ABSTRACT
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.
ABSTRACT
@#Objective: To determine the socio-demographic and clinical profile of exotropia surgery outcomes amongst paediatric patients. Methods: This is a descriptive, retrospective, clinical study of surgeries performed between 2014 and 2016 at the Sarawak Heart Centre, Malaysia. Medical records of patients with primary and secondary exotropia were reviewed. The following factors that affected the surgical outcomes were collected: onset age of squint, age at the time of surgery, the interval between diagnosis and surgery, the type of exotropia, visual acuity, presence of amblyopia, previous patching, anisometropia, refractive error, type of surgery, preoperative and postoperative deviation, pre-existing ocular comorbidity and systemic illness. Result: A total of 15 patients were studied with more than two thirds being females. Seven patients had primary exotropia while eight patients had secondary exotropia. Average interval between diagnosis and surgery was 1.3 years (±0.82) for primary exotropia and 1.2 years (±0.84) for secondary exotropia. Average pre-operative angle for primary exotropia was 50.57PD (±10.83) whereas secondary exotropia was 39.38PD (±8.63). Seven patients had successful surgical outcomes of within 10 prism dioptres, five for primary exotropia and two for secondary exotropia. The response to surgery was 3.0PD/mm (±0.59) for primary exotropia and 2.2PD/mm (±0.74) for secondary exotropia. Conclusion: In our study, primary exotropia had larger preoperative angle than secondary exotropia. The response to surgery was positively correlated with the preoperative angle of deviation. Primary exotropia showed better surgical outcome.
ABSTRACT
Objective@#Establish the post cardiovascular surgery SOFA score(pcvsSOFA)based on the Sequential Organ Failure Assessment(SOFA)score to evaluate the severity and prognosis of patients after cardiovascular surgery.@*Methods@#3 872 consecutive patients who underwent cardiovascular surgery and stayed in ICU more than 24 hours between July 2015 and December 2017 were retrospectively analyzed to establish a derivation cohort. Univariable and multivariable logistic regression were used to identify the predictors in the pcvsSOFA. And the validity of the new model was evaluated in the derivation cohort and validation cohort.@*Results@#Respiratory system score, coagulation system score, nervous system score and renal system score on the first day of ICU, Emergency surgery and re-surgery were risk factors and established the pcvsSOFA. The total score of pcvsSOFA was 20 point and was divided into four classes, namely class Ⅰ(pcvsSOFA-score: 1-5), class Ⅱ(pcvsSOFA-score: 6-10), class Ⅲ(pcvsSOFA-score: 11-15) and class Ⅳ(pcvsSOFA-score: 16-20)with their corresponding predicted mortality 0.9%(n=2 317), 5.7%(n=1 367), 26.8%(n=184), and 64.2%(n=4) in the derivation cohort. The area under the receiver operating characteristics curve(AUC)was 0.864(95%CI: 0.837-0.892), and the integrated discriminant improvement(IDI) was 0.035.In the validation cohort, AUC(pcvsSOFA)= 0.832(95%CI: 0.735-0.928), IDI=0.211. The AUC of SOFA, APACHE Ⅱ and SAPS Ⅱ was 0.771, 0.793 and 0.721 respectively.@*Conclusion@#Compared with the SOFA score, pcvsSOFA could be a better tool to assess the prognosis of critical patients in the early postoperative stage.