relationship between dietary intakes of amino acids and bone mineral density among individuals with spinal cord injury

Objectives: The effect of dietary protein intake on bone mineral density [BMD] has not been explained in patients with spinal cord injury [SCI]. In this study, we looked at the relationship between BMD and higher protein intake in patients with SCI while controlling for possible confounders

Methods: Patients with SCI, who were referred to the Brain and Spinal Cord Injury Research Center between November 2010 and April 2012, were included in the study. In total, the dietary intakes of 103 patients were assessed by 24-hour dietary recall interviews. We used dual-energy X-ray absorptiometry to measure BMD in the femoral neck, trochanter, intertrochanteric zone, hip, and lumbar vertebras

Results: Eighty-six men and 17 women participated in this study. Protein intake was negatively associated with the BMD of lumbar vertebrae [p = 0.001, r = -0.37 for T-score and p = 0.030, r = -0.24 for Z-score]. The BMD of lumbar vertebrae were negatively associated with intake of tryptophan, isoleucine, lysine, cysteine, and tyrosine [p = 0.007, 0.005, 0.009, 0.008, and 0.008 for T-score, respectively]. Higher intakes of threonine, leucine, methionine, phenylalanine, valine, and histidine were related to a lower BMD of lumbar vertebrae [p = 0.006, 0.010, 0.009, 0.010, 0.009, and 0.008 respectively for T-scores]

Conclusions: We found that high protein intake led to a lower BMD of lumbar vertebrae in patients with SCI after controlling for confounders including demographic and injury-related characteristics and calcium intake. No relationship between higher amino acids intake and BMD of the femur and hip was detected. Intake of alanine, arginine, and aspartic acid were not related to BMD

Comparative efficacy of meloxicam and placebo in vasospasm of patients with subarachnoid hemorrhage

Cerebral vasospasm considered to be a serious cause of morbidity and mortality following subarachnoid haemorrhage [SAH].Despite several available therapeutic options, current protocols do not prevent major consequences of vasospasm. Inflammation is believed to play an important role in post-haemorrhagic vasospasm. Meloxicam is a non-steroidal anti-inflammatory drug. The aim of this study was to compare the efficacy of meloxicam versus placebo on vasospasm in patients with SAH. In this randomized, double-blind, placebo-controlled trial, SAH patients randomly received 7.5 mg meloxicam or placebo twice daily for 7 days. End points were, middle cerebral artery velocity obtained with transcranial doppler, in-hospital mortality, hospital stay and discharge Glasgow Outcome Scale. Eighty-one patients enrolled in the study. [40 received meloxicam, 41 received placebo]. Baseline characteristics were similar between the groups. There were no differences in length of hospitalization [17.4 +/- 3.1 vs 18.6 +/- 4.2 days; p = 0.145], in-hospital mortality rate [15 vs 22%; p-value=0.569], or GOS [p = 0.972] between the two groups. MCA velocity were slightly less in patients who had received meloxicam, but not to a significant degree [p-value=0.564[. No side effect has been detected for meloxicam. This study did not prove meloxicam efficacy in vasospasm of SAH patients. But it demonstrated that clinical trial of meloxicam in these patients is feasible and probably safe. The effectiveness of meloxicam on cerebral vasospasm has to be studied in larger trials

Trauma care system in Iran / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to describe the current status of trauma system regarding the components and function.</p><p><b>METHODS</b>The current status of trauma system in all components of a trauma system was described through expert panels and semi-structured interviews with trauma specialists and policy makers.</p><p><b>RESULTS</b>Currently, various organizations are involved in prevention, management and rehabilitation of injuries, but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of public education through media, traffic regulation reinforcement, hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training standards of the front line medical team and continuing education and evaluation are yet to be addressed. Trauma registry has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance, financial resources), it is not yet established in our system of trauma care.</p><p><b>CONCLUSIONS</b>It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system.</p>

Lumbar vertebral hemangioma with extradural extension, causing neurogenic claudication: a case report

The authors present a rare case of lumbar vertebral hemangioma extending to the epidural space with a bisected appearance and impinging on thecal sac. This 52-year-old lady presented with one year history of low back pain and bilateral leg radiation. Plain radiography showed vertical linear streaks at L2 vertebral body and axial computed tomography [CT] scan revealed small "polka dot" appearance within the vertebral body. Magnetic resonance imaging [MRI] showed low signal intensity on T1-weighted images in L2 vertebral body which was not characteristic for hemangioma. The patient underwent an L2 laminectomy, spinal canal decompression and posterior spinal instrumentation. This study indicates that lumbar vertebral hemangioma can extend to the epidural space and cause neurologic symptoms. Magnetic resonance imaging may not show diagnostic features, especially in active lesions and plain radiography and CT scan may be helpful

Chest injury in victims of Bam earthquake / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To analyze the data of trauma patients with thoracic injury in the earthquake of Bam admitted to hospitals of Tehran University of Medical Science (TUMS) for better understanding the type and consequence of thoracic injuries in a major earthquake.</p><p><b>METHODS</b>After Bam earthquake registering 6.5 on the Richter scale, 526 trauma patients were admitted to hospitals of TUMS. Among them, 53 patients sustained thoracic injury.</p><p><b>RESULTS</b>This group was composed of 21 females (39.6%) and 32 males (60.4%). Fifteen patients (28.3%) had isolated chest injuries. Rib fracture (36.4%) was the most common injury in our patients and haemo/pneumothorax (25.5%) followed. Superficial injury was the most common accompanying injury. Multiple-trauma patients with chest injury had higher injury severity score (ISS) versus patients with isolated chest injury (P=0.003).</p><p><b>CONCLUSIONS</b>Chest wall injuries and haemo/pneumothorax comprise a considerable number of injuries in survival victims of earthquakes. Consequently, the majority of these patients can be treated with observation or tube thoracostomy. We should train and equip the health workers and members of rescue teams to treat and manage these patients in the field.</p>