Suffered Head Trauma Research Articles

Minimal is not minor also in patients with mild traumatic brain injury on oral direct anticoagulant therapy.

Currently, all patients, regardless of the type of head injury, should undergo a head computerized tomography (CT) if on oral anticoagulant therapy. The aim of the study was to assess the different incidences of intracranial hemorrhage (ICH) between patients with minor head injury (mHI) and patients with mild traumatic brain injury (MTBI) and whether there were differences in the risk of death at 30days as a result of trauma or neurosurgery. A retrospective multicenter observational study was conducted from January 1, 2016, to February 1, 2020. All patients on DOACs therapy who suffered head trauma and underwent a head CT were extracted from the computerized databases. Patients were divided into two groups MTBI vs mHI all in DOACs treatment. Whether a difference in the incidence of post-traumatic ICH was present was investigated, and pre- and post-traumatic risk factors were compared between the two groups to assess the possible association with ICH risk by propensity score matching. 1425 with an MTBI in DOACs were enrolled. Of these, 80.1% (1141/1425) had an mHI and 19.9% (284/1425) had an MTBI. Of these, 16.5% (47/284) patients with MTBI and 3.3% (38/1141) with mHI reported post-traumatic ICH. After propensity score matching, ICH was consistently found to be more associated with patients with MTBI than with mHI (12.5% vs 5.4%, p = 0.027). Risk factors associated with immediate ICH in mHI patients were high energy impact, previous neurosurgery, trauma above the clavicles, post-traumatic vomiting and headache. Patients on MTBI (5.4%) were found to be more associated with ICH than those with mHI (0.0%, p = 0.002). also when the need for neurosurgery or death within 30days were considered. Patients on DOACs with mHI have a lower risk of presenting with post-traumatic ICH than patients with MTBI. Furthermore, patients with mHI have a lower risk of death or neurosurgery than patients with MTBI, despite the presence of ICH.

The Frequency of Early Post Traumatic Cerebrospinal Fluid Rhinorrhea in Patients with Head Trauma

Objective: To determine the frequency of early post-traumatic CSF (cerebrospinal fluid) rhinorrhea in patients with head trauma. Materials and Methods: A prospective study was conducted in the Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi from 13th December 2019 to 12th December 2020. This study comprised 155 patients who had suffered head trauma. All patients were followed for one week. If patients developed clear, watery discharge from the nose, this was documented as being CSF rhinorrhea. The frequency was then further divided into immediate and early. Results: The ages of the patients were 34.28 ± 14.20 years on average. The prevalence of CSF rhinorrhea was observed in 3.2% (5/155) patients. In all the patients, the CSF leak presented within the first 48 hours i.e. it was immediate. Conclusion: Although rare, this post-traumatic complication continues to be a challenge in terms of morbidity and subsequent mortality. Key Words: Cerebrospinal fluid, Rhinorrhea, Head Trauma.

To Evaluate Frequency of Intracranial Hemorrhage in Patients of Head Trauma with GCS 10-15

Background: A common cause of mortality is traumatic brain injury (TBI). One of the deadliest complications is cerebral bleeding. Unanimously, CT scans are considered as gold-standard diagnostic tools for traumatic brain damage. In-patient assessment is aided by the patient's general condition score (GCS). Patients with a high GCS are often overlooked, yet it is possible that they may have major difficulties in the future. However, it is debatable whether or not a CT scan should be performed in individuals with GCS between 13 and 15 or not. Objective: It is our goal to examine individuals who have suffered head trauma and have a high GCS 10-15 on a CT scan who may have been overlooked but are now experiencing symptoms. We discovered the prevalence of ICH in 70 individuals with GCS ranging from 10-15. Methods: The computed tomography scans of 70 individuals with head trauma were performed. All patients underwent a non-contrast computed brain CT scan of 5mm axial images and slice thicknesses from the foramen magnum up to the vertex from which the findings were obtained. The patient's name, age, gender, and GCS score were all entered into a Performa. Results: The results showed that 32 patients (45.71 percent) experienced cerebral bleeding out of 70 individuals. Conclusion: Patients with RTA are at greater risk of developing ICH, and this risk is greater in men than in women.

Automation of Traumatic Brain Injury Diagnosis through an IoT - based Embedded Systems Framework

Traumatic Brain Injury (TBI) is a prevalent cause of death and disability with over 3.8 million annual cases and 130 daily deaths in the United States alone. Whenever athletes suffer head trauma, concussion field tests that measure their perceptiveness and cognitive abilities are commonly administered. To solve this, an expensive diagnostic helmet targeting youth sports teams was created, providing quantitative data regarding how much head trauma an athlete has experienced. The helmet is connected to a web-based application system that stores real time data regarding the impact of the head injury, The device and web application were programmed using JavaScript, HTML, CSS, and the Node.js platform in the Intel Edison IDE. This device therefore removes existing bias involved in diagnostics, allows doctors to more accurately handle injuries, and helps ensure player safety.

Multimodal characterization of Yucatan minipig behavior and physiology through maturation

Brain injuries induced by external forces are particularly challenging to model experimentally. In recent decades, the domestic pig has been gaining popularity as a highly relevant animal model to address the pathophysiological mechanisms and the biomechanics associated with head injuries. Understanding cognitive, motor, and sensory aspects of pig behavior throughout development is crucial for evaluating cognitive and motor deficits after injury. We have developed a comprehensive battery of tests to characterize the behavior and physiological function of the Yucatan minipig throughout maturation. Behavioral testing included assessments of learning and memory, executive functions, circadian rhythms, gait analysis, and level of motor activity. We applied traditional behavioral apparatus and analysis methods, as well as state-of-the-art sensor technologies to report on motion and activity, and artificial intelligent approaches to analyze behavior. We studied pigs from 16 weeks old through sexual maturity at 35 weeks old. The results show multidimensional characterization of minipig behavior, and how it develops and changes with age. This animal model may capitulate the biomechanical consideration and phenotype of head injuries in the developing brain and can drive forward the field of understanding pathophysiological mechanisms and developing new therapies to accelerate recovery in children who have suffered head trauma.

Implantable loop recorder follow-up

Abstract Introduction Long ambulatory ECG monitoring can be a useful component in the evaluation of the patient with unexplained syncope or syncope with suspected arrhythmic origin, as well as a sensitive tool for detecting asymptomatic spontaneous cardiac arrhythmias or conduction abnormalities in predisposed patients. Purpose To determine the diagnostic cost-effectiveness of the implantable loop recorder (ILR) in the origin of unexplained syncope in our center. Methods A retrospective observational study was carried out in a tertiary center, those patients with an ILR between August 2014 and March 2021 were included. Baseline characteristics of the population and their previous ECG, arrythmias detected during follow-up and pacemaker implant rate were evaluated. Results One hundred twenty-seven patients with a ILR were included (age 67 years, 49.6% males). Most often cause of ILR was unexplained syncope (90.6%) followed by monitoring after TAVI implant (3.9%). Normal LVEF (>50%) was present in 85.6%,and 75.6% had NYHA I functional class. 118 patients (92.9%) presented sinus rhythm at implant time, and 8 (6.3%) presented AF. 12.6% presented first degree atrioventricular (AV) block, 2 patients (1.6%) had presented previously Mobitz Type I AV block and one patient 2:1 block. Left bundle branch block (LBBB) was present in 13.4%,RBBB in 3.1%,LAFB in 9.4%, RBBB+LAFB in 11% and RBBB+LPFB in 2.4%. Median time of follow-up was 21 months. 3rd degree AV block was the most frequent arrhythmia detected (12.1%), followed by >3s pause (8%) and previously unknown AF (2.4%).The patients with syncope who suffered head trauma (33%) presented a higher rate of pacemaker (PCM) implant compared to those without head trauma: 31.6% vs 14.7%. In total,19.8% PCM rate implant during follow-up. No complications ILR related. Conclusion In conclusion, long home ECG monitoring with ILR is a powerful and helpful tool to find out or rule out potentially dangerous arrhythmias as cause of syncope, with no complications in our experience. Funding Acknowledgement Type of funding sources: None. Baseline characteristicsArrhythmias detected during follow-up

Epidemiological Study of Mortality Caused by Road Accidents in the Intensive Care Unit of Besat Educational-medical Hospital in Hamadan

Introduction: Road accidents are one of the causes of death and it's important to investigate the epidemiological indicators in this context. In this regard, this study aimed to determine the epidemiological causes of road accident mortality in the intensive care unit of Besat Educational-medical Hospital in Hamadan during Nowruz Holidays 2018. Material and Methods: In this descriptive cross-sectional study, data of the patients died for 13 days in Nowruz Holidays in the intensive care unit of Besat Hospital in Hamadan, by census method, was extracted from the medical records of patients by using a checklist from a researcher-made questionnaire. Data were analyzed by Fisher's exact test and SPSS 21 software. Results: Of the 28 Patient admitted to the intensive care unit,16 patients died. Most deaths were in the third decade of life, among single men, with a self-employment job, with diploma education level or cycle education level, with more than 10 days of hospitalization and in the night shift. Based on the results, most of the dead persons were rider (81.25%), suffered head trauma (50%), with head surgery (56.25%), without any underlying illness (93.75%) and without successful experience of cardiopulmonary resuscitation (87.5%). There were no statistically significant differences between the variables and mortality rate (P value > 0/05). Conclusion: Young single men with low level of education are a wide range of road accidents victims. Therefore, it seems it's necessary to reduce mortality from these accidents, health planning such as traffic culture training and driving rules, by using social media, should focus on learning and improving the level of community awareness, especially in this group of people.

Risk and Prognostic Factors for Intracranial Hemorrhage in Elderly Patients with Immune Thrombocytopenia

Introduction: Immune thrombocytopenia (ITP) is a hematological disease associated with thrombocytopenia and bleeding diathesis. Intracranial hemorrhage (ICH) is the most devastating complication in ITP patients. Prophylaxis for ICH is indispensable due to its high mortality. However, the morbidity of ICH is quite low, which makes general prophylaxis unrealistic. A previous study demonstrated risk stratification of ICH in ITP patients before 60 years of age(Platelets, 2020). However, few studies have analyzed the risk factors and outcomes in ICH in elderly ITP patients. Thus, ascertaining the characteristics of ICH in elderly ITP patients is in urgent need to make effective assessments and provide personalized prophylaxis. Here, a retrospective study of a series of ITP patients who developed ICH ≥ 60 years of age was conducted to explore potential risk and prognostic factors, which may contributes to identifying the feasible personalized prophylaxis for ICH in elderly ITP patients. Patients and methods: A total of 44 patients incorporated in the study were over 60 years of age with a diagnosis of primary ITP before the onset of ICH. All measures were chronologically performed before the onset of ICH. Univariate and multivariate analyses were conducted using conditional logistic regression model. Each variables with a p-value < 0.10 in the univariate analysis and well-reported factors were included in the multivariate analysis. A stepwise approach was used to exclude variables with a p-value > 0.10. Results: Platelet counts at ITP diagnosis were significantly lower among patients who developed ICH afterwards (P=0.004). Platelet counts were dichotomized and coded into binary variables. The cut off value was 25,000/μL according to the ROC curve and Youden index. Estimation by the Kaplan-Meier method indicated that the morbidity of ICH was higher among patients with a baseline platelet count less than 25,000/μL (P=0.001). Bleeding severity was also included in the analysis. The control group had a significantly higher probability of no bleeding(P=0.008), while the case group was more likely to suffer life-threatening bleeding(P=0.006). The anatomic sites of bleeding manifestations were then examined. There existed significant difference between cases and controls with respect to skin bleeding (P=0.002), oral cavity bleeding (P < 0.001), gastrointestinal bleeding (P=0.022) and hematuria (P < 0.001). Univariate analysis also revealed that patients with a complication of diabetes mellitus (P=0.007) exhibited a significantly lower incidence of ICH, and fewer patients over 75 years of age developed ICH(P=0.021). Patients who had suffered head trauma before the end point of follow-up had a significantly higher probability of developing ICH (P=0.016). Moreover, patients with a duration of ITP no more than 7 days showed potential relevance (P=0.016). Multivariate analysis was conducted using a conditional logistic regression model. A stepwise approach identified a platelet count ≤ 25,000/μL at ITP diagnosis(OR=3.389, 95% CI 1.290-8.907, P=0.013), head trauma (OR=9.753, 95% CI 1.029-92.414, P=0.047), ITP duration less than 7 days (OR=6.741, 95% CI 1.348-33.712, P=0.020) and life-threatening bleeding(OR=13.077, 95% CI 1.104-154.865, P=0.041) as independent risk factors for ICH in elderly ITP patients. A simple predictive model was established according to the results above. Patients were segregated into a low-risk (Score=0), an intermediate-risk (Score=1-3) and high-risk (Score≥4) groups. Significant differences (P < 0.001) were observed in the frequencies of ICH between the 3 risk groups (Table 1). Kaplan-Meier estimations of ICH incidence were markedly different among the risk groups (Figure 1). As for prognostic factors, skin bleeding (OR=17.400, 95% CI 1.926-157.190, P=0.011) was identified as an independent poor prognostic factor. No significance was found with respect to age, platelet count or ITP duration. Conclusion: Our study revealed that platelet count ≤ 25,000/μL at ITP diagnosis, head trauma, ITP duration < 7 days and life-threatening bleeding are all independent risk factors for ICH in elderly ITP patients. A simple predictive model was established using these factors, and skin bleeding was a poor prognostic factor for ICH in elderly ITP patients. Disclosures No relevant conflicts of interest to declare.

Abdominal pain due to the spinothalamic tract injury in patients with mild traumatic brain injury: a case report

BackgroundWe report on a patient with a mild traumatic brain injury (TBI) who developed abdominal pain due to spinothalamic tract (STT) injuries revealed by diffusion tensor tractography (DTT).Case presentationA 53-year-old female patient suffered head trauma resulting from a backward fall. While bathing at a public bathhouse, she fell backward and struck the occipital area of her head against the floor. After the head trauma, she experienced pain in the abdomen and in both hands and feet. She underwent evaluations including conventional brain MRI, abdominal and pelvic ultrasonography, and stomach and intestine endoscopy. No abnormality was observed in her brain or abdomen. In addition, her abdominal pain had not been relieved by medical management. When she came to our hospital 4 years after the head trauma, her pain characteristics and severity were as follows: intermittent pain without allodynia or hyperalgesia; squeezing and warm creeping-like pain in the abdomen (visual analog scale score: 7); tingling pain in both hands and feet (visual analog scale score: 7). She was prescribed pregabalin and gabapentin, and her abdominal and limb pain was well-controlled at a tolerable level. On DTT 4 years after head trauma, the upper portion of the spinothalamic tracts (STTs) in both hemispheres showed partial tearing.Discussion and conclusionsInjury of the STT was demonstrated by using DTT in a patient who showed abdominal pain that was refractory to medical management following mild TBI. Our results suggest that central pain due to STT injury might be suspected in patients with abdominal pain that is refractory to medical management following TBI.

Potential biomarkers to detect traumatic brain injury by the profiling of salivary extracellular vesicles.

Traumatic brain injury (TBI) is a common cause of death and acquired disability in adults and children. Identifying biomarkers for mild TBI (mTBI) that can predict functional impairments on neuropsychiatric and neurocognitive testing after head trauma is yet to be firmly established. Extracellular vesicles (EVs) are known to traffic from the brain to the oral cavity and can be detected in saliva. We hypothesize the genetic profile of salivary EVs in patients who have suffered head trauma will differ from normal healthy controls, thus constituting a unique expression signature for mTBI. We enrolled a total of 54 subjects including for saliva sampling, 23 controls with no history of head traumas, 16 patients enrolled from an outpatient concussion clinic, and 15 patients from the emergency department who had sustained a head trauma within 24 hr. We performed real‐time PCR of the salivary EVs of the 54 subjects profiling 96 genes from the TaqMan Human Alzheimer's disease array. Real‐time PCR analysis revealed 57 (15 genes, p < 0.05) upregulated genes in emergency department patients and 56 (14 genes, p < 0.05) upregulated genes in concussion clinic patients when compared with controls. Three genes were upregulated in both the emergency department patients and concussion clinic patients: CDC2, CSNK1A1, and CTSD ( p < 0.05). Our results demonstrate that salivary EVs gene expression can serve as a viable source of biomarkers for mTBI. This study shows multiple Alzheimer's disease genes present after an mTBI.

Causes leading to head trauma in children, clinical features and short term outcome - A prospective study

Background : Head Trauma is very common in children. Although head trauma in children and adults have several similarities, children should not be considered as young adults, given that the pediatric patients have more susceptible cranial vault due to thinner and more pliable bones, open fontanelle, large head-to-torso ratio and less developed neck musculature.Many studies are done in developed nations with good quality of emergency care and facilities. Data is lacking in developing countries for epidemiology, mechanism of injury and different management modalities. So I would like to carry out this study in our setup to obtain data for the following lag backs. Methods : This is a prospective observational study conducted over a period of ten months from October 2017 to July 2017. All cases with head trauma requiring hospitalization in the study period(n=65) were enrolled. After a detailed primary and secondary survey, all of them were triaged and treated as per our protocol. All of them required neuroimaging. Parents or caretakers were thoroughly interrogated for the circumstances in which the children suffered head trauma, and were requested to provide the site photographs whenever possible Results : Of 65 children, 42(64.6%) were less than 5 years, 20(30.7%) were between 5-10 years and 3(4.7%) were more than 10 years. As per the protocol of our hospital, 33(50.7%) of them required admission to PICU or high dependency unit and 32(49.3%) required observation in general pediatric ward. Of 65 children, severe head trauma was seen in 8 (12.4%) children, requiring intensive management including mechanical ventilation, of which neurosurgical intervention was needed in three children. There were 3(4.6%) children with moderate head trauma and 54(83%) with mild head trauma. Neuroimaging was abnormal in all children with moderate and severe head trauma. Of those with mild head trauma, 39(72%) had abnormal neuroimaging. Results showed that 2 children expired, 3 had deficits in the form of unable to speak, not recognizing parents, not responding to verbal commands and facial nerve palsy. Remaining children were functionally normal. Analysis of circumstances leading to head trauma revealed that 38(58.5%) happened at home, 19(29.3%) on road, 8(12.3%) at play places. Poor safety precautions at home in the form of unsafe stairs (n=6, 9.2%), unsafe balconies (n=7, 10.8 %), unsupervised activities of kids (n=22, 33.9 %) were some of the preventable causes on domestic side. Unsafe road traffic, rash driving were also preventable situation. Play-places of children with insufficient supervision was the other important cause. Conclusion : Almost all the situations were preventable suggesting need to improve child safety practices. All severe and moderate head injuries and 72% of mild head injuries were associated with abnormal neuroimaging suggesting vulnerability of children to head trauma.

Isolated LOC in head trauma associated with significant injury on brain CT scan

BackgroundA report of loss of consciousness (LOC) is frequently considered reason enough to obtain a computed tomography (CT) scan in the evaluation of head trauma. We conducted this study to reduce exposure to radiation from CT, while still not overlooking clinically significant injuries.ObjectiveThe objective of the study is to determine the correlation between LOC status and brain CT scan results in patients with blunt head trauma and to determine whether there is a subset of patients for whom CT scan need not be performed, without missing clinically significant intracranial injuries.MethodsThis is a retrospective study conducted in the emergency department of an inner-city hospital. The patient population included patients ranging between 13 and 35 years of age, with blunt head trauma, who presented to the emergency department (ED) between January 2010 and December 2013. Patients were divided into two groups: “LOC” group and “no LOC” group. The results of brain CT scans from each group were compared with LOC status. For study purposes, “clinically significant” were those that required interventions or ICU hospitalization of at least 24 h or extended hospitalization. The results were analyzed using chi-square calculations.ResultsDuring the study period, 494 patients were identified as having suffered head trauma. Of these, 185 (37.5%) reported LOC and 309 (62.5%) did not lose consciousness. In the LOC group, 15 (8.1%) had significant CT findings compared to 1.3% (4/309) of those without LOC (p < .001). Of the 4 who had no LOC and had significant brain CT findings, all 4 patients had positive physical findings of head, neck, or facial trauma. In the LOC group, only 1/15 (6.7%) had significant CT findings with a normal GCS of 15 and no physical signs of the head, neck, or facial trauma.ConclusionsA small proportion of patients with LOC had CT finding requiring intervention. Head trauma patients with no physical injuries to the head, neck, or face and a normal GCS had no significant brain CT findings. This raises the question of whether a routine brain CT scan should be obtained in patients with LOC, no physical findings, and a normal GCS after blunt head trauma.

Repeat Head CT? Not Necessary for Patients with a Negative Initial Head CT on Anticoagulation or Antiplatelet Therapy Suffering Low-Altitude Falls

Anticoagulation and antiplatelet (ACAP) medications are increasingly prescribed to patients at high risk for falls. Many trauma centers have developed protocols for obtaining repeat head CT (HCT) for patients with low-altitude falls on ACAP therapy. We assess the need for routine scheduled repeat HCT in this population. Prospective, observational analysis of all low-altitude fall (<6 feet) patients on ACAP therapy evaluated at a Level II trauma center. All low-altitude fall patients with visible or suspected head trauma received an initial HCT. Patients were admitted and repeat HCT was obtained 12 hours later or earlier if acute neurologic decline developed. Chi-squared, Fischer exact, t, and Wilcoxon rank-sum tests were used. Statistical significance was defined as P < 0.05. Total of 1501 patients enrolled suffering low-altitude falls with initial HCT. Among them 1379(91.2%) were negative and 122(8.1%) were initially positive for intracranial hemorrhage. Mean age was 79.9 ± 11.4 years, 61 per cent were female and 85 per cent had visible head trauma at presentation. One hundred ninety-nine were excluded secondary to not receiving repeat HCT. Of the 1180 patients with normal initial HCT who underwent repeat HCT, only 7 (0.51%) had delayed intracranial hemorrhage. None of these patients required surgery, major changes in medical management or suffered head trauma-related mortality; 69 per cent were taking aspirin (acetylsalicylic acid, ASA), 19 per cent warfarin, 17 per cent clopidogrel, 6 per cent other anticoagulants, and 11 per cent were on combination therapy. Repeat HCT for patients on any ACAP therapy after low-altitude fall with a negative initial HCT is not necessary. Thorough neurologic examination and close monitoring is as effective as obtaining a repeat HCT.

Hidrocefalia congênita em cão idoso

In the fetal nervous system training period faults can occur, leading to problems after birth, as the persistence of the fontanelle, which is due to no calcification of the cranial sutures. Hydrocephalus is a type of genetic defect caused by inadequate circulation of the cerebrospinal fluid that to build up promotes increased volume and consequent dilation of cerebral ventricles. It can be congenital or acquired, and the most predisposed breeds of dogs are those small. Among the most common clinical signs of hydrocephalus are deformities in the skull, the eye socket, or increased pressure in the midbrain integument, depression, apathy, delirium, blindness, ataxia, dementia, aggression, irritation, training of difficulty and learning to walk in circles and convulsions. The animal's history must be performed properly, followed by clinical and neurological examination, and may require the request for laboratory and imaging tests to make the diagnosis of hydrocephalus. brain imaging as ultrasound, computed tomography and magnetic resonance imaging have been providing currently better support as diagnostic tools. Among the therapeutic agents used in classical include: corticosteroids, diuretics and osmotic agents which will act reducing cerebral edema, and consequently the intracranial pressure. Patients who have seizures need to receive specific therapy. Depending on the case, treatment with medication is effective, however, for better control of symptoms, sometimes indicates the ventriculoperitoneal bypass surgery. We report a case of a canine Poodle, 11 years old, female, who after suffering head trauma and performed CT examination, was diagnosed with congenital hydrocephalus and persistent fontanelle in front and bilaterally region, between the parietal and temporal bones. The patient was treated with classical therapy using corticosteroids (dexamethasone and prednisone), and diuretics (furosemide and mannitol), obtaining successful recovery.

Diagnóstico de Simulación de Disfunción Neurocognitiva en sujetos que presentan accidentes laborales

Objetivo: Establecer la utilidad del Test de Simulación de la Memoria (TOMM) y las características psicométricas para determinar la Simulación de Disfunción Neurocognitiva (SND) en trabajadores que han sufrido Traumatismo Cráneo-Encefálico (TEC). Materiales y métodos: Los participantes de esta investigación fueron por conveniencia. Se conformaron tres grupos no pareados, mayores de 18 años, de ambos sexos. El primer grupo se conformó con un total de 32 participantes que estuvieron activamente laborales antes de sufrir el TEC, mínimamente 6 meses antes de la evaluación. El segundo grupo estuvo conformado por 30 personas que ya se encontraban pensionados laboralmente y no poseían necesidades de SDN. El último grupo eran 31 participantes cognitivamente sanos, que voluntariamente desearon participar en el estudio. Resultados: El TOMM es capaz de diferenciar entre aquellas personas probables de tener SDN y de las que no lo tienen. Aplicando el punto de corte de 45 para el ensayo 2, el 92.04% de los participantes controles (81/88 participantes) y 5 de los 5 simuladores (100%) fueron correctamente identificados, lo que corresponde a una sensibilidad del 100% y una especificidad del 92%, es decir la probabilidad de clasificar correctamente a un individuo como simulador, siendo éste un real simulador es del 100%, sin embargo la probabilidad de clasificar a un individuo como simulador, sin realmente serlo, es del 8%. Conclusiones: El TOMM es una herramienta clínica de exploración que permite distinguir entre los sujetos que posiblemente presenten necesidad de obtención de ganancias secundarias a un accidente laboral.

Influence of acute ethanol intoxication on neuronal apoptosis and Bcl-2 protein expression after severe traumatic brain injury in rats

ObjectiveTo study the influence and mechanism of acute ethanol intoxication (AEI) on rat neuronal apoptosis after severe traumatic brain injury (TBI). MethodsNinety-six Sprague-Dawley rats were randomly divided into four groups: normal control, AEI-only, TBI-only and TBI+AEI (n=24 for each). Severe TBI model was developed according to Feeney’s method. Rats in TBI+AEI group were firstly subjected to AEI, and then suffered head trauma. In each group, animals were sacrificed at 6h, 24h, 72h, and 168h after TBI. The level of neuronal apoptosis and the expression of Bcl-2 protein were determined by TUNEL assay and immunohistochemical method, respectively. ResultsApoptotic cells mainly distributed in the cortex and white matter around the damaged area. Neuronal apoptosis significantly increased at 6h after trauma and peaked at 72h. Both the level of neuronal apoptosis and expression of Bcl-2 protein in TBI-only group and TBI+AEI group were higher than those in control group (P<0.05). Compared with TBI-only group, the two indexes were much higher in TBI+AEI group at all time points (P<0.05). ConclusionOur findings suggest that AEI can increase neuronal apoptosis after severe TBI.

Profilaxia de Trombose Venosa Profunda em Doentes com Traumatismo Cranioencefálico

The risk of deep vein thrombosis is increased in patients with head trauma, but the prophylaxis against this event is confronted with the possible risk of worsening hemorrhagic injuries. In this article, we present an overview about deep vein thrombosis prophylaxis in patients with head trauma and we propose a practical protocol for clinical management of deep vein thrombosis prophylaxis. We reviewed relevant papers cited in the Medline/PubMed, Cochrane, and Scielo databases from January 1998 to January 2014. Based on a search with the following search expression: "deep venous thrombosis and prophylaxis and traumatic brain injury", we found 44 eligible articles. Twenty-three papers were selected using criteria as published in English or Portuguese, patients in acute phase of moderate and severe traumatic brain injury and noninvasive mechanical prophylaxis or chemistry. Head trauma alone is a risk factor for deep vein thrombosis. The chance of deep vein thrombosis is 2.59 times higher in patients with head trauma. The prevalence of deep vein thrombosis and pulmonary embolism in patients who have suffered head trauma is 20% in the literature, reaching 30% in some studies. Head trauma alone is a risk factor for deep vein thrombosis and pulmonary thromboembolism and the risks inherent in this disease requires methods of prevention for these complications. Clinical trials are needed to establish the efficacy of prophylaxis and the best time to start medication for deep vein thrombosis in patients with traumatic brain injury.

Emphysematous gastritis secondary to gastric mucormycosis

Abstract Background Mucormycosis is a rare fungal infection of the mucosa, which mainly affects immunocompromised patients. The association with emphysematous gastritis, produced by gas -forming bacteria, is rare and often fatal. The case is presented of a trauma patient with type 1 diabetes mellitus, and diabetic ketoacidosis complicated with gastric mucormycosis associated with emphysematous gastritis. Clinical case A male aged 32, who was involved in a car accident, and suffered head trauma, is admitted to the Intensive Care Unit, presenting with diabetic ketoacidosis and upper gastrointestinal bleeding. An endoscopy was performed, finding an erosive esophagitis Class C, ischaemia and gastric necrosis. Computed tomography scan showed emphysematous gastritis and gastric necrosis. He underwent total gastrectomy with a histopathology report of gastric mucormycosis. After the surgical procedure the patient died due to sepsis secondary to pulmonary mucormycosis Discussion Mucormycosis is a rare fungal disease which infrequently affects the gastrointestinal tract, with the stomach being the most affected site. The mortality is high if the diagnosis is not made promptly and appropriate treatment is given. Conclusion Suspecting its existence is necessary in patients with immunocompromised status to diagnose it and provide timely treatment to increase survival, due to its high mortality.

Absceso cerebral por Haemophilus influenzae serotipo e en un paciente pediátrico con síndrome de Apert

We report a case of a brain abscess caused by Haemophilus influenzae type e in a 12 year-old patient suffering from Apert syndrome. Apert syndrome is characterized by the premature closure of cranial sutures. In 2010 the patient suffered head trauma in the frontal area with cranial fracture and a cerebrospinal fluid fistula. In February 2013 he was admitted to hospital with fever, vomiting and generalized tonic-clonic seizure with deteriorating mental status/progressive sensory impairment. The computerized axial tomographic scan showed a right frontal lesion, perilesional edema, mild ventricular dilatation and pansinusitis. A brain abscess was diagnosed and drained. The clinical sample was then cultured. A gram negative coccobacillus was isolated and identified as Haemophilus influenzae serotype e. Empirical treatment was started with meropenem (120mg/kg/day) and vancomycin (60mg/kg/day), which was later switched to ceftriaxone (100mg/kg/day) and metronidazole (500mg/8h) after culture results arrived. The patient was discharged in good clinical condition.

Holiday Heart Block: Alcohol-induced PR Prolongation

Consumption of large quantities of alcohol has a number of well-known consequences, but the effect endured by one patient is rather remote. A 27-year-old black man was brought to the emergency department after suffering head trauma that initially left him unconscious. His score on the Glasgow Coma Scale was 14, denoting a mild head injury. Physical examination on admission revealed that the patient had a monocular hematoma. Computed tomography excluded intracranial bleeding and other serious injuries.