Experience, challenges and lessons learnt from microsurgical clipping of intracranial aneurysms at an emerging neurosurgical centre

Objectives: To share our experience, challenges faced, lessons learnt and analyze the results of surgical management by microsurgical clipping of intracranial aneurysms at an emerging neurosurgical centre at Guru Gobind Singh medical college and hospital (GGSMC&H) Faridkot, Punjab. India. Material and Methods: This study includes all the patients who presented with the diagnosis of intracranial aneurysm on CT angiography and were treated with the microsurgical clipping,  between March 2017 to April 2019. Results: There was a total of 23 patients 11female and 12 male. Age range 32 to 85years. On admission 22 patients had SAH on CT scan and one was admitted after incidental detection of the aneurysm without SAH. The time interval between ictus and admission was 0-3 days in 13 patients, 3-14 days in 8 patients and more than 14 days in 1 patient. WFNS grade (gd) I-15 patients, gd II-2, gd III-2, gd IV-3 patients. Fisher gd I-nil, gd II-9, gd III-4, gd IV-9 patients. In 23 patients 27 Aneurysms were clipped. Distribution of location was Anterior Communicating-12, Distal Anterior Cerebral Artery- 4, Middle cerebral artery (MCA) Bifurcation-3, MCA trifurcation-1, Anterior Choroidal-1, Posterior Communicating (P-com) -1, Ophthalmic Internal Carotid Artery (OICA)-4 and three patients had associated multiple aneurysms. Size of aneurysms varied from < 02mm diameter in 2 patients, 2-25mm - 23 and, more than 25mm-2 aneurysms. There was intra op rupture in 2 cases. Post-operatively 2 patients developed hemiparesis, which recovered, nine patients developed vasospasm. Two patients developed chest related complications. One patient developed renal failure.  There were 8 deaths. Patients are on follow up since March 2017 till date. Conclusions: Intracranial aneurysms are challenging to manage due to their proximity to vital intracranial structures, and difficulty in securing intracranial proximal control. Thorough knowledge of intracranial anatomy of adjacent relations, arachnoid planes and skilful dissection is a key element for a successful outcome. Data collected from GGSMC & Hospital may not be representative of the entire state or country’s population. Therefore, a large-scale data collection is necessary to create our own database to ascertain the risk factors and preventive measures that are exclusive to our state and nation

Intra-cranial malignant peripheral nerve sheath tumor of olfactory nerve: A case report and review of literature

Malignant Peripheral Nerve Sheath Tumors (MPNSTs) are one of the very rare high grade malignancies usually affecting extremities or trunk. Incidence is 1/Lac. Intra-cranial MPNSTs are even rarer, schwannomatous and commonly affecting cranial nerves VIII &VII). Intra-cranial MPNSTs are usually sporadic, arising de novo. The second most common mode of origin is from malignant transformation from pre-existing schwannomas or neurofibroma. We present an extremely rare and probably the first case of intra-cranial malignant peripheral nerve sheath tumor of the olfactory nerve in a non neurofibrosis patient with no prior history of irradiation

Cerebral pilocytic astrocytoma with spontaneous intratumoral haemorrhage in the elderly - a rare entity: A case report and review of the literature

Pilocytic astrocytomas (PA) are histologically are low-grade tumours, commonly found in the paediatric and young adult population. Although cases of adult and elderly pilocytic astrocytomas are described in the literature, they are quite uncommon. The rate of PAs with spontaneous bleeding is very less, with a high occurrence in children than in adults, moreover, that is in cerebellar PAs. Cerebral PAs with intratumoral haemorrhage in the older age group is extremely rare. We present a case of a 60-year female presenting with acute neurological compromise resulting from an acutely haemorrhagic Left temporal pilocytic astrocytoma. She was managed surgically with evacuation of tumoral haemorrhages, as well as resection of the tumour. Postoperatively the patient made a remarkable recovery

Gaps in availability, utilization and expectations of people from health care services: A study of resettlement colony, Chandigarh

Introduction: Health care services cover a wide spectrum of community services for the treatment of disease, prevention of illness and promotion of health.[1] Aim and Objective: This study was aimed at assessing the gap in availability and utilization of health services in a resettlement Colony of Chandigarh. Material and methods: Dadu Majra was purposely selected to assess the gap in availability and utilization of health care services and expectations of people from public health sector. Using semi structured interview schedule, interviews were carried with all health care providers. Six focused group discussions and interviews were held 114 sampled service users. Results: Most of the users were utilizing services from private medical clinics (96.5%) for the treatment of acute illnesses. For antenatal checkup/delivery (95.6%), chronic diseases (99.1%), and emergency services (95.6%) Government Multi-Speciality Hospital, Chandigarh was being utilized. Utilization of services provided at civil dispensary of study area was low. The expectations of users were availability of at least one doctor and availability of free medicine & laboratory facilities. Conclusions: Public health services were preferred over by the private and therefore need to be strengthened

Placental Immune Responses to Viruses: Molecular and Histo-Pathologic Perspectives

As most recently demonstrated by the SARS-CoV-2 pandemic, congenital and perinatal infections are of significant concern to the pregnant population as compared to the general population. These outcomes can range from no apparent impact all the way to spontaneous abortion or fetal infection with long term developmental consequences. While some pathogens have developed mechanisms to cross the placenta and directly infect the fetus, other pathogens lead to an upregulation in maternal or placental inflammation that can indirectly cause harm. The placenta is a temporary, yet critical organ that serves multiple important functions during gestation including facilitation of fetal nutrition, oxygenation, and prevention of fetal infection in utero. Here, we review trophoblast cell immunology and the molecular mechanisms utilized to protect the fetus from infection. Lastly, we discuss consequences in the placenta when these protections fail and the histopathologic result following infection

Intraabdominal pressure as a marker for physiologic and pathologic processes in pregnancy

Increased intraabdominal pressure (IAP) can result in compression of the abdominal-pelvic venous system leading to signs and symptoms of end organ dysfunction. It has been hypothesized as a pathophysiologic process of preeclampsia. We aim to evaluate the role of IAP in normotensive vs preeclamptic, and singleton vs twin pregnancies. We hypothesized that IAP would be higher in preeclamptics and twins. Women undergoing scheduled cesarean delivery were enrolled in four groups: Singletons- Preeclamptic and Normotensive, Twins- Preeclamptic and Normotensive. Elevated IAP was seen in singleton pregnancies with preeclampsia, representing a pathologic process; and in all twin pregnancies, suggesting a physiologic process

Complications and outcomes of SARS-CoV-2 in pregnancy:where and what is the evidence?

Objectives To add to the growing evidence on SARS-CoV-2 infection during pregnancy, so as to better inform clinical decision making and optimize patient outcomes. Methods A systematic search of relevant databases was perfomed on 25 March 2020 and a repeat search, on 10 April 2020. Reports of pregnant patients with SARS-CoV-2 infection at any time during their pregnancy were reviewed and summarized . Results We summarized the outcomes of a total of 155 pregnant women and 118 neonates. The evidence suggests a similar rate of severe COVID-19 cases in pregnant women and the general population. The frequency of cesarean deliveries is high, against guidelines recommendations. Conclusion Limited data on COVID-19 during preganacy, associated with a wide variation in the methodology make accurate data interpretation difficult