Search results for: blunt trauma

Authors: Hassan Ibrahim

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The prevalence of hyperacusis, an auditory condition characterized by heightened sensitivity to sounds, continues to rise, posing challenges for effective diagnosis and intervention. It is believed that this work deepens will deepens the understanding of hyperacusis etiology by employing graph theory as a novel analytical framework. it constructed a comprehensive graph wherein nodes represent various factors associated with hyperacusis, including aging, head or neck trauma, infection/virus, depression, migraines, ear infection, anxiety, and other potential contributors. Relationships between factors are modeled as edges, allowing us to visualize and quantify the interactions within the etiological landscape of hyperacusis. it employ the concept of the metric dimension of a connected graph to identify key nodes (landmarks) that serve as critical influencers in the interconnected web of hyperacusis causes. This approach offers a unique perspective on the relative importance and centrality of different factors, shedding light on the complex interplay between physiological, psychological, and environmental determinants. Visualization techniques were also employed to enhance the interpretation and facilitate the identification of the central nodes. This research contributes to the growing body of knowledge surrounding hyperacusis by offering a network-centric perspective on its multifaceted causes. The outcomes hold the potential to inform clinical practices, guiding healthcare professionals in prioritizing interventions and personalized treatment plans based on the identified landmarks within the etiological network. Through the integration of graph theory into hyperacusis research, the complexity of this auditory condition was unraveled and pave the way for more effective approaches to its management.

Keywords: auditory condition, connected graph, hyperacusis, metric dimension

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Authors: Jireh Reinor L. Vitto, Mylene S. Gumarao, Levy M. Fajanilan, Sheryll Ann M. Castillo, Leonardo B. Dorado, Miriam P. Narbarte

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Human trafficking may happen to anyone. The study aimed to explore the experiences of victim witnesses of human trafficking. It utilized a qualitative phenomenological study design. Eighteen women, 15 to 46 years old, had experienced human trafficking (sex or labor trafficking), and with a filed case or not. An in-depth semi-structured, open-ended interview was employed to gather information. Guardians were also interviewed for triangulation purposes. Findings showed that the participants experienced fatigue and abuse for their physical aspect and gained negative feelings such as burdened, sad, scared (fear), stress, anger, trauma, depress and suicidal thoughts for their psychological aspect. For the spiritual aspect, the participants concluded to have enhanced spiritual life where they knew about God, became closer to God, and learned how to pray. They also faced challenges such as dysfunctional family, delinquent friends, exploitation, problems kept from the family, and poverty, which resulted in their becoming victims of human trafficking. To cope with the situation, they utilized family support, prayers, guts or courage (lakas ng loob), negotiation with their employer, and support from kababayans. Their practices and mechanisms to recover were the Blas Ople Center, rescue/entrapment operation, shelter, and embassy. After the incident, the participants shared that they earned to have thoughts of having a good life without going abroad/makabayan, knowledge of overseas Filipino workers, wise choice of friends, contentment, and value for the family.

Keywords: victim-witnesses, human trafficking, lived experiences, challenges, coping strategies

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Authors: L. Petrosyan

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The problem of psychologist training remains a key priority in Armenia. During the Soviet period, the notion of a psychologist was obscure not only in Armenia but also in other Soviet republics. The breakup of the Soviet Union triggered a gradual change in this area activating the cooperation with specialists from other countries. The need for recovery from the psychological trauma caused by the 1988 earthquake pushed forward the development of practical psychology in Armenia. This phenomenon led to positive changes in perception of and interest to a psychologist profession.Armenian universities started designing special programs for psychologists’ preparation. Armenian psychologists combined their efforts in the field of training relevant specialists. During the recent years, the Bologna educational system was introduced in Armenia which led to implementation of education quality improvement programs. Nevertheless, even today the issue of psychologists’ training is not yet settled in Armenian universities. So far graduate psychologists haven’t got a clear idea of personal and professional qualities of a psychologist. Recently, as a result of educational reforms, the psychology curricula underwent changes, but so far they have not led to a desired outcome. Almost all curricula in certain specialties are aimed to form professional competencies and strengthen practical skills. A survey conducted in Armenia aimed to identify what are the ideas of young psychology specialists on the image of a psychologist. The survey respondents were 45 specialists holding bachelor’s degree as well as 30 master degree graduates, who have not been working yet. The research reveals that we need to change the approach of preparing psychology practitioners in the universities of Armenia. Such an approach to psychologist training will make it possible to train qualified specialists for enhancement of modern psychology theory and practice.

Keywords: practitioners, psychology degree, study, professional competencies

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Authors: Medagedara Kaushalya Sewwandi Supun Gunarathne

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This research explores the underlying motivations and consequences of individuals changing their sexual orientation as a response to sexual violence. The primary objective of the study is to unravel the psychological, emotional, and social factors that drive individuals, akin to Celie in Alice Walker’s ‘The Color Purple’, to contemplate and undergo changes in their sexual orientation following the trauma of sexual violence. Through an analytical and qualitative approach, the study employs in-depth textual and thematic analyses to scrutinize the complex interplay between sexual orientation and violence within the selected text. Through a close examination of Celie’s journey and experiences, the study reveals that her decision to switch sexual orientation arises from a desire for a more favorable and benevolent relationship driven by the absence of safety and refuge in her previous relationships. By establishing this bond between sexual orientation and violence, the research underscores how sexual violence can lead individuals to opt for a change in their sexual orientation. The findings highlight Celie’s transformation as a means to seek solace and security, thus concluding that sexual violence can prompt individuals to alter their sexual orientation. The ensuing discussion explores the implications of these findings, encompassing psychological, emotional, and social consequences, as well as the societal and cultural factors influencing the perception of sexual orientation. Additionally, it sheds light on the challenges and stigma faced by those who undergo such transformations. By comprehending the complex relationship between sexual violence and the decision to change sexual orientation, as exemplified by Celie in ‘The Color Purple’, a deeper understanding of the experiences of survivors who seek a safe haven through altering their sexual orientation can be attained.

Keywords: sexual violence, sexual orientation, refuge, transition

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Authors: S. Shafiee Ardestani, A. Najafi, N. Valizadeh, E. Payani, H. Karimian

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Objectives: Treatment of mild traumatic brain injury in emergency ward patients with any type of traumatic intracranial hemorrhage is flexible. The aim of this study is to assess the clinical outcomes of mild traumatic brain injury patients who had acute traumatic intracranial hemorrhage on initial emergency ward neuroimaging. Materials-Methods: From March 2011 to November 2012 in a retrospective cohort study we enrolled emergency ward patients with mild traumatic brain injury with Glasgow Coma Scale (GCS) scores of 14 or 15 and who had stable vital signs. Patients who had any type of intracranial hemorrhage on first head CT and repeat head CT within 24 hours were included. Patients with initial GCS < 14, injury > 24 hours old, pregnancy, concomitant non-minor injuries, and coagulopathy were excluded. Primary endpoints were neurosurgical procedures and/or death and for discharged patients, return to the emergency ward during one week. Results: Among 755 patients who were referred to the emergency ward and underwent two head CTs during first 24 hours, 302 (40%) were included. The median interval between CT scans was 6 hours (ranging 4 to 8 hours). Consequently, 135 (45%) patients had subarachnoid hemorrhage, 124 (41%) patients had subdural hemorrhage, 15 (5%) patients had epidural hemorrhage, 28 (9%) patients had cerebral contusions, and 54 (18%) patients had intra-parenchymal hemorrhage. Six of 302 patients died within 15 days of injury. 200 patients (66%) have been discharged from the emergency ward, 25 (12%) of whom returned to the emergency ward after one week. Conclusion: Discharge of the head trauma patients after a repeat head CT and brief period of observation in the emergency ward lead to early discharge of mild traumatic brain injury patients with traumatic ICH without adverse events.

Keywords: clinical outcomes, emergency ward, mild traumatic intracranial hemorrhage, Glasgow Coma Scale (GCS)

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Authors: Khadeeja Munawar, Shamsul Haque

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The claim that traumatic events influence the recalled memories and mental health has received mixed empirical support. This study examines the memories of a sample drawn from Pakistan, a country that has witnessed many life-changing socio-political events, wars, and natural disasters in 72 years of its history. A sample of 210 senior citizens (Mage = 64.35, SD = 6.33) was recruited from Pakistan. The aim was to investigate if participants retrieved more memories related to past traumatic events using a word-cueing technique. Each participant reported ten memories to ten neutral cue words. The results revealed that past traumatic events were not adversely affecting the memories and mental health of participants. When memories were plotted with respect to the ages at which the events happened, a pronounced bump at 11-20 years of age was seen. Memories within as well as outside of the bump were mostly positive. The multilevel logistic regression modelling showed that the memories recalled were personally important and played a role in enhancing resilience. The findings revealed that despite facing an array of ethnic, religious, political, economic, and social conflicts, the participants were resilient, recalled predominantly positive memories, and had intact mental health. The findings have clinical implications in Cognitive Behavioral Therapy (CBT). The patients can be made aware of their negative emotions, troublesome/traumatic memories, and the distorted thinking patterns and their memories can be restructured. The findings can also be used to teach Memory Specificity Training (MEST) by psycho-educating the patients around changes in memory functioning and enhancing the recall of memories, which are more specific, vivid, and filled with sensory details.

Keywords: cognitive behavioral therapy, memories, mental health, resilience, trauma

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Authors: Recep Duzsoz, Ozlem Gormez, Umit Memis, Selma Demer, Hikmet Orhan

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Stylohyoid ligament is a connective tissue extending from apex of the styloid process to small horn of the hyoid bone. The normal length of styloid process ranges from 20 to 30 mm and measurements more than 30 mm is named stylohyoid ligament calcification (SLC). Fluorosis is a health problem that arises in individuals who intake large amounts of fluor long periods of time. The aim of this study was to investigate the effects of fluorosis on SLC. This study has been conducted on 100 patients who had SLC detected on panoramic radiograph. The study group was consisted of 50 patients with dental fluorosis and control group was consisted of 50 patients without dental fluorosis. Length and thickness of SLC were measured and the type of SLC was determined on panoramic radiographs. There was no statistically significant differences between the study and control group for SLC length, thickness and type. The thickness of left and right SLC of severe dental fluorosis group was statistically significant higher than moderate dental fluorosis group (p < 0,05). Cervicopharyngeal trauma, tonsillectomy, endocrine disease in menopause, persistent mesenchymal tissue, mechanical stress have reported as etiology of SLC in the literature and studies are still ongoing. It was reported that fluorosis as a factor on calcification of some ligaments in body (posterior longitudunal ligament, ligamentum flavum and transverse atlantal ligament) previously but relationship between fluorosis with SLC was not investigated. Our study is unique because it is the first study on SLC thickness measurements on panoramic radiographs and the relationship between fluorosis and SLC to our knowledge. According to the obtained results, it is thought that fluorosis may have an effect on SLC in thickness due to the relationship between dental fluorosis severity with SLC thickness and this study will contribute to the progress of the future studies.

Keywords: calcification, fluorosis, ligament, stylohyoid

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Authors: Vivian Khamis

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Exposure to war and forced migration have been widely linked to child subsequent adaptation. What remains sparse is research spanning multiple risk and protective factors and examining their unique and relative implications to difficulties in mental health among refugee girls. This study investigated the mechanisms through which posttraumatic stress disorder (PTSD), emotion dysregulation , neuroticism, and behavioral and emotional disorders in Syrian refugee girls is impacted by exposure to war traumas, age, and other risk and protective factors such as coping styles, family relationships, and school environment. The sample consisted of 539 Syrian refugee girls who ranged in age from 7 to 18 years attending public schools in various governorates in Lebanon and Jordan. Two school counselors carried out the interviews with children at school. Results indicated that war trauma, older age, and a combination of negative copying style associated with conflict in the family could lead to an overall state of emotion dysregulation, neuroticism, behavioral and emotional disorders, and PTSD in refugee girls. On the other hand, lapse of time since resettlement in host country, positive copying style, cohesion, and expressiveness in the family would lead to more positive mental health status, including lower levels of emotion dysregulation, neuroticism, behavioral and emotional disorders, and PTSD . Enhanced understanding of the mechanistic role of risk and protective factors in contributing to difficulties in mental health in refugee girls may contribute to the development of effective interventions to target the psychological effects of the refugee experience.

Keywords: refugee girls, PTSD, emotion dysregulation, neuroticism, behavioral and emotional disorders

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Authors: Guncel Ozturk

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Background: Rhinoplasty is the most commonly performed cosmetic operations in plastic surgery. Maneuvers used in rhinoplasty lead to a firm and stiff nasal tip in the early postoperative months. This unnatural stability of the nose may easily cause distortion in the reshaped nose after severe trauma. Moreover, a firm nasal tip may cause difficulties in performing activities such as touching, hugging, or kissing. Decreasing the stability and increasing the mobility of the nasal tip would help rhinoplasty patients to avoid these small but relatively important problems. Methods: We use delivery approach with closed rhinoplasty and changed positions of intranasal incisions to reach a dynamic and mobile nose. A total of 203 patients who had undergone primary closed rhinoplasty in private practice were inspected retrospectively. Posterior strut flap that was connected with connective tissues in the caudal of septum and the medial crurals were formed. Cartilage of the posterior strut graft was left 2 mm thick in the distal part of septum, it was cut vertically, and the connective tissue in the distal part was preserved. Results: The median patient age was 24 (range 17-42) years. The median follow-up period was15.2 (range12-26) months. Patient satisfaction was assessed with the 'Rhinoplasty Outcome Evaluation' (ROE) questionnaire. Twelve months after surgeries, 87.5% of patients reported excellent outcomes, according to ROE. Conclusion: The soft tissue connections between that segment and surrounding structures should be preserved to save the support of the tip while having a mobile tip at the same time with this method. These modifications would access to a mobile, non-stiff, and dynamic nasal tip in the early postoperative months. Further and prospective studies should be performed for supporting this method.

Keywords: closed rhinoplasty, dynamic, mobile, tip

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Authors: U. V. Okpala

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Flood is an overflow of water that submerges or ‘drowns’ land. In developing countries it occurs as a result of blocking of natural and man-made drainages and poor maintenance of water dams/reservoirs which seldom give way after persistent heavy down pours. In coastal lowlands and swamp lands, flooding is aided mainly by blocked channels and indiscriminate sand fling of coastal swamp areas and natural drainage channel for urban development/constructions. In this paper, the causes of flood and possible scientific, technological, political, economic and social impacts of flood disaster on the environment a case study of Anambra State have been studied. Often times flooding is caused by climate change, especially in the developed economy where scientific mitigating options are highly employed. Researchers have identified Green Houses Gases (GHG) as the cause of global climate change. The recent flood disaster in Anambra State which caused physical damage to structures, social dislocation, contamination of clean drinking water, spread of water-borne diseases, shortage of crops and food supplies, death of non-tolerant tree species, disruption in transportation system, serious economic loss and psychological trauma is a function of climate change. There is need to encourage generation of renewable energy sources, use of less carbon intensive fuels and other energy efficient sources. Carbon capture/sequestration, proper management of our drainage systems and good maintenance of our dams are good option towards saving the environment.

Keywords: flooding, climate change, carbon capture, energy systems

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Authors: Tania Breton, Dorina Simeonov, Shauna MacEachern

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Ontario’s 10 Year Mental Health and Addictions Strategy has included the establishment of 18 Service Collaborative across the province; cross-sector tables in a specific region coming together to explore mental health and addiction system needs and adopting an intervention to address that need. The process is community led and supported by implementation teams from the Centre for Addiction and Mental Health (CAMH), using the framework of implementation science (IS) to enable evidence-based and sustained change. These justice initiatives are focused on the intersection of the justice system and the mental health and addiction systems. In this presentation, we will share the learnings, achievements and challenges of implementing innovative practices to the mental health and addictions needs of Ontarians within the justice system. Specifically, we will focus on the key points across the justice system - from early intervention and trauma-informed, culturally appropriate services to post-sentence support and community reintegration. Our approach to this work involves external implementation support from the CAMH team including coaching, knowledge exchange, evaluation, Aboriginal engagement and health equity expertise. Agencies supported the implementation of tools and processes which changed practice at the local level. These practices are being scaled up across Ontario and community agencies have come together in an unprecedented collaboration and there is a shared vision of the issues overlapping between the mental health, addictions and justice systems. Working with ministry partners has allowed space for innovation and created an environment where better approaches can be nurtured and spread.

Keywords: implementation, innovation, early identification, mental health and addictions, prevention, systems

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Authors: Tahir Khaleeq, Patrick Lancaster, Keji Fakoya, Pedro Ferreira, Usman Ahmed

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Introduction: Virtual fracture clinics (VFC) have been shown to be a safe and cost-effective way of managing outpatient referrals to the orthopaedic department. During the coronavirus pandemic there has been a push to reduce unnecessary patient contact whilst maintaining patient safety. Materials and Methods: A protocol was developed by the clinical team in collaboration with Advanced Physiotherapy Practitioners (APP) on how to manage common musculoskeletal presentations to A&E prior to COVID as part of routine service development. Patients broadly triaged into 4 categories; discharge with advice, referral to VFC, referral to face to face clinic or discussion with on call team. The first 9 months of data were analysed to assess types of injury seen and outcomes. Results: In total 2489 patients were referred to VFC from internal and external sources. 734 patients were discharged without follow-up and 182 patients were discharged for physiotherapy review. Only 3 patients required admission. Regarding follow-ups, 431 patients had a virtual follow-up while 1036 of patients required further face to face follow up. 87 patients were triaged into subspecialty clinics. 37 patients were felt to have been referred inappropriately. Discussion: BOA guidelines suggest all patients need to be reviewed within 72 hours of their orthopaedic injury. Implementation of a VFC allows this target to be achieved and at the same time reduce patient contact. Almost half the patients were discharged following VFC review, the remaining patients were appropriately followed up. This is especially relevant in the current pandemic where reducing unnecessary trips to hospital will benefit the patient as well as make the most of the resources available.

Keywords: virtual fracture clinic, lockdown, trauma and orthopaedics, Covid- 19

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Authors: Chia-Chen Hsieh, Fei-Hsiu Hsiao

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Objective: To examine the effects of supportive care interventions on depressive symptoms in patients with lung cancer. Methods: The databases of Cochrane Central Register of Controlled Trials (CENTRAL), Ovid EMBASE, PubMed, and Chinese Electronic Periodical Services (CEPS) were searched from their inception until September 2015. We included the studies with randomized controlled trial design that compared standard care with supportive care interventions using psychotherapeutic or exercises approach. The standardized mean differences (SMD) (Cohen’s d) were calculated to estimate the treatment effects. The Cochrane Risk of Bias Tool was used for quality assessment and subgroup analysis was conducted to identify possible sources of heterogeneity. Results: A total of 1472 patients with lung cancer were identified. Compared with standard care, the overall effects of all supportive care interventions significantly reduced depressive symptoms (SMD = -0.74 with 95% CI = -1.07 to -0.41), and the effect was maintained at the 4th, 8th, and 12th weeks of follow-up. Either psychotherapy combined with psychoeducation or exercise alone produced significant improvements in depressive symptoms, while psychoeducation alone did not. The greater improvements in depressive symptoms occurred in lung cancer patients with severe depressive symptoms at baseline, total duration of interventions of less than ten weeks, and intervention provided through face-to-face delivery. Conclusions: Psychotherapy combined with psychoeducation can help patients manage the causes of depressive symptoms, including both symptom distress and psychological trauma due to lung cancer. Exercise can target the impaired respiratory function that is a cause of depressive symptoms in lung cancer patients.

Keywords: supportive care intervention, depressive symptoms, lung cancer, meta-analysis

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Authors: Kamel Abd Elaziz Mohamed

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Introduction: Drug related problems (DRPs) are of major concern, affecting patients of both sex. They impose considerable economic burden on the society and the health-care systems. Aim of the work: The aim of this work was to identify and categorize drug-related problems in adult intensive care unit. Patients and methods: The study was a prospective, observational study as eighty six patients were included. They were consecutively admitted to ICU through the emergency room or transferred from the general ward due to DRPs. Parameters included in the study as length of stay in ICU, need for cardiovascular support or mechanical ventilation, dialysis, as well as APACHE II score were recorded. Results: Drug related problems represent 3.6% of the total ICU admission. The median (range) of APACHE II score for 86 patients included in the study was 17 (10-23), and length of ICU stay was 2.4 (1.5-4.2) days. In 45 patients (52%), DRP was drug over dose (group 1), while other DRP was present in the other 41 patients (48%, group 11). Patients in group 1 were older (39 years versus 32 years in group 11), with significant impaired renal function. The need of inotropic drugs and mechanical ventilation as well as the length of stay (LOS) in ICU was significantly higher in group 1. There were no significant difference in GCS between both groups, however APACHE II score was significantly higher in group 1. Only four patients (4.6%) were admitted by suicidal attempt as well as three patients (3.4%) due to trauma drug-related admissions, all were in (group 1). Nineteen percent of the patients had drug related problem due to hypoglycaemic medication followed by tranquilizer (15%). Adverse drug effect followed by failure to receive medication were the most causes of drug problem in (group11).The total mortality rate was 4.6%, all of them were eventually non preventable. Conclusion: The critically ill patients admitted due to drug related problems represented a small proportion (3.6%) of admissions to the ICU. Hypoglycaemic medication was one of the most common causes of admission by drug related problems.

Keywords: drug related problems, ICU, cost, safety

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Authors: Andriana Purnama, Reno Rudiman, Kezia Christy

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Anal stenosis which develops due to anoderm scarring usually caused by secondary to surgical trauma, has become common, causing significant decrease patient’s quality of life. Even though mild anal stenosis was treated with non-surgical treatment, but surgical reconstruction in unavoidable for moderate to severe anal stenosis that cause distressing, severe anal pain and inability to defecate. In our study, we intend to share our result with the use of diamond flap in treatment of anal stenosis. This case report illustrates a 57-year-old male patient who presented with difficulty and discomfort in defecation caused by anal stenosis after 2 years of open hemorrhoidectomy surgery. At physical examination, there was requirement of forceful dilatation when the index finger was inserted or precisely 6mm as measured by hegar dilator (moderate anal stenosis). Blood test result was within normal limits. The patient underwent anal repair and diamond flap where the scar tissue at 6 and 9 o’clock directions was excised and diamond graft was incised carefully while paying attention to the vascular supply. Finally, the graft was fixated without any tension to the anal canal, resulting in diameter of 2 cm after operation. After 2 days post operation, the patient was in stable condition, without any complication, and discharged. There was no abnormality concerning the stool. Ten days after the operation, diamond flap was in normal condition and without any complication. He was scheduled for futher follow up at the Digestive Surgery Department. Anal stenosis due to overzealous hemorrhoidectomy is a complication that is preventable when performed in experienced hands. Diamond flap was one of the options for the anal stenosis treatment with less complication.

Keywords: anal stenosis, diamond flap, post hemorrhoidectomy, anal repair

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Authors: Walter Rafael Ramos Villanueva

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The overwhelming majority of scholarship on David Chariandy’s novel Soucouyant focuses on how Adele’s dementia represents the preservation of “cultural memory” and the perniciousness of “historical trauma.” However, by metaphorizing Adele’s mental condition, these critics risk treating her dementia as mostly figurative, and they thus elide a more detailed discussion of the literal ramifications of her dementia diagnosis. To move beyond these readings, then, my paper will approach Adele’s disorder as a literal medical condition and explore how her caregiving needs affect not only her but also those around her. Soucouyant subverts traditional caregiving narratives by depicting the difficult and typically invisible labour of informal caregiving that is undertaken by the families and friends of those who are ill or otherwise disabled. Because Adele’s family is unable to access proper public healthcare resources within the community, the burden of care falls upon the protagonist and his brother, who become “parentified children.” Parentified children, according to Nancy D. Chase, are “parents to their parents, and fulfill this role at the expense of their own developmentally appropriate needs and pursuits.” The novel provides a depiction of informal caregiving that is multi-faceted and asks us to question why is it exactly that we place the burden of care on those who are not equipped to handle such pressures instead of putting the onus on the government and the public healthcare system to take care of its most vulnerable members. Ageing Studies scholar Larry Polvika notes that although policymakers often offer “pious expressions of appreciation” and acknowledge that informal caregiving is “the backbone of our long-term care system,” governmental support for these caregivers remains inadequate. It is my belief that, by showcasing the struggles of informal caregivers, Chariandy’s text combats this dangerous and empty political rhetoric.

Keywords: caregiving, dementia, literature, parentified children

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Authors: Nita Nurlaila Kadarwaty

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Purpose: This study presents a rare case of bilateral Acute Primary Angle Closure Glaucoma (PACG). Method: A case report of a 64-year-old woman with a good outcome Acute PACG in both eyes who underwent phacotrabeculectomy surgery. Result: A 64-year-old woman complained of acute pain in both eyes, accompanied by decreased vision, photophobia, and seeing halos for three weeks. There was no history of trauma, steroid or other systemic drugs used, or intraocular surgery before. Ophthalmologic examination revealed a right eye (RE) visual acuity of 0.1, left eye (LE) 0.2. RE intraocular pressure (IOP) was 12 mmhg and LE: 36.4 mmHg in medication of timolol maleat ED and acetazolamide oral. Both eyes' anterior segments revealed mixed injection, corneal edema, shallow anterior chamber, posterior synechiae, mid-dilatation pupil with negative pupillary reflection, and cloudy lens without intumescent. There was a glaucomatous optic and closed iridocorneal angle on the gonioscopy. Initial treatments included oral acetazolamide and potassium aspartate 250 mg three times a day, timolol maleate ED 0.5% twice a day, and prednisolone acetate ED 1% four times a day. This patient underwent trabeculectomy, phacoemulsification, and implantation of IOL in both eyes. One week after the surgeries, both eyes showed decreased IOP and good visual improvement. Conclusion: Bilateral simultaneous Acute PACG is generally severe and results in a poor outcome. It causes rapidly progressive visual loss and is often irreversible. Phacotrabeculectomy has more benefits compared to only phacoemulsification for the intervention regarding the reduced IOP post-surgical.

Keywords: acute primary angle closure glaucoma, intraocular pressure, phacotrabeculectomy, glaucoma

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Authors: Garg Ramneesh, Uppal Sanjeev, Mittal Rajinder, Shah Sheerin, Jain Vikas, Singla Bhupinder

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Introduction: Despite advances in trauma care, a classification system for soft tissue injuries of the face still needs to be objectively defined. Aim: To develop a classification system for soft tissue injuries of the face; that is objective, easy to remember, reproducible, universally applicable, aids in surgical management and helps to develop a structured data that can be used for future use. Material and Methods: This classification system includes those patients that need surgical management of facial injuries. Associated underlying bony fractures have been intentionally excluded. Depending upon the severity of soft tissue injury, these can be graded from 0 to IV (O-Abrasions, I-lacerations, II-Avulsion injuries with no skin loss, III-Avulsion injuries with skin loss that would need graft or flap cover, and IV-complex injuries). Anatomically, the face has been divided into three zones (Zone 1/2/3), as per aesthetic subunits. Zone 1e stands for injury of eyebrows; Zones 2 a/b/c stand for nose, upper eyelid and lower eyelid respectively; Zones 3 a/b/c stand for upper lip, lower lip and cheek respectively. Suffices R and L stand for right or left involved side, B for presence of foreign body like glass or pellets, C for extensive contamination and D for depth which can be graded as D 1/2/3 if depth is still fat, muscle or bone respectively. I is for damage to facial nerve or parotid duct. Results and conclusions: This classification system is easy to remember, clinically applicable and would help in standardization of surgical management of soft tissue injuries of face. Certain inherent limitations of this classification system are inability to classify sutured wounds, hematomas and injuries along or against Langer’s lines.

Keywords: soft tissue injuries, face, avulsion, classification

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Authors: R. Botrugno, S Basyuni, G. Nugent, I. Jenkyn, A. Ferro, H. Bennett, C. Hjalmarsson, J. Chu, V. Santhanam

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This trainee led randomised controlled trial (RCT) aims to assess various outcomes for resorbable versus non-resorbable sutures for traumatic lacerations to the face. Within this trial of resorbable versus non-resorbable sutures for traumatic lacerations of the face (TORNFace), patient recruitment was facilitated by trainees who were employed at an NHS University Teaching Hospital in the United Kingdom. The trainees received appropriate training prior to recruiting patients for the trial. This included the completion of a national research e-learning module and face-to-face training that was provided locally. The locally delivered training provided an understanding of the eligibility criteria for the trial and the consent process. Existing trainee skills were utilised involving clinical photography to record baseline data and delivering the intervention based on the treatment arm selected. Eligible patients who required primary closure of traumatic lacerations of the face were randomised into one of two treatment arms. These comprised of resorbable (vicryl rapide) or non-resorbable sutures (ethilon). Primarily the cosmetic outcome was assessed. Secondary outcomes included: complications rates, health care economics, and patient-reported outcomes. Remote follow-up of recruited patients utilised photographs of the facial laceration which had received the intervention. These took place at 1 week, 3 months and 6 months post-intervention. This study aims to demonstrate an example of trainee-led research within the specialty of oral and maxillofacial surgery. The available data for the randomised controlled trial will also be presented.

Keywords: laceration, suture, trauma, trial

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Authors: Fedili Benamar, Beloulou Mohamed Lamine, Ouahes Hassane, Ghattas Samir

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Background and aims: While in Western countries, unilateral spinal anesthesia has been widely practiced for a long time, it remains little known in the local anesthesia community, and has not been the object of many studies. However, it is a simple, practical and effective technique. Our objective was to evaluate this practice in emergency anesthesia management in frail patients and to compare it with conventional spinal anesthesia. Methods: This is a prospective, observational, comparative study between hypobaric unilateral and conventional spinal anaesthesia for hip fracture surgery carried out in the operating room of the university military hospital of Staoueli. The work was spread over of 12-month period from 2019 to 2020. The parameters analyzed were hemodynamic variations, vasopressor use, block efficiency, postoperative adverse events, and postoperative morphine consumption. Results: -75 cases (mean age 72±14 years) -Group1= 41 patients (54.6%) divided into (ASA1=14.6% ASA2=60.98% ASA3=24.39%) single shoot spinal anaesthesia -Group2= 34 patients (45.3%) divided into (ASA1=2.9%, ASA2=26.4% ASA3=61.7%, ASA4=8.8%) unilateral hypobaric spinal anesthesia. -Hemodynamic variations were more severe in group 1 (51% hypotension) compared to 30% in group 2 RR=1.69 and odds ratio=2.4 -these variations were more marked in the ASA3 subgroup (group 1=70% hypotension versus group 2=30%) with an RR=2.33 and an odds ratio=5.44 -39% of group 1 required vasoactive drugs (15mg +/- 11) versus 32% of group 2 (8mg+/- 6.49) - no difference in the use of morphine in post-op. Conclusions: Within the limits of the population studied, this work demonstrates the clinical value of unilateral spinal anesthesia in ortho-trauma surgery in the frail patient.

Keywords: spinal anaesthesia, vasopressor, morphine, hypobaric unilateral spinal anesthesia, ropivacaine, hip surgery, eldery, hemodynamic

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Authors: Gianluca Del Rossi

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Sub-concussive impacts occur frequently in collision sports such as American tackle football. Sub-concussive level impacts are defined as hits to the head that do not result in the clinical manifestation of concussion injury. Presently, there is limited information known about the short-term effects of repeated sub-concussive blows to the head. Therefore, the purpose of this investigation was to determine if standard clinical measures could detect acute impairments in neurologic function resulting from the accumulation of sub-concussive impacts throughout a season of high school American tackle football. Simple reaction time using the ruler-drop test, and oculomotor performance using the King-Devick (KD) test, were assessed in 15 athletes prior to the start of the athletic season, then repeated each week of the season, and once following its completion. The mean reaction times and fastest KD scores that were recorded or calculated from each study participant and from each test session were analyzed to assess for change in reaction time and oculomotor performance over the course of the American tackle football season. Analyses of KD data revealed improvements in oculomotor performance from baseline measurements (i.e., decreased time), with most weekly comparisons to baseline being significantly different. Statistical tests performed on the mean reaction times obtained via the ruler-drop test throughout the season revealed statistically significant declines (i.e., increased time) between baseline and weeks 3, 4, 10, and 12 of the athletic season. The inconsistent and contrasting findings between KD data and reaction time demonstrate the need to identify more robust clinical measures to definitively assess if repeated sub-concussive impacts to the head are acutely detrimental to patients.

Keywords: head injury, mTBI and sport, subclinical head trauma, sub-concussive impacts

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Authors: Joseph Mary Ssembatya, Blessing Michael Taremwa

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Background: Multiple schwannomas are typically associated with neurofibromatosis type 1 (NF1), but rare cases occur independently of neurofibromatosis. Schwannomas are benign, slow-growing tumors, primarily affecting the cervical and lumbar spine. When large, they may extend over multiple vertebral levels, posing surgical challenges. Case Presentation: A 13-year-old Ugandan Munyankore female patient, presented with a 6-year history of progressive quadriparesis, particularly in the lower limbs. Clinical examination showed hypertonia and hyperreflexia, with no indicators of neurofibromatosis or prior trauma. MRI revealed two “kissing” schwannomas extending from C2 to T2 in the cervical spine. Decompressive surgery was performed through laminoplasty and partial lesion resection, and histology confirmed schwannoma. Two weeks postoperatively, the patient experienced cerebrospinal fluid (CSF) leakage, neck pain, and headache, which required re-operation and duraplasty. Following these interventions, the patient’s neurological status stabilized, with noted improvement in lower limb strength. Discussion: “Kissing” schwannomas are most frequently documented in the cerebellopontine angle, rarely in the spine, and even more rarely in children. While multiple schwannomas are often associated with NF2, this case had no family history or clinical signs of the disorder. Giant invasive spinal schwannomas (GISS) that span multiple vertebrae demand intricate surgical approaches due to their proximity to neurovascular structures. Conclusion: This is the first reported case of kissing cervical schwannomas in a young patient from a low- to middle-income country. Surgical decompression, though challenging, is critical for neurological recovery in such advanced cases.

Keywords: kissing schwannoma, cervical spine, low resource, young, uganda

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Authors: Dumith Kulasekara

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This paper examines the representation of the body that particularly stresses the anatomical organs and the psychic conditions in contemporary art. The paper looks closely at the works that address personal and social meanings implying psychic conditions by bringing the internal hidden anatomical organs of the body to the surface of the visual language. The paper argues that contemporary artists conceptualize the idea of the body as a site of generating psychic conditions by excavating the body as material, subject, and object in art practice. The paper conceptualizes this excavating process of the body acts similarly to the idea of dissecting the corporeal body to understand its internal organism that again shapes the materiality of the surface of the body. In doing so, the paper brings together this argument, knowledge produced in the historical and contemporary anatomical education in art and science, and psychoanalytical approaches to the theme to develop new interpretations of representing psyche in the anatomical-bodied. The present paper defines this new form of body conceptually and materially addresses the issues related to psychic conditions: sexual desires, gender, traumas, and memories. The paper suggests that representation of the anatomical-bodied brings a new direction of the multidisciplinary approach introduced by artists to visualize the body and psyche in the contemporary context. The paper also presents an in-depth- discussion on technological, scientific, and philosophical knowledge employed in representing the idea of the body in addressing different psychic conditions to challenge the experiencing the body in contemporary art. Therefore, the paper focuses on examining the theme in the different forms of visual language and contexts in contemporary art. Finally, this research aims to offer a theoretical and conceptual background to curate an exhibition on the title of the anatomical-bodied and psyche in contemporary art with the body of work discussed in this paper.

Keywords: anatomy, body, contemporary art, psyche, psychoanalysis, representation, trauma

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Authors: Joyce Fernandez

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This study examined the effects of critical incident stress debriefing and other related interventions on the psychological recovery of earthquake survivors. It is a mixed experimental and qualitative study using post-test only control group design and focus group discussion. After the conduct of critical incident stress debriefing activities and other related interventions in the form of counseling and psychiatric treatment to the survivors of a 6.9 magnitude earthquake, a post-test measuring the level of psychological recovery was given to randomized participants categorized as intervention and control groups. Using the traumatic assessment and belief scale as instrument for the quantitative aspect in order to gauge recovery in the psychological need areas of safety, trust, esteem, intimacy and control, the findings are the following: Intervention group participants have relatively better adjustment along the five psychological need areas compared to the control group participants; there is no significant difference in the psychological recovery among female and male participants of the invention and control groups and; there are significant differences between intervention and control groups in the psychological need areas of self-safety, self-trust, other-trust, self-esteem, and self-intimacy. Using a guided interview for the qualitative data, the themes derived are the following. Safety: The world is an unsafe place to live because of the calamities. Trust: Trust and dependence are anchored on the family. Esteem: Participants are having confused self-worth. Intimacy: Participants are thriving on attachment with their family. Control: Participants have unaltered desire to help but feeling restricted because of personal and logistical concerns.As an outcome of the study a Psychosocial Care Program for Individuals, Families and Communities Affected by Disaster and Trauma was proposed.

Keywords: critical incident stress debriefing, earthquake survivors, psychological recovery, related interventions

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Authors: Ashmita Mukherjee, Yogesh Harishchandra Kabutare, Suritra Bandyopadhyay, Paulomi Ghosh

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Uncontrolled bleeding in the battlefield and the operation rooms can lead to serious injuries, trauma and even be lethal. Keratin was reported to be a haemostatic material which rapidly activates thrombin followed by activation of fibrinogen leading to the formation of insoluble fibrin. Also platelets, the main initiator of haemostasis are reported to adhere to keratin. However, the major limitation of pure keratin as a biomaterial is its poor physical property and corresponding low mechanical strength. To overcome this problem, keratin was cross-linked with alginate to increase its mechanical stability. In our study, Keratin extracted from feather waste showed yield of 80.5% and protein content of 8.05 ± 0.43 mg/mL (n=3). FTIR and CD spectroscopy confirmed the presence of the essential functional groups and preservation of the secondary structures of keratin. The keratin was then cross-linked with alginate to make a dope. The dope was used to draw fibers of desired diameters in a suitable coagulation bath using a customized wet spinning setup. The resultant morphology of keratin fibers was observed under a brightfield microscope. The FT-IR analysis implied that there was a presence of both keratin and alginate peaks in the fibers. The cross-linking was confirmed in the keratin alginate fibers by a shift of the amide A and amide B peaks towards the right and disappearance of the peak for N-H stretching (1534.68 cm-1). Blood was drawn in citrate vacutainers for whole blood clotting test and blood clotting kinetics, which showed that the keratin fibers could accelerate blood coagulation compared to that of alginate fibers and tissue culture plate. Additionally, cross-linked keratin-alginate fiber was found to have lower haemolytic potential compared to alginate fiber. Thus, keratin cross-linked fibers can have potential applications to combat unrestrained bleeding.

Keywords: biomaterial, biowaste, fiber, keratin

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Authors: Aanh Eduardo Dimate-Garcia, Diana Carolina Rodriguez-Romero, Edna Yuliana Gonzalez Rincon, Diana Marcela Pardo Lopez, Yessica Garibello Cubillos

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Musculoskeletal disorders (MD) are the new epidemic of chronic diseases, are multifactorial and affect the different productive sectors. Although there are multiple instruments to evaluate the static and dynamic load, the method of repetitive occupational action (OCRA) seems to be an attractive option. Objective: It is aimed to analyze the use of the OCRA method and the prevalence of MD in workers of various productive sectors according to the literature (2007-2018). Materials and Methods: A literature review (following the PRISMA statement) of studies aimed at assessing the level of biomechanical risk (OCRA) and the prevalence of MD in the databases Scielo, Science Direct, Scopus, ProQuest, Gale, PubMed, Lilacs and Ebsco was realized; 7 studies met the selection criteria; the majority are quantitative (cross section). Results: it was evidenced (gardening and flower-growers) in this review that 79% of the conditions related to the task require physical requirements and involve repetitive movements. In addition, of the high appearance of DM in the high-low back, upper and lower extremities that are produced by the frequency of the activities carried out (footwear production). Likewise, there was evidence of 'very high risks' of developing MD (salmon industry) and a medium index (OCRA) for repetitive movements that require special care (U-Assembly line). Conclusions: the review showed the limited use of the OCRA method for the detection of MD in workers from different sectors, and this method can be used for the detection of biomechanical risk and the appearance of MD.

Keywords: checklist, cumulative trauma disorders, musculoskeletal diseases, repetitive movements

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Authors: Xiao-Yin Liu, Liang-Xue Zhou

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Traumatic brain injury (TBI), as a kind of nerve trauma caused by an external force, affects people all over the world and is a global public health problem. Although there are various clinical treatments for brain injury, including surgery, drug therapy, and rehabilitation therapy, the therapeutic effect is very limited. To improve the therapeutic effect of TBI, scaffolds combined with exosomes are a promising but challenging method for TBI repair. In this study, we examined whether a novel 3D-printed collagen/chitosan scaffold/exosomes derived from neural stem cells (NSCs) pretreated with insulin growth factor-1 (IGF-I) scaffolds (3D-CC-INExos) could be used to improve TBI repair and functional recovery after TBI. Our results showed that composite scaffolds of collagen-, chitosan- and exosomes derived from NSCs pretreated with IGF-I (INExos) could continuously release the exosomes for two weeks. In the rat TBI model, 3D-CC-INExos scaffold transplantation significantly improved motor and cognitive function after TBI, as assessed by the Morris water maze test and modified neurological severity scores. In addition, immunofluorescence staining and transmission electron microscopy showed that the recovery of damaged nerve tissue in the injured area was significantly improved by 3D-CC-INExos implantation. In conclusion, our data suggest that 3D-CC-INExos might provide a potential strategy for the treatment of TBI and lay a solid foundation for clinical translation.

Keywords: traumatic brain injury, exosomes, insulin growth factor-1, neural stem cells, collagen, chitosan, 3D printing, neural regeneration, angiogenesis, functional recovery

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

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When operating on tibial plateau fracture especially medial tibial plateau, it has regularly been said “where do I put my thumb to reduce the fracture”. This refers to the ideal placement of the buttress device to hold the fracture till union. The aim of this study was to see if one can identify this sweet spot using a CT scan. Methods: Forty-five tibial plateau fractures with medial plateau involvement were identified and included in the study. The preoperative CT scans were analysed and the medial plateau involvement pattern was classified based on modified radiological classification by Yukata et-al of stress fracture of medial tibial plateau. The involvement of part of plateau was compared with position of buttress plate position which was classified as medial posteromedial or both. Presence and position of the buttress was compared with ability to achieve and hold the reduction of the fracture till union. Results: Thirteen fractures were type-1 fracture, 19 fractures were type-2 fracture and 13 fractures were type-3 fracture. Sixteen fractures were buttressed correctly according to the potential deformity and twenty-six fractures were not buttressed and three fractures were partly buttressed correctly. No fracture was over butressed! When the fracture was buttressed correctly the rate of the malunion was 0%. When fracture was partly buttressed 33% were anatomically united and 66% were united in the plane of buttress. When buttress was not used, 14 were malunited, one malunited in one of the two planes of deformity and eleven anatomically healed (of which 9 were non displaced!). Buttressing resulted in statistically significant lower mal-union rate (x2=7.8, p=0.0052). Conclusion: The classification based on involvement of medial condyle can identify the placement of buttress plate in the tibial plateau. The correct placement of the buttress plate results in predictably satisfactory union. There may be a correlation between injury shape of the tibial plateau and the fracture type.

Keywords: knee, tibial plateau, trauma, CT scan, surgery

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Authors: Bushra Alghamdi, Alla Alsharif, Hamzah Aljohani, Saba Kassim

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Introduction: Collaborative work has always been acknowledged as a fundamental concept in delivering oral health care. Aim: This study aimed to assess the perception and attitude of pharmacists in oral health promotion and to determine the confident levels of pharmacists in delivering advice on oral health problems. Methods: An observational cross-sectional survey, using self-administered anonymous questionnaires, was conducted between March and April 2017. The study recruited a convenience sample of registered community pharmacists who were working in local private pharmaceutical stores in the urban area of Madinah, Kingdom of Saudi Arabia (KSA). A preliminary descriptive analysis was performed. Results: Thirty-five pharmacists have completed the surveys. All participants were males, with a mean age of 35.5 ( ± 6.92) years. Eighty-six percent of the participants reported that pharmacists should have a role in oral health promotion. Eighty percent have reported adequate level of confident when giving advice on most of the common oral health problems that include; oral health related risk behaviors such as tobacco cessation (46%), bleeding gums (63%) and sensitive teeth (60%). However, higher percentages of pharmacists have reported low confident levels when giving advice in relation to specific domain of dentistry, such as lost dental fillings (57%), loose crowns (60%), trauma to teeth (40%), denture-related problems (51%) and oral cancer (6.9%). Conclusion: Community pharmacists recognized their potential role in promoting oral health in KSA. Community pharmacists had varying levels of ability and confidence to offer support for oral health. The study highlighted that inner professional collaboration between pharmacists and dental care healthcare should be enhanced.

Keywords: community, oral health, promotion, pharmacist

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Authors: Mariya Dzhyoyeva

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In the present paper, I examine manifestations of toxic masculinity in the novels by Tomás Eloy Martínez, a post-Boom author, journalist, literary critic, and one of the representatives of the Argentine writing diaspora. I focus on the analysis of Martínez´s characters that display hypermasculine traits to define the relationship between toxic masculinity and power, including the power of authorship and violence as they are represented in his novels. The analysis reveals a complex network in which gender, power, and violence are intertwined and influence and modify each other. As the author exposes toxic masculine behaviors that generate violence, he looks to undermine them. Departing from M. Kimmel´s idea of masculinity as homophobia, I examine how Martínez “outs” his characters by incorporating into the narrative some secret, privileged sources that provide alternative accounts of their otherwise hypermasculine lives. These background stories expose their “weaknesses,” both physical and mental, and thereby feminize them in their own eyes. In a similar way, the toxic masculinity of the fictional male author that wields his power by abusing the written word as he abuses the female character in the story is exposed as a complex of insecurities accumulated by the character due to his childhood trauma. The artistic technique that Martínez uses to condemn the authoritarian male behavior is accessing his subjectivity and subverting it through a multiplicity of identities. Martínez takes over the character’s “I” and turns it into a host of pronouns with a constantly shifting point of reference that distorts not only the notions of gender but also the very notion of identity. In doing so, he takes the character´s affirmation of masculinity to the limit where the very idea of it becomes unsustainable. Viewed in the context of Martínez´s own exilic story, the condemnation of toxic masculine power turns into the condemnation of dictatorship and authoritarianism.

Keywords: gender, masculinity., toxic masculinity, authoritarian, Argentine literature, Martínez

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