OBJECTIVEHypokalemia is a frequent complication observed after traumatic brain injury (TBI). We evaluated the effect of spironolactone on preventing hypokalemia following moderate to severe TBI.

METHODSPatients with moderate to severe TBI, whose Glasgow Coma Scale (GCS) scores of 9-12 and less than 9, respectively, were equally randomized into intervention and control groups, matching with severity of trauma and baseline serum level of potassium. For the intervention group, we administrated spironolactone (1 mg/kg per day) on the second day of admission or the first day of gavage tolerance and continued it for seven days. No additional intervention was done for controls. Hypokalemia (mild: 3-3.5 mg/L, moderate: 2.5-3 mg/L, and severe: less than 2.5 mg/L serum K+) and other electrolyte abnormalities were compared between the two groups at the end of the intervention.

RESULTSSixty-eight patients (58 males and 10 females) were included with mean age equal to (33.1+/-11.8) years, and GCS equal to 7.6+/-2.8. The two groups were similar in baseline characteristics. Patients who received spironolactone were significantly less likely to experience mild, moderate, or severe hypokalemia (8.8%, 2.9%, and 0) compared with controls (29.4%, 11.7%, and 2.9%, respectively, P less than 0.05). No significant difference was observed between the two groups in the occurrence of other electrolyte abnormalities, hyperglycemia or oliguria.

CONCLUSIONSpironolactone within the first week of head injury could prevent the occurrence of late hypokalemia with no severe side effects.

Adult ; Brain Injuries ; complications ; Female ; Humans ; Hypokalemia ; prevention & control ; Male ; Middle Aged ; Spironolactone ; adverse effects ; therapeutic use

Purpose::Obesity is a complex multifactorial disease with increasing prevalence worldwide. The present study was conducted, since there were different results on the effect of obesity on the prognosis of patients with moderate and severe brain trauma, and the issue was less investigated.Methods::The present descriptive-analytical study was conducted in 2 hospitals, Al-Zahra and Kashani in year 2022. Patients with Glasgow coma scale (GCS) score of 9 -12 (moderate concussion) and patients with a GCS score of < 8 (severe concussion) who consented to participate in the study were included in the study. Patients who died; had serious injuries related to the chest, abdomen, pelvis, spine, and organs, in addition to the concussion; had a part of their body amputated during the same incident; received medications; or had diseases which caused obesity like diabetes were excluded from the study. Patients’ height and weight were extracted for calculating the body mass index (BMI). Their functional independences were measured at admission and discharge according to the Glasgow outcome scaleextended (GOSE) scale. All the data were analyzed in SPSS 26.Results::This study examined a total of 287 traumatic brain injury (TBI) patients (251 with moderate concussion and 36 with severe concussion). In total, 91 (36.3%) patients with moderate TBI had a lower BMI, and 14 (38.9%) patients with severe TBI had a constant BMI. There was a significant difference between the mean changes of BMI and the GOSE, functional independence measure (FIM) motor ( p =0.006), FIM cognitive ( p =0.023), and FIM total scores ( p =0.002) in patients with severe TBI; however, significant difference was found only between the mean changes of BMI, GOSE and FIM motor scores ( p=0.001) in patients with moderate TBI. Conclusion::BMI is a risk factor affecting treatment results in patients with TBI, which should be controlled.

Objective: Since traumatic brain injury is more common in young people, who are the main workforce and builders of society, it is important to consider the effects caused by brain injury on them. In this study, we investigated the clinical manifestations, complications, and prognosis of patients with basilar skull fractures. Methods: This cross-sectional study was conducted from March 2021 to March 2022 at the Kashani Hospital, Esfahan, Iran. Patients with basilar skull fractures were included in this study by census for one year. Recorded patient information was divided into two parts:demographic information, including age and sex, and disease information including loss of consciousness, signs of meningitis, need for surgery, and neurologic examination. Results: In this study, 100 patients were included, of whom 89 were men. The most common complication was pain at the site of the trauma, followed by bruising and bleeding from the site of the trauma. Raccoon eyes and cerebrospinal fluid leakage were observed in 19% and 32% of the patients, respectively. Conclusion As the occurrence of trauma has an economic burden on the country's health system, we must identify its consequences and problems and prevent its occurrence as much as possible by implementing educational measures.