Pneumocephalus, defined as the presence of air within the cranial vault, can range from small, asymptomatic collections to life-threatening tension pneumocephalus. Etiologies include trauma, cranial surgery, infections, neoplasms, and rarely iatrogenic causes such as hemodialysis. We report a case of acute pneumocephalus in a 65 year old woman undergoing routine hemodialysis for end stage renal disease secondary to polycystic kidney disease. The patient collapsed within minutes of initiating dialysis with sudden alteration of consciousness. Emergency non-contrast brain CT revealed pneumocephalus. She was intubated, positioned in left Trendelenburg, and received supportive care, including resumption of hemodialysis via central venous access. Follow-up imaging showed resolution of intracranial air with residual ischemic changes in the right hemisphere. She was extubated after 14 days, with residual left hemiplegia, and transferred to the general ward. This case highlights the rare but potentially serious complication of pneumocephalus during hemodialysis and emphasizes the importance of early recognition, prompt management, and preventive measures.
Background:Every year, 15 million preterm births occur worldwide, and attendant complications are the main reason for mortality in children under five. A small proportion have extremely low birth weight (ELBW), needing close assistance to survive. There is limited information about ELBW neonates born in Rwanda. Objective:To assess the early outcomes and associated factors of ELBW neonates at three selected referral hospitals in Rwanda. Methods:This study conducted in 2020 was of retrospective cross-sectional design. Information was extracted from 108 files of ELBW neonates admitted to neonatal units in a referral hospital in Kigali, Rwanda. Results:The major cause of death was severe prematurity (45.10%). The majority of neonates with ELBW (52.8%) survived in the neonatal unit, and there was association with continuous positive airway pressure (81.48%) and ventilator (14.81%). Likewise, there was association between birth weight and neonatal outcome (p=0.004). Conclusion:This study revealed that the major cause of death of neonates with ELBW is severe prematurity associated with avoidable neonatal infection. However, the majority of ELBW neonates do survive. Continuous positive airway pressure, and ventilator machine are mostly used. Thus, strengthening preventive measures of preterm birth and infection prevention control are recommended to reduce deaths among ELBW neonates.
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, with in-hospital mortality rate exceeding 30% in critically ill patients. The increasing burden of sepsis in neurosurgical patients is a complex and poorly understood clinical challenge, underscoring the need for evidence-informed decision-making. This review aims to assess the proportion, etiology, predictors, and clinical outcomes in sepsis in neurosurgical patients. A systematic review and meta-analysis will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Databases to be searched include PubMed, Embase, and Scopus from database inception to date. We will include original peer-reviewed articles reporting primary data. Additionally, reference lists of relevant reviews will be screened for additional eligible studies. Two independent reviewers will screen records, extract data, and assess risk of bias using Newcastle-Ottawa Scale and Cochrane Risk of Bias 2.00 tool. In meta-analysis, the effect will be measured using proportions, odds ratios, relative risks, or mean differences, with their 95% confidence intervals. The I2 and τ2 will describe heterogeneity. Where applicable, meta-regression, subgroup, and sensitivity analyses will be conducted to explore sources of heterogeneity. About 95% prediction intervals will measure the expected range of the effect in future studies. Ethical approval is not required. Findings are expected to inform more effective treatment guidelines, while also guiding public health strategies through optimized resource allocation, increased investment in prophylactic and postoperative care, and evidence-based policy development. Systematic Review Registration: The protocol has been registered on the International Prospective Register of Systematic Review (CRD420251088061).
Introduction Basic tracheostomy management is an essential skill for primary care practitioners, yet there is often limited training in formal medical education. This study aimed to develop and evaluate a low-cost, 3D-printed tracheostomy model to enhance simulation-based training and improve proficiency and confidence in airway management among general practitioners (GPs) in Rwanda, where prior research has identified gaps in training. Materials and Methods This two-phase study included expert validation by otolaryngologists followed by pilot testing of the model. Five local otolaryngologists evaluated the model’s anatomical accuracy, clinical relevance, and training utility. Subsequently, 40 GPs from across Rwanda participated in a hands-on simulation workshop in Rwanda. Training focused on suctioning, tube replacement, neck tie placement, and managing accidental decannulation. Pre- and post-training surveys assessed changes in knowledge, confidence, skill, and perceived relevance. Procedural skills were independently evaluated through standardized video and rubric assessments. Results Otolaryngologists rated the model highly for accuracy, relevance, and cost-effectiveness. Each reusable 3D-printed tracheostomy simulation model was produced at a cost of $32.22 USD, offering a sustainable and affordable alternative to commercial simulation tools in low-resource settings. During the training workshop, significant improvements were observed across all domains. Knowledge scores increased by 15% (p<0.001), and confidence scores improved by +2.11 to +2.59 points (p<0.001) on a 5-point scale. Objective skills ratings showed marked gains in tracheostomy technique (+2.55, p<0.001) and post-care management (+2.90, p<0.001). Conclusion This affordable, 3D-printed tracheostomy model effectively enhanced GP confidence, skills, and knowledge. The project highlights the value of context-appropriate simulation tools in strengthening clinical capacity in low-resource settings.
