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Post Dural Puncture Headache (PDPH) remains a prominent clinical concern to the present day and common complication seen in the field of anesthesiology and pain medicine. Identification of such risk factors is a crucial step in the rational modification of anesthetic practice and evaluation of therapeutic interventions. This study was conducted to demonstrate the incidence and risk factors of PDPH in patients after spinal Anesthesia during three days' post operations at general hospital in Tripoli, Libya. In this study certain factors related to patient history, baseline clinical state or anesthetic technique might be associated with an increased risk for this side effect, so it was collected historical, physiologic, and technical data to determine their association with PDPH. Out of total of 100 patients distributed over 5 different hospitals admitted over a period (from November 2020 to April 2021) 27% of them have a PDPH, while 92.5% of cases with PDPH are females, that 55.6% of PDPH cases are between 20 and 25 years old, and this percentage getting smaller as patients get older, most of the operations were caesarean section, at a rate of 58%, followed by lower abdominal surgeries with 19% of cases, and orthopedic surgeries with 17% of cases, while the lowest percentage was for the Urologic surgeries. 55% of cases with PDPH are classified as (case I), and 44% of them are classified as (case II), 81.5% of PDPH cases used noncutting needles. In this study the PDPH remains the most problem in hospitalized patients after spinal Anesthesia at Tripoli hospitals can be caused by variety of risk factors, associated with ASA physical states, nonprofessional technique, the females are more common than males and the percentage increasing in early age group
Subject(s)
Humans , Male , Female , Post-Dural Puncture HeadacheABSTRACT
Objective:To investigate the optimal lengths of supine position after first lumber puncture for school-aged children with acute leukemia.Methods:From January 2020 to December 2021, a total of 152 children with acute leukemia who underwent first lumbar puncture were randomly divided into 1h group, 2 h group, 3 h group and 4 h group, there were 38 cases in each group. The lengths of supine position after lumber puncture were 1 h, 2 h, 3 h and 4 h in the 1h group, 2 h group, 3 h group and 4 h group, respectively. The effects of different lengths of supine position on headache, low back pain, comfort and postoperative complications were observed.Results:Finally, 38 cases were enrolled in the 1 h group, 36 cases in the 2 h group, 38cases in the 3 h group and 34 cases in the 4 h group. The scores of low back pain, sleep comfort, lying position comfort, emotional comfort as well as the incidence of limb numbness in the 1 h group were (1.71 ± 0.56), (1.95 ± 0.87), (2.74 ± 1.06), (2.63 ± 0.79), 5.3%(2/38), in the 2 h group were (1.61 ± 0.27), (2.08 ± 0.81), (2.92 ± 1.34), (2.86 ± 0.80), 2.8%(1/36), which were significant lower than those of in the 3 h group (2.32 ± 1.12), (2.92 ± 1.34), (3.71 ± 1.11), (3.55 ± 1.25), 21.1%(8/38) and 4 h group(2.74 ± 1.42), (3.06 ± 1.37), (3.85 ± 1.50), (3.88 ± 0.81), 23.5%(8/34), F=6.81 to 14.06, χ2=10.84, all P<0.05. The amount of cerebrospinal fluid exudation in 1 h group was (0.33±0.09) g, which was significantly higher than that in 2 h group(0.27±0.08) g, 3 h group (0.27±0.10) g and 4 h group (0.24±0.09) g, the difference was significant ( F=5.82, P<0.05). The incidence of pressure injury in 1 h group, 2 h group and 3 h group were 0, 2.0%(1/36), 7.9%(3/38), which were significantly lower than that in the 4 h group 23.5%(8/34), χ2=15.39, P<0.05. There was no significant difference in pain scores among the 4 groups ( P>0.05). Conclusion:Two hours for supine position after first lumber puncture does not increase cerebrospinal fluid exudation in children with acute leukemia, and effectively alleviate low back pain, improve the comfort degree.
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Background: Authors objective was to study the incidence and risk factors for meningitis in neonates with clinical suspicion of sepsis in Neonatal Intensive Care Unit (NICU) of tertiary care hospital of Mumbai, India.Methods: This descriptive observational study enrolled Consecutive 92 patients of either sex with suspected neonatal sepsis admitted in NICU of Tertiary Care Hospital. All neonates admitted to NICU with clinical suspicion of sepsis or developing signs of sepsis during NICU stay were included in study. Exclusion criteria were 1.Neonates with hemodynamic instability 2.major congenital malformations 3.contraindication or no willingness for Lumber puncture (LP ) 4.neonates who have received intravenous antibiotics for more than 24 hours elsewhere.Standard data collection form was used to collect all demographic data and clinical characteristics of neonates.Results: Incidence of meningitis in study population was 7.6%. Cases of meningitis in study population had mean birth weight 1.91 kg, 71.43% were preterm, 57.14% vaginaly delivered, 42.86% by LSCS, Premature rupture of membrane (PROM) observed in 28.57% cases. Meconium stained liquor in 42.86% cases and foul smelling liquor in 28.57% cases observed. 42.86% cases required resuscitation and 28.57% received surfactant therapy. Poor feeding (100%), lethargy (85.71%), weak cry (85.71%) and tachypnea (50.58%). Retractions (85.71%), Grunting (57.14%) and Nasal flaring (42.86%) were clinical presentation. Lab findings in a case of meningitis: mean Hemoglobin (Hb) 15.22 gm%, Leukopenia (28.57%), Leukocytosis 28.57%, Absolute Neutrophil count (ANC) <1800 (28.57%), Thrombocytopenia 42.85%, blood culture positive (28.57%) hypoglycemia (28.57%), CSF white cell count (124.57cells/ml.), mean CSF protein level (60 mg/dl.) Mean CSF glucose level (40.86 mg/dl.) CSF culture was positive in two cases of meningitis.Conclusions: Authors study highlights the diagnostic utility of routine lumbar puncture in neonates with clinically suspected sepsis.
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Introduction: A febrile convulsion is defined as a seizure that occurs in association with fever in children from six months to five years of age, with no evidence of a central nervous system infection or other identifiable causes of seizure and no history of an afebrile seizure. Simple febrile seizures are brief (<15 minutes), generalized, and occur in association with fever and only once during a 24-hour period without postictal pathology. Febrile Seizures have longer duration (>15 min), or have focal features or if they recur within 24 hours are defined as complex. In May 1996, the American Academy of Paediatrics (AAP) issued practice parameters regarding the neurodiagnostic evaluation of children with a first simple febrile seizure, who present within 12 hours after the seizure. It may be due to meningitis. This study was done to find out role of cerebro spinal fluid (CSF) analysis to rule out the meningitis in different age group of children presenting with first episode of fever with seizure. Design: A prospective study was carried out from June 2008 to July 2009 at the Western Regional hospital, Department of Paediatrics, Pokhara, Nepal. A total of 110 hospitalized children between the age group five months to 5 years were included in the study. Results: 16 (14.54%) children were diagnosed to have meningitis. In the age group of 6 – 12 months, 6 (21.4%) had meningitis while in 12-18 months, 6 out of 31 (19.3%) had meningitis and in more than 18 months age group only 4 out of 51 (7.84%) were detected with meningitis. Conclusion: In cases of apparent febrile seizure, meningitis should always be considered as a differential diagnosis. Lumbar puncture is must to rule out meningitis in all children between the ages of six months to eighteen months presenting with first episode of fever with seizure to rule out meningitis, even in the absence of meningeal signs.