Hyperhomocysteinemia in a Patient With Subdural Hematoma and Subarachnoid Hemorrhage Secondary to a Traumatic Brain Injury.

Traumatic brain injury (TBI) is a significant global health issue, contributing substantially to mortality and disability. Serum biomarkers, such as homocysteine (Hcy), play a critical role in the prognosis of brain injuries, with hyperhomocysteinemia (HHcy) potentially leading to neurological disorders. We present the case of a 64-year-old patient admitted to the emergency department following a road traffic accident (RTA). Magnetic resonance imaging (MRI) revealed parietal subdural hematoma (SDH), right frontal contusion, and left subarachnoid hemorrhage (SAH). The patient underwent a craniotomy to address SAH and SDH. Initial Hcy levels were markedly elevated compared to post-operative levels. Hcy represents a rapid, non-invasive, and cost-effective diagnostic tool for assessing brain injury severity and guiding medical intervention. Early detection of HHcy could potentially mitigate vascular and neurological complications, thereby improving patient outcomes.

Public Health Surveillance of Pediatric Polio in Pakistan: A Cohort Study.

Background and objective Polio continues to be endemic in Pakistan despite substantial international efforts to combat it, which presents a serious public health concern. Strategies for eradicating polio depend on understanding the dynamics of pediatric polio transmission and the efficacy of surveillance. This research study aimed to critically evaluate the public health surveillance system for pediatric polio in Pakistan and propose recommendations for improvement. Methodology This study was conducted from June 2020 to July 2023 in three well-known hospitals in different areas of Pakistan and involved 26 patients. Reviews of medical records, interviews, and surveillance report analysis were all part of the data collection process. Descriptive statistics, chi-square tests, and logistic regression analysis were performed using SPSS Statistics version 27.0 (IBM Corp., Armonk, NY) with the statistical significance set at p<0.05. Results The highest incidence of polio was observed in children aged 13-24 months (nine patients, 34.62%), with males accounting for 14 cases (53.85%) and urban residents 16 cases (61.54%). Vaccination status significantly influences disease incidence (p<0.001), with two patients (7.69%) unvaccinated, 10 patients (38.46%) partially vaccinated, and 14 patients (53.85%) fully vaccinated. Paralysis was the predominant symptom in 16 patients (61.54%). Recovery outcomes varied, with eight patients (31%) fully recovering, 12 patients (46%) showing partial improvement, and six patients (23%) experiencing chronic motor impairments. Effective surveillance depends on timely reporting [odds ratio (OR): 2.15, p<0.001] and healthcare worker training (OR: 1.67, p<0.001), highlighting crucial aspects of polio management strategies. Conclusions Based on our findings, vaccination status significantly impacts polio occurrence, with a notable proportion found in partially vaccinated or unvaccinated children. Paralysis remains the primary symptom, with varied recovery outcomes, including chronic motor impairments in some cases. This study underscores Pakistan's ongoing challenges with pediatric polio, highlighting the crucial need for improved vaccination, surveillance, and rehabilitation efforts.