Scalp Abrasions Research Articles

Pattern of Head Injury in Fatal Road Traffic Accident: Retrospective Study

Road traffic Accident have been reported to be a major cause of morbidity and mortality. Due to increasing modernization, road traffic accidents have become exponentially more frequent and dangerous. Mortality rate from road traffic injuries accounts 29.2 per 100000 people5. This study was conducted in the Department of Forensic Medicine, Silchar Medical College, Silchar, from 1st November 2021 to 31st October 2022. The aim of the study is the pattern of head injuries in fatal road traffic accident. Out of the 981 autopsy cases were conducted during the above-mentioned period, a total of 200 cases were found deaths due to head injuries. Out of 200 cases, common age group involved was from 40-50 years, the deceased were more from rural areas. Maximum cases during winter season. Commonest injuries were scalp abrasion, linear fracture of skull and subdural haemorrhage. Head injury has become a common cause of death and disability among Road Traffic Accident cases. This further shows the need of strict implementations of traffic rules. Positive policy initiatives such as mandatory helmet legislation need reliable and consistent data to support ongoing monitoring and enforcement of such initiatives.

Univariate and Multivariable Analyses on Independent Predictors for Cervical Spinal Injury in Patients with Head Injury

This study aims to identify independent factors associated with cervical spinal injuries in head-injured patients. The extent of injuries to other body parts was assessed by the Abbreviated Injury Scale (AIS) and was included in the analysis. Consecutive head-injured patients admitted via the emergency department from January 1, 2014 to December 31, 2016 were retrospectively reviewed. The inclusion criteria were head-injured patients with an Abbreviated Injury Scale (AIS) score ≥2 (i.e., head injuries with intracranial hematoma or skull fracture). Patients with minor head injuries with only scalp abrasions or superficial lacerations without significant intracranial injuries (i.e., head injury AIS score= 1) were excluded. The primary outcome was to identify independent predictors associated with cervical spinal injuries in these head-injured patients. Univariate and multivariable analyses were conducted. A total of 1105 patients were identified. Of these patients, 11.2% (n= 124) had cervical spinal injuries. Univariate and multivariable analyses identified male gender (P= 0.006), the presence of thoracic injury (including rib fracture, hemothorax, or pneumothorax) (P= 0.010), and hypotension with systolic blood pressure <90 mm Hg on admission (P= 0.009) as independent predictors for cervical spinal injury in head-injured patients. This study showed that about 1 in 10 patients with significant head injury had cervical spine injury, usually associated with fracture or dislocation. Male gender, the presence of thoracic injury, and hypotension on admission were independent risk factors associated with cervical spinal injuries.

Towards conductive-gel-free electrodes: Understanding the wet electrode, semi-dry electrode and dry electrode-skin interface impedance using electrochemical impedance spectroscopy fitting

The electrode-scalp impedance of six subjects is studied by electrochemical impedance spectroscopy using three representative electrodes, namely wet electrodes, semi-dry electrodes, and dry electrodes. With the analysis of proposed equivalent models and area-normalized impedance (kΩ cm2), the specific electrode double layer resistances are 530 Ω cm2 for all electrodes, their specific contact resistances Res are 80 Ω cm2, 114 Ω cm2 and 20,077 Ω cm2, and their specific skin resistances Rs are 867 Ω cm2, 1730 Ω cm2 and 46,145 Ω cm2 for these three representative electrodes respectively. When pressure was applied on dry electrodes, Res reduced by 47% and Rs reduced by 81%. When pressure was applied on semi-dry electrodes, Rs reduced by 50% (Res is not applicable for semi-dry electrodes). After application of scalp abrasion for dry electrodes, Res reduced by 36% and Rs reduced by 82%. After application of scalp abrasion for semi-dry electrodes, Rs reduced by 64%. Seeking novel interface materials may break through the bottleneck for dry electrodes development in terms of integrated materials, mechanical support and electronic circuitry, while semi-dry electrodes have much development space to meet a balance of quick setup, comfortable wear, and satisfactory signal quality in many medical and out-clinic applications.

Investigating Social Cognition in Infants and Adults Using Dense Array Electroencephalography (&lt;sub&gt;d&lt;/sub&gt;EEG)

Dense array electroencephalography (dEEG), which provides a non-invasive window for measuring brain activity and a temporal resolution unsurpassed by any other current brain imaging technology1,2, is being used increasingly in the study of social cognitive functioning in infants and adults. While dEEG is enabling researchers to examine brain activity patterns with unprecedented levels of sensitivity, conventional EEG recording systems continue to face certain limitations, including 1) poor spatial resolution and source localization3,4,2) the physical discomfort for test subjects of enduring the individual application of numerous electrodes to the surface of the scalp, and 3) the complexity for researchers of learning to use multiple software packages to collect and process data. Here we present an overview of an established methodology that represents a significant improvement on conventional methodologies for studying EEG in infants and adults. Although several analytical software techniques can be used to establish indirect indices of source localization to improve the spatial resolution of dEEG, the HydroCel Geodesic Sensor Net (HCGSN) by Electrical Geodesics, Inc. (EGI), a dense sensory array that maintains equal distances among adjacent recording electrodes on all surfaces of the scalp, further enhances spatial resolution4,5,6 compared to standard dEEG systems. The sponge-based HCGSN can be applied rapidly and without scalp abrasion, making it ideal for use with adults7,8, children9,10,11, and infants12, in both research and clinical4,5,6,13,14,15 settings. This feature allows for considerable cost and time savings by decreasing the average net application time compared to other dEEG systems. Moreover, the HCGSN includes unified, seamless software applications for all phases of data, greatly simplifying the collection, processing, and analysis of dEEG data. The HCGSN features a low-profile electrode pedestal, which, when filled with electrolyte solution, creates a sealed microenvironment and an electrode-scalp interface. In all Geodesic dEEG systems, EEG sensors detect changes in voltage originating from the participant's scalp, along with a small amount of electrical noise originating from the room environment. Electrical signals from all sensors of the Geodesic sensor net are received simultaneously by the amplifier, where they are automatically processed, packaged, and sent to the data-acquisition computer (DAC). Once received by the DAC, scalp electrical activity can be isolated from artifacts for analysis using the filtering and artifact detection tools included in the EGI software. Typically, the HCGSN can be used continuously for only up to two hours because the electrolyte solution dries out over time, gradually decreasing the quality of the scalp-electrode interface. In the Parent-Infant Research Lab at the University of Toronto, we are using dEEG to study social cognitive processes including memory, emotion, goals, intentionality, anticipation, and executive functioning in both adult and infant participants.

Investigating Social Cognition in Infants and Adults Using Dense Array Electroencephalography (&lt;sub&gt;d&lt;/sub&gt;EEG)

Dense array electroencephalography (dEEG), which provides a non-invasive window for measuring brain activity and a temporal resolution unsurpassed by any other current brain imaging technology1,2, is being used increasingly in the study of social cognitive functioning in infants and adults. While dEEG is enabling researchers to examine brain activity patterns with unprecedented levels of sensitivity, conventional EEG recording systems continue to face certain limitations, including 1) poor spatial resolution and source localization3,4,2) the physical discomfort for test subjects of enduring the individual application of numerous electrodes to the surface of the scalp, and 3) the complexity for researchers of learning to use multiple software packages to collect and process data. Here we present an overview of an established methodology that represents a significant improvement on conventional methodologies for studying EEG in infants and adults. Although several analytical software techniques can be used to establish indirect indices of source localization to improve the spatial resolution of dEEG, the HydroCel Geodesic Sensor Net (HCGSN) by Electrical Geodesics, Inc. (EGI), a dense sensory array that maintains equal distances among adjacent recording electrodes on all surfaces of the scalp, further enhances spatial resolution4,5,6 compared to standard dEEG systems. The sponge-based HCGSN can be applied rapidly and without scalp abrasion, making it ideal for use with adults7,8, children9,10,11, and infants12, in both research and clinical4,5,6,13,14,15 settings. This feature allows for considerable cost and time savings by decreasing the average net application time compared to other dEEG systems. Moreover, the HCGSN includes unified, seamless software applications for all phases of data, greatly simplifying the collection, processing, and analysis of dEEG data.The HCGSN features a low-profile electrode pedestal, which, when filled with electrolyte solution, creates a sealed microenvironment and an electrode-scalp interface. In all Geodesic dEEG systems, EEG sensors detect changes in voltage originating from the participant's scalp, along with a small amount of electrical noise originating from the room environment. Electrical signals from all sensors of the Geodesic sensor net are received simultaneously by the amplifier, where they are automatically processed, packaged, and sent to the data-acquisition computer (DAC). Once received by the DAC, scalp electrical activity can be isolated from artifacts for analysis using the filtering and artifact detection tools included in the EGI software. Typically, the HCGSN can be used continuously for only up to two hours because the electrolyte solution dries out over time, gradually decreasing the quality of the scalp-electrode interface.In the Parent-Infant Research Lab at the University of Toronto, we are using dEEG to study social cognitive processes including memory, emotion, goals, intentionality, anticipation, and executive functioning in both adult and infant participants.

Head Trauma: When Is a CT Not Indicated?

Head Trauma: When Is a CT Not Indicated?

Usefulness of a 1.5 T MRI-compatible EEG electrode system for routine use in the intensive care unit of a tertiary care hospital

Continuous electroencephalogram (cEEG) recordings are being increasingly used in intensive care units (ICUs) to detect epileptic seizures and other changes. MRI scans can interrupt such recordings if the EEG electrodes need to be removed and important data can be missed. We retrospectively examined EEG recordings from ICU patients who underwent MRI scans, comparing those from patients with the MRI-compatible EEG electrodes with those who had to have the EEG electrodes removed before scanning. We also examined technical aspects of the recording and scalp abrasions in both groups. Fourteen of 31 (45%) EEG recordings with the MRI-compatible electrode system in patients that underwent MRI scans between 03:00 p.m. and 07:00 a.m. (when technologists were not available) captured seizures. In contrast, all of the six EEG recordings with the MRI-incompatible electrode system in patients that underwent MRI scanning during the same interval were interrupted and had no data. Recording characteristics of the EEGs were comparable between the two groups and none had scalp abrasions. A significant proportion of patients undergoing MRI scans with the MRI-compatible EEG electrodes had seizures that would have been missed if the MRI-incompatible EEG electrodes had been used.

A Newborn Who Has a Neck Mass and Scalp Abrasion

A term newborn presents with a large left-sided neck mass and scalp abrasion ### Maternal History ### Birth History and Presentation The infant was delivered in vertex presentation via spontaneous vaginal delivery with vacuum assistance (6 pulls with 2 pop-offs). The delivery was attended by the Level II ICN RN, who called the pediatrician after noting a large neck mass on the infant. The infant was warmed, dried, and suctioned. Blow-by oxygen was administered for 5 minutes. The infant was breathing comfortably with no apparent respiratory compromise. Apgar scores were 6 at 1 minute and 8 at 5 minutes. Her birthweight was 2,920 g. ### Vital Signs ### Physical Examination

Complications des accouchements assistés par ventouse

To describe maternal and neonatal complications following deliveries assisted by vacuum extraction and to compare outcomes with those obtained after spontaneous vaginal delivery. We wanted to know if vacuum extractor was a risk factor by itself. We conducted a retrospective study of two years activity involving 4524 deliveries of which 845 (18.7%) were vacuum extractor assisted. We precisely defined maternal and neonatal complications to compare their rates in spontaneous vaginal delivery and vacuum extractor groups. There were 1333 maternal complications and 114 neonatal complications. The adjusted risks of maternal complications were significantly higher in the vacuum extractor group for simple vaginal tears (OR=3.0; p<0.001), the simple perineal tears (OR=1.8; p<0.001) and third degree perineal tears (OR=2.7; p<0.01). For neonatal complications, the difference was significant for cephalhematomas (OR=10; p<0.001) and scalp abrasions (OR=53; p<0.001). No cases of skull fracture or subgaleal subaponeurotic hemorrhage were recorded. Our rates of maternal and neonatal complications after vacuum extractor were similar to those described in the literature. We have been able to show that vacuum extraction is itself a risk factor for third degree perineal tears and cephalhematoma. However, these complications are so infrequent that the advantages of this method of extraction argue in favor of wide use in obstetrics.

Vacuum Assisted Vaginal Deliveries in Sagamu

A retrospective review of all cases of vacuum assisted vaginal deliveries at the Olabisi Onabanjo University Teaching Hospital, Sagamu, between January 1990 and December 2001 is presented. During the study period there were 4962 deliveries and assisted vaginal deliveries by vacuum was 223, giving an incidence of 4.53%. Primiparous patients accounted for 57.4% of the cases. The commonest indication was delayed second stage (87%). The mean birth weight of babies was 3.13 Kg + 0.51 SD. One hundred and fifty two (68.2%) babies had Apgar scores of seven and more at the fifth minute of birth. The commonest fetal injury was scalp abrasion and cervical laceration was the commonest maternal complication. Key Words: Vacuum, Delivery, Vagina. Nig. Medical Practitioner Vol. 45(3) 2004: 38-40

Clinical evaluation of a “hand pump” vacuum delivery device

Objective To evaluate the clinical performance of a hand-held vacuum delivery system. Methods Between December 1999 and September 2000, a prospective audit was undertaken of all vacuum deliveries performed at Derby City General Hospital. Results In this period, 3296 deliveries occurred, of which 317 (9.6%) were by vacuum. Of these, data were collected on 300 (94.6%), 78 deliveries with the hand-held vacuum and 222 with standard vacuum. There were no differences in the demographic profiles, indication, gestational age at delivery, or birth weights between the two groups ( P > .05 in all instances). In all types of delivery, nonrotational and rotational, the hand-held vacuum performed comparably to its contemporaries with no increase in delivery “failures” being noted. There were no differences in the extent or frequency of maternal injuries between the instruments, and other than transient scalp abrasions, there were no significant fetal injuries. Conclusion The hand-held vacuum delivery system is a functionally effective addition to the practitioners’ “armory,” providing an alternative to the standard metal and silastic cups.

Scalp electrode impedance, infection risk, and EEG data quality

Objectives: Breaking the skin when applying scalp electroencephalographic (EEG) electrodes creates the risk of infection from blood-born pathogens such as HIV, Hepatitis-C, and Creutzfeldt–Jacob Disease. Modern engineering principles suggest that excellent EEG signals can be collected with high scalp impedance (≈40 kΩ) without scalp abrasion. The present study was designed to evaluate the effect of electrode-scalp impedance on EEG data quality.Methods: The first section of the paper reviews electrophysiological recording with modern high input-impedance differential amplifiers and subject isolation, and explains how scalp-electrode impedance influences EEG signal amplitude and power line noise. The second section of the paper presents an experimental study of EEG data quality as a function of scalp-electrode impedance for the standard frequency bands in EEG and event-related potential (ERP) recordings and for 60 Hz noise.Results: There was no significant amplitude change in any EEG frequency bands as scalp-electrode impedance increased from less than 10 kΩ (abraded skin) to 40 kΩ (intact skin). 60 Hz was nearly independent of impedance mismatch, suggesting that capacitively coupled noise appearing differentially across mismatched electrode impedances did not contribute substantially to the observed 60 Hz noise levels.Conclusions: With modern high input-impedance amplifiers and accurate digital filters for power line noise, high-quality EEG can be recorded without skin abrasion.

Impact of FDA advisory on reported vacuum-assisted delivery and morbidity.

In May 1998 the US Food and Drug Administration (FDA) issued a health advisory reporting neonatal injuries/deaths following vacuum delivery and encouraged voluntary reports of future adverse events. We compared FDA reports of vacuum delivery adverse events prior to and following the advisory. The FDA database (MAUDE) was searched for vacuum deliveries using brand name, manufacturer name, and procedure "string searches." Cases were sorted by report date, source, and manufacturer. Neonatal morbidity was quantified as deaths and life-threatening or nonlife-threatening events. A total of 80 reported adverse cases were identified after duplicate cases were consolidated. Twenty-five were reported to the FDA prior to the 1998 advisory and 55 in the immediate 6-month period following the advisory. There was a 22-fold increase in reported events from five events/year prior to the advisory to an estimated 110 events/year following the advisory. The distribution of reporting sources changed significantly following the advisory with increased "manufacturer" (8-43%) and decreased "voluntary" reports (56-20%). All major brand names were represented. During the 6 months following the FDA advisory there were 10 neonatal deaths, 30 life-threatening events, 12 nonlife-threatening events, and three equipment-related reports. Infant deaths were due to intracranial or subgaleal hematomas. Injuries included skull fracture, scalp abrasions, and cephalohematomas. The FDA advisory was associated with a 22-fold increase in the rate of reported adverse events. This increase in reporting likely represents both enhanced awareness of complications as well as an increase in vacuum-related adverse neonatal sequelae. As vacuum delivery is associated with greater neonatal morbidity/ mortality than was previously recognized, the adage that the vacuum is "designed to come off before infant damage occurs" appears unsubstantiated. It is recommended that manufacturers quantify the suction and traction capabilities of present and new proposed vacuum cup designs.

Herpes Simplex Virus Infections

Case Report A term female developed fever and tachypnea and had a transient episode of poor color and tone on the third day of life. She was delivered by cesarean section 5 hours after rupture of membranes to a 19-year-old, gravida 4, para 0 mother whose serology was negative for syphilis, human immunodeficiency virus (HIV), and hepatitis B surface antigen. The mother had no history of sexually transmitted diseases. Apgar scores were 8 at 1 minute and 9 at 10 minutes. When the infant was admitted to the nursery, scalp abrasions were noticed by the nurse. On the third day of life, a sepsis evaluation was initiated, and the infant received ampicillin and gentamicin intravenously: no bacterial infection was found. On the fifth day of life, vesicular lesions were noticed on her scalp. Bilateral interstitial infiltrates were present On chest radiograph and laboratory studies revealed mild elevations in liver function tests. There were no cerebrospinal fluid (CSF) abnormalities. She was started on intravenous acyclovir, and herpes simplex virus (HSV)-2 subsequently was isolated from both her pharynx and scalp lesions. After receiving intravenous acyclovir for 3 weeks, she was discharged with no evidence of residual sequelae. Four days after acyclovir was discontinued, new scalp vesicles appeared and the infant developed a temperature of 38.8°C (102°F).

Herpes Simplex Virus Infections

Case Report A term female developed fever and tachypnea and had a transient episode of poor color and tone on the third day of life. She was delivered by cesarean section 5 hours after rupture of membranes to a 19-year-old, gravida 4, para 0 mother whose serology was negative for syphilis, human immunodeficiency virus (HIV), and hepatitis B surface antigen. The mother had no history of sexually transmitted diseases. Apgar scores were 8 at 1 minute and 9 at 10 minutes. When the infant was admitted to the nursery, scalp abrasions were noticed by the nurse. On the third day of life, a sepsis evaluation was initiated, and the infant received ampicillin and gentamicin intravenously: no bacterial infection was found. On the fifth day of life, vesicular lesions were noticed on her scalp. Bilateral interstitial infiltrates were present On chest radiograph and laboratory studies revealed mild elevations in liver function tests. There were no cerebrospinal fluid (CSF) abnormalities. She was started on intravenous acyclovir, and herpes simplex virus (HSV)-2 subsequently was isolated from both her pharynx and scalp lesions. After receiving intravenous acyclovir for 3 weeks, she was discharged with no evidence of residual sequelae. Four days after acyclovir was discontinued, new scalp vesicles appeared and the infant developed a temperature of 38.8°C (102°F).