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2015| July-September | Volume 8 | Issue 3
Online since
July 13, 2015
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ORIGINAL ARTICLES
An epidemiological study of traumatic brain injury cases in a trauma centre of New Delhi (India)
Chandra Shekhar, Laxmi Narayan Gupta, Ishwar Chandra Premsagar, Madhu Sinha, Jugal Kishore
July-September 2015, 8(3):131-139
DOI
:10.4103/0974-2700.160700
PMID
:26229295
Background:
Trauma is one of the leading causes of death and disability in Indian population.
Aim:
To correlate various variables like epidemiology, clinical status, severity of TBI & associated co-morbid conditions and its outcome.
Settings and Design:
This study involved retrospective collection, prospective management and follow up of 796 cases of TBI admitted to the neurosurgery department of a tertiary care hospital in New Delhi during one year study duration.
Materials and Methods:
All the relevant variables recorded and analyzed with Glasgow Outcome Scale (GOS) in 6 months into 3 groups i.e. group 1 (GOS-1/Dead), group 2 (GOS-2&3/Bad) and group 3- (GOS-3&4/good).
Statistical Analysis:
Compiled data collected, analyzed and difference between two proportions was analyzed using Chi Square test.
Results:
This study included 791 cases with 569 (72%) males and 222 (28%) females with average age of 24 years. Fall from height was the main cause of TBI (56%) followed by road traffic injury (RTI) (36%). Majority (61%) patients reached the hospital within 6 hours of injury out of which 27% patients were unconscious. As per Glasgow coma scale mild, moderate & severe grade of TBI was seen in 62%, 22% &16% cases respectively. Radiological examination of other body parts revealed injuries in 11% cases. Only 11% cases required surgical management, rest was managed conservatively. Good outcome noted in 80% cases and 20% cases expired. Average duration of hospital stay was 5 days. According to multivariate analysis, the factors which correlated with poor prognosis are presence of radiological injuries to other body parts, GCS, abnormal cranial nerve examination, abnormal plantar and abnormal pupillary reflex. (
P
< 0.05)
Conclusion:
TBI predominantly affects young male population and most of these are preventable. Early transportation to the hospital and first aid results in good outcome. Mortality increases with the severity of TBI and associated injuries therefore multimodality approach in polytrauma is essential.
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19
LETTERS TO EDITOR
Presence of rash in a catastrophic condition
Debabrata Bandyopadhyay, Tanmay S Panchabhai, Chirag Choudhary
July-September 2015, 8(3):170-171
DOI
:10.4103/0974-2700.160739
PMID
:26229303
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ORIGINAL ARTICLES
"Occult" rib fractures diagnosed on computed tomography scan only are still a risk factor for solid organ injury
Bishwajit Bhattacharya, Jennifer Fieber, Kevin Schuster, Kimberly Davis, Adrian Maung
July-September 2015, 8(3):140-143
DOI
:10.4103/0974-2700.160706
PMID
:26229296
Introduction:
Prior to the widespread use of computed tomography (CT) scan imaging, lower rib fractures diagnosed on chest X-rays (CXRs) were considered a risk factor for abdominal solid organ injury (ASOI). However, CXRs miss about 50% of the rib fractures that are detected on CT scans. We hypothesized that these "occult" rib fractures would not be predictive for ASOI.
Materials and Methods:
Retrospective review of a level I trauma center's database identified all adult blunt trauma patients (
n
= 11,170) over a 5-year period. Data were abstracted for demographics, injury severity score, presence of ASOI, extremity, pelvic and spine fractures as well as presence and location of rib fractures.
Results:
Rib fractures correlated with the presence of ASOI, regardless of whether they were diagnosed by CXR or CT scan alone (
P
< 0.01). Middle (3-7) and lower (8-12) rib fractures, especially, correlated with the presence of ipsilateral ASOI (
P
< 0.0001).
Discussion:
Although CT scan detects more rib fractures than CXR, rib fractures remain a marker for increased likelihood of ASOI regardless of the modality by which they are diagnosed. Patients with rib fractures also have a greater incidence of spine and pelvic fractures. As the trauma community debates moving away from routine whole-body CT imaging towards a more selective approach, these results suggest that any clinical suspicion of rib fractures, despite a negative CXR, may warrant further investigation.
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1
Pyruvate dose response studies targeting the vital signs following hemorrhagic shock
Pushpa Sharma, Makler Vyacheslav, Chalut Carissa, Rodriguez Vanessa, Mike Bodo
July-September 2015, 8(3):159-166
DOI
:10.4103/0974-2700.160729
PMID
:26229300
Objectives:
To determine the optimal effective dose of sodium pyruvate in maintaining the vital signs following hemorrhagic shock (HS) in rats.
Materials and Methods:
Anesthetized, male Sprague-Dawley rats underwent computer-controlled HS for 30 minute followed by fluid resuscitation with either hypertonic saline, or sodium pyruvate solutions of 0.5 M, 1.0 M, 2.0 M, and 4.0 M at a rate of 5ml/kg/h (60 minute) and subsequent blood infusion (60 minute). The results were compared with sham and non- resuscitated groups. The animals were continuously monitored for mean arterial pressure, systolic and diastolic pressure, heart rate, pulse pressure, temperature, shock index and Kerdo index (KI).
Results:
The Sham group remained stable throughout the experiment. Non-resuscitated HS animals did not survive for the entire experiment due to non-viable vital signs and poor shock and KI. All fluids were effective in normalizing the vital signs when shed blood was used adjunctively. Sodium pyruvate 2.0 M was most effective, and 4.0 M solution was least effective in improving the vital signs after HS.
Conclusions:
Future studies should be directed to use 2.0 M sodium pyruvate adjuvant for resuscitation on multiorgan failure and survival rate in HS.
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Insulin treatment before resuscitation following hemorrhagic shock improves cardiac contractility and protects the myocardium in the isolated rat heart
Mona Soliman
July-September 2015, 8(3):144-148
DOI
:10.4103/0974-2700.160714
PMID
:26229297
Background:
Insulin has been shown to exert positive inotropic effects in several
in vivo ex vivo
models and in human hearts. Resuscitation following hemorrhagic shock results in myocardial contractile dysfunction. However, the optimal timing for treatment with insulin for the cardioprotection effects is unclear.
Objectives:
The objective of this study was to test the hypothesis that treatment with insulin before resuscitation provides better cardioprotection than treatment with insulin after resuscitation.
Materials and Methods:
Rats were assigned to 3 experimental groups (
n
= 6 per group): (1) Hemorrhagic shock and resuscitation, (2) hemorrhagic shock resuscitated then treated with insulin and (3) hemorrhagic shock treated with insulin before resuscitation. Rats were hemorrhaged for 60 min to rach mean arterial blood pressure of 40 mmHg. Rats were resuscitated
in vivo
by reinfusion of the shedded blood to restore normotension and monitored for 60 min. Rats were treated or not with insulin 200 μU/g body weight intramuscularly either before or after resuscitation. The maximum of the left ventricular developed pressure (+dP/dt) was measured for 60 min in the isolated perfused hearts using the Langendorff method. Blood samples were obtained for measurements of tumor necrosis factor-alpha (TNF-α).
Results:
Treatment with insulin before resuscitation following hemorrhagic shock significantly elevated max dP/dt compared with insulin treatment after resuscitation and the untreated group. TNF-α levels were lower in the insulin treatment before resuscitation compared to the treatment after resuscitation and the untreated group.
Conclusion:
Insulin treatment before resuscitation following hemorrhagic shock provides better cardiac protection than treatment with insulin after resuscitation, as evidenced by the improved myocardial contractility, preservation of myocardial structure. The mechanism of cardiac protection involves decrease in the inflammatory response to shock by lowering the levels of TNF.
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LETTERS TO EDITOR
Rare case of pure medial subtalar dislocation: Conservative treatment and 32 months follow-up
Bassir Rida-Allah, Aitbenali Hicham, Mustapha Mahfoud, Ahmed Elbardouni, Mohamed Saleh Berrada, Moradh Elyaacoubi
July-September 2015, 8(3):174-175
DOI
:10.4103/0974-2700.145419
PMID
:26229307
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1
ORIGINAL ARTICLES
Ultrasound guided Deep Vein cannulation: "Perpendicular Insertion Technique (PIT)", an edge over "Conventional Insertion Technique (CIT)"
Bhavesh S Jarwani, Harsh Shah, Aharnish Shah, Malhar Madariya
July-September 2015, 8(3):149-153
DOI
:10.4103/0974-2700.160720
PMID
:26229298
Introduction:
The use of ultrasound imaging before or during vascular cannulation greatly improves first-pass success and reduces complications, but this skill must then be combined with manual dexterity to perform the three dimensional (3D) procedure of placing a catheter into the deep veins while analyzing the 2D images. Hence this study is an attempt to still decrease the above mentioned limitation of guided deep vein cannulation by slight modification in the insertion technique.
Aims and objectives:
Aims to compare the ultrasound guided deep vein cannulation by conventional insertion technique(CIT) v/s ultrasound guided perpendicular insertion technique (PIT). Main comparison parameters here are number of attempts required, time taken for successful insertion, vessel counter puncture, arterial puncture and other known mechanical complications of deep venous cannulation.
Material and method:
Prospective, non randomized cross sectional study, done over 200 patients in two arms. Data-analysed by epi2k and state-9 software.
Results:
Total number of insertions were 64 by CIT v/s 136 by the PIT. Mean of number of attempts required were 1.918 with the CIT v/s 1.106 for the PIT method. Mean of time of cannulation was 78.62 + 18 sec with CIT while it was 66.98 + 12 sec for PIT and this was statistically significant(
P
= 0.041). Incidence of vessel counter-puncture was much lower in PIT as compared to CIT (6.1 % v/s 16.2%). 5.9% cannulation done by CIT had arterial puncture v/s 0.8% with the PIT. Not a single episode of any other mechanical complications with either of the method.
Conclusion:
USG guided perpendicular method is less time consuming, less number of attempts are required and there are less chances of arterial picture or vessel counter puncture.
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3,019
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Patterns and outcomes of traumatic neck injuries: A population-based observational study
Hassan Al-Thani, Ayman El-Menyar, Sharon Mathew, Mahwish Khawar, Mohammad Asim, Husham Abdelrahman, Ruben Peralta, Ashok Parchani, Ahmad Zarour
July-September 2015, 8(3):154-158
DOI
:10.4103/0974-2700.160723
PMID
:26229299
Objectives:
We aimed to analyze the pattern and outcome of traumatic neck injury (TNI) in a small population. Materials and
Methods:
It is a retrospective analysis of all TNI patients who were admitted to the trauma center between 2008 and 2012. Patients' demographics, details of TNI, associated injuries, hospital course, and mortality were analyzed.
Results:
A total of 51 TNI cases were included revealing an overall incidence of 0.61/100,000 population. The mean age was 31 ± 9 years. The most frequent mechanism of injury was motor vehicle crash (29.4%) followed by stab (17.6%), machinery injury (17.6%), fall (9.8%), and assault (7.8%). Larynx, thyroid gland, trachea, jugular veins, and carotid were the commonly injured structures. The majority of cases had Zone II TNI whereas isolated injury was observed in 11 cases. TNI were mainly presented with active bleeding (38%), hypovolemic shock (16%) and respiratory distress (16%). Surgical interventions mainly included simple repair and closure (53%), vein ligation (12%), repair of major arteries (4%), tracheal repair (6%), larynx and hypopharynx repair (4%), and repair of parotid gland (2%). Neck exploration was performed in 88%, and emergency tracheostomy was required in 18% of cases. Overall mortality rate was 11.8%, of which five patients had associated injuries, and one had isolated TNI.
Conclusion:
TNI are not frequent but represent an alarming serious entity in Qatar. Patients with persistent signs of major injuries should undergo early operative interventions. Moreover, the effective injury prevention program should be developed to minimize these preventable injuries in the majority of cases.
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3
LETTERS TO EDITOR
An unexpected complication of sneezing: Blow-out orbital fracture
Pinar Yeşim Akyol, Erden Erol Erol Ünlüer, Orhan Oyar, Serkan Bilgin
July-September 2015, 8(3):172-173
DOI
:10.4103/0974-2700.145409
PMID
:26229305
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2,575
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Sagittal sinus thrombosis in puerperium
Rajlaxmi Mundhra, Neha Gami, Kiran Guleria, Vinita Rathi
July-September 2015, 8(3):173-174
DOI
:10.4103/0974-2700.145417
PMID
:26229306
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1
PICTORIAL EDUCATION
Ultrasound visualization of a pleural adhesion
Tamara Halaweh, Eric Adkins, Andrew King
July-September 2015, 8(3):167-168
DOI
:10.4103/0974-2700.160731
PMID
:26229301
A group of multidisciplinary sonologists conduct weekly Intensive Care Unit (ICU) rounds consisting of ultrasound examinations on select patients recommended by the critical care staff. This image was acquired on a 51-year-old male in the ICU with known valve vegetations, and a pleural adhesion was incidentally discovered on ultrasound.
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2
EDITORIAL
What's new in emergencies, trauma and shock? Traumatic Brain Injury Research in India: Getting shape, taking momentum
Amit Agrawal, Sagar Galwankar
July-September 2015, 8(3):129-130
DOI
:10.4103/0974-2700.160694
PMID
:26229294
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2,473
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BRIEF COMMUNICATION
Penetrating injury from high-speed motor vehicle collision
Alan H Daniels
July-September 2015, 8(3):169-169
DOI
:10.4103/0974-2700.160735
PMID
:26229302
We present the case history of a post motor vehicle crash victim with lower extremity fractures and decreased blood flow. Emergent Angipgraphy revealed a foreign body which was later operated and removed. The case emphasizes that High-speed motor vehicle accidents commonly lead to penetrating injury from objects within and outside of the vehicle.
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LETTERS TO EDITOR
Acid ingestion in pediatric population; negligence to be compensated with lifelong morbidity
Vinay Jadhav, Shailesh Solanki, Gowri Shankar, Ramesh Santhanakrishnan
July-September 2015, 8(3):175-176
DOI
:10.4103/0974-2700.145421
PMID
:26229308
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2,358
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Application of a scoring instrument to predict intracerebral hemorrhage and outcome after thrombolysis for acute ischemic stroke
Rolla T Sweis, Yaniv Kerem, Simon Waghchoure, Erik B Kulstad, Melvin D Wichter
July-September 2015, 8(3):171-172
DOI
:10.4103/0974-2700.160743
PMID
:26229304
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2,176
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2
Polytrauma patient with through and through penetrating rod in abdomen: Timing and team is of utmost importance in emergency management
Md. Yunus , Habib Md Reazaul Karim, Ranendra Hajong, Vijay Sundar Singh
July-September 2015, 8(3):176-177
DOI
:10.4103/0974-2700.160754
PMID
:26229309
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2,129
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