Injury Patterns Research Articles

Climate Change Effects on Agricultural Pests: Aphids, Diabrotica Balteata, and Asian Corn Borer in Plant-Pest Interactions and Pest Dynamics in the Context of Achieving SDGs

Objective: This study found that climate change affects pest biology and plant relationships through changes in temperature, precipitation, CO2 concentration, and wind patterns. Learn about these consequences and monitor their evolution to reduce their potential harm to farming and environmental sustainability. Method: The research incorporates recent experiments involving different pest families. These studies investigate the influence of climate change on pests in relation to their body size, geographic distribution, synchronization with predators, and survival during overwintering periods. Data collection involves observations of pest behavior, plant interactions, and reproductive success across varied environmental conditions. Results and Discussion: The findings reveal that elevated CO2 concentrations lead to changes in the carbon-to-nitrogen (C:N) ratio of plants, affecting the size of certain pests, while others show no significant size alteration. Altered precipitation patterns contribute to pest washout from plants and reduce overwintering survival rates. Furthermore, disruptions in the survival of pest generations have been observed. However, these results are mixed; some pest types benefit from climate changes, while others suffer, alongside corresponding impacts on plant health. Research Implications: The report recommends adaptive agricultural management and pest monitoring to protect crop production from climate change. We must understand these relationships to create solutions to reduce climate change's harmful effects on ecosystems and ensure long-term food security. Originality/Value: This research adds to climate change and pest control literature by revealing how environmental changes affect pest species and their biological interactions with plants. Results show need for customized pest control tactics that account for climatic change.

Biomechanics of flail chest injuries: tidal volume and respiratory work changes in multiple segmental rib fractures

BackgroundFlail chest (FC) injuries are segmental osseous injuries of the thorax that typically result from high-energy blunt trauma and regularly occur in multiple trauma (MT) patients. FC injuries are associated with paradoxical chest wall movements and, thus, have a high risk of respiratory insufficiency or even death. An increasing number of studies recommend an early surgical stabilization of FC injuries, but a definite trigger that would indicate surgery has, thus far, not been identified.MethodsBased on real-world injury computed tomography (CT) data, this study aimed to establish a finite elements (FE) model of a thorax simulating spontaneous breathing. The model is based on a 0.625 mm slice thickness CT data set. In this FE model, various FC injury patterns were implemented to examine the impact of an increasingly large flail segment on tidal volume and respiratory work. The impact of the segmental defect sizes on the outcome measures mentioned above was examined using correlation analyses.ResultsThe FE model in this study reliably simulated the spontaneous breathing patterns of an actively breathing patient in an uninjured setting as a reference and showed clinically realistic movements of the flail segments for various injury settings. Correlation analysis showed a significant negative correlation between the FC size and tidal volume (R2 = 0.852, p = 0.003), while absolute (R2 = 0.845, p = 0.0096) and relative loss (R2 = 0.844, p = 0.0096) of tidal volume concerning the intact model and the compensatory respiratory work required (R2 = 0.816, p = 0.0136) were positively correlated with FC size.ConclusionThis study presents an FE model of the thorax of a patient who presented to our clinic as an MT patient with an FC injury. The FE model fulfills physiologic active breathing patterns and simulates an FC injury’s paradoxical movement, realistically depicting clinical observations. The FE model showed that the number of consecutive ribs involved in the flail segment and the length of the flail segment significantly impacted active breathing concerning tidal volumes and respiratory work. With this, we have made the first step to define a trigger for surgery.

Post-Traumatic Hip Osteoarthritis after Pelvic Ring Injuries.

While rates of post-traumatic osteoarthritis after acetabulum fracture have been thoroughly studied, there has been less emphasis on hip osteoarthritis after pelvic ring injuries. The objective of this study was to determine the frequency of post-traumatic hip osteoarthritis in pelvic ring injury patients. It was hypothesized that more severe pelvic ring injuries would be associated with greater rates of post-traumatic hip osteoarthritis. Design: Retrospective Cohort. Urban/Suburban Academic Level I Trauma Center. Subjects were identified using a retrospective search for AO/OTA type A, B, and C pelvic ring injuries. Patients were included if they were age 18 or greater, had a pelvic ring injury, and one year or more of radiographic follow-up. Patients were excluded if they had prior total or hemi-arthroplasty of either hip, femoral neck fracture, acetabulum fracture, femoral head fracture, or inadequate radiographic follow-up. Both hips were graded using the Tönnis classification at the time of injury and available follow-up pelvis films. Comparison of rate of osteoarthritis progression was made between stable (LC I injuries stable on examination under anesthesia, all APC I injuries) and unstable (APC II, APC III, LC II, LC III, LC I injuries unstable on examination under anesthesia) pelvic ring injury patients, as well as severity of injury using the Young-Burgess classification. Two hundred and eleven patients were included for final analysis. Average age was 58.8 years (SD 28.1 years, range 18-100 years). Eighty-eight patients (41.7%) were male. 127 patients underwent non-operative management, and 84 underwent surgical stabilization. 34.5% (29/84) of patients with unstable pelvic ring injuries and 6.2% (8/127) of patients with stable pelvic ring injuries demonstrated progression of osteoarthritis on the ipsilateral side of their injury (p < 0.001). More severe pelvic ring injury patterns had a greater rate of post-traumatic osteoarthritis (PTOA) based on the Young-Burgess injury classification (44.4% of LC III versus 11.1% of LC I pelvic ring injury patients, p < 0.001). A significant frequency of post-traumatic osteoarthritis after pelvic ring injuries was identified. A higher rate of preogression to PTOA was found with unstable injuries compared with stable pelvic injuries. III, Retrospective Cohort Study.

Investigation of Vertical Profiles of Particulate Matter and Meteorological Variables up to 2.5 km in Altitude Using a Drone-Based Monitoring System

In this study, a drone-based measurement system equipped with miniaturized optical and condensation particle counters was deployed to investigate the vertical distribution of particulate matter and meteorological variables up to 2.5 km in altitude. Measurements captured at various altitudes demonstrated notable vertical variations in particle concentration and significant correlations with meteorological factors, particularly relative humidity (RH). Near the surface, within a well-mixed boundary layer, particle concentrations remained stable despite RH changes, indicating both anthropogenic and natural influences. At higher altitudes, a clear positive relationship between RH and particle number concentration emerged, particularly for smaller particles, while temperature inversions and distinct wind patterns influenced aerosol dispersion. The unmanned aerial vehicle system’s robust performance, validated against standard meteorological tower data, underscores its potential for high-resolution atmospheric profiling. These insights are crucial for understanding particle behavior in diverse atmospheric layers and have implications for refining air quality monitoring and climate models. Future work should incorporate chemical analysis of aerosols to further expand these findings and assess their environmental impact.

Exploring 3D Modeling for Enhanced Visualization and Analysis of Pediatric Pelvic Ring Fractures: A Pilot Study

Introduction Pediatric pelvic fractures are high energy injuries that present substantial treatment challenges due to their propensity for plastic deformation, complex fracture patterns, and lack of consensus on surgical indications. There is potential for negative long-term outcomes in patients with residual deformity, but our understanding of acceptable alignment is limited. Plain radiographs and computed tomography (CT) are frequently employed for pre- and post-operative assessment of injury patterns, but are limited to two-dimensional analysis. Three dimensional (3D) modeling offers an opportunity for improved assessment of pelvic anatomy. Methods Two pediatric patients who sustained unstable pelvic ring injuries requiring operative fixation, with both pre- and post-operative CT scans, were identified from an existing IRB-approved trauma database. Utilizing 3D Slicer, 3D segmentations were rendered from DICOM data and specific landmarks were identified to calculate deformity pre- and post-operatively including displacement at the sacroiliac (SI) joints, pubic symphysis, and iliac crest. A modified Keshishyan deformity index was also calculated. Mesh overlay was performed using Autodesk Maya in x, y and z planes to provide visual representation of post-operative changes. Results 3D renderings successfully illustrated complex pelvic fractures in a 9 year old female and 12 year old. Measurements made on 3D models showed similar improvements in diastasis and symmetry to measurements made in standard 2D imaging, but with generally smaller magnitudes. Graphic overlap allow for sophisticated representation of improvement in deformity. Measurements on plain radiographs and 2D CT differed from 3D measurements by anywhere from 0.1 mm to 6.7 mm. Conclusion This proof-of-concept pilot study demonstrates that 3D renderings enhance the ability to measure displacement and deformity in pediatric pelvic trauma for both pre-operative planning and post-operative evaluation. Future applications of this technology include evaluation of pelvic deformity remodeling after trauma in both operative and non-operatively treated pediatric patients.

Traumatic Cuboid Dislocation Without Cuboid Fracture: Literature Review and Case Report of a Rare Injury Pattern

Isolated cuboid dislocation in the absence of fracture is a rare injury pattern that can be easily missed on initial clinical assessment. We present a case report of such injury which required open reduction and internal fixation to reduce and stabilize the cuboid. We performed a literature review to guide the management of similar injuries. Ten studies of cuboid dislocation without fracture were identified. Six articles reported a plantar flexion and inversion mechanism of injury, with inferomedial dislocation of the cuboid. Open reduction was required in all but 1 case. In this paper, we discuss a case of an isolated cuboid dislocation in the absence of fracture, which required an operation with open reduction internal fixation. Furthermore, we undertake a review of similar such cases reported in the literature and present a suitable management strategy from the present evidence. Level of Clinical Evidence: Level IV.

Balconies can guide wind turbine placement in cities

The presence and geometry of balconies influences wind patterns and wind energy potential.

Asynchronous effects of heat stress on growth rates of massive corals and damselfish in the Red Sea.

Climate change is imposing multiple stressors on marine life, leading to a restructuring of ecological communities as species exhibit differential sensitivities to these stressors. With the ocean warming and wind patterns shifting, processes that drive thermal variations in coastal regions, such as marine heatwaves and upwelling events, can change in frequency, timing, duration, and severity. These changes in environmental parameters can physiologically impact organisms residing in these habitats. Here, we investigate the synchrony of coral and reef fish responses to environmental disturbance in the Red Sea, including an unprecedented combination of heat stress and upwelling that led to mass coral bleaching in 2015. We developed cross-dated growth chronologies from otoliths of 156 individuals of two planktivorous damselfish species, Pomacentrus sulfureus and Amblyglyphidodon flavilatus, and from skeletal cores of 48 Porites spp. coral colonies. During and immediately after the 2015 upwelling and bleaching event, damselfishes exhibited a positive growth anomaly but corals displayed reduced growth. Yet, after 2015-2016, these patterns were reversed with damselfishes showing a decline in growth and corals rebounding to pre-disturbance growth rates. Our results reveal an asynchronous response between corals and reef fish, with corals succumbing to the direct effects of heat stress, and then quickly recovering when the heat stress subsided-at least, for those corals that survived the bleaching event. Conversely, damselfish growth temporarily benefited from the events of 2015, potentially due to the increased metabolic demand from increased temperature and increased food supply from the upwelling event, before declining over four years, possibly related to indirect effects associated with habitat degradation following coral mortality. Overall, our study highlights the increasingly complex, often asynchronous, ecological ramifications of climate extremes on the diverse species assemblages of coral reefs.

A networked station system for high-resolution wind nowcasting in air traffic operations: A data-augmented deep learning approach.

This study introduces a high-resolution wind nowcasting model designed for aviation applications at Madeira International Airport, a location known for its complex wind patterns. By using data from a network of six meteorological stations and deep learning techniques, the produced model is capable of predicting wind speed and direction up to 30-minute ahead with 1-minute temporal resolution. The optimized architecture demonstrated robust predictive performance across all forecast horizons. For the most challenging task, the 30-minute ahead forecasts, the model achieved a wind speed Mean Absolute Error (MAE) of 0.78 m/s and a wind direction MAE of 33.06°. Furthermore, the use of Gaussian noise concatenation to both input and label training data yielded the most consistent results. A case study further validated the model's efficacy, with MAE values below 0.43 m/s for wind speed and between 33.93° and 35.03° for wind direction across different forecast horizons. This approach shows that combining strategically deployed sensor networks with machine learning techniques offers improvements in wind nowcasting for airports in complex environments, possibly enhancing operational efficiency and safety.

Injury incidence and associated factors among soccer players during the 2021 African Cup of Nations competition

Background Understanding the epidemiology of soccer injuries during specific international competitions is essential for customizing preventive strategies. Several studies have reported outcomes related to international competitions but, to the best of our knowledge, there has been no investigation into the injury patterns during any African Cup of Nations (AFCON) tournaments. This study aimed to analyse the incidence and the characteristics of soccer injuries during the 2021 African Cup of Nations (AFCON), which took place in Cameroon from January 9 to February 6, 2022. Methods A video-based analysis covering 52 matches was conducted by two independent consultant physicians. They reviewed injury replays to determine incidence and characteristics ( i.e. ; mechanisms, body location, match moment, player substitution, absence in the next match, and referee decisions). Results The tournament involved 519 male players, comprising 275 African (ALP) and 244 Non-African (NALP) league players. Eighty-seven injuries occurred, with incidences of 1.7 and 48.8 injuries per match and per 1000 match hours, respectively. Injury incidence rose with competition stages, particularly contact mechanism injuries. Non-contact injuries (23/87) predominantly occurred after 60 minutes of play (19/23), with the thigh being the most frequently affected body part (18/87). Older age and playing time significantly correlated with injury occurrence (p=0.032 and p&lt;0.001, respectively). NALP midfielders and forwards were notably injured by contact mechanisms (36/45) in the attacking zone. Although non-contact mechanisms were more common in ALP than NALP (13/42 vs. 9/45), the difference lacked statistical significance (p=0.240), with a higher rate of muscle injuries (13/42 vs. 10/45, p=0.001). Conclusion Muscle injuries prevailed among professional soccer players in the 2021 AFCON, with older age and playing time identified as key associated factors. Muscle injuries were more prevalent in ALP compared to NALP.

Unravelling the mechanism of transient coastal upwelling in the southeastern Arabian Sea triggered by Cyclone Michaung

Abstract This study investigates the impact of Cyclone Michaung on coastal dynamics and biological changes in the southeastern Arabian Sea (SEAS). Utilizing data from a moored autonomous buoy, the water quality nowcasting system (WQNS), and multi-satellite datasets, the research documents significant changes in sea surface temperature (SST), salinity, and dissolved oxygen (DO) concentrations were driven by cyclone-induced upwelling and downwelling processes in the SEAS. The findings revealed that the passage of Cyclone Michaung led to a transient coastal upwelling event along the southwest coast of India (SWCI), marked by a notable decrease in SST and DO and an increase in salinity and chlorophyll-a concentrations, indicating enhanced biological production. The wind stress strengthening and changing wind pattern, almost parallel to the coast, initiated this process through wind-induced Ekman pumping, which uplifted the biological activity in the region.&amp;#xD;

Identification and Prioritization of Criteria Affecting the Location of Safe Assembly Points Using the Best-Worst Method

Introduction: Identifying secure gathering spots during emergencies is a crucial step in emergency management across multiple industries, particularly in oil, gas, and petrochemical fields. This study was designed to identify and rank the factors affecting the placement of safe assembly points for implementation in the country’s process industries. Materials and Methods: This descriptive-exploratory study was conducted at the National Petrochemical Company. During the initial phase, criteria affecting the selection of safe assembly points were determined by examining scientific literature, standards, guidelines, along with national and international directives. A Delphi study involving 15 experts in emergency management experts was subsequently conducted to finalize the criteria list . During the second phase, these criteria were prioritized and ranked through a multi-criteria decision-making method utilizing and the Best-Worst Method. Results: The Delphi study was completed after two rounds, revealing 10 internal and 7 external criteria, amounting to 17 criteria that affect the determination of safe assembly points during emergencies in processing industries. Within the internal criteria, accessibility was the highest rated (weight: 0.1948), vulnerability to incidents was second (weight: 0.1543), and travel time was third (weight: 0.1109). Among the external criteria, the distance from nearby hazardous centres was the highest (weight: 0.2181), the type of potential scenarios was second (weight: 0.2081), and nearby emergency facilities placed third (weight: 0.1462). Conclusion: In process industries, the placement of safe assembly points during emergencies must take into account factors like the distance from surrounding hazardous areas, the type of possible incidents, ease of access, vulnerability to incidents, nearby emergency services, and wind patterns to guarantee optimal personnel protection.

Characteristics of e-scooter and bicycle injuries at a university hospital in a large German city – a one-year analysis

BackgroundThe increasing adoption of individual urban mobility in European cities is contributing to a rise in the number of bicycle and e-scooter users. Consequently, a corresponding increase in accidents, along with an additional burden on emergency departments, is anticipated, particularly in metropolitan areas. The objective of this prospective cross-sectional study was to gather detailed information regarding the patient demographics, accident mechanisms, and injury patterns of e-scooter riders in comparison to cyclists. Identifying any differences between these groups will provide a foundation for developing targeted prevention strategies and safety measures aimed at reducing the incidence of accidents and injuries.MethodsAll patients who presented to the emergency department of our level I university trauma center after an accident involving a traditional bicycle without electric assistance or an e-scooter in 2022 were recorded. Demographic data as well as information regarding the trauma mechanism, injury pattern, alcohol influence, treatment requirements and helmet use were analyzed and compared between the two groups.ResultsIn 2022, a total of 626 patients were identified after a bicycle accident and 98 patients after an e-scooter accident. E-scooter riders were with a mean age of 31.0 years (standard deviation (SD) 10.7) significantly younger compared to bicycle riders at 43.2 years (SD 16.5; p < 0.001). More than half of the patients in both groups were male (e-scooter 69.4% versus bicycle 60.7%). E-scooter riders were more likely to be intoxicated (31.6% vs. 5.4%; p < 0.001), not wearing a helmet (93.9% vs. 78.4%; p < 0.001) and to have had accidents at nighttime (39.8% vs. 11.5%; p < 0.001). There was no significant difference between the distribution of minor (e-scooter 75.2% vs. bicycle 70.3%) and major (24.8% vs. 29.7%) injuries. In terms of body regions, e-scooter riders suffered from major injuries to the skull, facial cranium, cervical spine (43.8% e-scooter vs. 22.4% bicycle; p = 0.008) and less frequently to the trunk, thoracic and lumbar spine and pelvis (0.0% vs. 13.6%).ConclusionCompared to cyclists, injured e-scooter riders are younger, mostly do not wear a helmet and more often ride under the influence of alcohol. E-scooter accidents occur more frequently at night and the riders are more likely to suffer serious head injuries.

Pediatric Craniofacial Injuries Involving Alcohol: An Epidemiologic Study.

Alcohol intoxication significantly increases an individual's risk for a variety of injuries including craniofacial injuries, although this research is limited to adults. Further research is needed on pediatric craniofacial injuries related to alcohol use in children, a group inherently different in anatomy and developmental considerations from adults. This study aims to identify alcohol-related craniofacial injury patterns, injury mechanisms, and patient disposition in the pediatric population presenting to the emergency department. A cross-sectional analysis of alcohol-related injuries in the pediatric population (0-18 years of age) was performed using the National Electronic Injury Surveillance System (NEISS) database from 2019 to 2023. Patient demographics, specific primary and secondary injury diagnoses, injury mechanism, location, and discharge disposition were collected. Descriptive statistics and χ2 tests were used to understand injury patterns. A total of 266 patients with alcohol-related craniofacial injuries were identified, with an age range of 12 to 18 years. The most common craniofacial injuries were brain injury, facial laceration, and concussions. Additional injuries occurred in most patients and were often either poisoning or an additional craniofacial injury. Injury mechanisms included falls, motorized and non-motorized recreational vehicles, motor vehicle collisions, and others. Although most patients were discharged from the emergency department, some required transfer or admission, particularly those with brain injuries or fractures. This study evaluates pediatric craniofacial injuries involving alcohol. Falls emerged as the most common injury mechanism, and most injuries occurred in older adolescents. This population had high rates of brain injury and concomitant injuries, highlighting the significant morbidity present.

Injury pattern of feet and lower limbs in a feet-first fall from height.

In fatalities caused by falls from height, the analysis of the injury pattern, alongside with circumstantial data, is crucial for understanding the dynamics of the incident. In rare cases, even a differentiation between accidental and intentional events might be possible. The injury pattern of the lower limbs is particularly significant in this context. In the present case - fall from height with primary impact on the feet - fractures of the lower limbs were diagnosed, including comminuted fractures in the middle-distal third of the tibiae and bilateral perforation of both feet and shoes by bone fragments. The longitudinal transmission of high kinetic energy caused by the impact could thus be proven. This specific feature allowed to conduct a complete and accurate assessment of injuries resulting from falls from height.

Incidence of fall-from-height injuries and predictive factors for severity

Abstract Context The injuries caused by falls-from-height (FFH) are a significant public health concern. FFH is one of the most common causes of polytrauma. The injuries persist to be significant adverse events and a challenge regarding injury severity assessment to identify patients at high risk upon admission. Understanding the incidence and the factors that predict injury severity can help in developing effective intervention strategies. Artificial intelligence (AI) predictive models are emerging to assist in clinical assessment with challenges. Objectives This retrospective study investigated the incidence of FFH injuries utilizing conventional statistics and a predictive AI model to understand the fall-related injury profile and predictive factors. Methods A total of 124 patients who sustained injuries from FFHs were recruited for this retrospective study. These patients fell from a height of 15–30 feet and were admitted into a level II trauma center at the border of US-Mexica region. A chart review was performed to collect demographic information and other factors including Injury Severity Score (ISS), Glasgow Coma Scale (GCS), anatomic injury location, fall type (domestic falls vs. border wall falls), and comorbidities. Multiple variable statistical analyses were analyzed to determine the correlation between variables and injury severity. A machine learning (ML) method, the multilayer perceptron neuron network (MPNN), was utilized to determine the importance of predictive factors leading to in-hospital mortality. The chi-square test or Fisher’s exact test and Spearman correlate analysis were utilized for statistical analysis for categorical variables. A p value smaller than 0.05 was considered to be statistically different. Results Sixty-four (64/124, 51.6 %) patients sustained injuries from FFHs from a border wall or fence, whereas 60 (48.4 %) sustained injuries from FFHs at a domestic region including falls from roofs or scaffolds. Patients suffering from domestic falls had a higher ISS than border fence falls. The height of the falls was not significantly associated with injury severity, but rather the anatomic locations of injuries were associated with severity. Compared with border falls, domestic falls had more injuries to the head and chest and longer intensive care unit (ICU) stay. The MPNN showed that the factors leading to in-hospital mortality were chest injury followed by head injury and low GCS on admission. Conclusions Domestic vs. border FFHs yielded different injury patterns and injury severity. Patients of border falls sustained a lower ISS and more lower-extremity injuries, while domestic falls caused more head or chest injuries and low GCS on admission. MPNN analysis demonstrated that chest and head injuries with low GCS indicated a high risk of mortality from an FFH.

Medication Hazards and Outcome Patterns of Pediatric Drug-Associated Liver Injury in Taiwan: An Analysis of 1998-2017 Spontaneous Adverse Drug Reaction Reports.

Accumulating pediatric efficacy and safety data on drug use is inherently challenging yet essential. This study aimed to analyze the frequency and compute the odds of pediatric drug-associated liver injury across age groups (early childhood, middle childhood, and adolescence) and therapeutic categories using adverse drug reactions (ADRs) reporting data spanning nearly two decades. We analyzed the reports of suspected ADRs occurring in children and adolescents in the Taiwan National Adverse Drug Reaction Reporting System during the period from May 1998 until July 2017. Standardized Medical Dictionary for Regulatory Activities Queries were utilized to identify suspected hepatic ADRs. Outcome patterns across age groups were compared using the chi-squared test, and disproportionality analysis was employed to calculate reporting odds ratios (RORs) of hepatic versus nonhepatic reports. Among 16,673 reports, 484 (2.9%) were identified as suspected hepatic ADRs, involving 193 distinct drugs. The mean age of affected individuals was 8.2 years. Outcome types in adolescents were predominantly serious (91.8%). Antibacterials for systemic use (18.8%) and antiepileptics (8.7%) were the most frequently implicated therapeutic categories. Drugs with high ADR occurrence rates and significant RORs included oxacillin (5.2%; ROR: 12.07), methotrexate (4.1%; ROR: 9.07), and phenobarbital (2.7%; ROR: 5.04). Some medications exhibited higher ratios of used-versus-recommended doses, suggesting inappropriate dosing. Pediatric drug-associated liver injury was not uncommon and may result in serious outcomes. This study underscores the need for heightened vigilance in administering certain high-risk drugs and attentiveness in proper dosing for children, including adolescents.

The impact of an All-Hazard mass casualty event on emergency department operations: A retrospective study.

Mass Casualty Events (MCI) which have a direct and persisting impact on the safety and well-being of an emergency department (ED) and its staff, secondary to specific targeting of the healthcare setting, represent a distinct and complex operational challenge. ED physicians may be faced with the prospect of providing ongoing patient care while simultaneously experiencing direct threats to their own health or physical safety. In our study we considered the unique operational challenges encountered, and management strategies adopted, by the ED staff and its leadership to an all-hazard MCI impacting an academic urban emergency department. We conducted a retrospective, observational study of data from a tertiary academic medical center of patients arriving to the ED during a protracted MCI lasting from May 11th to May 21st, 2021. No arriving patients were excluded from analysis. Patient demographics, ED resource utilization, throughput, disposition and other pertinent data were considered. Analysis was done of three distinct patient populations including the event-group (EG), a non-event-group (NEG) and a control group (CG). Descriptive statistics were used to evaluating observational findings. We reviewed the records of 8527 total patients presenting to the Shamir Medical Center ED during the event and control periods. Of those, 283 patients were identified as an EG consisting of casualties from the MCI. 3563 patients were identified as the NEG presenting with complaints not related to the event. Our CG consisted of the 4681 patients who presented in the two weeks prior to the MCI. EG patients were noted to have important characteristics including higher relative numbers of men n=173 (61.6%), higher CTAS triage acuities [n=10 (3.8%), classified as CTAS 1], and an increase utilization of specialty consultation and admission consistent with observed injury patterns, most notably for the orthopedic services [orthopedic consultations: n=126 (44.5%) / orthopedic admissions: n=13 (4.6%)]. Findings from our observational study suggested that in the absence of larger public health interventions a manmade MCI, with direct threats to an ED and its staff, could force EDs to concurrently address the unique clinical needs of two distinct patient populations while simultaneously needing to take measures to protect hospital staff. Additionally, a higher burden of patient volumes and clinical acuity are likely to be encountered by select specialty consultation services. Further studies could focus on quantitative analysis to better understand the operational impact of these types of events on both patients and staff.

Trauma of the midface : Symptoms, diagnostics and treatment

Midface fractures present aclinical challenge in otorhinolaryngology due to their often complex injury pattern and nonspecific symptoms. Precise diagnostics, including differentiated imaging procedures, are required. Interdisciplinary consultation between otorhinolaryngology, maxillofacial surgery, neurosurgery, and ophthalmology is often necessary. When selecting radiographic modalities, radiation hygiene should be taken into account. Sonography provides aradiation-free imaging alternative for fractures of the nasal framework and anterior wall of the frontal sinus. The goal of treatment is to achieve stable and symmetrical reconstruction. Depending on the injury pattern, different osteosynthesis materials, individual access routes, and various surgical procedures can be used. In clinical practice, the management of midface fractures requires amultidisciplinary, flexible, and pragmatic approach based on the fracture pattern and clinical experience.

Nephrotic and Non-Nephrotic Focal Segmental Glomerulosclerosis: Clinical Characteristics, Etiology, and Columbia Classification

Introduction: Focal segmental glomerulosclerosis (FSGS) is a pattern of kidney injury with diverse causes and pathogeneses, resulting in podocyte injury and depletion. It can be classified as primary, genetic, or secondary. Because FSGS classically has a worse prognosis in patients with nephrotic syndrome, most studies have focused on the treatment and evolution of these patients, resulting in a lack of data related to patients without nephrotic syndrome. The objective of this study was to establish the main etiologies, characteristics, and evolution of renal disease in FSGS patients with nephrotic and non-nephrotic proteinuria. Methods: This was a retrospective, single-center study that included 140 patients with a biopsy-confirmed diagnosis of FSGS in the 2009–2017 period. Patients were separated into those with and those without nephrotic syndrome at diagnosis, and these two groups were compared in terms of the clinical characteristics, histological profile, and outcome. Non-nephrotic patients with unfavorable progression were selected for ultrastructural analysis with electron microscopy. Results: During the study period, 32.9% of the patients with FSGS had non-nephrotic proteinuria at diagnosis. This group had a larger proportion of patients with hypertension and a not otherwise specified FSGS variant on histology. The proportion of patients with secondary forms of FSGS was comparable between the two groups, with HIV infection and systemic lupus erythematosus being predominant. Progression to renal replacement therapy occurred in 31.3% of the patients in the nephrotic group and in 26.8% of those in the non-nephrotic group, with no statistical difference between them. All of the non-nephrotic group patients who progressed to renal replacement therapy were analyzed by electron microscopy, the diagnosis of FSGS was confirmed, and there was the finding of high chronicity in these patients. Conclusions: Among patients with FSGS, those without nephrotic syndrome had a poor renal outcome at a frequency similar to that of those with nephrotic syndrome. Factors related to better renal survival were having had a complete response to treatment in the case of those with nephrotic syndrome and having achieved proteinuria values of less than 1.5 g/day in the case of those without nephrotic syndrome.