Firooz Salehpour

Traumatic brain injury (TBI) continues to be one of the world's top causes of mortality and long-term disability. It is a severe and frequently fatal disorder. Patients with traumatic brain injury (TBI) not only sustain neurological impairment but also undergo significant metabolic changes and psychological stress, which may affect their ability to recover. The purpose of this study was to investigate the nutritional determinants and epidemiological trends linked to outcomes in traumatic brain injury patients. This prospective cohort study was carried out at the Imam Reza Hospital's Trauma Department in Tabriz, Iran. Over the course of six months, 520 patients with moderate-to-severe traumatic brain injury were consecutively enrolled, and they were monitored for one month following their release from the hospital. Clinical findings, radiographic results, laboratory data, therapies, outcomes, mechanisms of injury, and demographics were all methodically documented. BMI and serum albumin levels were used at discharge and one-month follow-up to evaluate nutritional status. The Impact of Event Scale (IES) and the Hospital Anxiety and Depression Scale (HADS) were used to assess psychological status. Descriptive techniques, correlation analyses, paired comparisons, and receiver operating characteristic (ROC) curve analysis were among the statistical techniques used to evaluate the standalone discriminatory ability of psychological and nutritional variables. The mean age of the patients was 32.49 ± 13.78 years, and 71.7% were male. Nearly 75% of injuries were caused by falls, making them the most frequent cause. In total, 51.2% of patients passed away while in the hospital, whereas 48.8% of patients survived discharge. Discharge and one-month Glasgow Coma Scale (GCS) scores demonstrated a substantial correlation with outcome (p < 0.001), and neurological severity was strongly associated with survival. Survival, neurological improvement, and psychological distress did not significantly correlate with either discharge or follow-up BMI. Additionally, there was no significant correlation between serum albumin levels and survival, anxiety, depression, or symptoms of post-traumatic stress disorder. BMI, HADS, and IES all showed poor outcome discrimination, and ROC analyses supported their limited standalone discriminatory ability. In this cohort of patients with moderate-to-severe TBI, BMI and serum albumin were not associated with survival or psychological distress and showed limited standalone discriminatory ability for short-term outcomes. These findings suggest that recovery after TBI cannot be adequately characterized by simple nutritional indices alone and support the use of more comprehensive, multidimensional approaches to nutritional and prognostic assessment in TBI survivors.

Meningocele is the extension of the dural sac into the pleural or peritoneal cavity. Thoracic meningoceles mainly occur in neurofibromatosis type-1 (NF-1). It always coincides with kyphosis/scoliosis. Because the initial symptoms are respiratory problems, they are usually misdiagnosed as a massive pleural effusion at first. This is a 60-year-old man, a known case of NF-1, who presented with flank pain 8 months before surgery. As an incidental finding in the sonographic evaluation of the urinary system, he was diagnosed and managed as a massive pleural effusion for months until referred to our tertiary center. After further evaluations, a right thoracic huge meningocele was diagnosed. Posterolateral approach for laminectomy, costotransversectomy, ligation of the ectatic sleeves of the spinal nerve roots, cyst resection, dural repair, and spinal fusion was utilized. A pleural and lumbar draining tube was applied for 8 days. The patient recovered completely from his respiratory problems, without any neurological deficit or catastrophic events. Thoracic meningoceles limit the expansion of the lungs. The diagnosis and management are always challenging. Management of this pathology should include resection of the cyst to decompress the neighboring organs, repair of the dural sac, and reconstruction of the spinal canal. A two-step posterolateral approach was utilized: first, laminectomy and costotransversectomy with ligation of ectatic nerve roots; second, definitive ligation of the fistula, cyst resection, dural repair, and spinal fusion. Although the posterolateral approach typically allows single-stage management, complex anatomy may necessitate a planned second surgery after reassessment with cisternography.

Objective: To present an extremely rare case of atlantoaxial spondyloptosis in a neglected case of odontoid fracture, type-2, with complete anterior displacement. The surgical approach in such cases are always challenging. Background: C2 fractures are the most common type of spinal traumatic injury. Among them, odontoid fracture represents the most variable and complicated C2 fractures. When non-operative management is planned, close follow-up and patient compliance are mandatory. Neglecting these cases can lead to complications such as malunion, nonunion and subluxation, of which, atlantoaxial spondyloptosis is the most severe form. Presentation of Case: The patient was a 20-year-old male with the chief complaint of neck pain, progressive quadriparesis, and gait disturbance since 8 months prior to presentation, with Japanese orthopedic association score of 11. Imaging studies showed anterior non-reducible, malunited atlantoaxial spondyloptosis, associated with a type-II odontoid fracture. Methods: The patient underwent open reduction and posterior atlantoaxial instrumented fusion using Harm’s technique. One-year Follow-up examination and imaging evaluations revealed complete neurological recovery, with Japanese orthopedic association score of 15, and complete fusion in normal alignment. Conclusion: A posterior-only approach for the management of atlantoaxial spondyloptosis with malunited type-2 odontoid fracture is associated with lower morbidity and fewer complications than anterior or combined approaches, while still achieving all surgical goals. The integrity of the transverse ligament is mandatory in such cases.

Purpose: Attention deficit hyperactivity disorder (ADHD) in adults is one of the psychological problems that can increase the risk of accidents and trauma, especially head trauma. Recent studies have reported the frequency of adult attention deficit hyperactivity disorder (ADHD) among trauma patients. Adult AD0HD has been reported in trauma patients. In the present study, we hypothesized that adult ADHD was more common among head trauma patients following an accident compared to a group without trauma. Materials and Methods: In this case-control study, 230 patients with head injuries and 460 non-trauma patients were selected. The adult Connors self-report screening scale (CAARS-SV) was used to screen for ADHD. Three subscales as subscale A (attention deficit index), subscale B (hyperactivity index) and subscale D (ADHD index) were evaluated between the two groups. Using linear multiple regression analysis, the effect of group, age, gender, and socioeconomic variables on ADHD scores was evaluated. Results: The total frequency of adult ADHD was 9.5%, which was equal to 1.6% in the trauma group and 9.5% in the non-trauma group. The experimental group had more drivers as the job (11.7% vs 3.7%, P< 0.001) compared to the control group. Of the Connors subscales, only the D subscale was significantly lower in the case group than in the control group (6.35 6 5.11 vs 51.72 4 72.4, P=0.003). The prevalence of ADHD in patients with head trauma and non-trauma head injury was 6.1% and 5.9%, respectively, which did not show a statistically significant difference (P=0.9). Linear regression analysis showed that the subscale D only had a significant relationship with group and age. However, by entering variables in logistic regression analysis, it was observed that only the age variable was significant in the presence of other variables. Conclusion: According to the results of the present study, the frequency of adult ADHD in trauma patients, as a screening diagnosis, was not found to be higher than non-traumatic patients.

An orbitocranial injury with a penetrating Intraorbital Foreign Body (IOFB) is listed as a rare cause of penetrating trauma. Since this type of trauma is considered a surgical emergency, taking a thorough history along with careful examination to find out the mechanism and cause of the trauma is crucial towards correct diagnosis and management of the disease. A 35-year-old male patient was presented to the ER with an occupational craniofacial injury because of an IOFB. The patient underwent an extra-dural orbitocranial craniotomy procedure to remove the foreign body. Interestingly, a plastic foreign body (a piece of a plastic pipe) was removed from the orbital cavity, which was suspected to be a fractured orbital bone, at first place. In this study, we demonstrated that plastics could mimic bone structure in a Computerized Tomography (CT) scan leading to possible initial misdiagnosis. Hence high clinical suspicion is necessary for the correct diagnosis of such cases. However, despite the prompt intervention, our patient ended up with permanent vision loss in his injured eye.

Case report To report a case of foreign body mimicking spinal tumor. Gossypiboma or more broadly retained foreign object is a surgical complication resulting from foreign materials such as cotton or gauze pads and surgical sponge, accidentally left inside a patient's body. Such foreign materials cause foreign body reaction in the surrounding tissue. A retrospective case report was performed. Informed consent was obtained from patient. We describe a case of textiloma in which the patient presented with low back pain and radiculopathy 12 years after L5\S1 discectomy. Imaging revealed a round mass lesion in the sacral space. At the end of surgery, the operative site should be flushed with saline and carefully examined for any foreign materials. Level of Evidence: 4

Cervical and back pains are important clinical problems affecting human populations globally. It is suggested that Propionibacterium acnes (P. acnes) is associated with disc herniation. The aim of this study is to evaluate the distribution of P. acnes infection in the cervical and lumbar disc material obtained from patients with disc herniation.

Modic changes (MCs) in vertebral bones are induced by two mechanisms of mechanical factors and infection. As Propionibacterium acnes (P. acnes) have been reported to be associated with LBP. The aim of this study is to evaluate the MCs in patients with disc herniation and positive for P. acnes.