Combat Trauma Research Articles

P-753. Characterizing Multidrug-Resistant Acinetobacter baumannii Infections among Wartime Casualties

Abstract Background Acinetobacter baumannii (ACB) emerged as a key pathogen during the war in Iraq and was designated as a serious threat in the 2013 Centers for Disease Control’s antimicrobial resistance report. We describe the characteristics of wounded military personnel with ACB infections. Methods Data were obtained from the Trauma Infectious Disease Outcomes Study, an observational study of US service members injured in Iraq and Afghanistan (6/09-12/14). Patients who had ≥ 1 positive infecting ACB isolate were assessed. Multidrug resistance (MDR) was defined as resistance to ≥ 3 classes of antimicrobials or production of extended-spectrum β-lactamase or carbapenemase. Categorical variables were compared by Chi-square or Fisher’s Exact and continuous variables by Mann-Whitney U. Results Among 160 patients with ACB infections, 116 (73%) and 43 (27%) had MDR and non-MDR ACB, respectively. All were male with a median age of 23.5 years and the majority sustained injuries in combat (96%) in Afghanistan (93%) (Table 1). Blast was the primary injury mechanism (86%), resulting in high injury severity. There was a total of 283 ACB infections with 222 (78%) MDR and 61 (22%) non-MDR; 59 patients had ≥ 1 ACB infection (median of 2 [IQR 2-4] infections). Skin and soft-tissue infections (48%) were most common, followed by pneumonia (23%), bloodstream infections (15%), and osteomyelitis (11%) (Table 2). Compared to non-MDR ACB patients, patients with MDR ACB had greater transfusions requirements within 1st 24 hours post-injury (median 25 vs 15 units p=0.01, Table 1). There was a non-significant trend toward more abdominal/pelvic/groin injuries among MDR ACB patients (60% vs 42% with non-MDR p=0.051). Hospital duration was a median 52.5 days and crude mortality was 3% with no significant difference between the groups. Conclusion Battlefield casualties with ACB infections were characterized by high injury severity, frequently caused by blast trauma with MDR ACB more often in those with larger volume blood transfusions. Wound infections and pneumonia were most common. Overall, ACB infection patients were critically ill with large resource utilization regardless of MDR status. Further analysis to compare outcomes with non-ACB infection outcomes is warranted. Disclosures David Tribble, MD, DrPH, AstraZeneca: The IDCRP and HJF were funded to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial as part of US Govt COVID Response

Prehospital Trauma Compendium: Prehospital Administration of Antibiotics in Trauma Patients – an NAEMSP Resource Document

ABSTRACT OBJECTIVES To conduct a literature review and provide a summary of the evidence surrounding prehospital administration of antibiotics for open fractures and other major open wounds. METHODS We performed a literature search and summarized the evidence following the methodology established for the NAEMSP Prehospital Trauma Compendium. We searched PubMed from inception to 23 December 2022 for articles relevant to Emergency Medical Services, trauma, and antibiotics. Due to resource limitations, the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology was not used during review of the evidence, and no formal assessment of bias or strength of evidence was performed. RESULTS Of 105 articles identified in the initial search, 13 articles were included in the final evidence review and synthesis. Prehospital administration of antibiotics in combat and civilian trauma patients consists of mostly observational, retrospective studies that describe use as likely safe, but with uncertainty as to its effect on important clinical outcomes. Both combat and civilian analyses of protocol adherence and inter-rater reliability for recognition and treatment of injuries have also produced variable and inconsistent results. These results pose a challenge for implementation and highlight the inherent limitations and external validity of efficacy outcomes published to date. CONCLUSIONS Prehospital administration of prophylactic antibiotics for trauma appears safe and may be considered in some specific patient populations. Universal and widespread adoption of this intervention needs further study to identify the true impact on patient-centered outcomes and identification of patients who might confer greatest benefit. Local practice characteristics may support adoption of multidisciplinary-developed prudent and practicable protocols incorporating the use of prophylactic antibiotics for some trauma patients such as those with open fractures or those with significant delays in transport to definitive care. Future research should attempt to address the appropriate identification of wounds and injury patterns that have the highest likelihood of benefit from prehospital administration of antibiotics, the ideal timing of administering the antibiotic(s) following initial injury, impact on infection rates, and other important patient outcomes.

Experience of surgical treatment of combat pancreatic trauma

Background. Pancreatic injuries is a complex challenge for trauma surgeons, especially if combat, due to the presence of combined injuries and complications. The aim: to provide a structure, peculiarities of diagnosis and treatment of combat pancreatic trauma. Materials and methods. A retrospective analysis was done of medical records of 58 inpatients who sustained combat pancreatic trauma during the war in Ukraine. Their average age was 37.4 ± 3.6 years (range 21–60 years). The mechanism of combat injury included gunshot wounds (87.9 %), explosive (10.3 %) and closed injuries (1.7 %). All the wounded underwent laboratory and instrumental investigations. Results. According to the nature of the combat injury, pancreatic injuries were categorised into gunshot shrapnel wounds — 50 (86.2 %), gunshot bullet wounds — 1 (1.7 %), explosive trauma — 6 (10.3 %), and closed combat trauma — 1 (1.7 %) case. Distribution by location of pancreatic injury: tail — 38 (65.5 %), head — 11 (19 %), body — 5 (8.6 %), body and tail — 2 (3.4 %), head and tail — 2 (3.4 %) cases. The following methods of surgical intervention were used: damage control surgery (DCS) — 51 (87.9 %) cases, one-stage surgery — 7 (12.1 %) cases. Distribution by the type of surgical intervention for pancreatic injury: drainage of the parapancreatic space — 45 (77.6 %), pancreatorrhaphy — 4 (6.9 %), distal pancreatosplenectomy — 3 (5.2 %), removal of foreign bodies (metal fragments) — 3 (5.2 %), distal resection of the pancreas with spleen preservation — 1 (1.7 %), pancreatoduodenectomy — 1 (1.7 %), subtotal resection of the body and tail of the pancreas with splenectomy — 1 (1.7 %) case. Common complications (n = 42): peritonitis — 9 (21.4 %), acute surgical sepsis — 8 (19 %), acute renal failure — 7 (16.7 %), multiple organ failure syndrome — 7 (16.7 %), pneumonia — 6 (14.3 %), bleeding — 4 (9.5 %), pulmonary embolism — 1 (2.4 %). Organ-specific complications (n = 28) were as follows: acute pancreatitis — 21 (75 %), pancreatic fistula — 4 (14.3 %), pseudocysts — 2 (7.1 %), abscess — 1 (3.6 %) case. Treatment outcomes: 33 patients (56.9 %) were transferred to the next stage of treatment, 19 (32.8 %) died, and 6 (10.3 %) were discharged with a definite outcome. Mortality rate: 5 (26.3 %) died in the first 3 days, 14 (73.7 %) cases died in the period from 4 to 15 days. Conclusions. The incidence of combat pancreatic trauma among abdominal wounds is 8.7 %. Surgical treatment for combat pancreatic trauma using the DCS is performed in 87.9 % of cases, and in the volume of a single-stage operation, in 12.1 %. The DCS leads to a reduction in the incidence of complications. The overall complication rate for combat pancreatic trauma is 72.4 %, and the incidence of organ-specific complications is 48.3 %. Mortality from pancreatic injuries is 32.8 %. Combat trauma to the head of the pancreas was mainly treated with closed drainage. Distal injuries were treated by resection or drainage.

Retrospective analysis of the microbiological landscape of bacteremia after blast injury: experience of the 2022–2024 Russian-Ukrainian war

Background. Against the backdrop of ongoing russian aggression, the need for effective treatment of combat trauma is becoming increasingly urgent. Infectious complications, including sepsis, remain a significant concern, with up to 14 % of wounded individuals developing bacteremia compared to 4 % in civilian trauma. Studies have shown that S.epidermidis and E.coli are the most frequently detected blood isolates, while ESKAPE pathogens account for 8 % of cases. It should be noted that the literature data on bacteremia in blast injury is limited. This study purposed to evaluate the microbiological landscape of bacteremia and the antibiotic susceptibility of pathogens in military personnel with blast injury. Materials and methods. A retrospective cohort, single-center study was conducted in wounded servicemen treated at a tertiary care facility in Kyiv between February 24, 2022, and March 14, 2024. Inclusion criteria were blast injury as a result of hostilities, availability of blood culture results, admission to a medical facility within < 30 days after trauma. Data collection encompassed demographic, clinical, and microbiological information. Statistical analysis was performed using R and Microsoft Excel. Results. The study included 181 patients (mean age 38.00 ± 0.72 years), of whom 155 were discharged and 26 died. A total of 313 blood cultures were performed, yielding 318 isolates. No growth was detected in 233 cases (73.27 %, 95% confidence interval (CI) 68.41–78.13), while gram-positive pathogens were found in 47 isolates (14.78 %, 95% CI 10.88–18.68), gram-negative pathogens in 22 (6.92 %, 95% CI 4.13–9.71), and fungi in 16 (5.03 %, 95% CI 2.63–7.43) (p < 0.001). The most common isolates were S.epidermidis (7.86 %, 95% CI 4.9–10.82), Candida spp. (4.72 %, 95% CI 2.39–7.05), and K.pneumoniae (4.09 %, 95% CI 1.91–6.26). Among these, 77.78 % (n = 35/45) of gram-positive and 100 % (n = 20/20) of gram-negative isolates were resistant to ≥ 2 antibacterial agents. Gram-positive isolates demonstrated high susceptibility to tigecycline (100 %), amikacin (84.85 %), and linezolid (81.4 %), while gram-negative isolates — to colistin (100 %) and tigecycline (73.33 %). The presence of gram-negative bacteria in the blood significantly increased the risk of death (odds ratio 15.48, 95% CI 4.67–57.17, p < 0.001). Conclusions. Our findings confirm the predominance of gram-positive isolates in bacteremia, but gram-negative sepsis poses the greatest risk. More than 77 % of identified isolates were multidrug-resistant, with high sensitivity observed only to last-resort antibiotics.

Experentia Et Progressus: An Experiential Needs Assessment of Military Health care Providers in Treating Pediatric Combat Trauma.

Children are among the most vulnerable populations affected by armed conflicts, yet there is limited data on the preparedness of military medical personnel to care for pediatric combat trauma casualties in austere or large-scale combat operations. This study aimed to assess the confidence, training needs, and resource requirements of military medical providers who have managed pediatric patients during deployment. This IRB-exempt, cross-sectional mixed-methods study used a survey created via a modified Delphi method with input from subject matter experts. The survey was distributed to active duty and reservist physicians, nurses, medics, and corpsmen who had previously deployed to combat environments. Respondents answered Likert-style questions anonymously on the SurveyMonkey platform. Data were analyzed using Welch's t-test, with statistical significance defined as P < .05. Qualitative data were coded into discrete themes and summarized. A total of 84 respondents participated in the survey. Only 27% reported feeling confident or very confident in resuscitating pediatric casualties. Health care providers with prior exposure to pediatric patients reported significantly higher confidence in pediatric trauma resuscitation (P = .02). Key factors contributing to low confidence included difficulty with pediatric medication dosing, anatomical and physiological differences, lack of experience, and insufficient pediatric-specific equipment during deployment. Nearly all respondents with prior pediatric combat trauma experience expressed a desire for additional pediatric-specific predeployment training, with nearly half (47%) advocating for more robust military-civilian trauma center partnerships. Furthermore, 59% of respondents felt they lacked adequate emotional support following negative pediatric events and recommended stronger post-traumatic event debriefing and support mechanisms. Many recently deployed military medical providers reported low confidence in resuscitating pediatric patients in the combat environment, because of drug dosing, anatomic and physiologic differences, and inexperience. Regardless of specialty, almost all providers requested additional pediatric training to improve baseline preparedness. These results can guide future predeployment training and inform policy to reduce unnecessary pediatric mortality on the battlefield.

Blood-Based Lateral-Flow Immunoassays Dipstick Test for Damaged Mitochondrial Electron Transport Chain in Pyruvate Treated Rats with Combined Blast Exposure and Hemorrhagic Shock

Blast trauma presents a unique challenge due to its complex mechanism of injury, which impacts the brain and other vital organs through overpressure waves and internal bleeding. Severe blood loss leads to an inadequate oxygen supply and insufficient fuel delivery to cells, impairing ATP production by mitochondria—essential for cell survival. While clinical symptoms of metabolic disruption are evident soon after injury, the molecular, cellular, and systemic damage persists for days to years post-injury. Current challenges in treating traumatic brain injury (TBI) stem from (1) the lack of early blood-based biomarkers for detecting metabolic failure and mitochondrial damage and (2) the limited success of mitochondrial-targeted therapeutic strategies. Objectives: To identify blood-based mitochondrial biomarkers for evaluating the severity of brain injuries and to investigate therapeutic strategies targeting mitochondria. Methods: A preclinical rat model subjected to blast exposure, with or without hemorrhagic shock (HS), followed by resuscitation was utilized. Blood samples were obtained at baseline (T0), post-injury (T60), and at the conclusion of the experiment (T180), and analyzed using a validated dipstick assay to measure mitochondrial enzyme activity. Results: Blast and HS injuries led to a significant decrease in the activity of mitochondrial enzymes, including complex I, complex IV, and the pyruvate dehydrogenase complex (PDH), compared to baseline (p &lt; 0.05). Concurrently, blood lactate concentrations were significantly elevated (p &lt; 0.001). An inverse correlation was observed between mitochondrial enzyme dysfunction and blood lactate levels (p &lt; 0.05). Treatment with sodium pyruvate post-injury restored complex I, complex IV, and PDH activity to near-baseline levels, corrected hyperlactatemia, and reduced reactive oxygen species (ROS) production by mitochondria. Conclusions: Serial monitoring of blood mitochondrial enzyme activity, such as complex I, complex IV, and PDH, may serve as a valuable tool for prognostication and guiding the use of mitochondrial-targeted therapies. Additionally, mitochondrial enzyme assays in blood samples can provide insights into the global redox status, potentially paving the way for novel therapeutic interventions in TBI.

Criminal Justice System Involvement Among U.S. Military Veterans: Prevalence, Correlates, and Mental Health Burden

Studies of justice system involvement (JSI) among U.S. military veterans have yielded mixed results regarding both prevalence and correlates due in part to sampling variability and limitations. The present study examined factors associated with lifetime JSI in a nationally representative sample of 4,049 U.S. veterans. Bivariate and multivariate analyses indicate that JSI was associated with racial/ethnic minority, lower income/education, combat, and other lifetime traumas. Relative importance analysis revealed that lifetime substance use disorders, cumulative trauma, adverse childhood experiences, and male sex accounted for the majority of variance in predicting JSI. JSI was also independently associated with current substance use, suicidal ideation, and psychiatric treatment utilization. The study provides population-based findings that extend previous studies. Results underscore the need for informed identification, prevention, and intervention for veterans in the community who are at increased for JSI.

Neuropathic postamputation residual limb pain after combat trauma: an evidence-based review of diagnosis and injection therapy

Background. The devastating nature of the russian-Ukrainian war has led to a dramatic increase in the incidence of limb amputations. The purpose was to analyze the available medical literature concerning neuropathic postamputation residual limb pain and injection therapy. Materials and methods. A comprehensive literature search of electronic databases MEDLINE/PubMed, Embase, and Scopus was conducted to identify primary studies. The evidence-based review was reported in accordance with the critical evaluation of published articles, PRISMA, and OCEBM. A total of 64 publications were included in the final quantitative analyses. Results. The estimated prevalence of residual limb pain after combat traumatic amputations is higher (61 %) than due to general diseases or civilian injuries (22–27 %). Recent Ukrainian data (63.6 %) correspond to this pooled combat-related residual limb pain prevalence. Pro-inflammatory mediators and symptomatic neuromas are determined to make significant contribution to the peripheral mechanisms of postamputation neuropathic pain. Given the distinct nature of combat trauma, further research of military populations is needed. Ultrasound-guided alcohol injections and radiofrequency ablation of neuromas have comparable efficacy profiles in the treatment for neuropathic residual limb pain. Conclusions. A standardized approach to the terminology and diagnosis of postamputation pain is essential for producing high-quality research. The injection therapy of symptomatic terminal neuromas is promising; however, given the insufficient number of high-quality studies including homogeneous groups of patients after amputations, further analysis of the pharmacological agent effectiveness is required.

Tired of being tired: Black college students' experiences of racial battle fatigue from highly publicized anti-Black violence.

The highly publicized murders of Breonna Taylor, George Floyd, and Ahmaud Arbery in 2020 sparked public outrage and widespread discussion around anti-Black violence. While some studies have examined the effects of anti-Black violence exposure on mental health outcomes, there is a paucity of research that explores how these racially charged events contribute to cumulative stress and "weathering" for Black people, particularly. Informed by racial battle fatigue theory, this in-depth qualitative study explored the lived experiences of 30 Black male and female undergraduate college students (aged 18-28) exposed to highly publicized acts of anti-Black violence. Thematic analysis revealed four predominant themes: (a) witnessing an endless cycle of anti-Black violence, (b) experiencing cumulative and prolonged psychosocial effects, (c) grieving while Black, and (d) navigating the tension between activism and burnout. Findings expose the cyclical and inescapable nature of anti-Black violence, including the toll of these events on the lives of Black college students. Research, practice, and policy implications underscore the need for culturally relevant interventions to support resilience among Black people in the aftermath of anti-Black violence. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The effects of intelligence on exposure to combat and posttraumatic stress disorder across multiple deployments.

Past work relates intelligence quotient (IQ) to risk for Post-Traumatic Stress Disorder (PTSD) among soldiers. We gathered data over multiple deployments to assess how IQ relates to the rate of symptom development both directly and through increasing the risk for traumatic combat exposure. Male infantry soldiers from a maneuver brigade (N = 582) were followed over the 3-year period of their mandatory military service. Data were collected at 3-time-points: 1) shortly after enlistment and before deployment; 2) about 15 months into the service following one deployment, and another year later following additional deployments. IQ was measured before recruitment into the military; PTSD symptoms and combat exposure were measured at each time-point. Lower general IQ, and in particular lower abstract reasoning capabilities, related to steeper increases in PTSD symptoms, TIME×IQ= -.05, SE= .02, t(442.79) = -3.255, p < .01, controlling for the effect of pre-military traumatic experience. This relation was partly mediated by combat exposure, Effect= -.04, BootSE= .01, 95 % CI [-.06, -.02]. The results identify important risk factors for PTSD that can inform approaches to PTSD mitigation in the military and other organizations. Given that this study enrolled a male sample the generalizability of the results awaits further research.

INFLUENCE OF MINE-BLAST INJURY AND COMBAT STRESS ON THE STATE OF THE VEGETATIVE NERVOUS SYSTEM

Aim. In order to study the disorders of the autonomic nervous system as a result of mine-blast trauma and combat stress, as well as to analyze the dependence of the manifestation of these disorders on the age and duration of the injury, 62 people were examined. Materials and methods. The main group consisted of 37 servicemen with mine-blast trauma (MBT) and surgical interventions, and the control group consisted of 25 civilian men. The age of the subjects ranged from 18 to 45 years. The state of the autonomic nervous system was determined using ANS Analysis equipment and included three main parameters: resting heart rate, sympathetic nervous system parameters, and parasympathetic nervous system parameters. The significance of the difference between the groups of results was checked using the Mann-Whitney test, and the relationship between them, the age of patients and the time interval from the injury was checked using the Spearman rank correlation coefficient. Results. According to the results of the study, changes in the autonomic nervous system indices were absent in the group of civilians, while significant changes in the ANS indices in the group of servicemen with combat trauma were found for all three parameters: heart rate, sympathetic and parasympathetic autonomic nervous system indices. Also, in the group with MBT, a pronounced dissonance between the indicators of the autonomic nervous system was revealed: against the background of a significant increase in sympathetic status, a significant decrease in parasympathetic status was observed (179,0 (57,5; 309,0) vs. 13,0 (10,0; 28,0). Changes in the indicators of autonomic nervous system with combat trauma did not depend on the age of patients. Instead, there was a weak but statistically significant positive correlation between the duration of the injury and the parasympathetic nervous system: rs=0.325 (p=0.049). Therefore, the early use of a set of measures that increase the activity of the parasympathetic nervous system is logical. Conclusions. There were no changes in the autonomic nervous system parameters in the civilian group, but significant changes in the ANS parameters were found in the group of military personnel with combat trauma.

MODERN APPROACHES IN DIAGNOSTIC AND TREATMENT OF PRIAPISM IN MEN INJURED AS A RESULT OF COMBAT ACTIONS

Introduction. Priapism is a frequent painful erection that lasts more than 4 hours and is not caused by sexual stimulation, occurs when blood is blocked in the penis and cannot leave it. It is believed that the increase in the frequency of priapism directly depends on the prevalence of intracavernous injections of vasoactive substances in the treatment of erectile dysfunction. Aim. To evaluate the pathogenetic features of the development of priapism, as one of the forms of sexual dysfunction, in men injured as a result of combat operations (combat trauma) and to optimize treatment methods. Materials and methods. The study included 14 priapism patients who were treated at the urology clinic in 2022-2024. Priapism as a complication developed in 2 (4.4%) of 45 patients after intracavernous injection of 20 μg of prostaglandin E1 (PGE1) (group 1), in 1 (10%) of 10 patients after sequential injection of 20 μg of PGE1 and 0,5 mg of phentolamine (group 2), in 3 (20%) of 15 patients after injection of 2% solution papaverine (group 3). In 5 patients, priapism occurred against the background of systematic use of anticoagulants (low molecular weight heparin) in the treatment of severe vascular pathology (phlebothrombosis, thrombophlebitis) (group 4). In another 3 patients, the cause that led to priapism was not found, so the idiopathic form was established (group 5). Results. It was shown that in 3 cases, the duration of priapism in patients with psychogenic ED was insignificant, since all patients were warned about the possible development of priapism before the injection of the vasoactive drug and recommended to seek medical help immediately in case of its occurrence. Three out of three patients with a previous diagnosis of mixed erectile dysfunction (with an organic vascular component) failed to restore erectile function after shunting. Three out of four patients diagnosed with idiopathic priapism reported the absence of erections during several months of postoperative follow-up. In no case was there a recurrence of priapism in the postoperative period. Conclusions. The obtained data allow us to recommend prostaglandin E1 as the drug of choice among vasoactive substances for intracavernous use due to its highest safety. Unilateral transcaputal puncture of the cavernous body (Winter shunt) in patients with ischemic priapism made it possible to achieve detumescence in 100% of cases without subsequent recurrence and restore erectile function in 40% of patients.

Closed Cardiac Trauma: Literature Review and Case Series of Combat Trauma

The aim. Analysis of the causes, diagnosis and treatment methods of closed heart injuries through the examples of literary sources and our own clinical cases. Russia’s full-scale invasion of Ukraine led to massive hostilities. This war not only changed the geopolitical situation in Europe, but also presented new challenges to the medical community, particularly in the field of military medicine. Among many types of combat injuries, heart injury, which can be both open and closed, requires special attention. Although both types of injuries are life-threatening, the closed heart injury becomes more relevant in the conditions of modern warfare. A closed heart injury often accompanies any chest injuries, has a hidden course, and its real prevalence exceeds the number of diagnosed cases. Among the closed injuries of the heart, concussion is accompanied by the least damage to the structures and the mildest consequences, while heart rupture has an intensive clinical manifestation, an extremely difficult course, and often fatal consequences. Most often, a heart bruise occurs with a chest injury. The proper diagnosis of heart bruise at the pre-hospital stage is accompanied by difficulties. They are associated with the conditions of the history taking and physical examination of the wounded person. The mentioned conditions include the lack of time, impaired consciousness of the victim (for example, when combined with a craniocerebral injury), lack of additional laboratory and instrumental diagnostic methods as well as different levels of training of medical personnel. The article presents a detailed description of the types of closed heart trauma, clinical, laboratory and instrumental characteristics of each type, as well as a generalized scheme of treatment tactics. In addition, three clinical cases of heart bruise with different severity of clinical manifestation are provided. Conclusion. In the conditions of modern warfare, a closed heart injury is more relevant than an open type of the combat heart trauma. This requires military and civilian physicians to pay more attention to the possible presence of this type of injury, to improve diagnostics and treatment approaches, and to develop effective field care protocols.

PECULIARITIES OF PROVIDING MEDICAL ASSISTANCE TO CIVILIAN VICTIMS OF EXPLOSIVE INJURIES

Introduction. On February 24, 2022, Ukraine faced a stark new reality as war reshaped the lives of its people, including the medical community. In today's world, where wars and conflicts have become an unfortunate part of reality, the management of injuries sustained during combat operations has gained critical importance. Civilians, often unintended victims of conflict, lack the protective measures afforded to military personnel. Treating wounded civilians presents unique challenges, as they frequently suffer from comorbidities that complicate both medical care and rehabilitation. These factors necessitate tailored approaches to diagnosis, treatment, and recovery. The aim of this study was to analyze the injuries caused by blast trauma among the civilian population and to develop an algorithm for the diagnosis and treatment of patients affected by such trauma. Materials and methods. Medical records of 94 inpatients with explosive injuries treated in the surgical departments of the Communal Non-Commercial Institution of the Kharkiv Regional Council “Regional Clinical Hospital” and the Communal Non-Commercial Institution of the Kharkiv City Council “City Clinical Multidisciplinary Hospital No. 25” between 2022 and 2024 were analyzed. Among the patients, 36 (38.3%) were women aged 21 to 87 years, and 58 (61.7%) were men aged 23 to 86 years. Results and Discussion. Soft tissue injuries were observed in all 94 patients admitted to the hospital. Of these, 45 patients (47.9%) sustained soft tissue damage to one or more anatomical regions without involvement of thoracic, abdominal, or pelvic organs. All patients underwent surgical treatment of wound, which included hemorrhage control, removal of visible foreign bodies, and wound debridement. For patients with traumatic limb amputations, surgical treatment included the formation of limb stumps. Patients with bone injuries underwent immobilization of the affected areas. Subsequently, dynamic monitoring of the wounds was conducted to assess healing and detect complications. Internal organ damage was identified in 49 victims (52.1%). All patients with intrapleural complications underwent Bülau drainage of the pleural cavities as the initial intervention. The second stage of care for victims with combined trauma involved laparotomy, during which the extent of the surgical procedure was determined intraoperatively. The third stage focused on wound management. During the primary operation, interventions were limited to wound debridement, hemostasis, and tamponade of wound channels. Subsequent procedures included repeated wound treatments, the primary delayed closure, or the use of vacuum-assisted closure (VAC) systems in cases of extensive soft tissue damage. For such cases, the final step involved autodermoplasty. Conclusions. The experience of managing these victims highlights the importance of a stepwise approach to treating blast injuries, integrating modern surgical and resuscitation techniques. This structured approach has demonstrated its potential to yield favorable outcomes. Despite the severity of injuries and the presence of comorbidities, all patients were discharged in satisfactory condition, underscoring the high efficacy of the proposed treatment strategy.

Features of combat trauma pathogenesis

The world trend of military surgery of last decades is an improvement of treatment outcomes in combat trauma, the reduction of both early and late mortality, which is associated with the training of combatants in providing first aid, self-help, improving medical logistics, implementing the principles of damage control surgery and early resuscitation, staging of assistance. However, in the structure of mortality, especially late, the leading positions, as before, belong to acute lung damage, acute respiratory distress syndrome, multiple organ failure whose pathogenesis is considered in this review. The conceptual tool of this study goes beyond the usual surgical one. However, just as combat trauma requires a multisystem approach, so the solution to the problem of multiple organ failure can be found only with the interaction of various disciplines, and therefore only this level of understanding of this problem opens the prospect of further development.

Investigating Racial Battle Fatigue Among Black College Students Using Photo-Elicitation Methodology

ABSTRACT Using photo-elicitation methodology, we explored how seven Black undergraduates experienced racial battle fatigue in the context of a predominantly white university. Findings revealed five themes: (a) encountering racism and racial microaggressions, (b) demonstrating double consciousness, (c) contending with assimilation, (d) negotiating support networks, and (e) experiencing cumulative fatigue. We discuss how these findings complement and extend previous research in this area and offer implications for practice for supporting Black students.

Reconstructive and plastic treatment of extensive laryngotracheostomy following mine blast injury

BACKGROUND: The nature of combat operations in modern military conflicts is leading to an increase in the number of casualties due to mine blast trauma. Combat wounds to the neck are often associated with damage to the larynx and trachea, resulting in scarring airway stenosis. Surgery is the primary treatment for chronic scarring stenosis of the larynx and trachea. However, despite the large number of surgical techniques, not all of them are effective. Anatomic features of the larynx and trachea, difficulties in maintaining the formed airway lumen in most cases lead to postoperative restenosis of the larynx and trachea, which significantly reduces the effectiveness of surgical treatment and complicate the rehabilitation of the patient. CLINICAL CASE DESCRIPTION: This article presents the experience of treating an extensive laryngotracheal defect resulting from a mine blast injury. A patient with an extensive defect of the anterior wall of the larynx and trachea was admitted to the Department of Reconstructive Surgery of Cavitary Organs of the Neck of L.I. Sverzhevsky Research Clinical Institute of Otolaryngology. After clinical evaluation, laryngotracheoplasty was performed with alloimplant material, followed by stenting of the lumen of the larynx and trachea with a specially developed silicone stent. CONCLUSION: The use of the most advanced medical technologies allowed to achieve a positive clinical outcome, to reduce the number of stages of surgical treatment, to prevent restenosis of the lumen of the larynx and trachea, to restore breathing through the natural ways of breathing, the physiological process of swallowing and the voice of the patient.

Military sexual trauma, childhood trauma, and combat trauma: Associations with longitudinal posttraumatic growth among U.S. Veterans.

Military sexual trauma (MST), childhood trauma, and combat trauma are prevalent among U.S. military personnel. Cumulative trauma exposure may hinder posttraumatic growth, a positive psychological change following traumatic events, while social support can facilitate this growth. Understanding the influence of these traumas and social support on longitudinal posttraumatic growth is crucial. We assessed 1,230 veterans at 6, 9, 12, 18, and 24 months postinitial survey. Latent class analysis identified trauma experience classes, and latent growth models examined posttraumatic growth trajectories, incorporating social support as a time-varying covariate. The latent class analysis revealed four classes: high trauma exposure, moderate childhood trauma-moderate combat trauma, high MST-moderate combat trauma, and combat trauma only. Veterans in the combat-only class reported significant posttraumatic growth. The moderate childhood trauma-moderate combat class exhibited consistently low growth. Veterans in the high MST-moderate combat class showed slightly higher initial growth but no significant change over time. The high trauma exposure class experienced a significant decline in growth. Social support significantly predicted posttraumatic growth, with varying impacts across trauma classes. Interventions could be vital for survivors of MST, childhood trauma, or compounded traumas to enhance posttraumatic growth among military veterans. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Indicators of mental adaptation disorders in combatants of the special military operation

Relevance. Participants of armed conflicts are exposed to extreme stress amid life-threatening situations, which can lead to mental adaptation disorders exacerbated by combat stress disorders. Combatants facing these conditions require psychological correction and psychotherapy.The objective is to assess the risk of mental adaptation disorders in combatants using traditional diagnostics and fasts screening methods.Methods. A cohort of 163 combatants who participated in the special military operation underwent clinical and psychological examination. The average age of subjects was 34.3 years, and the average time of service in the special military operation was 8.2 months. The combatants’ psychological status was evaluated using the Mississippi Scale (military version), the Beck Depression Inventory, and the Beck Anxiety Inventory. In addition, a set of screening methods, like PC-PTSD-5, PHQ9, and GAD-7, were used to evaluate the risk of mental maladaptation, depressive symptoms, and anxiety. In the course of examination, the reliability of responses was assessed using 10 adapted questions for sincerity evaluation obtained from a standardized personality assessment method. The present study shows the median value, as well as the upper and lower quartiles (Me [Q1; Q3]). The consistency of the studied indicators was evaluated using Spearman’s rank correlation coefficient.Results and analysis. The average sincerity score was 7 [6; 8] points, showing sufficient reliability of the examination results. The psychological test results re concordant with the overall transformation pattern in the functional and mental profile of stress exposed combatants, depending on the duration of exposure to combat conditions. The average Mississippi Scale scores were 71 [63; 84] points, and 2 [1; 3] points on the PC-PTSD-5, associated with absence of mental adaptation disorders and a low probability of PTSD, respectively. PTSD clinical symptoms were identified in 3.7% of the examined combatants (compared to 14.3% in foreign publications), and mental adaptation disorders were observed in 8.6%. All these methods showed moderate, positive, and statistically significant (r = 0.627; p &lt; 0.001) consistency of obtained indicators. The average Beck Depression Inventory score was 7 [3; 12] points, and the PHQ-9 score was 5 [3; 8] points, suggesting absence or mild depression, respectively. The methods demonstrated strong, positive, and statistically significant (r = 0.799; p &lt; 0.001) consistency among the indicators. The average Beck Anxiety Inventory score was 10 [4; 18] points, and the GAD-7 screening method score was 5 [2; 6] points, corresponding to low or moderate anxiety. For both methods, the consistency among indicators was moderate, positive, and statistically significant (r = 0.567; p &lt; 0.001).Conclusion. The study justified the reliability of results obtained by traditional tests and screening methods, showing trustworthy indications for psychological correction (psychotherapy) in the examined combatants.

FRAGMENTED THIGH INJURY: TREATMENT WITH PREBIOTICS, NANOPARTICLES, AND CELL THERAPY

The purpose of this study was to investigate the possibility of staged local treatment of an infected mine-explosive wound using a gel containing Bacillus spp., cerium oxide nanoparticles, and cell therapy. Object and Methods. The article presents a clinical case demonstrating the effective staged treatment of a 57-year-old patient with a fragmentary fracture of the right femur and a large purulent wound of the right thigh. The patient underwent Ex-fix rod-type femur-tibia stabilization and resection of a post-traumatic aneurysm of the right superficial femoral artery. In the first stage of treatment, two sessions of negative pressure wound therapy (NPWT) were applied, with pressures ranging from 75-115 mm Hg and a session duration of 4-5 days. In the second stage, local treatment involved a combination of antiseptics and probiotics (Bacillus spp.) alongside cerium oxide nanoparticles. By the 7th day, the eradication of pathogenic microflora was achieved, allowing for the third stage of treatment—application of autologous mesenchymal stem cells. Results: The treatment of combat trauma has become increasingly relevant in Ukraine and globally due to its complexity and the rising proportion of multiple and combined injuries, which account for 25-60% of cases. Infectious complications occur in 25% of combat trauma cases and are responsible for 70% of related deaths. Most structural and functional disorders associated with wound infections develop at the time of injury, intensify over time, and require immediate surgical intervention, improvements in local treatment methods, and new approaches for wound closure. Conclusions: The use of a combination of probiotics and NPWT therapy led to a rapid reduction of the inflammatory process. Clinical observations showed accelerated wound cleansing from fibrin and necrotic tissue. The combined treatment significantly reduced the size and depth of wound due to the formation of active pink granulation tissue (observed by days 8-9) and marginal epithelialization by days 10-13. During this period, no pathogenic flora were detected, allowing for the subsequent application of autologous mesenchymal stem cells. This treatment approach reduced the need for antibacterial drugs and prevented the need for additional surgical interventions. The inclusion of cerium oxide nanoparticles was an effective enhancement for cell transplantation, facilitating stem cell delivery and contributing to the treatment of large wounds.