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

Comparative study of virtual and traditional teaching methods on the theoretical course of ECG in medical students of emergency department

Introduction: The emergency ward is one of the most important parts of the hospital, where people's activities can have many effects on the performance of other wards of the hospital and the satisfaction of patients. Changing lifestyle and transformation of cyberspace into one of the pillars of modern life has had a great impact on learning and teaching methods. To compare the level of theoretical emergency learning in medical students with two virtual and traditional methods. Materials and Methods: This quasi-experimental study was conducted on 88 medical students who started their emergency rotation in two hospitals of Guilan University of Medical sciences in 2021. Both groups participated in the same exam before and after the basics of electrocardiogram (ECG), normal ECG, types of blocks, diagnosis of MI and arrhythmias education. After collecting the information from the questionnaires, the data analysis was performed via SPSS software with a significant P<0.05. Results: Out of 88 students, 56.8% were female, and 43.2% were male. The mean and median knowledge score before and after education was statistically significant in two groups (P<0.001). The virtual group represented a higher average score of knowledge than the traditional group. The student’ grade point average affected the result of the score after education (P=0.019, β =0.234). Conclusion: The use of virtual education methods in combination with traditional methods might help to improve the learning process and knowledge of medical students in emergency department

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

COVID-19 Infection and Seropositivity in Multiple Sclerosis Patients in Guilan in 2021

Background: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system. COVID-19 has presented a significant challenge to the care providers of patients with MS. Objectives: The present study aimed to investigate the frequency of COVID-19 infection and its seropositivity in MS patients in Guilan, Iran, in 2021. Materials & Methods: In this analytical-cross-sectional study, all patients with relapsing-remitting MS registered in the Guilan MS Association with an expanded disability status scale of less than 5 who were referred for evaluation participated in the study. Information related to the clinical and serological symptoms of COVID-19 infection, changes in drug use, and the occurrence of new attacks were collected. Serological results of COVID-19 (IgG) among them were registered. Results: In total, 260 patients with MS (78.8% women, and 21.2% men) with a Mean±SD age of 38.7±9.9 years, and a Mean±SD duration of MS of 8.9±4.9 years were investigated. The most commonly used drugs were Dimethyl fumarate, Interferon, and Rituximab, respectively. Thirty-three patients (12.6%) had a clinical COVID-19 infection, of which 32 people had a mild and only one had a critical infection. Eight patients (1.3%) had positive COVID-19 IgG tests. No significant relationship was found between the COVID-19 infection with the type of medication, medication change, clinical attack of MS, and co-morbidities (P>0.05). Conclusion: A few patients had positive COVID-19 IgG tests and clinical COVID-19 infection. The vast majority had mild disease, and the clinical attack was not related to COVID-19 infection

Cell Therapy for Traumatic Brain Injury: Opportunities and Pitfalls

Today, stem cell transplantation is a hot topic in scientific circles as a novel therapeutic approach to repair the structure and function of central nervous system. The safe and neuroprotective effects of cell therapy in models and traumatic brain injury patients were evaluated in many experimental and clinical studies in recent decade and somewhat promising results were provided to the scientific community. Nevertheless, there are still obstacles in translating experimental studies in the laboratory into clinical practice that should not be overlooked. In this review study, a brief explanation is provided about biological events and endogenic neurogenesis and angiogenesis after TBI the performance of transplanted cells in restoration of damaged neurons the role and potential use of mesenchymal stem cells as adult stem cells preferred in cell transplantation and clinical trials ever conducted in this area features of cell transplant candidates who will most benefit from transplantation, the type of and proper time for cell transplantation, optimal method for conducting transplant to deliver cells to the brain, and the best dose for effectiveness of transplantation. Finally, the various neuroimaging techniques are discussed, which are used to track and evaluate the survival and implantation of transplanted cells

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

Pain and Related Pre-Hospital Factors in Patients With Trauma: A Cross-Sectional Study

Background and Aim: Pain is an experience often caused by tissue damage and is proportional to the severity of the injury. The role of underlying factors in severity of the pain such as prehospital factors have been discussed in some investigations. The current study aimed to assess the effect of different parameters on pain severity in patients with trauma. Methods and Materials/Patients: The current descriptive, cross-sectional study was conducted fully conscious 270 fully patients with trauma admitted to Poursina Hospital in Rast, Guilan, Iran, in 2016. They were assessed in terms of demographic and pre-hospital factors as well as mechanism and severity of trauma based on verbal rating scale. Results: Linear regression analysis demonstrated that among various factors like age, sex, level of education, opium dependence, vehicle type, ventilation, blood pressure, pulse rate, mechanism of trauma, and type of trauma, the highest severity of pain was pertaining to the type of trauma such as multiple trauma and large bone fracture with mean scores of 9.26 and 9.13, respectively. It also revealed that among these parameters, mechanism of trauma, type of trauma, transfer time, type of vehicle, and pulse rate were significantly associated with the severity of the pain. Conclusion: The current study showed that increasing the quality of vehicle, decreasing the transfer time, and paying more attention to hemodynamic factors such as pulse rate, blood pressure, use of analgesic agents, and immobilization of damaged tissue can diminish the severity of pain in patients with trauma

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

Changes in Serum Analytics and Biochemical Urinary Parameters Following Brain Tumor Operation

Background: Changes in the body fluid and serum electrolyte status following major operations, such as brain tumor resection, are always expected. These changes can increase post-operation morbidity and mortality. Objectives: We aimed to evaluate the changes in serum electrolyte levels and renal function parameters in brain tumor patients after operation. Materials & Methods: This cross-sectional study was performed on 168 patients with supratentorial tumors in Poursina Hospital, Rasht City, Iran, in 2020. The study parameters included patients’ demographics, hemodynamic stability, serum sodium, potassium, blood urea nitrogen (BUN) and creatinine levels, urine specific gravity, and urinary output, measured immediately and 12 hours after the operation. Results: This study revealed statistically significant increases in serum sodium level (from 139.70±5.60 meq/L to 140.34±6.23 meq/L, P=0.002), urinary output (from 1043.70±455.00 mL to 1967.50±661.10 mL, P=0.008), urine specific gravity (from 1.010±0.007 to 1.012±0.008, P=0.011), and in serum BUN level (from 17.46±6.92 to 18.41±6.40, P=0.001), but significant decrease in serum potassium level (from 3.88±0.49 meq/L to 3.78±0.28 meq/L, P=0.017) during the first 12 hours after operation. However, the change in serum creatinine level was not significant (from 1.18±2.08 mg/dL to 1.17±2.08 mg/dL, P=0.787). Conclusion: Significant changes in serum electrolytes (sodium and potassium) and renal function indicators (urine output, specific gravity, and serum BUN) are expected within the first 12 hours after brain tumor operation

Association Between Serum Electrolyte Disturbances and Glasgow Coma Scale Score in Patients With Diffuse Axonal Injury

Background: Appropriate clinical measures to prevent secondary brain damage in traumatic brain injury are of critical importance. Objectives: This study aims to investigate the relationships between serum electrolyte disturbances and Glasgow Coma Scale (GCS) score in patients with Diffuse Axonal Injury (DAI) at the time of admission and discharge. Materials & Methods: In this retrospective cross-sectional study, we evaluated 101 patients with DAI having GCS score <15 admitted to Poursina Hospital in Rasht, Iran from 2019 to 2020. Based on the presence or absence of serum potassium (K), sodium (Na), magnesium (Mg), and zinc (Zn), disturbances on the first day of hospitalization, patients were divided into two study groups of with and without abnormal electrolyte levels. The GCS scores of the two groups at the time of admission and discharge were recorded and the relationship between electrolyte disturbances and GCS score was evaluated. Results: There were no significant differences in the mean GCS score at the time of admission and discharge between patients with and without disturbances in serum Na, K, Zn and Mg levels based on the crude analysis. Regarding the simultaneous effects of the study variables on the GCS score, only Mg serum level exerted a significant impact on the GCS score at the time of admission (P=0.041) and discharge (P=0.017). Conclusion: The GCS score in patients with DAI at the time of admission and discharge has an association with the Mg serum level but not with Na, K, and Zn levels