Olufemi E. Idowu

Pedestrian Injuries in the Most Densely Populated City in Nigeria—An Epidemic Calling for Control

Objectives: Since the first pedestrian road fatality of 1896, pedestrians still remain vulnerable, with fatalities in Africa being 55% of global statistics. Many previous reports from Nigeria have emphasized passengers and drivers over pedestrians; this study was done in the most densely populated Nigerian city with no previous publication exclusively dedicated to pedestrians—the megacity has been projected by the World Bank to be the third largest in the world by 2015 (after Tokyo and Mumbai), so the study results would aid injury control and reduce morbidity and mortality. Methods: This is a one-year prospective study on pedestrians attending the surgical emergency room of the busiest referral hospital in Lagos, Nigeria, detailing age, sex, occupation, regions injured, injury mechanism, incident vehicles, highway collisions, and immediate outcomes. Results: Some 702 pedestrians were seen, including 494 (70%) males with overall peak incidence in the third decade, but the peak incidence among females is lower and in the first decade. Common injuries sustained were to the head (40%), lower limbs (35%), upper limbs (9%), multiple regions (6%), pelvis (3%), and others (7%). Gender differences also were noted—the predominant injury location in males was the head, followed by lower limbs; the opposite was true for females, though both regional injuries were fewer in females than in males. Students were 20% of the entire pedestrians, with nearly half of them injured by a motorcycle. The mechanism of injury included crossing a highway (63%), walking along the pavement (17%), standing by a bus stop (12%), at a shop/house (5%), and others (3%). However, 76% injuries occurred on highways, 22% on inner city roads, and 2% elsewhere. Vehicles included motorcycles (33%), cars (27%), buses (22%), trucks (6%), tricycles (2.4%), and other (9%). Overall fatality was 10% and about half were due to being knocked down by buses and cars. Conclusions: This study suggests a high incidence and significant underreporting of pedestrian injuries. A reduction in morbidity and mortality is possible (from head and lower limb injuries) by traffic calming techniques in crossing the highway, especially injuries due to being struck by motorcycles, cars, and buses.

Non-trauma surgical emergencies in adults: Spectrum, challenges and outcome of care

Introduction Significant deaths of between 21% and 38% occur from non-trauma surgical conditions in the accident and emergency room. Access to emergency surgical care is limited in many developing countries including Nigeria. We aimed to study the spectrum of non-trauma surgical emergencies, identify challenges in management and evaluate outcomes. Methods A one year prospective cohort study of all non-trauma emergencies in adults seen at the surgical emergency room of LASUTH from 1st October, 2011 to 30th September, 2012 was conducted. Data was analyzed using SPSS version 15.0. Results Of a total of 7536 patients seen, there were 7122 adults. Those with non-trauma conditions were 2065 representing 29% of adult emergencies. Age ranged between 15 and 97 years and male to female ratio was 1.7:1. Acute abdomen (30%), urological problems (18%) and malignancies (10%) were the most common. Among 985 patients requiring admission only 464 (47%) were admitted while the remaining 53% were referred to other centers. Emergency surgical intervention was carried out in 222 patients representing 48% of admitted patients. There were 12 (24%) non-trauma deaths in the emergency room. They were due to acute abdomen and malignancies in half of the cases. Conclusion Facilities for patients needing emergency care were inadequate with more than half of those requiring admission referred. Attention should be paid to the provision of emergency surgical services to the teeming number of patients seen on yearly basis in the Teaching Hospital.

Road Traffic Injury in Lagos, Nigeria: Assessing Prehospital Care

Introduction Injuries are the third most important cause of overall deaths globally with one-quarter resulting from road traffic crashes. Majority of these deaths occur before arrival in the hospital and can be reduced with prompt and efficient prehospital care. The aim of this study was to highlight the burden of road traffic injury (RTI) in Lagos, Nigeria and assess the effectiveness of prehospital care, especially the role of Lagos State Ambulance Service (LASAMBUS) in providing initial care and transportation of the injured to the hospital. METHODS A three-year, retrospective review of road traffic injured patients seen at the Surgical Emergency Room (SER) of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Nigeria, from January 1, 2012 to December 31, 2014 was conducted. Parameters extracted from the Institution Trauma Registry included bio-data, date and time of injury, date and time of arrival in SER, host status, type of vehicle involved, and region(s) injured. Information on how patients came to the hospital and outcome in SER also were recorded. Results were analyzed using Statistical Package for Social Sciences (SPSS; IBM Corporation; Armonk, New York USA) version 16. RESULTS A total of 23,537 patients were seen during the study period. Among them, 16,024 (68.1%) had trauma. Road traffic crashes were responsible in 5,629 (35.0%) of trauma cases. Passengers constituted 42.0% of the injured, followed by pedestrians (34.0%). Four wheelers were the most frequent vehicle type involved (54.0%), followed by motor cycles (30.0%). Regions mainly affected were head and neck (40.0%) and lower limb (29.0%). Less than one-quarter (24.0%) presented to the emergency room within an hour, while one-third arrived between one and six hours following injury. Relatives brought 55.4%, followed by bystanders (21.4%). Only 2.3% had formal prehospital care and were brought to the hospital by LASAMBUS. They also had significantly shorter arrival time. One hundred and nine patients (1.9%) died in the emergency room while 235 bodies were brought in dead. CONCLUSION Less than three percent among the victims of road crashes had formal prehospital care and shorter hospital arrival time. Current facilities for emergency prehospital care in Lagos are inadequate and require improvement. Training lay first-responders, who bring the majority of the injured to hospital, in basic first-aid may improve prehospital care in Lagos. Ibrahim NA , Ajani AWO , Mustafa IA , Balogun RA , Oludara MA , Idowu OE , Solagberu BA . Road traffic injury in Lagos, Nigeria: assessing prehospital care. Prehosp Disaster Med. 2017;32(4):424-430.

Morphometry, asymmetry and variations of the sylvian fissure and sulci bordering and within the pars triangularis and pars operculum: an autopsy study.

OBJECTIVE Speech and Language, one of the most lateralized of all cerebral functions is located within the pars opercularis (PO) and pars triangularis (PT). There is also inter-hemispheric variability of the sulcal contours bordering these areas. The study was undertaken to note the morphometry, asymmetry and variations of the Sylvian fissure (SF), and the sulci bordering and within the PO and PT. MATERIALS AND METHODS An adult autopsy cadaveric study was carried. The measurements made amongst others, included fronto-occipital cerebral length, cerebral width, Sylvian fissure length, and anterior Sylvian point (ASP) to inferior Rolandic point distance. The PT and PO were also studied. RESULTS Sixty-two adult cadaveric hemispheres were studied. The SF length on the right (mean=84.3mm, median=88mm) was significantly shorter than that on the left (mean=89.4mm, median=92.0mm) (p=0.037). The anterior ascending and anterior horizontal rami of the SF arose from the ASP and either divides at this point (43 hemispheres, 69.4%) or have a common short stem before separating distally giving a Y-shape configuration. The triangularis sulcus was noted in 49 hemispheres (79%) while the diagonal sulcus was noted in 26 hemispheres (41.9%). CONCLUSION The left SF was significantly longer than the right and both were positively correlated. The presence of the triangularis sulcus was not dependent on the side (p=0.348) or gender (0.622) unlike the diagonal sulcus was side dependent (p= 0.000).

Caval variations in neurologically diseased patients

Background The import of the cavum variation and its prevalence rate in healthy individuals is still not clear, likewise in neurologically diseased patients. Purpose To evaluate the frequency and pattern of caval variations in neurologically diseased patients. Material and Methods The presence or absence of the cavum septum pellucidum (CSP), cavum vergae (CV), or cavum velum interpositum (CVI) was reviewed from successive cranial computerized tomography (CT) images of patients who were aged 6 months and above. Two hundred and seventeen cranial CT images were reviewed. Results At least a cavum variation was noted in 130 (59.9%) of the CT scan images reviewed. The CV, CVI, and CSP were noted in 86 (39.6%), 53 (24.4%), and 50 images (23%), respectively. Caval multiplicity was noted in 102 patients (47%). There was no significant difference in the rate of occurrence of cavum variations in patients with congenital brain diseases and acquired brain conditions (P = 0.484), neither was there a significant difference in the frequency of cavum variation in children aged older than 6 months compared to adults (P = 0.101). Conclusion Cava variations are relatively common in neurological brain diseases. Patients with congenital brain diseases did not have a higher frequency of cava variation when compared with those that had acquired lesions. The most common type of cavum variation noted in this study was the vergae variety, while the CSP is the rarest.

Acknowledgments to Referees

M.-J. Chiu, Taipei, Taiwan M.C. Christensen, Bagsvaerd, Denmark A.B. Conforto, Sao Paulo, Brazil L.A. Corey, Richmond, Va., USA G. Corso, Aosta, Italy E. Cubo, Madrid, Spain A. Culebras, Syracuse, N.Y., USA R. D’Alessandro, Bologna, Italy J.-F. Dartigues, Bordeaux, France F. Davis, Chicago, Ill., USA M. Debouverie, Nancy, France L.M. de Lau, Rotterdam, The Netherlands V. Demarin, Zagreb, Croatia J. de Pedro Cuesta, Madrid, Spain R.K. Dhamija, New Delhi, India O. Dogu, Mersin, Turkey Y. Doi, Wako, Japan W.J. D’Souza, Melbourne, Vic., Australia A. Elbaz, Paris, France M. Elias, Orono, Me., USA A.W. Engberg, Hellerup, Denmark J.M. Ferro, Lisbon, Portugal J.L. Fisher, Columbus, Ohio, USA M. Flaherty, Dublin, Ireland G. Franklin, Seattle, Wash., USA P.D. Frenzen, Washington, D.C., USA G. Friday, Wynnewood, Pa., USA R. Friedland, Cleveland, Ohio, USA L. Frost, Silkeborg, Denmark V. Gallo, London, UK E. Granieri, Ferrara, Italy J. Grigsby, Aurora, Ill., USA W. Grisold, Vienna, Austria M.N. Haan, Ann Arbor, Mich., USA G. Hankey, Perth, W.A., Australia J. Harsh, Hattiesburg, Miss., USA W.A. Hauser, New York, N.Y., USA J.E. Heck, Lyon, France H. Heinzl, Vienna, Austria V.W. Henderson, Stanford, Calif., USA P. Heuschmann, Munster, Germany R. Hilsabeck, Encino, Calif., USA R. Hintzen, Rotterdam, The Netherlands M. Hutterer, Innsbruck, Austria A.A. Adeolu, Ibadan, Nigeria H. Akiyuki, Chiba, Japan S.M. Albert, Pittsburgh, Pa., USA K.D. Allen, Durham, N.C., USA N.B. Allen, New Haven, Conn., USA L.E. Almaguer-Mederos, Holguin, Cuba A. Alperovitch, Paris, France R. Al-Shahi, Edinburgh, UK M. Alter, Wynnewood, Pa., USA L.-C. Alvaro, Bilbao, Spain A. Anand, Chandigarh, India N. Andelic, Oslo, Norway D. Anderson, Bethesda, Md., USA M.A. Arami, Tehran, Iran C. Armon, Springfield, Mass., USA J. Artigas-Pallares, Sabadell, Spain H.O. Atladottir, Aarhus, Denmark L. Ayalon, Ramat Gan, Israel M. Balderesch, Florence, Italy A. Barber, Auckland, New Zealand S. Barker-Collo, Auckland, New Zealand E. Beghi, Milano, Italy J. Benito-Leon, Madrid, Spain D. Bennett, Chicago, Ill., USA D. Bennett, Oxford, UK D. Benninger, Bethesda, Md., USA F. Bermejo-Pareja, Madrid, Spain N. Bharucha, Mumbai, India M. Billiard, Montpellier, France M.M. Blewett, Madison, Wisc., USA J. Bower, Rochester, Minn., USA G. Boysen, Copenhagen, Denmark C. Brayne, Cambridge, UK J. Breitner, Seattle, Wash., USA M. Breteler, Rotterdam, The Netherlands L. Broer, Rotterdam, The Netherlands R. Brouns, Antwerp, Belgium K. Bruins Slot, Oslo, Norway A. Brusco, Torino, Italy S.F. Cappa, Milano, Italy A. Carolei, L’Aquila, Italy K. Carter, Christchurch, New Zealand T.D. Carter, Melbourne, Vic., Australia H. Chen, Bethesda, Md., USA

Pituitary gland trauma in fatal nonsurgical closed traumatic brain injury

ABSTRACT Background: Traumatic injury to pituitary gland can lead to significant endocrine dysfunctions. The aim of this study is to define the frequency of pituitary gland injury in patients with fatal nonsurgical closed traumatic brain injury (TBI), and to correlate if any, the type of craniocerebral injury associated with the pituitary gland injury. Methods: The study is a prospective autopsy review of 30 adult patients with fatal closed TBI. Patients who had any form of neurosurgical intervention were excluded from the study. The harvested pituitary glands were assessed morphologically and histologically with haematoxylin-eosin stains. Results: There were 25 males and five females (median age: 35 years). Fatal closed TBI was associated with at least pituitary stalk rupture or pituitary gland haemorrhage in 13 patients (43.3%). There was significant relationship between subdural haemorrhage (SH) and either pituitary gland haemorrhage or pituitary stalk rupture. Odds ratio (OR) of a patient with SH having accompanying glandular pituitary haemorrhage was 21 while the OR of a patient with SH having pituitary stalk rupture was 12. Conclusion: Pituitary gland haemorrhage and stalk rupture frequency are fairly common in fatal closed TBI that do not require surgical intervention. Injury to both structures probably plays substantial roles in closed TBI outcome. We suggest routine assessment of pituitary gland function test in patients with closed TBI associated with SH.

Relationship between demography, etiology, level of consciousness, and outcome of surgical intracranial suppurations of bacterial origin in a tropical tertiary center

Introduction: Intracranial suppurations (ICS) of bacterial origin are associated with significant mortality and morbidity. This study aimed to review demography, etiology, level of consciousness, and outcome of surgical ICS in a tropical tertiary hospital. Materials and Methods: All patients admitted to the neurosurgical unit within the study period of 7 years that had a surgical intervention for their ICS were prospectively included in the study. In accordance with the unit protocol, all patients in whom there was clinical suspicion of ICS had a preoperative computed tomography scan and/or magnetic resonance imaging done. The following data among others were documented and recorded electronically: demography, clinical and radiological diagnosis, etiology of ICS, admission Glasgow Coma Scale (GCS) score, type of neurosurgical intervention, mode of anesthesia, and outcome. Results: Forty-nine patients were included in the study. There were 33 males with a male-to-female ratio of 2.1:1. All patients presented at least a week after the use of antibiotics. The most common type of ICS was cerebral abscess (33 patients, 67.3%). There was no statistical significant association between outcome and age group (P = 0.630), gender (P = 0.999), diagnosis (P = 0.464), etiology of ICS (P = 0.169), solitary or multiplicity of ICS (P = 0.485), or type of offending organism (P = 0.278). Conclusions: ICS usually follows otorhinological infections in our center. The surgical outcome is dependent on the admission GCS score.

Giant Solitary Anterior Cervical Canal Neurofibroma: Case Report and Surgical Technique.

Giant solitary anterior cervical canal neurofibroma (GSACCN) is rarely reported in the literature. When the large lesion is ventrally located to the spinal cord, an anterolateral approach may not be ideal due to various technical challenges. In this report, we describe a case of intradural extramedullary GSACCN located at the cervical region extending from the axis to the sixth cervical vertebrae. Here we also describe a posterior technique successfully used to resect the tumour. Therefore, the posterior approach by En bloc decompressive laminectomy and laminoplasty might be used to adequately treat the lesion.

Emergency Medical Services Outcome Assessment in Lagos, Nigeria: Review of Cases of ''Brought in Dead'' Patients

Abstract BACKGROUND: This study sets out to establish a database of BID patients presenting at the Lagos State University Teaching Hospital (LASUTH). METHOD: A retrospective study of consecutive ‘’Brought in Dead‘’ (BID) patients seen from April to November 2011 at the surgical emergency room of the Lagos State University Teaching Hospital (LASUTH) was done using a validated questionnaire. RESULTS: A total of 144 BID patients were seen during the study period. There were 112 males or 78% and 32 females or 22% of the total (M:F=3:1). The age group with the largest number of victims was the 31-40 age groups; and there were 37 patients (30.8% of 120 cases captured under age group). Trauma also accounted for 104 patients (72.2%) with 52 (36.1%, 50% of trauma cases) of these caused by Road traffic injuries (RTI), and Gunshot injuries accounting for 21 (14.6%, 20.2% of trauma cases). Among the Trauma BID cases from RTI, 4-wheeled vehicles accounted for 20 cases (19.2%, 40% of RTI), whilst motor cycle injuries accounted for 12 cases (11.5%, 24% of RTI). CONCLUSION: The study shows that road traffic injuries and gunshot injuries, accounted for 70% of BID cases presenting at LASUTH. Majority of cases of RTI are from 4 wheeler vehicles (40%) and motorcycles (24%).