Drug repurposing, known as drug repositioning, is considered a method for redeveloping a compound to utilize in a distinctive illness, which is now becoming a progressively critical procedure for industrial researchers and the scholarly community. A large number of repurposed medicines have been discovered by chance in the lab or through the careful monitoring of drug action in the clinic and retrospective analysis of clinical findings. Additionally, statins are broadly used to treat hyperlipidemia and prevent cardiovascular disease although their application as the neuroprotective agents weakening secondary neurological harm is yet limited in TRAUMAtic brain injury (TBI). Their other non-cholesterol-mediated (i. e., pleiotropic) mechanisms of action include upregulating endothelial nitric oxide synthase expression, and enhancing neurogenesis and synaptogenesis, as well as anti-apoptotic effects, increased angiogenesis, and various antioxidant and anti-inflammatory mechanisms. Almost all studies have supported the potential role of statins in neuroprotection, and a few have particularly focused on their effects in TRAUMAtic brain injury models. The sulfonylurea receptor 1 (SUR1) protein is a regulatory component linked with pore-forming ion channels. Thus, ATP-sensitive potassium (KATP) channels are created, which can be demonstrated in pancreatic islet cells and certain neurons. Further, transient receptor potential melastatin 4 (TRPM4) is the second pore-forming subunit of SUR1. Upregulating SUR1 and opening SUR1-TRPM4 opening have been observed in the different models related to central nervous system (CNS) injuries such as TBI. Sulfonylurea drugs may prevent neuronal degeneration and improve post-TBI cognitive results by inhibiting the SUR1-TRPM4 channel.

Hyperglycemia, in TRAUMA patient, is commonly associated with a hyper metabolic stress response. Our objective is to determine the effects of hyperglycemia on the overall outcome of head TRAUMA patients. In this descriptive study data were collected from head TRAUMA patients' admitted to Intensive Care Unit (ICU) of Poursina University Hospital in a one-year period (Jan 2004-Jan 2005), retrospectively. All patients had stayed in the ICU for more than 48 hours post-injuries. They were divided into two groups according to their serum glucose levels at the time of admission (<200mg/dl or >200mg/dl), age, gender and Injury Severity Score (ISS). Patients with diabetes mellitus were excluded .We determined the outcome according to duration of hospitalization and ICU stay as well as mortality rates. Variables were analyzed with t-test and chi square test. Out of 115 patients, 89.6% were men. About 36 % of patients had serum glucose levels D 200 mg/dl over the study period and this group had significantly greater mortality rate but without necessarily longer ICU or hospital stay. In this study we have shown that admission hyperglycemia has significant t effect on patient’s mortality but it is still unclear whether it can be a cause for longer ICU/hospital stay.

Introduction: TRAUMAtic Brain Injury (TBI) is one of the most important matters of public health in which people affected often lose their functional abilities and have dependent life and in result these patients a caregiver for care and support. Thus families are at front line of challenges and great stresses.Objective: The aim of this study was to determine needs of caregivers of patients with head TRAUMA after discharge and level of its fulfillment in patients referring to one of educational- therapeutic center in Rasht city.Methods: This is a cross-sectional descriptive-analytical study conducted on 51 family members of patients with head injury who were selected by census method from available samples in 2013. In this study two questionnaires of demographics and Standard Family Need Questionnaire (FNQ) were used for data collection and analyzed by descriptive statistics and Chi square, independent T Test, ANOVA and Exact Fischer tests.Results: The most important need was related to subscale of health information and the least related to getting involved with caring. There was a significant relationship between level of caregivers’needs and their occupational status (P<0.046), patients’ age range (P<0.023) and patients’ clinical condition (P<042). The maximum rate (3.49 ± 0.56) of need fulfillment was related to subscales of community support and health information and the minimum (2.965 ± 0.78) was related to instrumental support. There was a significant relationship between meeting the needs in all domains and health insurance (P<0.044).Conclusion: The most important family need was related to subscales of health information that were often met. Apprehension of needs and difficulties of caregivers lead to increase of awareness of nurses and other custodians of healthcare about the necessity of helping caregivers of patients with TRAUMAtic Brain Injury.

CRANIOCEREBRAL gunshot injuries (CGI) are increasingly encountered by neurosurgeons in civilian and urban settings. Unfortunately, more prevalent condition in developing countries, with major armed conflicts which is still persisting, since the main trigger is violence at the national or state level. Management goals of CGI should focus on aggressive resuscitation and correction of coagulopathy; those with stable vital signs should undergo CT scan head at the earliest possible opportunity. Neuroimaging is vital for planning of surgical management, especially to determine the type of surgery, routes of the approach to the surgical target area and extraction of the impacted foreign bodies, however, surgical management is not always indicated. Although subset of such cases may be managed even with non-surgical management. The treatment comprises of immediate life salvaging resuscitative measures including control of the persistent bleeding, care of associated injury, management of raised intracranial pressure, prevention of cerebrospinal fistula formation by primary watertight dural repair and prevention of infection, through extensive debridement of contaminated, macerated or ischemic tissues; preservation of nervous tissue and restoration of anatomic structures through the hermetic sealing of dural and scalp defect. Recently, only few studies of CRANIOCEREBRAL penetrating injuries are published that too involving smaller patients sample sizes; although classic studies in the military and civil situation noticed associated relatively very high mortality and morbidity and psychological as well as economic impact on the affected individual, the family and the health system in providing ongoing care to the sufferers and society at large. Currently various measures are advocated with aim to reduce the incidence of CGI especially in civilian populations. It is highly necessary and immensely urgent to promote research in a neurocritical care of CGI to provide positive impact on improvement of the quality of life and further providing better care and reduction of overall health care cost.

Background: Head injury is a silent epidemic in developed countries and is one of the leading causes of death and disability. Determining the precise and early prognosis of head injury, especially in severe cases, is essential and will help define treatment actions and rehabilitation plans and counsel other family members. The purpose of this study was to determine the relationship between electroencephalographic findings and prognosis in patients with decreased levels of consciousness due to head injury. Methods: This is a retrospective descriptive-analytical study on patients with reduced levels of consciousness due to head injury, referred to Tir Hospital (Tehran) in the first half of 2018. Overall, 52 patients were studied and divided according to their GCS into two groups: favorable prognosis (30 patients, 57. 7%) and poor prognosis (22 patients, 42. 3%). We tried to find the relation between EEG findings such as voltage, electrographic seizures, periodic and rhythmic patterns, and the prognosis. Results: Normal voltage was associated with a favorable prognosis, with a high specificity (95%) and a less robust sensitivity (63%). The isoelectric voltage (electrocerebral shutdown) was associated with a poor prognosis. Normal and isoelectric voltages were good predictors with 95% and 100% Positive Predictive Values (PPV), respectively. There was a statistically significant relationship between EEG frequency range and prognosis. Conclusion: This study showed that EEG parameters might provide valuable data regarding the prognosis of decreased consciousness of patients with a head injury, also for the guidance of physicians and informing the patients’,family.

Introduction: TRAUMA is the third leading cause of death and is one of the most common causes for referrals to the emergencies. Assessment of prognosis in the patients with head TRAUMA can help find high risk patients and provide more complete care to them. The evaluation includes assessment of intracranial pressure and the brain circulation with Trans Cranial Doppler (TCD). Objective: The evaluation of prognosis in patients with moderate head TRAUMA using pulsatility index (PI), obtained by Trans Cranial Doppler (TCD). Materials and Methods: In this descriptive study, 52 patients with moderate head TRAUMA (GCS= 9-13) were studied during one year (2010). In the first 24 hours after TRAUMA, for all the patients TCD by their middle cerebral arteries (MCA) was performed to assess PI value. After seven days, all the patients were followed up for neurological deterioration and prognosis. Finally, data were entered in SPSS software v.17 and analyzed by Independent T-test, Chi- square test with 95% Confidence Interval (CI=0.95). Results: In total, 47 (90.4%) were men and 5 (9.6%) were women (with mean age of 33.81 ± 17.91 years). In the group with low PI (<1.2) ¸ 29 (69.05%), patients were with good prognosis, and 13 (30.95%) with poor prognosis. There was a significant relationship between GCS decline≥ 2 and average of PI (p<0.021). Average of PI in the patients who needed intubation (1.08 ± 0.26) was higher than that in other patients (0.91 ± 0.24, p<0.037). Also, 32 (61.54%) patients were with good prognosis, finally. Average values of PI in good and poor prognosis groups were 0.88±0.24 and 1.08±0.24, respectively; with significant difference (p<0.005). There was no significant relationship between average values of PI and gender, need for operating, osmol therapy and type of defect in CT scan. By using Roc curve, the best cut off point for PI was estimated at about 0.9 with sensitivity of 75% and specificity of 43%.Conclusion: The results demonstrated that the PI is a valuable parameter besides the other factors such as GCS decline, to determine the prognosis in the patients with moderate head injury admitted to emergency units.

Leigh syndrome is a severe progressive neurodegenerative disorder with different clinical presentations that usually becomes apparent in the first year of life and rarely in late childhood and elderly years. It is caused by failure of mitochondrial respiratory chain and often results in regression of both mental and motor skills and might even lead to death. In some of the inherited neurodegenerative diseases like Alexander disease, head TRAUMA is reported as a trigger for onset of the disease. We present a late onset Leigh syndrome in a 14-year-old girl whose symptoms were initiating following head TRAUMA.

Background: To assess the clinical value of two-dimensional (2D) plus four-dimensional (4D) ultrasonography in diagnosis of fetal CRANIOCEREBRAL anomalies. Methods: Retrospective analysis was performed on the sonographic features of 83 maternity patients admitted to Northwest Women’ s and Children’ s Hospital, Xian China from January 2013 to December 2017 diagnosed with suspected fetal anomalies of the brain and skull through 2D and 4D ultrasonography. Results: Fifty six patients were diagnosed with the anomalies by 2D ultrasonography only, 65 patients by 4D ultrasonography only, and 74 patients by 2D plus 4D ultrasonography. 76 patients were confirmed to have fetal CRANIOCEREBRAL anomalies after birth or induced labor. Diagnostic accuracies of 2D ultrasound only, 4D ultra-sound only, and 2D plus 4D ultrasound were 68. 67%, 81. 93% and 95. 18%, respectively (P<0. 05). The accuracy of 2D plus 4D ultrasound was greater than those of 2D ultrasound only and 4D ultrasound only, and the accu-racy of 4D ultrasound only was higher than that of 2D ultrasound only (P<0. 05). The sensitivity of 2D plus 4D ultrasound was greater than those of 2D ultrasound only and 4D ultrasound only (P<0. 05). The specificity of 2D plus 4D ultrasound was greater than those of 2D ultrasound only and 4D ultrasound only (P<0. 05). Conclusion: Combined ultrasonography can better differentiate fetal CRANIOCEREBRAL anomalies, providing early and more accurate information for clinicians as well as maternity patients to make a decision. This clinical prac-tice would be valuable for improving the quality of the newborn population.

Pneumocephalus refers to the presence of air in the cranial cavity. TRAUMA is the most common cause of acquired pneumocephalus. Tension pneumocephalus occurs when intracranial accumulation of air causes high pressure on the brain as compared to extracranial pressure. Tension pneumocephalus is usually acute, and causes neurological symptoms, and its delayed form rarely occurs. A 12-year-old girl presented with a headache, lethargy, mild fever, and nausea from two days before admission to emergency department of Shahid Rajaei Hospital, Qazvin, Iran. The patient had a history of head TRAUMA in a driving accident six weeks before and had undergone brain computed tomography (CT) scan in another centre, which had revealed no sign of pneumocephalus. The patient had been treated for one week and had been discharged in good general condition. Considering her reduced consciousness, the patient underwent brain CT scan again in our centre. CT scan revealed tension hydropneumocephalus. The patient was transferred to the intensive care unit (ICU) for treatment. Considering the trend of her recovery, the patient was a candidate for conservative non-surgical therapy based on the incharge neurosurgery specialist’ s decision. The patient reported no complications during the six-month followup. Delayed tension pneumocephalus is among neurosurgery emergencies usually treated with early surgical intervention and dura defect restoration, but this patient received non-surgical treatment without any serious problem during the six-month follow-up.