khalil komlakh

This study was conducted to investigate the factors affecting mortality due to spinal cord traumain patients admitted to the intensive care unit (ICU).

This study was conducted in a group of patients who were admitted to the ICU with a TraumaticSpinal Injuries (TSI) diagnosis. The researcher started sampling by assessing the documents of the patientshospitalized in the ICU, and the diagnosis of TSI was confirmed for them. Besides, utilizing a researcher-madechecklist, factors affecting the mortality of patients were identified. The data were analyzed using the SPSSsoftware version 16. P<0.05 was considered statistically significant.

About 412 (64.2%) patients were men, about 213 (33.2%) of the patients had GCS between 3-8 grade.There were injuries in the pelvis area. Moreover, there was a significant relationship between GCS score statusand the number of injury follow-ups in addition to TSI. Therefore, the mortality rate was higher in patients whohad lower GCS (Odds ratio=2.32, p<0.001). There was also a significant relationship between the number ofinjuries and the mortality rate, and patients who had multiple traumas had a higher mortality rate. Besides, asignificant relationship was observed between the complications caused by trauma, including cerebrovascularaccident, cardiac arrest, acute respiratory distress syndrome (ARDS), pneumonia, and the mortality of patientshospitalized in the SICU (p<0.05)

The patients’ mortality was influenced by factors such as their level of consciousness, the numberof traumas caused in the spinal cord, and the occurrence of comorbidities such as cerebrovascular accident,cardiac arrest, ARDS, and pneumonia. Therefore, it is necessary to take the essential measures to reduce thesecomplications.

Guillain‑Barré syndrome is an autoimmune disorder presented by ascending paralysis and areflexia. The condition has been reported after many infections, but Guillain‑Barré syndrome after spine surgery is rare. We, herein, present a case of Guillain‑Barré syndrome after multiple spine surgeries for degenerative lumbar scoliosis. A 60‑year‑old woman with degenerative scoliosis underwent surgery for the third time and developed Guillain‑Barré syndrome 3 weeks after the final operation. The patient received intravenous immune globulin therapy and needed mechanical ventilation and intensive care. She was discharged in good condition after 5 weeks.

It is important to identify the clinical education challenges and related factors. The aim of the present systematic review was to investigate the status of clinical rounds in universities of medical sciences.

Materials: 

This review study was conducted with the aim of investigating the quality of and satisfaction from clinical rounds from the viewpoint of faculty members, residents, interns, and apprentices of Iran’s Medical Sciences universities. The search was conducted by two members of the clinical faculty who were familiar with the subject and were expert in systematic review articles. The found articles were entered into the Word Software Ver. 2008.

Initially, 88 articles were searched, of which 67 articles were excluded from the study since they were not consistent with the research objectives. Then, eight articles were entered the systematic review stage after rechecking and studying all titles and abstracts of studies. It should be noted that the sample size was not mentioned in one of the published articles. The studied wards also included internal, surgery, pediatric, endocrine, and gynecology. Furthermore, the results showed that faculty members had a higher satisfaction with clinical rounds and their quality as compared with residents and interns, so that in faculty members assigned higher scores to the quality of clinical rounds than students in all the relevant previous studies.

It is suggested that necessary interventional studies be conducted to increase the quality of clinical rounds, especially from the perspective of students.

To probe the factors associated with the outcomes of traumatic brain injury (TBI) patients admittedto emergency department (ED). This is a cross-sectional study that data gathering was performed via census methods, retrospectively.During one year, all head injury’s patients who admitted to the ED of a tertiary center in Tehran, Iran wereincluded. Age, gender, mechanism of injury, Glasgow coma scale (GCS) and injury severity score (ISS)on admission, presence of extra-cranial injuries, findings of brain computed tomography (CT), duration ofhospitalization, and in hospital outcomes were recorded. Outcome’s assessment for survivors was performedwithin a 6 months-period after discharge based on Glasgow outcome scale (GOS). The variables and outcomes’association were assessed. Totally, 506 patients were evaluated with the mean age of 36.77±21.1 years that 411 (81.2%) were men.Follow up at 6-months post injury was feasible in 487 (96.2%) patients; 59 (11.7%) out of 506 eligible patientsdied. Logistic regression analysis showed the association between assessed variables and patients’ outcome asfollows: age>65 years (OR: 12.21; p<0.001), GCS on admission <8 (OR: 62.99; p<0.001), presence of traumaticIntracerebral hemorrhage (ICH) in brain CT scan (OR: 20.11; p=0.010), duration of hospitalization ≥ 5 days(OR: 0.28; p=0.001). The findings of the current study distinguished some variables that were associated with thepoor outcome of the patients with TBI. Therefore, TBI patients with any of these risk factors may need closecontinues monitoring, early ICU admission, and some other special extra care in ED.

 Traumatic brain injury (TBI) is one of the leading causes of death, which ranges from mild and irreversible to severe and life-threatening injuries.

 This study aimed to compare the pain score in patients with brain disorders using Care Pain Observation Tool (CPOT) and Nonverbal Pain Scale (NVPS).

 A descriptive comparative study was performed in Ilam province, Iran, in a group of head trauma patients admitted to the intensive care unit who were intubated. One hundred twenty observations of nurses’ practice were performed. A purposive sampling method was utilized. The CPOT and NVPS assessed the pain, and the Glasgow Coma Scale (GCS) assessed the state of consciousness. Data were analyzed by SPSS version 16 software.

 Patients’ mean ± SD age was 38.45 ± 4.2 years. The mean ± SD pain score on the CPOT before the procedure was 0.39 ± 0.49 in the facial expression dimension, 0.56 ± 0.49 in activity, 0.54 ± 0.50 in muscle tension, and 0.55 ± 0.49 in compatibility with the ventilator. The mean ± SD pain score on the NVPS before the procedure was 0.97 ± 0.20 in facial expression dimension, 0.94 ± 0.49 in activity, 0.95 ± 0.31 in guarding, 0.64 ± 0.49 in vital signs, and 0.92 ± 0.53 in excitement.

 Both CPOT and NVPS were effective in diagnosing patients’ pain, but the CPOT was more appropriate for diagnosing pain in intubated patients.

Increasing the satisfaction of students with the advisors can help to improve the educational status of students. Therefore, this study aimed to investigate the performance of advisors from the viewpoint of medical students in Iran in the form of a systematic review.

In this study, all studies on the performance of advisors of universities of medical sciences were reviewed from the students' viewpoint and students' satisfaction with the professors' performance systematically. The national databases of Iran and international databases were searched and the data and articles were entered EndNote version 7.

Results showed that 155 articles were searched at the first stage. 93 articles were excluded from the search at the first stage, and finally, a systematic review was conducted with 11 original articles. Also, 662 faculty members and 5697 students of 11 universities of the country including Kerman, Babol, Shiraz, Kurdistan, Rafsanjan, Alborz, Sabzevar, Urmia, Lorestan, Mashhad, and Semnan universities were investigated. Likewise, from the students' viewpoint, the professors' performance was in a range from poor to excellent. In addition, the level of satisfaction with the performance of the advisors from the students' viewpoint varied from poor to excellent.

According to the study results, it is suggested to hold training workshops on the necessary methods for the advisors’ principles while revising job description of advisors.

Tranexamic acid (TXA) belongs to the family of lysine-derived antifibrinolytics. TXA requires a simple molecular breakdown in the liver to be metabolized and has a high renal excretion.

This study aimed to determine the effect of TXA on subdural hematoma (SDH) treatment using the SR method.

Following a systematic review design, this study aimed to evaluate the effect of TXA on SDH treatment using studies published from 2000 to 2020. The search was performed by two researchers who were dominant in various types of SR studies and specialized discussion of neurosurgery. A checklist that contained the following items was used to collect the data: surname, year of study, year of publication, population, sample size, age, intervention, and outcomes. Data were also classified and reported using Word software.

Initially, 178 articles were identified, out of which 118 were removed due to the relevance of the title and method, 44 due to duplication, six due to following the SR method, and three due to having a case report design. Seven studies were found as eligible, as follows: the study by Wakabayashi et al. with a sample of 199 patients, Kageyama et al.’s study with 21 patients, Wan et al.’s study with 90 patients, Kutty et al.’ study with 27 patients, Tanweer et al.’s study with 14 patients, Yamada et al.’s study with 193 patients, and Lodewijkx et al.’s study with 7 patients. All articles showed that TXA could reduce SH.

Regarding the positive effect of TXA on reducing SDH, administration of this medicine is recommended in the treatment of patients with CSDH.

Thoracic disc herniation is a rare illness and is mainly asymptomatic. There are some surgical approaches to treat symptomatic patients, and none has absolute dominance over the others. For this reason, there is a debate between spine surgeons to decide which method could help these patients with better efficacy and safety.

To seek the potential differences between the two of these methods, the conventional anterior transthoracic and the more recent modified transfacet approaches, we conducted this study.

This is a retrospective case-series study comparing the anterior transthoracic and the modified transfacet method; each of these approaches was preferred and performed by one surgery team. Patients were divided into two groups based on the procedure and assessed using Frankel’s score, visual along scale (VAS) score, short-form health survey questionnaire (SF-36), and the spine functional index (SFI).

Eleven patients underwent a transthoracic approach, and eight patients had a posterior transfacet pedicle-sparing approach. The Frankel’s score improved at least one score in ten patients from the transthoracic group and seven patients from the transfacet pedicle-sparing group. No major difference was found between the two groups concerning SFI and SF-36 questionnaire.

This study exhibited satisfying efficacy and safety of the modified transfacet pedicle-sparing method compared to the transthoracic approach. Both improved Frankel’s scores, SFI, and patients’ quality of life. Despite encountering some limitations, especially a small number of subjects, our study suggests that these surgical methods could be used efficiently considering the patient’s comorbidities, location of the herniated disc and its calcification, and experience and skill of the surgeon.

Diffuse axonal injury (DAI) is an injury that occurs after the onset of traumatic brain injury (TBI), leading to many problems for patients and imposing high costs on the treatment system.

This study was conducted to investigate the status of laboratory variables in patients with DAI.

This cross-sectional study included 140 patients. Data collection tools were a demographic profile form and magnetic resonance imaging (MRI). Laboratory tests, including glucose, LDL-C, HDL-C, total cholesterol, triglycerides, Hb, HCT, PT, PTT, INR, BUN, creatinine, and CRP were evaluated. Also, specialized devices were used to study the laboratory and radiology variables.

Most (61.5%) of the patients were male, 47.1% had a non-governmental occupation, and 55.7% were less than 30 years old. Also, in 87.9% of cases, traffic accidents were the cause of DAI and in 65% of patients, the Glasgow Coma Scale (GCS) was less than 7. In all the laboratory variables differences were observed between the experimental and the control groups.

The laboratory variables in patients with DAI had a statistically significant difference compared to the case group, which indicates the negative effect of DAI on laboratory variables. Further studies are required to confirm our results.

There is a need to prepare clinical guidelines for conducting elective or emergency spinal cord surgeries in people who may be carriers of the COVID-19. Therefore, the study aimed to design a guideline for conducting elective spinal cord surgeries during the COVID-19 pandemic. The clinical guidelines and systematic reviews providing recommendations for elective and emergency spinal cord surgeries were collected by an initial search. A group of nine experts were designed a domestic preliminary guideline using six available guidelines presented in four studies. Scoring was conducted based on the AGREE (Appraisal of Guidelines Research and Evaluation) tool. The guideline was prepared in eight subscales, including outpatient visit and counseling, protective measures for health personnel, surgical considerations during the coronavirus pandemic, intraoperative considerations, managing aerosol producing activities, elective and emergency spinal cord surgery, and patient intubation and cardiopulmonary resuscitation. Each of these subscales included several specific recommendations. It recommended to reduce the capacity of inpatient wards to half during the coronavirus pandemic, give priority only to emergency surgeries, presence of skilled residents (senior year residents), use personal protective equipment, use the least number of people in the operating room, and reduce the length of surgery without compromising its quality.

One of the chronic diseases with various challenges for patients and caregivers is spinal cord injury (SCI). The spread and prevalence of coronavirus disease 2019 (COVID-19) have been an influential risk factor for abuse.

The aim of this study was to assess the rate of abuse in patients with SCI during the COVID-19 pandemic.

This cross-sectional descriptive study population was all SCI cases in Ilam, Iran. Researcher-made forms and questionnaires with confirmed validity and reliability, including the demographic characteristics, form and perceived abuse researcher-made questionnaire for people with SCI, were used. The perceived abuse questionnaire for patients with SCI was a researcher-made questionnaire designed based on library studies, interviews with patients, and determination of abuse instances. This instrument consists of 20 questions answered as yes (score 1) or no (score 0). After data collection, statistical analyzes were performed using the SPSS software version 16.

According to our results, the mean ± SD of the perceived abuse score by caregivers and patients was 8.48 ± 2.31 and 42.45% during the COVID-19 pandemic, respectively. Moreover, the mean ± SD of the age of patients was 62.86 ± 19.15 years, and the patient abuse increased with elevation in age (P = 0, F = 27.42). The possible abuse score was 0 - 20 divided into three categories of low (20, 20.4%), moderate (76, 76.5%), and high (2, 2%). The perceived abuse score was significantly higher among women and patients with a history of more than 10 years of SCI. Abuse prevalence did not have a significant relationship with income and marital status. Regarding age and abuse, our results showed a rise in perceived abuse scores with an increase in age.

The present study showed that it is necessary to take measures to prevent abuse in patients with SCI. Moreover, the prevalence of abuse related to COVID-19 in patients with SCI was high. Therefore, preventive actions need to be proposed in this field.

Several studies have examined the possible role of beta-blockers, including esmolol, in controlling intracranial pressure (ICP). This study aimed to evaluate the effect of esmolol on ICP in patients with severe traumatic brain injury.

In this case-control study, all TBI patients with ICP > 20 cmH2O, who were admitted to ICU during the study period, were included. Some patients received standard treatment plus esmolol (500 μg/kg and then 50 mg/kg/min for 24 hours), and some others just received standard treatment with no esmolol. The patients were monitored, and the ICP measurement was performed via inserted intra-ventricular catheter. The ICP and vital signs were measured and recorded before, 8, 16, and 24 hours after starting the treatment in the two groups, and the findings were then compared.

Twenty-two patients (13 males and 9 females) were included in this study, of whom 12 patients received esmolol, and 10 patients were in the control group. The mean age of those who received esmolol was smaller than those who did not receive it (46.6 ± 18.5 vs. 62.3 ± 19.1 years; P = 0.08). Moreover, the mean length of the ICU stay was smaller in the esmolol receivers than the control group (5.6 ± 1.1 vs. 17.3 ± 7.7 days; P = 0.04 (there was no significant difference between the two groups in terms of mortality rates (P = 0.30). The variations of the vital signs over time was not significantly different between the two groups (P > 0.05); however, the mean of ICP was lower in those who received esmolol compared to the control group at all checkpoints (P < 0.05).

Those patients with TBI who received esmolol as part of their ICP control management in ICU had lower ICP than those who received no esmolol.

The purpose of this study was to quantitatively evaluate if the use of the optic nerve sheath diameter (ONSD) can be a suitable noninvasive surrogate approach for repeated invasive intracranial pressure (ICP) measures. 

The study used a sample of 22 adult patients with traumatic brain injury (TBI) from an in intensive care unit (ICU). ICP levels were measured using the gold standard and recorded in cmH20. ONSD was measured using ultrasonography with 5.6-5.7 MHz linear probe and recorded in millimeters. The data analysis was done using STATA software version 15. 

The results showed a strong positive correlation between ICP and ONSD (r = 0.743, p = 0.001). The accuracy of the sonographic ONSD declined over time, starting from a high of 90.9% at the baseline and declining to a low of merely 20.0% after 48 hours. 

These findings indicate that the ONSD approach could be very useful alternative and noninvasive method for monitoring ICP.

We compared the effect of the teaching aids and review sessions on learning anatomy subjects by the medical students of Rafsanjan University of Medical Sciences.
In this study, during each semester, practical anatomy courses were presented by using different teaching aids such as, cadaver, bones, and training videos to the students. For all studied groups, at the end of each semester and a few days before the final exam, the regular review sessions were held by course lecturers. Then, student’s viewpoints about the effect of both teaching aids and review sessions on their learning process were investigated, using the study checklist. Finally, the mean final scores of students who participated in the review session were compared with those who did not.
The mean scores of anatomy practice exam (range 1-20) of students who did not participate in review sessions were significantly lower than the student who did participate in these sessions. Among the medical and dental students, a significant difference was reported with regard to the effectiveness of teaching aids and review sessions on learning process. Viewpoint of senior students in comparison to junior students were more positive about practical courses and review sessions. Overall, students’ viewpoints about the effect of both teaching aids and review sessions on their learning process were positive and there was no significant difference between them with regard to their gender or field of study. However, medical and dental students believed that using teaching aids such as bones and models was very effective in their learning process of head and neck course. These opinions were significantly different between students of these two courses compare to students in the other courses (for models: P=0.022, for bones: P=0.007).
Practical anatomy and review sessions play an important role in the learning process of different subjects. Therefore, we suggest that practical courses and review sessions be held with greater emphasis and for a longer time.