Background:Aneurysmal subarachnoid hemorrhage (aSAH) continues to be a devastating neurological condition with a high risk of associated morbidity and mortality. Inflammation has been shown to increase the risk of complications associated with aSAH such as vasospasm and brain injury in animal models and humans. The goal of this review is to discuss the inflammatory mechanisms of aneurysm formation, rupture and vasospasm and explore the role of sex hormones in the inflammatory response to aSAH.Methods:A literature review was performed using PubMed using the following search terms: “intracranial aneurysm,” “cerebral aneurysm,” “dihydroepiandrosterone sulfate” “estrogen,” “hormone replacement therapy,” “inflammation,” “oral contraceptive,” “progesterone,” “sex steroids,” “sex hormones” “subarachnoid hemorrhage,” “testosterone.” Only studies published in English language were included in the review.Results:Studies have shown that administration of sex hormones such as progesterone and estrogen at early stages in the inflammatory cascade can lower the risk and magnitude of subsequent complications. The exact mechanism by which these hormones act on the brain, as well as their role in the inflammatory cascade is not fully understood. Moreover, conflicting results have been published on the effect of hormone replacement therapy in humans. This review will scrutinize the variations in these studies to provide a more detailed understanding of sex hormones as potential therapeutic agents for intracranial aneurysms and aSAH.Conclusion:Inflammation may play a role in the pathogenesis of intracranial aneurysm formation and subarachnoid hemorrhage, and administration of sex hormones as anti-inflammatory agents has been associated with improved functional outcome in experimental models. Further studies are needed to determine the therapeutic role of these hormones in the intracranial aneurysms and aSAH.

Background: Bipolar electrocautery systems used during neurosurgical procedures have been shown to induce thermal injury to surrounding tissue. The goal of this study was to compare the thermal injury induced by two different systems commonly used in neurosurgical procedures (Silverglide by Stryker Corporation and SpetzlerMalis by Codman Neuro), with that of a newly introduced device (TRIOwand by NICO Corporation). Methods: A farm swine underwent craniectomy and durotomy with subsequent exposure of cortical brain tissue. Electrocoagulation for the duration of 3 s was conducted with three different bipolar systems under comparable power settings. The maximal depth of thermal injury and mean area of injury in Hematoxylin and Eosin stained slides were quantified using Image J. The tissues were evaluated for vacuolization and ischemic damage. One-way ANOVA followed by post hoc Tukey test was utilized for statistical analysis. Alpha level was set at 0.05. Results: TRIOwand lesions showed less depth of injury when compared to both Spetzler-Malis (P < 0.001) and Silverglide lesions (P = 0.048). Silverglide lesions showed significantly less depth of injury when compared to SpetzlerMalis lesions (P < 0.001). The injury area induced by the TRIOwand was significantly less than that of Spetzler-Malis (P < 0.001) and Silverglide systems (P < 0.001). Ischemic changes and vacuolization were seen in all three groups. Conclusion: Thermal damage is induced to varying extents by all bipolar systems. In this porcine model and under the conditions tested, bipolar cauterization with the TRIOwand resulted in less depth and decreased mean area of injury. Further studies are needed to characterize the injury caused by different bipolar systems with other settings and under surgical conditions in humans.

Introduction: Primary postpartum hemorrhage is one of the leading causes of maternal death in Bhutan but data on the incidence and risk factors for primary postpartum hemorrhage are scarce. The purpose of this research is to look into the incidence, its associated risk factors and maternal outcome of primary postpartum hemorrhage among women who gave birth at the national referral hospital. Methods: The incidence of primary postpartum hemorrhage was estimated total number of primary postpartum hemorrhage cases of total deliveries during the study period. A case-control study was conducted to identify risk factors for primary postpartum hemorrhage. Cases of primary postpartum hemorrhage was defined by blood loss of greater or equal to 500ml in vaginal delivery or greater or equal to 1000ml for abdominal delivery within 24 hours of delivery. A multivariable logistic regression was used to identify associated risk factors of primary postpartum hemorrhage. Results: Among 9,221 deliveries, primary postpartum hemorrhage occurred in 180 cases (1.95%; 95% CI=1.68%-2.26%) during two year period. The significant risk factors for primary postpartum hemorrhage were, labor induction (adjusted OR=2.27; 95% CI= 1.11-31.47, p=0.005), current pregnancy complications (aOR=2.50; 95% CI: 1.32-4.74, p=0.005), and gestational age at term delivery (aOR=6.49; 95% CI:1.12-37.48, p=0.037). The significant causes of primary postpartum hemorrhage were uterine atony (aOR=72.57; 95% CI:5.95-885.76, p=0.001), retained placenta (aOR=18.08; 95% CI:2.66-122.81, p=0.003) and perineal and cervical tear (aOR=27.80; 95% CI: 15.13-51.07, p less than 0.001). Conclusions: The incidence of primary postpartum hemorrhage was 1.95% which is lower compared to other South East Asian countries. The causes and risk factors identified in this study may help predict primary postpartum hemorrhage and aid healthcare providers in better management of primary postpartum hemorrhage in all women giving birth.