Physical Injury Research Articles

Evaluation Of The Frailty Index And Thiol-Disulphide Levels In Geriatric Orthopedic Injuries

Backround: One of the concepts recently discussed about old age is frailty. Frailty was found to be important in determining weakness and indulgence in the elderly. Frail older people are more likely to fall and experience related orthopedic trauma. Free oxygen radicals are known to cause oxidative stress in trauma patients. The aim of this study is to report the levels of frailty and thiol disulphide homeostasis and related factors in patients with geriatric orthopedic injury who presented to the emergency department.Methods: This study included 82 patients aged 65 and over who were admitted to the Emergency Department of XXX City Hospital in 2020 due to orthopedic trauma, and 38 people who presented for other reasons in a control group. FRAIL Frailty scale was used to evaluate frailty. In samples from patients' venous blood, native thiol and total thiol were analyzed.Results: The average age of the patients was78.48 ±7.86(min: 65-max: 99). Of the patients, 30.8% were in the prefrail group and56.7% were in the frail group. In patient and control group comparisons, total thiol values ​​in the patient group were significantly lower, and disulphide, ischemia-modified albumin, index 1 and index 2 values ​​were significantly higher in the patient group compared with the control group. There were significantly more prefrail individuals(41.5%) among orthopedic trauma patients, and frail individuals (81.6%) in the control group. There was a significant weak negative correlation between body mass index and native thiol and total thiol values.Conclusion: Oxidative stress is increased in patients with geriatric orthopedic injuries.

Exploring the lived experience of performance-related health and wellbeing among flautists.

The study has investigated the lived experience of flautists, focusing on their experiences and perceptions of performance-related physical discomfort, injury and related mental health challenges that they might have encountered in practice and performance. The aims of the research have been to provide flautists with an opportunity to reflect on any physical or psychological performance issues in their own words, and to understand the subjective meaning of these experiences. A basic qualitative approach was used for gathering data. All the fieldwork was undertaken during or immediately after the Covid-19 pandemic. Consequently, the participating flautists were deliberately selected using professional networks on the basis of their answers to a pre-interview initial questionnaire related to the characteristics of their personal backgrounds and their experiences, as well as being able to participate remotely. There have been two data collection phases. Phase 1 was a specially designed pre-interview questionnaire drawing on themes from appropriate literature. Phase 2 built on the pre-interview questionnaire responses and was designed as semi-structured interviews, undertaken on Zoom, and included a 'River of Flute-playing Experience' activity during the interview. The 'River of Experience' method is an autobiographical research tool in which participants were asked to annotate key biographical experiences and challenges at various points along their drawing of a meandering river. The combined data analyses drew on thematic analysis. The eight participants reported a personal history of performance-related health and wellbeing challenges that they had faced at some point in their lives. The findings reveal that flautists encounter health-related challenges associated with their practice and performances, and the data suggest that they each require an understanding of likely performance-related health challenges and supportive resources to assist them in managing these challenges. The participants' diverse experiences highlight the importance of managing health and the value of supportive social connections. They cope with health challenges by integrating passion, resilience, and adaptability into their lives, finding ways to grow and continue to thrive in their flute-playing journey. The study underscores the need for comprehensive health education and support resources for flautists, emphasising the significance of resilience and adaptability in fostering health, wellbeing, and success.

Ketone Esters Partially and Selectively Rescue Mitochondrial Bioenergetics After Acute Cervical Spinal Cord Injury in Rats: A Time-Course.

Spinal cord injury (SCI) pathology and pathophysiology can be attributed to both primary physical injury and secondary injury cascades. Secondary injury cascades involve dysregulated metabolism and energetic deficits directly linked to compromised mitochondrial bioenergetics. Rescuing mitochondrial function and reducing oxidative stress are associated with neuroprotection. In this regard, ketosis after traumatic brain injury (TBI), or after SCI, improves secondary neuropathology by decreasing oxidative stress, increasing antioxidants, reducing inflammation, and improving mitochondrial bioenergetics. Here, we follow up on our previous study and have used an exogenous ketone monoester, (R)-3-hydroxybutyl (R)-3-hydroxybutyrate (KE), as an alternative to a ketogenic diet, focusing on mitochondrial function between 1 and 14 days after injury. Starting 3 h following a cervical level 5 (C5) hemi-contusion injury, animals were fed either a standard control diet (SD) or a ketone ester diet (KED) combined with KE administered orally (OKE). We found that mitochondrial function was reduced after SCI at all times post-SCI, accompanied by reduced expression of most of the components of the electron transport chain (ETC). The KE rescued some of the bioenergetic parameters 1 day after SCI when D-β-Hydroxybutyrate (BHB) concentrations were ~2 mM. Still, most of the beneficial effects were observed 14 days after injury, with BHB concentrations reaching values of 4-6 mM. To our knowledge, this is the first report to show the beneficial effects of KE in rescuing mitochondrial function after SCI and demonstrates the suitability of KE in ameliorating the metabolic dysregulation that occurs after traumatic SCI without requiring a restrictive dietary regime.

First case report of a percutaneous coronary intervention with intracoronary lithotripsy in a heavily calcified and tortuous right coronary artery using the R-One+ robotic system

Abstract Background Advancement in interventional techniques has significantly improved the ability of percutaneous coronary intervention (PCI) to treat complex coronary artery disease. Despite these advancements, coronary artery calcification poses a substantial challenge during PCI, contributing to increased risks of procedural complications, prolonged procedure duration, an increase in radiation exposure dose for both patients and physicians. Recently, robotic PCI has emerged, allowing physicians to remotely control and deliver wires and catheters, leading to a notable reduction of the operator radiation exposure and a decrease in the risk of operator physical injuries such as back pain. Case summary We report the first robotic PCI with the R-One+™ robotic system using intracoronary lithotripsy for lesion preparation of two heavily calcified lesions in a tortuous right coronary artery of a 60-year old male patient followed by double drug-eluting stent implantation. Discussion Robotic PCI with the R-One+™ system can not only manage wires, balloons or stent systems but can also precisely position more bulky catheters such as intracoronary lithotripsy catheters to the target site even in the presence of a tortuous access.

Effects of Multimodal Analgesia Combined with Comfort Management on Pain and Stress Indexes in Patients with Orthopedic Trauma after Intervention: A Retrospective Study.

This study aims to assess the impact of combining multimodal analgesia with comfort care on pain levels, stress, negative emotions, and quality of life in individuals recovering from traumatic fractures. This retrospective study analyzed clinical data from traumatic fracture patients who underwent emergency operations at our hospital between June 2022 and February 2024. Patients were divided into two groups based on their postoperative pain management: the control group, which received standard measures, and the exposure group, which received a combination of multimodal analgesia and comfort-based care. We compared these groups for pain intensity (baseline and activity Visual Analog Scale (VAS) scores), serum stress biomarkers (norepinephrine, adrenaline, cortisol), emotional distress (self-rating depression scale (SDS), and the self-rating anxiety scale (SAS)), and overall quality of life (Comprehensive Quality of Life Assessment Questionnaire (GQOLI-74) score). Overall, this study evaluated differences in postoperative complications between the two pain management approaches. In this study, we included 101 participants, 41 in the exposed group and 60 in the control group. Before the intervention, baseline characteristics were similar between the two groups (p > 0.05). However, one week after the intervention, the resting and active VAS scores were significantly reduced in the exposed group than in the control group (p < 0.05). Furthermore, one week after the intervention, the exposed group had lower levels of serum sodium, epinephrine, cortisol, stress, and anxiety, as well as higher physical and mental health scores on the GQOLI-74 scale. During the intervention period, there was no significant difference in postoperative complications between the two groups (p > 0.05). Combining multi-mode analgesia with comfort management for patients with traumatic fractures significantly reduces postoperative pain and stress levels. Additionally, this approach can effectively enhance patients' negative emotions and improve their quality of life. This approach holds significant promise for practical use in clinical settings.

Neurobiological effects of childhood trauma: A literature review

This article is a comprehensive review of past literature focusing on neurobiological effects of childhood trauma. Chronic interpersonal violence in children is common worldwide (De Bellis &amp; Zisk, 2014). Exposure to continuous physical and emotional trauma in childhood undoubtedly has long lasting effects like developing post- traumatic stress disorder (PTSD), dysregulation of the hypothalamic–pituitary–adrenal axis (HPA) axis leading to hormonal issues, among other things, in an individual. A systematic review of these effects can prove beneficial in the field of psychiatry.

Development and Evaluation of a Wearable Upper Limb Assistive Device with a Remote Center of Motion Mechanism

Workers in factories, construction sites, and farms are often exposed to the risk of physical disability and injury. Particularly, the lower back and shoulders require assistance, as injuries can make it difficult to continue working. While social concern about back injuries is high and preventive measures are taken, lesser attention is paid to shoulders, resulting in inadequate assistance and prevention mechanisms. Therefore, wearable, low-cost, and lightweight upper limb assistive devices that can be used in multiple scenarios are desired by workers. In this study, we proposed a device that uses a remote center of motion (RCM) mechanism, enabling the device to support user’s upper arm from below, and the rotational center of device to correspond with shoulder joint. The theoretical assist torque is designed to be sufficient for arm gravity compensation of Japanese males of standard body size. The calculated theoretical assist torque for each shoulder joint is about 8 Nm and maximum assist force for each arm was about 36.3 N (3.7 kgf). Experimental evaluation using a prototype of this device on three healthy adult males demonstrated a decrease in muscle activity of approximately 38% in the anterior deltoid, 31% in the middle deltoid, and 11% in the posterior deltoid as an average of all results in a dynamic experiment in which the participants performed the indicated movements.

A hybrid 3D-printed and electrospun bilayer pharmaceutical membrane based on polycaprolactone/chitosan/polyvinyl alcohol for wound healing applications

Skin injuries resulting from physical trauma pose significant health risks, necessitating advanced wound care solutions. This investigation introduces an innovative bilayer wound dressing composed of 3D-printed propolis-coated polycaprolactone (PCL/PP) and an electrospun composite of polyvinyl alcohol, chitosan, polycaprolactone, and diltiazem (PVA/CTS/PCL/DTZ). SEM analysis revealed a bilayer structure with 89.23 ± 51.47 % porosity and uniformly distributed nanofibers. The scaffold tensile strength, with pore sizes of 100, 300, and 500 μm, was comparable to native skin. However, smaller pore sizes reduced water vapor transmission from 4211.59 ± 168.53 to 2358.49 ± 203.63 g/m2. The incorporation of DTZ lowered the contact angle to 35.23 ± 3.65°, while the addition of PCL reduced the degradation rate and modulated the release of DTZ by approximately 50 %. Moreover, lower pH increased the degradation rate and decreased swelling. The inclusion of propolis enhanced antibacterial activity, and 10 % DTZ promoted the viability, proliferation, and migration of fibroblasts and adipose-derived stem cells. However, increasing DTZ concentration to 12 % reduced cell viability. In vivo tests on rats demonstrated effective wound healing and anti-inflammatory properties of the bilayer samples. Regarding the aforementioned results, the PCL/PP-PVA/CTS/PCL/DTZ (10 % w/w) bilayer wound dressing is a promising candidate for wound healing applications.

The Effects of the COVID-19 Pandemic on Pediatric Orthopedic Injuries: A Single-Center Retrospective Study.

The COVID-19 pandemic has had a profound effect on the pediatric population worldwide. The consequences of the lockdown and the reallocation of hospital resources have caused notable changes in the presentation of pediatric orthopedic injuries. Through our use of patient records, we were able to display the epidemiological trends, as well as analyze the changes in the type and mechanism of various injuries. Our purpose is to further understand the considerable effects of the COVID-19 pandemic on pediatric orthopedic trauma and help guide the allocation of future healthcare resources. We conducted a retrospective cohort study on pediatric patients admitted for any orthopedic injury over a 3-year period (September 2018 to August 2021) at a Midwest level 1 trauma center. Cases were stratified into two groups based on the United States' COVID-19 lockdown (19 March 2020): Pre-COVID-19 cases were any cases prior to the lockdown and Intra-COVID-19 which are cases following the lockdown. Numerical data and categorical variables were summarized and differences between the case groups were examined using either two-Proportion Z-Test, Independent Two-Sample t-test, Pearson's chi-squared, or Fisher's exact tests. A total of 3179 pediatric orthopedic referrals occurred between the Pre-COVID-19 and Intra-COVID-19 study periods. We observed a general decrease in orthopedic injuries following the COVID-19 lockdowns with 1235 injuries compared to 1606 Pre-COVID-19. Patterns in the locations of injuries changed; notably, fractures of the humerus, tibia, and fibula decreased significantly (p < 0.05). Several mechanisms of injuries decreased significantly following the onset of COVID-19 including injuries caused by monkey bars, basketball, and automobiles (p < 0.01). There was a significant increase in the overall injury severity during the Intra-COVID-19 period (p < 0.05). Although there was a reduction in acute orthopedic trauma referrals, many injury mechanisms displayed similar trends regardless of restrictions. We clinically observed an overall increase in the severity of pediatric orthopedic injuries during the COVID-19 pandemic.

Ergonomics in Facial Plastic and Reconstructive Surgery: A Clinical Evaluation.

Surgeons experience a risk for physical strain and injury secondary to physical demands in the workplace. To minimize injury and maximize career longevity, physicians should be aware of ergonomics pitfalls and postural correction methods. This study investigates ergonomic trends in Facial Plastic and Reconstructive Surgery (FPRS) clinic by quantifying surgeons' and trainees' cervicothoracic spine posture. Participants completed a 22-item questionnaire to evaluate current ergonomic practices. A lightweight device was calibrated and attached to the mid-scapular region of participants, providing real-time posture feedback. The percentage of time in upright posture was recorded during clinical and operative workdays. Upright posture was defined as neutral spine positioning with acceptable mild to moderate deviations. Two FPRS attending surgeons, 1 FPRS fellow, and 11 otolaryngology residents participated over 12 months. Discomfort was most commonly reported in the neck, shoulders, and upper back during clinic. Symptoms were self-treated by changing body position, wearing specialized footwear, adjusting height of the chair or examination table, or ignoring discomfort. Eighty-two percent were unaware of ergonomic guidelines or appropriate considerations. Time spent in upright posture was significantly higher in clinic (84.9%) than in the OR (53.5%) (p < 0.001). Upright posture declined after reaching 6 work hours (p = 0.029); no such patterns were observed in the OR (p = 0.946). Although time spent in upright posture was objectively poorer in the OR, these data suggest ergonomics are an important consideration in the outpatient setting, with surgeons experiencing discomfort during and after clinic. Further investigation is warranted to identify actionable changes and promote healthy ergonomics. N/A Laryngoscope, 2024.

Advances in laryngopharyngeal reflux: Etiology, diagnosis, and management.

Laryngopharyngeal reflux (LPR) manifests as a variety of nonspecific upper aerodigestive tract symptoms. Rather than a single disorder, LPR may be conceived of as a spectrum of subtypes with varying clinical presentations. LPR signs and symptoms arise from the direct and/or indirect effects of refluxate, physical and molecular injury of the mucosa, and neurologic responses to esophageal events. Specific constituents of refluxate exert distinct mucosal responses and immediate or delayed effects resulting in transient or persistent symptoms and/or laryngeal hypersensitivity. While the complex etiology of LPR presents challenges to its diagnosis and management, tools that aid the identification of LPR subtypes can provide insight into treatment decision-making. Hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring provides detailed analysis of reflux events, enabling the development of individualized treatment plans, yet cost and availability limit its widespread use. Alginates offer temporary symptom relief and antireflux surgery may provide benefit when symptoms are recalcitrant to other approaches. Pepsin inhibitors hold promise as a medical therapy when surgery is not an option. Laryngeal hypersensitivity should be considered as part of a comprehensive therapeutic approach. Promising medical and scientific research continues to yield new insights into the complex etiology of LPR and novel strategies for its diagnosis and management.

Implementation of Standard Physiotherapy Service Policies In Puskesmas: Literature Review

The growing prevalence of non-communicable diseases (NCDs) such as hypertension, stroke, diabetes, joint disorders, lack of physical activity, injury, and disability has resulted in an increasing need for physiotherapy services within healthcare facilities, especially at community health centers. Despite many unresolved public health issues, the rise of NCDs continues to pose significant challenges. According to the Minister of Health Regulation No. 65 of 2015, physiotherapy services are crucial in primary healthcare as part of promotive and preventive efforts, without neglecting curative and rehabilitative functions. This study aims to highlight the importance of physiotherapy in community health centers in providing both preventive and supportive care to address the public's increasing healthcare demands. The findings emphasize the strategic role of physiotherapists in disease prevention and health promotion at the primary level. The novelty of this research lies in its focus on the integration of physiotherapy into primary care services as a proactive approach to managing NCDs. The contribution of this research is to support healthcare policy and practices that prioritize physiotherapy services to improve public health outcomes, particularly in the prevention and management of NCDs.

Configuration of accident trajectories after a rehabilitation programme: on the sharp edge between reintegration and socio-professional exclusion

Purpose To analyse the factors influencing the configuration of accident trajectories from de perspective of patients and assess the role of rehabilitation in managing pain and functional limitations autonomously. Material and methods Using a qualitative, longitudinal, interdisciplinary approach, we conducted two comprehensive interviews (one year apart) with patients experiencing chronic pain and functional limitations following orthopaedic trauma. Thematic analysis was conducted utilising MaxQDA® software to systematically analyse the data. Results Twenty-four patients participated (4 ♀; 20 ♂; 44.9 ± 10.6, min. 19; max. 63.5 yo; 1.0 ± 4.0 years duration; pain 4.6 (1.8) severity subscale (0-10) [mean (SD)]). Through reconstruction their experiences we identified three types of accident trajectories: socio-professional reintegration, ongoing reintegration, and exclusion. Factors influencing these trajectories included physical and psychological health status, occupational status, private and social context, and insurance and therapeutic aspects. Patients’ perceptions and socio-demographic characteristics also contributed to trajectories specificities. Conclusion Understanding the factors that influence accident trajectories links individual and social dimensions, offering an overall comprehension of patients’ situations and structural constraints. This understanding enables the factors influencing trajectories to be considered during rehabilitation, thereby promoting the patient’s socio-professional reintegration through targeted interventions.

Study protocol: Cerebral autoregulation, brain perfusion, and neurocognitive outcomes after traumatic brain injury -CAPCOG-TBI.

Moderate-severe traumatic brain injury (msTBI) stands as a prominent etiology of adult disability, with increased risk for cognitive impairment and dementia. Although some recovery often occurs within the first year post-injury, predicting long-term cognitive outcomes remains challenging, partly due to the significant pathophysiological heterogeneity of TBI, including acute cerebrovascular injury. The primary aim of our recently funded study, cerebral autoregulation, brain perfusion, and neurocognitive outcomes after traumatic brain injury (CAPCOG-TBI), is to determine if acute cerebrovascular dysfunction after msTBI measured using multimodal non-invasive neuromonitoring is associated with cognitive outcome at 1-year post-injury. This longitudinal observational study will be conducted at two Level 1 trauma centers in Texas, USA, and will include adult patients with msTBI, and/or mild TBI with neuroimaging abnormalities. Multimodal cerebral vascular assessment using transcranial Doppler and cerebral near-infrared spectroscopy (NIRS) will be conducted within 7-days of onset of TBI. Longitudinal outcomes, including cognitive/functional assessments (Glasgow Outcome Scale and Patient-Reported Outcomes Measurement Information System), cerebral vascular assessment, and imaging will be performed at follow-ups 3-, 6-, and 12-months post-injury. We aim to recruit 100 subjects with msTBI along with 30 orthopedic trauma controls (OTC). This study is funded by National Institute of Neurological Disease and Stroke (NINDS) and is registered on Clinicaltrial.org (NCT06480838). We anticipate that msTBI patients will exhibit impaired cerebrovascular function in the acute phase compared to the OTC group. The severity of cerebrovascular dysfunction during this stage is expected to inversely correlate with cognitive and functional outcomes at 1-year post-injury. Additionally, recovery from cerebrovascular dysfunction is expected to be linked to cognitive recovery. The results of this study could help to understand the contribution of cerebrovascular dysfunction to cognitive outcomes after TBI and pave the way for innovative vascular-focused interventions aimed at enhancing cognitive recovery and mitigating neurodegeneration following msTB. In addition, its focus toward personalized medicine to aid in the management and prognosis of TBI patients.

Assessing and mitigating building fire risk based on the scenario clusters in Bangladesh

The increasing occurrence of fire hazards in residential buildings in Bangladesh has led to severe property damage, physical injuries, and fatalities, underscoring a critical research gap in effective fire risk management. This study aims to address this gap by identifying key fire risks and proposing mitigation strategies using BIM technology. The research employs a comprehensive survey and scenario clustering methodology to identify these risks and assess the efficacy of various fire-resistant materials. Data collection involved questionnaires distributed to 200 respondents, including building owners, occupants, engineers, and firefighters. These clusters are based on the metrics of fatality numbers and property damage to quantify fire risk. Findings highlight the significant role of wall and ceiling lining materials (RII = 0.919) in contributing to fire risk. Further analysis was conducted using a residential building model developed in Autodesk Revit and simulated in Pyrosim software, assessing various lining materials. Quantitative results demonstrated that fire brick is the most effective material, exhibiting the lowest heat release rate (968 kW/m2), minimum adiabatic surface temperature (28°C), minimum heat transfer coefficient (1.75 W/m2/K), and lowest surface burning rate (7.5e−08 Kg/m2/s). These results suggest that fire brick is the optimal choice for enhancing fire resistance in residential buildings.

Reconstructing confidence: Fiber reinforced reattachment of a fractured maxillary lateral incisor – A clinical case report

AbstractA broken smile can be more than just a physical injury—it can impact self-esteem and confidence. This case highlights the successful reattachment of a fractured upper front tooth in a 32-year-old female following a recent fall. The comprehensive treatment strategy involved immediate root canal therapy to relieve pain, followed by a gingivectomy and osteotomy to correct the subgingival fracture and restore the biologic width. Advanced techniques, including fiber post and core reconstruction reinforced with ribbond fiber, were used to stabilize and support the tooth structure. The final touch is done with a layer of composite for optimal function and aesthetics. This holistic approach not only revived the patient's smile but also rejuvenated her confidence and psychological well-being.

Seven Identities Co-existing, A Noteworthy Manifestation of Complex Childhood Trauma: A Case Report

Background Childhood trauma increases the risk for psychiatric disorders such as Dissociative Identity Disorder (DID), Other Specified Dissociative Disorder (OSDD), Depersonalisation/Derealisation disorder (DDD), Post-Traumatic Stress Disorder Dissociative Type (D-PTSD), and Borderline Personality Disorder (BPD). Children who experience prolonged stress, trauma, or abuse during developmental years of growth and change have a wide range of outcomes. Case Presentation We report a case of a 22-year-old female with a significant history of physical abuse and sexual assault who initially presented to the hospital for suicidal ideation with a stated plan. During the patient’s stay at the hospital, we encountered two of the six alternate identities of the patient. The patient revealed she experiences all 7 identities (her true self plus 6 alters) in parallel, recalls the events of each alter, and can intermittently switch between identities; all rare features of dissociative disorders. Conclusion Given our patient’s extensive history of trauma, previous psychiatric diagnoses, and current dissociative presentation, we conclude that a diagnosis of OSDD and defence mechanisms of dissociation and regression may be appropriate. The patient was discharged with clomipramine for Obsessive-Compulsive Disorder and mood, lurasidone for mood, mirtazapine for mood, insomnia, and appetite stimulation, clonidine for nightmares and Postural Orthostatic Tachycardia Syndrome (POTS), fludrocortisone for POTS, gabapentin for Generalized Anxiety and fibromyalgia, and levothyroxine for hypothyroidism, and counselled to follow up with an outpatient therapist specialising in trauma. This case highlights the impact that childhood physical, sexual, and emotional trauma can have on one’s psychiatric presentation and the complexity of diagnosing dissociative presentations in an inpatient psychiatry setting.

Treatment of Multiple Soft Tissue Maxillofacial Wounds: A Case Report

Introduction: Trauma to the maxillofacial area is a frequent problem in medical emergencies, including injuries caused by external forces such as traffic accidents. These injuries can result in damage to the soft tissues, especially the face, which plays an important role in a person's expression, appearance, aesthetics, and identity. Prompt and appropriate treatment is essential to prevent serious complications, including infection and long-term damage. Case Report: A 21-year-old male patient suffered facial bleeding due to a traffic accident. This incident caused lacerations to the frontal region dextra, palpebra dextra, zygoma dextra, and mental, as well as multiple abrasions to the face. Radiographic examination showed no bone fracture, but the wounds required debridement and suturing of the lacerated soft tissues. Management: The patient was diagnosed with multiple lacerations to the maxillofacial area. Initial measures included Tetagam as anti-tetanus protection, followed by Ceftriaxone as prophylactic antibiotics, Omeprazole to reduce gastric irritation, and Ketorolac for analgesic and anti- inflammatory effects. Wound cleansing and debridement were performed to reduce the risk of infection and preserve healthy tissue. The wound was then sutured with the transpositional flap technique, which allows a change in wound direction to reduce the risk of infection and ensure aesthetic and functional wound closure. Conclusion: Multiple soft tissue wounds of the maxillofacial area due to physical trauma require prompt and appropriate management to prevent serious complications. Debridement, wound cleansing, and the use of transpositional flap technique in the treatment of laceration wounds in this case showed optimal wound healing results without complications. Keywords: Transpositional Flap, Maxillofacial, Soft tissue trauma, soft tissue wound, debridement

Vittorio Putti's decalogue of fractures: a historical perspective in orthopaedic trauma practice.

This article explores the historical significance and lasting impact of Vittorio Putti's "Decalogue of Fractures" in the field of orthopedic trauma. Putti served as director of the Rizzoli Orthopedic Institute in Bologna from 1915 until his death in 1940 and was one of the founding members of the "Société Internationale de Chirurgie Orthopédique et de Traumatologie" (SICOT). He also played a key role in organizing the third SICOT World Congress, held in Bologna in 1936.The "Decalogue" distills Putti's extensive clinical experience and remains a cornerstone of modern traumatology. He developed the *Decalogue* to enhance the principles of fracture treatment, addressing what he viewed as suboptimal outcomes. This article examines each of the tenets, emphasizing their influence on contemporary fracture management and the evolution of orthopaedic trauma care. It also reflects on Putti's forward-thinking vision for a comprehensive trauma network, underscoring his belief in the critical importance of specialization and centralization to ensure efficiency, quality, and consistency, principles that continue to shape orthopaedic practice today.

Predictors of emergency medical transport refusal following opioid overdose in Washington, DC.

Patient initiated transport refusal during Emergency Medical Service (EMS) opioid overdose encounters has become an endemic problem. This study aimed to quantify circumstantial and environmental factors which predict refusal of further care. In this cross-sectional analysis, a case definition for opioid overdose was applied retrospectively to EMS encounters. Selected cases had sociodemographic and situational/incident variables extracted using patient information and free text searches of case narratives. 50 unique binary variables were used to build a logistic model. Prehospital EMS overdose encounters in Washington, DC, USA, from July 2017 to July 2023. Of EMS encounters in the study timeframe, 14 587 cases were selected as opioid overdoses. Predicted probability for covariates was the outcome variable. Model performance was assessed using Stratified K-Fold Cross-Validation and scored with positive predictive value, sensitivity and F1. Prediction accuracy and McFadden's pseudo-R squared are also determined. The model achieved a predictive accuracy of 78% with a high positive predictive value (0.83) and moderate sensitivity (0.68). Bystander type influenced the refusal outcome, with decreased refusal probability associated with family (nondescript) (-28%) and parents (-16%), while presence of a girlfriend increased it (+28%). Negative situational factors like noted physical trauma (-62%), poor weather (-14%) and lack of housing (-14%) decreased refusal probability. Characteristics of the emergency response team, like a prior crew member encounter (+20%) or crew experience <1year (-36%), had a variable association with transport. Refusal of emergency transport for opioid overdose cases in Washington, DC, USA, has expanded by 43.8% since 2017. Several social, environmental and systematic factors can predict this refusal. Logistic regression models can be used to quantify broad categories of behavior in surveillance medical research.