Search results for: renal ischemia-reperfusion injury

Authors: Sarita Magu, Deepak Singh

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Study Design: This prospective study was conducted at the department of Radio Diagnosis, at Pt B.D. Sharma PGIMS, Rohtak in 57 patients of spine injury on radiographs or radiographically normal patients with neurological deficits presenting within 72 hours of injury. Aims: Evaluation of the role of Magnetic Resonance Imaging (MRI) in Spinal Trauma Patients and to compare MRI findings with clinical profile and neurological status of the patient and to correlate the MRI findings with neurological recovery of the patient and predict the outcome. Material and Methods: Neurological status of patients was assessed at the time of admission and discharge in all the patients and at long term interval of six months to one year in 27 patients as per American spine injury association classification (ASIA). On MRI cord injury was categorized into cord hemorrhage, cord contusion, cord edema only, and normal cord. Quantitative assessment of injury on MRI was done using mean canal compromise (MCC), mean spinal cord compression (MSCC) and lesion length. Neurological status at admission and neurological recovery at discharge and long term follow up was compared with various qualitative cord findings and quantitative parameters on MRI. Results: Cord edema and normal cord was associated with favorable neurological outcome. Cord contusion show lesser neurological recovery as compared to cord edema. Cord hemorrhage was associated with worst neurological status at admission and poor neurological recovery. Mean MCC, MSCC, and lesion length values were higher in patients presenting with ASIA A grade injury and showed decreasing trends towards ASIA E grade injury. Patients showing neurological recovery over the period of hospital stay and long term follow up had lower mean MCC, MSCC, and lesion length as compared to patients showing no neurological recovery. The data was statistically significant with p value <.05. Conclusion: Cord hemorrhage and higher MCC, MSCC and lesion length has poor prognostic value in spine injury patients.

Keywords: spine injury, cord hemorrhage, cord contusion, MCC, MSCC, lesion length, ASIA grading

Procedia PDF Downloads 355

Authors: Merav Ben Natan, Rawan Masarwa, Yaniv Steinfeld, Yaniv Yonai, Yaron Berkovich

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Background: Intimate partner violence is a growing public health concern worldwide, and nurses are uniquely positioned to help identify and refer patients for services. Yet, intimate partner violence injury patterns and characteristics often go unrecognized. Objective: The purpose of this study is to explore injury and sociodemographic characteristics associated with intimate partner violence in women presenting to a single emergency department in Israel. Methods: This retrospective cohort study analyzed medical records of married women injured by their spouse who presented to a single emergency department in Israel from January 1, 2016, to August 31, 2020. Results: In total, 145 cases were included, of which 110 (76%) were Arab and 35 (24%) were Jewish, with a mean age of 40. Patients' injury patterns consisted of contusions, hematomas, and lacerations to the head, face, or upper extremities, not requiring hospitalization, and having a history of emergency department visits in the past 5 years. Conclusion: Identifying intimate partner violence characteristics and patterns of injury will help nurses identify, initiate treatment, and report suspected abuse.

Keywords: emergency department, female patients, injuries, intimate partner violence, israel

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Authors: Murat Mert, Yusuf Ozer, Fatih Kolay

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Behaviour of giving harm to the body in literature has been named as “self-injury”, “self-mutilation” ve “self-harm”. “Self-injury”, or “self-mutilation” is generally used for the same meaning and mentioned as an action which is committed to the body itself directly. As is seen that alcohol and drug users have injured their bodies because of deprivation, whereas behaviour of self-injury in some societies is accepted as religious and cultural, it has nevertheless been diagnosed in people who have a borderline personality disorder, histrionic personality disorder, psychotic personality disorder and mood disorder. There has not been any direct self-murder tendency in people having self-harmed. However, death cases can be seen together with loss of consciousness depending on loss of blood by exceeding the limit in the course of injury action. 34- year old – male person who was alcohol addicted, having had a psycological treatment beforehand, had mutilated his small intestine together with fatty tissue by cutting his body with a razor-blade at the thought of insects strolling around the body (delirium tremens) due to deprivation attack and had died in the result of various cuts. In this study, crime scene investigation and death mechanism of the person having had self-harmed in a result of abstinence syndrome will be explained. Relevant criteria which differentiate this case from homicide will be examined.

Keywords: self-injury, autopsy, abstinence syndrome, CSI

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Authors: John E Coumbe-Lilley

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This IRB-approved study explored athletes' emotional recovery experiences following a severe sports injury keeping them out of their sport for six months or longer. A realistic thematic analytical approach was used to interpret the findings of 44 semi-structured interviews of athletes who competed at high school, college, and professional levels of competition. Thematic analysis validated by a self-rating scale demonstrated athletes cross a series of emotional thresholds during their injury rehabilitation process. Results showed athletes crossed two to six emotional thresholds before positive emotion and coping were consistently experienced following their injury. Athletes reported being unequipped to cope with negative emotional intensity, the longevity of recovery, and enduring depression during long-term rehabilitation. Positive emotional recovery was expected no sooner than nine months and up to 2.5 years following a sports injury. In addition, 100% of athletes received no psychological skills training (PST) for coping and recovery, and 93% of athletes indicated passive psychological coping strategies in the first month following injury, which extended their time to recover. Athletes recommended immediate, realistic, and evidence-based strategies benefitting the emotional recovery of severely injured athletes emotional recovery to improve athletes' emotional well-being during long-term rehabilitation and enhance their return to sport. Future experimental research might compare the post-PST program that emerged from this study to determine its efficacy in improving the recovery of severely injured athletes.

Keywords: sports, injury, rehabilitation, psychological skills training, coping

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Authors: Randall E. Osborne, Seth A. Doty

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As participation in organized sports increases, so does the risk of sustaining an athletic injury. These unfortunate injuries result in missed time from practice and, inevitably, the field of competition. Recovery time plays a pivotal role in the overall rehabilitation of the athlete. With time and rehabilitation, an athlete’s physical injury can be properly treated. However, there seem to be few measures assessing psychological recovery from injury. Although an athlete has been cleared to return to play, there may still be lingering doubt about their injury. Overall, there is a vast difference between being physically cleared to play and being psychologically ready to return to play. Certain personality traits might serve as predictors of an individual’s rate of psychological recovery from an injury. The purpose of this research study is to explore the correlations between athletes’ personality and their recovery from an athletic injury, specifically, examining how locus of control has been utilized through other studies and can be beneficial to the current study. Additionally, this section will examine the link between hardiness and coping strategies. In the current study, mental toughness is being tested, but it is important to determine the link between these two concepts. Hardiness and coping strategies are closely related and can play a major role in an athlete’s mental toughness. It is important to examine competitive trait anxiety to illustrate perceived anxiety during athletic competition. The Big 5 and Social Support will also be examined in conjunction with recovery from athletic injury. Athletic injury is a devastating and common occurrence that can happen in any sport. Injured athletes often require resources and treatment to be able to return to the field of play. Athletes become more involved with physical and mental treatment as the length of recovery time increases. It is very reasonable to assume that personality traits would be predictive of athlete recovery from injury. The current study investigated the potential relationship between personality traits and recovery time; more specifically, the personality traits of locus of control, hardiness, social support, competitive trait anxiety, and the “Big 5” personality traits. Results indicated that athletes with a higher internal locus of control tend to report being physically ready to return to play and “ready” to return to play faster than those with an external locus of control. Additionally, Openness to Experience (among the Big 5 personality dimensions) was also related to the speed of return to play.

Keywords: athlete, injury, personality, readiness to play, recovery

Procedia PDF Downloads 147

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

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

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

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Authors: Li Chen, Feng Zhang, Shizhong Zheng

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SaikosaponinD (SSD) is a major component of saikosaponins isolated from Bupleurumfalactum. Our current study was to examine the toxic effect of SSD on liver cells and explore the possible mechanism. The results demonstrated that SSD induced mouse liver injury and led to apoptosis in LO2 cells. HE staining and TUNEL analyses showed that SSD stimulated liver injury and hepatocyte apoptosis in vivo. Subsequent experiments showed that SSD down-regulated Bcl-2 but up-regulated Bax. In vitro, SSD-treated LO2 cells exhibited apparent down-regulated expression of p-p38. Moreover, PDGF-βR agonist PDGF-BB alone significantly upregulated p38 phosphorylation, while combined with SSD, p38 phosphorylation expression was reduced. Furthermore, shRNA-mediated PDGF-βR knockdown augmented the inactivation of p-p38 and Bcl2 but abrogated the activation of Bax, these results were more obvious when shRNA combined with SSD. These data indicated that SSD stimulated liver injury and apoptosis in hepatocytes and PDGF-βR /p38 pathway may be the potential mechanistic.

Keywords: saikosaponin D, hepatotoxicity, liver injury, apoptosis, platelet-derived growth factor-β receptor, p38

Procedia PDF Downloads 399

Authors: Zohreh Rostami, Arezoo Khosravi, Mohammad Nikpoor Aghdam, Mahmood Salesi

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Background: Cardiovascular mortality in chronic kidney disease (CKD) and end stage renal disease (ESRD) patients have a strong relationship with baseline or progressive left ventricular hypertrophy (LVH) meanwhile in hemodialysis patients 10% decrement in left ventricular mass was associated with 28% reduction in cardiovascular mortality risk. In consonance with these arguments, we designed a study to measure morphological and functional echocardiographic variations early after transplantation. Method: The patients with normal renal function underwent two advanced echocardiographic studies to examine the structural and functional changes in left ventricular mass before and 3-month after transplantation. Results: From a total of 23 participants 21(91.3%) presented with left ventricular hypertrophy, 60.9% in eccentric and 30.4% in concentric group. Diastolic dysfunction improved in concentric group after transplantation. Both in pre and post transplantation global longitudinal strain (GLS)- average in eccentric group was more than concentric (-17.45 ± 2.75 vs -14.3 ± 3.38 p=0.03) and (-18.08 ± 2.6 vs -16.1 ± 2.7 p= 0.04) respectively. Conclusion: Improvement and recovery of left ventricular function in concentric group was better and sooner than eccentric after kidney transplantation. Although fractional shortening and diastolic function and GLS-4C in pre-transplantation in concentric group was worse than eccentric, but therapeutic response to kidney transplantation in concentric was more and earlier than eccentric group.

Keywords: chronic kidney disease, end stage renal disease, left ventricular hypertrophy, global longitudinal strain

Procedia PDF Downloads 62

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

Abstract:

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

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

Procedia PDF Downloads 83

Authors: Shahan Waheed, Muhammad Waqas, Asher Feroz

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Objectives: To determine the utility of base deficit in traumatic brain injury in assessing the severity and to correlate with the conventional computed tomography scales in grading the severity of head injury. Methodology: Observational cross-sectional study conducted in a tertiary care facility from 1st January 2010 to 31st December 2012. All patients with isolated traumatic brain injury presenting within 24 hours of the injury to the emergency department were included in the study. Initial Glasgow Coma Scale and base deficit values were taken at presentation, the patients were followed during their hospital stay and CT scan brain findings were recorded and graded as per the Rotterdam scale, the findings were cross-checked by a radiologist, Glasgow Outcome Scale was taken on last follow up. Outcomes were dichotomized into favorable and unfavorable outcomes. Continuous variables with normal and non-normal distributions are reported as mean ± SD. Categorical variables are presented as frequencies and percentages. Relationship of the base deficit with GCS, GOS, CT scan brain and length of stay was calculated using Spearman`s correlation. Results: 154 patients were enrolled in the study. Mean age of the patients were 30 years and 137 were males. The severity of brain injuries as per the GCS was 34 moderate and 109 severe respectively. 34 percent of the total has an unfavorable outcome with a mean of 18±14. The correlation was significant at the 0.01 level with GCS on presentation and the base deficit 0.004. The correlation was not significant between the Rotterdam CT scan brain findings, length of stay and the base deficit. Conclusion: The base deficit was found to be a good predictor of severity of brain injury. There was no association of the severity of injuries on the CT scan brain as per the Rotterdam scale and the base deficit. Further studies with large sample size are needed to further evaluate the associations.

Keywords: base deficit, traumatic brain injury, Rotterdam, GCS

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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: Nurul Mazni Abdullah, Saw Kian Cheah, Raha Abdul Rahman, Qurratu 'Aini Musthafa

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Purpose: Candidemia was associated with high mortality in the critically ill patients. Early candidemia prediction is imperative for preemptive antifungal treatment. This study aimed to externally validate the candidemia risk prediction scores by Jameran et al. (2021) by identifying risk factors of acute kidney injury, renal replacement therapy, parenteral nutrition, and multifocal candida colonization. Methods: This single-center, retrospective observational study included all critically ill patients admitted to the intensive care unit (ICU) in a tertiary referral center from January 2018 to December 2023. The study evaluated the candidemia risk prediction score performance by analysing the occurrence of candidemia within the study period. Patients’ demographic characteristics, comorbidities, SOFA scores, and ICU outcomes were analyzed. Patients who were diagnosed with candidemia prior to ICU admission were excluded. Results: A total of 500 patients were analyzed with 2 dropouts due to incomplete data. Validation analysis showed that the candidemia risk prediction score has a sensitivity of 75.00% (95% CI: 59.66-86.81), specificity of 65.35% (95% CI: 60.78-69.72), positive predictive value of 17.28, and negative predictive value of 96.44. The incidence of candidemia was 8.86%, with no significant differences in demographics or comorbidities except for higher SOFA scoring in the candidemia group. The candidemia group showed significantly longer ICU, hospital LOS, and higher ICU in-hospital mortality. Conclusion: This study concluded the candidemia risk prediction score by Jameran et al. (2021) had good sensitivity and a high negative prediction value. Thus, the risk prediction score was validated for candidemia prediction in critically ill patients.

Keywords: Candidemia, intensive care, acute kidney injury, clinical prediction rule, incidence

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Authors: Mamta Thakur, Dr. Shashi Mawar, Ms. Levis Murry, Dr. D.k.sharma

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Aim: The aim of this study is to develop nephrology nursing procedure protocol after clinical audit of current nephrology nursing practices. Materials and methods: This descriptive observational study was conducted on 40 nurses who were working in Nephrology Department of AIIMS, New Delhi to observe their current practices to assess the existing gaps in the practice. The nurses were enrolled through total enumerative sampling. Sociodemographic profile of nurses and clinical profile for site of procedure was collected. Observation checklist was formed on the basis of standard nursing practices, which included 7 dimensions for hemodialysis procedure and 3 dimensions for procedure of assisting renal biopsy. Based on the gaps identified, nephrology nursing procedure protocol will be developed. Nurses were observed during two shifts, and each nurse was observed once. Scoring of items were done in each dimension, and for acceptable practices, nurses have to score ≥80% in each dimension. Results: Data was analyzed using descriptive statistics. Majority of nurses (73.7%) in nephrology ward and (80.9%) in hemodialysis unit have not undergone any special training in nephrology. Most of nurses (80.9%) followed the acceptable nursing practices for procedure of connection for hemodialysis. None of nurses followed the acceptable level (≥80%) of nursing practices for the procedure of predialysis assessment, the procedure for site preparation, during dialysis assessment and post dialysis assessment. None (100%) showed the acceptable level of nursing practices for all the dimensions of assisting renal biopsy procedure. Nephrology nursing procedure protocol was developed by researcher following a rigorous process, and this will reduce the gaps in the nursing practice. Conclusion: Clinical audit found that there were gaps in the existing nursing practices compared to the standardised nursing practices for procedure of hemodialysis and assisting renal biopsy, and these gaps have been addressed by the development of the protocol.

Keywords: nursing practice, nephrology nursing procedure, nursing protocol, renal biopsy, hemodialysis

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Authors: Elsayed A. M. Shokr, A. Alhazemi, T. Naser, Talal A. Zuhair, Adel A. Zuhair, Ahmed N. Alshamary, Thamer A. Alanazi, Hosam A. Alanazi

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The main threats to human health from heavy metals are associated with exposure to Pb, Cd, Cu, Mo, Zn, Ni, Mn Co and Cr. is mainly via intake of drinking water being the most important source in most populations. These metals have been extensively studied and their effects on human health regularly reviewed by international bodies such as the WHO. Heavy metals have been used by humans for thousands of years. Although several adverse health effects of heavy metals have been known for a long time, exposure to heavy metals continues, and is even increasing in some parts of the world, in particular in less developed countries, though emissions have declined in most developed countries over the last 100 years. A strong relationship between contaminated drinking water with heavy metals from some of the stations of water shopping in Hail, KSA and chronic diseases such as renal failure, liver cirrhosis, and chronic anemia has been identified in this study. These diseases are apparently related to contaminant drinking water with heavy metals such as Pb, Cd, Cu, Mo, Zn, Ni, Mn Co and Cr. Renal failure is related to contaminate drinking water with lead and cadmium, liver cirrhosis to copper and molybdenum, and chronic anemia to copper and cadmium. Recent data indicate that adverse health effects of cadmium exposure may occur at lower exposure levels than previously anticipated, primarily in the form of kidney damage but possibly also bone effects and fractures. The general population is primarily exposed to mercury via drinking water being a major source of methyl mercury exposure, and dental amalgam. During the last century lead, cadmium, zinc, iron and arsenic is mainly via intake of drinking water being the most important source in most populations. Long-term exposure to lead, cadmium, zinc, iron and arsenic in drinking-water is mainly related to primarily in the form of kidney damage. Studies of these diseases suggest that abnormal incidence in specific areas is related to toxic materials in the groundwater and thereby led to the contamination of drinking water in these areas.

Keywords: heavy metals, liver functions, kidney functions and chronic renal failure, hail, renal, water

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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: Bahlous Afef, Bouzid Kahena, Bardkis Ahlem, Mrad Mehdi, Kalai Eya, Sonia Bahri, Abdelmoula Jaouida

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Diabetic nephropathy is the first cause of chronic renal failure and hemodialysis use in several countries including Tunisia. The role of hypertension (HT) as major risk factor for nephropathy is undeniable. The aim of our study was to determine the relationship between blood pressure and nephropathy in a population of diabetic type 2 recently discovered. Materials and methods: We conducted a prospective study focused on 60 patients with type 2 diabetes recently discovered (<5 years). Each patient have benefited from: -a full clinical examination with measurement of blood pressure - exploring a blood-glucose control and renal function -urinary exploration with the determination of proteinuria microalbuminumie of 24 hours with a immunoturbidimetric method using Architect (ABBOTT CI 8200). Results and discussion: Hypertension was present in 46.7% of cases. Twenty patients, 35% of the study population showed nephropathy. Four of these patients (6.66% of cases) had proteinuria, while 16 (26.6% of patients) had microalbuminuria (> 30mg/24 hours). Systolic blood pressure was significantly (p < 0.05) associated with the presence of nephropathy (139 +19.44) vs. for the group with normal renal function (128.65 +15.12 mmHg). Conclusion: The etiology of diabetic nephropathy is multifactorial. However, systolic blood pressure and glycemic control remains the major risk factors. Better glycemic control and treatment of hypertension allowed preventing and slowing the progression of diabetic nephropathy.

Keywords: hypertension, nephropathy, hemodialysis, diabetes

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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: Gerard Bray, Arya Bahadori, Sachinka Ranasinghe

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Renal cell carcinoma (RCC) is among the top 10 most common cancers worldwide, where metastatic disease carries a poor prognosis. Herein, we present a 74-year-old male presenting with asymptomatic solitary metachronous metastasis to the gall bladder 4 years following nephrectomy for clear cell RCC. Solitary RCC metastasis to the gall bladder following nephrectomy is rarely reported in the literature and brings with it a clinical conundrum of whether surgical resection or systemic therapy should be utilized. In this case, surgical excision with cholecystectomy was employed without systemic therapy. We, therefore, contribute a rare and interesting case that highlights that metastasectomy of a solitary metastasis can improve survival according to current literature.

Keywords: renal cell carcinoma, gall bladder metastasis, solitary metastasectomy, metachronous

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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: 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: Clara Luwe, Oliver Harness, Helena Meally, Kim Martin, Alexandra Harrington

Abstract:

Background: The role of ‘Renal Specialist Podiatrist’ originated in 2022 due to prevailing evidence of patients with diabetes and end-stage renal disease (ESRD) on haemodialysis (HD) and active ulcerations that were at higher risk of rapid deterioration, foot-related hospital admissions, and lower limb amputations. This role started in April 2022 with the aim of screening all patients on haemodialysis and instigating preventative measures to reduce serious foot related complications. Methods: A comprehensive neurovascular foot assessment was completed to establish baseline vascular status and identify those with peripheral arterial disease (PAD) for all patients on HD. Individual’s foot risk was stratified, advice and education tailored and issued. Identifying all diabetes patients on HD as high-risk for diabetic foot complications. Major Findings: All patients screened revealed over half of the caseload had diabetes, and more than half had a clinical presentation of PAD. All those presenting with ulcerations had a diagnosis of diabetes. Of the presenting ulcerations, the majority of these ulcers predated the renal specialist post and were classified as severe >3 SINBAD Score. Since April’22, complications have been identified quicker, reducing the severity (SINBAD<3 or below), and have improved healing times, in line with the national average. During the eight months of the role being in place, we have seen a reduction in minor amputations and no major amputations. Conclusion: By screening all patients on haemodialysis and focusing on education, early recognition of complications, appropriate treatment, and timely onward referral, we can reduce the risk of foot Diabetic foot ulcerations and lower limb amputations. Having regular podiatry input to stratify and facilitate high-risk, active wound patients across different services has helped to keep these patients stable, prevent amputations, and reduce foot-related hospital admissions and mortality from foot-related disease. By improving the accessibility to a specialist podiatrist, patients felt able to raise concerns sooner. This has helped to implement treatment at the earliest possible opportunity, enabling the identification and healing of ulcers at an earlier and less complex stage (SINBAD <3), thus, preventing potential limb-threatening complications.

Keywords: renal, podiatry, haemodialysis, prevention, early detection

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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: 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: 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: Lalit Kishore, Randhir Singh

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Diabetic nephropathy (DN) is the major cause of morbidity among diabetic patients. In this study, the effect of Bacopa monnieri Linn. (Brahmi, BM), was studied in a Streptozotocin (STZ)-induced experimental rat model of DN. Diabetic nephropathy was induced in Male Wistar rats (body weight- 300± 10 gms) by single intra-peritoneal injection of STZ (45mg/kg, i.p.) after 15 min of Nicotinamide (230 mg/kg) administration. Different doses of alcoholic extract i.e. 100, 200 and 400 mg/kg was given for 45 days by oral gavage after induction of DN. Blood glucose level, serum insulin, glycosylated haemoglobin, renal parameters (serum urea, uric acid, creatinine and BUN) and lipid profile (total cholesterol, triglycerides, HDL, LDL and VLDL levels) were measured. Concentration of thiobarbituric acid reactive species (TBARS) and levels of antioxidant enzymes of reduced glutathione (GSH), superoxide dismutase (SOD), and catalase (CAT) were evaluated in the kidney, liver and pancreas. At the end of treatment period the alcoholic extract of BM reduced the elevated level of blood glucose, serum insulin, renal parameters, lipid levels, TBARS, AGE’s in kidney and significantly increased body weight, HDL and antioxidant enzymes in dose dependent manner as compared to diabetic control animals. These results suggested the BM possesses significant renoprotective activity.

Keywords: AGE's, lipid profile, oxidative stress, renal parameters

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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

Procedia PDF Downloads 466