The role of cell-free DNA measured by a fluorescent test in the management of isolated traumatic head injuries

BACKGROUND: Traumatic brain injury (TBI) is a major cause of death and disability. In this study a new method to measure cell free DNA (CFD) for the management of TBI is tested. Our hypothesis was that CFD concentrations correlate to the magnitude of brain damage, and may predict the outcome of injured patients. METHODS: Twenty eight patients with isolated head injury were enrolled. Their demographic and clinical data were recorded. CFD levels were determined in patients' sera samples by a direct fluorescence method developed in our laboratory. RESULTS: Mean admission CFD values were lower in patients with mild TBI compared to severe injury (760 ± 340 ng/ml vs. 1600 ± 2100 ng/ml, p = 0.03), and in patients with complete recovery upon discharge compared to patients with disabilities (680 ± 260 ng/ml vs. 2000 ± 2300 ng/ml, p = 0.003). Patients with high CFD values had a relative risk to require surgery of 1.5 (95% CI 0.83 to 2.9) a relative risk to have impaired outcome on discharge of 2.8 (95% CI 0.75 – 10), and a longer length of stay (12 ± 13 days vs. 3.4 ± 4.8 days, p = 0.02). CFD values did not correlate with CT scan based grading. CONCLUSIONS: CFD levels may be used as a marker to assess the severity of TBI and to predict the prognosis. Its use should be considered as an additional tool along with currently used methods or as a surrogate for them in limited resources environment

The role of cell-free DNA measured by a fluorescent test in the management of isolated traumatic head injuries.

BACKGROUND: Traumatic brain injury (TBI) is a major cause of death and disability. In this study a new method to measure cell free DNA (CFD) for the management of TBI is tested. Our hypothesis was that CFD concentrations correlate to the magnitude of brain damage, and may predict the outcome of injured patients. METHODS: Twenty eight patients with isolated head injury were enrolled. Their demographic and clinical data were recorded. CFD levels were determined in patients sera samples by a direct fluorescence method developed in our laboratory. RESULTS: Mean admission CFD values were lower in patients with mild TBI compared to severe injury (760 ± 340 ng/ml vs. 1600 ± 2100 ng/ml, p = 0.03), and in patients with complete recovery upon discharge compared to patients with disabilities (680 ± 260 ng/ml vs. 2000 ± 2300 ng/ml, p = 0.003). Patients with high CFD values had a relative risk to require surgery of 1.5 (95% CI 0.83 to 2.9) a relative risk to have impaired outcome on discharge of 2.8 (95% CI 0.75 - 10), and a longer length of stay (12 ± 13 days vs. 3.4 ± 4.8 days, p = 0.02). CFD values did not correlate with CT scan based grading. CONCLUSIONS: CFD levels may be used as a marker to assess the severity of TBI and to predict the prognosis. Its use should be considered as an additional tool along with currently used methods or as a surrogate for them in limited resources environment

The role of cell-free DNA measured by a fluorescent test in the management of isolated traumatic head injuries.

BackgroundTraumatic brain injury (TBI) is a major cause of death and disability. In this study a new method to measure cell free DNA (CFD) for the management of TBI is tested. Our hypothesis was that CFD concentrations correlate to the magnitude of brain damage, and may predict the outcome of injured patients.MethodsTwenty eight patients with isolated head injury were enrolled. Their demographic and clinical data were recorded. CFD levels were determined in patients' sera samples by a direct fluorescence method developed in our laboratory.ResultsMean admission CFD values were lower in patients with mild TBI compared to severe injury (760 ± 340 ng/ml vs. 1600 ± 2100 ng/ml, p = 0.03), and in patients with complete recovery upon discharge compared to patients with disabilities (680 ± 260 ng/ml vs. 2000 ± 2300 ng/ml, p = 0.003). Patients with high CFD values had a relative risk to require surgery of 1.5 (95% CI 0.83 to 2.9) a relative risk to have impaired outcome on discharge of 2.8 (95% CI 0.75 - 10), and a longer length of stay (12 ± 13 days vs. 3.4 ± 4.8 days, p = 0.02). CFD values did not correlate with CT scan based grading.ConclusionsCFD levels may be used as a marker to assess the severity of TBI and to predict the prognosis. Its use should be considered as an additional tool along with currently used methods or as a surrogate for them in limited resources environment

Nonoperative management of blunt splenic and liver injuries in adult polytrauma

Background: Isolated splenic or hepatic injuries are present in approximately 30% of all cases of adult abdominal trauma. Most authors quoted above have limited nonoperative management (NOM) to patients with isolated organ injury. Results of NOM following blunt hepatic and splenic trauma in patients with multiple injuries were evaluated in this study. Materials and Methods: Retrospective chart review was performed on multiple injured adults with splenic and liver injures resulting from blunt trauma. Associated injuries, clinical signs at presentation, used diagnostic tools, injury grading, transfusion requirements, morbidity and mortality were documented. Results: Medical records of 275 patients aged from 17 to 81 years with blunt splenic and liver trauma and associated injuries were analyzed. Patients with hemodynamic instability or obvious peritoneal signs were excluded from further study. Surgery was indicated in 106 patients without response or transient response for fluid challenge. 131 of 237(55%) patients were selected for NOM: 78 with splenic, 46 with liver and 7 with injuries to both. 25(19%) patients were older 55 years. The mean injury severity score was 25.2. Injury grade ranged from I-IV and the degree of hemoperitoneum was from mild to severe. 8 patients failed NOM (6%). Mean blood transfusion requirement during first 24 hours at admission was 0.3 units. Morbidity rate was 1.2%. Two patients (1.5%) died following severe head trauma. Conclusion: Nonoperative strategy is the preferred modality for the care of blunt splenic and liver injuries in the hemodynamically stable patients, irrespective of age, grade of injury, associated injuries or degree of hemoperitoneum

Ocular injuries associated with two-wheeled electric transportation devices and motorcycle accidents

Abstract Electric bicycles and scooters have gained popularity among riders; studies assessing these device-related injuries have not specified ocular trauma. Our study examined the types and risk factors for ocular and periocular injuries associated with electric devices compared to motorcycle accidents. The study was conducted on the National Trauma Registry database from 20 trauma centers, including patients involved in accidents with electric bicycles, scooters, and motorcycles between 2014 to 2019. Injured riders were assigned into two groups: motorcycle group (M) and electric bicycle & scooter group (E). Data such as gender, age, protective gear use, ocular injury type, injury severity score (ISS), and ocular surgery were captured. Logistic regression models were conducted for injury types and the need for surgery. 8181 M-riders and 3817 E-riders were involved in an accident and hospitalized. E-riders suffered from ocular injury more than M-riders. Males were most vulnerable and the ages of 15–29. Orbital floor fracture was the most common injury, followed by ocular contusion, eyelid laceration, and other ocular wounds. Electric bicycle and scooter riders are more likely to suffer from ocular injury than motorcycle riders. Riders without helmets are at greater risk for injuries, specifically orbital floor fractures. ISS of 16 + was associated with injury demanding ocular surgery

Low Norton Scale Score Predicts Worse Outcomes for Parkinson’s Disease Patients Hospitalized Due to Infection

Background: Parkinson’s disease (PD) patients are prone to infections leading to hospitalization. We used the Norton Scale score (NSS) as a prognostic tool for these patients. Method: Retrospective analysis of consecutive PD patients, all had NSS appreciation upon admission. Analyses were made to establish the association between NSS upon admission, short-term, and long-term clinical outcomes. Results: Five hundred twenty-eight PD patients’ records were reviewed, of which 81 were eligible for analysis. Patients who died during hospitalization had a significantly lower NSS (10.0 vs. 13.1, p = .026). Among surviving patients, those who were discharged to more intensive care facilities relative to their original place of arrival also had a significantly lower NSS (10.38 vs. 13.63, p = .0002). Lower NSS was found to increase the risk for 1-year mortality (odds ratio = 1.3; 95% confidence interval = [1.09, 1.56], p = .003). Conclusion: Lower NSS upon admission of PD patients, suffering from infection is associated with worse clinical outcomes