Search results for: traumatic brain injury.
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2127

Search results for: traumatic brain injury.

1647 Neural Synchronization - The Brain’s Transfer of Sensory Data

Authors: David Edgar

Abstract:

To understand how the brain’s subconscious and conscious functions, we must conquer the physics of Unity, which leads to duality’s algorithm. Where the subconscious (bottom-up) and conscious (top-down) processes function together to produce and consume intelligence, we use terms like ‘time is relative,’ but we really do understand the meaning. In the brain, there are different processes and, therefore, different observers. These different processes experience time at different rates. A sensory system such as the eyes cycles measurement around 33 milliseconds, the conscious process of the frontal lobe cycles at 300 milliseconds, and the subconscious process of the thalamus cycle at 5 milliseconds. Three different observers experience time differently. To bridge observers, the thalamus, which is the fastest of the processes, maintains a synchronous state and entangles the different components of the brain’s physical process. The entanglements form a synchronous cohesion between the brain components allowing them to share the same state and execute in the same measurement cycle. The thalamus uses the shared state to control the firing sequence of the brain’s linear subconscious process. Sharing state also allows the brain to cheat on the amount of sensory data that must be exchanged between components. Only unpredictable motion is transferred through the synchronous state because predictable motion already exists in the shared framework. The brain’s synchronous subconscious process is entirely based on energy conservation, where prediction regulates energy usage. So, the eyes every 33 milliseconds dump their sensory data into the thalamus every day. The thalamus is going to perform a motion measurement to identify the unpredictable motion in the sensory data. Here is the trick. The thalamus conducts its measurement based on the original observation time of the sensory system (33 ms), not its own process time (5 ms). This creates a data payload of synchronous motion that preserves the original sensory observation. Basically, a frozen moment in time (Flat 4D). The single moment in time can then be processed through the single state maintained by the synchronous process. Other processes, such as consciousness (300 ms), can interface with the synchronous state to generate awareness of that moment. Now, synchronous data traveling through a separate faster synchronous process creates a theoretical time tunnel where observation time is tunneled through the synchronous process and is reproduced on the other side in the original time-relativity. The synchronous process eliminates time dilation by simply removing itself from the equation so that its own process time does not alter the experience. To the original observer, the measurement appears to be instantaneous, but in the thalamus, a linear subconscious process generating sensory perception and thought production is being executed. It is all just occurring in the time available because other observation times are slower than thalamic measurement time. For life to exist in the physical universe requires a linear measurement process, it just hides by operating at a faster time relativity. What’s interesting is time dilation is not the problem; it’s the solution. Einstein said there was no universal time.

Keywords: neural synchronization, natural intelligence, 99.95% IoT data transmission savings, artificial subconscious intelligence (ASI)

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1646 Neuropsychology of Social Awareness: A Research Study Applied to University Students in Greece

Authors: Argyris Karapetsas, Maria Bampou, Andriani Mitropoulou

Abstract:

The aim of the present work is to study the role of brain function in social awareness processing. Mind controls all the psychosomatic functions. Mind’s functioning enables individual not only to recognize one's own self and propositional attitudes, but also to assign such attitudes to other individuals, and to consider such observed mental states in the elucidation of behavior. Participants and Methods: Twenty (n=20) undergraduate students (mean age 18 years old) were involved in this study. Students participated in a clinical assessment, being conducted in Laboratory of Neuropsychology, at University of Thessaly, in Volos, Greece. Assessment included both electrophysiological (i.e.Event Related Potentials (ERPs) esp.P300 waveform) and neuropsychological tests (Raven's Progressive Matrices (RPM) and Sally-Anne test). Results: Initial assessment’s results confirmed statistically significant differences between the males and females, as well as in score performance to the tests applied. Strong correlations emerged between prefrontal lobe functioning, RPM, Sally-Anne test and P300 latencies. Also, significant dysfunction of mind has been found, regarding its three dimensions (straight, circular and helical). At the end of the assessment, students received consultation and appropriate guidelines in order to improve their intrapersonal and interpersonal skills. Conclusions: Mind and social awareness phenomena play a vital role in human development and may act as determinants of the quality of one’s own life. Meanwhile, brain function is highly correlated with social awareness and it seems that different set of brain structures are involved in social behavior.

Keywords: brain activity, emotions, ERP's, social awareness

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1645 Management of Tibial Bone Defects Following Grade Three Injury in Adults

Authors: Rajendra Kumar Kanojia

Abstract:

Background; Massive bone gaps are common following road side accidents and injury to the tibia, specially open grade three fractures. It has been seen that the diaphyseal fractures in the tibia are prone to non-union, there are certain reasons known very well, like less soft tissues around the lower third tibia, less vascularity, less options of fixation of the fractures after trauma and prolonged surgical time, operation theatre time and special surgical means. Aim of study; To know the suitability of the ilizarov ring fixators in staged treatment of the fracture of the both bones leg, including tibia, we wish to see the role of ilizarov in management of open grade three fractures which have been operated and debrided, for getting the length use of ilizaorv ring in a tertiary canter is the aim of the study.

Keywords: open fracture, staged management, ilizarov, bone grafting, lengthening

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1644 Dosimetric Analysis of Intensity Modulated Radiotherapy versus 3D Conformal Radiotherapy in Adult Primary Brain Tumors: Regional Cancer Centre, India

Authors: Ravi Kiran Pothamsetty, Radha Rani Ghosh, Baby Paul Thaliath

Abstract:

Radiation therapy has undergone many advancements and evloved from 2D to 3D. Recently, with rapid pace of drug discoveries, cutting edge technology, and clinical trials has made innovative advancements in computer technology and treatment planning and upgraded to intensity modulated radiotherapy (IMRT) which delivers in homogenous dose to tumor and normal tissues. The present study was a hospital-based experience comparing two different conformal radiotherapy techniques for brain tumors. This analytical study design has been conducted at Regional Cancer Centre, India from January 2014 to January 2015. Ten patients have been selected after inclusion and exclusion criteria. All the patients were treated on Artiste Siemens Linac Accelerator. The tolerance level for maximum dose was 6.0 Gyfor lenses and 54.0 Gy for brain stem, optic chiasm and optical nerves as per RTOG criteria. Mean and standard deviation values of PTV98%, PTV 95% and PTV 2% in IMRT were 93.16±2.9, 95.01±3.4 and 103.1±1.1 respectively; for 3DCRT were 91.4±4.7, 94.17±2.6 and 102.7±0.39 respectively. PTV max dose (%) in IMRT and 3D-CRT were 104.7±0.96 and 103.9±1.0 respectively. Maximum dose to the tumor can be delivered with IMRT with acceptable toxicity limits. Variables such as expertise, location of tumor, patient condition, and TPS influence the outcome of the treatment.

Keywords: brain tumors, intensity modulated radiotherapy (IMRT), three dimensional conformal radiotherapy (3D-CRT), radiation therapy oncology group (RTOG)

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1643 Patient-Reported Adverse Reactions to Adolescent Non-Suicidal Self-Injury Disclosures and Implications for Clinical Practice

Authors: Renee Fabian, Jordan Davidson

Abstract:

Current research on non-suicidal self-injury (NSSI) provides ample insights on best practices for caregivers and clinicians to address and reduce NSSI behavior among adolescents. However, the efficacy of evidenced-based NSSI interventions and their delivery from the perspective of adolescent patients does not receive significant attention, creating a gap between the efficacy of research-based NSSI interventions and adolescent perceptions of NSSI treatment and adolescent willingness to engage in NSSI interventions. To address the gap between practice and patient perspectives and inform more effective treatment outcomes, the current survey aims to identify major patient-reported adverse reactions to NSSI disclosures from caregivers, treating mental health clinicians, and medical professionals using a mixed methods survey of 2,500 people with a history of NSSI completed by editors at a consumer-facing health publication. Based on the analyzed results of the survey, a majority of adolescents with a history of NSSI found parents and caregivers ineffective at empathetically addressing NSSI, and a significant number of participants reported at least one treating mental health professional inadequately responded to NSSI behaviors, in addition to other findings of adverse reactions to NSSI disclosures that serve as a barrier to treatment. NSSI is a significant risk factor for future suicide attempts. Addressing patient-reported adverse reactions to NSSI disclosures in the adolescent population can remove barriers to the effectiveness of caregiver and clinician NSSI interventions and reduce the risk of NSSI-related harm and lower the risk of future suicide attempts or completions.

Keywords: adolescent self-injury, non-suicidal self-injury, patient perspectives, self-harm interventions

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1642 Unidentified Remains with Extensive Bone Disease without a Clear Diagnosis

Authors: Patricia Shirley Almeida Prado, Selma Paixão Argollo, Maria De Fátima Teixeira Guimarães, Leticia Matos Sobrinho

Abstract:

Skeletal differential diagnosis is essential in forensic anthropology in order to differentiate skeletal trauma from normal osseous variation and pathological processes. Thus, part of forensic anthropological field is differentiate skeletal criminal injuries from the normal skeletal variation (bone fusion or nonunion, transitional vertebrae and other non-metric traits), non-traumatic skeletal pathology (myositis ossificans, arthritis, bone metastasis, osteomyelitis) from traumatic skeletal pathology (myositis ossificans traumatic) avoiding misdiagnosis. This case shows the importance of effective pathological diagnosis in order to accelerate the identification process of skeletonized human remains. THE CASE: An unidentified skeletal remains at the medico legal institute Nina Rodrigues-Salvador, of a male young adult (29 to 40 years estimated) showing a massive heterotopic ossification on its right tibia at upper epiphysis and adjacent articular femur surface; an extensive ossification on the right clavicle (at the sternal extremity) also presenting an heterotopic ossification at right scapulae (upper third of scapulae lateral margin and infraglenoid tubercule) and at the head of right humerus at the shoulder joint area. Curiously, this case also shows an unusual porosity in certain vertebrae´s body and in some tarsal and carpal bones. Likewise, his left fifth metacarpal bones (right and left) showed a healed fracture which led both bones distorted. Based on identification, of pathological conditions in human skeletal remains literature and protocols these alterations can be misdiagnosed and this skeleton may present more than one pathological process. The anthropological forensic lab at Medico-legal Institute Nina Rodrigues in Salvador (Brazil) adopts international protocols to ancestry, sex, age and stature estimations, also implemented well-established conventions to identify pathological disease and skeletal alterations. The most compatible diagnosis for this case is hematogenous osteomyelitis due to following findings: 1: the healed fracture pattern at the clavicle showing a cloaca which is a pathognomonic for osteomyelitis; 2: the metacarpals healed fracture does not present cloaca although they developed a periosteal formation. 3: the superior articular surface of the right tibia shows an extensive inflammatory healing process that extends to adjacent femur articular surface showing some cloaca at tibia bone disease. 4: the uncommon porosities may result from hematogenous infectious process. The fractures probably have occurred in a different moments based on the healing process; the tibia injury is more extensive and has not been reorganized, while metacarpals and clavicle fracture is properly healed. We suggest that the clavicle and tibia´s fractures were infected by an existing infectious disease (syphilis, tuberculosis, brucellosis) or an existing syndrome (Gorham’s disease), which led to the development of osteomyelitis. This hypothesis is supported by the fact that different bones are affected in diverse levels. Like the metacarpals that do not show the cloaca, but then a periosteal new bone formation; then the unusual porosities do not show a classical osteoarthritic processes findings as the marginal osteophyte, pitting and new bone formation, they just show an erosive process without bone formation or osteophyte. To confirm and prove our hypothesis we are working on different clinical approaches like DNA, histopathology and other image exams to find the correct diagnostic.

Keywords: bone disease, forensic anthropology, hematogenous osteomyelitis, human identification, human remains

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1641 The Effect of β-Cryptoxanthin on Testicular Ischemia-Reperfusion Injury in a Rat Model: Evidence from Testicular Histology

Authors: Kianoush Mohammadnejad, Rahim Mohammadi, Ali Soleimanzadeh, Ali Shalizar Jalai, Farshid Sareafzadeh Rezaei

Abstract:

Testicular torsion and detorsion are significant clinical issues for infertile men. Torsion of the spermatic cord is an emergency condition resulting from the rotation of the testis and epididymis around the axis of the spermatic cord. A rat testis model was used to assess the effects of β-cryptoxanthin on ischemia-reperfusion injury. Twenty healthy male Wistar rats were included and randomized into four investigational groups (n = 5): Group SHAM: In this group, midline incision of the scrotum was performed, and the testicles were taken out for 2 hours with a 720-degree rotation. Group ISCHEMIA: In this group, a midline incision of the scrotum was performed, and the testicles were taken out and underwent ischemia for 2 hours with a 720-degree rotation. Group IS/REP/Oil: In this group, a midline scrotum cut was performed the testicles were taken out, and ischemia was created for 2 hours with a 720-degree rotation and at the end of ischemia 100 µL of corn oil (β-cryptoxanthin solvent) was injected intraperitoneally. Group IS/REP/CRPTXNTN 2.5: The same as group IS/REP/Oil as well as intraperitoneal administration of 100 µL of β-cryptoxanthin (2.5 µg/kg) at the end of ischemia. In all groups, the testes were returned back to the scrotum and, after 60 days, were dissected out and removed for histopathological analyses. β-cryptoxanthin at the dose of 2.5 µg/kg significantly improved histologic indices compared to other treatment groups (p<0.05). β-cryptoxanthin could be helpful in minimizing ischemia-reperfusion injury in testicular tissue exposed to ischemia.

Keywords: beta-cryptoxanthin, testis, Ischemia-reperfusion, Intraperitoneal

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1640 The Diurnal and Seasonal Relationships of Pedestrian Injuries Secondary to Motor Vehicles in Young People

Authors: Amina Akhtar, Rory O'Connor

Abstract:

Introduction: There remains significant morbidity and mortality in young pedestrians hit by motor vehicles, even in the era of pedestrian crossings and speed limits. The aim of this study was to compare incidence and injury severity of motor vehicle-related pedestrian trauma according to time of day and season in a young population, based on the supposition that injuries would be more prevalent during dusk and dawn and during autumn and winter. Methods: Data was retrieved for patients between 10-25 years old from the National Trauma Audit and Research Network (TARN) database who had been involved as pedestrians in motor vehicle accidents between 2015-2020. The incidence of injuries, their severity (using the Injury Severity Score [ISS]), hospital transfer time, and mortality were analysed according to the hours of daylight, darkness, and season. Results: The study identified a seasonal pattern, showing that autumn was the predominant season and led to 34.9% of injuries, with a further 25.4% in winter in comparison to spring and summer, with 21.4% and 18.3% of injuries, respectively. However, visibility alone was not a sufficient factor as 49.5% of injuries occurred during the time of darkness, while 50.5% occurred during daylight. Importantly, the greatest injury rate (number of injuries/hour) occurred between 1500-1630, correlating to school pick-up times. A further significant relationship between injury severity score (ISS) and daylight was demonstrated (p-value= 0.0124), with moderate injuries (ISS 9-14) occurring most commonly during the day (72.7%) and more severe injuries (ISS>15) occurred during the night (55.8%). Conclusion: We have identified a relationship between time of day and the frequency and severity of pedestrian trauma in young people. In addition, particular time groupings correspond to the greatest injury rate, suggesting that reduced visibility coupled with school pick-up times may play a significant role. This could be addressed through a targeted public health approach to implementing change. We recommend targeted public health measures to improve road safety that focus on these times and that increase the visibility of children combined with education for drivers.

Keywords: major trauma, paediatric trauma, road traffic accidents, diurnal pattern

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1639 The Effect Study of Meditation Music in the Elderly

Authors: Metee Pigultong

Abstract:

The research aims at 1) composition of meditation music, 2) study of the meditation time reliability. The population is the older adults who meditated practitioners in the Thepnimitra Temple, Don Mueang District, Bangkok. The sample group was the older persons who meditated practitioners from the age of 60 with five volunteers. The research methodology was time-series to conduct the research progression. The research instruments included: 1) meditation music, 2) brain wave recording form. The research results found that 1) the music combines the binaural beats suitable for the meditation of the older persons, consisting of the following features: a) The tempo rate of the meditation music is no more than 60 beats per minute. b) The musical instruments for the meditation music arrangement include only 4-5 pieces. c) The meditation music arrangement needs to consider the nature of the right instrument. d) Digital music instruments are suitable for composition. e) The pure-tone sound combined in music must generate a brain frequency at the level of 10 Hz. 2) After the researcher conducted a 3-weeks brain training procedure, the researcher performed three tests for the reliability level using Cronbach's Alpha method. The result showed that the meditation reliability had the level = .475 as a moderate concentration.

Keywords: binaural beats, music therapy, meditation, older person, the Buddhist meditated practitioners

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1638 An Inherent Risk to Damage the Popliteus Tendon by Some Femoral Component Designs: A Pilot Study in Indian Knees

Authors: Rajendra Kanojia

Abstract:

Femoral components with inbuilt rotation require thicker flexion resection of the lateral femoral condyle and could potential risk to damage the popliteus tendon especially in the smaller Asian knees. We prospectively evaluated 10 patients with bilateral varus osteoarthritis knee to size the cuts and their location in relation to the popliteus tendon. Two different types of implant were used on either side, one side requires resection in 3° external rotation (group A) and other side femoral component with inbuilt external roation (group B). We had popliteus tendon injury in 3 knees all from group B. Risk of damaging the popliteus tendon was found higher in group B.

Keywords: popliteaus tendon injury, TKA, orthopaedic surgery, biomechanics and clinical applications

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1637 IoT Based Approach to Healthcare System for a Quadriplegic Patient Using EEG

Authors: R. Gautam, P. Sastha Kanagasabai, G. N. Rathna

Abstract:

The proposed healthcare system enables quadriplegic patients, people with severe motor disabilities to send commands to electronic devices and monitor their vitals. The growth of Brain-Computer-Interface (BCI) has led to rapid development in 'assistive systems' for the disabled called 'assistive domotics'. Brain-Computer-Interface is capable of reading the brainwaves of an individual and analyse it to obtain some meaningful data. This processed data can be used to assist people having speech disorders and sometimes people with limited locomotion to communicate. In this Project, Emotiv EPOC Headset is used to obtain the electroencephalogram (EEG). The obtained data is processed to communicate pre-defined commands over the internet to the desired mobile phone user. Other Vital Information like the heartbeat, blood pressure, ECG and body temperature are monitored and uploaded to the server. Data analytics enables physicians to scan databases for a specific illness. The Data is processed in Intel Edison, system on chip (SoC). Patient metrics are displayed via Intel IoT Analytics cloud service.

Keywords: brain computer interface, Intel Edison, Emotiv EPOC, IoT analytics, electroencephalogram

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1636 Whole Body Cooling Hypothermia Treatment Modelling Using a Finite Element Thermoregulation Model

Authors: Ana Beatriz C. G. Silva, Luiz Carlos Wrobel, Fernando Luiz B. Ribeiro

Abstract:

This paper presents a thermoregulation model using the finite element method to perform numerical analyses of brain cooling procedures as a contribution to the investigation on the use of therapeutic hypothermia after ischemia in adults. The use of computational methods can aid clinicians to observe body temperature using different cooling methods without the need of invasive techniques, and can thus be a valuable tool to assist clinical trials simulating different cooling options that can be used for treatment. In this work, we developed a FEM package applied to the solution of the continuum bioheat Pennes equation. Blood temperature changes were considered using a blood pool approach and a lumped analysis for intravascular catheter method of blood cooling. Some analyses are performed using a three-dimensional mesh based on a complex geometry obtained from computed tomography medical images, considering a cooling blanket and a intravascular catheter. A comparison is made between the results obtained and the effects of each case in brain temperature reduction in a required time, maintenance of body temperature at moderate hypothermia levels and gradual rewarming.

Keywords: brain cooling, finite element method, hypothermia treatment, thermoregulation

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1635 Death Due to Ulnar Artery Injury by Glassdoor: A Case Report

Authors: Ashok Kumar Rastogi

Abstract:

Glass is a material commonly used for Glassdoor, glass bottles, cookware, and containers. It can be harmful, as it is a hard and blunt object. Glass has been associated with severe injury and is a common cause of injuries warranting hospital visits to the emergency department (ED). These injuries can be accidental or intentionally inflicted. Broken glass injuries can be severe, even deadly. If broken glass shards fall out on your arm, it may cause fatal injuries. Case history: A 20-year-old male dead body was found aside the road, police informed, and a video recording ceased during an investigation. In the video recording, the person was in a drunken state (unable to walk and disoriented), wandering in the residential area road. He saw a barber shop, the shop door made of Glass. Suddenly, he hit the Glassdoor with his right hand forcefully. The Glassdoor broke into multiple pieces, and multiple injuries were seen over the right hand. Observations: Multiple small and large lacerations were seen over the right anterior part of the elbow. The main injury looked like an incised wound caused by a hard and sharp object. The main injury was noted as a laceration of size 13 x 06 cm bone deep, placed obliquely over the anteromedial aspect of the right elbow joint, its medial end at medial end of elbow joint while its anterior end was 04 cm below the elbow joint with laceration of underline brachialis muscles and complete transaction of ulnar artery and vein, skin margins looking sharply cut with irregular margins with tiny cuts at the medial lower border of laceration. Injuries were antemortem and fresh in nature, caused by hard and blunt objects but looking like hard and sharp objects. All organs were found pale, and the cause of death was shock and hemorrhage because of ulnar vessel injury. Conclusion: The findings of this case report highlight the potentially lethal consequences of glass injuries, especially those involving Glassdoors. The study underscores the importance of accurate interpretation and identification of wounds caused by Glass, as they may resemble injuries caused by other objects. It emphasizes the challenges faced by autopsy surgeons when determining the cause and manner of death in cases where visual evidence of injury is absent or when the weapon is not recovered. Ultimately, this case report serves as a reminder of the potential dangers posed by Glass and the importance of comprehensive forensic examinations.

Keywords: glassdoor, incised, wound, laceration, autopsy

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1634 Redefining Ostracism in Soundararajan’s Trauma of Caste

Authors: Pooja Kamble

Abstract:

The study discusses the traumatic circumstances in which the Dalits, who are on the lower rungs of society, endured in all social, political, cultural, and economic aspects. Trauma appears to be employed as a catch-all term in Psychoanalytic literature to describe anything that produces psychological distress. They have suffered for ages, yet there is still no witness to end their existence. Dalits who have suffered at the hands of the upper caste or Brahmins have had a lasting impact on their mentality in this caste system. The trauma of caste is a psychoanalytic method for studying the mental state, nature, and existence of Dalits in society. It also provides a little overview of how this experience evolved the mental wounds that were left undetected. The anguish of horrible harassment and repressive treatment faced by countless generations of souls was difficult to put into words. This article highlights some of the phases that must be understood and concentrated on, as well as the traumatic environment in which they lived for several years. After acquiring recognition and political support, it is proposed to eliminate its existence. Even after relocating to independent India, we were unable to delve further into its origins. Independence itself speaks of freedom in all aspects, yet Dalits continue to be suppressed; they have failed to win freedom for their existence, despite their lengthy struggle against oppression. This article will help you comprehend the Dalit's emotional trauma that has made their life and battles more difficult to deal with, as systematically analyzed by Thenmozhi Soundararajan in the work The Trauma of Caste.

Keywords: trauma, psychoanalytic, dalits, caste

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1633 Development of Electroencephalograph Collection System in Language-Learning Self-Study System That Can Detect Learning State of the Learner

Authors: Katsuyuki Umezawa, Makoto Nakazawa, Manabu Kobayashi, Yutaka Ishii, Michiko Nakano, Shigeichi Hirasawa

Abstract:

This research aims to develop a self-study system equipped with an artificial teacher who gives advice to students by detecting the learners and to evaluate language learning in a unified framework. 'Detecting the learners' means that the system understands the learners' learning conditions, such as each learner’s degree of understanding, the difference in each learner’s thinking process, the degree of concentration or boredom in learning, and problem solving for each learner, which can be interpreted from learning behavior. In this paper, we propose a system to efficiently collect brain waves from learners by focusing on only the brain waves among the biological information for 'detecting the learners'. The conventional Electroencephalograph (EEG) measurement method during learning using a simple EEG has the following disadvantages. (1) The start and end of EEG measurement must be done manually by the experiment participant or staff. (2) Even when the EEG signal is weak, it may not be noticed, and the data may not be obtained. (3) Since the acquired EEG data is stored in each PC, there is a possibility that the time of data acquisition will be different in each PC. This time, we developed a system to collect brain wave data on the server side. This system overcame the above disadvantages.

Keywords: artificial teacher, e-learning, self-study system, simple EEG

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1632 Research Trends in Using Virtual Reality for the Analysis and Treatment of Lower-Limb Musculoskeletal Injury of Athletes: A Literature Review

Authors: Hannah K. M. Tang, Muhammad Ateeq, Mark J. Lake, Badr Abdullah, Frederic A. Bezombes

Abstract:

There is little research applying virtual reality (VR) to the treatment of musculoskeletal injury in athletes. This is despite their prevalence, and the implications for physical and psychological health. Nevertheless, developments of wireless VR headsets better facilitate dynamic movement in VR environments (VREs), and more research is expected in this emerging field. This systematic review identified publications that used VR interventions for the analysis or treatment of lower-limb musculoskeletal injury of athletes. It established a search protocol, and through narrative discussion, identified existing trends. Database searches encompassed four term sets: 1) VR systems; 2) musculoskeletal injuries; 3) sporting population; 4) movement outcome analysis. Overall, a total of 126 publications were identified through database searching, and twelve were included in the final analysis and discussion. Many of the studies were pilot and proof of concept work. Seven of the twelve publications were observational studies. However, this may provide preliminary data from which clinical trials will branch. If specified, the focus of the literature was very narrow, with very similar population demographics and injuries. The trends in the literature findings emphasised the role of VR and attentional focus, the strategic manipulation of movement outcomes, and the transfer of skill to the real-world. Causal inferences may have been undermined by flaws, as most studies were limited by the practicality of conducting a two-factor clinical-VR-based study. In conclusion, by assessing the exploratory studies, and combining this with the use of numerous developments, techniques, and tools, a novel application could be established to utilise VR with dynamic movement, for the effective treatment of specific musculoskeletal injuries of athletes.

Keywords: athletes, lower-limb musculoskeletal injury, rehabilitation, return-to-sport, virtual reality

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1631 The Possible Role of the Endoneurial Fibroblast-like Cells in Resolution of the Endoneurial Edema Following Nerve Crush Injury

Authors: Faris M. Altaf, Abdullah M Elkeshy

Abstract:

Forty-two albino male rats aged between 30 and 40 days (weighted 200 g to 250 g) were used in the present study. The left sural nerves of 36 rats were subjected to crush injury at 1 to 6 weeks intervals using 6 animals at each interval. The right and left sural nerves of the rest 6 rats were used as a control. After 2 weeks of the crush injury, the endoneurium showed channel-like spaces that were lined by the fibroblast-like cells and collagen bundles. These channels contained degenerated myelin and were connected with the perivascular and subperineurial spaces. Some of the flattened fibroblast-like cells were arranged in several layers in the subperineurial and perivascular spaces, forming barrier-like cellular sheets localizing the endoneurial edema in these spaces. Fibroblast-like cells also wrapped the regenerating nerve fibers by their branching cytoplasmic processes. At the end of the third week, the flattened fibroblasts formed nearly continuous sheets in the subperineurial and perivascular spaces. Macrophages were frequently noticed between these cellular barrier-like sheets and in the subperineurial and perivascular spaces. Conclusion: it could be concluded that the endoneurial fibroblast-like cells form barrier-like cellular sheets that localized the endoneurial edema in the subperineurial and perivascular spaces and create also the endoneurial channel-like spaces containing degenerated myelin and endoneurial edema helping the resolution of such edema.

Keywords: sural nerve, endoneurial fibroblast-like cells, endoneurial edema, barrier-like and channel-like spaces

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1630 Reconstruction of Visual Stimuli Using Stable Diffusion with Text Conditioning

Authors: ShyamKrishna Kirithivasan, Shreyas Battula, Aditi Soori, Richa Ramesh, Ramamoorthy Srinath

Abstract:

The human brain, among the most complex and mysterious aspects of the body, harbors vast potential for extensive exploration. Unraveling these enigmas, especially within neural perception and cognition, delves into the realm of neural decoding. Harnessing advancements in generative AI, particularly in Visual Computing, seeks to elucidate how the brain comprehends visual stimuli observed by humans. The paper endeavors to reconstruct human-perceived visual stimuli using Functional Magnetic Resonance Imaging (fMRI). This fMRI data is then processed through pre-trained deep-learning models to recreate the stimuli. Introducing a new architecture named LatentNeuroNet, the aim is to achieve the utmost semantic fidelity in stimuli reconstruction. The approach employs a Latent Diffusion Model (LDM) - Stable Diffusion v1.5, emphasizing semantic accuracy and generating superior quality outputs. This addresses the limitations of prior methods, such as GANs, known for poor semantic performance and inherent instability. Text conditioning within the LDM's denoising process is handled by extracting text from the brain's ventral visual cortex region. This extracted text undergoes processing through a Bootstrapping Language-Image Pre-training (BLIP) encoder before it is injected into the denoising process. In conclusion, a successful architecture is developed that reconstructs the visual stimuli perceived and finally, this research provides us with enough evidence to identify the most influential regions of the brain responsible for cognition and perception.

Keywords: BLIP, fMRI, latent diffusion model, neural perception.

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1629 Developing a Systemic Monoclonal Antibody Therapy for the Treatment of Large Burn Injuries

Authors: Alireza Hassanshahi, Xanthe Strudwick, Zlatko Kopecki, Allison J Cowin

Abstract:

Studies have shown that Flightless (Flii) is elevated in human wounds, including burns, and reducing the level of Flii is a promising approach for improving wound repair and reducing scar formation. The most effective approach has been to neutralise Flii activity using localized, intradermal application of function blocking monoclonal antibodies. However, large surface area burns are difficult to treat by intradermal injection of therapeutics, so the aim of this study was to investigate if a systemic injection of a monoclonal antibody against Flii could improve healing in mice following burn injury. Flii neutralizing antibodies (FnAbs) were labelled with Alxa-Fluor-680 for biodistribution studies and the healing effects of systemically administered FnAbs to mice with burn injuries. A partial thickness, 7% (70mm2) total body surface area scald burn injury was created on the dorsal surface of mice (n=10/group), and 100µL of Alexa-Flour-680-labeled FnAbs were injected into the intraperitoneal cavity (IP) at time of injury. The burns were imaged on days 0, 1, 2, 3, 4, and 7 using IVIS Lumina S5 Imaging System, and healing was assessed macroscopically, histologically, and using immunohistochemistry. Fluorescent radiance efficiency measurements showed that IP injected Alexa-Fluor-680-FnAbs localized at the site of burn injury from day 1, remaining there for the whole 7-day study. The burns treated with FnAbs showed a reduction in macroscopic wound area and an increased rate of epithelialization compared to controls. Immunohistochemistry for NIMP-R14 showed a reduction in the inflammatory infiltrate, while CD31/VEGF staining showed improved angiogenesis post-systemic FnAb treatment. These results suggest that systemically administered FnAbs are active within the burn site and can improve healing outcomes. The clinical application of systemically injected Flii monoclonal antibodies could therefore be a potential approach for promoting the healing of large surface area burns immediately after injury.

Keywords: biodistribution, burn, flightless, systemic, fnAbs

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1628 Insight2OSC: Using Electroencephalography (EEG) Rhythms from the Emotiv Insight for Musical Composition via Open Sound Control (OSC)

Authors: Constanza Levicán, Andrés Aparicio, Rodrigo F. Cádiz

Abstract:

The artistic usage of Brain-computer interfaces (BCI), initially intended for medical purposes, has increased in the past few years as they become more affordable and available for the general population. One interesting question that arises from this practice is whether it is possible to compose or perform music by using only the brain as a musical instrument. In order to approach this question, we propose a BCI for musical composition, based on the representation of some mental states as the musician thinks about sounds. We developed software, called Insight2OSC, that allows the usage of the Emotiv Insight device as a musical instrument, by sending the EEG data to audio processing software such as MaxMSP through the OSC protocol. We provide two compositional applications bundled with the software, which we call Mapping your Mental State and Thinking On. The signals produced by the brain have different frequencies (or rhythms) depending on the level of activity, and they are classified as one of the following waves: delta (0.5-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), beta (13-30 Hz), gamma (30-50 Hz). These rhythms have been found to be related to some recognizable mental states. For example, the delta rhythm is predominant in a deep sleep, while beta and gamma rhythms have higher amplitudes when the person is awake and very concentrated. Our first application (Mapping your Mental State) produces different sounds representing the mental state of the person: focused, active, relaxed or in a state similar to a deep sleep by the selection of the dominants rhythms provided by the EEG device. The second application relies on the physiology of the brain, which is divided into several lobes: frontal, temporal, parietal and occipital. The frontal lobe is related to abstract thinking and high-level functions, the parietal lobe conveys the stimulus of the body senses, the occipital lobe contains the primary visual cortex and processes visual stimulus, the temporal lobe processes auditory information and it is important for memory tasks. In consequence, our second application (Thinking On) processes the audio output depending on the users’ brain activity as it activates a specific area of the brain that can be measured using the Insight device.

Keywords: BCI, music composition, emotiv insight, OSC

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1627 Brain-Computer Interfaces That Use Electroencephalography

Authors: Arda Ozkurt, Ozlem Bozkurt

Abstract:

Brain-computer interfaces (BCIs) are devices that output commands by interpreting the data collected from the brain. Electroencephalography (EEG) is a non-invasive method to measure the brain's electrical activity. Since it was invented by Hans Berger in 1929, it has led to many neurological discoveries and has become one of the essential components of non-invasive measuring methods. Despite the fact that it has a low spatial resolution -meaning it is able to detect when a group of neurons fires at the same time-, it is a non-invasive method, making it easy to use without possessing any risks. In EEG, electrodes are placed on the scalp, and the voltage difference between a minimum of two electrodes is recorded, which is then used to accomplish the intended task. The recordings of EEGs include, but are not limited to, the currents along dendrites from synapses to the soma, the action potentials along the axons connecting neurons, and the currents through the synaptic clefts connecting axons with dendrites. However, there are some sources of noise that may affect the reliability of the EEG signals as it is a non-invasive method. For instance, the noise from the EEG equipment, the leads, and the signals coming from the subject -such as the activity of the heart or muscle movements- affect the signals detected by the electrodes of the EEG. However, new techniques have been developed to differentiate between those signals and the intended ones. Furthermore, an EEG device is not enough to analyze the data from the brain to be used by the BCI implication. Because the EEG signal is very complex, to analyze it, artificial intelligence algorithms are required. These algorithms convert complex data into meaningful and useful information for neuroscientists to use the data to design BCI devices. Even though for neurological diseases which require highly precise data, invasive BCIs are needed; non-invasive BCIs - such as EEGs - are used in many cases to help disabled people's lives or even to ease people's lives by helping them with basic tasks. For example, EEG is used to detect before a seizure occurs in epilepsy patients, which can then prevent the seizure with the help of a BCI device. Overall, EEG is a commonly used non-invasive BCI technique that has helped develop BCIs and will continue to be used to detect data to ease people's lives as more BCI techniques will be developed in the future.

Keywords: BCI, EEG, non-invasive, spatial resolution

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1626 Exploratory Study on Psychosocial Influences of Spinal Cord Injury to Patients: Basis for Medical Social Work Intervention Plan

Authors: Delies L. Alejo

Abstract:

This study explores the psychosocial influences of Spinal Cord Injury (SCI) on patients in the Philippine Orthopedic Center Hospital in the Philippines, examining their social functioning and proposing interventions for reintegration. Quantitative data were collected through surveys using a concurrent triangulation research design, while qualitative insights were obtained via interviews. Findings revealed significant psychosocial challenges among SCI patients, impacting relationships, family dynamics, work, friendships, parenting, education, and self-care. Demographic profiles indicated variations in psychosocial functioning. The study underscores the importance of tailored interventions for SCI patients based on age, marital status, gender, education, and occupation. Triangulation of data enhanced understanding, revealing four themes: ‘Resilient Navigation of Intimacy and Connection,’ ‘Family Dynamics and Care Challenges,’ ‘Occupational Hurdles and Work Engagement,’ and ‘Social and Community Integration Obstacles.’ The study proposes a holistic intervention plan, addressing emotional challenges, creating support networks, implementing vocational rehabilitation, promoting community engagement, and sustaining collaboration with healthcare professionals.

Keywords: spinal cord injury, psychosocial influences, social functioning, concurrent triangulation, intervention plan

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1625 Hanta Virus Infection in a Child and Sequelae

Authors: Vijay Samuel, Tina Thekkekkara, Shoma Ganguly

Abstract:

There is no reported Hanta Seoul virus infection in children in the UK so far, making it quite challenging for clinicians in diagnosing, predicting and prognosticating the outcome of the infection to patients and parents. We report a case of a ten-year-old girl who presented with pyrexia associated with headache, photophobia and abdominal pain. The family had recently acquired two pet rats six weeks ago. She appeared flushed with peri-oral pallor, coated the strawberry tongue, inflamed tonsils and bilateral cervical lymphadenopathy. Her liver and splenic edges were palpable. Investigations showed that she was thrombocytopenic with deranged renal and liver functions. An ultrasound abdomen demonstrated a mildly enlarged spleen, peripancreatic lymph node and an acalculous cholecystitis. In view of her clinical presentation, a diagnosis of leptospirosis was considered and she was commenced on intravenous benzylpenicillin. The following day she became oliguric, developed significant proteinuria and her renal function deteriorated. Following conservative management, her urine output gradually improved along with her renal function, proteinuria and thrombocytopaenia. Serology for leptospirosis and various other viruses were negative. Following discussion with the Rare and Imported Pathogens Laboratory at Porton hanta virus serology was requested and found to be strongly positive for Seoul hanta virus. Following discharge she developed palpitations, fatigue, severe headache and cognitive difficulties including memory loss and difficulties in spelling, reading and mathematics. Extensive investigations including ECG, MRI brain and CSF studies were performed and revealed no significant abnormalities. Since 2012, there have been six cases of acute kidney injury due to Hantavirus infection in the UK. Two cases were from the Humber region and were exposure to wild rats and the other four were exposed to specially bred pet fancy rats. Hanta virus infections can cause mild flu like symptoms but two clinical syndromes are associated with severe disease including haemorrhagic fever with renal syndrome, which may be associated with thrombocytopenia and Hantavirus cardiopulmonary syndrome. Neuropsychological impairments reported following hantavirus pulmonary syndrome and following Puumala virus infection have been reported. Minor white matter lesions were found in about half of the patients investigated with MRI brain. Seoul virus has a global distribution owing to the dispersal of its carrier host rats, through global trade. Several ports in the region could explain the possible establishment of Seoul virus in local populations of rats in the Yorkshire and Humber region. The risk of infection for occupationally exposed groups is 1-3% compared to 32.9% for specialist pet rat owners. The report highlight’s the importance of routinely asking about pets in the family. We hope to raise awareness of the emergence of hantavirus infection in the UK, particularly in the Yorkshire and Humber region. Clinicians should consider hantavirus infection as a potential cause of febrile illness causing renal impairment in children. Awareness of the possible neuro-cognitive sequele would help the clinicians offer appropriate information and support to children and their families. Contacting Rare and Imported Pathogens Laboratory at Porton is a useful resource for clinicians in UK when they consider unusual infections.

Keywords: Seoul hantavirus in child Porton, UK Acute kidney injury

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1624 The Optimization of Sexual Health Resource Information and Services for Persons with Spinal Cord Injury

Authors: Nasrin Nejatbakhsh, Anita Kaiser, Sander Hitzig, Colleen McGillivray

Abstract:

Following spinal cord injury (SCI), many individuals experience anxiety in adjusting to their lives, and its impacts on their sexuality. Research has demonstrated that regaining sexual function is a very high priority for individuals with SCI. Despite this, sexual health is one of the least likely areas of focus in rehabilitating individuals with SCI. There is currently a considerable gap in appropriate education and resources that address sexual health concerns and needs of people with spinal cord injury. Furthermore, the determinants of sexual health in individuals with SCI are poorly understood and thus poorly addressed. The purpose of this study was to improve current practices by informing a service delivery model that rehabilitation centers can adopt for appropriate delivery of their services. Methodology: We utilized qualitative methods in the form of a semi-structured interview containing open-ended questions to assess 1) sexual health concerns, 2) helpful strategies in current resources, 3) unhelpful strategies in current resources, and 4) Barriers to obtaining sexual health information. In addition to the interviews, participants completed surveys to identify socio-demographic factors. Data gathered was coded and evaluated for emerging themes and subthemes through a ‘code-recode’ technique. Results: We have identified several robust themes that are important for SCI sexual health resource development. Through analysis of these themes and their subthemes, several important concepts have emerged that could provide agencies with helpful strategies for providing sexual health resources. Some of the important considerations are that services be; anonymous, accessible, frequent, affordable, mandatory, casual and supported by peers. Implications: By incorporating the perspectives of individuals with SCI, the finding from this study can be used to develop appropriate sexual health services and improve access to information through tailored needs based program development.

Keywords: spinal cord injury, sexual health, determinants of health, resource development

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1623 Comparing the Detection of Autism Spectrum Disorder within Males and Females Using Machine Learning Techniques

Authors: Joseph Wolff, Jeffrey Eilbott

Abstract:

Autism Spectrum Disorders (ASD) are a spectrum of social disorders characterized by deficits in social communication, verbal ability, and interaction that can vary in severity. In recent years, researchers have used magnetic resonance imaging (MRI) to help detect how neural patterns in individuals with ASD differ from those of neurotypical (NT) controls for classification purposes. This study analyzed the classification of ASD within males and females using functional MRI data. Functional connectivity (FC) correlations among brain regions were used as feature inputs for machine learning algorithms. Analysis was performed on 558 cases from the Autism Brain Imaging Data Exchange (ABIDE) I dataset. When trained specifically on females, the algorithm underperformed in classifying the ASD subset of our testing population. Although the subject size was relatively smaller in the female group, the manual matching of both male and female training groups helps explain the algorithm’s bias, indicating the altered sex abnormalities in functional brain networks compared to typically developing peers. These results highlight the importance of taking sex into account when considering how generalizations of findings on males with ASD apply to females.

Keywords: autism spectrum disorder, machine learning, neuroimaging, sex differences

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1622 Impact of Interventions on Brain Functional Connectivity in Young Male Basketball Players: A Comparative Study

Authors: Mohammad Khazaei, Reza Rostami, Hassan Gharayagh Zandi, Ruhollah Basatnia, Mahboubeh Ghayour Najafabadi

Abstract:

Introduction: This study delves into the influence of diverse interventions on brain functional connectivity among young male basketball players. Given the significance of understanding how interventions affect cognitive functions in athletes, particularly in the context of basketball, this research contributes to the growing body of knowledge in sports neuroscience. Methods: Three distinct groups were selected for comprehensive investigation: the Motivational Interview Group, Placebo Consumption Group, and Ritalin Consumption Group. The study involved assessing brain functional connectivity using various frequency bands (Delta, Theta, Alpha, Beta1, Beta2, Gamma, and Total Band) before and after the interventions. The participants were subjected to specific interventions corresponding to their assigned groups. Results: The findings revealed substantial differences in brain functional connectivity across the studied groups. The Motivational Interview Group exhibited optimal outcomes in PLI (Total Band) connectivity. The Placebo Consumption Group demonstrated a marked impact on PLV (Alpha) connectivity, and the Ritalin Consumption Group experienced a considerable enhancement in imCoh (Total Band) connectivity. Discussion: The observed variations in brain functional connectivity underscore the nuanced effects of different interventions on young male basketball players. The enhanced connectivity in specific frequency bands suggests potential cognitive and performance improvements. Notably, the Motivational Interview and Placebo Consumption groups displayed unique patterns, emphasizing the multifaceted nature of interventions. These findings contribute to the understanding of tailored interventions for optimizing cognitive functions in young male basketball players. Conclusion: This study provides valuable insights into the intricate relationship between interventions and brain functional connectivity in young male basketball players. Further research with expanded sample sizes and more sophisticated statistical analyses is recommended to corroborate and expand upon these initial findings. The implications of this study extend to the broader field of sports neuroscience, aiding in the development of targeted interventions for athletes in various disciplines.

Keywords: electroencephalography, Ritalin, Placebo effect, motivational interview

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1621 The Effects of Transcranial Direct Current Stimulation on Brain Oxygenation and Pleasure during Exercise

Authors: Alexandre H. Okano, Pedro M. D. Agrícola, Daniel G. Da S. Machado, Luiz I. Do N. Neto, Luiz F. Farias Junior, Paulo H. D. Nascimento, Rickson C. Mesquita, John F. Araujo, Eduardo B. Fontes, Hassan M. Elsangedy, Shinsuke Shimojo, Li M. Li

Abstract:

The prefrontal cortex is involved in the reward system and the insular cortex integrates the afferent inputs arriving from the body’ systems and turns into feelings. Therefore, modulating neuronal activity in these regions may change individuals’ perception in a given situation such as exercise. We tested whether transcranial direct current stimulation (tDCS) change cerebral oxygenation and pleasure during exercise. Fourteen volunteer healthy adult men were assessed into five different sessions. First, subjects underwent to a maximum incremental test on a cycle ergometer. Then, subjects were randomly assigned to a transcranial direct current stimulation (2mA for 15 min) intervention in a cross over design in four different conditions: anode and cathode electrodes on T3 and Fp2 targeting the insular cortex, and Fpz and F4 targeting prefrontal cortex, respectively; and their respective sham. These sessions were followed by 30 min of moderate intensity exercise. Brain oxygenation was measured in prefrontal cortex with a near infrared spectroscopy. Perceived exertion and pleasure were also measured during exercise. The asymmetry in prefrontal cortex oxygenation before the stimulation decreased only when it was applied over this region which did not occur after insular cortex or sham stimulation. Furthermore, pleasure was maintained during exercise only after prefrontal cortex stimulation (P > 0.7), while there was a decrease throughout exercise (P < 0.03) during the other conditions. We conclude that tDCS over the prefrontal cortex changes brain oxygenation in ventromedial prefrontal cortex and maintains perceived pleasure during exercise. Therefore, this technique might be used to enhance effective responses related to exercise.

Keywords: affect, brain stimulation, dopamine neuromodulation, pleasure, reward, transcranial direct current stimulation

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1620 Contribution to the Study of Automatic Epileptiform Pattern Recognition in Long Term EEG Signals

Authors: Christine F. Boos, Fernando M. Azevedo

Abstract:

Electroencephalogram (EEG) is a record of the electrical activity of the brain that has many applications, such as monitoring alertness, coma and brain death; locating damaged areas of the brain after head injury, stroke and tumor; monitoring anesthesia depth; researching physiology and sleep disorders; researching epilepsy and localizing the seizure focus. Epilepsy is a chronic condition, or a group of diseases of high prevalence, still poorly explained by science and whose diagnosis is still predominantly clinical. The EEG recording is considered an important test for epilepsy investigation and its visual analysis is very often applied for clinical confirmation of epilepsy diagnosis. Moreover, this EEG analysis can also be used to help define the types of epileptic syndrome, determine epileptiform zone, assist in the planning of drug treatment and provide additional information about the feasibility of surgical intervention. In the context of diagnosis confirmation the analysis is made using long term EEG recordings with at least 24 hours long and acquired by a minimum of 24 electrodes in which the neurophysiologists perform a thorough visual evaluation of EEG screens in search of specific electrographic patterns called epileptiform discharges. Considering that the EEG screens usually display 10 seconds of the recording, the neurophysiologist has to evaluate 360 screens per hour of EEG or a minimum of 8,640 screens per long term EEG recording. Analyzing thousands of EEG screens in search patterns that have a maximum duration of 200 ms is a very time consuming, complex and exhaustive task. Because of this, over the years several studies have proposed automated methodologies that could facilitate the neurophysiologists’ task of identifying epileptiform discharges and a large number of methodologies used neural networks for the pattern classification. One of the differences between all of these methodologies is the type of input stimuli presented to the networks, i.e., how the EEG signal is introduced in the network. Five types of input stimuli have been commonly found in literature: raw EEG signal, morphological descriptors (i.e. parameters related to the signal’s morphology), Fast Fourier Transform (FFT) spectrum, Short-Time Fourier Transform (STFT) spectrograms and Wavelet Transform features. This study evaluates the application of these five types of input stimuli and compares the classification results of neural networks that were implemented using each of these inputs. The performance of using raw signal varied between 43 and 84% efficiency. The results of FFT spectrum and STFT spectrograms were quite similar with average efficiency being 73 and 77%, respectively. The efficiency of Wavelet Transform features varied between 57 and 81% while the descriptors presented efficiency values between 62 and 93%. After simulations we could observe that the best results were achieved when either morphological descriptors or Wavelet features were used as input stimuli.

Keywords: Artificial neural network, electroencephalogram signal, pattern recognition, signal processing

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1619 Postmortem Analysis of Lidocaine in Women Died of Criminal Abortion

Authors: Mohammed A. Arishy, Sultan M. Alharbi, Mohammed A. Hakami, Farid M. Abualsail, Mohammad A. Attafi, Riyadh M. Tobaiqi, Hussain M. Alsalem, Ibraheem M. Attafi

Abstract:

Lidocaine is the most common local anesthetics used for para cervical block to reduce pain associated with surgical abortion. A 25-year-old pregnant woman who. She died before reaching hospital, and she was undergoing criminal abortion during the first trimester. In post-mortem investigations and autopsy shows no clear finding; therefore, toxic substances must be suspected and searched for routinely toxicology analysis. In this case report, the postmortem concentration of lidocaine was detected blood, brain, liver, kidney, and stomach. For lidocaine identification and quantification, sample was extracted using solid phase extraction and analyzed by GC-MS (Shimadzu, Japan). Initial screening and confirmatory analysis results showed that only lidocaine was detected in all collected samples, and no other toxic substances or alcohol were detected. The concentrations of lidocaine in samples were 19, 17, 14, 7, and 3 ug/m in the brain, blood, kidney, liver, and stomach, respectively. Lidocaine blood concentration (17 ug/ml) was toxic level and may result in death. Among the tissues, brain showed the highest level of lidocaine, followed by the kidney, liver, and stomach.

Keywords: forensic toxicology, GC-MS, lidocaine, postmortem

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1618 Association of Post-Traumatic Stress Disorder with Work Performance amongst Emergency Medical Service Personnel, Karachi, Pakistan

Authors: Salima Kerai, Muhammad Islam, Uzma Khan, Nargis Asad, Junaid Razzak, Omrana Pasha

Abstract:

Background: Pre-hospital care providers are exposed to various kinds of stressors. Their daily exposure to diverse critical and traumatic incidents can lead to stress reactions like Post-Traumatic Stress Disorder (PTSD). Consequences of PTSD in terms of work loss can be catastrophic because of its compound effect on families, which affect them economically, socially and emotionally. Therefore, it is critical to assess the association between PTSD and Work performance in Emergency Medical Service (EMS) if exist any. Methods: This prospective observational study was carried out at AMAN EMS in Karachi, Pakistan. EMS personnel were screened for potential PTSD using impact of event scale-revised (IES-R). Work performance was assessed on basis of five variables; number of late arrivals to work, number of days absent, number of days sick, adherence to protocol and patient satisfaction survey over the period of 3 months. In order to model outcomes like number of late arrivals to work, days absent and days late; negative binomial regression was used whereas logistic regression was applied for adherence to protocol and linear for patient satisfaction scores. Results: Out of 536 EMS personnel, 525 were found to be eligible, of them 518 consented. However data on 507 were included because 7 left the job during study period. The mean score of PTSD was found to be 24.0 ± 12.2. However, weak and insignificant association was found between PTSD and work performance measures: number of late arrivals (RRadj 0.99; 95% CI 0.98-1.00), days absent (RRadj 0.98; 95% CI 0.96-0.99), days sick (Rradj 0.99; 95% CI 0.98 to 1.00), adherence to protocol (ORadj 1.01: 95% CI 0.99 to 1.04) and patient satisfaction (0.001% score; 95% CI -0.03% to 0.03%). Conclusion: No association was found between PTSD and Work performance in the selected EMS population in Karachi Pakistan. Further studies are needed to explore the phenomenon of resiliency in these populations. Moreover, qualitative work is required to explore perceptions and feelings like willingness to go to work, readiness to carry out job responsibilities.

Keywords: trauma, emergency medical service, stress, pakistan

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