Effect of low-dose intravenous dexamethasone on post-lumbar discectomy pain: Randomized and Double blind study

The Pain is the most common complaint in various diseases. Postoperative pain is common complication and spatially in elderly patient because of exacerbation of heard and vessel was impotents. The aim of this study was evaluation of the effect of low-dose IV dexamethasone on postoperative pain in patients with lumbar discectomy.  In a clinical trial that studied in neurosurgery wards of Shohada and Imam Reza hospitals affiliated to the Tabriz University of Medical Sciences on patients underwent lumbar discectomy, the effect of low-dose IV dexamethasone on postoperative pain was evaluated. 80 patients divided in 2 equal groups, we used IV morphine (present routine treatment) in group A and IV morphine in addition to 8mg IV dexamethasone in group B, for reducing post lumbar discectomy pain. 21 patients in group A, & 22 in group B were male and 19 patients in group A & and 18 in group B were female (P=0.823). Mean age of patients in groups A and B was 39.32 and 39.22 years, respectively (P=0.945). Mean of pain score (VAS) at 6 hours post-operation in group A and B was 6.97 and 6.75, respectively (P=0.065). VAS at 12, 18 or 24 hours post-operation in both groups didn't differ significantly, too (P>0.05). We didn't observe any significant reduction in post lumbar discectomy pain after adding 8 mg dexamethasone into morphine. Regarding other studies, it seems that higher doses of dexamethasone should be used to achieve a significant pain reduction

Assessment of neuropsychiatric indicators in children and adolescents with primary brain tumors and other brain space occupying lesions before and after surgery

  Objective Cognitive abilities may be impaired due to brain lesions in children and adolescents. This study aimed to investigate neuropsychiatric indicators in children and adolescents with primary brain tumor and other brain space occupying lesions (SOL) before and after surgical procedure. Methods & materials the current study is a pre and post study which was conducted on 81 patients with brain space occupying lesions aged less than 18. Patients with metastatic brain tumors were excluded. The study was performed between 20 December 2016 to 20 December 2017 on patients hospitalized in neurosurgery ward of Imam Reza university hospital, Tabriz, Iran. Before and after surgical procedure, Digit span forward and backward Task (to assess working memory), Stroop task and Trail Making Task A & B (to assess attention) and Rey Osterrieth Complex Figure Test (to assess Visual Spatial Memory) were done. Then, scores of tests were compared with normal values as well as the post-surgery scores. Results the most prevalent type of space occupying brain lesion was medulloblastoma and the most common region of involvement was posterior fossa tumor. Scores of all tests after surgery comparing to before surgery were significantly improved (P<0.05). In assessment of Digit span forward and backward Task with standard scores, there was no significant difference among scores of patients before surgery with the standard value (P>0.05). Regarding scores of various stages of Rey Osterrieth Complex Figure Test, the  scores of immediate recall stage was significantly low (P<0.05). Among Trail Making Task A & B and stroop task, before surgery, just the Trail Making Task A & B was significantly increased (P<0.05). Scores of Trail Making Task A was significantly higher in patients with medulloblastoma and anatomically in left temporal tumors which indicate greater damage of attention field (P<0.05). In addition, in cerebellar tumor, scores of immediate recall stage of Rey Osterrieth Complex Figure Test was significantly lower (P<0.05). Conclusions Visuo-Spatial Memory and attention in pre-surgery assessments was significantly impaired comparing to general population (P<0.05). Working memory, Visuo-Spatial Memory and attention showed improvement comparing to pre-surgery. Deficits in attention domain was greater in medulloblastoma

Prognostic Serum Factors in Traumatic Brian Injury: A Systematic Review

Background & Aim: Traumatic brain injury is one of the main causes of death and disability. The aim of this study is to systematically review the articles which assessed some serum factors of traumatic brain injury patients in relation to their outcomes. Methods & Materials/Patients: Databases were searched for relevant publications from 2005 to 2014. Selection criteria were:Studies which evaluate the factors affecting the outcome after TBI, TBI defined as “acute changes in brain function resulting in a strong external force to the head”.Resultswere measured by Glasgow Outcome Score or a comparable measure.Factors were measured in first month after injury and the prognosis was addressed. All papers were checked and approved by a specialist and expert in that field. A systematic review was performed for prognostic factors. Results: Sixty-three studies were included. Most studies used Glasgow Outcome Score at 6 months post-injury as outcome measure, sometimes in combination with other outcome measures. Strong evidence for predicting outcome was found for serum concentration of S100 protein, NSE, MBP, NF-H, GFAP, UCH-L1, blood glucose levels, serum levels of LDH, sodium level, prothrombin time, partial thromboplastin time, platelet count, D.dimer, HSP 70, serum levels of IL-8, number of circulating EPCs, and  DNA levels in serum. Moderate evidence for predicting outcome was found for high serum MMP9. Strong evidence of no association was found for WBC count and serum cortisol levels. Moderate evidence of no association was found for serum total cholesterol for other determinants, inconclusive or no evidence or limited evidence was found. Conclusion: S100 protein, NSE, MBP, NF-H, GFAP, UCH-L1, blood glucose levels, serum levels of LDH, sodium level, prothrombin time, Partial thromboplastin time, platelet count, D.dimer, HSP 70, serum levels of IL-8, number of circulating EPCs, and  DNA levels in serum predicted outcome after traumatic brain injury. WBC count, serum cortisol levels, total cholesterol and MMP9 did not have predictive value