Journal of Surgery and Trauma
Volume:7 Issue: 1, Spring 2019

Dear Editor
Vitamin D deficiency or insufficiency affects about 30% of children and 60% of adults across the world (1). This condition also occurs in about 70% of critically ill patients (2). Although vitamin D is typically known as a fat-soluble vitamin in bone metabolism, it is a steroid hormone with pleiotropic effects (3). Vitamin D deficiency can lead to cardiovascular, neurological, and autoimmune diseases and different types of cancers, including the breast, prostate, lung, colon, and renal cancers. Accordingly, this deficiency has a direct correlation with mortality (4-6).
Many critically ill patients enter the Intensive Care Unit (ICU) with a deficient level of vitamin D. Disrupted metabolism of vitamin D in some critically ill patients results in a fast decrease in vitamin D levels after ICU admission (7). It has been well documented that vitamin D deficiency is associated with increased morbidity, mortality, and ICU length of stay (8, 9). The randomized clinical trials having been performed in recent years are indicative of no significant improvement in the clinical outcome of critically ill patients supplemented with vitamin D (10).
The ICU admission can be predicted in several conditions, such as some elective surgeries and intensive chemotherapies (7). Furthermore, one of the problems of the studies performed till now is that they have not exclusively investigated the​patients with vitamin D deficiency. However, the exclusive inclusion of patients with vitamin D deficiency can lower the sample size for a clinical trial.
It is required to perform randomized clinical trials with a reasonable sample size to investigate the effect of vitamin D supplementation among vitamin D deficient patients who are in a critical medical state. These studies will be useful for the better conceptualization of treatment with vitamin D in critically ill patients.

Traumatic brain injury (TBI) is the leading cause of morbidity and mortality worldwide. The initial injury is followed by a series of secondary processes that can further harm the injured brain and worsen the outcome. The endocannabinoid system (ECS) consists of ligands, such as anandamide and 2-arachidonoyl-glycerol (2-AG), receptors (e.g., Cannabinoid receptor type 1 and Cannabinoid receptor type 2), as well as transporters, and enzymes. Dexanabinol (HU-211) is a synthetic cannabinoid with cerebroprotective effects devoid of cannabimimetic effects, which exhibits the pharmacological properties of N-Methyl-D-aspartate receptor antagonist. The increase in the brain levels of endocannabinoids in the pathogenic events of brain injury suggests that this system plays a role in compensatory repair mechanisms. In recent year, the therapeutic effects of cannabinoid manipulative drugs have been numerously studied through the manipulation of the ECS in TBI. Therefore, the literature review was performed to assess the therapeutic effects of ECS manipulation, cannabinoid-derived drugs, and HU-211 in traumatic brain injury pathology. The ECS possesses promising effects in the treatment of diverse TBI pathologies through releasing endogenous ligands and changes in cannabinoid receptors activity or both. Preclinical studies suggest that the ECS has many targets for therapeutic agents that might help decrease TBI pathologic effects and should be considered for developing novel drugs. Furthermore, more clinical trials with larger populations and more

The presence of a predictor for traumatic brain injury (TBI) in patients with head trauma could play a crucial role in the identification of patients at higher risk of brain injury. The use of serum biomarkers like enolase to predict TBI in patients with head trauma is under investigation. Regarding this, the aim of the present study was to explore the association of neuron specific enolase (NSE) with TBI in patients with head trauma. This observational study was conducted on patients with isolated blunt head trauma. A total of 168 subjects were enrolled in the study, 84 cases of whom had isolated blunt head trauma, and 84 individuals had no head trauma (i.e., control group). The serum concentration of NSE in all included subjects was measured within the first 6 h. All patients underwent brain computed tomography (CT) scan. Statistical analysis was carried out using SPSS software, version 19.0. Independent t-test, one way ANOVA, and Chi-square test were used for statistical analysis. The receiver operating characteristic curve was plotted, and cut-off values of serum NSE were calculated to determine the sensitivity and specificity of this biomarker in the prediction of intracranial injuries. The mean serum NSE concentrations for patients with head trauma and controls were 23.14±22.63 (95% CI:18.77-28.39) and 7.00±4.42 ng/ml (95% CI: 3.67-10.33), respectively, which were not significantly different (P=0.049). Furthermore, the serum NSE level was significantly higher in the group with severe trauma, compared with that in the group with mild trauma (P=0.023). According to our findings, the NSE of ≤ 15.5 ng/ml can rule out the likelihood of brain injury associated with head trauma with a sensitivity of 100% and a specificity of 88%. The NSE can be helpful to predict severe brain injury in patients with head trauma where CT scan or other diagnostic tools are not available. According to our results, clinicians can rule out the possibility of a severe head injury after head trauma when having a case with a serum NSE level of ≤ 15.5 ng/ml.

Congenital heart disease (CHD) occurs in about 8 cases per 1,000 live births and is responsible for 30% of all neonatal deaths. The reportedly high prevalence of CHD underscores the necessity of the implementation of local evaluations and screening programs in order to plan for appropriate interventions. Regarding this, the present study was performed to determine the prevalence of CHD and its associated risk factors among the newborns with respiratory distress and cyanosis admitted to Vali-e-Asr Hospital in Birjand, Iran, in 2016. This cross-sectional analytical study was conducted on the records of 199 neonates admitted to the Neonatal Unit of Vali-e-Asr Hospital due to respiratory distress and cyanosis in 2016. The data were collected using a predesigned form covering such information as gender, type of delivery, and gestational diabetes. Data analysis was performed in SPSS software (version 22) using the Chi-squared test. P-value less than 5% was considered statistically significant. Out of the 199 neonates enrolled in this study, 168 (84.4%) cases suffered from CHD. Patent ductus arteriosus (PDA) was the most common anomaly among the neonates (n=85, 50.5%), followed by atrial septal defect (n=41, 24.4%), ventricular septal defect (n=36, 21.4%), transposition of great arteries (n=4, 2.2%), and other complex heart anomalies (e.g., shone complex; n=2, 1.1%), respectively. The results revealed that the presence of CHD, especially PDA, in neonates was associated with their parental interfamily marriage (P=0.024). The high prevalence and mortality of CHD necessitate the control of premarital and preconception potential risk factors (e.g., inter-family marriage) and preparation for the implementation of effective interventions for the neonates with respiratory distress and cyanosis.

Acquisition of clinical and practical skills is one of the highly critical and sensitive aspects of medical education, particularly in the areas related to surgical specialties. Moreover, one of the most important procedural strategies regarding educational medicine is the acquisition of practical skills in various psychological domains. Regarding this, the present study aimed to delineate the effects of practicing on goat’s eye for the residents expected to perform their first surgery on human eyes. This applied study was conducted on all the sophomore residents (n=8) of the Ophthalmology Department of Isfahan University of Medical Sciences, Isfahan, Iran, using a pre-experimental design. The procedures were instructed to the residents through three stages in the wet lab according to a protocol. After the completion of the second stage, the residents gained their first experience of performing surgery on human eyes in the operating room under the supervision of junior and senior residents and the attending specialist. At this stage, in case further experience was required, the resident could start practicing on goat’s eyes in the wet lab upon prior coordination. At the third stage, the residents received instructions and practiced more advanced techniques. After this stage and upon the entrance of the residents to the operating room, the 3rd and 4th year residents and the attending specialists were surveyed regarding the performance of the 2nd year residents in nine fields in accordance with the aims of the study. In addition, the 2nd year residents completed a self-evaluation checklist. The data were analyzed in SPSS software, version 16. The results revealed that practicing before surgery on the human eye resulted in the reduction of surgical errors (45%), surgical speed and proficiency (20%), and stress and hand tremors (35%) during the first surgical experiences. According to the 3rd and 4th year residents, the practices and instructions provided before the wet lab had a positive effect on decreasing the levels of stress and surgical error during the first surgical experiences of the 2nd year residents. The attending specialists believed that the wet lab experience could have a positive effect on all aspects of surgery, including mental, emotional, and practical factors. Nonetheless, some 3rd and 4th year residents believed that the wet lab could not provide circumstances identical to the conditions experienced in the operating room. Therefore, the effects of practicing in the wet lab on surgical speed, proficiency, stress, and surgical error were believed to be less significant. Overall, the study showed that repeated practice sessions on goat’s eye in the wet lab under the supervision of 3rd and 4th year residents and attending specialists could not only have positive effects on some practical, mental, and attitudinal indices but also improve the knowledge of the residents.

We reported the case of a 9-year-old boy with a complete right blue iris and left brown iris. Other Ophthalmic examinations were normal except for the homonymous symmetrical pattern of nasal retinal hypopigmentation. The case had no systemic finding or positive family history. The present case was unique because the presentation of iris heterochromia did not follow Mendelian law and was not associated with any diseases or syndromes.

The case in this study was a 33-year-old woman suffering from acute pericardial tamponade with severe left ventricular systolic dysfunction (LVEF=10%) after myocarditis as a result of possible viral respiratory infection.
The diagnosis was confirmed with two transthoracic echocardiography (TTE) evaluation showing moderate pericardial effusion with diastolic right atrium and ventricle collapse. The hemodynamic and respiratory condition of the patient was unstable and emergent. The drainage of pericardial space was life-saving with good results.