Traumatic Origin Research Articles

Imaging modalities for atraumatic shoulder hypermobility: a scoping review.

Objective measures from imaging studies have the potential to assist in timely diagnosis of atraumatic shoulder hypermobility to better guide management. The aim of this scoping review is to examine imaging modalities and techniques used to characterize atraumatic shoulder hypermobility. MEDLINE, EMBASE, SPORTDiscus, Cochrane Library, and Web of Science were searched up to May 2024 for any primary study investigating imaging findings seen in atraumatic shoulder hypermobility. Patients with unilateral instability were excluded given its frequent association with traumatic origin. Eighteen observational studies met inclusion criteria. Results were divided into outcomes relating to capsular redundancy, glenohumeral anatomy, and muscle activation. Five studies using magnetic resonance arthrography (MRA) demonstrated statistically significant increases in capsular cross-sectional area (CSA), while a significant superior capsular elongation was reported by two studies in patients with multidirectional instability (MDI). Labrocapsular distance, glenocapsular ratio, and the presence of a combined sail and triangle sign on MRA were highly sensitive and specific parameters for identifying MDI. There were inconsistent findings for alterations of glenohumeral anatomy. Ultrasound assessments of acromiohumeral distance (AHD) were significantly increased in patients with MDI, but not in shoulders with hypermobility alone. Similarly, muscle activity measured by electromyography or glenohumeral translations differed significantly in patients with MDI, but not in those with hypermobility alone. Radiographic markers of capsular redundancy (e.g., CSA, labrocapsular distance, glenocapsular ratio), AHD, and muscular activity are useful in the diagnosis of MDI. However, there are no definitive imaging markers for diagnosing atraumatic shoulder hypermobility without MDI.

Fracture morphology and ossification process of the keel bone in modern laying hens based on radiographic imaging.

Keel bone fractures (KBF) are one of the most important welfare problems in commercial laying hens. Despite extensive research on the matter, its etiology remains unclear. Studying fracture characteristics in radiographic images can aid in the understanding of the disorder. The aim of the current study was to provide detailed description of fracture characteristics and explore ossification in the keel bone. In this descriptive study, repeated cross-sectional sampling was performed in one commercial laying hen flock. The flock was visited at 11 time points from 17-57 weeks of age (WOA), radiographing 30 laying hens at each visit resulting in altogether 330 unique radiographs. Fracture characteristics and the keel bone's level of ossification were assessed in each radiograph. In total, 344 fractures were recorded, of which 71.5% were complete and 28.5% were incomplete. Of the complete fractures, 82.9% were recorded as transverse, and 15.9% as oblique. One comminuted and two butterfly fractures were recorded. The caudal third of the keel was the most common area for fractures. Fracture characteristics differed between the different regions of the keel bone; all incomplete fractures in the cranial third appeared on the ventral surface of the keel, whilst the majority of incomplete fractures on the caudal third appeared on the dorsal surface. This indicates that the underlying etiology might differ between the cranial and caudal part. Folding fractures were observed in 18.6% of all the fractures, and occurred in both cranial-, and caudal third of the keel, indicating possible underlying disorders of calcium metabolism. All hens at 32 WOA and older had a fully ossified keel, based on radiographic evaluation. Displacement and soft tissue swelling are common characteristics in fractures of traumatic origin. We found a high frequency of simple fractures, without these characteristics, indicating that non-traumatic causes may be of higher importance than conventional beliefs.

Traumatic and Non-traumatic Radiculomedullary Compressions: A Comparative Analysis.

Background Radiculomedullary lesions represent a significant public health issue, with their epidemiological, clinical, and therapeutic characteristics varying depending on whether they are of traumatic or non-traumatic origin. The aim of this study was to compare clinical, therapeutic, and postoperative aspects between traumatic radiculomedullary lesions (TRML) and non-traumatic radiculomedullary lesions (NTRML). Methods This was a prospective cohort study conducted from 2020 to 2023 involving patients suffering from radiculomedullary lesions operated at the Department of Neurosurgery, University Teaching Hospital of Kinshasa. In addition to socio-demographic characteristics, the two patient groups - traumatic and non-traumatic - were compared based on clinical, therapeutic, and postoperative aspects using the American Spinal Injury Association (ASIA)and Spinal Cord Independence Measures (SCIM III) scores. Results We included 153 patients, with 73 traumatic cases (47.7%) and 80 non-traumatic cases (52.3%). TRMLs were predominantly caused by road traffic accidents (34%) and falls (11%), while NTRMLs were mainly due to disc herniations (22.2%) and tuberculosis (13.7%). The mean age for TRMLs was 35.4 ±12.8 years with a sex ratio of 3.5, compared to 50.7±15.9 years and a sex ratio of 1.1 for NTRMLs. TRMLs were more frequently located in the cervical region (32.8%) and the thoracolumbar junction (40%), whereas NTRMLs predominantly affected the thoracic (22.5%) and lumbar (63.7%) regions. Patients with NTRMLs had more incomplete lesions (98.7%) and better SCIM III scores at admission compared to TRMLs (p ˂ 0.001). TRMLs had more complete deficits 42 (57.3%) vs 1 (1.3%). Both groups significantly improved their ASIA and SCIM III scores postoperatively (p ˂ 0.001) but in a similar manner (Diff-in-diff: ASIA, p=0.955; SCIM, p=0.967). TRMLs developed more complications than NTRMLs (p˂0,001). Only five patients (11.6%) with ASIA A progressed to higher grades, and all remained dependent (SCIM III score ˂50). The average hospital stay was 89.2 ±74.2 days for TRMLs and 57.5±52.9 days for NTRMLs (p˂0.001). Conclusion This study revealed that TRMLs frequently affect young male individuals and are often located in the cervical region and thoracolumbar junction. In contrast, NTRMLs affect older individuals without gender preference and are usually found in the thoracic and lumbar regions. TRMLs often lead to complete deficits, pressure sores, urinary infections, and longer hospital stays compared to NTRMLs. Both patient groups showed significant postoperative improvement with no significant difference between them. However, patients with complete deficits showed less improvement in both groups.

Metabolomic and Lipidomic Analysis of Manganese-Associated Parkinsonism: a Case-Control Study in Brescia, Italy.

Excessive Manganese (Mn) exposure is neurotoxic and can cause Mn-Induced Parkinsonism (MnIP), marked by cognitive and motor dysfunction. Although metabolomic and lipidomic research in Parkinsonism (PD) patients exists, it remains limited. This study hypothesizes distinct metabolomic and lipidomic profiles based on exposure status, disease diagnosis, and their interaction. We used a case-control design with a 2×2 factorial framework to investigate the metabolomic and lipidomic alterations associated with Mn exposure and their link to PD. The study population of 97 individuals was divided into four groups: non-exposed controls (n=23), exposed controls (n=25), non-exposed with PD (n=26) and exposed with PD (n=23). Cases, defined by at least two cardinal PD features (excluding vascular, iatrogenic, and traumatic origins), were recruited from movement disorder clinics in four hospitals in Brescia, Northern Italy. Controls, free from neurological or psychiatric conditions, were selected from the same hospitals. Exposed subjects resided in metallurgic regions (Val Camonica and Bagnolo Mella) for at least 8 continuous years, while non-exposed subjects lived in low-exposure areas around Lake Garda and Brescia city. We conducted untargeted analyses of metabolites and lipids in whole blood samples using ultra-high-performance liquid chromatography (UHPLC) and mass spectrometry (MS), followed by statistical analyses including Principal Component Analysis (PCA), Partial Least Squares-Discriminant Analysis (PLS-DA), and Two-Way Analysis of Covariance (ANCOVA). Metabolomic analysis revealed modulation of alanine, aspartate, and glutamate metabolism (Impact=0.05, p=0.001) associated with disease effect; butanoate metabolism (Impact=0.03, p=0.004) with the exposure effect; and vitamin B6 metabolism (Impact=0.08, p=0.03) with the interaction effect. Differential relative abundances in 3-sulfoxy-L-Tyrosine (β=1.12, FDR p<0.001), glycocholic acid (β=0.48, FDR p=0.03), and palmitelaidic acid (β=0.30, FDR p<0.001) were linked to disease, exposure, and interaction effects, respectively. In the lipidome, ferroptosis (Pathway Lipids=11, FDR p=0.03) associated with the disease effect and sphingolipid signaling (Pathway Lipids=9, FDR p=0.04) associated with the interaction effect were significantly altered. Lipid classes triacylglycerols, ceramides, and phosphatidylethanolamines showed differential relative abundances associated with disease, exposure, and interaction effects, respectively. These findings suggest that PD and Mn exposure induce unique metabolomic and lipidomic changes, potentially serving as biomarkers for MnIP and warranting further study.

Bilateral anterior shoulder dislocation: A 3 cases report

Introduction: Shoulder dislocations, common in emergency departments, often include anterior dislocations. Bilateral dislocations, particularly posterior, are rare and are generally caused by sporting accidents or convulsions. Bilateral anterior dislocations are even rarer and often of traumatic origin. Case report: We analyzed three new cases of bilateral anterior shoulder dislocation, examining the mechanisms, risks and treatments Discussion: Bilateral dislocation, often posterior but sometimes anterior, is rare and can result from high-energy trauma or convulsions. A careful clinical examination is crucial to avoid diagnostic errors. Approximately 15% of patients have greater tuberosity fractures. Arthroscopic Bankart and open Latarjet procedures are often recommended for the treatment of residual instability.

Dry eye syndrome associated with traumatic keratitis

Dry eye syndrome (DES) is an urgent problem in healthcare practice worldwide. Various diseases of the eye are of particular importance for the development of this syndrome. A special place among the diseases leading to symptomatic DES with ocular surface lesion belongs to corneal injuries of traumatic origin. The frequency of post-traumatic complications of the eye, especially the cornea, remains high due to its anatomical location. And often these patients are at risk of secondary DES. For the pathogenesis of DES after ke­ratitis, ultrastructural changes in the cells of different corneal layers and the toxic effect on the tear film layers of preservative-containing drugs used in the treatment of keratitis are important. The purpose of the study was to assess the severity of secondary DES in patients after traumatic keratitis and the effectiveness of hyaluronic acid combined with antioxidants in the treatment of this pathology. An ophthalmological examination, functional tests were made, and the Ocular Surface Disease Index was used to evaluate the symptoms and severity of the disease. The criteria for the effectiveness of the therapy with hyaluronic acid in combination with vitamins A and E four times a day were: reduction of corneal syndrome, increase in the tear film break-up time, a decrease in subjective discomfort. Clinical observation of patients with DES after traumatic keratitis showed that the use of hyaluronic acid can result in a significant reduction or complete disappearance of subjective symptoms of the disease, sustained improvement in vision and increased stability of the tear film. The use of these eye drops makes it possible to reach compliance and shorten the treatment period.

“Fish head” sign on magnetic resonance imaging in knee synovitis – An observational pilot study

Objectives: Synovitis, characterized by joint inflammation, has various causes, including inflammatory, infectious, degenerative, traumatic, hemorrhagic, and neoplastic origins. Early detection is essential, and magnetic resonance imaging (MRI) plays a vital role in identifying synovial diseases before they lead to irreversible joint damage. It provides characterization and non-invasive monitoring of synovial changes. This study introduces and describes the novel “fish head” sign, a unique identifier of early knee synovitis on MRI. Materials and Methods: We conducted a retrospective analysis of 50 MRI cases of patients with rheumatoid arthritis (RA)-related synovitis who were referred to our clinic due to knee pain. The primary aim was to uncover insights into the “fish head” sign, a unique imaging feature observed on sagittal views of the lateral meniscus using proton density (PD)-weighted fat-suppressed sequences. Results: Within our cohort of 50 patients, 20 displayed the fish head sign on MRI, whereas 30 did not exhibit this sign. 17/20 of these patients had mild synovitis, 1/20 patients had moderate synovitis, and 2/20 patients had severe synovitis. Fourteen patients with synovitis did not demonstrate the sign. Conclusion: Our study introduces the “fish head” sign observed in PD MRI images of early knee synovitis among patients with RA. This unique sign has the potential to serve as a diagnostic tool or adjunct for patients with synovitis of the knee, reducing the need for contrast-enhanced imaging. This discovery offers valuable insights into the field of synovitis assessment, imaging, and diagnosis.

Prevalence of skin disorders among psychiatric inpatients

IntroductionThe interface between dermatology and psychiatry is complex and of clinical importance. Skin disorders in psychiatric inpatients are common, serious and under diagnosed.ObjectivesThe aim of our study was to assess the prevalence and profile of several skin diseases observed in psychiatric inpatients.MethodsWe conducted a cross-sectional study in the period from october,13 2023 to october,20 2023, among psychiatric male inpatients, hospitalized in psychiatry B department of the Hedi Chaker University Hospital (Sfax, Tunisia). We collected sociodemographic and clinical data using a pre-established form.ResultsOver a period of a week, 35 patients were included in our study. The mean age of patients was 39,97 years. Among them, 80% were single and 14,3% were married. Addictive behaviors were reported in 74,3% of cases. The level of hygiene was good in 74,3% of patients. The three most common psychiatric diagnoses were schizophrenia (31,4%), followed by bipolar disorder (28,6%) and schizoaffective disorder (25,7%). We recorded 13 cases of skin diseases (37,2% of patients). Dermatological lesions were dominated by traumatic origin in 14,3% of cases. They were of infectious origin in 11,4% of cases, immunoallergic in 8,6% and parasitic in 2.9%.ConclusionsThe prevalence of skin diseases is high in psychiatric inpatients, for whom proper skin care is necessary to improve their quality of life.Disclosure of InterestNone Declared

A rare case of bilateral antero-internal shoulder dislocation: A case study and review of the literature

Introduction: Although anterior dislocations of the glenohumeral joint are the most frequent type of dislocation, bilateral forms are very rare [1] dominated by the posterior variant. We report a new case of bilateral anterior dislocation of the glenohumeral joints and discuss the mechanism and treatment. Case report: This concerns a 55-year-old patient, who presented to the emergency room with closed trauma to both shoulders in undetermined circumstances. The patient reported a disturbance of consciousness followed by a post-critical coma and generalized tonic-clonic seizures according to witnesses. Clinical examination revealed total functional impotence of the upper limbs, with the following findings: filling of the delto-pectoral groove, bilateral external axe strike, oedema of both shoulders. X-rays of both shoulders revealed bilateral anterior glenohumeral dislocation, with a nondisplaced fracture of the left great tuberosity. Discussion: Bilateral shoulder dislocation is a rare occurrence typically associated with specific etiologies such as epileptic seizures, electrical or neuromuscular disorders, or traumatic events. This report presents a case of bilateral shoulder dislocation in a patient with no history of ligament hyperlaxity, categorized under Brown's classification as traumatic origin. Despite the rarity of this presentation, similar unusual mechanisms of shoulder dislocation have been reported in the literature, including cases where each shoulder dislocated due to different mechanisms.

FORENSIC MEDICAL DIAGNOSIS OF REFLEXIVE CARDIAC ARREST WITH TRAUMATIC DAMAGE OF THE SOLAR PLEXUS (CASE FROM EXPERT PRACTICE)

In the practice of forensic medical experts, cases of sudden death of young people during conflict situations with no obvious signs of injury appear from time to time. During the autopsy, as a rule, no morphological abnormalities are detected, and the main cause of death remains undetermined. In this case, one should remember the possibility of viscero-cardiac reflexes during a traumatic effect on a person's reflexogenic zones. Modern scientific achievements, especially regarding the pathophysiology of cardiac activity and its disorders, prompted the authors to cover this topic with a view to forensic aspects.&#x0D; Results. The case demonstrates that a detailed analysis of the circumstances of a person's death, a detailed forensic medical examination of the corpse, which includes taking material from reflexogenic areas of the body with its subsequent histological examination, allow to verify a forensic medical diagnosis.&#x0D; Conclusion. This case demonstrates that a systematic approach using histological methods of diagnosis makes it possible to confirm the diagnosis of reflex cardiac arrest of traumatic origin by identifying signs of acute metabolic disorders of the myocardium, provided the primary source of traumatic irritation of the solar plexus is identified.

Advantages and disadvantages of percutaneous surgery of urolithiasis in the patient’s supine position

BACKGROUND: Studying the clinical features of different surgical approaches in patients with urolithiasis with stones localized in the kidney and the upper third of the ureter is an important practical issue in modern urology.&#x0D; AIM: The aim of the study is a clinical evaluation of the results of percutaneous surgery for urolithiasis with the patient in the supine position.&#x0D; MATERIALS AND METHODS: The results of surgical treatment of 316 patients with urolithiasis with stones localized in the kidney (more than 10 mm) and the upper third of the ureter (more than 8 mm) are presented. All patients underwent percutaneous nephrolithotripsy in the supine position.&#x0D; RESULTS: Complete elimination of stones was achieved in 91.3% of patients with stones of the upper third of the ureter and 96.2% of patients with kidney stones. Clinical evaluation of the surgical results showed that the frequency of intraoperative complications of traumatic origin is about 10%, the most common complication being bleeding. At the same time, complications of grades IV and V according to the Clavien–Dindo classification were noted. Performing percutaneous nephrolithotripsy in the supine position reduces the time required to position the patient, allows for the combination of transurethral and percutaneous interventions, is more effective for patients with increased weight and concomitant diseases, and also provides a significant advantage in the need for ventilation and possible resuscitation.&#x0D; CONCLUSIONS: It is advisable to introduce a personalized approach to the choice of surgical access when performing invasive interventions on the upper urinary tract.

The Effect of Epidural Electrical Stimulation Application in Individuals with Spinal Cord Injury

Spinal cord injury (SCI) is a significant cause of disability, affecting both children and adults worldwide. These injuries can arise from various conditions, including traumatic, vascular, tumor-related, infection-related, inflammatory (such as multiple sclerosis), or neurodegenerative (like motor neuron disease) origins. Among these, traumatic spinal cord injuries caused by reasons like falls and traffic accidents stand out, particularly in developed countries. Epidural electrical stimulation (EES) was initially used to inhibit chronic pain. Subsequent studies have shown its effectiveness in individuals with SCI. In research spanning from the past to the present, EES applications have been utilized for activities such as motor function improvement, sensory enhancement, bowel functions, increased sexual functionality, and regulating heart rhythms in people with SCI. However, the exact impact of EES remains inconclusive at present and is still a subject of debate.

What is the Injury Incidence and Profile in Professional Male Ice Hockey? A Systematic Review.

Professional male ice hockey is characterized by a congested in-season match schedule and by different scenarios where the whole body is exposed to great internal and external forces. Consequently, injuries occur from head to toe. However, there is a lack of data synthesis regarding the injury incidence and profile in this population. The aim of this study was to conduct a systematic review to quantify the injury incidence rates in professional male ice hockey. Systematic Review. The electronic databases PubMed, CINAHL, Web of Science, ProQuest-Sport medicine & Education Index, and Pro-Quest Dissertation and Thesis were searched utilizing terms related to ice hockey and injuries. Studies were included if they provided the incidence of injury in professional male hockey players and reported injuries in terms of time lost. The modified Newcastle Ottawa Scale for cohort studies and the Strengthening the Reporting of Observational Studies in Epidemiology - Sports Injury and Illness Surveillance Statement were used to assess the methodological quality of the studies. Eleven studies were included in the review. Match injury incidence ranged from 38 to 88.6 injuries/1000 hours of exposure, whereas training injury incidence varied from 0.4 to 2.6 injuries/1000 hours of exposure. Injuries of traumatic origin accounted for 76% to 96.6% of all injuries, with contusions and lacerations being the most common. Severe injuries accounted for 7.8% - 20% of all injuries. The lower extremities were the most susceptible to injury, comprising 27% to 53.7% of all reported injuries. Professional male ice hockey players are exposed to a substantial risk of injury during competitions, with lower extremities being the most commonly affected body part. The majority of injuries are traumatic and severe injuries account for a notable portion of overall injury cases.

Nutritional status and nutritional support of patients with chronic disorders of consciousness at the stage of medical rehabilitation

Chronic disturbances of consciousness (CDC) are a consequence of severe brain damage and are conditions that arise after emerging from a coma with the preservation of the sleep-wake cycle in the absence of signs of conscious behavior. When conducting inpatient medical rehabilitation of this group of patients, the state of nutritional status is not always taken into account and, as a rule, there is no nutritional support with an assessment of metabolic needs, including the introduction of various modes of physical activity during physical therapy and an increase in physical load on the patient's body. The purpose of the study was to assess the nutritional status and optimize the nutritional support system in patients with CDC at the inpatient stage of medical rehabilitation (MR). Material and methods. The study analyzed the results of examination and treatment of 152 patients with CDC of traumatic origin who received medical rehabilitation from 2016 to 2022 in the Department of Physical and Rehabilitation Medicine of the Nikiforov Russian Center of Emergency and Radiation Medicine, Ministry of Russian Federation for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters. Results. In patients with CDC of traumatic genesis, signs of malnutrition (objective, anthropometric, laboratory) were diagnosed at the inpatient stage of MR, and there were also risks of malnutrition progression with the introduction of additional physical activity. Conclusion. To create an effective and adequate nutritional support system during inpatient MR, metabolic monitoring (indirect calorimetry) is of fundamental importance, taking into account the influence of additional physical activity. The use of a calculation method for estimating energy requirements can lead to hyperalimentation.

Upper Extremity Functional Status in Patients with Chronic Tetraplegia in Universiti Malaya Medical Centre.

Persons with tetraplegia rank improved upper extremity (UE) function as the most important rehabilitation outcome because it allows them greater independence in activities of daily living (ADL). The aim of this study was to describe UE status in patients with tetraplegia using the International Spinal Cord Injury Upper Extremity Basic Data Set version 1.1 (ISCI-UE 1.1) and to determine differences in UE status between tetraplegic individuals with traumatic and non-traumatic SCIs. This cross-sectional study was conducted among patients with tetraplegia who attended the SCI rehabilitation clinic of a tertiary hospital from September 2021 to August 2022. Both upper limbs were assessed using ISCI-UE 1.1. One hundred patients were included in this study, of whom 80 were men. The mean (SD) age of the patients was 54.30 (16.95) years old. In these patients, most SCIs (62%) were of traumatic origin. Two hundred UEs were evaluated, of which 109 showed good hand function (level 5) and 10 had the poorest hand function (level 1). Meanwhile, 130 UEs showed good shoulder function (level D) and 10 had the poorest shoulder function (level A). A statistically significant association with UE status (reach-and-grasp ability and shoulder function) was found in both the non-traumatic and traumatic SCI groups, with better hand and shoulder functions in the non-traumatic SCI group (right-hand, P = 0.004 and left hand, P = 0.001; right shoulder, P < 0.001 and left shoulder, P = 0.002). ISCI-UE 1.1 is a feasible tool for documenting UE function in patients with tetraplegia. Compared with the individuals with traumatic SCI in this study, those with non-traumatic SCI demonstrated better upper extremity functionality.

Treatment strategy for an unstable chest wall after cardiopulmonary resuscitation

Every year ca. 60,000 people in Germany undergo cardiopulmonary resuscitation (CPR). The two most frequent underlying causes are of cardiopulmonary and traumatic origin. According to the current CPR guidelines chest compressions should be performed in the middle of the sternum with a pressure frequency of 100-120/min and to adepth of 5-6 cm. In contrast to trauma patients where different injury patterns can arise depending on the accident mechanism, both the type of trauma and the injury pattern are similar in patients after CPR due to repetitive thorax compression. It is known that an early reconstruction of the thoracic wall and the restoration of the physiological breathing mechanics in trauma patients with unstable thoracic injuries reduce the rates of pneumonia and weaning failure and shorten the length of stay in the intensive care unit. As a result, it is increasingly being propagated that an unstable thoracic injury as a result of CPR should also be subjected to surgical treatment as soon as possible. In the hospital of the authors an algorithm was formulated based on clinical experience and the underlying evidence in a traumatological context and a surgical treatment strategy was designed, which is presented and discussed taking the available evidence into account.

Emergency aid: emergency homeopathic treatment in a cat victim of a runway

The most common cause of shock in cats is trauma, due to fights with other animals and being run over. Regardless of the cause, shock can be fatal. Arnica montana is well used on tissues, skin and holes, always of traumatic origin. It reabsorbs internal bleeding, in addition to being a great option for controlling pain in these origins. This work aims to describe the use of homeopathy as a veterinary emergency tool, proving its effectiveness in supporting a cat victim of trauma due to being run over. A heavy seven-year-old mixed-breed cat received homeopathic support shortly after the trauma. Arnica montana 30 cH was administered in the plus method for two hours. Ultradilution kept the cat with a good breathing pattern and with all stimuli preserved, after six hours the patient presented cardiorespiratory arrest, leading to death. At necropsy, there was the presence of a discrete hematoma in the right lateral abdominal muscles and the presence of intestinal loops in the right internal femoral bone, characterizing a femoral hernia. The choice was unique and its use corroborates the well-being measures and responsibility of the Veterinarian in providing the first care. This study allowed a greater elucidation of the applicability of homeopathic therapy in the veterinary emergency room.

Effectiveness of high- versus low-dose four-factor prothrombin complex concentrate on hemostasis and thromboembolism in patients with oral factor Xa inhibitor-associated intracranial hemorrhage

Abstract Background Four-factor prothrombin complex concentrate (4F-PCC) is frequently used off-label for the reversal of oral factor Xa inhibitor-associated bleeding. Dosing of 4F-PCC in routine practice remains inconsistent as published observational studies and clinical guidelines have provided conflicting results. Purpose We evaluated the incidence of hemostatic effectiveness and thromboembolism with high- versus low-dose 4F-PCC in a cohort of patients with oral factor Xa inhibitor-associated intracranial hemorrhage (ICH). Methods We identified patients treated with 4F-PCC during a hospitalization for apixaban- or rivaroxaban-associated ICH between December 2016 and August 2020. Patients were included if they were ≥18 years old, had a radiographically confirmed ICH, and received their last dose of apixaban or rivaroxaban &amp;lt;24 hours prior. Patients with a hematoma volume &amp;gt;60 mL, a Glasgow Coma Scale score &amp;lt;7, or planned surgery within 12 hours were excluded. Patients were divided into cohorts based on 4F-PCC dose administered: high- (≥35 IU/kg) or low-dose (&amp;lt;35 IU/kg). Our primary outcome was hemostatic effectiveness, defined as ≤35% increase in hematoma size from index to repeat scan at 12±5 hours after administration of 4F-PCC. If no repeat scan was available within that timeframe, the worst scan within 24 hours was used. If no repeat scan was available within 24 hours, hemostatic effectiveness was adjudicated based upon clinical findings by two trained investigators. Our secondary outcome was development of thromboembolism within 5 days of receiving 4F-PCC. To adjust for potential differences in baseline characteristics between 4F-PCC dosing groups, propensity score-overlap weighted logistic regression was used. Results are reported as adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results Ninety-five patients, 24 in the high- and 71 in the low-dose group, were included. Mean ± standard deviation (SD) age of the total study cohort was 80.3 ± 9.1 years, time from initial imaging to start of reversal was 2.4 ± 2.1 hours, and time from end of reversal to repeat scan was 6.8 ± 4.6 hours. Intracerebral ± intraventricular bleeds were most common (46.6%), with 7.4% of patients having infratentorial involvement, and 13.5% having bleeds ≥10 mL/≥10 mm in size. Most ICHs were single compartment (91.8%) and were of traumatic origin (68.7%). Following propensity score-overlap weighted logistic regression, no difference in hemostatic effectiveness was observed between patients receiving high- (80.3%) or low-dose (77.2%) 4F-PCC (OR 1.20; 95%CI 0.28 to 5.15). No cases of thromboembolism were observed in either 4F-PCC dosing arm. Conclusion High-dose (≥35 IU/kg) 4F-PCC was not associated with increased odds of achieving hemostatic effectiveness compared to the low-dose (&amp;lt;35 IU/kg) in patients experiencing apixaban- or rivaroxaban-associated ICH, with no incidence of thrombotic events.

Effect of Analgesic Low-Dose Ketamine Infusions on the Cardiovascular Response: A Retrospective Analysis

BACKGROUND: Low-dose ketamine infusion (LDKI) has shown effectiveness for treating acute pain associated with surgical and nonsurgical (traumatic, neuropathic, and acute cancer-related) origin as an adjuvant to opioids. The increasing use of LDKI as an opioid-sparing agent in multimodal analgesia requires a better understanding of its effects on the cardiovascular response, a known dose-dependent side effect of ketamine administration. We investigated the cardiovascular response of acute pain patients treated with LDKI. OBJECTIVES: The aim of the present study was to evaluate the effect of LDKI in hemodynamic variables (blood pressure [BP] and heart rate [HR]) during LDKI analgesia for up to 48 hours of treatment in an acute pain setting. Secondary objectives were to evaluate psychomimetic effects. STUDY DESIGN: Retrospective unicentric cohort design. SETTING: The study was conducted at an academic university hospital. METHODS: We conducted a single-center retrospective cohort analysis of adult patients who underwent LDKI to treat surgical and nonsurgical acute pain. We obtained data from the Hospital San Vicente Fundación Health Documentation System database and evaluated the medical records of 318 patients with surgical and nonsurgical pain. Patients received a 0.1 mg/kg/h ketamine infusion as part of a multimodal analgesic plan. Baseline systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and HR values were compared with those measured after 24 and 48 hours of treatment. Pain level and psychomimetic effects were measured at 24 and 48 hours. Cardiovascular complications and treatment duration were also recorded. Patients with a history of psychiatric, cardiovascular, or cognitive disease were excluded from the study. This study was registered in the clinicaltrials.gov database (identifier: NCT03979105). RESULTS: No statistical differences in SBP, DBP, MAP, or HR were observed when baseline and post-LDKI treatment values were compared (P &lt; 0.05). When comparing hemodynamic variables after exposure to LDKI in patients with and without hypertension, we did not observe statistically significant differences in mean HR, systolic arterial pressure, diastolic arterial pressure, or MAP values at 24 and 48 hours. The frequency of severe pain was reduced from 72% on day 0 to 4.4% on day 1 and 6.2% on day 2 post-LDKI. Observed psychomimetic effects were confusion 4.39%, hallucinations 2.51%, and nightmares 1.25%. No major cardiovascular events were observed. LIMITATIONS: This study was limited by its retrospective design, the lack of a comparative matching cohort, and the good general condition of the majority of patients included in the study. CONCLUSIONS: LDKI (0.1 mg/kg/h) was not associated with significant changes in baseline BP or HR. Our results suggest that as an adjuvant in multimodal analgesia for surgical and nonsurgical acute pain, LDKI has a low impact on the cardiovascular response. KEY WORDS: Ketamine, adverse effects, tachycardia, hypertension, postoperative pain, chronic postsurgical pain

Opsoclonus and ocular flutter: evaluation and management.

Opsoclonus and ocular flutter are saccadic intrusions characterized by spontaneous, back-to-back, fast eye movements (saccades) that oscillate about the midline of central visual fixation without intervening inter-saccadic intervals. When this type of movement occurs exclusively in the horizontal plane, it is called ocular flutter. When it occurs in multiple planes (i.e. horizontal, vertical, and torsional) it is called opsoclonus. The most common etiologic categories are parainfectious and paraneoplastic diseases. Less common are toxic-metabolic, traumatic, or idiopathic origins. The mechanism of these movements relates to dysfunction of brainstem and cerebellar machinery involved in the generation of saccades. In this review, we discuss the characteristics of opsoclonus and ocular flutter, describe approaches to clinical evaluation and management of the patient with opsoclonus and ocular flutter, and review approaches to therapeutic intervention. Recent publications demonstrated eye position-dependent opsoclonus present only in left gaze, which may be related to dysfunction of frontal eye fields or structures in the cerebellar vermis. Opsoclonus and ocular flutter originate from a broad array of neuropathologies and have value from both a neuroanatomic and etiologic perspective.