MBTs, 58.1% were female and 41.9% male. The mean age was 51.0 ± 15.2 years. The most common presenting features were limb weakness (77.4%), headache (58.1%), and personality changes (54.8%). About a quarter (26.7%) were fully conscious at  presentation. Only 45.2% knew that they had a systemic malignancy (SM) before presentation. The breast (29.0%), lungs (22.6%), and skin (19.3%) were the common sources of metastases. The lesions were solitary in 25.8% and multiple in 74.2%. They were predominantly frontal (80.6%), with bilateral distribution in 64.5% of patients. Radiotherapy was done in 58.1% and surgery in 6.5% of patients. Prior knowledge of the existence of a SM (P = 0.045) and unilateral brain involvement (P = 0.013) were associated with better 30-day survival. Conclusion: The breast is the most common source of brain metastasis. Prior knowledge of the existence of a SM and unilateral brain involvement is associated with better short-term survival. Keywords: Brain, metastasis, primary, surviva

MDR/XDR-TB management of patients and contacts: Challenges facing the new decade. The 2020 clinical update by the Global Tuberculosis Network.

The continuous flow of new research articles on MDR-TB diagnosis, treatment, prevention and rehabilitation requires frequent update of existing guidelines. This review is aimed at providing clinicians and public health staff with an updated and easy-to-consult document arising from consensus of Global Tuberculosis Network (GTN) experts. The core published documents and guidelines have been reviewed, including the recently published MDR-TB WHO rapid advice and ATS/CDC/ERS/IDSA guidelines. After a rapid review of epidemiology and risk factors, the clinical priorities on MDR-TB diagnosis (including whole genome sequencing and drug-susceptibility testing interpretations) and treatment (treatment design and management, TB in children) are discussed. Furthermore, the review comprehensively describes the latest information on contact tracing and LTBI management in MDR-TB contacts, while providing guidance on post-treatment functional evaluation and rehabilitation of TB sequelae, infection control and other public health priorities

Surgically Treated Primary Spinal Cord Neoplasms in Southeastern Nigeria

Background: Primary spinal cord tumors are not as frequently encountered as their cranial counterparts. They could present in such an indolent manner that requires a reasonable index of suspicion for their diagnosis to be considered. Objective: The objective of this study is to analyze the incidence and pattern of primary spinal cord and appendage neoplasms in patients surgically treated in our institution over a decade of practice. Materials and Methods: A retrospective review of clinical, radiological, and histopathology profiles of patients surgically treated for primary spinal cord tumor from 2006 to 2016 was carried out. Retrieved data were analyzed using SPSS version 21. Results: Out of 472 spine procedures were performed within the study period 17 (3.6%) cases of histologically proven primary spinal cord tumors were identified. The age of patients ranged between 17 and 77 years with a mean age was 45 years. The male: female ratio was 1:1.1. Motor deficit and pain were the most common presenting symptoms seen in 35.3% and 29.4% of patients, respectively. Meningiomas are the most common histological diagnosis (70.6%), distantly followed by Schwannoma (17.6%). The most common location of the tumors was intradural extramedullary (70.6%). All patients had gross total resection of tumor with no perioperative mortality. Conclusion: Meningioma is the most common surgically treated primary spinal cord tumor in our setting. Surgery is associated with good outcome

Civilian Penetrating Gunshot Injury to the Neurocranium in Enugu

Introduction: Civilian penetrating gunshot injuries to the neurocranium are no longer uncommon in Nigeria. Such injuries are however poorly reported. They are associated with poor outcome and, at close range, are frequently fatal, especially when inflicted by high‑velocity weapons. Prompt transfer to neurosurgical service and urgent intervention may improve outcome in those that are not mortally wounded. Materials and Methods: Fifty‑two patients with civilian penetrating gunshot wounds seen over a 10‑year period (2004–2014) at the University of Nigeria Teaching Hospital and Memfys Hospital for Neurosurgery Enugu were reviewed retrospectively, and their data were analyzed to evaluate factors that impacted on outcome. Only patients with clinical and imaging evidence of cranial gunshot injuries who reached hospital alive were included in the study. The overall mortality and Glasgow outcome score were analyzed. Results: Fifty‑two patients with isolated civilian penetrating gunshot wounds were identified (M:F = 7.7:1); mean (standard deviation) age was 32.8 (11.9) years.  There was a high correlation (0.983) between the sex of the patients and the  outcome. The overall mortality was 30.8%, whereas the mortality for patients with postresuscitation Glasgow coma scale (GCS) score ≤8 was 57%, as against 12.9% in those in whom postresuscitation GCS was >8; meaning that 87.1% of patients in whom postresuscitation GCS was >8 survived. Thirty‑one patients (59.6%) had papillary abnormalities. Majority of patients with monohemispheric lesions survived while all those with diencephalic, transventricular, and posterior fossa involvement had 100% mortality.Conclusions: Admitting GCS and bullet trajectory were predictive of outcome.Keywords: Glasgow coma score, Glasgow outcome score, Penetrating gunshot injur