A fatal case of Mediterranean spotted fever associated with septic shock was reported in a 61-year-old man living in a village in southeastern Iran. The patient had a history of tick bite a few days before symptom onset. Phylogenetic analysis confirmed infection by
Rickettsia conorii
subspecies
israelensis
.
Systemic sclerosis (SSC) is an autoimmune disease of connective tissue and microvasculature mostly caused by autoantibodies. Likewise, neuromyelitis optica (NMO) is a demyelinating disease of the central nervous system correlating with autoantibodies against aquapourin-4. Reversible cerebral vasoconstriction syndrome (RCVS) is a disorder of brain vasculature resembling Raynaud phenomena in SSC. Despite co-occurrence is not rare in autoimmune disorders, the co-occurrence of NMO and SSC is extremely rare. In this case, we report a 35-year-old female presenting with paraplegia one day after discharge from hospital following surgical carnioplasty. She had a history of scleroderma and optic neuritis for which she was treated with high dose glucocorticoids causing renal crisis and RCVS causing intracranial and intracerebral hemorrhage which required a craniotomy to be performed in February 2020. In her recent admission, magnetic resonance imaging of the spinal cord indicated longitudinally extensive transverse myelitis (LETM) and blood tests revealed a highly positive titer of NMO-IgG. Daily plasmapheresis resulted in satisfactory improvement in her condition. This case highlights the importance of evaluating neurologic manifestations in systemic sclerosis patients considering the NMO and RCVS occurrence. Additionally, in concomitant cases, the treatment strategy should be modified regarding the risk of scleroderma renal crisis.
Background: COVID-19 quickly spread around the world as an epidemic with potentially unknown hazards. Like its impacts on various occupations, neurosurgery has undergone changes due to the virus, including changes in surgical planning, inpatient and outpatient clinics, emergency management, and even academic activities. Objectives: The present study was performed to determine neurosurgery challenges during the COVID-19 pandemic in Iran. Methods: The present study was conducted as a mixed qualitative and quantitative study in 2021. In the qualitative section using the targeted sampling method, 11 members of the target community were selected using the available sampling method and completed a questionnaire. The qualitative part was conducted in two stages of reviewing texts and interviewing experts and in the quantitative part we evaluated the validity of the structure and the reliability of the questionnaire. Results: This study examined in detail all aspects of the effects of COVID-19 on neurosurgery. 9 dimensions and 61 items were identified as the challenges of neurosurgery during the COVID-19 pandemic. In order of importance, the aspects were: treatment outcome, manpower, management psychological and physical diseases, education and research, tools and physical space, ethics, financial implications and information technology. Conclusion: The outbreak of epidemics has different risks for specialties, among them neurosurgery. Accordingly, to observe patien
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.
A 61‐year‐old male patient with Wegener's granulomatosis was admitted due to neck pain and quadriparesis. Clinical evaluation showed severe cervical noninfectious spondylodiscitis, myelopathy, sagittal imbalance, and atlantoaxial instability. A combined anterior and posterior approach was implemented. Postoperative clinical evaluation showed improved neurologic status.
Introduction: The COVID-19 pandemic has widely affected medical tourism on a global scale, thereby reducing the number and volume of medical services. Given the importance of this topic, the present study aimed to determine the challenges of medical tourism after the prevalence of COVID-19 in the field of neurosurgery. Methods: The present descriptive study was conducted by the neurosurgery department of Isfahan University of Medical Sciences, Isfahan, Iran in the first quarter of 2022. Using the convenience sampling method and based on Morgan’s table, 500 patients with neurosurgical diseases registered in Medical Tourism companies were identified and included in the study. The data were analyzed in SPSS. Results: 142 (28.4%) out of 500 patients with COVID-19 were willing to come to Iran for neurosurgical treatment. The most important non-medical reasons included natural attractions (4.37±0.44), cost-effective accommodation (4.03±0.23), and support from a country of destination (place of residence) (3.75±0.22). The most important medical reasons included the short waiting list, the fast treatment response (4.26±0.76), the availability of qualified doctors (3.96±0.27), and the low-cost treatment (3.87±0.53). Conclusion: The present study focused on the functions and potentials of medical tourism in neurosurgery. It can be more successful by providing the right conditions to improve the current situation.
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