Clinico-radiological Correlation with Outcome in Traumatic Pediatric Extradural Hematoma: A Single Institutional Experience.

BACKGROUND: Head injury is one of the leading causes of mortality and morbidity in the developing as well as developed countries. Extradural hematoma is seen in 1-2% of cases of head injury patients. Extradural hematoma is infrequent in the pediatric age group (less than 18 years) as duramater is tightly adherent to the inner table of the skull and is present in about 1-3% of all pediatric head injuries. MATERIALS AND METHODS: The study was a prospective study conducted in the Department of Neurosurgery at PGIMER, Dr. RML Hospital, New Delhi, over a period of 19 months with a follow-up of 6 months. In total, 38 patients were enrolled in the study. All traumatic extradural hematoma below 18 years of age of both sexes were included. Follow-up of all patients was done at 2 weeks, 1, 2, and 6 months. Noncontrast computed tomography (NCCT) head was done in all patients at the time of admission and whenever their neurological status deteriorated. Routine postoperative NCCT head was done. Outcome assessment was done by Glasgow outcome scale. RESULTS: Of the 38 children, 21 were males and 17 were females. The maximum number of patients was between the ages of 1-5 years (55.26%). Fall from height was the most common cause. Loss of consciousness was the most common presenting symptom (78.94%). Thirty-three patients had GCS of 14-15 at the time of presentation. The parietal region was the most common location of EDH in our study (44.74%). Thirty-five patients had supratentorial and three patients had infratentorial EDH. Eighteen patients had associated brain injury, commonest being brain edema. Six patients were operated. There was no mortality in our study. Two patients had limb paresis. CONCLUSION: Pediatric EDH is a rare entity but a potentially life-threatening condition. Prompt diagnosis and timely intervention decrease morbidity and mortality.

P53 and Ki-67 Expression in Primary Pediatric Brain Tumors: Does it Correlate with Presentation, Histological Grade, and Outcome?

CONTEXT: Pediatric brain tumors are a vexing problem for the neurosurgeon due to the fragile patient cohort. We attempt to find parameters which can help us to treat and prognosticate these patients in a better way. AIMS: This study aims to correlate clinical presentation, outcome, and histological grade with P53 and Ki-67 expression in primary pediatric brain tumors. SETTING DESIGN: This was a prospective, observational study. PATIENTS AND METHODS: Forty-seven patients with primary brain tumors in the age group 0-18 years were included in this study. Clinical presentation was noted. Patients were operated, and specimen was sent for histopathological and immunohistochemistry examination for p53 and Ki-67. The WHO classification of 2007 was used to grade the tumors. Follow-up was done at 3 and 6 months with Glasgow outcome score. Expression of p53 and Ki-67 in different tumors was correlated with clinical presentation, tumor grade and outcome. ANALYSIS METHOD: Statistical Package for Social Science version 17. P < 0.05 was considered statistically significant. RESULTS: There was statistically significant correlation between high tumor grade and high Ki-67 levels (P = 0.000). On post hoc analysis, there was a significant difference between p53 levels in Grade 1 and Grade 4 tumors. There was statistically significant correlation between neurological deficit and higher p53 levels (P = 0.040). There was statistically significant correlation between poor outcome and higher p53 (P = 0.034) and Ki-67 (P = 0.000) levels at 3 months follow-up which continued at 6 months. CONCLUSIONS: From this study, we conclude that p53 and Ki-67 expression in pediatric brain tumors is associated with poor outcome and correlates with tumor grade. Moreover, p53 expression correlates with neurological deficit.

Standard manufacturing procedure of Teekshna lauha bhasma.

BACKGROUND: Lauha bhasma is one of the herbo-metallic preparations used in Ayurveda, a traditional Indian system of medicine for treating various ailments such as anemia, diarrhea, hyperlipidemia and diabetes. OBJECTIVE: To establish standard manufacturing procedure of Teekshna lauha bhasma and analyze its physico-chemical properties. MATERIALS AND METHODS: The preparation of T. lauha bhasma (calx of iron [Fe] turning) involves samanya shodhana, vishesha shodhana followed by bhanupaka, sthalipaka and putapaka with Triphala kwatha as a medium under temperature of 650 °C in electric muffle furnace (EMF) and maintained for 1 h. T. lauha bhasma were subjected to different physico-chemical characterization using X-ray fluorescence spectrophotometer and scanning electron microscopy. RESULTS AND DISCUSSION: The results suggest that these steps are necessary to obtain a good quality of bhasma and also make it acceptable for trituration during Bhasmikarana process. It is found that T. lauha bhasma was prepared properly in 20 puta at a temperature of 650 °C. The particle size of 20 puta T. lauha bhasma is 100-500 nm in range. CONCLUSION: Pharmaceutical procedures given in Ayurvedic texts are necessary to prepare pakwa jambu phala varna T. lauha bhasma that complies with all the classical bhasma pariksha and modern analytical parameters in 20 puta at a temperature of 650 °C maintained for 1 h in EMF.

An epidemiological study of traumatic brain injury cases in a trauma centre of New Delhi (India).

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.

A prospective randomized study of use of drain versus no drain after burr-hole evacuation of chronic subdural hematoma.

OBJECTIVE: Chronic subdural hematoma (CSDH) recurs after surgical evacuation in 5-30% of patients. Inserting subdural drain might reduce the recurrence rate, but is not commonly practiced. There are few prospective studies to evaluate the effect of subdural drains. MATERIALS AND METHODS: A prospective randomized study to investigate the effect of subdural drains in the on recurrence rates and clinical outcome following burr-hole drainage (BHD) of CSDH was undertaken. During the study period, 246 patients with CSDH were assessed for eligibility. Among 200 patients fulfilling the eligibility criteria, 100 each were assigned to "drain group" (drain inserted into the subdural space following BHD) and "without drain group" (subdural drain was not inserted following BHD) using random allocation software. The primary end point was recurrence needing re-drainage up to a period of 6 months from surgery. RESULTS: Recurrence occurred in 9 of 100 patients with a drain, and 26 of 100 patients in without drain group (P = 0.002). The mortality was 5% in patients with drain and 4% in patients without drain group (P = 0.744). The medical and surgical complications were comparable between the two study groups. CONCLUSION: Use of a subdural drain after burr-hole evacuation of a CSDH reduces the recurrence rate and is not associated with increased complications.

Applicability of 15-item Geriatric Depression Scale to detect depression in elderly medical outpatients.

Elder depressives approach physicians for their medical problems, but the detection of their depression is poor. This study aimed to explore the screening for depressive symptoms using a 15-item Geriatric Depression Scale (GDS) in medical clinics. The study was carried out in outpatient setting of geriatric clinic of tertiary care hospital using the Hindi version of GDS-15. Out of 100 eligible older medical clinic patients, 22% of participants scored high on the GDS (≥5) and 18% were definitely having a depressive disorder as per ICD10. The sensitivity of the GDS instrument was 100% and specificity 94%. This study confirmed that a brief screening instrument like the GDS helps physicians to identify and diagnose depression in the medical settings. The need of the hour is to train health personnel involved in geriatric care regarding identifying, diagnosing and managing depression in medical clinics.