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

Small Cell Carcinoma of Bladder; Still A Diagnostic and Therapeutic Challenge: Seven Years of Experience and Follow-up in A Referral Center

PURPOSE: To report clinical, histopathological, and treatment features of small cell carcinoma of (SmccB) bladder during 7 years in a referral center. METHODS: The clinical, histopathological features, treatment modalities, and outcome of all patients with bladder SmccB treated between 2009 and 2016 who were managed in Hasheminejad Kidney Center (HKC) were retrospectively collected. RESULTS: Thirteen patients were diagnosed and managed with SmccB. The average age of patients was 64.92 years. For each patient, 8 markers were used for IHC staining on average. Neuroendocrine markers such as CD 56, Neuron Specific Enolase, Synaptophysin, and Chromogranin were found in a significant percentage of patients (69, 38, 54, and 31 respectively). Patients were managed with TURBT alone (N=3), chemotherapy after TURBT (N=4), chemotherapy plus radical surgery (N=4) and radical surgery alone (N=2). The best clinical result was seen in chemotherapy received patients with or without radical surgery. The mean(SE) of survival rate in patients who received only chemotherapy alone was 42.4 (10.0) months, while in those who were managed with chemotherapy plus radical surgery it was 47.7 (10.1) months. CONCLUSION: In our center immunohistochemistry was needed for definitive diagnosis in 17/19 samples. Misdiagnosis happened in two samples without IHC request. We think that use of immunohistochemistry should be mandatory for diagnosis of SmccB to exclude misdiagnosis. Chemotherapy is the most important part of treatment and the addition of radical surgery can slightly improve patients' survival

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

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

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

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

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

Determination of sensitivity, specificity and cut off point of visual- Motor Bender Gestalt Test in the diagnosis of traumatic brain injury

Background: Bender Gestalt Test is one of the most famous neuropsychological tests, simple and easy to perform, and is used to evaluate brain injuries. This study aimed at determining the rate of sensitivity, characteristic and cut-off point of this test in patients with traumatic brain injury (TBI). Methods and Materials: Overall, 120 TBI patients with mean age of 31.25± 13.60 years old in a descriptive-analytical research design entered the study using nonprobability and consecutive sampling method. All patients underwent Bender Visual-Motor Gestalt Test after neurological evaluations by CT scan. Roc curve test was utilized to analyze the data. Results: In this study, cut-off point was calculated as 6.5%, sensitivity as 55.8%, characteristic as 81.2%, and the area under the Roc curve as 0.69. Moreover, positive predictive value, negative predictive value and efficiency were 95.08%, 22.03%, and 59.17%, respectively. Conclusion: Results of this study revealed that Bender Gestalt Test is relatively weak in diagnosis of mild TBI. Hence, its characteristic is high and it was successful in diagnosing healthy individuals