Neurosciences
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Review Meta Analysis
Induced hypothermia to treat neonatal hypoxic-ischemic encephalopathy. Review of literature with meta-analysis and development of national protocol.
The efficacy of induced hypothermia to treat hypoxic-ischemic encephalopathy (HIE) in term infants has been evaluated in 6 multicenter randomized controlled trials. Meta-analysis of these trials shows that hypothermia in the first 6 hours after moderately severe HIE reduced the risk rate of death or neurological impairment at 18 months of age; risk ratio (RR): 0.81 (95% confidence interval [CI]: 0.71 to 0.93, p=0.002); risk difference -0.11 (95% CI: -0.18 to -0.04), with a number needed to treat of 9 (95% CI: 5-25). ⋯ We developed a national protocol using a simplified method of cooling. This protocol will hopefully lead to a widespread implementation of induced hypothermia in different settings within Saudi Arabia.
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To describe the patterns of formation, level of beginning, variations of course, and relation of the median nerve within the arm of human cadavers. ⋯ Knowledge of such variants of the median nerve helps clinicians and surgeons in the diagnosis of unexplained clinical cases.
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Management of intracranial hypertension is a major cornerstone of neurocritical care. Apart from traumatic brain injury, there are no clear guidelines for intracranial pressure (ICP) monitoring. The insertion of ICP monitors is an invasive procedure with inherent risks and could be contraindicated in case of severe coagulopathy. ⋯ This is a technical report with illustrative cases on the use of PI in the management of high ICP, as a guide for optimal dosing of hyperosmolar agents we use in our institution. The use of TCD PI is a useful adjunct to guide the use of hyperosmolar therapy in various conditions with raised intracranial hypertension. We will discuss the combination of the PI determination with an anatomical evaluation of the optic nerve diameter to eliminate confounding factors in PI determination.
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Prevalence and prediction of abnormal CT scan in pediatric patients presenting with a first seizure.
To estimate the prevalence of abnormal neuroimaging in children presenting to the emergency department (ED) with a new-onset seizure, and to identify the significant clinical predictors for an abnormal CT scan. ⋯ This study demonstrates a high prevalence of abnormalities identified on the CT scans of children who presented with their first apparent seizure. An emergency CT may be considered in children presenting with their first seizure.
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Suicide by self-immolation, or lighting oneself on fire, is the most common method of suicide used among women in rural Iran. Understanding the underlying mechanisms that may lead women to commit suicide by self-immolation is necessary for the development of empirically-supported prevention programs. ⋯ Based in ecology theory, we review the risk factors for suicide by self-immolation and present them in terms of ecological theory in an attempt to offer an integrative approach for prevention of self-immolation among women in rural Iran. We conclude by recommending a multifaceted approach to prevention of self-immolation.