Amos Adeleye | University of Ibadan Nigeria (original) (raw)

Papers by Amos Adeleye

Journal of Neurosciences in Rural Practice, Jan 29, 2021

Objectives Inappropriate use of mannitol is a medical error seen frequently in pre-neurosurgical ... more Objectives Inappropriate use of mannitol is a medical error seen frequently in pre-neurosurgical head injury (HI) care that may result in serious adverse effects. This study explored this medical error amongst HI patients in a Nigerian neurosurgery unit. Methods We performed a cross-sectional analysis of a prospective cohort of HI patients who were administered mannitol by their initial non-neurosurgical health care givers before referral to our center over a 22-month period. Statistical Analysis A statistical software was used for the analysis with which an α value of <0.05 was deemed clinically significant. Results Seventy-one patients were recruited: 17 (23.9%) from private hospitals, 13 (18.3%) from primary health facilities (PHFs), 20 (28.2%) from secondary health facilities (SHFs), and 21 (29.6%) from tertiary health facilities (THFs). Thirteen patients (18.3%) had mild HI; 29 (40.8%) each had moderate and severe HI, respectively. Pupillary abnormalities were documented in five patients (7.04%) with severe HI and neurological deterioration in two with mild HI. Mannitol administration was deemed appropriate in only 43.7% (31/71). Data on mannitol dosing in 60.6% (43/71) of the patients showed 8/43 (18.6%) receiving continuous 10% mannitol infusion. The remaining 35/43 received mannitol as a 20% solution but also showing dosing error in 62.9% (22/35): overdosing in 7/35 (20%), and nonbolus administration in 15/35 (42.9%). The distribution of the dosing error among the referring health facilities (all the 13 [100%] patients from private hospitals, 66.7% from PHF, 60% from SHF, and 45.5% from THF) showed a trend of better performance (p = 0.002) by the THFs. Conclusion Mannitol use is apparently fraught with an understudied medical error in the pre-neurosurgical care of the head injured.

West African journal of medicine, May 20, 2004

Traffic Injury Prevention, Feb 17, 2019

Objective: Though motor vehicle crashes (MVCs) were the main cause of head trauma from road traff... more Objective: Though motor vehicle crashes (MVCs) were the main cause of head trauma from road traffic injuries (RTIs), motorcycle crashes (MCCs) are now a major cause of RTI-related head injury (HI) in many developing countries. Methods: Using a prospective database of HIs from a neurosurgical practice in a sub-Saharan African developing country, a cross-sectional survey was conducted for the trauma demography and clinical epidemiology of this MCC-related HI. Results: Motorcycle crashes accounted for 57% (473/833) of all RTI-related HIs in this registry. The victims, with a mean age of 33.1 years (SD ¼ 18.3), consisted mainly of males (83.1%), those of low socioeconomic status (>90%), and those aged between 20 and 40 years old (56%). MCCs involved only riders in 114 cases (114/473, 32.1%), of which 69% were motorcycle-motorcycle crashes. The HI was moderate-severe in 50.8%; clinical symptomatology of significant HI included loss of consciousness (92%), anisocoria (35%), Abbreviated Injury Scale head (AIS-head) score > 3 (28%), and CT-Rotterdam score > 3 (30%). Extracranial systemic injury involved the limbs most frequently, with an Injury Severity Score (ISS) >25 in 49%. The fatality rate was 24%. MCC-related HI among pedestrian victims involved more vulnerable age groups (the young and elderly) but have lower mean ISS compared to motorcycle passengers (mean ISS ¼ 23.5 [11.6] vs. 27.4 [13.0]; 95% confidence interval [CI], 1.27-6.49; P ¼ .004). In addition, compared to a contemporary cohort of MVC-related HIs in our registry, MCC victims were older (mean age 34.8 years [18.0] vs. 30.8 [18.4]; P ¼ .002); had higher proportions of certain extracranial trauma like long bone fractures (71 vs. 29%; P ¼ .02); and suffered fewer surgical brain lesions (25.5 vs. 17.2%; P ¼ .004). Conclusions: Motorcycle crashes are now a significant threat to the heads, limbs, and lives of vulnerable road users in developing countries.

BMJ Neurology Open, 2023

Background Antiseizure medications, such as phenytoin sodium, have been shown in some reports to ... more Background Antiseizure medications, such as phenytoin sodium, have been shown in some reports to reduce the incidence of early post-traumatic seizure. These medications, however, are not without side effects which may be dose related or duration related. The risks associated with short-term therapy are minimal and often dose related (and hence avoidable). This study intends to determine the efficacy of a short-course (48-hour dose) of phenytoin in prevention of early post-traumatic seizure Methods This was a prospective randomised double-blind clinical intervention study. Head injured patients presenting within the first 24 hours were randomly assigned to either 48-hour dose of phenytoin or control groups, and were observed for clinical seizure over a week. The difference in the incidences of early post-traumatic seizure between the two groups was determined by χ 2 test. A p<0.05 was considered as statistically significant. Results A total of 94 patients were included in the study, 47 each in the control group and the phenytoin group. There were 77 males and 17 female (M:F 4.5:1). Both groups had similar demographic and clinical profile. The incidence of seizure was 21.3% in the control but 2.1% in the treatment arm (p<0.01). All seizures occurred within 24 hours of trauma in the control, while the only episode of seizure in the treatment group occurred later. Conclusion A short-course (48-hour dose) of phenytoin might be an effective prophylactic treatment to reduce the incidence of early post-traumatic seizure.

Interdisciplinary Neurosurgery, Sep 1, 2020

Background: While outcome of head injury has improved over the years in the advanced world, the d... more Background: While outcome of head injury has improved over the years in the advanced world, the developing countries with their less than the desired health systems lag behind. In these settings, deaths often result from trivial causes including scalp laceration. Case description: We present two cases of such fatalities from mere scalp lacerations seen in a new rural neurosurgery practice in Nigeria. Both patients had no other source of significant blood loss. These patients had been to some peripheral hospitals but were merely referred for 'expert neurosurgical care'without any attention to the scalp lacerations. Both patients arrived at the accident and emergency department of our health facility hours after the trauma in extreme conditions and subsequently died within minutes of arrival before they could be fully resuscitated. Conclusion: Though eminently treatable and complications preventable, scalp lacerations remain a highly preventable cause of death in rural health services of developing countries.

Journal of Neurosciences in Rural Practice, Dec 11, 2019

Background In Nigeria, pre-neurosurgical care of most neurotrauma patients usually involves admin... more Background In Nigeria, pre-neurosurgical care of most neurotrauma patients usually involves administration of many empirical agents including antibiotics with no apparent indications. This practice is fraught with two particular dangers: increase in health care costs and development of drug resistance. This study aimed to interrogate antibiotic stewardship in the pre-neurosurgical care of neurotrauma patients referred to our practice. Materials and Methods This 7-month prospective descriptive study was performed in one University Teaching Hospital of a developing country. Clinical data on all admitted neurotrauma patients with information on the pre-neurosurgical treatment received were captured and analyzed. Results There were 113 patients, 87(77.0%) males; 103(91.2%) had head injury, and 10(8.8%) spinal cord injury. Associated systemic injuries occurred in 47(41.6%): 40 involved skeletal and soft tissue systems, and 12(10.6%) presented with aspiration pneumonitis. These patients were referrals from public health facilities including primary health facilities (PHF), secondary (SHF), and tertiary (THF), as well as private clinics (PC). Antibiotics were given to 74 (65.5%) patients, with a probabilistic indication in only 17.6% (13/74) of these. The proportional distribution of this antibiotic administration according to the referral base was not statistically significant (χ 2 =6.87, p = 0.3): 70% (14/20) from PHF, 56% (14/25) from SHF, 71% (23/32) from THF, and 63% (23/36) from PC. The antimicrobial agent administered was specified in 40 cases: Ceftriaxone was the commonest antibiotic agent implicated. Conclusion There is apparent unnecessary exposure of patients to antibiotics in the pre-neurosurgical care of neurotrauma in this study. There is, therefore, need for education on antibiotic stewardship to the group of health workers involved.

Interdisciplinary Neurosurgery, Mar 1, 2019

Background: Current prognostic models for head injury were developed using data mostly from high ... more Background: Current prognostic models for head injury were developed using data mostly from high income countries. A more useful model may be obtained from predictors designed from data obtained from low and middle income countries where trauma is said to be a neglected endemic condition. Methods: This prospective study, after ethical and institutional clearance, examined 19 clinical and Computerized Tomographic (CT) scan parameters of all head injured patients who met the study's inclusion criteria. The significance of these parameters in predicting outcomes at 15 and 30 days post-injury using the Glasgow Outcome Scale (GOS) and mortality/survival was statistically determined using Univariate and Multivariate analysis. Results: One hundred and fifty patients were prospectively recruited. The age range was 0.33 to 82 years. After univariate analysis, the clinical parameters that were significantly predictive of outcomes were pupillary response (p < 0.0001, 95% CI = 0.0653-0.3589), Glasgow Coma Score (p < 0.0001, 95% CI = 15.3340-199.6713) and Age (p = 0.008, 95% CI = 0.0446-0.6142). Among the CT scan parameters, presence of multifocal contusions (p = 0.000), intracerebral haematoma (ICH) (p = 0.01), intraventricular haematoma (IVH) (p = 0.000), effacement of ventricles (p = 0.004) and cisterns (p = 0.000), midline shift (p = 0.012), and crowding of foramen magnum (p = 0.026) were found to be significantly associated with poor outcome. Multivariate analysis showed that GCS (p = 0.006, OR = 12.8171, 95% CI = 2.1013-78.1779), multifocal contusion (p = 0.01, OR = 0.1908, 95% CI = 0.0537-0.6773) and pupillary response (p = 0.046, OR = 0.2256, 95%CI = 0.0445-1.1453) were retained as independent predictors associated with overall outcome. Conclusions: This study suggests that GCS, pupillary response and multifocal contusions may independently predict outcome using GOS in head injury. A prediction model designed on these predictors needs to be considered and evaluated for this environment. 1. Introduction Head injury affects about 10 million people yearly worldwide and about 90% of these live in the low and middle-income countries[1-3], Many clinicians believe that outcome prediction helps clinical triage, resource allocation, diagnostic and therapeutic decisions, and

East African Medical Journal, 2020

PubMed, Jun 1, 2017

Background: Although there are now many neurosurgical units in Nigeria, cases of head injury (HI)... more 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.

Journal of The American College of Surgeons, Sep 1, 2013

International Journal of Surgery Open

Virginal breast hypertrophy VBH with the sobriquet "gigantomastia" is an uncomm... more Virginal breast hypertrophy VBH with the sobriquet "gigantomastia" is an uncommon condition with sporadic presentation usually in adolescence. Case presentation: In this retrospective study, eight patients (three case summaries presented, while the clinicopathologic features of all the patients are presented in Table 1) were managed. Discussion: The age range in this retrospective cohort study is 13-34 years and the series consists predominantly of teenagers, a third had bilateral disease, and the symptoms triad of mastalgia, cosmetic concerns, and psychosocial/esteem issues were present in all the patients. With a third consenting to surgical intervention. We present what to our knowledge must be in the global literature, one of the few largest accruals of cases of gigantomastia, the VBH, seen over time in our surgical oncology practice. Conclusion: VBH should be appraised along with other BBD to exclude malignancies and provide prompt and appropriate care whilst limiting complications. A multidisciplinary approach is particularly important and incorporating care for perceived low self-esteem cannot be overemphasized .

Neurosurgical Review, Aug 8, 2020

The surgical treatment of traumatic leptomeningeal cyst (LMC) is repair of the dural defect with ... more The surgical treatment of traumatic leptomeningeal cyst (LMC) is repair of the dural defect with or without cranioplasty. The dural substitutes used are either autografts (which may not be enough) or artificial grafts (which are foreign-body implantations and which also may be too expensive in a low-resource practice). In this report from a developing country, we present the surgical description of the use of the cyst capsule as a cost-free autologous graft in the surgical repair of the dural defects of two cases of traumatic leptomeningeal cyst.

East and Central African Journal of Surgery, Apr 11, 2014

Journal of neurological surgery, May 2, 2012

JMIR Research Protocols, Apr 17, 2023

Background: Core outcome sets (COSs) are important and necessary as they help standardize reporti... more Background: Core outcome sets (COSs) are important and necessary as they help standardize reporting in research studies. Cranioplasty following traumatic brain injury (TBI) or stroke is becoming increasingly common, leading to an ever-growing clinical and research interest, especially regarding the optimal material, cost-effectiveness, and timing of cranioplasty concerning neurological recovery and complications. Consequently, heterogeneous reporting of outcomes from such diverse studies has led to limited meta-analysis ability and an ongoing risk of outcome reporting bias. This study aims to define a standardized COS for reporting in all future TBI and stroke cranioplasty studies. Objective: This study has four aims: (1) undertake a systematic review to collate the most current outcome measures used within the cranioplasty literature; (2) undertake a qualitative study to understand better the views of clinicians, patients' relatives, and allied health professionals regarding clinical outcomes following cranioplasty; (3) undertake a Delphi survey as part of the process of gaining consensus for the COS; and (4) finalize consensus through a consensus meeting resulting in the COS. Methods: An international steering committee has been formed to guide the development of the COS. In addition, recommendations from other clinical initiatives such as COMET (Core Outcomes and Effectiveness Trials) and OMERACT (Outcome Measures in Rheumatology) have been adhered to. Phase 1 is data collection through a systematic review and qualitative study. Phase 2 is the COS development through a Delphi survey and consensus meetings with consensus definitions decided and agreed upon before the Delphi survey begins to avoid bias. Results: Phase 1 started at the end of 2019, following ethical approval in December 2019, and the project completion date is planned for the end of 2022 or beginning of 2023. Conclusions: This study should result in a consensus on a COS for cranioplasty, following TBI or stroke, to help standardize outcome reporting for future studies, which can be applied to future research and clinical services, help align future studies, build an increased understanding of cranioplasty and its impact on a patient's function and recovery, and help standardize the evidence base.

Journal of Neurosurgery, Sep 1, 2022

OBJECTIVE There is a paucity of data-driven reports on neurotrauma from the rural areas of develo... more OBJECTIVE There is a paucity of data-driven reports on neurotrauma from the rural areas of developing countries, despite a disproportionally higher and burgeoning disease burden from those areas. This study aims to define the burden of neurotrauma in a new rural neurosurgical practice of a developing sub-Saharan country in Africa (Nigeria). METHODS The authors conducted a prospective observational study of all neurotrauma patients managed at their center over a 36-month period beginning in August 2018. RESULTS There were 1067 patients, 816 (76.5%) of them male, accounting for 79% of all the neurosurgical patients seen at the authors’ center during the study period. The peak incidence of neurotrauma was in the 20- to 29-year age group. The median trauma duration was 9 hours before presentation. The neurotrauma involved only head injury (HI) in 78% of the patients and only the spine in 4%. HIs were predominantly mild in severity (79%). Spinal cord injuries were largely incomplete (86%) and cervical in location (72%). Road traffic accidents caused approximately 79% (845/1067) of this neurotrauma burden, mostly from motorcycle crashes (69%, 581/845). Fifty-three patients (5%) were managed surgically. The median time from trauma to surgery for the operated patients was 82 hours. Treatment outcome was good in 81.2% of the patients. CONCLUSIONS Neurotrauma, mostly caused by motorcycle crashes and other road accidents, accounts for the bulk of the neurosurgical workload in this rural neurosurgical center. Although late presentation and delayed surgical interventions were prominent features of this level of care, the in-hospital outcome was fortuitously good in the majority of patients.

Medical journal of Zambia, Dec 31, 2019

Introduction: The posterior cranial fossa contains many vital structures and mortality of patient... more Introduction: The posterior cranial fossa contains many vital structures and mortality of patients with tumours occurring in this area is high. Studies done in other geographic locations showed a higher occurrence of posterior cranial fossa tumours in paediatric patients while benign tumours were more commonly seen. Epidemiological data of tumours in this area in our environment is scarce. This study was done to ascertain the histopathologic pattern of tumours in the posterior cranial fossa in a predominantly black population. Method: A ten-year retrospective study of histologically diagnosed posterior cranial fossa tumours seen in our hospital facility was done. A total of 72 cases in which neurosurgical intervention was carried out were identified and this included all age groups. The age, sex, site of tumour and histological diagnosis were extracted from the patients' records. Result: Adult patients predominated with 55.6% while the paediatric patients were 44.4%. The male to female ratio in the paediatric patients was 2.56:1 but the ratio was equal in the adult patients. WHO grade 1 tumours were the commonest tumours seen (45.8%) while grade II tumours were the least (4.2%). Medulloblastomas (20.83%), Pilocytic astrocytomas (18.6%) and Meningiomas (8.33%) were the commonest tumours seen. Commonest locations are in the cerebellar hemispheres (56.9%) and the fourth ventricle (13.89%). Conclusion: Our study showed a higher occurrence of Medulloblastomas in contrast to other studies which have shown more of Schwannomas, a tumour type that was rare in this study. The relatively low number of metastatic tumours in this study may be due to lack of presentation of such patients.

Journal of Neurosciences in Rural Practice, Dec 1, 2016

Background: Benin republic is a very low-income French-speaking country in West Africa The develo... more Background: Benin republic is a very low-income French-speaking country in West Africa The development of Neurosurgery in the Republic of Benin took off with the arrival of the first Beninese neurosurgeons in the year 2003. Aims: This study aims to evaluate patients' attendance in a public neurosurgical center, and appreciate populations' affordability to a new specialty. Settings and Design: In the year 2004, the Benin Armed Forces established the first Department of Neurosurgery in the Nation's Military Teaching Hospital. From the public authorities, that was a proof of motivation to develop this specialty in the Benin Republic. Materials and Methods: A retrospective cross-sectional survey (September 2003 to December 2009) of the total neurosurgical patient population managed in a public pioneer hospital in a developing country. Statistical Analysis Used: Data were captured and analyzed with the SPSS software (SPSS Inc., Chicago, IL, USA) and presented in descriptive statistics such as frequencies and proportions. Results: 2908 new patients, civilians, and militaries were registered. The surgical treatment was offered adult (86%) as well as pediatric (14%) patients. Spinal degenerative diseases (52.1%) were the most common pathology; neurotraumatology emergency cases (8.4%) appeared low in representation. Three-quarters of patients experienced financial difficulties to procure the required radiologic investigations and although 609 (20.94%) benefited from surgery, most patients could not pay for the surgical operations as well as the perioperative care. Conclusions: In spite of the great constraints of this country's privately-funded health-care delivery system on the affordability of neurosurgical treatment for the average Beninese, this study demonstrates a globally increasing attendance of the department.

Egyptian Journal of Anaesthesia, Oct 1, 2016