Background: Recovery of patients with traumatic brain injury largely depends on the reduction in secondary brain damage. The present study aims at investigating the effect of Tranexamic Acid (TXA) administration within the first hours of brain trauma in the emergency department (ED). Methods: This randomized, double-blind, placebo-controlled clinical trial was carried out in patients with subdural and epidural hemorrhage. Patients with any type of bleeding were assigned into two groups of TXA and 0.9% normal saline as placebo. The rate of intracranial hemorrhage after surgery was assessed by CT-scan and amount of hemoglobin (Hb) was measured immediately before surgery and after 6 hours of surgery. Results: A total of 80 participants were randomly assigned into four groups of 20 people. There was a significant difference in the mean of intraoperative bleeding during surgery in patients receiving TXA and placebo in both SDH (Subdural hematoma) and EDH (Epidural Hemorrhage) groups (P= 0.012). The Hb drop amount had no significant difference with placebo (P< 0.0001). No complications were observed in any of the intervention and control groups during the study as well. Conclusion: The use of TXA may reduce bleeding, however, based on the results of this study, such effect was not statistically significant in controlling the epidural and subdural hemorrhage, but clinical trials with a higher sample size are suggested for further investigation in this regard.

Introduction: Controlling of secondary traumatic brain injuries (TBI) is necessary due to its salient effect on the improvement of patients with TBI and the final outcomes within early hours of trauma onset. This study aims to investigate the effect of intravenous tranexamic acid (TAX) administration on decreased hemorrhage during surgery. Methods: This double-blind, randomized, and placebo-controlled trial was conducted on patients referring to the emergency department (ED) with IPH due to brain contusion within 8 h of injury onset. The patients were evaluated by receiving TXA and 0.9% normal saline as a placebo. The following evaluation and estimations were performed: intracranial hemorrhage volume after surgery using brain CT-scan; hemoglobin (Hb) volume before, immediately after, and six hours after surgery; and the severity of TBI based on Glasgow Coma Score (GCS). Results: 40 patients with 55.02 ± 18.64 years old diagnosed with a contusion and intraparenchymal hemorrhage. Although the (Mean ± SD) hemorrhage during surgery in patients receiving TXA (784.21 ± 304.162) was lower than the placebo group (805.26 ± 300.876), no significant difference was observed between two groups (P=0.83). The (Mean ± SD) Hb volume reduction immediately during surgery (0.07 ± 0.001 and 0.23 ± 0.02) and six hours after surgery (0.04 ± 0.008 and 0.12 ± 0.006) was also lower in TXA group but had no significant difference (P = 0.89 and P = 0.97, respectively). Conclusion: Using TXA may reduce the hemorrhage in patients with TBI, but this effect, as in this study, was not statistically significant and it is suggested that a clinical trial with a larger population is employed for further investigation.

High-resolution computed tomography (HRCT) magnifies the role of preoperative imaging for detailed inner and middle ear anatomical information and enhances more efforts for better dependent correlation and measurements of round window (RW). Objectives: The aim of this study was to find an appropriate way by HRCT imaging for the prediction of the visibility of the round window during cochlear implant (CI) surgery. Methods: The study was conducted using hospital information from patients referring the Khuzestan Cochlear Implant Center (2017)(2018). 87 patients underwent cochlear implant surgery, 56 patients with high resolution CT scans were included in the study. All patients underwent surgical treatment via posterior tympanotomy approach. Results: 56 patients were examined. Patients were divided into three groups: children (0-12 years) and adolescence (18-13 years) and adults (19-59 years), of whom 45 patients (80.4%) were children, and 3 patients were adolescence (5.4%) and 8 patients (14.3%) were adults. 22 patients (39.3%) were fully visible and 13 patients (23.2%) were partially visible and 21 (37.5%) patients were difficult to visualize. In high-resolution imaging studies, mastoid 2 cases (3.6%) were poorly aerated and 8 cases (14.3%) were moderately aerated and 46 (86.1%) were well aerated. The amount of round window overhanging in 43 patients (76.8%) was 4.4 and in 12 patients (21.4%) was 3.4%. Conclusion:The presence of the air cell around the facial recess may provide easier access to the facial recess. There was a significant relationship between the RW in the operation and the angle between the RW and the facial nerve and the coronal axis. There is no significant relationship between the visibility of the RW and the facial recess, Vertical height RW and facial nerve (FN), the distance between the FN and the posterior canal in the axial, the angle between the FN and inner margin of RW, and the angle between the FN and the tympanic annulus with the inner margin RW in the Axial and FRL was not found.

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Purpose: Increased intracranial pressure (ICP) is one of the prevalent symptoms of trauma, especially traumatic headache, which requires quick action for the diagnosis and treatment. The optic nerve sheath diameter (ONSD) is a newly proposed technique for the detection of an increase in ICP. The aim of this study was to assess the efficacy of this new diagnostic method in patients with increased ICP induced by trauma. Methods: This prospective study was conducted between December 2016 and February 2017. The patients with traumatic headache and who had been diagnosed with increased ICP using clinical signs and computed tomography scan were compared to the voluntary healthy group. In each patient, measurements were performed employing ultrasound three times on each eye in an axial region, and the mean of these sizes was obtained as the ONSD. Results: A total of 112 participants were examined. The mean ONSD measurement of the patients and the voluntary healthy group was 6.01 ± 0.76 and 3.41 ± 0.56 mm in the right eye, 6.11 ± 0.75 and 3.39 ± 0.54 mm in the left eye, and 6.06 ± 0.75 and 4.02 ± 1.07 mm in both sides, respectively. The ONSD in the right and left sides had high and significant correlation in the patients ( r = 0.929, P < 0.000) and voluntary healthy ( r = 0.630, P < 0.000) group. The mean ONSD of one of the patients was 6.24 ± 0.56 mm, and in another patient with no clinical sign of increased ICP, the mean ONSD was 4.61 ± 0.09 mm. Conclusions: Ultrasound performed on the diaphragm of the optic nerve with acceptable sensitivity can detect patients with an increase in ICP and can be efficacious in expediting the action needed to reduce ICP. Due to the sensitivity and specificity of the ultrasound and high accuracy of the diameter of optic nerve sheath in detecting increase in ICP, as well as considering the fact that ultrasound is a noninvasive and available technique; it can be performed at the patient's bedside.

Background and Aims:Gas accumulation around the tracheamay is observed in neck and thoracic CT scans making the radiologist suspect whether these symptoms are associated with a pathologic process. This study was designed to evaluate the prevalence of partharesal cysts and their association with lung disease.Methods:The results of 400 patients evaluated for thoracic routine were analyzed for presence of paratracheal cysts. The location of cysts, size, shape and their relationship with the trachea were studied. The patients’ results were compared with and without paratracheal cysts. The collected data were analyzed using SPSS software version 22.Results:Paratracheal cysts were found in 30 patients (7.5%) including 12 males and 18 females (P = 0.07). The age range was between 3 to 78 years old and the mean ages in patients with and without paratracheal cysts were 54 and 38 years, respectively (P < 0.0001). More than 60% of patients had cysts associated with the trachea. The mean AP level in patients with paratracheal cysts was significantly higher (P = 0.04). In addition, it was observed that the incidence of paratracheal cysts in patients with lung disease and especially COPD patients was higher (P < 0.0001).Conclusion:In general, the results of this study showed that paratracheal cysts had a high prevalence and had a significant correlation with the presence of COPD. It was also observed that the incidence of these cysts increases in older people, which indicates that paratracheal cysts have an acquired mechanism.

Background: Atherosclerosis is the main cause of cardiovascular diseases, and its risk enhances in type 2 diabetes mellitus. Objectives: This study aimed to evaluate Carotid Intima-Media Thickness (CIMT) by carotid artery ultrasonography and assess its correlation with microalbuminuria and estimated Glomerular Filtration Rate (eGFR) in the patients with type 2 diabetes mellitus. Patients and Methods: This cross-sectional study was included 205 patients with Type 2 Diabetes Mellitus (T2DM). We recorded clinical and biochemical data such as FBS, lipid profile, and urinary albumin. Intima-media thickness of carotid arteries was measured in all patients by high frequency ultrasound. Results: In simple correlation coefficients analysis, CIMT was significantly associated with total cholesterol (r = 0.197, P = 0.008), serum creatinine (r = 0.240, P = 0.001), and urinary albumin (r = 0.420, P = 0.000). Also, CIMT elevated significantly with the stage progression of chronic kidney disease (0.67 ± 0.15 mm in stage 1, 0.73 ± 0.22 mm in stage 2, and 0.82 ± 0.21 mm in stage 3) (P value = 0.024). In multivariate linear regression analysis, the duration of diabetes, weight, HDL, serum creatinine, urinary albumin, and estimated Glomerular Filtration Rate (eGFR) were independently associated with CIMT (P value < 0.05 for all). Conclusions: Our study shows a relationship between CIMT and renal parameters, including eGFR and albuminuria. This study confirms the importance of intensive examinations for early detection of atherosclerosis and treatment of risk factors.