Characterization of Traumatic Brain Injury Research in the Middle East and North Africa Region: A Systematic Review

Computed tomography imaging findings in head injury victims of conflict in Northern Ethiopia treated at the University of Gondar comprehensive specialized hospital

BACKGROUND

Head injuries pose a major global health issue, especially among young adults in developing countries. Data on head trauma patterns in conflict situations is scarce, and computed tomography (CT) is the main imaging method for evaluating acute head injuries.

OBJECTIVES

This study aimed to assess the CT scan patterns of traumatic head injury among northern Ethiopian victims of war who were treated at the University of Gondar Comprehensive Specialized Hospital during the armed conflict in 2020 and 2021.

METHODS

A cross-sectional study was conducted on 76 cases of traumatic head injury who underwent CT scans from November 1, 2020, to January 30, 2021, at the Department of Radiology. Data regarding age, sex, mechanism of injury, and CT scan findings were collected and analyzed.

RESULTS

A total of 76 patients were assessed, with 73 (96.1%) being males and a male-to-female ratio of 24:1. Ages ranged from 19 to 48 years, with the most affected group being ≤ 29 years (44 or 57.9%). Common head injury mechanisms included bullets (50%), blunt trauma (26%), and blasts (21%). Abnormal CT findings were noted in 60 cases (78.95%), with the most common findings being skull fractures (64.5%), cerebral contusions (33%), and metallic foreign bodies (36%). Scalp and brain hematoma, presence of soft tissue foreign body, pneumocephalus, and subfalcine herniation exhibited a statistically significant correlation with bullet injuries (p-value < 0.05).

CONCLUSION

This study found a high rate of abnormal CT scans mainly involving young males as the primary victims of traumatic head injuries in war-affected areas of Northern Ethiopia. The leading causes were bullet injuries, with common CT scan findings including skull fractures and cerebral contusions, many requiring immediate intervention. The high rate of abnormal CT scans in these patients underscores the need to improve access to CT scans in conflict-affected areas.

Regional and National Burden of Traumatic Brain Injury and Spinal Cord Injury in North Africa and Middle East Regions, 1990-2021: A Systematic Analysis for The Global Burden of Disease Study 2021

BACKGROUND

Traumatic brain injury (TBI) and spinal cord injury (SCI) are significant central nervous system injuries with epidemiological importance, particularly in the North Africa and the Middle East (NAME) region, which is diverse in public health aspects across its 21 countries.

OBJECTIVE

This study aims to present an up-to-date assessment of the regional and national TBI and SCI burden and their causes in the NAME region from 1990 to 2021.

METHODS

We utilized the Global Burden of Disease (GBD) results tool to gather relevant data. The analysis included TBI and SCI incidence, prevalence, and years lived with disability (YLDs) rates, along with absolute numbers and percent change trends by gender, age, and country from 1990 to 2021. We also examined the causes of TBI and SCI and identified the most common causes for each country.

RESULTS

In 2021, TBI age-standardized rates of incidence, prevalence, and YLDs were 333 (293, 380), 593 (553, 642), and 87 (63, 114) per 100,000 people, respectively. For SCI, the rates were 10 (7, 13), 256 (200, 344), and 78 (51, 115). Since 1990, incidence rates of TBI and SCI have decreased in most countries. Saudi Arabia, Afghanistan, and Yemen experienced increasing incidence rates for both injuries. Transport injuries and unintentional injuries were the primary causes of TBI and SCI, respectively, in most countries.

CONCLUSION

Despite global trends showing a decreased burden of TBI and SCI, the NAME region's public health systems should remain vigilant. Both injuries are epidemiologically significant and require continued public health interventions to manage and control them in this particular region.

The Power of Advocacy in Global Neurosurgery

Advocacy, one of the five domains of global neurosurgery, represents a powerful avenue to influence public policy to expand access to safe, timely, and affordable neurosurgical care. In this manuscript, we characterize advocacy in global neurosurgery, describe specific neurosurgeon-led initiatives, and delineate how neurosurgeons can become involved in global neurosurgery advocacy efforts. Advocacy in global neurosurgery involves working together in organized neurosurgery with organizations focused on clinical provisions, training, and policy initiatives. Effective advocacy uses a data-driven approach with myriad facilitators, including collaboration and approach strategies for sharing information and a variety of contextual, ideological, and practical barriers. The main action fronts for global neurosurgery include identifying needs, broadening access, and assuring quality. Neurosurgery-led initiatives transforming public policy have occurred on regional and global scales and accelerated since 2019. Folate fortification of staple foods to prevent neural tube defects represents a recent and notably successful area of advocacy and remains in progress. Neurosurgeons who aspire to become involved in advocacy efforts must obtain competencies and skills distinct from, yet complementary to, the traditional neurosurgical training curriculum.

Pediatric Traumatic Brain Injury in the Middle East and North Africa Region: A Systematic Review and Meta-Analysis to Assess Characteristics, Mechanisms, and Risk Factors

Pediatric traumatic brain injury (pTBI) represents a major cause of child injuries in the Middle East and North Africa (MENA) region. This review aims to assess pTBIs in the MENA region and reports their clinical severity and outcomes. A search was conducted using major electronic databases, including Medline/Ovid, PubMed, EMBASE, Web of Science, and SCOPUS. Abstracts were screened independently and in duplicate to detect original research. The objective and study findings for each article were recorded, along with the mechanism of pTBI, patient age and sex, injury assessment tool(s) used, and outcome. A total of 1345 articles were retrieved, of which 152 met the criteria for full-text review, and 32 were included in this review. Males predominantly suffered from pTBIs (78%). Motor vehicle accidents, followed by child abuse, were the leading causes of pTBI. Overall, 0.39% of cases were mild, 0.58% moderate, 16.25% severe, and 82.27% unclassified. The mortality rate was 13.11%. Most studies used the computed tomography scan, Glasgow Coma Scale, Abbreviated Injury Scale, and Injury Severity Score as investigation methods. This review reports on the alarming rate of child-abuse-related pTBI and offers further understanding of pTBI-associated risk factors and insight into the development of strategies to reduce their occurrence, as well as policies to promote child well-being.

High fat diet exacerbates long-term metabolic, neuropathological, and behavioral derangements in an experimental mouse model of traumatic brain injury

AIMS

Traumatic brain injury (TBI) constitutes a serious public health concern. Although TBI targets the brain, it can exert several systemic effects which can worsen the complications observed in TBI subjects. Currently, there is no FDA-approved therapy available for its treatment. Thus, there has been an increasing need to understand other factors that could modulate TBI outcomes. Among the factors involved are diet and lifestyle. High-fat diets (HFD), rich in saturated fat, have been associated with adverse effects on brain health.

MAIN METHODS

To study this phenomenon, an experimental mouse model of open head injury, induced by the controlled cortical impact was used along with high-fat feeding to evaluate the impact of HFD on brain injury outcomes. Mice were fed HFD for a period of two months where several neurological, behavioral, and molecular outcomes were assessed to investigate the impact on chronic consequences of the injury 30 days post-TBI.

KEY FINDINGS

Two months of HFD feeding, together with TBI, led to a notable metabolic, neurological, and behavioral impairment. HFD was associated with increased blood glucose and fat-to-lean ratio. Spatial learning and memory, as well as motor coordination, were all significantly impaired. Notably, HFD aggravated neuroinflammation, oxidative stress, and neurodegeneration. Also, cell proliferation post-TBI was repressed by HFD, which was accompanied by an increased lesion volume.

SIGNIFICANCE

Our research indicated that chronic HFD feeding can worsen functional outcomes, predispose to neurodegeneration, and decrease brain recovery post-TBI. This sheds light on the clinical impact of HFD on TBI pathophysiology and rehabilitation as well.

Traumatic Brain Injury Cases' Mortality Predictors, Association, and Outcomes in the Emergency Department at a Tertiary Healthcare Center in Saudi Arabia

Aim Incidence of traumatic brain injury (TBI) in Saudi Arabia has been estimated to be 116 per 1,00,000 population as incidence of TBI continues to rise in our region. We aim to study the demographics, mortality predictors, and factors influencing the outcome of TBI cases in a tertiary care center in Jeddah, Saudi Arabia.

Materials and Methods We retrospectively collected data from all consecutive patients treated at the Emergency Department of King Abdulaziz Medical City including all acute TBI adult cases (>18 years) from 2016 to 2019. Logistic regression models were used to identify significant predictors of mortality. A total of 423 individuals with TBI were enrolled in the study. Nearly, half of them were in age group of 18 to 29 (40.77). Most patients were males (76.83%).

Results Injuries were most commonly mild-to-moderate TBI (73.83%). Road traffic accident was the most common mechanism of injury (49.7%) followed by fall (39.5%). Most common mode of transportation was private cars (47.57%). Most patient required less than or equal to24hours of admission (61.23%). A total of 30 (7%) died in the hospital all of which were male with no death cases reported among females.

Conclusion In conclusion, this study reports a mortality rate related to TBI that is among the lowest in the region. Injuries were male predominant with more balanced male to female ratio. Patients who were delivered to the hospital via private cars had an improved survival. These finding should be interpreted in the context of retrospective noncontrolled study design, and further future studies are encouraged to consolidate these findings.

Gender Discrepancy in Patients with Traumatic Brain Injury: A Retrospective Study from a Level 1 Trauma Center

Objectives. The objective of this study is to explore the gender discrepancy in patients with traumatic brain injury (TBI). Methods. A retrospective analysis of Qatar Trauma Registry (QTR) was conducted among patients (age ≥14y) who were hospitalized with TBI. Data were collected and analyzed based on the gender and age. Results. Over 5 years (2014-2019), 9, 309 trauma patients (90% males and 10% females) were admitted to the trauma center. Of these, 1, 620 (17.4%) patients were hospitalized with TBI (94% males and 6% females). Motor vehicle crash was the main mechanism of injury (MOI) in females, and fall from height was predominant among males. Subdural hematoma (SDH) was the more frequent type of TBI in both genders, but it was more prevalent in male patients ≥55 years. Injury severity score, Glasgow coma scale, and head abbreviated injury score were comparable between males and females. The length of stay in the ICU and hospital and mortality were similar in both genders. However, mortality was higher among males ≥55 years when compared to 14-54 years within the same gender (21% vs. 12%, $p=0.002$ ). The crude and adjusted odds ratio did not show that gender is a significant predictor of mortality among TBI patients. Conclusions. Although the incidence and MOI of TBI show significant differences between male and female patients, the severity and outcomes are comparable.

Non-Communicable Neurological Disorders and Neuroinflammation

Traumatic brain injury, stroke, and neurodegenerative diseases represent a major cause of morbidity and mortality in Africa, as in the rest of the world. Traumatic brain and spinal cord injuries specifically represent a leading cause of disability in the younger population. Stroke and neurodegenerative disorders predominantly target the elderly and are a major concern in Africa, since their rate of increase among the ageing is the fastest in the world. Neuroimmunology is usually not associated with non-communicable neurological disorders, as the role of neuroinflammation is not often considered when evaluating their cause and pathogenesis. However, substantial evidence indicates that neuroinflammation is extremely relevant in determining the consequences of non-communicable neurological disorders, both for its protective abilities as well as for its destructive capacity. We review here current knowledge on the contribution of neuroinflammation and neuroimmunology to the pathogenesis of traumatic injuries, stroke and neurodegenerative diseases, with a particular focus on problems that are already a major issue in Africa, like traumatic brain injury, and on emerging disorders such as dementias.

Head injury care in a low- and middle-income country tertiary trauma center: epidemiology, systemic lacunae, and possible leads

BACKGROUND

Although head injury (HI) from low- and middle-income countries (LMIC) heavily contributes to the global disease burden, studies are disproportionately less from this part of the world. Knowing the different epidemiological characteristics from high-income nations can target appropriate prevention strategies. This study aims to provide a comprehensive overview of the clinico-epidemiological data of HI patients, focusing on the existing challenges with possible solutions from a developing nation's perspective.

METHODS

This is a prospective, registry-based, observational study of HI in an Indian tertiary trauma-care center over 4 years. Various clinico-epidemiological parameters, risk factors, and imaging spectrum were analyzed in a multivariate model to identify the challenges faced by LMIC and discuss pragmatic solutions.

RESULTS

The study included a large-volume cohort of 14,888 patients. Notably, half of these patients belonged to mild HI, despite most were referred (90.3%) cases. Only one-third (30.8%) had severe HI. Less than a third reached us within 6 h of injury. Road traffic accidents (RTA) accounted for most injuries (61.1%), especially in the young (70.9%). Higher age, males, RTA, helmet non-usage, drunken driving, systemic injuries, and specific imaging features had an independent association with injury severity.

CONCLUSIONS

The study represents the much-needed, large-volume, epidemiological profile of HI from an LMIC, highlighting the suboptimal utilization of peripheral healthcare systems. Strengthening and integrating these facilities with the tertiary centers in a hub and enhanced spoke model, task sharing design, and efficient back-referrals promise effective neurotrauma care while avoiding overburden in the tertiary centers. Better implementation of road safety laws also has the potential to reduce the burden of HI.

Secular Trend, Seasonal Variation, Epidemiological Pattern, and Outcome of Traumatic Head Injuries Due to Road Traffic Accidents in Aseer, Saudi Arabia

Road traffic accidents (RTAs) are a leading cause of traumatic head injury (THI) and are regarded as a public health problem in Saudi Arabia. This hospital-based retrospective study aims to provide data on the frequency, type, and distribution of RTA-related THIs over the past decade; demonstrate their time trend and seasonality; and decipher age and sex differences in RTA-related THIs and their outcome. The results showed a decline in the number of RTA-related THIs between 2010 and 2019. The patients had a mean age of 26.16 ± 16.27 years, and the male-to-female ratio was 10.8:1. Head injury with multiple lesions was the most common diagnosis, followed by cerebral contusion and skull fracture (32.1%, 12.9%, and 11.2%, respectively). Subdural hematoma (SDH) and skull fracture were significantly more common in patients aged ≥60 years (standard residual > 1.96), and significantly less common in those aged ≤17 years (standard residual < 1.96), compared to other age groups. Males experienced significantly more SDHs than females (standard residual = −2.8, p = 0.029). The length of hospital stay was positively correlated with age (Spearman’s rho = 0.057, p = 0.046). No seasonal variation was found.