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BACKGROUND: Ventilator-associated pneumonia (VAP) is a common complication in traumatic brain injury (TBI) patients, which increases morbidity and negatively affects outcomes. Risk factors and outcomes in these patients remain controversial. The aim of the present study is to explore the risk factors and clinical outcomes of patients with VAP and TBI. METHODS: Two researchers conducted independent systematic literature searches of Pubmed, Cochrane Database, Scopus, Medline Ovid, Science Direct databases, published from inception to January 2024. The Newcastle-Ottawa scale was used to assess study quality. A meta-analysis was performed using a random-effects model when heterogeneity I2 > 50 % and a fixed-effects model when I2 < 50 %; in addition, a subgroup analysis was performed to explore VAP risk factors, and publication bias was assessed with the funnel plot and Begg's and Egger's tests. All results were considered statistically significant when p < 0.05. The certainty of the evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. RESULTS: Twelve studies were included in the meta-analysis with a total of 2883 patients. Male gender [OR 1.58 (95 % CI 1.23, 2.02) p < 0.05 I2 0 %] and abbreviated injury scale (head: H-AIS) [≥ 3 OR 2.79 (95 % CI 1.58, 4.93) p < 0.05 I2 0 %] increased the risk of VAP. After subgroup analysis, blood transfusion on admission [OR 1.97 (95 % CI 1.16-3.35) p ≤0.05 I2 5 %] and barbiturate infusion [OR 3.55 (95 % CI 2.01-6.30) p ≤0.05 I2 0 %] became risk factors. Prophylactic antibiotic use [OR 0.67 (95 % CI 0.51-0.88) p ≤0.05 I2 0 %] and younger age MD -3.29 (95 % CI -5.18, -1.40) p ≤0.05 I2 41 %] emerged as significant protective factors. In VAP patients ICU stay [MD 7.02 (95 % CI 6.05-7.99) p ≤0.05 I2 37 %], duration of mechanical ventilation [MD 5.79 (95 % CI 4.40, 7.18) p ≤0.05 I2 79 %] and hospital stay [MD 11.88 (95 % CI 8.71-15.05) p ≤0.05 I2 0 %] were significantly increased. The certainty of the evidence was moderate-high for the outcomes studied. CONCLUSIONS: Male gender, H-AIS ≥ 3, blood transfusion on admission, and barbiturate infusion were risk factors for VAP. In patients with VAP, ICU stay, duration of mechanical ventilation, hospital stay were significantly increased.

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Introducción: La hiponatremia se encuentra asociada aproximadamente con el 10% de los pacientes con traumatismo craneoencefálico, su baja frecuencia y la intuición clínica de esta relación la hace importante en el presente informe de caso. Objetivo: Describir la asociación de la hiponatremia con el traumatismo craneoen-cefálico con la finalidad de mejorar la comprensión de esta relación en el personal de salud y promover la implementación de estrategias de diagnóstico y manejo más efectivas basadas en predicciones bioquímicas y anatómicas actualizadas. Presentación del caso: Paciente masculino, adulto joven, con antecedentes de dos traumatismos craneoencefálicos, con hiponatremia sérica severa y síntomas persistentes de mareo y cefalea, tratado con diuréticos de asa y cloruro de sodio vía oral, con mejoría posterior al vigésimo día de hospitalización. Discusión: Ciertas alteraciones neurológicas con manifestación clínica evidente, se presentan por bajos niveles de sodio sérico, o por causas anatómicas y fisioló-gicas diferentes. Se ha demostrado una relación causal con mecanismo fisiopato-lógico no bien descrito sobre la hiponatremia y el traumatismo craneoencefálico. Conclusión: Es crucial tener una vigilancia meticulosa en pacientes con hipona-tremia severa, aunque presenten pocos síntomas clínicos (considerando antece-dentes como el traumatismo craneoencefálico en la anamnesis inicial y de segui-miento) como en este caso. Además, se destaca la necesidad de investigar las vías metabólicas que podrían verse afectadas por traumatismos craneoencefálicos, y que podrían tener un impacto directo en los niveles de sodio en sangre.

Introduction: Hyponatremia is found to be associated with approximately 10% of patients with traumatic brain injury. Despite its low frequency, the clinical intuition regarding this relationship underscores its significance in this case report. Objective: Describe the association between hyponatremia and traumatic brain in-jury, aiming to enhance healthcare professionals' understanding of this correlation and to advocate for the implementation of more effective diagnostic and manage-ment strategies based on updated biochemical and anatomical predictions. Case Presentation: A young adult male patient with a history of two traumatic brain injuries, severe serum hyponatremia, and persistent symptoms of dizziness and headache, treated with loop diuretics and oral sodium chloride, exhibited improvement after twenty days of hospitalization. Discussion: Certain neurological alterations with evident clinical manifestation are characterized by low levels of serum sodium, possibly stemming from distinct ana-tomical and physiological causes. A causal relationship with a poorly described pathophysiological mechanism between hyponatremia and traumatic brain injury has been suggested. Conclusion: Meticulous monitoring is imperative for patients with severe hypona-tremia, even when clinical symptoms are minimal, as observed in this case. Fur-thermore, emphasis is placed on the need to investigate metabolic pathways that may be affected by traumatic brain injuries, potentially exerting a direct impact on blood sodium levels.

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Introduction: Traumatic brain injury (TBI) is an important public health concern and that may lead to severe neural sequels, such as color vision deficits. Methods: We evaluated the color vision of 10 TBI patients with normal cognitive function using a color discrimination test in a fixed saturation level. We also analyzed computerized tomography scans to identify the local of the brain damages. Results: Four TBI patients that had lesions in brain areas of the ventral visual streams, five TBI patients had lesions inferred in brain areas of the dorsal visual stream, and one TBI patient had lesion in the occipital area. All the patients had cognitive and color vision screened and they had characterized the chromatic discrimination at high and low saturation. All participants had no significant cognitive impairment in the moment of the color vision test. Additionally, they had perfect performance for discrimination of chromatic stimulus at high saturation and similar to controls (n = 37 age-matched participants). Three of four TBI patients with lesions in the ventral brain and one patient with lesion in the occipital area had impairment of the chromatic discrimination at low saturation. All TBI patients with lesions in the dorsal brain had performance similar or slightly worse than the controls. Conclusion: Chromatic discrimination at low saturation was associated to visual damage in the ventral region of the brain and is a potential tool for functional evaluation of brain damage in TBI patients.

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OBJECTIVE: The purpose of this study was to identify the occurrence of AKI, and factors associated with in-hospital mortality and unfavorable outcomes in patients with severe traumatic brain injury (TBI) and acute kidney injury (AKI) severity. METHOD: A retrospective cohort study which analyzed data with severe TBI between 2013 and 2017. We examined demographic and clinical information, and outcome by in-hospital mortality, and the Glasgow Outcome Scale six months after TBI. We associated factors to in-hospital mortality and unfavorable outcome in severe TBI and AKI with an association test. RESULTS: A total of 219 patients were selected, 39.3% had an AKI, and several factors associated with AKI occurrence after severe TBI. Stage 2 or 3 of AKI (OR 12.489; 95% CI = 4.45-37.94) were independent risk for both outcomes in multivariable models, severity injury by the New Trauma Injury Severity Score (OR 0.97; 95% CI = 0.96-0.99) for mortality, and the New Injury Severity Score (OR1.07; 95% CI = 1.04-1.10) and Trauma and Injury Severity Score (OR = 0.98; 95% CI = 0.965-0.997) for unfavorable outcome. CONCLUSION: The findings of our study confirmed that AKI severity and severity of injury was also related to increased mortality and unfavorable outcome after severe TBI.

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Objetivo: Compreender o cotidiano de portadores de dor neuropática decorrente de lesão traumática. Metodologia: Pesquisa exploratória, descritiva, de abordagem qualitativa, com participantes selecionados por meio de mídias sociais. A coleta de dados foi realizada entre o período de julho a setembro de 2022, com indivíduos adultos que possuem diagnóstico de dor neuropática após lesão traumática. A coleta ocorreu por meio de um formulário online, utilizando um questionário sociodemográfico e um questionário aberto, para a captura de informações pertinentes sobre seu caso clínico e vivência com a dor crônica. Os dados foram analisados por meio de Bardin. Todos os preceitos éticos foram respeitados e o projeto foi aprovado sob parecer n.º 5.529.581 da Universidade Cesumar. Resultados: Participaram 15 pessoas com dor neuropática, com prevalência do sexo feminino (93,3%), com idade entre 41 a 50 anos (66,7%). Observou-se que 53,3% relataram comorbidades crônicas, sendo as doenças psíquicas, ansiolíticas e cardíacas mais citadas. Ainda, 33,3% dos participantes relataram que foram internados por causas de dores ou por tentativa de suicídio, 93,3% usam opióides e analgésicos potentes e ainda foram citados antidepressivos e ansiolíticos em 62% das respostas. Dentre os temas em destaque nas respostas, sobressaíram-se "Contexto e diagnóstico da dor neuropática; Vivência e frequência da dor; Apoio profissional e familiar diante da doença". Considerações Finais: Nesse sentido, a percepção acerca dos profissionais de saúde e valorização do médico para o tratamento da dor neuropática está relacionada, muitas vezes, à necessidade de aumentar o conhecimento referente ao manejo da dor e à utilização de opióides.

Objective: To understand the daily life of patients with neuropathic pain resulting from traumatic injury. Methodology: Exploratory, descriptive research, with a qualitative approach, with participants selected through social media. Data collection was carried out between July and September 2022, with adult individuals diagnosed with neuropathic pain after traumatic injury. The collection took place through an online form, using a sociodemographic questionnaire and an open questionnaire, to capture relevant information about their clinical case and experience with chronic pain. Data were analyzed using Bardin. All ethical precepts were respected and the project was approved by report n.º 5,529,581 of Cesumar University. Results: 15 people with neuropathic pain participated, with a prevalence of females (93.3%), aged between 41 and 50 years (66.7%). It was observed that 53.3% reported chronic comorbidities, with psychic, anxiolytic and cardiac diseases being the most cited. Also, 33.3% of the participants reported that they were hospitalized due to pain or a suicide attempt, 93.3% used opioids and potent analgesics, and antidepressants and anxiolytics were mentioned in 62% of the answers. Among the topics highlighted in the responses, the most important were "Context and diagnosis of neuropathic pain; Experience and frequency of pain; Professional and family support in the face of the disease". Final Considerations: In this sense, the perception of health professionals and the appreciation of physicians for the treatment of neuropathic pain is often related to the need to increase knowledge regarding pain management and the use of opioids.

Objetivo: Comprender el cotidiano de los pacientes con dolor neuropático resultante de lesiones traumáticas. Metodología: Investigación exploratoria, descriptiva, con enfoque cualitativo, con participantes seleccionados a través de las redes sociales. La recolección de datos se llevó a cabo entre julio y septiembre de 2022, con individuos adultos diagnosticados con dolor neuropático posterior a una lesión traumática. La recogida se realizó a través de un formulario online, utilizando un cuestionario sociodemográfico y un cuestionario abierto, para captar información relevante sobre su caso clínico y experiencia con el dolor crónico. Los datos se analizaron utilizando Bardin. Se respetaron todos los preceptos éticos y el proyecto fue aprobado bajo el dictamen número 5.529.581 de la Universidad Cesumar. Resultados: Participaron 15 personas con dolor neuropático, con predominio del sexo femenino (93,3%), con edades entre 41 y 50 años (66,7%). Se observó que 53,3% relataron comorbilidades crónicas, siendo las enfermedades psíquicas, ansiolíticas y cardíacas las más citadas. Aún así, el 33,3% de los participantes informaron que fueron hospitalizados por dolor o intento de suicidio, el 93,3% usaba opioides y analgésicos potentes, y los antidepresivos y ansiolíticos se mencionaron en el 62% de las respuestas. Entre los temas destacados en las respuestas, los más importantes fueron "Contexto y diagnóstico del dolor neuropático; Experiencia y frecuencia del dolor; Apoyo profesional y familiar ante la enfermedad". Consideraciones Finales: En este sentido, la percepción de los profesionales de la salud y la apreciación de los médicos por el tratamiento del dolor neuropático muchas veces se relaciona con la necesidad de aumentar el conocimiento sobre el manejo del dolor y el uso de opioides.

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Abstract Background Abnormal motor posturing (AMP), exhibiting as decorticate, decerebrate, or opisthotonos, is regularly noticed among children and adults. Objective This systematic review and meta-analysis examined the risk factors and outcome of posturing among severe head and brain injury subjects. Methods Based on the inclusion and exclusion criteria and using MeSH terms: "decerebrate posturing", "opisthotonic posturing", "brain injury", and/or "cerebral injury" articles were searched on Scopus, PubMed, Science Direct, and google scholar databases. Observational studies, case series, and case reports were included. Results A total of 1953 studies were retrieved initially, and based on the selection criteria, 20 studies were finally selected for review and were analyzed for meta-analysis based on the mortality between the hematomas. The functional outcomes of this study are the risk factors, mortality rate and Glasgow Outcome Scale. Decerebrative patients were higher among the studies related to head injury surgeries. Males were mainly treated for decerebrate postures compared with the female subjects. Extradural hematoma and acute subdural hematoma with cerebral contusion were quite common in the surgical mass lesions. Conclusion The findings reported that the lesion types, the operative procedures, and the age of the decerebrating patients with brain injuries are the significant prognostic factors determining the survival outcomes.

Resumo Antecedentes Postura motora anormal (AMP), exibindo-se como decorticada, descerebrada ou opistótono, é regularmente observada entre crianças e adultos. Objetivo Esta revisão sistemática e metanálise examinou os fatores de risco e os resultados da postura entre indivíduos com lesões graves na cabeça e no cérebro. Métodos Com base nos critérios de inclusão e exclusão e usando termos MeSH: artigos sobre "postura descerebrada", "postura opistótona", "lesão cerebral" e/ou "lesão cerebral" foram pesquisados nas bases de dados Scopus, PubMed, Science Direct e Google Scholar. Foram incluídos estudos observacionais, séries de casos e relatos de casos. Resultados Um total de 1.953 estudos foram recuperados inicialmente e, com base nos critérios de seleção, 20 estudos foram finalmente selecionados para revisão e analisados para metanálise com base na mortalidade entre os hematomas. Os resultados funcionais deste estudo são os fatores de risco, taxa de mortalidade e Escala de Resultados de Glasgow. Os pacientes descerebrados foram maiores entre os estudos relacionados a cirurgias de traumatismo cranioencefálico. Os homens foram tratados principalmente para posturas descerebradas em comparação com as mulheres. Hematoma extradural e hematoma subdural agudo com contusão cerebral foram bastante comuns nas lesões de massa cirúrgica. Conclusão Os achados relataram que os tipos de lesões, os procedimentos operatórios e a idade dos pacientes descerebrados com lesões cerebrais são os fatores prognósticos significativos que determinam os resultados de sobrevivência.

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Introduction Traumatic brain injury (TBI) is among the main causes of death and neurological sequelae worldwide. Injuries are classified as diffuse (diffuse axonal injury and brain swelling) or focal (cerebral contusion [CCo], epidural hematoma, and acute subdural hematoma). Among all TBIs, CCos are the most frequent focal lesion, and treatment modalities are many. Hematoma evacuation using large craniotomies has been well described in the literature. The main goal of the present study is to discuss the advantages of minimally invasive approaches for the treatment of CCos, regarding operative time, blood loss, and postoperative tomographic results. Methods An integrative literature review was conducted on the SciELO, LILACS, and PubMed databases. Seven case reports were included in the present study. Retrospective data collection was performed, analyzing gender, age, Glasgow coma scale score on hospital admission, surgical approach, and postoperative (tomographic) results. Results The minimally invasive keyhole approach was used in seven patients with CCos. The supraorbital approach (n » 5) was performed for frontal lobe contusions, and the minipterional approach (n » 2) was performed for temporal lobe contusions. All cases had adequate hematoma evacuation, confirmed by postoperative computed tomography scans. Conclusion The minimally invasive approaches were effective for hematoma evacuation, with adequate clinical and radiological postoperative results.

Introdução O traumatismo cranioencefálico se encontra entre as principais causas de óbito e sequelas neurológicas na estatística mundial. As lesões são classificadas como difusas (lesão axonal difusa e edema cerebral traumático) ou focais (contusões cerebrais [CoC], hematoma epidural, e hematoma subdural agudo). Dentre todos os tipos de lesões cerebrais traumáticas, as contusões são a lesão focal mais comum, e são reservadas a elas múltiplas modalidades de tratamento. O principal objetivo desse estudo é discutir as vantagens dos acessos minimamente invasivos no tratamento de contusões cerebrais, especialmente no que concerne à duração do procedimento, perda sanguínea e resultados tomográficos pós-operatórios. Métodos Uma revisão integrativa de literatura foi conduzida nas plataformas Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e PubMed. Sete relatos de caso foram incluídos neste estudo. A coleta retrospectiva de dados foi realizada com a análise das seguintes variáveis: gênero, idade, escala de coma de Glasgow à admissão, acesso cirúrgico utilizado e resultados tomográficos pós-operatórios. Resultados O acesso cirúrgico minimamente invasivo foi utilizado em sete pacientes com CoC. O acesso supraorbital (n » 5) foi usado para tratar contusões frontais, enquanto o acesso minipterional (n » 2) foi usado para o tratamento de contusões temporais. Em todos os casos, foi obtida drenagem satisfatória do hematoma, confirmada por meio de tomografias pós-operatórias. Conclusão Os acessos minimamente invasivos foram efetivos para evacuação dos hematomas intraparenquimatosos, com resultados clínicos e tomográficos favoráveis.

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Traumatic subdural hemorrhage (TSH) is an injury between the meningeal membranes, caused by traumas, especially traffic accidents. OBJECTIVE: To describe the mortality rate (MR) due to TSH in the period 2018-2022 in Chile. MATERIALS AND METHODS: Descriptive, observational, and cross-sectional study on MR due to TSH in the period 2018-2022 in Chile, according to gender, age group, regional distribution, place of death, and month of death. Anonymous and public databases were used. No ethics committee approval was required. RESULTS: The average MR due to TSH in Chile from 2018 to 2022 was 0.45/100,000 inhabitants, with a peak in 2018 (0.75) and a minimum in 2021 (0.31). Men had higher rates. Mortality increased with age, especially in those over 80 years. The Metropolitan Region accounted for 35.2% of TSH-related deaths. Hospitals and clinics were the main places of death (67.1%), with more deaths in March, July, and August. DISCUSSION: The MR due to TSH progressively decreased due to medical improvements. Men have higher rates, possibly due to risk factors or biological differences. The reduction in MR in hospitals is linked to changes in the severity and categorization of the place of death. The connection with traffic accidents is significant, especially between March and August, due to the return to academic activities and weather conditions. Additionally, TSH-related deaths are concentrated in densely populated regions with more traffic accidents.

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Introducción: El traumatismo craneoencefálico (TCE) puede generar vértigo, mareo e inestabilidad. Posibles causas otorrinolaringológicas son el vértigo postural paroxístico benigno (VPPB) que constituye el diagnóstico más frecuente, y la hipofunción vestibular. Objetivo: Describir la prevalencia de hipofunción vestibular en un grupo de pacientes con VPPB asociado a TCE. Material y Método: Estudio retrospectivo de pacientes con VPPB asociado a TCE que requirieron maniobra de reposición (MRP) entre los años 2017 y 2021. La información clínica, características clínico-demográficas, hallazgos en pruebas de función vestibular y número de MRP fueron evaluados. Resultados: Se incluyeron 48 pacientes con una edad promedio de 60,8 ± 16,5 años, siendo un 52% mujeres. La prevalencia de pacientes con paresia vestibular concomitante correspondió al 35,4%. Al comparar al grupo con y sin paresia se observó: (1) en el grupo con paresia fue, significativamente, más frecuente presentar contusión cerebral asociada, 47,1% vs 12,9%; (2) el sexo masculino fue, significativamente, más frecuente en el grupo con paresia, 70,59% vs 35,5%; (3) en ambos grupos, la mediana de MRP fue 1. Conclusión: La presencia de paresia vestibular en pacientes con VPPB secundario a TCE, no es un hallazgo infrecuente, en nuestro estudio, correspondió a un 35,4%, siendo este más frecuente en hombres. Adicionalmente, la contusión cerebral asociada es más frecuente en el grupo con paresia.

Introduction: Head trauma can generate vertigo, dizziness and instability. Possible otorhinolaryngologic causes are benign paroxysmal postural vertigo (BPPV), which is the most frequent diagnosis, and vestibular hypofunction. Aim: To describe the prevalence of vestibular hypofunction in a group of patients with BPPV associated with head trauma. We studied the clinical characteristics, vestibular function test findings and the number of (PRM). Material and Method: Retrospective study of patients with BPPV associated with head trauma who underwent particle repositioning maneuvers (PRM) during the years 2017 to 2021. Clinical characteristics, vestibular function test findings and the number of PRM were evaluated. Results: 48 patents were included. The mean age was 60.8 ± 16.5 years old, 52% were women. The prevalence of patients with concomitant vestibular paresis was 35.4%. When comparing the groups with and without paresis the following was observed: (1) associated brain contusions were significatively more frequent in the paresis group, 47.1% vs 12.9%; (2) male sex was significatively more frequent in the paresis group, 70.59% vs 35.5%; (3) in both groups, the median of needed PRM was 1. Conclusion: The presence of vestibular paresis in patients with BPPV secondary to head trauma is not an infrequent finding. In our study, its prevalence was 35.4%, being significatively more frequent in men. Also, associated brain contusions were significatively more frequent in the paresis group.

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This narrative review addresses the complex relationship between neurological diseases and artistic expression, which can have a profound impact on a painter´s works. This exploration highlights the dynamic and ever-evolving connection between neuroscience and art, offering insights into the extraordinary ways in which the human brain and artistic expression intersect and evolve. Following brain damage, there may be the emergence of sudden artistic talents, intriguing changes in the styles of established artists, the paradoxical facilitation of artistic abilities despite the cognitive decline consequent to these injuries, besides coping strategies that artists adopt in response to the challenges of health. Therefore, this article investigates different scenarios where brain injuries and disorders have had a profound impact on artists, leading to the emergence of new talents, changes in artistic styles, and unexpected improvements in their work, as well as adaptations in their artistic practices, as represented by some painters such as Tommy McHugh (1949 -2012), Francisco Goya (1746-1828), Otto Dix (1891-1969), Willem de Kooning (1904-1997), William Charles Utermohlen (1933-2007) and Charles Meryon (1821-1868). Consequently, works of art can be valuable but understudied tools for understanding brain dysfunction, although they must be interpreted with great care.

Esta revisão narrativa aborda a complexa relação entre doenças neurológicas e expressão artística, que pode ter um impacto profundo na obra de um pintor. Esta exploração destaca a conexão dinâmica e em constante evolução entre a neurociência e a arte, oferecendo insights sobre as formas extraordinárias pelas quais o cérebro humano e a expressão artística se cruzam e evoluem. Após danos cerebrais, pode haver o surgimento de talentos artísticos repentinos, mudanças intrigantes nos estilos de artistas estabelecidos, a facilitação paradoxal de habilidades artísticas, apesar do declínio cognitivo consequente a essas lesões, além de estratégias de enfrentamento que os artistas adotam em resposta aos desafios de saúde. Portanto, este artigo investiga diferentes cenários onde lesões e distúrbios cerebrais tiveram um impacto profundo nos artistas, levando ao surgimento de novos talentos, mudanças nos estilos artísticos e melhorias inesperadas em seu trabalho, bem como adaptações em suas práticas artísticas, bem como representado por alguns pintores como Tommy McHugh (1949 -2012), Francisco Goya (1746-1828), Otto Dix (1891-1969), Willem de Kooning (1904-1997), William Charles Utermohlen (1933-2007) e Charles Meryon (1821-1868). Consequentemente, as obras de arte podem ser ferramentas valiosas, mas pouco estudadas, para a compreensão da disfunção cerebral, embora devam ser interpretadas com muito cuidado.

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Introduction: In Brazil, traumatic brain injury (TBI) represents about two thirds of all causes of death and are often associated with traffic accidents, causing overload of medium and high complexity services. Objectives:To describe the occurrence and clinical-epidemiological profile of TBIs associated with traffic accidents in a regional hospital in the southeast of the state of Pará. Materials and Methods: This is a cross-sectional analytical study. It was based on data from the medical and statistical archives service of a regional hospital, through the analysis of electronic medical records of patients treated with TBI resulting from traffic accidents in the period from 2016 to 2020. Results: Of the 20,077 overall hospitalizations recorded, 4.0% were associated with the occurrence of TBI, of which, 75.3% were directly caused by traffic accidents involving motorcycles. The cases were concentrated in individuals of mixed race, male, aged between 18 and 29 years, with percentages of 92.5%, 86% and 39%, respectively. Conclusions: The occurrence of TBIs associated with automobile accidents is a problem that requires attention in the region. Moreover, there were several gaps in the completion of the medical records, which made it difficult to determine the association of the outcome, alcohol consumption and the use of PPE. However, considering all the information presented, assertive local public policies aimed at prevention can be implemented. And this can be the starting point for promoting changes aimed at mitigating traffic accidents and bed occupations due to preventable causes, impacting the quality of health care and economic factors (AU).

Introdução: No Brasil, os traumatismos cranioencefálicos (TCEs) representam cerca dois terços de todas as causas de óbitos e são frequentemente associados a acidentes de trânsito, causando sobrecarga dos serviços de média e alta complexidade. Objetivos: Descrever a ocorrência e o perfil clínico-epidemiológico de TCEs associados a acidentes de trânsito em um hospital regional no Sudeste do Estado do Pará. Materiais e Métodos: Trata-se de um estudo analítico de corte transversal. Baseou-se em dados provenientes do serviço de arquivos médicos e estatísticos de um hospital regional, através da análise de prontuários eletrônicos de pacientes diagnosticados com TCE decorrentes de acidentes de trânsito no período de 2016 a 2020. Resultados: Das 20.077 internações gerais re-gistradas, 4,0% foram associadas à ocorrência de TCE, das quais 75,3% foram diretamente causados por acidentes de trânsito envolvendo motocicletas. Os casos se concentraram em indivíduos pardos, do sexo masculino, com faixa etária entre 18 e 29 anos, com percentuais de 92,5%, 86% e 39%, respectivamente. Conclusões: A ocorrência de TCEs associados a acidentes automobilísticos é um problema que requer atenção na região. Além disso, verificou-se várias lacunas no preenchimento dos prontuários, o que dificultou a determinação da associação do desfecho, o consumo de álcool e a utilização dos EPIs. No entanto, considerando todas as informações apresentadas, políticas públicas assertivas locais que visem a prevenção podem ser implementadas. E esse pode ser o ponto de partida para promover mudanças que visem mitigação dos acidentes de trânsito e ocupações de leitos por causas evitáveis, impactando na qualidade da assistência em saúde e fatores econômicos (AU).

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In this retrospective study, we aimed to evaluate the effects of the neurotrophic compound Cerebrolysin on executive, cognitive, and functional performance in patients with traumatic brain injury (TBI) with a highly severe disability level. A total of 44 patients were included in the study, with 33 patients in the control group and 11 patients in the interventional group who received intravenous infusions of 30 mL Cerebrolysin. Both groups received standard rehabilitation therapy following the rehabilitation protocol for patients with TBI at Hospital Clínico Mutual de Seguridad. Functional and cognitive scales were evaluated at baseline, at four months, and at the endpoint of the intervention therapy at seven months (on average). The results revealed a significant improvement in the Cerebrolysin-treated group compared to the control group. Specifically, patients who received Cerebrolysin showed a moderate residual disability and a significant reduction in the need for care. Concerning the promising results and considering the limitations of the retrospective study design, we suggest that randomized controlled studies be initiated to corroborate the positive findings for Cerebrolysin in patients with moderate to severe brain trauma.

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RESUMEN El traumatismo craneoencefálico es un evento ocasionado por la fuerza sobre el continente que guarda al contenido cerebral, que hace que la inercia ocasione lesiones por aceleración y desaceleración produciendo hemorragias y/o fracturas Estas pueden generar una serie de complicaciones como el absceso epidural que al estar muy cerca al cerebro constituye una emergencia, siendo complejo su manejo y seguimiento. En esta oportunidad mostramos el caso de un paciente con absceso epidural ocasionado por traumatismo craneoencefálico y manejo neuroquirúrgico, con buena evolución clínica.

ABSTRACT Cranioencephalic trauma is an event caused by force on the container that holds the brain content, which causes inertia to cause acceleration and deceleration injuries, producing hemorrhages and/or fractures; These can generate a series of complications such as epidural abscess which, being very close to the brain, constitutes an emergency for its management and follow-up15. On this occasion we show the case of a patient with epidural abscess caused by cranioencephalic trauma and neurosurgical management.

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The number of people with central nervous system (CNS) injuries increases worldwide and only a few therapies are used to mitigate neurological damage. Crude extracts, compounds, and isolated molecules obtained from plants have neuroprotective effects; however, their actions on the central nervous system are still not fully understood. This systematic review investigated the neuroprotective effects of crude extracts, compound, and isolated molecules obtained from plants in different CNS lesions. This PICO (Population/Problem, Intervention, Control, Outcome) systematic review included in vivo and in vitro studies that used small rodents as experimental models of CNS injuries (P) treated with crude extracts, compounds, and/or isolated molecules obtained from plants (I), compared to non-intervention conditions (C), and that showed a neuroprotective effect (O). Fourteen out of 5,521 studies were selected for qualitative analysis. Several neuroprotective effects (improvement of antioxidant activity, modulation of the inflammatory response, tissue preservation, motor and cognitive recovery) in the brain and spinal cord were reported after treatment with different doses of crude extracts (10 studies), compounds (2 studies), and isolated molecules (2 studies). Crude extracts, compounds, or isolated molecules obtained from plants showed promising neuroprotective effects against several CNS injuries in both the brain and spinal cord, regardless of gender and age, through the modulation of inflammatory activity and oxidative biochemistry, tissue preservation, and recovery of motor and cognitive activity.

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Resumen Introducción: la depresión y ansiedad son frecuentes luego de un traumatismo craneoencefálico (TCE). Existe evidencia contradictoria en cuanto a la relación entre estos trastornos y la gravedad del TCE. El objetivo fue evaluar la asociación entre la aparición de síntomas ansiosos o depresivos con la gravedad del TCE en adultos que sufrieron TCE moderado o grave en Medellín - Antioquia. Métodos: estudio de tipo analítico en una cohorte prospectiva de pacientes mayores de 18 años con TCE moderado o grave. Se evaluaron los síntomas ansiosos de estado y rasgo (STAI E y STAI R) y los síntomas depresivos (PHQ-9) al inicio y a los 6 meses y se compararon según la gravedad del TCE medido con la Escala de Coma de Glasgow (ECG). Resultados: se incluyeron 58 pacientes, 35 con TCE grave y 23 con TCE moderado; 70,6 % de los pacientes completaron el seguimiento. Los accidentes de tránsito y las caídas representaron el 86 % de las causas de TCE. Los pacientes con TCE grave tenían síntomas depresivos más intensos al inicio (p= 0,027) y a los seis meses (p= 0,012). No se encontraron diferencias en los síntomas ansiosos entre grupos, a excepción de la ansiedad de rasgo a los 6 meses en el grupo de graves (p= 0,043). Conclusiones: la intensidad de los síntomas depresivos medidos con el PHQ-9 está directamente relacionada con la gravedad del TCE medido con la ECG, mientras que la relación de los síntomas ansiosos con la gravedad del TCE no es tan clara.

Abstract Background: Depression and anxiety are common following traumatic brain injury (TBI). However, the relationship between these disorders and TBI severity remains contradictory. The objective of this study was to evaluate the association between the occurrence of anxious or depressive symptoms and TBI severity in adults with moderate or severe TBI in Medellín, Antioquia. Methods: Analytical study with a prospective cohort of patients aged 18 years and above with moderate or severe TBI. State and trait anxiety symptoms (measured using the STAI-E and STAI-R, respectively) and depressive symptoms (measured using the PHQ-9) were assessed at baseline and at 6 months, and compared based on TBI severity measured using the Glasgow Coma Scale (GCS). Results: A total of 58 patients were included, with 35 having severe TBI and 23 having moderate TBI. 70.6% of the patients completed the followup. Traffic accidents and falls accounted for 86% of the TBI causes. Patients with severe TBI exhibited more intense depressive symptoms at baseline (p=0.027) and at six months (p=0.012). No significant differences were found in anxiety symptoms between groups, except for trait anxiety at six months in the severe TBI group (p=0.043). Conclusions: The intensity of depressive symptoms measured by the PHQ9 is directly related to TBI severity assessed by the GCS, while the relationship between anxiety symptoms and TBI severity is less clear.

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Resumen Introducción: el destete ventilatorio (weaning) y la extubación en el paciente con lesiones encefálicas agudas es un desafío para el personal de salud ya que no hay un consenso claro sobre los criterios de extubación. Objetivo: resumir la evidencia disponible sobre la extubación del paciente con lesiones encefálicas agudas y analizar posibles alternativas a los criterios clásicos de extubación. Métodos: se realizó una búsqueda de la literatura médica, en los idiomas español e inglés, de los últimos 20 años en diferentes bases de datos. Se incluyeron revisiones sistemáticas con o sin metaanálisis, guías y recomendaciones de sociedades científicas, ensayos clínicos y estudios observacionales que cumplieran los criterios de inclusión. Resultados: se recolectaron 262 artículos de interés, de los cuales, mediante un análisis y comparación de la evidencia, se seleccionaron 48 artículos que tuvieron más relevancia para cumplir el objetivo planteado. Conclusiones: la evidencia disponible es débil a la hora de brindar una recomendación sobre los criterios de extubación en el paciente neurocrítico. Podría realizarse una extubación precoz con un nivel mínimo de conciencia, pero manteniendo los reflejos protectores de las vías respiratorias, sin tener aumento en la tasa de reintubación o mortalidad

Palabras clave: Cuidados Críticos; Destete; Extubación Traqueal; Lesiones Encefálicas; Lesiones Traumáticas del Encéfalo; Manifestaciones Neurológicas

Abstract Introduction: Ventilator weaning and extubation in patients with acute brain injuries pose a challenge for healthcare professionals due to the lack of clear consensus on extubation criteria. Objective: To summarize the available evidence on extubation of patients with acute brain injuries and analyze potential alternatives to the classical extubation criteria. Methods: A literature search was conducted in the Spanish and English languages, covering the last 20 years, across different databases. Systematic reviews with or without meta-analysis, guidelines and recommendations from scientific societies, clinical trials, and observational studies that met the inclusion criteria were included. Results: A total of 262 relevant articles were collected, of which, through analysis and comparison of the evidence, 48 articles were selected as most relevant to fulfill the stated objective. Conclusions: The available evidence is weak in providing a recommendation on extubation criteria for neurocritical patients. Early extubation could be considered in patients with a minimal level of consciousness while maintaining protective airway reflexes, without an increase in reintubation rate or mortality.

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BACKGROUND: Restoration of brain tissue perfusion is a determining factor in the neurological evolution of patients with traumatic brain injury (TBI) and hemorrhagic shock (HS). In a porcine model of HS without neurological damage, it was observed that the use of fluids or vasoactive drugs was effective in restoring brain perfusion; however, only terlipressin promoted restoration of cerebral oxygenation and lower expression of edema and apoptosis markers. It is unclear whether the use of vasopressor drugs is effective and beneficial during situations of TBI. The objective of this study is to compare the effects of resuscitation with saline solution and terlipressin on cerebral perfusion and oxygenation in a model of TBI and HS. METHODS: Thirty-two pigs weighing 20-30 kg were randomly allocated into four groups: control (no treatment), saline (60 ml/kg of 0.9% NaCl), terlipressin (2 mg of terlipressin), and saline plus terlipressin (20 ml/kg of 0.9% NaCl + 2 mg of terlipressin). Brain injury was induced by lateral fluid percussion, and HS was induced through pressure-controlled bleeding, aiming at a mean arterial pressure (MAP) of 40 mmHg. After 30 min of circulatory shock, resuscitation strategies were initiated according to the group. The systemic and cerebral hemodynamic and oxygenation parameters, lactate levels, and hemoglobin levels were evaluated. The data were subjected to analysis of variance for repeated measures. The significance level established for statistical analysis was p < 0.05. RESULTS: The terlipressin and saline plus terlipressin groups showed an increase in MAP that lasted until the end of the experiment (p < 0.05). There was a notable increase in intracranial pressure in all groups after starting treatment for shock. Cerebral perfusion pressure and cerebral oximetry showed no improvement after hemodynamic recovery in any group. The groups that received saline at resuscitation had the lowest hemoglobin concentrations after treatment. CONCLUSIONS: The treatment of hypotension in HS with saline and/or terlipressin cannot restore cerebral perfusion or oxygenation in experimental models of HS and severe TBI. Elevated MAP raises intracranial pressure owing to brain autoregulation dysfunction caused by TBI.

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Introducción: el trauma craneoencefálico es una de las principales causas de morbimortalidad infantil en Colombia, sus secuelas impactan gravemente la calidad de vida de los pacientes y la evidencia científica actual de los factores asociados al trauma es escasa. Objetivo: analizar los factores asociados al desarrollo de secuelas por trauma craneoencefálico en menores de 15 años que consultaron a un hospital de Medellín entre 2010 y 2014. Materiales y métodos: estudio de cohorte retrospectivo. Se incluyeron 812 pacientes en un periodo de 5 años, de los cuales 294 no cumplieron los criterios de inclusión. Se evaluaron variables sociodemográficas, clínicas y se estimó la incidencia de secuelas con el método estadístico de Wilson. El riesgo relativo se calculó mediante regresión log-binomial. Resultados: en total se analizaron 518 pacientes. La mediana de edad fue de 5 años, el 64,3 % eran hombres, el 75,4 % de los participantes tenía un trauma leve y el 5 % un trauma grave. Las caídas fueron la principal causa (64,2 %), seguidas de los accidentes de tránsito (25,3 %). La incidencia de secuelas fue del 7.3 % (IC: 5,4 % - 9,9 %). Conclusiones: la carga de enfermedad en el paciente posterior a TCE representa un problema de salud pública. La probabilidad de desarrollar una secuela en este estudio fue del 7,3 %, la cual se relaciona con los siguientes factores que se identifican en el servicio de urgencias: lesión difusa, una escala de Glasgow al ingreso moderada o grave y sufrir un accidente de tránsito.

Background: traumatic brain injury is one of the main causes of infant morbidity and mortality. The sequelae after trauma seriously impact the quality of life of patients and the scientific evidence of associated factors is scarce. Objective: to analyze the factors associated with the development of sequelae due to head trauma in children under 15 years old who went to the emergency room of a hospital in Medellín between 2010 and 2014. Materials and methods: retrospective cohort study. 812 patients were included in a period of 5 years, of which 294 did not meet the inclusion criteria. Sociodemographic and clinical variables were evaluated and the incidence of sequelae was estimated with 95 % confidence intervals using the Wilson statistical method. The relative risk was calculated using log-binomial regression. Results: a total of 518 patients were analyzed. The median age was 5 years, 64,23 % were male children, 75,4 % had mild trauma, and 5 % suffered severe trauma. Falls were the main cause (64,2 %), followed by traffic accidents (25,3 %). The incidence of sequelae was 7,3 % (CI: 5,4% - 9,9 %). Conclusions: the burden of disease in the patient after TCE represents a public health problem. The probability of developing a sequel in this study was 7,3 %, which is related to the following factors that identify in the emergency department: diffuse injury, a moderate or severe Glasgow scale on admission, and suffering a traffic accident.

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