Predictors of Chronic Physical and Mental Quality of Life Following Traumatic Brain Injury

Objective and Background: This study aimed at determining the predictors of chronic physical and mental quality of life (QOL) in patients with traumatic brain injury (TBI) focusing on neuropsychological functions post trauma. Materials and Methods: This is a longitudinal study in which 257 patients having inclusion criteria were enrolled. Neuropsychological tasks including logical memory, verbal paired associates, visual memory, verbal expression, auditory comprehension, semantic judgment and semantic categories were implemented. The appearance of psychiatric disorder, Agnosia, Apraxia, Dysarthria and pragmatic linguistic disorder post trauma were evaluated at discharge. QOL was studied 6 months after injury by filling SF-36 questionnaire via phone interview with patients. Results: Appearance of some post-traumatic disorders including agnosia, pragmatic linguistic disorder and psychiatric disorder were significantly correlated to poor QOL. The final step of logistic regression model showed that TBI severity, verbal memory, auditory comprehension and semantic acceptability scores were predictors of unfavorable mental QOL as well as TBI severity, injury severity scale (ISS) score and multifocal lesions for unfavorable physical QOL. Discussion: Thus, it is recommended that clinicians choose medical therapeutic priorities to improve the verbal neuropsychological sequela and provide preliminaries for a chronic favorable mental QOL. Furthermore, to prevent of chronic unfavorable physical QOL, early care of organic injuries should be considered especially in patients with severe and multifocal TBI.

Comparison of the single-injection volar subcutaneous block and the two-injection dorsal block for digital anesthesia

Objectives: Local digital nerve blockade is frequently used in many trauma cases. Two commonly used techniques of digital nerve block with local anesthetic are the two-injection dorsal technique and the single-injection volar subcutaneous technique. In this study we compare various parameters of the single-injection volar subcutaneous block and the two-injection dorsal block. Pain score, amount of injected anesthetic, time of effect onset, patients’ and physicians’ satisfaction scores in each injection technique was compared. Methods: 128 participating patients were randomly divided into two equal experimental groups. Two-percentage Lidocaine was used as an anesthetic agent. Doses of 1.8 and 3-4 ml were used in the single-injection subcutaneous block and the two-injection dorsal block groups, respectively. Following injections, the patients were asked to score their discomfort experience on a standard visual analog scale of 0 (no pain) to 10 (most pain imaginable). They also were asked to score the rate of their satisfaction from 1(no satisfaction) to 5 (most satisfaction). The onset of effect was determined using the pinprick test. Results: Our results demonstrate that the two-injection dorsal block technique imposes more pain but the pain score difference was not statistically significant. Both patients and physicians were more comfortable with the single-injection subcutaneous digital block method. This satisfaction difference was statistically significant. Conclusions: The single-injection method is more efficient and the patients were more pleased. The advantages of this method are its safety, user friendly, need of lower amount of anesthetic drug and its easiness to teach and learn.

Magnetic resonance spectroscopy findings of brain olfactory areas in patients with COVID-19-related anosmia:A preliminary comparative study

Objectives:2019 novel coronavirus disease(COVID-19)infection is commonly associated with olfactory dysfunctions,but the basic pathogenesis of these complications remains controversial.This study seeks to evaluate the value of magnetic resonance spectroscopy(MRS)in determining the molecular neurometabolite alterations within the main brain olfactory areas in patients with COVID-19-related anosmia.Methods:In a cross-sectional study,seven patients with persistent COVID-19-related anosmia(mean age:29.57 years)and seven healthy volunteers(mean age:27.28 years)underwent MRS in which N-acetyl-aspartate(NAA),choline(Cho),creatine(Cr),and their ratios were measured in the anterior cingulate cortex,dorsolateral prefrontal cortex,orbitofrontal cortex(OFC),insular cortex,and ventromedial prefrontal cortex.Data were analyzed using TARQUIN software(version 4.3.10),and the results were compared with an independent sample t-test and nonparametric Mann-Whitney test based on the normality of the MRS data distribution.Results:The mean duration of anosmia before imaging was 8.5 months in COVID-19-related anosmia group.MRS analysis elucidated a significant association between MRS findings within OFC and COVID-19-related anosmia(P_(disease)<0.01),and NAA was among the most important neurometabolites(P_(interaction)=0.006).Reduced levels of NAA(P<0.001),Cr(P<0.001)and^(NAA)/Cho ratio(P=0.007)within OFC characterize COVID-19-related anosmia.Conclusions:This study emphasizes that MRS can be illuminating in COVID-19-related anosmia and indicates a possible association between central nervous system impairment and persistent COVID-19-related anosmia.

Predicting mortality, hospital length of stay and need for surgery in pediatric trauma patients

Purpose： Pediatric trauma is one of the major health problems around the world which threats the life of children. The survival of injured children depends upon appropriate care, accurate triage and effective emergent surgery. The objective of this study was to determine the predictive values of injury severity score （ISS）, new injury severity score （NISS） and revised trauma score （RTS） on children＇s mortality, hospitalization and need for surgery. Methods： In this study, records of trauma patients under 15 years old transported from a trauma scene to emergency department of Poursina hospital from 2010 to 2011 were included. Statistical analysis was applied to determine the ISS, NISS and RTS ability in predicting the outcomes of interest. Results： There were 588 records in hospital registry system. The mean age of the patients was （7.3 ± 3.8） years, and 62.1% （n = 365） of patients were male. RTS was the more ability score to predict mortality with an area under curve （AUC） of 0.99 （95% CI, 0.99-1）. In the hospital length of stay （LOS）, ISS was best predictor for both the hospital LOS with AUC of 0.72 （95% CI, 0.67-0.76） and need for surgical surgery with AUC of 0.94 （95% CI, 0.90-0,98）. Conclusion： RTS as a physiological scoring system has a higher predicting AUC value in predicting mortality. The anatomic scoring systems of ISS and NISS have good performance in predicting of hospital LOS and need for surgery outcomes.

Road traffic crashes in rural setting： an experience of a middle-income country

Objective： To date, there has been little information published on the death of rural road accident deaths. This study uses burden of injury method to explore a more accurate estimate of years of life lost due to road traffic crashes occurring over a four-year period in Guilan province, northern Iran. Methods： Rural road accident deaths from 2009 to 2013 were extracted from Iran＇s Forensic Medicine System, Death Registry System and Road Trauma Research center database. Results： During the study period, the average years of life lost due to motor vehicle crashes was 13.8 per 1 000 persons, ranging from 11.9 during March 2011- 2012 to 15.8 per 1 000 persons during March 2012-2013. Conclusion： Road accident deaths in 2013 remained at the same high level as in 2009. The information obtained from this study provides a new perspective on fatal road traffic crash victims in rural settings and show us that more attention is needed in this area.

Cell therapy for the treatment of reproductive diseases and infertility:an overview from the mechanism to the clinic alongside diagnostic methods

Infertility is experienced by 8%–12%of adults in their reproductive period globally and has become a prevalent concern.Besides routine therapeutic methods,stem cells are rapidly being examined as viable alternative therapies in regenerative medicine and translational investigation.Remarkable progress has been made in understanding the biology and purpose of stem cells.The affected pluripotent stem cells(iPSCs)and mesenchymal stem cells(MSCs)are further studied for their possible use in reproductive medicine,particularly for infertility induced by premature ovarian insufficiency and azoospermia.Accordingly,this study discusses current developments in the use of some kinds of MSCs such as adipose-derived stem cells,bone marrow stromal cells,umbilical cord MSCs,and menstrual blood MSCs.These methods have been used to manage ovarian and uterine disorders,and each technique presents a novel method for the therapy of infertility.