Efficacy of different hypertonic solutes in the treatment of refractory intracranial hypertension in severe head injury patients: A comparative study of 2ml/kg 7.5% hypertonic saline and 2ml/kg 20% mannitol

2007 ◽  
Vol 04 (02) ◽  
pp. 101-107 ◽  
Author(s):  
Nilay Chatterjee ◽  
Arpan Chaudhury ◽  
Sujoy Mukherjee ◽  
Gouri Kumar Prusty ◽  
Tapas Chattopadhyay ◽  
...  
Keyword(s):  
Head Injury ◽  
Intracranial Hypertension ◽  
Hypertonic Saline ◽  
Severe Head Injury ◽  
Randomized Study ◽  
Tertiary Care ◽  
Hypertonic Solution ◽  
Care Hospital ◽  
Hypertonic Saline Solution ◽  
The Mean

AbstractA prospective, randomized study to evaluate the clinical benefit of increasing the osmotic load of the hypertonic solution administered for the treatment of refractory intracranial hypertension episodes in patients with severe head injury. 25 patients with severe head injury and persistent coma, admitted in a Neurocritical Care Unit of a Tertiary Care Hospital, who required infusions of osmotic agents to treat episodes of intracranial hypertension resistant to well defined standard modes of therapy were randomly allocated to one of the two groups to receive isovolume infusions of either 7.5% hypertonic saline solution; HS [2400 mOsm/kg H2O] or 20% mannitol [1160 mOsm/kg of H2O] given 2ml/kg of either solution, i.e. 331.5 +/− 35.4 mOsm of hypertonic saline or 174.2 +/− 18 mOsm of mannitol per infusion. The variables recorded in the study were the duration and number of episodes of intracranial hypertension per day during the study period, which was stopped after the last episode of intracranial hypertension was recorded from intracranial pressure recording or after the allocated treatment failure. Patients of HS group were monitored for 7 +/− 6 days and those in the mannitol group for 8 +/− 5 days [p=NS]. The rate of failure for each treatment was also evaluated which was defined as the persistence of intracranial hypertension despite the two successive infusions of the same osmotic agent. The mean number of osmotic solute infusions was 3.4 +/− 4.5 in the HS group and 3.8 +/− 5.1 in mannitol group p=NS]. The mean number [7.1+/-2.9 vs. 14.6+/−3.4] of episodes of intracranial hypertension per day and the duration of such episode [62.6+/−28.1 vs. 93.4+/−37.2 min] was also significantly lower in the HS group [p<0.05]. The numbers of treatment failures were significantly lower in HS group: 1 out of 14 patients vs. 6 out of 11 patients [p<0.01]. In this study we have found that in patients with severe head injury requiring treatment with hypertonic solute for refractory intracranial hypertension, 2ml/kg body weight of 7.5% HS [356 +/− 14 mOsm] was more effective than giving 2ml/kg 20% mannitol [178 +/− 11mOsm]. Within the limitations of present study, the collected data suggest that giving 2ml/kg HS solution is an effective and safe initial treatment for intracranial hypertension episodes in head injury patients when there is indication of osmotherapy.

Phenytoin Prophylaxis in Posttraumatic Head Injury

1996 ◽  
Vol 12 (4) ◽  
pp. 160-164
Author(s):  
Stephen O Ohimor ◽  
Robert E Falcone
Keyword(s):  
Head Injury ◽  
Trauma Center ◽  
Severe Head Injury ◽  
Seizure Activity ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Posttraumatic Epilepsy ◽  
Trauma Service ◽  
The Face

Objective: To identify the effectiveness of prophylactic phenytoin in preventing posttraumatic epilepsy. Design: Retrospective cohort study. Setting: Urban tertiary-care hospital and trauma center. Subjects: Patients admitted to the trauma service in 1989 with moderate to severe head injury surviving to discharge. Interventions: Divided into two groups based on prophylaxis with phenytoin. Measurements and Main Results: Ninety-one patients with moderate to severe head injury were admitted during the study period; 6 were excluded from analysis for prehospital seizure activity. Forty-one patients received no anticonvulsants; 44 received phenytoin alone or in combination with other agents. None of the patients experienced a seizure during hospitalization. Seventy-four percent of all phenytoin concentrations were subtherapeutic (serum phenytoin 10–20 μg/mL). Conclusions: The lack of seizure activity in the face of absent or subtherapeutic phenytoin concentrations brings into question the benefit of prophylactic therapy.

scholarly journals The Outcome of Cervical Spine Injury Associated with Traumatic Brain Injuries: Tertiary Care Hospital Study

2021 ◽  
pp. 763-768
Author(s):  
Sher Hassan ◽  
Aurangzeb Kalhoro ◽  
Lal Rehman ◽  
Abdul Samad
Keyword(s):  
Cervical Spine ◽  
Head Injury ◽  
Cervical Spine Injury ◽  
Severe Head Injury ◽  
Brain Injuries ◽  
Tertiary Care ◽  
Traumatic Brain Injuries ◽  
Spine Injury ◽  
Care Hospital ◽  
Cervical Injury

Objective:  Outcome of cervical spine injury associated with traumatic brain injuries. Materials & Methods: This study is a cross-sectional descriptive study that was performed at the Jinnah Post Graduate Medical Centre, Karachi. 158 total patients were included in the study, this study by non-probability consecutive sampling. The diagnosis was based primarily on a CT scan brain plain and an x-ray of the cervical spine of all the patients who were admitted to the ward. Results: Among 158, the age distribution of the patient was observed as 43(27%)patients presented as less than 20 years, 32(20%) were between the age of 21-30 years range, 28(18%) patients were ranged between 31-40 years, 16(10%) patients aged in a range of 41-50 years while 39(25%) were above 50 years. Head injury severity was observed at 47% as mild head injury, 32% as moderate injury and 21% had a severe head injury while cervical injury in association with traumatic brain injury was found in 10% of patients. Conclusion: The prevalence of cervical traumatic injury associated with moderate to severe head injury remained similar in the world overall with minute differences in the percentages that we have noticed in our study. The severity of the head injury is directly proportional to cervical injury.

scholarly journals Gender-wise Comparative Assessment of Lifestyle Patterns and Well-being Status among Healthcare Employees at a Tertiary Care Hospital

2021 ◽  
Author(s):  
Vanajakshamma Velam ◽  
Vyshnavi Kancherla ◽  
Latheef Kasala ◽  
Anusha Kancherla ◽  
Mounica Reddy Pillaram
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Well Being ◽  
Care Hospital ◽  
Cross Sectional ◽  
Significant Difference ◽  
Female Employees ◽  
The Mean ◽  
Lifestyle Patterns ◽  
Comprehensive Study

Abstract Background This study was an attempt to assess and compare the gender-wise lifestyle patterns and well-being status among the employees of a tertiary care teaching hospital. Material and Methods This is a cross-sectional, questionnaire-based study conducted at a tertiary care hospital between May and August 2019. A total of 777 employees belonging to both genders (male and female) and working at different professional levels were assessed. All the enrolled employees were subjected to a comprehensive study tool consisting of various dimensions of their health, which included physical, mental, social, spiritual and intellectual health dimensions. Results Among the participants, 327 (42.1%) were male and 450 (57.9%) were female. There was no significant difference in the mean age of male (37.91 ± 7.52) and female (36.85 ± 8.16) employees (p = 0.07). A significantly higher proportion of diabetes and hypertension were seen in male employees (9.8% and 14.4%, respectively) than in female (5.6% and 6.2% respectively). The overall well-being was better in male employees than in females and was statistically significant (p < 0.0001). We found that male employees had statistically significant better well-being in terms of physical, mental and social health whereas female employees had intellectual health. Conclusion The overall well-being in healthcare staff was good at our tertiary care hospital, and the outstanding/good well-being rate was higher in male employees than in female employees. Female employees experienced risks with regard to their physical health.

scholarly journals Epidemiology and Treatment Outcomes of Head Injury in Bangladesh: Perspective from the Largest Tertiary Care Hospital

2021 ◽  
Author(s):  
Sukriti Das ◽  
Bipin Chaurasia ◽  
Dipankar Ghosh ◽  
Asit Chandra Sarker
Keyword(s):  
Head Injury ◽  
Road Traffic ◽  
Head Injuries ◽  
Skull Fracture ◽  
Tertiary Care ◽  
Acute Subdural Hematoma ◽  
Care Hospital ◽  
Female Ratio ◽  
Mortality And Morbidity ◽  
The Government

Abstract Background Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity. Economic impact is much worse in developing countries like Bangladesh, as victims are frequently male, productive, and breadwinners of the families. Objectives The objective of our study was to highlight the etiological pattern and distribution of varieties of head injuries in Bangladesh and give recommendations regarding how this problem can be solved or reduce to some extent at least. Methods From January 2017 to December 2019, a total of 14,552 patients presenting with head injury at emergency got admitted in Neurosurgery department of Dhaka Medical College and Hospital and were included in this study. Results The most common age group was 21 to 30 years (36%: 5,239) with a male-to-female ratio of 2.6:1. Injury was mostly caused by road traffic accident (RTA [58.3%: 8,484]), followed by fall (25%: 3,638) and history of assault (15.3%: 2,226). The common varieties of head injury were: acute extradural hematoma (AEDH [42.30%: 1,987]), skull fracture either linear or depressed (28.86%: 1,347), acute subdural hematoma (ASDH [12.30%: 574]), brain contusion (10.2%: 476), and others (6.04%: 282). Conclusion RTA is the commonest cause of TBI, and among them motor bike accident is the severe most form of TBI. AEDH is the commonest variety of head injuries. Proper steps taken by the Government, vehicle owners, and drivers, and proper referral system and prompt management in the hospital can reduce the mortality and morbidity from TBI in Bangladesh.

scholarly journals The clinical profile, management, and outcome of febrile neutropenia in acute myeloid leukemia from resource constraint settings

2021 ◽  
Vol 8 ◽  
pp. 204993612110365
Author(s):  
Kundan Mishra ◽  
Suman Kumar ◽  
Sandeep Ninawe ◽  
Rajat Bahl ◽  
Ashok Meshram ◽  
...  
Keyword(s):  
Overall Survival ◽  
Acute Myeloid Leukemia ◽  
Febrile Neutropenia ◽  
Burkholderia Cepacia ◽  
Myeloid Leukemia ◽  
Tertiary Care ◽  
Care Hospital ◽  
Significant Difference ◽  
The Mean ◽  
Acute Myeloid

Introduction: Acute myeloid leukemia (AML) is the commonest leukemia in adults. Mortality in thew first 30-days ranges from 6% to 43%, while infections account for 30–66% of early deaths. We aim to present our experience of infections in newly-diagnosed AML. Method: This prospective, observational study, was undertaken at a tertiary care hospital in Northern India. Patients with confirmed AML (bone marrow morphology and flow cytometry) and who had developed febrile neutropenia (FN), were included. Result: A total of fifty-five patients were included in the study. The median age of the patients was 47.1 years (12–71) and 28 (50.9%) were males. Fever (33, 60%) was the commonest presentation at the time of diagnosis. One or more comorbid conditions were present in 20 patients (36.36%). Infection at presentation was detected in 17 patients (30.9%). The mean duration to develop febrile neutropenia since the start of therapy was 11.24 days. With each ten-thousand increase in white blood cell (WBC) count, the mean number of days of FN development decreased by 0.35 days ( p = 0.029). Clinical and/or radiological localization was possible in 23 patients (41.81%). Thirty-four blood samples (34/242, 14.04%) from 26 patients (26/55, 47.3%) isolated one or more organisms. Gram negative bacilli (GNB) were isolated in 24 (70.58%) samples. Burkholderia cepacia (8/34, 23.52%) was the commonest organism. The number of days required to develop febrile neutropenia was inversely associated with overall survival (OS). However, when compared, there was no statistically significant difference in OS between patients developing fever on day-10 and day-25 ( p = 0.063). Thirteen patients (23.63%) died during the study period. Discussion: Low percentage of blood culture positivity and high incidence of MDR organisms are a matter of concern. Days to develop febrile neutropenia were inversely associated with overall survival (OS), emphasizing the importance of preventive measures against infections. Conclusion: Infections continues to be a major cause of morbidity and mortality among AML patients.

scholarly journals Attitude and Practice of Contraception among Gynecologists at a Tertiary Care Hospital

2013 ◽  
Vol 5 (3) ◽  
pp. 129-131 ◽  
Author(s):  
Sunita Hemani ◽  
Premlata Mital
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Healthcare Providers ◽  
Care Hospital ◽  
Barrier Method ◽  
Unintended Pregnancies ◽  
Attitude And Practice ◽  
Complete Knowledge ◽  
The Mean ◽  
Medical Healthcare

ABSTRACT Medical healthcare providers are an important link with the general public to impart knowledge regarding contraception. However, their own attitude and practice of contraception is often lacking. Objective This study was conducted to assess the attitude and practice of contraception over the last 5 years of the gynecologists themselves in a tertiary care hospital in Jaipur. Materials and methods The study was conducted on 125 female gynecologists in a tertiary care hospital in Jaipur. All were given a questionnaire which was duly filled by them and data obtained was analyzed. Results All the doctors used some form of contraception. The mean age was 29.32 years. The commonest was the barrier method (38.4%) followed by OC pills (27.2%). Twenty-one percent of the barrier users used them occasionally. Emergency contraception was used by either those using natural methods of contraception or who were occasional users of OC pills or condoms. Fifty percent of the couples relying on natural methods conceived. Conclusion Gynecologists have complete knowledge regarding contraception, yet fail to use it regularly. Proper attitude and practice is essential to prevent unintended pregnancies. How to cite this article Hemani S, Hooja N, Mital P. Attitude and Practice of Contraception among Gynecologists at a Tertiary Care Hospital. J South Asian Feder Obst Gynae 2013;5(3): 129-131.

A Comparative Study of Endoscopic Coblation Adenoidectomy and Regular Curettage Adenoidectomy in a Tertiary Care Hospital in Kerala

2021 ◽  
Vol 8 (41) ◽  
pp. 3559-3566
Author(s):  
Abdul Salam R. T. ◽  
Shahul Hameed A. ◽  
Meera Rajan
Keyword(s):  
Blood Loss ◽  
Comparative Study ◽  
Tertiary Care ◽  
Operation Time ◽  
Care Hospital ◽  
Adenoid Tissue ◽  
Significant Difference ◽  
Tube Function ◽  
Prospective Comparative Study ◽  
The Mean

BACKGROUND An ideal surgery to remove hypertrophied adenoid mass should be safe, with less bleeding and operation time along with post-operative improvement in the eustachian tubal ventilation and normal respiration. It should also have low morbidity and mortality. Among the various methods described for its removal, the two commonly used methods are conventional cold curettage method and coblation technique. The purpose of this study was to collate the safety and efficacy of endoscopic coblation adenoidectomy with the conventional curettage adenoidectomy. METHODS A prospective comparative study with fifty patients was studied who underwent adenoidectomy. Twenty five patients underwent endoscopy assisted coblation adenoidectomy and twenty five patients underwent regular adenoidectomy by curettage. RESULTS Patients who underwent coblation adenoidectomy showed better results during follow up in terms of completeness of removal. 80 % of children undergoing regular adenoidectomy by curettage method showed remnant adenoid tissue in the nasopharynx at the end of the procedure. But it was 6 % among the children undergoing endoscopic assisted coblation adenoidectomy. The mean duration of operation was higher for endoscopic assisted coblation adenoidectomy which was significant statistically. The mean blood loss was 30.36 ml in regular curettage adenoidectomy; 10.6 ml with endoscopic coblation adenoidectomy. The grading of pain was significantly lower in endoscopic assisted coblation adenoidectomy. There was no significant difference between two groups in terms of eustachian tube function after surgery. CONCLUSIONS Coblation adenoidectomy has significant advantages over conventional adenoidectomy in terms of completeness of removal, reduced blood loss, and lower post-operative pain grade. KEYWORDS Coblation, Adenoidectomy, Curettage, Haemorrhage and Complications

First and second wave of COVID-19: A comparative study of tertiary care hospitalized patients in Jalgaon, Maharashtra

2021 ◽  
Vol 19 (3) ◽  
pp. 23-29
Author(s):  
Yogita G Bavaskar ◽  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical History ◽  
Care Hospital ◽  
Age Group ◽  
Number Of Patients ◽  
The Mean ◽  
Collection Form ◽  
Time Of Admission ◽  
Second Wave

Background: Most of the countries including India have witnessed two or more waves of Covid 19 pandemic. The present study was conducted to compare the differences in clinico-demographic characteristics and outcomes of Covid 19 patients admitted in first and second wave of Covid 19 pandemic in a tertiary care hospital at Jalgaon, Maharashtra. Methods: A retrospective observational study was conducted at a tertiary care Dedicated Covid hospital for Covid 19 at Jalgaon, Maharashtra. All microbiologically proven corona positive patients were included in the study. The demographic records and clinical history was extracted from the case history sheets of the patients from first as well as second wave using standardized data collection form. Clinical outcome of the patients, i.e., development of complications, death or discharge was also recorded for each enrolled subject. Results: 3845 patients of Covid-19 admitted in the hospital during the first wave of epidemic and 2956 patients during second wave of the epidemic were included in the study. The mean age of patients admitted in the second wave was significantly lower as compared to first [48.77(15.31) years vs 50.23 (14.33) years, P<0.005]. There is increase in proportion of patients in the age group of < 15 years in second wave as compared to first wave (74/2956, 2.5% vs 52/3845, 1.3%). The number of patients requiring admission in ICU at the time of admission increased by 13% in second wave as compared to first wave. [827/2956 (28%) vs 577/3845(15%), P<0.0001]. More than half of the patients who got admitted for Covid 19 in first as well as second wave were having one or more comorbidities.But the proportion of the patients with previous co-morbities was significantly higher in second wave (1684/2956, 57% vs 1960/ 3845, 51%, P= 0.0004). The mortality was also higher in second wave (533/2956, 18.03% vs 541/3845, 14%, P=0.0004). Conclusions: The demographic, clinical characteristics and outcome of Covid 19 patients was different in first and second wave of pandemic with involvement of younger patients, increased rates of admission to ICU and more mortality in the second wave as compared to first wave of the pandemic.

Spinal Surgery During COVID-19 Pandemic in Saudi Arabia

2021 ◽  
pp. 12
Author(s):  
Faisal Konbaz ◽  
Taif Alqahtani ◽  
Nada Alharthi ◽  
Mohammad Baraja ◽  
Nazish Masud ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Tertiary Care ◽  
Case Series ◽  
Medical Intervention ◽  
Care Hospital ◽  
Hospital Data ◽  
Chi Square ◽  
Chi Square Test ◽  
The Mean ◽  
American Society

Introduction: The COVID-19 pandemic has challenged the healthcare system’s capacities around the world. Due to the alarming situation, medical activities have been restricted to allocate resources to treat COVID-19-infected patients. However, medical emergencies still need urgent medical intervention. Considering the lack of reliable data regarding spinal surgeries during the COVID-19 pandemic, the present study sought to analyze the pattern of spinal surgeries in KSA. Methodology: A case series of patients who had urgent spine surgeries during COVID-19 pandemic was conducted in a tertiary care hospital. Data on patients’ demographics, COVID-19 test result, American Society of Anesthesia Score, SSS grade, diagnosis, and data related to surgery and postoperative findings were collected. All collected data were then processed and analyzed. Surgical outcomes based on source of admission were compared using Chi-square test. Result: A total of 63 patients who underwent spine surgery during the COVID-19 pandemic were included. The mean age of the patients was 53 ± 18 years and males were predominant (59%). The positive COVID-19 patients were 3%. Almost half of the patients were classified into ASA II. The majority were categorized into grade B (65%) according to SSS. The frequently diagnosed condition was fracture (33%), followed by spinal stenosis (18%) and metastatic (10%), while the most mentioned location was lumbar (61%). Postoperative complications were found in 11% of the patients. The readmission rate within 30 days, unplanned return to OR and ICU admission were 19%, 13%, and 11%, respectively. While the mean duration between admission and surgery was 8 ± 20 days, the mean duration of length of stay was 20 ± 29 days. Further, a significant association was seen between the admission source and the surgical procedure performed and surgical indication. Conclusion: It has been demonstrated that the surgical intervention was only provided to patients requiring immediate or urgent spinal management. However, the length of hospitalization and duration between hospital admission and surgery was substantially prolonged. Further studies are warranted to determine the factors leading to prolonged hospitalization and time between hospital admission and surgery.

scholarly journals The Pattern of Day Case (Ambulatory) Percutaneous (PCNL): A Descriptive Retrospective Study from a Tertiary Care Hospital

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Rehan Fareed ◽  
Huma Shamim
Keyword(s):  
Retrospective Study ◽  
Tertiary Care ◽  
Ureteral Stones ◽  
Transfusion Rate ◽  
Care Hospital ◽  
High Grade ◽  
High Grade Fever ◽  
Access Methods ◽  
The Mean ◽  
Staghorn Stones

Background: Percutaneous nephrolithotomy (PCNL) has experienced remarkable development and alteration since it was first described in 1976 by Fernstorm et al. It has also experienced miniaturization of equipment, improvement in operative systems, and refining renal access methods leading to the achievement of maximum clearance of stone while causing minimal morbidity. For example, in endourological practice, when the patient is subjected to PCNL, he traditionally needs programmed inpatient admission, as part of their recovery, it is applicable as an outpatient method in properly selected cases. Objectives: We aimed at evaluating the safety and applicability of the outpatient PCNL procedure. Methods: This retrospective study was done on 210 cases of tubeless PCNL performed by a single urologist at our institute from January 2016 to January 2019. Patients’ mean age (134 males and 76 females) was 57 ± 11.8 years, and 7 patients aged 8 - 12 years. There were 71 pelvic or calyceal solitary stones, 62 non-complete staghorn stones, 17 ureteral stones, 32 renal + ureteric stones (simultaneous renal and ureteral stones) , and 28 complete staghorn stones. The average stone size was 3.5 ± 2.8 (range: 0.7 to 11.8 cm). Results: The mean operation duration was 85.0 ± 29.4 min, and the mean hospital stay was 21.7 ± 3.4 h. Out of 210 patients, 6 patients had longer stay due to high-grade fever and 3 patients due to severe pain, and also 7 patients refused discharge due to personal and social reasons. Our ambulatory PCNL rate was 97 % ( 194 out of 210). Within 72 h, 5 patients were readmitted due to high-grade fever, 3 patients due to haematuria, and 4 patients due to pain and dysuria, and all patients were discharged 2 - 4 days after conservative treatment. Thus, the readmission rate was 6.18% (12 cases were readmitted out of 194 cases). Patients showed a blood transfusion rate of 1.4 %. Also, 19 cases (9.02%) were found with post-operative fever, and no urosepsis was reported. No pulmonary complications and mortality were noted. No re-exploration was done, and no major leak was noted. The angio-embolization rate was 0.59%. We did not use HEMO-SEAL technology, cautery, or suture in the tracks. Conclusions: In conclusion, the outpatient PCNL procedure is an applicable and feasible procedure under selected criteria; however, more investigations using a larger sample size are needed.

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