Search results for: spinal cord injuries

Authors: Merilin Ivanova Ivanova, Kalin Dimitrov Atanasov, Stefan Petrov Enchev

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Backgroud: Neuromyelitis optica spectrum disorder, also known as Devic’s disease, is a relapsing demyelinating autoimmune inflammatory disorder of the central nervous system associated with anti-aquaporin 4 (AQP4) antibodies that can manifest with devastating secondary neurological deficits. Most commonly affected are the optic nerves and the spinal cord-clinically this is often presented with optic neuritis (loss of vision), transverse myelitis(weakness or paralysis of extremities),lack of bladder and bowel control, numbness. APS is a core clinical entity of NMOSD and adds to the clinical representation the following symptoms: intractable nausea, vomiting and hiccup, it usually occurs isolated at onset, and can lead to a significant delay in the diagnosis. The condition may have features similar to multiple sclerosis (MS) but the episodes are worse in NMO and it is treated differently. It could be relapsing or monophasic. Possible complications are visual field defects and motor impairment, with potential blindness and irreversible motor deficits. In severe cases, myogenic respiratory failure ensues. The incidence of reported cases is approximately 0.3–4.4 per 100,000. Paediatric cases of NMOSD are rare but have been reported occasionally, comprising less than 5% of the reported cases. Objective: The case serves to show the difficulty when it comes to the diagnostic processes regarding a rare autoimmune disease with non- specific symptoms, taking large interval of rimes to reveal as complete clinical manifestation of the aforementioned syndrome, as well as the necessity of multidisciplinary approach in the setting of а general paediatric department in аn emergency hospital. Methods: itpatient's history, clinical presentation, and information from the used diagnostic tools(MRI with contrast of the central nervous system) lead us to the conclusion .This was later on confirmed by the positive results from the anti-aquaporin 4 (AQP4) antibody serology test. Conclusion: APS is a common symptom of NMOSD and is considered a challenge in a differential-diagnostic plan. Gaining an increased awareness of this disease/syndrome, obtaining a detailed patient history, and performing thorough physical examinations are essential if we are to reduce and avoid misdiagnosis.

Keywords: neuromyelitis, devic's disease, hiccup, autoimmune, MRI

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Authors: Najeebullah Soomro, Habib Noorbhai, Mariam Soomro, Ross Sanders

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The demands on cricketers are increasing with more matches being played in a shorter period of time with a greater intensity. A ten year report on injury incidence for Australian elite cricketers between the 2000- 2011 seasons revealed an injury incidence rate of 17.4%.1. In the 2009–10 season, 24 % of Australian fast bowlers missed matches through injury. 1 Injury rates are even higher in junior cricketers with an injury incidence of 25% or 2.9 injuries per 100 player hours reported. 2 Traditionally, injury surveillance has relied on the use of paper based forms or complex computer software. 3,4 This makes injury reporting laborious for the staff involved. The purpose of this presentation is to describe a smartphone based mobile application as a means of improving injury surveillance in cricket. Methods: The researchers developed CricPredict mobile App for the Android platforms, the world’s most widely used smartphone platform. It uses Qt SDK (Software Development Kit) as IDE (Integrated Development Environment). C++ was used as the programming language with the Qt framework, which provides us with cross-platform abilities that will allow this app to be ported to other operating systems (iOS, Mac, Windows) in the future. The wireframes (graphic user interface) were developed using Justinmind Prototyper Pro Edition Version (Ver. 6.1.0). CricPredict enables recording of injury and training status conveniently and immediately. When an injury is reported automated follow-up questions include site of injury, nature of injury, mechanism of injury, initial treatment, referral and action taken after injury. Direct communication with the player then enables assessment of severity and diagnosis. CricPredict also allows the coach to maintain and track each player’s attendance at matches and training session. Workload data can also be recorded by either the player or coach by recording the number of balls bowled or played in a day. This is helpful in formulating injury rates and time lost due to injuries. All the data are stored at a secured password protected data server. Outcomes and Significance: Use of CricPredit offers a simple, user friendly tool for the coaching or medical staff associated with teams to predict, record and report injuries. This system will assist teams to capture injury data with ease thus allowing better understanding of injuries associated with cricket and potentially optimize the performance of such cricketers.

Keywords: injury, cricket, surveillance, smartphones, mobile

Procedia PDF Downloads 459

Authors: Catherine Portelli

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Felines, such as Panthera tigris, Panthera leo and Puma concolor, have become common residents in animal parks and zoos. They often sustain injuries from other felines within the same, or adjacent enclosures and from playing with items of enrichment and structures of the enclosure itself. These open wounds, and their treatments, are often challenging in the veterinary practice, where feline-specific studies are lacking. This study is based on the author’s clinical experience gained while working at local animal parks in the past five years, and current evidence of hydrocolloid dressing applied to other species. Hydrocolloid dressing is used for secondary healing of chronic and acute wounds, where there is a considerable amount of tissue loss. The patients included in this study were sedated using medetomidine and ketamine every three to four days, for wound treatment and bandage change. Comparative studies of different techniques of open wound management will improve the healing process of exotic felines in the future by decreasing the time of recovery and incidence of other complications. Such studies will also aid with treatment of injuries sustained in wild felines, such as trap and bite wounds, found in natural conservation areas and wild animal sanctuaries.

Keywords: felines, hydrocolloid dressing, open wound, secondary healing

Procedia PDF Downloads 101

Authors: Rabbya Ashrafi, Mohammad Tarikul Islam , Al-Amin Bhuiyan, Aminur Rahman

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Injury is the leading killer of children in Bangladesh. Anchal (community crèche) is an effective intervention to prevent injuries among children under 5. Through the SoLiD project, 1,600 Anchals are in place in three sub-districts in Bangladesh. The objectives of the Anchal are to provide supervision and early childhood development stimulations (ECD) to the children. A locally trained caregiver supervises 20-25 children, 9 to 59 months old, from 9 a.m. to 1 p.m., six days a week. Although it was found effective, during its implementation phase several challenges were noticed. To identify challenges and means to overcome those to improve the Anchal activities. In-depth interviews were conducted with Anchal caregivers, their supervisors, and trainers. Focus group discussions were conducted with the mothers of the Anchal children. The study was conducted in the Manohardi sub-district in November 2015. Decay of knowledge and skills after 2-3 months of training, lack of formal certification and inappropriate selection of women as Anchal caregivers, and enrollment of small children (less than 12 months) were the important challenges. The reluctance of parents to send children to the Anchal at the proper time, failure to engage children in various ECD activities, ineffective conduction of parents and community leaders meeting by the Anchal caregivers, insufficient accommodation, and poor supply of logistics for children were also the important challenges. The suggestion for improvement was to recruit caregivers as per standard criteria, provide them refreshers training at three months intervals, train them on effective conduction of parents and community leaders meetings, provide a formal certificate, and ensure regular supply of logistics. The identified challenges are needed to be addressed by utilizing the suggestions obtained from the IDIs and FGDs to make the Anchal intervention more effective in preventing childhood injuries.

Keywords: comunity crech, earlychildhood development, measures for improvement, childhood injury

Procedia PDF Downloads 89

Authors: R. Gwynn, P. Panwalkar, K. Veravalli , M. Tofighi, R. Clement, A. Mofidi

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The aim of this study was to access the impact of Covid-19 and lockdown on the incidence, injury pattern, and treatment of tibial plateau fractures in a combined rural and urban population in wales. Methods: Retrospective study was performed to identify tibial plateau fractures in 15-month period of Covid-19 lockdown 15-month period immediately before lockdown. Patient demographics, injury mechanism, injury severity (based on Schatzker classification), and associated injuries, treatment methods, and outcome of fractures in the Covid-19 period was studied. Results: The incidence oftibial plateau fracture was 9 per 100000 during Covid-19, and 8.5 per 100000, and both were similar to previous studies. The average age was 52, and female to male ratio was 1:1 in both control and study group. High energy injury was seen in only 20% of the patients and 35% in the control groups (2=12, p<0025). 14% of the covid-19 population sustained other injuries as opposed 16% in the control group(2=0.09, p>0.95). Lower severity isolated lateral condyle fracturesinjury (Schatzker 1-3) were seen in 40% of fractures this was 60% in the control populations. Higher bicondylar and shaft fractures (Schatzker 5-6) were seen in 60% of the Covid-19 group and 35% in the control groups(2=7.8, p<0.02). Treatment mode was not impacted by Covid-19. The complication rate was low in spite of higher number of complex fractures and the impact of covid-19 pandemic. Conclusion: The associated injuries were similar in spite of a significantly lower mechanism of injury. There were unexpectedly worst tibial plateau fracture based Schatzker classification in the Covid-19 period as compared to the control groups. This was especially relevant for medial condyle and shaft fractures. This was postulated to be caused by reduction in bone density caused by lack of vitamin D and reduction in activity. The treatment mode and outcome was not impacted by the impact of Covid-19 on care for tibial plateau fractures.

Keywords: Covid-19, knee, tibial plateau fracture, trauma

Procedia PDF Downloads 125

Authors: Genevieve Zingg

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Since the onset of the 2015 ‘refugee crisis’ in the European Union (EU), migrant deaths have overwhelmingly occurred in the Mediterranean Sea. However, far less attention has been paid to the startling number of injuries, deaths, and allegations of systematic human rights violations occurring within European refugee camps. Most troubling is the assertion that injuries and deaths in EU refugee camps have occurred as a result of negligent management and poor access to healthcare, food, water and sanitation, and other elements that comprise an adequate standard of living under international human rights law. Using available evidence and documentation, this paper will conduct a thorough examination of the causes of death and injury in EU refugee camps, with a specific focus on Greece, in order to identify instances of negligence or conditions that amount to potential breaches of human rights law. Based on its analysis, this paper will subsequently explore potential legal avenues to achieving justice and accountability under international human rights law in order to effectively address and remedy inadequate standards of living causing wrongful death or injury in European refugee camps.

Keywords: European Union, Greece, human rights, international human rights law, migration, refugees

Procedia PDF Downloads 195

Authors: Ardiansyah I. Ryan, Ashsholih K. R., Fathurrohman G. R., Kurniadi M. R., Huda P. A

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The burden of brain-related disease is very high. There are a lot of brain-related diseases with limited treatment result and thus raise the burden more. The Parkinson Disease (PD), Mental Health Problem, or Paralysis of extremities treatments had risen concern, as the patients for those diseases usually had a low quality of life and low chance to recover fully. There are also many other brain or related neural diseases with the similar condition, mainly the treatments for those conditions are still limited as our understanding of the brain function is insufficient. Brain Implant Technology had given hope to help in treating this condition. In this paper, we examine the current update of the brain implant technology. Neurotechnology is growing very rapidly worldwide. The United States Food and Drug Administration (FDA) has approved the use of Deep Brain Stimulation (DBS) as a brain implant in humans. As for neural implant both the cochlear implant and retinal implant are approved by FDA too. All of them had shown a promising result. DBS worked by stimulating a specific region in the brain with electricity. This device is planted surgically into a very specific region of the brain. This device consists of 3 main parts: Lead (thin wire inserted into the brain), neurostimulator (pacemaker-like device, planted surgically in the chest) and an external controller (to turn on/off the device by patient/programmer). FDA had approved DBS for the treatment of PD, Pain Management, Epilepsy and Obsessive Compulsive Disorder (OCD). The target treatment of DBS in PD is to reduce the tremor and dystonia symptoms. DBS has been showing the promising result in animal and limited human trial for other conditions such as Alzheimer, Mental Health Problem (Major Depression, Tourette Syndrome), etc. Every surgery has risks of complications, although in DBS the chance is very low. DBS itself had a very satisfying result as long as the subject criteria to be implanted this device based on indication and strictly selection. Other than DBS, there are several brain implant devices that still under development. It was included (not limited to) implant to treat paralysis (In Spinal Cord Injury/Amyotrophic Lateral Sclerosis), enhance brain memory, reduce obesity, treat mental health problem and treat epilepsy. The potential of neurotechnology is unlimited. When brain function and brain implant were fully developed, it may be one of the major breakthroughs in human history like when human find ‘fire’ for the first time. Support from every sector for further research is very needed to develop and unveil the true potential of this technology.

Keywords: brain implant, deep brain stimulation (DBS), deep brain stimulation, Parkinson

Procedia PDF Downloads 155

Authors: Jalil ur Rehman, Ramesh C. Tailor, Muhammad Isa Khan, Jahnzeeb Ashraf, Muhammad Afzal, Geofferry S. Ibbott

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Purpose: The purpose of this analysis was to investigate dose distribution of different techniques (3D-CRT, IMRT and VMAT) of head and neck cancer using 3-dimensional dosimeter called PRESAGETM Dosimeter. Materials and Methods: Computer tomography (CT) scans of radiological physics center (RPC) head and neck anthropomorphic phantom with both RPC standard insert and PRESAGETM insert were acquired separated with Philipp’s CT scanner and both CT scans were exported via DICOM to the Pinnacle version 9.4 treatment planning system (TPS). Each plan was delivered twice to the RPC phantom first containing the RPC standard insert having TLD and film dosimeters and then again containing the Presage insert having 3-D dosimeter (PRESAGETM) by using a Varian True Beam linear accelerator. After irradiation, the standard insert including point dose measurements (TLD) and planar Gafchromic® EBT film measurement were read using RPC standard procedure. The 3D dose distribution from PRESAGETM was read out with the Duke Midsized optical scanner dedicated to RPC (DMOS-RPC). Dose volume histogram (DVH), mean and maximal doses for organs at risk were calculated and compared among each head and neck technique. The prescription dose was same for all head and neck radiotherapy techniques which was 6.60 Gy/friction. Beam profile comparison and gamma analysis were used to quantify agreements among film measurement, PRESAGETM measurement and calculated dose distribution. Quality assurances of all plans were performed by using ArcCHECK method. Results: VMAT delivered the lowest mean and maximum doses to organ at risk (spinal cord, parotid) than IMRT and 3DCRT. Such dose distribution was verified by absolute dose distribution using thermoluminescent dosimeter (TLD) system. The central axial, sagittal and coronal planes were evaluated using 2D gamma map criteria(± 5%/3 mm) and results were 99.82% (axial), 99.78% (sagital), 98.38% (coronal) for VMAT plan and found the agreement between PRESAGE and pinnacle was better than IMRT and 3D-CRT plan excludes a 7 mm rim at the edge of the dosimeter. Profile showed good agreement for all plans between film, PRESAGE and pinnacle and 3D gamma was performed for PTV and OARs, VMAT and 3DCRT endow with better agreement than IMRT. Conclusion: VMAT delivered lowered mean and maximal doses to organs at risk and better PTV coverage during head and neck radiotherapy. TLD, EBT film and PRESAGETM dosimeters suggest that VMAT was better for the treatment of head and neck cancer than IMRT and 3D-CRT.

Keywords: RPC, 3DCRT, IMRT, VMAT, EBT2 film, TLD, PRESAGETM

Procedia PDF Downloads 395

Authors: Nermeen Elbeltagy, Sara Hassan, Tamer Hosny, Mostafa Abdelaziz

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Introduction: Adequate postoperative analgesia after caesarean section (CS) is crucial as it impacts the distinct surgical recovery needs of the parturient. Over recent years, there has been increased interest in regional nerve block techniques with promising results on efficacy. These techniques reduce the need for additional analgesia, thereby lowering the incidence of drug-related side effects. As postoperative pain after cesarean is mainly due to abdominal incision, the transverses abdomenis plane ( TAP ) block is a relatively new abdominal nerve block with excellent efficacy after different abdominal surgeries, including cesarean section. Objective: The main objective is to compare ultrasound-guided TAP block provided by the anesthesiologist with TAP provided by the surgeon through a caesarean incision regarding the duration of postoperative analgesia, intensity of analgesia, timing of mobilization, and easiness of the procedure. Method: Ninety pregnant females at term who were scheduled for delivery by elective cesarean section were randomly distributed into two groups. The first group (45) received spinal anesthesia and postoperative ultrasound guided TAP block using 20ml on each side of 0.25% bupivacaine which was provided by the anesthesiologist. The second group (45) received spinal anesthesia plus a TAP block using 20ml on each side of 0.25% bupivacaine, which was provided by the surgeon through the cesarean incision. Visual Analogue Scale (VAS) was used for the comparison between the two groups. Results: VAS score after four hours was higher among the TAP block group provided by the surgeon through the surgical incision than the postoperative analgesic profile using ultrasound-guided TAP block provided by the anesthesiologist (P=0.011). On the contrary, there was no statistical difference in the patient’s dose of analgesia after four hours of the TAP block (P=0.228). Conclusion: TAP block provided through the surgical incision is safe and enhances early patient’s mobilization.

Keywords: TAP block, CS, VAS, analgesia

Procedia PDF Downloads 49

Authors: Mozhgan Aliakbari, Sara Moridpour

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In recent years, much attention has been given to truck drivers’ fatigue management. Long working hours negatively influence truck drivers’ physiology, health, and safety. However, there is little empirical research in the heavy vehicle transport sector in Australia to identify the influence of working hours’ management on drivers’ fatigue and consequently, on the risk of crashes and injuries. There is no national legislation regulating the number of hours or kilometres travelled by truck drivers. Consequently, it is almost impossible to define a standard number of hours or kilometres for truck drivers in a safety management system. This paper reviews the existing studies concerning safe system interventions such as tachographs in relation to fatigue caused by long working hours. This paper also reviews the literature to identify the influence of frequency of rest breaks on the reduction of work-related road transport accidents involving trucks. A framework is presented to manage truck drivers’ fatigue, which may result in the reduction of injuries and fatalities involving heavy vehicles.

Keywords: fatigue, time management, trucks, traffic safety

Procedia PDF Downloads 288

Authors: Suneeta Gireesh Panicker

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Aim: Aminopeptidase P (APP) is an enzyme that has specificity for proline, can specifically cleave Xaa-Proline peptides and is a metallo-aminopeptidase. The bonds nearby to the imino acid proline are tough to cleave by many peptidases, but APP can specifically break peptide bonds engaged with proline. Membrane-bound form and a cytosolic form are the two forms in which this enzyme exists. The exact physiological function of APP remains unclear and hence the present work attempts to determine it. Methods: In the present study, the expression pattern of cytosolic Aminopeptidase P (DAP) was determined in all the embryonic stages and larval stages of wild-type Drosophila by using polyclonal monospecific antibodies. To show the presence of DAP RNA in embryonic and larval stages, RNA in situ hybridization was performed. DAP promoter-LacZ fusion reporter gene vector was used to construct transgenic embryos to study the regulation pattern of DAP. To study the DAP expression profile, a transgenic fly consisting of a DAP promoter with β-gal and GFP reporter genes in front of it was constructed. Results: DAP protein expression was observed in neuroectodermal cells, posterior midgut primordium, proctodeum, ventral neuroblast and primordial stomatogastric nervous system. It was observed in the ventral cord and midgut in stage 12. The completely developed embryos showed the intense occurrence of it in the ventral cord and gut region. The eye-antennal disc, wing disc and leg disc also showed the presence of DAP protein. LacZ expression in transgenic embryos also showed the same pattern. Conclusion: Similar to various known multiple-functional proteins, DAP could be one with different functions at different stages and in different cells. Data presented here designates DAP functions in the early embryonic and imaginal dics differentiation and development, suggesting that it may be required for the metabolism of proteins like neuropeptides and tachykinins.

Keywords: aminopeptidase P, in situ hybridization, transgenic fly, embryonic stages

Procedia PDF Downloads 85

Authors: Po-Ching Chou, Wen-Chen Liang, I. Chen Chen, Jong-Hau Hsu, Yuh-Jyh Jong

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Background：Cardiopulmonary complications seem to cause high morbidity and mortality in patients with neuromuscular diseases (NMD) but so far there is no domestic data reported in Taiwan. We, therefore attempted to analyze the factors to cause the death in NMD patients from our cohort. Methods：From 1998 to 2013, we retrospectively collected the information of the NMD patients treated and followed up in Kaohsiung Medical University Hospital. Forty-two patients with NMD who expired during these fifteen years were enrolled. The medical records of these patients were reviewed and the causes of death and the associated affecting factors were analyzed. Results：Eighteen patients with NMD (mean age=13.3, SD=12.4) with complete medical record and detailed information were finally included in this study, including spinal muscular atrophy (SMA) (n=9, 7/9: type 1), Duchenne muscular dystrophy (n=6), congenital muscular dystrophy (n=1), carnitine acyl-carnitine translocase (CACT) deficiency (n=1) and spinal muscular atrophy with respiratory distress (SMARD)(n=1). The place of death was in ICU (n=11, 61%), emergency room (n=3, 16.6%) or home (n=4, 22.2%). For SMA type 1 patients, most of them (71.4%, 5/7) died in emergency room or home and the other two expired during an ICU admission. The causes of death included acute respiratory failure due to pneumonia (n=13, 72.2 %), ventilator failure or dislocation (n=2, 11.1%), suffocation/choking (n=2, 11.1%), and heart failure with hypertrophic cardiomyopathy (n=1, 5.55%). Among the 15 patients died of respiratory failure or choking, 73.3% of the patients (n=11) received no ventilator care at home. 80% of the patients (n=12) received no cough assist at home. The patient died of cardiomyopathy received no medications for heart failure until the last admission. Conclusion: Respiratory failure and choking are the leading causes of death in NMD patients. Appropriate respiratory support and airway clearance play the critical role to reduce the mortality.

Keywords: neuromuscular disease, cause of death, tertiary care hospital, medical sciences

Procedia PDF Downloads 532

Authors: Francine Siy, Stephen Buñi

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Safety plays a significant role in everyone’s life on a day-to-day basis. We wish ourselves and our loved ones their safety as we all venture out on our daily commute. The road is undeniably dangerous and unpredictable, with abundant traffic collisions and pedestrians experiencing various injuries. For bicycle users, the risk of accidents is even more exacerbated, and injuries may be severe. Even when cyclists try their best to be safe and protected, the possibility of encountering danger is always there. Despite being equipped with protective gear, safety is never guaranteed. Cyclists often settle for helmets and standard reflector vests to establish a presence on the road. There are different types of vests available, depending on the profession. However, traditional reflector vests, mostly seen on construction workers and traffic enforcers, were not designed for riders and their protection from injuries. With insufficient protection for riders, they need access to ergonomically designed equipment and accessories that suit the riders and cater to their needs. This research aimed to offer a protective vest with safety features for riders that is comfortable, effective, durable, and intuitive. This sheds light and addresses the safety of the biker population, which continuously grows through the years. The product was designed and developed by gathering data and using the cognitive mapping method to ensure that all qualitative and quantitative data were considered in this study to improve other existing products that do not have the proper design considerations. It is known that available equipment for cyclists is often sold separately or lacks the safety features for cyclists traversing open roads. Each safety feature like the headlights, reflectors, signal or rear lights, zipper pouch, body camera attachment, and wireless remote control all play a particular role in helping cyclists embark on their daily commute. These features aid in illumination, visibility, easy maneuvering, convenience, and security, allowing cyclists to go for a safer ride that is of use throughout the day. The product is designed and produced effectively and inexpensively without sacrificing the quality and purpose of its usage.

Keywords: bicycle accessory, protective gear, safety, transport, visibility

Procedia PDF Downloads 83

Authors: Wilai Masanga, Chirapha Tannanonta, Sangutid Thongsawad, Sasikarn Chamchod, Todsaporn Fuangrod

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The major factors of radiotherapy for head and neck (HN) cancers include patient’s anatomical changes and tumour shrinkage. These changes can significantly affect the planned dose distribution that causes the treatment plan deterioration. A measured transit EPID images compared to a predicted EPID images using gamma analysis has been clinically implemented to verify the dose accuracy as part of adaptive radiotherapy protocol. However, a global gamma analysis dose not sensitive to some critical organ changes as the entire treatment field is compared. The objective of this feasibility study is to evaluate the dosimetric response to patient anatomical changes during the treatment course in HN IMRT (Head and Neck Intensity-Modulated Radiation Therapy) using a novel comparison method; organ-of-interest gamma analysis. This method provides more sensitive to specific organ change detection. Random replanned 5 HN IMRT patients with causes of tumour shrinkage and patient weight loss that critically affect to the parotid size changes were selected and evaluated its transit dosimetry. A comprehensive physics-based model was used to generate a series of predicted transit EPID images for each gantry angle from original computed tomography (CT) and replan CT datasets. The patient structures; including left and right parotid, spinal cord, and planning target volume (PTV56) were projected to EPID level. The agreement between the transit images generated from original CT and replanned CT was quantified using gamma analysis with 3%, 3mm criteria. Moreover, only gamma pass-rate is calculated within each projected structure. The gamma pass-rate in right parotid and PTV56 between predicted transit of original CT and replan CT were 42.8%( ± 17.2%) and 54.7%( ± 21.5%). The gamma pass-rate for other projected organs were greater than 80%. Additionally, the results of organ-of-interest gamma analysis were compared with 3-dimensional cone-beam computed tomography (3D-CBCT) and the rational of replan by radiation oncologists. It showed that using only registration of 3D-CBCT to original CT does not provide the dosimetric impact of anatomical changes. Using transit EPID images with organ-of-interest gamma analysis can provide additional information for treatment plan suitability assessment.

Keywords: re-plan, anatomical change, transit electronic portal imaging device, EPID, head, and neck

Procedia PDF Downloads 216

Authors: Shao-Huang Wu, Ai-Yun Wu, Meng-Chen Wu, Chun-Liang Wu, Kai-Ping Shaw, Hsiao-Ting Chen

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Objective: To analyze the forensic autopsy data of known passengers and compare it with the National database of the autopsy report in 2017, and obtain the special patterned injuries, which can be used as the reference for the reconstruction of hit-and-run motor vehicle accidents. Methods: Analyze the items of the Motor Vehicle Accident Report, including Date of accident, Time occurred, Day, Acc. severity, Acc. Location, Acc. Class, Collision with Vehicle, Motorcyclists Codes, Safety equipment use, etc. Analyzed the items of the Autopsy Report included, including General Description, Clothing and Valuables, External Examination, Head and Neck Trauma, Trunk Trauma, Other Injuries, Internal Examination, Associated Items, Autopsy Determinations, etc. Materials: Case 1. The process of injury formation: the car was chased forward and collided with the scooter. The passenger wearing the helmet fell to the ground. The helmet crashed under the bottom of the sedan, and the bottom of the sedan was raised. Additionally, the sedan was hit on the left by the other sedan behind, resulting in the front sedan turning 180 degrees on the spot. The passenger’s head was rotated, and the cervical spine was fractured. Injuries: 1. Fracture of atlantoaxial joint 2. Fracture of the left clavicle, scapula, and proximal humerus 3. Fracture of the 1-10 left ribs and 2-7 right ribs with lung contusion and hemothorax 4. Fracture of the transverse process of 2-5 lumbar vertebras 5. Comminuted fracture of the right femur 6. Suspected subarachnoid space and subdural hemorrhage 7. Laceration of the spleen. Case 2. The process of injury formation: The motorcyclist wearing the helmet fell to the left by himself, and his chest was crushed by the car going straight. Only his upper body was under the car and the helmet finally fell off. Injuries: 1. Dislocation of atlantoaxial joint 2. Laceration on the left posterior occipital 3. Laceration on the left frontal 4. Laceration on the left side of the chin 5. Strip bruising on the anterior neck 6. Open rib fracture of the right chest wall 7. Comminuted fracture of both 1-12 ribs 8. Fracture of the sternum 9. Rupture of the left lung 10. Rupture of the left and right atria, heart tip and several large vessels 11. The aortic root is nearly transected 12. Severe rupture of the liver. Results: The common features of the two cases were the fracture or dislocation of the atlantoaxial joint and both helmets that were crashed. There were no atlantoaxial fractures or dislocations in 27 pedestrians (without wearing a helmet) versus motor vehicle accidents in 2017 the National database of an autopsy report, but there were two atlantoaxial fracture or dislocation cases in the database, both of which were cases of falling from height. Conclusion: The cervical spine fracture injury of the motorcyclist, who was wearing a helmet, is very likely to be a patterned injury caused by his/her fall and rollover under the sedan. It could provide a reference for forensic peers.

Keywords: patterned injuries, atlantoaxial fracture or dislocation, accident reconstruction, motorcycle accident with helmet, forensic autopsy data

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Authors: Alireza Saidi

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Aside from injuries due to direct contact with hot or cold substances or objects, exposure to extreme temperatures in the workplace involves physical hazards to workers. On the other hand, a poorly acclimatized worker may have reduced performance and alertness and may, therefore, be more vulnerable to the risk of accidents and injuries. Due to the incompatibility of the standards put in place with certain workplaces and the lack of thermoregulation in many protective equipments, thermal strains remain among the physical risks most present in many work sectors. However, many of these problems can be overcome thanks to the potential of intelligent textile technologies allowing intelligent thermoregulation in protective equipment. Nowadays, technologies such as heating elements, cooling elements are applied in products intended for sport and leisure, and research work has been carried out in the integration of temperature sensors and thermal stress detectors in personal protective equipment. However, the usage of all of these technologies in personal protective equipment remains very marginal. This article presents a portrait of the current state of intelligent thermoregulation systems by carrying out a synthesis of technical developments, which is accompanied by a gap analysis of current developments. Thus, the research work necessary for the adaptation and integration of intelligent thermoregulation systems with personal protective equipment is discussed in order to offer a perspective of future developments.

Keywords: personal protective equipment, smart textiles, thermoregulation, thermal strain

Procedia PDF Downloads 110

Authors: Muhamad Ammar Bin Mohd Asri, Muhammad Hamizan Bin Yusof, Muhammad Haziq Bin Abdul Khalil, Esman Hanief Bin Khairul Anuar, Muhammad Fikri Bin Ishak, Amril Azim Bin Mohd Norrahim, Muhammad Danial Fakhri Bin Fakhruddin, Muhammad Khairul Nizam in Hosnodin, Muhammad Ezzat Hariz Bin Norhisam

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Ergonomics is the science of creating and arranging workplaces, products, and systems to increase human performance, comfort, and safety. This study researched ergonomics as a solution for preventing workplace injuries, specifically musculoskeletal disorders, among employers and employees. The method will be used in this project is a literature review which means conducting a study about ergonomics with peer-reviewed journal articles and books. It focuses on employees and employers who are in one company on other departments under the protection of Occupational Safety and Health (OSHA). These solutions include ergonomic assessments, workplace design improvements, effective training and education, and the use of ergonomic tools and equipment. Employers can build workplaces that are safer and more productive by putting these solutions in place, and employees can work comfortably and prevent accidents from bad ergonomics. Overall, the paper highlights how crucial it is to take injury prevention measures and consider ergonomics at work.

Keywords: occupational safety and health, musculoskeletal disorders, ergonomic, ergonomic risk

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Authors: Zi-Han Li, Lu Fang, Liang Wu, Dong-Yuan Chang, Manyuan Dong, Liang Ji, Qi Zhang, Ming-Hui Zhao, Sydney C. W. Tang, Lemin Zheng, Min Chen

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Uncoupling of mitochondrial respiration by chemical uncouplers has proven effective in ameliorating obesity, insulin resistance, and hyperglycemia, which were risk factors for diabetic nephropathy (DN). Recently, we found that ANXA1 could improve mitochondrial function to mitigate DN progression. However, the underlying mechanism is not fully clear yet. Here, we identified uncoupling protein 1 (UCP1), an inner membrane protein of mitochondria, as a key to mitochondrial homeostasis improved by ANXA1. Specifically, ANXA1 attenuated mitochondrial dysfunction via appropriately upregulating UCP1 by stabilizing its transcription factor GATA binding protein 3 (GATA3) by combining it with thioredoxin. Moreover, specific overexpression of UCP1 in the renal cortex rescued renal injuries in diabetic Anxa1-KO mice. UCP1 deletion aggravated renal injuries in HFD/STZ-induced diabetic mice. Mechanistically, UCP1 reduced mitochondrial fission through the aristaless-related homeobox (ARX)/cardiolipin synthase 1 (CRLS1) pathway. Therapeutically, CL316243, a UCP1 agonist, could attenuate established DN in db/db mice. This work established an alternative principle to harness the power of uncouplers for the treatment of DN.

Keywords: diabetic nephropathy, uncoupling protein 1, mitochondrial homeostasis, cardiolipin metabolism

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Authors: Seyed Abbas Tabatabaei, Afshin Ghanbarzadeh, Mehdi Abidizadeh

Abstract:

Nowadays the subject of road traffic accidents and the high social and economic costs due to them is the most fundamental problem that experts and providers of transport and traffic brought to a challenge. One of the most effective measures is to enhance the skid resistance of road surface. This research aims to study the intersection of one case in Ahwaz and the effect of increasing the skid resistance in reducing pedestrian injuries in accidents at intersections. In this research the device was developed to measure the coefficient of friction and tried the rules and practices of it have a high similarity with the Locked Wheel Trailer. This device includes a steel frame, wheels, hydration systems, and force gauge. The output of the device is that the force gauge registers. By investigate this data and applying the relationships relative surface coefficient of friction is obtained. Friction coefficient data for the current state and the state of the new pavement are obtained and plotted on the graphs based on the graphs we can compare the two situations and speed at the moment of collision between the two modes are compared. The results show that increasing the coefficient of friction to what extent can be effective on the severity and number of accidents.

Keywords: intersection, coefficient of friction, skid resistance, locked wheels, accident, pedestrian

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Authors: Zi-Han Li, Lu Fang, Liang Wu, Dong-Yuan Chang, Manyuan Dong, Liang Ji, Qi Zhang, Ming-Hui Zhao, Sydney C.W. Tang, Lemin Zheng, Min Chen

Abstract:

Uncoupling of mitochondrial respiration by chemical uncouplers has proven effective in ameliorating obesity, insulin resistance, and hyperglycemia, which were risk factors for diabetic nephropathy (DN). Recently, it was found that annexin A1(ANXA1) could improve mitochondrial function to mitigate DN progression. However, the underlying mechanism is not fully clear yet. Here, it was identified that uncoupling protein 1 (UCP1), an inner membrane protein of mitochondria, as a key to mitochondrial homeostasis improved by ANXA1. Specifically, ANXA1 attenuated mitochondrial dysfunction via appropriately upregulating UCP1 by stabilizing its transcription factor GATA binding protein 3 (GATA3) through combining with thioredoxin. Moreover, specific overexpression of UCP1 in renal cortex rescued renal injuries in diabetic Anxa1-KO mice. UCP1 deletion aggravated renal injuries in HFD/STZ-induced diabetic mice. Mechanistically, UCP1 reduced mitochondrial fission through the aristaless-related homeobox (ARX)/cardiolipin synthase 1 (CRLS1) pathway. Therapeutically, CL316243, a UCP1 agonist, could attenuate established DN in db/db mice. This work established a novel principle to harness the power of uncouplers for the treatment of DN.

Keywords: diabetic nephropathy, uncoupling protein 1, mitochondrial homeostasis, cardiolipin metabolism

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Authors: Knol Hester, Müller Swantje, Danchenko Natalya

Abstract:

Objective: Falls in older people cause an autonomy loss and result in an economic burden. LCare is an AI-based application to manage fall risks. The study's aim was to assess the effect of LCare use on patient outcomes in nursing homes in Germany. Methods: LCare identifies and monitors fall risks through a 3D-gait analysis and a digital questionnaire, resulting in tailored recommendations on fall prevention. A study was conducted with AOK Baden-Württemberg (01.09.2019- 31.05.2021) in 16 care facilities. Assessments at baseline and follow-up included: a fall risk score; falls (baseline: fall history in the past 12 months; follow-up: a fall record since the last analysis); fall-related injuries and hospitalizations; gait speed; fear of falling; psychological stress; nurses experience on app use. Results: 94 seniors were aged 65-99 years at the initial analysis (average 84±7 years); 566 mobility analyses were carried out in total. On average, the fall risk was reduced by 17.8 % as compared to the baseline (p<0.05). The risk of falling decreased across all subgroups, including a trend in dementia patients (p=0.06), constituting 43% of analyzed patients, and patients with walking aids (p<0.05), constituting 76% of analyzed patients. There was a trend (p<0.1) towards fewer falls and fall-related injuries and hospitalizations (baseline: 23 seniors who fell, 13 injury consequences, 9 hospitalizations; follow-up: 14 seniors who fell, 2 injury consequences, 0 hospitalizations). There was a 16% improvement in gait speed (p<0.05). Residents reported less fear of falling and psychological stress by 38% in both outcomes (p<0.05). 81% of nurses found LCare effective. Conclusions: In the presented study, the use of LCare app was associated with a reduction of fall risk among nursing home residents, improvement of health-related outcomes, and a trend toward reduction in injuries and hospitalizations. LCare may help to improve senior resident care and save healthcare costs.

Keywords: falls, digital healthcare, falls prevention, nursing homes, seniors, AI, digital assessment

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Authors: Avik Banerjee, Kavita Saggar

Abstract:

Infections of the nervous system and adjacent structures are often life-threatening conditions. Despite the recent advances in neuroimaging evaluation, the diagnosis of unclear infectious CNS disease remains a challenge. Our aim is to evaluate the typical and atypical neuro-imaging features of the various routinely encountered CNS infected patients so as to form guidelines for their imaging recognition and differentiation from tumoral, vascular and other entities that warrant a different line of therapy.

Keywords: central nervous system (CNS), Cerebro Spinal Fluid (Csf), Creutzfeldt Jakob Disease (CJD), progressive multifocal leukoencephalopathy (PML)

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Authors: Jochen Nelles, Susanne Kohns, Julia Spies, Friederike Schmitz-Buhl, Roland Thietje, Christopher Brandl, Alexander Mertens, Christopher M. Schlick

Abstract:

Industrial robots as part of highly automated manufacturing are recently developed to cooperative (light-weight) robots. This offers the opportunity of using them as assistance robots and to improve the participation in professional life of disabled or handicapped people such as tetraplegics. Robots under development are located within a cooperation area together with the working person at the same workplace. This cooperation area is an area where the robot and the working person can perform tasks at the same time. Thus, working people and robots are operating in the immediate proximity. Considering the physical restrictions and the limited mobility of tetraplegics, a hands-free robot control could be an appropriate approach for a cooperative assistance robot. To meet these requirements, the research project MeRoSy (human-robot synergy) develops methods for cooperative assistance robots based on the measurement of head movements of the working person. One research objective is to improve the participation in professional life of people with disabilities and, in particular, mobility impaired persons (e.g. wheelchair users or tetraplegics), whose participation in a self-determined working life is denied. This raises the research question, how a human-robot cooperation workplace can be designed for hands-free robot control. Here, the example of a library scenario is demonstrated. In this paper, an empirical study that focuses on the impact of head movement related stress is presented. 12 test subjects with tetraplegia participated in the study. Tetraplegia also known as quadriplegia is the worst type of spinal cord injury. In the experiment, three various basic head movements were examined. Data of the head posture were collected by a motion capture system; muscle activity was measured via surface electromyography and the subjective mental stress was assessed via a mental effort questionnaire. The muscle activity was measured for the sternocleidomastoid (SCM), the upper trapezius (UT) or trapezius pars descendens, and the splenius capitis (SPL) muscle. For this purpose, six non-invasive surface electromyography sensors were mounted on the head and neck area. An analysis of variance shows differentiated muscular strains depending on the type of head movement. Systematically investigating the influence of different basic head movements on the resulting strain is an important issue to relate the research results to other scenarios. At the end of this paper, a conclusion will be drawn and an outlook of future work will be presented.

Keywords: assistance robot, human-robot interaction, motion capture, stress-strain-concept, surface electromyography, tetraplegia

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Authors: Nguyen-Tri Phuong, Triki Ennouri, Gauvin Chantal, Tuduri Ludovic, Vu-Khanh Toan

Abstract:

Hand injuries due to mechanical hazards such as cuts and punctures are major risks and concerns for several occupational groups, particularly for workers in the metal manufacturing sector and mechanical automotive services. Personal protective equipment such as gloves or clothing is necessary for many professionals to protect against a variety of occupational hazards, which arise daily in their work environments. In many working places such as metal manufacturing or automotive services, mechanical hazards often occur together with industrial contaminants, particularly metalworking fluids (MWFs). The presence of these contaminants could modify the properties of gloves made from polymeric materials and thus increase the risk of hand injuries for workers. The focus of this study is to determine the swelling characteristics and the resistance of six polymer membranes when they are contaminated with several industrial metalworking fluids. These polymer membranes, commonly used in protective gloves, are nitrile, neoprene, vinyl, butyl, polyurethane and latex rubbers. Changes swelling index were continuously followed during the contamination procedure to compare the performance of each polymer under different conditions. The modification of the samples surface, tensile properties during the contamination process was also investigated. The effect of temperature on mechanical properties and morphology of material was also examined.

Keywords: metalworking fluid, swelling behavior, protective glove materials, elastomers

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Authors: Amirul Adlan, Motaz AlAqeel, Scott Evans, Vaiyapuri sumathi, Mark Davies, Rajesh Botchu

Abstract:

Background & Objectives: Osteoid osteoma (OO) is a benign tumor of the bone commonly found in childhood and adolescence, causing bone pain, especially during the night. CT-guided radiofrequency ablation (RFA) is currently the mainstay treatment for OO. There is currently no literature reporting the outcomes of OO following RFA based on the histological presence of a nidus seen on a biopsy taken at the time of RFA. The primary aim of this study was to compare the clinical outcomes of OO between the group of patients with the presence of nidus on biopsy samples from RFA with those without nidus. Secondly, we aimed to examine other factors that may affect the outcomes of OO, reflecting our experience as a tertiary orthopedic oncology center. Methods: We retrospectively reviewed 88 consecutive patients diagnosed with osteoid osteoma treated with RFA between November 2005 and March 2015, consisting of 63 males (72%) and 25 females (28%). Sixty-six patients (75%) had nidus present in their biopsy samples. Patients’ mean age was 17.6 years (4-53). The median duration of follow-up was 12.5 months (6-20.8). Lesions were located in the appendicular skeleton in seventy-nine patients (90%), while nine patients (10%) had an OO in the axial skeleton. Outcomes assessed were based on patients’ pain alleviation (partial, complete, or no pain improvement) and the need for further interventions. Results: Pain improvement in the patient group with nidus in the histology sample was significantly better than in the group without nidus (OR 7.4, CI 1.35-41.4, p=0.021). The patient group with nidus on biopsy demonstrated less likelihood of having a repeat procedure compared to the group without nidus(OR 0.092, CI 0.016-0.542, p=0.008). Our study showed significantly better outcomes in pain improvement in appendicular lesions compared to the axially located lesions (p = 0.005). Patients with spinal lesions tend to have relatively poor pain relief than those with appendicular or pelvic lesions (p=0.007). Conclusions: Patients with nidus on histology had better pain alleviation compared to patients without nidus. The histological presence of nidus significantly reduces the chance of repeat interventions. The pain alleviation of osteoid osteoma following RFA is better in patients with appendicular lesions than spinal or axially located lesions.

Keywords: osteoid osteoma, benign tumour, radiofrequency ablation, oncology

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Authors: Hansraj Bookun, Rachel Xuan, Angela Tan, Kejia Wang, Animesh Singla, David Kim, Christopher Loupos, Jim Iliopoulos

Abstract:

Introduction: Complex endovascular aortic aneursymal repairs with fenestrated and branched endografts require customised devices to exclude the pathology while reducing morbidity and mortality, which was historically associated with open repair of complex aneurysms. Such endovascular procedures have predominantly been performed in a large volume dedicated tertiary centres. We present here our nine year multidisciplinary experience with this technology in an Australian tertiary centre. Method: This was a cross-sectional, single-centre observational study of 670 patients who had undergone complex endovascular aortic aneurysmal repairs with conventional endografts, fenestrated endografts, and iliac-branched devices from January 2010 to July 2019. Descriptive statistics were used to characterise our sample with regards to demographic and perioperative variables. Homogeneity of the sample was tested using multivariant regression, which did not identify any statistically significant confounding variables. Results: 670 patients of mean age 74, were included (592 males) and the comorbid burden was as follows: ischemic heart disease (55%), diabetes (18%), hypertension (90%), stage four or greater kidney impairment (8%) and current or ex-smoking (78%). The main indications for surgery were elective aneurysms (86%), symptomatic aneurysms (5%), and rupture aneurysms (5%). 106 patients (16%) underwent fenestrated or branched endograft repairs. The mean length of stay was 7.6 days. 2 patients experienced reactionary bleeds, 11 patients had access wound complications (6 lymph fistulae, 5 haematoms), 11 patients had cardiac complications (5 arrhythmias, 3 acute myocadial infarctions, 3 exacerbation of congestive cardiac failure), 10 patients had respiratory complications, 8 patients had renal impairment, 4 patients had gastrointestinal complications, 2 patients suffered from paraplegia, 1 major stroke, 1 minor stroke, and 1 acute brain syndrome. There were 4 vascular occlusions requiring further arterial surgery, 4 type I endoleaks, 4 type II endoleaks, 3 episodes of thromboembolism, and 2 patients who required further arterial operations in the setting of patient vessels. There were 9 unplanned returns to the theatre. Discussion: Our numbers of 10 years suggest that we are not a dedicated high volume centre focusing on aortic repairs. However, we have achieved significantly low complication rates. This can be attributed to our multidisciplinary approach with the intraoperative involvement of skilled interventional radiologists and vascular surgeons as well as postoperative protocols with particular attention to spinal cord protection. Additionally, we have a ratified perioperative pathway that involves multidisciplinary team discussions of patient-related factors and lesion-centered characteristics, which allows for holistic, patient-centered care.

Keywords: aneurysm, aortic, endovascular, fenestrated

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Authors: Janki Shankar, Shu Ping Chen

Abstract:

Background: New immigrants are one of most vulnerable sections of the Canadian society. Unable to gain entry into Canada’s strictly regulated professions and trades, several skilled and qualified new immigrants take up precarious jobs without adequate occupational health and safety training, thereby increasing their risk of sustaining occupational injury and illness compared to Canadian born workers. Access to timely and appropriate support is critical for injured new immigrant workers who face additional challenges compared to Canadian born workers in accessing information and support post-injury. The purpose of our study was to explore the post-injury experiences and support needs of new immigrant workers who have sustained work-related injuries. Methods: Using an interpretive research approach and semi structured face to face qualitative interviews, 27 new immigrant workers from a range of industries operating in two cities in a province in Canada were interviewed. All had sustained work-related injuries and reported these to their work supervisors. A constant comparative approach was used to identify key themes across the worker experiences. Results: Findings reveal several factors that can shape the experiences of new immigrant workers and influence their return-to-work outcomes. Conclusion: Based on the insights of study participants, policies, practices, and potential interventions informed by their needs and preferences are proposed that can improve return to work outcomes for these workers.

Keywords: new immigrant workers, post-injury experiences, return to work outcomes, qualified

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Authors: Eiji Nakamachi, Ryota Sakiyama, Koji Yamamoto, Yusuke Morita, Hidetoshi Sakamoto

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The regeneration of injured central nerve network caused by the cerebrovascular accidents is difficult, because of poor regeneration capability of central nerve system composed of the brain and the spinal cord. Recently, new regeneration methods such as transplant of nerve cells and supply of nerve nutritional factor were proposed and examined. However, there still remain many problems with the canceration of engrafted cells and so on and it is strongly required to establish an efficacious treating method of a central nerve system. Blackman proposed the electromagnetic stimulation method to enhance the axonal nerve extension. In this study, we try to design and fabricate a new three-dimensional (3D) bio-reactor, which can load a uniform AC magnetic field stimulation on PC12 cells in the extracellular environment for enhancement of an axonal nerve extension and 3D nerve network generation. Simultaneously, we measure the morphology of PC12 cell bodies, axons, and dendrites by the multiphoton excitation fluorescence microscope (MPM) and evaluate the effectiveness of the uniform AC magnetic stimulation to enhance the axonal nerve extension. Firstly, we designed and fabricated the uniform AC magnetic field stimulation bio-reactor. For the AC magnetic stimulation system, we used the laminated silicon steel sheets for a yoke structure of 3D chamber, which had a high magnetic permeability. Next, we adopted the pole piece structure and installed similar specification coils on both sides of the yoke. We searched an optimum pole piece structure using the magnetic field finite element (FE) analyses and the response surface methodology. We confirmed that the optimum 3D chamber structure showed a uniform magnetic flux density in the PC12 cell culture area by using FE analysis. Then, we fabricated the uniform AC magnetic field stimulation bio-reactor by adopting analytically determined specifications, such as the size of chamber and electromagnetic conditions. We confirmed that measurement results of magnetic field in the chamber showed a good agreement with FE results. Secondly, we fabricated a dish, which set inside the uniform AC magnetic field stimulation of bio-reactor. PC12 cells were disseminated with collagen gel and could be 3D cultured in the dish. The collagen gel were poured in the dish. The collagen gel, which had a disk shape of 6 mm diameter and 3mm height, was set on the membrane filter, which was located at 4 mm height from the bottom of dish. The disk was full filled with the culture medium inside the dish. Finally, we evaluated the effectiveness of the uniform AC magnetic field stimulation to enhance the nurve axonal extension. We confirmed that a 6.8 increase in the average axonal extension length of PC12 under the uniform AC magnetic field stimulation at 7 days culture in our bio-reactor, and a 24.7 increase in the maximum axonal extension length. Further, we confirmed that a 60 increase in the number of dendrites of PC12 under the uniform AC magnetic field stimulation. Finally, we confirm the availability of our uniform AC magnetic stimulation bio-reactor for the nerve axonal extension and the nerve network generation.

Keywords: nerve regeneration, axonal extension , PC12 cell, magnetic field, three-dimensional bio-reactor

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Authors: David Mafullul, Jiang Lei, Edward Goacher, Jibin Francis

Abstract:

PURPOSE: Timely decompressive surgery for cauda equina syndrome (CES) is dependent on efficient referral pathways for patients presenting at local primary or secondary centres to tertiary spinal centres in the United Kingdom (UK). Identifying modifiable points of delay within this process is important as minimising time between presentation and surgery may improve patient outcomes. This study aims to analyse whether adequacy of referral impacts on time to surgery in CES. MATERIALS AND METHODS: Data from all cases of confirmed CES referred to a single tertiary UK hospital between August 2017 to December 2019, via a suspected CES e-referral pathway, were obtained retrospectively. Referral adequacy was defined by the inclusion of sufficient information to determine the presence or absence of several NICE ‘red flags’. Correlation between referral adequacy and delay from referral-to-surgery was then analysed. RESULTS: In total, 118 confirmed CES cases were included. Adequate documentation for saddle anaesthesia was associated with reduced delays of more than 48 hours from referral-to-surgery [X2(1, N=116)=7.12, p=.024], an effect partly attributable to these referrals being accepted sooner [U=16.5; n1=27, n2=4, p=.029, r=.39]. Other red flags had poor association with delay. Referral adequacy was better for somatic red flags [bilateral sciatica (97.5%); severe or progressive bilateral neurological deficit of the legs (95.8%); saddle anaesthesia (91.5%)] compared to autonomic red flags [loss of anal tone (80.5%); urinary retention (79.7%); faecal incontinence or lost sensation of rectal fullness (57.6%)]. Although referral adequacy for urinary retention was 79.7%, only 47.5% of referrals documented a post-void residual numerical value. CONCLUSIONS: Adequate documentation of saddle anaesthesia in e-referrals is associated with reduced delay-to-surgery for confirmed CES, partly attributable to these referrals being accepted sooner. Other red flags had poor association with delay to surgery. Referral adequacy for autonomic red flags, including documentation for post-void residuals, has significant room for improvement.

Keywords: cauda equina, cauda equina syndrome, neurosurgery, spinal surgery, decompression, delay, referral, referral adequacy

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Authors: Lamia Bouzgarrou, Amira Omrane, Leila Mrabet, Taoufik Khalfallah

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Background and aims: School accidents are one of the leading causes of morbidity and mortality among pupils and students. Indeed, they may induce an elevated number of lost school days, heavy emotional and physical disabilities, and financial costs on the victims and their families. This study aims to evaluate the annual incidence of school accidents in the central Tunisian governorate of Mahdia and to identify the epidemiological profile of victims and risk factors of these accidents. Methods: A retrospective study was conducted over the period of 5 school years, focusing on school accidents that occurred in public educational institutions (primary, basic, secondary and university) in the governorate of Mahdia (area = 2 966 km² and number of inhabitants in 2014 = 410 812). All accidents declared near the only official insurance of this type of injuries (MASU: Mutual School and University Accidents), and initially taken in charge at the University Hospital of Mahdia were included. Data was collected from the MASU reporting forms and the medical records of emergency and other specialized hospital departments. Results: With 3248 identified victims, the annual incidence of school accidents was equal to 0.69 per 100 pupils and students per year. The average age of victims was 14.51 ± 0.059 years and the sex ratio was 1.58. Pupils aged between 12 and 15 years, were concerned by 46.7% of the identified accidents. The practice of sports was the most relevant circumstances of these accidents (76.2 %). In 56.58 % of cases, falls were the leading mechanism. Bruises and fractures were the most frequent lesions (32.43 % and 30.51 %). Serious school accidents were noted in 28% of cases with hospitalization in 2.27 % of them. The average lost school days, was 12.23±1.73 days. Accidents occurring during sports or leisure activities were significantly more serious (p= 0.021). Furthermore, the frequency of hospitalization was significantly higher among boys (2.81% vs. 1.43%; p= 0.035), students ≤11 years (p= 0.008), and following crush trauma (p= 0.000). In addition, the surgical interventions were statistically more frequent among male victims (p=0.00), accidents occurring during physical education sessions (p=0.000); those associated to falls (p=0.000) and to crushes mechanisms (p=0.002), and injuries affecting lower limbs (p=0.000). Following this Multi-varied analysis concluded that the severity of school accident is correlated to the activity practiced during the trauma and the geographical location of the school. Conclusion: Children and adolescents are one of the most vulnerable groups against incidents with the risk of permanent disability, mainly related to the perturbation of the growth process and physiological limitations. Our five-year study, objectified a real elevate incidence of school accident among children and adolescents, with a considerable rate of severe injuries. In any community, the promotion of adolescents and children’s health is an important indicator of the public health level. Thus, it’s important to develop a multidisciplinary prevention strategy of school accident, based on safety and security rules and adapted to the specificity of our context.

Keywords: children and adolescents, children health, injuries and disability, school accident

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