ORIGINAL
Introdução: A lesão cerebral traumática (LCT) constitui um grande desafio de saúde pública globalmente. O estresse oxidativo, levando a insulto cerebral secundário, permanece um problema a ser superado. O efeito benéfico do selênio ainda é inconclusivo, pois estudos anteriores mostraram resultados conflitantes. Objetivo: O estudo visou determinar o efeito da administração de selênio nos resultados de pacientes com LCT moderada e grave que se apresentaram ao nosso hospital. Métodos: O estudo consistiu em 84 pacientes, com 42 pacientes em cada categoria de LCT moderada e grave. Cada categoria foi dividida em dois grupos (A (grupo selênio) e B (grupo não-selênio)) com 21 pacientes em cada grupo. Os pacientes do grupo A receberam selênio, enquanto os pacientes do grupo B serviram como grupo controle. A pontuação da escala de resultado de Glasgow estendida dos pacientes em ambos os grupos foi determinada três meses após o trauma ou na morte do paciente. Resultados: A taxa de mortalidade foi a mesma em ambos os grupos de pacientes com LCT moderada (9,5% cada), enquanto a taxa de mortalidade foi significativamente maior no grupo não-selênio (90,5%) do que no grupo selênio (52,4%) de pacientes com LCT grave (P=0,006). Conclusão: A administração de selênio resultou em uma taxa de mortalidade significativamente reduzida entre os pacientes com LCT grave, mas não entre os pacientes com LCT moderada.
Introduction: Traumatic brain injury (TBI) constitutes a major public health challenge globally. Oxidative stress, leading to secondary brain insult, remains a problem to be surmounted. The beneficial effect of selenium is still inconclusive as previous studies showed conflicting results. Objective: The study aimed to determine the effect of selenium administration on the outcomes of moderate and severe TBI patients who presented to our hospital. Methods: The study consisted of 84 patients, with 42 patients in each category of moderate and severe TBI. Each category was further divided into two groups (A (selenium group) and B (non-selenium group)) with 21 patients in each group. Patients in group A had selenium administered while patients in group B served as the control group. Glasgow outcome score extended of patients in both groups at three months post trauma or at patient’s demise were determined. Results: The mortality rate was the same in both groups of moderate TBI patients (9.5% each) while mortality rate was significantly higher in the non-selenium (90.5%) than in the selenium group (52.4%) of severe TBI patients (P=0.006). Conclusion: Selenium administration resulted in significantly reduced mortality rate among the severe TBI patients but not among moderate TBI patients.
2. Dewan MC, Rattani A, Gupta S, et al. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2018;130(4):108097. http://doi.org/10.3171/2017.10.JNS17352. PMid:29701556.
3. Kamal VK, Agrawal D, Pandey R. Epidemiology, clinical characteristics and outcomes of traumatic brain injury: evidences from integrated level 1 trauma center in India. J Neurosci Rural Pract. 2016;7(4):515-25. http://doi.org/10.4103/0976-3147.188637. PMid:27695230.
4. Deepika A, Devi BI, Shukla D. Predictive validity of disability rating scale in determining functional outcome in patients with severe traumatic brain injury. Neurol India. 2017;65(1):83-6. http:// doi.org/10.4103/0028-3886.198228. PMid:28084245.
5. Tobi KU, Azeez AL, Agbedia SO. Outcome of traumatic brain injury in the intensive care unit : a five-year review. South African J Anaesth Analg (Internet). 2016;22(5):135-9. http://doi.org/10.1080 /22201181.2016.1206293.
6. Yusuf AS, Odebode TO, Salaudeen AG, Alimi MF, Adeniran JO. Socio-demographic profiles and outcome of motorcycle related head injury in a Nigerian Tertiary Health Institution. Sahel Med J. 2013;16(3):116-20. http://doi.org/10.4103/1118-8561.121921.
7. Khalili H, Ahl R, Cao Y, et al. Early selenium treatment for traumatic brain injury : does it improve survival and functional outcome? Injury. 2017;48(9):1922-6. http://doi.org/10.1016/j.injury.2017.07.005. PMid:28711170.
8. Werner C, Engelhard K, Gutenberg-universita DJ. Pathophysiology of traumatic brain injury. Br J Anaesth. 2017;99(1):4-9. http:// doi.org/10.1093/bja/aem131. PMid:17573392.
9. Maas AIR, Murray G, Iii HH, Kassem N, Legrand V, Mangelus M, et al. Efficacy and safety of dexanabinol in severe traumatic brain injury : results of a phase III randomised, placebo-controlled, clinical trial. Lancet Neurol. 2006 Jan;5(1):38-45. http://doi.org/10.1016/ S1474-4422(05)70253-2.
10. Marshall LF, Maas AIR, Marshall SB, et al. A multicenter trial on the efficacy of using tirilazad mesylate in cases of head injury. J Neurosurg. 1998;89(4):519-25. http://doi.org/10.3171/jns.1998.89.4.0519. PMid:9761043.
11. Moghaddam OM, Lahiji MN, Hassani V, Mozari S. Early administration of selenium in patients with acute traumatic brain injury: a randomized double blinded controlled trial. Indian J Crit Care Med. 2017;21(2):75-9. http://doi.org/10.4103/ijccm.IJCCM_391_16. PMid:28250601.
12. Yusuf AS, Odebode TO, Adeniran JO. Pattern and outcome of motorcyclists head injury in Ilorin, Nigeria. Niger J Basic Clin Sci. 2014;11(2):80. http://doi.org/10.4103/0331-8540.140340.
13. Adam A, Alhassan A, Yabasin I. Incidence of traumatic brain injury in a ghanaian tertiary hospital. J Med Biomed Sci. 2016;5(2):5-12. http://doi.org/10.4314/jmbs.v5i2.2.
14. Jasper US, Opara MC, Pyiki EB, Akinrolie O. The epidemiology of hospital-referred head injury in Northern Nigeria. J Sci Res Rep.
2014;3(15):2055-64. http://doi.org/10.9734/JSRR/2014/9645.
15. Odebode TO, Ademola-Popoola DS, Ojo TA, Ayanniyi AA. Ocular and visual complications of head injury. Eye (Lond). 2005;19(5):5616. http://doi.org/10.1038/sj.eye.6701566. PMid:15332105.
16. Ogolo DE, Ibe MO. Determinants of outcome in traumatic head injuries: a South East Nigeria Experience. World Neurosurg. 2021;149:e386-91. http://doi.org/10.1016/j.wneu.2021.02.012. PMid:33578026.
17. Adeolu A, Malomo A, Shokunbi M, Komolafe E, Abiona T. Etiology of Head Injuries in Southwestern Nigeria: a public health perspective. Int J Epidemiol. 2004;2(2):10-3.
18. Rutland-Brown W, Langlois JA, Thomas KE, Xi YL. Incidence of traumatic brain injury in the United States. J Head Trauma Rehabil. 2006;21(6):544-8. http://doi.org/10.1097/00001199-200611000-00009. PMid:17122685.
19. Jonsdottir GM, Lund SH, Snorradottir B, et al. A population-based study on epidemiology of intensive care unit treated traumatic brain injury in Iceland. Acta Anaesthesiol Scand. 2017;61(4):408-17. http://doi.org/10.1111/ aas.12869. PMid:28194757.
20. Odebode TO, Abubakar AM. Childhood head injury : causes, outcome, and outcome predictors. Pediatr Surg Int. 2004;20(5):348-52. PMid:15179518.
21. Balogun JA, Akwada O, Awana E, Balogun FM. Access to the intensive care unit by severe head injury patients. J Neurosci Rural Pract. 2019;10(4):666-71. http://doi.org/10.1055/s-0039-3399476. PMid:31831988.
22. Nnadi MON, Bankole OB, Fente BG. Outcome of head injury in a tertiary hospital in Niger Delta, Nigeria: a prospective study. Afr J Med Heal Sci. 2014;13(1):51-5. http://doi.org/10.4103/2384-5589.139444.
23. Dhandapani Ss, Manju D, Sharma BS, Mahapatra AK. Prognostic significance of age in traumatic brain injury. J Neurosci Rural Pract. 2012;3(2):131-5. http://doi.org/10.4103/0976-3147.98208. PMid:22865961.
24. Skaansar O, Tverdal C, Rønning PA, et al. Traumatic brain injury: the effects of patient age on treatment intensity and mortality. BMC Neurol. 2020;20(1):1-10. http://doi.org/10.1186/s12883-020-01943-6. PMid:33069218.
25. Huang J-F, Hsu C-P, Ouyang C-H, et al. The impact of selenium supplementation on trauma patients-Systematic review and meta-analysis.
Nutrients. 2022;14(2):342. http://doi.org/10.3390/nu14020342.
1Division of Neurosurgery, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria.
2Department of Neurological Surgery, University College Hospital/University of Ibadan, Oyo State, Nigeria.
Received Mar 22, 2025
Corrected Apr 17, 2025
Accepted Apr 25, 2025
