Is Level of injury a determinant of quality of life among individuals with spinal cord injury? a tertiary rehabilitation center report

Objectives: The role of injury-related variables in determining health-related quality of life [HRQOL] among Iranian persons with spinal cord injury [SCI] has not yet been fully described. In this study, we compared HRQOL between individuals with injury at cervical level and those with injury at thoracolumbar sections and evaluated the discriminating value of injury level as a determinant of HRQOL among Iranian people with SCI

Methods: Individuals with SCI, who were referred to Brain and Spinal Cord Injury Research Center, were invited to participate in this investigation. HRQOL was assessed using the Short Form [SF-36] questionnaire to determine the quality of life [QOL] in eight domains: physical functioning [PF], role limitation due to physical problems [RP], bodily pain [BP], general health [GH], vitality [VT], social functioning [SF], role limitation due to emotional problems [RE], and mental health [MH]

Results: Ninety patients with paraplegia and 94 quadriplegic patients participated in this investigation. The mean score of PF domain was significantly lower in patients with injury at cervical level [p < 0.0001]. There was no significant difference in other domains of SF-36 between subjects with paraplegia and quadriplegia [p = 0.670, 0.700, 0.910, 0.710, 0.730, 0.290 and 0.850 for RP, RE, VT, MH, SF, BP and GH, respectively]. Similarly, the mean physical component summary [PCS] score was significantly higher among individuals with injury at thoracolumbar sections [p < 0.0001]. The mean mental component summary [MCS] score did not differ between the two groups [p = 0.720]

Conclusions: Patients with SCI at the cervical level have similar mental health compared to those with injury at thoracolumbar sections, which shows proper mental adaptability in quadriplegic individuals. Injury level can be used as a major determinant of the physical component of QOL among people with SCI

EEG abnormalities in clinically diagnosed brain death organ donors in Iranian tissue bank

Brain death is defined as the permanent, irreversible and concurrent loss of all brain and brain stem functions. Brain death diagnosis is based on clinical criteria and it is not routine to use paraclinical studies. In some countries, electroencephalogram [EEG] is performed in all patients for the determination of brain death while there is some skepticism in relying on EEG as a confirmatory test for brain death diagnosis. In this study, we assessed the validity of EEG and its abnormalities in brain death diagnosis. In this retrospective study, we used 153 EEGs from medical records of 89 brain death patients in organ procurement unit of the Iranian Tissue Bank admitted during 2002-2008. We extracted and analyzed information including EEGs, which were examined by a neurologist for waves, artifacts and EEG abnormalities. The mean age of the patients was 27.2 +/- 12.7 years. The most common cause of brain death was multiple traumas due to accident [65%]. The most prevalent artifact was electrical transformer. 125 EEGs [82%] were isoelectric [ECS] and seven EEGs [5%] were depictive of some cerebral activity which upon repeat EEGs, they showed ECS patterns too. There was no relationship between cause of brain death and cerebral activity in EEGs of the patients. In this study, we could confirm ECS patterns in all brain death patients whose status had earlier been diagnosed clinically. Considering the results of this study, it seems sensible to perform EEG as a final confirmatory test as an assurance to the patients' families.