Trauma Monthly
Volume:27 Issue: 6, Nov-Dec 2022

This study aimed to evaluate the effect of methylphenidate on the level of consciousness and length of hospitalization of patients with moderate to severe acute Traumatic Brain Injury (TBI) categorized as diffuse axonal injury. This randomized, double-blind clinical trial comprised 62 patients with moderate to severe traumatic brain injury with a Glasgow Coma Scale (GCS ) between 5 and 12 referred to our emergency department. Methylphenidate tablets were administrated from the second day with a dose of 0.3 mg/kg up to a maximum of 20 mg daily. A placebo was administered in the same manner and the patient's level of consciousness, delirium using the Confusion Assessment Method for the intensive care unit (CAM-ICU), agitation using Richmond Agitation Sedation Scale (RASS), and predicting the outcome of patients with GOS, were assessed. The patients' GOS on the day of discharge was significantly higher in the intervention group (P=0.013). The duration of hospitalization was significantly shorter in the intervention group (P<0.001). The patients' GCS upon discharge was significantly higher in the intervention group (P=0.01). Our results suggest that methylphenidate has some beneficial effects on the consciousness level and outcomes of patients with acute TBI. The use of methylphenidate also reduces the length of ICU stay and hospitalization and improves the outcome in patients with moderate to severe TBI not requiring surgery.

Strategies to prevent and provide an appropriate post-injury care system are vital save resources and reduce fatalities and disabilities. The present study aimed to evaluate risk factors for early and late mortality.

This cross-sectional study was conducted at a trauma referral center in southern Iran from June 2019 to June 2020. Based on the length of hospital stay, the patient’s outcomes were classified as short-term (within the first 48 hours of admission) or long-term (beyond 48 hours of admission) categories. Predictors of mortality evaluated included gender, age, Glasgow Coma Scale, presence of significant trauma using the Injury Severity Score, mechanism of injury, the need for intubation or chest tube placement, and hospital-acquired infection.

This study was performed on 1281 patients with a mean age of 37.9 ± 19.1 years. The median length of hospital stay was 7.7 days, with a mean injury severity score of 16.3 ± 11.3. The primary mechanism of injury was road-traffic accidents (65.5%), followed by falling (15.2%). During the first 48 hours of hospitalization, 217 of 1281 patients died or were discharged, the long-term group included 1,064. The risk factors were age≥65 years (OR=5.71, CI:3.16-10.3), GCS 9-12 (OR=3.39, CI:1.55-7.42), GCS≤8 (OR=5.88, CI:3.14-11.03) major trauma (OR=1.92, CI:1.05-3.52), and chest tube insertion (OR=2.49, CI:1.4-4.43) for short-term mortality and 45-64 age group (OR=5.95, CI:3.18-11.15), age≥65 years (OR=22.12, CI:11.38-42.97), GCS 9-12 (OR=2.9, CI:1.4-6.02), GCS≤8 (OR=5.53, CI:3.03-10.11), major trauma (OR=1.99, CI:1.11-3.54), chest tube insertion (OR=2.96, CI:1.68-5.23), and incidence of hospital-acquired infection (OR=2.42, CI:1.43-4.1) for long-term mortality.

Despite the similarities in the predictors of short-term and long-term mortality in trauma patients, our study showed that the effect of the age in these two groups varied. To improve the prognosis of unstable trauma patients, they should be categorized based on time and age.

Clinical decision-making for treating anterior shoulder instability relies on accurate glenoid bone loss quantification precision. This study aimed to assess the accuracy of the axial view of a 2-D CT scan compared with arthroscopy to measure glenoid bone loss following 3-D CT scanning.

This study was performed from March 2019 to February 2020 on patients who presented to the shoulder clinic of a referral teaching hospital in Tehran, Iran. Eighteen patients with at least one history of unilateral anterior shoulder dislocation without shoulder surgery participated in the study. Before surgery, the qualified participants had their injured and uninjured shoulders CT scanned. The Griffiths index was used to estimate the size of glenoid bone loss in CT scan imaging. Subsequently, the affected shoulders were arthroscopically evaluated, and glenoid bone loss was measured using a standard probe.

Among the 18 participants, glenoid bone loss was underestimated for 11 patients (61.1%) in CT scans compared to arthroscopy. The mean ± SD of glenoid bone loss percentage on CT scan (9.5% ± 4.9%) was significantly lower than on arthroscopy (11.7% ± 3.9%, p = 0.04). Nevertheless, Pearson’s correlation showed a significantly moderate correlation (r = 0.55, p = 0.01) between arthroscopic and CT scan measurements of glenoid bone loss.

Our findings indicate that glenoid bone loss width measurement via the axial view of a CT scan should not be considered a reliable method to measure glenoid bone loss.

Postoperative delirium (POD), a highly prevalent syndrome after cardiac surgery, is characterized by a rapid decline in brain function with inattention, disorganized thinking, and an altered level of consciousness. It is clinically important because it is associated with severe negative consequences. This study aimed to develop a protocol to help the prevent postoperative delirium in cardiac surgery.

This multiphase design study consisted of two phases. The first phase was a scoping review to identify risk factors associated with POD in cardiac surgery. The second phase included three consecutive rounds of expert panels based on a Delphi method to obtain consensus from experts to determine and use these risk factors to develop a protocol. A scoping review was performed using the Arksey and O'Malley framework. Literature searches using PubMed/MEDLINE, Scopus, Web of Science, and ProQuest databases were conducted. Two independent investigators performed the selection of studies and data extraction via checklists. In the second phase, based on two Delphi rounds, risk factors with a significant effect on postoperative delirium in cardiac surgery were identified according to the consensus of experts (≥75% agreement). In the third round of the expert panel, only modifiable factors that could improve based on existing conditions and context were used to develop a protocol.

The final protocol was developed based on 20 pharmacological and non-pharmacological interventions to prevent POD in three stages pre-, intra-, and post-cardiac surgery.  

Interventions such as prescribing melatonin instead of benzodiazepines, dexmedetomidine treatment, preoperative education patients that were candidated for cardiac surgery, training nurses, use of arterial filters and pre-bypass filters in the perfusion circuit, prevention of intraoperative hyperglycemia, cerebral oximetry and temperature management during CPB and some interventions in ICU-OH can reduce POD in cardiac surgery.

This study aimed to compare a new posteromedial approach with a conventional anteromedial approach to treat extra-articular distal tibia fractures.

Thirty-two patients underwent distal tibia fracture surgery. The patients were divided into two groups (anteromedial: n=17 and posteromedial: n=15) and followed for one year. Approaches were compared regarding their union time, American Orthopedics Foot and Ankle Society (AOFAS) score, and complications.

 AOFAS score was 87.3 ± 3.1 and 88.5 ± 2.8 in anteromedial and posteromedial groups, respectively, and there was no statistically significant difference (P-value = 0.282). The union time was 6.1 ± 3.8 months and 6.4 ± 3.1 months in the groups, which was not statistically significant (P-value = 0.807). The prevalence of non-union and delayed union was not significantly different between the two groups (p-value = 0.99).

The modified posteromedial approach is a safe and feasible alternative surgical method for distal tibia extra-articular fractures.

The Achilles tendon is the largest tendon in the body. Local infiltration is recognized to be cost-saving and effective in treating musculoskeletal pain. However, using corticosteroids in the long term can lead to adverse consequences such as osteoporosis, immunosuppressive effect, or tendon rupture.

In this paper, we reported a case with bilateral Achilles tendon rupture following corticosteroid treatment. When Achilles tendon rupture occurs, surgical treatment is necessary to rehabilitate Achilles tendon function and avoid severe complications.

This report reviewed a case of bilateral Achilles tendon rupture following corticosteroid treatment precautions which should be considered.

Iran is one of the countries with the highest rate of rhinoplasty. In previous years, the rate of rhinoplasty was significantly higher in women than in men. However, the change that has taken place today has it that rhinoplasty is more common in men. More recently, young men are pursuing rhinoplasty, some for the second or third time. Changes in Iranian culture, psychological causes, and Iranian ethnic characteristics are among the cause of this trend.