Effect of low fibrinogen level on in-hospital mortality and 6-month functional outcome of TBI patients, a single center experience.

In patients affected by traumatic brain injury (TBI), hypofibrinogenemia within the initial hours of trauma can be expected due to vascular and inflammatory changes. In this study, we aimed to evaluate the effect of hypofibrinogenemia on the in-hospital mortality and 6-month functional outcomes of TBI patients, admitted to Rajaee Hospital, a referral trauma center in Shiraz, Iran. This study included all TBI patients admitted to our center who had no prior history of coagulopathy or any systemic disease, were alive on arrival, and had not received any blood product before admission. On admission, hospitalization, imaging, and 6-month follow-up information of included patients were extracted from the TBI registry database. The baseline characteristics of patients with fibrinogen levels of less than 150 mg/dL were compared with the cases with higher levels. To assess the effect of low fibrinogen levels on in-hospital mortality, a uni- and multivariate was conducted between those who died in hospital and survivors. Based on the 6-month GOSE score of patients, those with GOSE < 4 (unfavorable outcome) were compared with those with a favorable outcome. A total of 3049 patients (84.3% male, 15.7% female), with a mean age of 39.25 ± 18.87, met the eligibility criteria of this study. 494 patients had fibrinogen levels < 150 mg/dl, who were mostly younger and had lower average GCS scores in comparison to cases with higher fibrinogen levels. By comparison of the patients who died during hospitalization and survivors, it was shown that fibrinogen < 150 mg/dl is among the prognostic factors for in-hospital mortality (OR:1.75, CI: 1.32:2.34, P-value < 0.001), while the comparison between patients with the favorable and unfavorable functional outcome at 6-month follow-up, was not in favor of prognostic effect of low fibrinogen level (OR: 0.80, CI: 0.58: 1.11, P-value: 0.19). Hypofibrinogenemia is associated with in-hospital mortality of TBI patients, along with known factors such as higher age and lower initial GCS score. However, it is not among the prognostic factors of midterm functional outcome.

Impact of treadmill running on distal femoral cartilage thickness: a cross-sectional study of professional athletes and healthy controls.

PURPOSE: This present study aimed to assess the impact of treadmill running on distal femoral cartilage thickness. METHODS: Professional athletes aged 20 to 40 years with a history of treadmill running (minimum 75 min per week for the past three months or more) and age-, sex-, and body mass index (BMI)-matched healthy controls were recruited. Demographics and clinical features of participants were recorded. Athletes were divided into subgroup 1 with less than 12 months of treadmill running and subgroup 2 with 12 months or more of treadmill running. Distal femoral cartilage thicknesses were measured at the midpoints of the right medial condyle (RMC), right intercondylar area (RIA), right lateral condyle (RLC), left medial condyle (LMC), left intercondylar area (LIA), and left lateral condyle (LLC) via ultrasonography. RESULT: A total of 72 athletes (mean age: 29.6 ± 6.6 years) and 72 controls (mean age: 31.9 ± 6.7 years) were enrolled. Athletes had significantly thinner cartilages in the RLC (2.21 ± 0.38 vs. 2.39 ± 0.31 cm, p = 0.002), LLC (2.28 ± 0.37 vs. 2.46 ± 0.35 cm, p = 0.004), and LMC (2.28 ± 0.42 vs. 2.42 ± 0.36 cm, p = 0.039) compared with the control group. Furthermore, cartilage thickness was significantly thinner in subgroup 2 athletes compared with the control group in the RLC (2.13 ± 0.34 vs. 2.39 ± 0.31 cm, p = 0.001), LLC (2.22 ± 0.31 vs. 2.46 ± 0.35 cm, p = 0.005), and LMC (2.21 ± 0.46 vs. 2.42 ± 0.36 cm, p = 0.027); however, subgroup 1 athletes did not have such differences. There was a weak negative correlation between total months of treadmill running and cartilage thickness in the RLC (r = - 0.0236, p = 0.046) and LLC (r = - 0.0233, p = 0.049). No significant correlation was found between the distal femoral cartilage thickness at different sites and the patients' demographic features, including age, BMI, speed and incline of treadmill running, and minutes of running per session and week (p > 0.05). CONCLUSION: Compared with healthy controls, professional athletes with a history of long-term high-intensity treadmill running had thinner femoral cartilages. The duration (months) of treadmill running was weakly negatively correlated with distal femoral cartilage thickness. Longitudinal studies with prolonged follow-ups are needed to clarify how treadmill running affects femoral cartilage thickness in athletes.

Development of a Novel Neurological Score Combining GCS and FOUR Scales for Assessment of Neurosurgical Patients with Traumatic Brain Injury: GCS-FOUR Scale.

BACKGROUND: Consciousness assessment is crucial for patients with traumatic brain injury. In this study, we developed a novel scoring system combining the Glasgow coma scale (GCS) and the full outline of unresponsiveness (FOUR) and evaluated its association with the intensive care unit (ICU) length of stay, mortality, and functional outcome. METHODS: We retrospectively analyzed the data from patients with traumatic brain injury admitted to the neurosurgical ICU of our institution during a 2-year period. The eye and motor components of the GCS and the brainstem reflex component of the FOUR were used to compute the GCS-FOUR. We performed statistical analysis to demonstrate the association between the GCS, FOUR, and GCS-FOUR and the ICU length of stay, mortality, the development of a persistent vegetative state, and desirable recovery. RESULTS: A total of 140 patients were included. The mean age was 30.6 years, and 89.3% were male. All 3 scores were associated with the ICU length of stay, mortality, a persistent vegetative state, and good recovery. In terms of predicting mortality, the GCS score exhibited a slight superiority compared with the other indexes, and the GCS-FOUR score showed a slight superiority over the other indexes in predicting for good recovery. CONCLUSIONS: The GCS-FOUR is a novel scoring system comparable to the GCS and FOUR regarding its association with functional status after injury, ICU length of stay, and mortality. The GCS-FOUR score provides greater neurological detail than the GCS due to the inclusion of brainstem reflexes, in addition to using the experience of healthcare providers with the GCS score compared with the FOUR in most settings.

Correlation Between Pituitary Adenoma Surgery and Anxiety Disorder: Systematic Review and Meta-Analysis.

OBJECTIVE: This study aims to evaluate the impact of surgical intervention on anxiety levels in patients with various types of pituitary adenoma (PA). METHOD: A systematic review was conducted following PRISMA guidelines until October 2022, searching Embase, PubMed, Web of Sciences, and Scopus. RESULTS: A total of 32 studies were included, encompassing 2,681 patients with the mean age of 53.33 ± 6.48 years (43.4% male). Among all subtypes, 664 diagnosed with Cushing's disease (25.8%), 612 with acromegaly (23.8%), 282 with prolactinoma (10.9%), and 969 with nonfunctional pituitary adenomas (37.6%). Pituitary insufficiency was the most common complication. Considering therapeutic modalities, 515 patients (29.8%) underwent endoscopic trans-sphenoidal surgery, while 222 (12.9%) underwent microscopic trans-sphenoidal surgery. The type of trans-sphenoidal surgery was not specified in 977 (56.6%) patients. A total of 17 studies including 1510 patients which mostly assessed anxiety using the Hospital Anxiety and Depression Scale (HADS) and Zung Self-Rating Anxiety Scale (SAS) were included in the meta-analysis. Preoperative evaluation using Hospital Anxiety and Depression Scale (HADS) questionnaire showed a pooled score of 8.27 (95%CI 4.54-12.01), while postoperative evaluation yielded a pooled score of 6.49 (95%CI 5.35-7.63), indicating no significant difference. Preoperative SAS assessment resulted in a pooled score of 50.43 (95%CI 37.40-63.45), with postoperative pooled score of 55.91 (95%CI 49.40-62.41), showing no significant difference. CONCLUSIONS: Our analysis revealed no significant difference in anxiety scores pre- and postoperatively. While our findings suggest stability in anxiety levels following surgical intervention, it is imperative to recognize the limitations of the current evidence base. The observed lack of consensus may be influenced by factors such as the heterogeneous nature of the patient population, variations in the characteristics of pituitary adenomas, diverse therapeutic approaches, and potential confounding variables such as pre-existing mental health conditions and coping mechanisms. Further research is warranted to elucidate the nuanced relationship between surgical intervention for PA and anxiety outcomes, considering these complex interactions and employing rigorous methodologies to address potential sources of bias.