Spondylodiscitis instrumented fusion, a prospective case series on a standardized neurosurgical protocol with long term follow up.

PURPOSE: To investigate the fusion construct properties, construct length, intervertebral prosthesis (IVP) selection, bone grafting methods, complications management, and follow-up outcomes of spondylodiscitis fusion. METHOD: This case series was conducted in Al-Zahra University referral hospital from March 2016 to November 2021. All the surgery-eligible patients were enrolled. Those who did not participate or failed the neurosurgical intervention were excluded. A unified neurosurgical protocol was defined. After operation and follow-up, all variables were documented. IBM SPSS v.26 was used for data analysis. P-value ≤ 0.05 was considered significant. RESULT: Ninety-two patients were reviewed in the final analysis with 65.2 % males. The mean age was 55.07 ± 14.22 years old. The most frequent level of pathology and surgery was the lumbar spine (48.9 %). Short and long constructs were almost equally used (57.6 and 42.4 %, respectively). Bone graft mixture was the dominant IVP (75 %). The most frequent persistent postoperative symptom was back pain (55.4 %), while the neurological deficits resolution rate was 76.7 %. The fusion rate was 92.3 %. Proximal junctional kyphosis incidence was 16.3 % and had a significant association with on-admission neurological symptoms, thoracic and thoracolumbar junction involvements (p < 0.05). Follow-up Oswestry disability index scores showed 44.6 % of the patients had mild or no functional disabilities. Advanced age, On-admission deficits, comorbidities, titanium cages, and poor fusion status were associated with poor functional outcomes and higher mortality rates (P < 0.05). CONCLUSION: The introduced neurosurgical protocol could effectively achieve acceptable SD treatment, spine stabilization, and fusion with low long-term surgical complications. Autologous bone graft mixture in comparison to titanium cages showed a higher fusion rate with a lower mortality rate. Patients with older age, neurological symptoms, and comorbidities are expected to experience less favorable clinical outcomes.

Efficacy and safety of fibrinogen administration in acute post-traumatic hypofibrinogenemia in isolated severe traumatic brain injury: A randomized clinical trial.

AIM: This study was conducted to evaluate clinical outcomes after fibrinogen administration in hypofibrinogenemia following severe traumatic brain injury. BACKGROUND: Post traumatic coagulopathy (PTC) is a common but devastating medical condition in patients with severe head injury. Hypofibrinogenemia is considered as an indicator for poor clinical outcomes in traumatic brain injury (TBI). METHODS: In this randomized clinical trial (RCT), primarily 137 patients with severe traumatic brain injury (Glasgow coma scale score: GCS < 9) were enrolled. Thereafter, their plasma fibrinogen level was measured. The patients with primary hypofibrinogenemia (<200 mg/dL) with no concurrent coagulopathy were randomly allocated into fibrinogen-receiving (n = 50) and control (n = 54) groups. P-value < 0.05 was considered as statistically significant. RESULTS: Seventy-one patients were analyzed in the final step of the study. The mean value for age in fibrinogen and control groups was 25.64 ± 10.71 and 28.91 ± 12.25 years old, respectively. Male - female patients in both groups were equally distributed. In the fibrinogen receiving group, GCS scores were significantly higher after 24, 48, and 72 h compared to the control group (p = 0.000). Hematoma expansion was better controlled in the fibrinogen receiving group (p = 0.000). Notably, the number needed to treat (NNT) for fibrinogen infusion and hematoma expansion control was 2.3. Glasgow outcome scale-extended (GOSE) was significantly better in the fibrinogen group (p = 0.25). Multiple regression tests showed intracerebral hematoma (ICH) and severe brain edema had the most detrimental effect on GOSE outcomes. The need for cranial surgery, hospital stay duration, mechanical ventilator dependency, in hospital and 90-day post discharge mortality rates were similar in both study groups. CONCLUSION: In severe TBI, hypofibrinogenemia correction (>200 mg/dL) could improve GOSE, GCS score progression within 3 days after primary head injury and hematoma expansion controllability.

Atlantoaxial instability and cervical noninfectious spondylodiscitis in a patient with Wegener's granulomatosis: A case report.

A 61-year-old male patient with Wegener's granulomatosis was admitted due to neck pain and quadriparesis. Clinical evaluation showed severe cervical noninfectious spondylodiscitis, myelopathy, sagittal imbalance, and atlantoaxial instability. A combined anterior and posterior approach was implemented. Postoperative clinical evaluation showed improved neurologic status.

Sleep quality and associated factors in Iranian inflammatory bowel disease patients.

BACKGROUND: Sleep is essential in maintaining health and quality of life. Inflammatory bowel disease (IBD) patients suffer from poor sleep quality. This study aimed to investigate the prevalence of sleep disturbances in Iranian IBD patients as well as the variables which can be attributed to the quality of sleep in IBD patients. MATERIALS AND METHODS: Seventy-one patients filled in Pittsburg Sleep Quality Index (PSQI) questionnaire and a sociodemographic questionnaire. Disease activity was assessed by Crohn's Disease (CD) Activity Index and Ulcerative Colitis (UC) Activity Index. Regression analysis was used to identify the association between sociodemographic and disease characteristics with sleep quality. RESULTS: We found that 32.4% of all patients, 23.1% of patients with "in remission to mild" disease, and 66.7% of patients with "moderate" disease, had poor sleep quality. CD patients were more likely to have poor sleep quality comparing UC ones in crude (odds ratio [OR] =2.14; 95% confidence interval [CI] 1.14-4.04) and adjusted (OR = 6.19; 95% CI 1.13, 34.07) models. Patients with good quality of sleep had lower systolic blood pressure and diastolic blood pressure (P = 0.09 and 0.035 respectively). CONCLUSION: Notable percentage of IBD patients suffer from poor sleep quality even in the remission phase. Treatment of sleep disturbances, especially in CD patients, is recommended in the IBD patient-care program.

Quality of life in inflammatory bowel disease patients: A cross-sectional study.

BACKGROUND: Inflammatory bowel disease (IBD) has a significant impact on health-related quality of life (HRQOL). This study aims to investigate the variables which can be attributed to HRQOL in IBD patients. MATERIALS AND METHODS: Seventy-one patients filled in IBD questionnaire (IBDQ-32), Pittsburgh sleep quality index questionnaire, and sociodemographic questionnaire. Disease activity was assessed by Crohn's disease activity index (CDAI) and ulcerative colitis activity index (UCAI). The correlations of sleep quality, sociodemographic variables, and disease characteristics with IBDQ were investigated. RESULTS: IBDQ-32 mean score was lower in patients who had hospitalization (P = 0.01), poor sleep quality (P < 0.001), anemia (P = 0.03), more severe disease (P = 0.01), and those who had not consumed folic acid (P = 0.01) relative to their counterparts. A multivariate regression analysis identified the predictors of decreased HRQOL as not consuming folic acid (P = 0.008), poor sleep quality (P = 0.014), and disease severity (P = 0.043). CONCLUSION: Impaired HRQOL was significantly associated with poor sleep quality, lack of folic acid consumption, and disease severity in IBD patients. Therefore, evaluation of folic acid level and efficacy of its supplementation in prospective studies is recommended. Treatment of sleep disturbance with pharmacological agents and nonpharmacological methods should be kept in mind as well.

Herpes zoster segmental paresis in an immunocompromised breast cancer woman.

Herpes zoster is an infectious disease with neurological complications caused by reactivation of varicella zoster virus in dorsal root ganglia of spinal cord which is also known as "Shingles." Suppression of immune system is the major predisposing factor for reactivation of latent virus. Disease is mainly characterized by rash, vesicles and pain along one or more dermatomes which are innervated from one or more spinal nerve roots. Complications may be present after a while despite of patient treatment. Motor involvement is included. Some previous studies showed segmental zoster paresis as a rare complication, a few weeks after first presentation, among immunocompetent individuals. We present post herpetic motor involvement of C5 and C6 in a 59-year-old woman who underwent chemotherapy and radiotherapy due to breast cancer, manifesting left upper limb weakness and paresis, 6 months after left partial mastectomy. Segmental paresis of zoster virus should be considered as a cause of motor impairment in an immunocompromised person suffering from shingles.