Evaluation of Blood Urea, Creatinine, and Glucose Levels as Biochemical Indicators of the Type and Severity of Traumatic Brain Injury

AIM

To investigate the effects of trauma type and survival on biochemical parameters including blood urea, creatinine, and glucose levels on patients with traumatic brain injury (TBI).

MATERIAL AND METHODS

The medical records of 102 patients with TBIs who were admitted to the emergency department and/ or hospitalized in the neurosurgery department between 2016 and 2019 were examined retrospectively.

RESULTS

Types of trauma included: 19 cases of subarachnoid hemorrhage, 25 cases of subdural hemorrhage, 9 cases of epidural hemorrhage, 28 cases of intracerebral hemorrhage, 4 cases of multiple hemorrhage, and 12 cases with other hemorrhages. We examined the effects of trauma type and survival on a total of 17 blood test parameters, but only three (blood urea, creatinine, and glucose) showed significance for the overall model, meaning that either trauma type or survival or an interaction between the two had significant effects on these three blood parameters.

CONCLUSION

Our findings imply that the risk of fatality due to TBI might be deduced from observation of the patient?s blood urea and glucose levels as these two parameters differed significantly in fatal versus surviving cases. Blood urea and creatinine levels were different for different trauma types and may be useful in distinguishing the type of injury.

Evaluation of Empirical Antibiotic Treatment in Culture Negative Pyogenic Vertebral Osteomyelitis

AIM

To investigate the efficacy of empirical antibiotic treatment in culture-negative pyogenic vertebral osteomyelitis (PVO) cases.

MATERIAL AND METHODS

The records of patients with culture-negative PVO who were treated at infectious diseases and neurosurgery outpatient clinics in the past four years were examined retrospectively. The control group comprised healthy subjects with similar age, gender, and body mass index but without pathology. The comparison of the groups was performed by analysis of variance. Statistical significance was accepted as p < 0.05.

RESULTS

No statistically significant difference in the white blood cell count and erythrocyte sedimentation rate was found between the spondylodiscitis and the healthy subject groups when the blood parameters obtained before and after the treatment (p > 0.05). However, a statistical significance was assessed in the results of the comparison for C-reactive protein (p < 0.05).

CONCLUSION

In the context of evidence-based medicine and the rational use of antibiotics, it is clear that antibiotics should be preferred according to the culture antibiogram results in the treatment of infectious diseases.

Are Intervertebral Disc Tissue Cells Damaged When Attempting to Prevent Thrombus Formation Using Dabigatran, A New Oral Anticoagulant?

AIM

To investigate the effect of dabigatran, a new oral anticoagulant, on human primary cell cultures isolated from intact intervertebral disc tissue.

MATERIAL AND METHODS

Cell cultures were prepared from tissues obtained from six cases who had undergone surgery due to spinal trauma. Dabigatran, an active pharmacological agent, was applied to intact annulus fibrosus (AF)/nucleus pulposus (NP) primary cell cultures from the study group. After performing cell viability, toxicity, and proliferation tests on all cultures in the control and study groups, the surface morphologies of the samples were evaluated. Subsequently, chondroadherin (CHAD), cartilage oligomeric matrix protein (COMP), and matrix metalloproteinase (MMP)-13 and -19 expressions were measured via a real-time polymerase chain reaction (RT-PCR). Data were analyzed statistically.

RESULTS

In the proliferation assays performed on the 20th day of the study, cells in the dabigatran-supplemented group were reported to have lost 46.37% more viability than those in the control group. Expressions of all genes examined except MMP-13 were evaluated in the control group by time, but in contrast to the control group results, COMP and MMP-19 gene expressions decreased in the dabigatran-treated group. No CHAD or MMP-13 expression was noted in these cultures.

CONCLUSION

The potential for a systemically applied drug to accumulate in tissue and negatively affect surrounding tissues and microstructures must be emphasized.

Evaluation of the Effect of Daptomycin, a Glycopeptide Agent, on Intact Intervertebral Disc Tissue

AIM

To evaluate the effects of pre- and intra-operatively administered daptomycin (DAP) on the intact human primary intervertebral disc tissue cells.

MATERIAL AND METHODS

Primary cell cultures were established using tissues obtained through decompressive laminectomy, traumatic intervertebral disc herniation excision, and posterior transpedicular stabilization. Non-drug-administered samples were used as a control group. The samples treated with DAP formed the study group. Molecular assays for proliferation and gene expression were performed. The obtained data were evaluated statistically, and results with a value of p < 0.05 were accepted as significant.

RESULTS

While no reduction was observed in the proliferation, the gene expression of intact intervertebral disc tissue cells was time-dependently decreased compared to the control group, and these results were reported to be statistically significant.

CONCLUSION

This study observed the effect that a pharmaceutical preparation, which was used on intervertebral disc tissue before and after the operation, had on normal, healthy, and intact tissue. It concludes that alterations in the expression of genes involved in the anabolic and/or catabolic process, even in adjacent healthy tissue, may slow down the healing process of the damaged tissue or cause undesired cell differentiation.

Investigation of the effect of dipyrone on cells isolated from intervertebral disc tissue

The present study aimed to evaluate the effects of dipyrone, an indispensable analgesic, anti-pyretic and anti-spasmodic used in emergency departments, on nucleus pulposus and annulus fibrosus cells in vitro. After surgical biopsy, primary cell cultures were prepared from intact intervertebral disc tissues. Dipyrone was administered to the cultures in the experimental groups except for the control group. The data obtained were statistically evaluated. The proliferation was identified to be suppressed via MTT analysis. The gene expression profile of the intervertebral disc cells in the dipyrone-treated groups was significantly changed. The expression of chondroadherin, cartilage oligo matrix protein, interleukin-1β and metalloproteinase (MMP)-19 genes were decreased, but MMP-13 and MMP-7 genes expressions were increased, as determined via reverse transcription-quantitative PCR. AO/PI staining revealed that no apoptotic or other type of cell death was detectable after administration of dipyrone does not mean that the drug is innocuous. The occurrence of cellular senescence and/or the halt of cell proliferation may also be important mechanisms underlying the adverse inhibitory effects of dipyrone. Therefore, prior to administering dipyrone in clinical practice, all possible adverse effects of this drug should be considered.

Effects of etanercept, a tumor necrosis factor receptor fusion protein, on primary cell cultures prepared from intact human intervertebral disc tissue

The aim of the present study was to investigate the effects of etanercept (ETA), a tumor necrosis factor (TNF) inhibitor, on human cell cultures prepared from intact intervertebral disc tissue. ETA is used as a treatment for cases of rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis and ankylosing spondylitis accompanied by moderate or severe joint pain. ETA was applied to primary cell cultures [annulus fibrosus and nucleus pulposus (NP) from intact intervertebral disc tissue]. Cell cultures without ETA treatment served as the control group. Morphological and quantitative molecular analyses of the two groups were performed. The number of viable cells and cell proliferation decreased in the ETA-treated cultures as compared with those in the control group. Furthermore, in the treatment group, the chondroadherin gene, an NP-specific marker, was not expressed after 24 h. By contrast, the cartilage oligo matrix protein was expressed 24, 48 and 72 h post-ETA treatment, while its expression was significantly lower than that in the control group. In addition, the expression of interleukin-1β, as well as matrix metallopeptidase-7 and −19, was markedly decreased. Overall, the cell proliferation and gene expression in the ETA-treated cells were significantly different from those in the control group (P<0.05). These results suggest that the treatment duration and dosage of TNF inhibitors, which are used to suppress active inflammation, should be considered in the clinical setting. These biological agents may delay the healing of intervertebral disc tissue damage by slowing cell proliferation and altering gene expression via anabolic and catabolic pathways.

Forestier syndrome presenting with dysphagia: case report of a rare presentation

Diffuse idiopathic skeletal hyperostosis (DISH) (Forestier syndrome) is a rheumatologic disease, the etiology of which is not exactly known. It is characterized by spinal osteophyte formations resulting from the ossification of the paravertebral ligaments and muscles. Anterior longitudinal ligament is the usual site of involvement and the frequency of the disease increases after the 5th decade. Lower cervical segments are the most frequently involved regions whereas the upper cervical involvement leading to dysphagia is very rare. In this report, a 77-year-old patient with Forestier syndrome in upper cervical region presenting with dysphagia was presented. Anterior cervical osteophyte resection was performed with no need for discectomy, fusion or stabilization. The patient showed a significant improvement in his all preoperative symptoms, and no recurrence was detected at 1-year follow-up.