exudates and Brain-Damage--Chronic

Nipah virus, a novel paramyxovirus, closely related to Hendra virus emerged in northern part of Peninsular Malaysia in 1998. The virus caused an outbreak of severe febrile encephalitis in humans with a high mortality rate, whereas, in pigs, encephalitis and respiratory diseases but with a relatively low mortality rate. The outbreak subsequently spread to various regions of the country and Singapore in the south due to the movement of infected pigs. Nipah virus caused systemic infections in humans, pigs and other mammals. Histopathological and radiological findings were characteristic of the disease. Fruitbats of Pteropid species were identified as the natural reservoir hosts. Evidence suggested that climatic and anthropogenic driven ecological changes coupled with the location of piggeries in orchard and the design of pigsties allowed the spill-over of this novel paramyxovirus from its reservoir host into the domestic pigs and ultimately to humans and other animals.

Topics: Agriculture; Animal Husbandry; Animals; Brain Damage, Chronic; Chiroptera; Disease Outbreaks; Disease Reservoirs; Ecology; Encephalitis, Viral; Hematologic Diseases; Housing, Animal; Humans; Malaysia; Paramyxoviridae Infections; Paramyxovirinae; Population Surveillance; Radiography; Recurrence; Respiratory Tract Infections; Singapore; Swine; Swine Diseases

The determination of cerebral perfusion pressure (CPP) is regarded as vital in monitoring patients with severe traumatic brain injury. Besides indicating the status of cerebral blood flow (CBF), it also reveals the status of intracranial pressure (ICP). The abnormal or suboptimal level of CPP is commonly correlated with high values of ICP and therefore with poor patient outcomes. Eighty-two patients were divided into three groups of patients receiving treatment based on CPP and CBF, ICP alone, and conservative methods during two different observation periods. The characteristics of these three groups were compared based on age, sex, time between injury and hospital arrival, Glasgow Coma Scale score, pupillary reaction to light, surgical intervention, and computerized tomography scanning findings according to the Marshall classification system. Only time between injury and arrival (p = 0.001) was statistically significant. There was a statistically significant difference in the proportions of good outcomes between the multimodality group compared with the group of patients that underwent a single intracranial-based monitoring method and the group that received no monitoring (p = 0.003) based on a disability rating scale after a follow up of 12 months. Death was the focus of outcome in this study in which the multimodality approach to monitoring had superior results.

Topics: Accidents, Traffic; Adolescent; Adult; Aged; Blood Pressure; Brain Damage, Chronic; Brain Injuries; Cerebrovascular Circulation; Child; Cohort Studies; Craniotomy; Female; Follow-Up Studies; Glasgow Coma Scale; Humans; Hypotension; Intracranial Pressure; Malaysia; Male; Middle Aged; Monitoring, Physiologic; Oximetry; Reflex, Pupillary; Respiration, Artificial; Severity of Illness Index; Tomography, X-Ray Computed; Transducers; Treatment Outcome

There are few local statistics on the incidence of hydrocephalus and the outcome of hydrocephalic shunts in the South East Asian region. We report a retrospective study on 285 hydrocephalic patients who underwent shunting procedures between 1990 and 1998 at the University Hospital Science Malaysia, a regional referral center. Multiple logistic regression analysis was applied to predict determinants of outcome in relation to the timing of diagnosis, other congenital abnormalities associated with the hydrocephalus, timing of surgery and cortical thickness from CT scan. The relationship of shunt infection was correlated to the age of the patient and surgical procedure. The predictors for developmental outcome reported by this study were age at diagnosis, type of brain abnormalities and gender. Time of operation and cortical thickness did not contribute to the outcome.

Topics: Adolescent; Brain Damage, Chronic; Cerebrospinal Fluid Shunts; Child; Child, Preschool; Cross-Sectional Studies; Developing Countries; Female; Follow-Up Studies; Humans; Hydrocephalus; Incidence; Malaysia; Male; Postoperative Complications; Treatment Outcome

The outcome of 151 children less than 15 years of age and admitted within 24 h of head injury was studied in relation to clinical and computed tomography (CT) scan features. Thirty one (20.5%) had a poor outcome (24 died, 6 were severely disabled at 6 months after injury and 1 was in a persistent vegetative state) while 120 (79.5%) had a good outcome (89 recovered well and 31 were moderately disabled). Factors associated with a poor outcome were Glasgow Coma Scale (GCS) score 24 h following injury, presence of hypoxia on admission and CT scan features of subarachnoid haemorrhage, diffuse axonal injury and brain swelling. GCS scores alone, in the absence of other factors, had limited predictive value. The prognostic value of GCS scores < 8 was enhanced two-to fourfold by the presence of hypoxia. The additional presence of the CT scan features mentioned above markedly increased the probability of a poor outcome to > 0.8, modified only by the presence of GCS scores > 12. Correct predictions were made in 90.1% of patients, indicating that it is possible to estimate the severity of a patient's injury based on a small subset of clinical and radiological criteria that are readily available.

Topics: Adolescent; Brain Damage, Chronic; Brain Edema; Brain Injuries; Child; Child, Preschool; Disability Evaluation; Female; Glasgow Coma Scale; Humans; Hypoxia; Hypoxia, Brain; Infant; Malaysia; Male; Neurologic Examination; Prognosis; Subarachnoid Hemorrhage; Survival Rate; Tomography, X-Ray Computed; Treatment Outcome