Journal of

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Introduction: Since surgical treatment for tumorous lesions does not always lead to complete patient recovery, it is possible for the attacks to continue. To help plan for the patients' health, this study aimed to compare the therapeutic effects of adjuvant therapy and surgery in controlling seizure of low-grade glioma (LGG) patients in Firoozgar Hospital in 2013-2014.
Methods: In this analytical cross-sectional study, 114 patients with LGG (grade 2) tumors admitted in Firoozgar Hospital during 2013-2014 were divided into two groups of adjuvant therapy and surgical treatment. All of these patients were followed by telephone and were asked about the incidence, frequency, and intensity of seizure attacks up to one year after surgery. The age and sex of the patients, along with the drug used after surgery, were also recorded on a checklist. Electroencephalography (EEG) was performed on all the patients under the supervision of a neurologist. Patient information was entered into the SPSS V.16 and analyzed. Chi-2 test was used to analyze and compare the qualitative variables, and T-test was employed to compare quantitative variables between the two groups. Alpha values below 0.05 were considered significant.
Results: In the present study, the incidence of seizure after surgery and adjuvant therapy were 16 (1.28%) and 20 (35.1%), respectively. The severity of seizure before and after treatment was not significantly different between the two groups. However, in both groups, the severity and frequency of seizure decreased significantly after treatment, although there was no significant difference between the two groups before and after treatment. In the surgery group, 17 patients (29.82%) and in the adjuvant therapy group, 19 patients (33.33%) had an unusual EEG. There was a significant correlation between the post-treatment seizure and abnormal EEG (p <0.001).
Conclusions: Based on the results of this study, it can be concluded that the incidence, severity, and frequency of seizure in patients with LGG were decreased after surgical treatment or adjunct therapy, but there is no significant difference between the two methods.

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• Traumatic brain injury (TBI) is the leading cause of morbidity and mortality worldwide. The initial injury is followed by a series of secondary processes that can further harm the injured brain and worsen the outcome. The endocannabinoid system (ECS) consists of ligands, such as anandamide and 2-arachidonoyl-glycerol (2-AG), receptors (e.g., Cannabinoid receptor type 1 and Cannabinoid receptor type 2), as well as transporters, and enzymes. Dexanabinol (HU-211) is a synthetic cannabinoid with cerebroprotective effects devoid of cannabimimetic effects, which exhibits the
• pharmacological properties of N-Methyl-D-aspartate receptor antagonist. The increase in the brain levels of endocannabinoids in the pathogenic events of brain injury suggests that this system plays a role in compensatory repair mechanisms. In recent year, the therapeutic effects of cannabinoid manipulative drugs have been numerously studied through the manipulation of the ECS in TBI. Therefore, the literature review was performed to assess the therapeutic effects of ECS manipulation, cannabinoid-derived drugs, and HU-211 in traumatic brain injury pathology. The ECS possesses promising effects in the treatment of diverse TBI pathologies through releasing endogenous ligands and changes in cannabinoid receptors activity or both. Preclinical studies suggest that the ECS has many targets for therapeutic agents that might help decrease TBI pathologic effects and should be considered for developing novel drugs. Furthermore, more clinical trials with larger populations and more  extended follow-up periods should be performed for a better understanding of the effects of ECS manipulative drugs. 

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• Introduction: The ever-increasing and common occurrence of head traumas highlight the importance of adopting therapeutic measures for the reduction of the associated morbidity and mortality. Citicoline, as a safe medicine with positive effects on improving traumatic injuries, has been proven to be useful in various studies. However, there are still no data on the specific standard method and dosage of citicoline for the treatment of patients with traumatic head injuries. Regarding this, the present study was performed to determine the effective therapeutic dosage of citicoline and its impact on patients with traumatic head injuries.
• Methods: This double-blind clinical trial was performed on 30 patients with traumatic concussion (a Glasgow coma scale [GCS] of ≤8) admitted to the intensive care unit and neurosurgery department. The patients were randomly divided into three groups of A (control), B (citicoline with a dosage of 0.5 g/twice a day), and C (citicoline with a dosage of 1.5 g/twice a day). The GCS, degree of muscle strength, Glasgow outcome score (GOS), contusion volume, and cerebral edema (based on brain CT scans) were calculated at specific times and intervals. In addition, the patients' dependency on a ventilator and their length of ICU stay were registered.
• Results: Mean GCS on the first day of stay, GCS changes on the third and fourth days of stay, first and seventh days of stay, seventh and fourteenth days of stay, and first and fourteenth days of stay in the three study groups showed the significant statistical difference (P<0.05). Significant statistical differences were seen between the GOS of the 30th day of stay in the three study groups (P<0.05). The contusion volume difference was only significant between the first and seventh days of stay in groups A and C (P<0.05). No significant difference was observed in the mean length of stay in ICU and duration of dependency on a ventilator in the three study groups (P<0.05). The mean degree of muscle strength was only significantly different on the first day of stay between groups B and C (P=0.008).
• Conclusions: In contrary to similar studies, the results of the current study revealed that citicoline had no positive effect on patient healing. This result may be due to the small sample size and the inconsistent first-day GCSs of the patients in all three groups. Therefore, given the confirmation of the effectiveness of citicoline even at higher dosages in other studies in future studies, it is recommended to use populations with a larger number of patients.

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• The COVID-19 pandemic is the most serious threat to national health systems in a century. The rapid development and spread of the COVID-19 disease necessitated a significant shift in clinical practice and a restructuring of institutional structures. Elective surgery has been drastically reduced in Spinal Surgery Units around the world since the start of the pandemic, and spine trauma management techniques have changed dramatically. All elective treatments, including spinal surgeries, were cancelled due to the virus's highly contagious nature, reduced nosocomial infection, and freed up extra beds for COVID-19 diseases. Emergencies, such as growing neurological deficits or spine instability caused by fractures, infections, or malignancies, could not be postponed. While different considerations should have been made before performing routine spine procedures, the latter was rendered more difficult due to unknown characteristics of the COVID-19 infection. In one study, all patients were polytrauma patients with a higher risk of pneumonia complications due to trauma. The usefulness of corticosteroids in the treatment of spinal cord injury is debated. In the instance of COVID-19 infection, Russell et al. advised not to use corticosteroids. Pneumonia was linked to a 20percent increase in death rate following posterior lumbar fusion surgeries in research by Bohl et al.
   

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• In traumatic brain injury many objects may enter the cranium, if these injuries are associated with the entry of contaminated foreign bodies into the brain; they can cause more damage and complications. This is a case report of such patients with different aspects of treatment. We reported a case followed motor accident suffered dirty large scalp lacerations, multiple linear and depressed skull fractures, and exposure to dura matter, pneumocephalus, and many sands and soil under the cranium. Several therapeutic actions were done including adequate irrigation, administration of Prophylactic antimicrobial and anticonvulsant therapy, and early surgical intervention. The Patient did not show any signs or symptoms of infections or other complications during the hospitalization period and he had a favorable 10-month follow-up period. We concluded in penetrating brain injury with contaminated foreign bodies, adequate irrigation and early administration of prophylactic antibiotic therapy and antiepileptic agents associated with early neurosurgical intervention can be helpful in complications prevention.