Prophylactic antibiotic for prevention of posttraumatic meningitis after traumatic pneumocephalus: design and rationale of a placebo-controlled randomized multicenter trial [ISRCTN71132784]

BACKGROUND: The purpose of this study is to compare the efficacy of prophylactic antibiotic for prevention of meningitis in acute traumatic pneumocephalus patients. METHODS: In this prospective, randomized controlled clinical trial, 200 selected head injury patients with traumatic pneumocephalus are randomly assigned to receive intravenous antibiotics (2 grams Ceftriaxone twice a day), oral antibiotics (Azithromycin) or placebo for at least 7 days after trauma. The patients will be followed for one month posttrauma. CONCLUSION: The authors hope that this study helps clarifying the effectiveness and indications of antibiotics in prevention of meningitis in traumatic pneumocephalus after head injury and in specific subgroup of these patients

Bilateral asynchronous acute epidural hematoma : a case report

BACKGROUND: Bilateral extradural hematomas have only rarely been reported in the literature. Even rarer are cases where the hematomas develop sequentially, one after removal of the other. Among 187 cases of operated epidural hematomas during past 4 years in our hospital, we found one case of sequentially developed bilateral epidural hematoma. CASE PRESENTATION: An 18-year-old conscious male worker was admitted to our hospital after a fall. After deterioration of his consciousness, an emergency brain CT scan showed a right temporoparietal epidural hematoma. The hematoma was evacuated, but the patient did not improve afterwards. Another CT scan showed contralateral epidural hematoma and the patient was reoperated. Postoperatively, the patient recovered completely. CONCLUSIONS: This case underlines the need for monitoring after an operation for an epidural hematoma and the need for repeat brain CT scans if the patient does not recover quickly after removal of the hematoma, especially if the first CT scan has been done less than 6 hours after the trauma. Intraoperative brain swelling can be considered as a clue for the development of contralateral hematoma

Intraparenchymal hemorrhage after surgical decompression of a Sylvian fissure arachnoid cyst

Letter to Editor.2 page(s

بررسی عوامل موثر بر توسعه آموزش کارآفرینی در دانشگاههای استان مازندران

The purpose of this study was to investigate the effective factors on the development of entrepreneurship education in Mazandaran Universities. The statistical population of this study is all faculty members of Universities of Mazandaran province. The sample size in this study is 384 according to Morgan table. In the research, the research method is descriptive-survey method. The instrument of this research is a questionnaire. Reliability of the questionnaires was calculated using Cronbach's alpha coefficient higher than (0.7). To determine the validity of these tools, formal and content validity was used. In this research, structural equation modeling and Smart PLS software were used to analyze the data. The results of data analysis confirmed the effect of behavioral factors and structural factors and environmental factors on entrepreneurship education in Mazandaran Universities. Contract

Lumbar epidural hematoma due to lumbar acupunctures

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Transorbital cerebellar airgun pellet injury

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Prophylactic administration of ceftriaxone for the prevention of meningitis after traumatic pneumocephalus : results of a clinical trial

Object. The purpose of this study was to compare the efficacy of the prophylactic use of ceftriaxone for the prevention of meningitis in patients with acute traumatic pneumocephalus. Methods. In this prospective, single-institution, randomized clinical trial, 109 patients with mild head injury and traumatic pneumocephalus were randomly assigned to receive or not receive an antibiotic medication (ceftriaxone, 1 g given twice a day) until occurrence of meningitis or at least 5 days after trauma. The patients were followed up for 1 month posttrauma. The 109 patients were divided into two groups: 53 were assigned to the prophylactic antibiotics therapy group and 56 to the control group. The overall rate of meningitis was 20.1% and the rates of meningitis in the two groups were not significantly different. The results were the same when adjusted for the patient's Glasgow Coma Scale score, sex, and age, as well as for an intradural location of air, air volume, presence of cerebrospinal fluid (CSF) rhinorrhea or CSF otorrhea, radiological sign of a skull base fracture, or intracranial hemorrhage. Conclusions. The results of this study do not substantiate the efficacy of ceftriaxone used in the prevention of meningitis in patients with traumatic pneumocephalus after mild head injury or in any specific subgroup of these patients. Cerebrospinal fluid rhinorrhea and intracranial hemorrhage may be considered primary risk factors for the development of meningitis in patients with posttraumatic pneumocephalus and, in the absence of these symptoms, intradural location of air and air volume greater than 10 ml may be considered secondary risk factors. Further studies in this area are warranted.5 page(s

Optical Ring Resonators: A Platform for Biological Sensing Applications

Rapid advances in biochemistry and genetics lead to expansion of the various medical instruments for detection and prevention tasks. On the other hand, food safety is an important concern which relates to the public health. One of the most reliable tools to detect bioparticles (i.e., DNA molecules and proteins) and determining the authenticity of food products is the optical ring resonators. By depositing a recipient polymeric layer of target particle on the periphery of an optical ring resonator, it is possible to identify the existence of molecules by calculating the shift in the spectral response of the ring resonators. The main purpose of this paper is to investigate the performance of two structures of optical ring resonators, (i) all-pass and (ii) add-drop resonators for sensing applications. We propose a new configuration for sensing applications by introducing a nanogap in the all-pass ring resonator. The performance of these resonators is studied from sensing point of view. Simulation results, using finite difference time domain paradigm, revealed that the existence of a nanogap in the ring configuration achieves higher amount of sensitivity; thus, this structure is more suitable for biosensing applications

Foramen Magnum Surgery: Experience With 22 Cases

The foramen magnum is one of the important anatomic structures in the craniovertebral junction. Various tumors and lesions may involve the foramen magnum. Surgery in this region is challenging and a variety of surgical approaches have been advocated for the operation in this area only recently has this surgery been done outside major centers. We report our experience with the surgery of the foramen magnum tumors. This clinical study was done on a series of 22 cases of foramen magnum tumors over a period of 8 years. Surgical approaches were classic midline posterior fossa in 20 cases and lateral approach in 2 cases. The most frequent clinical presentations were suboccipital neck pain, with complaints of weakness and sensory changes. The most frequent neurologic findings were weakness, hyperreflexia, sensory changes, cerebellar signs, and gait disturbance. Pathologies included 7 meningiomas, 4 neurofibromas, 3 schwannomas, 2 hydatid cysts, 2 astrocytomas, and 4 miscellaneous lesions (tuberculoma, syphilis, ependymoma, and choroid plexus papilloma). Gross total resection was performed in 14 (64%) cases, subtotal resection in 4 (18%) cases, and partial resection in 4 (18%) cases. There were 2 (9%) mortality and 4 (18%) patients who developed 6 complications including cerebrospinal fluid leakage, meningitis, lower cranial nerves palsy, gait disturbance, sensory and motor deficits. Foramen magnum tumors are diverse in pathology and clinical manifestations. With the modern diagnostic tools such as magnetic resonance imaging and advances in surgical techniques especially skull base approaches, resection of the lesions could be performed with acceptable and minimum morbidity and mortality. The posterior approach is adequate for the majority