Search results for: self injury behavior

Authors: Priyanka Kalra

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Background: Complementary and alternative medicine (CAM) includes various practices like Ayurveda, Yoga & Meditation Acupressure Acupuncture and Reiki. These practices are frequently used by patients with spinal cord injury (SCI). They have shown effectiveness in the management of pain and stress consequently improving overall quality of life post injury. Objective: The goals of the present case series were to evaluate the feasibility of 1) Using of Ayurvedic herbal oil massages in shoulder pain management, 2) Using yoga & meditation on managing the stress in spinal cord injury. Methodology: 15 SCI cases with muscular pain around shoulder were treated with Ayurvedic herbal oil massage for 10 days in CAM Department. Each session consisted of 30 min oil massage followed by 10 min hot towel fomentation. The patients continued regular therapy medications along with CAM. Another 15 SCI cases were treated with yoga and meditation for 15 days 30 min yoga (20 min Asana+ 10 min Pranayam + 15 min Meditation) in isolated yoga room of CAM department. Results: On the VAS scale the patients reported a reduction in their pain score by 70 %. On the PSS scale, the patients reported a reduction in their stress score by 80 %. Conclusion: These case series may encourage more people to explore CAM therapies.

Keywords: spinal cord injury, Ayurveda, complementary and alternative medicine, yoga, meditation

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Authors: Inkyong Yi

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Acute kidney injury (AKI) in trauma patients is known to be associated with multiple factors, especially shock and consequent inadequate renal perfusion, yet its clinical presentation is little known in severe trauma patients. Our aim was to investigate the clinical presentation of acute kidney injury and its outcome in severe trauma patients at a level I trauma center. A total of 93 consecutive adult trauma patients with an injury severity score (ISS) of more than 15 were analyzed retrospectively from our Level I trauma center data base. Patients with direct renal injury were excluded. Patients were dichotomized into two groups, according to the presence of AKI. Various clinical parameters were compared between two groups, with Student’s T test and Mann-Whitney’s U test. The AKI group was further dichotomized into patients who recovered within seven days, and those who required more than 7days for recovery or those who did not recover at all. Various clinical parameters associated with outcome were further analyzed. Patients with AKI (n=33, 35%) presented with significantly higher age (61.4±17.3 vs. 45.4±17.3, p < 0.0001), incidence of comorbidities (hypertension; 51.5% vs. 13.3%, OR 6.906 95%CI 2.515-18.967, diabetes; 27.3% vs. 6.7%, OR 5.250, 95%CI 1.472-18.722), odds of head and neck trauma (69.7% vs. 41.7%, OR 3.220, 95%CI 1.306-7.942) and presence of shock during emergency room care (66.7% vs 21.7% OR 7.231, 95%CI, 2.798-18.687). Among AKI patients, patients who recovered within 1 week showed lower peak lactate (4.7mmol/L, 95%CI 2.9-6.5 vs 7.3mmol/L, 95%CI 5.0-9.6, p < 0.0287), lesser units of transfusion during first 24 hours (pRBC; 20.4unit, 95%CI 12.5-28.3 vs. 58.9unit, 95%CI 39.4-78.5, p=0.0003, FFP; 16.6unit, 95%CI 6.8-26.4 vs. 56.1unit, 95%CI 26.9-85.2, p=0.0027). In severe trauma patients, patients with AKI showed different clinical presentations and worse outcomes. Initial presence of shock and higher DIC profiles may be important risk factors for AKI in severe trauma patients. In patients with AKI, peak lactate level and amounts of transfusion are related to recovery.

Keywords: acute kidney injury, lactate, transfusion, trauma

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Authors: Yong Hwang, Kang Yeol Suh, Yundeok Jang, Tae Hoon Kim

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Introduction: Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle constituents into the circulation. Acute kidney injury is a potential complication of severe rhabdomyolysis and the prognosis is substantially worse if renal failure develops. We try to identify the factors that were predictive of AKI in severe trauma patients with rhabdomyolysis. Methods: This retrospective study was conducted at the emergency department of a level Ⅰ trauma center. Patients enrolled that initial creatine phosphokinase (CPK) levels were higher than 1000 IU with acute multiple trauma, and more than 18 years older from Oct. 2012 to June 2016. We collected demographic data (age, gender, length of hospital day, and patients’ outcome), laboratory data (ABGA, lactate, hemoglobin. hematocrit, platelet, LDH, myoglobin, liver enzyme, and BUN/Cr), and clinical data (Injury Mechanism, RTS, ISS, AIS, and TRISS). The data were compared and analyzed between AKI and Non-AKI group. Statistical analyses were performed using IMB SPSS 20.0 statistics for Window. Results: Three hundred sixty-four patients were enrolled that AKI group were ninety-six and non-AKI group were two hundred sixty-eight. The base excess (HCO3), AST/ALT, LDH, and myoglobin in AKI group were significantly higher than non-AKI group from laboratory data (p ≤ 0.05). The injury severity score (ISS), revised Trauma Score (RTS), Abbreviated Injury Scale 3 and 4 (AIS 3 and 4) were showed significant results in clinical data. The patterns of CPK level were increased from first and second day, but slightly decreased from third day in both group. Seven patients had received hemodialysis treatment despite the bleeding risk and were survived in AKI group. Conclusion: We recommend that HCO3, CPK, LDH, and myoglobin should be checked and be concerned about ISS, RTS, AIS with injury mechanism at the early stage of treatment in the emergency department.

Keywords: acute kidney injury, emergencies, multiple trauma, rhabdomyolysis

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Authors: Parviz Almasi

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Ethylene is produced as a gaseous growth regulator in all plants and their constructive parts such as roots, stems, leaves, flowers and fruits. It is considered a multifunctional phytohormone that regulates both growths including flowering, fruit ripening, inhibition of root growth, and senescence such as senescence of leaves and flowers and etc. In addition, exposure to external ethylene is caused some changes that are often undesirable and harmful. Some flowers are more sensitive to others and when exposed to ethylene; their aging process is hastened. 1-MCP is an exogenous and endogenous ethylene action inhibitor, which binds to the ethylene receptors in the plants and prevents ethylene-dependent reactions. The binding affinity of 1- MCP for the receptors is about 10 times more than ethylene. Hence, 1-MCP can be a potential candidate for controlling of ethylene injury in horticultural crops. This review integrates knowledge of ethylene biosynthesis in the plants and also a mode of action of 1-MCP in preventing of ethylene injury.

Keywords: ethylene injury, biosynthesis, ethylene sensitivity, 1-MCP

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Authors: Hiroaki Hirose, Hiroshi Ikeda, Isao Takeda

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The Japanese version of the SF-36 has been employed to assess individuals’ health-related QOL (HRQOL). This study aimed to clarify the HRQOL of motorists with a spinal cord injury, in order to compare these individuals' SF-36 scores and national standard values. A total of 100 motorists with a spinal cord injury participated in this study. Participants’ HRQOL was evaluated using the Japanese version of the SF-36 (second edition). The score for each subscale was standardized based on data on the Japanese population. The average scores for NPF, NRP, NBP, NGH, NVT, NSF, NRE, and NMH were 10.9, 41.8, 45.9, 47.1, 46.1, 46.7, 46.0, and 47.4 points, respectively. Subjects showed significantly lower scores for NPF and NRP compared with national standard values, which were both ≤ 45.0 points, but relatively normal scores for the other items: NBP, NGH, NVT, NSF, NRE and NMH (> 45.0 points). The average scores for PCS, MCS and RCS were 21.9, 56.0, and 50.0 points, respectively. Subjects showed a significantly lower PCS score (≤ 20.0 points); however, the MCS score was higher (> 55.0 points) along with a relatively normal RCS score in these individuals (= 50.0 points).

Keywords: health-related QOL, HRQOL, SF-36, motorist, spinal cord injury, Japan

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Authors: Sally Shepherd, Jessica Wong, David Read

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Traumatic brachiocephalic artery aneurysm is a rare injury that typically occurs as a result of a blunt chest injury. A 19-year-old female sustained a head-on, high speed motor vehicle crash into a tree. Upon release after 45 minutes of entrapment, she was tachycardic but normotensive, with a significant seatbelt sign across her chest and open deformed right thigh with weak pulses in bilateral lower limbs. A chest XR showed mild upper mediastinal widening. A CT trauma series plus gated CT chest revealed a grade 3a aortic arch transection with brachiocephalic pseudoaneurysm. Endovascular repair of the brachiocephalic artery was attempted post-presentation but was unsuccessful as the first stent migrated to the infrarenal abdominal aorta and the second stent across the brachiocephalic artery origin had a persistent leak at the base. She was transferred to Intensive Care for strict blood pressure control. She returned to theatre 5 hours later for a median sternotomy, aortic arch repair with an 8mm graft extraction, and excision of the innominate artery pseudoaneurysm. She had an uncomplicated post-operative recovery. This case highlights that brachiocephalic artery injury is a rare but potentially lethal injury as a result of blunt chest trauma. Safe management requires a combined Vascular and Cardiothoracic team approach, as stenting alone may be insufficient.

Keywords: blunt chest injury, Brachiocephalic aneurysm, innominate artery, trauma

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Authors: Jiping Cai, Ningzhi Wangyang, Jun Shao

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Traumatic brain injury (TBI) is one of the major causes of morbidity and mortality that leads to structural and functional damage in several parts of the brain, such as cranial nerves, optic nerve tract or other circuitry involved in vision and occipital lobe, depending on its location and severity. As a result, the function associated with vision processing and perception are significantly affected and cause blurred vision, double vision, decreased peripheral vision and blindness. Here two cases complaining of monocular vision loss (actually temporal hemianopia) due to traumatic chiasmal syndrome after frontal head injury were reported, and were compared the findings with individual case reports published in the literature. Reported cases of traumatic chiasmal syndrome appear to share some common features, such as injury to the frontal bone and fracture of the anterior skull base. The degree of bitemporal hemianopia and visual loss acuity have a variable presentation and was not necessarily related to the severity of the craniocerebral trauma. Chiasmal injury may occur even in the absence bony chip impingement. Isolated bitemporal hemianopia is rare and clinical improvement usually may not occur. Mechanisms of damage to the optic chiasm after trauma include direct tearing, contusion haemorrhage and contusion necrosis, and secondary mechanisms such as cell death, inflammation, edema, neurogenesis impairment and axonal damage associated with TBI. Beside visual field test, MRI evaluation of optic pathways seems to the strong objective evidence to demonstrate the impairment of the integrity of visual systems following TBI. Therefore, traumatic chiasmal syndrome should be considered as a differential diagnosis by both neurosurgeons and ophthalmologists in patients presenting with visual impairment, especially bitemporal hemianopia after head injury causing frontal and anterior skull base fracture.

Keywords: bitemporal hemianopia, brain injury, optic chiasma, traumatic chiasmal syndrome.

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Authors: Elif Ates, Naile Bilgili

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Background: One of the most important medical complications that individuals with spinal cord injury (SCI) face are the neurogenic bladder. Objectives: To review methods used for management of neurogenic bladder and their effects. Methods: The study was conducted by searching CINAHL, Ebscohost, MEDLINE, Science Direct, Ovid, ProQuest, Web of Science, and ULAKBİM National Databases for studies published between 2005 and 2015. Key words used during the search included ‘spinal cord injury’, ‘bladder injury’, ‘nursing care’, ‘catheterization’ and ‘intermittent urinary catheter’. After examination of 551 studies, 21 studies which met inclusion criteria were included in the review. Results: Mean age of individuals in all study samples was 42 years. The most commonly used bladder management method was clean intermittent catheterization (CIC). Compliance with CIC was found to be significantly related to spasticity, maximum cystometric capacity, and the person performing catheterization (p < .05). The main reason for changing the existing bladder management method was urinary tract infections (UTI). Individuals who performed CIC by themselves and who voided spontaneously had better life quality. Patient age, occupation status and whether they performed CIC by themselves or not were found to be significantly associated with depression level (p ≤ .05). Conclusion: As the most commonly used method for bladder management, CIC is a reliable and effective method, and reduces the risk of UTI development. Individuals with neurogenic bladder have a higher prevalence of depression symptoms than the normal population.

Keywords: bladder management, catheterization, nursing, spinal cord injury

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Authors: Abbas Shafiee, Mohammad Taghi Ahmadian, Maryam Hoviattalab

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The biomechanical behavior of brain tissue is needed for predicting the traumatic brain injury (TBI). Each year over 1.5 million people sustain a TBI in the USA. The appropriate coefficients for injury prediction can be evaluated using experimental data. In this study, an experimental setup on brain soft tissue was developed to perform unconfined compression tests at quasistatic strain rates ∈0.0004 s-1 and 0.008 s-1 and 0.4 stress relaxation test under unconfined uniaxial compression with ∈ 0.67 s-1 ramp rate. The fitted visco-hyperelastic parameters were utilized by using obtained stress-strain curves. The experimental data was validated using finite element analysis (FEA) and previous findings. Also, influence of friction coefficient on unconfined compression and relaxation test and effect of ramp rate in relaxation test is investigated. Results of the findings are implemented on the analysis of a human brain under high acceleration due to impact.

Keywords: brain soft tissue, visco-hyperelastic, finite element analysis (FEA), friction, quasistatic strain rate

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Authors: Janki Shankar, Shu Ping Chen

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

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

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Authors: Seema Dhariwal, Kiran Maan, Ruchi Baghel, Apoorva Sharma, Poonam Rana

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Introduction: Traumatic brain injury (TBI) is defined as the temporary or permanent alteration in brain function and pathology caused by an external mechanical force. It represents the leading cause of mortality and morbidity among children and youth individuals. Various models of TBI in rodents have been developed in the laboratory to mimic the scenario of injury. Blast overpressure injury is common among civilians and military personnel, followed by accidents or explosive devices. In addition to this, the lateral Controlled cortical impact (CCI) model mimics the blunt, penetrating injury. Method: In the present study, we have developed two different mild TBI models using blast and CCI injury. In the blast model, helium gas was used to create an overpressure of 130 kPa (±5) via a shock tube, and CCI injury was induced with an impact depth of 1.5mm to create diffusive and focal injury, respectively. C57BL/6J male mice (10-12 weeks) were divided into three groups: (1) control, (2) Blast treated, (3) CCI treated, and were exposed to different injury models. Serum was collected on Day1 and day7, followed by biphasic extraction using MTBE/Methanol/Water. Prepared samples were separated on Charged Surface Hybrid (CSH) C18 column and acquired on UHPLC-Q-TOF-MS using ESI probe with inhouse optimized parameters and method. MS peak list was generated using Markerview TM. Data were normalized, Pareto-scaled, and log-transformed, followed by multivariate and univariate analysis in metaboanalyst. Result and discussion: Untargeted profiling of lipids generated extensive data features, which were annotated through LIPID MAPS® based on their m/z and were further confirmed based on their fragment pattern by LipidBlast. There is the final annotation of 269 features in the positive and 182 features in the negative mode of ionization. PCA and PLS-DA score plots showed clear segregation of injury groups to controls. Among various lipids in mild blast and CCI, five lipids (Glycerophospholipids {PC 30:2, PE O-33:3, PG 28:3;O3 and PS 36:1 } and fatty acyl { FA 21:3;O2}) were significantly altered in both injury groups at Day 1 and Day 7, and also had VIP score >1. Pathway analysis by Biopan has also shown hampered synthesis of Glycerolipids and Glycerophospholipiods, which coincides with earlier reports. It could be a direct result of alteration in the Acetylcholine signaling pathway in response to TBI. Understanding the role of a specific class of lipid metabolism, regulation and transport could be beneficial to TBI research since it could provide new targets and determine the best therapeutic intervention. This study demonstrates the potential lipid biomarkers which can be used for injury severity diagnosis and identification irrespective of injury type (diffusive or focal).

Keywords: LipidBlast, lipidomic biomarker, LIPID MAPS®, TBI

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Authors: Sruthi Ramagiri, Rajeev T.

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Free radical damage has been entailed as the major culprit in the ischemic stroke contributing for oxidative damage. Recent investigations on Hydroxy Safflower Yellow A (HSYA) suggested its role in cerebral ischemia and various neurodegenerative disorders with unidentified molecular mechanisms. The current study was designed to investigate putative therapeutic role and possible molecular mechanisms of HSYA administration during the onset of reperfusion in cerebral ischemia-reperfusion (I/R) injury in cerebral stroke. Cerebral stroke was achieved by focal ischemic model. HSYA (10 mg/kg) was injected intravenously via the tail vein 5 minutes before reperfusion. Losses of sensorimotor abilities were evaluated by neurological scoring, spontaneous locomotor activity, and rotarod performance. Extent of oxidative stress was evaluated by biochemical parameters i.e., malondialdehyde (MDA), Glutathione (GSH), Super Oxide Dismutase (SOD) and catalase levels. The infarct volume of brain was assessed by 2,3,5-triphenyl tetrazolium chloride (TTC) staining technique. Increased cerebral injury (I/R) was evidenced by motor impairment, increased infarct volume and elevation of MDA levels along with significant reduction in antioxidant i.e.,MDA levels along with significant reduction in antioxidant i.e., GSH, SOD and catalase levels when compared to sham control. However, post conditioning with HSYA (10 mg/kg, i.v.) at the onset of reperfusion has significantly ameliorated sensorimotor abilities, attenuated MDA levels and reduced the infarct volume as compared with vehicle treated I/R injury group. Moreover, HSYA treatments improved antioxidant enzyme levels as compared with vehicle treated I/R-injury group. In conclusion, it may be suggested that HSYA post conditioning could be novel therapeutic approach against I/R injury in cerebral stroke possibly through its anti-oxidant mechanism.

Keywords: HSYA, Ischemia reperfusion injury, oxidative stress, stroke

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Authors: Zhidong Zhang, Zhi-Chao Zhang

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This study focuses on early adolescent externalizing behavioral problems which specifically concentrate on rule breaking behavior and aggressive behavior using the instrument of Achenbach System of Empirically Based Assessment (ASEBA). The purpose was to analyze the relationships between the externalizing behavioral problems and relevant background variables such as sports activities, hobbies, chores and the number of close friends. The stratified sampling method was used to collect data from 1975 participants. The results indicated that several background variables as predictors could significantly predict rule breaking behavior and aggressive behavior. Further, a hierarchical modeling method was used to explore the causal relations among background variables, breaking behavior variables and aggressive behavior variables.

Keywords: aggressive behavior, breaking behavior, early adolescence, externalizing problem

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Authors: Muhandiram Rallage Ruvini Nisansala Yatigammana, Anuruddhika Kumudu Kumari Rajakaruna Jayathilaka

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Sports injuries are common among teenagers and children engaged in organized sports. While most sports injuries are typical, some rare occurrences involve conditions such as eye, dental, cervical, and rare internal organ injuries, such as pancreatic injuries. These injuries, especially traumatic pancreatitis, require prompt attention due to their potential for severe and sometimes fatal complications. This case revolves around a real accident involving a 12-year-old girl, Piyumi, who suffered a face-to-face collision during netball practice, resulting in severe abdominal pain. After a medical examination, she was diagnosed with a rare pancreatic injury, uncommon in children compared to adults. In Piyumi’s case, she had a grade 3 pancreatic injury and underwent non-surgical management, successfully healing her wound without surgery. The study attempts to fill empirical and population gaps, addressing a rarely discussed injury experienced by a 12-year-old female netball player. The paper will also provide an in-depth understanding of pancreatic injury, which is a rare sports injury. The study’s main objective was to investigate the incidence and characteristics of pancreatic injury, particularly focusing on pancreatic trauma, among children and adolescents engaged in high-impact sports, such as netball. This research adopted a case study strategy, employing interviews as the primary data collection method. Interviews were conducted with Piyumi, her parents, and the two specialist doctors directly involved in her treatment, providing firsthand accounts and insights. By examining the case, the paper arrives at three main conclusions. Firstly, pancreatic damage is uncommon, especially in the sports world, and proper diagnosis is essential to avoiding health concerns, particularly for minors. Secondly, CT (Computed Tomography) was useful in locating the injury, as injuries can be diagnosed very well with Computed Tomography (CT) images. Finally, and most importantly, pancreatic injuries are infrequent, but trauma can still occur, particularly in high-impact sports or accidents involving extreme force or falls. These injuries should be accurately diagnosed and treated promptly.

Keywords: child athlete, pancreatic injury, rare sports injuries, sportswoman

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Authors: Amr A. Fouad, Waleed H. Albuali, Iyad Jresat

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The protective effect of thymoquinone (TQ) was investigated in rats exposed to testicular injury induced by sodium arsenite (10mg/kg/day, orally, for two days). TQ treatment (10mg/kg/day, intraperitoneal injection) was applied for five days, starting three day before arsenic administration. TQ significantly attenuated the arsenic-induced decreases of serum testosterone, and testicular reduced glutathione level, and significantly decreased the elevations of testicular malondialdehyde and nitric oxide levels resulted from arsenic administration. Also, TQ ameliorated the arsenic-induced testicular tissue injury observed by histopathological examination. In addition, TQ decreased the arsenic-induced expression of inducible nitric oxide synthase and caspase-3 in testicular tissue. It was concluded that TQ may represent a potential candidate to protect against arsenic-induced testicular injury.

Keywords: thymoquinone, arsenic, testes, rats

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Authors: Mohammad Khamoushi, Reza Mirmahdi

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The aim of this research was the effect of sensory integration in reduction of stereotype behaviors in autistic children. The statistical population included 55 children with the age range 2/8 – 14 in Esfahan Ordibehesht autistic center. Purposive sampling was used for selecting the sample group and 20 children with random assignment were designated in two group; experimental and control . Research project was quasi-experimental two-group with pretest and posttest. Data collection tools included repetitive behavior scale-revised with six sub-scales: stereotype behavior, self-injurious behavior, compulsive behavior, ritualistic behavior, sameness behavior, restricted behavior. Analysis of covariance was used for analyzing hypotheses. Result show that sensory integration procedure was effective in reduction of stereotype behavior, compulsive behavior and self-injurious behavior in autistic children. According to the findings, it is suggested that effect sensory integration procedure in stereotype behavior of autism children should be studied and used for treatment of other disabilities of this children.

Keywords: autism, sensory integration procedure, stereotype behavior, compulsive behavior

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Authors: Fanniyah Anis, Bram Kilapong

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Myocardial reperfusion injury is defined as the cellular damage that results from a period of ischemia, followed by the reestablishment of the blood supply to the infarcted tissue. Ventricular tachycardia is one of the most commonly encountered reperfusion arrhythmia as one of the types of myocardial perfusion injury. Prompt and early treatment can reduce mortality, despite limited resources of the hospital in high risk patients with history of triple vessel disease. Case report, Male 53 years old has been diagnosed with NSTEMI with 3VD and comorbid disease of Hypertension and has undergone revascularization management with Percutaneous coronary intervention. Ventricular tachycardia leading to cardiac arrest occurred right after the stent was inserted. Resuscitation was performed for almost 2 hours until spontaneous circulation returned. Patient admitted in ICU with refractory cardiac shock despite using combination of ionotropic and vasopressor agents under standard non-invasive monitoring due to the limitation of the hospital. Angiography was performed again 5 hours later to exclude other possibilities of blockage of coronary arteries and conclude diagnosis of myocardial reperfusion injury. Patient continually managed with combination of antiplatelet agents and maintenance dose of anti-arrhythmia agents. The handling of the patient was to focus more on supportive and preventive from further deteriorating of the condition. Patient showed clinically improvement and regained consciousness within 24 hours. Patient was successfully discharged from ICU within 3 days without any neurological sequela and was discharge from hospital after 3 days observation in general ward. Limited Resource of hospital did not refrain the physician from attaining a good outcome for this myocardial reperfusion injury case and angiography alone can be used to confirm the diagnosis of myocardial reperfusion injury.

Keywords: limited resources hospital, myocardial reperfusion injury, prolonged resuscitation, refractory cardiogenic shock, reperfusion arrhythmia, revascularization, triple-vessel disease

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Authors: Dina Muharib

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Specific metabolic challenges are present following spinal cord injury. The acute stage is characterized by a reduction in metabolic activity, as well as a negative nitrogen balance that cannot be corrected, even with aggressive nutritional support. Metabolic demands need to be accurately monitored to avoid overfeeding. Enteral feeding is the optimal route following SCI. When oral feeding is not possible, nasogastric, followed by nasojejunal, then by percutaneous endoscopic gastrostomy, if necessary, is suggested.

Keywords: SCI, energy, protein, nutrition assessment, eneral feeding, nitrogen balance

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Authors: Muhammad Waqas, Shahan Waheed, Mohsin Qadeer, Ehsan Bari, Salman Ahmed, Iqra Patoli

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Objective: To determine the value of aPTT, platelets and INR as the predictor of unfavorable outcomes in patients with blunt isolated traumatic brain injury. Methods: This was an observational cohort study conducted in a tertiary care facility from 1st January 2008 to 31st December 2012. All the patients with isolated traumatic brain injury presenting within 24 hours of injury were included in the study. Coagulation parameters at presentation were recorded and Glasgow Outcome Scale calculated on last follow up. Outcomes were dichotomized into favorable and unfavorable outcomes. Relationship of coagulopathy with GOS and unfavorable outcomes was calculated using Spearman`s correlation and area under curve ROC analysis. Results: 121 patients were included in the study. The incidence of coagulopathy was found to be 6 %. aPTT was found to a significantly associated with unfavorable outcomes with an AUC = 0.702 (95%CI = 0.602-0.802). Predictive value of platelets and INR was not found to be significant. Conclusion: Incidence of coagulopathy was found to be low in current population compared to data from the West. aPTT was found to be a good predictor of unfavorable outcomes compared with other parameters of coagulation.

Keywords: aPTT, coagulopathy, unfavorable outcomes, parameters

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Authors: Ravid Yinon

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Introduction: Pelvic trauma causes high mortality, particularly among the elderly population. Pelvic injury ranges from low-energy incidents such as falls to high-energy trauma like motor vehicle accidents. The mortality rate among high-energy trauma patients is higher, as can be expected. The elderly population is more vulnerable to pelvic trauma even at low energy mechanisms due to the fragility and diminished physiological reserve of these patients. The aim of this study is to examine whether there is a higher long-term mortality in pelvic injuries in the elderly from the low-energy mechanism than those injured in high energy. Methods: A retrospective cohort study was conducted in a level 1 trauma center with injured patients aged 65 years and over with pelvic trauma. The patients were divided into two groups of low and high-energy mechanisms of injury. Multivariate analysis was conducted to characterize the differences between the groups. Results: There were 585 consecutive injured patients over the age of 65 with a documented pelvic injury who were treated at the primary trauma center between 2008-2020. The injured in the high energy group were younger (mean HE- 75.18, LE-80.73), with fewer comorbidities (mean 0.78 comorbidities at HE and 1.28 at LE), more men (52.6% at HE and 27.4% at LE), were consumed more treatments facilities such as angioembolization, ICU admission, emergency surgeries and blood products transfusion and higher mortality rate at admission (HE- 19/133, 14.28%, LE- 10/452, 2.21%) compared to the low energy group. However, in a long-term follow-up of one year after the injury, mortality in the low-energy group was significantly higher (HE- 14/114, 12.28%, LE- 155/442, 35.06%). Discussion: Although it can be expected that in the mechanism of high energy, the mortality rate in the long term would be higher, it was found that mortality at the low energy patient was higher. Apparently, low-energy pelvic injury in geriatric patients is a measure of frailty in these patients, causes injury to more frail and morbid patients, and is a predictor of mortality in this population in the long term. Conclusion: The long-term follow-up of injured elderly with pelvic trauma should be more intense, and the healthcare provider should put more emphasis on the rehabilitation of these special patient populations in an attempt to prevent long-term mortality.

Keywords: pelvic trauma, elderly trauma, high energy trauma, low energy trauma

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Authors: Brenagh E. Schlingermann, Clare Lodge, Paula Rankin

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Background: Gaelic football, hurling and camogie are highly popular field games in Ireland. Research into the epidemiology of injury in Gaelic games revealed that approximately three quarters of the injuries in the games occur in the lower extremity. These injuries can have player, team and institutional impacts due to multiple factors including financial burden and time loss from competition. Research has shown it is possible to record injury data consistently with the GAA through a closed online recording system known as the GAA injury surveillance database. It has been established that determining the incidence of injury is the first step of injury prevention. The goals of this study were to create a dynamic GAA15 injury prevention programme which addressed five key components/goals; avoid positions associated with a high risk of injury, enhance flexibility, enhance strength, optimize plyometrics and address sports specific agilities. These key components are internationally recognized through the Prevent Injury, Enhance performance (PEP) programme which has proven reductions in ACL injuries by 74%. In national Gaelic games the programme is known as the GAA15 which has been devised from the principles of the PEP. No such injury prevention strategies have been published on this cohort in Gaelic games to date. This study will investigate the effects of the GAA15 on injury incidence and neuromuscular function in Gaelic games. Methods: A total of 154 players (mean age 20.32 ± 2.84) were recruited from the GAA teams within the Institute of Technology Carlow (ITC). Preseason and post season testing involved two objective screening tests; Y balance test and Three Hop Test. Practical workshops, with ongoing liaison, were provided to the coaches on the implementation of the GAA15. The programme was performed before every training session and game and the existing GAA injury surveillance database was accessed to monitor player’s injuries by the college sports rehabilitation athletic therapist. Retrospective analysis of the ITC clinic records were performed in conjunction with the database analysis as a means of tracking injuries that may have been missed. The effects of the programme were analysed by comparing the intervention groups Y balance and three hop test scores to an age/gender matched control group. Results: Year 1 results revealed significant increases in neuromuscular function as a result of the GAA15. Y Balance test scores for the intervention group increased in both the posterolateral (p=.005 and p=.001) and posteromedial reach directions (p= .001 and p=.001). A decrease in performance was determined for the three hop test (p=.039). Overall twenty-five injuries were reported during the season resulting in an injury rate of 3.00 injuries/1000hrs of participation; 1.25 injuries/1000hrs training and 4.25 injuries/1000hrs match play. Non-contact injuries accounted for 40% of the injuries sustained. Year 2 results are pending and expected April 2016. Conclusion: It is envisaged that implementation of the GAA15 will continue to reduce the risk of injury and improve neuromuscular function in collegiate Gaelic games athletes.

Keywords: GAA15, Gaelic games, injury prevention, neuromuscular training

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Authors: Phil P. Wagner

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There is an overwhelming amount of athlete-centric information available for sport practitioners in this era of tech and big data, but protocols in athletic rehabilitation remain arbitrary. It is a common assumption that the rate at which tissue heals amongst individuals is the same; yielding protocols that are entirely time-based. Progressing athletes through rehab programs that lack individualization can potentially expose athletes to stimuli they are not prepared for or unnecessarily lengthen their recovery period. A 7-year aggregated and anonymous database was used to develop reliable and valid assessments to measure athletic resilience. Each assessment utilizes force plate technology with proprietary protocols and analysis to provide key thresholds for injury risk and recovery. Using a T score to analyze movement qualities, much like the Z score used for bone density from a Dexa scan, specific prescriptions are provided to mitigate the athlete’s inherent injury risk. In addition to obliging to surgical clearance, practitioners must put in place a clearance protocol guided by standardized assessments and achievement in strength thresholds. In order to truly hold individuals accountable (practitioners, athletic trainers, performance coaches, etc.), success in improving pre-defined key performance indicators must be frequently assessed and analyzed.

Keywords: analytics, athlete rehabilitation, athlete resilience, injury prediction, injury prevention

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Authors: Xianping Du, Runlu Miao, Guanjun Zhang, Libo Cao, Feng Zhu

Abstract:

Current vehicle safety standards and human body injury criteria were established based on the biomechanical response of Euro-American human body, without considering the difference in the body anthropometry and injury characteristics among different races, particularly the East Asian people with smaller body size. Absence of such race specific design considerations will negatively influence the protective performance of safety products for these populations, and weaken the accuracy of injury thresholds derived. To resolve these issues, in this study, we aim to develop a race specific finite element model to simulate the impact response of the lower extremity of a 50th percentile East Asian (Chinese) male. The model was built based on medical images for the leg of an average size Chinese male and slightly adjusted based on the statistical data. The model includes detailed anatomic features and is able to simulate the muscle active force. Thirteen biomechanical tests available in the literature were used to validate its biofidelity. Using the validated model, a pedestrian-car impact accident taking place in China was re-constructed computationally. The results show that the newly developed lower leg model has a good performance in predicting dynamic response and tibia fracture pattern. An additional comparison on the fracture tolerance of the East Asian and Euro-American lower limb suggests that the current injury criterion underestimates the degree of injury of East Asian human body.

Keywords: lower limb, East Asian body characteristics, traffic accident reconstruction, finite element analysis, injury tolerance

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Authors: Arif Anwar Surani, Salman Ali, Asif Surani, Sohaib Zahid, Akbar Shoukat Ali, Zeeshan-Ul-Hassan Usmani, Joseph Varon, Salim Surani

Abstract:

Objective: Terrorism and suicidal bomb blast attacks are commonplace in Karachi, Pakistan. During the years 2000 to 2007, there were over 60 bomb explosions resulting in more than 1500 casualties. These explosions produce a wide variety of external injuries. We undertook this study to evaluate pattern of external injury produced after bomb blast attacks and to compare injury profile resulting from explosions in open versus semi-confined blast environments. Method: A retrospective, cross-sectional, study was conducted to review injuries sustained after bomb blast attacks in Karachi, Pakistan, from January 2000 to October 2007. Emergency medical records and medico legal certificates of patients presented to three major public sector hospitals of Karachi were evaluated using self-design proforma. Results: Data of 481 victims meet inclusion criteria and were incorporated for final analysis. Of these, 63.6% were injured in open spaces and 36.4% were injured in semi-confined blast environments. Lacerations were commonly encountered as external injury (47.7%) followed by penetrating wounds (15.3%). Lower and upper extremities were most commonly affected (38.6% and 19% respectively). Open and semi-confined blast environments produced a specific injury pattern and profile (p=<0.001). Conclusions: Bomb blast attacks in Karachi produce an external injury pattern consistent with other studies, with exception of an increased frequency in penetrating wounds. Semi-confined blast environments were associated with severe injuries. Further studies are required to better classify injuries and their severity based on standardized scoring systems. Effective emergency response systems must be designed to cope with mass causalities following bomb explosions.

Keywords: bomb blast attacks, injury pattern, external injury, open space, semi-confined space, blast environment

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Authors: Salim Cerig, Fatime Geyikoglu, Pınar Akpulat, Suat Colak, Hasan Turkez, Murat Bakir, Mirkhalil Hosseinigouzdagani, Kubra Koc

Abstract:

This study was designed to evaluate whether carvacrol (CAR) could provide protection against lung injury by acute pancreatitis development. The rats were randomized into groups to receive (I) no therapy; (II) 50 μg/kg cerulein at 1h intervals by four intraperitoneal injections (i.p.); (III) 50, 100 and 200 mg/kg CAR by one i.p.; and (IV) cerulein+CAR after 2h of cerulein injection. 12h later, serum samples were obtained to assess pancreatic function the lipase and amylase values. The animals were euthanized and lung samples were excised. The specimens were stained with hematoxylin-eosin (H&E), periodic acid–Schif (PAS), Mallory's trichrome and amyloid. Additionally, oxidative DNA damage was determined by measuring as increases in 8-hydroxy-deoxyguanosine (8-OH-dG) adducts. The results showed that the serum activity of lipase and amylase in AP rats were significantly reduced after the therapy (p<0.05). We also found that the 100 mg/kg dose of CAR significantly decreased 8-OH-dG levels. Moreover, the severe pathological findings in the lung such as necrosis, inflammation, congestion, fibrosis, and thickened alveolar septum were attenuated in the AP+CAR groups when compared with AP group. Finally, the magnitude of the protective effect on lung is certain, and CAR is an effective therapy for lung injury caused by AP.

Keywords: antioxidant activity, acute pancreatitis, carvacrol, experimental, lung injury, oxidative DNA damage

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Authors: Natasha Yasmin Felles, Gerard Riley

Abstract:

Background and Aims: Relationship breakdown is typical when one partner lives with an acquired brain injury caused by issues like a stroke. Research has found that the perception of relationship satisfaction decreases following such an injury among non-injured partners. Non-injured partners also are found to experience caregiver stress/burden as they immediately have to take the role of a caregiver along with being a partner of the injured. Research has also found that the perception of a continuous relationship, i.e. the perception of the relationship to be essentially the same as it was before the injury, also changes among those caregiving partners. However, there is a lack of available intervention strategies that can help those partners with both individual and relationship difficulties. The aim of this case study was to conduct a pilot test of an intervention aimed to explore whether it is possible to support a partner to experience greater continuity within the relationship poststroke, and what benefits such a change might have. Method: A couple, where one partner experienced an acquired brain injury poststroke were provided with Integrated Behavioural Couples Therapy for 3-months. The intervention addressed goals identified as necessary by the couple and by the formulation of their individual and relationship difficulties, alongside the goal of promoting relationship continuity. Before and after measures were taken using a battery of six questionnaires to evaluate changes in perceptions of continuity, stress, and other aspects of the relationship. Results: Both quantitative and qualitative data showed that relationship continuity was improved after the therapy, as were the measures of stress and other aspects of the relationship. The stress felt by the person with the acquired brain injury also showed some evidence of improvement. Conclusion: The study found that perceptions of relationship continuity can be improved by therapy and that improving these might have a beneficial impact on the stress felt by the carer, their satisfaction with the relationship and overall levels of conflict and closeness within the relationship. The study suggested the value of further research on enhancing perceptions of continuity in the relationship after an acquired brain injury. Currently, the findings of the study have been used to develop a pilot feasibility study to collect substantive evidence on the impact of the intervention on the couples and assess its feasibility and acceptability, which will help in further developing a specific generalized relationship continuity intervention, that will be beneficial in preventing relationship breakdown in the future.

Keywords: acquired brain injury, couples therapy, relationship continuity, stroke

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Authors: Stig H. Jørgensen, Trond Nordfjærn, Øyvind Teige Hedenstrøm, Torbjørn Rundmo

Abstract:

The aim of the paper is to estimate and forecast road traffic injuries in the coming 10-15 years given new targets in urban transport policy and shifts of mode of transport, including injury cross-effects of mode changes. The paper discusses possibilities and limitations in measuring and quantifying possible injury reductions. Injury data (killed and seriously injured road users) from six urban areas in Norway from 1998-2012 (N= 4709 casualties) form the basis for estimates of changing injury patterns. For the coming period calculation of number of injuries and injury rates by type of road user (categories of motorized versus non-motorized) by sex, age and type of road are made. A prognosticated population increase (25 %) in total population within 2025 in the six urban areas will curb the proceeded fall in injury figures. However, policy strategies and measures geared towards a stronger modal shift from use of private vehicles to safer public transport (bus, train) will modify this effect. On the other side will door to door transport (pedestrians on their way to/from public transport nodes) imply a higher exposure for pedestrians (bikers) converting from private vehicle use (including fall accidents not registered as traffic accidents). The overall effect is the sum of these modal shifts in the increasing urban population and in addition diminishing return to the majority of road safety countermeasures has also to be taken into account. The paper demonstrates how uncertainties in the various estimates (prediction factors) on increasing injuries as well as decreasing injury figures may partly offset each other. The paper discusses road safety policy and welfare consequences of transport mode shift, including reduced use of private vehicles, and further environmental impacts. In this regard, safety and environmental issues will as a rule concur. However pursuing environmental goals (e.g. improved air quality, reduced co2 emissions) encouraging more biking may generate more biking injuries. The study was given financial grants from the Norwegian Research Council’s Transport Safety Program.

Keywords: road injuries, forecasting, reduced private care use, urban, Norway

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Authors: Mohammad Karimizadehardakani, Hooman Minoonejad, Reza Rajabi, Ali Sharifnejad

Abstract:

Background: Ankle sprain is one of the most important risk factor of anterior cruciate ligament (ACL) injury. Also, functional ankle instability (FAI) population has alterations in lower extremity sagittal plane biomechanics during landing task. We want to examine whether biomechanical alterations demonstrated by FAI patients are associated with the mechanism of ACL injury during high risk and sport related tasks. Methods: Sixteen basketball player with FAI and 16 non-injured control performed a single-leg cross drop landing. Knee sagittal and frontal (ATSF) was calculated. Independent t-tests, multiple linear regression, and Pearson correlation were used for analysis data. Result: Subject with FAI showed more peak ATFS, posterior ground reaction force (GRF) and less knee flexion, compared to the controls (P= 0.001, P= 0.004, P= 0.011). Knee flexion (r= −0.824, P = 0.011) and posterior GRF (r= 0.901, P = .001) were correlated with ATSF; Posterior GRF was factor that most explained the variance in ATSF (R2= 0.645; P = .001) in the FAI group. Conclusions: Result of our study showed there is a potential biomechanical relationship between the presence of FAI and risk factors associated with ACL injury mechanism.

Keywords: functional ankle instability, anterior cruciate ligament, biomechanics, risk factor

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Authors: Beth Taylor, Kojima Mituaki, Atsushi Senda, Koji Morishita, Yasuhiro Otomo

Abstract:

Intestinal ischaemia-reperfusion injury drives systemic inflammation and organ failure following trauma/haemorrhagic shock (T/HS), through the release of pro-inflammatory mediators into the mesenteric lymph (ML). However, changes in the biological function of ML are not fully understood, and therefore, a specific model of intestinal ischaemia-reperfusion injury is required to obtain ML for the study of its biological function upon inflammatory cells. ML obtained from a model of intestinal ischaemia-reperfusion injury was used to assess biological function upon inflammatory cells and investigate changes in the biological function of individual ML components. An additional model was used to determine the effect of vagal nerve stimulation (VNS) upon biological function. Rat ML was obtained by mesenteric lymphatic duct cannulation before and after occlusion of the superior mesenteric artery (SMAO). ML was incubated with human polymorphonuclear neutrophils (PMNs), monocytes and lymphocytes, and the biological function of these cells was assessed. ML was then separated into supernatant, exosome and micro-vesicle components, and biological activity was compared in monocytes. A model with an additional VNS phase was developed, in which the right cervical vagal nerve was exposed and stimulated, and ML collected for comparison of biological function with the conventional model. The biological function of ML was altered by intestinal ischaemia-reperfusion injury, increasing PMN activation, monocyte activation, and lymphocyte apoptosis. Increased monocyte activation was only induced by the exosome component of ML, with no significant changes induced by the supernatant or micro-vesicle components. VNS partially attenuated monocyte activation, but no attenuation of PMN activation was observed. Intestinal ischaemia-reperfusion injury induces changes in the biological function of ML upon both innate and adaptive inflammatory cells, supporting the role of intestinal ischaemia-reperfusion injury in driving systemic inflammation following T/HS. The exosome component of ML appears to be critical to the transport of pro-inflammatory mediators in ML. VNS partially attenuates changes in innate inflammatory cell biological activity observed, presenting possibilities for future novel treatment development in multiple organ failure patients.

Keywords: exosomes, inflammation, intestinal ischaemia, mesenteric lymph, vagal stimulation

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Authors: Seung Chul Lee, Jooyeong Kim, Ki Ok Ahn, Juok Park

Abstract:

Background: Injuries caused by motorcycle crashes are one of the major public health burdens leading to high mortality, functional disability. The risk of death among motorcyclists is 30 times greater than that among car drivers, with head injuries the leading cause of death. The motorcycle helmet is crucial protective equipment for motorcyclists. Aims: This study aimed to measure the protective effect of motorcycle helmet use on intracranial injury and mortality and to compare the preventive effect in drivers and passengers. Methods: This is a cross-sessional study based on the Emergency Department (ED)–based Injury In-depth Surveillance (EDIIS) database from 23 EDs in Korea. All of the trauma patients injured in motorcycle crashes between January 1, 2013 and December 31, 2016 were eligible, excluding cases with unknown helmet use and outcomes. The primary and secondary outcomes were intracranial injury and in-hospital mortality. We calculated adjusted odds ratios (AORs) of helmet use for study outcomes after adjusting for potential confounders. Using interaction models, we compared the protective effect of helmet use on outcomes across driving status (driver and passenger). Results: Among 17,791 eligible patients, 10,668 (60.0%) patients were wearing helmets at the time of the crash, 2,128 (12.0%) patients had intracranial injuries and 331 (1.9%) patients had in-hospital death. 16,381 (92.1%) patients were drivers and 1410 (7.9%) patients were passengers. 62.6% of drivers and 29.1% of passengers were wearing helmets at the time of the crash. Compared to un-helmeted group, the helmeted group was less likely to have an intracranial injury(8.0% vs. 17.9%, AOR: 0.43 (0.39-0.48)) and in-hospital mortality (1.0% vs. 3.2%, AOR: 0.29 (0.22-0.37)).In the interaction model, AORs (95% CIs) of helmet use for intracranial injury were 0.42 (0.38-0.47) in drivers and 0.61(0.41-0.90) in passengers, respectively. There was a significant preventive effect of helmet use on in-hospital mortality in drivers (AOR: 0.26(0.21–0.34)). Discussion and conclusions: Wearing helmets in motorcycle crashes reduced intracranial injuries and in-hospital mortality. The preventive effect of motorcycle helmet use on intracranial injury was stronger in drivers than in passengers. There was a significant preventive effect of helmet use on in-hospital mortality in driver but not in passengers. Public health efforts to increase motorcycle helmet use are needed to reduce health burden from injuries caused by motorcycle crashes.

Keywords: intracranial injury, helmet, mortality, motorcycle crashes

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