Post Trauma Research Articles

Cerebral dysautonomy as a clinical repercussion in children with traumatic brain injury

Introduction: Dysautonomia or Paroxysmal Sympathetic Hyperactivity (PSH) affects more than 50% of patients suffering from severe traumatic brain injury (TBI), which is a major cause of morbidity and mortality in children under 12 years. The goal is to demonstrate that PSH is established as a consequence in children with severe brain trauma. 
 Methodology: Forty articles were found in databases such as LILACS, Elsevier and Scielo that address the theme, excluding those that addressed the TBI in adults and including those that addressed the theme in the pediatric context and published about the PSH, published until the year of 2019.
 Results: Severe TBI is established as a common cause of hospitalization of children and PSH as a common consequence. Diagnosis and management of this complication require the help of tools such as "PSH-Assessment Measure (PSH-AM)", which has criteria that facilitate the exclusion of other possible causes and guide the treatment. Non-pharmacological therapeutic measures include control of room temperature and low sensory and pharmacological stimuli to deal with symptoms, such as drugs such as opioids, gabaergic agonists, benzodiazepines and adrenergic antagonists. 
 Conclusion: Severe TBI, a common pediatric emergency, can be considered a predictor of PSH. Even though there is no consensus on the diagnosis, PSH-AM proves to be a reliable alternative to professionals dealing with conditions that may or may not correspond with post trauma dysautonomia. This makes it possible to determine not only the child's clinical condition but also the best therapy to apply.

Influence of Obesity on the Organization of the Extracellular Matrix and Satellite Cell Functions After Combined Muscle and Thorax Trauma in C57BL/6J Mice.

Obesity has been described as a major factor of health risk in modern society. Next to intricately linked comorbidities like coronary artery disease or diabetes, an influence of obesity on regeneration after muscle injury has been described previously. However, the influence of obesity on tissue regeneration in a combined trauma, merging the more systemic influence of a blunt lung trauma and the local blunt muscle trauma, has not been investigated yet. Therefore, the aim of this study was to investigate the influence of obesity on regeneration in a mouse model that combined both muscle and thorax trauma. Using gene expression analysis, a focus was put on the structure as well as the organization of the extracellular matrix and on functional satellite cell physiology. An increased amount of debris in the lung of obese mice compared to normal weight mice up to 192 h after combined trauma based on visual assessment can be reported which is accompanied by a decreased response of Mmp2 in obese mice. Additionally, a delayed and elongated response of inhibitor genes like Timp1 has been revealed in obese mice. This elongated response to the trauma in obese mice can also be seen in plasma based on increased levels of pro-inflammatory chemo- and cytokines (IL-6, MCP-1, and IL 23) 192 h post trauma. In addition to changes in the lung, morphological analysis of the injured extensor iliotibialis anticus of the left hind leg in lean and diet-induced obese mice revealed deposition of fat in the regenerating muscle in obese animals hindering the structure of a compact muscle. Additionally, decreased activation of satellite cells and changes in organization and build-up of the ECM could be detected, finally leading to a decreased stability of the regenerated muscle in obese mice. Both factors contribute to an attenuated response to the trauma by obese mice which is reflected by a statistically significant decrease in muscle force of obese mice compared to lean mice 192 h post trauma induction.

COVID-19 Pandemic and the Mental Health of Health Care Workers: Awareness to Action

AbstractThe enormity of the coronavirus disease-2019 (COVID-19) pandemic has overwhelmed most health services and has placed health care service providers under unprecedented stress. The rapidity of spread, uncertain clinical course, and unavailability of effective treatment make clinical decisions cognitively demanding. Extended work hours inside uncomfortable protective gears, improper hydration, with conflictual health systems and patients at work; and social stigma and isolation after it ends, have created an unending downward spiral of mental health in care providers. Care providers are at increased risk of developing mental health problems in form of burnout, stress reactions, anxiety, depression, and post trauma stress. Concerted strategies for managing the mental health of care providers are urgently needed at individual and systems level. A plethora of strategies, developed from previous experience of crisis management, need to be made available to care providers through accessible mediums of delivery. This paper explores the mental health problems encountered by health care personnel and examines various strategies which need to be implemented to manage them.

Interleukin 10 and Heart Fatty Acid-Binding Protein as Early Outcome Predictors in Patients With Traumatic Brain Injury.

Background: Patients with traumatic brain injury (TBI) exhibit a variable and unpredictable outcome. The proteins interleukin 10 (IL-10) and heart fatty acid-binding protein (H-FABP) have shown predictive values for the presence of intracranial lesions.Aim: To evaluate the individual and combined outcome prediction ability of IL-10 and H-FABP, and to compare them to the more studied proteins S100β, glial fibrillary acidic protein (GFAP), and neurofilament light (NF-L), both with and without clinical predictors.Methods: Blood samples from patients with acute TBI (all severities) were collected <24 h post trauma. The outcome was measured >6 months post injury using the Glasgow Outcome Scale Extended (GOSE) score, dichotomizing patients into: (i) those with favorable (GOSE≥5)/unfavorable outcome (GOSE ≤ 4) and complete (GOSE = 8)/incomplete (GOSE ≤ 7) recovery, and (ii) patients with mild TBI (mTBI) and patients with TBIs of all severities.Results: When sensitivity was set at 95–100%, the proteins' individual specificities remained low. H-FABP showed the best specificity (%) and sensitivity (100%) in predicting complete recovery in patients with mTBI. IL-10 had the best specificity (50%) and sensitivity (96%) in identifying patients with favorable outcome in patients with TBIs of all severities. When individual proteins were combined with clinical parameters, a model including H-FABP, NF-L, and ISS yielded a specificity of 56% and a sensitivity of 96% in predicting complete recovery in patients with mTBI. In predicting favorable outcome, a model consisting IL-10, age, and TBI severity reached a specificity of 80% and a sensitivity of 96% in patients with TBIs of all severities.Conclusion: Combining novel TBI biomarkers H-FABP and IL-10 with GFAP, NF-L and S100β and clinical parameters improves outcome prediction models in TBI.

Computed tomography estimation of the prevalence of neuro-ophthalmic injuries in head trauma patients seen in a tertiary health facility in Ghana

IntroductionPrevalence of traumatic brain injury (TBI) is extremely high and potentially associated with severe incapacitating consequences. Literature reports that 90% of road traffic deaths and injuries including TBI occur in low and middle-income countries including Ghana. Computed Tomography (CT) scan is the imaging modality of choice for the initial assessment of the extent of head injury. Some Neuro-ophthalmic injuries (NOI) may sometimes be ambiguous and indistinct although a serious injury with potential damaging consequences. Data on the prevalence of NOI post trauma is non-existent in Ghana to inform policy. The onus therefore lies on the Radiologist who will review the head CT scan to be very meticulous not to miss any NOI if present. We therefore decided to diligently review a large cross-sectional retrospective post trauma head CT scans for occurrence of NOI. ObjectiveTo determine the incidence of NOI secondary to head trauma and the possible loss of vision thereof in a retrospective study using patients' head CT scan data from a tertiary hospital's CT centre in Cape Coast, Ghana. MethodAll head CT scans secondary to trauma for the period January 2016 to December 2018, were retrieved and carefully analysed. A total number of 1043 of head CT scan images were analyzed by Consultant Radiologists. ResultsResults showed out of 1043 CT scans reviewed, 742 (71,1%) were males and 301 (28.9%) were females. A total of 609 (58.4%) out of the 1043 patients sustained NOIs of various anatomical types. More Males 398 (65.4%) sustained NOI than females 211 (34.6%). The incidence of NOI was more among the youth as majority 167 (27.4%) of the patients were within the 18–29 years followed by 30–39 years bracket of 148 (24.3%). Fourteen anatomical types of NOI were elicited and further analysis revealed, intra-ocular foreign body to be the highest 107 (17.6%) cases, orbital floor fractures injury was 92 (15.1%) cases, with globe rupture injury and intraocular hemorrhage recording 79 (13.0%) cases each. Optic nerve injury was the least revealing 7 (1.1%) cases. There was a relationship between the gender of patient and the propensity to sustain NOI as males were more disposed to NOI than females. Road traffic accident (RTA) was the main pervasive cause of TBI and this accounted for 71.9% of all cases, followed by fall from height 24%, and the least cause of TBI was ascribed to gunshot injury of 0.33%. ConclusionPrevalence of NOI is high. Urgent measures must therefore be implemented to reduce the RTA menace in general and to mitigate the associated NOI and possible loss of vision thereof.

Genere violence prevention and collective efficacy in young woman from violent contexts

An intervention program with women victims of gender violence is designed and addressed evaluating effects on social effectiveness by analyzing: perceptions, sensations and adverse behaviors that have an impact on their health and reduce their quality of life. Self-regulated group techniques were used. The sample consisted of 66 women, in the age range of 17 to 21 years, 33 women in the treatment group and 33 women in the control group. A workshop was designed to identify risk factors and promote coping strategies for proactive adaptation. For this effect, we worked with a quasi-experimental design using repeated measures, Ex ante (pretest)-intervention-Ex post (posttest), with a control group. It was carried out in a weekend mode for 11 weeks in a 6-hour workshop mode, a total of 66 hours. The intervention addressed pro-social strategies considering risk factors, endemic aspects of violence, among others, modulation of negative cognitive and behavioral processes and of physio-affective responses labeled to lead at risk to the evolution of individual pathologies that normally lead to depression processes, generalized anxiety, chronic stress and post trauma nature. The program exerted significant changes determined by the analysis of variance and of moderate to high effects demonstrated by Cohen’s d, the differences in pre and post-treatment means in pro-social aspects, in terms of risk factors, among others, in the Negative cognitive and behavioral processing and physio-affective responses that shaped traits of generalized anxiety, and post-traumatic stress in young women.

The role of microfinance post trauma: the case of Syria

ABSTRACT Microfinance emerged in the 1970s as a strategy to reduce the vulnerability of the poor and to promote microenterprise. The literature showed that microfinance plays a vital role as a tool for reconstruction in post-conflict communities and this urged the researcher to study the extent to which microfinance can be used as an effective tool for post-trauma reconstruction. The methodology was based on obtaining primary data by raising questions in structured interviews with the officers of microfinance institutions in Syria and obtaining secondary data from their financial reports. The study was conducted at four institutions engaged in microfinance which together represent the population. The descriptive analysis of the data gathered to demonstrate the real role these institutions played. The main conclusions were: The European Investment Bank played a prominent role in supporting microfinance institutions in Syria beside to small and medium enterprises; the distribution of microfinance institutions in Syria did not cover the whole of the country; microfinance institutions make finance accessible to women and encourage them to participate in the economy particularly in rural areas; the typical loan-level microfinance institutions provide is considered inconsequential for financing working capital to entrepreneurs; microfinance institutions charge interest on a monthly basis, the rate amounting on average is around 18–24 per cent annually, even though their main role is assisting in promoting the economy; loans financed by all of the microfinance institutions covered most economic activities; microfinance in alignment with Islamic principles was not accessible.

Occlusal Analysis Using T-Scan in Patients With Condylar Fractures When Managed by Closed Method.

The aim of the study is to assess the occlusion in mandibular condyle fractures using T-Scan and analyze the data obtained. Twenty patients underwent non-surgical management for condylar fractures were treated with Erich arch bar and guiding elastics, and periodically subjected to T-Scan III evaluations. The data obtained was analyzed with the clinical evaluation conducted. There were 18 males and 2 females. Mean age of the patients was 25.4 ± 7.4 years. There were statistically no significant changes in Centre of Force values, in Bite Force at First Contact (P < 0.05) during the study period. There were significant differences in Maximum Bite Force between preoperative and postoperative values, preoperative and sixth-month values, postoperative and first-month values, first-month and sixth-month values. There were significant (P < 0.05) differences in Bite Force at Maximum Intercuspation between preoperative and third month, preoperative and sixth-month values, postoperative and sixth-month values, first-month and consequent follow-ups. Subjective evaluation of occlusion revealed significant differences (P < 0.05) between preoperative and 1-month, preoperative and postoperative, postoperative and 1-month values. All patients improved by the end of 6 months with regards to their mouth opening. The center of force does not alter significantly in post trauma period. Mouth opening improves significantly at the end of 6-month period post-operative. Improvement in maximum bite force and maximum intercuspation take place simultaneously. Mouth opening improved significantly. Subjective evaluation of occlusion does not change significantly after the third month evaluation. Longer follow-ups would help us in understanding when or if the bite forces equilibrate after a condylar trauma.

Proximal And Distal Femur Replacement For Patient With Non Union Fracture Of Intertrochanteric And Supracondylar Of Femur In A District Hospital

Introduction:Non-union of intertrochanteric and supracondylar fractures of femur are uncommon which results in pain and functional disability, presenting major surgical challenge. We wish to report on two cases regarding endoprosthesis as management for non-union.Case Presentation:Patient A is 54 years old lady sustained closed comminuted intertochanteric fracture of right femur (31A2.3). She underwent open reduction, intramedullary nail with cerclage wire on day 3 post trauma. At 6 months, there is sign of avascular necrosis of femur head with non-union fracture site. Patient still complaining of pain, on non-weight bearing ambulation. At 1 year, patient underwent right proximal femur replacement. At 3 months post replacement, she is able to full weight bear with walking cane without pain. Patient B is 56 years old gentleman sustained Grade IIIa open comminuted fracture of right supracondylar with intercondylar split (33C2.2). He underwent emergency wound debridement, screw fixation with high tibial pin insertion. At 4 months, he underwent distal locking plate of right femur with synthetic bone grafting. At 8 months post fixation, there is non-union comminuted fracture of supracondylar, still unable to weight bear. At 1.5 year post trauma, patient underwent right distal femur replacement. At 3 weeks post replacement, he is able to full weight bear without aid.Discussion:Most failures of treatment occur in unstable fracture patterns of hip. (1) Endoprosthesis may provide as alternative treatment if internal fixation are recognized to be suboptimal, amount and quality of remaining distal bone stock and level of the non-union. (2,3) In both our cases, patient experienced marked improvement in functional capacity and pain free, which are the hallmarks of a successful salvage procedure. (4)Conclusion:Endoprosthesis can be consider as alternative treatment for non-union intertrochanteric and supracondylar fracture of femur, hence providing stable joint, pain free and early return to daily activities.

Single dose of anti-high mobility group box 1 protein (HMGB-1) neutralizing antibody ameliorates dysregulated inflammation and restores fracture healing in a polytrauma rat (Rattus norvegicus) model

Abstract Polytrauma (PT) is associated with dysregulated inflammation (DI) and complicated/delayed fracture healing. We recently reported delayed fracture healing and increased circulating levels of HMGB-1 in a rat model of PT compared to osteotomy (OST). Since HMGB-1 binds to and activates TLR2, TLR4 and RAGE surface receptors to induce pro-inflammation, we investigated this protein’s role in delayed healing. We hypothesized that neutralization of cell-free HMGB-1 immediately after PT would resolve DI and restore fracture healing in PT. Anti-HMGB-1 polyclonal antibody (2mg/kg) was administered via IP injection following PT (PT-Ab) and bone/tissue volume (BV/TV) of fractures was evaluated by micro-CT imaging at 5 weeks post PT. As hypothesized, by neutralizing HMGB-1, fracture healing was improved with significantly higher BV/TV ratio in PT-Ab compared to PT rats. Changes to circulating CD68+ CD86+ (M1) and CD68+CD163+ (M2) monocyte/macrophage populations, as well as alterations to CD4+ and CD8+ T cells and their RAGE and TLR4 surface expression, were assessed on 1 and 3 days post-injury (d). While circulating M1 and M2 populations are scarce in naïve rats, these populations elevated post trauma. M1 was significantly higher in PT than in OST and PT-Ab at 1d but not at 3d. M2 was significantly high in only OST at 1d. In contrast to OST, we observed decreased RAGE and TLR4 expression on circulating T cells at 1d in PT and PT-Ab and at 3d in PT but not in OST and PT-Ab. Our observations suggest that elevated levels of HMGB-1 following severe trauma initiate immune dysregulation causing delayed fracture repair and the data presented herein indicates that HMGB-1 may be a therapeutic target to restore normal immune response and normal fracture healing in PT.

Tension Viscerothorax in a Patient with Missed Traumatic Diaphragmatic Hernia. A Case Report.

Background: Diaphragmatic hernias occurring post trauma are a challenge to diagnose early especially when they follow blunt trauma. Many of those diagnosed early occur in penetrating thoraco-abdominal trauma which necessitates emergency exploration where the diagnosis is picked. Rarity of traumatic diaphragmatic hernia coupled with poor sensitivity of easily available imaging modalities makes it a big challenge to pick up this potentially fatal pathology.&#x0D; Case presentation: We present a rare case of tension viscerothorax in a young man who had presented to the emergency department at a provincial hospital of Rwanda three days before the second consultation where the chest x-ray was interpreted as normal and later as a pneumothorax before the diagnosis and treatment of tension viscerothorax could be made.&#x0D; Conclusion: Viscerothorax is an elusive diagnosis which when missed can complicate to strangulation of hernia contents or tension viscerothorax which carry a high mortality.

Serum alkaline phosphatase: A prospective biomarker for assessment of progress of fracture healing in diaphyseal fractures of long bones in adult patients

Introduction: Serum biomarkers such as Alkaline Phosphatase can be used to assess bone-forming activity. Studies have shown that the measurement of bone formation markers such as Serum Alkaline phosphatase during the fracture healing process could enhance the accuracy of the bone healing stage assessment, allowing early detection in patients at risk of the development of delayed union or non-union. Aims: To evaluate the changes of serum alkaline phosphatase levels during healing of diaphyseal fractures of long bones in adults treated operatively. Materials and methods: A hospital based prospective study was conducted in the Department of Orthopaedics, Silchar Medical College and Hospital, Assam. 91 adult patients ranging from 18 yrs to 50 yrs with diaphyseal fractures of the tibia or femur who met the inclusion criteria were recruited in our study. Patients with systemic diseases and drugs intake which could affect the bone turnover were excluded from our study. The fractures were treated with closed reduction or open reduction and internal fixation with intramedullary nailing. The biomarker serum Alkaliine Phosphatase was measured at definite intervals until bony union was achieved clinico-radiologically. Results: Out of the 91 patients, 36 patients (Group A=normal healing group) achieved bony union by the end of 6 months. 50 patients (Group B=delayed healing group) where bony union was not completed by the end of 6 months but completed by 9 months. 5 patients (Group C=non-union group) where bony union was not seen even by the end of 9 months. At the time of admission, mean serum ALP levels remained within normal limits in all the three groups. Mean serum ALP levels followed the same pattern in Group A and Group B reaching the maximum levels at 3rd week post trauma but the mean serum ALP at every selected interval was significantly higher in Group A than Group B. In Group A, the mean serum ALP returned to baseline level by the end of 6 months, whereas, in Group B patients, the mean serum ALP remained elevated even by the end of 6 months. In group C patients, the mean serum ALP level did not rise significantly throughout the period of study. Conclusion: Thus, the determination of serum ALP levels during the fracture healing could be an additional tool to help predict fractures at risk of delayed union or non-union of diaphyseal fractures therby allowing the clinician to step in early and take appropriate intervention.

Traumatic appendicitis: Is it a fairy tale? A literature review

Acute appendicitis is the most common surgical condition in patients presenting to emergency departments worldwide. It was only in the early 1930s that the relationship between blunt trauma and acute appendicitis was reported. Searches on the terms “traumatic appendicitis” and “appendicitis post blunt trauma” in PubMed, Google, and Medline yielded 23 full-text articles about traumatic appendicitis. The articles reported on acute post-traumatic appendicitis. Nevertheless, the relationship between acute appendicitis and trauma is still controversial. A few theories have attempted to explain the relationship; however, a definitive cause has not yet been identified. A patient presenting with right iliac fossa or diffuse abdominal pain after a traumatic event should be investigated, and acute appendicitis should be included in a differential diagnosis.

Role of Magnetic Resonance Imaging in Evaluation of post traumatic Vertebral Column

Abstract Background Trauma of the vertebral column is potentially devastating as they may lead to significant neurological damage as the clinical and prognostic spectrum of the effects of spinal injuries is vast. Timely imaging studies can help mitigate these possibly life threatening complications. There is a dearth of studies that purely evaluate the role of MR imaging after spinal trauma. Aim of the work Hence, this study was undertaken to assess the ability of MRI in identifying traumatic injuries to the tissue structures of the spine. Methods The study performed over 20 cases after spinal vertebral traumatic injuries then underwent MR imaging in the period 2016 till March 2018. The osseous and non-osseous structures namely; Para vertebral tissues, Vertebrae, Anterior Longitudinal Ligament (ALL), Posterior Longitudinal Ligament (PLL), Intervertebral Disc, Ligamentum Flavum, Interspinous Ligament and the Spinal Cord were evaluated. The data were classified to; patient's age, sex, mode of trauma, region of imaging, main findings, associated findings and others. The statistically significant and non-significant relations between primary data and different post-traumatic findings of MRI were thus calculated. Results Of the 20 patients, 85% of patients were male, common ages affected were 20-30 and &amp;gt;40 years with 30% for each. The site of injury was the cervical spine (30%) and thoracolumbar spine was the next highest in occurrence with 25%. L1 was the commonest level exposed to fracture (30%). Cord compression was the commonest MRI main finding in post trauma (60 %), but syrinx was (5%). In associated findings; the spinal muscles spasm was the commonest (40%) and ligamentum flavum injury comprised (15%). Bone marrow edema was the highest (35%) as other findings. There were statically significant relations between age and T12 vertebral fracture and between mode of trauma and facet joint affection. Conclusion MRI was found to be the best modality in detecting injuries to the spinal cord and the ligaments and as well as for detection of vertebral fractures and also bone marrow edema. Though more studies required for further highlight the advancing ability of the MRI.

IMPACT OF THE PRESENCE OF ATRIAL FIBRILLATION ON OUTCOMES IN PATIENTS PRESENTING TO THE HOSPITAL WITH TRAUMATIC INJURIES

Atrial fibrillation (AF) alters anabolism and delivery of inflammatory mediators and oxygenated blood to damaged tissues post trauma, but has been relatively poorly studied in its direct effect in trauma victims which we aimed to evaluate. Retrospective matched control review was performed on

Surgical ciliated cyst of the left maxilla - A case report of unusual pathogenesis

Introduction:Surgical ciliated cyst (SCC) is a type of true epithelial lined antral cysts, which mostly occurs in maxilla from the sinonasal mucosa and gland, comprising 20% of all oral cysts in Japan. It is also called as postoperative maxillary cyst or postoperative paranasal cyst. The etiology is believed to be post trauma or surgery in the region of maxillary antrum.Patient concerns:Patient's concern is less evident in this cystic pathology, because this cyst even though an aggressive cyst, presents with fewer symptoms that can be uncomfortable to the patient or push them to seek medical attention. Often, this becomes an incidental finding during routine postoperative follow-up.Rationale:The rationale behind this report is to emphasize even a traumatic extraction of tooth can damage the floor of the sinus and lead to the cyst formation.Report:We report a case of SCC in a 76-year-old female of the left maxillary sinus possibly after a traumatic extraction of the tooth, for which enucleation of the cyst was done as a primary modality of treatment.Diagnosis:Diagnosis was made after a computed tomography (CT) scan and incisional biopsy. Diagnosis of such rare cases poses a great challenge due to its paucity in etiology, and it often requires a CT scan that becomes an essential gold standard investigation.Outcomes:Patient is currently under one year follow up and without any signs of recurrence.Lessons:It should be acknowledged that tampering trauma or with sinus mucosa can trigger the formation of a SCC of the maxilla, and it should always be considered as a possible sequel after any procedure of such potential in the maxilla.

Posterior keratoconus in a patient with familial exudative vitreoretinopathy.

Posterior keratoconus is a rare nonprogressive noninflammatory condition unlike anterior keratoconus. It can be congenital or acquired, sporadic or familial, unilateral or bilateral. Bilateral sporadic posterior keratoconus is an extremely rare entity (as bilateral cases are predominantly familial). It is associated with many systemic and ocular features. Various posterior segment manifestations are described in association with posterior keratoconus. We describe a case of FEVR in the setting of bilateral sporadic posterior keratoconus. An occurrence was not reported previously. A 17-year-old male presented with gradual painless diminution of vision OU for 2 years and nystagmus since birth. There was no history of trauma or ocular surgery. Family history was noncontributory. Best-corrected visual acuity (BCVA) was 20/600 in OD and 20/1200 in OS. Deep-set eyeballs with horizontal pendular nystagmus of low frequency and low amplitude were noted. Slit-lamp examination revealed OU localized depression of posterior corneal curvature measuring 4 mm in diameter suggestive of posterior keratoconus [Fig. 1a and d], which was confirmed on anterior segment OCT [Fig. 1b and e]. Typical oil droplet reflex was noted on retro-illumination [Fig. 1c and f]. Rest of the anterior segment was normal in OU.Figure 1: (a-c) slit-lamp photograph of OD showing posterior keratoconus, anterior segment OCT of OD showing posterior keratoconus, clinical photograph in retroillumination. (d-f) slit-lamp photograph of OS showing posterior keratoconus, anterior segment OCT of OS showing posterior keratoconus, clinical photograph in retroilluminationDilated fundus examination of OU revealed small, tilted optic disc with gliotic changes on its surface. Old rhegmatogenous retinal detachment was seen along with multiple subretinal bands [Fig. 2a and b] in bilateral eyes. Tortuous retinal vessels with supernumerary branches ending short of equator were noted, leaving peripheral retina avascular. These findings were confirmed on UWFA [Fig. 2c and d]. In addition, peripheral lattice degeneration in temporal retina with multiple holes was observed OU. Based on clinical and diagnostic evidences, patient was diagnosed to be a case of both eye posterior keratoconus with associated FEVR and RD.Figure 2: (a and b) wide-field clinical photograph of fundus OD showing attached retina with temporal buckle indent with lattice with hole with temporal avascular retina, FFA showing temporal avascular retina. (c and d) wide-field clinical photograph of fundus of OS showing retinal detachment with subretinal band with temporal avascular retina, FFA showing temporal avascular retinaAfter informed consent, the patient underwent scleral buckling surgery in OU sequentially. One month postoperatively, BCVA improved to 20/120 in OD and 20/200 in OS with retina attached. The patient was advised regular follow-up. Discussion Posterior keratoconus is developmental in most cases and is due to anterior chamber cleavage anomaly.[1] Acquired causes, on the other hand, are rare and mostly post trauma.[2] There is constellation of posterior segment features quoted in the literature that can occur along with posterior keratoconus with undetermined genetic linkage.[345678] Our patient had a unique association of bilateral sporadic posterior keratoconus with FEVR, which to our knowledge never reported earlier. Atypical presentation of FEVR with associated retinal detachment and subtle posterior keratoconus makes our case a diagnostic challenge. To conclude, FEVR can occur in the setting of posterior keratoconus. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Bridging the Gap: A novel use of rib plating post blast chest wall trauma.

Introduction: Surgical rib fixation is an evolving area for trauma medicine and the indications incorporate both physiological and anatomical factors. The level of bony destruction involved in the fracture fragments is only a relative indication, as those with preserved respiratory function may not truly need surgery. We describe a case where the chest injury led to bone loss between the fracture fragments, creating concern for the development of lung herniation. His respiratory function was preserved with an intercostal drain, however the level of tissue loss meant the injury undoubtedly required surgical fixation. Case report: A 37-year-old male sustained a chest wall injury after metal pipe was flung onto his right chest in a workplace accident. The injury led to a significant tissue loss on his chest wall leading to a flail segment involving right sided ribs of 5, 6, and 7. Furthermore, there was such destruction of his 7th rib that there was bone loss. He required mesh repair of his chest wall to prevent lung herniation, along with fixation of ribs 5, 6 and 7. The rib plate on rib 7 was used to bridge the gap of the bone defect and the soft tissue defect was closed with a latissimus dorsi flap. Conclusion: This case report describes a novel use of rib plating used to bridge a bone defect sustained after a secondary blast injury, the first documented case to our knowledge.

Trauma in Primary Teeth at a Specialized Service Center: Retrospective Cohort

Objective: To evaluate the factors associated with the occurrence of dental trauma in children up to six years of age and describe the results of clinical follow-up and possible sequelae. Material and Methods: A retrospective study was carried out with data collected from the dental records of 96 pediatric patients up to 6 years old with traumatized primary teeth who sought care from the. Pediatric Dental Trauma project of a private university in the city of Rio de Janeiro from July 2014 to July 2017, and who had clinical and radiographic follow-up for up to three months as of their initial visit. Results: 96 children (58.3% boys and 41.7% girls) included who presented 166 traumatized primary teeth. Intrusion was the most observed type of trauma and in 45.8% of cases, the care occurred one-week post trauma. The maxillary central incisors were the most affected teeth (97.6%). The prognosis of the dental elements with more than 3 months of follow-up was considered favorable, and 59.6% of the teeth did not present any clinical or radiological sequelae. Oral hygiene instruction and monitoring were the most common approaches. Conclusion: The prevalence of dental trauma in the present study was high and occurred mainly in domestic settings. The upper central incisors were the teeth that suffered the most injuries. The presence of patients at follow-up visits was an important factor for the positive result in most cases.

Epidemiological profile of fatal burn cases in tertiary care centre of Lucknow: An observational study

Burn is one of the most common injuries which has been recognized as public health problem. It affects nearly every population and every geographical zone in the world and have always been considered as one of the most destructive injuries, causing not only morbidity and mortality but also major economic and psychological impacts. This study intends to explore the medicolegal aspects and recent epidemiological trends of burn cases. This is an autopsy based cross sectional observational study from a period of August 2015- July 2016 and was carried out in the department of Forensic Medicine and Toxicology, King George's Medical University, Lucknow, Uttar Pradesh. Cases were thoroughly studied using specially designed proforma that include demographic profile of deceased, history from relatives, police and hospital records and autopsy findings. A total of 550 burn cases were studied for which significant information regarding epidemiological and medicolegal aspects have been obtained. Out of 550 cases, majority were females 70.18%. Male: Female ratio was 1:2.35. The age of the victims ranged from age 7 months to 84 years and mean age was 28.98+11.65 years. Most common affected age group was 21–30 years (47.45%). Majority of cases were married. A statistically significant (p=0.019) higher proportion of married cases were found among female. Majority of the cases were housewives (60.97%), followed by students (15.80%), farmers (11.52%), businessmen (4.83%) and laborers (4.46%). Majority of the cases, 82.55% occurred at home and only 2.91% at workplaces, rest 14.55% cases occurred elsewhere. The majority of the cases occurred in Summer and Winters seasons (38.91%and37.91%), while least number of cases were seen during Monsoon season (6.36%). Majority of burn injuries were found to occur between 2:00 pm -10:00 pm. Flame was the most common type of causative agent in males as well as in females, however difference in causative agent of burn injuries of female and male cases was found to be statistically significant (p 80% (36.73%), while in 2.18% cases %TBSA was 1–20%. Commonest manner of death among burn injury cases was found to be accidental. And also, among accidental cases, proportion of males was higher than females, while proportion of females was higher in homicidal and suicidal cases. This study highlights the parameters that should make the clinician reassess the course of treatment, warning that the patient might be critically near death. For example, the probability of sepsis increases with prolonged ICU stay. Patient's age and % TBSA affect the mortality of post trauma victim.