Outcome of patients with traumatic cranial nerve palsy admitted to a university hospital in Nepal.

BACKGROUND: Cranial nerve palsy (CNP) is a common complication of traumatic brain injury (TBI). Despite a high incidence of TBI in Nepal (382 per 100,000), literature on the specific management and outcome of CNP is lacking. This study aimed to examine the outcomes of TBI patients involving single versus multiple CNP. METHODS: A retrospective chart review of 170 consecutive TBI patients admitted to the tertiary neurosurgical center in Nepal between April 2020 and April 2022 was conducted. Demographic, clinical, and etiological characteristics; imaging findings; and management strategies were recorded, compared, and analyzed using descriptive statistics. The Glasgow Outcome Scale Extended (GOSE) was used to measure the outcomes in two groups of patients (single and multiple CNP) at 3 months. RESULTS: Out of 250 eligible patients, 80 were excluded and CNP was noted in 29 (17.1%) of the remaining 170. The median age was 34.9 years, and falls (60.6%) were the most common cause of trauma. TBI severity was categorized based on GCS: mild (82.4%), moderate (15.9%), and severe (1.8%). Cranial nerve involvement was seen in 29 (17.05%) patients: single cranial nerve involvement in 26 (89.65%) and multiple nerve involvement in 3 (10.34%). The most common isolated cranial nerve involved was the oculomotor nerve (37.9%). CT findings revealed a maximum of skull fractures with no significant association between CNP and CT findings. CONCLUSIONS: CNP is a common consequence of TBI with the most common etiology being falls followed by RTA. Single CNP was more common than multiple CNP with no significant difference in the outcome in the 3-month GOSE score. Further research is needed to determine the burden of traumatic CNP and establish specific management guidelines for different types of CNP.

Marshall Computed Tomography Scoring System in Predicting Early Mortality in Patients with Traumatic Brain Injury.

BACKGROUND: Traumatic brain injury is common neurological emergency worldwide associated with high rates of morbidity and mortality. Marshall scoring system is one of the several scoring systems that uses initial computed tomography findings to predict outcome. This study aims to determine the role of Marshall scoring system in predicting early mortality in patients with Traumatic brain injury in Nepalese patient population. METHODS: Patients admitted with diagnosis of Traumatic brain injury between August 2017 and July 2018 in our institution were studied prospectively. Clinical status of patient was noted and computed tomography scan of head was interpreted according to Marshall scoring system. Patients were monitored during the hospital stay and in-hospital mortality was correlated with different components of Marshall scoring system at discharge. RESULTS: The most common cause of Traumatic brain injury was road traffic accident (45%). Severe Traumatic brain injury was noted in 17% of patients and commonest intracranial mass lesion was contusion (24%). Surgery was performed in 29% of patients. There was significant correlation between increase in Marshall score and mortality (p<0.001). Degree of midline shift (p<0.016), status of basal cisterns (p<0.001), and combination of mass lesions (p=0.005) were independent predictors of early mortality. CONCLUSIONS: Marshall scoring is highly reliable scoring system to predict early mortality in patients with Traumatic brain injury. Degree of midline shift, status of basal cisterns, and combination of mass lesions are independent parameters predicting early mortality in patients with traumatic brain injury.

Recreationist willingness to pay for aquatic invasive species management.

We estimated willingness to pay for local aquatic invasive species lake management in the form of a daily lake access fee by conducting summer lake surveys in Minnesota, USA. Similar pairs of lakes with differing infestations of zebra mussels, Dreissena polymorpha, and starry stonewort, Nitellopsis obtuse, were used as study sites to infer how being at an infested lake vs. being at an uninfested lake and different local species would impact responses. We also examined recreationists' visit motivation, and aquatic invasive species perceived risk, knowledge, and awareness of problem. We estimated mean willingness to pay about nine to ten dollars per day, which did not differ significantly by lake. Additionally, perceived risk, awareness of problem, and visit motivation were significant in predicting willingness to pay, which could have important ramifications for aquatic invasive species management.

Predicting Farmer Adoption of Water Conservation Practices Using a Norm-based Moral Obligation Model.

This study examines the social-psychological drivers of conservation practice adoption among farmers in Minnesota. Specifically, it applies a moral obligation model to understand farmer decision-making related to water resource management, focusing in particular on conservation tillage and drainage management. Data were collected through a self-administered mail survey of 1500 landowners in two subwatersheds of the Red River Basin: Wild Rice River and Middle Snake-Tamarac Rivers. Data were analyzed using structural equation modeling. Study results demonstrate that farmers' decisions to adopt conservation practices are influenced by personal norms and perceived ability to protect water resources. Further, beliefs about personal responsibility for water protection, and perceived ability to protect water resources activate personal norms of water protection. Collectivistic and biosphere-altruistic values serve as the basis for the activation of personal norms. Study findings suggest that a combination of behavioral intervention strategies that provide tailored information about local water resource problems, appeal to farmers' values, sense of responsibility and personal obligation, and enhance farmers' ability to use conservation practices may be effective in achieving higher levels of conservation practice adoption.

Pediatric Central Nervous System Tumors in Nepal: Retrospective Analysis and Literature Review of Low- and Middle-Income Countries.

BACKGROUND: Central nervous system (CNS) tumors are the most common cause of cancer-related death in children. Little is known about the demographics and treatment of pediatric brain tumors in low- and middle-income countries (LMICs). METHODS: We performed a retrospective chart review of all pediatric patients who presented to the neurosurgical service at Tribhuvan University Teaching Hospital in Kathmandu, Nepal from 2009-2014 and collected information on patients <18 years old who received a diagnosis of a CNS tumor. We analyzed age, gender, clinical presentation, extent of surgical resection, histopathology, and length of hospital stay. We also conducted a literature review using specific terminology to capture studies of pediatric neuro-oncologic epidemiology conducted in LMICs. Study location, length of study, sample size, study type, and occurrence of 4 common pediatric brain tumors were extracted. RESULTS: We identified 39 cases of pediatric CNS tumors, with 62.5% observed in male children. We found that male children (median = 13 years) presented later than female children (median = 8 years). The most frequently observed pediatric brain tumor type was ependymoma (17.5%), followed by astrocytoma (15%) and medulloblastoma (15%). Surgical resection was performed for 80% of cases, and gross total resection reported in 62.9% of all surgeries. More than half (54.1%) of patients had symptoms for more than 28 days before seeking treatment. Symptomatic hydrocephalus was noted in 57.1% of children who presented with CNS tumors. The literature review yielded studies from 18 countries. Study length ranged from 2-20 years, and sample sizes varied from 35-1948. Overall, we found more pronounced variation in the relative frequencies of the most common pediatric brain tumors, compared with high-income countries. CONCLUSIONS: We present the first operative series of childhood CNS tumors in Nepal. Children often had delayed diagnosis and treatment of a tumor, despite symptoms. More comprehensive data are required to develop improved treatment and management algorithms in the context of a given country's demographics and medical capabilities for childhood CNS tumors.