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Clinical and Biochemical Predictors of Fatality in Traumatic Brain Injury
Kadhaya David Muballe,
Sewani Constance Rusike,
Benjamin Longo-Mbenza,
Jehu Iputo
Issue:
Volume 8, Issue 5, October 2020
Pages:
140-152
Received:
24 June 2020
Accepted:
20 July 2020
Published:
13 August 2020
Abstract: Traumatic brain injury is a global health problem, it is a major cause of devastating neurological sequelae and significant mortality. The underlying physiological events in traumatic brain injury are responsible for the poor clinical outcomes seen in patients. Inflammatory and oxidative stress changes in traumatic brain injury result in the release of inflammatory biomarkers, a reduction in the endogenous anti-oxidants and dysfunction of the blood brain barrier. An understanding of the natural history of oxidative stress and inflammatory changes in traumatic brain injury can help design appropriate management protocols to reduce mortality and morbidity in these patients. Aim of the study: The aim of this study was to identify potential biomarkers that are predictive of fatality in patients with moderate to severe traumatic brain injury. Methods: This was a prospective study of patients with moderate to severe traumatic brain injury managed at the Nelson Mandela Academic Hospital during the period March 2014 - March 2016. Following admission and management, the patient demographics (sex, age) and admission Glasgow Coma Score were recorded. Oxidative stress and inflammatory biomarkers in blood and cerebrospinal fluid where sampled on day 1 to 7. On day 14 only blood was sampled for the same biomarkers. The primary outcome was the Glasgow Outcome score assessed on day 90. Due to its simplicity the Glasgow Outcome scale was used to assess clinical outcomes at day 90. Because of difficulty in regular follow up due to the vastness of our region, difficult terrain and long travel distances a 3 month follow up period was used to avoid default. Results: Of the 64-patient’s, fatality was noted in 12.5% of them. There was a significant association between fatality and the; ages of the patients, anti-oxidant levels, proinflammatory biomarkers and admission Glasgow Coma Score. Conclusion: The admission Glasgow Coma Score, low anti-oxidant levels and elevated serum interleukin-1β levels were associated with fatal outcomes.
Abstract: Traumatic brain injury is a global health problem, it is a major cause of devastating neurological sequelae and significant mortality. The underlying physiological events in traumatic brain injury are responsible for the poor clinical outcomes seen in patients. Inflammatory and oxidative stress changes in traumatic brain injury result in the releas...
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Pilot-Study Lumina Switchable Post-Op Dressing & Postsurgical Wounds: A Non-interventional, Non-placebo-controlled, National Pilot Study
Michael Helmut Schmitz,
Sven Rogmans,
Sabine Kasparek,
Nesat Mustafi
Issue:
Volume 8, Issue 5, October 2020
Pages:
153-157
Received:
1 June 2020
Accepted:
12 August 2020
Published:
3 September 2020
Abstract: Dressings applied to primarily closed surgical incisions should be appropriate interactive dressing [13] and demonstrate an ability to protect the wound from contaminants and trauma, manage exudate, and avoid excessive pressure to the incision line. Additionally, they should be flexible, well fixed to the skin on application, skin protective (e.g. reduce the risk of blistering or irritation, not excessively adhesive) and waterproof [14]. Film dressings were one of the first modern wound-dressing products. They are extremely flexible, transparent and adhesive. During the removal of the dressing skin stress occurs. An essential role are shearing and friction forces between skin and wound dressing playing. This problem includes missing elasticity, flexibility and too strong adhesion. A non-interventional, non-placebo-controlled, national pilot study was done to prove a new shearing force reducing technique and dressing. The used post-op dressing consists of a thin film backing with a switchable polyurethane adhesive and non-adhering absorption pad. Before removal the adhesion is reduced by illuminating the dressing with the UV-A lamp. 52 patients at a mean age of 55.79 years (SD±16.22) with a total of 52 wounds were included in the study, all of them finalized the 1-week study period. At baseline, pain was measured with a mean of 3.52 (SD±1.26), during the study period pain decreased to a mean of 2.10 (SD±0.97) (VAS 0=no pain, 10=excruciating pain). Significance was calculated as 0,000 (paired t-test). At each dressing change, pain level after dressing change was rated lower compared to the pain level before dressing change. Overall, pain level decreased over the study period. The removal of the dressing after illumination with the UV-A lamp was rated in mean with 1.79 (2. Visit) and 1.86 (3. Visit) on the 6–point-scale (1=very good – 6=insufficient). Significance was calculated as 0,000 for visit 3 (one sample t-test [test value=3,0]). Reactions on the wound edge/wound surroundings have not been reported. In contrast, a reduction of maceration and redness of the wound edge/wound surrounding was observed. The results confirm that the adhesive ensures a safe and effective occlusion/fixation of the dressing and that the strong adhesion enables dressing to function according to specification. There was no deterioration of the wound situation or an infection in any of the cases. The switchable function of the adhesive allows the adhesion of the post-op dressing to the skin to be reduced when illuminated by the supplied UV-A lamp. The results of the present study show that the reduced adhesion upon illumination enables easy and comfortable removal of the dressing.
Abstract: Dressings applied to primarily closed surgical incisions should be appropriate interactive dressing [13] and demonstrate an ability to protect the wound from contaminants and trauma, manage exudate, and avoid excessive pressure to the incision line. Additionally, they should be flexible, well fixed to the skin on application, skin protective (e.g. ...
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Surgical Management of Undescended Testis in Infants, Single Scrotal Incision Orchiopexy Versus Traditional Inguinal Approach: A Comparative Study
Omar Atef Elekiabi,
Ehab Mahroos Oraby,
Mohamed Abdallah Zaitoun,
Abdelwahab Saleh Almoregy
Issue:
Volume 8, Issue 5, October 2020
Pages:
158-162
Received:
13 June 2020
Accepted:
22 June 2020
Published:
3 September 2020
Abstract: Background: Surgical intervention is mostly needed in many cases of undescended testis to improve fertility; it is still unsure which approach is better than the other in management of undescended testicle in infants; classic inguinal approach or scrotal single incision approach. Aim of the current study was to compare between classic inguinal approach and scrotal single incision approach to perform orchiopexy for management of un-descended testis in infants and to clarify which is better; inguinal orchidopexy or scrotal orchidopexy. Patients and methods: we included forty male patients with undescended testis who were divided into two groups; group A included twenty patients and they were surgically managed with single trans-scrotal orchiopexy and group B included twenty patients and they were surgically managed with classic inguinal approach by two incisions (inguinal and scrotal). We assessed operative time and complications as wound infection, recurrence and testicular atrophy. Results: Operative time in group A was shorter than the operative time of group B which was managed by the inguinal approach (p=0.004). Immediate post-operative complications as; skin site infection, hematoma and edema, in group A were slightly more than the complications in group B (p=0.002). group A showed no recurrence or testicular atrophy after six months while group B showed 2 cases of recurrence and one case of testicular atrophy (p=0.005). At three months after surgery, cosmetic results and patients satisfaction of the incision scar was higher in group A than group B (p<0.001). Conclusions: performing orchiopexy through single scrotal incision approach is better than the approach of inguinal incision regarding operative time, rabid healing time, parents’ satisfaction, fewer long-term complications, less incidence of testicular atrophy and recurrence.
Abstract: Background: Surgical intervention is mostly needed in many cases of undescended testis to improve fertility; it is still unsure which approach is better than the other in management of undescended testicle in infants; classic inguinal approach or scrotal single incision approach. Aim of the current study was to compare between classic inguinal appr...
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“Bubbles in My Urine” – A Presentation After Blunt Trauma
Maheshwaran Sivarajah,
Jonathan Gates
Issue:
Volume 8, Issue 5, October 2020
Pages:
163-165
Received:
19 July 2020
Accepted:
24 August 2020
Published:
3 September 2020
Abstract: Fistulae forming between the alimentary tract and kidney after trauma are an anomaly. In contrast to general vesico-alimentary communication, a colonephric fistula almost invariably results secondary to an initial pathological process in the kidney. A primary infectious cause has by far been the most common renal pathology implicated in its formation. The diagnosis of this condition is suggested by pneumaturia but almost entirely based on radiological examination. Even though conservative strategies have been attempted, surgical resection is the treatment of choice and should be pursued if all else fails. We report a case of a subacute presentation of a colonephric fistula following blunt trauma with a documented injury to the kidney associated with a possible concomitant injury to the large bowel. However, the inciting event could also have been a primary occult colon injury overlying the renal injury, eventually culminating in a fistula between the two organs resulting in pneumaturia and signs of sepsis. A review of the literature on colonephric fistulae and their appropriate management strategies are reported and briefly discussed. It is important to be familiar with its clinical symptoms so that the diagnosis can be suspected, and adequate investigative and therapeutic approaches can be implemented.
Abstract: Fistulae forming between the alimentary tract and kidney after trauma are an anomaly. In contrast to general vesico-alimentary communication, a colonephric fistula almost invariably results secondary to an initial pathological process in the kidney. A primary infectious cause has by far been the most common renal pathology implicated in its formati...
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Tibiotalocalcanean Fusion by Retrograde Sign Nail: An Amazing Solution for Old Ankle Fracture
Jibananda Halder,
Md Zulfiqur Ali,
Nahid Sultana
Issue:
Volume 8, Issue 5, October 2020
Pages:
166-170
Received:
20 June 2020
Accepted:
13 July 2020
Published:
26 October 2020
Abstract: Background: Old ankle fracture is the most challenging problem in whole over the world. Still it is an unsolved problem in many countries like Bangladesh. For ankle fracture so many under-privileged people in our country usually take traditional treatment in the village and suffer from severe pain during walking. Sometimes they want to commit suicide due to pain. Earlier the tibiotalocalcanean fusion was done by only steinman pin, then by conventional interlocki nail. But retrograde SIGN nail is the amazing solution to relief pain in old ankle fracture. Aim of the study: The aim of this study was to assess the outcomes of tibiotalocalcanean fusion (Arthrodesis) by retrograde SIGN nail. Methods: It was a prospective case series of patients with old ankle fractures treated with the SIGN nail conducted during the period from 2017 to 2019 at NITOR, Dhaka of Bangladesh. A total of 35 patients with old ankle fractures were operated using the SIGN nail among which 29 patients came for follow up at 6, 16 and 18, 48 weeks. So finally 29 patients were finalized as the study population. Result: As per AOFAS score in pre-operative stage, condition of all the participants were ‘poor’ but at post-operative stage AOFAS score was found ‘Excellent’ in 10.34% (n=3), ‘Good’ in 34.48% (n=10) ‘Fair’ in 20.69% (n=6) and ‘Poor’ in 23.48% (n=10) participants respectively. Besides this, according to the VAS score in the pre-operative stage 3.45% mild (n=1), 6.90% moderate (n=2), and 89.65% severe (n=26) cases patients. Besides this, in post-operative stage 48.24% mild (n=14), 44.83% moderate (n=13), and 6.90% severe (n=2) cases. Conclusion: This implant may be a good alternative in developing countries. The findings of this study may be helpful in further similar studies and in the treatment procedure.
Abstract: Background: Old ankle fracture is the most challenging problem in whole over the world. Still it is an unsolved problem in many countries like Bangladesh. For ankle fracture so many under-privileged people in our country usually take traditional treatment in the village and suffer from severe pain during walking. Sometimes they want to commit suici...
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