Psychological and Psychiatric Aspects of Brain and Spinal Cord Tumors.

Central nervous system (CNS) tumors are mainly diagnosed by physical symptoms such as paralysis, visual field defect, seizure, and loss of consciousness. The psychological and psychiatric background of CNS tumors, whether in preoperative or postoperative period, has long been a neglected topic; however, lately, many authors and researchers have paid more attention to these manifestations. Neurocognition is a subset of parameters, including attention, memory, mood, emotions, language production, personality, executive function, problem-solving, calculation, and spatial cognition, making up the patient's cognitive performance. Also, it is worthy to say that neurocognition is considered a parameter of quality of life (QoL). Currently, we know that neurocognitive disorders are a group of symptoms presenting by the patients. These symptoms may be the first picture of CNS lesions, which result in incorrect treatment, a higher financial burden on the patient and health system, and finally, poorer QoL and performance scale if they are not diagnosed early. Psychological and psychiatric problems such as depression, anxiety, and phobia following the CNS tumors have two aspects. These may present before any treatment resulting from the tumoral mass effect, peritumoral edema, or cerebral tissue disruption due to the space-occupying lesion. On the other hand, we can see these features after a kind of therapy such as surgery, medical therapy, or adjuvant therapy. Sometimes, the CNS tumors lead to psychosocial complications postoperatively. Indeed, considering tumor surgery complications, some patients may find various degrees of deficits that make the patient isolated either socially or professionally. Obviously, the improvement rate and outcome of this specific situation depend on the mechanism of occurrence and its causes. For instance, postoperative symptom relief would be expected when the symptoms are related to the tumoral mass effect. Getting familiar with this constellation of the symptoms, realizing them, and then localizing them to the correct area of the CNS are very crucial. Accordingly, because of their importance in QoL, their influence on patient's survival even more than the extent of resection of the tumor, and somehow their ignorance, we will discuss different neurocognitive manifestations related to CNS tumors in this chapter.

Complications in Endoscopic Endonasal Pituitary Adenoma Surgery: An Institution Experience in 310 Patients.

Objective Endoscopic endonasal approaches (EEAs) have shown excellent results for majority of hypophyseal tumors. The aim of this study was to evaluate and report the complications of EEA in patients with pituitary adenoma (PA) who underwent surgery between 2013 and 2018. Methods We performed a retrospective review of 310 consecutive patients/325 procedures with PA treated with an EEA from May 2013 to January 2018. Minor complications including transient diabetes insipidus (DI) or new anterior pituitary hormone insufficiency in one axis and major complications including CSF leakage, hematoma needing reoperation, vascular damage, brain infection, new pan-hypopituitarism permanent DI, new visual impairment, neurological deficits, and mortality were recorded. Results We encountered 58 complications in 310 patients (18.7%) and 325 procedures (17.7%). Minor complications were 43 (13.9 and 13.2%) in 310 patients and in 325 procedures, respectively; whereas, major complications were 28 (9 and 8.6%, respectively). Total complications were associated with diameter group 2 (>30 mm), diaphragm sella violation, suprasellar extension, parasellar involvement, nonfunctional secretory type, and intraoperative arachnoid tearing. Conclusion EEA can be considered as a safe surgical treatment which has acceptable complications in the management of PAs.

Transverse sinus obstruction caused by extradural supra-infratentorial hydatid cyst: A case report and literature review.

Approximately 1-3% of cases of hydatid disease involve the central nervous system (CNS). This study aims to report an extremely rare case of supra-infratentorially located epidural hydatid cyst with transverse venous sinus obstruction which presented with chronic cerebral vein thrombosis (CVT) signs and symptoms.

Brain and Spinal Cord Tumors Among the Life-Threatening Health Problems: An Introduction.

As one of the global concerns, cancers, including brain and spinal cord tumors, are responsible for mortalities and irreversible morbidities in the affected patients. Although advancements in molecular pathology and imaging of tumors may have influenced the incidence rate due to higher diagnosis in early stages, exposure to environmental risk factors could be another explanation for increased incidence of these tumors over the past decades. Similar to many other tumors, the CNS tumors begin in cellular dimension with activation of different molecular pathways. Several genetic, epigenetic, and immunologic pathways and processes are already discovered to play roles in pathophysiology of these tumors, which mostly will eventually become symptomatic. Each of these tumors may exhibit imaging characteristics, making it possible to list a series of differential diagnosis before histopathologic examination. Advances in molecular pathology have resulted in better understanding and categorization of CNS tumors, leading to better decision-making on the most appropriate therapeutic approach for each category, as well as proposing new therapeutic modalities to treat these tumors. As an introduction to the 2-volume book, this chapter addressed different types of human brain and spinal cord tumors based on the fifth version of WHO classification of CNS tumors.

VEGF gene polymorphisms in Iranian patients with intracranial glioblastoma.

BACKGROUND: Glioblastoma is one of the most common malignant brain tumors in adults with poor prognosis. Neovascularization is one of the characteristics of these tumors, which is associated with overexpression of vascular endothelial growth factor (VEGF). Accordingly, single nucleotide polymorphisms of this gene could play an important role in structural and functional alterations leading to overexpression of this gene in GBM. METHODS: A total number of 49 patients with GBM and 50 healthy controls were included in the current study. The Genomic DNA was extracted from brain tumor/tissue samples, and after purification assessment, the alleles, and genotypes of rs3025039 and rs2010963 polymorphisms of the VEGF gene were investigated using T-ARMS-PCR. RESULTS: The "T" allele of rs3025039 was 2.79 times more frequent in GBM patients compared to controls (P=0.01). Moreover, the "CT" genotype was 2.83 times more common among patients (P=0.015), while the "CC" was more frequent in controls (P=0.009). The mean overall survival was significantly different between three genotypes of rs3025039, with the longest survival time in "CT" genotype (15.10±5.21, P=0.041). Besides, rs2010963, was significantly associated with GBM occurrence, with the "G" allele being 1.96 times more frequent in patients (P=0.01), as well as the "GG" genotype, which was 7.87 times more common in patients (P<0.001). CONCLUSIONS: Polymorphisms of VEGF could potentially play a role in pathogenesis of GBM, as the allele and genotype distributions of rs3025039 and rs2010963 SNPs were significantly associated with GBM occurrence.

Traumatic acute convexity interdural hematoma: a case report and literature review.

INTRODUCTION: Interdural hematoma (IDH) is an extremely rare hemorrhage between the outer periosteal dura mater and the inner meningeal dura mater. There are 8 cases of convexity IDH reported previously but none of them were acute post traumatic one. We report the case of a patient with an initial diagnosis of acute epidural hematoma (EDH) that was eventually revealed to be an acute convexity IDH. CASE REPORT: A 57-year-old man presented to the emergency department with a complaint of falling from 2 meters. Imaging findings revealed an expanding intracranial hematoma with a linear skull fracture extending to sagittal suture, which was mistaken as an EDH. Emergent surgical evacuation was performed; the hematoma was lodged between two dural layers. DISCUSSION: This is the first case of acute convexity IDH following trauma that has been reported. In chronic and sub-acute hematomas MRI scans could be very useful, but in acute cases under emergent circumstances, CT scan cannot make a proper differentiation between an EDH and IDH. IDH should be considered during craniotomy when extradural findings do not explain the CT scan findings. This case showed a linear skull fracture expanding to the sagittal suture, and this can be a possible explanation for IDH formation. Surgical evacuation of the hematoma without inner nor outer layer resection and leaving the outer layer open, to connect the interdural space to epidural space was first described in this report.

A placebo-controlled randomized clinical trial of amantadine hydrochloride for evaluating the functional improvement of patients following severe acute traumatic brain injury.

BACKGROUND: Considering the known derangements in the dopaminergic neurotransmitter systems following traumatic brain injury (TBI), dopamine agonists are used as a pharmacologic option. In this study, we evaluate the effects of amantadine hydrochloride on the functional improvement of severe TBI patients. METHODS: Within a triple-blinded (patients, intervention administrators, and outcome assessors) placebo-controlled randomized clinical trial, we evaluated the effects of amantadine (100 mg BD (twice a day) for 14 days, then 150 mg BD for another 7 days, and 200 mg BD for another 21 days) on outcome measurements of weekly mean Glasgow Outcome Scale (GOS) and Disability Rating Scale (DRS), through six weeks of trial for 57 patients (29 amantadine, 28 placeboes) with severe TBI admitted in our hospital. RESULTS: Although both groups had improvement in their DRS, the change from baseline was significantly better in the amantadine group (10.88±5.24 for amantadine vs. 8.04±4.07 for placebo, P=0.015). No significant difference was observed between groups for GOS (1.04±0.55 for amantadine vs. 1.12±1.05 for placebo, P=0.966). CONCLUSIONS: Based on our findings, amantadine hydrochloride might improve the speed of functional ability improvement in severe TBI patients, evaluated by DRS, and is also well tolerated by patients. Although, there were some limitations in this study, including small sample size, short time interval, not providing a wash-off period and invalidity of GOS for measuring recovery rates in short-term periods.

The role of cross-link augmentation on fusion rate and patient satisfaction among patients with traumatic thoracolumbar spinal fracture: A randomized clinical trial.

INTRODUCTION AND OBJECTIVES: Most of the studies evaluating the effect of cross links on spinal stability are performed in vitro on porcine or human spine segments and there is limited data regarding clinical benefits of cross link augmentation in traumatic injuries. In this study we aimed to evaluate the effects of cross-links insertion between rods on the fusion rates and post-surgical patients' satisfaction among patients with traumatic thoracolumbar fractures who underwent posterior spinal fixation with pedicle screws. MATERIALS AND METHODS: This study was conducted as a randomized clinical trial on 60 patients suffering from traumatic thoracolumbar vertebrae fractures. Patients were randomized into three groups: A (without any cross-link), B (One cross-link insertion) and C (two cross-links insertion). Six months after surgery outcomes were evaluated: fusion rates (plain X-ray and CT scan), Back pain (Visual Analog Scale) and patient satisfaction (fair, good, excellent). RESULTS: In group A 13 (65%) patients had structured bone fusion, but in 7 (35%) patients bone fusion was not observed. In both groups B and C, 19 patients (95%) had bone fusion, but only in 1 patient (5%) fusion failed (p=0.009). In group A, fair satisfaction has the highest rate (8 patients (40%)) compared to the other groups. The highest reported severity of back pain was observed in group A while the lowest reported intensity of back pain was related to group B (p=0.001). CONCLUSIONS: Adding cross link to posterior spinal fixations of patients with traumatic thoracolumbar fractures can be associated with better final fusion results and patients' satisfaction. However it is necessary to design studies with greater sample sizes to confirm this theory. TRIAL REGISTRATION NUMBER: IRCT20120527009878N3.

Endoscopic endonasal management of skull base defects in pediatric patients.

PURPOSE: Skull base defects in children may be the result of congenital anomalies or trauma. They often present as cerebrospinal fluid (CSF) rhinorrhea, meningitis, brain abscess or nasal obstruction. Surgical intervention is predominantly the treatment of choice. Our goal is to assess the efficacy of endoscopic endonasal approach in treating skull base defects in pediatric patients. MATERIAL AND METHODS: In this retrospective study we identified 38 patients (mean age 8.7 ± 5.6 years old, ranging 2 months-18 years) who underwent endoscopic endonasal repair of skull base defects, between March 2010 and February 2020. Patients who had skull base reconstruction after tumor resection, those who were lost to follow-up or did not sign the consent forms were excluded from the study. RESULTS: The clinical indications for endoscopic endonasal repair were trauma (n = 24, 63.1%) and congenital defects (n = 14, 36.9%). Congenital skull base defects included basal meningoencephalocele (n = 5, 35.7%) and frontoethmoidal defects (n = 9, 64.3%). Mean follow up time was 32 ± 29.04 months, ranging 2-103 months. Fat graft (alone or in combination) was the most commonly used material to repair the skull base defects. Thirty-seven patients (97%) showed successful results after endoscopic endonasal surgery and were symptom free. CONCLUSION: The endoscopic endonasal repair of CSF leak and skull base defects proved to be safe and feasible with 97% success rate.

The role of cross-link augmentation on fusion rate and patient satisfaction among patients with traumatic thoracolumbar spinal fracture: A randomized clinical trial.

INTRODUCTION AND OBJECTIVES: Most of the studies evaluating the effect of cross links on spinal stability are performed in vitro on porcine or human spine segments and there is limited data regarding clinical benefits of cross link augmentation in traumatic injuries. In this study we aimed to evaluate the effects of cross-links insertion between rods on the fusion rates and post-surgical patients' satisfaction among patients with traumatic thoracolumbar fractures who underwent posterior spinal fixation with pedicle screws. MATERIALS AND METHODS: This study was conducted as a randomized clinical trial on 60 patients suffering from traumatic thoracolumbar vertebrae fractures. Patients were randomized into three groups: A (without any cross-link), B (One cross-link insertion) and C (two cross-links insertion). Six months after surgery outcomes were evaluated: fusion rates (plain X-ray and CT scan), Back pain (Visual Analog Scale) and patient satisfaction (fair, good, excellent). RESULTS: In group A 13 (65%) patients had structured bone fusion, but in 7 (35%) patients bone fusion was not observed. In both groups B and C, 19 patients (95%) had bone fusion, but only in 1 patient (5%) fusion failed (p=0.009). In group A, fair satisfaction has the highest rate (8 patients (40%)) compared to the other groups. The highest reported severity of back pain was observed in group A while the lowest reported intensity of back pain was related to group B (p=0.001). CONCLUSIONS: Adding cross link to posterior spinal fixations of patients with traumatic thoracolumbar fractures can be associated with better final fusion results and patients' satisfaction. However it is necessary to design studies with greater sample sizes to confirm this theory. TRIAL REGISTRATION NUMBER: IRCT20120527009878N3.

Association between shift working and musculoskeletal symptoms among nursing personnel.

BACKGROUND: Some health problems are more prevalent in shift workers than day workers. Musculoskeletal disorders are considered as one of the most common health-related problems that can cause disability among health care workers. The aim of this study was to assess the associations between shift working and the prevalence of musculoskeletal symptoms (MSs) among nursing personnel. MATERIALS AND METHODS: This study was conducted among 454 health care workers including nurses and nurses' aides in a general hospital in Iran. A Nordic musculoskeletal questionnaire was used to evaluate the prevalence of MSs. Logistic regression analysis with adjusting for confounding factors was performed to evaluate the associations between shift working and the prevalence of MSs. RESULTS: Lower back, knees, and upper back symptoms with the prevalence of 57.4%, 48.4%, and 47%, respectively, were the most common MSs. The prevalence of MSs in eight regions of the body (lower back, neck, knees, upper back, shoulder, wrist, buttock, and ankle) was higher among shift workers than day workers. The differences were statistically significant only in the lower back and ankle regions (P < 0.05). Odds Ratio for lower back symptoms in shift workers was 1.94 compared to day workers (P = 0.003). CONCLUSION: Findings of this study suggested that shift working could be associated with increased prevalence of lower back disorders among nursing personnel. This study emphasizes on the importance of proper work planning and regulating working hours for nursing personnel.

Combined effects of physical demands and shift working on low back disorders among nursing personnel.

The aim of this study was to investigate the synergistic effects of physical demands and shift working on low back disorders (LBDs) among nursing personnel. The study used 2 questionnaires: a self-administered questionnaire composed of parts of Nordic musculoskeletal questionnaire to assess LBDs and job content questionnaire to assess physical demands. The participants were divided into 4 groups: from group 1 (low physical demands day workers) to group 4 (high physical demands shift workers). In regression analysis, high physical demands were associated with the prevalence of LBDs independently (OR 4.4, 95% CI [2.40, 8.00] and p < .05), but there was no association between shift working and LBDs (p > .05). Odds ratio in high physical demands shift workers was 9.33 compared to the reference group (p < .001). Calculated synergistic index was 7.37. Simultaneous impacts of shift working and high physical demands may increase the prevalence of LBDs among nursing personnel.

The effect of sleep disorder on the work ability of workers in a car accessories manufacturing plant.

BACKGROUND: Work ability assessment and its affecting factors are important in the field of occupational health. One of the factors affecting work ability is sleep disorder, which is very common among workers. Therefore, the present study aimed to assess work ability and its relationship with sleep disorder in workers of a manufacturing plant. METHODS: This cross- sectional study was conducted in a manufacturing plant in Tehran in 2013. All the 931 male workers of this plant were enrolled in the study, and their work ability was assessed using the Work Ability Index (WAI). The scores of this index range from 7 to 49, and the higher work ability score indicates a better work ability status. In this study, sleep disorder was assessed using the MUSIC-Norrtalje Questionnaire. RESULTS: The average score of WAI was 42.81, ranging from 22 to 49. This score was significantly lower in the group with sleep disorder (41.28) than in the group without sleep disorder (44.10) (p< 0.001). The results of the logistic regression analysis revealed a significant relationship between work ability and sleep disorder even after adjustment for the confounding variables (OR= 2.52, 95% CI= 1.07 - 5.93, p= 0.033). CONCLUSION: The results of this study found a relationship between sleep disorder and work ability. Therefore, it is recommended to identify workers with sleep disorder and attend to their problem in order to increase their work ability.

Menstrual disturbances and hormonal changes in women workers exposed to a mixture of organic solvents in a pharmaceutical company.

BACKGROUND: Chemicals are among risk factors that can affect women's reproductive system. This study is aimed to investigate the association of occupational exposure to a mixture of organic solvents with menstruation disturbances and hormonal changes among female workers. METHODS: Female workers of a pharmaceutical company were divided into three groups of non-exposed, lowexposed and highly-exposed to a mixture of organic solvents (formaldehyde, phenol, N-hexane, and chloroform) based on workplace measurements. Menstrual disturbances (in terms of short cycles, long cycles, irregular cycles, and bleeding or spotting between periods) and mean of hormone levels (including follicle stimulating hormone, luteinizing hormone, thyroid stimulating hormone, prolactin, estrogen and progesterone levels) were compared between these three groups. For investigating associations, logistic regression was performed. RESULTS: Our study showed that mean length of cycles, duration of bleeding, and amount of flow and also prevalence of long cycles, irregular cycles, and bleeding or spotting between periods were higher in exposed groups (p≤0.05). Odds ratio for prevalence of menstrual disturbances in the low exposure group and high exposure group were 9.69 (p=0.001) and 3.40 (p=0.002) respectively compared to the reference group. Estrogen and progesterone levels were not affected (p> 0.05), but other hormones levels were significantly disturbed in the exposed groups compared with the non-exposed group (p=0.001). CONCLUSION: Occupational exposure to the mixture of organic solvents may be associated with the increase of menstrual disorders and hormonal changes in female workers. Based on our findings, periodic evaluation of reproductive system of female workers in pharmaceutical companies is recommended.

Effects of psychosocial strain on back symptoms in Tehran general hospital nursing personnel.

Nursing is a stressful and highly demanding job. The aim of this study was to investigate the association between psychosocial job strain and the prevalence of back symptoms in nursing personnel using the demand-control model. In a cross-sectional study, 545 nursing professionals answered to a self-administered questionnaire on demography, job content, and lower and upper back symptoms (LBS and UBS, respectively). Based on their answers, the participants were grouped as follows: low strain, high strain, active job, and passive job. The groups were compared in regard to the prevalence of LBS and UBS (totalling 58.5% and 47.9%, respectively) over the past 12 months. We found no association between job control and back symptoms, but participants with high psychosocial job demands showed greater risk of LBS (OR=1.57 and p=0.014) and UBS (OR=1.73 and p=0.005) than those with low job demands. LBS in the low strain, high strain, and active job groups was more prevalent than in the passive group (OR=1.64, OR=2.49 and OR=1.90, respectively; p≤0.05). In addition, the high strain group showed greater prevalence of UBS than the passive group (OR=1.82 and p=0.019). Our study suggests that psychosocial job strain, high psychosocial demands in particular, may be associated with greater prevalence of back symptoms in nursing personnel. Our findings may help to design preventive measures that would lower the prevalence of musculoskeletal disorders in this profession.