Trauma

摘要： BACKGROUND: Elevated troponin I(TnI) is common among trauma patients. TnI is an indicator of myocardial injury, but clinical diagnosis of blunt cardiac injury cannot be based solely on an increase in TnI. Therefore, this study aims to explore the changes and clinical significance of serum TnI in trauma patients. METHODS: The clinical data of consecutive trauma patients admitted to our trauma center between July 1, 2017 and July 31, 2020 were retrospectively analyzed. According to TnI levels within 24 hours of admission, patients were divided into the elevated and normal TnI groups. According to the TnI levels after 7 days of admission, a graph depicting a change in trend was drawn and then analyzed whether TnI was related to in-hospital mortality. RESULTS: A total of 166 patients(69 and 97 cases with elevated and normal TnI, respectively) were included in this study. The average hospital stay, intensive care time, mechanical ventilation time, and in-hospital mortality were higher in the elevated TnI group than in the normal TnI group(P<0.05). The TnI level of trauma patients gradually increased after admission and peaked at 48 hours(7.804±1.537 ng/mL). Subsequently, it decreased, and then recovered to normal within 7 days. However, 13 patients did not recover. Logistic regression analysis revealed that abnormal TnI at 7 days was independently related to in-hospital mortality. CONCLUSIONS: Trauma patients with elevated TnI levels may have a worse prognosis. Monitoring the changes in serum TnI is important, which can reflect the prognosis better than the TnI measured immediately after admission.

摘要： BACKGROUND:To investigate the clinical effectiveness of a pneumatic compression device(PCD)combined with low-molecular-weight heparin(LMWH)for the prevention and treatment of deep vein thrombosis(DVT)in trauma patients.METHODS:This study retrospectively analyzed 286 patients with mild craniocerebral injury and clavicular fractures admitted to our department from January 2016 to February 2020.Patients treated with only LMWH served as the control group,and patients treated with a PCD combined with LMWH as the observation group.The incidence of DVT,postoperative changes in the visual analogue scale(VAS)score,and coagulation function were observed and compared between the two groups.Excluding the influence of other single factors,binary logistic regression analysis was used to evaluate the use of a PCD in the patient’s postoperative coagulation function.RESULTS:After excluding 34 patients who did not meet the inclusion criteria,252 patients were were included.The incidence of DVT in the observation group was significantly lower than that in the control group(5.6%vs.15.1%,χ^(2)=4.605,P0.05).According to logistic regression analysis,the postoperative risk of DVT in patients who received LMWH alone was 1.764 times that of patients who received LMWH+PCD(P<0.05).The area under the receiver operating characteristic(AUROC)curve of partial thromboplastin time(APTT)and platelet(PLT)were greater than 0.5,indicating that they were the influence indicators of adding PCD to prevent DVT.Excluding the influence of other variables,LMWH+PCD effectively improved the coagulation function of patients.CONCLUSIONS:Compared with LMWH alone,LMWH+PCD could improve blood rheology and coagulation function in patients with traumatic brain injury and clavicular fracture,reduce the incidence of DVT,shorten the length of hospital stay,and improve the clinical effectiveness of treatment.

摘要： Background: Scleroderma is a complex immune-mediated rheumatic disease that is characterized by fibrosis of the skin, internal organs, and vasculopathy. Extensive fibrosis, especially in the limited compartment, has been reported to induce acute compartment syndrome frequently reported involving the upper and lower extremities. Case Presentation: We present a rare case of a 54-year-old Caucasian female who underwent surgery for abdominal compartment syndrome in the setting of scleroderma. Upon arrival, at the hospital, the patient’s health status showed signs of improvement with no indicators of abdominal compartment syndrome until the tenth hospital day. A CT scan showed a new intra-abdominal fluid collection with total lower abdominal anasarca and a stable retroperitoneal hematoma. Following emergency surgery, significant bowel edema without other intra-abdominal injuries was noted. Conclusion: Secondary abdominal compartment syndrome may occur in patients with scleroderma without evidence of intra-abdominal trauma or emergent abdominal surgery. Further research is warranted to investigate the relationship between scleroderma and secondary abdominal compartment syndrome.

摘要： Introduction: cervical spine trauma remains one of the most common causes of morbidity in the world with a significant financial burden on our society. It is a devastating event for the patient and family. The aim of this study is to share our experience in the surgery management of cervical spine injury in rural area. Methods: We did retrospective and single center study for one year from August 2020 to August 2021. We included all the patients who had undergone surgery for cervical spine injury in our hospital. Results: The study is based on 14 patients, 9 males and 5 females (sex ratio: 1.8). The average age was 34 years old and 08 (57%) were employed at time of injury. Road traffic accident was the most common cause, it was found in 11 (78%) cases followed by falls in 2 (14%) and interpersonal assault in 1 (7%). The Time admission ranged from 03 hours to 03 weeks. The most associated lesion was head trauma 7 (50%) followed by chest injury in 05 (35%) and 92% of our patient had motor deficit. Surgery was performed in all cases. Closed reduction was performed in 09 (64%) before surgery. Different types of complications that we had encountered were: infection 01 (07%) case, bed sores 02 (14%) cases, respiratory distress 02 (14%) cases and cervical kyphosis 01 (07%) case. After 06 months 71% of patients have progressed well with partial or complete recovery of their deficit. 14% of death in our series were noted and 28% of patients returned to work. Conclusion: cervical spine trauma remains a heavy socio-professional handicap. In rural areas, despite the lack of equipment and the difficulties of care, our results are satisfactory. However, it is necessary to insist on psychotherapy for these patients.

摘要： Jungian Advanced Motor Processing (JAMP) is a mode of treatment developed in May of 2020 by Dr. Lahab Al-Samarrai during the COVID-19 pandemic. Dr. Al-Samarrai had many students who reported increased anxiety, negative thoughts, fearful thoughts, and self-defeating thoughts. These students needed symptom relief more quickly than conventional talk therapy typically provides. Dr. Al-Samarrai developed a treatment modality incorporating light, bilateral audible beats, and positive affirmations. So far, more than 100 subjects have undergone JAMP, and this paper is a case study of one such subject. The research currently being compiled on JAMP, the subject of a future paper, to date shows positive improvement after receiving 5 - 6 sessions, and demonstrated decreases in both somatic symptoms and post-traumatic symptoms ranging from 45 - 55 percent. This paper will share the following: 1) Description of the underlying theoretical components supporting the treatment;2) Description of the treatment;3) Discussion of the case of Grace and her experience with JAMP.

摘要： Background: Mortality and morbidity due to trauma are a significant public health challenge. There is paucity of data on the waiting times and length of stay (LOS) of trauma patients in emergency departments in Botswana. The aim of this study was to determine the Emergency Department (ED) waiting times and LOS of trauma patients at Princess Marina Hospital in Gaborone, Botswana. Methods: This was a retrospective medical records review of waiting times (time from triage to review by ED medical officer) and LOS (time from triage to disposition from the emergency department). The waiting times for the different assigned acuities were assessed against the South African Triage System (SATS) standards. All trauma patients seen from 19/11/2018 to 18/12/2018 were included in the study. Prolonged length of stay was defined as duration > 6 hours. Categorical data was summarized with frequencies while numeric data was summarized with medians and interquartile ranges. Results: A total of 187 trauma patients’ files were analyzed. Of these, 72 (38.5%) were females. The median waiting time was 3.8 hours and the maximum was 19.2 hours. The median length of stay (LOS) was 8.8 hours with a maximum of 37.2 hours. Only 53 (28.3%) of the participants had a LOS of less than 6 hours. None of the emergent patients were seen immediately. Only 5 (4.0%) of the very urgent patients were seen within the target of 10 minutes. Finally, only 10 (20.4%) of urgent patients were seen within the target time of 1 hour. Conclusion: The waiting times and length of stay in Princess Marina Hospital were mostly above the recommended standards. Urgent interventions are needed to reduce waiting times and length of stay for trauma patients. More studies are needed to explore the sources of delay and investigate possible solutions to this public health challenge.

摘要： Otological injuries are common during cervicofacial trauma. The aim of this study is to describe the epidemiological characteristics and to map otological injuries during head and neck trauma. This was an observational, descriptive, prospective study conducted at the ENT unit of the Referral Health Center Hospital in Mali from January 2017 to September 2018. Patients with middle and/or inner ear injuries due to trauma were included. The prevalence of otologic injuries was 34.54% of cases. The mean age was 25 years and the sex ratio was 1.11. Students accounted for 42.10%. The mechanism of occurrence was an intentional assault in 68.42% of the cases followed by road traffic accidents (15.79%). The most common functional signs were hearing loss (68.42%), tinnitus (57.89%), and facial paralysis in 5.26%. Otoscopy showed tympanic perforation (47.83%), otorrhagia (21.05%) and otoliquorrhea (5.26%). Rock fractures with osteodural breach (10.53%) and pneumencephaly were found on a CT scan of the rock. The evolution was marked by the regression of the facial paralysis and the healing of the tympanum in 45.45% of the cases. Sequelae persisted in the form of sensorineural deafness (17%). The otological lesions observed during cervicofacial trauma are varied. The challenges in our context are felt at three levels: the improvement of the technical platform, the long-term follow-up of patients, and the cost of care in terms of equipment. These lesions are responsible for disabling deafness, a source of difficulty in social and school integration.

摘要： BACKGROUND In order to successfully manage traumatic pancreatic duct(PD)leaks,early diagnosis and operative management is paramount in reducing morbidity and mortality.In the acute setting,endoscopic retrograde cholangiopancreatography(ERCP)can be a useful,adjunctive modality during exploratory laparotomy.ERCP with sphincterotomy and stent placement improves preferential drainage in the setting of injury,allowing the pancreatic leak to properly heal.However,data in this acute setting is limited.CASE SUMMARY In this case series,a 27-year-old male and 16-year-old female presented with PD leaks secondary to a gunshot wound and blunt abdominal trauma,respectively.Both underwent intraoperative ERCP within an average of 5.9 h from time of presentation.A sphincterotomy and plastic pancreatic stent placement was performed with a 100%technical and clinical success.There were no associated immediate or long-term complications.Following discharge,both patients underwent repeat ERCP for stent removal with resolution of ductal injury.CONCLUSION These experiences further demonstrated that widespread adaption and optimal timing of ERCP may improve outcomes in trauma centers.

摘要： Background: As a cause of blindness, ocular injury constitutes 1.5% of all causes of blindness. In the developed world, trauma is also the leading cause of unilateral blindness and is preceded only by the cataract as a cause for vision impairment. Males are much more likely than females to sustain ocular trauma. The ocular effects of trauma can be far-reaching, so timely intervention is of prime importance to improve the visual outcome. General Objective: To evaluate the visual outcome after ocular injury. Methods: This study was conducted at Nagri Eye Hospital, Ahmadabad. In total, 68 eyes of 68 patients with eye injury were included in this study. Detail history was taken from the entire patient and a detailed ocular examination was done. Results: The mean age of incidence of the patients was 25.39 ± 16.89. The commonest age group presented with ocular trauma was nd decade, i.e., 11 - 20 yrs. A great majority of patients were male with the mean age of 25.89 ± 16.55 accounting for 83.82%. The majority of the patients have visited the hospital in between the time period of 24 hrs - 1 wk (57.35%), followed by 23.52% within the time period of st visit to the final visit (p-value Conclusions: The majority of cases were youth males with the age group of 25 yrs. All the cases with ocular trauma were unilateral. The trauma was common in industrial workers with the majority of the cases of blunt type. There was satisfactory visual improvement in patients who followed-up well.

摘要： BACKGROUND Common mental disorders such as anxiety and depression in geriatric orthopedic trauma patients have received little attention in research.AIM To investigate the prevalence of emotional disorders among geriatric orthopedic trauma patients and identify demographic,social and clinical risk factors.METHODS This cross-sectional study was performed in geriatric patients(aged≥60 years,both sexes)with orthopedic trauma admitted to a level I trauma center between May 2015 and December 2017.Demographic,social,and clinical characteristics were described.Huaxi Emotional-Distress Index(HEI)was used to evaluate the severity of anxiety and depression status.Differences in continuous variables were tested using the t-test,and differences in categorical variables were assessed using the Pearsonχ2 test.Binary logistic regression analyses were used to identify the factors associated with a HEI score>8.RESULTS Among the 966 patients,487 were male and 479 were female,with a mean age of 70.2±7.1 years.The age ranged from 60 to 90 years.Seventy-five patients had an HEI score>8,accounting for about 7.8%of all patients.A higher Injury Severity Score(4.17±3.10 vs 7.96±6.68,P8.On logistic regression,a higher education level was a protective factor for emotional disorders(P=0.047),whereas Injury Severity Score(P=0.024),Visual Analog Score(P<0.001),two or more chronic diseases(P<0.001)were the related independent risk factors.CONCLUSION Emotional disorders are common in geriatric patients with orthopedic trauma.Clinicians should remain vigilant of emotional disorders in geriatric patients and screen for anxiety and depression in higher risk groups.