Dor neuropática: sentimentos e vivências de pacientes após lesões traumáticas / Neuropathic pain: feelings and experiences of patients after traumatic injuries / Dolor neuropático: sentimientos y experiencias de pacientes después lesiones traumáticas

Objetivo: Compreender o cotidiano de portadores de dor neuropática decorrente de lesão traumática. Metodologia: Pesquisa exploratória, descritiva, de abordagem qualitativa, com participantes selecionados por meio de mídias sociais. A coleta de dados foi realizada entre o período de julho a setembro de 2022, com indivíduos adultos que possuem diagnóstico de dor neuropática após lesão traumática. A coleta ocorreu por meio de um formulário online, utilizando um questionário sociodemográfico e um questionário aberto, para a captura de informações pertinentes sobre seu caso clínico e vivência com a dor crônica. Os dados foram analisados por meio de Bardin. Todos os preceitos éticos foram respeitados e o projeto foi aprovado sob parecer n.º 5.529.581 da Universidade Cesumar. Resultados: Participaram 15 pessoas com dor neuropática, com prevalência do sexo feminino (93,3%), com idade entre 41 a 50 anos (66,7%). Observou-se que 53,3% relataram comorbidades crônicas, sendo as doenças psíquicas, ansiolíticas e cardíacas mais citadas. Ainda, 33,3% dos participantes relataram que foram internados por causas de dores ou por tentativa de suicídio, 93,3% usam opióides e analgésicos potentes e ainda foram citados antidepressivos e ansiolíticos em 62% das respostas. Dentre os temas em destaque nas respostas, sobressaíram-se "Contexto e diagnóstico da dor neuropática; Vivência e frequência da dor; Apoio profissional e familiar diante da doença". Considerações Finais: Nesse sentido, a percepção acerca dos profissionais de saúde e valorização do médico para o tratamento da dor neuropática está relacionada, muitas vezes, à necessidade de aumentar o conhecimento referente ao manejo da dor e à utilização de opióides.

Objective: To understand the daily life of patients with neuropathic pain resulting from traumatic injury. Methodology: Exploratory, descriptive research, with a qualitative approach, with participants selected through social media. Data collection was carried out between July and September 2022, with adult individuals diagnosed with neuropathic pain after traumatic injury. The collection took place through an online form, using a sociodemographic questionnaire and an open questionnaire, to capture relevant information about their clinical case and experience with chronic pain. Data were analyzed using Bardin. All ethical precepts were respected and the project was approved by report n.º 5,529,581 of Cesumar University. Results: 15 people with neuropathic pain participated, with a prevalence of females (93.3%), aged between 41 and 50 years (66.7%). It was observed that 53.3% reported chronic comorbidities, with psychic, anxiolytic and cardiac diseases being the most cited. Also, 33.3% of the participants reported that they were hospitalized due to pain or a suicide attempt, 93.3% used opioids and potent analgesics, and antidepressants and anxiolytics were mentioned in 62% of the answers. Among the topics highlighted in the responses, the most important were "Context and diagnosis of neuropathic pain; Experience and frequency of pain; Professional and family support in the face of the disease". Final Considerations: In this sense, the perception of health professionals and the appreciation of physicians for the treatment of neuropathic pain is often related to the need to increase knowledge regarding pain management and the use of opioids.

Objetivo: Comprender el cotidiano de los pacientes con dolor neuropático resultante de lesiones traumáticas. Metodología: Investigación exploratoria, descriptiva, con enfoque cualitativo, con participantes seleccionados a través de las redes sociales. La recolección de datos se llevó a cabo entre julio y septiembre de 2022, con individuos adultos diagnosticados con dolor neuropático posterior a una lesión traumática. La recogida se realizó a través de un formulario online, utilizando un cuestionario sociodemográfico y un cuestionario abierto, para captar información relevante sobre su caso clínico y experiencia con el dolor crónico. Los datos se analizaron utilizando Bardin. Se respetaron todos los preceptos éticos y el proyecto fue aprobado bajo el dictamen número 5.529.581 de la Universidad Cesumar. Resultados: Participaron 15 personas con dolor neuropático, con predominio del sexo femenino (93,3%), con edades entre 41 y 50 años (66,7%). Se observó que 53,3% relataron comorbilidades crónicas, siendo las enfermedades psíquicas, ansiolíticas y cardíacas las más citadas. Aún así, el 33,3% de los participantes informaron que fueron hospitalizados por dolor o intento de suicidio, el 93,3% usaba opioides y analgésicos potentes, y los antidepresivos y ansiolíticos se mencionaron en el 62% de las respuestas. Entre los temas destacados en las respuestas, los más importantes fueron "Contexto y diagnóstico del dolor neuropático; Experiencia y frecuencia del dolor; Apoyo profesional y familiar ante la enfermedad". Consideraciones Finales: En este sentido, la percepción de los profesionales de la salud y la apreciación de los médicos por el tratamiento del dolor neuropático muchas veces se relaciona con la necesidad de aumentar el conocimiento sobre el manejo del dolor y el uso de opioides.

Producción científica sobre traumatismo craneoencefálico en revistas estudiantiles cubanas. Enero de 2015-junio de 2021

Introducción: los traumatismos craneoencefálicos son un reto para los servicios de salud. Recibir desde pregrado una formación en su atención constituye una necesidad. Objetivo: caracterizar la producción científica sobre traumatismo craneoencefálico, publicada en revistas estudiantiles cubanas entre enero de 2015 y junio de 2021. Materiales y métodos: se realizó un estudio bibliométrico, descriptivo y retrospectivo. El universo estuvo constituido por nueve artículos, de los que se analizó tipología, año de publicación, cantidad de autores, provincia y centro de procedencia de los mismos, cantidad de referencias, cantidad de artículos por revista y número de veces citados. Resultados: el 77,8 % de los artículos fueron originales, y 2020 fue el año más productivo (55,6 %). El 44,4 % de los artículos fue firmado por cinco autores; el 32,4 % de los autores pertenecían a la provincia de Pinar del Río. La media de referencias por artículos fue de 19,9; el Índice de Price se encontró entre 0,45 y 0,82, con una media de 0,75. El 55,6 % de las publicaciones aparecieron en la revista Universidad Médica Pinareña, cuyos artículos también fueron los más citados (85 %). Conclusiones: la producción científica estudiantil sobre trauma craneoencefálico es baja, y la influencia y visibilidad de los artículos disponibles, atendiendo a la cantidad de citas, es pequeña.

Introduction: crania-encephalic traumas are a challenge for health services. Receiving training on their care since undergraduate studies is a necessity. Objective: to characterize the scientific production on crania-encephalic trauma published in Cuban student journals between January 2015 and June 2021. Materials and methods: a bibliometric, descriptive and retrospective study was carried out. The universe was constituted by 9 articles, of which typology, year of publication, quantity of authors, province and centers of origin, quantity of references; quantity of articles per journal and number of times cited were analyzed. Results: 77.8% of the articles were originals, and 2020 was the most productive year (55.6%). 44% of the articles were signed by five authors; 32.4% of the authors belonged to the province of Pinar del Rio. The average number of references per articles was 19.9; the Price Index was found between 0.45 and 0.85, with an average of 0.75. 55.6% of the publications appeared in the journal Universidad Médica Pinareña, the articles of which were also the most cited ones (85%). Conclusions: the student scientific production on crania-encephalic trauma is low, and the influence and visibility of the available articles, taking into account the quantity of cites, is small.

Trauma unit admissions at the Ugandan National Referral Hospital: a descriptive study

Background: Injuries are a neglected epidemic globally accounting for 9% global deaths; 1.7 times that of HIV, TB and malaria combined. Trauma remains overlooked with key research and data focusing on infectious diseases, yet Uganda has one of the highest rates of traumatic injury. We described demographics of patients admitted to Mulago Hospital's Shock Trauma Unit within the Emergency Department. Methods: This was a retrospective record review Trauma Unit admission from July 2012 to December 2015. Information collected included: age, sex, time of admission, indication for admission and mechanism of trauma. Results: 834 patient records were reviewed. The predominant age group was 18-35 with majority of patients being male. 54% of patients presented during daytime with 46% admitted in the evening hours or overnight. Mechanism of injury was documented in 484 cases. The most common mechanism was Road Traffic Accident (67.4%), followed by assault (12.8%) and mob violence (5.6%). The most common indication for admission was traumatic brain injury (84.5%), followed by hemodynamic instability (20.0%) and blunt chest injury (6.1%). Conclusion: There's a significant burden of high-acuity injury particularly among males with RTAs as the leading cause of admission associated with Traumatic Brain Injury as main admission indication

Primeras experiencias de niños helitransportados en Uruguay / First experiences of helicopter transportation of children in Uruguay / Primeiras experiências de crianças transportadas de helicóptero no Uruguai

Se presentan los primeros tres pacientes pediátricos helitransportados con traumatismo encéfalo craneano (TEC) grave asistidos en nuestra institución. Se muestra el protocolo de asistencia utilizado en el hospital para la recepción, estabilización y oportuno traslado previa coordinación con sectores públicos y privados de asistencia médica. Se solicita consentimiento informado a los padres para el uso de los datos en actividades científicas y publicaciones.

We present the first three pediatric patients transported by helicopter with severe cranioencephalic trauma assisted at our institution. The assistance protocol used in our Hospital for the reception, stabilization and timely transfer is shown after coordination with public and private health providers. Informed consent was requested from the children's parents for the use of the data in scientific activities and publications.

Apresentamos os três primeiros pacientes pediátricos transportados de helicóptero com traumatismo cranioencefálico grave (TCE) atendidos em nossa instituição. Descrevemos o protocolo de atendimento utilizado em nosso Hospital para o acolhimento, estabilização e transferência oportuna prévia coordenação aos setores público e privado de assistência médica. Solicitamos consentimento informado aos pais para o uso dos dados em atividades e publicações científicas.

Tomografía computarizada de cráneo en traumatismo craneoencefálico leve, ¿son estas necesarias en todos los casos? / CT scan of the skull in mild head trauma, are these necessary in all cases? / Tomografia computadorizada de crânio em traumatismo cranioencefálico leve, são necessárias em todos os casos?

Resumen: Introducción: La realización sistemática de tomografías cráneo en trauma encefalocraneano leve es controversial, corresponden al 70-90% de los casos. Hasta 10% de dichos traumatismos presentarán lesiones y 1,4% requerirán neurocirugía. El objetivo del estudio es determinar el número de tomografías patológicas en el traumatismo encefalocraneano leve e identificar los factores predictivos de lesión. Materiales y métodos: Estudio observacional, prospectivo, analítico. Se identificaron las consultas por traumatismo encefalocraneano leve entre el 30 de julio de 2018 y el 15 de agosto del 2019. Se valoró la presencia de factores de riesgo para lesión como escala de coma de Glasgow al ingreso y a las 2 horas, cinemática del trauma, sospecha de fractura de base y bóveda de cráneo, cefalea, vómitos, mayores a 65 años, pérdida de conocimiento, amnesia del episodio, anticoagulación o antiagregación y consumo de alcohol o drogas. Se consignaron los casos con tomografías patológicas y necesidad de neurocirugía. Resultados: Se incluyeron 1319 pacientes, 9% de estudios patológicos y 1,2% requirieron neurocirugía. Resultaron significativas como factores de riesgo la alta cinemática del traumatismo (p 0,02); escala de coma de Glasgow a las 2 horas (p 0,014); sospecha de fractura de bóveda (p 0,003) y base de cráneo (p 0,000); vómitos en más de dos ocasiones (p 0,000); cefalea (p 0,01) y amnesia del episodio (p 0,012) Conclusiones: La identificación de factores predictivos de lesión ayuda a optimizar el uso de tiempo del tomógrafo suprimiendo estudios innecesarios y priorizando los potencialmente patológicos.

Abstract: Introduction: The systematic performance of skull tomography in mild brain trauma is controversial, corresponding to 70-90% of cases. Up to 10% of these traumas will present injuries and 1.4% will require neurosurgery. The objective of the study is to determine the number of pathological scans in mild head injury and to identify predictive factors for injury. Materials and methods: Observational, prospective, analytical study. Consultations for mild brain injury were identified between July 30, 2018 and August 15, 2019. The presence of risk factors for injury was assessed as the Glasgow coma scale at admission and at 2 hours, trauma kinematics, suspicion of skull base and vault fracture, headache, vomiting, people over 65 years of age, loss of consciousness, amnesia of the episode, anticoagulation or antiplatelet therapy and alcohol or drug use. The cases with pathological tomography and the need for neurosurgery were consigned. Results: 1,319 patients were included, 9% of pathological studies and 1.2% required neurosurgery. The high kinematics of trauma were significant as risk factors (p 0.02); Glasgow coma scale at 2 hours (p 0.014); suspicion of fracture of the vault (p 0.003) and skull base (p 0.000); vomiting on more than two occasions (p 0.000); headache (p 0.01) and episode amnesia (p 0.012). Conclusions: The identification of predictive factors of injury helps to optimize the use of tomography time by eliminating unnecessary studies and prioritizing potentially pathological ones.

Resumo: Introdução: O desempenho sistemático da tomografia de crânio no trauma cerebral leve é ​​controverso, correspondendo a 70-90% dos casos. Até 10% desses traumas apresentarão lesões e 1,4% necessitarão de neurocirurgia. O objetivo do estudo é determinar o número de exames patológicos em traumatismo craniano leve e identificar fatores preditivos de lesão. Materiais e métodos: Estudo observacional, prospectivo e analítico. As consultas para lesão cerebral leve foram identificadas entre 30 de julho de 2018 e 15 de agosto de 2019. A presença de fatores de risco para lesão foi avaliada pela escala de coma de Glasgow na admissão e em 2 horas, cinemática do trauma, suspeita de fratura da base do crânio e abóbada, dor de cabeça, vômitos, pessoas com mais de 65 anos, perda de consciência, amnésia do episódio, anticoagulação ou terapia antiplaquetária e uso de álcool ou drogas. Os casos com tomografia patológica e necessidade de neurocirurgia foram dispensados. Resultados: 1.319 pacientes foram incluídos, 9% dos estudos patológicos e 1,2% neurocirurgia necessária. A alta cinemática do trauma foi significativa como fator de risco (p 0,02); Escala de coma de Glasgow em 2 horas (p 0,014); suspeita de fratura de abóbada (p 0,003) e base do crânio (p 0,000); vômito em mais de duas ocasiões (p 0,000); dor de cabeça (p 0,01) e episódio de amnésia (p 0,012). Conclusões: A identificação de fatores preditivos de lesão auxilia na otimização do uso do tempo de tomografia, eliminando estudos desnecessários e priorizando os potencialmente patológicos.

Effectiveness of seatbelts in mitigating traumatic brain injury severity / 世界急诊医学杂志（英文）

@#Over the past few decades, traumatic brain injuries (TBIs) have become one of the leading causes of death and the leading cause of injury-related death in the USA.[1,2] It is estimated that 1.70 million people are subject to TBIs each year.[2] Males are more likely to sustain TBIs (59%); the most common age groups are 0-5 years, 15-19 years, and >65 years.[2] Approximately 1.36 million people present to the emergency department (ED), 275,000 are admitted to the hospital, and 52,000 people die from TBIs.[2] The leading causes of TBIs are falling (35.2%), motor vehicle collisions (MVCs, 17.3%), struck by/against an object (16.5%), and assault (10.0%).[2] These statistics combine to make TBIs the leading cause of injury-related death in the USA at 30.5%.[2] It has been estimated that, with specific guidelines from the Brain Trauma Foundation, up to 50.0% of the 52,000 TBI-related deaths may be prevented.[3]

Gender differences in adult traumatic brain injury according to the Glasgow coma scale: A multicenter descriptive study / 中华创伤杂志(英文版)

PURPOSE@#Patients' gender, which can be one of the most important determinants of traumatic brain injury (TBI) outcomes, is also likely to interact with many other outcome variables of TBI. This multicenter descriptive study investigated gender differences in epidemiological, clinical, treatment, mortality, and variable characteristics in adult TBI patients.@*METHODS@#The selection criteria were defined as patients who had been diagnosed with TBI and were admitted to the hospital between January 1, 2016 and December 31, 2018. A total of 4468 adult TBI patients were enrolled at eight University Hospitals. Based on the list of enrolled patients, the medical records of the patients were reviewed and they were registered online at each hospital. The registered patients were classified into three groups according to the Glasgow coma scale (GCS) score: mild (13-15), moderate (9-12), and severe (3-8), and the differences between men and women in each group were investigated. The risk factors of moderated and severe TBI compared to mild TBI were also investigated.@*RESULTS@#The study included 3075 men and 1393 women and the proportion of total males was 68.8%. Among all the TBI patients, there were significant differences between men and women in age, past history, and GCS score. While the mild and severe TBI groups showed significant differences in age, past history, and clinical symptoms, the moderate TBI group showed significant differences in age, past history, cause of justice, and diagnosis.@*CONCLUSION@#To the best of our knowledge, this multicenter study is the first to focus on gender differences of adult patients with TBI in Korea. This study shows significant differences between men and women in many aspects of adult TBI. Therefore, gender differences should be strongly considered in TBI studies.

Comparison of half-molar sodium lactate and mannitol to treat brain edema in severe traumatic brain injury: A systematic review / 中华创伤杂志(英文版)

PURPOSE@#Hypertonic fluids such as mannitol and half-molar sodium lactate are given to treat intracranial hypertension in patients with severe traumatic brain injury (TBI). In this study, sodium lactate was compared to mannitol in patients with TBI to investigate the efficacy in reducing intracranial pressure (ICP).@*METHODS@#This study was a systematic review with literature research on articles published in any year in the databases of PubMed, ScienceDirect, Asian Journal of Neurosurgery, and Cochrane Central Register of Controlled Trials. The keywords were "half-molar sodium lactate", "mannitol", "cerebral edema or brain swelling", and "severe traumatic brain injury". The inclusion criteria were (1) studies published in English, (2) randomized control trials or retrospective/prospective studies on TBI patients, and (3) therapies including half-molar sodium lactate and mannitol and (4) sufficient data such as mean difference (MD) and risk ratio (RR). Data analysis was conducted using Review Manager 5.3.@*RESULTS@#From 1499 studies, a total of 8 studies were eligible. Mannitol group reduced ICP of 0.65 times (MD 0.65; p = 0.64) and improved cerebral perfusion pressure of 0.61 times (MD 0.61; p = 0.88), better than the half-molar group of sodium lactate. But the half-molar group of sodium lactate maintained the mean arterial pressure level of 0.86 times, better than the mannitol group (MD 0.86; p = 0.09).@*CONCLUSION@#Half-molar sodium lactate is as effective as mannitol in reducing ICP in the early phase of brain injury, superior over mannitol in an extended period. It is able to prevent intracranial hypertension and give better brain tissue perfusion as well as more stable hemodynamics. Blood osmolarity is a concern as it increases serum sodium.

Edaravone improves the post-traumatic brain injury dysfunction in learning and memory by modulating Nrf2/are signal pathway

OBJECTIVES: To investigate the molecular mechanism of edaravone (EDA) in improving the post-traumatic brain injury (TBI) dysfunction in learning and memory. METHODS: In vitro and in vivo TBI models were established using hydrogen peroxide (H2O2) treatment for hippocampal nerve stem cells (NSCs) and surgery for rats, followed by EDA treatment. WST 1 measurement, methylthiazol tetrazolium assay, and flow cytometry were performed to determine the activity, proliferation, and apoptosis of NSCs, and malondialdehyde (MDA), lactic dehydrogenase (LDH), and reactive oxygen species (ROS) detection kits were used to analyze the oxides in NSCs. RESULTS: Following EDA pretreatment, NSCs presented with promising resistance to H2O2-induced oxidative stress, whereas NSCs manifested significant increases in activity and proliferation and a decrease in apoptosis. Meanwhile, for NSCs, EDA pretreatment reduced the levels of MDA, LDH, and ROS, with a significant upregulation of Nrf2/antioxidant response element (ARE) signaling pathway, whereas for EDA-treated TBI rats, a significant reduction was observed in the trauma area and injury to the hippocampus, with improvement in memory and learning performance and upregulation of Nrf2/ARE signaling pathway. CONCLUSIONS: EDA, by regulating the activity of Nrf2/ARE signal pathway, can improve the TBI-induced injury to NSCs and learning and memory dysfunction in rats.

Observational study of patients with occipital condyle fracture at a brazilian referral trauma center / Estudo observacional de pacientes com fratura de côndilo ocipital em centro de referência em trauma no brasil

ABSTRACT Objective: to evaluate the clinical-epidemiological characteristics, treatment, and evolution of patients with occipital condyle fracture (OCF) at one of the largest referral trauma centers in Latin America. Methods: this was a retrospective observational study of OCF identified from trauma cases admitted between December 2011 and December 2019 by the neurosurgery team at a Type 3 trauma center. Results: a total of twenty-eight occipital condyle fractures were identified in twenty-six patients. The incidence was less than 0.2% per year and more common in male patients (4:1 ratio) involved in traffic accidents. The mean age was 42.08 years. Anderson and Montesano type II and Tuli type 1 were the most frequent (67.9% and 89.3%, respectively) and no case presented C0-C1-C2 instability. All patients were treated with a cervical collar for 3 to 6 months. About 65% of the patients exhibited good progression (Glasgow Outcome Scale equal to 4), and the severity of traumatic brain injury was the main determinant for negative outcomes. Conclusion: the findings of this study are in accordance with available literature data. The use of external stabilization with a cervical collar is reinforced for the treatment of stable lesions, even when these are bilateral. Assessment of the patients' follow-up results in the studied sample may contribute with useful information for the treatment of occipital condyle fractures.

RESUMO Objetivo: avaliar o perfil clínico-epidemiológico, o tratamento e a evolução de pacientes com fraturas do côndilo occipital (FCO) em um dos maiores centros especializados em trauma na América Latina. Método: este é um estudo observacional retrospectivo de FCO identificadas em casos de trauma que foram atendidos no período de Dezembro de 2011 a Dezembro de 2019 pela equipe de trauma de centro de trauma Tipo 3. Resultados: um total de vinte e oito fraturas do côndilo occipital foram identificadas em 26 pacientes. A incidência foi inferior a 0.2% ao ano e mais comum em pacientes do sexo masculino (proporção 4:1) envolvidos em acidentes de trânsito. A idade média foi de 42.08 anos. O Tipo II de Anderson e Montesano e o Tipo 1 de Tuli foram os mais frequentes (67.9% e 89.3%, respectivamente) e nenhum caso teve instabilidades C0C1C2. Todos os pacientes foram tratados com colar cervical por período de 3 a 6 meses. Cerca de 65% dos pacientes apresentaram boa evolução (Escala de Resultados de Glasgow maior ou igual a 4), e a gravidade da lesão cerebral foi o principal determinante para os resultados negativos. Conclusão: os achados deste estudo são similares a dados disponíveis na literatura. O uso de colar cervical para estabilização externa é reforçado para o tratamento de lesões estáveis, mesmo quando bilaterais. A avaliação dos resultados do acompanhamento dos pacientes na amostra estudada pode contribuir com informações úteis para o tratamento de fraturas de côndilo occipital.

Progesterona para el tratamiento del trauma craneoencefálico grave: una revisión sistemática y metaanálisis / Progesterone to treat severe traumatic brain injury: a systematic review and meta-analysis / Progesterona para o tratamento do traumatismo crânio-encefálico grave: revisão sistemática e meta-análise

Resumen: Objetivo: revisar sistemáticamente la evidencia sobre la administración de progesterona tras un trauma craneoencefálico grave en adultos y su relación con mortalidad y pronóstico neurológico. Criterios de inclusión: ensayos clínicos aleatorizados que incluyan a pacientes adultos mayores de 18 años, haber sufrido un traumatismo craneal grave (Glasgow <8), donde se compare la administración de progesterona vs grupo control (placebo o no administración). Método: se realizó la búsqueda en las siguientes bases de datos: MEDLINE, the Central Register of Controlled Trials (CENTRAL); PubMed, HINARI, EMBASE; Cochrane Injuries group y lista de referencia de los artículos. Resultados: no hubo reducción de la mortalidad comparado con el grupo control (RR 0,93, IC95% 0,79-1,10 p= 0,41), no hubo diferencias entre progesterona y el grupo control en desenlaces neurológicos positivos ni negativos (RR 1,07, IC95% 0,97-1,17 p= 0,20; RR 0,94, IC 95% 0,81-1,08 p= 0,27), respectivamente. Conclusiones: no se encontró evidencia respecto a que la administración de progesterona posterior a un traumatismo craneoencefálico reduzca la mortalidad o mejore desenlaces neurológicos, aunque se necesitan más estudios de buena calidad para extraer conclusiones definitivas.

Summary: Objective: to systematically review evidence on the administration of progesterone after a traumatic brain injury in adults and its relationship with mortality and neurological head prognosis. Inclusion criteria: randomized clinical trials that include: patients older than 12 years old, having had an injury (Glasgow <8), comparing the administration of Progesterone versus the control group (placebo or no administration). Methods: we searched the following databases: MEDLINE, the Central Register of Controlled Trials (CENTRAL); PubMed, HINARI, EMBASE; Cochrane Injury Group and reference list of articles. Results: there was no reduction in mortality in patients in the control group (RR 0.93, 95% CI 0.79-1.10 p = 0.41), there were no differences between progesterone and the control group in favorable or adverse neurological outcomes (RR 1.07, 95% CI: 0.97-1.17 p = 0.20, RR 0.94, 95% CI: 0.81 -1,08 p= 0.27), respectively. Conclusions: there is no evidence that the administration of progesterone after a traumatic brain injury reduces or improves neurological results, although further good quality studies are required to obtain conclusive results.

Resumo: Objetivo: realizar uma revisão sistemática da evidência sobre a administração de progesterona depois de traumatismo crânio-encefálico grave em adultos e sua relação com a mortalidade e o prognóstico neurológico. Critérios de inclusão: ensaios clínicos aleatorizados que incluam: pacientes adultos maiores de 18 anos, haver sofrido um traumatismo craniano grave (Glasgow <8) donde se compare a administração de progesterona versus grupo controle (placebo ou não administração). Métodos: foi feita uma pesquisa bibliográfica nas seguintes bases de dados: MEDLINE, Central Register of Controlled Trials (CENTRAL), PubMed, HINARI, EMBASE, Cochrane Injuries Group e nas referências bibliográficas dos artigos. Resultados: não foi observada uma redução da mortalidade comparada com o grupo controle (RR 0,93, IC del 95%: 0,79-1,10 p= 0,41), não foram observadas diferenças entre o grupo que recebeu progesterona e o grupo controle nos resultados neurológicos positivos ou negativos (RR 1,07, IC del 95%: 0,97-1,17 p= 0,20; RR 0,94, IC del 95%: 0,81-1,08 p= 0,27), respectivamente. Conclusões: não se encontrou evidência de que a administração de progesterona depois de um traumatismo crânio-encefálico reduza a mortalidade ou melhore os resultados neurológicos embora novos estudos de boa qualidade sejam necessários para chegar a conclusões definitivas.

Semiología Radiológica en Patología Cerebral de Emergencia / Radiological Semiology In Emergency Brain Pathology

La radiología es una gran herramienta en el diagnóstico de patologías encefálicas, especialmente en situaciones de urgencia y emergencia neurológicas, para descartar la presencia de una patología específica, y definir la localización y tamaño de la lesión, o esclarecer un diagnóstico inicial incierto. De esa forma, el conocimiento de sus principales signos, hallazgos y características es importante para realizar un examen adecuado, porque esto facilita la descripción de las imágenes obtenidas con una mayor rapidez y precisión permitiendo una labor óptima e inmediata del médico tratante en favor del paciente. Por ello, este artículo presenta una breve revisión de la semiología radiológica representativa obtenida en la literatura médica, donde las referencias fueron bibliografías e investigaciones, lo cual resulta conveniente para ubicar los signos que pudiese existir apenas fue obtenido el examen, para la futura terapéutica del paciente, así como la posibilidad de ampliación en el examen radiológico o sugerencia del tecnólogo médico de radiología en coordinación con el médico solicitante para garantizar la atención efectiva del paciente.

Radiology is a great tool in the diagnosis of encephalic pathologies, especially in situations of neurological urgency and emergency, to rule out the presence of a specific pathology, and to definite the location and size of the lesion, or clarify an initial uncertain diagnosis. In this way, the knowledge of its main signs, findings and characteristics is important to perform an adequate examination, because it facilitates the description of the images obtained with greater speed and precision allowing an optimal and immediate labor of the treating doctor in favor of the patient. Therefore, this article presents a brief review of the representative radiological semiology obtained in the medical literature, where the references were bibliographies and researches, which is convenient to localize the signs that could exist as soon as the examination was obtained, for the future therapeutic of the patient, such as the possibility of extension in the radiology exam or suggestion by the medical technologist of radiology in coordination with the requesting physician to guarantee the patient's care effective.

Características neuroanatômicas e linguísticas na dislexia adquirida / Neuroanatomical and linguistic characteristics of acquired dyslexia / Características neuroatómicas y linguísticas en la dyslexia adquirida

Introdução: a dislexia adquirida caracteriza-se pela perda da capacidade de compreender o significado de palavras escritas desenvolvida previamente. Esta afecção pode ter origem em acidentes vasculares, traumatismos e outras doenças cerebrais. Objetivo: investigar as características da dislexia adquirida, explorando as correlações neuroanatômicas nas encefalopatias que as produzem, por meio de uma revisão de literatura. Método: Para a realização do estudo, os autores seguiram os critérios sugeridos pela Cochrane Handbook. Primeiramente, formulou-se uma pergunta, seguida da localização e seleção criteriosa dos artigos. Em seguida, ocorreu a avaliação crítica de cada estudo, finalizando com a análise, interpretação e apresentação dos resultados encontrados. Foram consultadas as bases de dados Science Direct, Pubmed/Medline e Scopus, com a utilização dos descritores "brain diseases", "brain injuries", "traumatic brain injuries" e "stroke" com o operador booleano OR, associado aos descritores "alexia" e "acquired dyslexia" por meio do operador booleano AND. Revisão de Literatura: A primeira busca eletrônica contabilizou 137 artigos científicos, dos quais 11 foram eleitos por se tratar de estudos contendo a relação anatômica das lesões e/ou sinais clínicos e linguísticos da dislexia adquirida. Conclusão: A principal causa da dislexia adquirida foi o acidente vascular cerebral, sobretudo no lobo occipital, em ambos os hemisférios, repercutindo na percepção e, posteriormente, no reconhecimento visual da palavra. Faz-se necessário ampliar as pesquisas sobre a dislexia adquirida, a fim de aprofundar o conhecimento sobre a mesma, instrumentalizando os clínicos para o processo de reabilitação.

Introduction: acquired dyslexia is characterized by the loss of the capacity to understand the meaning of written words previously developed. This condition can be caused by strokes, trauma and other brain diseases. Objective: to investigate the characteristics of acquired dyslexia, exploring the neuroanatomical correlations in the encephalopathies that produce them, through a literature review. Method: For the study, the authors followed the criteria suggested by the Cochrane Handbook. Firstly, a question was asked, followed by the location and careful selection of the articles. Then, the critical evaluation of each study occurred, ending with the analysis, interpretation and presentation of the results found. The databases Science Direct, Pubmed / Medline and Scopus, using the descriptors "brain diseases", "brain injuries", "traumatic brain injuries" and "stroke" with the Boolean operator OR, associated with the descriptors "alexia" and "acquired dyslexia" through the Boolean operator AND. Literature Review: The first electronic search counted 137 scientific articles, of which 11 were chosen because they were studies containing the anatomical relationship of lesions and/or clinical and linguistic signs of acquired dyslexia. Conclusion: The main cause of acquired dyslexia was stroke, especially in the occipital lobe, in both hemispheres, affecting the perception and subsequent visual recognition of the word. It is necessary to broaden the research on acquired dyslexia in order to deepen the knowledge about it, instrumentalizing the clinicians for the rehabilitation process.

Introducción: la dislexia adquirida se caracteriza por la pérdida de la capacidad en comprender el significado de palabras escritas desarrollada previamente. Esta afección puede originarse en accidentes vasculares, traumatismos y otras enfermedades cerebrales. Objetivo: investigar las características de la dislexia adquirida, explorando las correlaciones neuroanatómicas en las encefalopatías que las producen, por medio de una revisión de literatura. Metodos: Para la realización del estudio, los autores siguieron los criterios sugeridos por la Cochrane Handbook. Primero, se formuló una pregunta, seguida de la localización y selección criteriosa de los artículos. A continuación, ocurrió la evaluación crítica de cada estudio, finalizando con el análisis, interpretación y presentación de los resultados encontrados. Se han consultado las bases de datos Science Direct, Pubmed / Medline y Scopus, con la utilización de los descriptores "brain diseases", "brain cura", "traumatismo cerebrovascular" y "stroke" con el operador booleano OR, asociado a los descriptores "alexia" y "adquirido dyslexia" a través del operador booleano AND. Revisión de Literatura: La primera búsqueda electrónica contabilizó 137 artículos científicos, de los cuales 11 fueron elegidos por tratarse de estudios que contenían la relación anatómica de las lesiones y/o signos clínicos y lingüísticos de la dislexia adquirida. Conclusión: La principal causa de la dislexia adquirida fue el accidente cerebrovascular, sobre todo en el lobo occipital, en ambos hemisferios, repercutiendo en la percepción y posterior reconocimiento visual de la palabra. Se hace necesario ampliar las investigaciones sobre la dislexia adquirida, a fin de profundizar el conocimiento sobre la misma, instrumentalizando a los clínicos para el proceso de rehabilitación.

Global Synchronization Index as an Indicator for Tracking Cognitive Function Changes in a Traumatic Brain Injury Patient: A Case Report

Traumatic brain injury is a main cause of long-term neurological disability, and many patients suffer from cognitive impairment for a lengthy period. Cognitive impairment is a fatal malady to that limits active rehabilitation, and functional recovery in patients with traumatic brain injury. In severe cases, it is impossible to assess cognitive function precisely, and severe cognitive impairment makes it difficult to establish a rehabilitation plan, as well as evaluate the course of rehabilitation. Evaluation of cognitive function is essential for establishing a rehabilitation plan, as well as evaluating the course of rehabilitation. We report a case of the analysis of electroencephalography with global synchronization index and low-resolution brain electromagnetic tomography applied, for evaluation of cognitive function that was difficult with conventional tests, due to severe cognitive impairment in a 77-year-old male patient that experienced traumatic brain injury.

Sinking Skin Flap Syndrome or Syndrome of the Trephined: A Report of Two Cases

Decompressive craniectomy (DC) is commonly performed in patients with intracranial hypertension or brain edema due to traumatic brain injury. Infrequently, neurologic deteriorations accompanied by sunken scalp may occur after DC. We report two patients with traumatic subdural hemorrhage who had neurologic deteriorations accompanied by sunken scalp after DC. Neurologic function improved dramatically in both patients after cranioplasty. Monitoring for neurologic deterioration after craniectomy is advised. For patients showing neurologic deficit with a sunken scalp, early cranioplasty should be considered.

Dizziness in Traumatic Brain Injury: Visual-Vestibular Dysfunction, Neurotological Approach / 대한평형의학회지

Traumatic brain injury (TBI) could give rise to variable clinical manifestations based on the involved structures of our bodies. Although there are no structural abnormalities proven, the patients with mild TBI suffer from chronic dizziness and imbalance. Herein, I will discuss the visuo-vestibular interaction and neurotological finding in TBI, which could demonstrate the clue to the diagnosis and management in dizzy patients with TBI.

Caracterização das vítimas de traumatismo encefálico que evoluíram para morte encefálica / Characterization of cranioencephalic traumatism victims who evolved to brain death / Caracterización de las víctimas de traumatismo encefálico que evolucionaron a muerte encefálica

Resumo Introdução O Trauma Cranioencefálico constitui a principal causa de morte, de sequelas irreversíveis nos politraumatizados e tem custo elevado para o poder público, além de estar entre os principais problemas de saúde pública no país. Leva a várias complicações, entre elas a morte encefálica que é definida como a parada total e irreversível das funções cerebrais, sendo incompatível com a vida. Desta forma faz-se necessário uma equipe capacitada e treinada para abordar as vítimas de Trauma Crânioencefálico. Este estudo teve como objetivo descrever os fatores clínicos/ traumáticos presentes nas vítimas de trauma crânioencefálico que evoluíram para morte encefálica. Materiais e Métodos Estudo descritivo, retrospectivo e documental realizado em hospital público de referência do Estado de Pernambuco. Resultados Foram analisados 121 prontuários de vítimas de Trauma Cranioencefálico, no período de janeiro de 2013 a dezembro de 2014. Houve predominância do sexo masculino (83%), na faixa etária de 21-30 anos (34,7%), etiologia do trauma acidentes automobilísticos (35%) seguido de agressão por arma de fogo (21%). Ocorrendo os acidentes aos domingos (27,3%), sendo a maioria Trauma Crânioencefálico grave (78,5%) chegando ao local de atendimento em uso de via aérea definitiva (73,6%). Discussão As vítimas que evoluem para morte encefálica são geralmente homens, em idade produtiva, envolvidos em acidentes automobilísticos graves, com atenção para o aumento da violência por agressão com arma de fogo. Conclusões Essas informações podem auxiliar a prática clínica dos enfermeiros e a elaboração de protocolo de avaliação mais sistematizado para as vítimas de Trauma Crânioencefálico que evoluem para morte encefálica.

Abstract Introduction Cranioencephalic Trauma is the main cause of death and irreversible sequelae in polytraumatized patients, which represents a high cost for the public authorities. This is also one of the main public health problems in the country since it leads to several complications, including brain death, defined as the total and irreversible interruption of brain functions, which is incompatible with life. As a result, it is necessary to have a trained and qualified team to address the victims of Cranioencephalic Trauma. The aim of this study is to describe the clinical/traumatic factors present in Cranioencephalic Trauma victims who evolved to brain death. Materials and Methods Descriptive, retrospective and documentary study carried out in a public hospital of reference in the State of Pernambuco. Results 121 medical records of cranioencephalic trauma victims who evolved to brain death victims were analyzed from January 2013 to December 2014. A predominance of males (83%) was observed in the age range of 21 to 30 years (34.7%), etiology of road traffic trauma (35%), followed by assault with firearms (21%). Accidents occurred on Sundays (27.3%), of which the majority were in severe Cranioencephalic Trauma (78.5%), with patients arriving at the site of care using a definitive airway (73.6%). Discussion The victims who evolve to brain death are generally male, of productive age, involved in serious traffic accidents, with attention to the increase in violence due to aggression by firearm. Conclusions This information may assist in the clinical practice of nurses and in the development of a more systematic assessment protocol for Cranioencephalic Trauma victims who evolve to brain death.

Resumen Introducción El Trauma Craneoencefálico constituye la principal causa de muerte y de secuelas irreversibles en pacientes politraumatizados y representa un alto costo para el poder público, además de estar entre los principales problemas de salud pública del país, dado que conduce a varias complicaciones, entre ellas, la muerte encefálica definida como la interrupción total e irreversible de las funciones cerebrales, lo cual es incompatible con la vida. A raíz de lo anterior, se hace necesario contar con un equipo capacitado y entrenado para abordar a las víctimas de Trauma Craneoencefálico. Este estudio tiene por objeto describir los factores clínicos/traumáticos presentes en las víctimas de trauma craneoencefálico que evolucionaron a muerte encefálica. Materiales y Métodos Estudio descriptivo, retrospectivo y documental realizado en un hospital público de referencia del Estado de Pernambuco. Resultados Se analizaron 121 historias médicas de víctimas de trauma craneoencefálico, en el período comprendido entre enero de 2013 a diciembre de 2014. Se observó predominio del sexo masculino (83%), en el rango de edad de 21 a 30 años (34,7%), etiología del trauma por accidentes de tránsito (35%), seguido de agresión por arma de fuego (21 %). Los accidentes ocurrieron los domingos (27,3%), de los cuales la mayoría correspondió a Trauma Craneoencefálico grave (78,5%), con pacientes que llegaron al lugar de atención utilizando vía aérea definitiva (73,6%). Discusión Las víctimas que evolucionan a muerte encefálica son generalmente hombres, en edad productiva, involucrados en accidentes de tránsito graves, con atención hacia el aumento de la violencia por agresión con arma de fuego. Conclusiones Esta información puede ayudar en la práctica clínica de los enfermeros y en la elaboración de un protocolo de evaluación más sistematizados para las víctimas de Trauma Craneoencefálico que evolucionan a muerte encefálica.

Immediate Effects of a Single Exercise on Behavior and Memory in the Early Period of Traumatic Brain Injury in Rats

OBJECTIVE: To evaluate the immediate effect of single exercise on physical performance and memory in the early stage of traumatic brain injury (TBI) in rats. METHODS: Ninety TBI rats were randomly assigned to T0 (sedentary), T10 (treadmill 10 m/min for 30 minutes), or T20 (treadmill 20 m/min for 30 minutes) groups, on day 3 (D3), D7, and D14 after TBI, respectively. Rotarod (RR), Barnes maze (BM), brain magnetic resonance imaging (MRI) and MR spectroscopy were performed immediately before and 6 hours after exercise. Rats were sacrificed for immunohistochemistry with heat shock protein 70 (Hsp70) and glial fibrillary acidic protein (GFAP). RESULTS: On D3, the T10 and T20 groups demonstrated significant improvement in RR (p < 0.05). On D7, only the T20 group showed significantly enhanced RR (p < 0.05). In BM on D3, the T20 group showed significant deterioration compared with the other groups (p < 0.05). Lesion volume did not significantly differ among the groups. MR spectroscopy on D3 showed that only the T20 group had significantly increased choline/creatine and 0.9/creatine (p < 0.05). In the perilesional area on D3, only T20 had a significantly higher Hsp70 and GFAP than the T0 group. On D7, Hsp70 was significantly higher in the T20 group than in the T0 group (p < 0.05). In the ipsilesional hippocampus on D3, the T20 group showed a significantly higher Hsp70 and GFAP than the T0 group (p < 0.05). CONCLUSION: A single session of low-intensity exercise in the early period of TBI improves behavioral performance without inducing cognitive deficits. However, high-intensity exercise can exacerbate cognitive function in the early period after TBI. Therefore, the optimal timing of rehabilitation and exercise intensity are crucial in behavior and memory recovery after TBI.

The characteristics of mild head injuries in preschool-age children fall: a retrospective observational study

OBJECTIVE: Falling is a common cause of head injury in preschool aged children. We investigated the characteristics of mild head injuries caused by falling and the association between body weight and occurrence of traumatic brain injuries (TBI). METHODS: This retrospective observational study was conducted on head-injured preschool-aged children that visited the emergency department from January 2012 to December 2015. Characteristics such as age, sex, weight, free fall height, floor type, and presence of TBI, as defined as cerebral hemorrhage or skull fracture, were investigated. We calculated body weight percentiles by calibrating age and weight and categorized them into four quartile ranges. We grouped all included cases into two groups according to the presence of TBI. The characteristics of the two groups were compared by using chi-square test, and the association with TBI was investigated by using binomial logistic regression. RESULTS: A total of 701 children were included, and TBI was observed in 95 children. Children with TBI were younger. The proportion of children with TBI was higher in the third and fourth quartiles of the body weight group as well as according to soft floor and fall from high height (≥1 m). The odds of soft floor being associated with TBI was higher than the odds for hard floor (odds ratio, 2.734; 95% confidence interval [CI], 1.597–4.680). The odds of high height (≥1 m) being associated with TBI was higher than that for low height (odds ratio, 2.306; 95% CI, 1.155–4.601), and the odds ratio for the weight percentile group was 1.228 (95% CI, 1.005–1.499). CONCLUSION: Prevalence of TBI after falling in preschool-aged children might be associated with high fall-height and body weight quartiles.

Effects of Electric Cortical Stimulation (ECS) and Transcranial Direct Current Stimulation (tDCS) on Rats With a Traumatic Brain Injury

OBJECTIVE: To evaluate the effects of electric cortical stimulation (ECS) and transcranial direct current stimulation (tDCS) on motor and cognitive function recovery and brain plasticity in focal traumatic brain injury (TBI) of rats model. METHODS: Forty rats were pre-trained to perform a single pellet reaching task (SPRT), rotarod test (RRT), and Y-maze test for 14 days, then a focal TBI was induced by a weight drop model on the motor cortex. All rats were randomly assigned to one of the three groups: anodal ECS (50 Hz and 194 μs) (ECS group), tDCS (0.1 mA, 50 Hz and 200 μs) (tDCS group), and no stimulation as a control group. Four-week stimulation, including rehabilitation, was started 3 days after the operation. SPRT, RRT, and Y-maze were measured from day 1 to day 28 after the TBI was induced. Histopathological and immunohistochemistry staining evaluations were performed at 4 weeks. RESULTS: SPRT was improved from day 7 to day 26 in ECS, and from day 8 to day 26 in tDCS compared to the control group (p < 0.05). SPRT of ECS group was significantly improved on days 3, 8, 9, and 17 compared to the tDCS group. Y-maze was improved from day 8 to day 16 in ECS, and on days 6, 12, and 16 in the tDCS group compared to the control group (p < 0.05). Y-maze of the ECS group was significantly improved on day 9 to day 15 compared to the tDCS group. The c-Fos protein expression was better in the ECS group and the tDCS group compared to the control group. CONCLUSION: Electric stimulation in rats modified with a focal TBI is effective for motor recovery and brain plasticity. ECS induced faster behavioral and cognitive improvements compared to tDCS during the recovery period of rats with a focal TBI.