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Introduction: After direct mortality from an aneurysmal subarachnoid hemorrhage (aSAH), delayed cerebral ischemia (DCI) secondary to cerebral vasospasm is a cause of severe morbidity and mortality. Distinct from perimesencephalic SAH with favorable prognosis, non-aneurysmal diffuse SAH has been observed to have a more variable outcome and requires close clinical observation as this subset of patients has a higher likelihood for developing DCI. Treatment of radiographic and clinical vasospasm is limited to only a few pharmacological agents with varying degrees of success. Several recent publications have demonstrated efficacy with using intravenous (IV) milrinone to treat cerebral vasospasm. Here, we audit the use of IV milrinone in the clinical management of vasospasm and DCI in an adult non-aneurysmal SAH population. Methods: A retrospective quality audit was conducted at a single neurosurgical center over a 1-year period (2019). Data was extracted from electronic medical records. Results: A total of 93 adult patients were admitted for management of SAH. Twenty-four patients presented with non-aneurysmal SAH. Four patients in this group required symptomatic DCI management. All 4 patients presented with a diffuse pattern of SAH. Two of these patients presented with acute hydrocephalus requiring external ventricular drain (EVD) insertion. Most non-aneurysmal SAH patients had a good clinical outcome (92%, mRS 0–2). Two patients had a poor clinical outcome (mRS 3 and 4) at clinical follow up. These two patients initially presented with a poor clinicoradiological grading score and one patient required an urgent EVD for acute hydrocephalus. Intravenous milrinone was commenced for reduced level of consciousness (LOC) in 2/4 patients, while focal neurological deficit prompted initiation of IV therapy in the remaining 2. Conclusion: Patients with diffuse non-aneurysmal SAH can develop symptomatic DCI and should be closely monitored and provided a standardized protocol for cerebral hyperdynamic therapy.

In this paper A progressive damage model based on multi-scale modeling has been developed to predict the initiation and propagation of damage in plain weave fabrics. For this purpose, microscopic damage in yarns and resin is calculated by an RVE (Representative Volume Element) FE simulation. By applying suitable boundary conditions of RVE, macro-scale average stresses were derived to extract the components of the equivalent stiffness matrix. Finally, by developing UMAT and USDFLD subroutines in the ABAQUS commercial software, the strength of the woven composite rings is predicted numerically. In order to confirm the numerical predictions, composite rings using the woven glass tapes of 5 cm width and epoxy resin are fabricated according to ASTM D2290 and tested. A good correlation between experimental and numerical results could confirm the accuracy of the finite element simulation.

Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms that can occur intraventricularly, presenting diagnostic and management challenges. We describe a case of a 21-year-old male with no significant medical history who presented with intermittent headaches and vomiting, progressing to continuous symptoms. Neurological examination was unremarkable. Brain MRI revealed an isointense lesion in the occipital horn of the left lateral ventricle, diagnosed as an SFT. Surgical excision via a transcortical approach was successful, followed by postoperative radiotherapy. This case highlights the complexities in diagnosing and treating intraventricular SFTs, emphasizing the need for comprehensive evaluation and multimodal management strategies., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Abdellah et al.)

Objective: To further the understanding of sanitation and hygiene in long-term camp populations., Methods: Data were collected by structured observation of handwashing (126 households), a questionnaire on sanitation, hygiene and household characteristics (1089 households) and discussions with mothers. Random walk algorithms were used to select households for observation and survey. Respondents for qualitative methods were a convenience sample., Results: Across all key handwash occasions [excluding events with no handwash (n=275)], soap was used for 30% of handwashes. After latrine use, both hands were washed with soap on 20% of occasions observed. Availability of soap in households differed across sites and mirrored the extent to which it was distributed free of charge. Qualitative data suggested lack of free soap as a barrier to 'safe' handwashing. Laundry was the priority for soap. In Ethiopia and Kenya, open defecation was practised by a significant minority and was more prevalent amongst households of rural origin. In Ethiopia, open defecation was significantly more prevalent amongst women., Conclusions: Despite continuing hygiene education, rates of 'safe' handwashing are sub-optimal. Soap scarcity in some households and the prioritisation of laundry are barriers to safe practice. Heterogeneity with respect to education and place of origin may need to be taken into account in the design of improved interventions., (© 2012 Blackwell Publishing Ltd.)