Therapeutic Effect of Enteral Nutrition Supplemented with Probiotics in the Treatment of Severe Craniocerebral Injury: A Systematic Review and Meta-Analysis.

BACKGROUND: Whether early enteral nutrition with probiotics can reduce the mortality and infection rate of patients with severe craniocerebral injury (SCI), improve their gastrointestinal function, and shorten the length of stay in the intensive care unit (ICU) has not been determined. METHODS: PubMed, China National Knowledge Infrastructure, and Embase were electronically searched for the purpose of identifying randomized controlled trials investigated the potential of early enteral nutrition supplemented with probiotics on patients with SCI from the establishment of databases to August 26, 2019. STATA software version 12.0 was used to perform meta-analysis. RESULTS: A total of 39 trials enrolling 3387 patients were included. Early enteral nutrition supplemented with probiotics was associated with decreased risk of infection (pooled risk ratio [RR], 0.486; 95% confidence interval [CI], 0.394-0.599), decreased risk of 7-, 14-, and 28-day mortality (pooled RRs, 0.415, 0.497, and 0.385; 95% CIs, 0.196-0.878, 0.297-0.833, and 0.197-0.751, respectively), and decreased risk of gastrointestinal complications (pooled RR, 0.363; 95% CI, 0.274-0.481). It also shortened the time course recovery of enteral function and shortened the length of stay in hospital and length of ICU stay (standardized mean differences, -3.327 and -1.461; 95% CIs, -6.213 to -0.440 and -2.111 to -0.811, respectively). CONCLUSIONS: Enteral nutrition supplemented with probiotics effectively decreases the risk of mortality, gastrointestinal complications, and infection, and shortens the stays in ICU; therefore, it should be extensively adopted to manage these given patients.

Impact of Zinc Supplementation on the Clinical Outcomes of Patients with Severe Head Trauma: A Double-Blind Randomized Clinical Trial.

To determine the effects of zinc supplementation on clinical outcomes of patients with severe head trauma, this double-blind clinical trial randomly allocated 100 patients with severe head trauma, aged between 18 to 65 years, to receive placebo or 120 mg zinc via a nasogastric tube for 15 days. Plasma zinc and copper, 24-hour urinary zinc excretion, Sequential Organ Failure Assessment (SOFA) were assessed on days 1, 7, and 16. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC) count were measured on days 1 and 16. Glasgow outcome score (GOS), mortality rate on day 28, and length of stay (LOS) were compared between groups. There were no significant differences in baseline data between groups (all p > .05). Mean plasma zinc concentration was significantly higher in the zinc group than the placebo group on day 7 (119.5 vs. 81.7 µg/dl, p < .001) and day 16 (124.1 vs. 101.1 µg/dl, p < .001). The SOFA, GOS, and inflammation factors were significantly better in the zinc-supplemented group by day 16 (all p < .05). The LOS was shorter (52 vs. 65 days, p = .043) and mortality rate on day 28 was borderline lower (17% vs. 22%, p = .507) in zinc versus placebo groups. Zinc supplementation in the study had favorable effects on GOS, SOFA score, and inflammatory markers in patients with severe head injury.

Current topics in sports-related head injuries: a review.

We review the current topic in sports-related head injuries including acute subdural hematoma (ASDH), concussion, and chronic traumatic encephalopathy (CTE). Sports-related ASDH is a leading cause of death and severe morbidity in popular contact sports like American football in the USA and judo in Japan. It is thought that rotational acceleration is most likely to produce not only cerebral concussion but also ASDH due to the rupture of a parasagittal bridging vein, depending on the severity of the rotational acceleration injury. Repeated sports head injuries increase the risk for future concussion, cerebral swelling, ASDH or CTE. To avoid fatal consequences or CTE resulting from repeated concussions, an understanding of the criteria for a safe post-concussion return to play (RTP) is essential. Once diagnosed with a concussion, the athlete must not be allowed to RTP the same day and should not resume play before the concussion symptoms have completely resolved. If brain damage has been confirmed or a subdural hematoma is present, the athlete should not be allowed to participate in any contact sports. As much remains unknown regarding the pathogenesis and pathophysiology of sports-related concussion, ASDH, and CTE, basic and clinical studies are necessary to elucidate the crucial issues in sports-related head injuries.

Traumatismo craneoencefálico pediátrico grave. Factores predictores de mortalidad / Severe head injury in children. Predictive factors of mortality

Describir las características epidemiológicas de los pacientes pediátricos con traumatismo craneoencefálico grave (TCEG) y los factores asociados con la mortalidad.Revisión de los pacientes ingresados en una unidad de medicina intensiva pediátrica (UMIP) con TCEG en el período comprendido entre julio de 1983 y enero de 2001.De los 262 pacientes con TCE ingresados en nuestra unidad durante el período de estudio, presentaron TCEG 125 (48 por ciento). La edad media de este grupo fue de 69,1 (41,5) meses, con una puntuación media en la escala de Glasgow (GCS) de 5,4 (1,8). El 43 por ciento de los pacientes presentaron lesión encefálica difusa (LED) grave en la TAC.En 32 pacientes (26 por ciento) se objetivaron secuelas de relevancia clínica, que fueron graves en un 66 por ciento de los casos. Un 75 por ciento de los pacientes en los que se monitorizó la presión intracraneal (PIC) presentaron hipertensión endocraneal (HTC). La mortalidad de los pacientes con TCEG fue de un 29 por ciento y se asoció de forma significativa a una menor puntuación del GCS, a la existencia de hiperglucemia o HTC, a la presencia de midriasis o shock y a la necesidad de ventilación mecánica. La mortalidad de la LED grave fue significativamente más elevada que la LED leve-moderada (69 frente a 6 por ciento; p < 0,001) y que la lesión focal (69 frente a 26 por ciento; p < 0,001). Los factores responsables de la mortalidad de forma independiente en los pacientes pediátricos con TCEG fueron la existencia de midriasis (p = 0,001), shock (p = 0,03) y LED grave en la TAC (p = 0,08).La morbimortalidad de la población estudiada con TCEG coincide globalmente con la mayoría de las series publicadas; b) la menor puntuación en la escala de Glasgow y la mayor afección en la TAC inicial se asociaron a una mayor mortalidad; c) los pacientes con TCEG en los que se monitorizó la PIC presentaron una alta incidencia de HTC; d) los factores de riesgo causantes de mortalidad fueron la midriasis, el shock y la lesión encefálica difusa grave en la TAC (AU)

The effect of nimodipine on outcome after head injury: a prospective randomised control trial. The British/Finnish Co-operative Head Injury Trial Group.

To study the effect of nimodipine on the outcome of head injury, three hundred and fifty-two patients who were not obeying commands were randomised to placebo or nimodipine (2 mg per hour intravenously for 7 days). The 2 groups were well matched for important prognostic features. Six months after injury, more of the patients who were given nimodipine had a favourable outcome (moderate/good recovery) than in the control group, but the increase in favourable outcome (8%) was not significant statistically.