Background Hypertonic saline and mannitol are hyperosmolar agents frequently used to lower ICP and relax the brain during surgeries. Several methods have been used to achieve a good and relaxed brain, such as hyperventilation, cerebrospinal fluid drainage, head position correction, and administration of hyperosmolar agents. Comparing equiosmolar doses between hypertonic saline and mannitol in patients undergoing elective craniotomies is important to further notice the differences in several outcomes. This study aims to compare the outcome of hypertonic saline versus mannitol on brain relaxation in patients undergoing elective craniotomy. Results 10 articles from 2007 to 2021 were included. Hypertonic saline is associated with better brain relaxation (OR  = 1.84, 95% CI 1.31–2.59; P = 0.001) but significantly increase blood natrium level, both serum and arterial (MD = 3.03, 95% CI 1.70–4.36; P =  < 0.001 and MD = 7.14, 95% CI 0.04–14.24; P =  < 0.001, respectively). Mannitol was associated with increased fluid input and urine output (SMD = − 0.56, 95% CI − 0.98 to − 0.15; P =  < 0.001 and SMD = − 0.96, 95% CI − 1.42 to − 0.50; P =  < 0.001, respectively). Serum osmolality and hemodynamic parameters difference was insignificant. Conclusions Hypertonic saline is associated with significantly better brain relaxation score and increased blood sodium level without increase in urine. This may prove to be clinically significant in patients with electrolyte imbalance.

No abstract

Carpal tunnel syndrome (CTS) remains one of the most common peripheral nerve entrapment syndromes. The patient may experience pain, numbness, and tingling in hand and arm of the affected individual. Treatment for CTS falls under two choices between conservative and surgical therapy. Mild and moderate symptoms are offered to be treated with conservative treatments, including oral and transvenous steroids, vitamin B6, vitamin B12, and corticosteroids injection. A further option is using a surgical procedure with a carpal tunnel release (CTR) by cutting the transverse carpal ligament (TCL) to increase space and relieve the pressure within the tunnel. As there are many cases of CTS worldwide, astute primary care physicians (PCP) must diagnose and choose the right treatment option. Clinicians should acknowledge some basic information about CTS to provide cost-effective and proper treatment. Clinicians can select Conservative treatments before referring the patient to an orthopedic surgeon or neurosurgeon. Failure to respond to conservative therapies is a case that needs hospital referral consideration. Keywords: carpal tunnel syndrome, primary care, primary care physician

Intracerebral hemorrhage (ICH) is a significant morbid disease with a secondary injury effect on the brain. Such risk factors contributing to ICH are hypertension, smoking, excessive consumption of alcohol, high cholesterol levels, and use of drugs, as well as unmodifiable risk factors, including old age, male sex, Asian ethnicity, and cerebral amyloid angiopathy (CAA). We report a 30-year-old man with a relatively healthy status who presented with a sudden onset of unconsciousness and right-sided weakness. Babinski reflex was also found on the right toe. Multi-slice non-contrast CT scan revealed intracerebral hemorrhage with a volume of 189 ccs in the left temporoparietal region with perifocal edema and midline shifting to the right. Keywords: spontaneous intracerebral haemorrhage, cerebral hemorrhage, young age, risk factor

Glaucoma is a group of progressive and irreversible optic neuropathies linked to intraocular pressure-related damage of the optic head. It is the second leading cause of blindness with estimation of 76 million people affected. Among many types of glaucoma, Primary Open-Angle Glaucoma (POAG) is the most common. Management of POAG primarily focus on lowering IOP with a variety of topical, oral, intravenous therapy, and surgery. Prostaglandin Analogue and Beta-blocker have long been the first line therapy for POAG with proven efficacy and safety profile. Rho-kinase Inhibitor is a novel class of drug with IOP lowering property through its ability to increase aqueous humor drainage via trabecular meshwork. Rho-kinase Inhibitor is proven to have mild local adverse effects and rare systemic drug reaction. This might be beneficial for patients with contraindication to Prostaglandin Analogue and/ or Beta-blocker use. Keywords: glaucoma, rho-kinase inhibitor