Use of Neuroprotective agents for Traumatic Brain Injury

Traumatic brain injury (TBI) is the leading cause of mortality and morbidity especially in young ages, while over 30 years of neuroprotective agents use for TBI management provided neither any recommended agent for favorable outcome nor less adverse effects in TBI management yet. This review got selected keywords? search and ran in known international and local databases, with no limitation up to September 6, 2015. Related to the subject, clinical human studies have been selected for the review. Data from 32 studies were classified into 10 subgroups. About 18 studies with a population of 4637 participants were included in 6 topic reviews and meta-analyses. Oxygen use in acute management of TBI to reduce mortality rates could be recommended. Corticosteroid use in solo acute TBI management is prohibited due to increasing risk of mortalities. However, in dual-diagnosed patients (TBI and spinal cord injury (SCI) together), corticosteroid use should be obtained by a Bracken protocol. The use of citicoline in acute TBI is no more supported. The use of cyclosporine-A for ICP control depends on the resources and physician?s decision. Rivastigmine use for chronic neurocognitive conditions of TBI management had some beneficence in severely impaired participants. However, the use of other agents in TBI has no field of support yet

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

A cost utility and cost effectiveness analysis of different oral antiviral medications in patients with HBeAg-Negative chronic hepatitis B in Iran: an economic microsimulation decision model

Background: Although hepatitis B infection is the major cause of chronic liver disease in Iran, no studies have employed economic evaluations of the medications used to treat Iranian patients with chronic hepatitis B (CHB). Therefore, the cost-effectiveness of the different treatment options for this disease in Iran is unknown. Objectives: The aim of this study was to compare the cost utility and cost-effectiveness of medication strategies tailored to local conditions in patients with HB e antigen (HBeAg)-negative CHB infection in Iran. Methods: An economic evaluation of the cost utility of the following five oral medication strategies was conducted: adefovir (ADV), lamivudine (LAM), ADV + LAM, entecavir (ETV), and tenofovir (TDF). A Markov microsimulation model was used to estimate the clinical and economic outcomes over the course of the patient’s lifetime and based on a societal perspective. Medical and nonmedical direct costs and indirect costs were included in the study and life-years gained (LYG) and quality-adjusted life-years (QALY) were determined as measures of effectiveness. The results are presented in terms of the incremental cost-effectiveness ratio (ICER) per QALY or LYG. The model consisted of nine stages of the disease. The transition probabilities for the movement between the different stages were based on clinical evidence and international expert opinion. A probabilistic sensitivity analysis (PSA) was used to measure the effects of uncertainty in the model parameters. Results: The results revealed that the TDF treatment strategy was more effective and less costly than the other options. In addition, TDF had the highest QALY and LYG in the HBeAg-negative CHB patients, with 13.58 and 21.26 (discounted) in all comparisons. The PSA proved the robustness of the model results. The cost-effectiveness acceptability curves showed that TDF was the most cost-effective treatment in 59% - 78% of the simulations of HBeAg-negative patients, with WTP thresholds less than $14010 (maximum WTP per QALY). Conclusions: The use of TDF in patients with HBeAg-negative CHB seemed to be a highly cost-effective strategy. Compared with the other available medication options, TDF was the most cost-saving strategy. Thus, TDF may be the best option as a first-line medication. Patients can also be switched from other medications to TDF

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

Effects of Atorvastatin in Patients with Acute Spinal Cord Injury

Study DesignClinical trial study.PurposeThe aim of this study was to evaluate the effect of atorvastatin on sensory and motor function in patients with acute spinal cord injury.Overview of LiteratureThe prevalence and incidence of traumatic spinal cord injury are increasing. Statins are well established for use in hypercholesterolemia as well as during anti-inflammatory events.MethodsThis clinical trial study included 60 patients with acute spinal cord injury. These were randomly divided into two groups: the case group which received atorvastatin and also underwent surgical therapy and the control group which only underwent surgical therapy.ResultsThe severity of spinal cord lesions was evaluated based on the Frankel grade at three periods; this showed no significant difference between the two groups. Comparisons of the levels of pain between the groups based on a Visual Analog Scale system showed no significant difference at the three periods.ConclusionsWe observed no improvement at the 3- and 6-month follow-up in patients who were administered atorvastatin. However, a comparison of the two groups based on pain severity demonstrated a significant difference, suggesting that atorvastatin had a positive effect on patients with spinal cord injury

Citicoline for traumatic brain injury: a systematic review & meta-analysis

Background: Traumatic Brain Injury (TBI) is the leading cause of mortality and morbidity especially in young ages. Despite over 30 years of using Neuroprotective agents for TBI management, there is no absolute recommended agent for the condition yet. Methods: This study is a part of a scoping review thesis on "Neuroprotective agents using for Traumatic Brain Injury: a systematic review & meta-analyses"; which had a wide proposal keywords and ran in "Cochrane CENTRAL", "MedLine/PubMed", "SCOPUS", "Thomson Reuters Web of Science", "SID.ir", "Barket Foundation", and "clinicaltrials.gov" databases up to September 06, 2015. This study limits the retrieved search results only to those which used citicoline for TBI management. The included Randomized Clinical Trials' (RCTs) were assessed for their quality of reporting by adapting CONSORT-checklist prior to extracting their data into meta-analysis. Meta-analyses of this review were conducted by Glasgow Outcome Scale (GOS) in acute TBI patients and total neuropsychological assessments in both acute and chronic TBI management, mortalities and adverse-effects. Results: Four RCTs were retrieved and included in this review with 1196 participants (10 were chronic TBI impaired patients); analysis of 1128 patients for their favorable GOS outcomes in two studies showed no significant difference between the study groups; however, neuropsychological outcomes were significantly better in placebo/control group of 971 patients of three studies. Mortality rates and adverse-effects analysis based on two studies with 1429 patients showed no significant difference between the study groups. However, two other studies have neither mortality nor adverse effects reports due to their protocol. Conclusions: Citicoline use for acute TBI seems to have no field of support anymore, whereas it may have some benefits in improving the neuro-cognitive state in chronic TBI patients. It's also recommended to keep in mind acute interventions like Psychological First Aid (PFA) during acute TBI management

Assessing the correlation of trauma severity, blood sugar level, and neurologic outcomes in traumatic spinal cord injury patients

Introduction: Trauma, due to stimulating stress responses like hormones, leads to increased blood sugar level (BS level), which worsens cerebrospinal and renal damages. Admission hyperglycemia associated with poor outcomes in severe traumatic injuries, therefore glucose control leads to improved outcomes and better prognosis of these patients. This study aims to analyze the impact of severity of spinal cord injury (SCI) (based on Frankel classification) on BS level in these patients. Furthermore, the effect of controlling the BS level in a normal range on improving the neurological outcomes [muscular force (MF)] was examined. Methods: This is a cross-sectional study in which admission BS level of all SCI patient, were measured, and regular treatments were applied based on standard protocols. The recovery process of motor and sensory disorders was also examined in discharge and was evaluated with the primarily measured BS level. Besides, patients with high BS level (more than 200 mg/dl) underwent the insulin protocol, and the effects of glucose level control on the final outcome of SCI patients were evaluated. Results: Among the 380 patients enrolled in this study, 266 were male (70%) and 114 were female (30%). The mean age of patients was 35.84 ± 18-65 years old. The mean hospital length of stay was 5.98 days (from 3 to 14 days). The mean BS level in patients with MF of 0/5, 1/5, 2/5, 3/5, 4/5 and 5/5 were 169.8, 185.9, 177.3, 172.8, 117.5 and 118.0 mg/dl, respectively. The rate of MF changes was measured in hyperglycemic patients who underwent an insulin protocol. Conclusion: As the SCI trauma becomes more severe, the BS level increases with a higher rate. Besides, there was a significant difference (P = 0.001) in MF of patients before and after the insulin protocol prescription

Systemic juvenile xanthogranuloma with multiple central nervous system lesions

Juvenile xanthogranulomatosis (JXG) is an uncommon histiocytic disorder that is usually benign and limited to the skin. The systemic form of JXG is rare and may be associated with severe morbidity and mortality especially in central nervous system (CNS) involvement. Here, we describe a six-year-old boy with disseminated skin lesions and neurological signs and symptoms. Diagnostic work up revealed multiple brain lesions. A skin biopsy and a stereotactic brain biopsy considered suggestive of systemic JXG. Treatment with prednisolone, vinblastine and methotrexate was successful with regression of skin and CNS lesions. The patient has been in remission for almost three years