Overview of systematic reviews: Management of common Traumatic Brain Injury-related complications.

BACKGROUND: Many clinical interventions are trialled to manage medical complications following Traumatic Brain Injury (TBI). However, published evidence for the effects of those clinical interventions is limited. This article is an overview of common complications and their management from published systematic reviews in TBI. METHODS AND FINDINGS: A health science electronic database search for published systematic reviews for management of common complications in TBI was conducted in the last decade till 31st January 2021. Methodological quality and evidence were critically appraised using the Grading of Recommendations, Assessment, Development and Evaluations and Revised-Assessment of Multiple Systematic review tools. Overall, only six systematic reviews complied with search criteria, these evaluated fatigue, spasticity and post traumatic seizures (29 RCTs, 13 cohort studies, n = 5639 participants). No systematic reviews for other common TBI-related complications met criteria for this review. The included reviews varied from 'moderate to high' in methodological quality. The findings suggest beneficial treatment effect of anti-epileptic drugs (phenytoin/levetiracetam) compared with placebo in reducing early seizure incidence, but no significant benefit of phenytoin over levetiracetam, valproate, or neuroprotective agent for early or late posttraumatic seizures. There was 'limited' evidence for spasticity-related interventions, and 'insufficient' evidence of cardiorespiratory training on fatigue levels. CONCLUSIONS: Despite the high prevalence and associated functional impact of TBI-related complications, there is limited evidence to guide treating clinicians for management of common TBI complications. More robust studies are needed to build evidence in this population.

A comprehensive Ayurvedic treatment along with counseling in oligoasthenozoospermia with previous intrauterine insemination failure-A case report.

Male infertility contributes for 50% of infertility globally, and several etiological factors contribute to it. Oligoasthenozoospermia and anxiety, forms a vicious cycle, resulting in male infertility. A man advised for assisted reproductive techniques, even after correcting seminal parameters has poor success rate if the symptoms of anxiety is left untreated. The signs and symptoms of oligoasthenozoospermia can be compared with Kshina shukra of Ayurvedic classics. The present case report presents, the role of an indigenous combination of drugs in improving the quantity and quality of semen, along with the reduction in anxiety levels through counseling. The patient with low sperm motility and volume was subjected to Ayurvedic management protocol of initially Counseling, followed by Shodhana treatment and then administration of Mashadi choornam for 90 days. A marked improvement was observed in seminal parameters and anxiety levels and patient could undergo natural conception, a few months after the treatment, thus focusing on an integrative approach.

Rehabilitation in Disaster Relief.

Rehabilitation plays a crucial role in natural disasters owing to the significant upsurge of survivors with complex and long-term disabling injuries. Rehabilitation professionals can minimize mortality, decrease disability, and improve clinical outcomes and participation. In disaster-prone countries, skilled rehabilitation workforce and services are either limited and/or comprehensive rehabilitation-inclusive disaster management plans are yet to be developed. The World Health Organization Emergency Medical Team initiative and guidelines provide structure and standardization to prepare, plan, and provide effective and coordinated care during disasters. Many challenges remain for implementation of these standards in disaster settings and integrating rehabilitation personnel.

Intravenous fluid administration and monitoring for adult ward patients in a teaching hospital.

Many acutely unwell, hospitalized patients receive continuous intravenous (IV) fluids. Complications of IV fluid administration include electrolyte abnormalities and fluid overload, which be detected by appropriate IV fluid administration and monitoring practices. This prospective clinical audit described the administration and monitoring of maintenance IV fluid in ward patients in an Australian tertiary teaching hospital. Of 332 inpatients (98%), 85 (26%) were receiving IV fluids. Serum electrolyte and renal function measurements were obtained in 85% versus 65% of patients receiving IV fluids versus no IV fluids (P < 0.001). Fluid balance charts were being maintained for 94% versus 44% of patients receiving IV fluids versus no IV fluids (P < 0.001). Body weight measurements were documented for 15% versus 14% for patients receiving IV fluids versus no IV fluids (P = 0.078). Findings show that approximately one-quarter of adult ward patients in our hospital received IV fluids. Monitoring of such patients using regular blood tests and fluid balance charts is high, but patient weight measurements are low. Why hospitalized patients who require maintenance IV fluids do not have regular body weight measurements requires further investigation.