Spinal Cord Tumors: A Review of Demographic Characteristics and Treatment Follow-Up of Patients in Isfahan City, Iran.

Background: Given that spinal cord tumors cause damage to the central nervous system, the involvement of body organs, patients' reduced quality of life, and the follow-up of patients should be performed with more sensitivity. Therefore, the present study aimed to determine the demographic characteristics and treatment follow-up of patients with spinal cord tumors. Materials and Methods: The present descriptive-analytical and cross-sectional study investigated all patients with spinal cord tumors in 2022 who visited the Kashani Hospital Isfahan. A total of 31 patients were included in the study using the census sampling method. The data were collected by a checklist and three pain scales, namely the Dennis pain scale, the Frankel Grade classification, and Nurick's grading scales. Results: The present cross-sectional study examined 31 patients with spinal cord tumors who visited the Kashani Hospital in Isfahan. Most spinal cord tumors were ependymoma with nine cases (29%) and neurofibroma with six cases (19.35%). The tumor site was thoracic in 10 cases (33.33%). In the follow-up phase, 31 patients (53.4%) returned to their normal life with full recovery and 10 (17.2%) died. Three (75%) out of four cases of tumor recurrence had ependymoma tumors and one (25%) had astrocytoma. There was a significant difference between the patients' pre- and post-operative pain severity and functional status as the post-operative scores decreased on all three scales. Conclusion: The results may contribute to improve the pre-operative planning, optimization, and monitoring of the patient's recovery after the operation.

The impact of body mass index changes on traumatic brain injury patients' outcomes during hospitalization.

PURPOSE: Obesity is a complex multifactorial disease with increasing prevalence worldwide. The present study was conducted, since there were different results on the effect of obesity on the prognosis of patients with moderate and severe brain trauma, and the issue was less investigated. METHODS: The present descriptive-analytical study was conducted in 2 hospitals, Al-Zahra and Kashani in year 2022. Patients with Glasgow coma scale (GCS) score of 9 - 12 (moderate concussion) and patients with a GCS score of < 8 (severe concussion) who consented to participate in the study were included in the study. Patients who died; had serious injuries related to the chest, abdomen, pelvis, spine, and organs, in addition to the concussion; had a part of their body amputated during the same incident; received medications; or had diseases which caused obesity like diabetes were excluded from the study. Patients' height and weight were extracted for calculating the body mass index (BMI). Their functional independences were measured at admission and discharge according to the Glasgow outcome scale-extended (GOSE) scale. All the data were analyzed in SPSS 26. RESULTS: This study examined a total of 287 traumatic brain injury (TBI) patients (251 with moderate concussion and 36 with severe concussion). In total, 91 (36.3%) patients with moderate TBI had a lower BMI, and 14 (38.9%) patients with severe TBI had a constant BMI. There was a significant difference between the mean changes of BMI and the GOSE, functional independence measure (FIM) motor (p = 0.006), FIM cognitive (p = 0.023), and FIM total scores (p = 0.002) in patients with severe TBI; however, significant difference was found only between the mean changes of BMI, GOSE and FIM motor scores (p = 0.001) in patients with moderate TBI. CONCLUSION: BMI is a risk factor affecting treatment results in patients with TBI, which should be controlled.

Citicoline on the Barthel Index: Severe and moderate brain injury.

INTRODUCTION: Traumatic brain injury (TBI) is a paramount factor in mortality and morbidity. The clinical trials conducted to investigate the efficacy of neuroprotective agents, such as citicoline, as a therapeutic alternative for TBI have presented divergent findings. Therefore, this study aimed to evaluate and compare citicoline's effect on the Barthel Index in patients with severe and moderate brain injury. MATERIALS AND METHODS: The study is a randomized clinical trial. Patients in the case group (35 patients) were treated with citicoline and the control group (34 patients) received a placebo. Data were analyzed using SPSS 16 software. RESULTS: The results showed that changes in the Glasgow Coma Scale, changes in quadriceps muscle force score, Barthel Index score changes, achieving the status without intubation, and spontaneous breathing in patients treated with citicoline were not a statistically significant difference in the two groups (P > 0.05). CONCLUSION: Findings revealed that citicoline did not impact the recovery process of severe and moderate TBI patients.

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.

Basilar Skull Fractures and Their Complications in Patients With Traumatic Brain Injury.

Objective: Since traumatic brain injury is more common in young people, who are the main workforce and builders of society, it is important to consider the effects caused by brain injury on them. In this study, we investigated the clinical manifestations, complications, and prognosis of patients with basilar skull fractures. Methods: This cross-sectional study was conducted from March 2021 to March 2022 at the Kashani Hospital, Esfahan, Iran. Patients with basilar skull fractures were included in this study by census for one year. Recorded patient information was divided into two parts: demographic information, including age and sex, and disease information including loss of consciousness, signs of meningitis, need for surgery, and neurologic examination. Results: In this study, 100 patients were included, of whom 89 were men. The most common complication was pain at the site of the trauma, followed by bruising and bleeding from the site of the trauma. Raccoon eyes and cerebrospinal fluid leakage were observed in 19% and 32% of the patients, respectively. Conclusion: As the occurrence of trauma has an economic burden on the country's health system, we must identify its consequences and problems and prevent its occurrence as much as possible by implementing educational measures.

Comparison between rivaroxaban versus enoxaparin for venous thromboembolism prophylaxis following spine surgeries, a randomized clinical trial.

BACKGROUND: Enoxaparin is currently used for VTE prophylaxis. Rivaroxaban is more cost-effective and is as potent as enoxaparin in VTE prophylaxis. METHODS: The study was held at Al-Zahra and Kashani university hospitals in Isfahan, Iran, from January 2019 to October 2020. Two hundred ninety-six patients requiring instrumented spine surgery were enrolled; 23 were excluded (lack of consent/interfering medical situations). They were randomized into the groups of rivaroxaban (case, n = 137) and enoxaparin receiving (control, n = 136). Medical data were recorded and 244 patients (case = 123, control = 121) were analyzed value < 0.05 was meaningful. RESULTS: 150 patients were males, and 94 were females. The mean age was 52.09 ± 12.6 years. Postoperative drain volume was higher in rivaroxaban received patients than in enoxaparin (p = 0.02). Post-operation epidural hematoma was detected in 3 patients in the case and 1 in the control group, which was not meaningful(p = 0.622). All of them were evacuated surgically. POH was associated with cervical canal stenosis surgery, existing comorbidities, and new medical events. New medical events were associated with postoperative wound dehiscence (p = 0.001). Short and long-term postoperative outcomes were similar in both groups. The mean follow-up duration was 25.8 ± 7.5 months. CONCLUSION: Rivaroxaban is as effective as enoxaparin in venous thromboembolic event prophylaxis. Regarding postoperative epidural hematoma, statistical analysis showed equal safety of both drugs. Still, the authors would like to recommend more discretion in rivaroxaban administration in cervical spine laminectomy until future studies are conducted.

Systemic Sclerosis, Reversible Cerebral Vasoconstriction Syndrome, and NeuroMyelitis Optica in a Patient.

Systemic sclerosis (SSC) is an autoimmune disease of connective tissue and microvasculature mostly caused by autoantibodies. Likewise, neuromyelitis optica (NMO) is a demyelinating disease of the central nervous system correlating with autoantibodies against aquapourin-4. Reversible cerebral vasoconstriction syndrome (RCVS) is a disorder of brain vasculature resembling Raynaud phenomena in SSC. Despite co-occurrence is not rare in autoimmune disorders, the co-occurrence of NMO and SSC is extremely rare. In this case, we report a 35-year-old female presenting with paraplegia one day after discharge from hospital following surgical carnioplasty. She had a history of scleroderma and optic neuritis for which she was treated with high dose glucocorticoids causing renal crisis and RCVS causing intracranial and intracerebral hemorrhage which required a craniotomy to be performed in February 2020. In her recent admission, magnetic resonance imaging of the spinal cord indicated longitudinally extensive transverse myelitis (LETM) and blood tests revealed a highly positive titer of NMO-IgG. Daily plasmapheresis resulted in satisfactory improvement in her condition. This case highlights the importance of evaluating neurologic manifestations in systemic sclerosis patients considering the NMO and RCVS occurrence. Additionally, in concomitant cases, the treatment strategy should be modified regarding the risk of scleroderma renal crisis.

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.

Fatal Case of Mediterranean Spotted Fever Associated with Septic Shock, Iran.

A fatal case of Mediterranean spotted fever associated with septic shock was reported in a 61-year-old man living in a village in southeastern Iran. The patient had a history of tick bite a few days before symptom onset. Phylogenetic analysis confirmed infection by Rickettsia conorii subspecies israelensis.

Comparison of subcutaneous pocket with cryopreservation method for storing autologous bone flaps in developing surgical wound infection after Cranioplasty: A randomized clinical trial.

BACKGROUND: Following a decompressive craniectomy (DC), the harvested bone flap is stored for future cranioplasty. There are two different methods proposed for bone banking, namely subcutaneous pocketing (SP) in the abdominal wall and cryopreservation (CP) in a refrigerator. This study was designed to evaluate the risk of developing infection in each study group. METHODS: In this randomized clinical trial design, a total of 143 patients underwent a primary decompressive craniectomy. Thereafter, they were randomly allocated into two groups, as SP and CP, and they were then scheduled for a future cranioplasty. Next, 108 patients underwent cranioplasty using an autologous bone flap and then followed-up for 18 months. Some variables, including demographic data, indications for primary DC, rate of post-operative clinical infection, bacterial culture results, the interval between craniectomy and cranioplasty, post-operative hospitalization duration, new morbidities, mortality rate, bone flap resorption rate, and several possible associated risk factors, were also recorded. The obtained data were analyzed by an expert bio-statistician using proper bio-statistical methods. A P value < 0.05 was considered as statistically significant. RESULTS: Four patients in the cryopreservation group (n = 50) indicated post-operative bone flap infection (8%), which was statistically significant (P = 0.041). Accordingly, all of them were resulted as positive for Methicillin-Resistant-Staphylococcus aureus (MRSA). Using the subcutaneous pocket method, no post-operative infection was observed after cranioplasty. The overall postoperative infection rate was estimated as 4%. The mean of age in the post-operative infection group's participants was 50.25 years old, and in the non-infected, it was 34.93 years old, which was also significant (P = 0.048). Bone flap resorption (BFR) rate was found to be higher by the use of CP method in comparison to SP technique (p = 0.0001). Of note, no other risk factor was found attributable to a higher BFR rate (p-values > 0.05). CONCLUSIONS: Older age and cryopreservation method at higher storage temperature (-18C˚) may be associated with infection's development after performing cranioplasty. BFR is more prevalent in the use of CP method rather than SP preservation technique.

Seroprevalence of hepatitis B before marriage: a study on marriage candidates in the Southeast of Iran; is it worthy of consideration?

OBJECTIVES: Hepatitis B virus infection is one of the most common causes of acute and chronic hepatitis worldwide. Furthermore, since most people with hepatitis B virus are asymptomatic, timely diagnosis is important for prevention. This study has evaluated the prevalence of Hepatitis B seromarkers in marriage candidates. DESIGN: In this Cross-sectional study, 370 marriage volunteers selected by the simple sampling method were investigated in 2011 - 2012. RESULTS: A total of 185 men and 185 women were investigated. Mean Age of participants was 24.7 years. The prevalence rates of hepatitis B surface antigen (HBsAg), anti hepatitis B surface antibody (anti-HBs) and anti-hepatitis B core antibody (anti-HBc) were 1.1%, 47.6% and 8.9% respectively. Frequency of HBsAg was 0.5% and 1.6% in men and women respectively. The prevalence of anti-HBs was 43.8% in men and 51.45% in women. Anti-HBs was more common in young people and those with higher levels of education and positive history of vaccination. The prevalence of anti-HBc was 8.1% and 9.7% in men and women respectively. CONCLUSION: Although Kerman is a low endemic area, due to the high risk of transmission to the spouse and offspring, screening for HBV study before marriage is recommended.

Challenges in the Area of Training and Prevention at the HIV Triangulation Clinic, Kerman, Iran.

BACKGROUND: Since 2000, Iran has been delivering training and treatment services, including methadone therapy, to human immunodeficiency virus (HIV) positive patients through triangular clinics. This study aims to evaluate the effectiveness of these activities at the HIV Triangulation Centre in the city of Kerman, Iran, through clients' views. METHODS: Participants were recruited using a convenience sample and assessed through in-depth interviews, and observations. Data were analyzed using a thematic analysis, matrix based method. FINDINGS: The results found problems in training and counseling which was described by the staff to be due to the effects of the economic difficulties of the clients, not being of the same sex as the consultant, and lack of utilization of a variety of training methods by the clients. Furthermore, the absorption of clients was perceived as being affected by the appearance of the center, gossip around the center, limited working hours, and interpersonal relations between clients and staff. The clients also criticized the building of the center as it failed to maintain anonymity of the patients. The need for supplementary services, such as dentistry, was perceived by many clients. CONCLUSION: The application of appropriate strategies such as providing adequate training and removing the obstacles of absorption should be taken into account to increase the utility and coverage of the triangular clinic. These interventions could be a range of activities, such as relocating the center to a more decent place and encouraging the staff to appear in a professional white coat to help gain the trust of clients.

Spironolactone in preventing hypokalemia following traumatic brain injury.

OBJECTIVE: Hypokalemia is a frequent complication observed after traumatic brain injury (TBI). We evaluated the effect of spironolactone on preventing hypokalemia following moderate to severe TBI. METHODS: Patients with moderate to severe TBI, whose Glasgow Coma Scale (GCS) scores of 9-12 and less than 9, respectively, were equally randomized into intervention and control groups, matching with severity of trauma and baseline serum level of potassium. For the intervention group, we administrated spironolactone (1 mg/kg per day) on the second day of admission or the first day of gavage tolerance and continued it for seven days. No additional intervention was done for controls. Hypokalemia (mild: 3-3.5 mg/L, moderate: 2.5-3 mg/L, and severe: less than 2.5 mg/L serum K+) and other electrolyte abnormalities were compared between the two groups at the end of the intervention. RESULTS: Sixty-eight patients (58 males and 10 females) were included with mean age equal to (33.1+/-11.8) years, and GCS equal to 7.6+/-2.8. The two groups were similar in baseline characteristics. Patients who received spironolactone were significantly less likely to experience mild, moderate, or severe hypokalemia (8.8%, 2.9%, and 0) compared with controls (29.4%, 11.7%, and 2.9%, respectively, P less than 0.05). No significant difference was observed between the two groups in the occurrence of other electrolyte abnormalities, hyperglycemia or oliguria. CONCLUSION: Spironolactone within the first week of head injury could prevent the occurrence of late hypokalemia with no severe side effects.

Low-threshold bistability in nonlinear microring tower resonator.

Microring tower resonators, which are a chain of microring resonators stacked on top of each other, are of great interest for nonlinear optics due to their unique features such as very high compactness, coupling efficiency and quality factor. In this research, we investigate the optical bistability in microring tower (MRT) with Kerr nonlinearity by using the coupled mode theory, and demonstrate how a proper defect into the structure can lead to low threshold bistability. In particular, we observed optical bistability in nonlinear defect modes with switching power as low as 165 µW through numerical calculations in a structure with a overall loss on the order of 0.01 mm. In addition, we also develop an analytical model that excellently gives the position of defect modes in linear regime.

Linear transmission properties of a vertically stacked multiring resonator with a defect.

The linear characteristics of a vertically stacked multiring resonator (VMR) that can support a photonic bandgap with a defect located at the middle of the structure are investigated numerically. Initially, the spectral transfer characteristics of the uniform structure are studied. Then, the transmission properties of the VMR structure possessing a defect are investigated. The defect is realized by varying the waveguide width of one of the rings in the VMR chain. Finally, the existence of defect modes in the linear periodic array is numerically demonstrated by solving the corresponding coupled wave equations. Numerical results predict a high quality factor (Q) of up to 1.6x10(5) for this microcavity. We also show that our microcavity has a good insensitivity of quality factor to geometric imperfections.