Recent Traumatic Injury Research Articles

Face-off Droop: A Case Report of Pediatric Stroke.

Cerebrovascular accidents rarely occur in children; the incidence of ischemic stroke in patients <16years of age is between 0.6-7.9/100,000. However, they are the fourth most common cause of acute neurological deficits in the pediatric population, and possible cases should be evaluated with a high index of suspicion to ensure timely intervention. We describe a previously healthy 17-year-old male who presented to the pediatric emergency department with a left facial droop and hemiparesis consistent with a stroke. The patient's age and lack of comorbidities made this an extremely uncommon presentation. Our patient's neurologic symptoms were believed to have been caused by a recent traumatic clavicular injury sustained two weeks prior, which subsequently led to vascular insult. Cerebrovascular accidents are an important cause of morbidity and mortality in pediatric patients. Cerebrovascular accidents in children are most often secondary to congenital causes; however, care should be taken to assess for acquired causes, such as trauma to major blood vessels. While rarely implicated in traumatic injuries, arterial structures posterior to the medial clavicle can result in severe complications.

Incidence of thromboembolism and associated factors in multiple myeloma patients treated with immunomodulatory drugs: a retrospective analysis in Belo Horizonte, Brazil.

The use of immunomodulators in the treatment of multiple myeloma (MM) patients has been associated with venous thromboembolism (VTE). Due to the increase in mortality of cancer patients, venous thromboembolism is an important concern for newly diagnosed multiple myeloma (NDMM) patients. The aim of this study was to determine the incidence of thromboembolic events and evaluate associated risk factors among Brazilian NDMM patients using immunomodulators. Real-life retrospective cohort study in two Brazilian institutions with newly diagnosed multiple myeloma (NDMM) patients treated with immunomodulators from January 2009 to December 2019. Data was collected from patients' medical records for the period of 1 year, and Cox regression was performed to identify risk factors on the development of VTE. We included 131 patients of which there was a mean age of 61.5 years (SD 11.3), 51.9% female, and predominantly using thalidomide (97.7%) as immunomodulator. We found 9 VTE episodes among our patients, with a 12-month cumulative incidence of 6.97% (95% CI 3.41-12.24). Associated factors after multivariate analysis were recent sepsis, recent traumatic injury, previous VTE, and thromboprophylaxis. Our real-life retrospective cohort presented a low incidence of VTE among Brazilian NDMM patients treated with immunomodulators.

Experiences of racial discrimination and adverse gene expression among black individuals in a level 1 trauma center sample

Up to 40 % of individuals who sustain traumatic injuries are at risk for posttraumatic stress disorder (PTSD) and the conditional risk for developing PTSD is even higher for Black individuals. Exposure to racial discrimination, including at both interpersonal and structural levels, helps explain this health inequity. Yet, the relationship between racial discrimination and biological processes in the context of traumatic injury has yet to be fully explored. The current study examined whether racial discrimination is associated with a cumulative measure of biological stress, the gene expression profile conserved transcriptional response to adversity (CTRA), in Black trauma survivors. Two-weeks (T1) and six-months (T2) post-injury, Black participants (N = 94) provided a blood specimen and completed assessments of lifetime racial discrimination and PTSD symptoms. Mixed effect linear models evaluated the relationship between change in CTRA gene expression and racial discrimination while adjusting for age, gender, body mass index (BMI), smoking history, heavy alcohol use history, and trauma-related variables (mechanism of injury, lifetime trauma). Results revealed that for individuals exposed to higher levels of lifetime racial discrimination, CTRA significantly increased between T1 and T2. Conversely, CTRA did not increase significantly over time in individuals exposed to lower levels of lifetime racial discrimination. Thus, racial discrimination appeared to lead to a more sensitized biological profile which was further amplified by the effects of a recent traumatic injury. These findings replicate and extend previous research elucidating the processes by which racial discrimination targets biological systems.

Investigation of a Prolonged and Large Outbreak of Healthcare-Associated Mucormycosis Cases in an Acute Care Hospital-Arkansas, June 2019-May 2021.

Outbreaks of healthcare-associated mucormycosis (HCM), a life-threatening fungal infection, have been attributed to multiple sources, including contaminated healthcare linens. In 2020, staff at Hospital A in Arkansas alerted public health officials of a potential HCM outbreak. We collected data on patients at Hospital A who had invasive mucormycosis during January 2017-June 2021 and calculated annual incidence of HCM (defined as mucormycosis diagnosed within ≥7 days after hospital admission). We performed targeted environmental assessments, including linen sampling at the hospital, to identify potential sources of infection. During the outbreak period (June 2019-June 2021), 16 patients had HCM; clinical features were similar between HCM patients and non-HCM patients. Hospital-wide HCM incidence (per 100 000 patient-days) increased from 0 in 2018 to 3 in 2019 and 6 in 2020. For the 16 HCM patients, the most common underlying medical conditions were hematologic malignancy (56%) and recent traumatic injury (38%); 38% of HCM patients died in-hospital. Healthcare-associated mucormycosis cases were not epidemiologically linked by common procedures, products, units, or rooms. At Hospital A and its contracted offsite laundry provider, suboptimal handling of laundered linens and inadequate environmental controls to prevent mucormycete contamination were observed. We detected Rhizopus on 9 (9%) of 98 linens sampled at the hospital, including on linens that had just arrived from the laundry facility. We describe the largest, single-center, HCM outbreak reported to date. Our findings underscore the importance of hospital-based monitoring for HCM and increased attention to the safe handling of laundered linens.

Distal Radioulnar Joint Instability.

Instability of the distal radioulnar joint is a source of ulnar-sided wrist pain and functional impairment. Symptomatic instability may present acutely, after a recent traumatic injury, or in a delayed fashion as chronic instability following a history of a traumatic event. A detailed understanding of the complex anatomy, biomechanics, and stabilizing structures of the distal radioulnar joint is important to evaluate and treat acute and chronic instability. This article describes the pathophysiology of distal radioulnar joint instability with attention to the anatomic structures involved and provides information about evaluation and treatment.

Right mandibular angle and left comminuted mandibular body fractures stabilised with a combination of an acetabular plate and secured pin intermandibular ventral epoxy resin (SPIVER) frame in a four‐month‐old puppy

SUMMARYThis case report aimed to describe a surgical technique combining a secured pin intermandibular ventral epoxy resin (SPIVER) frame and an acetabular plate to manage a complex mandibular fracture configuration in a puppy. A four‐month‐old, entire male, German wirehaired pointer was referred for assessment of a combination of recent (three days before hospitalisation) and older traumatic (45 days before hospitalisation) facial injuries inflicted by the dam. CT revealed multiple mandibular and maxillary fractures with complex acute mandibular fractures requiring surgical stabilisation. wo techniques were combined on stabilisation of the mandible: a single acetabular plate 2.7 to repair the mandibular angle fracture and a SPIVER frame to repair the comminuted mandibular fracture. Both fractures healed uneventfully, and the dog had normal jaw function one year postoperatively. Occlusion was not modified compared with the preoperative condition, considering that the patient already had a malocclusion defect due to old lesions. The combination of two different osteosynthesis techniques had satisfactory short‐term and long‐term outcomes in this puppy.

Prevalence Rate of Restless Leg Syndrome among Healthcare Students of Karachi

Background: Restless leg syndrome (RLS) is an undiagnosed sensorimotor disorder that is accompanied by an unpleasant sensation in the lower limbs which cause an urge to move the leg for temporary relaxation. It causes symptoms such as insomnia, concentration and mood disturbance which affect the quality of life, job and academic performance. Objective: This study was proposed to find out the prevalence of RLS among healthcare undergraduate students with its primary complications. Method: This was a cross-sectional study, conducted in Healthcare Institutes of Karachi in July-19 to October-19. A questionnaire was given to 337 students, which was designed to diagnose RLS on the basis of criteria set by “International Restless Leg Syndrome Study Group”. The inclusion criteria were students aged between 18-25 years. Students having any neurological problem, hypertension, diabetes, pregnancy, musculoskeletal deformity or recent traumatic injuries were excluded from this study. Data were analyzed by SPSS version 22. Results: The median (IQR) age of students was 21 (20-22) years. Out of these 337 students 40(11.9%) were males and 297(88.1%) were females. Restless Leg syndrome was diagnosed in 120(35.6%) students in which 110(91.7%) were females and 10(8.3%) males. 116(34.4%) students experienced leg cramps, while RLS positive students 116(96.7%) did not seek any consultation to health care professional. Conclusion: This study concluded that there was a high prevalence of RLS among healthcare students yet remains undiagnosed. There should be more awareness programs regarding RLS to prevent its symptoms and to improve the quality of life.

Assessment of human wrist rigidity and pain in post-traumatic patients.

The aim of this work is to present a novel robot-based method to assess the sources of a lack of functionality in patients with recent traumatic wrist injuries. Post-traumatic patients experience limited range of motion as well as strength and proprioceptive deficits. These dysfunctions are related to different complications that usually follow the injuries: pain, increased rigidity, lack of movement fluency and loss of stability could arise differently, according to the severity, site and kind of lesion. Their quantitative evaluation could be essential to target rehabilitation treatments to the specific problem and to optimize and speed up the functional recovery. The use of robotic devices for assessment not only ensures objectivity and repeatability, but could also help to estimate the goodness of the evaluation itself, in terms of reliability and patient's engagement. Ten subjects with different types of wrist injuries were enrolled in this study and required to perform passive robot-guided reaching movements. Forces and angular positions were used to evaluate subject's range of motion, rigidity and pain that, considered together, allowed a comprehensive characterization of the level of healing and functionality achieved by each subject.

Children detained in French police cells.

Police custody is detention in response to a suspicion of crime. In France, until the age of 13, pre-trial detention and police custody are not allowed. We aimed to evaluate the practical implementation of police detention of children aged between 10 and 12 years and describe the medical characteristics and history, perceived health status and opinion on custody of the potentially affected children. A descriptive study was conducted in a French reference regional department of forensic medicine at the time of medical examination in police cells among arrestees younger than 13 years old examined over a 5-year period (1 January 2011-31 December 2015). Children aged 10-12 years (n = 60; males, 48, 80%), accounting for 60 of 57 687 examined arrestees (0.1%), were examined over the study period. Six individuals (10%) were arrested twice or more times during the study period (for a total of 76 detentions analysed). The most common suspected crimes were theft or robbery (42/76, 55%) and physical assault (22/76, 29%). Arrestees had a favourable opinion of custody in 33 of 76 cases (43%). Children reported physical assault by the police in 6 of 76 cases (8%), and the physicians observed recent traumatic injuries in 7 of 76 cases (9%). Daily tobacco consumption was reported by 4 of 60 children (7%). No child was considered unfit for detention by the physician. Children aged 10-12 years suspected of serious crimes accounted for 0.1% of detained individuals in police cells. Although infrequent, such situations are a matter of concern.

Recognition of Association Between Blood Stasis Syndrome and Traumatic Injury among Doctors of Korean Medicine: A Cross-Sectional Observation Study.

To investigate the diagnostic indicators and herbal treatments for blood stasis syndrome (BSS) patients with traumatic injuries and to identify the association between BSS and traumatic injury in Korea. Two-hundred and four patients with traumatic injury were recruited from the Gangnam and Daejeon branches of Jaseng Hospital of Oriental Medicine between June 2014 and December 2014. Two independent doctors of Korean medicine (DKMs) determined the diagnosis of BSS or non-BSS based on the subjects signs and symptoms. The scores assigned to BSS symptoms and DKMs' reasons for diagnosing BSS in patients with traumatic injury were investigated. Both medication and herbal prescription records from a 3-month period were collected for all patients diagnosed with BSS by both DKMs. A total of 169 of 204 (82.8%) patients received consistent diagnosis related to BSS by two DKMs. Among them, 54.4% (92 cases) were diagnosed with BSS, and 45.6% (77 cases) were not diagnosed with BSS. DKMs most frequently cited symptoms of recent traumatic injury as justifications for BSS diagnoses, and also selected pain-related indicators such as abdominal pain, sharp pain and nocturnal pain as important reasons in diagnosing BSS. In addition, an inconsistency in the pattern identification theory with respect to traumatic injury was observed. Although only 92 cases (54.4%) of patients were diagnosed with BSS, 77.6% of them were prescribed decoctions for BSS. DKMs considered traumatic injury could cause BSS, and utilized decoction for BSS in patients with traumatic injury without confirming a diagnosis of BSS because they assumed the main symptoms or pathologies of traumatic injury to be closely related to BSS.

Accueil en médecine légale des adolescents et adultes victimes de violences sexuelles ou de violences dans le couple n’ayant pas déposé plainte – étude observationnelle en Seine-Saint-Denis

to identify characteristics of victims of sexual assault or domestic violence who consulted in a Department of Forensic Medicine without a formal complaint to the police. observational study (03/01/2014-08/31/2015) of individuals (age>15years) consulting in a Department of Forensic Medicine near Paris, France, after a sexual assault or domestic violence. Among the individuals who were examined in the department of Forensic Medicine, we compared the individuals who had not complained to the police to those who had complained to the police. A hundred and nine individuals have consulted without a prior complaint to the police, including 73 persons after domestic violence (i.e. 4% of all persons examined with or without a complaint to the police) and 36 persons after a sexual assault (i.e. 8% of all persons examined). Regarding domestic violence, the proportion of persons presenting recent traumatic injuries was lower among those who did not complain to the police than among those who did (64% vs. 78%, P=0.008). Regarding sexual violence, the persons who did not complain to the police were more frequently uncertain about the assault (42% vs. 13%, P<0.001), reported more frequently a recent alcohol or drug intake (42% vs. 26%, P=0.039) and less frequently showed extragenital traumatic injuries than the persons who did complain to the police (22% vs. 43%, P=0.016). the persons examined who had not complained to the police accounted for less than one in 20. The extension of the activity of a Department of Forensic Medicine to persons who do not want to be involved in a judicial process is not sufficient for the majority of victims to consult a forensic physician.

Hypernatraemic hypovolaemia with anaemia: an unusual presentation of primary testicular insufficiency.

Hypogonadal men may experience intense vasomotor symptoms, and vasomotor sweating can occasionally be associated with profound fluid losses. We describe a 37-year-old male, who exhibited persistent hypovolaemic hypernatraemia that was challenging to treat despite a continuous high fluid input (>4–5 L/day). He was noted to have drenching sweats and normochromic anaemia. He had recent traumatic head injury, which resulted in neurocognitive dysfunction, so pituitary function tests were done which showed primary hypogonadism. After exclusion of all other possible causes of excess sweating, hypernatraemia and anaemia, a trial of testosterone therapy was instituted. Sweating dramatically ceased within hours of his first testosterone injection, hydration status normalised within days and anaemia and neurocognitive function progressively improved with continued testosterone replacement. This case demonstrates how, in a susceptible individual, hypovolaemic hypernatraemia can arise from insensible cutaneous fluid loss through eccrine sweating, mediated by vasomotor symptoms of untreated hypogonadism. Although this scenario has not been described in the literature, we felt it needed to be shared with the wider medical community because of how the diagnosis and treatment utterly transformed this patient’s functional status and outcome.Learning points:Hypogonadal men may experience intense vasomotor symptoms and vasomotor sweating can occasionally be associated with profound fluid losses.Whether or not there is also hyperosmolar hypernatraemia, clinicians should always consider the possibility of underlying hypogonadism in men with normocytic anaemia and excessive sweating.Androgen (testosterone) replacement in hypogonadal men can have a dramatic effect on vasomotor sweating and hot flushes.

The health of female arrestees in police cells: A descriptive study

IntroductionLittle information is available regarding the medical status and health care needs of female arrestees. Our objective was to evaluate the perceived health and somatic or psychiatric disorders reported by female arrestees in police cells. Material and methodsWe conducted an observational study in a regional reference department of forensic medicine in France. We studied female arrestees examined in police cells (01/01/2013–06/30/2013). Data were collected regarding individuals' medical characteristics, addictive behaviours, and perceived health status, as well as reported assaults or recent traumatic injuries. We recorded medical decisions regarding fitness for detention in police cells. ResultsA total of 438 women (median age, 29; range, 13–67) accounted for 5% of the 7408 examined arrestees. Females considered their overall health as good or very good in 314/395 cases (70%). Women reported chronic somatic or psychiatric disorders more frequently than men (89/379, 23% vs. 757/6,135, 12%, p < 0.001 and 59/379, 15% vs. 392/6319, 6%, p < 0.001, respectively). Daily tobacco consumption and cannabis use were reported by 255/403 (63%) and 98/438 female arrestees (22%), respectively. Physical assaults were reported in 113/415 cases (27%). Female arrestees were considered fit for detention in 92% of cases. Among 24 pregnant arrestees, 6 (25%) were unfit for detention, 2 (8%) were fit for custody during daytime only and 16 (67%) were fit for detention if certain conditions were met. ConclusionsDetention in police custody involves a minority of females. Females are older and report somatic or psychiatric disorders more frequently than males.

Fatality Rate of Trauma Victims in Southern Part of Iran: A Five-Year Survey

Background: In recent years traumatic injuries and their related mortality have become a major public health issue in Iran. This study aimed to assess injuries and mortality rate in southern Iran. Methods: In this cross-sectional study, all trauma cases aged above 14 years, who were referred to Rajaee hospital, Shiraz, Iran from January 2010 to December 2014, were enrolled. Age, gender, cause of injury, and in-patient hospital mortality were extracted from the hospital information system and analyzed. Results: The study participants included 41,182 patients, among whom 32,219 (78.2%) were male and 8,963 (21.8%) were female. The frequency of all injuries was higher in males. In the current study, fatality rate was 2.65%, male and female fatality rates were 2.70% and 2.45%, respectively. Even though admission had an ascending trend from 2010 to 2014, a noticeable reduction in the trend of fatality rate was seen 4.5 % and 3% in pedestrian-related injuries and gunshot -related injuries. Conclusions: In the light of medical advances in trauma management, allocating budget is necessary for prevention and implementation of vehicles’ safety protocols and developing educational programs to reduce mortality

The association between daily PTSD symptom severity and alcohol-related outcomes in recent traumatic injury victims.

The self-medication hypothesis proposes that individuals experiencing posttraumatic stress disorder (PTSD) symptoms may use alcohol (or other substances) to self-medicate distress, while the mutual maintenance hypothesis proposes that alcohol use also exacerbates or maintains distress. Existing research largely supports the self-medication hypothesis. However, findings are often based upon retrospective reporting of problems and assessment of symptoms anchored to a trauma occurring in the remote past. To improve on these retrospective designs, the current study examined the relationship between daily PTSD symptom severity and alcohol-related outcomes during the early phase of recovery following a traumatic physical injury. Specifically, 36 injury victims reported on PTSD symptom severity, alcohol craving, alcohol consumption, and negative drinking consequences thrice daily (morning, afternoon, night) over 7 days beginning 6 weeks postinjury. Results indicated relationships between PTSD symptom severity and alcohol craving/negative consequences when these experiences were assessed concurrently within the same signal (particularly during the nighttime assessments). Prospective models found that nighttime PTSD symptom severity was related to negative drinking consequences occurring the following morning, even after controlling for consumption level, suggesting a more general behavioral regulation problem. Results were less supportive of the mutual maintenance hypothesis. Collectively, these results suggest that health interventions targeting PTSD symptom severity in recent injury victims-particularly when delivered at night-may be able to prevent problematic alcohol use. (PsycINFO Database Record

Trajectories of daily PTSD symptoms in recent traumatic injury victims.

Prior research has identified different PTSD symptom (PTSS) trajectories over months and years posttrauma that warrant different levels of clinical attention. Earlier identification of at-risk trauma victims can facilitate efficient and appropriate intervention efforts. Using latent class growth analysis, we examined daily PTSS trajectories beginning 6 weeks postinjury in 68 injury victims. Resulting classes were compared on key characteristics at 6 and 21 weeks postinjury. Three trajectories were identified: a nonreactive class (67.8%) with low initial symptom levels that remained low, a moderate-stable class (27.9%) with elevated symptom levels that remained constant, and a severe-increasing class (4.4%) with high symptom levels that increased. High-risk injury victims can be identified by their daily PTSS, allowing for early identification of those at risk for elevated distress and in greater need for intervention. (PsycINFO Database Record

A 49-Year-Old Woman with a Sore and Swollen Throat

A 49-year-old woman sought care at a walk-in clinic for treatment of a “scratchy” throat that became sore and swollen within hours of onset. Over-the-counter ibuprofen and oral lozenges provided no relief. The woman described her pain as constant, with a severity rating of 8 on a 0 to 10 scale. The patient was referred to an emergency department because of pain severity and pharyngeal edema. Associated symptoms included hoarseness, mild dysphonia, dysphagia, feeling feverish, and the presence of chills and sweats. The woman was not overtly dyspneic, yet kept her mouth open to facilitate breathing. She was able to drink, but swallowing proved too painful to eat. The patient denied experiencing nasal discharge, earache, coughing, sinus pain, or a recent traumatic injury. She had no significant medical or surgical history and took no routine medications. Amy Culbertson is Assistant Professor of Nursing, Georgetown University, and Nurse Practitioner, Murfreesboro, TN. Damon B. Cottrell is Clinical Associate Professor, Texas Woman’s University, Dallas, TX, and Nurse Practitioner, Providence Health Network, Waco, TX.

Supplemental Material for Trajectories of Daily PTSD Symptoms in Recent Traumatic Injury Victims

Supplemental Material for Trajectories of Daily PTSD Symptoms in Recent Traumatic Injury Victims

Welfare indicators during broiler slaughtering

The aim of this study was to identify the most relevant welfare indicators for unloading, lairage, stunning, killing and post-mortem inspection in a poultry slaughter plant. Different indicators were unloading duration, lairage time, environmental variables in the lairage facilities, shackling time and electrical variables used in the water bath.Lairage time did not correlate strongly with dead on arrival. Heat stress was limited by means of ventilation systems, correct cage placement and appropriate stocking density per crate. The acceptable shackling period was about 30 s.The presence of a corneal reflex showed that an animal was alive, while spontaneous wing flapping, spontaneous eye blinking and response to a painful stimulus were regarded as indicators of stunning efficiency.It was concluded that the presence of recent traumatic injuries during the post-mortem inspection could be a valid means to establish whether corrective measures concerning the handling, transport and loading procedures should be taken.

Fitness for detention in police custody: A practical proposal for improving the format of medical opinion

Health issues among arrestees are a worldwide concern for which only local policies have been established. Physicians attending detainees in police custody are expected to decide whether the detainee's health status is compatible with detention in a police station and make any useful observations. A high degree of heterogeneity in the information collected by the physician and transmitted to the police has been observed. We analyzed the content and limitations of available documents and developed a model that could serve as a guide for any attending physician. The document presented here has been used in France on over 50,000 occasions since June 2010. We developed a two-page template consisting of (1) a standard medical certificate to be sent to the authority who requested the doctor's attendance and (2) a confidential medical record, not sent to the requesting authority. We evaluated perceived health by the three global health indicators of the Minimum European Health Module and used DSM IV criteria for the evaluation of addictive disorders. In the case of recent traumatic injuries, the certificate has also included the collection of data on traumatic injuries and the contexts of their occurrence. The proposed certificate achieved several goals, by protecting the interests of the person examined, in case of poor conditions of arrest or detention, protecting doctors in cases of legal proceedings, and allowing epidemiological data to be collected. The certificate may also contribute to an international awareness of medical care for detainees in police custody.