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Salvage Therapy for Childhood Medulloblastoma: A Single Center Experience
- Michelle M. Kameda-Smith, Alick Wang, Noora Abdulhadi, Rebecca Voth, Anjali Sergeant, Arjuna Maharaj, David Bakhshinyan, Ashley A. Adile, Akshat M. Pai, Olufemi Ajani, Blake Yarascavitch, M. Cheryl Alyman, JoAnn Duckworth, M. Constantine Samaan, Forough Farrokhyar, Sheila K. Singh, Adam Fleming, on behalf of the Pediatric Brain Tumour Study Group
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 46 / Issue 4 / July 2019
- Published online by Cambridge University Press:
- 11 July 2019, pp. 403-414
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Introduction: Children diagnosed with medulloblastoma (MB) who are refractory to upfront therapy or experience recurrence have very poor prognoses. Although phase I and phase II trials exist, these treatments bear significant treatment-related morbidity and mortality. Methods: A retrospective review of children diagnosed with a recurrence of MB from 2002 to 2015 at McMaster University was undertaken. Results: Recurrent disease in 10 patients involved leptomeningeal dissemination, with 3 experiencing local recurrence. In three recurrent patients the disease significantly progressed, and the children were palliated. The remaining 10 children underwent some form of salvage therapy, including surgical re-resection, radiation, and chemotherapy, either in isolation or in varying combinations. Of the 13 children experiencing treatment-refractory or recurrent disease, 4 are currently alive with a median follow-up of 38.5 months (75.5 months). Of the eight patients with molecular subgrouping data, none of the Wnt MB experienced recurrence. Conclusion: Recurrent MB carried a poor prognosis with a 5-year overall survival (OS) of 18.2% despite the administration of salvage therapy. The upfront therapy received, available treatment, and tolerability of the proposed salvage therapy resulted in significant heterogeneity in the treatment of our recurrent cohort.
Road Traffic Injury in Lagos, Nigeria: Assessing Prehospital Care
- Nasiru A. Ibrahim, Abdul Wahab O. Ajani, Ibrahim A. Mustafa, Rufai A. Balogun, Mobolaji A. Oludara, Olufemi E. Idowu, Babatunde A. Solagberu
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- Journal:
- Prehospital and Disaster Medicine / Volume 32 / Issue 4 / August 2017
- Published online by Cambridge University Press:
- 02 May 2017, pp. 424-430
- Print publication:
- August 2017
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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.
MethodsA 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.
ResultsA 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.
ConclusionLess 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 .