ABSTRACT
BACKGROUND: Mild traumatic brain injury (mTBI) is a health problem with an increasing incidence in many developed countries. The standard for examining mTBI is a CT scan, but it is costly, is not always available in all hospitals, and carries a risk of radiation. Meanwhile, S100ß is a protein component produced by central nervous system cells. This study aims to determine the presence of changes in S100ß protein in adult patients with mTBI during treatment as an alternative to examination. METHODS: This research is an analytic observational quantitative study with a cross-sectional study approach to investigate changes in S100ß protein levels in blood serum using the ELISA method of mTBI patients in the first 3 h posttrauma (pretest) and treatment on day 1 (27 h posttrauma/posttest). The research sample consisted of 22 people. This research was conducted in the Surgery Section, Sub-Division of Neurosurgery, Dr. Moewardi Public Hospital, during September-December 2019. The data were then analyzed using a discrimination test (comparing t-test means) and a nonparametric test (Wilcoxon). RESULTS: There was a significant difference in mean S100ß change between the pretest and posttest treatments. The S100ß examination results at posttest decreased to 0.0223 + 0.0029 µg/l or decreased S100ß by 21.7% after treatment. Previously, it was known that the mean of S100ß at pretest was 0.0285 + 0.0137 µg/l. CONCLUSION: There was a significant change in S100ß protein levels at each examination time. Changes in S100ß levels that occurred were in the form of decreased levels from 3 h to 27 h posttrauma. Thus, S100ß protein can be used as a parameter to assess the clinical development of adult patients with mTBI. Moreover, none of the patients with an S100ß value >0.1 µg/l was found to be the cutoff value set by SNC in adult patients with mTBI for head CT scan.
ABSTRACT
BACKGROUND: A decrease in hospital visits including neurosurgery cases during the coronavirus disease 2019 (COVID-19) pandemic has been reported by many countries. This study aims to reveal important data regarding the effect that the COVID-19 pandemic has on services, neurosurgical surgery, and inpatients before and during the COVID-19 pandemic. METHODS: This comparative study compares neurosurgical services, neurosurgical patients, outpatient visits, and monthly inpatients assessed from January to December 2020 (onset of the pandemic) with those of the same period in 2019. RESULTS: The average number of outpatient visits per month during the pandemic (January to December 2020) was 369 visits per month, compared to 397 visits in the same period in the previous year. The lowest outpatient visits occurred in May 2020 with 227 outpatient visits. There was a decrease in the number of neurosurgical patients in January-December during the pandemic period compared to the same period in 2019. A significant decrease in outpatients during and before the pandemic was noted with P = 0.046 (P < 0.05). CONCLUSION: There are differences in the number of visits by outpatients, neurosurgical patients, and inpatients during the pandemic compared to the period before the onset of the pandemic.
ABSTRACT
BACKGROUND: Various complications after ventriculoperitoneal (VP) shunt surgery have been reported, but peroral extrusion of peritoneal catheter is an extremely rare complication, and only 20 cases have been reported since 1987. The pathophysiology still remains unclear and the management is challenging. CASE DESCRIPTION: A 5-year-old boy presented with a catheter coming out of his mouth. The boy had a posterior fossa tumor surgery and had VP shunt insertion 1 year earlier. Clinical signs and imaging studies showed that the distal end of the catheter had perforated the gaster and migrated upward and extruded through the mouth. Emergency removal of the shunt and proper treatment were done and he made uneventful recovery. CONCLUSION: Peroral extrusion of VP shunt is extremely rare. Clinicians should be aware of this complication. With early diagnosis and proper management, the prognosis for good recovery is excellent, with only two deaths being reported in the literature. Complication of shunt extrusion is difficult to avoid, but knowing the risk factors, pathophysiology and proper management will decrease the morbidity and mortality of such cases.
