Background: To present the very rare comorbidity of developing non-specific orbital inflammation (NSOI) in two patients with histories of definite thyroid eye disease (TED). Case presentation: Both patients complained of new-onset progressive proptosis although their thyroid disease was controlled and computed tomography scan revealed an intraorbital inflammatory mass. The pathological assessment indicated that both patients had developed fibrosing NSOI. Therefore, intravenous corticosteroids were administered. The mass regressed and the amount of proptosis was decreased in both patients. Conclusions: We reviewed all related cases in the literature and extracted their clinical and radiological characteristics for this paper. Ophthalmologists should consider TED and NSOI in patients with a new-onset complaint of proptosis. Despite rare comorbidity of TED and NSOI, it should be considered especially in patients with refractory proptosis, and lead to its further evaluation and prompt management.

Mild traumatic brain injury (mTBI) is a health challenge world widely. Local evidence is essential to establish decision-making algorithms. According to the lack of sufficient evidence, the present study aimed to investigate the epidemiology of mTBI and predictive factors of abnormal brain computed tomography (CT) scans. The present analytical cross-sectional study was conducted between March 2021 to September 2022 on patients with the diagnosis of mTBI. Subjects were individuals who were diagnosed with mTBI in 2 Level I trauma centers located in Isfahan province, which serves as the referral center for the entire population of the province. Demographic and clinical data were recorded during a face-to-face interview. The brain CT scans were interpreted by an experienced radiologist. Data were analyzed using IBM SPSS Statistics for Mac, Version 24.0. 498 patients were enrolled in the study, consisting of 393 (78.9%) men and 65 (13.1%) children younger than 10 years old. 100 (20%) of them had abnormal CT scan findings. The mean age of participants was 33.39 ± 19.69, which was significantly higher in patients who had abnormal CT scans (P value = .002). Despite the most common mechanism in both groups being motor accidents, the rate of motor accidents was higher in patients with abnormal findings of CT scan (P value = .048). Multiple logistic regression revealed that post-traumatic vomiting (PTV) (odd ratios [OR]: 3.736), post-traumatic amnesia (PTA) (OR:3.613), raccoon eyes (OR:47.878), and Glasgow coma scale (GCS) of 15 (OR:0.11) are predictive factors for abnormal findings. The present study suggested the presence of PTV, PTA, raccoon eyes and GCS of 13 or 14 as predictive factors for abnormal findings in mTBI populations.

To evaluate the role of lumbar sacralization (LS) on the surgical outcomes of L4-L5 microdiscectomy. This prospective cohort study was conducted in a university referral hospital. The patients with L4-L5 disc herniation and eligible for microdiscectomy were enrolled and allocated in G1 (with LS) and G2 (no LS). After the L4-L5 microdiscectomy patients were followed, clinical and radiological parameters were collected to investigate the influence on the outcomes. Recurrence, low back outcome score (LBOS), and the Oswestry disability index (ODI) were defined as main outcomes. Two hundred and forty patients (n = 120, each), were reviewed in the final analysis. There was no difference between groups regarding baseline characteristics. Postoperative radicular and back pain was more severe in LS(P < 0.05). Univariate analysis showed recurrence was significantly higher in LS with a direct correlation with postoperative back pain persistence and low LBOS (p = 0.001). Age had a negative impact on G2 recurrence(p = 0.008). LS had a negative impact on LBOS and ODI scores. Postoperative radicular pain and higher lumbar lordosis were associated with a higher disability (ODI) index. L4-L5 microdiscectomy in patients with lumbar sacralization was associated with higher recurrence rates, worse ODI and LBOS scores, persistent postoperative axial back pain, and radicular pain. Postoperative axial back pain and poor LBOS results could effectively predict a higher recurrence rate following L4-L5 microdiscectomy in lumbar sacralization.

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Background: The impact of splenectomy on immune function and infection risk in trauma patients remains debated. Severely ill trauma patients are known to have a high risk for ventilator-associated pneumonia (VAP). We hypothesize that trauma patients undergoing splenectomy do not have a higher incidence of VAP compared with those managed with splenic preservation. Patients and Methods: We conducted a retrospective review of trauma registry data for patients admitted with splenic injuries from 2017 to 2023. Exclusions included patients who died within 48 h, had an Injury Severity Score (ISS) <25, or required <3 ventilator days. Only patients admitted to the surgical intensive care unit (ICU) with confirmed splenic injuries were included. The American Association for the Surgery of Trauma splenic injury scale was used to grade injury severity. VAP was defined per the 2024 National Trauma Data Standard by the American College of Surgeons. We collected data on ISS, Abbreviated Injury Scale for chest, abdomen-pelvis, and head, demographics, hospital, ICU length of stay, ventilator days, mechanism of injury, microbiology, vaccination status, and splenic injury grade. Patients were stratified into splenectomy and splenic preservation groups, which included embolization, splenorrhaphy, or observation. VAP incidence was compared across groups. Results: Among 140 patients, 64 (46%) underwent splenectomy, and 76 (54%) had splenic preservation. Uni-variable analysis showed higher VAP rates in the splenic preservation group (32.9% vs. 18.8%), but this was not statistically significant (p = 0.059). Multi-variable regression confirmed that longer ventilator days increased VAP risk (OR: 1.13, p < 0.001). Splenectomy itself was not associated with a higher VAP incidence (OR: 0.42, p = 0.054). Conclusion: In this study, splenectomy was not substantially associated with VAP, whereas prolonged ventilator duration remained the strongest predictor. Larger studies are needed to clarify whether splenectomy influences pneumonia risk.