Indirect Injury Research Articles

Acute and Chronic Kidney Disease Worsen Outcomes in Experimental Sepsis.

Infection is a leading cause of morbidity in individuals with acute and chronic kidney disease (AKD, CKD). However, there is significant difficulty in modeling infection into an animal host with preexisting kidney disease. We report a novel method of peritoneal infection induced via cecal slurry inoculation deployed into mice with experimental aristolochic acid-induced AKD and CKD. AKD, CKD, and paired control mice were injected with sham, low, or higher doses of donor-recipient matched cecal slurry solution. Animal survival, sepsis severity, and change in glomerular filtration rate was tracked longitudinally throughout the study. Histology for kidney injury, flow cytometry, plasma cytokines, and evidence of indirect organ injury from sepsis were also assessed. Infected AKD mice experienced significantly heightened sepsis severity, with 100% mortality by 24 hours after high cecal slurry doses versus no mortality in control mice. Additionally, AKD mice receiving lower cecal slurry doses developed dramatically increased pro-inflammatory cytokines and persistent cytopenias. Infected CKD mice also had worse outcomes than paired CKD-controls, though less severe than in AKD mice. Interestingly, animals with AKD had worse outcomes than mice with CKD after any cecal slurry dose or time-point after inoculation, despite higher baseline kidney function and less uremic sequela. These data confirm that acute bacterial infection can be modeled in animals with established kidney disease; and suggest that the clinical state of kidney disease (AKD versus CKD) may influence host susceptibility to infection more than the degree of kidney failure alone.

The relationship between cognitive functioning and syndromic characteristics and neuroimaging changes in patients with different types of encephalopathies

Cognitive impairment can be a consequence of direct and indirect brain injury, hypoxia, edema, metabolic disorders, neurodegenerative processes, metabolic encephalopathies, electrolyte abnormalities, organ failure, the effects of pesticides, toxins, drugs, and infectious processes. The results are presented from the study on correlations between cognitive functioning and syndromic characteristics and neuroimaging changes in patients with chronic post-traumatic (CTE), chronic vascular (CVE), chronic alcohol-induced (CAIE) and post-infectious (PIE) encephalopathies. The data of 520 medical records of patients with CTE (n = 145), CVE (n = 145), CAIE (n = 102) and PIE (n = 128) were analyzed. Neuroimaging was performed using multislice computed tomography. Cognitive functions were examined using the Montreal Cognitive Assessment. Statistical analysis of data was carried out with the help of computer software Microsoft Excel and Statistica 13.0. There was a probable relationship between cognitive functioning and extrapyramidal syndrome in patients with CVE; cognitive impairment and emotional lability disorder in patients with CAIE; cephalalgia syndrome, motor disorder syndrome and cerebellar ataxia syndrome in patients with PIE. In participants with CTE and CAIE, there was a significant correlation between cognitive functioning and ventricular enlargement; in patients with PIE — between cognitive functioning and the enlargement of the subarachnoid spaces.

Practices of Adult Spine Immobilization During Trauma Resuscitation: Proposal for Improved Guidelines.

This narrative review aims to evaluate the impact of current spinal immobilization practices on clinical outcomes in adult trauma patients with suspected or confirmed spinal injury to direct the creation of improved practice management guidelines. PubMed, ProQuest, Embase, Google Scholar, and Cochrane were searched for studies that evaluated the impact of spine immobilization practices during resuscitation in adult trauma patients and reported associated clinical outcomes. Outcomes included neurological deficits, in-hospital mortality, hospital length of stay (HLOS), ICU length of stay (ICU-LOS), discharge disposition, long-term functional status (modified Rankin scale), vascular injury rate, and respiratory injury rate. Nine studies were included in this review, divided into two groups based on patient immobilization status. Patients compared with and without cervical immobilization had higher mortality, longer ICU-LOS, and a higher incidence of neurological deficits if immobilized. Immobilization only was associated with a higher incidence of indirect neurological injury and poor functional outcomes. Spinal immobilization during resuscitation in adult trauma patients is associated with a higher risk of neurological injury, in-hospital mortality, and longer ICU-LOS. Further research is needed to provide strong evidence for spinal immobilization guidelines and identify the optimal method and timing for immobilization practices in trauma patients.

Clinical Profile and Outcome of Moderate to Severe Acute Respiratory Distress Syndrome in a Paediatric Intensive Care Unit of Eastern India: A Prospective Cohort Study

Introduction: Paediatric Acute Respiratory Distress Syndrome (PARDS) remains a major cause of mortality and morbidity in Paediatric Intensive Care Units (PICU) despite various advanced management strategies. The management and outcome of PARDS depend on the severity of the disease. Aim: To study the clinical profile in terms of aetiology and outcome of paediatric patients with moderate to severe Acute Respiratory Distress Syndrome (ARDS) in the PICU. Materials and Methods: A prospective cohort study was conducted at the PICU in Dr. BC Roy Postgraduate Institute of Paediatric Sciences, Kolkata, West Bengal, India, from July 2018 to June 2019. A total of 120 children aged between two months and 12 years who developed moderate to severe ARDS according to Paediatric Acute Lung Injury Consensus Conference (PALICC) criteria were included. Demographic details, different risk factors, morbidity patterns, and outcomes were recorded. Patients were categorised into three groups based on Positive End Expiratory Pressure (PEEP): 5-8 cm of H2 O, 9-12 cm of H2 O, and >12 cm of H2 O. Based on Peak Inspiratory Pressure (PIP), patients were divided into two groups: <30 cm of H2 O and 30-35 cm of H2 O. Data were statistically analysed using the Chisquare test, Fisher’s test, and t-tests where applicable. Results: Out of a total of 120 children with moderate to severe ARDS, there were 75 males and 45 females. Direct lung injury accounted for 79 cases (65.5%), while indirect lung injury occurred in 41 cases (34.5%). Pneumonia and sepsis were the most common causes of direct and indirect lung injury, respectively. Among 75 cases of pneumonia, 40 deaths were reported (53.3%), and out of 37 cases of sepsis, 31 resulted in death (83%). On the day of admission, 38.3% of cases were classified as moderate ARDS and 61.7% as severe ARDS. The mortality rate for severe ARDS was 77%, compared to 43.5% for moderate ARDS. The mortality rate was 100% in the PEEP max >12 cm of H2 O group and 84.4% in the PIP 30-35 cm of H2 O group. Conclusion: The majority of ARDS cases are due to direct lung injury caused by pneumonia, and the outcome is better than in cases of indirect lung injury. Mortality is nearly twice as high in severe ARDS as in moderate ARDS.

Consequence Analysis of An Industrial Accident at a Fuel Station

Major industrial accident is a type of technological disaster that may require extraordinary intervention in areas outside the facility, in addition to those affected within the facility. It causes damage to the environment and loss of life at the time it occurs or afterward. Studies to be carried out to prevent these accidents Zor to reduce their effects are important. In this study, a case study for the consequences of an industrial accident that may occur in a fuel station was analyzed. Firstly, possible accident scenarios were created by obtaining chemical, atmospheric and source data. The LPG (Liquefied Petroleum Gas) storage tank (40m3) was considered in modeling a fuel station in the Korfez district of Kocaeli province, where the industry is dense in Turkey. The average atmospheric data of the province for the months of August and January were used to represent summer and winter conditions, respectively. Threat zones were produced with ALOHA (Areal Locations of Hazardous Atmospheres) software based on a release to atmosphere without burning, a jet fire as a result of a leak in the LPG tank and BLEVE scenarios. The two most dangerous scenarios were determined as a possible jet fire in August and a possible BLEVE (Boiling Liquid Expanding Vapor Explosion) in January. Overpressure effects were also obtained using the BST (Baker-Strehlow-Tang) method, thus ensuring the validation. With the software, the vapor cloud explosion distance as a result of the leak in August was obtained as 456m and 268m for the yellow (6.89kPa) and orange (24.13kPa) threat zones, respectively. Overpressure in an area of 500 meters was calculated as 5.06kPa with BST method. This calculated overpressure has the potential for damage that can lead to glass and window breakage in parallel with the ALOHA output. It has been determined that indirect injuries may occur to living beings.

Traumatic Rosette Cataract

A 39-years-old man was referred to the ophthalmology department because of a progressive unilateral decrease of visual acuity over the previous 9 months. The patient reported having blunt ocular trauma from a fist punch one year earlier. On examination, he was noted to have a stellate-shaped axial opacification of the right lens. Traumatic cataracts are caused by blunt or penetrating ocular trauma. The proposed mechanism for indirect injury is shock waves progressing through the eye along the line of concussion. Opacification of the lens may occur in the cortex or capsule and can result in the formation of a stellate-shaped or rosette-shaped cataract. If such injuries disrupt the visual axis, cataract surgery may be required. This patient regained full visual acuity after successful phacoemulsification and intraocular-lens implantation.

Frontal and anterior temporal hypometabolism post chemoradiation in head and neck cancer: A real-world PET study.

Adverse neurological effects after cancer therapy are common, but biomarkers to diagnose, monitor, or risk stratify patients are still not validated or used clinically. An accessible imaging method, such as fluorodeoxyglucose positron emission tomography (FDG PET) of the brain, could meet this gap and serve as a biomarker for functional brain changes. We utilized FDG PET to evaluate which brain regions are most susceptible to altered glucose metabolism after chemoradiation in patients with head and neck cancer (HNCa). Real-world FDG PET images were acquired as standard of care before and after chemoradiation for HNCa in 68 patients. Linear mixed-effects voxelwise models assessed changes after chemoradiation in cerebral glucose metabolism quantified with standardized uptake value ratio (SUVR), covarying for follow-up time and patient demographics. Voxelwise analysis revealed two large clusters of decreased glucose metabolism in the medial frontal and polar temporal cortices following chemoradiation, with decreases of approximately 5% SUVR after therapy. These findings provide evidence that standard chemoradiation for HNCa can lead to decreased neuronal glucose metabolism, contributing to literature emphasizing the vulnerability of the frontal and anterior temporal lobes, especially in HNCa, where these areas may be particularly vulnerable to indirect radiation-induced injury. FDG PET shows promise as a sensitive biomarker for assessing these changes.

Blocking P2Y2 purinergic receptor prevents the development of lipopolysaccharide-induced acute respiratory distress syndrome.

Acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality resulting from a direct or indirect injury of the lung. It is characterized by a rapid alveolar injury, lung inflammation with neutrophil accumulation, elevated permeability of the microvascular-barrier leading to an aggregation of protein-rich fluid in the lungs, followed by impaired oxygenation in the arteries and eventual respiratory failure. Very recently, we have shown an involvement of the Gq-coupled P2Y2 purinergic receptor (P2RY2) in allergic airway inflammation (AAI). In the current study, we aimed to elucidate the contribution of the P2RY2 in lipopolysaccharide (LPS)-induced ARDS mouse model. We found that the expression of P2ry2 in neutrophils, macrophages and lung tissue from animals with LPS-induced ARDS was strongly upregulated at mRNA level. In addition, ATP-neutralization by apyrase in vivo markedly attenuated inflammation and blocking of P2RY2 by non-selective antagonist suramin partially decreased inflammation. This was indicated by a reduction in the number of neutrophils, concentration of proinflammatory cytokines in the BALF, microvascular plasma leakage and reduced features of inflammation in histological analysis of the lung. P2RY2 blocking has also attenuated polymorphonuclear neutrophil (PMN) migration into the interstitium of the lungs in ARDS mouse model. Consistently, treatment of P2ry2 deficient mice with LPS lead to an amelioration of the inflammatory response showed by reduced number of neutrophils and concentrations of proinflammatory cytokines. In attempts to identify the cell type specific role of P2RY2, a series of experiments with conditional P2ry2 knockout animals were performed. We observed that P2ry2 expression in neutrophils, but not in the airway epithelial cells or CD4+ cells, was associated with the inflammatory features caused by ARDS. Altogether, our findings imply for the first time that increased endogenous ATP concentration via activation of P2RY2 is related to the pathogenesis of LPS-induced lung inflammation and may represent a potential therapeutic target for the treatment of ARDS and predictably assess new treatments in ARDS.

Magnetic resonance imaging predicts the days lost from training and competition: evaluation of 56 indirect muscle injuries in professional football players.

Lower limb muscle injuries have a strong impact in training and official competitions stoppage for professional football players. This study aimed to explore the relationship between oedema-like changes found on magnetic resonance imaging (MRI) in acute indirect thigh injuries muscles and the time required for the athlete to return to individual training - "return to training" (RTT) and for full availability for official competitions - "return to play" (RTP). Professional football players from 2017/2018 to 2021/2022 seasons top league team with clinical and ultrasound (US) diagnosis of acute hamstrings or quadriceps muscle injury, confirmed on 48/72h subsequent MRI, were included. MRI images were retrospectively re-evaluated. MRI parameters evaluated were cross-sectional area (CSA), cranio-caudal extension (CCE), distance to nearest insertion (DI) and volume (V). Univariate and multivariate analysis was performed to find factors related to RTT, RTP, and episodes of reinjuries. Thirty-four first traumatic muscle injuries met the inclusion criteria. The mean time to RTT and RTP was 22 (4-49) and 25 (4-55) days, respectively. CCE and V resulted as independent predictive MRI variables for the time to RTT (P=0.012) and RTP (P=0.02), respectively. Thresholds of CCE≥11.31 cm and V ≥19.5cc can predict a time to RTT≥22 days (Odds Ratio [OR] 9.5) and RTP≥25 days (OR 4.583), respectively. The decision on the time required for RTP is based on clinic and imaging evaluation; CCE and V of the MRI oedema-like changes help to define the prognosis of the injury.

Falling decreased anterior cruciate ligament loading variables during single-leg landings after mid-flight external trunk perturbation

Mid-flight external upper-trunk perturbation is associated with increased anterior cruciate ligament (ACL) injury risk during landing. This study aimed to assess the effect of natural, soft, and falling landing techniques on knee mechanics and vertical ground reaction forces (VGRF) during single-leg landings with/without mid-flight medial–lateral external upper-trunk pushing perturbation. Twenty-eight participants performed single-leg landings using the three landing techniques with/without mid-flight pushing perturbation. The perturbation was created by a customized apparatus releasing a slam ball and pushing the participants near the peak jump height at the upper trunk. Perturbation resulted in significantly greater lateral trunk bending angles, knee flexion angles at initial contact, peak knee abduction angles, and peak knee adduction moments compared to no perturbation. The falling condition significantly demonstrated the greatest lateral trunk bending angles, knee flexion angles, and peak knee external rotation moments and the smallest peak knee abduction angles, peak VGRF, and peak knee extension moments compared to natural/soft landings regardless of perturbation conditions. Mid-flight external perturbation resulted in variables associated with greater ACL loading during single-leg landings. Falling demonstrated variables associated with smaller ACL loading, particularly for perturbation conditions. Incorporating falling techniques into jump-landing training programs may guide players to safely fall on the ground when perturbation occurs. Falling provides an alternative strategy to potentially decrease indirect contact ACL injury risk when the sports environment allows.

Traumatic Rosette Cataract

A 39-years-old man was referred to the ophthalmology department because of a progressive unilateral decrease of visual acuity over the previous 9 months. The patient reported having blunt ocular trauma from a fist punch one year earlier. On examination, he was noted to have a stellate-shaped axial opacification of the right lens. Traumatic cataracts are caused by blunt or penetrating ocular trauma. The proposed mechanism for indirect injury is shock waves progressing through the eye along the line of concussion. Opacification of the lens may occur in the cortex or capsule and can result in the formation of a stellate-shaped or rosette-shaped cataract. If such injuries disrupt the visual axis, cataract surgery may be required. This patient regained full visual acuity after successful phacoemulsification and intraocular-lens implantation.

Intact peritoneum in a child with ileal perforation from a firearm injury

Introduction Indirect intra-abdominal injury with an intact peritoneum following close passage of highly energized projectiles is an uncommon but clearly described phenomenon; likewise delayed gastrointestinal perforation hours or days after passage of a high-energy stress wave from primary blast injury is uncommon. Awareness of these two rare occurrences is required to ensure delayed perforations are diagnosed and managed in a timely manner. Case report An 8-year-old male child sustained a shotgun injury to the right elbow and the abdominal wall only of the right hypochondrium. Due to a non-salvageable joint injury, he underwent amputation of the right upper limb above the elbow, but on the third day of admission, he developed peritonitis and an X-ray revealed pneumoperitoneum. On abdominal exploration, two small ileal perforations were found without penetration of the peritoneum or diaphragm. The ileal injuries were primarily repaired and the postoperative course was uneventful. Conclusion Indirect injury to abdominal viscera from the primary blast effect of close passage of high-energy projectiles resulting is rare and can have significant consequences if not diagnosed and managed early.

Cataracts after Ophthalmic andNonophthalmic Trauma Exposure inService Members, U.S. Armed Forces.

IntroductionWe aimed to identify injury-related risk factors for secondary cataract incidence after eye and brain injury and polytrauma. We also examined the effect of direct and indirect eye injury management on cataract diagnosis and treatment. Prevention or mitigation strategies require knowledge of the causes and types of combat injuries, which will enable more appropriate targeting of resources toward prevention and more efficient management of such injuries. Data were gathered from the Military Health System using the Military Health System Management and Analysis Reporting Tool (M2) between 2017 and 2021 from inpatient and outpatient Service Members (SMs) (active duty and National Guard). The date of the first cataract diagnosis was tracked to estimate the annual incidence rate, and it was longitudinally linked to any prior diagnosis of ocular trauma (OT), traumatic brain injury (TBI), or polytrauma to calculate the relative risk. International Classification of Disease codes, 10th Revision, were used to identify those diagnosed with cataracts, TBI, and polytrauma. Defense and Veterans Eye Injury and Vision Registry data were used to examine SMs who sustained ocular injuries from 2003-2020 and who may have had cataract surgery following a cataract diagnosis. The relative risk of traumatic cataract formation from OT, TBI, and polytrauma are 5.71 (95% CI, 5.05-6.42), 2.32 (95% CI, 2.03-2.63), and 8.95 (95% CI, 6.23-12.38), respectively. Traumatic cataracts in SMs more commonly result from open-globe injuries (70%) than closed-globe injuries (30%). By specific sub-injury type, traumatic cataracts occur most frequently from intraocular foreign bodies (22%). More than 400 patients in the cohort suffered from TBI and traumatic cataracts, more than 300 from OT and cataracts, and more than 20 from polytrauma and cataracts. The battlefield is the riskiest environment for trauma exposure, with 62% of OT occurring in combat. There was a statistically significant difference between the mean visual acuity value before cataract surgery (M = 1.17, SD = 0.72) and the mean visual acuity value after cataract surgery (M = 0.44, SD = 0.66, P < .001). Traumatic cataracts often occur in SMs who sustain ocular injuries. New to the literature is that relationships exist between traumatic cataract formation and nonglobe trauma, specifically TBI and polytrauma. Ocular injury calls for an ophthalmic examination. A low threshold should exist for routine ocular exam consultation in the setting of TBI and polytrauma. Separately, polytrauma patients should undergo a review of systems questions, particularly questions about the ocular and visual pathways. A positive response to screening warrants further investigation of possible ocular pathology, including traumatic cataract formation. Cataract surgery is an effective treatment in improving the vision of SMs who suffer from traumatic cataracts. Constant effort must be made to limit occurrences of occupation-related traumatic cataracts.

COVID-19 and acute pancreatitis clinical outcomes among hospitalized patients in the United States: A propensity matched analysis of national inpatient sample

BackgroundPancreatitis is one of the leading causes of gastrointestinal-related hospitalization, with significant morbidity and mortality. SARS-COV-2 virus can access the pancreas via angiotensin-converting enzymes and can cause direct and indirect injury to the pancreatic parenchyma. The objective of this study to understand clinical outcomes of hospitalized patients with COVID-19 with and without pancreatitis utilizing National Inpatient Sample database. MethodsWe utilized the United States National Inpatient Sample database to study clinical outcomes in hospitalized patients with COVID-19 infection (a total of 1,659,040 hospitalized patients with 10,075 (0.6 %) with pancreatitis) between January 1 to December 31, 2020, along with propensity matching. ResultsWhile after propensity matching, we did not find a statistical difference in in-hospital mortality amongst COVID-19 patients with pancreatitis compared to COVID-19 patients without pancreatitis (13.2 % vs 10.3 %, adjusted odds ratio: 0.7 [95 % CI 0.5–1], p = 0.11). Patients with COVID-19 and pancreatitis had more episodes of septic shock, higher incidence of acute kidney injury and acute kidney injury requiring hemodialysis. We also found an increased prevalence of NASH cirrhosis, alcohol liver cirrhosis, and a lesser incidence of pulmonary embolisms in the COVID-19 with pancreatitis cohort. ConclusionWorse in-hospital outcomes, including increased incidence of septic shock, acute kidney injury, and acute kidney injury requiring hemodialysis in hospitalized patients with COVID-19 infection and pancreatitis, emphasize the need for more research to understand the effect of COVID-19 disease in hospitalized patients with pancreatitis and in the role of vaccination to improve long term outcome in this patient population.

Traumatic muscle injury.

Traumatic muscle injury represents a collection of skeletal muscle pathologies caused by trauma to the muscle tissue and is defined as damage to the muscle tissue that can result in a functional deficit. Traumatic muscle injury can affect people across the lifespan and can result from high stresses and strains to skeletal muscle tissue, often due to muscle activation while the muscle is lengthening, resulting in indirect and non-contact muscle injuries (strains or ruptures), or from external impact, resulting in direct muscle injuries (contusion or laceration). At a microscopic level, muscle fibres can repair focal damage but must be completely regenerated after full myofibre necrosis. The diagnosis of muscle injury is based on patient history and physical examination. Imaging may be indicated to eliminate differential diagnoses. The management of muscle injury has changed within the past 5 years from initial rest, immobilization and (over)protection to early activation and progressive loading using an active approach. One challenge of muscle injury management is that numerous medical treatment options, such as medications and injections, are often used or proposed to try to accelerate muscle recovery despite very limited efficacy evidence. Another challenge is the prevention of muscle injury owing to the multifactorial and complex nature of this injury.

Characterization of Nerve Damage After an Injury to the Adjacent Soft Tissue: A Pilot Animal Study.

Traumatic injuries may result in the formation of soft tissue adhesions between peripheral nerves and surrounding soft tissue. These soft tissue adhesions lead to compression and ischemic stress within fascicles due to nonpliability of adhered scar tissue, and nerve tension due to loss of nerve gliding from scar tethering. These changes in the soft tissue bed surrounding the nerve may result in axon degeneration and neuroma-in-continuity. Preclinical models that simulate clinically relevant levels of scar in the nerve environment may be impactful to the development of surgical techniques and treatments to prevent adhesions. This study presents the results of a rodent model with an induced indirect nerve injury by (1) thermal insult to the soft tissue bed surrounding the nerve and (2) air-drying the surrounding soft tissue bed of the nerve. Our findings suggest that inducing an injury of the soft tissue bed results in increased intraneural scar and extraneural adhesions to the nerve compared to a sham procedure. Thermal induced injuries showed more macrophages and changes in nerve health compared to air-dried induced injuries. The changes in the nerves of the induced injury groups, specifically the thermal injury group, may be meaningful for evaluating treatments for nontransected nerve injuries.

Assessment of alterations in the retina and vitreous in pre- and post-COVID-19 patients using swept-source optical coherence tomography and angiography: A comparative study.

Ocular manifestations have been well recognized in coronavirus disease 2019 (COVID-19) outbreak. Several studies have detected ocular manifestations in patients after COVID-19. However, little is known about the retinal and vitreal alterations in patients before and after COVID-19 infection. This study aimed to investigate the retinal and vitreal alterations in patients before and after contracting COVID-19 infection using swept-source optical coherence tomography (SS-OCT) and angiography (SS-OCTA). A total of 38 participants (76 eyes) were enrolled and followed-up 1 month after COVID-19 infection. Then, 26 patients (52 eyes) were evaluated 3 months after COVID-19 infection. Compared with the pre-COVID-19 status, patients with 1- and 3-month post-COVID-19 statuses had significant thinning of ganglion cell and inner plexiform layer, thickening of inner nuclear layer, a decrease in the vessel density (VD) of superficial vascular complex, and an increase in the VD of deep vascular complex. Meanwhile, alteration in parameters of foveal avascular zone (all p < 0.05) and hyper-reflective dots in the vitreous of 27 patients (54 eyes) (71.1% vs. pre-COVID-19, 34.2%, p = 0.006) were observed. These findings suggest significantly retinal and vitreal alterations occurred in patients after COVID-19 infection, possibly due to direct or indirect virus-induced injuries. Further longitudinal studies are required to investigate the long-term effects of COVID-19 infection on the human eyes.

Psychiatric Symptoms and Fatigue in COVID-19 Survivors.

Psychiatric symptoms and fatigue are common after the coronavirus disease 2019 (COVID-19) illness. The cause of these symptoms is direct neuronal injury and indirect injury with immune-mediated inflammation. In addition, social factors also affect mental health. We aim to compare psychiatric symptoms and fatigue between COVID-19 survivors and healthy controls. We prospectively evaluated 100 COVID-19 survivors for anxiety, depression, positive affect, andbehavior control using the Mental Health Inventory (MHI). Fatigue is assessed using the Modified Fatigue Impact Scale (MFIS) score. We compared them with 100 healthy controls. There was a significant statistical difference between the MHI score and individual components of MHI. Overall, MHI scores in cases and controls were 79.41 and 93.31, respectively, with a P value of less than 0.0001. Computed scores for anxiety, depression, behavior control, and positive affect of COVID-19 survivors showed statistically significant differences as compared to healthy controls.There was a weak association between hospital stay duration and poor MHI scores. Fatigue was significantly worse in COVID-19 survivors, with a mean score of 6.93 in cases and 5.35 in controls, with a P value of 0.0001. This was a cross-sectional study evaluating psychiatric symptom scores, but not establishing the diagnosis. It is suggested that appropriate treatment and counseling for these symptoms should be done. Psychiatric symptoms and fatigue were significantly more common in COVID-19 patients after recovery from acute illness. It is a major contributing cause of morbidity other than organic complications of COVID-19 and requiresattention in management.

Influence of Posterior Tibial Slope on the Risk of Recurrence After Anterior Cruciate Ligament Reconstruction

Background. Anterior cruciate ligament (ACL) graft rupture has multifactorial causes, with traumatic factors being the most prevalent. Modern literature presents conflicting data regarding the influence of the posterior tibial slope on the risk of traumatic ACL graft rupture.&#x0D; Aim of the study to determine if there is a correlation between the posterior tibial slope and ACL graft injury in patients who have previously undergone ACL reconstruction.&#x0D; Methods. This was a single-center cohort retrospective study that included patients diagnosed with a complete ACL rupture and who had undergone ACL reconstruction using standard techniques without graft rupture at the last follow-up. Inclusion criteria for the first group included a diagnosis of traumatic ACL rupture followed by reconstruction, a graft composed of semitendinosus and gracilis tendons (St+Gr), femoral fixation with a cortical button, tibial fixation with a sleeve and screw, and the absence of graft rupture at the time of the study. This group included 30 consecutive patients (15 males and 15 females) with a mean age of 36.3 years (min 17, max 59). Inclusion criteria for the second group included an indirect traumatic mechanism of ACL graft rupture and subsequent revision ACL reconstruction. This group consisted of 33 patients (23 males and 10 females) with a mean age of 33.0 years (min 19, max 60). The lateral (LPTS) and medial (MPTS) posterior tibial slopes were measured on lateral knee radiographs.&#x0D; Results. The median time from surgery to the last follow-up in the first group was 65 months (IQR 60; 66), while in the second group, it was 48 months (IQR 9; 84). The median MPTS in the first group was 7.8 (IQR 5.3; 9.4), while in the second group, it was 8.5 (IQR 7.5; 11). The median LPTS in the first group was 9.9 (IQR 8.4; 12.1), whereas in the second group, it was 12.0 (IQR 9; 15.4). There was no statistically significant difference in MPTS and LPTS based on gender in both groups and the entire sample (p0.05). When comparing LPTS values between both groups, a statistically significant difference (p = 0.04) was found, with higher LPTS values in patients in the second group (with ACL graft injury).&#x0D; Conclusion. Increased posterior tibial slope, particularly LPTS, is identified as a potential predictor of ACL graft rupture. The study demonstrates the impact of LPTS on the risk of ACL graft rupture (p0.05) in cases of indirect traumatic injury.

Bursting of the upper jaw prosthesis and fractures of the lower jaw as indirect injury pattern caused by a headshot: a case report

Gunshots to the human body can cause direct and indirect injuries. Direct injuries are a consequence of the projectile guiding its way through the body, creating a permanent wound channel and thereby damaging the penetrated as well as the adjacent tissue. In addition, the temporary wound cavity is responsible for indirect injuries occurring distant to the actual wound tract. This can potentially affect different types of tissue, like blood vessels, organs, or bones, that are not directly passed through by the projectile. For this case report, we describe a suicidal headshot to the temporal area where the extension of the temporary wound cavity and its subsequent collapse led to massive energy transfer to the surrounding tissue leading to breakage of the upper dental prosthesis and fractures of the lower jaw. Thereby outlining the ballistic mechanisms causing indirect injury pattern that have to be considered when examining gunshot wounds.