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BackgroundWorldwide, over 10 million people are killed or hospitalized because of traumatic brain injury each year. About 90% of deaths occur in low- and middle-income countries. The condition mostly affects young adults, and many experience long lasting or permanent disability. The social and economic burden is considerable. Tranexamic acid (TXA) is commonly given to surgical patients to reduce bleeding and the need for blood transfusion. It has been shown to reduce the number of patients receiving a blood transfusion by about a third, reduces the volume of blood transfused by about one unit, and halves the need for further surgery to control bleeding in elective surgical patients.Methods/designThe CRASH-3 trial is an international, multicenter, pragmatic, randomized, double-blind, placebo-controlled trial to quantify the effects of the early administration of TXA on death and disability in patients with traumatic brain injury. Ten thousand adult patients who fulfil the eligibility criteria will be randomized to receive TXA or placebo. Adults with traumatic brain injury, who are within 8 h of injury and have any intracranial bleeding on computerized tomography (CT scan) or Glasgow Coma Score (GCS) of 12 or less can be included if the responsible doctor is substantially uncertain as to whether or not to use TXA in this patient. Patients with significant extracranial bleeding will be excluded since there is evidence that TXA improves outcome in these patients. Treatment will entail a 1 g loading dose followed by a 1 g maintenance dose over 8 h.The main analyses will be on an ‘intention-to-treat’ basis, irrespective of whether the allocated treatment was received. Results will be presented as appropriate effect estimates with a measure of precision (95% confidence intervals). Subgroup analyses for the primary outcome will be based on time from injury to randomization, the severity of the injury, location of the bleeding, and baseline risk. Interaction tests will be used to test whether the effect of treatment differs across these subgroups. A study with 10,000 patients will have approximately 90% power to detect a 15% relative reduction from 20% to 17% in all-cause mortality.Trial registrationCurrent Controlled Trials ISRCTN15088122; Clinicaltrials.gov NCT01402882

Background: In developing countries, the rate of complications from chronic suppurative otitis media is still high, due to factors associated with poverty. This study aimed to determine the prevalence of chronic suppurative otitis media and associated complications.Patients and methods: We prospectively studied all patients presenting with chronic suppurative otitis media to the ear, nose and throat unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, over a two-year period.Results: One hundred and sixty new cases of chronic suppurative otitis media were seen. These constituted 11.1 per cent of all new cases and 21.5 per cent of all otological cases seen. About half (51.7 per cent) of these patients were younger than 15 years. Most patients were from rural areas and had been previously managed by unlicensed, untrained practitioners. Complications were mostly seen in children. Intracranial complications were seen in 10 (6.3 per cent) cases; this was associated with a high mortality rate.Conclusion: This study found that, in Nigeria, a developing country, 'safe' chronic suppurative otitis media was not without serious problems. Provision of adequate health facilities may reduce such problems. Key words: Chronic Suppurative Otitis Media; Developing Country; Late Presentation; Complications; Management IntroductionOtitis media comprises inflammation of the middle-ear cleft. It remains a relevant topic of research both in the developing and the developed world. It is the most common otological presentation in most ENT units 1 and is commonly encountered in general practice. 2 The anatomical relation between the small middle-ear cleft in the temporal bone and the middle cranial fossa superiorly makes spreading infection in this space potentially fatal.3 However, the incidences of this and other forms of complications have reduced tremendously since the advent of antibiotics.However, within rural and some semi-urban communities in developing countries such as Nigeria, the interplay of poverty and inadequate specialist ENT health care still makes complications of chronic suppurative otitis media (CSOM) a problem for the few available otolaryngologists. Late presentation and low socioeconomic factors are identifiable risk factors for the development of such complications.This study assessed CSOM amongst patients presenting at the otorhinolaryngology unit of Obafemi Awolowo University Teaching Hospitals Complex,

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Background and Objective: There is paucity of data on the pattern and factors affecting the management outcome of patients with spina bifida cystica in the Ife-Ijesa zone, Nigeria. This study was designed to address this research question. Method: One hundred and six consecutive cases of spina bifida cystica who presented in our hospital from January 1990 to December 2004 were reviewed. We obtained information on sociodemographic factors, medical history and management as well as clinical outcome. SPSS was used to analyze the data. Result: Males constituted 54.7% and females 45.2% of cases. Mortality was high in those presented after the 4th week of life (p = 0.04). The malformation occurred in the lumbar and lumbosacral regions in 77.4%. Myelomeningocele was the most common type (86.8%). Hydrocephalus was recorded in 53.8% of patients. Surgical closure was done for 91.5% of the patients. About 77% of all the patients were discharged while 22.7% died. This was significantly related to age at presentation (p = 0.04) and infection before surgery (p = 0.045). Postoperative complications were more frequent in patients with ruptured lesions (p = 0.025), a larger size of defect (p = 0.028) and a lower birth weight (p = 0.006). Conclusion: Myelomeningocele is the most common type of spina bifida cystica in our environment. Late presentation and preoperative infection are associated with high mortality in our patients.