Post-traumatic Injury Research Articles

Assessment and management of shoulder pain at primary care level.

Most patients with shoulder pain will initially visit their community health centre, private general practitioner or family physician, with various levels of experience in the assessment and management of shoulder conditions. Shoulder conditions will range from early, simple ailments that can be treated in the primary care setting, to post-traumatic injuries and complex pathologies requiring the expertise of an orthopaedic surgeon or a fellowship-trained shoulder surgeon. Correct assessment of the patient’s shoulder condition at the index consultation is a prerequisite for appropriate management. This article sets out straightforward guidelines to help general practitioners confidently identify the patient’s source of shoulder pain and initiate an appropriate management plan at primary care level. Criteria for urgent and elective referral for specialist care are also outlined.

Study of Traumatic Head Injuries Using Computed Tomography

The aim of this retrospective research was to study traumatic head injury (THI) using CT scan and to classify the types of head trauma fractures and types of hemorrhages. Methods and Results: The current study included 53 THI patients (43/81.1%) males and 10/18.9% females) with positive and negative CT scan findings. A complete clinical history and patients’ data were taken from CT reports, which included age, gender, type of trauma, associated injury, and CT findings with their percentages. The study was carried out in Taif city in King Abdelaziz Hospital and King Faisal Hospital. The distribution of various etiologies of THI has shown that the most common etiology was road traffic accident (RTA) (45.3%). The typical age for THI was between 21 to 30 years old (26.4%). The distribution of the traumatic causes for each age group is shown in Table 1. The typical age for RTA was the age group of 11-20 years (33.3%), for falls – the age groups of 0-10 years (33.3%) and over 60 years of age (33.3%). The frequency of various CT findings of THI was as follows: intracranial hemorrhage (56.6%), fracture (39.6%), pneumocephalus (22.6%), contusion (22.6%), foreign body (11.3%), and proptosis (3.8%). The distribution of fracture cases, according to their types, was as follows: a linear fracture (76.2%), comminuted fracture (23.8%), basilar fracture (14.3%), and depressed fracture (9.5%). The frontal bone was the most affected site with fractures (30.7%). Conclusion: CT is an appropriate clinical modality used in the management of THI patients in the emergency department. CT has the advantage of being fast, safe, available, sensitive to most acute post-traumatic injuries, accurate in identifying the head abnormalities such as fractures and hemorrhage during the first 24 hours after injury, which is beneficial in the early assessment, therapy planning, monitoring, and long-term patient care.

Systemic and local cardiac inflammation after experimental long bone fracture, traumatic brain injury and combined trauma in mice

BackgroundTrauma is the leading cause of death and disability worldwide, especially in the young population. Cardiac injuries are an independent predictor for a poor overall outcome after trauma. The aim of the present study was to analyze systemic inflammation as well as local cardiac inflammation after experimental limb-, neuro- and combined trauma in mice.MethodsMale C57BL/6 mice received either a closed tibia fracture (Fx), isolated traumatic brain injury (TBI) or a combination of both (Fx ​+ ​TBI). Control animals underwent sham procedure. After 6 and 24 ​h, systemic levels of inflammatory mediators were analyzed, respectively. Locally, cardiac inflammation and cardiac structural alterations were investigated in left ventricular tissue of mice 6 and 24 ​h after trauma.ResultsMice showed enhanced systemic inflammation after combined trauma, which was manifested by increased levels of KC, MCP-1 and G-CSF. Locally, mice exhibited increased expression of inflammatory cytokines (IL-1β, TNF) in heart tissue, which was probably mediated via toll-like receptor (TLR) signaling. Furthermore, mice demonstrated a redistribution of connexin 43 in cardiac tissue, which appeared predominantly after combined trauma. Besides inflammation and structural cardiac alterations, expression of glucose transporter 4 (GLUT4) mRNA was increased in the heart early after TBI and after combination of TBI and limb fracture, indicating a modification of energy metabolism. Early after combination of TBI and tibia fracture, nitrosative stress was increased, manifested by elevation of nitrotyrosine in cardiac tissue. Finally, mice showed a trend of increased systemic levels of cardiac troponin I and heart-fatty acid binding protein (HFABP) after combined trauma, which was associated with a significant decrease of troponin I and HFABP mRNA expression in cardiac tissue after TBI and combination of TBI and limb fracture.ConclusionMice exhibited early cardiac alterations as well as alterations in cardiac glucose transporter expression, indicating a modification of energy metabolism, which might be linked to increased systemic- and local cardiac inflammation after limb-, neuro- and combined trauma. These cardiac alterations might predispose individuals for secondary cardiac damage after trauma that might compromise cardiac function after TBI and long bone fracture.Translational potential statementInjuries to the head and extremities frequently occur after severe trauma. In our study, we analyzed the effects of closed tibia fracture, isolated TBI, and the combination of both injuries with regard to the development of post-traumatic secondary cardiac injuries.

A Prospective Study on the Incidence and Outcome of Cranial Nerve Injuries in Patients with Traumatic Brain Injuries

Abstract Background Posttraumatic cranial nerve injuries are not uncommon and can occur by shearing forces, rapid acceleration/deceleration, or injury to the skull base. The incidence of cranial nerve injury in craniocerebral trauma varies between 5 and 23 percent in various literature. Methodology A prospective study was conducted on the incidence and outcome of cranial nerve injuries (CNI) in 256 consecutive cases of traumatic brain injuries (TBI). Patients over the age of 5 years with a follow-up of 6 months in the period from September 2017 to November 2018 in our institution were sampled. Results A total of 256 patients were included in our study. The incidence of CNI in TBI patients was 14.8% (38 patients). Facial nerve was the most common cranial nerve to be involved, followed by olfactory nerve and vestibulocochlear nerve. Cranial nerve injury was more common in patients with severe head injury (p < 0.005), younger age group, associated base of skull fractures (p < 0.001), and facial fractures (p < 0.005). Twenty-eight patients (73.7%) had a delayed presentation of CNI (p < 0.001). Of the 73.6% patients who recovered, 16 (42%) patients had partial recovery, while 12 (31%) patients had complete recovery. Younger age group (p < 0.05) and delayed onset of deficit (p < 0.001) were associated with significant better outcome. Conclusions CNI are a major cause of morbidity in TBI patients. All patients admitted with TBI should be examined meticulously for CNI on follow-up.

Falanga: The clinical correlates of surgical outcomes as a result of foot whipping in a resource poor setting

BackgroundFalanga is a punishment that involves hitting the bare soles of a person's feet. The consequences of this punishment may be limb and life-threatening. Post-traumatic acute kidney injury (AKI) secondary to rhabdomyolysis is a well-documented complication. Patients often require prompt surgical intervention and renal replacement therapy (RRT). The clinical and biochemical presentation of these patients and subsequent outcomes are poorly understood. AimsThis prospective observational study describes the clinical presentation and effects of foot whipping on patient outcomes. MethodologyProspective data were collected over a one-year period for 135 patients presenting following blunt force assault admitted to a single centre. Presenting clinical characteristics and patient outcomes were recorded and correlations between presenting clinical characteristics and surgical and clinical outcomes were assessed. ResultsOf 138 patients presenting following blunt force assault 96% were male with a mean age of 28.8 ± 8.01. Thirty-six out of the 138 patients presenting following blunt force assault had received foot-whipping only (falanga group, FG). Ten of these 36 patients in the FG group required surgical intervention, with one requiring a below knee amputation, compared with only two patients who required surgical intervention in the group who experienced blunt force trauma not restricted to foot whipping (Sjambok group). Average length of stay was 4 days (range 2-38) in FG group compared with 5 (range 1-21) in SG group, with no mortalities in either group. For patients in the FG, Hb was higher at presentation compared to patients in the SG group (135.2 33.7 vs 124.2 21.3, p = 0.03) and correlated positively with the need for surgical intervention (r = 0.6, p < 0.01). In this same group, the presenting characteristics of CK (4251.3 3087.4, p = 0.1 vs 7422.6 12347.7, p = 0.1) and urine output (0.95 0.4 vs 0.7 0.4) positively correlated with RRT [CK r = 0.6, p < 0.01, UO r = 0.46, p < 0.01]. ConclusionPatients who present following falanga frequently require surgical intervention and the related healthcare utilisation and morbidity is high. Clinical indicators of a greater systemic injury at presentation may correlate with an increased likelihood of requiring surgical intervention or RRT.

Emergency Endovascular Treatment of Recurrent Internal Carotid Artery False Aneurysm Complicated By Carotid-Cutaneous Fistula and Life-Threatening Bleeding

Background: Carotid pseudoaneurysms can generally be the result of arterial wall degeneration developed after carotid endarterectomy, previous spontaneous carotid dissection, post-traumatic neck injuries, non-vascular procedures and, rarely, infections. The ideal surgical management of extracranial carotid artery false aneurysms is still controversial and treatment should be tailored to the aneurysm’s aetiology, anatomy and presentation. Case presentation: We describe the case of an 81-year-old man presented with an enlarged pulsatile cervical mass coupled with a small cutaneous fistula, which had developed in roughly 1 year. He had undergone several carotid operations over the last 15 years (endarterectomy, venous-patch-angioplasty for restenosis and bovine-pericardial patch-angioplasty for a pseudoaneurysm). Methods: A CT-Scan revealed a recurrent pseudoaneurysm. Due to the previous multiple cervicotomies, the aneurysm wall was very closely adjacent to the skin plane; no gas bubbles or cervical fluid collections were evident. The patient rejected treatment at first, but six months later suffered major bleeding from the fistula. Results: The pseudoaneurysm was emergency excluded with a Viabhan-Stent-graft while the external carotid artery was occluded via vascular-plug. The fistula healed spontaneously in four months. There was no pseudo-aneurysm recurrence, endoleak or any sign of graft infection at 36-month follow-up. Conclusion: We present a singular case of emergency endovascular treatment of recurrent post-surgical internal carotid artery pseudoaneurysm complicated by a carotid-cutaneous and life-threatening bleeding. In these cases emergency endovascular treatment via covered-stent-graft represents the most effective, definitive or “bridge” management option. Carotid sheath protection via a myo-cutaneous flap could be considered in cases of previous multiple cerivcotomies.

The Diagnostic Value of Magnetic Resonance Imaging in Posttraumatic Trigeminal Neuropathic Pain.

To evaluate the diagnostic value of non-nerve-selective MRI sequences in posttraumatic trigeminal neuropathic pain (PTNP). This study retrospectively analyzed all MRI protocols performed between February 2, 2012 and June 20, 2018 commissioned by the Department of Oral and Maxillofacial Surgery, University Hospitals Leuven. Demographic, clinical, and radiologic data were extracted from the records of patients with an MRI in the context of PTNP. A contingency table was constructed based on the opinions of the treating physician and the radiologist who initially evaluated the MRI. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. The sample consisted of 27 women (65.9%) and 14 men (34.1%). The sensitivity and negative predictive value of MRI in PTNP were 0.18 and 0.77, respectively. Artifacts interfered with visualization of a possible cause of the trigeminal pain in 24.4% of MRIs. Almost all artifacts (90%) were caused by metal debris originating from the causal procedure or posttraumatic surgeries. MRI resulted in changed management for PTNP patients only once. The diagnostic value of non-nerve-selective MRI sequences for PTNP is low and has little impact on clinical management. Therefore, there is a need for dedicated sequences with high resolution and low artifact susceptibility for visualizing the posttraumatic injuries of the trigeminal branches.

Club Cell Protein 16 Attenuates CD16brightCD62dim Immunosuppressive Neutrophils in Damaged Tissue upon Posttraumatic Sepsis-Induced Lung Injury.

Background Recently, identification of immunosuppressive polymorphonuclear leukocytes (PMNL) that were traditionally described as proinflammatory cells emerged in the field of posttraumatic immunity. To understand their local and remote distribution after trauma, PMNL-subsets and the impact of immunomodulatory Club Cell protein (CC)16 that correlates with pulmonary complications were assessed. Methods C57BL/6N mice were divided into three groups, receiving isolated blunt chest trauma (TxT), undergoing TxT followed by cecal ligation and puncture (CLP, TxT + CLP) after 24 h, or sham undergoing analgosedation (n = 18/group). Further, each group was subdivided into three groups receiving either no treatment (ctrl) or intratracheal neutralization of CC16 by application of anti-CC16-antibody or application of an unspecific IgG control antibody (n = 6/group). Treatment was set at the time point after TxT. Analyses followed 6 h post-CLP. PMNL were characterized via expression of CD11b, CD16, CD45, CD62L, and Ly6G by flow cytometry in bone marrow (BM), blood, spleen, lung, liver, and bronchoalveolar and peritoneal lavage fluid (BALF and PL). Apoptosis was assessed by activated (cleaved) caspase-3. Results from untreated ctrl and IgG-treated mice were statistically comparable between all corresponding sham, TxT, and TxT + CLP groups. Results Immature (CD16dimCD62Lbright) PMNL increased significantly in BM, circulation, and spleen after TxT vs. sham and were significantly attenuated in the lungs, BALF, PL, and liver. Classical-shaped (CD16brightCD62Lbright) PMNL increased after TxT vs. sham in peripheral tissue and were significantly attenuated in circulation, proposing a trauma-induced migration of mature or peripheral differentiation of circulating immature PMNL. Immunosuppressive (CD16brightCD62Ldim) PMNL decreased significantly in the lungs and spleen, while they systemically increased after TxT vs. sham. CLP in the TxT + CLP group reduced immunosuppressive PMNL in PL and increased their circulatory rate vs. isolated TxT, showing local reduction in affected tissue and their increase in nonaffected tissue. CC16 neutralization enhanced the fraction of immunosuppressive PMNL following TxT vs. sham and decreased caspase-3 in the lungs post-CLP in the TxT + CLP group, while apoptotic cells in the liver diminished post-TxT. Posttraumatic CC16 neutralization promotes the subset of immunosuppressive PMNL and antagonizes their posttraumatic distribution. Conclusion Since CC16 affects both the distribution of PMNL subsets and apoptosis in tissues after trauma, it may constitute as a novel target to beneficially shape the posttraumatic tissue microenvironment and homeostasis to improving outcomes.

Multivariate analysis of early surgical management factors affecting posttraumatic penoscrotal avulsion injury: a level I trauma center study

BackgroundTo conduct an accurate evaluation of patients presenting with posttraumatic penoscrotal injuries, and to formulate a treatment algorithm based on this assessment.MethodsWe conducted a retrospective chart review study. Patients with penoscrotal defects admitted to our level I trauma center from 2017 to 2019 were evaluated. The Braden scale score was used for wound evaluation and the Korean patient classification system (KPCS) was used for assessment of severity. Univariate and multivariate analyses were performed for potential risk factors associated with early surgical management.ResultsIn total, there were 58 male patients, and the average Braden scale score was 12.08 ± 2.54, with the scrotum (36.20%), and the penile shaft (32.76%) being popular sites for injuries. The wounds requiring surgical treatment were 20.68% (n = 12), with local flaps (33.33%) being most commonly used. The significant predictors of advanced wounds which required surgical treatment were old age (p = 0.026, odds ratio [OR] 8.238), orthopedic combined injuries (p = 0.044, OR 1.088), intubation (p = 0.018, OR 9.625), restraint (p = 0.036, OR 0.157) and blood transfusion (p < 0.001, OR 2.462).ConclusionIn multiple trauma patients, penoscrotal defects caused by high-speed trauma are an important matter of concern. Specifically, patients with combined skeletal injuries or requiring respiratory care were prone to advanced wounds. We proposed a five-category algorithm to manage such patients, which included severity of the patient’s condition, respiration, hemodynamic status, comorbidity, and immobilization. Additionally, inter-departmental cooperation and active intervention by plastic surgeons is needed for the comprehensive treatment of such injuries.Trial registration This study was performed in line with the principles of the Declaration of Helsinki. The study and all its protocols were approved by the institutional review board of Ajou Medical Center (approval no. AJIRB-MED-MDB-17-254). The need for informed consent was waived by the institutional review board of our hospital due to the retrospective design of the study.

En-Bloc Kidney Transplant Using an Aortic Extension from a Paediatric Multi-Visceral Donor to a Paediatric Recipient

Aim: To analyze the results of surgical treatment of cicatricial post-traumatic deformities of the breasts. Methods: There has been presented treatment experience of 149 patients with cosmetic and post-traumatic changes of the breasts in the clinical base of the Department of Surgery, Endoscopy and Reconstructive Surgery of DNMU. The number of the patients treated for post-traumatic cicatricial deformity was 34 patients (22.8%) aged 7 to 62 years. There were 27 injured of them (79.4%) with the consequences of burns, 2 (5.9%) after the complications of cosmetic surgeries, 5 patients (14.7%) were operated on for the consequences of cancer treatment and three of them (8,8%) were hospitalized for radiation ulcers. The patients underwent 54 surgical interventions: Free autodermoplasty 13 (24.1%); local flaps grafting 14 (25.9%); combined plastic surgery and endoprosthetics 13 (24.1%); expander dermatotension 5 (9.3%); plastic surgery with complex composite flaps 9 (16.7%). Results: The article gives a historical overview of breast reconstructive operations and the classification of their post-traumatic injuries. Depending on the anatomy of cicatricial damage to the chest wall and the breast an algorithm for reconstructive mammoplasty is generalized. When performing surgical interventions in patients with the consequences of any type of the injury the main task was to eliminate scar-modified skin, correct the elevation of the breast, functional disorders such as contractures and make normal development of breast tissue possible. In any case, the operation is aimed at releasing the breasts from scars and creating the conditions for their normal development in adolescents, as well as restoring the shape, size and the appearance of already formed breasts in case of the patients’ late appointment with a doctor. When eliminating breast deformities in women of mature age it is often rational to separate the nipple-areolar complex from cicatricial tissue and transpose it to its usual location. Conclusion: Good cosmetic results, stable restoration of the shape, position and the skin of the breasts deformed by scars were obtained during all surveys. Reconstructive operations contribute to a significant regression of psychological and social disorders in patients with cicatricial deformities after a burn injury, and therefore they improve their overall rehabilitation result. If it’s possible surgical treatment of cicatricial deformities of the anterior surface of the chest wall should be started before breast development in adolescent girls and they should be followed-up.

Outcomes of Non operative Treatment of Isolated, Acute Posterior Cruciate Ligament (PCL) Injury

1.1. Objectives: The aim of this study is to evaluate the results of non-operative treatment of acute, isolated PCL injury. 1.2. Study Design: Prospective Observational Study. 1.3. Setting: Orthopedics and spine unit, Hayatabad Medical Complex, Peshawar. 1.4. Method: 63 patients who had post traumatic PCL injury were recruited for our study). There were 23 partial PCL injuries and 40 total PCL injuries among the 63 knees. These 63 knees were subjected to a thorough subjective, objective, functional, and radiological examination. 1.5. Results: There was no discomfort in 38 knees (60%), mild pain in 14 knees (22%), and significant pain on exercise in 6 (9.5%) knees at the most recent follow-up examination (10 percent). In 54 knees (93%), there was no swelling, mild, intermittent swelling in three knees (5%), and moderate swelling on exertion in one knee (2 percent). Fifty-two patients (91%) experienced no giving way, whereas five patients (9%) complained of giving way on occasion, especially while walking downstairs. 1.6. Conclusion: We currently believe that patients with acute, isolated, complete PCL tears and up to 10 mm of posterior tibial translation (anterior border of tibial plateau flush with anterior surface of femoral condyles with knee in 90-degree flexion) can be treated non operatively and that the majority of patients can achieve a satisfactory functional result.

Functional Evaluation of Levator Scapulae Tendon to Supraspinatus in Adult Brachial Plexus Injuries.

Introduction Brachial plexus injuries are severe life-altering injuries. The surgical method to restore shoulder abduction in adult upper brachial plexus injuries involves the usage of nerve grafts and nerve transfers targeting the suprascapular and/or the axillary nerve. When the primary nerve surgery has been unsuccessful or recovery has been incomplete or with a late presentation, muscle transfer procedures are needed to provide or improve shoulder abduction. Levator scapulae to supraspinatus is a transfer to improve shoulder abduction in posttraumatic brachial plexus injuries. Material and Methods The study included 13 patients with the age ranging from 17 to 47 years with a mean age of 30 years. All these patients had preop shoulder abduction of Medical Research Council (MRC) grade ≤3. All had a minimum of MRC grade 4 of active elbow flexion. Eleven patients had primary surgery. Only patients with a minimum of 1 year postoperative follow-up were included. All 13 patients underwent levator scapulae transfer only. Results All patients had a stable shoulder postoperatively. The average increase in active shoulder abduction was from 6.15°(median: 0°) preoperatively to 61.92°(median: 60°), with an average gain in shoulder abduction of 49.61°(median: 50°). Conclusions Transfer of levator scapulae tendon to the supraspinatus is an option to improve shoulder abduction in posttraumatic brachial plexus. In conditions where supraspinatus alone is not functioning, levator scapulae is the best available transfer, considering its strength and maintaining the form of the shoulder unlike trapezius transfer. In patients with previous surgery where supraspinatus has recovered partially but not functionally significant, this tendon transfer can be considered for the augmentation of the existing shoulder abduction.

Multicentre review of intramedullary lengthening nails: A middle-income country perspective

Background: Lengthening nails (ILN) are an established method of limb reconstruction for leg length discrepancy (LLD). Literature on these nails is predominantly from developed countries, with more accessible resources for the procurement of devices and post-operative therapies. This paper aims to present the results and lessons learned from four tertiary level limb reconstruction units working within two middle-income countries (MIC). Methods: Ethical approval was obtained from all four units. All ILN (PRECICE II, NuVasive, USA) undertaken between 2013 and 2020 were included. Demographics, etiology, surgical approach, and information about the planned versus achieved correction were compared. Data on time to consolidation and complications were recorded with a 12-month minimum follow-up. Complications were classified according to the Black et al. criteria. Results: Sixty limb segments lengthened in 56 patients, of which 46 were femora, 12 tibiae and two humeri. Etiology of LLD was predominately posttraumatic (33%), congenital (26%), and growth plate injuries (22%). Mean distraction length was 46 mm (20–90 mm). Fifty-four segments (90%) had <5 mm discrepancy of planned distraction lengths. Mean healing index was 34.6 days/cm (range: 18–180 days/cm). Thirteen patients experienced complications, of which ten required further surgery. Conclusion: The findings of our work support the use of intramedullary ILN in MIC with equivalent complication rates and healing indices compared to the literature. Patient compliance and remote geography were not an issue during treatment. The lack of access to weekly rehabilitation therapy did not seem to impact the majority of patients. Reusing nails for extensive LLD cases were safe but should be used with caution.

Label-free lipidome study of paraventricular thalamic nucleus (PVT) of rat brain with post-traumatic stress injury by Raman imaging.

Post-traumatic stress disorder (PTSD) is a widespread psychiatric injury that develops serious life-threatening symptoms like substance abuse, severe depression, cognitive impairments, and persistent anxiety. However, the mechanisms of post-traumatic stress injury in brain are poorly understood due to the lack of practical methods to reveal biochemical alterations in various brain regions affected by this type of injury. Here, we introduce a novel method that provides quantitative results from Raman maps in the paraventricular nucleus of the thalamus (PVT) region. By means of this approach, we have shown a lipidome comparison in PVT regions of control and PTSD rat brains. Matrix-assisted laser desorption/ionization (MALDI) mass spectrometry was also employed for validation of the Raman results. Lipid alterations can reveal invaluable information regarding the PTSD mechanisms in affected regions of brain. We have showed that the concentration of cholesterol, cholesteryl palmitate, phosphatidylinositol, phosphatidylserine, phosphatidylethanolamine, sphingomyelin, ganglioside, glyceryl tripalmitate and sulfatide changes in the PVT region of PTSD compared to control rats. A higher concentration of cholesterol suggests a higher level of corticosterone in the brain. Moreover, concentration changes of phospholipids and sphingolipids suggest the alteration of phospholipase A2 (PLA2) which is associated with inflammatory processes in the brain. Our results have broadened the understanding of biomolecular mechanisms for PTSD in the PVT region of the brain. This is the first report regarding the application of Raman spectroscopy for PTSD studies. This method has a wide spectrum of applications and can be applied to various other brain related disorders or other regions of the brain.

Neutrophil Gelatinase-associated Lipocalin Predicts Post-traumatic Acute Kidney Injury in Severely Injured Patients.

Early detection of acute kidney injury (AKI) is crucial in the management of multiple-organ dysfunction syndrome in severely injured patients. Standard laboratory parameters usually increase with temporal delay. Therefore, we evaluated neutrophil gelatinase-associated lipocalin (NGAL) as an early marker for acute kidney injury. We retrospectively evaluated patients admitted to a level 1 trauma center. We collected clinicodemographic data and measured kidney-related factors and plasma cytokines. A total of 39 patients were included. Patients with AKI had significantly higher levels not only of serum creatinine and urea, but also of NGAL (all p<0.001) than patients without AKI. The optimal NGAL cut-off value was determined to be 177 ng/ml, showing significant correlation with imminent or manifest AKI (p<0.001). Other independent markers correlated with AKI included pre-existing chronic kidney disease, use of catecholamines, and severe injury (p<0.001). The serum level of NGAL is feasible early predictor of AKI.

Diagnostic and therapeutic approach to post-traumatic tracheobronchial injuries

Post-traumatic tracheobronchial lesions are associated with high mortality unless adequately diagnosed and treated. They may be caused by blunt and penetrating trauma, although iatrogenic lesions are also increasingly observed. An early and accurate diagnosis significantly impacts the results of treatment. Radiological assessment with computed tomography is highly accurate, but bronchoscopy remains the gold standard technique in the diagnosis of airway trauma and plays an important role in determining the therapeutic approach. For a long time, surgery has been considered the treatment of choice for post-traumatic airway lesions, but recent reports have shown that favourable results may also be obtained with a conservative approach, especially in the treatment of iatrogenic lesions. The indication for a conservative or surgical treatment has to be defined on the basis of a thorough clinical, radiological, and endoscopic assessment. Specific issues concerning airway management in the emergency setting and during surgical treatment must also be addressed. A multidisciplinary approach in a center with specific experience in the treatment of airway lesions is of utmost importance to obtain favourable results.

Outcome of Physical Rehabilitation Interventions in Persons with Post-Traumatic Spinal Cord Injuries at Paraplegic Centre Peshawar, Pakistan

Objective: To determine the outcomes of physical rehabilitation interventions at Paraplegic Center, Peshawar. Methods: This was Quasi experimental study, conducted from January 2018 to December 2019 at Paraplegic Center, Peshawar. A total of 306 persons with SCI were included in the study. Patients with ASIA-E level were excluded. Rehabilitation interventions including nursing care, physical and occupational therapy was applied for 4 days per week for a month. Spinal Cord Independence Measure (SCIM) scale was used for data collection. Data were analyzed using SPSS version 20 and T-test was used to compare the pre and post intervention’s scores, where p-value &lt;0.05 was considered as significant.

Step by Step: Autologous Fat Transfer in Oral and Maxillofacial Surgery

Autologous fat transfer (AFT), a technique first performed in the late 19th century for treatment of facial deformity,1 has seen a resurgence during the last 2 decades with the introduction and widespread use of the Coleman technique. The Coleman method of harvesting and processing fat prevents the traumatic handling of fat, which historically led to significant fat resorption and unpredictable results. Although fat grafting to the face is most often thought of as a rejuvenating cosmetic procedure to address volume loss and facial aging, AFT has additional utility in maxillofacial reconstruction for post-traumatic injuries, craniofacial deformities, and acquired deformities.

Burdock leaf and B&amp;W ointment: A natural and suitable alternative to negative pressure wound therapy and skin grafting in the treatment of traumatic crush injury post surgical debridement

Abstract Alternative therapies to current medicinal practices are becoming increasingly popular in today's culture. We explored the efficacy of using burdock leaves and Burn and Wound (B&W) ointment as an alternative to negative pressure wound therapy (NPWT) and skin grafting in a Mennonite pediatric patient post traumatic crush injury and surgical debridement. Although burdock leaves and B&W have been used for decades in treating minor burns and wounds, there is little literature describing their use in the treatment of traumatic injury that would otherwise require full thickness skin grafting. This case demonstrated a collaborative approach between physicians and a Mennonite healer to treat a complex traumatic wound. This unique approach was effective in healing the wound, albeit slightly slower than conventional therapy, and resulted in less pain due to dressing changes. Here, we describe an effective and safe alternative therapy for select patients who desire avoidance of numerous operations and prefer to attempt a more natural healing process. Additional information is included to educate providers on a therapy that significantly reduces the pain and trauma associated with dressing changes and decreases hospital time and costs.

Very complex and difficult rehabilitation process in a post traumatic SCI (Spinal Cord Injury) complete tetraplegic patient with intense and refractory spasticity and frequency of spasm with presacral pressure sores (successfully operated)- case report

Introduction. Spinal cord injury (SCI) is the injury of the spinal cord from the foramen magnum to the cauda equina which occurs as a result of compulsion, incision or contusion.(1) As a result of the injury, the functions performed by the spinal cord are interrupted at the distal level of the injury. SCI causes serious disability among patients.(2) The treatment and rehabilitation period is long, expensive and exhausting in SCI. The results of SCI bring not only damage to independence and physical function, but also include many complications from the injury. Neurogenic bladder and bowel, urinary tract infections, pressure ulcers, orthostatic hypotension, fractures, deep vein thrombosis, spasticity, autonomic dysreflexia, pulmonary and cardiovascular problems, and depressive disorders are frequent complications after SCI.(3) Material and method. Having the patient’s consent and The Teaching Emergency Hospital “Bagdasar-Arseni” Ethics Committee’s approval, a 48 years old patient, complete tetraplegic with intense and refractory spasticity and frequency of spasm with presacral pressure sores (successfully operated) post traumatic spinal cord injury. The patient was functionally assessed using the following scales: : Glasgow Outcome Scale Extended, Modified Rankin Scale, Modified Ashworth, Penn Spasm Frequency Scale Functional Independence Measure, FAC International Scale, Quality of Life Assessment. Conclusions. Spasticity is a common secondary impairment after SCI characterized by hypertonus, increased intermittent or sustained involuntary somatic reflexes (hyperreflexia), clonus and painful muscle spasms. Severe spasticity may contribute to increased functional impairment, contractures, ulcers, posture disorders and pain. Treatment should start as soon as possible to prevent such negative effects. Keywords: tetraplegia, spinal cord injury, spasticity, pressure sores, traumatism, rehabilitation,