Articles: traumatic-brain-injuries.
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Comparative Study
Traumatic brain injury in a rural and an urban Tanzanian hospital--a comparative, retrospective analysis based on computed tomography.
In a resource-poor environment such as rural East Africa, expensive medical devices such as computed tomographic (CT) scanners are rare. The CT scanner at the rural Haydom Lutheran Hospital (HLH) in Tanzania therefore offers a unique chance to observe possible differences with urban medical centers in the disease pattern of trauma-related cranial pathologies. The purpose of this study was to compare traumatic brain injuries (TBIs) between a rural and an urban area of Tanzania. ⋯ This study documents the burden of TBI and the differences in TBI-related CT diagnoses and their incidence between urban and rural areas in Eastern Africa. These results are important as they demonstrate that patients with severe TBI are not a primarily urban concern. Management of TBI should be included in the training curricula for health personnel alike irrespective of whether their workplace is primarily urban or rural.
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To determine the percentage of patients with correction of their first international normalized ratio (INR) less than 1.5 after administration of moderate-dose three-factor prothrombin complex concentrate (PCC), 35 IU/kg compared with low-dose PCC, 25 IU/kg. ⋯ Moderately dosed PCC at 35 IU/kg compared with a lower dosage of 25 IU/kg was associated with a higher percentage of INR reversal and more rapid time to INR normalization in patients with TBI. Future randomized controlled studies to further investigate this novel dose and the impact on potential reductions in the use of fresh frozen plasma are warranted.
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Epilepsy & behavior : E&B · Mar 2014
Risk of severe and repetitive traumatic brain injury in persons with epilepsy: a population-based case-control study.
While traumatic brain injury (TBI) can lead to epilepsy, individuals with preexisting epilepsy or seizure disorder (ESD), depending on the type of epilepsy and the degree of seizure control, may have a greater risk of TBI from seizure activity or medication side effects. The joint occurrence of ESD and TBI can complicate recovery as signs and symptoms of TBI may be mistaken for postictal effects. Those with ESD are predicted to experience more deleterious outcomes either because of having a more severe TBI or because of the cumulative effects of repetitive TBI. ⋯ The consequences of TBI may be greater in individuals with ESD owing to the potential for a more severe or repetitive TBI. Seizure control is paramount, and aggressive management of comorbid conditions among persons with ESD and increased awareness of the hazard of repetitive TBI is warranted. Furthermore, future studies are needed to examine the long-term outcomes of cases in comparison with controls to determine if the higher risk of severe or repetitive TBI translates into permanent deficits.
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Intensive care medicine · Mar 2014
Cerebral metabolic effects of exogenous lactate supplementation on the injured human brain.
Experimental evidence suggests that lactate is neuroprotective after acute brain injury; however, data in humans are lacking. We examined whether exogenous lactate supplementation improves cerebral energy metabolism in humans with traumatic brain injury (TBI). ⋯ Exogenous supplemental lactate can be utilized aerobically as a preferential energy substrate by the injured human brain, with sparing of cerebral glucose. Increased availability of cerebral extracellular pyruvate and glucose, coupled with a reduction of brain glutamate and ICP, suggests that hypertonic lactate therapy has beneficial cerebral metabolic and hemodynamic effects after TBI.
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Clin Neurol Neurosurg · Mar 2014
Observational StudyFrequency, magnitude, and distribution of head impacts in Pop Warner football: the cumulative burden.
A growing body of research suggests that subconcussive head impacts or repetitive mild Traumatic Brain Injury (mTBI) can have cumulative and deleterious effects. Several studies have investigated head impacts in football at the professional, collegiate, and high school levels, in an attempt to elucidate the biomechanics of head impacts among football players. Youth football players, generally from 7 to 14 years of age, constitute 70% of all football players, yet burden of, and susceptibility to, head injury in this population is not well known. ⋯ Despite smaller players and slower play when compared to high school, collegiate or professional players, those involved in youth football sustain a moderate number of head impacts per season with several high magnitude impacts. Our results suggest that players involved in open-field, tackling plays that have head-to-head contact sustain impacts with the highest linear accelerations. Our data supports previously published data that suggests changes to the rules of play during practice can reduce the burden of hits.