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5. Lower extremities Duplex-Doppler ultrasonography for the detection of suspected deep venous thrombosis: A preliminary report from Sokoto

Author

Shehu B Kakale

Subjects
lower extremities, duplex-doppler, ultrasonography, Medicine
Abstract

Background: There is a paucity of reports on the deep vein thrombosis in our environment. Aims and Objective: The aim of this study is to document the role of Doppler ultrasound in detecting deep vein thrombosis in our environment. Methods and Materials: Between Januarys to December 2014 forty six in patients with suspicion of DVT were evaluated prospectively. All patients presented with symptoms of single or bilateral disease, and a high probability of the disease. Two trained radiologists performed all duplex scan examinations. The patients were scanned using Mindray DC-3/DC-3T Diagnostic ultrasound scanner (Mindray Bio- Medical Electronics Co., LTD) linear (7-12MHz) transducers was used. Results: A total of 46 patients had duplex-Doppler scan examination carried out between January-December 2014. There were 30(65.2%) males and 16(38.8%) females subjects recruited for the study. The mean age was 48.9±SD17.3 with range of 18-85 years. A total of 21 patients (45.6%) were found to have deep vein thrombosis (DVTs) on duplex-Doppler examination. Proximal DVTs was seen in 6(12.9%) and 14(30.3%) for right and left lower limbs respectively. Distal DVTs was seen in 1(2.2%) in the right lower limb and 25(54.4%) show normal findings bilaterally. Diffused DVTs was seen in 2(4.3%) patients involving external, through popliteal veins on the right lower limb. In 3(6.5%) of the patients only the common femoral, superficial femoral and popliteal shows diffuse DVTs. Conclusion: With availability of Doppler ultrasound in our environment the diagnosis of DVT is now easier. Duplex scanning techniques are faster, safer, and less expensive. Because of its noninvasive nature, venous duplex is repeatable, allowing for continued follow up after the diagnosis.

Published
2016
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8. Role of Browse Tree Legumes as Dietary Supplements for Ruminants: A Review.

Author

Yusuf, A., Shehu, B., and Murtala, U.

Subjects
RUMINANT nutrition, RUMINANT feeding & feeds, ANIMAL feeding behavior, ANIMAL feeding, ANIMAL nutrition
Abstract

The leaves and soft stems of leguminous trees are important in ruminant nutrition. Browse include fruits and pods of trees and shrubs. Browse spans from temperate to tropical areas of the world, particularly in areas prone to drought. A variety of feed resources exist throughout the tropics, especially the humid regions These include a variety of forages and abundant supplies of crop residues, agro-industrial byproducts and also non-conventional feed resources. Among these, approximately 50-60% of the feeds produced are bulky roughages. The advantages of the use of tree and shrub forages as animal feeds include availability on the farm, accessibility, provision of variety of diets and source of dietary nitrogen, energy, minerals and vitamins. Others include laxative influence on the alimentary system, reduction in requirement for purchased concentrates and reduced feeding cost. The contribution of browse to the livestock diet varies with the nature of the ecosystem; in less favourable environments, the grazing season for vegetation is short, and the contribution of native fodder shrub to the animal's diet is very high and may exceed 70%. However, in more favourable areas, they are used on seasonal basis. This review mainly focuses on the different types of browse tree legumes and their utilization as supplemental diets for ruminants especially during dry season. [ABSTRACT FROM AUTHOR]

Published
2023

9. INFLUENCE OF LAND USE SYSTEMS ON CARBON STOCK AND STRUCTURAL STABILITY OF A TROPICAL ALFISOL

Author

null Adam, A. M., null Amba, A. A., null Shehu, B. M., null Nasir, N. M., and null Jibrin, J. M.

Abstract

The study was conducted to investigate the influence of four adjacent land use systems (Arable [A], Pasture [PL], Fallow [FL] and orchard [OL]) on carbon stock and structural stability of a tropical Alfisol in Sudan Savannan agro-ecological zone of Nigeria. The result reveals that carbon stock was statistically higher (P = 0.03) in OL and FL than the other two land use systems. Carbon stock in the soil increased by 5.67t ha-1 in OL relative to FL for over 10 years. But in contrary, a decline in carbon stock of 6.4 t ha-1 and 4.9 t ha-1 was observed relative to FL in AL and PL, respectively. This indicates soil carbon stock in the study area lost rapidly under continuous arable cropping than any other land use systems. Correlation analysis showed that soil carbon stock in the study area was significantly explained by clay (r = 0.71**), silt (r = 0.54*) and sand (r = -0.70**) contents. The structural stability index (SI) did not significantly vary (P = 0.195) among the land use systems were all values fell below less than 5% that indicates structurally degraded condition of the soil due to generally small organic carbon content. The structural stability index was significantly related to pH in KCl2, available phosphorus and carbon stock with correlation coefficients (r) of 0.45*, 0.62** and 0.72**, respectively. Therefore, there is a need to adopt proven management practices that enhance and maintain organic carbon content especially in the AL in order to improve productivity and structural stability of the soil vis-à-vis environmental resilience.

Published
2020

10. Phytochemical, High Performance Liquid Chromatography and Antimicrobial Evaluations of the Ethanolic Root Extract of Phoenix dactylifera L

Author

Ya'aba, Yakubu, Mohammed, Shehu B., Adamu, Aliyu, Yakubu, Japhet G., and Adigwe, Obi P.

Subjects
Phytochemicals, Antibacterial activities, ethanolic root extract, Clinical isolates, Phoenix dactylifera L
Abstract

Bioactive compounds from plants have received a great deal of interest from scientists all over the globe for development of drugs. This study was aimed at evaluating phytochemicals, High Performance Liquid Chromatography (HPLC) and antibacterial activities of ethanolic root extract of Phoenix dactylifera L. (date plant) against some clinical isolates. Roots of date plant were dried and extracted with ethanol using the cold maceration method before concentrating it with water bath at 45 oC. The phytochemicals were identified using HPLC based on their individual retention time. Antibacterial activities of the methanolic root extract were assessed against some clinical isolates including Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pyogenes, and Pseudomonas aeruginosa utilizing agar disc diffusion method. The percentage yield of ethanol extract was 0.3892%. The result of the phytochemical screening revealed the presence of carbohydrate, phenols, tannins, saponins, flavonoids, cardiac glycosides, steroids, alkaloids and terpenes at various retention time of 2.853, 3.235, 4.129, 4.713, 6.722, 8.954, 11.228 and 22.912 min. Compounds identified include phenolic acid (caffeic acid) and two flavonoids (rutin and quercetin). The zone of inhibition diameter ranged from 15 to 19 mm. The maximum zone of inhibition was detected against Streptococcus pyogenes, (19 mm). Staphylococcus aureus and Klebsiella pneumoniae were inhibited with 17 mm and 16 mm zone of inhibition respectively, followed by Pseudomonas aeruginosa which had the least zone of inhibition (15 mm). The result of the present study suggests that the root of Phoenix dactylifera L. possesses important phytochemical components with antibacterial activity that could be possibly exploited for pharmaceutical development.

Published
2021

11. Nutrient Intake, Digestibility and Nitrogen Balance of Growing Yankasa Rams Fed Urea Treated and Ensiled Millet Stover Based Diet with Supplements.

Author

Yusuf, A., Abubakar, M., and Shehu, B.

Subjects
INGESTION, DIETARY supplements, ANIMALS, COTTONSEED, MICROBIAL aggregation
Abstract

This study was conducted at the Small Ruminant Unit of the Teaching and Research Farm, Federal University Dutsinma, Katsina State to investigate the effect of feeding urea treated and ensiled millet stover based diets with supplements on nutrient intake, digestibility and nitrogen balance in growing Yankasa. rams. Thirty (30) growing Yankasa rams weighing 16.35 to 18.21 kg were allotted to six treatments of five animals per treatment in a Completely Randomized Design. Four kilograms of urea was dissolved in 100 litres of water, sprinkled on 100 kg of crushed millet stover, ensiled for 21 days and used as a basal diet. The supplement consisted of 300 g of cottonseed cake, Faidherbia albida meal, CSC and maize offal, FA and maize offal, CSC and wheat offal and FA and wheat offal, designated as diets 1,2, 3, 4, 5 and 6. All supplements were fed 150 g twice daily. Three (3) Yankasa rams of each diet were randomly selected to determine nutrient intake, digestibility and nitrogen balance. The study lasted for 90 days. Nutrient intake (NI, g/day), faecal (unit) and urine (unit) outputs were recorded. Results indicated that DMI were similar (P>0.05) with higher intake (628.95g/day) in rams fed diet containing FA and MO followed by 615.81g/day CSC and MO and CSC and WO (608.60g/day). The digestibilities of dry matter (DM) and crude protein (CP) were higher (P<0.05) in rams fed diet containing CSC and MO while Neutral Detergent Fibre (NDF) and Acid Detergent Fibre (ADF) were higher (P<0.05) in rams fed diet containing CSC sole compared to other treatment diets. The quantity of N retained by the rams was higher (P<0.05) in treatment containing CSC and MO (4.36g/day) compared to those fed FA and WO (2.08g/day) and FA sole (1.74g/day). It is concluded that farmers should feed CSC and MO as supplement to growing Yankasa rams fed urea treated and ensiled millet stover based diets for optimum production under peasant production system. [ABSTRACT FROM AUTHOR]

Published
2022

12. Impact-Based Forecasting for Pluvial Floods

Author

Rözer, V., Peche, A., Berkhahn, S., Feng, Y., Fuchs, L., Graf, T., Haberlandt, U., Kreibich, H., Sämann, R., Sester, M., Shehu, B., Wahl, J., Neuweiler, I., Rözer, V., Peche, A., Berkhahn, S., Feng, Y., Fuchs, L., Graf, T., Haberlandt, U., Kreibich, H., Sämann, R., Sester, M., Shehu, B., Wahl, J., and Neuweiler, I.

Abstract

Pluvial floods in urban areas are caused by local, fast storm events with very high rainfall rates, which lead to inundation of streets and buildings before the storm water reaches a watercourse. An increase in frequency and intensity of heavy rainfall events and an ongoing urbanization may further increase the risk of pluvial flooding in many urban areas. Currently, warnings for pluvial floods are mostly limited to information on rainfall intensities and durations over larger areas, which is often not detailed enough to effectively protect people and goods. We present a proof-of-concept for an impact-based forecasting system for pluvial floods. Using a model chain consisting of a rainfall forecast, an inundation, a contaminant transport and a damage model, we are able to provide predictions for the expected rainfall, the inundated areas, spreading of potential contamination and the expected damage to residential buildings. We use a neural network-based inundation model, which significantly reduces the computation time of the model chain. To demonstrate the feasibility, we perform a hindcast of a recent pluvial flood event in an urban area in Germany. The required spatio-temporal accuracy of rainfall forecasts is still a major challenge, but our results show that reliable impact-based warnings can be forecasts are available up to 5 min before the peak of an extreme rainfall event. Based on our results, we discuss how the outputs of the impact-based forecast could be used to disseminate impact-based early warnings.

Published
2021

14. Impact‐Based Forecasting for Pluvial Floods

Author

Rözer, V., primary, Peche, A., additional, Berkhahn, S., additional, Feng, Y., additional, Fuchs, L., additional, Graf, T., additional, Haberlandt, U., additional, Kreibich, H., additional, Sämann, R., additional, Sester, M., additional, Shehu, B., additional, Wahl, J., additional, and Neuweiler, I., additional

Published
2021
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21. Lower extremities Duplex-Doppler ultrasonography for the detection of suspected deep venous thrombosis: A preliminary report from Sokoto

Author

Shamsuddeen A Aliyu, Shehu B Kakale, and Salisu M Ma'aji

Subjects
medicine.medical_specialty, lower extremities, business.industry, Deep vein, lcsh:R, lcsh:Medicine, ultrasonography, 030204 cardiovascular system & hematology, medicine.disease, Thrombosis, duplex-doppler, 030218 nuclear medicine & medical imaging, Duplex scanning, 03 medical and health sciences, Duplex doppler ultrasonography, Venous thrombosis, 0302 clinical medicine, medicine.anatomical_structure, Preliminary report, Duplex (building), medicine, Right lower limb, Radiology, General Agricultural and Biological Sciences, business
Abstract

Background: There is a paucity of reports on the deep vein thrombosis in our environment. Aims and Objective: The aim of this study is to document the role of Doppler ultrasound in detecting deep vein thrombosis in our environment. Methods and Materials: Between Januarys to December 2014 forty six in patients with suspicion of DVT were evaluated prospectively. All patients presented with symptoms of single or bilateral disease, and a high probability of the disease. Two trained radiologists performed all duplex scan examinations. The patients were scanned using Mindray DC-3/DC-3T Diagnostic ultrasound scanner (Mindray Bio- Medical Electronics Co., LTD) linear (7-12MHz) transducers was used. Results: A total of 46 patients had duplex-Doppler scan examination carried out between January-December 2014. There were 30(65.2%) males and 16(38.8%) females subjects recruited for the study. The mean age was 48.9±SD17.3 with range of 18-85 years. A total of 21 patients (45.6%) were found to have deep vein thrombosis (DVTs) on duplex-Doppler examination. Proximal DVTs was seen in 6(12.9%) and 14(30.3%) for right and left lower limbs respectively. Distal DVTs was seen in 1(2.2%) in the right lower limb and 25(54.4%) show normal findings bilaterally. Diffused DVTs was seen in 2(4.3%) patients involving external, through popliteal veins on the right lower limb. In 3(6.5%) of the patients only the common femoral, superficial femoral and popliteal shows diffuse DVTs. Conclusion: With availability of Doppler ultrasound in our environment the diagnosis of DVT is now easier. Duplex scanning techniques are faster, safer, and less expensive. Because of its noninvasive nature, venous duplex is repeatable, allowing for continued follow up after the diagnosis. Asian Journal of Medical Sciences Vol.7(6) 2016 53-57

Published
2016

22. Probiotic Supplemented diet improved the gut morphology of broiler chickens

Author

Buba, W. and Shehu, B. N.

Abstract

An experiment was conducted to evaluate the effect of baker’s yeast (saccharomyces cerevisiae) inclusion as probiotic on gut morphology of broiler chickens in the northern guinea savannah. Two hundred and fifty-five day old broiler chicks were used for the study. The chickens were fed diets containing graded levels of saccharomyces cerevisiae (SC). There were five treatment groups for both starter and finisher phases. Each treatment group had three replicates with 17 birds per replicate and fifty-one birds per group in a completely randomized design (CRD). Treatments 1, 2, 3, 4 and 5 contained 0, 0.5, 1.0, 1.5 and 2.0% SC respectively.Data obtained from the experiment were subjected to the analysis of variance (ANOVA) using the general linear model procedure of (SAS, 2001). Significant differences among treatment means were compared using Dunnetts. The results obtained showed significant difference (P0.05) difference between treatment groups fed 0.5, 1.0 and 1.5% level of SC inclusion in terms of villi area. Villi perimeter was significantly higher (2347.2μm) in broiler chickens fed 2.0% SC. Broiler chickens fed 1.0 and 1.5% SC did not differ (P>0.05) significantly in terms of villi height; though chickens fed 1.0% SC had the highest (870.3μm) mean value while the least value (525.5μm) was obtained in the broiler chickens fed control diet. Villi width was higher (358.14μm) in chickens fed 2.0% SC compared to other treatment groups. It is concluded from the study that inclusion of SC in the diet of broilers improved the gut morphology which is an indication of healthy gut which is important for optimum performances of the birds.

Published
2018

29. Prevalence of HCV coinfection in HIV-infected individuals in Nigeria and characterization of HCV genotypes

Author

Kimmy Leung, Barney Graham, Ruth Negedu-Momoh, Israel Audu, Chad Womack, Uford S. Inyang, Simon Agwale, Rainer Ziermann, Dolores Duey, Shehu B. Mohammed, Lillian Odama, and Lorine Tanimoto

Subjects
Adult, Male, Genotype, Hepatitis C virus, Population, Nigeria, HIV Infections, Hepacivirus, Biology, medicine.disease_cause, Flaviviridae, Virology, HIV Seropositivity, medicine, Prevalence, Humans, education, Retrospective Studies, education.field_of_study, virus diseases, Hepatitis C, Middle Aged, medicine.disease, biology.organism_classification, digestive system diseases, CD4 Lymphocyte Count, Infectious Diseases, Immunology, Coinfection, RNA, Viral, Female, Viral disease, HCV Genotype Assay
Abstract

Background: Coinfection with hepatitis C virus (HCV) in individuals infected with HIV is associated with a higher incidence of liver injury, hepatic decompensation, and decreased survival time than that seen in an HIV-monoinfected population. While prevalence studies on HIV/HCV coinfection have been performed in the U.S. and in some European countries, little is known about coinfection rates in Africa. Design: Retrospectively collected specimens from 146 confirmed HIV-positive individuals in Nigeria who had access to antiretroviral therapy (ART) were tested for HCV RNA, using the VERSANT ® HCV RNA qualitative assay (TMA), and, if HCV RNA-positive, for HCV genotype using the VERSANT ® HCV genotype assay (LiPA). Results: Twelve out of the 146 individuals tested (8.2%) were HCV positive. Nine of the 12 HCV-positive individuals were infected with HCV genotype 1 (five 1a, three 1b, one non-subtypable) and three were infected with HCV genotype 2 (all non-subtypable). Coinfected individuals were more likely to be male, older, and have lower CD4+ cell counts than HIV-monoinfected individuals, although none of the differences reached statistical significance. Conclusion: The results highlight the potential public health impact of HCV infection in Nigeria, where anti-HCV testing is generally not performed in HIV-infected populations or in most blood transfusion centers.

Published
2004

30. Neurosurgical infections

Author

Shehu, B. B., Mahmud, M. R., Ismail, N. J., Shehu, B. B., Mahmud, M. R., and Ismail, N. J.

Abstract

The central nervous system is a very delicate and vulnerable organ which enjoys protection by layers of coverings. It is described as an immunological vacuum, and when afflicted by infections the outcome is most often devastating. Factors leading to compromise of the host defense play a major role in establishing neurosurgical infections. A number of such factors can either be avoided or minimized. Over the past decades, these infections have been fatal. However, more recently, the advent of newer more effective antibiotics, improved bacteriological studies, advanced imaging facilities, and meticulous surgical techniques have turned around the outcomes. This article will review infections of the central nervous system of neurosurgical significance.

Published
2008

31. Predicting outcome after traumatic brain injury: Practical prognostic models based on large cohort of international patients

Author

Perel, P. A., Olldashi, F., Muzha, I., Filipi, N., Lede, R., Copertari, P., Traverso, C., Copertari, A., Vergara, E. A., Montenegro, C., De Huidobro, R. R., Saladino, P., Surt, K., Cialzeta, J., Lazzeri, S., Pinero, G., Ciccioli, F., Videtta, W., Barboza, M. F., Svampa, S., Sciuto, V., Domeniconi, G., Bustamante, M., Waschbusch, M., Gullo, M. P., Drago, D. A., Linares, J. C. A., Camputaro, L., Troccoli, G., Galimberti, H., Tallott, M., Eybner, C., Buchinger, W., Fitzal, S., Mazairac, G., Oleffe, V., Grollinger, T., Delvaux, P., Carlier, L., Braet, V., Jacques, J. -M., De Knoop, D., Nasi, L., Choi, H. K., Schmitt, M., Gentil, A., Nacul, F., Barrios, P. B., Xinkang, C., Hua, L. S., Tian, H. H., Xiaodong, C., Gualteros, W., Otero, A. A., Arango, M., Ciro, J., Jaramillo, H., Gonzalez, I., Gomez, C., Arias, A., Fonseca, M., Mora, C., Cabrera, E. G. L., Betancurth, J. L., Munoz, P., Quinonez, J. A., Castillo, M. E. G., Lopez, O., Yepes, R. P., Cuellar, D. L., Paez, G., Chaves, H. D., Ordonez, P. E., Plata, Riccardo, Pineda, M., Pulido, L. E., Jaramillo, J. S. V., Rebolledo, C., Palma, O., Soler, C., Pastrana, I., Falero, R., Perera, M. D., Garcia, A. A., Oliva, R., Delgado, H. L., Carnero, A. M., Lopez, B. L., Gallardo, A. L., Morales, A. O., Lezcano, H., Ferrer, M. I., Bess, I. Z., Canino, G. R., Ruiz, E. M. P., Cruz, O. G., Svoboda, P., Kantorova, I., Ochmann, J., Scheer, P., Kozumplik, L., Marsova, J., Edelmann, K., Chytra, I., Bosman, R., Andrejsova, H., Pachl, J., Burger, J., Kramar, F., Ulloa, M. I., Gonzalez, L., Daccach, A., Ortega, A., Cevallos, S., Cueva, B. Z., Ochoa, M., Tapia, J. V., Hurtado, J., Wong, M. C. S., Santos, R., Khamis, H., Abaza, A. H., Fekry, A., El Kordy, S., Shawky, T., El-Sayed, H., Khalil, N., Negm, N., Fisal, S., Alamin, M., Shokry, H., Elhusseny, A. Y., Radwan, A., Rashid, M., Gogichaisvili, T., Ingorokva, G., Gongadze, N., Otarashvili, A., Kleist, W., Kalkum, M., Ulrich, P., Andrews, N., Nakos, G., Karavelis, A., Archontakis, G., Myrianthefs, P., Yadav, Y., Yadav, S., Khatri, R., Baghel, A., Husain, M., Jha, D., Chhang, W. H., Dhandhania, M., Fonning, C., Iyengar, S. N., Gupta, S., Ravi, R. R., Bopiah, K. S., Herur, A., Venkataramana, N. K., Satish, A., Bhavadasan, K., Morris, R., Ramesh, S., Dewan, Y., Singh, Y., Bhagchandani, R., Bhagchandani, S., Sethurayar, V. U., Ipe, S., Sreekumar, G., Panigrahi, M., Reddy, A., Khosla, V., Pillay, H., Thomas, N., Sridhar, K., Jose, B., Kurian, N., Praharaj, S., Pillai, S., Ramana, Kiyawat, D., Maheshwari, K., Panikar, D., Chawla, J., Shenoy, S., Raja, A., Rupayana, Y., Reddy, S., Mohan, N., Kelkar, S., Johri, M., Golden, N., Maliawan, S., Fauzi, A., Farouk, U., Fakharian, E., Aramesh, A., Eghtedari, M., Ahmadzadeh, F., Gholami, A., Plunkett, P., Redican, C., Mcmahon, G., Annetta, Maria Giuseppina, Mouchaty, H., Bruzzone, E., Harding, B., Qureshi, M., Idris, Z., Jafri Abdullah, N. C., Ghazali, G., Ghani, A. R. I., Cheah, F., Cabrera, A., Gonzalez, J. L. M., Loria-Castellanos, J., Jackson, S., Hutchinson, R., Komolafe, E., Adeolu, A., Komolafe, M., Adeyemi-Doro, O., Bankole, F., Shehu, B., Danlami, V., Odebode, O., Oluwadiya, K., Sanni, A., Giebel, H., Kumar, S., Jooma, R., Mezquita, J. E., Ovelar, C. O., Portillo, M. G., Rodriguez, D., Balica, L., Oprita, B., Sklerniacof, M., Steflea, L., Bandut, L., Danil, A., Iliescu, R., Ciurea, J., El-Dawlatly, A., Alwatidy, S., Al-Yafi, W., El-Dawlatly, M., Krunic-Protic, R., Janosevic, V., Tan, J., Seah, C., Trenkler, S., Humenansky, M., Stajancova, T., Schwendt, I., Laincz, A., Julius, Z., Maros, S., Firment, J., Cifranicova, M., Saniova, B., Kalig, K., Medekova, S., Wiszt, R., Macuga, I., Hartzenberg, B., Du Plessis, G., Houlie, Z., Nathoo, N., Khumalo, S., Tracey, R., Munoz-Sanchez, A., Francisco Murillo-Cabezas, N. C., Flores-Cordero, J., Rincon- Ferrari, D., Rubi, M., Caler, L., Del Campo, M. M., Laguna, L. B., Nava, J. M., Minguillon, M. A., Lopez, A. M., Ramos-Gomez, L., De La Torre-Prados, V., Pellejero, R., Laloe, V., Mandrella, B., Suganthan, Perera, S., Mahendran, K., Stocker, R., Ludwig, S., Zimmermann, H., Denzler, U., Yutthakasemsunt, S., Kittiwattanagul, W., Piyavechvirat, P., Tapsai, P., Namuang-Jan, A., Chantapimpa, U., Watanachai, C., Subsompon, P., Pussanakawatin, W., Khunjan, P., Tangchitvittaya, S., Nilapong, S., Klangsang, T., Taechakosol, W., Srinat, A., Jerbi, Z., Borsali- Falfoul, N., Rezgui, M., Cakar, N., Ssenyonjo, H., Kobusingye, O., Lomas, G., Yates, D., Lecky, F., Bleetman, A., Baldwin, A., Jenkinson, E., Pantrini, S., Stewart, J., Contractor, N., Roberts, T., Butler, J., Pinto, A., Lee, D., Brayley, N., Robbshaw, K., Dix, C., Graham, S., Pye, S., Green, M., Kellins, A., Moulton, C., Fogg, B., Cottingham, R., Funnell, S., Shanker, U., Summers, C., Malek, L., Ashcroft, C., Powell, J., Moore, S., Buckley, S., Grocutt, M., Chambers, S., Morrice, A., Marshall, H., Harris, J., Matthews, W., Tippet, J., Mardell, S., Macmillan, F., Shaw, A., Luthra, P., Dixon, G., Ahmed, M., Young, M., Mason, S., Loveday, I., Clark, C., Taylor, S., Wilson, P., Ali, K., Greenwood, S., White, M., Perez, R., Eljamel, S., Wasserberg, J., Shale, H., Read, C., Mccarron, J., Pennell, A., Ray, G., Thurston, J., Brown, E., Jaffey, L., Graves, M., Bailey, R., Loveridge, N., Evans, G., Hughes, S., Ahmed, M. K., Richardson, J., Gallagher, C., Odedun, T., Lees, K., Foley, D., Payne, N., Pennycook, A., Griffiths, C., Moore, D., Byrne, D., Dasan, S., Banerjee, Abhishek, Mcguinness, S., Chikhani, C., Zoltie, N., Barlow, I., Stell, I., Hulse, W., Crossley, J., Watkins, L., Dorani, B., Van Viet, T., Plata R., Annetta M. G. (ORCID:0000-0001-7574-1311), Banerjee A., Perel, P. A., Olldashi, F., Muzha, I., Filipi, N., Lede, R., Copertari, P., Traverso, C., Copertari, A., Vergara, E. A., Montenegro, C., De Huidobro, R. R., Saladino, P., Surt, K., Cialzeta, J., Lazzeri, S., Pinero, G., Ciccioli, F., Videtta, W., Barboza, M. F., Svampa, S., Sciuto, V., Domeniconi, G., Bustamante, M., Waschbusch, M., Gullo, M. P., Drago, D. A., Linares, J. C. A., Camputaro, L., Troccoli, G., Galimberti, H., Tallott, M., Eybner, C., Buchinger, W., Fitzal, S., Mazairac, G., Oleffe, V., Grollinger, T., Delvaux, P., Carlier, L., Braet, V., Jacques, J. -M., De Knoop, D., Nasi, L., Choi, H. K., Schmitt, M., Gentil, A., Nacul, F., Barrios, P. B., Xinkang, C., Hua, L. S., Tian, H. H., Xiaodong, C., Gualteros, W., Otero, A. A., Arango, M., Ciro, J., Jaramillo, H., Gonzalez, I., Gomez, C., Arias, A., Fonseca, M., Mora, C., Cabrera, E. G. L., Betancurth, J. L., Munoz, P., Quinonez, J. A., Castillo, M. E. G., Lopez, O., Yepes, R. P., Cuellar, D. L., Paez, G., Chaves, H. D., Ordonez, P. E., Plata, Riccardo, Pineda, M., Pulido, L. E., Jaramillo, J. S. V., Rebolledo, C., Palma, O., Soler, C., Pastrana, I., Falero, R., Perera, M. D., Garcia, A. A., Oliva, R., Delgado, H. L., Carnero, A. M., Lopez, B. L., Gallardo, A. L., Morales, A. O., Lezcano, H., Ferrer, M. I., Bess, I. Z., Canino, G. R., Ruiz, E. M. P., Cruz, O. G., Svoboda, P., Kantorova, I., Ochmann, J., Scheer, P., Kozumplik, L., Marsova, J., Edelmann, K., Chytra, I., Bosman, R., Andrejsova, H., Pachl, J., Burger, J., Kramar, F., Ulloa, M. I., Gonzalez, L., Daccach, A., Ortega, A., Cevallos, S., Cueva, B. Z., Ochoa, M., Tapia, J. V., Hurtado, J., Wong, M. C. S., Santos, R., Khamis, H., Abaza, A. H., Fekry, A., El Kordy, S., Shawky, T., El-Sayed, H., Khalil, N., Negm, N., Fisal, S., Alamin, M., Shokry, H., Elhusseny, A. Y., Radwan, A., Rashid, M., Gogichaisvili, T., Ingorokva, G., Gongadze, N., Otarashvili, A., Kleist, W., Kalkum, M., Ulrich, P., Andrews, N., Nakos, G., Karavelis, A., Archontakis, G., Myrianthefs, P., Yadav, Y., Yadav, S., Khatri, R., Baghel, A., Husain, M., Jha, D., Chhang, W. H., Dhandhania, M., Fonning, C., Iyengar, S. N., Gupta, S., Ravi, R. R., Bopiah, K. S., Herur, A., Venkataramana, N. K., Satish, A., Bhavadasan, K., Morris, R., Ramesh, S., Dewan, Y., Singh, Y., Bhagchandani, R., Bhagchandani, S., Sethurayar, V. U., Ipe, S., Sreekumar, G., Panigrahi, M., Reddy, A., Khosla, V., Pillay, H., Thomas, N., Sridhar, K., Jose, B., Kurian, N., Praharaj, S., Pillai, S., Ramana, Kiyawat, D., Maheshwari, K., Panikar, D., Chawla, J., Shenoy, S., Raja, A., Rupayana, Y., Reddy, S., Mohan, N., Kelkar, S., Johri, M., Golden, N., Maliawan, S., Fauzi, A., Farouk, U., Fakharian, E., Aramesh, A., Eghtedari, M., Ahmadzadeh, F., Gholami, A., Plunkett, P., Redican, C., Mcmahon, G., Annetta, Maria Giuseppina, Mouchaty, H., Bruzzone, E., Harding, B., Qureshi, M., Idris, Z., Jafri Abdullah, N. C., Ghazali, G., Ghani, A. R. I., Cheah, F., Cabrera, A., Gonzalez, J. L. M., Loria-Castellanos, J., Jackson, S., Hutchinson, R., Komolafe, E., Adeolu, A., Komolafe, M., Adeyemi-Doro, O., Bankole, F., Shehu, B., Danlami, V., Odebode, O., Oluwadiya, K., Sanni, A., Giebel, H., Kumar, S., Jooma, R., Mezquita, J. E., Ovelar, C. O., Portillo, M. G., Rodriguez, D., Balica, L., Oprita, B., Sklerniacof, M., Steflea, L., Bandut, L., Danil, A., Iliescu, R., Ciurea, J., El-Dawlatly, A., Alwatidy, S., Al-Yafi, W., El-Dawlatly, M., Krunic-Protic, R., Janosevic, V., Tan, J., Seah, C., Trenkler, S., Humenansky, M., Stajancova, T., Schwendt, I., Laincz, A., Julius, Z., Maros, S., Firment, J., Cifranicova, M., Saniova, B., Kalig, K., Medekova, S., Wiszt, R., Macuga, I., Hartzenberg, B., Du Plessis, G., Houlie, Z., Nathoo, N., Khumalo, S., Tracey, R., Munoz-Sanchez, A., Francisco Murillo-Cabezas, N. C., Flores-Cordero, J., Rincon- Ferrari, D., Rubi, M., Caler, L., Del Campo, M. M., Laguna, L. B., Nava, J. M., Minguillon, M. A., Lopez, A. M., Ramos-Gomez, L., De La Torre-Prados, V., Pellejero, R., Laloe, V., Mandrella, B., Suganthan, Perera, S., Mahendran, K., Stocker, R., Ludwig, S., Zimmermann, H., Denzler, U., Yutthakasemsunt, S., Kittiwattanagul, W., Piyavechvirat, P., Tapsai, P., Namuang-Jan, A., Chantapimpa, U., Watanachai, C., Subsompon, P., Pussanakawatin, W., Khunjan, P., Tangchitvittaya, S., Nilapong, S., Klangsang, T., Taechakosol, W., Srinat, A., Jerbi, Z., Borsali- Falfoul, N., Rezgui, M., Cakar, N., Ssenyonjo, H., Kobusingye, O., Lomas, G., Yates, D., Lecky, F., Bleetman, A., Baldwin, A., Jenkinson, E., Pantrini, S., Stewart, J., Contractor, N., Roberts, T., Butler, J., Pinto, A., Lee, D., Brayley, N., Robbshaw, K., Dix, C., Graham, S., Pye, S., Green, M., Kellins, A., Moulton, C., Fogg, B., Cottingham, R., Funnell, S., Shanker, U., Summers, C., Malek, L., Ashcroft, C., Powell, J., Moore, S., Buckley, S., Grocutt, M., Chambers, S., Morrice, A., Marshall, H., Harris, J., Matthews, W., Tippet, J., Mardell, S., Macmillan, F., Shaw, A., Luthra, P., Dixon, G., Ahmed, M., Young, M., Mason, S., Loveday, I., Clark, C., Taylor, S., Wilson, P., Ali, K., Greenwood, S., White, M., Perez, R., Eljamel, S., Wasserberg, J., Shale, H., Read, C., Mccarron, J., Pennell, A., Ray, G., Thurston, J., Brown, E., Jaffey, L., Graves, M., Bailey, R., Loveridge, N., Evans, G., Hughes, S., Ahmed, M. K., Richardson, J., Gallagher, C., Odedun, T., Lees, K., Foley, D., Payne, N., Pennycook, A., Griffiths, C., Moore, D., Byrne, D., Dasan, S., Banerjee, Abhishek, Mcguinness, S., Chikhani, C., Zoltie, N., Barlow, I., Stell, I., Hulse, W., Crossley, J., Watkins, L., Dorani, B., Van Viet, T., Plata R., Annetta M. G. (ORCID:0000-0001-7574-1311), and Banerjee A.

Abstract

Objective: To develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury. Design: Multivariable logistic regression to select variables that were independently associated with two patient outcomes. Two models designed: "basic" model (demographic and clinical variables only) and "CT" model (basic model plus results of computed tomography). The models were subsequently developed for high and low-middle income countries separately. Setting: Medical Research Council (MRC) CRASH Trial. Subjects: 10 008 patients with traumatic brain injury. Models externally validated in a cohort of 8509. Results: The basic model included four predictors: age, Glasgow coma scale, pupil reactivity, and the presence of major extracranial injury. The CT model also included the presence of petechial haemorrhages, obliteration of the third ventricle or basal cisterns, subarachnoid bleeding, midline shift, and non-evacuated haematoma. In the derivation sample the models showed excellent discrimination (C statistic above 0.80). The models showed good calibration graphically. The Hosmer-Lemeshow test also indicated good calibration, except for the CT model in low-middle income countries. External validation for unfavourable outcome at six months in high income countries showed that basic and CT models had good discrimination (C statistic 0.77 for both models) but poorer calibration. Conclusion: Simple prognostic models can be used to obtain valid predictions of relevant outcomes in patients with traumatic brain injury.

Published
2008

34. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): Randomised placebo-controlled trial

Author

Olldashi, F., Muzha, I., Filipi, N., Lede, R., Copertari, P., Traverso, C., Copertari, A., Vergara, E. A., Montenegro, C., De Huidobro, R. R., Surt, K., Cialzeta, J., Lazzeri, S., Pinero, G., Ciccioli, F., Videtta, W., Barboza, M. F., Svampa, S., Sciuto, V., Domeniconi, G., Bustamante, M., Waschbusch, M., Gullo, M. P., Drago, D. A., Linares, J. C. A., Camputaro, L., Troccoli, G., Galimberti, H., Tallott, M., Eybner, C., Buchinger, W., Fitzal, S., Mazairac, G., Oleffe, V., Grollinger, T., Delvaux, P., Carlier, L., Braet, V., Jacques, J. -M., De Knoop, D., Nasi, L., Choi, H. K., Schmitt, M., Gentil, A., Nacul, F., Barrios, P. B., Xinkang, C., Hua, L. S., Tian, H. H., Xiaodong, C., Gualteros, W., Otero, A. A., Arango, M., Ciro, J., Jaramillo, H., Garcia, G., Gonzalez, I., Gomez, C., Arias, A., Fonseca, M., Mora, C., Cabrera, E. G. L., Betancurth, J. L., Munoz, P., Quinonez, J. A., Castillo, M. E. G., Lopez, O., Yepes, R. P., Cuellar, D. L., Paez, G., Chaves, H. D., Ordonez, P. E., Plata, Riccardo, Pineda, M., Pulido, L. E., Jaramillo, J. S. V., Rebolledo, C., Palma, O., Soler, C., Pastrana, I., Falero, R., Perera, M. D., Garcia, A. A., Oliva, R., Delgado, H. L., Carnero, A. M., Lopez, B. L., Gallardo, A. L., Morales, A. O., Lezcano, H., Ferrer, M. I., Bess, I. Z., Canino, G. R., Ruiz, E. M. P., Cruz, O. G., Svoboda, P., Kantorova, I., Ochmann, J., Scheer, P., Kozumplik, L., Marsova, J., Edelmann, K., Chytra, I., Bosman, R., Andrejsova, H., Pachl, J., Burger, J., Kramar, F., Ulloa, M. I., Gonzalez, L., Daccach, A., Ortega, A., Cevallos, S., Cueva, B. Z., Ochoa, M., Tapia, J. V., Hurtado, J., Wong, M. C. S., Santos, R., Khamis, H., Abaza, A. H., Fekry, A., El Kordy, S., Shawky, T., El-Sayed, H., Khalil, N., Negm, N., Fisal, S., Shokry, H., Alamin, M., Elhusseny, A. Y., Radwan, A., Rashid, M., Gogichaisvili, T., Ingorokva, G., Gongadze, N., Otarashvili, A., Kleist, W., Kalkum, M., Ulrich, P., Andrews, N., Nakos, G., Karavelis, A., Archontakis, G., Myrianthefs, P., Yadav, Y., Yadav, S., Khatri, R., Baghel, A., Husain, M., Jha, D., Hoong Chhang, W., Dhandhania, M., Fonning, C., Iyengar, S. N., Gupta, S., Ravi, R. R., Bopiah, K. S., Herur, A., Venkataramana, N. K., Satish, A., Bhavadasan, K., Morris, R., Ramesh, S., Dewan, Y., Singh, Y., Bhagchandani, R., Bhagchandani, S., Sethurayar, V., Ipe, S., Sreekumar, G., Panigrahi, M., Reddy, A., Khosla, V., Pillay, H., Thomas, N., Sridhar, K., Jose, B., Kurian, N., Praharaj, S., Pillai, S., Ramana, Kiyawat, D., Maheshwari, K., Panikar, D., Chawla, J., Shenoy, S., Raja, A., Rupayana, Y., Reddy, S., Mohan, N., Kelkar, S., Johri, M., Golden, N., Maliawan, S., Fauzi, A., Farouk, U., Fakharian, E., Aramesh, A., Eghtedari, M., Ahmadzadeh, F., Gholami, A., Plunkett, P., Redican, C., Mcmahon, G., Annetta, Maria Giuseppina, Mouchaty, H., Bruzzone, E., Harding, B., Qureshi, M., Idris, Z., Abdullah, J., Ghazali, G., Ghani, A., Cheah, F., Gonzalez, J., Loria-Castellanos, J., Jackson, S., Hutchinson, R., Komolafe, E., Adeolu, A., Komolafe, M., Adeyemi-Doro, O., Bankole, F., Shehu, B., Danlami, V., Odebode, O., Oluwadiya, K., Sanni, A., Giebel, H., Kumar, S., Jooma, R., Mezquita, J., Ortiz Ovelar, C., Gonzales-Portillo, M., Rodriguez, D., Balica, L., Oprita, B., Sklerniacof, M., Steflea, L., Bandut, L., Danil, A., Iliescu, R., Ciurea, J., El-Dawlatly, A., Alwatidy, S., Al-Yafi, W., El-Dawlatly, M., Krunic-Protic, R., Janosevic, V., Tan, J., Seah, C., Trenkler, S., Humenansky, M., Stajancova, T., Schwendt, I., Laincz, A., Julius, Z., Maros, S., Firment, J., Cifranicova, M., Saniova, B., Kalig, K., Medekova, S., Wiszt, R., Macsuga, I., Hartzenberg, B., Du Plessis, G., Houlie, Z., Nathoo, N., Khumalo, S., Tracey, R., Munoz-Sanchez, A., Murillo-Cabezas, F., Flores-Cordero, J., Rincon-Ferrari, D., Rubi, M., Caler, L., Del Campo, M., Laguna, L., Manuel Nava, J., Minguillon, M., Lopez, A., Ramos-Gomez, L., De La Torre-Prados, V., Pellejero, R., Laloe, V., Mandrella, B., Suganthan, Perera, S., Mahendran, K., Stocker, R., Ludwig, S., Zimmermann, H., Denzler, U., Yutthakasemsunt, S., Kittiwattanagul, W., Watanachai, C., Subsompon, P., Pussanakawatin, W., Khunjan, P., Tangchitvittaya, S., Nilapong, S., Klangsang, T., Taechakosol, W., Srinat, A., Jerbi, Z., Borsali-Falfoul, N., Rezgui, M., Cakar, N., Ssenyonjo, H., Kobusingye, O., Lomas, G., Yates, D., Lecky, F., Bleetman, A., Baldwin, A., Jenkinson, E., Pantrini, S., Stewart, J., Contractor, N., Roberts, T., Butler, J., Pinto, A., Lee, D., Brayley, N., Robbshaw, K., Dix, C., Graham, S., Pye, S., Green, M., Kellins, A., Moulton, C., Fogg, B., Cottingham, R., Funnell, S., Shanker, U., Summers, C., Malek, L., Ashcroft, C., Powell, J., Moore, S., Buckley, S., Grocutt, M., Chambers, S., Morrice, A., Marshall, H., Harris, J., Matthews, W., Tippet, J., Mardell, S., Macmillan, F., Shaw, A., Luthra, P., Dixon, G., Ahmed, M., Young, M., Mason, S., Loveday, I., Clark, C., Taylor, S., Wilson, P., Ali, K., Greenwood, S., White, M., Perez, R., Eljamel, S., Wasserberg, J., Shale, H., Read, C., Mccarron, J., Pennell, A., Ray, G., Thurston, J., Brown, E., Jaffey, L., Graves, M., Bailey, R., Loveridge, N., Evans, G., Hughes, S., Richardson, J., Gallagher, C., Odedun, T., Lees, K., Foley, D., Payne, N., Pennycook, A., Griffiths, C., Moore, D., Byrne, D., Dasan, S., Banerjee, Abhishek, Mcguinness, S., Chikhani, C., Zoltie, N., Barlow, I., Stell, I., Hulse, W., Crossley, J., Watkins, L., Dorani, B., Vanviet, T., Saladino, P., Cabrera, A., Baigent, C., Bracken, M., Chadwick, D., Curley, K., Duley, L., Farrell, B., Haegi, M., Nickson, G., Peto, R., Pickard, J., Roberts, I., Sandercock, P., Teasdale, G., Collins, R., Haines, S., Macmahon, S., Warlow, C., Edwards, P., Ritchie, N., Shakur, H., Ramos, M., Barnetson, L., Fernandes, J., Tooth, D., Free, C., Narayanan, L., Collander, J., Abernethy, J., Bardswell, J., Mashru, R., Godward, C., Afolabi, L., Ritchie, A., Hosford, T., Collingwood, A., Massey, S., Plata R., Annetta M. (ORCID:0000-0001-7574-1311), Banerjee A., Olldashi, F., Muzha, I., Filipi, N., Lede, R., Copertari, P., Traverso, C., Copertari, A., Vergara, E. A., Montenegro, C., De Huidobro, R. R., Surt, K., Cialzeta, J., Lazzeri, S., Pinero, G., Ciccioli, F., Videtta, W., Barboza, M. F., Svampa, S., Sciuto, V., Domeniconi, G., Bustamante, M., Waschbusch, M., Gullo, M. P., Drago, D. A., Linares, J. C. A., Camputaro, L., Troccoli, G., Galimberti, H., Tallott, M., Eybner, C., Buchinger, W., Fitzal, S., Mazairac, G., Oleffe, V., Grollinger, T., Delvaux, P., Carlier, L., Braet, V., Jacques, J. -M., De Knoop, D., Nasi, L., Choi, H. K., Schmitt, M., Gentil, A., Nacul, F., Barrios, P. B., Xinkang, C., Hua, L. S., Tian, H. H., Xiaodong, C., Gualteros, W., Otero, A. A., Arango, M., Ciro, J., Jaramillo, H., Garcia, G., Gonzalez, I., Gomez, C., Arias, A., Fonseca, M., Mora, C., Cabrera, E. G. L., Betancurth, J. L., Munoz, P., Quinonez, J. A., Castillo, M. E. G., Lopez, O., Yepes, R. P., Cuellar, D. L., Paez, G., Chaves, H. D., Ordonez, P. E., Plata, Riccardo, Pineda, M., Pulido, L. E., Jaramillo, J. S. V., Rebolledo, C., Palma, O., Soler, C., Pastrana, I., Falero, R., Perera, M. D., Garcia, A. A., Oliva, R., Delgado, H. L., Carnero, A. M., Lopez, B. L., Gallardo, A. L., Morales, A. O., Lezcano, H., Ferrer, M. I., Bess, I. Z., Canino, G. R., Ruiz, E. M. P., Cruz, O. G., Svoboda, P., Kantorova, I., Ochmann, J., Scheer, P., Kozumplik, L., Marsova, J., Edelmann, K., Chytra, I., Bosman, R., Andrejsova, H., Pachl, J., Burger, J., Kramar, F., Ulloa, M. I., Gonzalez, L., Daccach, A., Ortega, A., Cevallos, S., Cueva, B. Z., Ochoa, M., Tapia, J. V., Hurtado, J., Wong, M. C. S., Santos, R., Khamis, H., Abaza, A. H., Fekry, A., El Kordy, S., Shawky, T., El-Sayed, H., Khalil, N., Negm, N., Fisal, S., Shokry, H., Alamin, M., Elhusseny, A. Y., Radwan, A., Rashid, M., Gogichaisvili, T., Ingorokva, G., Gongadze, N., Otarashvili, A., Kleist, W., Kalkum, M., Ulrich, P., Andrews, N., Nakos, G., Karavelis, A., Archontakis, G., Myrianthefs, P., Yadav, Y., Yadav, S., Khatri, R., Baghel, A., Husain, M., Jha, D., Hoong Chhang, W., Dhandhania, M., Fonning, C., Iyengar, S. N., Gupta, S., Ravi, R. R., Bopiah, K. S., Herur, A., Venkataramana, N. 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(ORCID:0000-0001-7574-1311), and Banerjee A.

Abstract

Background Corticosteroids have been used to treat head injuries for more than 30 years. In 1997, findings of a systematic review suggested that these drugs reduce risk of death by 1-2%. The CRASH trial—a multicentre international collaboration—aimed to confirm or refute such an effect by recruiting 20 000 patients. In May, 2004, the data monitoring committee disclosed the unmasked results to the steering committee, which stopped recruitment. Methods 10 008 adults with head injury and a Glasgow coma score (GCS) of 14 or less within 8 h of injury were randomly allocated 48 h infusion of corticosteroids (methylprednisolone) or placebo. Primary outcomes were death within 2 weeks of injury and death or disability at 6 months. Prespecified subgroup analyses were based on injury severity (GCS) at randomisation and on time from injury to randomisation. Analysis was by intention to treat. Effects on outcomes within 2 weeks of randomisation are presented in this report. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN74459797. Findings Compared with placebo, the risk of death from all causes within 2 weeks was higher in the group allocated corticosteroids (1052 [21·1%] vs 893 [17·9%] deaths; relative risk 1·18 [95% CI 1·09-1·27]; p=0·0001). The relative increase in deaths due to corticosteroids did not differ by injury severity (p=0·22) or time since injury (p=0·05). Interpretation Our results show there is no reduction in mortality with methylprednisolone in the 2 weeks after head injury. The cause of the rise in risk of death within 2 weeks is unclear.

Published
2004

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