Injury Research Articles

Optimization of tracheoesophageal fistula model established with T-shaped magnet system based on magnetic compression technique.

The magnetic compression technique has been used to establish an animal model of tracheoesophageal fistula (TEF), but the commonly shaped magnets present limitations of poor homogeneity of TEF and poor model control. We designed a T-shaped magnet system to overcome these problems and verified its effectiveness via animal experiments. To investigate the effectiveness of a T-shaped magnet system for establishing a TEF model in beagle dogs. Twelve beagles were randomly assigned to groups in which magnets of the T-shaped scheme (study group, n = 6) or normal magnets (control group, n = 6) were implanted into the trachea and esophagus separately under gastroscopy. Operation time, operation success rate, and accidental injury were recorded. After operation, the presence and timing of cough and the time of magnet shedding were observed. Dogs in the control group were euthanized after X-ray and gastroscopy to confirm establishment of TEFs after coughing, and gross specimens of TEFs were obtained. Dogs in the study group were euthanized after X-ray and gastroscopy 2 wk after surgery, and gross specimens were obtained. Fistula size was measured in all animals, and then harvested fistula specimens were examined by hematoxylin and eosin (HE) and Masson trichrome staining. The operation success rate was 100% for both groups. Operation time did not differ between the study group (5.25 min ± 1.29 min) and the control group (4.75 min ± 1.70 min; P = 0.331). No bleeding, perforation, or unplanned magnet attraction occurred in any animal during the operation. In the early postoperative period, all dogs ate freely and were generally in good condition. Dogs in the control group had severe cough after drinking water at 6-9 d after surgery. X-ray indicated that the magnets had entered the stomach, and gastroscopy showed TEF formation. Gross specimens of TEFs from the control group showed the formation of fistulas with a diameter of 4.94 mm ± 1.29 mm (range, 3.52-6.56 mm). HE and Masson trichrome staining showed scar tissue formation and hierarchical structural disorder at the fistulas. Dogs in the study group did not exhibit obvious coughing after surgery. X-ray examination 2 wk after surgery indicated fixed magnet positioning, and gastroscopy showed no change in magnet positioning. The magnets were removed using a snare under endoscopy, and TEF was observed. Gross specimens showed well-formed fistulas with a diameter of 6.11 mm ± 0.16 mm (range, 5.92-6.36 mm), which exceeded that in the control group (P < 0.001). Scar formation was observed on the internal surface of fistulas by HE and Masson trichrome staining, and the structure was more regular than that in the control group. Use of the modified T-shaped magnet scheme is safe and feasible for establishing TEF and can achieve a more stable and uniform fistula size compared with ordinary magnets. Most importantly, this model offers better controllability, which improves the flexibility of follow-up studies.

Нарушения углеводного обмена у пациентов с боевыми травмами

Aim. To investigate the prevalence and some aspects of the carbohydrate metabolism pathology in patients with combat limb injuries. Materials and methods. 210 patients who suffered from combat injuries of the lower and/or upper extremities from 4 to 58 days (mean 15.9±8.7 days) before admission to the hospital were enrolled in the study. All study participants were men. The mean age of the patients was 36.0±8.4 years (19–59 years). Fasting venous blood glucose concentrations were determined in all patients. Patients with hyperglycemia underwent a study of the glycemic profile and HbA1c. Stress-induced hyperglycemia, estimated mean glucose level over the past 3 months (ADAG), and glycemic gap were calculated. Insulin in fasting blood plasma was determined and the HOMA-IR insulin resistance index was calculated. Results. The incidence of hyperglycemia was 23.3%. In the general group of patients, the mean glucose concentration was 5.5±1.0 mmol/l (3.1–9.73 mmol/l). In the group of patients with hyperglycemia, the mean blood glucose level reached 6.7±0.9 mmol/l, in patients with normal glucose concentration – 5.1±0.5 mmol/l (p&lt;0.000001). The mean fasting blood glucose concentration in patients aged 40 years and older reached 5.7±1.1 mmol/l, those under 40 years old – 5.2±0.8 mmol/l (p=0.005). A significant direct correlation was registered between the fasting glucose level upon admission to the hospital and the age of the patients (r=0.26; p=0.00003). The relative risk of hyperglycemia in patients aged 40 years and older was 1.84 (confidence interval 1.005–3.37; p=0.01). The mean time elapsed since injury in patients with hyperglycemia reached 13.2±5.7 days, with normal glucose concentration – 16.7±9.2 days (p=0.02). Patients with hyperglycemia had lower levels of total protein (58.3±10.2 and 62.1±6.9 g/l, respectively; p=0.004), albumin (31.2±4.6 and 33.2±4.9 g/l; p=0.04), hemoglobin (97.7±18.9 and 105.9±16.9 g/l; p=0.004), but higher levels of C-reactive protein (61.0±55.4 and 32.9±38.1 mg/l; p=0.0001), leukocytes (10.6±4.4 and 9.3±3.4×109/l; p=0.02), count of neutrophils (7.8±4.3 and 6.4±2.9×109/l; p=0.01), proportion of neutrophils (71.6±9.6% and 67.7±7.7%; p=0.004), as well as fibrinogen concentration (5.7±1.4 and 4.8±1.2 g/l; p=0.0002) than patients with normal blood glucose levels. In patients with hyperglycemia, the mean HbA1c level was 5.3±0.6%, stress-induced hyperglycemia – 1.4±0.2 mmol/l. The median glycemic gap reached 1.51 mmol/l (Q1–Q3: 0.88–2.1 mmol/l). The median insulin concentration was 12.9 µIU/ml (Q1–Q3: 9.2–27.0 µIU/ml), the insulin resistance index was 3.3 (Q1–Q3: 2.1–8.8). The mean fasting blood glucose concentration at the last determination in patients with initial hyperglycemia reached 5.8±1.3 mmol/l. During observation, in 64.6% of the patients with hyperglycemia upon admission, glucose levels returned to normal, while in 35.4% mild hyperglycemia remained. The median time to normalization of fasting blood glucose concentration or to the last determination of this indicator was 17.5 days (Q1–Q3: 8–30 days). Conclusions. The study results indicate a frequent detection of hyperglycemia in patients with combat limb injuries. In most cases the increase in fasting glucose levels is small and in most patients this indicator returns to normal within a relatively short time. It is necessary to continue research of stress-induced hyperglycemia in the patients with combat injuries and to elucidate the pathogenetic basis of this pathology.

INSTITUTIONAL WELFARE AND RESILIENCE INITIATIVES FOR DEPLOYED MILITARY PERSONNEL AND FAMILIES: THEORY AND PRACTICE. A CRITICAL REVIEW OF LITERATURE

The recent unprecedented levels of deployment of troops in operations in the Horn of Africa region has dramatically changed the Military families’ growth due to the large number of troops being deployed. Families get affected by deployment-related family separation, combat injury, and death. With continued involvement in operations, there is a deep concern over parental deployment and its impact on the well-being of military families. Parental absence or loss invokes emotional uncertainty and ambiguity in the family. Through Institutional Resilience programmes, family members can successfully adapt to the situation with significant adversity or trauma through interactions with environmental factors such as community environment, the population, and risk factors. This paper therefore reviews extant conceptual and theoretical literature on common resilience programmes, proposes a theoretical framework for transition and wellbeing of military personnel and their families, proposes a definition for the construct ‘social welfare’ and makes recommendations on resilience and welfare initiatives for adoption by the Disciplined Forces and other organizations with employees in conflict prone areas in the Horn of Africa. KEY WORDS: Peacekeeping, Resilience, Welfare, Wellbeing, Counselling, Communication.

The effectiveness of local action of nano oxides on wound infection

The treatment of wound-related combat injuries and antibiotic resistance require the search for new approaches to reduce the risk of infectious complications, this will increase the effectiveness of therapy and even save lives. The aim of our study was to establish the mechanism of action and effectiveness of nano oxides applied to wound infection. The antimicrobial activity of different concentrations of solutions of zinc (nZnO), magnesium (nMgO) and silicon (nSiO2) nano oxides was studied by agar diffusion against clinical antibiotic-sensitive strains of opportunistic Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli), isolated from patients with purulent-septic diseases. It was found that nZnO exhibits extremely high antibacterial activity against S. aureus, E. сoli. The ultra-low content of nZnO (1.56 mg/ml) completely destroys S. aureus, unlike nMgO, the effective concentration of which exceeds the minimum by 16 times. It is known that nZnO has the highest antimicrobial properties against S. aureus and E. coli, this effectiveness is achieved due to the features of the structure and the possibility of the formation of oxygen and a number of other radicals. These qualities of nZnO make it possible to integrate it into dressings for wound treatment.

Long-term exposure to ambient ozone and adult-onset asthma: A prospective cohort study

BackgroundThe association between long-term exposure to ozone (O3) and adult-onset asthma (AOA) remains inconclusive, and analysis of causality is lacking. ObjectivesTo examine the causal association between long-term O3 exposure and AOA. MethodsA prospective cohort study of 362,098 participants was conducted using the UK Biobank study. Incident cases of AOA were identified using health administrative data of the National Health Services. O3 exposure at participants’ residential addresses was estimated by a spatio-temporal model. Instrumental variable (IV) modelling was used to analyze the causal association between O3 exposure and AOA, by incorporating wind speed and planetary boundary layer height as IVs into time-dependent Cox model. Negative control outcome (accidental injury) was also used to additionally evaluate unmeasured confounding. ResultsDuring a mean follow-up of 11.38 years, a total of 10,973 incident AOA cases were identified. A U-shaped concentration-response relationship was observed between O3 exposure and AOA in the traditional Cox models with HR of 0.916 (95% CI: 0.888, 0.945) for O3 at low levels (<38.17 ppb), and 1.204 (95% CI: 1.168, 1.242) for O3 at high levels (≥38.17 ppb). However, in the IV analysis we only found a statistically significant association between high-level O3 exposure and AOA risk, but not for low-level O3 exposure. No significant associations between O3 exposure and accidental injury were observed. ConclusionOur findings suggest a potential causal relationship between long-term exposure to high-level ambient O3 and increased risks of AOA.

Successful management of pulmonary edema secondary to accidental electrocution in a young dog

BackgroundHuman records describe pulmonary edema as a life-threatening complication of electric shock. Successful management requires prompt recognition and intensive care. However, in companion animals, electrocutions are rarely reported, even though domestic environments are full of electrical devices and there is always the possibility of accidental injury. Therefore, it is important for veterinarians to know more about this condition in order to achieve successful patient outcomes.Case presentationA 3-month-old male Labrador Retriever was presented with a history of transient loss of consciousness after chewing on a household electrical cord. On admission, the puppy showed an orthopneic position with moderate respiratory distress. Supplemental oxygen via nasal catheter was provided, but the patient showed marked worsening of respiratory status. Point-of-care ultrasound exams suggested neurogenic pulmonary edema due to electrical shock close to the central nervous system and increased B-lines without evidence of cardiac abnormalities. Mechanical ventilation of the patient was initiated using volume-controlled mode with a tidal volume of 9 to 15 ml/kg until reaching an end-tidal carbon dioxide ≤ 40 mm Hg, followed by a stepwise lung-recruitment maneuver in pressure-controlled mode with increases of the peak inspiratory pressure (15 to 20 cm H2O) and positive end-expiratory pressure (3 to 10 cm H2O) for 30 min, and return to volume-controlled mode with a tidal volume of 15 ml/kg until reaching a peripheral oxygen saturation ≥ 96%. Weaning from the ventilator was achieved in six hours, and the patient was discharged two days after admission without neurological or respiratory deficits.ConclusionsWe present a rather unusual case of a neurogenic pulmonary edema subsequent to accidental electrocution in a dog. Timely diagnosis by ultrasound and mechanical ventilation settings are described. Our case highlights that pulmonary edema should be considered a potentially life-threatening complication of electrical shock in small animal emergency and critical care medicine.

742 Injury Pattern Analysis to Optimize Burn Injury Prevention in the Unhoused Community

Abstract Introduction Unhoused patients represent a unique and vulnerable population of burn survivors. Burn injuries in unhoused patients are more likely to be related to assault, drug use, and mental health issues compared to the general population. Here, we explore the more specific circumstances and activities contributing to burn admissions among unhoused patients to better inform injury prevention efforts. Methods After IRB approval, the burn registry at an urban regional burn center was queried for burn admissions in unhoused adults from 2019-2022. Registry data pulled included demographics, urine toxicology, mechanism of injury, and injury subjective history. Subjective injury history was reviewed to determine more specific injury circumstances and activities during which accidental burns occurred. Demographic and mechanistic trends in burn admissions were explored via descriptive statistics. Results There were 254 admissions to the burn unit for unhoused patients. Patients were mostly male (76.8%), Hispanic (49.6%), and middle aged (IQR 33-55 years). 58.1% of patients were positive for stimulants on admission. The most common burn etiologies were open flame (27.6%), burning clothing or bedding (17.7%), and accelerants (14.2%). Most burns were self-reported accidental (69.7%), 9.8% assault, and 7.1% self-inflicted (missing = 34). Among accidental injuries, 11.3% were related to cooking, 10.1% involved cooking or using methamphetamine, 9.6% involved smoking, 7.3% were due to bonfires, and 5.6% were caused by candles. Conclusions Most burn injuries among unhoused patients were accidental. Although methamphetamine use was directly related to only a small proportion of accidental injuries, more than half of unhoused patients were positive for stimulants upon admission. Most burn injuries among unhoused patients were preventable, with many accidental injuries related to cooking, smoking, and open flames for warmth or light. Applicability of Research to Practice Analysis of admission patterns and subjective history can reveal potential interventions for preventable causes of injury. Safe consumption sites, as well as outreach efforts to educate unhoused patients about situational awareness, accelerants, safe smoking practices, and safe cooking practices may be effective tools in reducing burn admissions in this vulnerable population.

739 Epidemiology of Accidental Burn Injuries: National Trends in Hospitalizations and Emergency Department Visits (2017-2022)

739 Epidemiology of Accidental Burn Injuries: National Trends in Hospitalizations and Emergency Department Visits (2017-2022)

Pattern and severity of injuries, risk factors and outcome of Road Traffic Accident victims attending emergency department of Birat Medical College Teaching Hospital

Introduction: Road Traffic Accidents (RTA) is considered as one of the major public health problems around the globe. It is one of the top 5 causes of morbidity and mortality in South East Asia. Objectives: To find out pattern and severity of injuries, possible risk factors and outcome of victims of RTA attending emergency ward. Methodology: This is a cross-sectional study. All the patients with history of RTA attending the emergency ward have been enrolled with written informed consent after obtaining ethical clearance. Those patients with a history of sudden accidental fall or injury by falling objects were not included. The patients are assessed based on a semi standardized study proforma. The final outcome of the patient at the emergency department is noted. Result: Young adults (17-30 years) were injured most in Road traffic accident (38.41%) Most of them had head injury (59.8%) due to light vehicle (65.2%). Most accidents occurred during evening time (64.3%). Fewer of them were under the influence of alcohol (17%). 39% of the patients were severely injured. 3% patients expired at the emergency ward and 32% of the patients got admitted in ICU. Young adults were severely injured (53.8%) compared to older adults (33.33%). Conclusion: Young adults were involved most and major accidents were due to light vehicles. The majority of the patients had a milder form of injury requiring hospital admissions. The most common pattern was head injury. fewer of them were under alcohol influence.

Unintended Consequences: A Case Study of a Toddler's Accidental Burn Injury Caused by a Hair Crimper.

Recognizing when an injury is concerning for abuse is of utmost importance, as failure to do so places the child at a significant risk for further inflicted injury. Misinterpreting accidental injury as abuse can also have dire consequences for a child and their caregivers. The provider must be aware of characteristics of cutaneous injuries, including burns, that are concerning for abuse. Understanding these characteristics and putting them into clinical practice is necessary to protect children from additional abuse and protect families from wrongful accusations. This case report evaluates a 12-month-old boy who presented to a pediatric emergency room with a patterned, full-thickness burn to the leg. After evaluation, we summarized the additional medical evaluation needed, including a focused history and physical examination, and recommended appropriate diagnostic testing needed to evaluate a child of this age for possible child maltreatment.

Adjusting to a Partners’ Changed Appearance Following Military Combat-Related Appearance-Altering Injuries: The Challenges of Looking “Different” and How Life Continues

Combat-related physical injuries not only affect the individual but also close family members. Emerging evidence indicates that injuries that change appearance, such as limb loss and physical scarring, may create additional psychosocial challenges for the injured person and their family. However, to date the impact of appearance-altering combat injuries have not been explored among the partners of those who were injured. Using a qualitative individual interview design, this study aimed to gain experiential insights into the appearance-specific impact on the partners of military personnel who sustained appearance-altering injuries during deployments or training. Reflexive Thematic Analysis of interviews with 11 female partners identified two main themes “The challenges of looking different” and “How our life continues.” The themes reflect challenges experienced by the partners in relation to their injured partner looking “different” from societally accepted appearance ideals, and the impact this could have on their children. Yet, they had found ways for life to continue such as drawing on positive emotions, having gratitude, pride in their partner’s service, and normalizing difference for their children. While the partners found ways to adapt, this study draws attention to unmet needs for appearance-specific support.

Clinical analysis of 1301 children with hand and foot fractures and growth plate injuries.

Fractures of hands and feet are common in children, but relevant epidemiological studies are currently lacking. We aim to study the epidemiological characteristics of hand and foot fractures and growth plate injuries in children and provide a theoretical basis for their prevention, diagnosis, and treatment. We retrospectively analyzed the data of children with hand and foot fractures who were hospitalized at Shenzhen Children's Hospital between July 2015 and December 2020. Data on demographic characteristics, fracture site, treatment method, etiology of injury, and accompanying injuries were collected. The children were divided into four age groups: infants, preschool children, school children, and adolescents. The fracture sites were classified as first-level (the first-fifth finger/toe, metacarpal, metatarsal, carpal, and tarsal) and second-level (the first-fifth: proximal phalanx, middle phalanx, distal phalanx, metacarpal, and metatarsal) sites. The changing trends in fracture locations and injury causes among children in each age group were analyzed. Overall, 1301 children (1561 fractures; 835 boys and 466 girls) were included. The largest number of fractures occurred in preschool children (n = 549, 42.20%), with the distal phalanx of the third finger being the most common site (n = 73, 15.57%). The number of fractures in adolescents was the lowest (n = 158, 12.14%), and the most common fracture site was the proximal phalanx of the fifth finger (n = 45, 29.61%). Of the 1561 fractures, 1143 occurred in the hands and 418 in the feet. The most and least common first-level fracture sites among hand fractures were the fifth (n = 300, 26.25%) and first (n = 138, 12.07%) fingers, respectively. The most and least common first-level foot fracture locations were the first (n = 83, 19.86%) and fourth (n = 26, 6.22%) toes, respectively. The most common first-level and second level etiologies were life related injuries (n = 1128, 86.70%) and clipping injuries (n = 428, 32.90%), respectively. The incidence of sports injuries gradually increased with age, accounting for the highest proportion in adolescents (26.58%). Hand and foot fractures had many accompanying injuries, with the top three being nail bed injuries (570 cases, 36.52%), growth plate injuries (296 cases, 18.96%), and distal severed fracture (167 cases, 10.70%). Among the 296 growth plate injuries, 246 occurred on the hands and 50 on the feet. In contrast to previous epidemiological studies on pediatric hand and foot fractures, we mapped the locations of these fractures, including proximal, shaft, distal, and epiphyseal plate injuries. We analyzed the changing trends in fracture sites and injury etiologies with age. Hand and foot fractures have many accompanying injuries that require attention during diagnosis and treatment. Doctors should formulate accident protection measures for children of different ages, strengthen safety education, and reduce the occurrence of accidental injuries.

Epidemiology of Accidental Injuries at Home and Related Risk Factors for Mortality among Older Adults in South Korea: A Retrospective Cohort Study.

Background and Objectives: Accidental home injuries among older adults are increasing globally, but reporting is limited. This study aims to establish foundational data for program development and policies to prevent accidental injuries at home in older adults by using data on the occurrence of accidental injuries at home and analyzing the risk factors of mortality due to accidental injuries among adults aged 65 years and older. Materials and Methods: This retrospective study used data from the community-based Severe Trauma Survey in South Korea. This study identified general, injury-related, and treatment-related characteristics of older adults who were transported to the emergency department with accidental injuries at home. Single-variable and multiple logistic regression analyses were used to identify risk factors for mortality after injury. Results: The majority of older adults in this study who experienced accidental injuries at home were aged 75 to 84 (42.8%) and female (52.8%), with 1465 injured from falls and slips (68.0%). Risk factors for mortality included older age (≥85 years) (ORs 2.25, 95% CI 1.47-3.45), male sex (ORs 1.60, 95% CI 1.15-2.20), mechanism of injury (falls or slips vs. contact injury, ORs 6.76, 95% CI 3.39-13.47; airway obstruction vs. contact injury, ORs 13.96, 95% CI 6.35-30.71), higher severity (moderate vs. mild, ORs 2.56, 95% CI 1.45-4.54; severe vs. mild, ORs 12.24, 95% CI 6.48-23.12; very severe vs. mild, ORs 67.95, 95% CI 38.86-118.81), and receiving a blood transfusion (ORs 2.14, 95% CI 1.24-3.67). Conclusions: Based on these findings, the home and community environments where older adults live should be inspected and monitored, and in-home accidental injury prevention strategies should be developed tailored to the characteristics of older adults' risk factors and their injury-related characteristics.

A profile of facial bone fractures in an Oral and Maxillofacial Unit in Trinidad and Tobago

Objective: Investigate the patterns of facial fractures presenting to an oral and maxillofacial service at a teaching hospital in Trinidad. Methods: A retrospective study was conducted to obtain information on traumatic maxillofacial and mandibular fractures from the Oral and Maxillofacial unit at the Eric Williams Medical Complex, Trinidad. Data was collected from February 2019 to February 2020 from 174 patients. For each patient the month of presenting injury, age, sex, ethnicity, mechanism of injury and fracture type was recorded. Results: In the (174) patients that reported fractures, 72% were male and 28% were female patients with a mean age of 34.9 years and mainly from the ethnicity of Afro-Caribbean (63.2%) followed by East Indian (30.5%). Two hundred and thirty-one (231) fractures were reported in this study with the highest number of fractures occurring in the 20-29 years age group (22%) and the most common fracture type was orbital floor fractures (31.6%). The predominant cause of traumatic fracture was physical assault (37.9%) followed by accidental injury (25.9%). Conclusion: The main cause of traumatic maxillofacial injury was physical assault and generally in young adult males. Orbital floor fractures comprised the most common fracture type in this study.

265 Inpatient Outcomes in Pediatric Patients With Non-accidental Versus Accidental Head Trauma: National Trauma Data Bank Analysis

INTRODUCTION: Non-accidental trauma (NAT) is a leading cause of pediatric traumatic brain injury (TBI). Recent studies suggest NAT results in worse outcomes than accidental TBI, independent of severity of the injury and interventions. METHODS: Patients under 18 years old diagnosed with head trauma with or without NAT during 2019-2021 were identified in the NTDB. The predictor variables were demographics; previously validated prognostic factors , including motor score, verbal score, pupillary score, pupillary reactivity, image findings; neurosurgical interventions including EVD, ICPM, PbO2 monitoring; length of stay, and number of ventilated days. Data evaluation and univariate analysis were performed using summary statistics, t-tests, chi-square tests, and non-parametric tests. Mortality, length of ICU stay and complication rates were modeled using a multivariate logistic regression model. Outcomes were controlled for age, race, sex, and teaching vs nonteaching hospital. RESULTS: A total of 90,607 pediatric TBI events were identified in the database, 1721 (1.90%) cases with NAT. NAT was observed most often in 0-2 year-olds (64.78%), followed by 2-5 year-olds (22.66%), 6-10 and 15-18 year-olds (0.09% each), then 11-14 year-olds (0.07%). Patients with NAT had longer ICU stays (6.18 vs 4.93 days, p &lt; 0.0001) and ventilator days, despite similar injury severity scores (p &lt; 0.0001). In-hospital mortality was 30% more likely if NAT was the MOI (LR 1.3046, p &lt; 0.001). CONCLUSIONS: Pediatric TBI patients with NAT have worse inpatient outcomes than similar patients with accidental injuries. Accurate diagnosis and better prognostication scales specific to patients with non-accidental trauma may lead to improved management and resource allocations for these sicker patients.

Military Injuries: Helocasting Accident.

Accidental injuries sustained during helocasting remain unexamined. Conditions prevalent during a helocasting exercise performed at a still water body and the resulting casualties were analyzed. Despatch from greater-than-ideal height (>7 m) and speed (>5 knots) causes a high-velocity impact of the body with water in a non-aerodynamic configuration, exposing maximal body area at penetration. The brunt is borne by the torso/back, specifically, the lungs, ribs, and posterior aspect of the spine. The injuries result from direct trauma, sudden deceleration, barotrauma, and hyperflexion. Computerized tomography (CT) is the imaging of choice in the assessment of these injuries. Prompt evacuation to an equipped center, whilst stabilizing the spine in the suspected, proves pivotal to the outcome. Adverse slamming dynamics cause accidental injuries in helocasting. Thorax and spine are predominantly traumatized, both directly and indirectly, and are assessed best using CT. Timely spine stabilization and evacuation prove vital. Accurate assessment of height/speed and adherence to their ideal limits, at despatch, may avert such injuries.

Management of Ballistic Injuries Affecting the Limbs at the University Hospital of Tengandogo, Burkina Faso, West Africa

Abstract Introduction: Limb arterial injuries are serious clinical conditions that can lead to amputation or death. In Burkina Faso, there is a rise in gun shooting since 2016 because of armed conflict. In this study, the authors report the management of limb arterial injuries that occurred in ballistic traumas. Patients and Methods: From January 1, 2019, to December 31, 2022, 15 patients (14 males and 1 female) consecutively underwent operative management of limb arterial injuries at the University Hospital of Tengandogo. The mean age was 29.9 years old (17–55). Outcomes were defined according to intensive care unit stay time and postoperative morbidity and mortality. Results: Hospital admission after 6 h represented 93.7%. Unstable hemodynamic status was noted in 40%. Upper limbs arteries were more injured (60%) and these included false aneurysms (9) and complete arterial cut (6). Revascularization techniques consisted of direct suture in eight cases and prosthetic grafting in seven cases. Postoperatively, five patients presented complications: two superinfections, two skin necrosis, and one limb paresis. Amputation and mortality were nil. Conclusion: The management of ballistic arterial trauma to the limbs is late in our context. Circumstances are dominated by combat injuries and the militaries are more affected. However, a good indication for revascularization and rigorously executed technique can save the limbs.

Risks of mental health of foreign medical residents who study in Ukraine

IntroductionThe high level of psycho-emotional stress today significantly increases the moral burden on the mental health of medical workers. One of the most vulnerable groups of medical specialists in Ukraine are foreign resident doctors. Since in Ukraine this contingent of doctors is faced with extraordinary problems of high psycho-emotional stress, such as COVID-19 around the world and the russian war against Ukraine. Raising the issue of resident doctors, the main issue becomes not only their professional identity, but also the formation of the necessary stress resistance in different conditions of professional activity.ObjectivesTo study the level of tolerance to stress and uncertainty among foreign resident doctors in unusual conditions of performing professional duties.MethodsThe examination included the use of clinical-psychological, psychodiagnostic and psychometric research methods.ResultsAs of the beginning of 2020, 395 foreigners were studying. During the first phase of the pandemic, 118 foreigners left Ukraine. By the beginning of 2022 (before the full-scale war), 302 medical residents were trained. As of the beginning of 2023, 167 doctors are studying, of which only 61 people are on the territory of Ukraine.The primary analysis of the clinical-psychological study showed that the most common complaints among foreign resident doctors are: increased levels of feelings of tension (in 75,4%), decreased motivation for activity (73,2%), anxious (72,7%) and depressive symptoms (69,3%), frequent headaches (68.6%), constant feelings of irritation (65,4%), manifestations of aggression in relation to colleagues (63,9%) and patients(61,4%), a feeling of fear for the future (60,1%), conflicts in the family (59,5%).The study of factors that influence the increase in the level of stress among foreign resident doctors were sorted according to the principle of ordinary and extraordinary. Ordinary stress factors include: the nature of the specialty, the conditions of professional activity, a foreign country, relationships in the team. Extraordinary factors include new working conditions (professional challenges of COVID-19, war on the territory of Ukraine), increased risks of responsibility for the patient’s life (search for a treatment solution against the background of COVID-19), nature of assistance (providing assistance due to combat injuries).ConclusionsAt the end of the study, a comprehensive program will be created for the early detection of signs of adaptation disorder, which will be aimed at reducing emotional distress, tension in the learning process, support in the first years of training for medical residents.Disclosure of InterestNone Declared

Pain after combat injury in male UK military personnel deployed to Afghanistan

BackgroundChronic pain after injury poses a serious health burden. As a result of advances in medical technology, ever more military personnel survive severe combat injuries, but long-term pain outcomes are unknown. We aimed to assess rates of pain in a representative sample of UK military personnel with and without combat injuries. MethodsWe used data from the ADVANCE cohort study (ISRCTN57285353). Individuals deployed as UK armed forces to Afghanistan were recruited to include those with physical combat injuries, and a frequency-matched uninjured comparison group. Participants completed self-reported questionnaires, including ‘overall’ pain intensity and self-assessment of post-traumatic stress disorder, anxiety, and depression. ResultsA total of 579 participants with combat injury, including 161 with amputations, and 565 uninjured participants were included in the analysis (median 8 yr since injury/deployment). Frequency of moderate or severe pain was 18% (n=202), and was higher in the injured group (n=140, 24%) compared with the uninjured group (n=62, 11%, relative risk: 1.1, 95% confidence interval [CI]: 1.0–1.2, P<0.001), and lower in the amputation injury subgroup (n=31, 19%) compared with the non-amputation injury subgroup (n=109, 26%, relative risk: 0.9, 95% CI: 0.9–1.0, P=0.034). Presence of at least moderate pain was associated with higher rates of post-traumatic stress (RR: 3.7, 95% CI: 2.7–5.0), anxiety (RR: 3.2, 95% CI: 2.4–4.3), and depression (RR: 3.4, 95% CI: 2.7–4.5) after accounting for injury. ConclusionCombat injury, but not amputation, was associated with a higher frequency of moderate to severe pain intensity in this cohort, and pain was associated with adverse mental health outcomes.

Increased safety in periodontal surgery: Doppler ultrasound for detection of relevant palatal blood vessels-A proof-of-concept and cross-sectional study.

To evaluate the suitability of a Doppler ultrasound probe in detecting the greater palatine artery or its greater branches non-invasively. The palatal mucosa of 108 participants (median age 34 years, 51 female) was systematically divided into transversal sectors, each aligning with the positions of the upper molars (M), premolars (P) and canine teeth (C), aiming to facilitate precise and consistent localization of the detected palatal blood vessel across different patients. Blood flow of the palatal blood vessels, presumably, was located by scanning the palatal vault bilaterally using an 8-MHz ultrasound probe linked to a transducer. The distance to the corresponding tooth was measured using a millimetre-scale periodontal probe. Within the regions of M2 to P1, the ultrasound transducer gave a delimitable acoustic pulse signal in 80%-98% of all measurements. The measured median distances between the determined position of the artery and the corresponding teeth ranged from 13 to 15 mm, with smaller distances in the anterior region. In several sectors, the distance was significantly higher for men (C: p = .048; P1: p = .041, M1: p < .01; M2: p = .034). Use of the Doppler ultrasound transducer might be a promising approach to non-invasively detect relevant palatine blood vessels preoperatively. It, therefore, might have the potential to reduce the risk of accidental injury during palatal surgery.