Morphology of Rat Hippocampal CA1 Neurons Following Modified Two and Four-Vessels Global Ischemia Models

Background: An appropriate animal model of ischemia stroke is essential for evaluation of different therapeutic methods. Two and four-vessel global ischemia models are one of the most common types of transient cerebral ischemia. Objectives: In this study, the morphology of rat hippocampal CA1 neurons in modified models of two and four-vessel ischemia and reperfusion were evaluated. Materials and Methods: In this study, 20 Wistar rats were randomly divided into five groups. In group 2 and 3, both common carotid arteries were occluded for 10 minutes in either 3 or 24 hours of reperfusions, respectively. In group 4 and 5, both common carotid and vertebral arteries were occluded for 10 minutes in either 3 or 24 hours of reperfusions, respectively. Group 1 as control, underwent the whole surgery without any arteries occlusion. Hippocampi of the rats in all groups were processed and tissue sections were stained using the Nissl method. The morphology of CA1 neurons were studied under a light microscope and compared different groups. Results: In all groups ischemic changes were apparently observed in hippocampus CA1 neurons. In two-vessel occlusion model, after 3 and 24 hours of reperfusions, ischemic cells accounted for 14.9% and 23.2%, respectively. In four-vessel occlusion model, after 3 and 24 hours of reperfusions, ischemic cells accounted for 7.6% and 44.9% (P < 0.0001), respectively. Conclusions: Modified four-vessel occlusion model resulted in significant ischemic changes after 24 hours of reperfusion in CA1 neurons of rat hippocampus

Agreement of Cerebral State Index and Glasgow Coma Scale in Brain-Injured Patients

Background: Variables derived from electroencephalogram like cerebral state index (CSI) have been used to monitor the anesthesia depth during general anesthesia. Observed evidences show such variables have also been used as a detector of brain death or outcome predictor in traumatic brain-injured (TBI) patients. Objectives: The current study was designed to determine the correlation between Glasgow coma score (GCS) and CSI among TBI patients. Patients and Methods: In 60 brain-injured patients who did not need and receive sedatives, GCS and CSI were daily measured during the first ten days of their hospital stay. Correlation between GCS and CSI was studied using the Pearson's correlation test. The Gamma agreement coefficient was also calculated between the two variables for the first day of hospitalization. Results: A significant correlation coefficient of 0.611-0.796 was observed between CSI and GCS in a ten-day period of the study (P < 0.001). Gamma agreement coefficient was 0.79 ( P < 0.001) for CSI and GCS for the first day of hospitalization. An increased daily correlation was observed in both CSI and GCS values. However, this increase was less significant in CSI compared with the GCS. Conclusions: A statistically significant correlation and agreement was found between GCS and CSI in the brain-injured patients and GCS was also found to be more consistent and reliable compared with CSI

Effects of right hepatic artery ligation

Abstract Background: Injury to right hepatic artery (RHA) may occur during hepatobiliary operative procedures. Although it may not be detected and is clinically silent in most of the cases, liver abscess, bleeding, hemobilia, and right hepatic lobe ischemia needing surgical excision have been reported. The aim of this study was a more detailed evaluation of hepatic consequences following RHA injury in an animal model. Methods: This study was conducted on 20 New Zealand rabbits 6 months of age. Blood samples for the measurement of hepatic enzymes was obtained from the rabbits before ligation of the hepatic artery. After 10 days, blood sampling was repeated and the animals were killed and 0.5 × 2 cm liver wedge biopsy was prepared from right lateral lobe, the distribution area of RHA. P values of < 0.05 were considered significant. Results: Laboratory data before and after surgical intervention showed serum bilirubin of 0.133 ± 0.044 and 0.135 ± 0.042, respectively (P value = 0.47). Serum alkaline phosphatase (ALP) was 122.4 ± 44.12 and 122.8 ± 44.43, (P value = 0.36) respectively. Serum glutamic-pyruvic transaminase (SGPT) was 31.2 ± 5.34 and 86.2 ± 33.9, (P value = 0.001) respectively. Serum glutamic oxaloacetic transaminase (SGOT) was 30.13±8.46 and 69.4±47.7, respectively (P value = 0.001). Laparotomy showed no considerable change in median lobe of livers, except mild necrosis in one (5%) rabbit. Severe necrosis was found in the right lateral lobe of 15 rabbits (75%), moderate necrosis in 3 (15%), and mild necrosis in 2 (10%) cases. No abscess or gangrene was found. The Gall bladder was intact in all animals. Conclusions: The RHA obliteration causes an increase in liver enzymes and considerable right lateral hepatic lobe necrosis (75%) but no liver abscess, gangrene or gall bladder abnormality. © 2017, Trauma Monthly

The data set development for the National Spinal Cord Injury Registry of Iran (NSCIR-IR): progress toward improving the quality of care

STUDY DESIGN: Descriptive study. OBJECTIVES: The aim of this manuscript is to describe the development process of the data set for the National Spinal Cord Injury Registry of Iran (NSCIR-IR). SETTING: SCI community in Iran. METHODS: The NSCIR-IR data set was developed in 8 months, from March 2015 to October 2015. An expert panel of 14 members was formed. After a review of data sets of similar registries in developed countries, the selection and modification of the basic framework were performed over 16 meetings, based on the objectives and feasibility of the registry. RESULTS: The final version of the data set was composed of 376 data elements including sociodemographic, hospital admission, injury incidence, prehospital procedures, emergency department visit, medical history, vertebral injury, spinal cord injury details, interventions, complications, and discharge data. It also includes 163 components of the International Standards for the Neurologic Classification of Spinal Cord Injury (ISNCSCI) and 65 data elements related to quality of life, pressure ulcers, pain, and spasticity. CONCLUSION: The NSCIR-IR data set was developed in order to meet the quality improvement objectives of the registry. The process was centered around choosing the data elements assessing care provided to individuals in the acute and chronic phases of SCI in hospital settings. The International Spinal Cord Injury Data Set was selected as a basic framework, helped by comparison with data from other countries. Expert panel modifications facilitated the implementation of the registry process with the current clinical workflow in hospitals

Evaluating mechanism and severity of injuries among trauma patients admitted to Sina Hospital, the National Trauma Registry of Iran

Purpose: Injuries are one of the leading causes of death and lead to a high social and financial burden. Injury patterns can vary significantly among different age groups and body regions. This study aimed to evaluate the relationship between mechanism of injury, patient comorbidities and severity of injuries. Methods: The study included trauma patients from July 2016 to June 2018, who were admitted to Sina Hospital, Tehran, Iran. The inclusion criteria were all injured patients who had at least one of the following: hospital length of stay more than 24 h, death in hospital, and transfer from the intensive care unit of another hospital. Data collection was performed using the National Trauma Registry of Iran minimum dataset. Results: The most common injury mechanism was road traffic injuries (49.0), followed by falls (25.5). The mean age of those who fell was significantly higher in comparison with other mechanisms (p < 0.001). Severe extremity injuries occurred more often in the fall group than in the vehicle collision group (69.0 vs. 43.5, p < 0.001). Moreover, cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls (27.8 vs. 12.9, p = 0.003). Conclusion: Comparing falls with motor vehicle collisions, patients who fell were older and sustained more extremity injuries. Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls. Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions. © 2021 Chinese Medical Associatio

The data set development for the National Spinal Cord Injury Registry of Iran (NSCIR-IR): progress toward improving the quality of care

STUDY DESIGN: Descriptive study. OBJECTIVES: The aim of this manuscript is to describe the development process of the data set for the National Spinal Cord Injury Registry of Iran (NSCIR-IR). SETTING: SCI community in Iran. METHODS: The NSCIR-IR data set was developed in 8 months, from March 2015 to October 2015. An expert panel of 14 members was formed. After a review of data sets of similar registries in developed countries, the selection and modification of the basic framework were performed over 16 meetings, based on the objectives and feasibility of the registry. RESULTS: The final version of the data set was composed of 376 data elements including sociodemographic, hospital admission, injury incidence, prehospital procedures, emergency department visit, medical history, vertebral injury, spinal cord injury details, interventions, complications, and discharge data. It also includes 163 components of the International Standards for the Neurologic Classification of Spinal Cord Injury (ISNCSCI) and 65 data elements related to quality of life, pressure ulcers, pain, and spasticity. CONCLUSION: The NSCIR-IR data set was developed in order to meet the quality improvement objectives of the registry. The process was centered around choosing the data elements assessing care provided to individuals in the acute and chronic phases of SCI in hospital settings. The International Spinal Cord Injury Data Set was selected as a basic framework, helped by comparison with data from other countries. Expert panel modifications facilitated the implementation of the registry process with the current clinical workflow in hospitals

Infection Rate in Patients with Compound Depressed Skull Fractures and Primary Bone Fragment Replacement, Kashan-Iran, 1997-2005

Background : Compound depressed skull fracture (CDF) is a complication of trauma to head. In spite of many decades of studies on the management of CDF there is yet disagreements regarding primary repair or discarding the bone fragments and late repair. This study has conducted to evaluate infection rate in primary repair of CDF. Materials and Methods : This study included 60 patients with blunt trauma to head and CDF admitted to Naghavi hospital of Kashan University of Medical Sciences (KAUMS), from 1997 to 2005. Age, sex, the interval between admission and operation, severity of trauma, duration of hospital stay, and infections were recorded and analyzed with descriptive statistics. Results : Male to female ratio was 7.6:1, and mean age 19±12.4 years. It was most common in the age range of 11-20 (19 patients, 31.7). Motorcycle was the most common cause of the problem (45 patients, 75). Tirty nine patients (65) had dural laceration. The most common site of fracture was frontal bone (37 and 61.7). Twenty eight cases (46.6) had mild, 13 (21.7) moderate, and 19 (31.7) severe head injury. Fifty four patients (90) underwent operation in less than 24 hours of their arrival to hospital and had primary bone replacement. In 6 months follow up there was no infection in either the wound or bone. Conclusion : In the absence of heavy contamination, and by carrying debridment as soon as possible there will be excellent outcome with primary replacement of bone fragments in CDF patients, excluding the need for another operation and the apprehension about infection

The effect of age on result of straight leg raising test in patients suffering lumbar disc herniation and sciatica

Background: Ninety percent of all people sometimes during their lives experience low back pain, and 30-40 develops radicular leg pain with the sciatica characteristics. Although for clinical diagnosis of lumbar disc herniation (LDH) straight leg raising (SLR) test in 85-90 of cases indicates LDH, but in our practice with LDH patients this test is frequently negative despite radicular leg pain due to LDH. Hence, we decided to evaluate this test in LDH in different age groups. Materials and Methods: All patients with leg pain referring to neurosurgery clinic were enrolled. Those with a history of pain other than sciatica excluded and SLR test and magnetic resonance imaging (MRI) of the lumbosacral spine performed. The patients with negative MRI findings excluded and finally 269 patients with true sciatica and positive MRI were included. SLR tests were performed for different age groups. Results: Of 269 patients, 167 were male. The age range was 16-80 years. The most involved levels were L5-S1 (47) and L4-L5 (42), respectively. The rate of positive SLR result, which was 100, 87 and 82 for 10-19, 20-29 and 30-39 years age group respectively. With an increment of age, the rate of positive test regularly declined. The chance of positive SLR in men is 1.3 times the women (odds ratio OR 2.4; 95% confidence interval CI = 1.265-4.557; P = 0.007). Increasing the age has suppression effect in positivity of SLR so that for each 1-year the chance of SLR become 0.27 times less to become positive and this is also statically meaningful (OR = 0.271;95% CI = 0.188-0.391; P,0.001). The chance of positive SLR for patients under 60 is 5.4 folds more than patients above 60 years old (OR = 5.4; 95% CI = 4-8.3; P, 0.001). Conclusion: Age, sex (male), and disk level had statistically the effect on SLR positive test. © 2015, Isfahan University of Medical Sciences(IUMS). All rights reserve

Cerebral state index versus Glasgow coma scale as a predictor for in-hospital mortality in brain-injured patients

Objective To compare the value of Glasgow coma scale (GCS) and cerebral state index (CSI) on predicting hospital discharge status of acute brain-injured patients. Methods In 60 brain-injured patients who did not receive sedatives, GCS and CSI were measured daily during the first 10 days of hospitalization. The outcome of prognostic cut-off points was calculated by GCS and CSI using receiver operating characteristic (ROC) curve regarding the time of admission and third day of hospitalization. Sensitivity, specificity and other predictive values for both indices were calculated. Results Of the 60 assessed patients, 14 patients had mild, 13 patients had moderate and 33 patients had severe injuries. During the course of the study, 17 patients (28.3) deteriorated in their situation and died. The mean GCS and CSI in patients who deceased during hospitalization was significantly lower than those who were discharged from the hospital. GCS < 4.5 and CSI < 64.5 at the time of admission was associated with higher mortality risk in traumatic brain injury patients and GCS was more sensitive than CSI to predict in-hospital death in these patients. For the first day of hospitalization, the area under ROC curve was 0.947 for GCS and 0.732 for CSI. Conclusion GCS score at ICU admission is a good predictor of in-hospital mortality. GCS < 4.5 and CSI < 64.5 at the time of admission is associated with higher mortality risk in traumatic brain injury patients and GCS is more sensitive than CSI in predicting death in these patients. © 2014 Daping hospital and the Research Institute of Surgery of the Third Military Medical University