A retrospective study to analyze treatment of post traumatic cerebro spinal fluid rhinorrhea and role of trans cranial pedicled pericranial repair in present day context

: Skull base fractures are a major cause of morbidity and mortality in head injury. Anterior cranial Fossa (ACF) skull base fracture, leading to Cerebro Spinal Fluid (CSF) Rhinorrhea is one of the most commonly encountered presentation in ACF base fractures. The key to successful management of such cases lies in early diagnosis and surgical management before it leads to meningitis and avoidable mortality.To evaluate the cases of post traumatic CSF rhinorrhea and analyze the parameters utilized to guide the management strategies. An attempt was made to come up with guidelines for its management in a tertiary care hospital.This was a retrospective study in which all cases of traumatic CSF Rhinorrhea admitted to Tertiary care hospital were included. Patients were divided into three groups. First group was conservatively managed in which the rhinorrhea and serial imaging findings showed favourable response.In thesecond group patients were subjected to endoscopic repair by the ENT surgeon based on anatomical considerations. The third group included patients who were had failed the trial of conservative management and the site of leak did not favor endoscopic repair.The outcomes in all these groups were analyzed and conclusions drawn.A total of 54 patients were included in the study which was conducted between Jan 2014 to 2020. 24 were successfully managed conservatively,10 were managed with endoscopic repair and 20 were managed by bifrontal craniotomy and pedicled pericranial ACF Base repair. There was one case from the first group who developed CSF leak after one month necessitating ACF base repair. There was no recurrence reportedin the cases managed endoscopically, whereas one case subjected to craniotomy had recurrence requiring lumbar drain placement. With each transcranial surgery there was a refinement in the technique further minimizing complications. We have elaborated on the surgical nuances to ensurebetter outcomes. : Pedicledpericranial flap ACF base repair is an elegant approach which requires an understanding of the mechanism of CSF leak from skull base fractures. This procedure can easily be mastered and when performed correctly provides best results for cases where there are multiple ACF defects, those not accessible by endoscope and also in those cases where imaging is not able to localize the exact site of defect leading to CSF rhinorrhea. Anosmia is an in evitable complication of this procedure. However, the trade off between mortality resulting from meningitis versus anosmia makes it a viable and attractive treatment option.

Short Term Outcome in Sleep Disturbance Intervention in Children with ASD in a Tertiary Care Hospital in Bangladesh

Aim: The aim of this study was to identify the relationship between sleep patterns and behavioral difficulties in children with ASD using sleep disturbance treatments. Methods: We selected a total 41 children with sleep disorders as study population. The sleep services (behavioral sleep management techniques) were given by the child development center team of Dhaka Shishu Hospital comprising of physician , developmental therapist and psychologist. Children were split into eight groups and two gender divisions based on their age, and they were then studied over a period of 6 months . Sleep disorders were investigated both before and after intervention. Results: The results revealed that the children’s sleep dysfunction improved from before, with the lowest improvement percentage decreasing from 62.9 percent to 51.8 percent and the greatest improvement percentage increasing from 100 percent to 59.2 percent, whereas a sleep problem showed no change at all (sleepwalking). Conclusion: The study has tried and succeeded to an extent to intervene in the sleep dysfunction process of children with ASD in a tertiary care hospital. However, there is still much to learn about the clinical efficacy of these types of behavioral interventions in children with ASD who have sleep disruption.

Correlates of COVID-19 vaccination drop-out among health care workers in a tertiary Care hospital of West Bengal

The Government of India launched “COVID-19 vaccination drive” on 16th January, 2021 and health care workers were the first to be prioritised for vaccination. However, the uncertainty regarding safety and efficacy of the vaccine was the major concern amongst them. These led to vaccine hesitancy and ultimately drop out.To estimate the proportion of drop out of COVID-19 vaccination among vaccine-hesitant health care workers (HCWs) of a tertiary care hospital and to find out their perception and other background characteristics responsible for drop out. A facility based descriptive type of observational study, cross-sectional in design was carried out among 329 HCWs of a tertiary care hospital in Kolkata from 16th March- 12thApril, 2021using a pre-designed, pre-tested, structured questionnaire. The study population selected by simple random sampling technique. Data was analysed using Microsoft Excel 2010 and SPSS v25.0 in the form of descriptive statistics and binary logistic regression. About 44.1% of the study population didn’t take the COVID-19 vaccine. Socio-demographic factors like age, gender, religion, education, occupation,perception regarding necessity of vaccination, vaccine efficacy, dose and contraindication, safety in humans and role in future infections were significantly associated with drop out. There was a high proportion of vaccine drop out among health care workers. Different modifiable perceptions with socio-demographic factors had played important roles in COVID-19 vaccination drop out. As the global threat of COVID-19 continues, greater efforts through campaigns that target HCWs are needed to improve the intention of professionals’ vaccine acceptance.

An Observational Study on Idiopathic Intracranial Hypertension (IIH) in a Tertiary Care Hospital in Bangladesh

Background: Among the risk factors of cardiovascular diseases, hypertension is one of the major reason. Intracranial hypertension (IIH) is a pressure buildup around the brain. It can happen unexpectedly, as a result of a severe head injury, stroke, or brain abscess could be occurred. It could also be a chronic, long-term condition, known as IIH. It results in the signs and symptoms of a brain tumor. Which is also known as benign intracranial hypertension. Cerebrospinal fluid, or CSF, is the fluid that surrounds the spinal cord and brain. CSF can accumulate if too much fluid is produced or not enough is reabsorbed. This can induce symptoms similar to a brain tumor. Intracranial Hypertension can be classified into three categories, they are Acute, Chronic and Idiopathic. IIH is recognized when the increased intracranial pressure cannot be explained by any other underlying cause.Aim: The aim of the study was to observe idiopathic intracranial hypertension patients in a select tertiary care hospital of Bangladesh.Methods:This cross-sectional observational study was conducted at the Department of Neurosurgery, Sylhet M. A. G. Osmani Medical College Hospital, Sylhet, Bangladesh. The study duration was from January 2012 to December 2020. A total number of 47 participants had been recruited as study population.Results:Male: female ratio was 1:10.75, and 91% of the total participants were female. 40.43% of the participants were aged between 21-30 years. 46.81% were overweight and 34.04% were obese. Most common symptom was nausea, followed by visual impairment and double vision.Conclusion:The prevalence of Idiopathic Intracranial Hypertension is much higher among the female. Female and high BMI are significant risk factors of IIH. It is more prevalent among young adults, and results on various vision related symptoms.

Plethora of Resistance Genes in Carbapenem-Resistant Gram-Negative Bacteria in Greece: No End to a Continuous Genetic Evolution

Carbapenem-resistant Gram-negative bacteria are a public health threat that requires urgent action. The fact that these pathogens commonly also harbor resistance mechanisms for several other antimicrobial classes further reduces patient treatment options. The present study aimed to provide information regarding the multidrug resistance genetic background of carbapenem-resistant Gram-negative bacteria in Central Greece. Strains from a tertiary care hospital, collected during routine practice, were characterized using a DNA microarray-based assay. Various different resistance determinants for carbapenems, other beta-lactams, aminoglycosides, quinolones, trimethoprim, sulfonamides and macrolides were detected among isolates of the same sequence type. Eighteen different multidrug resistance genomic profiles were identified among the twenty-four K. pneumoniae ST258, seven different profiles among the eight K. pneumoniae ST11, four profiles among the six A. baumannii ST409 and two among the three K. oxytoca. This report describes the multidrug resistance genomic background of carbapenem-resistant Gram-negative bacteria from a tertiary care hospital in Central Greece, providing evidence of their continuous genetic evolution.

The study about mindset of COVID-19 vaccination among health care employees and general population at tertiary care hospital

Background: Definitive treatment and vaccination are basic necessity to bring down the burden of COVID-19 disease. Due to rapid development of vaccine against COVID-19, associated anxiety and mistrust raises hesitancy for vaccination. We aim to study about the mindset of COVID-19 vaccination among health care employees (HCE) and general population at tertiary care hospital in north east India.Methods: This was a cross sectional and observational study; questionnaires were distributed among 200 HCE and 400 general populations visiting at different OPD regarding their mindset for vaccination. Questionnaires consisted of parameter such as history of previous COVID-19 infection or hospitalization, co-morbidities, job status during pandemic and educational qualification and contained specific questions for causes of vaccine hesitancy.Results: In the survey participants from general population were more hesitant for vaccination as compared to HCE (p<0.001). Most common cause for hesitancy among HCE was pregnancy/lactation followed by concern regarding adverse effects. Doubted efficiency and adverse effects were leading concerns (67%) for vaccine hesitancy among general population. Past history of infection or hospitalization due to COVID-19 did not affect the attitude for getting vaccinated (p>0.05). Among general population, 25% had their job affected during pandemic of which 78% were in favour of vaccination.Conclusions: Increased awareness and high risk of getting infected with COVID-19 makes HCE less hesitant for vaccination. It is important to increase awareness among the general population to bring down the concerns regarding adverse effect and potency of vaccine to reduce the hesitancy for vaccination.