Comparison of various Head Injury Prognostic Scales

INTRODUCTION: Traumatic Brain injury (TBI) is a considerable health care problem1-3 and is one of the most common causes of death. Its incidence is rising at large proportions in regions with rapidly increasing motorization because of industrialized development. The incidence varies from 67 to 317 per 100000 individuals and mortality rates range from around 4-8% for moderate injury to approximately 50% with severe head injury. The symptoms of TBI can be various depending on the extent of damage to the brain. The outlook for patients with mild TBI is generally a good recovery, while patients with a severe TBI have a substantial risk to die. Predicting outcome for very good or very severe patients is therefore rather easy. However, for severe and moderate TBI patients the outcome is not so easy to predict, while such predictions would be helpful in supporting clinical decision making, providing realistic and evidence based expectations to relatives and care givers, as well as in clinical research. Any ideal prediction score or model should be easy to apply, with high sensitivity and specificity rates irrespective of the management protocol, its time and place of application. Several prospective and retrospective studies have been done to derive a baseline predictive model for patients in the intensive care unit in general or specific to traumatic brain injury. AIM OF THE STUDY: 1. The application of various prognostic scales on outcome of moderate and severe traumatic brain injury patients. 2. To compare the sensitivity, specificity and efficacy of the various prognostic scales. MATERIALS AND METHODS: This study was conducted at Madras Medical College and Rajiv Gandhi Government. General Hospital, Institute of Neurology which included 300 patients with moderate and severe traumatic brain injury. It was a prospective study from 2010 to 2013. A thorough Clinical and detailed neurological examination was done and the patient details were recorded in a Proforma and the following Prognostic Scores were calculated for every patient: - Madras Head Injury Prognostic Scale (MHIPS). - NIMHANS Model (NM). - Edinburgh Prognostic Scale. The efficacy, sensitivity and specificity was noted for every score and compared for the outcome of these patients. All Patients presenting to the trauma ward of our hospital with moderate and severe head injury along with other systemic injuries were included in our study population. All patients presenting with mild head injury were excluded from our study population. The primary reason for choosing to compare these three scores in this study is: 1. All the three scores have taken into account almost similar variables. 2. All these scores are objective and measurable on a numerical scale. 3. All the three scores are simple enough to be used during a routine bed side clinical assessment. 4. Also these scores are easy to apply even for a junior member of the team. CONCLUSION: In patients with moderate and severe head injury age of the patient plays a significant role in deciding the outcome. Older the patient poorer the prognosis. • In Glasgow Coma Scale, the best motor response is the most accurate predictor of outcome in moderate and severe head injury patients. • Both Occulocephalic and pupillary reflexes should be noted on admission in patients with moderate and severe TBI. Their response holds a significant correlation to the final outcome. • Single variable is not enough to prognosticate the outcome in traumatic brain injury patients. The scoring should always be a multivariate analysis • In this study Madras Head Injury prognostic Scale (MHIPS) was the most significant scoring system in accurate prediction of outcome in moderate and severe head injury patients as compared to Edinburgh and NIMHANS models

Sonneratia ovata (Sonneratiaceae)－A New Distributional Record for India from Andaman and Nicobar Islands

Sonneratia ovata Backer was found from Havelock, Andaman and Nicobar Islands, representing a new addition to the mangrove flora of India. This species lacks petals and is characterized by the finely warty calyx, the lobes of which are red on the inner side and by the adpressed calyx lobes in fruit. Since S. ovata is considered rare as a whole, conservation measures are imperative for managing the mangrove diversity of the Islands with special reference to this species

Fishery and Exploitation of Malabar Grouper, Epinephelus malabaricus (Bloch & Schneider 1801) from Andaman Islands

The fishery and population dynamics of groupers from Andaman Islands were studied from Jan 2010 to Dec 2011 with a special emphasis on Malabar grouper, Epinephelus malabaricus (Bloch & Schneider 1801). The average annual catch of Malabar grouper was 1,296 tonnes contributing to 21.6% of annual grouper landings. Length-weight relationship of Malabar grouper showed that growth was allometric (b=2.96) and relative condition factor (Kn) was 1 and the growth parameters viz., L∞, K and t0 were 124.60 cm, 0.80 and -0.05 respectively. The recruitment pattern was unimodal with one major peak during April to July throughout the study period. The natural mortality (M), fishing mortality (F) and total mortality (Z) were 1.05, 1.48 and 2.53 respectively and exploitation rate (E) was 0.58. The M/K ratio (1.31) was found to be well within the normal range of 1to 2.5. Catch per unit effort varied from 4 to16.5 kg.h-1. The maximum sustainable yield (MSY) was 1,107 tonnes which was lower than the average annual catch (1,296 tonnes), indicating over exploitation. The current study calls for further research in identifying the grouper fishing and spawning aggregation grounds and introduce measures for reducing fishing efforts with input and output controls to sustain the Malabar grouper fishery in Andaman waters

Tropical storm off Myanmar coast sweeps reefs in Ritchie’s Archipelago, Andaman

The reefs in some islands of Andaman and Nicobar suffered severe damage following a tropical storm in the Bay of Bengal off Myanmar coast during 13–17 March 2011. Surveys were conducted at eight sites in Andaman, of which five were located in the Ritchie’s Archipelago where maximum wind speeds of 11 ms-1 was observed; and three around Port Blair which lay on the leeward side of the storm and had not experienced wind speeds of more than 9 ms-1. Corals in the shallow inshore reefs were broken and dislodged by the thrust of the waves. Significant damage in the deeper regions and offshore reefs were caused by the settlement of debris and sand brought down from the shallower regions. The fragile branching corals (Acropora sp.) were reduced to rubbles and the larger boulder corals (Porites sp.) were toppled over or scarred by falling debris. The reefs on the windward side and directly in the path of the storm winds were the worst affected. The investigation exposes the vulnerability of the reefs in Andaman to the oceanographic features which generally remain unnoticed unless the damage is caused to the coastal habitats

Validation of Potential Fishing Zone (PFZ) forecasts from Andaman and Nicobar Islands

The annual exploitable fisheries of Andaman and Nicobar Islands are estimated to be 1.48 lakh t of which a meagre 22% is harvested currently. Potential Fishing Zone (PFZ) forecasts based on remotelysensed chlorophyll concentration and sea surface temperature were applied for harvesting the unexploited marine fishery resources. Simultaneous validation experiments (n = 87) synchronizing with PFZ forecasts within (PFZs) and outside (non-PFZs) the demarcated zones employing different vessel categories viz., gillnetters (n = 50), trawlers (n = 22) and longliners (n = 15) were carried out. Significant disparity in fish catch was observed within and outside PFZs. Fish catch from gillnetters composed of carangids, clupeids, scombrids with Megalaspis cordyla being dominant at PFZ. Carangids, sphyraenids, serranids, lutjanids, lethrinids and carcharhinids were reported from trawlers with significantly higher CPUE from PFZs except nemipterids. Fish catch from longliners constituted mainly of carcharhinids and serranids, where the catch of former was found to be significantly higher at PFZs

Influence of mesoscale eddies on a commercial fishery in the coastal waters of the Andaman and Nicobar Islands, India

Mesoscale eddies enhance the productivity in a stratified coastal environment by upwelling. The seas around the Andaman and Nicobar Islands have been found to have frequent mesoscale eddy activity. Commercial fishing grounds coincide with upwelling areas associated with cyclonic and anticyclonic eddies and also with areas between two adjacent eddies. There are different eddy zones supporting different types of fishing gears and fish. The current study aims at identifying the different zones of mesoscale eddies in the Andaman Sea and compares the productivity and fishing activity in each of them. Data collected from 454 commercial fishing trips in the Andaman Sea along with maps of sea level anomaly and Moderate Resolution Imaging Spectroradiometer (MODIS) global level 3 mapped thermal infrared (IR) daytime sea surface temperature (SST) from the Aqua and Terra satellites were used for the study. Known upwelling areas such as the periphery of anticyclonic and the core of cyclonic eddies showed higher catches in longlines, ring seines among the fishing gears, and among all the fish species groups. Downwelling areas such as the periphery of cyclonic and the core of anticyclonic eddies showed lower catches with ring seines and the fish species groups. Areas in between adjacent eddies were explored in this study and the fish captures in such areas were found to be different with types of fishing and the target fish group. The study shows results that link eddy activity with the performance of a fishery

Persistent metabolic acidosis on regular hemodialysis or peritoneal dialysis

Metabolic acidosis is known to have adverse consequences in patients with chronic kidney disease (CKD) including protein-energy wasting, inflammation, bone disease, and disturbance in endocrine function. Unlike in the management of patients with predialysis CKD, bicarbonate levels were not being routinely monitored in dialysis patients at our center. The KDOQI guidelines recommend serum bicarbonate levels ≥22 mEq/L in patients on dialysis. We measured the predialysis serum bicarbonate levels in 100 adult patients on regular hemodialysis (HD) and 41 adult patients on peritoneal dialysis (PD). We also studied the extent of rise in serum bicarbonate levels from predialysis levels after HD in our patients. Predialysis serum bicarbonate level was <22 mEq/L in 73% of patients on HD and 12% of patients on PD. The serum bicarbonate levels remained <22 mEq/L at the end of HD in 41% of patients on HD. Thirty-nine percent of patients were on a HD schedule of thrice a week, and 93% of PD patients performed three PD exchanges a day. The dialysate bicarbonate level was 34 mEq/L. There was a significant increase in serum bicarbonate levels with HD, but the mean postdialysis bicarbonate level was 23.45 mEq/L. A very high proportion of our patients on HD continued to have uncorrected metabolic acidosis, with metabolic acidosis persisting in the immediate postdialysis period in a significant number of patients. Predialysis serum bicarbonate level needs to be monitored in patients on HD. There is an urgent need to modify HD prescription to ensure better correction of metabolic acidosis in our HD population. Compared to HD, the proportion of patients having persistent metabolic acidosis is significantly lower in PD

Not Available

Not AvailableOpisthobranchia (Phylum:Mollusca) are one of the least studied groups in India, and very little is known from remotely located islands like Nicobar. Recent marine faunistic surveys conducted at Nicobar Group of Islands in the intertidal and subtidal zones revealed the presence of four opisthobranchs.Not Availabl

Not Available

Not AvailableSonneratia ovata Backer was found from Havelock, Andaman and Nicobar Islands, representing a new addition to the mangrove flora of India. This species lacks petals and is characterized by the finely warty calyx, the lobes of which are red on the inner side and by the adpressed calyx lobes in fruit. Since S. ovata is considered rare as a whole, conservation measures are imperative for managing the mangrove diversity of the Islands with special reference to this species.Not Availabl