Patient Injury Patterns Research Articles

Rationale and design of the multi organ inflammation with serial testing study: a comprehensive assessment of functional and structural abnormalities in patients with recovered COVID-19.

Short-term clinical outcomes from SARS-CoV-2 infection are generally favorable. However, 15-20% of patients report persistent symptoms of at least 12 weeks duration, often referred to as long COVID. Population studies have also demonstrated an increased risk of incident diabetes and cardiovascular disease at 12 months following infection. While imaging studies have identified multi-organ injury patterns in patients with recovered COVID-19, their respective contributions to the disability and morbidity of long COVID is unclear. A multicenter, observational study of 215 vaccine-naïve patients with clinically recovered COVID-19, studied at 3-6 months following infection, and 133 healthy volunteers without prior SARS-CoV-2 infection. Patients with recovered COVID-19 were screened for long COVID related symptoms and their impact on daily living. Multi-organ, multi-parametric magnetic resonance imaging (MRI) and circulating biomarkers were acquired to document sub-clinical organ pathology. All participants underwent pulmonary function, aerobic endurance (6 min walk test), cognition testing and olfaction assessment. Clinical outcomes were collected up to 1 year from infection. The primary objective of this study is to identify associations between organ injury and disability in patients with long-COVID symptoms in comparison to controls. As a secondary objective, imaging and circulating biomarkers with the potential to exacerbate cardiovascular health were characterized. Long-term sequelae of COVID-19 are common and can result in significant disability and cardiometabolic disease. The overall goal of this project is to identify novel targets for the treatment of long COVID including mitigating the risk of incident cardiovascular disease. clinicaltrials.gov (MOIST late cross-sectional study; NCT04525404).

Clonal hematopoiesis of indeterminate potential is associated with acute kidney injury.

Age is a predominant risk factor for acute kidney injury (AKI), yet the biological mechanisms underlying this risk are largely unknown. Clonal hematopoiesis of indeterminate potential (CHIP) confers increased risk for several chronic diseases associated with aging. Here we sought to test whether CHIP increases the risk of AKI. In three population-based epidemiology cohorts, we found that CHIP was associated with a greater risk of incident AKI, which was more pronounced in patients with AKI requiring dialysis and in individuals with somatic mutations in genes other than DNMT3A, including mutations in TET2 and JAK2. Mendelian randomization analyses supported a causal role for CHIP in promoting AKI. Non-DNMT3A-CHIP was also associated with a nonresolving pattern of injury in patients with AKI. To gain mechanistic insight, we evaluated the role of Tet2-CHIP and Jak2V617F-CHIP in two mouse models of AKI. In both models, CHIP was associated with more severe AKI, greater renal proinflammatory macrophage infiltration and greater post-AKI kidney fibrosis. In summary, this work establishes CHIP as a genetic mechanism conferring impaired kidney function recovery after AKI via an aberrant inflammatory response mediated by renal macrophages.

Demographic characterization and pattern of injury in patients with ocular trauma at the San Ignacio University Hospital in Bogotá, Colombia, during the period 2017–2021

Abstract Introduction: Ocular trauma is an important and preventable cause of decreased vision or blindness. There are just a few studies in Colombia describing the prevalence of ocular trauma in the country. The characterization of these events may lead to the development of preventive strategies, effective treatment, and efficient allocation of economic resources. Methods: Descriptive, retrospective, cross-sectional observational study. Results: Data from 1.373 patients who were evaluated by an ophthalmologist at the Hospital Universitario San Ignacio in Bogotá, Colombia, were collected. Most of the patients were men with a mean age of 36 years. The most prevalent context of trauma was domestic injuries; and the most frequent mechanism was blunt trauma with a classification of 5 on the ocular trauma score. Discussion: The collected data showed similar results compared to the literature. The prevalence of ocular trauma is higher in men in all the scenarios. On the other hand, it is of extreme concern the lack of consciousness as to why use of ocular protection is key.

The spectrum of glomerular and vascular kidney pathology associated with myeloproliferative neoplasms

A high prevalence of chronic kidney disease (CKD) occurs in patients with myeloproliferative neoplasms (MPN). However, MPN-related glomerulopathy (MPN-RG) may not account for the entirety of CKD risk in this population. The systemic vasculopathy encountered in these patients raises the hypothesis that vascular nephrosclerosis may be a common pattern of injury in patients with MPN and with CKD. In an exhaustive, retrospective, multicenter study of MPN kidney biopsies in four different pathology departments, we now describe glomerular and vascular lesions and establish clinicopathologic correlations. Our study encompassed 47 patients with MPN who underwent a kidney biopsy that included 16 patients with chronic myeloid leukemia (CML) and 31 patients with non-CML MPN. Fourteen cases met a proposed definition of MPN-RG based on mesangial sclerosis and hypercellularity, as well as glomerular thrombotic microangiopathy. MPN-RG was significantly associated with both myelofibrosis and poorer kidney survival. Thirty-three patients had moderate-to-severe arteriosclerosis while 39 patients had moderate-to-severe arteriolar hyalinosis. Multivariable models that included 188 adult native kidney biopsies as controls revealed an association between MPN and chronic kidney vascular damage, which was independent of established risk factors such as age, diabetes mellitus and hypertension. Therefore, MPN-RG is associated with myelofibrosis and has a poor kidney prognosis. Thus, our findings suggest that the kidney vasculature is a target during MPN-associated vasculopathy and establish a new link between MPN and CKD. Hence, these results may raise new hypotheses regarding the pathophysiology of vascular nephrosclerosis in the general population.

Injury patterns in patients with severe traumatic brain injuries from motor crashes admitted to Mulago hospital accidents & emergency unit.

The global burden of Road Traffic Crashes (RTC) is increasing. Uganda has one of the highest rates of RTCs in Sub-Sahara. Victims of RTCs sustain varying degrees of injuries depending on factors including the velocity at time of impact, protective gear; and if it was a motorcycle-motorcycle or motorcycle-vehicle crash. High speed collisions can result in severe forms of injuries and polytrauma. Some injuries are undetected. A cross sectional study was carried at Mulago Hospital Accidents & Emergency Unit, between November 2021 and February 2022; on all adult patients (≥18 years) with severe head injury from motor road traffic crashes. The study looked at injury patterns and assessed the relationship of polytrauma in patients with severe head injury to the mechanism of injury (motorcycles versus vehicles). Data were extracted from patient charts using a validated data abstraction tool and complete head to toe physical examination was carried out and injuries recorded. Data were analysed to determine the relationship of polytrauma in patients with severe head injury to the mechanism of injury. The participants were predominantly males with a population median age of 32 (25-39). The commonest modes of transportation of patients to the hospital were Police Pickup trucks (40%) and ambulance (36.1%). Among motorcycle RTCs, (19.2%) wore helmets; 21.2% had protective gear; with injury identified mainly in; the limbs (84.8%), neck (76.8%), chest (39.4%), and abdomen (26.3%). Patients from vehicle RTCs were 19% more likely to have polytrauma compared to patients from motorcycle RTCs. This study showed that patients who sustain severe traumatic brain injuries from vehicle crashes have an increased likelihood of having multiple injuries, compared to patients from motorcycle RTCs. For motorcycle users, injuries mostly affect the limbs. At particular risk are motorcyclists who do not wear helmets and protective coveralls.

Demographics and Patterns of Injury in Patients with Sharp Penetrating Trauma admitted to a Greater Manchester Major Trauma Centre: A Retrospective Five-Year Study

Background: Sharp penetrating trauma represents 4.1%-6.9% of all major trauma cases in the UK. The incidence of Sharp penetrating trauma is rising, with 47,000 offences in England and Wales in 2019. There has been limited published data on the victims of sharp penetrating trauma. Methods: We performed a single centre retrospective case note review of patients admitted to an urban major trauma centre following an assault with a sharp object from 1st January 2014 to the 31st December 2018. Data was collected on demographics, injury pattern, management, and outcome. Results: In total, 686 patients were included in the study. There was a year-on-year increase of admissions with sharp penetrating trauma from 100 admissions in 2014, to 194 in 2018. The majority of patients were male, with a mean age of 31, and 73% of our patients were of Caucasian ethnicity. Patients presented most frequently on weekends (53%). The length of stay increased over the study period from 2.3 days in 2014 to 4.0 days in 2018. The thorax was the most commonly injured body region, involved in 29% of presentations, followed by the abdomino-pelvis (21%). 51% of patients presented with multiple injuries, and the average number of stab wounds per patient increased from 1.95 in 2014 to 2.40 in 2018. Conclusion: Our study has demonstrated the incidence and severity of sharp penetrating trauma is increasing in central Manchester. The authors advocate the creation of a national knife crime database to further the implementation of prevention strategies.

Intimate Partner Violence and Pregnancy: Nationwide Analysis of Injury Patterns and Risk Factors.

Intimate partner violence (IPV) is a significant cause of injury, and in pregnant patients (PIPV) poses a risk to both mother and fetus. Characteristics and outcomes for PIPV patients have not been well described. We hypothesize that PIPV patients have higher admission rates and mortality than non-IPV pregnant trauma (PT) patients and nonpregnant female IPV patients of childbearing age. We also hypothesize differences exist between PIPV and PT patient injury patterns, allowing for targeted IPV screening. The Nationwide Emergency Department Sample database was queried from 2010 to 2014 to identify IPV in adult women patients by injury code E967.3. Patients were compared in 2 ways, PIPV vs PT and PIPV vs nonpregnant female IPV patients. Demographics, injury mechanisms, and National Trauma Data Standard injury diagnoses were surveyed. Primary outcomes were hospital admissions and mortality. Logistic regression was used to estimate risk factors of the outcomes of hospitalization and IPV victimization in pregnant injured patients. There were 556 PIPV patients, 73,970 PT patients, and 56,543 nonpregnant female IPV patients. When comparing PIPV to PT, more PIPV patients had Medicaid coverage or were self-pay. Suffocation, head injuries, face/neck/scalp contusions, multiple contusions, and abrasions/friction burns were more prevalent in PIPV patients. Mortality and hospital admissions were scarce among all cohorts. Predictors of IPV victimization among injured pregnant patients include multiple injuries, head injuries, face/neck/scalp contusions, abrasions/friction burns, contusions of multiple sites, and those with Medicaid or self-pay coverage. Among injured pregnant patients, those with multiple injuries, head injuries, contusions of the face/neck/scalp, abrasions/friction burns, and multiple contusions should undergo IPV screening. Admissions and mortality are low; therefore, prevention measures should be implemented in the emergency department to reduce repeat victimization.

Sex Differences In Posterior Cruciate Ligament Injuries

BACKGROUND: Acute tears of the posterior cruciate ligament (PCL) have been more commonly reported in males than females, with males constituting between 60 and 84% of isolated and combined PCL injuries. However, there is a paucity of studies comparing the injury patterns between males and females. This study aimed to evaluate the differences in patterns of isolated PCL tears and associated injuries between males and females on magnetic resonance imaging (MRI). METHODS: Patients with PCL tears were identified through an institutional database. Two musculoskeletal imaging radiologists independently reviewed each case to describe injury patterns as well as the presence and severity of concurrent injuries. After applying exclusion criteria, male and female cohorts were compared for differences in injury patterns and the presence of concurrent injuries. Linear regression analysis was performed to assess for differences in injury patterns related to age. RESULTS: A search yielded 322 consecutive patients with PCL injury. After reviewing MRI exams and applying exclusion criteria, the cohorts included 79 patients (21 female and 58 male). Overall, females with PCL tears were more likely to sustain concurrent injuries to the posteromedial corner (71.4% vs. 25.9%, p < 0.001), anterior cruciate ligament (14.3% vs. 0%, p = 0.003), partial injury to the medial collateral ligament (23.8% vs. 6.9%, p = 0.037), and lateral meniscus (38.1% vs. 3.5%, p < 0.001). Comparison of patients with Grade 3 PCL injuries showed that this type of injury occurred at a greater age in females when compared to males (46.0±22.1 vs. 32.3±13.5, p=0.019). Regression analysis between age and injury pattern in patients with Grade 3 PCL tears revealed significant findings only in female patients, with a positive correlation between age and distal location of the PCL tear (R2 = 0.5937, p = 0.003). We also observed significant negative correlations between age and associated injuries of the ACL (R2 = 0.3623, p = 0.038), and lateral retinaculum (R2 = 0.3325, p = 0.049). CONCLUSION: We observed significant sex differences in the number and type of accompanying injuries with acute PCL injuries. Complete PCL injuries were found to occur at a greater age in females, with an age-dependent distribution of PCL injury location and number of accompanying injuries. Further studies are needed to understand the role of these findings in the treatment and outcomes after PCL injury.

Different injury patterns exist among patients undergoing operative treatment of isolated PCL, combined PCL/ACL, and isolated ACL injuries: a study from the Swedish National Knee Ligament Registry

PurposeTo compare demographic characteristics and concomitant injury patterns in patients undergoing primary isolated posterior cruciate ligament reconstruction (PCL-R) and combined posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) reconstruction (PCL-R/ACL-R) with isolated ACL reconstruction (ACL-R) as a reference using data from the Swedish National Knee Ligament Registry (SNKLR).MethodsThis cohort study based on the SNKLR comprised patients undergoing either PCL-R, ACL-R, or combined PCL-R/ACL-R between January 1, 2005 and December 31, 2019 in Sweden. Demographic and surgery-related data with regards to injury mechanism, concomitant intraarticular lesions and their treatment, neurovascular damage, and concomitant ligamentous injuries were extracted. Exclusion criteria included concomitant fractures of the femur, fibula, patella or tibia, and quadriceps or patellar tendon injury.ResultsA total of 45,564 patients were included in this study. Isolated PCL-R, combined PCL-R/ACL-R, and isolated ACL-R were performed in 192 (0.4%), 203 (0.5%) and 45,169 (99.1%) patients, respectively. Sports were identified as the cause of 64% of PCL-Rs, 54% of PCL-R/ACL-Rs, and 89% of ACL-Rs, while a traffic-related mechanism was identified in 20% of PCL-Rs, 27% of PCL-R/ACL-Rs and 2% of ACL-Rs. Meniscus injury prevalence was 45% in ACL-Rs, 31% in PCL-R/ACL-Rs and 16% in isolated PCL-Rs (p < 0.001). Cartilage injuries were more common in PCL-R (37%) and PCL-R/ACL-R patients (40%) compared to ACL-R patients (26%, p < 0.001). Concomitant knee ligament injury was identified in 28–44% of PCL-R/ACL-R patients. Neurovascular injuries were present in 9% of PCL-R/ACL-Rs, 1% of PCL-Rs, and 0.3% of ACL-Rs (p < 0.001).ConclusionDifferences in injury mechanisms among patient groups confirm that operatively treated PCL tears are frequently caused by both traffic and sports. Cartilage and ligament injuries were more frequent in patients with PCL-R compared to ACL-R. Consequently, combined PCL and ACL tears should raise suspicion for concomitant knee lesions with clinical relevance during the operative treatment of these complex injuries.Level of evidenceIII.

Differences in injury patterns in motorcycle accidents involving children and adolescents

Traffic accidents and the traumatic injury consequences are frequent causes of mortality and irreversible damage in children and young adults. In motorcycle accidents the injury patterns differ depending on the age of the patient. The aim of this study was to describe the typical injury patterns after motorcycle accidents involving children and adolescents as these can have adecisive influence on the prevention and the adequate treatment in the respective patient groups. The study included 22,923 patients from the years 2002-2018 which were extracted from the TraumaRegister DGU®. Injury patterns of 4age categories were analyzed: group1 (4-15years), group2 (16-17years), group3 (18-20years) and group4 (21-50years). In both younger age groups, limb injuries mostly of the lower extremities, showed the highest incidence. Moreover, younger patients with traumatic brain injury showed better outcomes despite of initially poor conditions. Ribcage, abdominal, pelvic and spinal injuries are the least frequent in younger patients. In terms of diagnostics, children are less likely to undergo whole-body computed tomography (CT) diagnostics than adults. The study revealed age-specific differences with respect to injury patterns in patients involved in motorcycle accidents, either as drivers or co-drivers. Furthermore, the analysis of preclinical and in-hospital treatment elucidated the relevance of preventive and protective measures.

Emergency response of the UNRWA health programme to Great March of Return injuries: a descriptive analytic study in Gaza

BackgroundThe United Nations Relief and Work Agency for Palestine Refugees (UNRWA) is one of the main health-care providers in the Gaza Strip. It provides primary health services to approximately 1·3 million Palestine refugees, comprising approximately 76% of the population of the Gaza Strip. UNRWA has well-prepared emergency health plans that are based on previous conflict experiences. However, the Great March of Return (GMR) injuries that UNRWA has faced since Mar 31, 2018, are considered a new experience of emergency. GMR is a protest activity launched by Palestinians in the Gaza Strip to express their right to return to their homes, from which they were expelled in 1948. This study aimed to describe the GMR-related injury patterns in patients and the health services provided as a part of the UNRWA emergency response in Gaza. MethodsThis was a descriptive analysis of medical and data reports of patients who sought care at 22 UNRWA health centres in Gaza for GMR-related injuries between Mar 31 and Sept 30, 2018. Data were collected from each individual on first contact with their health-care provider. We analysed the data using SPSS version 21. The study protocol was approved by the Gaza Field Office, and each participant provided oral informed consent to disclose their medical data for analysis. Findings2020 patients attended the 22 UNRWA health centres for GMR-related injuries during the study period. 18·9% (381) were below 18 years of age, and 94·9% (1916) were male. 10·0% (202 of 2020) of injuries were classified as severe, 54·2% (1095) as moderate, and 35·8% (723) as mild. The majority of injuries (86%; 1737 of 2020) were due to gunshots, and 14% (283) were due to other causes (such as gas inhalation, rubber bullets, burns, and falling down). 54% (1090 of 2020) received wound care and dressing, 20% (404), received medical treatment only, and 26% (526) received both medical treatment and wound care. 9% (169 of 2020) developed motor dysfunction or disability as a complication, and received rehabilitation physiotherapy at UNRWA health centres. In addition to injury treatment, all patients received psychological first aid according to UNRWA Mental Health and Psychosocial Support Services guidelines. Individual and group psychosocial support sessions and home visits were provided for injured individuals and their families as needed. The UNRWA Health Programme collaborated with partners (eg, the International Committee of the Red Cross and Médecins Sans Frontières) for hospital referral for patients with severe injuries who needed advanced treatment. InterpretationGiven the unprecedented situation, UNRWA health centres responded positively and comprehensively to the GMR-related injuries, providing care and essential medical and psychosocial support. However, many patients will require long-term care owing to their injuries. Further consideration should be given to developing a more systemised response to such emergencies, and to the human resources that are needed to support health, physiotherapy, and rehabilitation in Gaza. FundingNone.

Histologic Features of Tacrolimus-induced Colonic Injury.

Tacrolimus is a common immunosuppressant used in solid organ transplant recipients. Although most patients develop diarrheal symptoms, data regarding patterns of injury in patients taking tacrolimus are limited. We performed this study to characterize tacrolimus-related features of colonic injury. We retrospectively identified colonic samples from 20 patients receiving tacrolimus monotherapy. Records were reviewed for symptoms, endoscopic findings, other medications, and infections. None of the patients had gastrointestinal infections or used other drugs known to cause colonic injury; none had received mycophenolate within 6 months of presentation. Cases were evaluated for the nature and distribution of inflammation and crypt abnormalities, including distortion, destruction, and apoptosis. Eighteen (90%) patients were solid organ transplant recipients. Seventeen (85%) had gastrointestinal symptoms, particularly diarrhea (75%). More than 50% had endoscopic colitis and 15% had ulcers and/or erosions. Most (90%) cases showed regenerative epithelial changes; apoptotic crypt cells were present in 55% and numerous in 10% of cases. Neutrophilic cryptitis was present in 60% of cases; 35% showed crypt destruction. Plasma cell-rich lamina propria inflammation and crypt distortion were observed in 40% and 25% of cases, respectively. There was no correlation between therapy duration and features of chronic injury. We conclude that tacrolimus can cause symptomatic colitis. Histologic abnormalities are often mild, featuring regenerative crypts and scattered apoptotic debris. However, 40% of symptomatic patients have chronic colitis, most likely reflecting drug-induced immune dysregulation. Pathologists should be aware of these associations because colitis often resolves with decreasing drug dosage rather than treatment directed toward inflammatory bowel disease.

Liver Pathology and SARS-CoV-2 Detection in Formalin-Fixed Tissue of Patients With COVID-19.

ObjectivesThe novel coronavirus, severe acute respiratory syndrome coronavirus 2, causing coronavirus disease 2019 (COVID-19) remains a global health threat and a significant source of human morbidity and mortality. While the virus primarily induces lung injury, it also has been reported to cause hepatic sequelae.MethodsWe aimed to detect the virus in formalin-fixed tissue blocks and document the liver injury patterns in patients with COVID-19 compared with a control group.ResultsWe were able to detect viral RNA in the bronchioalveolar cell blocks (12/12, 100%) and formalin-fixed, paraffin-embedded tissue of the lung (8/8, 100%) and liver (4/9, 44%) of patients with COVID-19. Although the peak values of the main liver enzymes and bilirubin were higher in the patients with COVID-19 compared with the control group, the differences were not significant. The main histologic findings were minimal to focal mild portal tract chronic inflammation (7/8, 88%, P < .05) and mild focal lobular activity (6/8, 75%, P = .06).ConclusionsWe found that most patients who died of COVID-19 had evidence of mild focal hepatitis clinically and histologically; however, the virus was detected in less than half of the cases.

Injury patterns of patients with upper limb and hand trauma sustained during the COVID-19 pandemic lockdown in the UK: a retrospective cohort study

This work aimed to identify the lead causes of upper limb injury presenting to a busy hand and major trauma unit during the UK COVID-19 domestic lockdown period, in comparison to a cohort from the same period one year previously. Hand and upper limb injuries presenting to the host organization during a pre-lockdown period (23rd March 2019–11th May 2019) and the formal UK lockdown period (23rd March 2020–11th May 2020) were compared, using data collated from the host institution’s hand surgery database. The UK lockdown period was associated with a 52% fall in the number of patients presenting to the service with hand and upper limb injuries (589 pre-lockdown vs. 284 during lockdown). There was a significant increase in the proportion of injuries due to machinery use during lockdown (38, 6.5% pre-lockdown vs. 33, 11.6% during lockdown, P = 0.009), other etiologies were consistent. The proportion requiring surgical management were similar (n = 272, 46.2% pre-lockdown vs. n = 138, 48.6% during lockdown, P = 0.50). The proportion requiring overnight admission fell (n = 94, 16.0% pre-lockdown vs. 29, 10.2% during lockdown, P = 0.022). COVID-19 related lockdown in the UK resulted in a reduction in the presenting numbers of hand related injuries; however almost half of these patients still required surgery. These data may be of use to other hand surgery centers for resource planning during future lockdown periods, and for injury prevention strategies in the post-COVID-19 world.

Acute Diaphragmatic Injuries Associated with Traumatic Rib Fractures: Experiences of a Major Trauma Centre and the Importance of Intra-Pleural Assessment.

BackgroundDiaphragmatic injuries following blunt or penetrating thoraco-abdominal trauma are rare, but can be life-threatening. Rib fractures are the most common associated injury in patients with a traumatic diaphragmatic injury (TDI). We hypothesized that the pattern of rib fracture injuries could dictate the likelihood of acute TDIs.MethodsA retrospective study was carried out between April 2014 and October 2018 to analyze patients with TDIs and rib fractures at a major trauma center in London, United Kingdom.ResultsOver the study period, 1,560 patients had rib fractures, of whom 14 had associated diaphragmatic injuries. Left-sided diaphragmatic injuries were found in 8 patients (57%) . A significant proportion of the rib fractures were located posterolaterally (44.9%). The highest frequency of fractures was found in ribs 5–10, which accounted for 74% of all the fractures. Ten patients underwent surgery, of whom 7 were diagnosed with a diaphragmatic injury intraoperatively after video-assisted thoracoscopic surgery assessment of the pleural cavity. Two patients died due to severe injuries of other organs and the remaining 2 patients were managed conservatively.ConclusionOur series of patients demonstrates a relationship between significant rib fractures and diaphragmatic injuries in trauma patients, and the diagnostic difficulties in identifying the condition. We found that the location of the rib fractures and the pattern of injury in patients with TDIs were much lower and posterolateral in the chest wall without a preference for laterality. We suggest using a thoracoscope in patients undergoing chest wall surgery post-trauma to aid in diagnosing this condition.

Medication-specific variations in morphological patterns of injury in immune check-point inhibitor-associated colitis.

A varied spectrum of histopathological changes has been associated with immune checkpoint inhibitor (ICI) colitis. This study was performed to evaluate the prevalence of different histopathological patterns of injury in patients with ICI colitis and their association with specific immune check-point inhibitors. Biopsies from patients with clinically and histologically confirmed ICI colitis were reviewed blindly to determine the predominant pattern of injury and to quantitate discrete histological parameters using the Geboes score. Paneth cell metaplasia, intraepithelial lymphocytes, abnormal subepithelial collagen and degree of crypt epithelial apoptosis was also recorded. A total of 86 patients with ICI colitis (ipilimumab, n=14; ipilimumab+nivolumab, n=29; nivolumab, n=20 and pembrolizumab, n=23) were included. The patterns of injury identified included diffuse active colitis (n=22), chronic active colitis (n=22), lymphocytic colitis (LC, n=16), collagenous colitis (CC, n=14), graft-versus-host disease-like colitis (n=7) and mixed colitis (n=5). Patients on ipilimumab were more likely to have a diffuse active colitis pattern without features of chronicity (P<0.01) and less likely to have LC (P<0.05) compared to other ICIs. LC and CC were more common in patients on nivolumab and pembrolizumab relative to other groups (P<0.05). Chronic active colitis was most frequent in nivolumab patients (P<0.05), and these patients had received more ICI doses and had been on ICI treatment longer compared to other treatment groups. ICI colitis should be considered in the differential diagnosis of all the common inflammatory patterns of colitis and shows medication specific differences in patterns of injury.

An Elucidation of Pattern of Injuries in Patients with Fall from Height.

BackgroundFall from height (FFH) is the second most common cause of trauma presenting to the emergency department (ED). They account for majority of the polytrauma cases. This study was done to determine the pattern of injuries sustained due to FFH and outcome.Materials and methodsThis was a retrospective observational study of all patients with history of FFH presenting to the ED of a large tertiary care hospital in South India. Details of the incident, fall height, injuries, and outcome were noted and analyzed.ResultsThis study cohort included 861 patients with a mean age was 36.2 (SD 20.8) years. A male predominance (74%) was noted. Majority of the patients, i.e., 62%, were triaged as priority 2, depending on the hemodynamic stability. Approximately a quarter (26%) sustained injury to the lower limbs with 18% sustaining spinal cord injury (SCI). Among the patients suffering SCI (35%), patients were further categorized in the American Spinal cord Injury Association (ASIA) classification. New Injury Severity Score (NISS) was more than 8 in 47% of the total study population. Majority of the patients, i.e., 62%, were discharged stable from ED after primary care with a plan of follow-up in the outpatient department. One-third (30%) of the total patients required hospital admission and among them 20% of the patients had to undergo major surgical intervention. The rest were either discharged stable or left against medical advice (LAMA) after primary care. The in-hospital mortality rate was 1.04%.ConclusionThis study has expressed the pattern of injuries in patients with FFH. An alarmingly high number of young adults with significant lower limbs and spinal injuries were noted. We observed that with increase in fall height there was a proportional increase in SCI and decrease in lower limb injuries.How to cite this articleLohanathan A, Hazra D, Jyothirmayi CA, Kundavaram AP. An Elucidation of Pattern of Injuries in Patients with Fall from Height. Indian J Crit Care Med 2020;24(8):683–687.

Craniomaxillofacial War Injuries in Misrata, Libya

Injury to the craniomaxillofacial (CMF) area has major implications for mortality and morbidity depending on many factors that influence the level of treatment. In warzones, the extent of CMF injuries is amplified mainly due to the damage caused by bomb blasts. This study presents CMF injury as the result of war incidents to highlight the differences in injury type as well as the impact that an austere environment has on treatment. The author has unique insight and experience of treating CMF injuries in Misrata, Libya, where there is ongoing civil conflict. Surgeons in Libyan hospitals require intensive training intervention to effectively manage gunshot injuries, blast injuries and disasters and while these cases represent an austere environment, conclusions can be drawn for recent incidents involving terrorism. This study presents an analysis of injury patterns of patients presenting with CMF trauma during the Misrata battle of the Libyan conflict in 2011.

Injury patterns in patients with QINGQI motorcycle rickshaw related road traffic accidents presenting at accident and emergency department of Mayo Hospital, Lahore.

Objectives: The objective of this study was to determine the patterns of the injuries in patients of Qingqi rickshaw related accidents. Study Design: Descriptive Cross-Sectional study. Setting: Accident and Emergency Department of Mayo Hospital, Lahore. Period: Six months from 1st of March, 2019 to 31st of August, 2019. Material &amp; Methods: Non-probability consecutive sampling technique was used and all tri-wheeler Qingqi related trauma patients fulfilling the inclusion and exclusion criteria were included. Frequency and percentages were calculated for patterns of injuries and presented as tables. Results: A total of 356 Qingqi rickshaw related injured patients presented in six months study period. There were 243 (68.3%) males and 113 (31.7%) females and a mean age of 32.5 +2.5 years. Soft tissues injuries like subcutaneous edema, abrasions and lacerations were noticed in 206 patients (57.9%). Most common region involved was lower limb in 98 (27.5%) cases followed by upper limb trauma in 65 (18.2%) cases. Ploy trauma was present in 58 (16.3%) and head and spinal injuries were noticed in 27 (7.6%) and13 (3.7%) cases, respectively. The turning over of the rickshaw due to different reasons (47.2%) and head on collision (38.4%) were the leading cause of serious injuries. None of the Qingqi rickshaw drivers (0%) were wearing helmet. A total of 46 (12.9%) cases were pedestrians. Three patients had to undergo amputation for mangled limb injuries. Conclusion: The common pattern of injuries related to Qingqi accidents include lower limb injuries followed by upper limb and poly trauma comprising of head injuries. Males in their younger age group are most commonly injured. These accidents can result in serious morbidity and even mortality. It is now time to consider measures for safety of three-wheelers to reduce such incidents.

Current Knowledge and Research Priorities in the Digestive Manifestations of COVID-19

Current Knowledge and Research Priorities in the Digestive Manifestations of COVID-19