Limb Region Research Articles

Numerical modeling of magnetic induction in standard and triple Epstein frames considering cutting and staggering of sensor strips

For magnetic energy loss measurements on electric steel sheets, the Epstein tester (ET) is applied for 100 years. However, it suffers from unsolved problems, such as inhomogeneity of flux in the corners and even more of impact of sample cutting. As a matter of fact, a detailed study of flux distributions—as a pre-condition for improvements—has not been performed so far. In this work, we present the results of an advanced numerical 3D-magnetic anisotropic circuit calculation modeling. It considers most relevant impacts such as anisotropy, non-linearity, method of staggering, and in particular, consequences of sample cutting. According to the literature, the latter may yield material deterioration for edge zones of high width WDET. Here, we set WDET to 2.5 mm as a “coarse-cut” convention for practice, and we compare it with perfect “fine-cut” (W = 0). As a main result, deteriorated edge zones of standard ET strips of low width W = 30 mm yield a distinct concentration of flux along inner axial strip regions as a reason for strong local flux inhomogeneity and distortion. Consistent numerical comparisons predict that higher grades of magnetic homogeneity can be expected from wider sample strips, e.g., from a “Triple ET” with W = 90 mm. As a global conclusion, the Epstein frame represents a system of extreme 3D inhomogeneity, especially in the corners. The grade of inhomogeneity reaches its maximum in instants of high permeability. It may be strongly increased through coarse cutting. On the other hand, consequences of cutting can be decreased by increasing the strip width. This would allow for loss measurements using tangential field coils arranged in the central limb regions of TET.

Hind-Foot Synovial Sarcoma Treated With Wide Resection and Sural Fasciocutaneous Flap – A Case Report

Synovial sarcoma comprises about 5% to 10% of soft tissue sarcomas. Initial growth is often slow and a small circumscribed tumour may misleadingly appear to a benign lesion by clinical examination and imaging, occurring in up to 50% of cases. The modalities of treatment of foot malignant conditions depend on histological diagnosis and staging. A radical surgical procedure in the distal region of the lower limb is often difficult due to a limited soft-tissue situation and can result in soft-tissue defects. Plastic surgical techniques remain particularly indispensable in the treatment of such distal tumors. Authors present a hindfoot synovial sarcoma, diagnosed with a incisional biopsy, in which a wide margin surgery was achieved and a limb salvage was permitted by a sural fasciocutaneous flap.

Accidents in agriculture involving muscle skeletal system in children. Analysis based on hospitalization in the Paediatric Orthopaedics and Rehabilitation Department University Children’s Hospital in 2010-2019

Introduction. Accidents in agriculture involving children happen every year. They are attributable to a lack of safety and low awareness of caretakers, who oftentimes don’t pay enough attention to the little ones. Injuries in agriculture involve mainly falls from great heights: ladders, trailers, tractors; crushing by various types of agricultural machinery; partial or complete amputations within the regions of upper and lower limbs: amputations of feet or fingers. Those cases often include multi-tissue damages, which means that in addition to bone fractures, there might also occur other concurrent injuries like interstitial infections, crushing, neurovascular damages, or soft tissue damage. Material and Methods. In the years 2010-2019 there were 207 patients hospitalized in the Paediatric Orthopaedics and Rehabilitation Department of University Children’s Hospital in Lublin due to accidents in agriculture. Patients who suffered bone injuries, either caused by falling from heights or falling from agricultural machines, constitute the majority of the total 207 cases. The second case in terms of frequency, were the children whose limbs got stuck, or struck, by moving parts of agricultural machines and devices, which resulted in amputations at different levels. The third group consisted of patients crushed by agricultural machines or livestock. Results. The following data indicate a gradual decrease in the number of children requiring hospitalization. Between 2010 and 2019 there was a year-onyear decrease of 38.4%. Conclusions. After the analysis of causes and mechanisms of the injuries mentioned before, we conclude that the vast of these accidents could have been avoided if the caretakers looked after children with due attention, and the children were not allowed in the vicinity of currently functioning agricultural machines.

اپیدمیولوژی آسیب های اسکلتی - عضلانی اندام فوقانی و اندام تحتانی در بین کشتی گیران کاراد تالوکا

Introduction: Wrestling has been a very ancient and popular sport in India. A variety of biomechanical forces are applied on these athletes due to the very nature of this game, leading to injury to different parts of the body. This study aimed to find the prevalence of musculoskeletal injuries among wrestlers from the taluka of Karad. Methods: 100 wrestlers were selected for this study based on the inclusion and exclusion criteria. They completed a structured questionnaire to assess for any injuries regarding wrestling and also their demographic data was recorded. Results: All the wrestlers reported at least 1 lesion. The most commonly injured body regions were at the lower limb region (57.1%) and then at upper limb region (31.4%). Lesions were more frequent in the Lower limb region (45%) and less in the Upper limb region (13%). Sprains were commonly seen in the Lower limb region (34%) as well and followed by Upper limb region (28%). Conclusion: musculoskeletal injuries of both the upper and lower extremities was found to be high among the wrestlers of Karad. It was found to be more common in males and less in females. Lesions and sprains were found to be more frequent in the lower limb region of the body.

The keystone flap: A multi-centric experience in elderly patients treatment

Soft tissue reconstruction in elderly patients must be rapid and reliable. The keystone island flap (KF) offers an effective solution, with low complication rates and quick recovery. This multi-centric study aims to show authors' experience with KFs in treating soft tissue defects of trunk and limbs. Patients with soft tissue defects suitable for KF reconstruction were recruited from March 2019 to December 2019. Active inflammation and previous surgeries in the same region were considered exclusion criteria. Complications that occurred during follow-up were recorded, and their incidence pattern was assessed with the Fisher test. Seventy-two patients with mean age of 76.2 years old were selected. They presented lesions in torso (46; 63.9%) or in upper (4; 5.6%) or lower (22; 30.6%) limb regions. Fifteen (20.8%) wounds were non-oncologic lesions, and the others were oncologic lesions, mostly non-melanoma skin cancers. KF type I was carried out in 42 (58.3%) cases, KF type II-A in 13 (18%) cases, double opposed type III KF in 16 (22.2%) patients, and 1 (1.4%) case required partial flap's undermining (IV KF). Mean post-operative recovery period was 4.3 days (range, 1-9 days). Post-surgical complications occurred in 15 (20.8%) cases, 7 (9.7%) of them were considered major complications. No statistically significant difference in complications' incidence, nor among different surgical sites nor among KF types, was registered. Reconstructive surgeons have to adapt their work to elderly patients. The KF allows rapid operative times, low morbidity rates, and short post-operative recovery time, thus appearing as a feasible solution.

Polish Cross-Cultural Adaptation of the Lower Limb Functional Index (LLFI) Demonstrates a Valid Outcome Measure for the Lower Limb Region and Joints.

This study aimed to perform linguistic and cross-cultural adaptation to establish a Polish version of the Lower Limb Functional Index (LLFI) as well as an evaluation of the psychometric properties. This was a two-stage, cross-sectional study. The first stage—linguistic and cultural adaptation, complied with the International Society for Pharmacoeconomics and Outcomes Research guidelines to produce the Lower Limb Functional Index, Polish version (LLFI-PL). The subjects were recruited to the second stage of the study from a sample of convenience (n = 125, age = 52.86 ± 19.53 years, 56% female, symptoms duration = 17.69 ± 18.39 weeks). Baseline reliability was performed on the LLFI-PL with retest period at 3–7 days. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC), EuroQol Health Questionnaire 5-Dimensions 5-Level (EQ-5D-5L), and an 11-point Pain Numerical Rating Scale (P-NRS) were completed to assess the validity of the LLFI-PL. Statistical analysis showed high internal consistency (α = 0.94), and excellent test–retest reliability (ICC2.1 = 0.96). The measurement error was SEM = 1.69% with MDC90 = 3.93%. Construct validity demonstrated strong correlations between the LLFI-PL and WOMAC (r = 0.81) and moderate correlations with the EQ-5D-5L (r = −0.63) and P-NRS (r = −0.39). Exploratory factor analysis confirmed a single-factor structure. The LLFI-PL is a psychometrically sound questionnaire for Polish-speaking patients with lower limb musculoskeletal conditions. The results support findings from the previous original English, Spanish, and Turkish versions.

A neonate with Klippel\u2013Tr\xe9naunay syndrome: a case report\xa0

BackgroundKlippel–Trénaunay syndrome is a rare congenital capillary–lymphatic–venous condition characterized by the clinical triad of capillary malformations (port wine stains), varicose veins with or without venous malformations, and bony and/or soft-tissue hypertrophy. It has a very low incidence of about 1:100,000.Case presentationWe report the case of 21-day-old neonate Black African female (born in Uganda) with Klippel–Trénaunay syndrome who presented with macrodactyly and ectrodactyly on the left foot, as well as numerous port wine stains on the left thoracoabdominal region and anteroposterior left lower limb. Color Doppler ultrasound examination of the left lower limb and abdomen revealed varicose veins without signs of arteriovenous fistula.ConclusionThe report presents the case of a neonate with a rare congenital vascular disorder type Klippel–Trénaunay syndrome.

Skin masses in dogs under one year of age.

To utilise a large histopathology database to ascertain the incidence and nature of skin masses in young dogs from 0 to 12 months of age. A total of 2554 submissions received for histopathology from dogs 0 to 12 months of age, clinically diagnosed with a skin mass between 2006 and 2013, were retrieved from the database of a large commercial diagnostic laboratory. The histological diagnosis and site of the lesion, together with age, breed and sex of the dog were recorded. The most common skin mass found in this study was histiocytoma (n=2212, 86.6%). The majority of all submissions were neoplastic (n=2408, 94.3%), and most of those were benign (n=2372, 98.5%). Almost all of the benign neoplastic lesions were of round cell origin (n=2229, 94.0%) whereas most of the non-neoplastic lesions were derived from the epithelium (n=136, 93.8%). The five most commonly diagnosed skin masses in young dogs were histiocytoma, papilloma, dermoid cyst, follicular cyst and mast cell tumour. A male predisposition was shown for histiocytoma (odds ratio 1.72) and mast cell tumour (odds ratio 2.18) with a strong site predilection for the limb region (30.8% and 27.8% respectively). Dermoid cysts and follicular cysts were most commonly found in the skin of the abdomen (64.7% and 52.3% respectively) with boxers being predisposed (25.9% of dermoid cyst and 25.0% of follicular cyst). A large proportion of skin mass submissions in young dogs were neoplastic and benign. Also, the most common skin mass in young dogs was found to be histiocytoma. Tumours can occur in this age group and should be considered as a potential differential diagnosis also in young patients presenting with a skin mass.

Lower limb lymphedema staging based on magnetic resonance lymphangiography

ObjectiveDermal backflow (DBF) and reduced lymphatic visualization are common findings of lymphedema on various imaging modalities. However, there is a lack of knowledge about how these findings vary with the anatomic location and severity of lymphedema, and previous reports using indocyanine green lymphography or lymphoscintigraphy show variable results. Magnetic resonance lymphangiography (MRL) is expected to clarify this clinical question due to its superior ability for lymphatic visualization. This retrospective study aimed to investigate the following: (1) Are there any characteristic patterns for DBF and lymphatics' visualization, depending on the anatomic location within lower limbs and severity of lymphedema? (2) Is it possible to classify the severity of lymphedema based on MRL findings? MethodsTwo radiologists performed consensus readings of MRL of 56 patients (112 limbs) with lower-limb lymphedema. The frequency of visualized DBF and lymphatics was analyzed in six regions in each lower limb. The results were compared with the International Society of Lymphology clinical stages and etiology of lymphedema. Characteristic findings were categorized and compared with the clinical stage and duration of lymphedema. ResultsDBF and lymphatics were observed more frequently in the distal regions than the proximal regions of lower limbs. DBF appeared more frequently as the clinical stage increased, reaching statistical significance (P < 10−3) between stages 0 or I and II. DBF above the knee joint was rarely observed (0.48%) in early stages (0 and I) but appeared more frequently (13.5%, P < 10−5) in stage II. Lymphatics appeared less frequently as the stage progressed, with significant differences (P < .05) between stages I and II and between II and III. The frequency of lymphatics above the knee joint decreased significantly (P < .05) between stages I and II and between II and III as the stage progressed, reaching 0% in stage III. An MRL staging was proposed and showed significant positive correlations with the clinical stage (r = 0.79, P < .01) and the duration of lymphedema (r = 0.57, P < .01). ConclusionsMRL-specific patterns of DBF and lymphatics that depended on the site within the lower limb and clinical stage were shown. The DBF pattern differed from those observed in previous studies with other imaging techniques. The proposed MRL staging based on these characteristic findings allows new stratification of patients with lymphedema. Combined with its excellent ability to visualize lymphatic anatomy, MRL could enable a more detailed understanding of individual patient's pathology, useful for determining the most appropriate treatment.

Malassezia sp. Infection Prevalence in Dermatitis Dogs in Badung Area

Malasseziosis is a common fungal infection in dogs and it is secondary to the initial underlying dermatitis infection. These infections can worsen the prognosis of disease in dogs. The study was conducted on 26 dogs that were treated in several veterinary clinics in the Badung, Bali. This study aimed to determine the incidence rate of Malassezia sp. in dogs with dermatitis. Samples were collected using tape smear method from the skin lesion and then by microscopic examination. The results were tabulated and analyze descriptively. The results showed that 15 of the 26 samples of dogs tested positive were infected with Malassezia sp. (58%). Infection is more common in male (60%) and geriatric dogs (40%). Lesions were more common in the ear, limb, vaginal and inguinal region of infected dogs

Analysis of Extended Resection of Limb Soft Tissue Leiomyosarcoma.

Leiomyosarcoma is an uncommon soft tissue sarcoma that composed of malignant mesenchymal cells with distinct features of the smooth muscle lineage. Typically affects the uterus and gastrointestinal tract, it can rarely be seen in large blood vessels, lymphatic and glandular duts, the mesentery, the omentum, retroperitoneum, and limbs. Occurrence is particularly rare in the limb region. Retrospective study based on patient records and postoperative pathological histological features. Four patients with limb leiomyosarcoma that were operated between 2016 and 2020 were included, three of them arising in the subcutis of the thigh region and one in cubitus. Extend resection with satisfactory outcomes is reported. Pathological examination showed that masses were composed of a fascicular arrangement of hyperchromatic spindle-shaped cells, characterized by the proliferation of epithelioid cells with eosinophilic cytoplasm for epithelioid leiomyosarcoma. Leiomyosarcomas that arise in the soft tissue, although rare, should be differentiated from other lesions, such as neurilemoma, neurofibroma, liomyoma,lipomyoma, synoviosarcoma, rhabdomyosarcoma, malignant fibrous histiotoma, and malignant neurinoma.

Relationship between Skin Temperature Variation and Muscle Damage Markers after a Marathon Performed in a Hot Environmental Condition.

This study aimed to assess the effect of a marathon running at a hot environmental temperature on the baseline skin temperature (Tsk) of the posterior day and to analyze the relationship between Tsk response and muscle damage markers variation. The Tsk, creatine kinase, and lactate dehydrogenase of 16 marathon runners were assessed four times before (15 days and 45 min) and after (24 h and 6 days) a marathon in a hot environment (thermal stress index = 28.3 ± 3.3 °C and humidity ~81%). The Tsk of thirteen different body regions of both right and left lower limbs were analyzed. Higher values after the marathon were observed than 45 min before in creatine kinase (174.3 ± 136.4 UI/L < 1159.7 ± 699.7 UI/L, p < 0.01 and large effect size) and lactate dehydrogenase (362.6 ± 99.9 UI/L < 438 ± 115.5 UI/L, p = 0.02 and moderate effect size). Generally, Tsk was higher the day after the marathon than at the other three moments (e.g., rectus femoris region, 6 days before vs. the day after, 95% confidence interval of the difference (0.3, 1.6 °C), p = 0.04 and large effect size). No relationship or correlation was observed between the variation of Tsk and muscle damage markers (p > 0.05). In conclusion, performing a marathon in a hot environmental condition results in a higher Tsk the day after the marathon. This increase in Tsk could be because of the heat generated by the marathon and its subsequent physiological processes (e.g., increase in endothelial nitric oxide, glycogen resynthesis, or increase of systemic hormones), which would be reflected in the Tsk due to the peripheral vasodilation promoted by the hot environment. However, among these processes, muscle damage does not seem to be of great importance due to the lack of an observed relationship between Tsk and muscle damage markers.

Regional variation in nitric oxide-dependent cutaneous vasodilatation during local heating in young adults.

What is the central question of this study? Are regional differences in nitric oxide (NO)-dependent cutaneous vasodilatation during local skin heating present in young adults? What is the main finding and its importance? NO-dependent cutaneous vasodilatation varied across the body. The abdomen demonstrated larger NO contributions, while the chest demonstrated smaller NO contributions, compared to other regions. This exploratory work is an important first step in characterizing regional heterogeneity of cutaneous microvascular control across the torso and limbs. Equally, it serves to generate hypotheses for future studies examining regional cutaneous microvascular control in ageing and disease. Regional variations in cutaneous vasodilatation during local skin heating exist across the body. While nitric oxide (NO) is a well-known modulator of this response, the extent of regional differences in NO-dependent cutaneous vasodilatation during local skin heating remains uncertain. In 16 habitually active young adults (8 females; 25±5years), cutaneous vascular conductance, normalized to maximum vasodilatation (% CVCmax ), was assessed at the upper chest, abdomen, dorsal forearm, thigh and lateral calf during local skin heating. Across all regions, local skin temperatures were simultaneously increased from 33 to 42°C (1°Cper 10s), and held until a stable heating plateau was achieved (∼40min). Next, with local skin temperature maintained at 42°C, 20mM of NG -nitro-l-arginine methyl ester (l-NAME) was continuously infused at each site until a stable l-NAME plateau was achieved (∼40min). The difference between heating and l-NAME plateaus was identified as the NO contribution for each region. There was no evidence for region-specific responses at baseline (P=0.561), the heating plateau (P=0.351) or l-NAME plateau (P=0.082), but there was for the NO contribution (P=0.048). Overall, point estimates for between-region differences in the NO contribution varied across the body from 0 to 19% CVCmax . The greatest effects were observed for the abdomen, wherein the NO contribution was consistently greater than for the other regions (range: 9-19% CVCmax ). The chest was consistently lower than the other regions (range: 7-19% CVCmax ). The smallest effects were observed between limb regions (range: 0-2% CVCmax ). These findings advance our understanding of the mechanisms influencing regional variations in the cutaneous vasodilator response to local skin heating in young adults.

The anatomical distribution of non-melanoma skin cancer: a retrospective cohort study of 22 303 Australian cases.

Non-melanoma skin cancers (NMSC) are the most common skin cancers worldwide with research establishing that ultraviolet (UV) radiation influences occurrence. However, recent studies about NMSC tumour frequencies suggested high NMSC predilections in low UV-exposed skin regions. The 'Human Surface Anatomy Labeling System' was used to define 100 skin regions to map NMSC locations excised at Flinders Medical Centre (FMC) between 1 January 2012 and 31 December 2017. Data were retrieved from the FMC histopathology database. A customised phrase algorithm was used to run a systematic word search on the dataset to quantify NMSC locations. A total of 22 303 NMSC excisions were identified; 80% were head and neck excisions. Scalp, periocular and nasal regions showed a significantly greater predilection for basal cell carcinomas (BCC). Squamous cell carcinomas (SCC) had significantly more excisions in lip, neck and scalp regions. Regarding gender-related variations, more males had BCC excisions in ear regions and more females had nasal, lip, and ankle excisions. In SCC excisions, more males had scalp excisions and more females had leg and lip excisions. Considering age-related variation, significantly higher proportions of BCC were found with forehead excisions compared to scalp, neck and lower limb regions for SCC, all being highest for 60-79-year age groups. The relationship between NMSC type and anatomical distribution may be partially explained by gender and age affecting NMSC predilections particularly in the head and neck. However, other skin regions could not be explained solely by these factors.

Effect of Kinesiology Tape on Tri-Axial Accelerometry During the Dance Aerobic Fitness Test.

Kinesiology tape (KT) is thought to provide greater mechanical support during physical activity, however, there is a paucity of research investigating its application in dance. The study aimed to determine whether KT reduces PlayerLoad (PL) during the Dance Aerobic Fitness Test (DAFT) in addition to examining the relative sensitivity of accelerometer site locations.<br/> Methods: University-level dancers (N = 11; age 18 ± 0.45 years, height 168.17 ± 12.25 cm, body mass 57.50 ± 9.91 kg) participated in two trials of the DAFT protocol in two conditions: no tape (NT) and kinesiology tape (KT). Global positioning systems (GPS) and accelerometer units were attached onto the seventh vertebra (C7) at the mid-scapula region and lower limb (LL) located at the midgastrocnemius of the dominant leg calculating measurements of triaxial (PLTotal) and uniaxial measures (anteroposterior [PLAP], mediolateral [PLML], and vertical [PLV]) measures of PlayerLoad during the DAFT.<br/> Results: No significant main effect was observed for the taping condition in all measures of PlayerLoad (P > 0.10). A significant main effect (p < 0.01) was observed for unit location and time, with greater loading at the LL compared to C7 and during each consequent stage of the DAFT. No significant (p > 0.52) location*taping, nor location*taping*time (p > 0.36) interactions were observed for all variables measured.<br/> Conclusions: Kinesiology tape does not reduce loading patterns in healthy dancers during a fatigue protocol. However, triaxial accelerometers provide adequate sensitivity when detecting changes in loading, suggesting the LL may be deemed as a more relevant method of monitoring training load in dancers.

Spread of segmental/multifocal idiopathic adult-onset dystonia to a third body site

BackgroundAdult-onset focal dystonia can spread to involve one, or less frequently, two additional body regions. Spread of focal dystonia to a third body site is not fully characterized. Materials and methodsWe retrospectively analyzed data from the Italian Dystonia Registry, enrolling patients with segmental/multifocal dystonia involving at least two parts of the body or more. Survival analysis estimated the relationship between dystonia features and spread to a third body part. ResultsWe identified 340 patients with segmental/multifocal dystonia involving at least two body parts. Spread of dystonia to a third body site occurred in 42/241 patients (17.4%) with focal onset and 10/99 patients (10.1%) with segmental/multifocal dystonia at onset. The former had a greater tendency to spread than patients with segmental/multifocal dystonia at onset. Gender, years of schooling, comorbidity, family history of dystonia/tremor, age at dystonia onset, and disease duration could not predict spread to a third body site. Among patients with focal onset in different body parts (cranial, cervical, and upper limb regions), there was no association between site of focal dystonia onset and risk of spread to a third body site. Discussion and conclusionSpread to a third body site occurs in a relative low percentage of patients with idiopathic adult-onset dystonia affecting two body parts. Regardless of the site of dystonia onset and of other demographic/clinical variables, focal onset seems to confer a greater risk of spread to a third body site in comparison to patients with segmental/multifocal dystonia at onset.

Pulsatile pseudoaneurysm: a delayed diagnosed with a risk of limb ischemic in toddler: a case report

Background: Pseudoaneurysm is a vascular injury complication in lower extremity that’s rarely been reported, especially in toddlers. Should it not appropriately treated, it can lead to worst conditions and even limb ischemic.Case description: a 3-year-old toddler, presented in the emergency room (ER) of Dr. Zainoel Abidin General Hospital (RSUZA) with bleed wound in the left limb persistent active bleeding. The shattered glass hit the patient On the physical examination, we found bleeding wound on the medial malleolus region of left limb, a pulsatile mass on the palpation, history of active bleeding was positive. To confirm the diagnosis, we performed CT angiography showing a sac shaped vascular lesion measuring 2.8 x 2.2 x 2.8 cm of proximal segment of the left posterior tibial artery, suggesting a pseudoaneurysm. We performed open surgery with excision procedure and a clot was found in medial malleolus region. As a result of open surgery, the left medial malleolus region is red, indicating a good blood flow and the patient discharged from hospital 4 days after surgery with a good result.Conclusion: Pseudoaneurysm resulting from vascular injury or iatrogenic injury can lead on various serious complications. If pseudoaneurysm is not appropriately treated, it can even threaten the patient’s life.Â

Trends in Poisoning and Bites among Patients Referred to the Limbe Regional Hospital, South-West Cameroon

Poisoning is a common public health issue as it affects millions of people in all social levels worldwide. This retrospective cohort study assessed trends in poisoning and bites among patients referred to the Limbe Regional Hospital from the 1st January 2009 to the 31st December 2018 (10 years). After clearance from public health authorities, data was collected from April to July 2019 at the Emergency Ward of the Limbe Regional Hospital from records. The Limbe Regional Hospital received 244 patients from 2009 to 2018 because of poisoning and animal bites. Twelve types of poisons and eight types of bites were recorded. Dog bite (33.20%), snake bite (15.16%) and ingestion of bleaching agent (11.48%) were significantly (p&lt;0.001) more frequent. Based on gender, males (55%) significantly (p&lt;0.01) suffered from more than females (45%). The age of the patient significantly (p&lt;0.001) influenced the frequency of poisons and bites as patients under 30 years old were the most affected group. The occupation of the patient significantly (p&lt;0.001) influenced the frequency of poisoning and bites with a high percentage occurring in unemployed patients (67.21%). The number of cases significantly changed according to seasonality. While a few cases (7%) occurred under unknown circumstances, accidental cases (80%) were significantly (p&lt;0.001) higher than suicide attempts (13%). This study raises awareness of poisoning and bites, and stresses on the importance of the safekeeping of toxic compounds, respecting prescribed drugs doses, being careful when dealing with animals and the need to create psychological and poison management centers in Cameroon.

Healthcare system impacts of the 2017 Manchester Arena bombing: evidence from a national trauma registry patient case series and hospital performance data

IntroductionIn response to detonation of an improvised explosive device at the Manchester Arena on 22 May 2017, we aimed to use detailed information about injured patients flowing through hospital healthcare...

Vibrio vulnificus-Induced Necrotizing Fasciitis Complicated by Multidrug-Resistant Acinetobacter baumannii Infection: Efficacy of Chemical Necrectomy Using 40% Benzoic Acid.

Necrotizing fasciitis is a life-threatening skin and soft tissue infection associated with high morbidity and mortality in adult patients. This infection can present as either type 1 infection caused by a mixed microflora (Streptococci, Enterobacteriacae, Bacteroides sp., and Peptostreptococcus sp.), most commonly developing in patients after surgery or in diabetic patients, or as type 2. The latter type is monomicrobial and, usually, caused by group A Streptococci. Rarely, this type can be also caused by other pathogens, such as Vibrio vulnificus. V vulnificus is a small mobile Gram-negative rod capable of causing 3 types of infections in humans-gastroenteritis, primary infection of the vascular bed, and wound infections. If infecting a wound, V vulnificus can cause a life-threatening condition-necrotizing fasciitis. We present a rare case of necrotizing fasciitis developing after an insect bite followed by exposure to the seawater. Rapid propagation of the infectious complication in the region of the right lower limb led to a serious consideration of the necessity of amputation. Due to the clearly demarcated necroses and secondary skin and soft tissue infection caused by a multiresistant strain of Acinetobacter baumannii, we, however, resorted to the use of selective chemical necrectomy using 40% benzoic acid-a unique application in this kind of condition. The chemical necrectomy was successful, relatively gentle and thanks to its selectivity, vital parts of the limb remained preserved and could have been subsequently salvaged at minimum blood loss. Moreover, the antimicrobial effect of benzoic acid led to rapid decolonization of the necrosis and wound bed preparation, which allowed us to perform defect closure using split-thickness skin grafts. The patient subsequently healed without further complications and returned to normal life.