Background: Several studies have examined the possible role of beta-blockers, including esmolol, in controlling intracranial pressure (ICP). This study aimed to evaluate the effect of esmolol on ICP in patients with severe traumatic brain injury. Methods: In this case-control study, all TBI patients with ICP > 20 cmH2O, who were admitted to ICU during the study period, were included. Some patients received standard treatment plus esmolol (500 μg/kg and then 50 mg/kg/min for 24 hours), and some others just received standard treatment with no esmolol. The patients were monitored, and the ICP measurement was performed via inserted intra-ventricular catheter. The ICP and vital signs were measured and recorded before, 8, 16, and 24 hours after starting the treatment in the two groups, and the findings were then compared. Results: Twenty-two patients (13 males and 9 females) were included in this study, of whom 12 patients received esmolol, and 10 patients were in the control group. The mean age of those who received esmolol was smaller than those who did not receive it (46.6 ± 18.5 vs. 62.3 ± 19.1 years; P = 0.08). Moreover, the mean length of the ICU stay was smaller in the esmolol receivers than the control group (5.6 ± 1.1 vs. 17.3 ± 7.7 days; P = 0.04 (there was no significant difference between the two groups in terms of mortality rates (P = 0.30). The variations of the vital signs over time was not significantly different between the two groups (P > 0.05); however, the mean of ICP was lower in those who received esmolol compared to the control group at all checkpoints (P < 0.05). Conclusions: Those patients with TBI who received esmolol as part of their ICP control management in ICU had lower ICP than those who received no esmolol.

Background: One of the chronic diseases with various challenges for patients and caregivers is spinal cord injury (SCI). The spread and prevalence of coronavirus disease 2019 (COVID-19) have been an influential risk factor for abuse. Objectives: The aim of this study was to assess the rate of abuse in patients with SCI during the COVID-19 pandemic. Methods: This cross-sectional descriptive study population was all SCI cases in Ilam, Iran. Researcher-made forms and questionnaires with confirmed validity and reliability, including the demographic characteristics, form and perceived abuse researcher-made questionnaire for people with SCI, were used. The perceived abuse questionnaire for patients with SCI was a researcher-made questionnaire designed based on library studies, interviews with patients, and determination of abuse instances. This instrument consists of 20 questions answered as yes (score 1) or no (score 0). After data collection, statistical analyzes were performed using the SPSS software version 16. Results: According to our results, the mean ± SD of the perceived abuse score by caregivers and patients was 8.48 ± 2.31 and 42.45% during the COVID-19 pandemic, respectively. Moreover, the mean ± SD of the age of patients was 62.86 ± 19.15 years, and the patient abuse increased with elevation in age (P = 0, F = 27.42). The possible abuse score was 0 - 20 divided into three categories of low (20, 20.4%), moderate (76, 76.5%), and high (2, 2%). The perceived abuse score was significantly higher among women and patients with a history of more than 10 years of SCI. Abuse prevalence did not have a significant relationship with income and marital status. Regarding age and abuse, our results showed a rise in perceived abuse scores with an increase in age. Conclusions: The present study showed that it is necessary to take measures to prevent abuse in patients with SCI. Moreover, the prevalence of abuse related to COVID-19 in patients with SCI was high. Therefore, preventive actions need to be proposed in this field.

Background: Traumatic brain injury (TBI) is one of the leading causes of death, which ranges from mild and irreversible to severe and life-threatening injuries. Objectives: This study aimed to compare the pain score in patients with brain disorders using Care Pain Observation Tool (CPOT) and Nonverbal Pain Scale (NVPS). Methods: A descriptive comparative study was performed in Ilam province, Iran, in a group of head trauma patients admitted to the intensive care unit who were intubated. One hundred twenty observations of nurses’ practice were performed. A purposive sampling method was utilized. The CPOT and NVPS assessed the pain, and the Glasgow Coma Scale (GCS) assessed the state of consciousness. Data were analyzed by SPSS version 16 software. Results: Patients’ mean ± SD age was 38.45 ± 4.2 years. The mean ± SD pain score on the CPOT before the procedure was 0.39 ± 0.49 in the facial expression dimension, 0.56 ± 0.49 in activity, 0.54 ± 0.50 in muscle tension, and 0.55 ± 0.49 in compatibility with the ventilator. The mean ± SD pain score on the NVPS before the procedure was 0.97 ± 0.20 in facial expression dimension, 0.94 ± 0.49 in activity, 0.95 ± 0.31 in guarding, 0.64 ± 0.49 in vital signs, and 0.92 ± 0.53 in excitement. Conclusions: Both CPOT and NVPS were effective in diagnosing patients’ pain, but the CPOT was more appropriate for diagnosing pain in intubated patients.

Background: Diffuse axonal injury (DAI) is an injury that occurs after the onset of traumatic brain injury (TBI), leading to many problems for patients and imposing high costs on the treatment system. Objectives: This study was conducted to investigate the status of laboratory variables in patients with DAI. Methods: This cross-sectional study included 140 patients. Data collection tools were a demographic profile form and magnetic resonance imaging (MRI). Laboratory tests, including glucose, LDL-C, HDL-C, total cholesterol, triglycerides, Hb, HCT, PT, PTT, INR, BUN, creatinine, and CRP were evaluated. Also, specialized devices were used to study the laboratory and radiology variables. Results: Most (61.5%) of the patients were male, 47.1% had a non-governmental occupation, and 55.7% were less than 30 years old. Also, in 87.9% of cases, traffic accidents were the cause of DAI and in 65% of patients, the Glasgow Coma Scale (GCS) was less than 7. In all the laboratory variables differences were observed between the experimental and the control groups. Conclusions: The laboratory variables in patients with DAI had a statistically significant difference compared to the case group, which indicates the negative effect of DAI on laboratory variables. Further studies are required to confirm our results.

Background: Thoracic disc herniation is a rare illness and is mainly asymptomatic. There are some surgical approaches to treat symptomatic patients, and none has absolute dominance over the others. For this reason, there is a debate between spine surgeons to decide which method could help these patients with better efficacy and safety. Objectives: To seek the potential differences between the two of these methods, the conventional anterior transthoracic and the more recent modified transfacet approaches, we conducted this study. Methods: This is a retrospective case-series study comparing the anterior transthoracic and the modified transfacet method; each of these approaches was preferred and performed by one surgery team. Patients were divided into two groups based on the procedure and assessed using Frankel’s Score, Visual Along Scale (VAS) Score, Short-Form Health Survey Questionnaire (SF-36), and the spine functional index (SFI). Results: Eleven patients underwent a transthoracic approach, and eight patients had a posterior transfacet pedicle-sparing approach. The Frankel’s score improved at least one score in ten patients from the transthoracic group and seven patients from the transfacet pedicle-sparing group. No major difference was found between the two groups concerning SFI and SF-36 questionnaire. Conclusions: This study exhibited satisfying efficacy and safety of the modified transfacet pedicle-sparing method compared to the transthoracic approach. Both improved Frankel’s scores, SFI, and patients’ quality of life. Despite encountering some limitations, especially a small number of subjects, our study suggests that these surgical methods could be used efficiently considering the patient’s comorbidities, location of the herniated disc and its calcification, and experience and skill of the surgeon.