Actitudes sexuales de acuerdo con el nivel de severidad del trauma craneoencefálico / Sexual attitudes according to the level of severity of the cranioencephalic trauma

El objetivo de esta investigación fue analizar la actitud hacia la sexualidad en pacientes con antecedentes de trauma craneoencefálico (TCE), de acuerdo al nivel de severidad presentado. Método: se llevó a cabo un estudio de tipo descriptivo en una muestra de 126 personas, con edades comprendidas entre los 18 y 49 años, con antecedente de trauma craneoencefálico leve, moderado y severo, a quienes se les aplicó la Escala de Actitudes hacia la Sexualidad Ampliada (ATSS) y una encuesta de actitudes hacia la sexualidad. Resultados: se encontró que la mayoría de los participantes manifestaron haber sufrido cambios en su sexualidad tras el TCE, caracterizados por la disminución de la frecuencia de las relaciones y el deseo sexual, sin embargo, evidencian una actitud positiva frente a la sexualidad. Conclusiones: si bien la sexualidad es considerada importante por los participantes del estudio, no se evidenció una conducta tendiente a la erotofilia. No se encontraron diferencias significativas respecto al nivel de severidad del trauma craneoencefálico

The objective of this research was to analyze the attitude towards sexuality in patients with a history of cranioencephalic trauma (TCE), according to the level of severity presented. Method: a descriptive study was carried out in a sample of 126 people, aged between 18 and 49 years, with a history of mild, moderate, and severe head trauma, to whom the Scale of Attitudes towards Extended Sexuality -ATSS and a Survey of Attitudes towards Sexuality were applied. Results: it was found that most of the participants reported having suffered changes in their sexuality after TCE, characterized by a decrease in the frequency of relationships and sexual desire, however, they show a positive attitude towards sexuality. Conclusions: although sexuality is considered important by the study participants, there was no evidence of behavior tending to erotophilia. No significant differences were found regarding the level of severity of cranioencephalic trauma

Head and neck burns are associated with long-term patient-reported dissatisfaction with appearance: A Burn Model System National Database study.

INTRODUCTION: Burns affecting the head and neck (H&N) can lead to significant changes in appearance. It is postulated that such injuries have a negative impact on patients' social functioning, quality of life, physical health, and satisfaction with appearance, but there has been little investigation of these effects using patient reported outcome measures. This study evaluates the effect of H&N burns on long-term patient reported outcomes compared to patients who sustained burns to other areas. METHODS: Data from the National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System National Database collected between 1996 and 2015 were used to investigate differences in outcomes between those with and without H&N burns. Demographic and clinical characteristics for adult burn survivors with and without H&N burns were compared. The following patient-reported outcome measures, collected at 6, 12, and 24 months after injury, were examined: satisfaction with life (SWL), community integration questionnaire (CIQ), satisfaction with appearance (SWAP), short form-12 physical component score (SF-12 PCS), and short form-12 mental component score (SF-12 MCS). Mixed regression model analyses were used to examine the associations between H&N burns and each outcome measure, controlling for medical and demographic characteristics. RESULTS: A total of 697 adults (373 with H&N burns; 324 without H&N burns) were included in the analyses. Over 75% of H&N injuries resulted from a fire/flame burn and those with H&N burns had significantly larger burn size (p<0.001). In the mixed model regression analyses, SWAP and SF-12 MCS were significantly worse for adults with H&N burns compared to those with non-H&N burns (p<0.01). There were no significant differences between SWL, CIQ, and SF-12 PCS. CONCLUSIONS: Survivors with H&N burns demonstrated community integration, physical health, and satisfaction with life outcomes similar to those of survivors with non-H&N burns. Scores in these domains improved over time. However, survivors with H&N burns demonstrated worse satisfaction with their appearance. These results suggest that strategies to address satisfaction with appearance, such as reconstructive surgery, cognitive behavior therapy, and social skills training, are an area of need for survivors with H&N burns.

Craniofacial Trauma Is Associated With Significant Psychosocial Morbidity 1 Year Post-Injury.

PURPOSE: The face and head play critical roles in one's sense of self and body image; as such, facial, head, and scalp injuries and potential associated disfigurement can lead to particular difficulties in coping. This study examined the psychosocial outcomes of patients with craniofacial (CF) trauma 1 year after injury and compared these outcomes with those of other traumatically injured patients who did not sustain such injuries. It was hypothesized that participants in the CF injury group would have worse outcomes than those without CF trauma. MATERIALS AND METHODS: This prospective longitudinal study included patients at least 18 years of age admitted to the trauma service of a level I trauma center for at least 24 hours. Demographic and injury-related variables were collected. CF injury was determined by International Classification of Diseases, Ninth Revision codes. Outcomes were measured at baseline and at 12 months and included depression, post-traumatic stress disorder (PTSD), alcohol use, and pain severity. Paired t tests and logistic regression were used for analysis. RESULTS: Fifteen percent (n = 35) of the study sample (N = 230) had CF injuries. Those with CF injuries had lower income, higher injury severity, and higher intensive care unit admission rates. The CF and non-CF trauma groups did not differ in rates of depression or PTSD at either time point. However, participants with CF trauma had higher odds of risky alcohol use than those without CF trauma at baseline and lower odds of a higher pain severity score at baseline and 12 months. CONCLUSIONS: The groups did not differ in depression and PTSD. However, rates of depression, PTSD, alcohol use, and physical pain were higher than expected for the 2 groups. Given the high rate of psychological morbidity found after CF trauma, patients with these injuries should be screened for symptoms soon after injury and provided with resources for treatment.

Nicotine-Induced Conditional Place Preference Is Affected by Head Injury: Correlation with Dopamine Release in the Nucleus Accumbens Shell.

Background: Traumatic brain injury is known to impact dopamine-mediated reward pathways, but the underlying mechanisms have not been fully established. Methods: Nicotine-induced conditional place preference was used to study rats exposed to a 6-psi fluid percussion injury with and without prior exposure to nicotine. Preference was quantified as a score defined as (C1 - C2) / (C1 + C2), where C1 is time in the nicotine-paired compartment and C2 is time in the saline-paired compartment. Subsequent fast-scan cyclic voltammetry was used to analyze the impact of nicotine infusion on dopamine release in the shell portion of the nucleus accumbens. To further determine the influence of brain injury on nicotine withdrawal, nicotine infusion was administered to the rats after fluid percussion injury. The effects of fluid percussion injury on conditional place preference after prior exposure to nicotine and abstinence or withdrawal from nicotine were also assessed. Results: After traumatic brain injury, dopamine release was reduced in the nucleus accumbens shell, and nicotine-induced conditional place preference preference was significantly impaired. Preference scores of control, sham-injured, and fluid percussion injury groups were 0.1627±0.04204, 0.1515±0.03806, and -0.001300±0.04286, respectively. Nicotine-induced conditional place preference was also seen in animals after nicotine pretreatment, with a conditional place preference score of 0.07805±0.02838. Nicotine preexposure substantially increased tonic dopamine release in sham-injured animals, but it did not change phasic release; nicotine exposure after fluid percussion injury enhanced phasic release, though not to the same levels seen in sham-injured rats. Conditioned preference was related not only to phasic dopamine release (r=0.8110) but also to the difference between tonic and phasic dopamine levels (r=0.9521). Conclusions: Traumatic brain injury suppresses dopamine release from the shell portion of the nucleus accumbens, which in turn significantly alters reward-seeking behavior. These results have important implications for tobacco and drug use after traumatic brain injury.

Headache following head injury: a population-based longitudinal cohort study (HUNT).

BACKGROUND: Headache is the most frequent symptom following head injury, but long-term follow-up of headache after head injury entails methodological challenges. In a population-based cohort study, we explored whether subjects hospitalized due to a head injury more often developed a new headache or experienced exacerbation of previously reported headache compared to the surrounding population. METHODS: This population-based historical cohort study included headache data from two large epidemiological surveys performed with an 11-year interval. This was linked with data from hospital records on exposure to head injury occurring between the health surveys. Participants in the surveys who had not been hospitalized because of a head injury comprised the control group. The head injuries were classified according to the Head Injury Severity Scale (HISS). Multinomial logistic regression was performed to investigate the association between head injury and new headache or exacerbation of pre-existing headache in a population with known pre-injury headache status, controlling for potential confounders. RESULTS: The exposed group consisted of 294 individuals and the control group of 25,662 individuals. In multivariate analyses, adjusting for age, sex, anxiety, depression, education level, smoking and alcohol use, mild head injury increased the risk of new onset headache suffering (OR 1.74, 95% CI 1.05-2.87), stable headache suffering (OR 1.70, 95% CI 1.15-2.50) and exacerbation of previously reported headache (OR 1.93, 95% CI 1.24-3.02). The reference category was participants without headache in both surveys. CONCLUSION: Individuals hospitalized due to a head injury were more likely to have new onset and worsening of pre-existing headache and persistent headache, compared to the surrounding general population. The results support the entity of the ICHD-3 beta diagnosis "persistent headache attributed to traumatic injury to the head".

Investigating structural and perfusion deficits due to repeated head trauma in active professional fighters.

Repeated head trauma experienced by active professional fighters results in various structural, functional and perfusion damage. However, whether there are common regions of structural and perfusion damage due to fighting and whether these structural and perfusion differences are associated with neuropsychological measurements in active professional fighters is still unknown. To that end, T1-weighted and pseudocontinuous arterial spin labeling MRI on a group of healthy controls and active professional fighters were acquired. Voxelwise group comparisons, in a univariate and multivariate sense, were performed to investigate differences in gray and white matter density (GMD, WMD) and cerebral blood flow (CBF) between the two groups. A significantly positive association between global GMD and WMD was obtained with psychomotor speed and reaction time, respectively, in our cohort of active professional fighters. In addition, regional WMD deficit was observed in a cluster encompassing bilateral pons, hippocampus, and thalamus in fighters (0.49 ± 0.04 arbitrary units (a.u.)) as compared to controls (0.51 ± 0.05a.u.). WMD in the cluster of active fighters was also significantly associated with reaction time. Significantly lower CBF was observed in right inferior temporal lobe with both partial volume corrected (46.9 ± 14.93 ml/100 g/min) and non-partial volume corrected CBF maps (25.91 ± 7.99 ml/100 g/min) in professional fighters, as compared to controls (65.45 ± 22.24 ml/100 g/min and 35.22 ± 12.18 ml/100 g/min respectively). A paradoxical increase in CBF accompanying right cerebellum and fusiform gyrus in the active professional fighters (29.52 ± 13.03 ml/100 g/min) as compared to controls (19.43 ± 12.56 ml/100 g/min) was observed with non-partial volume corrected CBF maps. Multivariate analysis with both structural and perfusion measurements found the same clusters as univariate analysis in addition to a cluster in right precuneus. Both partial volume corrected and non-partial volume corrected CBF of the cluster in the thalamus had a significantly positive association with the number of fights. In addition, GMD of the cluster in right precuneus was significantly associated with psychomotor speed in our cohort of active professional fighters. Our results suggest a heterogeneous pattern of structural and CBF deficits due to repeated head trauma in active professional fighters. This finding indicates that investigating both structural and CBF changes in the same set of participants may help to understand the pathophysiology and progression of cognitive decline due to repeated head trauma.

The effect of cranioplasty following decompressive craniectomy on cerebral blood perfusion, neurological, and cognitive outcome.

OBJECTIVE Decompressive craniectomy is an established therapy for refractory intracranial hypertension. Cranioplasty following decompressive craniectomy not only provides protection to the brain along with cosmetic benefits, but also enhances rehabilitation with meaningful functional recovery of potentially reversible cortical and subcortical damaged areas of the affected as well as the contralateral hemisphere. The aim of the study was to assess neurological and cognitive outcome as well as cerebral blood flow after cranioplasty. METHODS Thirty-four patients admitted for replacement cranioplasty after decompressive craniectomy for head injury were studied prospectively. Clinical, neurological, and cognitive outcomes were assessed by the Glasgow Outcome Scale (GOS), the Glasgow Coma Scale, and a battery of cognitive tests, respectively. Simultaneously, cerebral blood perfusion was assessed by technetium-99m ethyl cysteinate dimer (99mTc-ECD) brain SPECT imaging 7 days prior to and 3 months after cranioplasty. RESULTS Prior to cranioplasty 9 patients (26.5%) had GOS scores of 5 and 25 patients (73.5%) had GOS scores of 4, whereas postcranioplasty all 34 patients (100%) improved to GOS scores of 5. Approximately 35.3%-90.9% patients showed cognitive improvement postcranioplasty in various tests. Also, on comparison with brain SPECT, 94% of patients showed improvement in cerebral perfusion in different lobes. CONCLUSIONS Cranioplasty remarkably improves neurological and cognitive outcomes supported by improvement in cerebral blood perfusion.

Children presenting in delayed fashion after minor head trauma with scalp swelling: do they require further workup?

PURPOSE: It is common to evaluate children who have sustained minor head trauma with computed tomography (CT) of the head. Scalp swelling, in particular, has been associated with intracranial injury. A subset of patients, however, present in delayed fashion, often days after the head trauma, as soft tissue edema progresses and their caregiver notices scalp swelling. We explore the value of further workup in this setting. METHODS: We conducted a retrospective review of a prospectively collected cohort of children ≤24 months of age presenting to the Texas Children's Hospital with scalp swelling more than 24 h following a head trauma. Cases were collected over a 2-year study period from June 1, 2014 to May 31, 2016. RESULTS: Seventy-six patients comprising 78 patient encounters were included in our study. The mean age at presentation was 8.8 months (range 3 days-24 months). All patients had noncontrast CT of the head as part of their evaluation by emergency medicine, as well as screening for nonaccidental trauma (NAT) by the Child Protection Team. The most common finding on CT head was a linear/nondisplaced skull fracture (SF) with associated extra-axial hemorrhage (epidural or subdural hematoma), which was found in 31/78 patient encounters (40%). Of all 78 patient encounters, 43 patients (55%) were discharged from the emergency room (ER), 17 patients (22%) were admitted for neurologic monitoring, and 18 patients (23%) were admitted solely to allow further NAT evaluation. Of those patients admitted, none experienced a neurologic decline and all had nonfocal neurologic exams on discharge. No patient returned to the ER in delayed fashion for a neurologic decline. Of all the patient encounters, no patient required surgery. CONCLUSIONS: Pediatric patients ≤24 months of age presenting to the ER in delayed fashion with scalp swelling after minor head trauma-who were otherwise nonfocal on examination-did not require surgical intervention and did not experience any neurologic decline. Further radiographic investigation did not alter neurosurgical management in these patients; however, it should be noted that workup for child abuse and social care may have been influenced by CT findings, suggesting the need for the future development of a clinical decision-making tool to help safely avoid CT imaging in this setting.

Taste Quality Confusions: Influences of Age, Smoking, PTC Taster Status, and other Subject Characteristics.

Many persons misidentify the quality of taste stimuli, a phenomenon termed "taste confusion." In this study of 1000 persons, we examined the influences of age, sex, causes of chemosensory disturbances, and genetically determined phenylthiocarbamide (PTC) taster status on taste quality confusions for four tastants (sucrose, citric acid, sodium chloride, caffeine). Overall, sour-bitter confusions were most common (19.3%), followed by bitter-sour (11.4%), salty-bitter (7.3%), salty-sour (7.0%), bitter-salty (3.5%), bitter-sweet (3.4), and sour-salty (2.4%) confusions. Confusions for sweet were <1%. Asymmetries were common (e.g., bitter-sour confusions were less frequent than sour-bitter confusions). Women had fewer salty-bitter confusions than did men (5.7% vs. 11.4%). Overall, PTC tasters had fewer confusions than non-tasters except for salty-bitter confusions. Confusions typically increased monotonically with age. Current smokers exhibited more sour-bitter confusions than never smokers (48.9% vs. 32.2%), whereas past smokers had more bitter-sour confusions than never smokers (23.8% vs. 14.2%). Previous head trauma was associated with higher bitter-salty and salty-bitter confusions relative to those of some other etiologies. This study demonstrates, for the first time, that multiple subject factors influence taste confusions and, along with literature accounts, supports the view that there are both biological and psychological determinants of taste quality confusions.

Déficits primários e secundários de funções executivas pós-TCE: análise de dissociações / Primary and secondary executive function deficits following TBI: analysis of dissociations

Este estudo avaliou as associações e dissociações encontradas entre déficits de memória episódica em relação aos de funções executivas e verificou se estes déficits encontrados eram primários ou secundários. Os 81 pacientes pós-Traumatismo Cranioencefálico (TCE) foram avaliados por meio do Teste de Aprendizagem Auditivo-Verbal de Rey e do Teste Hayling. Os resultados sugerem que prejuízo na velocidade de controle inibitório pode contribuir para déficit na memória episódica e que as velocidades de iniciação e inibição parecem ser complementares, mas a primeira precede a segunda. Nossos achados ressaltam que os prejuízos executivos provavelmente sejam primários em nossa amostra de pacientes pós-TCE e que estes prejuízos podem causar déficits na memória episódica

The present study evaluated the presence of associations and dissociations between impairments in episodic memory and executive functions in patients with traumatic brain injury (TBI), and verified whether these deficits were primary or secondary. Eighty-one patients with TBI were assessed using the Rey Auditory Verbal Learning Test and the Hayling Test. The results suggest that impairments in inhibition speed may contribute to deficits in episodic memory, and that initiation and inhibition abilities may be complementary and the first precedes the second. Our findings highlighted that primary executive impairment following TBI may lead to episodic memory deficits

Análisis neuropsicológico de un caso con alteración de la función ejecutiva / Neuropsychological analysis of a case with alteration of executive function

Producto de un traumatismo craneoencefálico un individuo puede perder capacidades mentales previamente adquiridas, una de ellas es la función ejecutiva. Ésta es conceptualizada como un grupo de habilidades mentales que permiten a un ser humano evidenciar un comportamiento eficaz dentro de parámetros socialmente aceptados. Estas habilidades han sido descritas como la inhibición, memoria operativa, flexibilidad mental, regulación emocional, monitorización; entre otras. En el presente artículo se revisa un caso clínico que producto de un traumatismo craneoencefálico frontal presenta un cuadro de alteración de su función ejecutiva. En el análisis del caso se toma en consideración teorías clásicas en la neuropsicología sobre el funcionamiento cerebral que permitirán comprender de forma clara qué sucede actualmente con el paciente...

How are you really feeling? A prospective evaluation of cognitive function following trauma.

BACKGROUND: Mild traumatic brain injury is associated with persistent cognitive difficulties. However, these symptoms may not be specific to the head injury itself. We sought to evaluate the prevalence of these symptoms in patients following trauma. METHODS: A prospective analysis of patients who were seen in the outpatient trauma clinic during a 20-month period and completed self-administered Rivermead Post-Concussion Symptoms Questionnaire was conducted. "Significant" difficulty with cognition was defined by two or more symptoms reported as severe or four or more symptoms reported as moderate. Head injury was defined as head Abbreviated Injury Scale (AIS) score greater than 0, including the diagnosis of concussion. Multivariable logistic regression was used to test associations between head injury, injury severity, sex, and age with significant cognitive difficulties, loss of work/school, and unmet physical, occupational, or psychological therapy needs. RESULTS: A total of 587 completed questionnaires were matched to trauma registry admissions (382 early, 111 mid, 86 late). The incidence of significant cognitive difficulties was 37% at less than 1 month, 40% at 1 month to 3 months, and 45% of patients at more than 3 months following injury. Head injury was not associated with increased odds for significant cognitive difficulties (adjusted odds ratio, 1.21; 95% confidence interval, 0.82-1.77; p = 0.3) There was no significant difference in symptoms in patients who carried a head injury diagnosis and those who did not. CONCLUSION: Cognitive problems occur frequently following injury even in the absence of a head injury diagnosis. Either mild traumatic brain injury is grossly underdiagnosed or these symptoms are not specific to postconcussive states and simply are the cognitive sequelae of traumatic injury. The reporting of moderate-to-severe symptoms suggests a need to better understand the effects of trauma on cognitive function and strongly suggests that services for these patients are badly needed to maximize cognitive function and return to preinjury quality of life. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level II.

[Comparative analysis of gerontologic prophylaxis efficiency and membranotropic action of various gas therapy].

The research was executed on 320 male patients aged 35-92 years with various polyorgan pathology in a compensation stage. The treatment by gases was used: hyperbaric oxygenation, dry carbonic acid baths, ozon therapy, hypo oxygen therapy and their combinations. On indicators of biological age various age-dependent geroprophylactics effect of gas therapy was established. On indicators of resistance of erythrocytes various safety of used modes was found.

Helmet use is associated with safer bicycling behaviors and reduced hospital resource use following injury.

BACKGROUND: While the efficacy of helmet use in the prevention of head injury is well described, helmet use as it relates to bicyclists' behaviors and hospital resource use following injury is less defined. The objective of this study was to compare the demographics, behaviors, hospital workups, and outcomes of bicyclists based on helmet use. METHODS: This study was a subset analysis of a 2.5-year prospective cohort study of vulnerable roadway users conducted at Bellevue Hospital Center, a New York City Level 1 trauma center. All bicyclists with known helmet status were included. Demographics, insurance type, traffic law compliance, alcohol use, Glasgow Coma Scale (GCS) score, initial imaging studies, Abbreviated Injury Scale (AIS) score, Injury Severity Score (ISS), admission status, length of stay, disposition, and mortality were assessed. Information was obtained primarily from patients; witnesses and first responders provided additional information. RESULTS: Of 374 patients, 113 (30.2%) were wearing helmets. White bicyclists were more likely to wear helmets; black bicyclists were less likely (p = 0.037). Patients with private insurance were more likely to wear helmets, those with Medicaid or no insurance were less likely (p = 0.027). Helmeted bicyclists were more likely to ride with the flow of traffic (97.2%) and within bike lanes (83.7%) (p < 0.001 and p = 0.013, respectively). Nonhelmeted bicyclists were more likely to ride against traffic flow (p = 0.003). There were no statistically significant differences in mean GCS score, AIS score, and mean ISS for helmeted versus nonhelmeted bicyclists. Nonhelmeted patients were more likely to have head computed tomographic scans (p = 0.049) and to be admitted (p = 0.030). CONCLUSION: Helmet use is an indicator of safe riding practices, although most injured bicyclists do not wear them. In this study, helmet use was associated with lower likelihood of head CTs and admission, leading to less hospital resource use. Injured riders failing to wear helmets should be targeted for educational programs. LEVEL OF EVIDENCE: Epidemiologic study, level III.

The impact of head injury mechanism on mental health symptoms in veterans: do number and type of exposures matter?

This study examined the association between screening results for mental health problems and the number and type of head injuries in 1,082 Iraq and Afghanistan War veterans who received population-based screening for traumatic brain injury at a Veterans Administration health care facility. Nearly one third of all veterans reported multiple types of head injuries (median = 1 among those with any head injury, range = 1-6 types of head injury). Veterans reporting multiple head injury mechanisms had 6 times the odds of screening positive for posttraumatic stress disorder (PTSD), adjusted odds ratio (OR) = 6.15, 95% confidence interval (CI) [4.4, 8.7], p < .001, over 4 times the odds of screening positive for depression, adjusted OR = 4.09, 95% CI [2.8, 5.9], p < .001, and about twice the odds of screening positive for alcohol misuse, adjusted OR = 1.64, 95% CI [1.19, 2.3], p = .003, compared to those without head injuries. Veterans reporting a blast plus another head injury mechanism had higher odds of screening positive for all mental health outcomes than any other group (e.g., compared to no head injury group): PTSD, adjusted OR = 6.52, 95% CI [4.6, 9.3], p < .001; depression, adjusted OR = 4.42, 95% CI [3.0, 6.4], p < .001; alcohol misuse, adjusted OR =1.59, 95% CI [1.14, 2.2], p = .006. Given their association with a variety of mental health outcomes, number and type of head injury mechanism should be considered as part of any postdeployment evaluation.

Perfil cognitivo de los pacientes con traumatismo craneoencefálico grave: un estudio a los dos años de evolución / Cognitive profiles of patients with severe traumatic brain injury: study at two years follow-up

Las alteraciones cognitivas de los sujetos con traumatismos craneoencefálicos (TCE) han sido estudiadas ampliamente en fase aguda y post-aguda. El objetivo del presente trabajo es obtener el perfil cognitivo de los pacientes con TCE graves a los dos años de evolución. La muestra de estudio estuvo compuesta por 42 sujetos adultos con TCE cerrado grave, a los que se les realizó una evaluación neuropsicológica que abarcó un amplio número de funciones cognitivas. Se comparó la ejecución de los sujetos con las puntuaciones estándar para la población normal. Los resultados mostraron una disminución generalizada de todas las funciones cognitivas evaluadas: inteligencia general, atención, visuopercepción y razonamiento visual, memoria, aprendizaje, funciones verbales, destrezas académicas, visuoconstrucción y funciones ejecutivas. La atención compleja es, con diferencia, la función más afectada. Esto tiene repercusiones importantes en la rehabilitación cognitiva de estos pacientes.

Cognitive impairments of the patients with traumatic brain injury (TBI) have been studied in the first year of evolution extensively. The objective of this work is to study the cognitive deficits of the TBI after two years at follow up. We analyzed 42 adult patients with severe closed TBI that underwent a neuropsychological assessment of a wide range of cognitive functions. We compared the performance of the patients with the scores standard for the normal population. The results show a decrease in performance of all cognitive functions: general intelligence, attention, visual visuoperception and reasoning, memory, learning, verbal functions, aca-demic skills, and executive functions. The lowest scores are given on the function of complex attention. This has important implica-tions for cognitive rehabilitation of patients with closed TBI.

An overview of war-related thermal injuries.

Thermal injuries have always been a source of morbidity and mortality in times of war. Historically, they constitute 5% to 20% of all injuries and approximately 4% mortality. Although burn patients constitute a small number of casualties, they consume a disproportionate amount of resources and require specialized care. The current conflicts in the Middle East report similar numbers for thermal injuries despite improvement in predeployment education to reduce noncombat-related burns, flame retardant military clothing, and decline of war patterns usually associated with increased thermal injuries. However, the increased use of improvised explosive devices and vehicle-borne improvised explosive devices presents a new source of potential thermal injury. Indeed, the burden of explosion-related burns has increased as has its associated Injury Severity Score. As has been the case in previous conflicts, most burns are hand and head burns. Although usually not life threatening, burns to hands and face lead to significant physical and psychologic morbidities. In this paper, we will review the currently available literature on war-related thermal injuries in Operation Iraqi and Operation Enduring Freedom. We will describe the epidemiology of burn injuries, prewar preparation to prevent and treat thermal injuries, and the assessment, triage, and final treatment of burn patients. In addition, we will discuss the associated physical and psychologic morbidities and, finally, the role of plastic surgeon in burn rehabilitation and reconstruction.

Secuelas en las funciones ejecutivas posteriores al traumatismo craneoencefálico en el adulto / Executive functions after traumatic brain injury in adults

Las funciones cognitivas, entre ellas las ejecutivas (FE), después de un traumatismo craneoencefálico (TCE) presentan alteraciones, que afecta la vida cotidiana de los pacientes. El propósito del estudio fue evaluar las funciones ejecutivas de pacientes adultos con TCE moderado y severo, para conocer las características neuropsicológicas distintivas de la intensidad de la lesión. Participaron 26 pacientes, 10 con TCE Moderado (edad=34.80+/-14.45; escolaridad=15.20+/-2.525 años); y 16 con TCE Severo (edad=32.17+/-9.42; escolaridad= 12.11+/-4.15 años), pareados por edad y escolaridad con un grupo control sano. Evaluados individualmente con la Batería de Funciones Ejecutivas y Frontales(Flores, Ostrosky-Solís y Lozano, 2008). Los resultados indican que los pacientes con TCE presentan principalmente problemas en el WCST, torre de Hanoi, la Iowa Gambling Task, memoria de trabajo, y habilidades semánticas. Además muestran compromiso en la velocidad del procesamiento de información, comete errores perseverativos, y dificultades en la flexibilidad mental. Los resultados sugieren mayor afección en tareas de la corteza prefrontal dorso lateral. Estos datos permitirán diseñar e implementar programas dedicados a la intervención cognitiva enfocados la mejoría de las FE.

Cognitive functions including executive functions (FE) are affected following a traumatic brain injury (TBI), diminished patient’s daily life. The purpose of the present study was measuring EF of adult moderate and severe TBI patients, and knows the neuropsychological profile related with lesion intensity. Participated 26 patients, divided in 10 with Moderate TBI (age=34.80+/-14.45; education= 15.20+/-2.525 years); and 16 with Severe TBI (age=32.17+/-9.42; education= 12.11+/-4.15 years), matched by age and level of education with a healthy control group. Participants were individually assessing with the Executive Function and Frontal Lobes Neuropsychological Battery (Flores, Ostrosky-Solís y Lozano, 2008). Results show that TBI patients mainly had problems in resolve the WCST, Hanoi Tower, Iowa Gambling Task, working memory and in process semantic information. At the same time shows decreased time in processing information, perseverations,intrusions, and less mental flexibility. Data suggest a major affection on dorso lateral prefrontal cortex tasks. This data would help to design rehabilitation programs to cognitive intervention focused on EF.