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@#Objective To evaluate the effect of follicular fluid(FF)exosomal miRNAs on follicular dysplasia in patients with polycystic ovary syndrome(PCOS)mediated by glycolysis pathway of granulosa cells(GCs),and to explore the mechanism. Methods Three PCOS infertile patients and three non-PCOS infertile patients were recruited. The baseline hormone levels of the two groups were measured before ovulation induction. The bilateral FF was obtained by puncture after short-acting and long-term ovulation induction,and the exosomes were collected by ultracentrifugation and identified by transmission electron microscopy. The total exosomal RNA was extracted by Trizol method to construct the library,which was compared to the reference genome GRCh38 for statistical analysis after miRNA sequencing and quality control processing. Clustering Profiler R package was used to implement GO annotation analysis and KEGG pathway analysis of the differentially expressed genes(DEGs),and Omnipath software for miRNAs interaction analysis. A total of 16 miRNA were randomly selected and detected by qPCR to verify the accuracy of the miRNA sequencing results. Results Compared with the non-PCOS group,luteinizing hormone(LH),anti-Muerian hormone(AMH),testosterone and antral follicle counts in PCOS group increased significantly(t = 2. 479 ～ 9. 163,each P < 0. 05). The exosomes of FF in both groups showed the cup-shaped vesicles with clear edge and light staining in the center,with the diameters of 100 — 150 nm and intact structure,and the concentration was about 8 × 1010particles/mL. A total of 928 miRNAs were detected by miRNA sequencing. Compared with the non-PCOS group,59 differentially expressed miRNA(DEmiRNA)were screened out in exosomes of POCS group,of which 31 were up-regulated and 28 were down-regulated. The differential trend of gene expression detected by qPCR was highly similar to that of miRNA sequencing. In FF exosomes of PCOS patients,the glycolysis efficiency and apoptosis of GCs were significantly changed by miRNA regulating mRNA. PKM,PFKL and HK2 were the key target genes for miRNA to regulate GCs glycolysis,and SLC2A1 was the key target gene for miRNA to regulate GCs apoptosis. Conclusion The miRNAs in FF exosomes of PCOS patients can weaken the glycolysis of GCs while accelerate the apoptosis,thus reducing the production of ATP and lactic acid,resulting in follicular dysplasia.
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Spontaneous cerebellar hemorrhages are rare when compared to cerebral hemorrhages. They are characterized by occipital headache, repeated vomiting, and ataxia of gait. In mild cases there may be only gait ataxia. There may be Dizziness or vertigo, paresis of conjugate lateral gaze towards the side of the lesion, forced deviation of the eyes to the opposite side, or an ipsilateral sixth nerve palsy, blepharospasm, and skew deviation. Dysarthria and dysphagia may occur. The patient often becomes stuporous and then comatose from brainstem compression or obstructive hydrocephalus; immediate surgical evacuation before brainstem compression occurs, may be lifesaving. The introduction of computed tomography (CT) scan, had brought about a sea change in diagnosis and management. The most significant prognostic factors determining the outcome at one month were the grade of quadrigeminal cistern obliteration on the initial CT scan and the Glasgow Coma Scale on admission. The introduction of drugs like nimodepine made all the difference in the outcomes. We hereby share our experience in managing 12 cases of spontaneous cerebellar hemorrhage.
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Neuron Speci?c Enolase (NSE) is a glycolytic enzyme. It is exclusively present in neurons and neuroendocrine cells. It is an important marker to assess functional damage to neurons. Studies have shown that NSE is more than 90% sensitive to decide the severity of stroke. This study was conducted to compare the Serum levels of NSE and radiological imaging in assessing the severity of stroke. A hospital based descriptive study was conducted on 60 stroke patients (<72hrs from onset) and 60 controls. Glasgow Coma Scale (GCS) was assessed, and serum NSE was measured. Non contrast CT brain was taken. mRS scale was assessed after 30 days of onset of stroke. ROC curve analysis was done which showed a Sensitivity of 82.5% and Speci?city of 82.5% for serum levels of NSE at a cut off value 12ng/mL. NSE showed a positive correlation with mRS; negative correlation with GCS. Hence it is advisable to measure serum NSE levels at the existing health care facilities, where CT brain is not available.
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Background:Standardized scales for scoring severity of poisoning is need of time in Emergency department(ED)to identify high risk patients for intensive monitoring and treatment before disposal and for compatibility of data. So in this study we try to evaluate utility of Glasgow coma scale (GCS), poisoning severity score (PSS) and Acute physiology and chronic health evaluation II (APACHE II) in estimating clinical severity and prognosis of poisoning patients.Material and methods: A Retrospective observational study was conducted between1stJune 2019 to 28thFebruary 2021 in the Emergency Department of tertiary care teaching hospital, Ahmedabad, India. Data was collected from computerized hospital information system and analysed in CDC software Epi Info (version 7.3.2.1).Results:Out of total 50 patients during study,majority of patients were in age group of 21-30 year (yr)with Male: Female ratio of 1:1. Out of 50 cases, 44 consumed chemical substances, 3 had corrosive and 3 had medication consumption with organophosphates (OP) being most common compound. Mean PSS in expired was significantly high in comparisonof survivors (p value= 0.0118). Present study found significant association between PSS within first 24 hours and GCS of patients pre sented with poisoning with p value 0.0117 (GCS on admission) and 0.0002 (GCS at 24 hr). A statistically significant correlation was found between PSS and APACHE II, with a p value= 0.0242 and also between GCS and APACHE II with a p value= 0.0018 (CI=95%).Conclusion:Both PSS and GCSare effective in predicting Severity and outcome of patients presented with poisoning in ED.GCSis more useful as it is easy to use, does not require any laboratory investigations and less time consuming.
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Objective:To investigate the change and clinical significance of serum alkaline phosphatase (ALP) level in patients with acute spontaneous intracerebral hemorrhage(AICH).Methods:81 patients with AICH admitted to the Neurosurgery Department of Tianjin Third Central Hospital from January 2019 to October 2020 were retrospectively analyzed. 81 patients with non cerebral hemorrhage who came from the health examination center or complained of dizziness and had no hepatobiliary and skeletal diseases were selected as the control group. The clinical data of all the patients were recorded, including gender, age, Glasgow Coma Scale (GCS) score, hemorrhage location, liver function indexes, the history of hypertension, diabetes, heart disease, smoking, drinking, and so on. The differences in clinical data between the two groups were compared. Pearson correlation was used to analyze the correlation between liver function indexes and GCS score. The independent risk factors for AICH were screened by binary logistic regression, and the receiver operating characteristic (ROC) curve was used to evaluate the value of serum ALP in predicting intracerebral hemorrhage.Results:Serum ALP level in AICH group was significantly higher than that in the control group [85.0(70.0, 103.0) U/L vs 65.0(54.5, 71.5)U/L, Z=6.740, P<0.001]. Pearson correlation analysis showed that serum ALP had a negative correlation with GCS score ( r=0.255, P=0.022). Binary logistic regression analysis showed that hypertension ( OR=20.440, 95% CI 8.572-48.737) and ALP ( OR=1.077, 95% CI 1.049-1.105) were risk factors for intracerebral hemorrhage. Serum ALP level was an independent risk factor ( OR=1.069, 95% CI 1.038-1.101) for AICH after adjusting for confounding variables including age, AST, history of hypertension. ROC curve showed that the area under the curve (AUC) of serum ALP in predicting intracerebral hemorrhage was 0.807 (95% CI 0.740-0.873, P<0.001), with sensitivity of 67.9% and specificity of 81.5%. Conclusions:Serum ALP level may be related to the occurrence and severity of AICH. Therefore, serum ALP level can be used as a reference index to evaluate the occurrence, severity of patients with AICH.
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Objective:Based on clinical data, establish and verify the prediction model of hyponatremia after craniocerebral trauma.Methods:Through retrospective analysis of 226 patients with traumatic brain injury who were eligible for inclusion in Department of Neurosurgery, Qingpu Branch, Zhongshan Hospital, Fudan University from June 2019 to January 2021. After 6 months of follow-up, the patients were divided into the hyponatremia group ( n=81) and the normal group ( n=145) according to their blood sodium level. Various factors that may be related to the occurrence of hyponatremia were analyzed. Logistic multivariate regression was used to analyze the independent risk factors of patients with hyponatremia, the best cut-off point of was determined by the characteristic curve (ROC), and the nomogram prediction model was established and verified based on the independent risk factors of patients with hyponatremia. Results:Patients in the normal blood sodium group were(40.33±15.32) years old, 87 cases (60.00%) of cerebral contusion, 3 cases (2.07%) of intraventricular hemorrhage, 15 cases (10.34%) of cerebral hernia, 35 cases (24.14%) of GCS score <6 and 110 cases (75.86%) of GCS score ≥6; In the hyponatremia group, patients were (47.17±16.03) years old, with 65 cases (80.25%) of cerebral contusion, 7 cases (8.64%) of intraventricular hemorrhage, 19 cases (23.46%) of cerebral hernia, 44 cases (54.32%) of GCS score <6 and 37 cases (45.68%) of GCS score ≥6, the difference between the two groups was statistically significant ( P<0.05). Logistic multivariate regression analysis found that increasing age, ventricular hemorrhage, cerebral herniation, elevated ADH and GCS score <6 were all independent risk factors for patients with hyponatremia( OR=2.287, 2.531, 1.344, 1.387, 1.582; 95% CI: 1.945-2.628, 1.338-3.723, 1.256-1.431, 1.013-1.761, 1.233-1.931; P<0.05). The GCS score predicts that the area under the ROC curve for patients with hyponatremia was 0.795, the cut-off point was 6 points, the sensitivity was 95.00%, and the specificity was 64.30%. A nomogram model was constructed to predict patients with hyponatremia based on independent risk factors, in which the C-index calculation result and ROC curve AUC were 0.798 (95% CI: 0.751-0.842) and 0.815 (95% CI: 0.767-0.877), respectively, indicating a good degree of discrimination; Calibration curve evaluation results showed that the model has good consistency. Conclusion:GCS score is an independent risk factor that affects whether patients with craniocerebral trauma are complicated by hyponatremia. It has a good predictive value for whether this type of patients is complicated by hyponatremia, which is conducive to early identification and intervention of patients.
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Background: Incidence of head injuries is rising all over the world. Only few studies have been performed regarding severe head injury in elderly people. We aimed to study the epidemiology, mode of injury, management, co-morbidity, associated injuries which affects the outcomes. Severe head injury is unconsciousness >6 hours and GCS 3-8. In India 6.63% of the total population above 60 years is considered elderly. Falls are the major contributor to TBI in elderly but in India RTA is still the main contributor. Outcomes of TBI, both in terms of mortality and function, are significantly worse in the elderly.Methods: Objective of this study was to find the risk factors affecting the outcome in severe head injury. This was a prospective study and carried on 56 patient in Department of surgery of M. L. N. Medical College, Prayagraj from September 2018 to September 2019.Results: Male were most commonly affected but the gender had no significant prognostic effect on outcome. RTA were the most common cause of head injury. GCS at admission was directly related to outcome. Bilateral non-reactive pupils had poor outcome. Type of hematoma and midline shift had also affected the outcome. Operated cases had better outcome than non-operated cases. Any associated injury with TBI had worsened the outcome in patient. Any co-morbid condition associated with brain injury had slower recovery and worsen the outcome. Overall mortality in this series was 64.28% and unfavourable outcome was 76.79%.Conclusions: Severe head injury in elderly people had worst outcome.
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Background: Glasgow coma scale (GCS) and the Glasgow outcome scale help us with confident predictions after 24 h following the injury, but not on admission. The IMPACT and CRASH studies provided new methods for performing prognostic studies of traumatic brain injury. And this prognostic scoring system has been studied in our study.Methods: This is an observational prospective cohort study performed at the department of surgery, Gandhi medical college and Hamidia hospital, Bhopal on 87 patients during a period of 2 years. A preformed pro-forma was filled for each patient after 6 hours of resuscitation which included all the details of the patients like name, age, sex, CR no., and GCS after resuscitation, mode of injury, the clinical evaluation score used by IMPACT trial and neurological finding, management details, CT scan was done as soon as possible for all patients and findings were included in the pro-forma. The final outcome was recorded at the time of discharge.Results: Among Patients with mean total prognostic score of 0-4, 97% patients discharged without deficit, 3% discharged with deficit with no mortality. Among score of 15-20, only 7 % can be discharged without deficit and 7% could be discharged without deficit, while 86 % patient died.Conclusions: The mean total prognostic score of discharged groups was significantly lower than the patients in discharged group. We concluded that this prognostic model helps us to individually identify patients who will succumb to death and early need for surgical intervention.
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Intracerebral haemorrhage constitutes 10-20 % of all strokes & remains without treatment of proven benefit & has higher risk of morbidity & mortality than cerebral infarction or subarachnoid bleed. Thus, these models may accurately predict outcome, and hence the purpose of this study is to define a clinical grading scale for patients with ICH which uses criteria that are predictive of outcome & that can be rapidly & accurately assessed at the time of presentation in emergency/casualty. Estimation of basal plasma D-dimer levels an indicator of systemic activation of coagulative & fibrinolytic system has shown to a powerful predictor of both early neurological worsening & mortality outcome & hence the present study is undertaken.METHODSThe study was carried out in the IPD of Department of General Medicine, Basaveshwara Teaching and General Hospital, Kalaburagi, attached to Mahadevappa Rampure Medical College. It is a cross sectional study conducted among 100 intracerebral bleed patients between November 2018 to November 2019 with simple random sampling procedure. Patients were followed up at the end of 1 month with telephone/letter/email.RESULTSThe mortality among patients who scored 0 of ICH scale was 0%, ICH score of 1 was 13.6 %, ICH score of 5 was 100 %. No patient scored 6. Higher the ICH score, higher is the mortality. Mortality among patients with D-Dimer value between 1500 – 5000 ng/ml is 55.2 %, and > 5000 ng/ml is 92.3 %. Above table indicates that higher the basal level of D-Dimer value higher is the mortality. Mortality among patients of either sex was equal i.e., 50 % between 8 - 15 days, and no deaths were noted between 15 - 30 days.CONCLUSIONSIntracerebral haemorrhage (ICH) has remained a serious disease despite recent improvements in management. So, efforts must be directed towards better understanding and modification of risk factors. The major risk factor in our study was hypertension. The other common risk factors were alcohol consumption and smoking. Thus, measures to ensure adequate control of hypertension/compliance of treatment among hypertensive, abstinence from alcohol and smoking may reduce the incidence of ICH. High initial plasma D-Dimer levels would indicate bad prognosis in ICH. In addition to diagnosis of ICH, CT Scan can also be used as a useful tool in assessing prognostic outcome of ICH, by using radiological parameters like larger volume of haematoma, presence of midline shift, intraventricular extension of haemorrhage and hydrocephalus which indicated bad prognosis i.e., using ICH score, higher the ICH score higher is the mortality.
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Introduction: Organophosphate compounds are often usedfor homicidal and suicidal purposes. It accounts for about80% of pesticide related hospital admissions. Study aimed toassess the severity of OP poisoning by POP scale, PSS andGCS and to compare POP scale, PSS and GCS in predictingthe treatment outcome in OP poisoning.Material and Methods: 100 patients of OP compoundpoisoning were included in the study. POP score, PSS andGCS were assessed at the time of presentation and weregrouped based on the severity. These scores were individuallyevaluated in predicting the ventilator requirement andmortality in OP compound poisoning and the scores werecompared with each other, as to asses which score was betterin predicting the severity of OP poisoning.Results: Ventilator requirement and mortality was found tobe in 43% and 16% of patients respectively. Intubation ratesand mortality rates were higher in patients with severe gradesof POP score, PSS and GCS with a significant p value (0.00),than in patients with mild to moderate grades. All three scorescorrelated well in predicting the requirement of ventilatorysupport and mortality in OP compound poisoning cases.Conclusion- The three scoring systems are simple andeffective tool that can be assessed based on the clinicalexamination. For a resource limited country, like India, any ofthe three scoring systems can be applied at the primary caresetting level which helps in making timely decision regardingneed for ventilatory support and timely shifting of patient tothe ICU care setting.
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OBJECTIVE@#To evaluate recovering consciousness effect of electroacupuncture (EA) on patients after traumatic brain injury (TBI) surgery.@*METHODS@#A total of 100 patients with traumatic coma were randomly divided into an observation group and a control group, 50 cases in each group. The control group was mainly treated with awakening drugs and neurotrophic drugs; on the basis of treatment in the control group, the observation group was treated with EA at Neiguan (PC 6) and Shuigou (GV 26) with disperse-dense wave, 2 Hz/100 Hz in frequency, 0.1-5 mA in intensity. After 30 min of EA, the needles were stayed 60 min. The treatment was performed once a day for 14 consecutive days. The changes in Glasgow coma score (GCS) was observed in the two groups before treatment and after 7, 14 days of treatment; and the two groups were followed up for 3 months after treatment to evaluate the Glasgow outcome scale (GOS) and Barthel index (BI) scores.@*RESULTS@#After 7, 14 days of treatment, the GCS scores of the two groups were higher than those before treatment (<0.05), and the increase degree in the observation group was significantly larger than that in the control group (<0.05). At 3 months of follow-up, the GOS and BI scores of the observation group were better than those of the control group (<0.05).@*CONCLUSION@#Early electroacupuncture intervention can effectively promote the recovery of consciousness after traumatic brain injury surgery, and has a curative long-term effect.
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Humans , Acupuncture Points , Brain Injuries, Traumatic , General Surgery , Therapeutics , Consciousness , ElectroacupunctureABSTRACT
Background: Altered mental status (AMS) is a common presentation in the emergency department (ED) and poses a significant challenge to the emergency physician (EP). The prognosis seems to depend upon many diverse factors, like etiology of AMS patient, clinical variables and various laboratory tests.Methods: The aim of the study was to determine outcome in patients presenting with new onset AMS to emergency department in our population. And further to look for various prognostic factors for death. Adult patients aged >14 years, not having dementia and with no history of trauma, presenting to ED with altered mental status were included in the study.Results: Out of 200 patients, 108 were male and 92 females. Patients having AMS because of poisoning, seizure, intracranial infection all had decreased mortality. Whereas patients having AMS because of stroke, infection, cardiovascular causes had significantly increased mortality. Season, sex, pH, SaO2, TLC, GCS, mean Bp. were associated with increased mortality in patients of AMS presenting to emergency department. The logistic regression model was statistically significant (chi square=39.3, p=0.000). The model predicted 26% of the variance in predicting death and correctly classified 74.6% of patients.Conclusions: The importance of being able to prognosticate AMS patients at outset in emergency is immense.Male sex, low mean BP, low GCS, low pH, low arterial SaO2, and high TLC were predictive of higher death rate in this cohort of patients presenting to emergency department
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Acute subdural hematoma is one of the most common types of intra cranial hematoma caused by trauma accounting for more than 20% severe head injuries and resulting in highest mortality. Various studies have been made to understand the consequences and surgical outcomes of SDH patients. Therefore, the present study was designed to evaluate the clinical spectrum and assess the outcome of surgery in SDH patients. Methods: Present study included 50 patients of both sexes from 1 to 70 years age group with head injury, diagnosed to have traumatic subdural haemorrhage. Clinical examination included pupillary anisocoria, hemodynamic status, extent of hematoma either focal or diffuse, midline shift, GCS, status of basal cisterns, blood pressure. All the patients included in the study underwent surgical procedure for the removal of haematoma. Results: There was 100% mortality rate in patients with bilaterally dilated pupils. Whereas, there was 24.13% and 5.5% mortality rate respectively in unilateral dilated and normal pupil patients. Most of the patient had GCS <8 (40%), followed by GCS 9-12 (34%) and GCS 13-15 (26%) at the time of admission in the hospital. Further, GCS <8, GCS 9-12and GCS 13-15 were found in 32%, 40% and 28% correspondingly in patients after resuscitation. Conclusion: Findings of present study showed that there was an inverse relation between interval between injury and surgery with prognosis, Greater the interval poor will be outcome of surgery. Basal cistern obliteration is a reliable marker of increased intra cranial pressure which is responsible for poor outcome. Further, hypotension is also one of the important factors affecting the outcome of surgery in SDH patients.
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Intra-cerebral haemorrhage (ICH) is responsible for strokes in up to 20 % patients in European countries while this became higher up to 30 % in Asian countries. Various different approaches have been applied for the surgery of ICH in the search of ideal surgical technique and prompt management without any success. Therefore, the present study was designed to assess the advantages and risk of open craniotomy surgical technique for the treatment of spontaneous supra tentorial intra-cerebral haemorrhage. Methods: This was a descriptive type of study which was conducted in a tertiary care centre. This study included thirty patients of both gender male (21) and female (9) from 18 to 70 years age. Patients with hypertension, spontaneous supratentorial haemorrhage, having Glasgow Coma Scale (GCS) 8-13 and volume of blood 20 ml or above were included in the study. ICH patients with GCS 14-15 and GCS level less than 7 were excluded from the study. Results: Results of the current study showed that 6 patients with ICH more than 50 ml had GCS less than 8. Whereas, GCS 9-10 and GCS 11-13 were recorded in 17 and 7 patients respectively before the operation. Further, GCS level was unchanged even after surgery in 6 patients who had pre-operative GCS less than 8. After surgery GCS level improved to 9-10 and 11-13 in 9 and 15 patients respectively. Conclusion: Findings of the present study suggest that GCS level and Size of haematoma significantly affects the surgical prognosis in patients with spontaneous supra tentorial intra-cerebral haemorrhage patients. Moreover, results of current study showed that GCS level less than 8 and blood volume of haemorrhage more than 50 ml have been found associated with higher rate of mortality in ICH patients.
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Background: This study was undertaken to correlate Glasgow Coma Scale (GCS) score with Non-Contrast Computed Tomography (NCCT) findings in patients with acute traumatic brain injury (TBI) attending tertiary care Shree Narayana Hospital, Raipur, Chhattisgarh, India.Methods: A cross-sectional study was performed among 100 patients of acute traumatic head injury (those presenting to hospital within 24 hours of injury) over a period of six months. The patient’s GCS score was determined and NCCT Brain scan was performed in each case immediately (within 30 minutes) after presenting to casualty of the hospital. A 16 slice siemens Somatom CT scan was utilized and 5mm and 10mm sections were obtained for infratentorial and supratentorial parts respectively.Results: The age range of the patients was 0 to 76 years and male: female ratio was 2.85:1. Younger age group was more commonly involved, with 61% of cases seen in 11-40 years of age group. The most common causes of head injury were road traffic accident (RTA) (65%) and fall from height (25%). The distribution of patients in accordance with GCS was found to be 55% with mild TBI (GCS 12 to 14), 25% with moderate TBI (GCS 11 to 8) and 20% with severe TBI (GCS 7 or less).Conclusions: The presence of multiple lesions and midline shift on CT scan were accompanied with lower GCS, whereas patients having single lesion had more GCS level. There was significant correlation between GCS and NCCT findings in immediate post TBI.
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Introduction: Stroke is amongst the leading causes of death exceeded only by heart disease and cancer. Those who survive are usually left with permanent disability. Cerebral infarction is responsible for about 80 percent of all strokes, primary intra-cerebral haemorrhage for 10 percent, subarachnoid haemorrhage for 5 percent and 5 percent cases are due to uncertain causes. Predictors of prognosis in primary intraparenchymal haemorrhage have been evaluated in numerous studies. Objective: To observed the effect of different sizes of hematoma and utilizing them, if feasible as a marker of prognostic significance. Material and methods: In this study we observed 60 patients from the time of admission till 30th day in various wards of Department of Medicine RIMS with hypertensive intra-cerebral haemorrhage, during the period of 2008-2009. A simple method of measuring the volume of haematoma (in cc) on the CT scan is by using the following formula: A*B*C A = longest diameter of the haematoma (in cm.), B = Diameter perpendicular to A (in cm.), C = Height (in cm) which is measured by No. of slices showing the haematoma x thickness of each slide. Result: Total 60 patient were taken into study out of which 33(55%) were alive and 27(45%) were dead in 30 days follow up. In our study, 38 were male and 22 were female out of 38 male 22(66.66%) were alive and 16 (59.2%) dead and in 22 female 11(33.33%) were alive and 11 (40.7%) were dead. Outcome with volume of ICH using the χ2 had shown significant correlation (p < 0.005) with GCS at the time stroke onset (P<0.01), IVH/VE (P<0.01), midline shift test (P<0.01), B.P. at the time of admission (P<0.01). Conclusion: In these study patients with hematoma volume exceeds 60 cm3, the mortality was 100%. Mean volume of hematoma in our study was 35.21 cm3.
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Background: Extradural hematomas occur in approximately 2% of all patients of head injuries and 5- 15% of fatal head injuries. EDH is considered to be one of the most serious conditions of head injury requiring immediate diagnosis and surgical intervention. Aim and Objectives: The purpose of this study was to evaluate the clinical presentation of patients with extradural hematoma and to decide upon the mode of management and to study the results of the management and the outcome and the factors affecting morbidity and mortality. Materials and Methods: Patients with EDH admitted in Neurosurgery Department, King George Hospital Andhra Medical College, Visakhapatnam were studied. Study period was one year July 2018 to June 2019. The sample size of the study was 106 patients who fulfill the inclusion and exclusion criteria. All the patients with head injury, diagnosed to have EDH on CT scan were included in the study. The management includes conservative measures and/or surgical intervention. The patients’ outcome was assessed during the hospital stay, at discharge and followed up to 6 months after discharge. The various factors were analyzed which are likely to affect the outcome. Results: Temporo-parietal and temporal region was the most common location of EDH. The most significant factors which influences outcome are - time of surgical intervention, older age group, low GCS and associated injuries on CT scans like contusions and other injuries. The patients were followed after 1, 3 and 6 months. P Prahaladu, M V Vijaya Sekhar, K Satyavara Prasad, Hemal Chheda. Assessment of Extra Dural Hematoma - Factors affecting morbidity, mortality and outcome. IAIM, 2019; 6(9): 102-107. Page 103 Conclusion: From this study, it was observed that neurological status of patient at the time of presentation, time of surgical intervention, associated injuries on CT scan and the volumetric details of EDH are the most important factors in management and outcome of EDH.
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Introduction: CT plays a key role in accurate diagnosis and important diagnostic tool in the management of traumatic brain injury. Materials and methods: Present study was under taken in the Department of Surgery Gandhi Medical College and Hamidia Hospital, Bhopal in the duration of July 2015 to July 2016. Total 105 patients (M: 80, 76.1% and F: 25; 23.80%) with traumatic head injury were admitted and managed and were include in this study. They were followed by serial CT scan and analyzed. Results: Commonest cause of brain injury was road traffic accidents (75 cases 70%). Altered sensorium was the most common symptom in 88 cases (88.0%), followed by vomiting in 49 cases (75.38%). Contusions were the most common radiological findings in 80.95% (85 cases) followed by extradural haematoma in 18.46% and pneumocephalus in 16.92%. Out of these the most common location for contusion was frontal (14 cases), followed by parietal (12 cases) and then bilateral contusions in 10 cases. Repeat scan showed increase in volume of contusion in 29 cases (44.61%), no change in 26 cases (40.0%) and decrease in 10 cases. The increase was mainly due to edema in 18 cases (27.69%) and due to actual increase in contusion in only 11 cases. Only 4 cases needed operative intervention. Conclusions: Sequential serial CT scan results in the management changes and has role in the management even in the patients without any clinical deterioration in early stages.
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Background: A simple clinical scale of intracerebral hemorrhage, comprising the Glasgow Coma Scale score, age, Infratentorial origin, ICH volume, and Intraventricular hemorrhage, was recently shown to predict 30-day mortality. We studied how well the original ICH Score would predict morbidity and mortality. Materials and methods: We did a retrospective study, in which records of all the patients with acute intracerebral hemorrhage were reviewed. Components of the ICH Score were recorded along with other clinical characteristics. Outcome was analyzed using modified ranking scale. Results: The mean age was 69 15 years with 45.4% males and 54.6% females. Common risk factors were smoking, diabetes mellitus and hypertension. Supratentorial lesions were 93.25% and Infratentorial lesions were 6.74 %. The overall 30 day mortality rate for ICH was 29.03%. Important predictors of mortality were, GCS score on admission (P<0.0001), hematoma volume >30ml (P <0.0001), Intraventricular extension (P <0.0001), and ICH score (P <0.0001). Conclusion: The study shows ICH score is very useful in prognostication. The overall mortality rate with ICH is similar to the previously published studies.
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Objective To explore the rule of the Nrf2-ARE in renal interstitial fibrosis and the mechanism of butylphthalide on renal protective effect.Methods Seventy-two male CD-1 mice were divided into 4 groups,Sham group,UUO group,NBP group,ACEI group.The Sham group and UUO group were gavaged with physiological saline.The NBP group was gavaged with butylphthalide.The ACEI group was gavaged with benazepril.After 3,7,14 days,6 mice were executed and collection of kidney tissue.The expression of Nrf2,γ-GCS and type Ⅰ collagen were detected by immunohistochemisty,RT-PCR and Western blot.The correlation of Nrf2 and γ-GCS was assessmented by linear regression.Results The expression of type Ⅰ collagen in UUO group was increased compared with the Sham group,However,the expression of Type Ⅰ collagen in NBP group or ACEI group were reduced compared with the UUO group.Compared with Sham group,the expression of Nrf2mRNA,γ-GCSmRNA and type Ⅰ collagen mRNA in uuogroup were increased in 3,7,14 days after surgery.Compared with UUO group at 7th,14u day,the lelve of Nrf2 mRNA were apparently increased in NBP group (P＜0.05).It was a positive correlation between the Nrf2 and γ-GCS and negative correlation between the γ-GCS and Type Ⅰ collagen.Conclusion The renal protective effect of butylphthalide in the renal interstitial fibrosis was more predominant than benazepril.The roles maybe occurred through increased the expression of Nrf2 and γ-GCS and alleviated the expression of Type Ⅰ collagen in nephridial tissue.