scholarly journals Hypopituitarism other than sellar and parasellar tumors or traumatic brain injury assessed in a tertiary hospital

2019 ◽  
Vol 35 (4) ◽  
Author(s):  
Sarwar Malik ◽  
Zareen Kiran ◽  
Muhammad Owais Rashid ◽  
Minaz Mawani ◽  
Asma Gulab ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Empty Sella ◽  
University Hospital ◽  
Imaging Data ◽  
Empty Sella Syndrome ◽  
Secondary Hypothyroidism

Objective: Data regarding the etiology, clinical and biochemical patterns in hypopituitarism is scant for Pakistan. We describe the characteristics of patients with hypopituitarism other than sellar and parasellar tumors or traumatic brain injury from a tertiary care center in Pakistan. Methods: We conducted a retrospective descriptive study in the Aga Khan University Hospital, Karachi, Pakistan. We studied all patients presenting with hypopituitarism, between January 2004 and December 2013. Clinical, hormonal and imaging data pertinent to the study was collected according to inclusion criteria. Results: Forty-two patients presented to the endocrinology clinics at the Aga Khan University Hospital during the study period. Thirty-seven patients (88.1%) were females. Mean age ± standard deviation of the participants was 53.8 ± 14.7 years. Sixteen patients had secondary infertility and all were females; a majority of patients in this group had Sheehan’s syndrome (n=8) followed by empty sella syndrome (n=3), partial empty sella syndrome (n=2), idiopathic cause (n=2) and tuberculoma (n=1). Eighteen females (48.6%) reported inability to lactate. Conclusions: Non-traumatic hypopituitarism was more common in women, with Sheehan syndrome being the most common cause of hypopituitarism in our study (35.7%). Secondary hypothyroidism was the most common hormonal deficiency. The most commonly reported symptom was weakness. doi: https://doi.org/10.12669/pjms.35.4.174 How to cite this:Malik S, Kiran Z, Rashid MO, Mawani M, Gulab A, Masood MQ, et al. Hypopituitarism other than sellar and parasellar tumors or traumatic brain injury assessed in a tertiary hospital. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.174 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals 198 Outcomes Following Exploratory Burr Holes for Traumatic Brain Injury in a Resource-Poor Setting

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 253-253
Author(s):  
Jessica C Eaton ◽  
Asma Bilal Hanif ◽  
Gift Mulima ◽  
Chifundo Kajombo ◽  
Anthony Charles
Keyword(s):  
Traumatic Brain Injury ◽  
Logistic Regression ◽  
Brain Injury ◽  
Care Center ◽  
Tertiary Care ◽  
Total Mortality ◽  
Resource Poor Setting ◽  
Trauma Patients ◽  
Therapeutic Procedure ◽  
Burr Holes

Abstract INTRODUCTION Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Low- and middle-income countries (LMICs) suffer from a high incidence of and mortality from TBI. Computed tomography (CT) scan is the diagnostic method of choice, but is often inaccessible in LMICs, where exploratory burr holes (EBH) remain a necessary diagnostic and therapeutic procedure. We sought to describe indications and outcomes of patients undergoing EBH at our sub-Saharan African tertiary care center. METHODS We performed a retrospective review of prospectively collected data at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi. All trauma patients presenting between June 2012 and July 2015 with a deteriorating level of consciousness and localizing signs who underwent EBH were included. Additionally, we included all patients admitted with TBI, requiring higher-level care during 2011. Because there was no neurosurgeon on staff in 2011, no patients underwent EBH. We performed logistic regression to identify predictors of mortality in the total population of TBI patients. RESULTS >241 patients presented to KCH with TBI requiring higher-level care, with a total mortality of 16.4% (Table 1). 163 (68%) underwent EBH. Of patients that underwent EBH, 87.6% of patients had intraoperative findings, with subdural hematoma being the most common (51.2%). Mortality in patients who underwent EBH was 6.8%. In surviving patients who underwent exploratory burr hole, 71.1% had a favorable outcome, defined as good recovery or moderate disability on the Glasgow Outcome Scale. Mortality in patients that did not undergo EBH was 43.9%. Upon logistic regression adjusted for age, sex, and Glasgow Coma Score, not undergoing EBH significantly increased the odds of mortality (OR = 12.0, P = 0.000, 95% CI = 4.48-31.9). CONCLUSION EBH remain an important diagnostic and therapeutic procedure for TBI in LMICs. In low-resource settings, EBH technique should be incorporated into general surgery education to attenuate TBI-related mortality.

scholarly journals Low rate of delayed deterioration requiring surgical treatment in patients transferred to a tertiary care center for mild traumatic brain injury

2010 ◽  
Vol 29 (5) ◽  
pp. E3 ◽  
Author(s):  
Andrew P. Carlson ◽  
Pedro Ramirez ◽  
George Kennedy ◽  
A. Robb McLean ◽  
Cristina Murray-Krezan ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
High Resource ◽  
Interhospital Transfer ◽  
Neurosurgical Intervention

Object Patients with mild traumatic brain injury (mTBI) only rarely need neurosurgical intervention; however, there is a subset of patients whose condition will deteriorate. Given the high resource utilization required for interhospital transfer and the relative infrequency of the need for intervention, this study was undertaken to determine how often patients who were transferred required intervention and if there were factors that could predict that need. Methods The authors performed a retrospective review of cases involving patients who were transferred to the University of New Mexico Level 1 trauma center for evaluation of mTBI between January 2005 and December 2009. Information including demographic data, lesion type, need for neurosurgical intervention, and short-term outcome was recorded. Results During the 4-year study period, 292 patients (age range newborn to 92 years) were transferred for evaluation of mTBI. Of these 292 patients, 182 (62.3%) had an acute traumatic finding of some kind; 110 (60.4%) of these had a follow-up CT to evaluate progression, whereas 60 (33.0%) did not require a follow-up CT. In 15 cases (5.1% overall), the patients were taken immediately to the operating room (either before or after the first CT). Only 4 patients (1.5% overall) had either clinical or radiographic deterioration requiring delayed surgical intervention after the second CT scan. Epidural hematoma (EDH) and subdural hematoma (SDH) were both found to be significantly associated with the need for surgery (OR 29.5 for EDH, 95% CI 6.6–131.8; OR 9.7 for SDH, 95% CI 2.4–39.1). There were no in-hospital deaths in the series, and 97% of patients were discharged with a Glasgow Coma Scale score of 15. Conclusions Most patients who are transferred with mTBI who need neurosurgical intervention have a surgical lesion initially. Only a very small percentage will have a delayed deterioration requiring surgery, with EDH and SDH being more concerning lesions. In most cases of mTBI, triage can be performed by a neurosurgeon and the patient can be observed without interhospital transfer.

Long Term Symptoms and Limitations of Activity of People with Traumatic Brain Injury: A Ten-Year Follow-up

2005 ◽  
Vol 97 (1) ◽  
pp. 169-179 ◽  
Author(s):  
C. O'Connor ◽  
A. Colantonio ◽  
H. Polatajko
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Care Center ◽  
Tertiary Care ◽  
Consecutive Series ◽  
Post Injury ◽  
What Is Said

This study examined the effect of Traumatic Brain Injury 10 years post-injury. Frequencies of head injury symptoms and activity limitation by level of severity were measured in a consecutive series of 61 adults who were admitted to a tertiary-care center for traumatic brain injury. Irritability and Anxiety were the most frequently reported symptoms from the Head Injury Symptom Checklist. Bothered by noise and Bothered by light were the least frequently reported. Trouble hearing what is said in a group conversation and Trouble hearing what is said in a one-to-one conversation were the most commonly reported limitations of activity from the Health and Activity Limitations Survey. Overall, this study illustrates that symptoms remain many years following brain injury, irrespective of the injury's severity.

scholarly journals Experience of a Pituitary Clinic for US Military Veterans With Traumatic Brain Injury

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Jonathan Lee ◽  
Lindsey J Anderson ◽  
Dorota Migula ◽  
Kevin C J Yuen ◽  
Lisa McPeak ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Care Center ◽  
Hormone Replacement ◽  
Tertiary Care ◽  
Puget Sound ◽  
Symptom Burden ◽  
Hormone Deficiency ◽  
Pituitary Hormone ◽  
Pituitary Dysfunction

Abstract Context Traumatic brain injury (TBI) is considered the “signature” injury of veterans returning from wartime conflicts in Iraq and Afghanistan. While moderate/severe TBI is associated with pituitary dysfunction, this association has not been well established in the military setting and in mild TBI (mTBI). Screening for pituitary dysfunction resulting from TBI in veteran populations is inconsistent across Veterans Affairs (VA) institutions, and such dysfunction often goes unrecognized and untreated. Objective This work aims to report the experience of a pituitary clinic in screening for and diagnosis of pituitary dysfunction. Methods A retrospective analysis was conducted in a US tertiary care center of veterans referred to the VA Puget Sound Healthcare System pituitary clinic with a history of TBI at least 12 months prior. Main outcome measures included demographics, medical history, symptom burden, baseline hormonal evaluation, brain imaging, and provocative testing for adrenal insufficiency (AI) and adult-onset growth hormone deficiency (AGHD). Results Fatigue, cognitive/memory problems, insomnia, and posttraumatic stress disorder were reported in at least two-thirds of the 58 patients evaluated. Twenty-two (37.9%) were diagnosed with at least one pituitary hormone deficiency, including 13 (22.4%) AI, 12 (20.7%) AGHD, 2 (3.4%) secondary hypogonadism, and 5 (8.6%) hyperprolactinemia diagnoses; there were no cases of thyrotropin deficiency. Conclusion A high prevalence of chronic AI and AGHD was observed among veterans with TBI. Prospective, larger studies are needed to confirm these results and determine the effects of hormone replacement on long-term outcomes in this setting.

scholarly journals A PROSPECTIVE STUDY OF TRAUMATIC BRAIN INJURY (TBI) AT TERTIARY CARE CENTER

2021 ◽  
Vol 5 (7) ◽  
Author(s):  
Govind Mangal ◽  
Uday Bhaumik ◽  
Gaurav Varnwal ◽  
Giriraj Prajapati
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Trauma Center ◽  
Care Center ◽  
Tertiary Care ◽  
Study Group ◽  
Age Group ◽  
Trauma Injury ◽  
A Prospective Study ◽  
Traffic Rules

Background: Worldwide, traumatic brain injury (TBI) is the single largest cause of death and disability following injury. Most TBI’s are due to road side accidents. According to WHO data, by the year 2020, head trauma will be third largest killer in the developing world. Methods: The present study was conducted in Department of Neurosurgery. The study group consisted of a total of 200 head injury patients presenting to the Trauma center and admitted in neurosurgery ward. Results: Out of 200 cases maximum case(40.00%) were from 21-30 year age group and minimum case(3.00%) were from 0-10 year age group. 81.00% were male and 19.00% were female. Only 21.00% patients managed by surgical treatment. Conclusion: The lack of awareness among the pedestrians and disregard for traffic rules by the motorists were important reasons for most of the accidents. Keywords: Neurosurgery, Trauma, Injury.

scholarly journals Registry-based pilot epidemiological study of traumatic brain injury in a tertiary trauma care center in Kerala, India – Difficulties encountered during data collection warranting the need for standardized electronic database

2021 ◽  
Vol 12 ◽  
pp. 414
Author(s):  
Vinu V. Gopal
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Pilot Study ◽  
Head Injury ◽  
Data Collection ◽  
Care Center ◽  
Tertiary Care ◽  
Developed Countries ◽  
Electronic Database ◽  
Traumatic Head Injury

Background: Head injury is referred to as a “silent epidemic” globally. Studies regarding epidemiology of head injury are very few especially in Kerala and most have conflicting reports. Unlike developed countries, there is no well-established system for collecting and managing information on traumatic brain injury (TBI) in India, especially in Kerala. The present study shares the difficulties encountered and the insights acquired by conducting a registry-based epidemiological pilot study for collecting a baseline data of traumatic head injury patients in a tertiary care center in Kerala. Methods: The pilot study was conducted to know the efficiency of present reporting system of a tertiary hospital in Kerala. We tried to collect retrospective data from December 2018 to December 2019 in the department of neurosurgery. As there was no standardized protocol or electronic database for data collection in hospital, we made a sample proforma for data collection. The patient details were obtained from medical records (case sheets), resident doctor’s, and staff nurse’s notes which included demography, clinical details, and radiological findings which were analyzed. Results: We were not able to fill the full details regarding demography, prehospital data, and clinicoetiological details which are important as far as head injury management is considered. The hospital records were grossly inadequate for full retrieval of information. Inadequate case definition and lack of centralized electronic reporting mechanisms were some of the major difficulties we faced obviating the need for collecting, managing, and utilizing epidemiological data using an electronic database. Conclusion: We believe that the present pilot study will give an insight regarding the difficulties encountered in collecting data regarding TBI. This study will be the first of its kind in Kerala highlighting the importance of maintaining a proper head injury electronic registry. The data from this study would definitely guide future experimental operational research on these unexplored areas which will be relevant in head injury policy-making in Kerala as well as in India.

scholarly journals Incidence, Predictors, and Adverse Outcomes of Extubation Failure in Young Children with Isolated Traumatic Brain Injury: A Prospective Observational Study

2020 ◽  
Author(s):  
Amarjyoti Hazarika ◽  
Aakriti Gupta ◽  
Kajal Jain ◽  
Kamal Kajal
Keyword(s):  
Traumatic Brain Injury ◽  
Mechanical Ventilation ◽  
Brain Injury ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Pediatric Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Extubation Failure ◽  
Adverse Outcomes

Abstract Background Mechanical ventilation is a life-saving mainstay of therapy in pediatric patients with isolated traumatic brain injury (iTBI). Because of the numerous complications and side effects associated with tracheal intubation, it is prudent to remove it as early as possible. Extubation failure and reintubation, however, are also associated with significant risks. Till date, there has been no comprehensive study on extubation failure in pediatric patients less than 5 years with iTBI. Materials and Methods A prospective observational study was conducted in the trauma intensive care unit (TICU) of a tertiary care center. All the children with iTBI, aged 0 to 5 years, on mechanical ventilation for more than 24 hours, admitted to the TICU were included. Extubation failure was defined as the need for reintubation occurring within 24 hours of extubation. Only the first attempt at extubation was included in the analysis. Results Pre-extubation paO2/FiO2 ratio < 310 mm Hg is a predictor for extubation failure. Mean base deficit postextubation were found to be 2 ± 0.9 and –0.2 ± 1 (p = 0.00) between success and failure groups, respectively. Similarly, postextubation systolic blood pressure was also high in the failure group than in the success group (113.8 ± 10.4 vs. 100.5 ± 7.4; p = 0.00). Conclusions The incidence of first attempt extubation failure was 62.5%. Lower values of pre-extubation paO2/FiO2 ratio (ratio < 310 mm Hg) are a predictor for extubation failure. Developing predictive tools and optimizing extubation decisions lead to timely identification of patients at elevated risk of extubation failure.

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