Explosive Injury Research Articles

Non-penetrating combat-related thoracic trauma (review)

Combat-related thoracic trauma is a significant cause of morbidity and mortality in all military opera­tions. Penetrating, blunt, and explosive wounds are the most common mechanisms of injury. Visualization diagnosis plays a key role in the treatment. This review discusses the visualization signs of chest injuries from blunt trauma and blast trauma. Objective was to study in detail the mechanisms and visualization signs of non-penetrating combat-related thoracic trauma. 235 literature sources were found in the PubMed system by the query Thoracic AND Trauma AND Combat, 34 of which were selected for further detailed study. In modern warfare, thoracic trauma accounts for 8.6—16.0 % of casualties. Chest X-ray and CT are the visualization methods most commonly used in the evaluation of polytrauma patients from combat and peacetime. Chest X-ray can be quickly obtained in a patient with blunt trauma and emergency conditions that include tension pneumothorax, large hemothorax, chest compression, and others. Chest CT is an important component of trauma visualization. Compared to chest X-ray, chest CT identifies 20 % more pathology, and occult chest trauma due to blunt force trauma can be identified in 71 % of patients. CT provides 38—81 % additional diagnoses compared to chest X-ray.Thoracic trauma is often diagnosed in places of combat. As medical imaging technology moves closer to combat areas, this tool is becoming increasingly available to aid in the diagnosis and rapid treatment of combat-related thoracic trauma. Clinical and surgical management of the traumatized patient relies on skills learned in modern civilian training and honed in war. However, imaging of blunt and explosive injuries may be different in civilian and military settings. The distinct injury pattern and atypical imaging findings of blunt trauma and blast lung injury are important to recognize at an early stage because of the severity of this pathology and the impact of an accurate diagnosis on clinical management.We present our own observations of patients who were treated at the Military Medical Clinical Center of the Northern Region (Kharkiv) in 2022 for non­penetrating combat­related thoracic trauma.

A Contemporary Analysis of Combat-related Urological Injuries: Data From the Department of Defense Trauma Registry.

There has been little to no literature published on combat-related genitourinary injuries beyond 2013. With the goal of enhancing medical readiness prior to deployment and making recommendations to improve the long-term rehabilitation of service members as they become civilians, we sought to describe the incidence of combat-related genitourinary injuries and interventions from January 1, 2007, to March 17, 2020. We conducted a retrospective analysis of the Department of Defense Trauma Registry, which is a prospectively maintained database, for the time between 2007 and 2020. We used predefined search criteria to primarily identify any casualties that arrived at a military treatment facility with urological-based injuries. The registry contained 25,897 adult casualties, of which 7.2% sustained urological injuries. The median age was 25. Explosive injuries (64%) and firearms (27%) predominated. The median injury severity score was 18 (IQR 10-29). Most patients survived until hospital discharge (94%). The most frequently injured organs were the scrotum (60%), testes (53%), penis (30%), and kidneys (30%). Massive transfusion protocols were activated in 35% of all patients who sustained a urological injury and accounted for 28% of all protocols between 2007 and 2020. The incidence of genitourinary trauma persistently increased for both military and civilian personnel as the U.S. remained actively engaged in major military conflicts during this period. Patients with genitourinary trauma in this data set were often associated with high injury severity scores and required an increased number of immediate and long-term resources for survival and rehabilitation.

Pathogenesis of acquired heterotopic ossification: Risk factors, cellular mechanisms, and therapeutic implications

Heterotopic ossification (HO), including hereditary and acquired HO, is the formation of extraskeletal bone in skeletal muscle and surrounding soft tissues. Acquired HO is often caused by range of motion, explosion injury, nerve injury or burns. Severe HO can lead to pain and limited joint activity, affecting functional rehabilitation and quality of life. Increasing evidence shows that inflammatory processes and mesenchymal stem cells (MSCs) can drive HO. However, explicit knowledge about the specific mechanisms that result in HO and related cell precursors is still limited. Moreover, there are no effective methods to prevent or reduce HO formation. In this review, we provide an update of known risk factors and relevant cellular origins for HO. In particular, we focus on the underlying mechanisms of MSCs in acquired HO, which follow the osteogenic program. We also discuss the latest therapeutic value and implications for acquired HO. Our review highlights the current gaps in knowledge regarding the pathogenesis of acquired HO and identifies potential targets for the prevention and treatment of HO.

DEPENDENCE ON ANESTHESIOLOGY SUPPORT IN VICTIMS WITH COMBINED MINE-EXPLOSIVE THORACO-ABDOMINAL INJURIES AND PENETRATING HEAD INJURIES AT THE STAGE OF PREPARATION AND CONDUCTING OF AEROMEDICAL EVACUATION

Introduction. Explosive explosive injuries account for more than 50% of all injuries received in military battles, and the proportion of casualties among the civilian population is also increasing [1]. However, only limited research has been conducted on the pathophysiology of blast-induced brain injury, and the effect of changes in cerebral blood flow (CBF) or cerebral vascular reactivity on blast-induced brain injury has not been investigated [2]. Although secondary hypotension and hypoxemia are associated with increased mortality and morbidity after blunt head injury, the effect of secondary injury factors in blast injury is unknown [2]. TBI itself causes cerebral hypoperfusion, reduced oxygen delivery to the brain, excitotoxicity, and disruption of cerebral blood flow autoregulation, which explains the vulnerability of the affected brain to hypoxia and hypotension caused by blood loss [2,3].

SURGICAL TREATMENT OF VICTIMS WITH MINE AND EXPLOSIVE INJURIES DURING MILITARY ACTIONS

Summary. Mine-explosive injury is a gunshot combined multiple injury that occurs in a person as a result of the impact of the impact factors of the explosion of engineering, mine ammunition and is accompanied by deep and widespread tissue damage and contusion.
 The purpose of the work is to analyze the methods of surgical treatment of patients with mine-explosive injuries in the conditions of martial law.
 Materials and methods. The results of surgical treatment of 64 patients with mine-explosive injuries were analyzed, 27 (42.2 %) were women, 37 (57.8 %) were men, who were being treated at Dergachiv Central Hospital. All victims underwent surgical interventions depending on the location of the injury, its nature, the severity of the patient, the development of traumatic or hemorrhagic shock.
 Results and their discussion. Given that the most frequent type of injuries were wounds of various localization, the most common type of surgical intervention was surgical treatment of wounds. The scope of the intervention depended on the depth and size of the wound, as well as the nature of tissue damage. Surgical manipulations on the chest were performed to eliminate pneumothorax (pneumohydrothorax), pleural puncture was performed or pleural drainage was established. If the Rouvilois-Gregoir test was positive, a thoracotomy was performed followed by suturing of the lung wound. Invasive diagnostic methods, laparocentesis and laparoscopy were performed for suspicion of damage to the organs of the abdominal cavity, with the help of which damage to the organs of the abdominal cavity was excluded. The use of laparocentesis in such situations, although its diagnostic value is lower than that of video laparoscopy, allows to determine the pathological content in the abdominal cavity, which is sufficient to detect life-threatening consequences of abdominal injuries, for example, such as intra-abdominal bleeding.
 Conclusions. Victims with explosive lesions require a large number of surgical interventions in various anatomical areas. When providing assistance to victims of an explosive injury, one should be guided by the principles of “damage control”, determining the amount of interventions that should be performed based on vital indications.

Evaluation of the decision-making process within the table-top exercise of the Terror and Disaster Surgical Care (TDSC®) course

PurposeThe threat of terror is omnipresent in Europe and the number of attacks worldwide is increasing. The target of attacks in Europe is usually the civilian population. Incalculable dangerous situations at the scene of the event and severe injury patterns such as complex gunshot and explosion injuries with a high number of highly life-threatening people present rescue forces, emergency physicians and subsequently hospitals with medical, organizational as well as tactical and strategic challenges. The Terror and Disaster Surgical Care (TDSC®) course trains clinical decision-makers to meet these challenges of a TerrorMASCAL in the first 24–48 h.MethodsA table-top exercise was developed for the TDSC® course as a decision training tool, which was prospectively evaluated in six courses. The evaluation took place in 3 courses of the version 1.0, in 3 courses in the further developed version 2.0 to different target values like, e.g., the accuracy of the in-hospital triage. Furthermore, 16 TDSC® course instructors were evaluated.ResultsFor the evaluation, n = 360 patient charts for version 1.0 and n = 369 for version 2.0 could be evaluated. Overall, the table-top exercise was found to be suitable for training of internal clinical decision makers. Version 2.0 was also able to depict the action and decision-making paths in a stable and valid manner compared to the previous version 1.0. The evaluation of the instructors also confirmed the further value and improvement of version 2.0.ConclusionWith this prospective study, the table-top exercise of the TDSC® course was tested for decision stability and consistency of the participants’ decision paths. This could be proven for the selected target variables, it further showed an improvement of the training situation. A further development of the table-top exercise, in particular also using digital modules, will allow a further optimization.http://www.bundeswehrkrankenhaus-ulm.de

Oral and Maxillofacial Injuries Associated With E-Cigarette Explosions: A Systematic Review and Management Guidelines Proposal

E-cigarettes have become increasingly popular devices used to consume nicotine in recent years. There is a growing body of evidence regarding the risk of spontaneous explosion of these devices causing burn and projectile injuries. The primary purpose of this review was to summarize all injuries to the oral and maxillofacial region secondary to explosion of e-cigarettes. The secondary purpose was to propose an initial management algorithm for such injuries based on the findings in the literature. This review also aims to test the hypothesis that e-cigarette explosive injuries to the oral region were associated with an increased risk of intubation and surgery and examine whether any other injury pattern was associated with an increased risk of intubation or surgery. A cohort study based on identifying cases in the literature was conducted to summarize injuries to the oral and maxillofacial region and examine the associations between injury types and location and management. A literature search of the major biomedical databases was conducted in September 2022 using terms such as e-cigarette, explosion, blast, trauma, and burn, among others, which yielded 922 studies. Nonclinical studies, review articles, and studies without injuries to the facial region were excluded. Study subjects were recorded for demographics, device characteristics, injury mechanism, injury location, management, and complications. Chi-squared analysis was used to determine if the predictor variables of type of injury (burn or projectile) and its associated location (ocular, facial, or intraoral for burns and facial thirds for projectile) were associated with the outcomes of intubation and surgical management. The collected data were then used as a guide to propose an initial management algorithm for these injuries. Twenty eight studies, including 20 case reports and 8 case series met the inclusion criteria. A total of 32 explosions of e-cigarettes to 32 patients caused 105 recorded injuries to the facial region. Projectile injuries made up 73.3% (n=77) of all facial injuries, while burn injuries made up of 26.7% (n=28). There were 14 (43.8%) patients who suffered both projectile and burn injuries. Burn injuries mostly involved the face (64.3%, n=18), oral cavity (25%, n=7), and eye (10.7%, n=7). The majority (81.8%, n=63) of projectile injuries occurred in the lower facial third. There were 20 (62.5%) patients who suffered a bone or tooth fracture. Management of injuries involved surgery in 62.5% (n=20) of patients, which included open reduction and internal fixation of fractures, dental extraction, bone and skin grafts, and ocular surgery. A complication rate of 44.4% (n=8) was observed across studies that reported on follow-up. There was no statistically significant association between explosive injury to the oral region and intubation or surgical management. There was also no other statistically significant association between any other injury type and location with intubation or surgical management. E-cigarettes are at risk for spontaneous combustion that can cause serious oral and maxillofacial injuries, particularly to the lower facial third and commonly requiring surgical management. Safety of these devices should be improved through increased user education and regulation.

The use of centrally acting analgesics in the postoperative analgesia in patients with the consequences of a severe mine-explosive injury of the lower extremities

In this article, the authors discuss the place of modern analgesics of central action (nefopam hydrochloride) in the analgesia of patients with explosive injuries of the lower extremities. Currently, there is no information in global practice regarding the use of centrally acting analgesics for analgesia in patients with combat trauma. An example was the analgesia of patients in the p/o period with a severe explosive injury of the lower extremities. Attention is drawn to the need for effective analgesia for patients with a combo injury not only in the acute period. A feature of the treatment of such patients is the need for major restorative and reconstructive surgical interventions, which in turn are accompanied by a pronounced pain syndrome. In our experience, the addition of non-narcotic analgesics of central action (nefopam hydrochloride) to the scheme of multimodal analgesia is appropriate to improve analgesia in this category of patients. The addition of nefopam hydrochloride to a multimodal analgesia regimen at 20 mg IV every 6 hours was effective in the treatment of severe acute postoperative pain.

Epidemiological characteristics and comparative outcome of blast versus gunshot injuries of the extremities in Somalia

BackgroundWar conflicts and terror-related injuries constitute a significant public health problem in Somalia. We aim to characterize and compare the injury characteristics of gunshot and blast injuries of the extremities.MethodsThe data of 333 patients with gunshot and blast injuries of the extremities over three years were retrospectively reviewed. The demographics, injury characteristics, and outcomes were analyzed.ResultsMost of the patients had injuries due to gunshot casualties compared with blast victims (n = 222, 66.7% vs. n = 111, 33.3%). Patients with gunshot wounds (GSW) had a more significant proportion of males than those with blast wounds (BW) (95.5% vs. 85.6%, P < 0.001). There were more open extremity fractures in GSW casualties (96.4% vs. 81.1%). The BW victims had significantly higher associated injuries (52.3% vs. 18.5%, P < 0.001). The BW group had a higher injury severity score (ISS ≥ 16 in 55%, P < 0.001). The need for an intensive care unit (ICU) admission was significantly higher in the BW patients (18% vs. 6.3%, P < 0.001); as well as the length of hospital stay (LOS) was higher in the BW group compared with the GW patients (> 2-week hospital stay in 31% vs. 19%, P < 0.04). About a 2.7% mortality rate was observed in BW (P < 0.014).ConclusionGunshot and explosion injuries comprise the majority of war and terror-related trauma of the extremities. These injury mechanisms differ in the body regions involved, the severity of the injury, duration of hospital stay, need for ICU admission, and mortality. Assessment and management of such devastating casualties require a complex and multidisciplinary approach.

Explosive eye injuries: characteristics, traumatic mechanisms, and prognostic factors for poor visual outcomes

BackgroundExplosions can produce blast waves, high-speed medium, thermal radiation, and chemical spatter, leading to complex and compound eye injuries. However, few studies have comprehensively investigated the clinical features of different eye injury types or possible risk factors for poor prognosis.MethodsWe retrospectively reviewed all consecutive records of explosive eye injuries (1449 eyes in 1115 inpatients) in 14 tertiary referral hospitals in China over 12 years (between January 2008 and December 2019). Data on demographics, eye injury types, ocular findings, treatments, and factors affecting visual prognosis were extracted from a standardized database of eye injuries and statistically analyzed.ResultsMechanical ocular trauma accounted for 94.00% of explosion-related eye injuries, among which intraocular foreign bodies (IOFBs) resulted in 55.17% of open globe injuries (OGIs) and contusion caused 60.22% of close globe injuries (CGIs). Proliferative vitreous retinopathy (PVR) was more common in perforating (47.06%) and IOFB (26.84%) than in penetrating (8.79%) injuries, and more common with laceration (24.25%) than rupture (9.22%, P < 0.01). However, no difference was observed between rupture and contusion. Ultimately, 9.59% of eyes were removed and the final vision was ≤ 4/200 in 45.82% of patients. Poor presenting vision [odds ratio (OR) = 5.789], full-thickness laceration of the eyeball ≥ 5 mm (OR = 3.665), vitreous hemorrhage (OR = 3.474), IOFB (OR = 3.510), non-mechanical eye injury (NMEI, OR = 2.622, P < 0.001), rupture (OR = 2.362), traumatic optic neuropathy (OR = 2.102), retinal detachment (RD, OR = 2.033), endophthalmitis (OR = 3.281, P < 0.01), contusion (OR = 1.679), ciliary body detachment (OR = 6.592), zone III OGI (OR = 1.940), and PVR (OR = 1.615, P < 0.05) were significant negative predictors for poor visual outcomes.ConclusionsExplosion ocular trauma has complex mechanisms, with multiple eyes involved and poor prognosis. In lethal level I explosion injuries, eyeball rupture is a serious condition, whereas contusion is more likely to improve. In level II injuries, IOFBs are more harmful than penetrating injuries, and level IV represents burn-related eye injuries. PVR is more associated with penetrating mechanisms than with OGI. Identifying the risk predictors for visual prognosis can guide clinicians in the evaluation and treatment of ocular blast injuries.

Single-nucleus profiling of adult mice sub-ventricular zone after blast-related traumatic brain injury

Explosive blast-related traumatic brain injuries (bTBI) are common in war zones and urban terrorist attacks. These bTBIs often result in complex neuropathologic damage and neurologic complications. However, there is still a lack of specific strategies for diagnosing and/or treating bTBIs. The sub-ventricular zone (SVZ), which undergoes adult neurogenesis, is critical for the neurological maintenance and repair after brain injury. However, the cellular responses and mechanisms that trigger and modulate these activities in the pathophysiological processes following bTBI remain poorly understood. Here we employ single-nucleus RNA-sequencing (snRNA-seq) of the SVZ from mice subjected to a bTBI. This data-set, including 15272 cells (7778 bTBI and 7494 control) representing all SVZ cell types and is ideally suited for exploring the mechanisms underlying the pathogenesis of bTBIs. Additionally, it can serve as a reference for future studies regarding the diagnosis and treatment of bTBIs.

Assessment of firearm injuries undergoing advanced airway management: Role II hospital experience.

Airway problems are one of the most important factors affecting mortality in firearm injuries. The present study aims to examine the data of patients who underwent advanced airway support due to explosion and bullet injuries in a Role II hospital. Ninety three patients who underwent advanced airway support due to gunshot wounds in a Role II hospital between January 2015 and September 2016 were included in this study. The patients were divided into two groups as blast (Group A) (handmade explosives, rocket, and mine) and bullet (Group B) (rifle and pistol bullet) trauma injuries. The groups were compared regarding pre-hospital intubation, NISS (New Injury Severity Score), cardio-pulmonary resuscitation (CPR), emergency surgical intervention and mortality rates. There was no difference between the patient groups concerning demographic and clinical features. Thirty-six patients were included in group A, and 57 patients were included in group B. There was no statistically significant difference between the groups about emergency surgical intervention rates (p=0.42). However, a statistically significant difference was observed between the groups in terms of pre-hospital intubation (p=0.001), CPR application (p=0.001), mortality (p=0.001) rates and NISS (p=0.002) scores. Bullet injuries that require advanced airway are more destructive and more deadly than explosion injuries. This may be due to direct airway or organ damage in bullet gunshot wounds.

PROSPECTS FOR THE USE OF IMMUNOHISTOCHEMISTRY METHODS IN THE STUDY OF THE PATHOMORPHOLOGY OF EXPLOSIVE AND GUNSHOT TRAUMA

Improving the methods of prevention of various types of fatal and non-fatal injuries, exogenous intoxication, sudden death, improving the quality of medical and diagnostic work are reflected in the results of forensic medical examination. Forensic diagnostics of gunshot and explosive injuries are a little-studied aspect. The article is devoted to the prospects of using immunohistochemistry methods in the study of the pathomorphology of explosive and gunshot trauma. The results of a brief analysis of the literature and their own scientific developments allowed the authors to outline the prospects for the use of immunohistochemistry methods in the study of the consequences of gunshot and explosive trauma. The authors propose a number of possibilities for using immunohistochemistry methods in the study of pathomorphosis and morphogenesis of these types of trauma. The study allows us to analyze a significant range of changes in purulent- resorptive fever, sepsis, which often complicate the course of gunshot and explosive trauma when using modern lethal weapons. The presented materials emphasize the relevance of the study of gunshot and explosive trauma by methods of immunohistochemistry. The use of immunohistochemistry methods can enrich the pathology of explosive and gunshot injuries with new knowledge that would be of interest to the practice of military field surgery for such lesions.

Mechanisms of gunshot and mine - explosive wounds in using personal armor protection (Literature review)

Mechanisms of gunshot and mine - explosive wounds in using personal armor protection (Literature review)

ХИРУРГИЯ ПЕРВОГО КОНТАКТА ПРИ ЛЕЧЕНИИ ПАЦИЕНТОВ С ОГНЕСТРЕЛЬНЫМИ И ВЗРЫВНЫМИ РАНЕНИЯМИ КОНЕЧНО-СТЕЙ

Gunshot wounds of extremities are the most frequent among gunshot and ex-plosive injuries. Debridement is the main method of treatment of this type of damage. Surgeons of civil hospital organizations have difficulties in determining the scope of surgical intervention and the priority of the performed activities in most cases. This is due to the lack of clinical experience in providing medical care to patients with a gunshot injury. The concept of "First contact surgery" is a set of the minimum required amount of the debridement aimed at saving the patient's life and preventing the development of serious complications. The author consid-ers in details the content of each element of the debridement, options for its im-plementation, depending on the equipment of the hospital and the surgeon's qual-ifications. The main aims for the surgeon at the first contact with a patient with a gunshot injury are to stop external bleeding, determine the state of the main blood flow in the limb, eliminate uncompensated ischemia of the limb, wide the wound open, refuse the primary wound suture, perform immobilization, if neces-sary, and prescribe antibiotic therapy.

Traumatic intracranial aneurysms following combat damage

To develop the principles for the treatment of traumatic intracranial aneurysms after combat damage to skull and brain. There were 18 patients with traumatic intracranial aneurysms from February 2022 to the present. Of these, 15 ones had gunshot penetrating wounds of the skull and brain. In 3 cases, aneurysms developed after explosive injury. All patients underwent computed tomography (CT) of the brain, CT angiography of brain vessels and selective cerebral angiography. We analyzed nature of brain damage, trajectory of the wounding projectile and aneurysm location to determine predictors of traumatic intracranial aneurysms. Surgical treatment was performed in all cases. Hemorrhagic manifestations were observed in 11 patients. In 4 cases, traumatic intracranial aneurysms were diagnosed before rupture. Blunt head injury was followed by subarachnoid hemorrhage in 2 cases and ischemic stroke in 1 case. Endovascular or microsurgical intervention was performed depending on location of aneurysm, clinical manifestations and severity of brain damage. In case of distal aneurysms, endovascular and microsurgical destructive interventions prevailed. At the same time, proximal aneurysms (within or below the circle of Willis) required reconstructive endovascular treatment. Traumatic aneurysms should be suspected in all patients with penetrating craniocerebral injuries. Follow-up is contraindicated for traumatic intracranial aneurysms due to high risk of hemorrhage.

TREATMENT OF COMBAT SURGICAL TRAUMA OF THE LIMBS IN THE CONDITIONS OF MODERN WAR

Among the total number of wounded who entered the Military Medical Clinical Center of the Western Region from February to September 2022, combat injury to the limbs was in 63.3%. Bullet wounds caused combat injury to the limbs in 10.4%, shrapnel and mine-explosive – in 68.1%, explosive injury – in 21.5%. At the second role of medical care, emergency surgical interventions were performed on the wounded, immobilization of bone fractures with an external fixation and anti-shock therapy. At the third and fourth roles – the treatment of the wounded consisted in the use of a multidisciplinary approach with the involvement of doctors of various specialties, first of all, general surgeons, traumatologists, vascular, plastic surgeons and anesthesiologists. The most frequent surgical intervention was repeatened and secondary debridment of gunshot wounds, which was required by 93% of the wounded. The main pathogens that vegetated in wounds were Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter aerogenes, Proteus vulgaris, Enterococcus faecalis with high levels of microbial contamination – 104-108/g in tissues., Various types of plastics were used to close soft tissue defects, according to the rule of the reconstruction ladder. After healing a soft tissue wound to determine the timing of replacing the method of fixing fractures with internal osteosynthesis, were analyzed clinical and laboratory parameters and assessed the risks of complications. The main causes of amputations of the limbs were common defects in soft tissue and bones, which were not subject to reconstruction with no prognosis for bone fusion and progression of the infectious-necrotic process.

Dynamics and structure of forensic medical investigations of violent death in St. Petersburg over the past 10 years

BACKGROUND: Among other things, changes in the structure of forensic medical expert material serve as an indicator of dynamic processes in society. The levels of injuries and violent and nonviolent death somehow depend on the state of the economy and health care in the region and the state as a whole. In recent years, the spread of coronavirus disease 2019 (COVID-19), which was proclaimed as a pandemic with tangible social and economic damage to States, has been one of the determining factors. AIMS: This study aimed to investigate the dynamics of the volume and structure of violent death in the Russian Federation over the past 10 years, including the pandemic period, using the megalopolis example. MATERIAL AND METHODS: This study reviewed the annual reports of the Bureau of Forensic Medical Examination of St. Petersburg using data grouping, frequency analysis, correlation analysis, comparison, system analysis, and inductive generalization. RESULTS: Over the past 10 years, several significant changes have occurred in St. Petersburg in the scope and structure of forensic medical investigations of violent deaths. The main positive trend was a decreased absolute and relative number of cases of violent death. Statistically significantly (p 0.05) decreased number of cases of transport injuries, injuries resulting from the action of blunt and sharp objects, gunshot, thermal injury, and mechanical asphyxia, as well as poisoning with ethanol and carbon monoxide, significantly decreased infant mortality, and fewer unidentified and unclaimed corpses were observed. Additionally, a steady increase in the number of drug poisoning was found, and the fatal injury level due to falling from a height remained consistently high. The background incidence of COVID-19 in 2020 was 2.43.2%. CONCLUSION: The proportion of cases of falling from a height, thermal burns, and strangulation with a noose increased among the dead with a confirmed COVID-19 diagnosis, and transport (primarily rail), gunshot and explosive injuries, cases of drowning, poisoning with drugs, and alcohol detection in the biological environments of the body of the victims were less common.

Terror-related injuries in Somalia: a retrospective cohort of 2426 hospitalized cases along 7 years

Terrorism-related injuries and deaths have become a major threat to the Somalian population, as in the rest of the world. We aimed to characterize and compare firearm and explosion injuries caused by terrorist acts. This retrospective study reviewed the data of all patients injured by explosions and firearm attacks over seven years. Epidemiological characteristics, injury pattern, severity scores, hospital resource utilization parameters, length of stay, and death rates were evaluated. A total of 2426 patients were injured by 359 explosions and firearm attacks during the study period. Eighty-one percent of the patients (n = 1974) were male, while 19% of the cases were female. Multiple body site injuries occurred more frequently in explosion injuries (75%) than firearm wounds (48%) (P < 0.001). The relative frequency of internal injuries in explosion injuries was higher than in firearm wounds (46.7% vs. 36.2%). Patients injured due to the explosion have a greater rate of severe and critical injuries than those injured by firearms (30.2% vs. 21.2%, P < 0.001). About a quarter (24%) of the patients were hospitalized in the intensive care unit. The inpatient mortality rate was 11.6%. The findings of the study revealed that suicide bombings explosions are associated with multiple body site injuries, a greater rate of severe and critical internal injuries, and a higher mortality rate.

Systemic inflammatory response in rats with explosive wound

Aim. To evaluate the temporal changes in circulating cytokines rallying systemic inflammatory response after a blast injury.Material and Methods. Experiments were performed on 60 male Wistar rats (50 rats with blast-related soft tissue injury of the thigh and 10 intact rats). Blast injury was modeled under general anaesthesia using grater firecrackers stuffed with a pyrotechnic mixture. After 3, 7, 14 and 28 days post injury, we carried out a gross examination of the wound and its drainage, measured wound area, assessed local oedema severity, and evaluated serum potassium, myoglobin TNF-α, IL-1β, IL-6, and IL-10.Results. Three to seven days post injury, therewas abundant serous and purulent exudate and pronounced local edema without considerable changes in the wound area. Serum myoglobin and potassium were raised 2.2-2.6-fold and 1.3-fold, respectively (p &lt; 0.05); in addition, we documented the elevation of a major pro-inflammatory cytokine IL-1β. Fourteen days post injury, wound area reduced by 24%, (p &lt; 0.05) along with the decreased wound drainage and local edema of the injured area. Although the levels of serum myoglobin and pro-inflammatory cytokines (in particularIL-6) lowered, they were still significantly higher as compared with the intact rats. Twenty eight days post injury, fibrosis has been completed, epithelialization occurred and only a small scab remained on the wound surface. Yet, serum IL-1β still was 1.3-fold higher than in the intact animals (p &lt; 0.05), albeit IL-6 and TNF-α returned to the reference values. The concentration of anti-inflammatory cytokine IL-10 reached its maximum values relative to the control (3.9-fold, p &lt; 0.05) to the 14th day post injury that was followed by a considerable reduction (though not reaching the reference values) by the period of scar formation.Conclusion. Blast injury in rats is accompanied by a dysregulated balance between pro-inflammatory and anti-inflammatory cytokines throughout all regeneration phases.