Fatal road traffic accidents and injuries: a preliminary study.

Road traffic accidents (RTAs) are a major public health problem globally and cause deaths, disability, and significant economic costs. In Italy, there was an increased number of road accidents, deaths, and injuries in 2022 compared to 2021, although still below pre-pandemic levels. A retrospective observational study was performed on a case series of 53 consecutive fatal RTAs examined by the Section of Forensic Medicine of Verona. The case series was divided, according to the type of victims involved, into pedestrians, car drivers, car passengers, and motorcyclists. For each, the times and causes of death, the distribution of external and internal injuries, and toxicological data were analysed, and the results were compared with those in the literature. Although this is a preliminary study on a small case series and lacks statistical validation, so more cases are needed, the preliminary results seem to provide a useful tool for assessing injuries in complex fatal road accidents.

Stem cell transplantation in cerebrovascular accidents: A global bibliometric analysis (2000-2023).

BACKGROUND: Cerebrovascular accident (CVA) is a major global contributor to death and disability. As part of its medical management, researchers have recognized the importance of promising neuroprotective strategies, where stem cell transplantation (SCT) is thought to confer advantages via trophic and neuroprotective effects. AIM: To evaluate the current state of research on SCT in patients with CVA, assess key trends and highlight literature gaps. METHODS: PubMed was screened for SCT in CVA-related articles in October 2023, for each country during the period between 2000 and 2023. Using the World Bank data, total population and gross domestic product were collected for comparison. VOSviewer_1.6.19 was used to create the VOS figure using the results of the same query. Graphs and tables were obtained using Microsoft Office Excel. RESULTS: A total of 6923 studies were identified on SCT in CVA, making 0.03% of all published studies worldwide. Approximately, 68% were conducted in high-income countries, with a significant focus on mesenchymal stem cells. The journal "Stroke" featured the largest share of these articles, with mesenchymal SCT having the highest rate of inclusion, followed by hematopoietic SCT. Over time, there has been a noticeable shift from in vitro studies, which assess stem cell proliferation and neurogenesis, to in vivo studies aimed at evaluating efficacy and safety. Additionally, the number of reviews increased along this approach. CONCLUSION: This bibliometric analysis provides a comprehensive guide for physicians and researchers in the field through an objective overview of research activity, and highlights both current trends and gaps. Having a potential therapeutic role in CVA, more research is needed in the future to focus on different aspects of SCT, aiming to reach a better treatment strategy and improve life quality in patients.

Prevalence and Pattern of Ocular Trauma in a Secondary Eye Care Center in Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Ocular trauma stands as the leading preventable cause of monocular blindness worldwide. The aim of the study was to calculate the prevalence of ocular trauma and the circumstances, causes, and types of ocular injuries at emergency department of Community Eye Hospital. METHODS: This was a descriptive cross-sectional study conducted retrospectively on patientsvpresenting to the Emergency Department in the year 2020. Ethical clearance was received from the Institutional Review Board with reference number 12/2021. Data collection commenced in April 2021, following the approval in March 2021. Descriptive statistics with mean and frequency were used for analysis. RESULTS: Among the 6526 emergency cases visiting the emergency department of Hetauda community eye hospital the prevalence of ocular trauma was 2143 (32.83%; 95% CI: 31.69%-33.97%). The mean age among the 2143 trauma cases was 33.55±15.63 years. Among them, 1851 (86.40%) fell in the working age group. The male-to-female ratio was 3:1. Occupational injuries due to welding, agriculture and industries were in 604 (28.19%) of all ocular injuries. CONCLUSIONS: The prevalence of ocular trauma in our study was higher than other studies. Occupational ocular trauma mainly welding injury, cement factory injury and agricultural injury are common cause of ocular trauma.

Analyzing the Burden of Midface Fractures Due to Road Traffic Accidents in Vietnam: An Epidemiological Approach.

BACKGROUND: Road traffic accidents have significantly impacted public health in Vietnam. This study investigated the patterns of midface fractures in Vietnam and their correlation with road traffic accidents in the country. METHODOLOGY: This retrospective cross-sectional study reviewed 2187 medical records of patients with midface fractures in Ho Chi Minh City. After applying exclusion criteria, the fractures were categorized. Statistical analyses, including chi-squared and logistic regression, were conducted to identify associations and relationships among the types and causes of fractures. RESULTS: The study found that 89.3% of midface fractures stemmed from road traffic accidents, with 55.2% and 14.4% zygomatic complex fractures and Le Fort type II fractures, respectively. Adults aged 19-39 accounted for 65.1% of patients, with males at 80.5%. Traffic accidents were significantly associated with an 18.7 times higher risk of concomitant mandibular fractures and a 10.5 times higher risk of Le Fort type II fractures, irrespective of age and gender. CONCLUSION: This study underscores the need for targeted prevention strategies to decrease the incidence of maxillofacial injuries resulting from road traffic accidents in Vietnam, particularly among high-risk groups such as males and young adults.

A Comprehensive Study of Risk Factors, Etiology, and Infarction Patterns in Cerebrovascular Accidents at a Tertiary Care Hospital in India.

Background Stroke is a debilitating cerebrovascular condition characterized by sudden neurological deficits. The incidence of stroke is rising in India, posing significant public health concerns. This study aims to examine the risk factors and etiology of stroke using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification and analyze infarct areas in cerebrovascular accidents (CVA) at a tertiary care hospital. Methodology This cross-sectional, hospital-based observational study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to Be University), Pune, India, from January 2023 to January 2024. The study included 100 adult patients diagnosed with CVA based on clinical and radiological criteria. Patients aged 18 years and older were eligible, while those with a history of head trauma or those below 18 years were excluded. The investigation protocol included routine biochemical assessments and radiological investigations, such as computed tomography (CT), magnetic resonance imaging (MRI) with angiography or venography, and Doppler ultrasound of bilateral carotid arteries. Results The study population consisted of 100 patients, with 84 males (84%) and 16 females (16%). Age distribution showed 44% were over 60 years old, 23% aged 51-60 years, 15% aged 31-40 years, 14% aged 41-50 years, and 4% aged 21-30 years. Hypertension was the most prevalent risk factor, affecting 75% of patients, with a higher occurrence in males (62%), compared to females (13%). Smoking was observed in 51% of patients, and alcohol consumption was seen in 50%. Other significant risk factors included dyslipidemia (39%), diabetes mellitus (33%), chronic kidney disease (11%), ischemic heart disease (10%), atrial fibrillation (4%), valvular heart disease (4%), and pregnancy or postpartum conditions (2%). Ischemic stroke was predominant, occurring in 80% of patients, while hemorrhagic stroke occurred in 20%. High occurrences of ischemic strokes were noted in the frontal lobe (41%), parietal lobe (37%), occipital lobe (27%), and temporal lobe (26%), with the internal capsule region also showing significant numbers (27%). According to the TOAST classification, the most prevalent cause of stroke in this study was undetermined etiology with two or more causes, accounting for 32% of cases, followed by large artery atherosclerosis, which accounted for 30%. Cardioembolic stroke was identified in 11% of the patients, with 4% due to atrial fibrillation, 3% due to acute myocardial infarction, 3% due to rheumatic valvular heart disease, and 1% due to infective endocarditis. Conclusion This study highlights the significant prevalence of hypertension, smoking, alcohol consumption, and hyperhomocysteinemia as major risk factors for stroke. Ischemic strokes were predominant, with high occurrences in the cerebral lobes and gangliocapsular region. These findings emphasize the need for targeted prevention strategies, including managing hypertension and lifestyle modifications such as smoking cessation and reducing alcohol consumption, to mitigate the risk of stroke. Effective management of blood pressure, lipid levels, and blood glucose is crucial for stroke prevention. Recognizing gender-specific differences and addressing comorbidities through an integrated approach can enhance patient outcomes and reduce the burden of stroke.

Longitudinal relationship between posttraumatic cognitions and internalising symptoms in children and adolescents.

Background: Little is known about the naturalistic course of posttraumatic cognitions (PTCs) after exposure to a potentially traumatic event (PTE) in children and adolescents. Moreover, previous studies on the longitudinal associations of PTCs with internalising symptoms yielded mixed results.Objective: To explore the naturalistic courses and longitudinal associations of dysfunctional PTCs and functional PTCs with posttraumatic stress symptoms (PTSS), depression, and anxiety.Method: A total of 115 children and adolescents, aged 7-15 years, were assessed within 1 month, 3 months, and 6 months after exposure to an acute accidental PTE. Repeated measures analyses of variance were conducted to capture the naturalistic courses of PTCs and internalising symptoms. Cross-lagged panel analyses were applied to explore the longitudinal relationship between dysfunctional and functional PTCs, along with their longitudinal associations with PTSS, depression, and anxiety.Results: Dysfunctional PTCs and internalising symptoms decreased, whereas functional PTCs increased over time. Dysfunctional and functional PTCs were moderately inversely related, but no significant cross-lagged paths emerged among them. Dysfunctional PTCs were moderately to strongly associated with internalising symptoms, while functional PTCs were weakly to moderately inversely associated with internalising symptoms. Initial PTSS predicted later dysfunctional PTCs (ß = .31, p < .05), but not vice versa.Conclusions: Dysfunctional PTCs, functional PTCs, and internalising symptoms were entangled over time. Our findings support the cognitive scar model with initial PTSS predicting later dysfunctional PTCs. Future research complementing between-subject with within-subject analyses could offer additional insights into the longitudinal relationship between dysfunctional PTCs, functional PTCs, and psychological symptoms.

Dysfunctional posttraumatic cognitions and internalising symptoms naturally decreased, whereas functional posttraumatic cognitions naturally increased over a 6-month period following exposure to an acute accidental potentially traumatic event.Above the significant longitudinal associations of dysfunctional posttraumatic cognitions with internalising symptoms, functional posttraumatic cognitions were significantly inversely related to internalising symptoms over time.Posttraumatic stress symptoms assessed within 1 month after the potentially traumatic event predicted dysfunctional posttraumatic cognitions assessed 3 months after the potentially traumatic event, but not vice versa.

The Prevalence of HIV Seroconversion in Healthcare Workers Following Sharp Injuries and Exposure to Biofluids.

Background and objective Workplace accidents (WPAs) are a common problem worldwide. They are often considered a public health concern due to the potential transmission of infections such as HIV, hepatitis B, and hepatitis C through sharp devices or direct exposure to biofluids. Post-exposure prophylaxis (PEP) has demonstrated effectiveness in such instances, especially immediately after exposure. The present study aimed to report the prevalence rate of HIV seroconversion following such exposure among healthcare workers (HCWs). Methods We conducted a cross-sectional study involving a database analysis of cases from 2015 to 2024. Central tendency measures were used to describe population characteristics, and rates were calculated using standard methods. Results A total of 514 HCWs were included in the study. The prevalence of WPAs was 13 per 100 HCWs. Regarding WPAs related to HIV exposure, the prevalence was 0.9 per 100 HCWs, with 0% seroconversion thanks to timely PEP. Conclusions WPAs related to HIV exposure are a serious issue for public health systems worldwide. Although protocols are available and no seroconversion cases were reported in the present study, PEP is not always accessible in several settings, increasing the risk of seroconversion. International public policy measures should be uniformly implemented to provide faster access to prophylaxis, educate the personnel, raise awareness about bloodborne diseases, and reduce excessive red tape.

Mild Traumatic Brain Injury by the Glasgow Coma Scale Score and Early CT-Brain Findings in Acute Alcohol Intoxication Patients: A Prospective Observational Study.

Introduction Traumatic brain injuries (TBI) in recent years have proved to be a significant public health problem, with potentially life-changing consequences for the individual and their family. Alcohol consumption is a regular, well-documented problem among persons sustaining TBI due to road traffic accidents and accidental falls. The primary objective of this study was to find out the correlation between the Glasgow Coma Scale (GCS) score and CT brain findings among mild TBI patients under acute alcohol intoxication and determine if early CT-brain is indicated in this group. Methods A prospective observational study was conducted involving 111 alcohol-intoxicated patients with mild head injuries admitted to the surgical wards of Thanjavur Medical College Hospital over a period of three months. The Glasgow Coma Scale was used to assess the patient's neurological status and determine the severity of the brain injury. A semi-structured CT-brain findings chart and a severity of alcohol intoxication objective-based scoring system were developed and validated by experts. Descriptive statistics tools such as frequency, percentage, and mean were used, along with inferential statistics tools like the Chi-squared test, Fisher exact test, and Pearson's correlation coefficient test. Results The study findings showed that the comparison of GCS with early CT-brain was significant at a p-value of 0.012, and a negative correlation (r=-0.253) was found between GCS and CT-brain findings. A comparison of CT-brain findings with the severity of alcohol intoxication was non-significant at a p-value of 0.433. Conclusions Early CT-brain in intoxicated mild TBI patients may have a positive impact on early diagnosis and management, even in centers with limited resources catering to low-income population groups. The results of our short-term study show that early CT-Brain picks up lesions and helps initiate early management while it is up to the attending physician to keep in mind an adverse cost-benefit ratio in overuse of hospital resources and misdiagnosis leading to undertreatment causing long-term sequelae and morbidity before prescribing early CT-brain in this cohort of patients.

Economic Evaluation of a Novel Treatment of Attention-Deficit/Hyperactivity Disorder in US Motor Vehicle Drivers.

Background: Attention-deficit/hyperactivity disorder (ADHD) affects approximately 4.4% of US adults. ADHD is associated with high-risk driving behavior and costly motor vehicle accidents. DYANAVEL XR (DXR) (Tris Pharma, Inc.) is a once-daily fast-acting amphetamine developed for ADHD treatment. A randomized controlled trial showed that DXR patients were 43% less likely to crash during a driving simulation than individuals taking placebo. Study outcomes suggest a DXR crash rate similar to that of a driver without ADHD, while patients treated with the current standard of care (SOC) have a 52% higher crash risk than non-ADHD drivers. Objective: The aim was to evaluate the economic benefits attributable to improved driving abilities and avoided crashes in DXR patients compared with patients treated with the SOC or those who are untreated. Methods: A cost-impact model estimated 1-year crash-related cost outcomes for DXR-treated patients compared with SOC-treated and untreated ADHD patients. SOC was assumed to consist of a combination of short-, intermediate-, and long-acting ADHD stimulant and non-stimulant medications. DXR crash risk was assumed equivalent to the non-ADHD population risk, as supported by trial data. Crash risk for untreated and SOC-treated ADHD patients were assumed to be 99% and 52% higher than the general US population, respectively. Model outcomes included the cost impact (medication- and crash-related costs) and the number of crashes, injuries, and fatalities avoided with DXR. Results: Treatment with DXR would avoid 0.82 crashes, 0.016 injuries, and 0.036 fatalities per year compared with untreated patients, and 0.036 crashes, 0.007 injuries, and 0.0001 fatalities per year compared with SOC-treated patients. Compared with a population of 25% SOC-treated patients and 75% untreated patients, DXR use would save an average of 4581 p e r p e r s o n p e r y e a r a c r o s s a l l a g e g r o u p s w h e n p r i c e d a t 80 per month, assuming all SOC-treated and untreated patients utilized DXR. When the value of quality-of-life improvement is considered, savings increase over 7-fold. Discussion: Outcomes suggest that DXR may be an economically beneficial treatment compared with SOC for ADHD patients. Conclusions: The economic model showed that DXR is cost-saving compared with no treatment and SOC by reducing the number of motor vehicle crashes in the ADHD population.

Maryland opioid overdose deaths from 2018 to 2022: occupational patterns and their sociodemographic variations.

INTRODUCTION: We aimed to describe the occupational pattern of opioid overdose deaths in Maryland between 2018 and 2022 and determine the occupations at higher risk of opioid overdose death. METHODS: The sample included undetermined or unintentional opioid overdose deaths among those aged 16 years or older in Maryland, drawn from the State Unintentional Drug Overdose Reporting System. We calculated population-based incidence overdose rates by occupation, stratified by sex and race. We further calculated the incidence rate ratios (IRRs) comparing each occupation with all other groups combined and estimated the IRRs among males versus females and non-Hispanic whites versus other racial/ethnic groups. RESULTS: The pooled sample included 11 455 opioid overdose decedents (72% male and 55% non-Hispanic whites) of whom 80% were employed. The three occupation groups with the highest incidence rates were 'construction and extraction', 'transportation and material moving' and 'installation/maintenance and repair' with 291, 137 and 133 deaths per 100 000 workers in these respective occupational groups. Incidence rates were significantly higher in males than females in all categories except those 'Not in Labour Force' (IRR=0.51, p<0.001). Non-Hispanic whites relative to other racial/ethnic groups had a lower incidence of opioid overdose death in 'Military-Specific' occupations (IRR=0.53, p=0.031). CONCLUSION: Opioid overdose deaths vary by type of occupation and certain occupations are at higher risk of overdose death. The findings highlight the need for priority setting in the implementation and expansion of existing strategies to target the workers most impacted by opioid overdose.