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Home > Impact of Intracranial Pressure Monitoring on Mortality in Severe Head Injury at the Aga Khan University Hospital and the Nairobi Hospital

Impact of Intracranial Pressure Monitoring on Mortality in Severe Head Injury at the Aga Khan University Hospital and the Nairobi Hospital

Thesis Info

Author

Mohamed, Abdirahaman N.

Department

General Surgery (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2012

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728053990

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Background: Traumatic brain injury is a major public health problem both in developed and developing nations. It is a particular challenge and a strain on the economy of the developing nations because of the high rates of road traffic accidents, affecting mainly the economically productive age group. World-wide mortalities from severe head injuries range between 39-52% and in our country is estimated at 60%, although it might actually be higher. Patients with severe head injury (defined by a Glasgow Coma Score from 3 to 8) are at highest risk of developing raised intracranial pressure and therefore, are more likely to benefit from an intervention that aims to control intracranial pressure. In the developed world, with organized trauma care systems, studies have shown that intracranial pressure monitoring has shown a significant decrease in mortality from severe head injury, and intracranial pressure monitoring has thus become the standard of care. Though intracranial pressure monitoring started in 1960 in the developed world, it has only become available at the Aga Khan University Hospital in 2009. Its routine use in traumatic brain injury has not been fully embraced and there are no clear guidelines on its use in trauma. Its utility has thus not been validated. It is believed that due to the delays in referral and intervention, intracranial pressure monitoring might not be of benefit in traumatic brain injury in our country. Objectives: The purpose of the present study was to determine the impact of introducing intracranial pressure monitoring and drainage on the mortality from severe head injury and comparing mortality from the period before monitoring intracranial pressure(pre-2009)with mortality after instituting intracranial pressure monitoring and drainage(2010 and after). Study question: With the challenges in trauma care and referral, does intracranial pressure monitoring actually improve mortality in severe head injury? Design: A before and after study comparing a retrospective period before 2010 with a prospective period from 2010-2012 for patients admitted with severe head injury (Glasgow Coma Scale score of 3-8) at the Aga Khan University Hospital, Nairobi and the Nairobi Hospital. Methods: Retrospective data was analyzed from 42 patients with severe head injury (Glasgow Coma Score of 8 or less) admitted between 2007 and 2010, who did not have intracranial pressure monitoring, and their mortality was compared with the outcomes of 31 patients admitted between 2010 and 2012 with severe head injury who did receive intracranial pressure monitoring as part of their treatment.
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نیکی دا صلہ

نیکی دا صلہ

کسے پنڈ وچ اک بہت وڈی فیملی رہندی سی۔ دادا، دادی، بیٹا، بہو، پنج پوتے تے تن پوتیاں۔ سارا ٹبر اپنی محنت، چنگے اخلاق تے مذہب نال محبت کرن دی وجہ توں سارے پنڈ کیہ علاقے وچ مشہور سن۔ گھر دے سارے جی اپنا اپنا کم بہت محنت نال کردے۔ جس پاروں گھر وچ خوشحال وی بہت سی۔ گھر وچ چیزاں وافر ہوون پاروں اوہ کسے سوالی نوں خالی نئیں سن موڑ دے۔ دادا اپنے پتر تے پوتیاں نال کھیت وچ کم کردا تے شام نوں سارے جی گھر آ جاندے۔ گھر آ کے دادا اپنے پتر نال گھر وچ بنائی گئی دکان تے بہہ کے لوکاں دے زرعی آلاات دی مرمت دا کم وی کر دے سن۔ جس پاروں سارے لوک اوہناں نوں جاندے تے اوہناں دی عزت کردے سن۔ انج ای چنگے اخلاق پاروں اوہناں دی شہرت علاقے وچ دور دورتک پھیلی ہوئی سی سارے جی وڈیاں دی عزت تے نکیاں نال پیار کردے۔ ہر کوئی ایہناں دی تعریف کردا۔ رج کے ایمان دار تے مہمان نواز سن۔ کوئی اوپرا بندہ وی ایہناں کول آ جاندا تاں ایہہ اوس دی رج سیوہ کردے۔ نماز روزے دے پابند سن۔ نماز فجر توں بعد تلاوت قرآن مجید کردے۔ جھوٹ توں بچدے تے دوجیاں نوں بچن دی تلقین کردے۔

پنڈ وچ رہندے اوہناں نوں کئی سال ہو گئے سن۔ پر اوہناں بارے کسے نوں بہت گھٹ معلومات سن۔ ایس لئی کہ اوہ اپنے کم نال کم رکھدے دوسریاں دے معاملے وچ مداخلت نہ کردے۔ نہ آپس وچ کدے لڑے تے نہ ای گھر والے کسے نال۔ اوہناں کدے کسے نوں گالی گلوچ نئیں سی کیتی۔ آندے جاندے جو وی ملدا اوس نوں سلام کردے۔ ادب نال پیش آندے تے جنے جوگے ہوندے اوس دی خدمت وی کردے ہر کوئی...

علّامہ ابن الجوزی کی تفسیر (زاد المسیر فی علم التفسیر) میں اشعار سے استشہاد کا علمی اور تحقیقی جائزہ

This paper describes that if we want to know about poetry we must understand that out of context we can never arrive at our destination. The Qur‘ān should be read and understood in totality of its message and spirit. Its verses are local and universal. Some verses are in local environments but leave universal and external message. The verses of Sūrah Yāsīn and Sūrah Najm related to poetry clearly exhibit the truth that God rejected the claim of the infidels who regarded the Qur‘ān as the book of poetry and Prophet Muhammad as a poet. It is an apt reply to the infidels that Qur‘ān is a message of God with a serious mission and motto. The Holy prophet used to ask people to recite the Holy poetry of Abu ║ālib. ╓assān bin thābit used to recite ‘Nāt’ in the presence of the Prophet. They enhanced the divine mission of the prophets through their facile pen and noble spirit. Hence in the light of above brief dissertation we can profess that Islam does not oppose poetry if it is written on didactic and divine lines.

Production of Bacterial Pectinase Using Submerged Culture for Various Applications

Pectinases are pectin degrading enzymes and are naturally produced by plants, animals and microorganisms. Their major source of production at industrial scale is from microorganisms especially Bacillus sp, Aspergillus sp. and yeast sp. which are generally regarded as safe. Aspergillus sp. generally produce acidic pectinases which are used in the food and beverage industry for the extraction and clarification of fruit juices and maceration of vegetables for production of purees and pastes. Bacillus sp. are usually capable of producing alkaline pectinases which have diverse functions and are in use in many industrial processes, successfully substituting the use of harsh chemicals which not only causes the deterioration of product quality but also the deterioration of environment. Pectinases from Bacillus sp. are generally active at broad ranges of pH and temperature and due to this reason, they are multi-functional enzymes. Pectinases account for more than 10% of the industrial enzymes market and they constitute 25% of the global food enzymes market. The present study was concerned with the search for a novel bacterial isolate for the lab scale production of pectinase (Polygalacturonase). Keeping in view the increasing demand of pectinase, specially its need in Faisalabad, a textile city of Pakistan, isolation of new hyper producer bacterial strains locally is an easy and cheap way of getting the desirable products at low cost. Therefore, isolation of new strains for industrial enzyme production has been, and will be, a part of research. This method alone can also provide raw material for further research such as enzyme engineering or molecular directed evolution. Pectinase positive cultures were isolated using PSAM, the medium that is able to grow and differentiate pectin consuming bacteria from others. The pectinase producing bacteria form clear halos around their colonies while others do not form any clear zones. For the identification of hyper producer strains, colony PCR was done for 16S rRNA analysis. The reason to use the 16S rRNA gene for identification purposes is that there is a large database of DNA sequences available for the gene from the widest range of microbial species as compared with any other genetic target. The selected bacterial isolate NS1 (source of pectinase enzyme) was identified based on PCR amplification of 16S rRNA and for this purpose the amplified product was electrophoresed in agarose gel against a known species of Bacillus licheniformis. The 16S rRNA sequencing confirmed the Bacillus status of the strain NS1 and the nucleotide sequence BLAST results showed 98% similarity of strain NS1 having Accession No. KX765286 with few species of Bacillus licheniformis. The growth conditions of the newly isolated Bacillus licheniformis strain were investigated using submerged fermentation to understand the fermentation behaviour of the microorganism and the pattern of pectinase production by it. The growth of the organism and enzyme production by it was investigated using some local agrowastes such as wheat bran, gram bran, citrus peel, apple pomace, carrot pomace and peanut shells as carbon sources. Among these agrowastes citrus peel powder at 2.5% concentration proved as best substrate for pectinase production followed by wheat bran. Among various nitrogen sources investigated for their role in pectinase production, organic sources such as tryptone and yeast extract gave better results than inorganic nitrogen sources. Among inorganic sources Diammonium hydrogen phosphate gave more pectinase units than other inorganic nitrogen sources. Physical parameters like pH, temperature, inocula size and incubation period for high yield of pectinase in submerged fermentation were optimized by using Response Surface Methodology. Which is an efficient tool for increasing product yield many folds in short time due to limited number of experiments and lab work. In the present study, the yield of pectinase was increased 5.6 fold that optimization produced 219U/mL as compared to one variable at a time method which produced only 38.86U/mL. Several purification methods were evaluated to observe that which one is more advantageous and cost effective in the present study for pectinase purification. Three methods of protein purification (aqueous two phase purification system, macro-affinity ligand facilitated three phase partitioning and gel filtration chromatography) were used in the present study and macro-affinity ligand facilitated three phase partitioning were found to give high purification of pectinase with purification fold of 13.05. The pectinase from newly isolated Bacillus licheniformis showed some novelty in characteristics as compared to most of the pectinases produced by other species. Although its optimum activity was achieved at a temperature of 70ºC in glycine buffer pH 8 but it also showed considerable activity (26.75U/mL) even at 100ºC in phosphate buffer pH 7. Addition of 15mM CaCO3 to the enzyme assay mixture increased the pectinase activity by 3.1 fold and addition of chloroform to enzyme assay mixture increased the pectinase activity by 7.45 fold. Surfactants (CTAB, SDS and Triton X-100) increased the pectinase activity many fold as compared to control. Among various sugars investigated for their effect on pectinase activity, sorbitol was found as a stimulator of pectinase activity by increasing its activity by 1.8 fold while glucose, lactose and sucrose inhibited its activity. The pectinase produced in this study was investigated for applications such as oil extraction from sunflower seeds, apple juice extraction and clarification and starch extraction from potatoes. In all of the above applications, the locally produced pectinase enhanced the yield of apple juice, oil and starch several fold as compared to control without the application of pectinase enzymes. Apple juice yield was increased by 2.06 fold due to pectinase treatment while the juice clarification was increased by 1.62 fold. Pectinase application also increased the oil yield some 3.15 fold as compared to oil extraction by water without the addition of pectinase. Its effect on potato starch extraction was also appreciable and 3.95 fold increase in starch yield was observed due to pectinase treatment of potato slurry. All these investigations showed that the low cost pectinase produced by locally isolated microorganisms using low cost agrowastes as nutrient supplements are able to compete with costly commercial enzymes and can bring a revolution in product quality and yield if used by local industries.