Kidney disease improving global outcome for predicting acute kidney injury in traumatic brain injury patients

AbstractAimTo determine the incidence of acute kidney injury (AKI) based on Kidney Disease Improving Global Outcome (KDIGO) criteria in patients with severe traumatic brain injury and to study AKI in relation to risk factors and outcomes.MethodThis trial was a descriptive analytic study on 83 patients with severe traumatic brain injury admitted to Poursina Hospital (Rasht, Iran). The incidence of AKI was determined based on KDIGO criteria over a 12-month period. The correlation of mortality rates, multi-organ failure (MOF), and neurologic outcome to AKI were studied.ResultsOf 83 eligible patients who entered the study, 25.3% (N=21) developed AKI based on KDIGO criteria. Glasgow Outcome Scale on admission was the only risk factor significantly associated with the incidence of AKI (p=0.001). Mortality rates (62% vs. 22.6%, p=0.002) and the occurrence of MOF were significantly higher in patients who developed AKI (23.8% vs. 0% MOF based on Sequential Organ Failure Assessment, p<0.0001; 19% vs. 0% MOF based on Multiple Organ Dysfunction score, p<0.0001). Poor neurologic outcome was observed in 95% and 92% of patients with and without AKI, respectively (p=0.674).ConclusionThe incidence of AKI among patients with severe traumatic brain injury is striking. The association of Glasgow Outcome Scale with AKI helps to identify patients at a higher risk of developing AKI. Significant rates of mortality and MOF among patients with severe traumatic brain injury and AKI, necessitates consideration of renoprotective measures from the early days of hospital admission

The outcomes of head trauma due to road traffic accident in hospitalized elderly patients

Introduction: Head trauma is one of the most important causes of death in trauma centers. In particular, treatment of head injury in the elderly seems more complicated than that of the young and middle aged. This study aimed to identify the outcomes of head trauma due to road traffic accidents (RTAs) in elderly patients. Materials and Methods: In a descriptive-analytical study, records of 294 elderly patients with head trauma due to RTA retrieved from health information system were reviewed using a checklist. The outcomes of patients were evaluated using the Glasgow Outcome Scale. Complete recovery and partial disability were considered as favorable outcomes, whereas severe disability, vegetative state, and death were defined as unfavorable outcomes. Descriptive factors and adjusted coefficients were calculated using SPSS software. Results: Of 294 elderly patients, 77.2 were men. About half of the road accidents had occurred in urban areas (58.8). Less than half of the injured elderly were pedestrian (44.9). The mean Glasgow Coma Scale of patients equaled 13.42 ± 3.29. Unfavorable outcomes were observed only in 20.4 of the patients. There were significant differences in head injury severity between the groups with favorable and unfavorable outcomes (P Conclusion: The results of our study mentioned that most of the elderly who had accidents were pedestrian, most of which occurred in the cities. Moderate and severe head injuries in patients had unfavorable clinical outcome

The Outcome of Surgical Versus Conservative Management in Old Patients With Traumatic Brain Injury

Background and Aim: It is still unclear whether the surgical or conservative approach has the best recovery and the least adverse outcomes after the treatment of patients with traumatic brain injury (TBI), especially the elderly. The use of invasive versus conservative therapies in elderly patients with TBI is controversial, and the current brain surgery procedures for the elderly require further evaluation. Methods and Materials/Patients: In this retrospective cohort study, the medical records of 238 patients with TBI (119 surgical patients and 119 patients treated with conservative methods) over the age of 65 were reviewed. The patients were compared for the degree of recovery indicated by the Glasgow outcome score (GOS) and postoperative complications. Results: No difference was found in the primary Glasgow coma scale (GCS) between surgical and conservative approaches, but after two treatment protocols, the assessment of GCS and GOS showed a significant difference between the two groups; however, after adjusting baseline parameters in a multivariable logistic regression model, the difference between the two groups in CGS and recovery state turned to insignificance. There was no difference between surgical and conservative management in the post-treatment sequels, including contusion, hydrocephalus, myocardial infarction, pulmonary infection, and death. However, the recurrence of hematoma was significantly higher in those who were treated by the conservative method even after multivariate regression modeling. Conclusion: In TBI patients aged over 65 years, surgical management can result in more favorable outcomes compared with the conservative approach

Sensitivity, Specificity, and Cut-off Point of the Mini-Mental State Examination in Patients With Mild Traumatic Brain Injury

Background and Aim: Most patients suffering from traumatic brain injury (TBI) are those with mild injuries (mTBI). However, due to the absence of symptoms in brain imaging until long after the injury, the manifestations of cognitive impairments remain undiagnosed. Therefore, cognitive screening is considered a key measure in these patients. One of the common screening tools for evaluating cognitive impairments is the mini-mental state examination (MMSE) test. The present study aimed to determine the cut-off point, sensitivity, and specificity of the MMSE test in mTBI patients. Methods and Materials/Patients: In this observational and cross-sectional-analytical study, the statistical population included all patients with mTBI who were injured in the 1st half of 2022. The case group included 79 mTBI patients admitted to the trauma, neurosurgery, and intensive care unit (ICU) departments of Poursina Hospital in Rasht City, Iran, in the 1st half of 2022, who had been referred to the same hospital and Velayat specialized clinic for rehabilitation and re-visit, and the control group included 79 normal healthy individuals. Both groups were cognitively evaluated by the MMSE test on two occasions with an average time interval of 2-3 weeks. Results: The results of the discriminant analysis showed a cut-off point of 27 to 28 as the probable point of cognitive impairment. Also, to identify the cognitive impairment in mTBI patients, this test reported low sensitivity of 0.43-0.58 and a moderate specificity of 0.69-0.80 in two tests. Conclusion: In screening for possible mild cognitive impairment in mTBI patients, the MMSE is relatively useful and should not be used solely to replace a comprehensive neuropsychological evaluation with diagnostic purposes

Pharmacotherapy to Improve the Acquired Aphasia following Brain Damages: A Review Study

Background & Aim: Using pharmaceutical agents in treatment of aphasia has caught the attention of many neurologists and neuroscientists. This short review study has sought the role of pharmacotherapy in treatment of aphasia, a linguistic impairment after acquired brain lesions. The pharmacological principles and mechanisms related to the effects of drugs used in aphasia rehabilitation are pointed. Then, some evidence of clinical trials on different drugs in this field is presented. Methods & Materials/Patients: A comprehensive search in databases including MEDLINE, Cochrane, PubMed, Scopus, EMBASE, Science Direct on experimental studies and clinical trials associated with pharmacotherapy of aphasia after neurological damages was performed. Results: Pharmacological interventions through manipulating neurochemical levels in synapses, the pre- and post-synaptic spaces and even inside neurons start to modulate the disturbed balance of neurotransmitters due to brain lesions. Pharmacotherapy is based on the principle that drugs via balancing the molecular signaling cascades triggered due to neuronal damage can restore the function of neurons, facilitate the brain plasticity process and improve the linguistic deficits in aphasic patients. Among the drugs that have been studied in treatment of aphasia, those acting on central cholinergic and glutamergic systems were more effective and led to better clinical outcomes. Conclusion: Although existing evidence has proved the pivotal role of pharmacotherapy in treatment of aphasia after acquired brain lesions in adults, further research is required to assure the clinicians in using pharmacotherapy as a standard approach in treatment of aphasia

Predicting mortality, hospital length of stay and need for surgery in pediatric trauma patients

Purpose: Pediatric trauma is one of the major health problems around the world which threats the life of children. The survival of injured children depends upon appropriate care, accurate triage and effective emergent surgery. The objective of this study was to determine the predictive values of injury severity score (ISS), new injury severity score (NISS) and revised trauma score (RTS) on children's mortality, hospitalization and need for surgery. Methods: In this study, records of trauma patients under 15 years old transported from a trauma scene to emergency department of Poursina hospital from 2010 to 2011 were included. Statistical analysis was applied to determine the ISS, NISS and RTS ability in predicting the outcomes of interest. Results: There were 588 records in hospital registry system. The mean age of the patients was (7.3 ± 3.8) years, and 62.1% (n = 365) of patients were male. RTS was the more ability score to predict mortality with an area under curve (AUC) of 0.99 (95% CI, 0.99–1). In the hospital length of stay (LOS), ISS was best predictor for both the hospital LOS with AUC of 0.72 (95% CI, 0.67–0.76) and need for surgical surgery with AUC of 0.94 (95% CI, 0.90–0.98). Conclusion: RTS as a physiological scoring system has a higher predicting AUC value in predicting mortality. The anatomic scoring systems of ISS and NISS have good performance in predicting of hospital LOS and need for surgery outcomes

Hydatid Disease of the Cervical Spine Mimicking Traumatic Burst Fracture

Background & Importance: Hydatid disease of the spine is rare but constitutes approximately 50% of bone involvement cases in human hydatidosis. It is a severe condition associated with a high rate of morbidity, disability and mortality. Case Presentation: In the present paper, we report an intriguing case of cervical spinal hydatid disease mimicking traumatic burst fracture. Conclusion: A high degree of suspicion combined with good-quality neuroimaging is important for early and correct diagnosis. Because of th

Simultaneous Diffuse Idiopathic Hyperostosis, Ossification of the Posterior Longitudinal Ligament and Ligamentum Flavum

Background and Importance: A 60-year-old diabetic man with simultaneous diffuse idiopathic hyperostosis, massive ossification of the posterior longitudinal ligament and cervical and higher part of thoracic ligamentum flavum is reported in this article. Such comorbidity rarely occurs. Case Presentation: The patient’s chief complaint was sensation abnormalities without gait disturbance or severe cord compression symptoms despite the advanced stage of the disease. Computed tomography scan and magnetic resonance imaging confirmed multi-level involvement of cervicothoracic spine. Conclusion: After surgical treatment, his symptoms resolved completely with no complication

Pattern Changes of Stroke Frequency in the COVID-19 Pandemic

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with an increased risk of acute cerebrovascular disease. Objectives: In this study, we compared the relative frequency of ischemic stroke (IS) and intraparenchymal hemorrhage (IPH) during the SARS-CoV-2 pandemic with a similar period in the previous year. Materials & Methods: This comparative cross-sectional study was conducted on patients with acute ischemic stroke and IPH. They were admitted to an academic stroke referral hospital in Guilan Province, Iran, between December 2019 and June 2020 (COVID-19 pandemic period) and a similar 6-month period in the previous year. This study compared the patients’ demographic data, clinical information, risk factors, comorbidities, and outcomes. Results: A remarkable reduction of 28.6% in the relative frequency of stroke admission was observed during the COVID-19 pandemic period compared with the same period in the previous year (P<0.001). The ratio of ischemic stroke to hemorrhagic stroke decreased from 2.6 in the corresponding period during the last year to 2.2 during the SARS-CoV-2 pandemic period. However, this change was not significant (P=0.232). Conclusion: This study revealed that the relative frequency of stroke significantly declined at the pandemic’s peak compared to the same time in the previous year despite cerebrovascular complications associated with COVID-19. However, the ratio of ischemic stroke to hemorrhagic stroke did not change significantly

Psychopathological Symptoms in Caregivers of Patients With Vegetative State

Background: Taking care of patients in a vegetative state is a great challenge and affects the mental health of the caregivers. Objectives: This study aimed to determine the psychopathological symptoms in caregivers of patients with Vegetative State (VS) and determine the demographic and social predictors of the common symptoms. Materials & Methods: This cross-sectional study was conducted in an educational hospital in the north of Iran from 2012 to 2013. The psychopathological symptoms of 80 caregivers of VS patients were evaluated by Symptom Checklist-Revised (SCL-90-R) questionnaire. Results were analyzed using SPSS (Version 18) by the Mann-Whitney U test. Finally, the predictors of psychopathological symptoms were determined through a simple regression model. Results: The highest scores of the psychological symptoms were of the depression subscale (2.88±0.86) and somatoform subscale (2.85±0.83). The psychopathological symptoms including somatoform (P=0.012), obsessive-compulsive (P=0.032), depression (P=0.035), anxiety (P=0.027), phobia (P=0.015), and paranoid ideations (P=0.027) were significantly higher in women than in men. However, there was no significant relationship between these symptoms and marital status. The simple regression model showed that none of the sociodemographic variables could predict psychopathological symptoms in the caregivers. Conclusion: A significant number of caregivers had psychopathological symptoms, especially depression and somatoform complaints