Hediye Gholamshahi

Background: Placenta accreta spectrum (PAS) has high maternal morbidity and poor neonatal outcomes, although the best time for delivery is not clear. Cervical length (CL) may serve as a useful adjunct for risk stratification and individualized delivery planning in PAS pregnancies. Objective: To examine the association of serial cervical length measurement with delivery timing and maternal and neonatal outcomes in women with PAS. Methods: In this prospective cohort study at three university hospitals in Tehran, 41 pregnant women antenatally diagnosed with PAS had transvaginal sonographic CL measurements performed at 28, 32, and 34 weeks' gestation. The main outcome was gestational age at delivery and its connection with the CL. Maternal complications and neonatal morbidity constituted secondary outcomes. Results: Short CL (< 25 mm) at 28 and 32 weeks was significantly related to delivery at ≤ 34 weeks ( p < 0.05) and increased Cesarean hysterectomy rates ( p = 0.002 at 32 weeks; p = 0.005 at 34 weeks). Emergent Cesarean delivery was more common among PAS patients with CL < 25 mm at 32 and 34 weeks ( p = 0.02). Neonates from mothers with short CL had increased likelihood for antibiotics, surfactant, resuscitation, and intubation (all p < 0.05). No significant relations were seen for CL and intraoperative bladder damage or estimated blood loss. Conclusions: Cervical shortening in the late second and early third trimester in PAS women is significantly associated with earlier term delivery, increased risk of Cesarean hysterectomy, and neonatal morbidity for PAS pregnancies. Repeated assessments of CL may be a useful adjunct for individualizing delivery timing and optimizing maternal‐fetal outcomes. Larger prospective multicenter trials are essential to validate the role of CL in risk stratification and to integrate it into an individualized delivery planning algorithm.

Background: Veterans experience a high prevalence of traumatic brain injuries (TBIs) due to combat‐related incidents such as explosive blasts, penetrating injuries, and blunt force trauma. These military TBIs are often more complex than civilian TBIs, leading to increased long‐term neurological consequences. Over 414,000 service members have been diagnosed with TBI since 2000, highlighting the need to understand the implications of these injuries and the neurosurgical challenges in their treatment. Methods: This narrative review examines the literature on TBIs in veterans, focusing on the characteristics, health impacts, and neurosurgical challenges associated with these injuries. The review synthesizes relevant articles to provide an overview of the topic. Results: Veterans with TBIs commonly experience cognitive deficits, including impairments in memory, executive functioning, processing speed, and visual disturbances. Research explores the relationship between TBI and neurodegenerative diseases, with some studies indicating a correlation between TBI severity and an increased risk of all‐cause and vascular dementia. Managing TBIs in veterans presents neurosurgical challenges such as timely diagnosis and intervention, tailored treatment approaches due to injury variability (blast vs. blunt trauma), and co‐occurring conditions like PTSD and depression. Initial medical measures include osmotherapy, sedation, hyperventilation, oxygenation, control of temperature and infection. In specific scenarios, an external ventricular drain (EVD) may be necessary to drain cerebrospinal fluid (CSF). Conclusion: Addressing TBIs in veterans necessitates a multidisciplinary approach with timely neurosurgical interventions, comprehensive rehabilitation, and mental health support. Future research should develop targeted treatments and explore novel technologies to improve recovery outcomes. Clinicians should prioritize early screening for TBI and co‐occurring conditions, while policymakers should improve access to specialized TBI care, ultimately enhancing veterans' long‐term quality of life.

Background: Chronic Achilles tendinopathy following Haglund disease is a common ankle condition that is difficult to manage. In this study, we will compare the clinical outcomes of debridement and ostectomy with and without FHL tendon transfer in treating Haglund deformity. Methods: Forty eligible patients aged >50 years who did not respond to conservative treatment were randomly divided into 2 groups for surgical approach: using flexor hallucis longus (FHL) tendon transfer (FHL group) or “standard procedure” (control group). The main surgical treatment included debridement and ostectomy. AOFAS and VISA-A scores were obtained from all patients pre- and postoperatively. Results: Twenty patients were assigned to each of the 2 groups and were observed for at least 1 year. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot scores and the Victorian Institute of Sports Assessment self-administered Achilles (VISA-A) questionnaires scores improved more in the FHL group; however, the average difference in the change in scores did not reach the levels previously reported for minimal clinically important differences. Surgical complications and hallux function were not significantly different between the 2 groups. Conclusion: We found that FHL tendon transfer may improve the clinical outcome scores of Achilles tendon treatment in patients aged >50 years using debridement and ostectomy. However, tendon transfer increases the time of surgery and creates additional skin incisions, which may cause more short-term wound complications, and the significance of the differences in outcome improvement may not be clinically meaningful. Level of Evidence: Level II, grade A recommendation.

Background Without clear signs of infection, spinal implant failure is attributed to mechanical overloads and aseptic loosening. However, how low-grade infections contribute to seemingly aseptic implant failure is unclear. Purpose The systematic review examined unexpected positive cultures (UPCs) in revision spine surgery regarding prevalence, isolated pathogens, risk factors, and strategies to reduce infection among asymptomatic patients undergoing revision spine surgery. Methods We followed the PRISMA guidelines and searched four main databases (PubMed, EMBASE, SCOPUS, Web of Science) comprehensively until January 2023 for articles reporting UPC after presumed aseptic adult revision spine surgery. The UPC rates were pooled, and risk factors were compared with the culture-negative control group and represented as odds ratio (OR) or mean difference (MD). Results Fifteen studies of 1057 individuals were included in two groups: culture-positive or UPCs (n = 317) and culture-negative or control (n = 740). The overall UPC prevalence was 33.2% (317/1057, range: 0 to 53%, 95% CI = 30.2%–36.4%), and Cutibacterium acnes (43.0%, 95% CI = 37.4%–48.8%), Coagulase-negative Staphylococci (CoNS), (39.5%, 95% CI = 33.2%–46.2%), and Staphylococcus species in general (49.5%, 95%CI = 43.7%–55.4%) were reported the most common isolated microbes. 16.1% of the UPCs were polymicrobial. Risk factors associated with UPC rates were female sex (OR = 2.62, 95%CI = 1.76–3.90, P < 0.001), screw loosening (OR = 4.43, 95%CI = 1.31–15.02, P = 0.02), number of operated levels (MD = 0.77, 95%CI = 0.33–1.22, P = 0.0007), and shorter time since index surgery (MD = − 8.57 months, 95%CI = − 14.76, -2.39, P = 0.02). Conclusions One-third of patients undergoing spine revision surgery revealed UPC in this study. Each UPC pathogen interpretation and antibiotic use decision should be interpreted case by case. Level of evidence: IV.

Introduction: Trauma is a major cause of death in hospitals around the world according to the World Health Organization (WHO). Massive transfusion (MT) has specific indications in many trauma centers in the United States, but the need for definite criteria and indications for MT remains. In this study, we try to define exact indications of whether and/ when a trauma patient needs PRBCs transfusion, or even how much transfusion may be needed. Methods: This study was a retrospective analysis of the prospectively collected data of the trauma patients that have been registered in the National Trauma Registry of Iran (NTRI) from July 2016 to October 2021. Age, sex, body mass index (BMI), preexisting cardiovascular problems, endocrine issues, kidney dysfunction. Gastrointestinal diseases, whether or not the patient had multiple trauma, obesity, systolic blood pressure, pulse rate, temperature, Oxygen saturation, Glasgow coma scale (GCS), and injury severity score (ISS) were the principal variables of this study. Results: Hypotension, temperature > 37º, hyperpnea, and O2 saturation < 90% were significantly more prevalent among PRBCs receivers. Hypertension, tachycardia, and bradycardia were more prevalent as well, but the difference was not statistically significant. In terms of trauma scores, Glasgow Coma Scale (GCS) ≤ 8, and both ISS 9–14 and ≥ 15 had more chance of needing PRBCs transfusion which was meaningful, but GCS 14 − 9 didn’t prove significant chances. Conclusion: Based on these criteria, we can estimate if a patient will need a blood transfusion and make a PRBC reservation in the blood bank.