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Background Infectious brain abscesses and granulomas, characterized by localized collections of pus or inflammatory tissue within the brain parenchyma, pose significant clinical challenges due to their potentially life-threatening nature and complex management requirements. Methods This cross-sectional study investigated patients diagnosed with infectious brain abscesses and granulomas from March 1, 2012, to October 22, 2021, in Mashhad, Iran. Data were collected from adult patients admitted to the two primary referral centers for community-acquired neuroinfections and neuroinflammations. Demographic information, clinical features, laboratory and neuroimaging characteristics, and clinical outcomes were analyzed. Results A total of 110 episodes were identified in 106 patients, with a median age of 45 years (IQR 30-56.3) and 62.7% male. Predisposing conditions included immunocompromised states (27.5%), preceding otitis/mastoiditis (16.2%), sinusitis (13.3%), and pulmonary infections (17.2%). The most common clinical manifestations were headache (57.3%), fever (49.1%), altered consciousness (44.4%), and seizures (31.8%). Neuroimaging revealed that brain lesions were solitary in 51% and multiple in 48% of episodes. Surgical intervention was performed in 46.4% of cases. The in-hospital mortality rate was 24.5%, with significant associations found between mortality and factors such as age, altered consciousness, multiple brain lesions, and cerebellum and brainstem involvement. The median length of hospital stay was 28 days (IQR 16-46.5). Conclusion Our study underscores challenges in diagnosing and treating brain abscesses and granulomas, with high mortality rates (24.5%) despite advanced techniques. Age, altered consciousness, and lesion characteristics predict death. Addressing changing microbial patterns and improving diagnostics are vital for better outcomes, especially in low- and middle-income countries.

Study designPilot double-blinded randomized controlled trial.ObjectivesTo investigate the additive effect of recombinant human erythropoietin (rhEPO) on functional outcome and disability in patients with traumatic cervical spinal cord injury (TCSCI).SettingsUniversity-affiliated hospital in Mashhad, Iran.MethodsPatients with acute TCSCI admitted within 8 h after injury were randomly assigned to receive only methylprednisolone (M group) or rhEPO 500 IU/mL plus methylprednisolone (M + E group). All the patients underwent surgery within the next several days. Neurological function was assessed on admission, and at 6th and 12th months after the injury according to the sphincter function and American spinal cord injury association (ASIA) scale.ResultsOverall, 54 patients (mean age: 39.7 ± 13.3 years) including 46 (85%) males were studied in two groups of 27. The likelihood of developing adverse neurological outcomes (ASIA impairment score of A compared to D or E) was not significantly different between the groups after 6 (OR = 0.39, 95% CI = 0.03–4.80, P = 0.46) and 12 months (OR = 0.83, 95% CI = 0.11–6.11, P = 0.86). The groups also showed no significant difference in 1-year mortality (OR = 0.83, 95% CI = 0.25–2.74, P = 0.76).ConclusionsIt is not clear whether combination therapy with erythropoietin compared to methylprednisolone alone improves neurological functions of patients with TCSCI. Our study provides interim data to guide future larger definitive trials.

Background Osteoporosis is a prevalent condition leading to an increased risk of bone fractures . Osteoporosis poses a worldwide public health concern, impacting over 200 million individuals and resulting in a staggering 1.66 million hip fractures each year. Opportunistic osteoporosis screening can be employed during CT scans to assess bone mineral density (BMD) through Hounsfield units (HU) without the need for additional imaging, radiation exposure, or appointments. This study aimed to investigate a CT scan's diagnostic value in the opportunistic osteoporosis screening through L1 vertebra densitometry and compare it with dual-energy x-ray absorptiometry (DXA) findings. Results One hundred forty-nine patients with an average age of 67.70 ± 10.94 years were included in the study. The age of osteoporotic patients was significantly higher than osteopenic ( p = 0.001) and normal individuals ( p < 0.001). The HU of osteoporotic patients was found to be significantly lower compared to both osteopenic ( p = 0.023) and normal individuals ( p < 0.001). According to the ROC curve for osteoporosis prediction using the HU (AUC = 0.793 and p < 0.001), with a cut-off of 103 HU, the CT scan had a sensitivity of 69% and a specificity of 74% for the diagnosis of osteoporosis. Conclusion Individuals with osteoporosis exhibit a significantly lower average HU compared to both osteopenic and healthy individuals. A CT scan can serve as an effective predictor of osteoporosis in patients. The CT images obtained for reasons unrelated to osteoporosis diagnosis can be employed to discern patients with osteoporosis without incurring the added cost or radiation exposure.

Tethered cord syndrome (TCS) is a type of occult spinal dysraphism, which necessitates early detection as an essential component of patient management in reducing complications. This study aimed to compare the findings of spinal cord ultrasonography between TCS patients and healthy individuals. The current study is a case-control study of patients who were admitted to the Akbar and Ghaem Hospitals (Mashhad, Iran) in 2019. The study population comprised 30 children with TCS aged under two years old, and the control group included 34 healthy peers of the same age. The maximum distance of the spinal cord from the posterior canal wall was measured in millimeters using ultrasonography. Demographic and sonographic findings of each participant were recorded in checklists, which were then entered into SPSS software. P values less than 0.05 were considered statistically significant. The study included 30 children with TCS and 34 healthy individuals with a mean age of 7.67±6.39 months. TCS patients had a significantly shorter maximum distance of the spinal cord from the posterior wall of the spinal canal than the control group (1.75±0.62 mm vs. 2.79±0.76, P<0.001). After performing corrective surgery, the TCS patients indicated significant improvement in this interval (1.57±0.54 mm to 2.95±0.49 mm, respectively, P=0.001). In comparison to children without TCS, the spinal cord was substantially closer to the posterior canal wall in TCS patients. However, these outcomes were improved significantly in patients after surgery.

Infectious brain abscesses and granulomas, characterized by localized collections of pus or inflammatory tissue within the brain parenchyma, pose significant clinical challenges due to their potentially life-threatening nature and complex management requirements. This cross-sectional study investigated patients diagnosed with infectious brain abscesses and granulomas from March 1, 2012, to October 22, 2021, in Mashhad, Iran. Data were collected from adult patients admitted to the two primary referral centers for community-acquired neuroinfections and neuroinflammations. Demographic information, clinical features, laboratory and neuroimaging characteristics, and clinical outcomes were analyzed. A total of 110 episodes were identified in 106 patients, with a median age of 45 years (IQR 30-56.3) and 62.7% male. Predisposing conditions included immunocompromised states (27.5%), preceding otitis/mastoiditis (16.2%), sinusitis (13.3%), and pulmonary infections (17.2%). The most common clinical manifestations were headache (57.3%), fever (49.1%), altered consciousness (44.4%), and seizures (31.8%). Neuroimaging revealed that brain lesions were solitary in 51% and multiple in 48% of episodes. Surgical intervention was performed in 46.4% of cases. The in-hospital mortality rate was 24.5%, with significant associations found between mortality and factors such as age, altered consciousness, multiple brain lesions, and cerebellum and brainstem involvement. The median length of hospital stay was 28 days (IQR 16-46.5). Our study underscores challenges in diagnosing and treating brain abscesses and granulomas, with high mortality rates (24.5%) despite advanced techniques. Age, altered consciousness, and lesion characteristics predict death. Addressing changing microbial patterns and improving diagnostics are vital for better outcomes, especially in low- and middle-income countries.