Accidental Trauma Research Articles

Rates, characteristics and toxicology of cocaine-related deaths in Australia, 2000-2021.

To (i) assess the population mortality rates of cocaine-related deaths in Australia, 2000 to 2021; (ii) determine the circumstances of death and case characteristics; and (iii) determine their toxicological profile. Retrospective study of cocaine-related deaths in Australia, 2000 to 2021, retrieved from the National Coronial Information System. Australia-wide. A total of 884 cases, mean age = 33.8 (SD, 10.0) years and 86.5% (n = 765) male. Information was collected on characteristics, manner of death and toxicology. Only cases in which the presence of blood cocaine and/or metabolites were included. Population rates did not significantly increase during 2001-2011 (annual percentage change [APC] = 1.5; CI, -3.2, 6.5), but from 2012, there was a marked acceleration (APC = 20.0, 95% CI, 15.5, 25.3). Circumstances of death were unintentional drug toxicity (70.7%, n = 625), intentional self-harm (17.8%, n = 157), traumatic accident (11.5%, n = 102). The proportion of cases constituted by unintentional toxicity declined across the study period (APC = -2.6; CI, -3.1, -2.1). There was a substantial decline in the proportion of cases with a history of injecting drug use (APC = -5.7; CI, -6.5, -4.9) and with a history of substance use problems (APC = -3.2; CI, -3.9, -2.5). Both cocaine (0.100 vs 0.050 mg/L, P < 0.001) and benzoylecgonine (0.590 vs 0.240 mg/L, P < 0.001) concentrations were higher amongst toxicity cases than in cases of death from traumatic injury. Cocaethylene was present in 26.4% (n = 233), levamisole in 18.6% (n = 164) and lignocaine in 11.5% (n = 102). Psychoactive drugs in addition to cocaine were present in 92.9% (n = 821), most commonly opioids (50.5%, n = 446), alcohol (47.1%, n = 416), hypnosedatives (43.2%, n = 382) and psychostimulants (30.3%, n = 268). There was a steady decline in the proportion of opioid positive cases (APC = -5.4; CI, -6.3, -4.5). There was a large increase in cocaine-related deaths across Australia from 2000 to 2021. This was accompanied by changes in case profiles, with histories of injecting drug use and substance use problems, as well as recent opioid use, becoming less prominent.

Self Amputation of the Penis to a Schizophrenic Patient: A Case Report

Introduction: We present a rare case of complete self-amputation of the penis to a patient followed for schizophrenia under neuroleptic. Case Presentation: A 44 years old patient, schizophrenic under neuroleptic, who presents following an almost total section of his penis 48 hours after his self-mutilation. After having ruled out a life-threatening emergency, hemostasis control with urethral catheterization was carried out in the operating room and then phallic replacement may be indicated to the patient after psychological stabilization. Discussion: The section of the penis is a rare urological emergency that requires a fast surgical catch and can be classified into 3 groups: self-mutilation, criminal amputation or traumatic accident. Schizophrenia and depression represent the two most common causes of psychosis. Iatrogenic amputations of the penis have been described in the literature secondary to circumcisions. Surgical management is based on emergency reimplantation of the penis, section with placement of a urethral catheter or phallic replacement. Conclusion: The section of the penis is a rare urological emergency and the choice of treatment depends on the severity of the lesions and the consultation time.

Out of the box - Traumatic autoenucleation

A 53-year-old gentleman, presented with an alleged history of seizures at home during which he suffered trauma to his left eye leading to prolapse of the globe. This globe luxation was associated with lid lacerations and active bleeding from the orbit. The lacerations were repaired, the globe was enucleated, and eventually, a prosthesis was fit for cosmesis. Autoenucleation usually occurs in patients with psychiatric illness or drug abuse and rarely in cases of accidental trauma. We present this case report to highlight the clinical presentation of such a trauma with complications, which might be overlooked while treating such patients.

Pattern and Magnitude of Ocular Trauma Sustained in Road Traffic Accidents (A Trauma Centre Study)

Purpose: To find out the pattern and magnitude of ocular trauma in road traffic accidents (RTA). Study Design: Descriptive cross sectional study. Place and Duration of Study: Shaheed Mohtarma Benazir Bhutto Trauma Centre, from September 2021 to December 2021. Methodology: Patients meeting the inclusion criteria had history and detailed examination. Data included age, gender, duration of presentation, eye involved, vehicle and type of eye trauma. Frequencies and percentages were computed for all categorical variables and mean and standard deviation was calculated for age. Effect modifiers like age, gender and vehicle were addressed through stratification. Effect of reporting time of injury, age, gender and type of vehicle involved in the pattern of injury was addressed. Post stratification chi-square was applied. P-value less than or equal to 0.05 was considered as significant. Results: Out of 117 patients, 81.1% were males and 18.9% were females. Average age was 29.88 ± 13.9 years. Maximum number of patients was in the age range of 10 – 20 years (35%). Two wheelers were 65.8%. Sixty five percent reported within 24hours of accident. Closed globe trauma accounted for 78.6% and contusion was found in 51 patients (43.6%). Among all, 66.7% had 6/6 – 6/9 visual acuity. No significant association of age and gender was found with pattern of ocular trauma. Reporting time and type of wheeler had association with type of ocular trauma and pattern of ocular trauma (p values less than 0.05). Conclusion: Ocular trauma is more common in young males and patients who report early have better visual acuity.

Analysis of the Prevalence of Types of Traumatic Dental Injuries in Young Children in Lahore.

Aim: To analyze the prevalence of type of dental traumatic injuries in young children in Lahore, Pakistan. Method: A descriptive cross-sectional study was conducted at a Co-Education school named the Ali Public School of Raiwind over a period of one month. The sample of total 280 students were used in this study. The data for all students were collected on type of dental traumatic injuries, age and gender. This data was analyzed using SPSS version 23.0. Results: The most frequent TDI involved is Type-I (58.9%) having age group 11–13 years (63.3%) with males (62%) predominance. The result of that study reveals that Type-I fracture of anterior teeth was most common in males who were more vulnerably subjected to traumatic dental injuries than females. Conclusion: There should be cautionary measures taken to avoid dental traumatic accidents that most frequently occur at home and on the roads. Keywords: Traumatic Dental Injuries, Enamel fracture

Factors associated with new mental health diagnoses and resource utilization among pediatric patients following trauma admission

PurposeInjured children are at risk for a variety of physical and emotional sequelae that may impair their ability to return to prior function. The effect of traumatic injury on mental health in children is not well characterized or understood. We sought to determine factors associated with new mental health diagnoses and/or mental health resource utilization following admission to a Level 1 pediatric trauma center for traumatic injury. MethodsA retrospective chart review of patients admitted for accidental trauma between 2016 and 2019 was performed. Demographic data, injury characteristics, new mental health diagnoses and/or mental health resource utilization following hospitalization were extracted. Patients with prior mental health diagnosis, psychotropic prescription(s), or resource utilization were excluded from this cohort. A multivariable logistic regression model was used to examine predictors of new mental health diagnoses and/or resource utilization. ResultsThe prevalence of new mental health diagnoses or resources utilization was 9.5% (363/3828). The most common diagnoses were anxiety disorders and nonbipolar depression. The most common psychotropic medication prescribed was antidepressants. Patients with new mental illness were older (odds ratio [OR] 1.1 [95% CI: 1.06, 1.12]), more likely to sustain burn injuries (OR 6.3 [4.2, 9.5]), have non-sports related injuries (OR 3.5 [2.1, 6.0]), and be pedestrian struck (OR 2.7 [1.5, 4.8]). They additionally were more likely to sustain head, neck, and spine injuries (OR 3.8 [2.9, 5.1], 2.4 [1.1, 5.5], and 2.1 [1.3, 3.3], respectively). ConclusionsThere are a variety of demographic and injury specific factors associated with new mental health diagnoses and/or resource utilization in children following admission for trauma. Knowledge of these risk factors may ensure patients are allocated adequate resources to promote timely access to appropriate mental health services after hospitalization. Type of StudyRetrospective comparative study Level of EvidenceIII

Acceptance of Advance Care Planning Among Young Adults in Shijiazhuang, China: A Mixed-Methods Study.

Context: In the event of accidental trauma, incurable disease and public health emergencies, young adults are unable to participate in their own medical decisions, family members face the huge decision-making pressure and medical resources of the society were unevenly distributed. Objective: The purposes of this study is to investigate the Advanced Care Planning (ACP) acceptance and examine its influencing factors using sequential explanatory mixed methods in order to provide a basis for the formulation of later interventions. Methods: A cross-sectional study of young adults (N = 785) and 12 other young adults from two other communities were investigated from January 2021 to February 2022. Descriptive statistics and multiple linear regressions were conducted. Content analysis was performed on the qualitative data. Results: The primary factors that contributed to the acceptance of ACP were the natural acceptance of death, being female, having a high level of education, having a loved one diagnosed with a chronic disease, and having heard of ACP. Among young adults, the acceptance of ACP may be impeded by a fear of the unknown nature of death, a poor understanding of ACP, and family-led decision-making. Discussion: Our study found that 77.1% had not heard of ACP before participating in the study and showed potential to accept ACP-related interventions. The study highlighted the importance of implementing regular young adult education courses, promoting routine ACP knowledge, individualized education, discussing family member's disease experiences, conducting family meetings, and identifying young adult responsibilities and roles in implement ACP for young adults in China.

P254 Clinical and microbiological spectrum of invasive trichosporonosis from a tertiary care institute in India

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMIntroductionTrichosporonosis has emerged as an opportunistic pathogen causing invasive infections in immunocompromised patients. Invasive trichosporonosis can involve most organs of the human body. Trichosporon species can colonize many parts of our body and hence it is important to differentiate between colonization and infection for appropriate management of the patients.ObjectiveTo understand the clinical and epidemiological features of infections caused by Trichosporon spp.MethodsAll patients with clinically significant isolation of Trichosporon spp from various samples during a period of one year from January 2019-December 2019 were included in the study.In the present retrospective study demographic data, risk factors, clinical features, microbiological data, treatment, and the outcome of patients with invasive trichosporonosis were analyzed.All the specimens were processed by standard mycological procedures. Identification and susceptibility were done by VITEK 2. The isolates were sent to NCCPF, PGIMER Chandigarh for identification by MALDI-TOF. As no clinical breakpoints for Trichosporon spp. have been established by CLSI and EUCAST, antifungal susceptibility results were interpreted as suggested by Lemes et al.ResultsThere were 14 cases of trichosporonosis during the study period. The predominant age group was 60-70 years and the male: female ratio is 6.5:1.The underlying condition of the patient at admission was accidental trauma in 4/14 (28.7%) chronic kidney disease in 2/14 (14.2%), hematological malignancy in 2/14 (14.2%), pneumonia in 1/14 (7.1%), retroviral disease in 1/14 (7.1%), acute febrile illness in 1/14 (7.1%). The risk factors for acquisition of infections with Trichosporon species in the 14 patients were administration of broad-spectrum antibiotics in 13 (92.8%), urinary catheterization in 11 (78.5%), central venous catheterization, and prolonged ICU stay in 8 (57.1%) each, previous antifungal therapy in 6 (42.8%). The other risk factors were chemotherapy, steroid usage, and neutropenia.The clinical presentations were urinary tract infections in 10/14 (71.4%) patients (9 were catheter-associated UTIs), fungemia in 2/14 (14.2%), and wound infections in 2/14 (14.2%) patients. Trichosporon asahii is the predominant species isolated in 12/14 (85.7%) patients. Other Trichosporon spp. isolated include T. inkin and T. dohaense. All the isolates were correctly identified by VITEK 2 except one which was identified as T. inkin in VITEK 2 and T. dohaense by MALDI-TOF.All the isolates were susceptible to voriconazole and amphotericin B. 9/14 (64.2%) of the isolates were susceptible to fluconazole. Trichosporon spp. is inherently resistant to echinocandins.A total of 7 patients (50%) were successfully treated with voriconazole for a period of 14 days with advice to follow up and discharged. In all, 5 patients (35.7%) died due to underlying diseases before treatment could be started.ConclusionUrinary tract infection, mostly CA-UTI was the commonest clinical presentation of Trichosporonosis in our study followed by bloodstream infection and wound infection. The commonest risk factor was prolonged broad-spectrum antibiotic therapy followed by urinary catheterization. The growth of Trichosporon spp. from various samples has to be interpreted with caution as the organism can also exist as a colonizer in different body sites. Voriconazole was effective in the treatment of trichosporonosis.

P140 Saksenaea vasiformis infection: case report of extensive abdominal wall necrotizing fasciitis with systematic review and analysis of 64 cases

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMIntroduction Saksenaea vasiformis is a rarely reported Mucorales causing mucormycosis in both immunocompromised and immunocompetent individuals. Due to few reported cases, the clinical characteristics and optimal management strategy for this rare agent are not clearly described. Therefore, we conducted a combined analysis of a case of extensive abdominal wall necrotizing fasciitis from our center with individual patient data extracted from other reports in world literature to give an overview of clinical and demographic profiles as well as factors affecting outcomes in this rare infection.MethodsWe systematically reviewed Medline, Embase, and CINHAL for studies on S. vasiformis infections reported till January 1, 2022, and 57 studies (63 patients) were retrieved. We also describe clinical and demographic characteristics and outcomes of a case of extensive abdominal wall necrotizing fasciitis managed at our institution.ResultsOf the 64 included cases, the majority were reported from India (26.6%). The most common risk factors for infection were accidental trauma (31.3%), health-care-related wounds (14.1%), and animal/insect bites (12.5%). Subcutaneous infection was the most common clinical presentation (60.9%) followed by rhino-orbito-cerebral mucormycosis (ROCM) (14%), necrotizing fasciitis (10%), and disseminated infection (9.3%), pulmonary (3.2%) and osteomyelitis (1.6%). Mortality was observed in 24 (37.5%) patients and healthcare-related injuries were significantly associated with higher mortality (P .001). The use of posaconazole (P .019) and surgical intervention (P: .032) was associated with significantly better survival.See Figures 1 and 2 below.DiscussionIn this study, we describe the largest compendium of mucormycosis due to S. vasiformis and can be useful in increasing awareness regarding this rare Mucorales in addition to guiding patient management.

Loss of Vhl alters trabecular bone loss during S. aureus osteomyelitis in a cell-specific manner.

Osteomyelitis, or bone infection, is a major complication of accidental trauma or surgical procedures involving the musculoskeletal system. Staphylococcus aureus is the most frequently isolated pathogen in osteomyelitis and triggers significant bone loss. Hypoxia-inducible factor (HIF) signaling has been implicated in antibacterial immune responses as well as bone development and repair. In this study, the impact of bone cell HIF signaling on antibacterial responses and pathologic changes in bone architecture was explored using genetic models with knockout of either Hif1a or a negative regulator of HIF-1α, Vhl. Deletion of Hif1a in osteoblast-lineage cells via Osx-Cre (Hif1aΔOB ) had no impact on bacterial clearance or pathologic changes in bone architecture in a model of post-traumatic osteomyelitis. Knockout of Vhl in osteoblast-lineage cells via Osx-Cre (VhlΔOB ) caused expected increases in trabecular bone volume per total volume (BV/TV) at baseline and, intriguingly, did not exhibit an infection-mediated decline in trabecular BV/TV, unlike control mice. Despite this phenotype, bacterial burdens were not affected by loss of Vhl. In vitro studies demonstrated that transcriptional regulation of the osteoclastogenic cytokine receptor activator of NF-κB ligand (RANKL) and its inhibitor osteoprotegerin (OPG) is altered in osteoblast-lineage cells with knockout of Vhl. After observing no impact on bacterial clearance with osteoblast-lineage conditional knockouts, a LysM-Cre model was used to generate Hif1aΔMyeloid and VhlΔMyeloid mouse models to explore the impact of myeloid cell HIF signaling. In both Hif1aΔMyeloid and VhlΔMyeloid models, bacterial clearance was not impacted. Moreover, minimal impacts on bone architecture were observed. Thus, skeletal HIF signaling was not found to impact bacterial clearance in our mouse model of post-traumatic osteomyelitis, but Vhl deletion in the osteoblast lineage was found to limit infection-mediated trabecular bone loss, possibly via altered regulation of RANKL-OPG gene transcription.

P213 Lasiodiplodia theobromae: an emerging human pathogen

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objectives Lasiodiplodia theobromae is a dematiaceous fungus, rarely reported to cause infections in humans. This case-series was conducted to identify the potential risk-factors and spectrum of diseases caused by L. theobromae.MethodsWe performed a retrospective analysis of all cases from which the isolates of the L. theobromae were accessioned at the National culture collection of pathogenic fungi (NCCPF), over the last 10 years (January 2012- March 2022). The isolates were retrieved and identified by conventional (colony morphology, color, and microscopic appearances) and molecular (sequencing of ITS1 region of ribosomal DNA) methods. In vitro antifungal susceptibility testing (AFST) was performed by microbroth dilution recommended by the Clinical and Laboratory Standards Institute (CLSI). (M38-A2). The clinical features, demographic details and outcome were recorded.ResultsIn 10 years, a total of 20 patients were identified. The median age of all cases was 39.5 (range: 13-71 years) and 75% were males. The most common clinical presentation was keratomycosis (12,68.6%), followed by soft tissue/sub-cutaneous infection (3,15%), rhinosinusitis (3,15%), onychomycosis (1, 5%), and pneumonia (1, 5%). Most patients were immunocompetent (85%). Among immunocompromised, two patients had acute myeloid leukemia and developed fungal rhinosinusitis while one patient of post-renal transplant on immunosuppressants developed subcutaneous tissue infection in the interscapular region. The fourth patient had decompensated alcoholic hepatitis, encephalopathy, sepsis, and developed pneumonia while he was on mechanical ventilation. Among the various potential risk factors associated with keratomycosis, the most common were, accidental trauma wounds (9, 45%), and mosquito bite in the eye in one patient. The culture on Sabouraud's dextrose agar (SDA) revealed the growth of black mycelial fungus (Fig. 1a). The lactophenol cotton blue (LCB) mount revealed the presence of only dematiaceous septate hyphae which failed to sporulate (Fig. 1b). All the isolates were confirmed by sequencing of ITS (internal transcribed spacer) region of the rDNA using universal primers ITS1 and ITS2. In vitro antifungal susceptibility testing (AFST) was performed using a broth microdilution (BMD) method which revealed variable MIC (μg/ml), i.e., amphotericin (1-2), voriconazole (0.25-2), itraconazole (8-16), posaconazole (1-2). All patients improved on therapy except one patient who succumbed to death due to pneumonia.Conclusion Lasiodiplodia theobromae is an emerging cause of human infections in both immunocompetent and immunosuppressed individuals. It is often difficult to identify due to lack of sporulation making morphological identification challenging. Hence, prompt suspicion and rapid diagnosis with guided therapy are necessary for a better outcome.

Development of a Three-Dimensional Nerve Stretch Growth Device towards an Implantable Neural Interface.

Because of rising traumatic accidents and diseases, the number of patients suffering from nerve injury is increasing. Without effective rehabilitation therapy, the patients will get motor or sensory function losses or even a lifelong disability. As for amputees, neural interface technology can be used to splice nerves and electrical wires together in a way that allows them to control an artificial limb as if it was a natural extension of the body. However, the means the need for an autologous nerve to stimulate axonal regeneration and extension into target tissues, which are limited by the supply of donor nerves. Based on the principle of mechanical force regulating axon growth, in this paper, we developed a three-dimensional nerve stretch growth device for an implantable neural interface. The device consists of three motors controlled by single chip microcomputer and some mechanical parts. The stability and reliability of the device were tested. Then, we used neurons derived from human pluripotent stem cells by small chemical molecules to explore the optimal three-dimensional stretch culture parameters. Furthermore, we found that the axons were intact through 10 rotations per day and 1 mm of horizontal pulling per day. The results of this research will provide convenience for patients treated through an implantable neural interface.

Bilateral Herpes Simplex Keratoconjungtivitis: A Case Report

Introduction: Herpes Simplex Virus (HSV) is one of the DNA viruses known to infect the human eye. Herpes simplex keratitis is, in general, a unilateral disease. Simultaneous bilateral involvement is a rare occurrence that has been observed in patients with compromised immune systems. Purpose: To report a case of bilateral herpes simplex keratoconjunctivitis Case Report: A 22-year-old man arrives with the primary complaint of redness in both eyes in the last four days. The patient complained of blurred vision, tearing, and foreign body sensations. Ophthalmology examination of both eyes revealed visual acuity of 1.0 in the right eye and 0.8 in the left eye, a dendritic lesion, and a decrease in corneal sensation. Patient was diagnosed with bilateral keratoconjunctivitis HSV and was treated with acyclovir ointment, levofloxacin eye drops, acyclovir 400 mg five times a day, and vitamin C 500 mg. Discussion: Bilateral herpes simplex keratitis can occur in both immunocompromised and immunocompetent individuals. Recurrence of HSV infectious keratitis is common. Factors such as emotional stress, fever, postoperative tear dysfunction, ultraviolet (UV-A) radiation exposure, and ocular (accidental or surgical) trauma have also been related to the reactivation of the herpes simplex virus. History, physical, and laboratory examinations support the patient?s diagnosis in order to get the appropriate treatment. Conclusion: Simultaneously occurring bilateral herpetic keratitis has a high proportion of complications, either because of the greater virulence of the virus or because of altered host susceptibility. Therefore, prompt administration of medication upon diagnosis is essential to reduce the severity and frequency of viral attacks and delay the progression of corneal damage.

Precautionary measures, speeding behaviour, and accidental trauma in shaping post-accidental driving behaviour and word of mouth

This research strived to analyse the significant factors affecting the driver's post-accidental behavioural changes. The target sampling technique analysed 325 surgical patients in three government hospitals in north China who got a bone fracture. Structural equation modelling (SEM) technique results considerably differ in behavioural changes. Surgical patients believe that post-accidental behavioural changes combined with WOM creation by surgical patients (drivers) can improve road safety and accidental awareness at a macro level. The f 2 results from SEM show that drivers' post-accidental behavioural changes were strongly affected by accidental trauma and due to attitude toward precautionary measures. Strong effect on WOM creation by driver's behavioural changes and accidental trauma. Mediation effect shows 34.31%, 30.14%, and 29.88% as a partial but significant effect of behavioural changes. Since this is preliminary research in this area, our findings will provide avenues for future research and enrich the policy aspects.

Consequences of road transportation accidents, their standard growth, modern management and tactics of treatment of victims

Aim. Improvement of the results of diagnostics and provision of pre- and hospital medical care to victims with concomitant and multiple trauma in road accidents. Material and research methods. Based on the analysis of the results of diagnosis and treatment, it was found that the Department of Traumatology and Orthopedics of the Regional Clinical Hospital named after B. Vohidov of the city of Bokhtar (former Kurgan-Tyube) for the period 2012 - 2020. there were 2120 patients with injuries. 1234 (58.2 %) victims were injured as a result of road accidents. Research results and their discussion. Prehospital care for victims with concomitant and multiple trauma:1) Pain relief through the use of non-narcotic and narcotic analgesics, aseptic dressings on wounds;2) Immobilizing position of the victim on the shield and stretcher for transportation;3) Introduction of cardiac and respiratory analeptics (strophanthin, korglikon, cordiamine); Conclusion. Thus, in the provision of emergency care to patients with concomitant and multiple trauma on the background of road traffic accidents, the following seems justified.1. Constantly train traffic police officers, drivers of passenger vehicles in the methods of providing first aid directly at the scene of the accident.2. Strengthen the personnel and material - technical potential of regional hospitals located on the highway.3. Improvement of diagnostic and treatment algorithms, training, regular discussion of tactical guidelines their possible correction.

Clinical Study and Profile of Ocular Trauma: Findings From a Rural Hospital in Central India.

ObjectiveIn this study, we aimed to examine the presence of visual damage due to ocular trauma and assess visual outcomes, and document the clinical spectrum and outcomes following ocular injuries among patients presenting to a tertiary care hospital in rural central India.MethodsThis was a hospital-based prospective interventional study conducted over a period of two years from August 2019 to August 2021. Patients with ocular injuries attending the casualty and the Ophthalmology department were included in the study after applying the inclusion and exclusion criteria. A detailed and comprehensive ophthalmic examination was performed and visual acuity was noted at the presentation and follow-ups. The patients were followed up at regular intervals, initially at one week and subsequently at three and six weeks.ResultsThe incidence of ocular trauma was highest in the age group of 31-40 years. There were only three patients aged more than 60 years; 15 were in the pediatric age group (1-20 years). The ocular trauma was highest in males (88.33%) than in females (11.67%). The majority of the patients were from rural areas (70%) and 30% were from urban areas. In this study, both eyes were equally involved. The right eye was involved in 45% of patients and the left eye was involved in 55%. Of note, 80% of the patients presented with closed globe injury, and 20% presented with open globe injury. On classifying the open and closed globe injuries into their subtypes, it was observed that the majority of the patients had lid laceration (n=43, 71.67%), followed by corneal penetration in 12 patients (20%), corneal abrasion in three patients (5%), and lid abrasion in two patients (3.33%). While 34 patients presented to the hospital with a history of road traffic accidents (56.67%), accidental trauma (by a wooden stick, hook of a blouse, bangle, etc.) was noted in 17 patients (28.33%), trauma by soil particle and hand pump in five patients (8.33%), and electrical trauma caused by the blast of capacitor in one patient (1.67%). One patient (1.67%) had sustained trauma from a piece of wood while working on the farm and two patients (3.33%) had a trauma because of assault. Thirty-four patients (66.67%) had a history of falls from bikes, and the next most common object causing trauma was a wooden piece/stick (four patients, 6.67%), followed by trauma caused by an iron particle in four patients (6.67%), trauma by stone in three patients (5%), and trauma by hand pump in two patients (3.33%).ConclusionRoad traffic accidents were the most common cause of ocular trauma in patients attending this rural hospital in central India. The ocular structures involved and types of ocular trauma play a significant role in determining the visual outcomes in these patients.

Evaluating patients’ satisfaction level after using 3D printed PEEK facial implants in repairing maxillofacial deformities

Backgroundit is generally the case in any traumatic accident where a loss in hard tissue occurs to preform restorative plastic surgery, as there are many materials and approaches used to restore the loss, this research sheds the light on the use of one such material and approach being 3D printed facial implants manufactured from PolyEther Ether Ketone (PEEK) and to evaluate the level of patients’ satisfaction following the use of said method in repairing maxillofacial deformities. Materials and methodsa research sample consisting of 10 patients with facial deformities underwent maxillofacial reconstructive surgery between 2020 and 2021 in the Department of Oral and Maxillofacial Surgery in the Tishreen University Hospital - Latakia - Syria. All patients underwent Computed Tomography (CT) scans, then the design of the required facial implant was carried out, the final form of the facial implant was printed from PolyEther Ether Ketone (PEEK), and then surgical work was performed, a check-up after 3 months of the surgical procedure was carried out to evaluate the level of satisfaction on a scale of 1–5. ResultsThe results from the 10 patients showed a good level of satisfaction except in one case where the facial implant had to be removed due to recurrent infection where the patient showed no signs of response to medicinal treatment following the surgery. Conclusionsthis research suggests that the use of 3D printed PEEK facial implants to be very agreeable in terms of functionality and aesthetics in treating various facial deformities.

A Case of Subgaleal Hematoma in a Child from Combing Hair

A subgaleal hematoma is the collection of blood in the subgaleal space of the scalp. This entity is mostly seen in neonates as result of birth trauma. In children, it has been described in both accidental and non-accidental trauma and presents as painful scalp swelling. Subgaleal hematoma, outside the setting of birth or other trauma, is rare. In this report, we describe a case of a massive subgaleal hematoma in a child from non-abusive hair pulling.

추나요법을 동반한 한방복합치료로 호전된 요추 전만각 1례: 증례보고

Objectives :To introduce a case of a traffic accident trauma in a patient with lumbar kyphosis and straightened lumbar curvature, where the Korean medicine treatment with Chuna manual therapy (CMT) improved lumbar lordotic angle(LLA) and lower back pain.&#x0D; Methods : Chuna manual therapy and other Korean medicine treatments; were pro- vided to patient with a flat back posture and low back pain due to the trauma from a traffic accident. Cobb’s angle to evaluate LLA and numeric rating scale (NRS) to eval- uate pain were compared before and after the treatment.&#x0D; Results : There was a significant increase in LLA to reach the normal range and a de- crease in low back pain NRS after Korean medicine treatment with CMT for 9 days of admission treatment and 3 weeks of outpatient treatment.&#x0D; Conclusions :This study suggests that Korean medicine treatment, including CMT, may improve low back pain as well as LLA of straightened lumbar curvatures in patients.

Refocusing SIDS research: Is butylcholinesterase a predictive biomarker?

Unexpected infant and childhood deaths are defined as those where the child was not thought by the family or healthcare professionals to be at risk of death 24 hours before the death or the major collapse leading to the death.1 Unexpected deaths include those subsequently shown to be explained by rapidly progressive natural causes e.g., previously unrecognised cardiac abnormalities, or infections, accidental and non-accidental trauma, drowning and suicide. They also include sudden infant death syndrome a term allocated to an infant death (< 1 year) when no sufficient explanation can be identified following a thorough investigation of the scene and circumstances of death, a post-mortem examination including microbiology and histopathology performed by a pathologist or medical examiner with paediatric training, and a multi-professional review of all available information.