Correlation between the skull base fracture and the incidence of intracranial hemorrhage in patients with traumatic brain injury / 中华创伤杂志(英文版)

PURPOSE@#A head injury (HI) may cause a skull fracture, which may or may not be associated with injury to the brain. In essence, a skull base fracture (SBF) is a linear fracture at the base of the skull. Loss of consciousness and Glasgow coma score (GCS) may vary depending on an associated intracranial pathology. The pathomechanism is believed to be caused by high energy impact directly to the mastoid and supraorbital bone or indirectly from the cranial vault. Aim of this study is to define the correlation between SBF and intracranial hemorrhage (ICH) in patients with HI.@*METHODS@#Analysis of data obtained from a retrospective review of medical records and from a systematized database pertaining to diagnostic criteria of SBF patients based only on clinical symptoms associated with ICH caused by HI treated in the Department of Neurosurgery at Dr. Hasan Sadikin Hospital, Bandung, Indonesia from January 1, 2012 to December 31, 2017. The exclusion criteria included age less than 15 years and no head computed tomography (CT) scan examination provided.@*RESULTS@#A total of 9006 patients were included into this study in which they were divided into 3 groups: group 1, HI with no ICH; group 2, HI with single ICH and group 3, HI with multiple ICH. In all the SBF cases, SBF at anterior fossa accounted for 69.40% of them, which were mostly accompanied with mild HI (64.70%). Severity of HI and site of SBF correlated with the existence of traumatic brain lesions on CT scan, thus these factors were able to predict whether there were traumatic brain lesions or not. Most of the patients with epidural hemorrhage (EDH) has single traumatic lesion on CT scan, whereas most of the patients with cerebral contusion (CC) has multiple traumatic lesions on CT scan. On patients with both traumatic brain injury and SBF, most of the patients with anterior fossa SBF has EDH; whereas most of the patients with middle fossa SBF were accompanied with CC. Surgery was not required for most of the patients with SBF.@*CONCLUSION@#SBFs were strongly correlated with traumatic ICH lesions patients with anterior fossa SBF were more likely to suffer EDH whereas with middle fossa SBF were more likely to suffer CC.

Comparison of two different matrix band systems in restoring two surface cavities in posterior teeth done by senior undergraduate students at Qassim University, Saudi Arabia: A randomized controlled clinical trial

Dental students commonly face the problem of overhanging proximal margins and unsatisfactory proximal contact points (PCPs) while restoring Class II cavities in posterior teeth. Various matrix band systems are used in dental clinics to avoid such problems. Aims: The aim of this study is to compare the effects of two matrix band systems, circumferential matrix system and sectional matrix system on the PCPs and contours when restoring Class II cavities in posterior teeth. Settings and Design: This was a randomized controlled clinical trial done at College of Dentistry, Qassim University, Saudi Arabia. Subjects and Methods: Total 1200 Class II cavities in teeth were selected for this study. Treatment was done by senior undergraduate students. Cavities were randomly divided into two groups. Group 1: Total 600 cavities were restored using circumferential band system. Group 2: Total 600 cavities were restored using sectional band system. Teeth were restored either with the composite or the amalgam restoration. Contact points were evaluated. The presence or absence of proximal overhangs was assessed. Overhanging margins were categorized as positive overhangs, negative overhangs, and absent overhangs. Statistical Analysis Used: To identify the relationship between matrix band systems and other factors, Chi-square tests (χ2-tests) and Z-tests were used. Pearson correlation coefficient was computed and logistic regression analysis was carried out to assess variables that can affect proximal margins and contact points of final restorations. Results: All optimum contacts 389 (100%) were found in restorations done using sectional band system. A highly significant association was found between open contact points and negative overhanging margins with the use of circumferential matrix band system (P < 0.00). Conclusion: Sectional matrix band system has been found superior to circumferential matrix band system.

Prevalence and outcome of pregnancy among elderly primigravida in Aminu Kano teaching hospital, Kano: a 5 year review

Background: As women increasingly delay child bearing, the proportion of women having their first delivery at ''advanced maternal age'' is expected to rise. These elderly primigravidae have traditionally been considered to be at increased risk of adverse maternal and perinatal outcomes compared to their younger counterparts, because of associated pregnancy and labour complications. Objectives: To determine the prevalence of elderly primigravidae and compare their pregnancy outcome with that of younger primigravidae in Aminu Kano Teaching Hospital, Kano. Materials And Methods: This was a retrospective case control study comparing the pregnancy outcome of primigravid mothers aged 35 years and above (elderly primigravidae) with those of younger primigravidae aged 20-25 years, who delivered at Aminu Kano Teaching Hospital between January 2009 and December 2013. Results: There were 18,452 deliveries during the period under review, out of which 295 were primigravidae aged 35 years or above giving a prevalence of 1.6%. There was statistically significant higher preterm delivery rate ( X2= 10.30, P= 0.001) and caesarean delivery rate (X2= 12.15, P= 0.0001) among the elderly primigravidae compared to younger primigravidae. The elderly primigravidae were more prone to hypertensive disorders in pregnancy (X2=23.96, P=0.0001) and diabetes (X2=4.689, P=0.030) compared to the younger primigravidae. The prevalence of antepartum haemorrhage (X2=6.434, P=0.011) and uterine fibroids (X2=5.549, P=0.019) were also statistically significant among the elderly primigravidae compared to the younger primigravidae. There was no significant difference in the other maternal and foetal outcome measures. Conclusion: The prevalence of elderly primigravidae in this study was 1.6%. The prevalence of obstetric complications such as preterm delivery, antepartum haemorrhage, uterine fibroids coexisting with pregnancy and medical conditions like hypertensive disorders in pregnancy and diabetes mellitus are higher among elderly primigravidae compared to younger primigravidae. The elderly primigravidae were also more liable to have caesarean deliveries than the younger primigravidae. However there was no difference in the fetal outcome in the two groups

Relationship between hair nicotine levels with blood pressure, body composition, lipid profile and leptin among healthy male smokers in Kelantan

Objectives: Cigarette smoking has been reported to cause acute blood pressure elevation. Therefore, it is important to assess the relationships between chronic smoking and blood pressure, body composition, and the metabolic profile to gain an understanding of the long-term effects of smoking on an individual's body weight and health. This study examined the relationships between the hair nicotine level, blood pressure, body composition, lipid profile, and leptin in healthy male smokers

Methods: For this cross-sectional study, 107 male smokers aged between 20 and 50 years old were recruited as volunteers. The nicotine levels in the volunteers' hair were measured using gas chromatography-mass spectrometry. Moreover, the subjects' blood pressure, body composition [weight, height, body mass index, body fat percentage, visceral fat, waist and hip circumferences, and basal metabolic rate], lipid profile, and leptin concentration were also measured

Results: The means for age and BMI among the subjects were 37.00 [9.42] years and 24.59 [4.33] kg/m[2], respectively. The average length of time as a smoker was 16.91 years. The hair nicotine level was found to be positively correlated with the total cholesterol [r = 0.314, r[2] = 0.099, p = 0.028] and triglyceride [r = 0.351, r[2] = 0.0.123, p = 0.013] levels. However, no significant correlations were found between the hair nicotine level and blood pressure, body composition, or leptin concentration

Conclusion: The positive correlations between the hair nicotine level and total cholesterol and triglyceride levels highlighted the harmful effects of chronic smoking, even among healthy male subjects

Antimicrobial susceptibility patterns of multidrugresistant Pseudomonas aeruginosa and Acinetobacter baumannii against carbapenems, colistin, and tigecycline

To examine susceptibility of Pseudomonas aeruginosa [P. aeruginosa] and Acinetobacter baumannii [A. baumannii] against carbapenems along with colistin and tigecycline as alternative therapeutic options. A total of 117 strains of multidrug-resistant [MDR] non-fermenting Gram negative bacteria isolated from non-duplicate samples were collected consecutively. We included one sample from each patient [84 isolates of A. baumannii and 33 isolates of P. aeruginosa isolated from patients seen at King Khalid University Hospital, Riyadh, Saudi Arabia, from June to December 2010]. Isolates were identified by the MicroScan WalkAway 96 Plus system. The minimum inhibitory concentrations [MICs] were determined by E-test following the Clinical and Laboratory Standards Institute breakpoint recommendations. Most A. baumannii strains were resistant to imipenem [90.5%], meropenem [90.5%], and doripenem [77.4%]. Whereas, a higher percentage of P. aeruginosa was resistant to imipenem [90.9%], and meropenem [81.8%], only 39.4% were resistant to doripenem. Colistin had excellent activity against both A. baumannii [100%] and P. aeruginosa [93.9%], while 89.3% of A. baumannii strains were susceptible to tigecycline. Among the carbapenems, doripenem was found to be the most potent antimicrobial agent against P. aeruginosa, whereas colistin proved to be an effective alternative antimicrobial agent for treatment of A. baumannii or P. aeruginosa. Tigecycline remains the best therapeutic option for MDR A. baumannii

Caroli's syndrome in a post renal transplant patient: case report and review of the literature

Caroli's syndrome is characterized by bile duct ectasia in association with hepatic fibrosis. It is usually transmitted in an autosomal recessive fashion and has been well documented to be associated with autosomal recessive polycystic kidney disease and occasionally with autosomal dominant polycystic kidney disease. However, there has been only few case reports published with Caroli's syndrome diagnosed postrenal transplantation

Management of Eclampsia at AKTH: Before and after Magnesium Sulphate

Eclampsia contributes significantly to maternal and perinatal morbidity and mortality in Nigeria. The world Health Organisation recommended Magnesium Sulphate as the most effective; safe and low cost drug for the treatment of eclamptic seizures and for prophylaxis in severe pre-eclamptic.This study is aimed to evaluate the effect of the introduction of magnesium sulphate for the management of eclamptic seizures on maternal and fetal indices in Aminu Kano Teaching Hospital [AKTH]; Kano. A retrospective study of all patients who presented with eclampsia in AKTH; Kano. The study period included 3years prior to introduction o magnesium sulphate [January 2002- December 2004] and 3years after its introduction [January 2005 - December 2007]. During the study period; the prevalence of eclampsia was1.02[1: 97 deliveries]. Sixty six [50.5] of the patients were aged 19 and below. Approximately 62of the patients were primigravida and 87were unbooked. Thirty eight [29] were treated with diazepam while ninety three[71] were treated with magnesium sulphate. 39.4of those treated with diazepam died compared to 15of those treated with magnesium sulphate. Approximately ninety percent of those that died had no antenatal care. Overall perinatal mortality rate in this study was 312 per 1000 births [41]. 368.4per 1000 births among those treated with diazepam and296.7 per 1000births in the magnesium sulphate group. Approximately nine percent of those treated with magnesium sulphate develop toxicity [85.5renal and12respiratory] This study is in support of the findings that magnesium sulphate is superior to diazepam in the reduction of maternal morbidity and mortality

Pattern of Epistaxis in Sokoto; Nigeria: a Review of 72 Cases

Background: Epistaxis remains a common otorhinolaryngological emergency in most hospital emergency departments with varied manifestations. The pattern as seen in a tertiary health institution in sokoto; Nigeria is the subject of this paper. Method: This is a 5 year retrospective study (January 1995-December 1999) of all cases of epistaxis presenting at or referred to the Ear; Nose and Throat (ENT) Department of Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto; Nigeria whose data were analyzed. Results: A total number of 72 cases were seen with epistaxis out of 3;706 new cases seen at the ENT clinic. The incidence of epistaxis amongst UDUTH ENT patients was 19/1000.There were 45 males (62.5) and 27 Females (37.5) with a male to female ratio of 1.7:1.Their ages ranged between 1and 70 years with the 0-10 age range recording the highest number (26.4).The commonest cause of epistaxis was idiopathic (29.2); followed by trauma (27.8) and hypertension (18.0).Non surgical methods (97.2) such as observation alone (34.7) without active intervention to arrest bleeding; and nasal packing (34.7);being the commonest intervention measures used to actively arrest bleeding followed by cauterization of the bleeding points (11.1) were the frequent treatment measures. Surgical extirpation was carried out in 2 cases (2.8) to arrest the epistaxis Conclusion: Although epistaxis is a common otorhinolaryngological emergency and varied in its manifestation; it affects mainly the young peoplein this environment with idiopathic; trauma; and hypertension being the common causes which are amendable to treatment with excellent results

Efficacy and safety of sevelamer. Comparison with calcium carbonate in thereatment of hyperphosphatemia in hemodialysis patients

Current phosphate binders used in hemodialysis patients include calcium-based binders that result in frequent hypercalcemia. The use of a calcium- and aluminum-free phosphate-binding polymer in hemodialysis [sevelamer] disclosed efficacy in the short and long-term studies. However, due to race differences we performed a short-term study on the Saudi hemodialysis patients and compared sevelamer with a standard calcium-based phosphate binder. An open-label, randomized, cross-over study was performed to evaluate the safety and effectiveness of sevelamer hydrochloride in controlling hyperphosphatemia in hemodialysis patients. After a 2-week phosphate binder washout period, stable hemodialysis patients were given either sevelamer or calcium carbonate, and the dosages were titrated to achieve phosphate control over an 8-week period. After a 2-week washout period, patients crossed over to the alternate agent for 8 weeks. Twenty patients from the Dialysis Unit of King Fahd Hospital, Jeddah, Kingdom of Saudi Arabia, were recruited for the study between March 2003 and June 2003. There was a similar decrease in serum phosphate values over the course of the study with both sevelamer [-3.3 +/- 2.2 mg/dL] and calcium carbonate [-3.9 +/- 2.8 mg/dL]. Fifty-two% of patients developed serum calcium greater than 2.75 mmol/L [11.0 mg/dL] while receiving calcium carbonate versus 26% of patients receiving sevelamer [p<0.05]. The incidence of hypercalcemia for sevelamer was not different from the incidence of hypercalcemia during the washout period. Patients treated with sevelamer also sustained a 13% mean decrease in serum cholesterol levels. Sevelamer was effective in controlling hyperphosphatemia without resulting in an increase in the incidence of hypercalcemia seen with calcium carbonate. This agent appears quite effective in the treatment of hyperphosphatemia in hemodialysis patients, and its usage may be advantageous in the treatment of dialysis patients

Age related changes in the rat adrenal gland during prenatal period; [study-1]

Adrenals are complex and important glands of dual character in mammals. The growth of the rat adrenal gland is relatively slower than the general body growth. To observe the age related changes in the adrenal gland of the albino rat during prenatal period. SETTING: Albino rats used were obtained from Animal House of BMSI, JPMC, Karachi. Twenty four fetuses of 15,17,19 and 21 days of gestation were used by dividing into four groups [A to D] each composing 6 fetuses. METHODS: Right adrenals were dissected free, fixed and then stained with 1% toluidine blue solution to study under light microscope. Were dissected free, fixed and then stained with 1% toluidine blue solution to study under light microscope. RESULTS AND CONCLUSIONS: The adrenals showed continuous growth throughout the study. The pancenchymal zonation of cortex started on 15th day and developed on 21st day. In all the cortical zones, the predominance of desk cells over the light cells was observed irrespective of age group studied. The mitotic activity was maximum at the time of birth in both the zones of cortex. The lipid globules in the cortex started developing on 21st day. The medulla appeared distinctly on the 19th day. Both myelinated and unmyelinated nerve fibers were observed in between the cortical cells traversing the whole thickness of cortex from capsule to the medulla

Distribution of epidermal melanin pigment among the inhabitants of Karachi

A study was conducted at Department of Anatomy, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre [JPMC] Karachi, to investigate the distribution of epidermal melanin with respect to age and ethnic groups in Pakistan and intensity of epidermal melanin under ultraviolet radiation among the inhabitants population of Karachi. Epidermal malanin in 5 micro m thick vertical paraffin embedded sections of eighty human skin samples were studied with light microscopy from different age and ethnic groups with schmort technique. The quantity of epidermal melanin diminished as the age advanced. There was no significant difference among different ethnic groups in Pakistan, and the amount of epidermal melanin was significantly higher in exposed than in unexposed parts of body among the population of Karachi. The distribution of epidermal melanin appeared to be inversely proportional to the advancing age, it remained constant among different ethnic groups of Pakistan, but the intensity was significantly higher in exposed than in unexposed parts of body among Karachiites

fibre size of the hindlimb nerves and their roots in albino rat

OBJECTIVE: To estimate the number and diameters of myelinated fibres in the tibial nerve[TN]; common peroneal nerve[CPN] and their dorsal and ventral roots L4, L5 and L6 in albino rat. SETTING: Department of Anatomy, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. SUBJECT: Male adult albino rats. Period: One year. MATERIAL AND METHODS: The number and diameters of myelinated fibres were estimated from the photomicrographic montages of their araldite embedded transverse sections. The mean count of myelinated fibres in TN was more than CPN while their population in both the dorsal and ventral roots of L5 segment outnumbered the other two segments. The mean diameters of myelinated fibres forming TN and CPN ranged between 2.3-12.2 [micro]m and 2.4-12 [micro]m respectively, while their dorsal and ventral roots measured between 1-12 [micro]m and 2-14 [micro]m. A decrease in the fibre size in both the nerve roots occurred rostrocaudally, however, the size range in the ventral roots appeared to be larger than in the dorsal roots whereas the CPN has slightly more larger sized fibres than the TN

Study of myelinated fibers in the common peroneal nerve in monkey

The common peroneal nerve [CPN] motoneurons were localized by horseradish peroxidase neuronal tracing technique. They extended from caudal part of L4 to the caudal part of L6 segments of the spinal cord in monkey [macaca mulatta]. The number and diameters of myelinated fibres in the CPN and its ventral roots, L4, L5 and L6 of the monkey were estimated from the photomicrographic montages of their araldite embedded transverse sections. The mean count of these fibres was 896 in L4, 3228 in L5, 6959 in L6 and 7497 in CPN. The average diameters of myelinated fibres in ventral root measured between 2 and 1 [micro]m and in CPN between 2 and 22 [micro]m. The percentage of myelinated fibres measuring 9 [micro]m and above was 79.1% in L4, 86.7% in L5, 63.4% in L6 and 63.5% in common peroneal nerve

Projections in the dorsal column nuclei of femoral and obturator nerves in the rat

The central projection of primary afferent fibres of the femoral and obturator nerves to the dorsal column nuclei were studied in the albino rat. Horseradish Peroxidase [HRP] labelled terminations were observed through most of the caudorostral extent of the ipsilateral gracile nucleus. This formed an oblique band whose long axis was directed in a drosolateral and ventromedial direction in case of femoral nerve while in case of obturator nerve, the terminations occupied a central area in gracile nucleus. No labeling was observed in cuneate or external cuneate nuclei

Visualization of neurons forming the obturator nerve in albino rat

To localize and estimate the size, number and segmental distribution of motor, dorsal root ganglion [DRG] and postganglionic sympathetic [PSN] neurons whose axons form the obturator nerve in albino rat. Setting: Department of Anatomy, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. Subjects: Male, adult albino rats of Charles River strain. Main outcome measures: Horseradish peroxidase [HRP] method of tracing neurons by injecting 25-30% HRP solution into the muscles supplied by the obturator nerve. The motoneurons extended between L2 and L4 segments of the spinal cord, appeared as groups of neurons occupying anterolateral, posterolateral and central groups. The labelled sensory neurons located in L2-L4 ipsilateral dorsal root ganglia were densely populated in L3 DRG without any somatotopic organization. Ike sympathetic neurons were labelled in L2-L4 sympathetic ganglia with heavy labelling in The. The somal diameters of the motoneurons ranged between 10 and 50 micro m with majority having somal diameters greater than 25 micro m. The size spectrum of sensory neurons measured between 12 and 50 micro m and that of sympathetic ganglion cells between 10 and 38 micro m