Tatakelola Anestesi untuk Dekompresi Kraniektomi pada Cedera Otak Traumatik Berat dengan Penyulit Obesitas Morbid

Anestesi dan pembedahan mungkin meyebabkan risiko yang cukup besar untuk pasien obesitas, apalagi obesitas morbid. Populasi orang gemuk meningkat, baik di negara maju dan berkembang, sehingga para ahli anestesi lebih sering menghadapi tantangan dalam mengelola pasien obesitas. Trauma multipel bertanggung jawab atas 5 juta kematian per tahun di seluruh dunia dan merupakan penyebab kematian utama bagi orang-orang muda di bawah 40 tahun, mewakili peristiwa akut dan tak terduga. Kami akan melaporkan seorang lelaki 36 tahun dengan obesitas morbid, BMI 48,97 kg/m2, yang mengalami multipel trauma akibat kecelakaan lalulintas, yang akan menjalani operasi evakuasi perdarahan subdural dan dekompresi kraniektomi. Pemilihan obat dan dosis aman sangat sulit pada pasien dengan multipel trauma, karena mungkin status volumenya tidak diketahui secara akurat. Rencana anestesi harus mempertimbangkan status resusitasi dan riwayat penyakit penyerta lain. Peran penting lainnya dari anestesiologis adalah pencegahan cedera sekunder yang disebabkan oleh syok berulang atau resusitasi tidak tepat. Anesthesia Management for Craniectomy Decompression on Severe Brain Traumatic Injury with Comorbid Morbid Obesity AbstractAnesthesia and surgery may cause considerable risk for obese patients, especially morbid obesity. Obese populations increase, both in developed and developing countries, so anesthesiologists more often face challenges in managing obese patients. Multiple traumas is responsible for 5 million deaths per year worldwide and is the leading cause of death for young people under 40, representing acute and unexpected events. We will report a 36-year-old man with morbid obesity, a BMI of 48.97 kg/m2, who experienced multiple traumas due to a traffic accident, who will undergo an evacuation operation for subdural hemorrhage and craniectomy decompression. The selection of drugs and safe doses is very difficult in patients with multiple traumas, because their volume status may not be accurately known. Anesthetic plan must consider resuscitation status and history of other comorbidities. Another important role of anesthesiologist is the prevention of secondary injury caused by recurrent shock or improper resuscitation.

Clinical Outcome of Patients with Diffuse Axonal Injury Receiving Adrenocorticotropin Analogue at Dr. Soetomo Hospital

Brain traumatic injury (BTI) is one of the causes of death and disability worldwide that affects people regardless of sex, age, income and social status, race, or nationality. In patients with brain traumatic injury, one of the problems that occurs is Diffuse Axonal Injury (DAI) that can produce a direct clinical effect, leading to coma and death. Adrenocorticotropin analogues (ACTH) is one of neuroprotective therapy in brain injury. The aim of this study was to analyze the effect of ACTH analogue on the clinical output (Glasgow Outcome Score/GOS and Bartle Index) in patients with DAI at hospital discharge, 3 months and 6 months post-treatment. This study revealed that ACTH analogue administration resulted in higher GOS and Barthel Index scores than that in control. Further study will required with other variables, such as cognitive and motor examination, and some biomarkers can also be examined serially.Brain traumatic injury (BTI) is one of the causes of death and disability worldwide that affects people regardless of sex, age, income and social status, race, or nationality. In patients with brain traumatic injury, one of the problems that occurs is Diffuse Axonal Injury (DAI) that can produce a direct clinical effect, leading to coma and death. Adrenocorticotropin analogues (ACTH) is one of neuroprotective therapy in brain injury. The aim of this study was to analyze the effect of ACTH analogue on the clinical output (Glasgow Outcome Score/GOS and Bartle Index) in patients with DAI at hospital discharge, 3 months and 6 months post-treatment. This study revealed that ACTH analogue administration resulted in higher GOS and Barthel Index scores than that in control. Further study will required with other variables, such as cognitive and motor examination, and some biomarkers can also be examined serially.

STUDY ON FACTORS AFFECTING MORTALITY IN PATIENTS WITH BRAIN TRAUMATIC INJURIES RESULTING FROM TRAFFIC ACCIDENT BY USING DATA MINING

Introduction: One of the most important health problems is road traffic accident. Brain traumatic injury caused by crashes is the first cause of mortality among young people. Capabilities of Data Mining methods to find factor affecting and the prediction therapeutic outcomes leads to the improvement and effectiveness of the services. The aim of this study was to find the Factors affecting mortality in patients with brain traumatic injuries resulting from traffic accident by using the C5.0 decision tree and Bayesian network data mining methods. Methods: In this cross-sectional study, the population of this study was 106 records of patients with brain traumatic injury caused by traffic accident referred to Khatam-al-Anbia hospital in Zahedan city. Data were collected with a researcher-made checklist that was prepared in consultation with experts in this field and review of previous studies. The validity of this checklist was confirmed by three health information technology experts. Data were analyzed by using two software SPSS MODELER 18.0 and SPSS Statistics 24. Results: The accuracy of C5.0 decision tree and Bayesian network were 84.9% and 74.5% obtained. The most important variables that affect the death of accidental patients include Type of lesions, the work of the person in an accident (driver, passenger, pedestrian), accident location (inside or outside the city), and age of the patient. According to the result of this study, the type of lesions with the cause of death (p-value=0.024) is statistically significant. Conclusion: The results of C5.0 decision tree and Bayesian network showed the most important and effective variable is type of lesions. Hence, by predicting the factors affecting in death of brain traumatic patients, healthcare provider with timely action can reduce the death and irreparable of injuries to these patients.

Microglia: roles and rules in brain traumatic injury

Microglia are a special type of supporting cells in the nervous system. between the functions they perform are myelin production, structural support, regulation of extracellular fluid, glial scar formation among others. This cell type for its versatility, is also related to pathological events, where his multiple roles and the release of proinflammatory factors can contribute to understand especially in traumatic brain injury, as secondary injury and the healing process, important aspects the context of brain injury.