Predictors of poor outcome of decompressive craniectomy in pediatric patients with severe traumatic brain injury: a retrospective single center study from Pakistan

Objective

This study aimed to determine the risk factors associated with poor outcome of decompressive craniectomy (DC) for severe traumatic brain injury (TBI) in pediatric patients.

Methods

This retrospective study is conducted on pediatric population (age 1–15 years) presenting with TBI who underwent DC at our institute between January 2000 and 2010. Based on Glasgow outcome score (GOS) at a minimum follow-up of 5 months, patients were divided into two groups, namely poor outcome (GOS 1, 2, and 3) and good outcome (GOS 4 and 5). Records were reviewed and analyzed for preoperative and intraoperative predictors.

Results

We found 25 patients who were eligible as per selection criteria. Mean age at presentation was 6?±?4 years and there was male preponderance (84 %). Fall (60 %) was the most common mechanism of injury followed by gunshots and road traffic accident. On univariate analysis, presenting GCS ≤5 (p value?=?0.009), delay in presentation of more than 150 min (p value?=?0.010), DC performed after more than 4 h of arrival in hospital (p value?=?0.042), and intraoperative blood loss exceeding 300 ml (p value?=?0.001) were significant predictors of poor outcome.

Conclusion

Our study suggests that DC in children is not only a life-saving procedure, but also leads to a good functional outcome after severe injury. However, patient selection still remains an important aspect, and the above-mentioned factors should be considered while deciding for DC to improve survival. Further prospective studies on larger sample size are warranted to validate our results.     

Socioecological and message framing factors influencing maternal influenza immunization among minority women

Objective

A suboptimal level of seasonal influenza vaccination among pregnant minority women is an intractable public health problem, requiring effective message resonance with this population. We evaluated the effects of randomized exposure to messages which emphasize positive outcomes of vaccination (“gain-frame”), or messages which emphasize negative outcomes of forgoing vaccination (“loss-frame”). We also assessed multilevel social and community factors that influence maternal immunization among racially and ethnically diverse populations.

Study design

Minority pregnant women in metropolitan Atlanta were enrolled in the longitudinal study and randomized to receive intervention or control messages. A postpartum questionnaire administered 30 days postpartum evaluated immunization outcomes following baseline message exposure among the study population. We evaluated key outcomes using bivariate and multivariate analyses.

Results

Neither gain- [OR = 0.5176, (95% CI: 0.203,1.322)] nor loss-framed [OR = 0.5000, 95% CI: (0.192,1.304)] messages were significantly associated with increased likelihood of immunization during pregnancy. Significant correlates of seasonal influenza immunization during pregnancy included healthcare provider recommendation [OR = 3.934, 95% CI: (1.331,11.627)], use of hospital-based practices as primary source of prenatal care [OR = 2.584, 95% CI: (1.091,6.122)], and perceived interpersonal support for influenza immunization [OR = 3.405, 95% CI: (1.412,8.212)].

Conclusion

Dissemination of vaccine education messages via healthcare providers, and cultivating support from social networks, will improve seasonal influenza immunization among pregnant minority women.     

Effect of Glycemic Control on Self‐Perceived Oral Health,Periodontal Parameters,and Alveolar Bone Loss Among Patients With Prediabetes

Background: The effect of glycemic control on severity of periodontal inflammatory parameters in patients with prediabetes is unknown. The aim of the present study is to assess the effects of glycemic control on self‐perceived oral health, periodontal parameters, and marginal bone loss (MBL) in patients with prediabetes. Methods: A total of 303 individuals were included. Hemoglobin A1c (HbA1c) and fasting blood glucose levels (FBGLs) were recorded. Participants were divided into three groups: 1) group A: 75 patients with prediabetes (FBGLs = 100 to 125 mg/dL [HbA1c ≥5%]); 2) group B: 78 individuals previously considered prediabetic but having FBGLs <100 mg/dL (HbA1c <5%) resulting from dietary control; and 3) control group: 150 medically healthy individuals. Self‐perceived oral health, socioeconomic status, and education status were determined using a questionnaire. Plaque index (PI), bleeding on probing (BOP), probing depth (PD), and clinical attachment loss (AL) were recorded. Premolar and molar MBLs were measured on panoramic radiographs. Results: Periodontal parameters (PI, BOP, PD, and AL) (P <0.01) and MBL (P <0.01) were worse among individuals in group A than those in group B. Self‐perceived gingival bleeding (P <0.001), pain on chewing (P <0.001), dry mouth (P <0.001), and oral burning sensations (P <0.05) were worse among patients in group A than those in group B. There was no difference in periodontal parameters, MBL, and self‐perceived oral symptoms among patients with prediabetes in group B and healthy controls. Conclusions: Self‐perceived oral health, severity of periodontal parameters, and MBL are worse in patients with prediabetes than controls. Glycemic control significantly reduces the severity of these parameters as well as the state of prediabetes in affected individuals.     

Effect of Isothermal Conditions on the Charge Trapping/Detrapping Parameters in e-Beam Irradiated Thermally Aged XLPE Insulation in SEM

The effect of isothermal conditions on the trapping/detrapping process of charges in e-beam irradiated thermally aged XLPE insulation in scanning electron microscopy (SEM) has been investigated. Different isothermal conditions ranging from room temperature to 120 °C are applied on both unaged and aged XLPE samples (2 mm thick) by a suitable arrangement associated with SEM. For each applied test temperature, leakage, and influence currents have been measured simultaneously during and after e-beam irradiation. Experimental results show a big difference between the fresh and aged material regarding trapping and detrapping behavior. It has been pointed out that in the unaged material deep traps govern the process, whereas the shallow traps take part in the aged one. Almost all obtained results reveal that the trapped charge decreases and then increases as the temperature increases for the unaged sample. A deflection temperature corresponding to a minimum is observed at 50 °C. However, for the aged material, the maximum trapped charge decreases continuously with increasing temperature, and the material seems to trap fewer charges under e-beam irradiation at high temperature. Furthermore, thermal aging leads to the occurrence of detrapping process at high temperatures even under e-beam irradiation, which explains the decrease with time evolution of trapped charge during this period. The recorded leakage current increases with increasing temperature for both cases with pronounced values for aged material. The effect of temperature and thermal aging on electrostatic influence factor (K) and total secondary electron emission yield (σ) were also studied.     

Combustion Synthesis of High Density ZrN/ZrSi2 Composite: Influence of ZrO2 Addition on the Microstructure and Mechanical Properties

In this study, a high-density ZrN/ZrSi₂ composite reinforced with ZrO₂ as an inert phase was synthesized under vacuum starting with a Zr-Si₄N₃-ZrO₂ blend using combustion-synthesis methodology accompanied by compaction. The effects of ZrO₂ additions (10–30 wt%) and compression loads (117–327 MPa) on the microstructure, porosity and hardness of the samples were studied. The process was monitored using XRD, SEM, EDS, porosity, density and hardness measurements. Thermodynamic calculations of the effect of ZrO₂ addition on the combustion reaction were performed including the calculation of the adiabatic temperatures and the estimation of the fractions of the liquid phase. The addition of up to 20 wt% ZrO₂ improved the hardness and reduced the porosity of the samples. Using 20 wt% ZrO₂, the sample porosity was reduced to 1.66 vol%, and the sample hardness was improved to 1165 ± 40.5 HV at 234 MPa.     

Synthesis and Characterization of Imidazolium-Based Ionic Liquids and Evaluating Their Performance as Asphaltene Dispersants

With the projected increase in the production of heavy oil due to the energy crisis, asphaltene-related issues are likely to come to the forefront. This leads to operational problems, safety hazards, and oil production deficiencies, resulting in huge economic losses for the petroleum industry. Therefore, in this work, we aimed to inhibit asphaltene precipitation using ionic liquid (IL) compounds. ILs with long alkyl chains can inhibit the precipitation of asphaltene molecules due to the π–π* interactions between them and the formation of hydrogen bonds. A series of imidazolium-based ionic liquids, IL-0, IL-4, IL-10, and IL-16, were synthesized with yield percents of 79, 81, 80, and 83%, respectively. The prepared materials were characterized well using FTIR, ¹H-NMR, and Elemental Analysis. The surface tension, interfacial tension (IFT), and different surface parameters were investigated at different temperatures to simulate the reservoir temperature. IL-0, IL-4, IL-10, and IL-16 displayed their γ_cmc values at 35, 34, 31, and 32 mN/m at 303 °K, respectively. It was found that the prepared ILs are good surfactants with low values of interfacial tension. Quantum structure–activity relationships using Density Functional Theory (DFT) were used to investigate the geometry optimization electronic structures, the energy gap (ΔE), and the reactivity of the cations of the prepared ILs. The synthesized ILs were evaluated as asphaltene dispersants using two different techniques. The viscometric technique showed that the asphaltene onset precipitation was 28.5 vol.%. This percent was postponed to 42.8, 50, 78.5, and 64.3 vol.%, after adding IL-0, IL-4, IL-10, and IL-16, respectively, and the spectroscopic technique confirmed the results.     

Exposure of Skin Homografts from Related Living Donors to Radiotherapy and Its Effects on Acute Rejection and Wound Healing in Children with Deep Burns: A Randomized Controlled Trial

Background  The ideal skin substitute should be more similar to normal skin function while causing fewer reactions. The purpose of this study was to assess the effect of radiotherapy on minimizing acute rejection and enhancing wound healing in children with deep burns. Patients and Methods  A prospective randomized control study included 34 children admitted to the burn unit with deep burns under the age of 12 years. Through the tomotherapy device, a skin homograft from a related living donor was exposed to a local dose of radiotherapy of 500 centigray (cGy). It was immediately used for coverage of the prepared bed after the irradiation was completed. Results  The mean values of the laboratory parameters (ESR, CRP, IL-6, and TNF) for all burn patients in the study showed a significant difference, with p  < 0.001. The mean ± standard deviation (SD) of the time from homograft coverage to the appearance of rejection was 9.62 ± 1.45 in group 1 and 14.35 ± 2.8 in group 2, with p  < 0.001 (highly significant difference), indicating that exposure to radiotherapy can reduce graft rejection. Conclusions  The exposure of skin homografts from related living donors to a local low dose of radiotherapy can reduce a graft''s ability to initiate inflammatory and immunological reactions, thereby minimizing rejection of a graft and enhancing epithelialization in children with deep second- and third-degree burns.