Camel-related major vascular injuries: A 20-years' experience.

BACKGROUND: Majority of human animal-related injuries in the United Arab Emirates are caused by camels. These may involve major vessels and can be life-threatening. We aimed to study the biomechanism, injured regions, management, and outcome of major camel-related human vascular injuries. METHODS: We retrospectively studied all patients who were admitted to Al-Ain Hospital with camel-related major vascular injury during January 2001 to January 2020. Studied variables included demography, mechanism of injury, injured structures, clinical presentation, vital signs on arrival, associated injuries, surgical management, ICU stay, length of hospital stay, complications, and outcome. RESULTS: Seven patients were studied; all were males having a median age of 26 years. Five out of six bite injuries (83%) occured during the camel rutting season. The injuries were severe and life-threatening. A camel bite causes four small elliptical wounds of the canine teeth which resembles two stab wounds of 8 cm long, penetrating deeply and injuring major vessels. Four involved the carotid artery, one the femoral artery and vein, one the external iliac vein and one the aorta which was due to a fall from a camel. Although the standard of surgical care was high, the outcome was poor. Six patients were admitted to the ICU for a median of 5 days. One patient died, one became vegetative, and one had arm paralysis. CONCLUSIONS: Major camel-related vascular injuries have a poor clinical outcome. This is related to the biomechanism of injury which combines penetrating, crushing and blunt trauma. Neck wounds of camel bites can be closed primarily after debridement.

Novel noninvasive identification of biomarkers by analytical profiling of chronic wounds using volatile organic compounds.

A complex profile of volatile organic compounds ("VOC"s) emanates from human skin, which is altered by changes in the body's metabolic or hormonal state, the external environment, and the bacterial species colonizing the skin surface. The aim of this study was to compare VOC profiles sampled from chronic leg wounds with those from asymptomatic skin. Five participants with chronic arterial leg ulcers were selected. VOC samples were obtained using polydimethylsilicone membranes ("skin-patch method") and analyzed by gas chromatography-ion trap mass spectrometry. Resultant data were analyzed using multivariate analysis and mass spectral matches were compared against the National Institute of Standards and Technology database. Principal component analysis showed differences in profiles obtained from healthy skin and boundary areas and between profiles from healthy skin and lesion samples (p<0.05). Partial least squares for discriminant analysis gave an average prediction accuracy of 73.3% (p<0.05). Mass spectral matching (verified against microbial swab results) identified unique VOCs associated with each sample area, wound bacterial colonization, and ingested medications. This study showcases a reproducible, robust, noninvasive methodology that is applicable in a clinical setting and may offer a new, hitherto unexplored, class of biochemical markers underpinning the metabolism of chronic wounds.

A comparative study of neovascularisation in atherosclerotic plaques using CD31, CD105 and TGF beta 1.

OBJECTIVES: This study aims to identify plaque neovascularisation using antibodies to CD31, CD105 and TGFbeta1, and to compare their patterns of expression. METHODS: Tissue expression of CD31, CD105 and TGFbeta1 was examined immunohistologically in atherosclerotic plaques from 53 patients who had undergone carotid endarterectomy and in 10 controls. RESULTS: CD31 was observed in a proportion of the microvessels within atheroma. The expression of CD105 was barely visible in normal arteries, but was markedly enhanced in atherosclerotic plaques. The vast majority of the microvessels in atheroma were positive for CD105 with pronounced expression around the periphery of the lipid core. In consecutive sections, microvessels showing negative staining for CD31 were positive for CD105. Although TGFbeta1 was seen in the thickened intima, it was more strongly expressed in well-formed fibrous plaques. Consecutive sections showed that some microvessels were stained by both CD105 and TGFbeta1, but in certain areas microvessels were exclusively CD105 positive. CONCLUSIONS: These observations highlight the distinctive expression patterns of CD31, CD105 and TGFbeta1, suggesting their specific roles in the development of atherosclerotic plaques. CD105 is almost universally expressed in microvessels within the atheroma and is therefore a better vascular marker than CD31 and TGFbeta1for assessing neovascularisation in atherosclerotic plaques.

Erectile dysfunction after open versus angioplasty aortoiliac procedures: a questionnaire survey.

Erectile dysfunction (ED) is a common complication after aortoiliac surgery. The aims of this study were to determine the incidence of ED in patients with aortoiliac occlusive disease or aneurysm and evaluate the effect of revascularization by means of open surgery or iliac angioplasty/stenting upon erectile function by using the new International Index of Erectile Function (IIEF) questionnaire. All male patients who had previously undergone open aortoiliac reconstruction or iliac angioplasty/stenting and who were alive at the time of this study were first contacted by telephone. Those who agreed to take part in the study were sent anonymous IIEF questionnaires. Patients were asked to recall their sexual function before and 3 months after the procedure. ED was defined as IIEF score of <11. After telephone interview, a total of 116 patients agreed to take part in the study. The response rate was 61%. Two patients, one in each group, had ED preoperatively. The preoperative IIEF scores were no different in surgery and angioplasty/stenting groups (p=0.3). Overall, 46/63 patients reported worsening erectile function postoperatively. In the surgery group (n=37), 32 patients reported deterioration of their sexual function, 3 no change, and 2 improvement, while in the angioplasty/stenting group (n=26), 14 patients had deterioration, 11 no change, and 1 improvement. In both groups, the IIEF score decreased significantly postintervention; however, the deterioration was much more pronounced after open surgery (p<0.001). Of the 61 patients with "normal" erectile function (IIEF > or =11), 10 patients (28%) developed ED following surgery, but none after angioplasty/stenting (p=0.003). As judged by the IIEF, a significant proportion of patients undergoing open and endovascular procedures experience worsening sexual function.

Prediction of cardiac risk prior to elective abdominal aortic surgery: role of multiple gated acquisition scan.

Debate continues regarding the value of cardiac testing before major vascular surgery. Studies looking at whether a low radioisotope left ventricular ejection fraction (LVEF) could reliably predict postoperative cardiac events have produced conflicting results. Technetium-99m multiple gated acquisition (MUGA) scanning was employed in 122 patients undergoing elective abdominal aortic aneurysm surgery to estimate the resting LVEF and to detect regional or global myocardial wall motion abnormalities (WMAs). Adverse cardiac outcomes were predicted using logistic regression analysis. Among this group of patients, 20 did not proceed to surgery for a variety of reasons, and 102 underwent surgical repair. More than half of the patients (55%) had a history of cardiac disease. The mean +/- SD LVEF was 55.5% +/- 11.1%. Altogether, 31 patients had WMAs, and 21 had both WMAs and an abnormal LVEF (< or = 50%). Altogether, 20 cardiac complications were encountered in 17 patients (17%). Logistic regression analysis identified four significant predictors of cardiac complications: history of cardiac disease [odds ratio (OR) 10.43; 95% confidence interval (CI) 1.3 and 80.5], the presence of WMAs (OR 10.1, CI 1.4 and 74.6), additional procedures (OR 12.1, CI 1.4 and 103.0), and reoperation during the postoperative period (OR 6.4, CI 1.4 and 30.4). This is the largest reported British series of cardiac testing using MUGA scans prior to abdominal aortic reconstruction. Only the presence of WMAs (not the resting LVEF) was useful for predicting postoperative cardiac events. A history of cardiac disease, additional procedures, and reoperation during the postoperative period also place a patient at high risk for cardiac complications. A normal LVEF is by no means reassuring that a patient is at low risk of suffering an adverse cardiac outcome.