Prognostic Factors for Decompressive Hemicraniectomy in Severe Traumatic Brain Injury Patients with Traumatic Mass Lesions: A Prospective Experience from a Developing Country

Objective:  To evaluate the prognostic factors affecting functional clinical outcomes in severe traumatic brain injury patients with traumatic mass lesions undergoing decompressive hemicraniectomy (DHC). Materials and Methods:  A prospective cohort of 85 patients of severe traumatic brain injury patients with traumatic mass lesions underwent a unilateral decompressive hemicraniectomy. Functional outcomes were assessed using the Glasgow Outcome Score at 28 days, 3 months, and 6 months. Bivariate analysis (chi-squared) was used to identify parameters that resulted in poor outcomes and multiple regression was used to identify independent factors predicting poor outcomes. Results:  85 patients were recruited. Functional outcomes were dichotomised as favourable (Glasgow Outcome Score of 4 – 5) and poor (Glasgow Outcome Score 1-3) and evaluated at 28 days, 3 and 6 months. A total of 59 patients expired (69.4%). Bivariate analysis revealed GCS 3 – 5 at presentation (P = 0.002), midline shift greater than 7.5mm (P < 0.001), the volume of the mass lesion more than 40ml (P = 0.006) resulted in a poor outcome. Age dichotomised to less than or more than 50 years bordered statistical significance (P = 0.063). Only GCS at presentation and midline shift were independent factors that predicted poor outcomes when controlling for covariates.  Conclusion:  Decompressive hemicraniectomy can be a lifesaving intervention in managing severe traumatic brain injury patients with traumatic mass lesions. However, its use needs to be employed judiciously.&nbsp

One Health for Dog-mediated Rabies Elimination in Asia. A Collection of Local Experiences

Although an effective human rabies vaccine has existed since 1885, rabies continues to kill an estimated 59,000 people every year. Sixty per cent of these human deaths occur in Asia. The number of animals, especially dogs, who die of rabies is uncalculated. To work towards the global target of eliminating dog-mediated human rabies deaths, the rabies community is applying the One Health approach by jointly focusing on humans and dogs. Written by a multidisciplinary group of scholars and rabies control programme specialists, this book is a collection of experiences and observations on the challenges and successes along the path to rabies control and prevention in Asia. The book: grounds chapters in solid scientific theory, but retains a direct, practice-focused and inspirational approach;provides numerous examples of lessons learned and experience-based knowledge gained across countries at different levels of rabies elimination;brings together and highlights the practices of a strong, international rabies network that works according to the One Health concept. Covering perspectives from almost a dozen Asian countries and a wide range of sectors and disciplines, such as healthcare facilities, veterinary services, laboratories, public health institutes, wildlife research centres and academia, this book is an invaluable resource for rabies practitioners and scholars, but also those working in the wider fields of disease control and cross-sectoral One Health