Salman Abbasi Fard

The efficacy of Cyclosporine-A on Diffuse Axonal Injury after Traumatic Brain Injury

Background: To evaluate the efficacy and side-effects of cyclosporine-A (CsA) in improvement of consciousness and cognitive dysfunction of patients with diffuse axonal injury (DAI) after traumatic brain injury (TBI). Materials and Methods: This study is designed as a randomized double-blind placebo-controlled with 100 patients suffered from DAI. CsA was administered to the intervention group (n = 50) as 5 mg/kg/24 h via 250 ml dextrose water (DW) 5% solution (DW 5%) during the first 8 h after trauma. The control group (n = 50) received only DW 5% in the same course. The presenting Glasgow coma scale in addition to the Glasgow outcome scale-extended (GOS-E) and mini-mental state examination (MMSE) in the 3 rd and 6 th months after trauma were documented. The serum values for complete blood count (CBC), blood urea nitrogen (BUN), creatinine (Cr), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) were checked to assess for complications. Results: Most patients in both groups had type II DAI (46%). There was no significant difference between groups in the GOS-E scores after 3 and 6 months. All participants were in moderate or severe classes of MMSE with no statistically significant difference. Except for the higher BUN level in the cyclosporine treated group, 48 h after admission (P = 0.012), the difference in the level of Cr, AST, ALT, and ALP was not significant and all were in the normal range. The CBC results showed only significant difference for White Blood Cell (WBC) count at 12 h (P = 0.000). Conclusion: The administration of CsA is not effective in the improvement of consciousness and cognitive function. However, it brings about no adverse effects.

Mini Nutritional Assessment (MNA) is Rather a Reliable and Valid Instrument to Assess Nutritional Status in Iranian Healthy Adults and Elderly with a Chronic Disease.

This study aimed to evaluate the usefulness of the Mini Nutritional Assessment (MNA) to assess nutritional status of Iranian population and to compare its psychometric properties between patients suffering from a chronic disease, healthy elderly and younger adults. As a group of elderly with a chronic disease, 143 Parkinson’s disease (PD) patients and as the control group, 467 healthy persons were enrolled. The Persian-translated version of MNA was filled-up through interviews together with anthropometric measurements. Cronbach’s α coefficient of entire MNA was 0.66 and 0.70 in healthy individuals and PD patients, respectively. The total MNA score could significantly discriminate the ones with BMI ≥ 24kg/m2 in both groups. In general, MNA was a valid and reliable tool for nutritional assessment. We acknowledge study limitations including lack of serum measurements and a selection bias towards mild-to-moderate PD. MNA is a more reliable tool in older healthy individuals and rather younger elderly with PD.

The effect of Boswellia Serrata on neurorecovery following diffuse axonal injury

Abstract Objectives: This pilot trial was conducted to establish whether Boswellia Serrata (BS), a traditional herbal medicine, could improve the outcome of patients who have diffuse axonal injury (DAI). Methods: In total, 38 patients with pure DAI were enrolled in this 12-week, double-blind, randomized, cross-over study. The patients were randomly assigned to receive either placebo (group A, n = 20) or BS capsules (group B, n = 18) for 6 weeks and then switched to the other intervention for another 6 weeks. The disability rating scale (DRS) was used to assess the outcome at 2-, 6- and 12-weeks post-trauma. Results: A non-significant trend for improvement of DRS total scores was observed after the use of BS. Regarding the DRS sub-scores, however, there was significant improvement in ‘cognitive ability to self-care’ during the second 6 weeks in group A on BS compared to an insignificant spontaneous recovery in group B during the same period on placebo. Moreover, both groups experienced a close-to-significant increase in the cognitive function-related items of the DRS during the periods they were on BS. The reported adverse events were all of mild quality and had similar frequency between the groups. Conclusion: These results suggest that BS resin does not significantly affect general outcome, but may enhance the cognitive outcome of patients with DAI.

Outcome of Decompressive Craniectomy in Patients With Severe Head Injury: A Pilot Randomized Clinical Trial

Background:Head injury is the most important cause of death caused by trauma. Decompressive craniectomy is the best-known way to reduce otherwise intractable intracranial pressure and its complications in traumatic brain injury. Aim:This aim of this study was to evaluate the outcome of patients with decompressive craniectomy after severe traumatic brain injury and compare with a control group. Setting:Al-Zahra and Kashani hospital in Isfahan. Design:Pilot randomized clinical trial. Methods:Twenty patients were entered in this study. Patients were randomly divided into group A and group B. Group A received surgical and conservative treatment and group B underwent conservative treatment alone. Both groups were then followed for 6 months. Both groups’ presentation Glasgow Coma Scale and Glasgow Outcome Scale (GOS) were compared. Results:A favorable GOS was achieved in 6 cases (60%) of patients in group A and in 2 cases (20%) in group B. However, the difference was not statistically significant. The death rate was higher in group B, with 3 cases (30%), and only 1 patient (10%) died in group A, but the difference was not significant. Conclusions:Decompressive craniectomy seems to be helpful and may lead to a better GOS achievement and improve the mortality rate among traumatic brain injury patients; however, further investigation will be needed to confirm the results.

An intracranial extramedullary hematopoiesis in a 34-year-old man with beta thalassemia: a case report

IntroductionExtramedullary hematopoiesis occurs in approximately 15% of cases of thalassemia. Intracranial deposits of extramedullary hematopoiesis are an extremely rare compensatory process in intermediate and severe thalassemia.Case presentationWe present an unusual case of an intracranial extramedullary hematopoiesis with a choroid plexus origin in a 34-year-old Caucasian man with beta thalassemia intermedia, who presented with the complaints of chronic headache and rapid progressive visual loss.ConclusionAn intracranial extramedullary hematopoiesis, although extremely rare, should be considered as a potential ancillary diagnosis in any thalassemic patient and therefore appropriate studies should be performed to investigate the probable intracranial ectopic marrow before any surgical intervention.

Primary solitary hydatid cyst in paraspinal cervical muscles: a case report and review of the literature

Hydatid disease caused by Echinococcus granulosus and Echinococcus multilocularis commonly presents with pulmonary and hepatic cysts. Primary paraspinal muscle cysts are a rare presentation. We report a case of hydatid cyst within paraspinal muscles presenting with cervical mass and associated pain. The hydatid disease serological test was negative. Neither hepatic nor pulmonary cystic lesions were found. Radiographic findings were unspecific for hydatid cysts. Surgical resection was planned due to the provisional diagnosis of muscular cystic neoplasm. During surgery, a cyst containing a clear liquid was found. The cyst wall was excised and the surgical field was irrigated with hypertonic saline. The patients symptoms resolved by discharge day. Postoperative pathological examinations revealed a muscular hydatid cyst.

Analyzing the effects of intra-operation video-clip display on hemodynamic and satisfaction of patients during lumbar discectomy under spinal anesthesia

Objective: Most neurosurgeons and anesthesiologists prefer the less invasive intervention for most surgeries; recently, the lumbar anesthesia is more popular method. In this study we have tried to distract the attention of the patients to their favorite video-clip instead of their surrounding operating room background to evaluate the hemodynamic as well as their satisfaction during the operation. Methods: 80 patients who were scheduled for an elective one level discectomy under the regional spinal anesthesia enrolled in this prospective randomized clinical trial. The patients were randomized with sealed envelope method and each envelope was randomly assigned from this set of envelops to be either in case group one (video group) or control groups two (no audio and video and only head phone on their ears) group. In all patients, systolic and diastolic blood pressure, pulse rate and SPO2 were measured and recorded in the questionnaire charts. Results: Of the 80 patients with Lumbar disk herniation, 53 patients were male and 27 female. The mean age for all patients was 44 year. Systolic and diastolic blood pressure at the end of surgery was significantly lower in video group (P=0.045 and 0.004). Systolic Blood pressure differences between 3rd and 5th and the end of the surgery with minute zero was significantly less in the video group. (P=0.025, 0.018 and 0.030). Diastolic blood pressure differences between 3rd and 5th and the end of the surgery with minute zero was significantly less in the video group.(P=0.051, 0.019 and 0.15). Pulse rate differences between first, 3rd, 5th and exactly before leaving the recovery room with minute zero was significantly less in the video group. (P=0.015, 0.028, 0.030 and 0.008). Conclusion: According to our study, by displaying patients favorite video clip during the surgical intervention we could highly reduce the patients attention to what is happening in operating room and therefore, decrease their anxiety and stress.

QT Interval Changes in Moderate and Severe Brain Injuries

Backgrounds:Traumatic brain injuries are common mortality causes in many countries. Electrocardiogram (ECG) changes after brain injuries are known, and among them alteration of QT interval is common. The aim of this study was to evaluate QT interval changes in patients suffering from moderate-to-severe brain injuries. Methods:In a descriptive analytical study with 2 retrospective and prospective components, we first evaluated 200 files of patients with moderate-to-severe brain damage who were admitted in Kashani and Alzahra hospitals from 2003 to 2005. Second, 39 patients with moderate-to-severe brain damage admitted at the same hospitals after 2005 were observed for 3 consecutive days by performing serial ECGs. Results:Retrospective study: From the total of 200 patients, 117 were male and 83 were female. There was no statistically significant relationship between sex and computed tomography scan lesions (P>0.05). The mean QT interval in patients who subsequently died was longer, which was statistically significant (P<0.05). A total of 119 patients had prolonged QT interval in the first ECG. Prospective study: From the total of 39 patients, 23 were male and 16 were female. Mean QT intervals in the first, second, and third days were 461, 459, and 453 ms, respectively. They decreased significantly in those undergoing another surgery by the second and third day after the first surgery (P<0.05). Conclusions:It is obvious from this study that in patients with brain injuries QT interval is prolonged and this prolongation has a significant relationship with the Glasgow Coma Scale score and mortality rate. Female patients were more likely to have a prolonged QT interval after brain injury.