Return to work
Determining the ideal time for a person to return to work will depend on personal factors and job-related factors including the intensity of the job and the risk of falling or hitting ones head at work during recovery. After the required initial recovery period of complete rest (24–48 hours after the concussion began), gradually and safely returning to the workplace with accommodations and support in place, should be prioritized over staying home and resting for long periods of time, to promote physical recovery and reduce the risk of people becoming socially isolated. The person should work with their employer to design a step-wise "return-to-work" plan. For those with a high-risk job, medical clearance may be required before resuming an activity that could lead to another head injury. Students should have completed the full return-to-school progression with no academic accommodations related to the concussion required before starting to return to part-time work. Prognosis
The majority of children and adults fully recover from a concussion, however some may experience a prolonged recovery. There is no single physical test, blood test (or fluid biomarkers), or imaging test that can be used to determine when a person has fully recovered from concussion.A persons recovery may be influenced by a variety of factors that include age at the time of injury, intellectual abilities, family environment, social support system, occupational status, coping strategies, and financial circumstances. Factors such as a previous head injury or a coexisting medical condition have been found to predict longer-lasting post-concussion symptoms.
Mesna, sold under the brand name Mesnex among others, is a medication used in those taking cyclophosphamide or ifosfamide to decrease the risk of bleeding from the bladder. It is used either by mouth or injection into a vein.Common side effects include headache, vomiting, sleepiness, loss of appetite, cough, rash, and joint pain. Serious side effects include allergic reactions. Use during pregnancy appears to be safe for the baby but this use has not been well studied. Mesna is an organosulfur compound. It works by altering the breakdown products of cyclophosphamide and ifosfamide found in the urine making them less toxic.Mesna was approved for medical use in the United States in 1988. It is on the World Health Organizations List of Essential Medicines. Medical uses
Chemotherapy adjuvant
Mesna is used therapeutically to reduce the incidence of haemorrhagic cystitis and haematuria when a patient receives ifosfamide or cyclophosphamide for cancer chemotherapy. These two anticancer agents, in vivo, may be converted to urotoxic metabolites, such as acrolein. Mesna assists to detoxify these metabolites by reaction of its sulfhydryl group with α,β-unsaturated carbonyl containing compounds such as acrolein. This reaction is known as a Michael addition. Mesna also increases urinary excretion of cysteine. Other
Outside North America, mesna is also used as a mucolytic agent, working in the same way as acetylcysteine; it is sold for this indication as Mistabron and Mistabronco. Administration
It is administered intravenously or orally (through the mouth). The IV mesna infusions would be given with IV ifosfamide, while oral mesna would be given with oral cyclophosphamide.