Gyaninder Pal Singh

Traumatic cervical spine injury in children and adolescents is uncommon but may cause major disability and prolonged critical care. This retrospective descriptive cohort characterizes patients aged 18 years or younger admitted to the Neurosurgical Intensive Care Unit (ICU) of a tertiary trauma center in New Delhi, India, during 2008–2015. Discharge status was classified as favorable (American Spinal Injury Association [ASIA] Impairment Scale D–E) or unfavorable (ASIA A–C or in-hospital death). We used chi-square tests with Yates’ continuity correction, with unadjusted odds ratios (ORs) and 95% confidence intervals (CIs). Among 112 patients, 83.0% were male, 85.7% were aged 9–18 years, and 77.7% had spinal canal compromise. Forty-seven patients (42.0%) had favorable and 65 (58.0%) had unfavorable discharge status, including nine in-hospital deaths (8.0%). Favorable status was associated with absence of spinal canal compromise (OR 6.67, 95% CI 2.40–18.54) and absence of the composite ICU complication indicator (OR 6.44, 95% CI 2.61–15.93), and with fracture rather than subluxation, absence of tracheostomy, and favorable admission ASIA category. No multivariable adjustment was performed; these exploratory, unadjusted associations do not establish independent or causal effects. The cohort provides descriptive data from an under-reported tertiary trauma setting and identifies variables for prospective multicenter study.

Deep brain stimulation (DBS) is an established neuromodulation therapy for a range of neurological and psychiatric disorders, including Parkinson disease, dystonia, essential tremor, epilepsy, and obsessive-compulsive disorder. Conventional DBS systems operate in an open-loop manner, delivering continuous stimulation with fixed parameters that require periodic manual reprogramming. This approach does not account for dynamic fluctuations in disease state and may result in suboptimal symptom control. Advances in neuro-engineering have led to the development of closed-loop DBS systems, which automatically adjust stimulation parameters in real time based on patient-specific neural and behavioral biomarkers. Closed-loop DBS integrates sensing, control, and stimulation components to enable adaptive neuromodulation, with the aid of artificial intelligence and biomarkers. As the clinical adoption of closed-loop DBS expands, perioperative physicians are more likely to encounter patients with these systems. An understanding of their mechanisms, advantages over open loop DBS, and unique perioperative considerations is essential. This primer provides an overview of the evolution, principles, and perioperative implications of closed-loop DBS to support safe and effective clinical care.

Frontonasal encephalocele is a rare variant of neural tube defect that usually presents with swelling over the face, requiring surgical repair. Anesthetic concern in such cases includes anticipated difficult bag-mask ventilation owing to the location of the pathology, which is more challenging in a non-operating room anesthesia (NORA) environment. We report the case of a 1-year-old male child who presented with a large frontonasal encephalocele for brain magnetic resonance imaging (MRI) under general anesthesia prior to surgical intervention. The swelling over the face prevented placement of a normal-sized face-mask and bag-mask ventilation. The limited access of equipment in the MRI suite and expert help at the remote location further exaggerated the challenge. Alternate strategies and meticulous planning helped secure the airway, and the procedure was uneventful. Difficult airway management is more challenging in NORA setups with limited access to equipment and expert help. Proper planning and preparation are crucial in such limited-resource facilities to avoid catastrophe.

The gut–brain axis (GBA) represents a complex bidirectional communication network linking the gastrointestinal tract and the central nervous system through neural, immune, endocrine, and metabolic pathways. Increasing evidence indicates that traumatic brain injury (TBI) and spinal cord injury (SCI) disrupt gut microbial homeostasis, resulting in dysbiosis, increased intestinal permeability, systemic inflammation, and secondary neurological injury. Alterations in microbial composition, depletion of short-chain fatty acid–producing bacteria, and dysregulated immune signaling contribute to neuroinflammation and multisystem dysfunction following neurotrauma. Experimental studies highlight the role of microbial metabolites, inflammatory mediators, enteroendocrine signaling, and vagal pathways in modulating neurological outcomes. Emerging therapeutic strategies targeting the GBA, including probiotics, prebiotics, dietary modification, short-chain fatty acid supplementation, fecal microbiota transplantation, amino acid supplementation, and judicious antibiotic use have shown promise in attenuating inflammation and supporting recovery. However, robust clinical evidence remains limited. This narrative review synthesizes current knowledge on the pathophysiological mechanisms linking the gut and brain in neurotrauma, evaluates existing and emerging therapeutic interventions, and identifies key gaps in knowledge that must be addressed to translate microbiome-based strategies into effective clinical therapies.

Herpes reactivation following posterior fossa surgery is an underrecognized but clinically significant complication. This case series describes three patients who developed herpes labialis within 3 to 4 days after posterior fossa surgery involving the trigeminal nerve. Surgical stress, direct nerve manipulation, and perioperative corticosteroid use likely contributed to reactivation. Prompt diagnosis and early antiviral therapy with acyclovir led to complete resolution in all cases. These findings highlight the need for greater awareness, early recognition, and potential prophylactic antiviral use in high-risk neurosurgical procedures to prevent herpes-related complications.

Phytochemicals or herbal medicines (HMs) with neuroprotective and nootropic properties are being increasingly utilized in various neurological conditions owing to their antioxidative, anti-inflammatory, and antiapoptotic properties, as well as their role in immune regulation, hormonal regulation, and modulation of neurotransmitters and ion channels. While HMs are often regarded as safe, they are not without risks. The aim of this review was to know the various neurological and non-neurological side effects of long-term consumption of neuroprotective and nootropic phytochemicals. An electronic search was conducted using the following databases from January 2000 to December 2023: PubMed, PubMed Central, Embase, Scopus, and Science Citation Index (Web of Science). Only studies published in the English language were considered. The search used key terms such as “Herbs,” “Phytochemicals,” “India,” “Asia,” “Neuroprotection,” “Neurological diseases,” and “Complications.” The sources included research articles, systematic reviews and meta-analyses, narrative reviews, and editorials. Letters to the editor, commentaries, abstracts only, and unpublished data were excluded. While HMs are increasingly being used therapeutically for various neurological and non-neurological conditions, they also carry the risk of adverse effects due to contamination, adulteration, direct effects of metabolites, herb–drug interactions, interindividual susceptibility, and other factors. In addition, widespread availability, over-the-counter sale, and unsupervised dosing are the key reasons for their unregulated prolonged use. As such, correct identification of HMs and consequent assessment of their toxicological profile are deemed extremely crucial. Neurotoxicity testing for HMs is challenging considering the limitations of traditional methods (morphological, microscopic, and chemical); nevertheless, in the recent years, several novel procedures have been developed. Large studies are warranted to establish the safety profile of consuming HMs either alone or in combination in humans.

Introduction: Catheter-associated urinary tract infections (CAUTIs) are one of the most common device-associated infections acquired in a hospital. Trauma patients are highly susceptible to CAUTI, as catheterization is a lifesaving measure often required for their management. This study focuses on the profile of CAUTI, the organism profile with antibiotic susceptibility patterns, and the clinical outcomes in the ICUs of a trauma care center. Methodology: A retrospective analysis of prospective surveillance data of patients in ICUs was done over a period of ten years (2010-2019) in a level 1 trauma center. A modified NHSN definition of CAUTI was used. Microbiological processing and antibiotic susceptibility profile was done based on standard guidelines. Clinical outcomes were considered for analysis. Results: A total of 10,732 patients were included in the study, accounting for 98,131 patient days and 78,126 urinary catheter days (UCD). Among 546 patients, 577 episodes of CAUTI were recorded, giving a CAUTI rate of 7.4/1,000 catheter days. The average length of stay (LOS) of patients was 19.9 days. There was a significant relationship between UCD and the development of CAUTI. Orthopedic and spinal injuries (91%) accounted for the maximum device utilization ratio, followed by polytrauma (90%), miscellaneous injuries (88%), and head injuries (69%). CAUTI episodes were the highest in head injury patients. Gram-negative organisms (53.4%) dominated the pathogen profile. The crude mortality was 25.1%. Conclusions: Surveillance of CAUTI with analysis of the organisms and the antibiotic susceptibility trend will help improve infection prevention practices and antibiotic stewardship programs in local hospital settings.

Obstructive sleep apnea (OSA) is a prevalent global health issue, with recent advances in pharmacotherapy expanding treatment options. Tirzepatide, a dual GLP-1 and GIP receptor agonist, has been newly approved by the FDA for managing moderate to severe OSA, following promising results from major randomized trials. Initially indicated for type 2 diabetes mellitus, Tirzepatide promotes glycemic control and weight loss through incretin-mediated insulin secretion and appetite suppression. As its use becomes more widespread, perioperative physicians and head-neck surgeons must be familiar with its pharmacokinetics and associated risks. Notably, delayed gastric emptying, a dose-dependent side effect, raises concerns of pulmonary aspiration during general anesthesia. Preoperative gastric ultrasound, diet modification, and individualized glycemic management are recommended strategies. Given the limited high-quality data, a multidisciplinary, institution-specific approach remains essential in managing patients on Tirzepatide in the perioperative setting.