scholarly journals A clinicoradiological scoring for management of acute subdural hematoma: a prospective study

2018 ◽  
Vol 32 (2) ◽  
pp. 359-365
Author(s):  
Sachidanand Gautam ◽  
Anubhav Sharma ◽  
S.C. Dulara
Keyword(s):  
Prospective Study ◽  
Subdural Hematoma ◽  
Scoring System ◽  
Head Injuries ◽  
Postoperative Outcome ◽  
Clinical History ◽  
Acute Subdural Hematoma ◽  
Subdural Hemorrhage ◽  
Male Predominance ◽  
A Prospective Study

Abstract Background: Acute subdural hematoma is the most common type of traumatic intra cranial hematoma accounting for 24% cases of severe head injuries and caries highest mortality. The aim of this study is to analyze the prognostic factors and to propose Neuro-clinical and radiological prognostic scoring system on the clinical spectrum and to evaluate the postoperative outcome and validate the same. Methods: This is a prospective Study which included 100 patients admitted in Government Medical College, Kota, Rajasthan from 01st Jan 2016 to 30 June 2017 with head injury and were diagnosed to have Traumatic Subdural Hemorrhage. A detailed clinical history, Physical examination, Computerized Tomography scan was performed in all patients and were divided into 2 groups; that is conservative or surgical interventional as per Neuro-clinical and radiological prognostic scoring system. Results: The maximum patients suffering from Subdural Hematoma were in the age group of 11-60 years with male predominance 72%. The most common mode of injury was RTA with 68 % of incidence. 36 out of 100 cases presented to hospital with GCS <8 while 44 patients showed improvement of GCS after resuscitation. Out of 100 cases, surgical approach was considered in 34 patients while remaining patients were managed conservatively. Pupillary reaction, Hypotension, CT scan findings that is, thickness of hematoma >10mm and midline shift of >5mm, delay in interval between the surgery had greatly affected on outcome of patients. Conclusions: According to the results, use of Neuro-clinical and radiological prognostic scoring system is very useful in determining early intervention and also avoids unnecessary surgical intervention.

scholarly journals Clinical study of acute subdural haematoma – a level I trauma care centre experience

2017 ◽  
Vol 5 (3) ◽  
pp. 857 ◽  
Author(s):  
P. Prahaladu ◽  
K. Satyavara Prasad ◽  
B. Rajasekhar ◽  
K. Satyanarayana Reddy
Keyword(s):  
Ct Scan ◽  
Head Injuries ◽  
Clinical History ◽  
Favourable Outcome ◽  
Acute Subdural Hematoma ◽  
Subdural Hemorrhage ◽  
Acute Subdural Haematoma ◽  
Male Predominance ◽  
Post Traumatic ◽  
King George Hospital

Background: Acute subdural hematoma is the most common type of traumatic intra cranial hematoma accounting for 24% cases of severe head injuries and caries highest mortality. The aim of this study is to analyse the clinical spectrum, and to evaluate the postoperative outcome.Methods: This is a prospective observational Study which included 150 patients  admitted  in King George hospital, Andhra Medical College, Visakhapatnam, India over the past two years (01st August 2013 to 30th August 2015) with head injury, diagnosed to have Traumatic subdural Hemorrhage. A detailed clinical history, physical examination, CT scan was performed in all patients. Patients who were subjected to surgery, post-operative out-come were compared.Results: The maximum patients suffering from SDH are in the age group of 20-40 years (63%) with male predominance (73%). The most common mode of injury is RTA (73.33%). 40% of cases presented to hospital with gcs <8. Pupillary reaction, hypotension, CT scan findings i.e. thickness of hematoma >10mm and midline shift of >5mm, Basal cisterns obliteration, post traumatic seizure and delay in interval between the surgery had greatly affected on outcome of patients. Out of 150 cases, surgical approach was considered in 120 patients while remaining 30 patients were managed conservatively.Conclusions: Interval between injury to surgery with interval <4 hours having favourable outcome. Basal cistern obliteration, which is an indicator of increased intra cranial pressure is the single most important factor for unfavourable outcome. Hypotension and post traumatic seizures influence high mortality.

A Prospective Study on Acute Subdural Hematoma in Mild Head Injury Patients: Outcome with Initial Nonoperative Management

2018 ◽  
Vol 15 (02/03) ◽  
pp. 082-086
Author(s):  
R. K Barooah ◽  
Hriday Haloi ◽  
B. K. Baishya ◽  
Kishore Sarma
Keyword(s):  
Head Injury ◽  
Prospective Study ◽  
Decompressive Craniectomy ◽  
Conservative Management ◽  
Subdural Hematoma ◽  
Nonoperative Management ◽  
Acute Subdural Hematoma ◽  
Mild Head Injury ◽  
A Prospective Study

Abstract Introduction Incidence of acute subdural hematoma (SDH) is 21% in head injury patients. Decompressive craniectomy done for acute SDH itself carries a very high morbidity and mortality. The skull bone defect, prolonged hospital stay, the need of a second surgery (cranioplasty), and bone flap infection are other problems associated with decompressive craniectomy. Hence, this study looks into the outcome of conservative management in acute SDH in patients with mild head injury. Aims and Objectives The main objective of this article is to study the patients included in the study with regard to outcome, morbidity, duration of hospital stay, and hospital cost. This article also studies the efficacy and outcome of lesser aggressive management (burr-hole evacuation) after initial nonoperative management of the patients included in the study. Materials and Methods This is a prospective study performed in the Department of Neurosurgery, Gauhati Medical College and Hospital. A total of 30 patients arriving in the emergency department during a 6-month period from December 1, 2017 to May 31, 2018 with a diagnosis of acute SDH and with Glasgow coma scale (GCS) 13 to 15 were evaluated. Evaluation was done by history, clinical examination, GCS, computed tomography (CT) (plain) scan brain, and Glasgow outcome score at 6 months follow-up. Results and Observations Twenty patients showed complete resolution of the clot, and eight patients had liquefaction of clot which was evacuated by burr-hole. One mortality was recorded and one had to undergo decompressive craniectomy. About 93.33% of patients managed by initial nonoperative management showed functionally independent outcome at 6 months follow-up. Conclusion Conservative management in patients with acute SDH can be a viable alternative in certain cases. Those patients with GCS of 13 and above with CT scan showing midline shift of even ≥5 mm or thickness of 10 mm and more can also be managed conservatively by close monitoring.

scholarly journals Spectrum of adverse drug reactions and implicated drugs in a tertiary care centre: a prospective study

2018 ◽  
Vol 7 (7) ◽  
pp. 1345
Author(s):  
Kabilan K. ◽  
Sathyanarayanan V. ◽  
R. Jammuna Rani
Keyword(s):  
Prospective Study ◽  
Adverse Drug Reactions ◽  
Spontaneous Reporting ◽  
Causality Assessment ◽  
Tertiary Care ◽  
Type A ◽  
Drug Reactions ◽  
Male Predominance ◽  
Organ Systems ◽  
A Prospective Study

Background: Adverse Drug Reaction(ADR) is the major limitation in providing health care to patients at a global level. It affects patient’s recovery and is an important cause of mortality and morbidity in both hospitalized and ambulatory patients. ADR can occur with any class of drugs. Early detection and evaluation of ADR is essential to reduce harm to the patients. Thus, the present study was aimed to estimate the number of ADR’s reported, analyze its spectrum and the drugs attributed to it.Methods: This was a prospective study conducted in a tertiary care teaching hospital for a period of 3 months from March 2016 to May 2016 in SRM Medical College and Hospital, Potheri. Adverse drug reactions were collected by spontaneous reporting by active and passive methods. The causality assessment of the reported ADR’s was done using Naranjo causality assessment scale.Results: A total of 38 ADR’s were reported during the study period with male predominance (58%). Most of the ADR’s (42%) were common in patients in the age group 19-39 years. More number of ADR’s were from Medicine (29%) followed by Surgery (16%) and OG (16%) departments. Most commonly affected organ systems were skin (45%) followed by GIT (24%). The drugs mostly accounted were antibiotics (55%) especially Cephalosporins (33%). Most of the reactions were type A (68%) rather than type B (32%) and thus predictable. According to Naranjo’s causality assessment, 63% of reactions were probable, 26% were possible and 11% were definite. No reactions were unlikely. Severity assessment by Modified Hartwig and Seigel scale revealed 45% ADRs to be moderate, 42% were mild and 13% were severe and life threatening.Conclusions: The study concluded that Adverse Drug Reactions are common and some of them resulted in increased healthcare cost due to need of some interventions and increased length of hospital stay. As majority of ADR is predictable (Type A), so preventable. The health system should promote the spontaneous reporting of Adverse Drug Reactions (May be done mandatory). The proper documentation and periodic reporting to regional pharmacovigilance centres to ensure drug safety.

scholarly journals A Prospective Study on Changes in Nutritional Status and Growth Following Two Years of Ketogenic Diet (KD) Therapy in Children with Refractory Epilepsy

Nutrients ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 1596 ◽  
Author(s):  
Marisa Armeno ◽  
Antonella Verini ◽  
Mariana del Pino ◽  
Maria Beatriz Araujo ◽  
Graciela Mestre ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Prospective Study ◽  
Ketogenic Diet ◽  
Refractory Epilepsy ◽  
Growth Monitoring ◽  
Male Predominance ◽  
History Of ◽  
A Prospective Study ◽  
Growth Deceleration

Introduction: Epilepsy is a neurological disorder characterized by an increased susceptibility to seizures. The ketogenic diet (KD) is currently the most important alternative non-pharmacological treatment. Despite its long history of clinical use, it is not clear how this diet affects longitudinal growth in children. Methods: A prospective study was designed to evaluate growth and nutritional status in 45 children on KD. Growth was assessed by measuring weight, height, and body mass index (BMI). Standard deviation scores (SDS) were calculated for all measurement parameters at KD initiation and at a two-year follow-up. Results: Overall, 45 patients who completed 24 months on KD were enrolled. Median age was 6.6 years (0.8 to 17.3), with a male predominance (n = 23); 74% of the 45 patients were responders on seizure reduction at three months; 26% of patients were non-responders. In our study, using −1 SDS as a cut-off point, growth deceleration was observed in 9% (n: 4) of the patients; however, the nutritional status was maintained or even improved. No correlation with age, sex, or ambulatory status was found. Conclusions: The nutritional follow-up of these patients was helpful to improve overweight and thinness but could not avoid growth deceleration in some of them. These findings confirm that children with refractory epilepsy on KD treatment require careful growth monitoring.

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