Resource utilization in management of spontaneous intracerebral hemorrhage without systemic risk factors. Does early surgical decompression matter?

BACKGROUND: Even though different subtypes of spontaneous ICH are frequently linked to a poor prognosis, their causes, pathological features, and prognoses vary. Atypical intracerebral hemorrhage is the subtype of spontaneous ICH that usually occurs due to an underlying localized vascular lesion. It is unrelated to systemic vascular risk factors, mostly affects children and young adults and is associated with a relatively good outcome. This fact should be considered when planning the evaluation and treatment. Investigating the cause of this subtype is fundamental to providing optimal management. However, if resources do not allow completing the investigations, the cause will be more difficult to discover. Treatment decisions will be made under stress to save the patient's life, especially with rapidly deteriorating patients. METHODS: We described three cases of spontaneous ICH without systemic risk factors where the bleeding source could not be determined before surgery due to a lack of resources, preventing preoperative vascular investigation. Knowing that the atypical ICH has a distinct identity, regarding etiology and prognosis, encouraged the surgeons to resort to early surgical decompression as an alternative plan. We reviewed the literature searching for supporting evidence. RESULTS: The results of treatment of the presented cases were satisfactory. The lack of reported similar cases was brought to light by a literature analysis that sought to provide backing for the proposed management strategy. In the end, we supplied two graphic organizers to help readers remember the different types and treatment of hemorrhagic stroke. CONCLUSION: There isn't enough evidence to show that there are other ways to treat atypical intracerebral haemorrhage when resources are limited. The presented cases highlight the importance of decisionmaking in resource-constrained situations when patient outcomes can be improved.

The Integrated Amendment of Sodic-Saline Soils Using Biochar and Plant Growth-Promoting Rhizobacteria Enhances Maize (Zea mays L.) Resilience to Water Salinity.

The utilization of low-quality water or slightly saline water in sodic-saline soil is a major global conundrum that severely impacts agricultural productivity and sustainability, particularly in arid and semiarid regions with limited freshwater resources. Herein, we proposed an integrated amendment strategy for sodic-saline soil using biochar and/or plant growth-promoting rhizobacteria (PGPR; Azotobacter chroococcum SARS 10 and Pseudomonas koreensis MG209738) to alleviate the adverse impacts of saline water on the growth, physiology, and productivity of maize (Zea mays L.), as well as the soil properties and nutrient uptake during two successive seasons (2018 and 2019). Our field experiments revealed that the combined application of PGPR and biochar (PGPR + biochar) significantly improved the soil ecosystem and physicochemical properties and K+, Ca2+, and Mg2+ contents but reduced the soil exchangeable sodium percentage and Na+ content. Likewise, it significantly increased the activity of soil urease (158.14 ± 2.37 and 165.51 ± 3.05 mg NH4+ g-1 dry soil d-1) and dehydrogenase (117.89 ± 1.86 and 121.44 ± 1.00 mg TPF g-1 dry soil d-1) in 2018 and 2019, respectively, upon irrigation with saline water compared with non-treated control. PGPR + biochar supplementation mitigated the hazardous impacts of saline water on maize plants grown in sodic-saline soil better than biochar or PGPR individually (PGPR + biochar > biochar > PGPR). The highest values of leaf area index, total chlorophyll, carotenoids, total soluble sugar (TSS), relative water content, K+ and K+/Na+ of maize plants corresponded to PGPR + biochar treatment. These findings could be guidelines for cultivating not only maize but other cereal crops particularly in salt-affected soil and sodic-saline soil.