Aim: The purpose of this study was to determine the factors that help predict early mortality in patients in the emergency department that have suffered a severe traumatic brain injury. Study design: A retrospective cross-sectional study Place and duration: Chandka Medical College/ Civil Hospital Larkana. April 2018- March 2020 Methodology: Retrospective analysis was used to study 198 patients that were admitted to the emergency department due to severe traumatic brain injury. The radiological, clinical, basic demographical, and biological data were all recorded when the patient was first admitted and while they were staying in the emergency department. Results: The results showed that 42 patients died. According to the univariate analysis, the presence of low value of Glasgow coma scale, bilateral mydriasis, shock, the high value of injury severity score, and cardiac arrest played a major role in the deaths of such patients. Poor outcome was associated with cerebral hematoma, subdural hematoma, and meningeal hemorrhage. A link was seen between poor prognosis and cardiac arrest and cerebral hematoma. Conclusions: In our study, subdural hematoma, intracranial hematoma, and meningeal hemorrhage were associated with mortality. To improve the prognosis of severe traumatic brain injury, prehospital care has to be improved. Additionally, futile resuscitations should be avoided. It is also very important to take a CT scan of the head as urgently as possible to detect operable mass lesions. Keywords: traumatic brain injury, early outcome, emergency department

Aim: To analyze the characteristics of Post-neurosurgical nosocomial bacterial meningitis in adults Study design: A retrospective cross-sectional study Place and duration: Riyadh Care Hospital/ National Care Hospital, from July 2005 to June 2010 then 2013 to 2018. Methodology: Over ten years, sixty-two patients above the age of 16 years who suffered from Post-neurosurgical nosocomial bacterial meningitis were evaluated by collecting clinical data. The cases were divided into two categories, the first one from July 2007 to June 2012 and second one from August 2013 to July 2018. Results: Among the 62 patients, there were 43 males and 19 females with post-neurosurgical nosocomial bacterial meningitis. It was recorded in the first group that the percentage of post-neurosurgical nosocomial meningitis in all culture-proven adult bacterial meningitis was 12 percent and for the second group it was seen to be 27 percent. The most constant clinical characteristics were fever and gradual consciousness disruption, which may be related to various postoperative neurosurgery issues. The most prevalent pathogens were recorded to be pseudomonas aeruginosa, staphylococcus aureus, coagulase-negative staphylococcus, Acinetobacter baumannii, and lastly, Escherichia coli. During the second era, there was a rise in polymicrobial illnesses and multi antibiotic resistance. Mortality was 22% in the first group of the study and 36% in the second group of the study. Conclusion: The selection of appropriate empirical antibiotics is complex and is necessary to be guided by knowledge of the comparative ratio of multiple diseases as well as the rising prevalence of resistant strains. To increase the likelihood of survival, early diagnosis is suggested with optimal antibiotic selection based on in vitro susceptibility testing, epidemiologic patterns, and lastly, metabolic derangement treatment to be advised and required. Keywords: Bacterial Meningitis, adults, post-neurosurgery

No abstract

Aim: The purpose of this study was to determine the factors that help predict early mortality in patients in the emergency department that have suffered a severe traumatic brain injury. Study design: A retrospective cross-sectional study Place and duration: Chandka Medical College/ Civil Hospital Larkana. April 2018- March 2020 Methodology: Retrospective analysis was used to study 198 patients that were admitted to the emergency department due to severe traumatic brain injury. The radiological, clinical, basic demographical, and biological data were all recorded when the patient was first admitted and while they were staying in the emergency department. Results: The results showed that 42 patients died. According to the univariate analysis, the presence of low value of Glasgow coma scale, bilateral mydriasis, shock, the high value of injury severity score, and cardiac arrest played a major role in the deaths of such patients. Poor outcome was associated with cerebral hematoma, subdural hematoma, and meningeal hemorrhage. A link was seen between poor prognosis and cardiac arrest and cerebral hematoma. Conclusions: In our study, subdural hematoma, intracranial hematoma, and meningeal hemorrhage were associated with mortality. To improve the prognosis of severe traumatic brain injury, prehospital care has to be improved. Additionally, futile resuscitations should be avoided. It is also very important to take a CT scan of the head as urgently as possible to detect operable mass lesions. Keywords: traumatic brain injury, early outcome, emergency department

No abstract

Aim: To analyze the characteristics of Post-neurosurgical nosocomial bacterial meningitis in adults Study design: A retrospective cross-sectional study Place and duration: Riyadh Care Hospital/ National Care Hospital, from July 2005 to June 2010 then 2013 to 2018. Methodology: Over ten years, sixty-two patients above the age of 16 years who suffered from Post-neurosurgical nosocomial bacterial meningitis were evaluated by collecting clinical data. The cases were divided into two categories, the first one from July 2007 to June 2012 and second one from August 2013 to July 2018. Results: Among the 62 patients, there were 43 males and 19 females with post-neurosurgical nosocomial bacterial meningitis. It was recorded in the first group that the percentage of post-neurosurgical nosocomial meningitis in all culture-proven adult bacterial meningitis was 12 percent and for the second group it was seen to be 27 percent. The most constant clinical characteristics were fever and gradual consciousness disruption, which may be related to various postoperative neurosurgery issues. The most prevalent pathogens were recorded to be pseudomonas aeruginosa, staphylococcus aureus, coagulase-negative staphylococcus, Acinetobacter baumannii, and lastly, Escherichia coli. During the second era, there was a rise in polymicrobial illnesses and multi antibiotic resistance. Mortality was 22% in the first group of the study and 36% in the second group of the study. Conclusion: The selection of appropriate empirical antibiotics is complex and is necessary to be guided by knowledge of the comparative ratio of multiple diseases as well as the rising prevalence of resistant strains. To increase the likelihood of survival, early diagnosis is suggested with optimal antibiotic selection based on in vitro susceptibility testing, epidemiologic patterns, and lastly, metabolic derangement treatment to be advised and required. Keywords: Bacterial Meningitis, adults, post-neurosurgery

Background: Fixation of thoracolumbar burst fractures (TLBF) with short segment pedicle screw construct has become popular over last few decades. Spine surgeons have started to deal advanced degenerative spinal pathologies with percutaneous pedicle screw fixation (PPSF) as well. Short segment PPSF has been demonstrated to be an effective treatment option for TLBF fixation in fewer studies so far. This study compared the short segment open pedicle screw fixation (OPSF) with fusion to a short segment PPSF without fusion in the management of TLBF. Methods: Between December 2019 and October 2021, fifty nine patients underwent short-segment pedicle screw fixation, 32 PPSF while 27 OPSF for TLBF. Each of the three follow-up examinations included radiographs to ensure that the spinal column had recovered to its pre-injury state. A lateral thoracolumbar radiograph was used to calculate the Cobb angle, vertebral wedge angle, and vertebral body compression ratio. In this study, patients' pain and function were assessed using the VAS, the Frankel grading system, and the Low Back Outcome Score (LBOS). Additionally, the volume of blood loss and the time required to finish the procedure were also noted. Results: Regional Cobb angle improved post operatively in both groups without any disparity when assessed the two groups, which was noticed till three months. Operative time and blood loss was less in PPSF. LBOS and VAS markedly improved during early follow ups in PPSF group compare to OPSF. Concluding follow up did not show significant difference between PPSF and OPSF. Conclusions: Open or percutaneous short-segment pedicle fixation with or without fusion is secure and efficient treatment option for TLBF. PPSF alone resulted in a greater reduction in pain and improvement in functional ability than the OPSF during initial time period which substantially improve overall outcome in management of TLBF.

Aim: To determine the prevalence of minor head injury and determination a suitable strategy for diagnosis and management Study design: A cross-sectional study Place and duration: Chandka Medical College/Civil Hospital Larkana, (April 2019-March 2020) Methodology: A total of 317 participants with traumatic brain injury (TBI) were included in this study. Out of that number 181 (57.09%) had a Glasgow coma scale of less than 15. A Head CT scan was done after 4 hours of their arrival in the Emergency room (ER). Those patients who had penetrating injuries of the head were excluded from the study. Results: Out of 181 participants who had GCS less than 15, 47 (14.82%) participants had abnormal brain CT scans. A total of 16 (5.04%) needed surgery. Some patients presented with lethal brain lesions. However, even in severe cases, early diagnosis and management were useful. Conclusion: The present approach of risk stratification regarding minor head injuries in adults based on skull radiography should be replaced with NICE guidelines. This modification will result in relying on CT scans rather than skull radiography eventually increasing the rate of admissions. Intracranial lesions can be detected on early CT scanning and help in the reduction of unnecessary admissions in hospitals. Keywords: Minor head injury, traumatic brain injury, computed tomography, skull fractures, intracranial lesions, GCS