Brain-lung interaction: a vicious cycle in traumatic brain injury

The brain-lung interaction can seriously affect patients with traumatic brain injury, triggering a vicious cycle that worsens patient prognosis. Although the mechanisms of the interaction are not fully elucidated, several hypotheses, notably the “blast injury” theory or “double hit” model, have been proposed and constitute the basis of its development and progression. The brain and lungs strongly interact via complex pathways from the brain to the lungs but also from the lungs to the brain. The main pulmonary disorders that occur after brain injuries are neurogenic pulmonary edema, acute respiratory distress syndrome, and ventilator-associated pneumonia, and the principal brain disorders after lung injuries include brain hypoxia and intracranial hypertension. All of these conditions are key considerations for management therapies after traumatic brain injury and need exceptional case-by-case monitoring to avoid neurological or pulmonary complications. This review aims to describe the history, pathophysiology, risk factors, characteristics, and complications of brain-lung and lung-brain interactions and the impact of different old and recent modalities of treatment in the context of traumatic brain injury

Relationship between Duffy Genotype/Phenotype and Prevalence of Plasmodium vivax Infection: A Systematic Review

The Duffy protein, a transmembrane molecule, functions as a receptor for various chemokines and facilitates attachment between the reticulocyte and the Plasmodium Duffy antigen-binding protein. Duffy expression correlates with the Duffy receptor gene for the chemokine, located on chromosome 1, and exhibits geographical variability worldwide. Traditionally, researchers have described the Duffy negative genotype as a protective factor against Plasmodium vivax infection. However, recent studies suggest that this microorganism’s evolution could potentially diminish this protective effect. Nevertheless, there is currently insufficient global data to demonstrate this phenomenon. This study aimed to evaluate the relationship between the Duffy genotype/phenotype and the prevalence of P. vivax infection. The protocol for the systematic review was registered in PROSPERO as CRD42022353427 and involved reviewing published studies from 2012 to 2022. The Medline/PubMed, Web of Science, Scopus, and SciELO databases were consulted. Assessments of study quality were conducted using the STROBE and GRADE tools. A total of 34 studies were included, with Africa accounting for the majority of recorded studies. The results varied significantly regarding the relationship between the Duffy genotype/phenotype and P. vivax invasion. Some studies predominantly featured the negative Duffy genotype yet reported no malaria cases. Other studies identified minor percentages of infections. Conversely, certain studies observed a higher prevalence (99%) of Duffy-negative individuals infected with P. vivax. In conclusion, this systematic review found that the homozygous Duffy genotype positive for the A allele (FY*A/*A) is associated with a higher incidence of P. vivax infection. Furthermore, the negative Duffy genotype does not confer protection against vivax malaria.Revisión por pare

Notes on the history of Walter Edward Dandy - one of the outstanding fathers of neurosurgery

Walter Dandy was born in 1886 in Missouri into an immigrant family. From an early age, he stood out as a good and curious student, which led him to study initially at the University of Missouri and later at the John Hopkins School of Medicine where he had the opportunity to develop his potential as a researcher in the Hunterian surgical laboratory, under the tutelage of the prestigious Dr Harvey Cushing. His contributions to medicine as a surgical resident and later neurosurgeon marked a before and after in the history of the modernization of neurosurgery and enriched the knowledge of the anatomical structures of the central nervous system, considering his discovery of ventriculography as "the greatest single contribution to brain surgery", also being the first to successfully perform various surgical procedures, such as the clipping of aneurysms and the resection of tumours of the cerebellopontine and hypophysial angle

Practical concepts in the identification of bilateral chronic subdural hematoma

Bilateral chronic subdural hematoma is a neurosurgical pathology whose incidence in older adults has been increasing, as a consequence of the ageing of the population, added to the factors that are linked to it. Neurosurgical diseases with chronic evolution generate a high burden of disease due to morbidity, disability, mortality and health costs associated with reinterventions and rehabilitation. For this reason, the interest in this disease has been increasing, also justified by the little information there is about it, unlike unilateral chronic subdural hematomas, although it has been described that both may have pathophysiological similarities that help to understand them

Acute phase of traumatic brain injury: Overview of neuroimaging tools and significant findings

In neurotrauma, diagnostic imaging plays a fundamental role in the early detection of treatable injuries or the mitigation of secondary injuries. Currently, the routine imaging techniques used in the setting of a head trauma patient include non-contrast computed tomography (CT), computed tomography angiography (CTA), conventional magnetic resonance imaging (MRI) with T1, T2 or diffusion imaging. Of the above mentioned, CT is superior to MRI in terms of speed of examination, due to the greater access to portable equipment in the patient's environment, which reduces the risk of secondary complications at the time of transfer to the radiology department. Nevertheless, MRI provides a much higher quality of images than CT. MRI is not indicated for the diagnosis of acute brain injury, but if the results of CT without contrast are normal, and neurological manifestations are present, it is indicated. As a result, CT should be the first study requested to the imaging service by the medical team in charge of the patient during the acute phase of the traumatic brain injury. The main objective of this review is to present some of the advantages and disadvantages offered by the different diagnostic imaging methods when approaching and managing brain-injured patients, with emphasis on the acute phase of trauma

Hyperbaric oxygen therapy: Application in traumatic brain injury

The extent and progression of neurological impairment in traumatic brain injury depend significantly on the area of perilesional gloom, where neuronal apoptosis occurs. Inhibition of apoptosis becomes a therapeutic strategy to preserve brain tissue and promote functional recovery. Hyperbaric oxygen therapy is a treatment by which 100% oxygen is administered, with the aim of achieving a higher pressure than atmospheric pressure at sea level, to decrease ischemia and intensity of inflammatory processes triggered, compromising the viability of the tissues. For mild traumatic brain injury, studies indicate that hyperbaric oxygen therapy is no better than sham treatment. For acute treatment of moderate to severe traumatic brain injury, although the methodology is questionable in certain studies due to the complexity of the brain injury, hyperbaric oxygen therapy has been shown to be beneficial as a relatively safe adjunctive therapy. The objective of this review is to discuss aspects related to the pathophysiology of traumatic brain injury, the mechanism of action of hyperbaric oxygen therapy, and correlate these results with the use of this therapy in the prevention of neuronal injury, supported by original studies reported in the scientific literatur

Traumatic brain contusions: Key things to know in the emergency room

Traumatic brain injury is one of the most important causes of morbidity and mortality worldwide. One of its presentations includes traumatic brain contusions. Brain contusions are cortical lesions of necrotic tissue and multiple petechial haemorrhages, initially perivascular, that predominantly affect the crests of the convolutions, but that can extend through the cortex and reach the subcortical white matter. These result from a collision of the brain with the adjacent inner table of the skull, without proper treatment these can evolve and cause a rapid deterioration of clinical and neurological status. The classification includes mild, moderate, and severe TBI depending on the nature of the injury and the impact on the patient's clinical status. For the initial evaluation, computed tomography is usually used, although the magnetic resonance has greater sensitivity for the detection in these patients. Treatment is guided at preventing the progression of the lesion or the development of a secondary lesion, avoiding hypotension and hypoxia and maintaining adequate cerebral perfusion. Surgery is frequently needed in severe cases to remove intracranial hematomas, provide space for the brain to swell, or place monitors to track intracranial pressure and brain oxygenation. The aim of this article is to review the most important aspects to know about brain contusion