Predictors of radiological contusion progression in traumatic brain injury.

BACKGROUND: Traumatic brain injury, mainly caused by the unintentional falls and motor vehicle accidents, is a serious condition encompassing a spectrum of pathological features from axonal to hemorrhagic injuries. Among these, cerebral contusions significantly contribute to death and disability following the injury and occur in up to 35% of cases. This study aimed to investigate the predictors of radiological contusion progression in traumatic brain injury. METHODS: We performed a retrospective cross-sectional study using the files of the patients with mild traumatic brain injury who had cerebral contusions from 21 March 2021 to 20 March 2022. The severity of brain injury was determined using the Glasgow Coma Score. Furthermore, we used a cut-off value of a 30% increase in contusion size in the secondary CT scans (up to 72 hours) compared to the first one to define the significant progression of the contusions. For the patients with multiple contusions, we measured the biggest contusion. RESULTS: 705 patients with traumatic brain injury were found, the severity of the injury was mild in 498 of them, and 218 had cerebral contusions. 131 (60.1%) patients were injured in vehicle accidents. 111 (50.9%) had significant contusion progression. Most patients were conservatively managed, but 21 out of them (10%) required delayed surgical intervention. CONCLUSION: We found that the presence of subdural hematoma, subarachnoid hemorrhage, and epidural hematoma were predictors of radiological contusion progression, and the patients with a subdural hematoma and epidural hematoma were more likely to undergo surgery. In addition to providing prognostic information, predicting risk factors for the progression of the contusions is crucial for identifying patients who might benefit from surgical and critical care therapies.

Contrast-enhanced weighted-T1 and FLAIR sequences in MRI of meningeal lesions.

Magnetic resonance imaging (MRI) is widely used in meningeal lesions due to rapid and accurate diagnosis and prevention of serious complications. The aim of the present study was to compare these two sequences after injection of a contrast agent into meningeal lesions. This is a descriptive-analytical study that was performed in 2018-2020 on patients referred to the radiology ward with detection of any meningeal involvements in the MRI images. In addition to T1-W, FLAIR sequence imaging was also performed. Images were initially evaluated by two expert radiologists and a neurologist. The diagnostic values of the sequences were compared. Overall, a total number of 147 patients with meningeal lesions in their brain MRI entered the study. 57.1% of cases (84 patients) had an infectious etiology and 42.9% (63 patients) had a tumoral etiology. T1-W images without contrast were able to diagnose 78 cases of meningitis (92.8% of them), and FLAIR sequences could diagnose 82 patients (97.6% of them). Without contrast injection on MRI, the diagnostic value of T1-W sequence was higher than FLAIR sequence for tumoral lesions (P < 0.01). The enhancement degree of T1-W was higher for tumoral findings (P < 0.01). In contrast, the enhancement degree of the FLAIR sequence was higher for infectious findings, which was also statistically significant (P = 0.015). FLAIR sequences had 92% sensitivity and 85% specificity for diagnosis of brain inflammatory diseases. Similar analysis showed that T1 sequence had 82% sensitivity and 73% specificity for diagnosis of brain inflammatory diseases.

Evaluation of the serum level of osteoprotegerin and bone mineral density in postmenopausal women.

OBJECTIVES: Women might face different issues after menopause. Reduction in bone mineral density (BMD) is one of these problems that put a heavy burden on the healthcare system, especially in developing countries. Studies assume that along with increased age, lack of physical activity and hormonal issues, some other factors might take part in this process. Osteoprotegerin (OPG) is one of the assumed factors. Here we aimed to assess the relation between serum levels of OPG and BMD in postmenopausal women. METHODS: In this prospective cross-sectional study, 90 postmenopausal women were entered. Our cases were divided based on former medical documents into two groups of osteoporotic women (n=45) and healthy women (n=45). All cases were then analyzed using Dual-energy X-ray absorptiometry (DXA) and BMD and T-score were assessed for each case in different sites. Serum levels of OPG were also assessed using Enzyme-linked immunosorbent assay (ELISA). Data were then analyzed using SPSS software. RESULTS: There were higher OPG levels in osteoporotic women compared with healthy women (P<0.001). We also indicated a significant difference in BMD between two groups of postmenopausal women in different sites (i.e. lumbar vertebrae L2-L4, trochanters, femoral neck and hip). We showed there is a reverse relation between serum OPG levels and BMD in lumbar vertebrae (r=-0.4, P=0.002), hip (r=-0.3, P=0.03) and femoral neck (r=-0.3, P=0.02) in both groups. There is a reverse relation between BMD and serum levels of OPG in postmenopausal women. CONCLUSION: OPG levels are higher in osteoporotic women and have a reverse relation with BMD.

Gabapentin versus Pregabalin for management of chronic inflammatory demyelinating polyradiculoneuropathy.

INTRODUCTION: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a chronic autoimmune demyelinating peripheral neuropathy that leads to symmetrical muscular weakness, sensory deficit, hyporeflexia, chronic fatigue, and impaired quality of life (QoL). The current study aims to investigate the effects of gabapentin versus pregabalin on pain, sleep disturbances, and QoL in CIDP patients. METHODS: This clinical trial was conducted on 40 patients diagnosed with CIDP randomly allocated to treatment with 100-500 mg gabapentin (n=20) or 50-300 mg pregabalin (n=20) both co-medicated with 37.5 mg venlafaxine. The dose of gabapentin/pregabalin was adjusted based on the patient's tolerability/response to the treatment. Visual analogue scale (VAS), Pittsburg Sleep Quality Questionnaire and Short Form Health Survey (SF-36) were filled at baseline, within three, six, nine and 12 months after the interventions to assess pain severity, sleep quality and QoL, respectively. The Iranian Registry of Clinical Trials (IRCT) code: IRCT20200217046523N16, https://fa.irct.ir/search/result?query=IRCT20200217046523N16. RESULTS: Gabapentin revealed a dose-dependent efficacy in pain severity (P-value =0.004, r=0.287), sleep quality (P-value <0.001, r=0.387) and QoL (P-value =0.001, r=-0.378), but pregabalin (P-value >0.05). Co-medication of gabapentin plus venlafaxine could significantly improve sleep quality (P-value =0.009) and QoL (P-value =0.004), but pain severity (P-value =0.796). Pregabalin plus venlafaxine showed statistically significant improvement in pain (P-value =0.046), sleep quality (P-value <0.001) and QoL (P-value <0.001). The comparison of the two medications revealed the superiority of pregabalin in pain relief (P-value >0.001) and QoL (P-value =0.03) to pregabalin. CONCLUSION: Based on this study, the co-medication of pregabalin and venlafaxine led to remarkable superior outcomes compared to venlafaxine plus gabapentin in the management of pain, sleep quality, and QoL due to CIDP.

Evaluation of the efficacy of Agicoat in the treatment of partial-thickness skin graft donor sites of burn patients.

INTRODUCTION: Burns is the most common condition that requires extensive skin grafting. Treatment of burns is associated with long hospital stays, expensive medications, multiple surgeries, and long-term rehabilitation. Rapid healing of skin donor areas in partial-thickness burn wounds is important for the patient. Partial-thickness skin grafting is a technique that can reduce healing time and improve the treatment. Nanocrystalline silver contains antibacterial and anti-inflammatory properties. This study aimed to evaluate the efficacy of Agicoat in the treatment of partial-thickness skin graft donor sites of burn patients in terms of healing time, pain and scarring. METHOD: This clinical trial study was performed on 100 patients who burn and were referred to Imam Khomeini Hospital in Tehran from July to January 2020. Patients with second- and third-degree burns who had burned 10 to 30 percent of their body surface and required partial-thickness skin graft surgery, were considered for this study. Each patient was compared to herself. The skin donor site was then randomly divided into three parts A, B and C and each part was dressed with AgicoatTM, Mepitel and Vaseline gauze. On days 4 and 8, the amount of pain when changing the dressing was recorded based on visual analog scale (VAS). After six months, the patients were evaluated and compared for the scarring site based on Vancouver Scar Scale (VSS). RESULT: Comparison of the average healing time between groups showed that the average healing time in both groups was significantly shorter than the Vaseline group (P=0.005). Comparison of wound pain between groups on Day 4 showed that the mean pain in the Agicoat group and also the Mepitel group was significantly lower than the Vaseline group (P=0.004). However, Agicoat and Mepitel groups did not show a significant difference. Also, a comparison of pain between groups on Day 8 and the mean VAS six months after skin graft showed no difference between groups. CONCLUSION: According to the findings of this study, if the Agicoat dressing is cost-effective, it can be a good alternative to cover the wound of the skin donor site, and it heals faster and reduces pain.

Urinary incontinency after radical prostatectomy and effects of 1 month pre-operative biofeedback training.

BACKGROUND: Radical prostatectomy is one of the treatment choices in patients with prostate cancer. Urinary incontinency is a common complication of this surgery that could significantly influence on the quality of life (QOL) in patients. In the present study, we aimed to investigate the effects of pre-operative biofeedback training on this issue. METHODS: This is a randomized controlled clinical trial that was performed in 2017-2021 on 240 patients that were candidates for radical prostatectomy. The demographic data of all patients including age and gender were collected. The patients were randomized into two groups each containing 120 patients. The first group of patients were visited by an experienced physiotherapist and he instructed them in pelvic floor muscle training (Kegel training) using biofeedback technique in a one-hour-long training class for one month before their surgery. The other group received no pelvic floor muscle training instructions. Presence of urinary incontinence was asked from all patients 24 hours, one week, one month, three months and six months after removal of the patients' urinary catheter. We used International Consultation on Incontinence Questionnaire Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) long-form questionnaire to obtain data regarding urinary incontinence. By the means of this questionnaire, we evaluated patient's QOL. RESULTS: The QOL of patients in the intervention group was significantly higher within 1 day, 1 week, 1 month and 3 months after the surgical operations compared to the control group (P<0.05). No significant differences were observed between groups at the 6 months after the surgeries (P>0.05). CONCLUSION: Biofeedback has significant short-term effects on the urinary incontinence immediately after the surgical operation. We also observed that biofeedback had no significant long-term effects.