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2.
Br J Anaesth ; 123(5): 610-617, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31542162

RESUMO

BACKGROUND: Traumatic brain injury (TBI) is associated with reduced cerebral blood flow and impaired autoregulation after TBI, which may lead to poor outcome. Clinical evidence has implicated neurological injuries and associated neuroinflammation as causes of cardiac dysfunction. Studies on newborn pigs show an association of elevated catecholamines with a sex-dependent impairment of cerebral autoregulation after TBI. One strategy to decrease sympathetic hyperactivity is pharmacological intervention with beta blockade. We tested the hypothesis that propranolol would prevent the impairment of cerebral autoregulation and tissue changes after TBI via inhibition of interleukin-6 (IL-6) upregulation. METHODS: Using newborn pigs of both sexes equipped with a closed cranial window, TBI was induced via lateral fluid percussion injury. Propranolol was administered at 1 h post-TBI. Analyses included cerebral autoregulation (pial artery reactivity) before and 4 h post-TBI, CSF IL-6 analysed (enzyme-linked immunosorbent assay), and histopathology at 4 h post-TBI. RESULTS: Propranolol administration prevented impairment of hypotensive dilation in both male and female newborn pigs after fluid percussion injury, which was paralleled by reduced upregulation of IL-6 in the CSF. Moreover, propranolol prevented neuronal cell death in cornu amonis (CA)1 and CA3 hippocampus equivalently in male and female pigs after TBI. Papaverine-induced dilation was unchanged by TBI and propranolol. CONCLUSIONS: These data indicate that sympathetic hyperactivity noted after TBI can be limited by propranolol administration to result in improved brain outcome post-injury via block of IL-6 upregulation, and this effect is irrespective of sex.


Assuntos
Lesões Encefálicas Traumáticas/tratamento farmacológico , Morte Celular/efeitos dos fármacos , Hipocampo/efeitos dos fármacos , Homeostase/efeitos dos fármacos , Interleucina-6/antagonistas & inibidores , Propranolol/farmacologia , Antagonistas Adrenérgicos beta/farmacologia , Animais , Animais Recém-Nascidos , Lesões Encefálicas Traumáticas/patologia , Lesões Encefálicas Traumáticas/fisiopatologia , Modelos Animais de Doenças , Feminino , Hipocampo/fisiologia , Homeostase/fisiologia , Masculino , Neurônios/efeitos dos fármacos , Suínos , Regulação para Cima/efeitos dos fármacos
3.
Adv Exp Med Biol ; 1161: 193-217, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31562631

RESUMO

Headache is a common complaint after mild traumatic brain injury (mTBI). Changes in the CNS lipidome were previously associated with acrolein-induced headache in rodents. mTBI caused similar headache-like symptoms in rats; therefore, we tested the hypothesis that mTBI might likewise alter the lipidome. Using a stereotaxic impactor, rats were given either a single mTBI or a series of 4 mTBIs 48 h apart. 72 h later for single mTBI and 7 days later for repeated mTBI, the trigeminal ganglia (TG), trigeminal nucleus (TNC), and cerebellum (CER) were isolated. Using HPLC/MS/MS, ~80 lipids were measured in each tissue and compared to sham controls. mTBI drove widespread alterations in lipid levels. Single mTBI increased arachidonic acid and repeated mTBI increased prostaglandins in all 3 tissue types. mTBI affected multiple TRPV agonists, including N-arachidonoyl ethanolamine (AEA), which increased in the TNC and CER after single mTBI. After repeated mTBI, AEA increased in the TG, but decreased in the TNC. Common to all tissue types in single and repeated mTBI was an increase the AEA metabolite, N-arachidonoyl glycine, a potent activator of microglial migration. Changes in the CNS lipidome associated with mTBI likely play a role in headache and in long-term neurodegenerative effects of repeated mTBI.


Assuntos
Lesões Encefálicas Traumáticas , Sistema Nervoso Central , Cefaleia , Inflamação , Lipídeos , Neoplasias , Animais , Lesões Encefálicas Traumáticas/fisiopatologia , Sistema Nervoso Central/fisiopatologia , Cefaleia/fisiopatologia , Inflamação/fisiopatologia , Lipídeos/química , Lipídeos/genética , Lipídeos/fisiologia , Neoplasias/fisiopatologia , Ratos
4.
Med. intensiva (Madr., Ed. impr.) ; 43(6): 362-372, ago.-sept. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-183255

RESUMO

El traumatismo craneoencefálico (TCE) es una de las patologías más importantes en la actualidad, ya que afecta a un alto porcentaje de individuos de todas las edades. A pesar de los avances en el campo del diagnóstico, la monitorización y el tratamiento del TCE, quedan importantes cuestiones sin resolver alrededor de la fisiopatología de este tipo de traumatismo. Con el fin de profundizar en dicho conocimiento y poder evaluar y aplicar un posible tratamiento que resulte eficaz para estos pacientes, se han desarrollado diferentes modelos experimentales que simulan los mecanismos de acción y el cuadro clínico del TCE. A su vez, cada modelo representa un determinado tipo de traumatismo y evalúa un aspecto concreto de la cascada fisiopatológica desencadenada tras el TCE. El objetivo de este trabajo es detallar los principales modelos experimentales que abordan la lesión cerebral tras un TCE, así como su potencial traslación a la práctica clínica diaria


Traumatic brain Injury (TBI) is a major public healthcare concern, affecting people of all ages. Despite advances in the diagnosis, monitoring and clinical management of TBI, many unresolved questions remain regarding its physiopathology. In an attempt to understand the pathological features of TBI and to evaluate single potential therapeutic strategies, various animal models have been developed to simulate the mechanisms of action and the clinical manifestations of TBI patients. In turn, each model represents a specific type of trauma and evaluates a specific physiopathological aspect of the cascade triggered as a result of TBI. This review describes the main experimental models currently available referred to TBI and their possible application to the clinical setting


Assuntos
Animais , Modelos Animais , Traumatismos Cranianos Penetrantes/veterinária , Técnicas In Vitro/instrumentação , Lesões Encefálicas Traumáticas/fisiopatologia , Técnicas In Vitro/métodos , Lesões Encefálicas/veterinária
5.
Undersea Hyperb Med ; 46(3): 227-241, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31394594

RESUMO

Background: Audiology clinics have many tools available to evaluate auditory and vestibular complaints. However, many tools lack established normative ranges across the life span. We conducted this study to establish reference ranges across the life span for audiology/vestibular measures commonly used to evaluate patients with traumatic brain injury. Materials and Methods: In this repeated measures study, 75 adults, ages 18-65 years, without a history of traumatic brain injury, underwent robust auditory/vestibular evaluations three times over six months, including rotational chair, videonystagmography, computerized dynamic posturography, vestibular evoked myogenic potentials, and retinal fundoscopy. Results: Age effect was notable for transient evoked otoacoustic emissions, pure-tone audiometry, auditory brainstem response, auditory middle latency response, and auditory-steady state response at 4000 hertz (Hz). Older participants (50-65 years) were more likely to have delayed latency horizontal saccades, positional nystagmus, slowed lower-extremity motor control responses, and delayed latency ocular vestibular evoked myogenic potentials. Low to mid-frequency horizontal (0.003-4 Hz) and mid-frequency vertical (1-3 Hz) vestibulo-ocular reflex, otolith-mediated reflexes, dynamic visual acuity and balance measures were generally not influenced by age. Females had larger static subjective visual testing offset angles, longer cervical vestibular evoked myogenic potential P1 latency, faster velocity horizontal saccades, and quicker motor control latency for large backward translations than age-matched males. Conclusion: These reference ranges can be used to discern impairment within the auditory and vestibular pathway following traumatic brain injury in young to middle-aged adults. ID: TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT01925963.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Testes Auditivos/normas , Testes de Função Vestibular/normas , Adolescente , Adulto , Fatores Etários , Idoso , Audiometria de Resposta Evocada/normas , Audiometria de Tons Puros/normas , Lesões Encefálicas Traumáticas/complicações , Potenciais Evocados Auditivos do Tronco Encefálico , Feminino , Fundo de Olho , Testes Auditivos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Nistagmo Fisiológico , Otoscopia/métodos , Equilíbrio Postural , Estudos Prospectivos , Valores de Referência , Reflexo Acústico , Rotação , Movimentos Sacádicos , Fatores Sexuais , Fatores de Tempo , Potenciais Evocados Miogênicos Vestibulares , Testes de Função Vestibular/métodos , Acuidade Visual , Adulto Jovem
6.
Neuron ; 103(3): 367-379, 2019 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-31394062

RESUMO

Traumatic brain injury (TBI) is one the most common human afflictions, contributing to long-term disability in survivors. Emerging data indicate that functional improvement or deterioration can occur years after TBI. In this regard, TBI is recognized as risk factor for late-life neurodegenerative disorders. TBI encompasses a heterogeneous disease process in which diverse injury subtypes and multiple molecular mechanisms overlap. To develop precision medicine approaches where specific pathobiological processes are targeted by mechanistically appropriate therapies, techniques to identify and measure these subtypes are needed. Traumatic microvascular injury is a common but relatively understudied TBI endophenotype. In this review, we describe evidence of microvascular dysfunction in human and animal TBI, explore the role of vascular dysfunction in neurodegenerative disease, and discuss potential opportunities for vascular-directed therapies in ameliorating TBI-related neurodegeneration. We discuss the therapeutic potential of vascular-directed therapies in TBI and the use and limitations of preclinical models to explore these therapies.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Circulação Cerebrovascular , Microvasos/patologia , Doenças Neurodegenerativas/etiologia , Acoplamento Neurovascular , Animais , Barreira Hematoencefálica , Lesões Encefálicas Traumáticas/fisiopatologia , Isquemia Encefálica/etiologia , Progressão da Doença , Endotélio Vascular/fisiopatologia , Humanos , Microcirculação , Micronutrientes/farmacocinética , Modelos Animais , Proteínas do Tecido Nervoso/metabolismo , Doenças Neurodegenerativas/patologia , Doenças Neurodegenerativas/fisiopatologia , Doenças Neurodegenerativas/prevenção & controle , Neuroimagem
7.
J Craniofac Surg ; 30(7): 2217-2223, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31469742

RESUMO

This study aimed to investigate the clinical efficacy of intracranial pressure (ICP) monitoring regarding the perioperative management of patients with severe traumatic brain injury (sTBI). This was a cohort study performed between Jan 2013 and Jan 2016 and included all patients with sTBI. All patients were split into ICP monitoring and non-ICP monitoring groups. The primary outcomes were in-hospital mortality and Glasgow Outcome Scale (GOS) scores 6 months after injury, whereas the secondary outcomes include rate of successful nonsurgical treatment, rate of decompression craniotomy (DC), the length of stay in the ICU, and the hospital and medical expenses. This retrospective analysis included 246 ICP monitoring sTBI patients and 695 without ICP monitoring sTBI patients. No significant difference between groups regarding patient demographics. All patients underwent a GOS assessment 6 months after surgery. Compared to the non-ICP monitoring group, a lower in-hospital mortality (20.3% vs 30.2%, P < 0.01) and better GOS scores after 6 months (3.3 ±â€Š1.6 vs 2.9 ±â€Š1.6, P < 0.05) with ICP monitoring. In addition, patients in the ICP monitoring group had a lower craniotomy rate (41.1% vs 50.9%, P < 0.01) and a lower DC rate (41.6% vs 55.9%, P < 0.05) than those in the non-ICP monitoring group. ICU length of stay (12.4 ±â€Š4.0 days vs 10.2 ±â€Š4.8 days, P < 0.01) was shorter in the non-ICP monitoring group, but it had no difference between 2 groups on total length of hospital stay (22.9 ±â€Š13.6 days vs 24.6 ±â€Š13.6 days, P = 0.108); Furthermore, the medical expenses were significantly higher in the non-ICP monitoring group than the ICP monitoring group (11.5 ±â€Š7.2 vs 13.3 ±â€Š9.1, P < 0.01). Intracranial pressure monitoring has beneficial effects for sTBI during the perioperative period. It can reduce the in-hospital mortality and DC rate and also can improve the 6-month outcomes. However, this was a single institution and observational study, well-designed, multicenter, randomized control trials are needed to evaluate the effects of ICP monitoring for perioperative sTBI patients.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Pressão Intracraniana , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas Traumáticas/cirurgia , Criança , Craniectomia Descompressiva , Feminino , Escala de Resultado de Glasgow , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Período Perioperatório , Estudos Retrospectivos , Adulto Jovem
8.
J Rehabil Med ; 51(8): 566-574, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31243467

RESUMO

OBJECTIVE: To determine whether the UK Functional Assessment Measure (UK FIM+FAM) fits the Rasch model in patients with complex disability following traumatic brain injury. DESIGN: Psychometric evaluation including preliminary exploratory and confirmatory factor analyses followed by Rasch analysis. PARTICIPANTS: A multicentre UK national cohort of 1,956 patients admitted for specialist rehabilitation following traumatic brain injury. RESULTS: The suitability of the Partial Credit Model was confirmed by the likelihood-ratio test (χ2 (df86) =7,325.0, p < 0.001). Exploratory and confirmatory factor analyses supported 3 factors (Motor, Communication, Psychosocial). Rasch analysis of the full scale incorporating the 3 factors as super-items resulted in an acceptable overall model fit (χ2 (df24)=36.72, p = 0.05) and strict uni-dimensionality when tested on a sub-sample of n = 320. These results were replicated in a full sample (n = 1,956) showing uni-dimensionality and good reliability with Person Separation Index = 0.81, but item trait interaction was significant due to the large sample size. No significant differential item functioning was observed for any personal factors. Neither uniform re-scoring of items nor exclusion of participants with extreme scores improved the model fit. CONCLUSION: The UK FIM+FAM scale satisfies the Rasch model reasonably in traumatic brain injury. A conversion table was produced, but its usefulness in clinical practice requires further exploration and clinical translation.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Lesões Encefálicas Traumáticas/reabilitação , Avaliação de Resultados da Assistência ao Paciente , Adolescente , Adulto , Idoso , Estudos de Coortes , Bases de Dados Factuais , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Reino Unido , Adulto Jovem
9.
Life Sci ; 228: 285-294, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31063733

RESUMO

AIMS: Oxidative stress and apoptosis have major roles in the progression of traumatic brain injury (TBI)-associated motor and cognitive deficits. The present study was aimed to elucidate the putative effects of chrysin, a natural flavonoid compound, against TBI-induced motor and cognitive dysfunctions and possible involved mechanisms. MAIN METHODS: Chrysin (25, 50 or 100 mg/kg) was orally administered to rats starting immediately following TBI induction by Marmarou's weight-drop technique and continuously for 3 or 14 days. Neurological functions, motor coordination, learning and memory performances, histological changes, cell apoptosis, expression of pro- and anti-apoptotic proteins, and oxidative status were assayed at scheduled time points after experimental TBI. KEY FINDINGS: The results indicated that treatment with chrysin improved learning and memory disabilities in passive avoidance task, and ameliorated motor coordination impairment in rotarod test after TBI. These beneficial effects were accompanied by increased the concentrations of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione (GSH), decreased malondialdehyde (MDA) content, prevented neuronal loss, diminished apoptotic index, elevated the expression of anti-apoptotic Bcl-2 protein, and reduced the expression of pro-apoptotic Bax protein in the cerebral cortex and hippocampus tissues. SIGNIFICANCE: Our findings suggest that both anti-oxidative and anti-apoptotic properties of chrysin (especially in the dose of 100 mg/kg) are possible mechanisms that improve cognitive/motor deficits and prevent neuronal cell death after TBI.


Assuntos
Antioxidantes/uso terapêutico , Lesões Encefálicas Traumáticas/tratamento farmacológico , Encéfalo/efeitos dos fármacos , Flavonoides/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Administração Oral , Animais , Apoptose/efeitos dos fármacos , Encéfalo/metabolismo , Encéfalo/fisiopatologia , Lesões Encefálicas Traumáticas/metabolismo , Lesões Encefálicas Traumáticas/fisiopatologia , Modelos Animais de Doenças , Flavonoides/administração & dosagem , Aprendizagem/efeitos dos fármacos , Masculino , Transtornos da Memória/tratamento farmacológico , Transtornos da Memória/metabolismo , Transtornos da Memória/fisiopatologia , Estresse Oxidativo/efeitos dos fármacos , Desempenho Psicomotor/efeitos dos fármacos , Ratos Wistar
10.
Pediatr Ann ; 48(5): e192-e196, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31067334

RESUMO

Pediatric head injuries are common and may present with varying degrees of altered mental status in children. The approach to evaluation, diagnosis, treatment, and prevention of further injury is important in achieving good health outcomes after a head injury. In this article, we review the pathophysiology, classifications, signs and symptoms, and management of traumatic brain injury. We also discuss the importance of preventing a secondary injury during recovery by educating families about head injury sequelae and return-to-play guidelines. [Pediatr Ann. 2019;48(5):e192-e196.].


Assuntos
Lesões Encefálicas Traumáticas , Transtornos da Consciência/etiologia , Adolescente , Lesões Encefálicas Traumáticas/classificação , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/fisiopatologia , Lesões Encefálicas Traumáticas/terapia , Criança , Maus-Tratos Infantis/diagnóstico , Pré-Escolar , Transtornos da Consciência/diagnóstico , Transtornos da Consciência/fisiopatologia , Transtornos da Consciência/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Prognóstico , Prevenção Secundária/métodos
11.
BMC Health Serv Res ; 19(1): 288, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31068184

RESUMO

BACKGROUND: Neurological disorders may negatively impact community integration and/or quality of life. Peer support has emerged as a potential strategy to enhance patients' efficacy in managing their own health. This review examines the key characteristics and impact of peer support interventions for adults with acquired brain injury, cerebral palsy, and spina bifida on community integration and quality of life. METHODS: Eligible studies reported on peer support interventions for adults (16 years of age or older) with acquired brain injury, cerebral palsy, or spina bifida. Only randomized controlled trials published in English in the last 10 years were included. MEDLINE, EMBASE, PsycINFO, and CINAHL were used to conduct the literature search. Two reviewers independently screened studies, abstracted data, and evaluated the risk of bias (for individual study elements and overall) using the Cochrane Risk of Bias Tool. RESULTS: The systematic review included 6 trials reporting on acquired brain injury only. Of these studies, 4 reported on stroke and 2 reported on traumatic brain injury. Two studies found significant improvements in quality of life following peer support. No studies reported significant results on community integration. Considerable heterogeneity existed in the key characteristics of interventions. CONCLUSIONS: There are a limited number of studies on the impact of peer support interventions for adults with acquired brain injury, cerebral palsy, or spina bifida on community integration and quality of life. Standardization of key intervention characteristics may aid the global adoption of peer support as a formalized, evidence-based practice.


Assuntos
Lesões Encefálicas Traumáticas/reabilitação , Paralisia Cerebral/reabilitação , Tutoria , Grupo Associado , Disrafismo Espinal/reabilitação , Lesões Encefálicas Traumáticas/fisiopatologia , Lesões Encefálicas Traumáticas/psicologia , Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/psicologia , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Disrafismo Espinal/fisiopatologia , Disrafismo Espinal/psicologia
12.
Rev. neurol. (Ed. impr.) ; 68(9): 375-383, 1 mayo, 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-180674

RESUMO

Introducción. El electroencefalograma (EEG) permite obtener información directa de la actividad bioeléctrica del cerebro y es una herramienta fundamental para la evaluación de la condición neurológica del paciente. En los últimos años ha comenzado a emplearse también para obtener indirectamente información sobre la hemodinámica cerebral y las variables que intervienen en la autorregulación del flujo sanguíneo cerebral. Objetivo. Estudiar la posible relación entre la actividad electroencefalográfica y la presión intracraneal (PIC) en pacientes con traumatismo craneoencefálico y hemorragia subaracnoidea ingresados en cuidados intensivos. Pacientes y métodos. Se incluyó a 21 pacientes (10 mujeres) mayores de 18 años con traumatismo craneoencefálico o hemorragia subaracnoidea que requerían monitorización de la PIC y a los que se les registró el EEG de forma continua. Se determinó la causalidad de Granger entre la PIC con respecto a las variables espectrales del EEG para ventanas temporales de 10 minutos durante la estancia en cuidados intensivos. Resultados. La causalidad de Granger mostró una alta correlación entre la PIC con las bandas del EEG. En la mayoría de los pacientes existe una causalidad de Granger significativa en la dirección del EEG hacia la PIC en gran parte del tiempo de monitorización, de forma que las variables del EEG precedían a la PIC. Conclusiones. El presente trabajo expone la relación temporal subyacente entre la dinámica de la PIC y la actividad bioeléctrica cerebral registrada mediante EEG en pacientes con traumatismo craneoencefálico y hemorragia subaracnoidea. El potencial uso de esta relación podría permitir estimar la PIC de manera no invasiva


Introduction. The capability of the electroencephalography (EEG) of recording the bioelectrical activity of the brain has made of it a fundamental tool for the evaluation of the patient’s neurological condition. In recent years, moreover, it has also begun to be used in obtaining information for other kind of variables, as the ones related with the cerebral hemodynamics Aim. To study the potential relationship between the EEG activity and the intracranial pressure (ICP) in patients suffering from traumatic brain injury and subarachnoid hemorrhage, during their stay at the intensive care unit. Patients and methods. Twenty-one adult patients (10 women) were included in the present observational prospective cohort study. They suffered from either traumatic brain injury or subarachnoid hemorrhage, requiring continuous EEG and ICP monitoring. In every patient, Granger causality between spectral functions of the EEG and the ICP was evaluated. Temporal windows of 10 minute were used to evaluate whether a causal relationship between those variables exist or not. In all of the cases, several days of continuous recording and assessment were performed. Results. In most patients and during most of the time, Granger causality turns out to be significant in the direction from the EEG to the ICP, meaning that the EEG dynamics actually leads the ICP dynamics. Conclusions. The present work provides useful information and shed light in discovering a hidden relationship between the ICP and EEG dynamics. The potential use of this relationship could lead to develop a medical device to measure ICP in a non-invasive fashion


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Nível de Alerta/fisiologia , Cérebro/fisiologia , Eletroencefalografia , Pressão Intracraniana/fisiologia , Lesões Encefálicas Traumáticas/fisiopatologia , Hemorragia Subaracnóidea/fisiopatologia , Estudos Prospectivos , Escala de Coma de Glasgow , Estudo Observacional
13.
Codas ; 31(2): e20170278, 2019 Apr 01.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30942285

RESUMO

PURPOSE: To characterize and compare the functional aspects of swallowing and clinical markers in intensive care patients with traumatic brain injury (TBI) in Intensive Care Unit (ICU). METHODS: Participants of this study were 113 adults diagnosed with TBI. Data collection stage involved: clinical assessment of the risk for bronchoaspiration performed by a speech-language therapist; assessment of the functional level of swallowing (American Speech-Language-Hearing Association National Outcome Measurement System - ASHA NOMS ); assessment of the patient' health status (Sequential Organ Failure Assessment - SOFA). RESULTS: After the inclusion criteria were applied, patients were grouped according to their swallowing functional level: levels 1 and 2 - ASHA1 (n=25); levels 3, 4 and 5 - ASHA2 (n=37); levels 6 and 7 - ASHA3 (n=51). The statistical analyses indicated the following significant results: the ASHA3 group presented lower severity levels of TBI at the clinical assessment of bronchoaspiration, remained less time intubated (approximately um third less than the more severe group), remained fewer days in hospital and needed less therapy sessions to return to safe oral feeding. The clinical predictor signs for bronchoaspiration that best characterized the groups were the presence of altered auscultation and the presence of coughing after swallowing. Patients in the ASHA3 group presented these signs less frequently. CONCLUSION: The score obtained on the SOFA and the time of orotracheal intubation were identified as the prognostic indicators of functional swallowing. The presence of altered cervical auscultation and coughing were clinical predictors of dysphagia.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Transtornos de Deglutição/etiologia , Deglutição/fisiologia , Adulto , Biomarcadores/análise , Lesões Encefálicas Traumáticas/complicações , Estudos Transversais , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Estudos Retrospectivos , Índices de Gravidade do Trauma
14.
Pituitary ; 22(3): 261-269, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30929220

RESUMO

Traumatic brain injury (TBI) is an important public health problem with an increasing incidence in the last years. Relatively few cases are fatal; most individuals will survive and, in the long-term, the sequalae of TBI will include neuroendocrine dysfunctions with a much higher frequency than previously suspected. Patients who develop hypopituitarism after TBI present manifestations due to the number of deficient hormones, severity of hormonal deficiency, and the duration of hypopituitarism without diagnosis and treatment. The clinical spectrum of hypopituitarism is very large and many signs and symptoms of TBI survivors such as fatigue, concentration difficulties, depressive symptoms are nonspecific and overlap with symptoms of post-traumatic stress disorder and variably severe hypopituitarism related to brain damage remaining undiagnosed. This can explain why the diagnosis of hypopituitarism is often missed or delayed after this condition with potentially serious and hazardous consequences for the affected patients. Moreover, clinical experience cumulatively suggests that TBI-associated hypopituitarism is associated with poor recovery and worse outcome, since post-traumatic hypopituitarism is independently associated with cognitive impairment, poor quality of life, abnormal body composition, and adverse metabolic profile. In the present review, the current data related to clinical consequences of pituitary dysfunction after TBI in adult patients and therapeutic approaches are reported.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/fisiopatologia , Hipopituitarismo/etiologia , Hipopituitarismo/fisiopatologia , Animais , Composição Corporal/efeitos dos fármacos , Composição Corporal/fisiologia , Disfunção Cognitiva/tratamento farmacológico , Disfunção Cognitiva/fisiopatologia , Humanos , Hipopituitarismo/tratamento farmacológico
15.
Transfusion ; 59(S2): 1529-1538, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30980755

RESUMO

Traumatic brain injury (TBI) is a common disorder with high morbidity and mortality, accounting for one in every three deaths due to injury. Older adults are especially vulnerable. They have the highest rates of TBI-related hospitalization and death. There are about 2.5 to 6.5 million US citizens living with TBI-related disabilities. The cost of care is very high. Aside from prevention, little can be done for the initial primary injury of neurotrauma. The tissue damage incurred directly from the inciting event, for example, a blow to the head or bullet penetration, is largely complete by the time medical care can be instituted. However, this event will give rise to secondary injury, which consists of a cascade of changes on a cellular and molecular level, including cellular swelling, loss of membrane gradients, influx of immune and inflammatory mediators, excitotoxic transmitter release, and changes in calcium dynamics. Clinicians can intercede with interventions to improve outcome in the mitigating secondary injury. The fundamental concepts in critical care management of moderate and severe TBI focus on alleviating intracranial pressure and avoiding hypotension and hypoxia. In addition to these important considerations, mechanical ventilation, appropriate transfusion of blood products, management of paroxysmal sympathetic hyperactivity, using nutrition as a therapy, and, of course, venous thromboembolism and seizure prevention are all essential in the management of moderate to severe TBI patients. These concepts will be reviewed using the recent 2016 Brain Trauma Foundation Guidelines to discuss best practices and identify future research priorities.


Assuntos
Transfusão de Componentes Sanguíneos , Lesões Encefálicas Traumáticas , Cuidados Críticos/métodos , Hospitalização , Adulto , Idoso , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/fisiopatologia , Lesões Encefálicas Traumáticas/terapia , Feminino , Humanos , Hipotensão/etiologia , Hipotensão/mortalidade , Hipotensão/fisiopatologia , Hipotensão/prevenção & controle , Hipóxia Encefálica/etiologia , Hipóxia Encefálica/mortalidade , Hipóxia Encefálica/fisiopatologia , Hipóxia Encefálica/prevenção & controle , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/mortalidade , Hipertensão Intracraniana/fisiopatologia , Hipertensão Intracraniana/prevenção & controle , Masculino , Pessoa de Meia-Idade , Convulsões/etiologia , Convulsões/mortalidade , Convulsões/fisiopatologia , Convulsões/prevenção & controle , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/mortalidade , Tromboembolia Venosa/fisiopatologia , Tromboembolia Venosa/prevenção & controle
16.
J Neurosci Nurs ; 51(3): 134-141, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30964844

RESUMO

PROBLEM: Uninterrupted nighttime sleep is associated with better cognition and functional outcomes in healthy adults, but the relationship between sleep and functional outcome in individuals hospitalized with severe traumatic brain injury (TBI) remains to be clarified. OBJECTIVE: The aims of this study were to (1) describe nighttime rest-activity variables-wake bouts (counts), total wake time (minutes), and sleep efficiency (SE) (percentage; time asleep/time in bed)-in people on a neuroscience step-down unit (NSDU) post-TBI and (2) describe the association between injury and nighttime rest-activity on post-TBI functional outcome (using Functional Independence Measure [FIM] at discharge from inpatient care). METHODS: This study is a cross-sectional, descriptive pilot study. We recruited participants from the NSDU (n = 17 [age: mean (SD), 63.4 (17.9)]; 82% male, 94% white) who wore wrist actigraphy (source of nighttime rest-activity variables) for up to 5 nights. For injury variables, we used Glasgow Coma Scale (GCS) score and Injury Severity Score (ISS). We used Spearman ρ and regression to measure associations. RESULTS: Glasgow Coma Scale mean (SD) score was 8.8 (4.9), ISS mean (SD) score was 23.6 (6.7), and FIM mean (SD) score was 48 (14.5). Averages of nighttime rest-activity variables (8 PM-7 AM) were as follows: SE, 73% (SD, 16); wake bouts, 41 counts (SD, 18); total wake time, 74 minutes (SD, 47). Correlations showed significance between FIM and GCS (P = .005) and between SE and GCS (P = .015). GCS was the only statistically significant variable associated with FIM (P = .013); we eliminated other variables from the model as nonsignificant (P > .10). Sleep efficiency and FIM association was nonsignificant (P = .40). In a separate model (ISS, GCS, and SE [dependent variable]), GCS was significant (P = .04), but ISS was not (P = .25). CONCLUSION: Patients with severe TBI on the NSDU have poor actigraphic sleep at night. GCS has a stronger association to functional outcome than nighttime rest-activity variables.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Avaliação da Deficiência , Escala de Gravidade do Ferimento , Pacientes Internados/estatística & dados numéricos , Sono/fisiologia , Adulto , Estudos Transversais , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
17.
BMJ Case Rep ; 12(4)2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30996067

RESUMO

A young man with severe traumatic brain injury and refractory intracranial hypertension was treated with a barbiturate coma. A rare side effect of barbiturates is dyskalaemia. The dyskalaemia presented with acute hypokalaemia that quickly became hyperkalaemia. Both electrolyte disturbances can have serious physiological complications. The cellular cause of the dyskalaemia is not well understood. The correct diagnosis and treatment of barbiturate dyskalaemia is essential in providing care. Clinicians treating patients with barbiturates need to be aware of this rare side effect. Our patient was quickly and correctly treated for the dyskalaemia and suffered no complications related to this side effect.


Assuntos
Barbitúricos/efeitos adversos , Lesões Encefálicas Traumáticas/tratamento farmacológico , Coma/induzido quimicamente , Hiperpotassemia/induzido quimicamente , Hipertensão Intracraniana/tratamento farmacológico , Barbitúricos/administração & dosagem , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/fisiopatologia , Cloreto de Cálcio/uso terapêutico , Cuidados Críticos , Glucose/uso terapêutico , Humanos , Hiperpotassemia/fisiopatologia , Hiperpotassemia/terapia , Infusões Intravenosas , Insulina/uso terapêutico , Masculino , Monitorização Fisiológica , Cloreto de Potássio/uso terapêutico , Resultado do Tratamento , Adulto Jovem
19.
Med Sci Monit ; 25: 1871-1885, 2019 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-30860987

RESUMO

BACKGROUND Traumatic brain injury (TBI) produces a series of pathological processes. Recent studies have indicated that autophagy pathway is persistently activated after TBI, which may lead to deterioration of nerve injury. Our preliminary work found miR-21-5p was upregulated in both in vivo and in vitro TBI models. MicroRNAs (miRNAs) could be loaded into exosomes to perform cell-to-cell interactions. This research aimed to evaluate the therapeutic effect of neuron-derived exosomes enriched with miR-21-5p on the TBI in vitro and to further explore the possible mechanisms. MATERIAL AND METHODS Brain extracts harvested from an rTBI mouse model were added to cultured HT-22 neurons to imitate the microenvironment of injured brain on in vitro cultured cells. Ultracentrifugation was performed to isolate exosomes. Transmission electron microscopy and Nano sight technology were used to examine exosomes. An in vitro model of TBI was established to study the effect of exosomal miR-21-5p on nerve injury and on neuronal autophagy regulation. RESULTS The expression of miR-21-5p was increased in exosomes derived from HT-22 neurons after treatment with rTBI mouse brain extracts. Autophagy was activated in HT-22 neurons after scratch injury. Exosomal miR-21-5p produced a protective effect by suppressing autophagy in a TBI model in vitro. MiR-21-5p could directly target the Rab11a 3'UTR region to reduce its translation and further suppressed Rab11a-mediated neuronal autophagy. CONCLUSIONS The levels of miR-21-5p in neuronal exosomes increased from the acute to the chronic phase of TBI. Neuronal exosomes enriched with miR-21-5p can inhibit the activity of neuronal autophagy by targeting Rab11a, thus attenuating trauma-induced, autophagy-mediated nerve injury in vitro.


Assuntos
Lesões Encefálicas Traumáticas/genética , MicroRNAs/genética , MicroRNAs/fisiologia , Animais , Autofagia/genética , Autofagia/fisiologia , Encéfalo/patologia , Lesões Encefálicas Traumáticas/fisiopatologia , Células Cultivadas , Modelos Animais de Doenças , Exossomos/genética , Masculino , Camundongos , Camundongos Endogâmicos C57BL , MicroRNAs/metabolismo , Neurônios/metabolismo , Neurônios/fisiologia , Neuroproteção/efeitos dos fármacos , Proteínas rab de Ligação ao GTP/metabolismo , Proteínas rab de Ligação ao GTP/fisiologia
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