Visceral Injury Research Articles

Retrospective observational study comparing hand-assisted, retroperitoneal and trans-abdominal laparoscopic adrenalectomy

Abstract Aim Laparoscopic adrenalectomy is considered the optimal approach for most lesions. Various subsets of minimally invasive adrenalectomy are practiced in the UK, including trans-abdominal (TLA), hand-assisted (HLA) and retroperitoneal (RLA) laparoscopic procedures. We aimed to examine the relative operative outcomes between the 3 techniques. Methods We performed a retrospective observational review of contemporaneously maintained databases from two nearby institutions to establish differences in outcomes between minimally invasive adrenalectomy for any size lesion. Statistical analysis was undertaken using R v3.6.0. Results Two hundred and ninety-seven patients underwent laparoscopic adrenalectomy and were included in the analysis (45 RLA, 77 HLA and 175 TLA). There were no significant differences between groups for institution location, wound infection, intra-operative bleeding, blood product requirements, visceral injury, open conversion, re-operation, incisional hernia, laterality of lesion, oncological outcomes and medical complications. Boxplots revealed a wider spread and increased mean operating time for TLA, with less difference in operation time between HLA and RLA groups. This was confirmed by an overall significant finding from Kruskal-Wallis rank sum test (p=<0.001) and pairwise comparisons using Wilcoxon rank sum test with a bonferroni correction for multiple testing which demonstrated significant differences between HLA and TLA, and RLA and TLA (p<0.001), but not between RLA and HLA (p=1.000). Conclusion Minimally invasive adrenalectomy can safely be performed by any of 3 techniques. TLA showed a longer mean operating time. The analysis of outcomes revealed otherwise no significant differences in operative or medical outcomes.

Cardiopulmonary resuscitation related injuries: Man versus machine

Cardiopulmonary resuscitation (CPR) has been a recognised emergency intervention and has become the expected response for all persons found without a pulse or respiration. The goal of CPR is to maintain temporary artificial circulation until return of spontaneous circulation is achieved. Despite its potentially life saving properties, CPR consists of repeated blunt force trauma to the chest, and as such it is generally accepted that injuries can result. Thoracic skeletal injuries are not infrequently seen, and once the stability of the bony skeleton is compromised, visceral injuries are also possible, and if return of spontaneous circulation is achieved, these injuries can complicate the subsequent clinical course.

Frequency of intra-abdominal visceral injury due to penetrating trauma in the Emergency Department of Imam Khomeini Hospital in 2020

Introduction: Trauma is an injury that occurs due to the exchange of environmental energy with the body to an extent that is unbearable. In developing countries, such as Iran, trauma, especially abdominal trauma, has become increasingly important due to the enhanced development of vehicles and industries. The present study aimed to assess the frequency of intra-abdominal visceral injury due to penetrating trauma in the Emergency Department of Imam Khomeini Hospital in 2020. Methods: This descriptive cross-sectional study was performed on 162 patients with penetrating abdominal trauma who were selected via the census method out of the patients referring to the Emergency Department of Imam Khomeini Hospital in Urmia, Iran. Data were collected using a checklist which included items on gender, age, length of hospital stay, patient's final condition, and cause of trauma, injury outcome, location of the injury, and laparotomy outcome. Data were entered into SPSS software (version 18) and analyzed using descriptive statistics (frequency, percentage, mean, and standard deviation) and chi-square test. Results: Out of 162 impenetrable trauma patients, 135 (83.3%) and 27 (16.7%) cases were male and female, respectively. The mean age of patients was 33.25±18.99 years. The causes of trauma were accidents (75.4%) and falls from height (24.6%). Furthermore, regarding laparotomy results, 29.6% of patients had no intra-abdominal visceral injury, while intestinal, liver, and spleen injuries were observed in 24.7%, 25.9%, and 19.8% of cases, respectively. Conclusion: As evidenced by the results of this study, the majority of trauma patients were male. Moreover, the most common mechanisms of trauma in patients referring to the emergency department of this accident center and the most commonly injured organs were the spleen and intestine. Therefore, appropriate measures are required to prevent these injuries.

Safety of Minimally Invasive Percutaneous Nephrolithotmy in High Risk Patients in Lateral Position - A Single Center Study

Objective: To assess the safety and efficacy of minimally invasive percutaneous nephrolithotomy with fluoroscopy aided renal access in the lateral position, in patients who were high-risk cases for anesthesia in prone position.
 Study Design: Prospective observational study.
 Place and Duration of Study: Armed forces institute of Urology, Rawalpindi, from Jan 2018 to Dec 2019.
 Methodology: Fifty-three patients with renal stones >1.8cm underwent minimally invasive percutaneous nephrolithotomy with fluoroscopy-guided renal access in the lateral position. All the patients were obese, some had severe ischemic heart disease, few had diabetes mellitus. All the patients were unfit for the prone position.
 Results: Successful renal access was achieved in all the patients (100%). The mean size of stone was 28 + 13.2 mm, with an average operative time being 55 ± 13.56 minutes and the mean hospital stay was 1.8 ± 2.3 days (range 2-4 days). No visceral or pleural injuries were documented. In addition, only two patients required postoperative transfusion. After procedure, the rate of complete stone clearance initially was 90.6%, which improved to 96% after single session of extracorporeal shockwave lithotripsy (ESWL). Only 2 (3.77%) patients had persistent residual stone fragment.
 Conclusion: Minimally invasive percutaneous nephrolithotomy with fluoroscopy-guided renal access in the lateral decubitus flank position, is safe and convenient in high-risk patients where prone position is contraindicated.

A breath-taking case of pneumoscrotum.

Pneumoscrotum is a rare physical exam finding that is commonly associated with life-threatening perineal infections or secondary causes from visceral or pulmonary injury.1 However, it is usually found in conjunction with multiple other concerning physical exam findings. In this report, we describe a young competitive diver who presented with isolated pneumoscrotum, which eventually was found to be due to a spontaneous tracheal tear

A rare case of isolated pancreatic injury in blunt trauma abdomen

Injury to the pancreas by a blunt trauma is very rare and accounts for less than 2% of all abdominal injuries. It can be acute or delayed presentation. CT abdomen is the major imaging method in the diagnosis of abdominal visceral injuries. We can confirm pancreatic main duct injuries with magnetic Resonance Cholangiopancreatography (MRCP) or ERCP by contrast extravasation. ERCP has also been used therapeutically with transpapillary stunting across the pancreatic duct disruption or simply across the sphincter of Oddi aiming at a reduction of the intrapancreatic pressure gradient. There are several surgery options for which can be employed to manage this injuries.

Use of minimally invasive surgery for the management of hollow viscus traumatic injuries.

The objective of this study is to assess surgical outcomes following the initial use of laparoscopy versus laparotomy when managing patients with hollow viscus injuries due to trauma. Using the database from the American College of Surgeons Trauma Quality Improvement Program we identified all patients from 2015-2017 with ICD-10 Diagnosis codes for hollow viscus trauma. Types of procedures were identified by ICD-10 PCS codes. Patient outcomes were stratified by major trauma(ISS > 15) and minor trauma. Continuous variables were compared by ANOVA and categorical variables compared by Chi-Square. Analysis performed using STATA 16. We identified 16,284 patients that matched inclusion criteria within the study time frame. Of those, 1986 patients received a surgical intervention, 1911(96%) were open and 75(4%) were laparoscopic. In blunt trauma there were 106 diagnostic procedures, 87(82%) were open and 19(18%) were laparoscopic. There were 574 therapeutic procedures, 543(95%) were open and 31(5%) were laparoscopic. In penetrating trauma there were 223 diagnostic procedures, 215(96%) were open and 8(4%) were laparoscopic. There were 1039 therapeutic procedures for penetrating trauma, 1023(98%) were open and 16(2%) were laparoscopic. For minor trauma, mean length of stay(days) after open surgery was 5 while for laparoscopy it was 2 (p = 0.04). There were 203 complications noted in the open group and 7 in the laparoscopic group (p = 0.19). For major trauma, mean length of stay(days) after open surgery was 5 and 6 for laparoscopy p = 0.54). There were 242 complications in the open group and 1 in the laparoscopic group (p = 0.07). There was no noted significant difference noted in the disposition at discharge in either group in both major and minor trauma. For those that required surgery for hollow viscous injury, laparoscopy appeared to be safe, had less adverse outcomes and was underutilized, particularly when only a diagnostic procedure was required.

Frequency of Visceral Injury and Post-Operative Port Site Hernia from Direct Trocar Insertion for Gaining Access to Peritoneal Cavity in Laparoscopic Cholecystectomy

Aim: To see the frequency of visceral injury and port site hernia from direct trocar entry in laparoscopic cholecystectomy. Study Design: Place and Duration of Study: Department of Surgery, District Headquarters Teaching Hospital Abbottabad from 1st December 2017 to 20th September 2019. Methodology: Two hundred and sixty patients requiring laparoscopic cholecystectomy were enrolled. Direct trocar technique was used for peritoneal first port entry using retractable trocar in all patients. Demographic characteristics of the patients, as well as intraoperative visceral injury and post operative port site hernia formation were recorded. Results: Majority of study participants were females: 229 (88 %) women while remaining men. Mean age of study population was recorded as 37±8 years. Females were older than males (p > 0.05).We have not seen a single case of visceral injury or hernia formation in our study. Conclusions: The blind technique with retractable port is safe for first port entry into peritoneum in terms of visceral injury and also hernia formation. Key words: Direct trocar, Laparoscopic cholecystectomy, Visceral injury, Port site hernia

Impact of Standard and Low-Pressure Pneumoperitoneum on Intraoperative Complications in Laparoscopic Cholecystectomy

Aim: To compare LPP and SPP laparoscopic cholecystectomy regarding efficiency and complications Methodology: Sixty patients were enrolled. Patients were divided into two groups. 30 patients were placed in each group A and B. The intensity of postoperative shoulder pain was assessed by using visual analog scale (VAS) at 4,8,12 and 24 hours after surgery. Nausea & vomiting episodes also measured at 4,8,12 and 24 hours after surgery. The length of operation, intra-operative findings, intra-operative complications (bile spilling, visceral injury and hemorrhage), and hospital stay were also noted. Results: Patients in this study were divided into two groups: group A and B. The frequency of shoulder pain at different periods was from 0 to 7 i.e. No pain, Mild, Moderate, and worst which was counted by the minimum to maximum i.e. 2 and 7 at 4 hours, 2 and 9 at 8 hours, 1 and 8 at 12 hours and 0 to 8 at 24 hours. Regarding intra-operative complications i.e. Bile Spillage, bleeding and visceral injury, only a few patients had bouts of nausea/vomiting in the 4 hours and 24 hour time intervals. However, more patients were affected by this condition at 8 and 12-hour intervals. Conclusion: LP laparoscopic surgery is an achievable alternative to SP laparoscopic procedure for benign issues of gall stone. LPP is a better choice for the LC since it minimizes post-operative pain of the shoulder & the PONV while causing no significant increase in intraoperative complications. Keywords: Laparoscopic surgery, low pressure pneumoperitonium, standard pneumoperitonium

Abdominal stab wounds with retained knife: 15 years of experience from a major trauma centre in South Africa.

This study reviews our cumulative experience with the management of patients presenting with a retained knife following an abdominal stab wound (SW). A retrospective study was conducted at a major trauma centre in South Africa over a 15-year period from July 2006 to December 2020 including all patients who presented with a retained knife in the abdomen following a SW. A total of 42 cases were included: 37 males (93%) with a mean age of 26 years. A total of 18 knives (43%) were in the anterior abdomen and 24 were posterior abdomen. Plain radiography was performed in 88% (37/42) of cases and computed tomography was performed in 81% (34/42); 90% (38/42) underwent extraction in the operating theatre. Laparotomy was performed in 62% (26/42). Of all the laparotomies performed, 77% (20/26) were positive for intra-abdominal organ or visceral injury. Overall morbidity was 31%. There were two mortalities (5%). Laparotomy was less commonly required for the posterior abdomen (33% (8/24) vs 100% (18/18), p<0.001). For retained knives in the anterior abdomen, 72% (13/18) of the laparotomies were positive for intra-abdominal organ or visceral injury. For the posterior abdomen, 7 of the 8 (88%) were positive for intra-abdominal organ or visceral injury. There were no differences in the need for intensive care unit admission, length of hospital stay, morbidities or mortalities. Uncontrolled extraction of a retained knife in the abdomen outside of the operating theatre must be avoided. Retained knives in the anterior abdomen usually require formal laparotomy, but this is generally not required for posterior abdomen.

The analgesic efficacy of transversus abdominis plane block vs. wound infiltration after inguinal and infra-umbilical hernia repairs: A systematic review and meta-analysis with trial sequential analysis.

Both transversus abdominis plane (TAP) block and wound infiltration with local anaesthetic have been used to relieve pain after inguinal or infra-umbilical hernia repair. To determine whether TAP block or local anaesthetic infiltration is the best analgesic option after inguinal or infra-umbilical hernia repair. Systematic review and meta-analysis with trial sequential analysis. MEDLINE, Embase, Cochrane Central Register of Controlled Clinical Trials, Web of Science, up to June, 2020. We retrieved randomised controlled trials comparing TAP block with wound infiltration after inguinal or infra-umbilical hernia repair. Primary outcome was rest pain score (analogue scale 0 to 10) at 2 postoperative hours. Secondary pain-related outcomes included rest pain score at 12 and 24 h, and intravenous morphine consumption at 2, 12 and 24 h. Other secondary outcomes sought were block-related complications such as rates of postoperative infection, haematoma, visceral injury and systemic toxicity of local anaesthetic. Seven trials including 420 patients were identified. There was a significant difference in rest pain score at 2 postoperative hours in favour of TAP block compared with wound infiltration, with a mean (95% confidence interval) difference of -0.8 (-1.3 to -0.2); I2 = 85%; P = 0.01. Most secondary pain-related outcomes were also significantly improved following TAP block. No complication was reported. The overall quality of evidence was moderate. There is moderate level evidence that TAP block provides superior analgesia compared with wound infiltration following inguinal or infra-umbilical hernia repair. PROSPERO CRD42020208053.

Surgical stabilization of serial rib fractures is advantageous in patients with relevant traumatic brain injury

PurposeTo evaluate the clinical benefit of surgical stabilization of rib fractures (SSRF) in polytrauma patients with serial rib fractures.MethodsRetrospective single-center cohort analysis in trauma patients. Serial rib fracture was defined as three consecutive ribs confirmed by chest computer tomography (CT). Study cohort includes 243 patients that were treated conservatively and 34 patients that underwent SSRF. Demographic patient data, trauma mechanism, injury pattern, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) and hospital course were analyzed. Two matched pair analyses stratified for ISS (32 pairs) and GCS (25 pairs) were performed.ResultsThe majority of patients was male (74%) and aged 55 ± 20 years. Serial rib fractures were associated with more than 6 broken ribs in average (6.3 ± 3.7). Other thoracic bone injury included sternum (18%), scapula (16%) and clavicula (13%). Visceral injury consisted of pneumothorax (51%), lung contusion (33%) and diaphragmatic rupture (2%). Average ISS was 22 ± 7.3. Overall hospital stay was 15.9 and ICU stay 7.4 days. In hospital, mortality was 13%. SSRF did not improve hospital course or postoperative complications in the complete study cohort. However, patients with a significantly reduced GCS (7.6 ± 5.3 vs 11.22 ± 4.8; p = 0.006) benefitted from SSRF. Matched pair analysis stratified for GCS showed shorter ICU stays (9 vs 15 days; p = 0.005) including shorter respirator time (143 vs 305 h; p = 0.003).ConclusionPatients with serial rib fractures and simultaneous moderate or severe traumatic brain injury benefit from surgical stabilization of rib fractures.

Imaging Utilization Patterns and Injury Characteristics Associated with Electric Standing Scooters in a Major Urban Area.

The recent proliferation of electric standing scooters in major urban areas of the United States has been accompanied by injuries of varying severity and nature, representing a growing public health concern. Our aim was to characterize imaging utilization patterns for injuries associated with electric scooter (e-scooter) use, including their initial emergency department (ED) management. We conducted a retrospective review of the electronic medical record for all patients presenting to affiliated EDs for e-scooter-related injuries between July 2018 and April 2020. Demographics, date and time of presentation, imaging study type, resultant injury, and procedural details were recorded. Ninety-seven patients were included; mean age was 27.6 years. Of these, 55 patients (57%) had injuries identified on imaging and 40% of all imaging studies were positive. Most identified injuries (61%) were musculoskeletal, with a small number of neurological (2%) and genitourinary (1%) injuries. The highest prevalence of presentations occurred in August; most patients (72%) presented between 3 pm and 1 am and granular peaks were between 12 am and 1 am and 5 pm and 6 pm. Patients presenting with e-scooter injuries have a high likelihood of injury to the radial head, nasal bone, and malleoli. Emergency physicians should be especially vigilant for injuries in these areas at presentation. Visceral injuries are uncommon but may be severe enough to warrant surgery.

Posttraumatic Adrenal Hematoma a Case Report and Literature Review

Post-traumatic adrenal hematoma is a difficult to diagnose condition with rare but severe complications. Post-traumatic adrenal hematoma occurs in up to 2% of patients with abdominal trauma. Only CT scans performed during lesion assessments of violent thoracoabdominal trauma can confirm the diagnosis. Symptomatology is often masked by associated visceral or parietal injuries. Standard biological examinations are generally of little help. We describe a case of a 12-year-old child who presented with a right adrenal hematoma after a road traffic accident (MVA), associated with a peritoneal effusion and a fracture of the right sacral fin as well as a fracture of the right pubic ischium.

Preparation and characterization of tranexamic acid modified porous starch and its application as a hemostatic agent

Effective bleeding control is essential for the reduction of traumatic deaths among civilians and military personnel, particularly for physical visceral and arteriovenous injuries. Materials with good hemostatic properties have recently attracted significant scientific attention. In this study, a novel material of tranexamic acid modified porous starch (TAMPS) was produced through esterification. The structure of the final product was characterized using Fourier-transform infrared spectroscopy, X-ray diffraction, scanning electron microscopy, and thermogravimetric analysis. The hemostatic effect of TAMPS was preliminarily analyzed via in vitro clotting time, mouse tail amputation model and liver injury model experiments. Hemostatic effect of TAMPS was found to be significantly better than that of the positive control Quickclean. Through the exploration of related hemostatic mechanisms, TAMPS can promote coagulation via rapid fluid absorption and high erythrocyte aggregation capacity. The in vitro cytotoxicity, acute toxicity, and hemolysis tests revealed that TAMPS is safe and nontoxic and has perfect blood compatibility. Therefore, the TAMPS has a great potential for future clinical application as a rapid and multitarget hemostatic material.

Depth-labeled lumbar disc forceps for safe lumbar disc surgery: Our experience with 405 patients

Depth labeled lumbar disc forceps for safe lumbar disc surgery: Our experience with 405 patients Aim : Injury of intraabdominal structures by rupturing the anterior longitudinal ligament is a known complication of diskectomy. Despite its very low incidence, it has a high mortality. Although various minimally invasive methods are defined for discectomy, no significant reduction in this complication has been achieved. Positioning of the patient, aggressive discectomy, and deep-seated use of disc forceps are important risk factors. The aim of this study is to share our experience with modified instruments to minimize the risk of vascular and visceral injury during discectomy in surgically treated 405 patients with lumbar disc herniation. Materials and Methods: We routinely perform preoperative depth measurements at the level of lumbar disc herniations for the patients undergoing lumbar disc surgery and check the neighborhood with the prevertebral structures. During the operation, we perform discectomy with custom disc forceps that were labeled with centimeter measurements in accordance with these lengths. We performed discectomy on 405 patients using these forceps between January 2015 and May 2021. Results: In this retrospective study, disc depth measurements differed according to disc levels and gender. Disc depth was longer in males at all lumbar disc levels. Conclusion: It is very important to avoid vascular and visceral injuries for spinal surgeons. For this reason, we believe that knowing the safe preoperative discectomy depth and area and using centimeter-labeled disc forceps is the best method to prevent such complications.

Anterior lumbar spine exposure with vascular surgeon assistance

Objective:Evaluate access related complications contributing to adverse outcomes in patients undergoing retroperitoneal anterior lumbar interbody fusion (ALIF). MethodsA retrospective analysis was conducted of prospectively collected data on patients undergoing ALIF in a multidisciplinary setting at our institution from January 2007 to December 2021. Patients’ demographics, comorbidities, exposure related and postoperative complications within 30 days were included. Main outcome measures included vascular and visceral injuries requiring repair, nerve injuries, blood transfusion requirements, myocardial infarction, stroke, erectile dysfunction, retrograde ejaculation, length of stay and death. ResultsSeventy-four consecutive patients were included. Forty-seven were female and 27 male. The median body mass index was of 25.46 ± 4.76. Mean age was of 45.74 years. Twelve had a history of previous abdominal surgery and 31 a previous spinal surgery. The level operated on was L5/S1 in 58 patients (78.37%), L4/L5 in 2 patients (2.7%) and multi-level in 14 patients (18.91%). Sixteen patients had both anterior and posterior approach. There were no major intra-operative vascular injuries. Two patients had an intestine serosal tear. Seven patients had sexual dysfunction after surgery, of which 5 suffered impotence and 4 retrograde ejaculation. Two patients had both. There were no cases of disc space infections. There were no postoperative deaths. ConclusionsIn a multidisciplinary setting, ALIF can be performed safely with a reasonably low overall complication rate. Impotence and retrograde ejaculation are, even if generally temporary, important issues that have to be informed to the patient and inquired at follow up.

Blunt abdominal trauma: initial resuscitation followed by clinical and focused abdominal sonography assessment important diagnostic tools of organ injury due to restricted use of CT-scan in a tertiary care in India

Background: Blunt abdominal trauma (BAT) is one of the common causes of admission in surgical ward in any hospital. It requires high level of suspicion, urgent evaluation and timely management to decrease morbidity and mortality. Objective was to evaluate the role of clinical and ultrasound assessment in early diagnosis of intra-abdominal injury following blunt abdominal trauma and follow up in patients with intraabdominal injury for detecting complications.Methods: 130 patients who presented to the emergency room were evaluated by clinical and focused abdominal sonography for trauma (FAST) and follow-up sonography was done after 6-12 hours upto 72 hours.Results: In our study, road traffic accidents (RTA) were the most common cause of blunt abdominal trauma (70.76%) with 75% patients being were males. X-ray erect abdomen and ultrasound of the abdomen were the most sensitive investigation for hollow viscous injury and solid organ injuries, respectively, with bowel (38.33%) and liver injury (26.67%) being the most common organ involved in this study. This study found sensitivity (93.7%) and specificity (98.5%) of focused abdominal ultrasonography (FAST).Conclusions: Initial resuscitation followed by clinical and ultrasonography assessment is considered the best modality in initial evaluation of blunt abdominal trauma patients as it is noninvasive, readily available, and requires minimal preparation time and also due to restricted use of modern amenities such as CT-scan in tertiary care in India.

Splenic artery embolization improves outcomes and decreases the length of stay in hemodynamically stable blunt splenic injuries – A level 1 Australian Trauma centre experience

BackgroundSplenic injuries are the most common visceral injury following blunt abdominal trauma. Increasingly, non-operative management (NOM) and the use of adjunctive splenic angioembolization (ASE) is favoured over operative management (OM) for the hemodynamically stable patient. However, clinical predictors for successful NOM, particularly the role of ASE as an adjunct, remain poorly defined. This study aims to evaluate the outcomes of patients undergoing ASE vs NOM. MethodsA retrospective clinical audit was performed of all patients admitted with blunt splenic injury (BSI) from January 2005 to January 2018 at the Royal Adelaide Hospital. The primary outcome was ASE or NOM failure rate. Secondary outcomes were grade of splenic injury, Injury Severity Score (ISS), length of hospital stay (LOS), and delayed OM or re-angioembolization rates. ResultsOf 208 patients with BSI, 60 (29%) underwent OM, 54 (26%) ASE, and 94 (45%) NOM only. Patients were predominantly male 165 (79%), with a median age of 33 (IQR 24–51) years. The median ISS was 29 (20–38). There was no difference in the overall success rates for each modality of primary management (48 (89%) ASE vs 77 (82%) NOM, p = 0.374), though patients managed with ASE were older (38 vs 30 years, p = 0.029), had higher grade of splenic injury (grade ≥ IV 42 (78%) vs 8 (8.5%), p<0.001), with increased rates of haemo-peritoneum (46 (85%) vs 51 (54%), p<0.001) and contrast blush (42 (78%) vs 2 (2%), p<0.001). However, for grade III splenic injury, patients managed with ASE had a trend towards better outcome with no failures when compared to the NOM group (0 (0%) vs 8 (35%), p = 0.070) with a significant reduction in LOS (7.2 vs 10.8 days, p = 0.042). Furthermore, the ASE group overall had a significantly shorter LOS compared to the NOM group (10.0 vs 16.0 days, p<0.001). ConclusionASE as an adjunct to NOM significantly reduces the length of stay in BSI patients and is most successful in managing AAST grade III injuries.

Profile of Medico legal Autopsies Conducted at Tertiary Medico-legal Centre in Northern India

The present study is a retrospective study of medico-legal autopsies conducted in the Department of Forensic Medicine and Toxicology MMIMSR Mullana, Ambala, India, from Jan 2016 to December 2020. During this period, 793 cases of medico-legal autopsies were done in the mortuary of MMIMSR, Mullana, Ambala. The majority of victims were male 670 (84.48 %) cases and female 123 (15.52%) cases. A maximum number of post mortem done in the age group 20-40 years was 385(48.56 %) cases and minimum in age group 0-10 year were 18 (02.26%) cases. In our study, 601 (75.78%) were married, 169 (21.31%) unmarried, and unknown 23 (02.99%) cases. Hindus were 660 (83.22%), Muslim 50(06.30%), and Sikh 83 (10.48%) cases. The total number of deaths from rural areas was 406(51.20%) cases, which is slightly higher than urban area 387 (48.80%) cases. Manners of death due to natural causes were 38 (04.97%) cases and unnatural 755 (95.20%) cases. In unnatural, (accidents 551 (69.44%), Suicides 186 (23.44%) and homicides 18 (02.24%) cases). A maximum number of death due to Head injury were 235 (29.64%), shock and hemorrhage 188 (23.70%), poisoning 124 (15.64%), others-skeleton and visceral injuries 81 (10.22%), hanging 44 (05.54%), heart attack 38(04.78%), Drowning 23(02.90%), Electrocution 14 (01.76%), strangulation 13(01.64%), burns 11(1.38%), alcoholic 10(01.26%), septicemia 10(01.26%) and snake bite 2(00.26%)cases. A maximum number of deaths occurring between 0-6 hrs of injury was 395(49.82%) cases, and a minimum number of deaths in 24-48 hrs of injury was 22(02.77%) cases.