Geriatric fall-related injuries.

Background: Falls are the leading cause of geriatric injury. Objectives: We aimed to study the anatomical distribution, severity, and outcome of geriatric fall-related injuries in order to give recommendations regarding their prevention. Methods: All injured patients with an age ≥ 60 years who were admitted to Al-Ain Hospital or died in the Emergency Department due to falls were prospectively studied over a four year period. Results: We studied 92 patients. Fifty six of them (60.9%) were females. The mean (standard deviation) of age was 72.2 (9.6) years. Seventy three (89%) of all incidents occurred at home. Eighty three patients (90.2%) fell on the same level. The median (range) ISS was 4 (1-16) and the median GCS (range) was 15 (12-15). The lower limb was the most common injured body region (63%). There were no statistical significant differences between males and females regarding age, ISS, and hospital stay (p = 0.85, p = 0.57, and p = 0.35 respectively). Conclusion: The majority of geriatric fall-related injuries were due to fall from the same level at home. Assessment of risk factors for falls including home hazards is essential for prevention of geriatric fall-related injuries.

Missed Chopart dislocation: the importance of being aware of midtarsal injuries

Chopart (midtarsal) joint dislocations are relatively rare but potentially serious injuries. Their low prevalence and the possible absence of evident radiological findings cannot justify misdiagnosis because an adequate and correct treatment is required to achieve a proper clinical outcome. A midtarsal joint dislocation in a 19-year-old-woman is described, in which diagnosis was performed at 8 weeks of evolution. An open reduction was performed by a double approach (medial and lateral) and a Kirschner wire joint stabilization. At one-year of follow-up, loss of reduction was not observed and the patient was pain-free, although she referred to functional limitation when running. Besides describing the treatment of this particular injury, this study is aimed at increasing the level of clinical suspicion in order to avoid misdiagnosis such as occurred in our case.

Effect of hamstring injuries on kicking in soccer using inverse dynamics

Las lesiones musculares del muslo tienen una gran incidencia en el fútbol. El objetivo del estudio ha sido desarrollar un nuevo procedimiento para evaluar el efecto de las lesiones de isquiotibiales en los golpeos con el pie s en el fútbol utilizando los principios de la dinámica inversa. El trabajo se ha centrado en la evaluación de la diferencia entre sujetos que habían sufrido la lesión en los últimos 5 años y los que no. Se analizaron 17 jugadores de fútbol profesionales realizando cinco tiros con el empeine y cinco con el interior del pie. Los movimientos se registraron mediante una plataforma de fuerza y un sistema de captura de movimiento Vicon funcionando a 500Hz. Los participantes también tomaron parte en una prueba de isocinético en la que se midió el torque isocinético en 60 º/s y 120 º/s. Se observaron diferencias significativas en los parámetros cinemáticos y cinéticos entre los dos grupos (lesionados y no lesionados) en la fase posterior del golpeo y en el instante de máxima flexión de cadera. No se encontraron diferencias significativas entre los dos grupos en la prueba isocinética tradicional. Estos resultados indican que el procedimiento empleado probablemente podría ser muy útil en la evaluación del efecto de las lesiones de isquiotibiales en el fútbol.

Observational research on golf-related injuries

The determination of aetiological factors in sports injuries is challenging. Recently, investigators have devoted significant attention to this topic. A reasonable amount of studies provides information on the occurrence, aetiology, and severity of golf-related injuries. However, gaps of evidence still limit the understanding of the injury problem in golf and the comparability of epidemiological findings. Observational studies using surveys and medical records were reviewed. Surveys are suited to find precise occurrence patterns of golf-related injuries, but fail to adequately ascertain the levels of exposure and aetiological factors. Due to the proximity to the injury event, medical records are able to clearly identify the aetiology and severity of golf-related injuries. While reviewing observational studies using surveys a comment was provided on the methodological quality and risk of bias. Overall, these studies seem to be disturbed on their ability to produce generalizations and comparison of study findings. With the information obtained from reviewing observational studies and the collaboration of a panel of internationally recognised experts on golf science and sports injury research, a web-based bilingual questionnaire was developed and tested for one of the provided languages. The bilingual nature of the questionnaire is also expected to facilitate the acceptance of the scientific community and enable the translation to different languages. A standardised questionnaire applied in different cultural contexts is expected to help and further improve the comparability of epidemiological findings. The questionnaire was proficient in capturing information on golf-related injuries and participation habits of golfers. While using a wider outcome definition focusing on any type of physical complaints, episodes of injury could be recognized despite onset and level of severity. Questions on the need for medical attention, time loss, and impact on performance also enabled additional categorisation of severity.

Injuries of non-lethal child physical abuse to the crania and orofacial regions: a scientific review

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

In situ epicatechin-loaded hydrogel implants for local drug delivery to spinal column for effective management of post-traumatic spinal injuries

Purpose: To prepare hydrogels loaded with epicatechin, a strong antioxidant, anti-inflammatory, and neuroprotective tea flavonoid, and characterise them in situ as a vehicle for prolonged and safer drug delivery in patients with post-traumatic spinal cord injury. Methods: Five in situ gel formulations were prepared using chitosan and evaluated in terms of their visual appearance, clarity, pH, viscosity, and in vitro drug release. In vivo anti-inflammatory activity was determined and compared with 2 % piroxicam gel as standard. Motor function activity in a rat model of spinal injury was examined comparatively with i.v. methylprednisolone as standard. Results: The N-methyl pyrrolidone solution (containing 1 % w/w epicatechin with 2 to 10 % w/w chitosan) of the in situ gel formulation had a uniform pH in the range of 4.01 ± 0.12 to 4.27 ± 0.02. High and uniform drug loading, ranging from 94.48 ± 1.28 to 98.08 ± 1.24 %, and good in vitro drug release (79.48 ± 2.84 to 96.48 ± 1.02 % after 7 days) were achieved. The in situ gel prepared from 1 % epicatechin and 2 % chitosan (E5) showed the greatest in vivo anti-inflammatory activity (60.58 % inhibition of paw oedema in standard carrageenan-induced hind rat paw oedema model, compared with 48.08 % for the standard). The gels showed significant therapeutic effectiveness against post-traumainduced spinal injury in rats. E5 elicited maximum motor activity (horizontal bar test) in the spinal injury rat model; the rats that received E5 treatment produced an activity score of 3.62 ± 0.02 at the end of 7 days, compared with 5.0 ± 0.20 following treatment with the standard. Conclusion: In situ epicatechin-loaded gel exhibits significant neuroprotective and anti-inflammatory effects, and therefore can potentially be used for prolonged and safe drug delivery in patients with traumatic spinal cord injury.

The Epidemiology and Health Economics of Ankle Injuries

Thesis (Ph.D, Community Health & Epidemiology) -- Queen's University, 2016-10-03 22:59:05.858

The Impact of Community Social Capital on the occurrence of Injuries in adolescents and falls in older adults: Population-based Studies Conducted in Canadian samples

The objectives of this thesis were to study specific Canadian populations in order to examine; (1) relationships between the neighbourhood-level social capital and injuries in youth, as well as (2) falls in older adults, and; (3) to address methodological issues relevant to the study of such relationships. The thesis is comprised of four manuscripts. The first addresses methodological issues surrounding the validation of neighbourhood-level variables for the study of adolescent health, and demonstrates the existence of structural confounding in the study of related etiological relationships. Informed by the latter, the second manuscript examines the association between neighbourhood-level social capital and injuries in youth, and demonstrates that lower levels of social capital are protective factors for girls but not for boys. Manuscript 3 uses an international database focused on older adults, and shows that our existing measure of social capital is valid at neighbourhood levels, but also that there is a high possibility for the existence of structural confounding among Canadian older adults. The fourth manuscript then examines the association between neighbourhood-level social capital and the occurrence of falls in older adults and determines that differences between neighbourhoods are important factors in the occurrence of falls, and that higher levels of social capital are a risk factor for falls. Taken together, results from this thesis provide a better understanding of the role of neighbourhood-level social capital on the occurrence of injuries in Canadian youth and on the occurrence of falls in older adults. Our contributions were important both methodologically and etiologically.

Congenital thoracic vertebral malformations in brachycephalic “screw-tailed” dog breeds: Validation of a human classification scheme and a method of Cobb angle measurement in the assessment of vertebral column deformity

Congenital vertebral malformations are common in brachycephalic “screw-tailed” dog breeds such as French bulldogs, English bulldogs, Boston terriers, and Pugs. Those vertebral malformations disrupt the normal vertebral column anatomy and biomechanics, potentially leading to deformity of the vertebral column and subsequent neurological dysfunction. The initial aim of this work was to study and determine whether the congenital vertebral malformations identified in those breeds could be translated in a radiographic classification scheme used in humans to give an improved classification, with clear and well-defined terminology, with the expectation that this would facilitate future study and clinical management in the veterinary field. Therefore, two observers who were blinded to the neurologic status of the dogs classified each vertebral malformation based on the human classification scheme of McMaster and were able to translate them successfully into a new classification scheme for veterinary use. The following aim was to assess the nature and the impact of vertebral column deformity engendered by those congenital vertebral malformations in the target breeds. As no gold standard exists in veterinary medicine for the calculation of the degree of deformity, it was elected to adapt the human equivalent, termed the Cobb angle, as a potential standard reference tool for use in veterinary practice. For the validation of the Cobb angle measurement method, a computerised semi-automatic technique was used and assessed by multiple independent observers. They observed not only that Kyphosis was the most common vertebral column deformity but also that patients with such deformity were found to be more likely to suffer from neurological deficits, more especially if their Cobb angle was above 35 degrees.

Cordectomía por sustracción pedicular en la columna dorsal y lumbar en fracturas traumáticas: experiencia en el hospital universitario mayor Mederi y revisión sistemática de la literatura

Objetivo: Presentar la experiencia con la técnica de corpectomia por sustracción pedicular en fracturas traumática a nivel de la columna dorsal y Lumbar en el Hospital Universitario Mayor en Bogotá y hacer una revisión sistemática de la literatura de esta técnica quirúrgica. Material y métodos: Se realizó un análisis retrospectivo de las historias clínicas de pacientes que consultaron al servicio de neurocirugía entre los años 2013 y 2015 con fracturas traumáticas a nivel de la columna dorsal y lumbosacra. Se realizó un análisis de déficit neurológico pre y posoperatorio por medio de la Clasificación neurológica estándar de lesión medular (ASIA), al igual que tiempos de cirugía, sangrado intraoperatorio y complicaciones. A su vez se realiza una revisión sistemática de la literatura sobre esta técnica quirúrgica. Resultados: El total de pacientes que se sometieron a cirugía fue de 32, de los cuales el tiempo quirúrgico promedio fue de 396 min, se obtuvo un ASIA prequirúrgico B: 50% C: 47% y E: 3%. El ASIA post operatorio fue de B: 9% C: 47% D: 38% E: 6%. Se obtuvo una mejoría del déficit neurológico en el 75% los pacientes intervenidos. El promedio de sangrado fue de 1,223 cc. Se tuvieron 4 complicaciones, 2 hematomas en lecho quirúrgico que requirió re intervención y dos fistulas de líquido cefalorraquídeo las cuales se manejaron con vendaje compresivo y reposo absoluto. Conclusiones: La corpectomia por sustracción pedicular requiere de un adecuado entrenamiento y un grupo multidisciplinario dentro de los que se incluye neuroanestesiologo, a su vez de neurocirujanos entrenados en columna. Este abordaje presenta grandes beneficios como disminución de tiempos quirúrgicos, disminución de sangrado intraoperatorio y disminución de morbilidad entre otras.

FAST-E en Pacientes con Trauma Abdominal Cerrado Estable, en un Departamento de Urgencias en Colombia

El impacto que ha generado el trauma en Colombia a lo largo de la historia, nos ha obligado a mejorar y adaptar diferentes tipos de sistemas de atención en trauma, basados en los lineamientos internacionales, los cuales buscan evitar el significativo aumento en las tasas de mortalidad y discapacidad que se obtienen de este, especialmente en los servicios de Emergencias en los cuales se reciben el 100% de estos pacientes con traumatismo múltiple o politraumatismo. Dentro de este grupo de pacientes hay un subgrupo que son las pacientes con trauma de abdomen que cursan con estabilidad hemodinámica y además son clasificados de bajo riesgo, ya sea por índices de trauma o por otros métodos como la medición sérica de lactato, los cuales tienen un papel poco despreciable al momento de ver mortalidad y discapacidad por trauma, ya sea penetrante o cerrado; en este trabajo específicamente nos centramos en las personas que consultan al servicio de Emergencias con trauma cerrado de abdomen los cuales son considerados de bajo riesgo, siendo este subgrupo de pacientes uno de los más difíciles de abordar y enfocar al momento de la valoración inicial, ya que se debe tener la seguridad de que no hay lesiones que comprometen la vida y por consiguiente estos pacientes puedan ser dados de alta.

Assessment of Injuries Caused by Anastrepha fraterculus (Wied.) (Diptera: Tephritidae) on the Incidence of Bunch Rot Diseases in Table Grape.

Resumo: Anastrepha fraterculus (. Wied) é a principal praga de uvas de mesa (Vitis vinifera) na Região Sul do Brasil. Neste estudo, o objetivo foi investigar o efeito da punção de frutas por fêmeas adultas e infestação larvária por A. fraterculus na ocorrência da doença podridões na uva (cultivar "Itália"). Abstract: Anastrepha fraterculus (Wied.) is the main insect pest of table grapes (Vitis vinifera) in the Southern Region of Brazil. In this study, we aimed to investigate the effect of fruit puncturing by adult females and larval infestation by A. fraterculus on the occurrence of bunch rot disease in the grape (cultivar ?Itália?) by evaluating grapes (a) punctured for oviposition by females of A. fraterculus, sterilized in laboratory with novaluron (40 mg L−1) and further spray-inoculated separately with Botrytis cinerea (1 × 106 conidia mL−1), Glomerella cingulata (1 × 106 conidia mL−1), and bacteria and yeast that cause sour rot (1 × 105 cells mL−1), (b) grapes punctured for oviposition by non-sterilized females with pathogen spraying, (c) grapes with mechanical wounds and pathogen spraying, (d) grapes with no wounds and with pathogen spraying, (e) grapes punctured for oviposition by A. fraterculus chemically sterilized in laboratory with novaluron, (f) grapes punctured for oviposition by A. fraterculus non-sterilized in laboratory with novaluron, (g) grapes with mechanical wounds, and (h) grapes with no sterilization or pathogen spraying. Our data indicated that the mechanical and oviposition wounds caused by A. fraterculus increased the percentage of grapes infected by B. cinerea, G. cingulata, and microorganisms of acid rot. The grape puncturing by A. fraterculus and the mechanical wound allows the penetration of B. cinerea and microorganisms leading to acid rot. We conclude that the fruit fly A. fraterculus may facilitate phytopathogens penetration leading to bunch rots in the table grape Itália.

Methods to evidence mechanical injuries on "Packham's Triumph" pears.

2016

Innovative Infrastructures for Sustainable Mobility in Urban Areas: Protective Asphalt to Prevent Vulnerable Road Users Injuries.

Nell’elaborato viene studiato il fenomeno dell’incidentalità singola delle utenze deboli sulla strada (perdita di controllo, scivolamento ecc..ecc..), con particolare enfasi nell’analizzare le conseguenze traumatiche dovute all’impatto con la superficie stradale. Una nuova tecnologia viene sviluppata per rendere le pavimentazioni di piste ciclabili, marciapiedi e zone pedonali con capacità di assorbimento degli impatti, prevenendo, o riducendo drasticamente, la probabilità e entità di eventi traumatici a seguito di una caduta. Attraverso una stesa di prova avvenuta ad Imola (BO), si sono analizzate e risolte le problematiche dovute alle discrepanze riscontrate fra “costruzione” in laboratorio e costruzione nella realtà urbana. La nuova tecnologia, infatti, è stata studiata come “construction-friendly”, permettendo alle società di costruzione e pavimentazione di stendere il nuovo manto protettivo con strumenti e macchinari tradizionali. Infine l’asfalto modificato è stato testato nei laboratori svedesi del KTH – Royal Institute of Technology per provarne l’efficacia in termini di assorbimento degli impatti. Nel “Drop Impact Test”, test specifico per l’approvazione dei caschi protettivi da bicicletta, l’asfalto modificato ha performato ben al di sotto della soglia di approvazione dei caschi da ciclista, e si colloca in un range di valore di accelerazione lineare perfino al di sotto della soglia di “Low Risk of Injuries”. La nuova tecnologia, inoltre, fa utilizzo di gomma granulata riciclata da pneumatici fuori uso. Tale dettaglio conferisce maggiore sostenibilità al progetto: oltre all’utilizzo di legante a freddo, che diminuisce le emissioni di CO2, e di incentivare l’utilizzo della mobilità dolce attraverso una più sicura rete infrastrutturale, l’utilizzo di gomma riciclata dà nuova vita al materiale che altrimenti andrebbe in discarica e prolunga, così, la vita utile del materiale.

Protezione cerebrale nella chirurgia dell'arco aortico

Negli ultimi decenni, l’outcome dei pazienti sottoposti a chirurgia dell’aorta toracica è migliorato grazie ai progressi ottenuti nella gestione della circolazione extracorporea, della protezione miocardica e cerebrale e del monitoraggio intra- e postoperatorio dei pazienti. Malgrado questo però, la chirurgia dell’arco aortico è ancora gravata da una significativa mortalità e morbilità dovute principalmente alle complicanze neurologiche conseguenti all’interruzione temporanea della circolazione cerebrale. Nel presente studio sono stati analizzati 364 pazienti trattati per sostituzione dell’arco aortico con l’ausilio della perfusione cerebrale selettiva anterograda, presso l’Unità Operativa di Cardiochirurgia dell’Ospedale di Sant’Orsola di Bologna dal 1° gennaio 2015 al 31 maggio 2020.Le disfunzioni neurologiche permanenti sono state diagnosticate in 33 dei 364 pazienti (9.1%) operati, utilizzando la perfusione cerebrale selettiva anterograda come tecnica di perfusione cerebrale. Pertanto abbiamo confrontato due gruppi di pazienti: un gruppo di 33 pazienti con deficit permanenti con il resto dei pazienti (331) che non aveva alcun deficit. Tra le variabili intraoperatorie, i tipi di cannulazione arteriosa, in particolare la cannulazione dell’arteria femorale (109 [32.9%] vs 17 [51.5%], p-value=0.032) e dell’aorta ascendente (56 [16.9%] vs 0, p-value=0.010), presentano delle differenze statisticamente significative tra i due gruppi. Per quanto riguarda la perfusione cerebrale selettiva anterograda, i valori del flusso medio (899.63 ± 214.12 vs 952.52 ± 160.72, p-value=0.051) presentano una differenza statisticamente significativa tra i due campioni. All’analisi multivariata, la dissezione aortica di tipo A (p = 0.010), la cannulazione femorale (p = 0.033) e l’arresto di circolo totale (p = 0.046) si confermano dei fattori di rischio statisticamente significativi per l’insorgenza di disfunzioni neurologiche permanenti