Coagulation abnormalities are common in patients with head injuries. However, the effect of brain injury on fibrinogen levels has not been well studied prospectively to assess coagulation abnormalities in patients with moderate and severe head injuries and correlate these abnormalities with the neurologic outcome. Consecutive patients with moderate (Glasgow Comma Scale (GCS),9-12) and severe (GCS≤8) head injuries were the subjects of this pilot study, All patients had coagulation parameters, including plasma fibrinogen levels measured. Clinical and computed tomography (CT) scan findings and immediate clinical outcome were analyzed. Of the 100 patients enrolled, only seven (7%) patients had hypofibrinogenemia (fibrinogen ≤200 mg/dL). The head injury was moderate in two patients and severe in five patients. Fibrinogen levels showed a progressively increasing trend in four patients (three with severe head injuries and one with moderate head injury). CT scan revealed subdural hematoma in five patients; extradural hematoma in one; and subarachnoid hemorrhage in another patient. Of the seven patients, two patients died during hospital. Large-scale prospective studies are needed to assess the fibrinogen level in patients with head injury and its impact on outcome.

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Context:Coagulopathy frequently occurs following traumatic brain injury (TBI) and usually occurs 6-72 hour post-trauma. The incidence and the probable risk factors for development of coagulopathy and poor outcome following TBI are largely unknown and vary considerably.Aims:To assess the incidence and probable risk factors for development of coagulopathy and to identify the risk factors for poor outcome in terms of median survival time following TBI.Materials and Methods:In this prospective study over two years, patients of isolated moderate and severe traumatic brain injury (GCS≤12) admitted to trauma center had coagulation profile (PT, APTT, thrombin time, fibrinogen and D-dimer), arterial lactate and ABG analysis done on day of admission and on day three. Coagulopathy was defined as prothrombin time (PT) or/and activated partial thromboplastin time (APTT) more than 1.5 times the normal control. Incidence of in-hospital mortality was assessed in all cases.Statistical Analysis:A stepwise logistic regression analysis was performed to identify risk factors for coagulopathy and mortality in these patients.Results:A total of 208 patients were enrolled in the study. The mean age was 32 ± 12 years and mean GCS was 7.1 ± 2.8. Coagulopathy was present in 46% (n = 96) of patients. Risk factors for development of coagulopathy were found out to be severity of head injury (OR: 2.81), elevated D-dimer (OR: 3.43), low hemoglobin (OR: 3.13), and effaced cisterns in the CT scan (OR: 2.72). Presence of coagulopathy (OR: 2.97) and severity of head injury (OR: 5.70) strongly predicted poor outcome, and were associated with a decreased median survival time.Conclusions:There is a high incidence of coagulopathy following TBI. The presence of coagulopathy as well as of severity of TBI are strong predictors of in-hospital mortality in these patients.

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Background Neuroblastic tumor (NT) is the most common extracranial solid tumor of childhood with variable outcome which again depends on risk stratification related to distinct biology of the tumor. The use of fine‐needle aspiration (FNA) material for evaluation of cytomorphological parameters and risk stratification in NTs using cytology prognostic score (PS) is limited in routine practice. Methods We reviewed 38 FNA cytology cases diagnosed as pediatric small round cell tumor between time period June 2017 to December 2019 for clinical, cytomorphological and immunohistochemical features. Results Ten out of 38 small round cell tumors were NTs. All 10 cases were further subclassified according to International Neuroblastoma Pathology Classification into undifferentiated neuroblastoma (n = 1), poorly differentiated neuroblastoma (n = 5), differentiating neuroblastoma (n = 2), and ganglioneuroblastoma (n = 2). Cytologic PS was done using the morphological criteria as described previously in literature. The patients were divided into favorable and unfavorable cytomorphological prognostic categories with a cut off scoring of 12. A score of more than 12 is associated with high risk morphology and advanced stage. All cases with PS > 12 (n‐4) (unfavorable cytomorphology) had a poor outcome compared to six patients with PS < 12 (n‐6) (favorable cytomorphology). Conclusion Aspiration cytology can be used as a first line investigation to evaluate the cytomorphological features for risk stratification and diagnosis in patients with NTs using cytological prognostic scoring system. A larger multi‐centric validation study necessitates for cytological risk stratification.

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Background: Inhalational therapy for patients with chronic respiratory disorder can greatly benefit. Nurses are one of the major components of health care system of hospital and have an important role in education and training of patients. This study was planned to assess knowledge, attitude, and practices of inhalational therapy among nurses.Methods: This questionnaire based cross sectional study was conducted after taking permission from the institutional ethics committee in all the nurses of a tertiary care teaching hospital. This questionnaire consists of few socio-demographic questions and other questions for assessing level of knowledge, attitudes, and practices related to inhalational therapy. Incompletely filled questionnaire were excluded out for data analysis. Data was interpreted in percentage.Results: Total 344 (87.31%) questionnaires were analysed. 334 (97.09%) have heard the term inhalational therapy and 310 (90.12%) responded that it is preferred in respiratory disease. 117 (34.01%) nurses could not mention single side effect of inhalational therapy. 178 (51.74%) nurses always assess/observe the patient and 211 (61.34%) always train the patients for correct inhalational technique. 165 (47.97%) nurses responded that knowledge of inhaler use came from attending meetings, courses or workshops organized by scientific bodies. 163 (47.38%) nurses considered ‘Disease to be treated’ the most important variable while prescribing an inhalational device.Conclusions: The knowledge of inhalational therapy was satisfactory while the demonstration of inhaler techniques to patients was moderate in this study. So regular training courses and workshop should be conducted for the nurses about inhalational therapy practical approach.