Indications for Brain Computed Tomography Scan After Mild Traumatic Brain Injury

Trauma to the head may cause damage to the brain parenchyma. This intracranial damage is more probable in severe than mild forms of head trauma. Despite this knowledge, physicians could not disregard the risk of brain injury in mild forms; thus, in many cases of head trauma, computed tomography (CT) scans are performed to detect possible intracranial injuries. Thi

Value of ABCD2-F in predicting cerebral ischemic attacks: Three months follow-up after the primary attack

Cerebrovascular attack (CVA) and transient ischemic attack (TIA) are major causes of emergency department visits around the globe. A significant number of these patients may experience repeat attacks if left untreated. Several risk stratifying scoring systems have been developed in recent years to point out the high risk patients. ABCD2 is based on age, blood pressure, clinical status, diabetes mellitus, and duration of symptoms and is used commonly for this purpose. In this study, we were to enhance its sensitivity and specificity with the addition of another criterion namely atrial fibrillation and making ABCD2-F. A prospective study in two hospitals was performed and 138 patients diagnosed with TIA/CVA were enrolled. Demographic, clinical, and paraclinical data of all patients were registered. All patients were followed for three months for any sign or symptom of a recurrent ischemic attack. Recurrent ischemic attacks happened in 9.4 of the patients. None of the criteria of ABCD2-F was associated with higher chance of ischemic attacks. Similarly, ABCD2-F was not different between patients with or without repeat cerebral ischemia. The addition of atrial fibrillation to ABCD2 did not enhance the accuracy of this scoring system to detect patients high risk for repeat cerebral ischemia. More studies in the future to improve sensitivity and specificity of this test are warranted. © 2016 Tehran University of Medical Sciences. All rights reserved

Epidemiology and short-term mortality in traumatic patients admitted to Shariati Hospital in Iran between 2012 and 2013

Purpose Trauma is an inevitable part of the health burden in every country. Both the preventive and rehabilitative aspects of traumatic injuries are expensive. Since most of the injuries happen in low- and middle-income developing countries, a judicious allocation of the limited resources to the most cost-efficient strategies is necessary. The present study was designed to report the causes of trauma, injured body regions, trauma severity scores and the one year survival rate of a randomly selected sample of trauma patients in a major referral hospital in Tehran, Iran. Methods We chose and analyzed a random subgroup of traumatic patients admitted during the one-year period of May 2012 to May 2013 to Shariati Hospital, a major University Teaching Hospital in Tehran, Iran. Patients who stayed at the hospital for less than 24 h were excluded. In total, 73 traumatic patients were registered. The mean age was (40.19 ± 20.34) years and 67.1 of them were male. Results In general, the most common cause of injury was falls (47.9), followed by road traffic crashes (RTCs, 40.8). Assault and exposure to inanimate mechanical forces each were only associated with 5.6 of all injuries. The only cause of injury in ages of more than 65 years was fall. The most common cause of injury in ages between 15 and 45 years was RTCs. During the study, two deaths occurred: one was at ICU and the other was at home. The most commonly injured body region was the head (23.8), followed by the elbow and forearm (19), hip and thigh (15.9), and multiple body regions (14.3). The mean abbreviated injury score was 2.23 ± 1.02; injury severity index was 7.26 ± 7.06; and revised trauma score was 7.84, calculated for 38 patients. Conclusion Prevention strategy of traumatic injury should focus on falls and RTCs, which are respectively the most common cause of trauma in older aged people and young males. © 2015 Production and hosting by Elsevier B.V

Clinical application of ceramics in anterior cervical discectomy and fusion: A review and update

Study Design: Narrative review. Objectives: Anterior cervical discectomy and fusion (ACDF) is a reliable procedure, commonly used for cervical degenerative disc disease. For interbody fusions, autograft was the gold standard for decades; however, limited availability and donor site morbidities have led to a constant search for new materials. Clinically, it has been shown that calcium phosphate ceramics, including hydroxyapatite (HA) and tricalcium phosphate (TCP), are effective as osteoconductive materials and bone grafts. In this review, we present the current findings regarding the use of ceramics in ACDF. Methods: A review of the relevant literature examining the clinical use of ceramics in anterior cervical discectomy and fusion procedures was conducted using PubMed, OVID and Cochrane. Result: HA, coralline HA, sandwiched HA, TCP, and biphasic calcium phosphate ceramics were used in combination with osteoinductive materials such as bone marrow aspirate and various cages composed of poly-ether-ether-ketone (PEEK), fiber carbon, and titanium. Stand-alone ceramic spacers have been associated with fracture and cracks. Metallic cages such as titanium endure the risk of subsidence and migration. PEEK cages in combination with ceramics were shown to be a suitable substitute for autograft. Conclusion: None of the discussed options has demonstrated clear superiority over others, although direct comparisons are often difficult due to discrepancies in data collection and study methodologies. Future randomized clinical trials are warranted before definitive conclusions can be drawn. © The Author(s) 2017

Analysis of trauma outcome at a university hospital in Zahedan, Iran using the TRISS method

Objective: To evaluate validity of TRISS (Trauma score and injury severity score) method in trauma outcome analysis and compare trauma care at a university hospital, with the standards reported in the Major Trauma Outcome Study (MTOS). Design: Analytical and descriptive study. Setting: Khatam-ol-anbia University Hospital in Zahedan, Iran, from March 22, 1997 to March 21, 1998. Subjects: Seven hundred and sixty eight consecutive patients with multiple trauma were included in the study. Survival analysis was completed for all of the patients. Results: The majority of patients were men (82), and the average age was 23 years. Seven hundred and one patients (91) sustained blunt trauma, with road traffic accidents being the most common (59). The predicted mortality was 3.1 and the observed mortality was 8. The M-statistics was 0.91. Conclusion: In developing countries the same as developed countries, the TRISS methodology is an acceptable method for evaluation of the difference between predicted and observed mortality. This study shows that our mortality is significantly more than universal standards and there are weak points in our trauma care system