Paediatric traumatic brain injury: Study of analysis of outcome predictors

Introduction. Traumatic brain injury is a leading cause of death and disability among children, adolescents. Therefore, analysing outcome predictors and initiating preventive policies may contribute to decreased incidence and better prognosis. Aim. Aim to describe the epidemiologic characteristics, mechanism of injury, radiological findings and also to analyse the determinants of outcome that could help to provide better critical care and also to establish effective preventive policies. Material and Methods. We conducted a prospective study including patients ?18 years admitted to our Neuro-intensive care unit at R.N.T. Medical College ,Udaipur, Rajasthan, India from September 2016 to June 2018.Factors including age, gender ,mode of injury, Glasgow coma score(GCS) at admission ,pupillary size-reaction, radiological findings and their relation to outcome was assessed .Patients were divided into mild, moderate and severe head injury according to GCS. Outcome of patients was assessed by Glasgow outcome scale. For statical Analysis used Chisquare test. Statistical Analysis was carried out using Stata 11.0(College station, Texas, USA) Results. The study comprised of 84 paediatric patients. 44.4%of patients were within 1–5-year age group. The most common cause for trauma was falls and traffic accidents. Patients with mild, moderate and severe head injury were 38.1%, 47.6%and 14.3% respectively. Poor outcome predictors included severity of head injury, pupil size and reaction, midline shift on CT. Conclusion. This study emphasizes increased burden of paediatric brain injury with assessment of predicting factors for more effective critical care of patients and emerging need for effective fall and traffic accidents prevention strategies

Traumatic posterior fossa extradural hematoma: A comprehensive analysis of cases from a tertiary care centre in Southwestern Rajasthan

Background. Extradural hematoma of posterior fossa (PFEDH) is less common and there are not many articles about PFEDH. These patients can deteriorate very rapidly due to compression over brainstem. Thus, early identification and immediate intervention can save the lives of these patients.Objective. This study aims to conduct a comprehensive analysis of patients with PFEDH and evaluate the postoperative outcome which may be of help to make further preventive strategies.Methods and Materials. The study included 16 patients admitted with traumatic PFEDH from July 2016 to July 2018 at R.N.T. Medical College & M.B. Groups of Hospital Udaipur, southwestern Rajasthan, India. We have retrospectively reviewed the data. Analysed factors were gender, age, Glasgow Coma Scale (GCS), Noncontrast CT scan findings, associated brain injury, type of intervention, Glasgow Outcome Scale (GOS). GOS was assessed at discharge, at 3 months and 6 months follow-up.Results. Out of a total of 16 patients, 11 were male and 5 were female with age ranging from 05-46 years. 12 patients had GCS 13 -15 at admission and only one of them had GCS < 8. 15 patients underwent surgical intervention. At 6 months follow-up, 12 patients had good recovery GOS is 5.Conclusion. Early detection and immediate evacuation of PFEDHs should be done if causing fourth ventricle, basal cistern or brain stem compression. It may be rapidly fatal due to the expansion of hematoma leading to brainstem compression, tonsillar herniation, and/or obstructive hydrocephalus. Early detection and immediate evacuation lead to a better outcome in these patients

Bilateral traumatic basal ganglia haemorrhage, a rare entity: Experience at single institute with review of literature

Aims. Traumatic basal ganglia haemorrhage is rare entity but post traumatic bilateral basal ganglia hematoma is even extremely rare and was earlier presented as case reports. Its incidence is about 3% after a closed head injury however, the incidence is higher in post mortem studies. Material & Methods. Out of 1485 head injury patients admitted to our institute from January 2012 to January 2019, there were 9 cases of traumatic bilateral basal ganglia haemorrhage. The incidence of traumatic bilateral basal ganglia Haemorrhage in our series is 0.61% which is very less compared to previous literature. Results. There were 6 males and 3 females; age ranging from 19 to 50 years (average 32 years). Patients with hypertension, history of drugs abuse, history of coagulopathy, with doubtful history of trauma or unknown mode of injury were excluded from the study. The mode of injury in all the patients was road traffic accidents. Average follow up was 9.54 months. Outcome was assessed by Glasgow outcome Score. In 8 out of 9 patients, outcome was good. One patient died. All the nine cases were managed conservatively. Conclusion. We report nine cases from a single institute which to the best of our knowledge is the largest series in world literature. Prognosis is variable and dependent on many factors. The prognosis of TBGH is favourable if not associated with other disorders like hypertension, diabetes mellitus, and coagulation disorders or diffuse axonal injury

Efficacy of Public Private Partnership (PPP) for City Bus Operations: experience from Indian cities

City Bus Systems (CBS) have traditionally been managed and operated by various State Transport Undertakings (STUs) in Indian cities. However, other than few exceptions, the experience suggests that STUs have always treated City Bus Operations as a liability as compared to rural and inter-state services. Thus, managerial problems and accruing financial losses to the STUs on account of CBS has resulted in neglect of the latter and the image of bus based urban public transport has severely suffered over the past decades. On the other hand, growing interest from the private sector in urban bus services over the last five years has resulted in the evolution of various Public Private Partnership (PPP) models for city bus operations. As a result, more than twenty cities in the country have started city bus operations on PPP mode in the last five years. After a successful inception year, however, most of the systems have not been able to sustain themselves on a long-term basis and have either been terminated or are merely surviving. Over the past two years, city bus operations on PPP mode has gained further weight after the launch of Funding for purchase of buses for urban transport systems under Jawaharlal Nehru National Urban Renewal Mission scheme by the Ministry of Urban Development, Government of India that encourages operation of buses on PPP basis. This paper documents the experience of various Indian cities that have adopted various PPP models for financing, operating and managing their city bus operations and attempts to suggest a more sustainable framework for operating city bus services. Two basic models of PPP have been adopted over the years by cities for urban bus operations: Gross Cost Model and Net Cost Model. Under the Gross Cost Model, the operator is paid a specified amount to provide the specified service for a specified period whereas the entire revenue accruing out of fare, advertisement rights, etc. is collected by the city authority. Under this model, the financial risk lies with the city authority contracting the services. Under the Net Cost Model, the operator provides a specified service for a specified period and retains all the revenue. The operator pays the authority a royalty per bus per month in lieu of this. Under a net-cost contract the operator has to forecast his cost, revenue and risk over the entire concession period. The study has picked up case studies from cities like Indore, Jodhpur, Kota, Udaipur, Jalandhar, Surat (Net-cost) and Ahmedabad, Delhi (Gross-cost) that have adopted these two models for managing CBS on PPP basis. For each case study, the contracting models used are studied and evaluated under various indicators, such as sharing of risks and responsibilities between the operators and authority, fleet expansion after inception, coverage (equitable/inequitable), existence of fare revision mechanism, institutional framework & capacity building at the level of authority, etc. Further, for each case study, the problems faced by the authority and the private operator since the inception of services and the resulting impacts of the overall quality of the city bus service are documented and possible relationships established between the contracting framework and the problems faced. The study further documents some of the best practices in STU running CBS in India and examines them against the same aspects as for the PPP models. The study aims to conclude by answering the following questions: (i) Whether cities really need to adopt PPP models for CBS and under what conditions is it advisable to go for it? (ii) What should be the considerations while choosing a gross-cost or net-cost model and how each can be improved? (iii) How can the risks be minimised while structuring CBS on PPP mode? Overall, the paper seeks to establish a framework to make the PPP model of city bus operations more sustainabl