Factors Affecting Traumatic Brain Injury Outcome Among Patients Treated for Head Injury at Surgical Side, in Nekemte Referral Hospital, Oromia, Ethiopia.

Background Traumatic brain injury is an expanding major public health problem and the leading cause of death of the young and productive part of the world’s population. Research is mainly done in high-income countries where only a small proportion of the worldwide fatalities occur. Only few studies have examined prognostic factors of traumatic brain injury outcome in developing countries including Ethiopia. This study was aimed at defining the peculiar demographic and other associated factors of traumatic brain injury (TBI) outcome among patients treated for head injury at Nekemte Referral Hospital. Objective The main purpose of this study was to describe the magnitude of TBI outcome and assess factors associated with unfavourable outcome of TBI among patients treated for head injury at the surgical side in Nekemte Referral Hospital from July 8, 2016 to July 7, 2018. Methods A retrospective cross-sectional document review was conducted among TBI patients treated for head injury from July 8, 2016 to July 7, 2018 at Nekemte Referral Hospital. Data were collected using a pre-tested data collection format. Data analysis was done using SPSS version 20. Descriptive statistics were computed and association between the dependent and independent variables were assessed by using logistic regression. Odds ratios with 95% confidence interval were computed. Significant association was declared when the p value was <0.05. Results In this study, out of 378 cases 95 (25.1%) were discharged with unfavourable outcome of which 37(9.8%) were neurologic deficits and 58 were deaths giving overall mortality rate of 15.3%. Patient age>60years (AOR: 15.13; 95%CI: 3.575-64.028), time interval from injury to treatment (AOR: 16.054; 95%CI: 5.832-44.194), low GCS (AOR: 18.224; 95%CI: 4.167, 79.695), conservative management (AOR: 20.774; 95%CI: 6.106-70.681), pupils abnormality (AOR: 9.078; 95%CI: AOR: 2.996-27.509) were associated with unfavourable outcome. Conclusions A quarter of patients treated for TBI at Nekemte Referral Hospital are discharged with unfavourable outcomes. Old age, delayed presentation to the hospital, low GCS, conservative management, and pupillary abnormality increase the odds of unfavourable outcome. Timely management of TBI before patients develop secondary brain injury and use of surgical intervention based on CT scan diagnosis will reduce the occurrence of unfavourable outcome.

Caffeine Components Empower the Brain Potentiality

The brain requires certain fuels to function in high level. Literally, nutritional components can modulate the brain productivity. One of the right nutrition to enhance the brain power is dietary component of caffeine. Caffeine as a component of coffee, tea and chocolate is very popular. Although, depending on the dietary demands or conventional habits some people do not consume caffeine-containing substances (i.e. foods or beverage). Nonetheless, caffeine constituents maximize the brain potential via promoting the central nervous system (CNS) through blocking an inhibitory neurotransmitter (adenosine) and releasing some other specific neurotransmitters (noradrenaline, dopamine and serotonin) in brain. The chemistry of caffeine in a standard dose in fact can affect the brain intelligence.

Dexamathasone Pulse Therapy in Refractory Childhood Seizure Disorders

15 children with variable intractable seizure disorders who were on multiple anti-convulsant medications were treated with pulse monthly doses of parentral dexamethsone varying from 4 – 7 months. EEG and clinical response were assessed periodically as well at the end of the study. 53% of the patients showed clinical response and EEG response. Hypertension was noted in 6, hypokalemia in 3 and hyperglycaemia in 1 patient. The ultimate compliance from the parents for this treatment was seen among 12 patients because of its proven efficacy and parents of seven patients insisted to continue the treatment for long duration.

Suboccipital Decompression for Occipital Neuralgia

Cervicogenic headaches are a significant cause of head and neck pain, and occipital neuralgia is a common component of these cervicogenic headaches. Occipital injections are commonly performed at the occipital ridge, but this site does not address more proximal entrapments of the nerve in the suboccipital region. Because of the potentially dangerous structures in this region, clinicians have tended to avoid the suboccipital region, despite the pathologies seen in this region. This article discusses the pathology of the region, the alternative techniques, and the novel interventional approach developed for this region, specifically the “Stealth” approach of occipital decompression.

Psychopathology of Brain Frontal Lobe Tumors: When the Neurosurgery Meets Psychiatry

Brain tumors occur when abnormal cells form within the brain.There are two main types of tumors: malignant and benign tumors. Then, tumors can be divided into primary that start within the brain, and secondary tumors that have spread from somewhere else, known as brain metastasis tumors. Secondary brain tumors occur in approximately 15 % of cancer patients with about half of metastases coming from lung cancer. Primary brain tumors occur in around 250,000 people a year globally, making up less than 2% of whole body tumors. According to American Brain Tumor Association the most common types of primary tumors are gliomas, representing 74,6 % of all malignant tumors and meningiomas ( 36,6% ) while more affected region is frontal lobe, about 22 % . Particularly, prefrontal cortex ( PFC ), the anterior part of the frontal lobe that is highly developed in humans plays a role in the regulation of personality, emotional, and behavioral functioning, leading to serious cognitive impairments 1. These are the psychological signs of frontal lobe tumors, in addition to other functions such as the expressive language of Broca's area or those relating to voluntary movement, linked to frontal cortical motor areas. It relates to the so-called higher nervous functions, concerning the life of relationship and communication. The PFC physiology explains the psychological mechanisms of its associated functions: connections with the limbic cortex, thalamus, hypothalamus, basal ganglia and other subcortical areas.The regions of the PFC at the base of the psychophysiological mechanisms involved are basically the dorso-lateral, the ventro-medial, the orbito-frontal establishing contacts primarily with limbic structures, such as the cingulate gyrus, hippocampus, amygdala.