[Acute care of patients with cerebral palsy in neuro-resuscitation surgery]. / La prise en soins des patients cérébrolésés à la phase aiguë en neuroréanimation chirurgicale.

Severe head trauma, with or without polytrauma, subarachnoid haemorrhage due to aneurysm rupture, is an unexpected tragedy for patients and their families. These accidents are likely to result in extremely serious neurological damage, with many of the patients under our care facing a life-threatening prognosis. To protect the brain, one solution is to put the patient into a deep sleep during the so-called "acute" phase, making it impossible to assess the repercussions of the initial injuries at the time: this is what we call "waiting resuscitation".

[Psychological dysfunctions and management of cerebral palsy patients]. / Dysfonctionnements et prise en charge psychologiques des patients cérébrolésés.

Cerebrospinal patients are victims of acquired brain lesions of multiple etiologies: head trauma, stroke, brain tumors, arteriovenous malformations, progressive degenerative diseases. Their care requires a combination of neurological, neuropsychological, psychiatric and psychopathological knowledge. Psychological follow-up of patients with cerebral palsy is one of the dimensions of their care.

[Ophthalmic disqualification from the military services: Multicentric cross-sectional study]. / Inaptitude ophtalmologique dans les armées : étude épidémiologique multicentrique.

PURPOSE: This article aims to describe the causes of ophthalmological disqualification from the military services detected during specialist consultations conducted at Army Training Hospitals. METHODS: This observational, cross-sectional, multicenter study retrospectively included individuals deemed as "unfit for military service" due to eye diseases identified during the specialist consultation conducted at 3 ATHs between January 2020 and December 2021. The data collected included age, medical and surgical history, reasons for ophthalmological disqualification, uncorrected distance visual acuity, best corrected distance visual acuity and cycloplegic refraction. RESULTS: Over this period, 133 subjects (98 men and 35 women) were included. Thirty-eight candidates (28.6%) were declared unfit due to a refractive error beyond the required limits, including 30 myopic subjects in excess of -10 diopters (D) and 8 hypermetropic subjects over +8 D. Twenty-five candidates (18.8%) were unfit under the age of 21 years due to corneal refractive surgery performed before the required age. Four subjects (3.0%) were unfit due to phakic intraocular lenses. Degenerative conditions were observed in 23 subjects (17.3%), including 21 patients with severe keratoconus. Other causes of incapacity were linked to oculo-orbital trauma in 11 subjects (8.3%), moderate or severe amblyopia in 7 patients (5.3%), congenital causes in 7 subjects (5.3%), inflammatory or infectious diseases in 7 candidates (5.3%), hereditary causes in 6 subjects (4.5%) and undetermined visual dysfunctions in 4 subjects (3.0%). CONCLUSION: The three main causes of ophthalmological disqualification were high ametropia, refractive surgery performed before the required age and keratoconus.

Management of combat-sustained radial nerve injury during World War I: The case of Louis-Ferdinand Céline.

The radial nerve conveys sensory and motor information to and from the upper limb, and radial nerve injury can induce functional disability, as demonstrated by the case of the renowned French writer Louis-Ferdinand Céline (1894-1961), who sustained a gunshot injury to his right arm in October 1914. Radial nerve injuries treated during World War I inspired the publication of several medical handbooks and medical theses, such as that of the military surgeon Major Robert Bretton (1889-1956). The aim of this paper is, via Céline's injury, to explore the management of radial nerve injury during and since World War I. It is important to consider the historical perspective in order to improve radial nerve injury management so as to adapt to modern warfare.

Effect of traumatic upper-limb injury on cognitive functions: A cross-sectional observational study.

OBJECTIVES: There is growing evidence of cognitive impairment after traumatic peripheral lesions. The purpose of this study was to explore the association between cognitive function and traumatic upper-limb injury. We assessed difference in cognitive function between participants with and without upper-limb injury, and explored the association between cognitive function and certain variables in injured individuals: gender, age, body mass index (BMI), educational level, and occupation. We sought to identify the factors associated with cognitive function in injured subjects: time since injury, injury side, nerve injury, hand function, pain, and finger sensation. MATERIAL AND METHODS: A cross-sectional observational study was conducted, with 2 groups: observational group (with traumatic upper-limb injury) and control group (uninjured). The 2 groups were matched for age, gender, BMI, educational level and occupation. Short-term memory and executive functions were assessed using the Rey Auditory and Verbal Learning Test (RAVLT) and Stroop Color and Word Test (SCWT), respectively. RESULTS: 104 participants with traumatic upper-limb injury and 104 uninjured control subjects were included. There was a significant inter-group difference only in RAVLT (p < 0.01; Cohen d, of 0.38). Regression analysis demonstrated an association of pain on VAS (beta = -0.16, p < 0.01) and touch-test (beta = 1.09, p < 0.05) with total RAVLT score (short-term memory) in injured subjects (R2 = 0.19, F (2, 82) = 9.54, p < 0.001). CONCLUSION: Traumatic upper-limb injury can impact short-term memory, which should be kept in mind during rehabilitation.

[Improving the accuracy of the preoperative planning of mandibular osteogenic distraction by an external custom-made device]. / Optimisation du transfert de planification de la distraction ostéogénique mandibulaire par dispositif externe sur mesure.

PURPOSE: The aim of this study was to analyze the predictability of virtual surgical planning of mandibular reconstruction by osteogenic distraction (OD) with a custom-made osteogenic distraction device (DEOS) after ballistic trauma and to make recommendations to mitigate potential sources of discrepancy. METHODS: This retrospective study involved 12 patients who were victims of facial mandibular ballistic trauma and were reconstructed with osteogenic distraction with a DEOS device. Postoperative images were compared to the planned situation by means of several measures made in two plans : distraction plane and frontal plane. RESULTS: The mean bone loss was 54.2mm. The anteroposterior difference was systematically inferior or equal postoperatively (10.8mm). The interrami angle difference in the frontal plane was positive, with an average of 4.8°. There was a significant negative correlation in univariate analysis between the antero-posterior difference measurement and the difference of the interrami angle in distraction. CONCLUSION: A significant difference between the planning and postoperative results was shown, explained by the device being too adjustable leading to the loosening of the locking screws of the device. A static analysis showed that there are significant rotational forces at the carriages, which can lead to the loosening of the locking elements. It is then proposed that the device be optimized by customization of some elements.

Spare part's free contralateral medial plantar flap for emergency reconstruction in a bilateral lower legs ballistic trauma.

The medial plantar flap is frequently used in heel reconstruction and has been described since 1969. We took care of a 25-year-old patient with a bilateral ballistic trauma and open fractures to the distal third of both legs. Given the seriousness of the damage to the left lower limb, a trans-tibial amputation had to be performed. Concerning the right lower limb, we decided to cover the defect with a spare part's free medial plantar flap thanks to the amputated fragment. The extremity spare tissues principle is already known and described, more particularly concerning hands, in emergency traumatic surgery and in planned surgery, mainly concerning thumb reconstruction, for example for hypoplasia or after traumatic amputation. Apart from an article on the use of foot spare part in the coverage of amputation stumps, no article has reported the use of a foot spare part in reconstructive surgery, even more in traumatic surgery. We believe that the use of an extremity spare tissues should be considered in rare cases where this is possible, in order to reduce donor-site morbidity in the context of reconstructive surgery.

[Quality of life after severe hand trauma: A review of 36 cases]. / Qualité de vie apres un traumatisme grave de la main : a propos de 36 cas.

OBJECTIVE: Improve the quality of life of patients with severe hand trauma. MATERIALS AND METHOD: A retrospective study was carried out from August, 1st, 2017, to May 31st, 2020, at the emergency department of a private clinic in Abidjan. Were included in this study all patients with severe hand trauma who had undergone emergency surgery with a quality-of-life assessment time of over six months after surgery. The data were reported on a structured and standardized survey form. RESULTS: We analyzed 36 patients, with average age of 38.6 years (min. 8, max. 71 years). The population study was predominantly male with a sex ratio of 17. 92% of patients were right-handed, and in 53% of cases, the trauma involved the dominant hand. 64.2% of the patients were manual workers. In 83.3% of the cases, the patients had no difficulty in writing. Patients had no difficulty in washing or drying their hair 88.9% of the time. Eighty-nine percent of the patients no longer felt pain. The patients didn't feel any weakness in the hand in 72.2% of the cases and in 63.9% of the cases there was no stiffness in the hand. Only 5.6% of the injured felt their health was poor and 83.3% of patients strongly disagree with feeling less valuable, less confident, or even less capable because of the trauma. 72% of patients were incapacitated for work between 5 and 15 weeks. 80.6% of trauma victims had no loss of income, and 88.9% of patients kept their previous jobs. 83.3% of patients did not experience any social discomfort. CONCLUSION: The patients had a good quality of life despite the severity of hand injuries they had due to early and adequate management combined with good physiotherapy.

[Maxillo-facial loss of substances of traumatic origin at the Yalgado Ouedraogo University Hospital]. / Pertes de substances maxillo-faciales d'origine traumatique au centre hospitalier universitaire Yalgado Ouedraogo.

OBJECTIVE: This work aims to report the modalities of management of maxillofacial substance loss following trauma in our context. METHODS: This was a descriptive cross-sectional study with retrospective data collection of 55 cases of maxillofacial substance loss of traumatic origin over a period of 7 years from 2014 to 2020 in the department of stomatology and maxillofacial surgery of Yalgado Ouedraogo University Hospital. RESULTS: The annual prevalence was 7.86 cases. The etiology was dominated by road traffic accidents (80% of cases). Loss of labial substance was the most frequent (58.18%). The lesions were severe, Lakmann type IV in 76.36% of cases. Bone loss occurred in 9.10% of the cases and was mainly located in the mandible. The repair of substance losses by locoregional flaps was the main technique for soft tissue reconstruction. Bone defects were repaired with non-vascularized bone grafts. The evolution was satisfactory in the majority of cases (80.3%). Infections were the main complications (5 cases) and the sequelae were dominated by unaesthetic scars (45.45%). CONCLUSION: The management of maxillofacial substance loss of traumatic origin must be early and adequate for a better aesthetic and functional result.

Do Congresso Psicanalítico da Banana à cisão de 1998: deslocamentos traumáticos no lacanismo brasileiro1 / From the Psychoanalytic Congress of the Banana to the split of 1998: traumatic displacements in Brazilian lacanism / Du Congrès Psychanalytique de la Banane à la scission de 1998: des déplacements traumatiques dans le lacanisme brésilien / Del Congreso Psicoanalítico de Banana al división de 1998: dislocamiento traumáticos en el lacanismo brasileño

O manuscrito tem como objetivo uma reflexão sobre as rupturas na história das instituições de psicanálise lacaniana brasileiras. Tomou-se como base o Congresso Psicanalítico da Banana e a cisão de 1998 da Escola Brasileira de Psicanálise, eventos precursores do lacanismo brasileiro, que ainda reverberam na relação entre analistas. Documentos institucionais e discursos dos analistas partícipes desses eventos foram analisados adotando a temporalidade como característica fulcral da historiografia. Procedeu-se a uma análise histórica em direção êmica a partir do conceito de trauma articulado com as suas formas clínicas de apresentação. Concluiu-se que, no campo psicanalítico, prevalece uma política de identidade com seus aspectos de subordinação e identificação a grupos visando a hegemonia no interior do campo.

The manuscript aims to reflect on the ruptures in the history of Brazilian Lacanian psychoanalysis institutions. The basis was the Psychoanalytic Congress of the Banana and the 1998 Division of the Brazilian School of Psychoanalysis; precursor events of Brazilian lacanism that still reverberate in the relationship between analysts. Institutional documents and discourses of analysts who participated in these events were analyzed, adopting temporality as a central characteristic of historiography. A historical analysis was carried out in an emic direction from the concept of trauma articulated with its clinical forms of presentation. It was concluded that in the psychoanalytic field a policy of identity prevails with its aspects of subordination and identification to groups aiming at hegemony within the field.

L'objectif de ce manuscrit concerne à réfléchir sur les ruptures dans l›histoire des institutions psychanalytiques lacaniennes brésiliennes. Il a été basé sur le Congrès Psychanalytique de la Banane et la scission de 1998 de l'École Brésilienne de Psychanalyse; des événements précurseurs du lacanisme brésilien qui résonnent encore dans la relation entre analystes. Des documents institutionnels et les discours des analystes qui ont participé à ces événements ont été analysés en adoptant la temporalité comme caractéristique principale de l'historiographie. Une analyse historique a été effectuée d'une façon émique à partir du concept de traumatisme articulé avec ses formes cliniques de présentation. On a conclu que dans le champ psychanalytique prévaut une politique identitaire avec ses aspects de subordination et d'identification à des groupes visant l'hégémonie au sein du champ.

El manuscrito tiene como objetivo una reflexión sobre las rupturas en la historia de las instituciones de psicoanálisis lacaniana brasileñas. Se tomó como base el Congreso Psicoanalítico de Banana y la División de 1998 de la Escuela Brasileña de Psicoanálisis; eventos precursores del lacanismo brasileño que todavía reverberan en la relación entre analistas. Documentos institucionales y discursos de los analistas partícipes de estos eventos fueron analizados adoptando la temporalidad como característica indispensable de la historiografía. Se procedió un análisis histórico en dirección émica a partir del concepto de trauma articulado con las sus formas clínicas de presentación. Se concluyó que en el campo psicoanalítico prevalece una política de identidad con sus aspectos de subordinación e identificación a grupos visando la hegemonía en el interior del campo.

Memória, desmentida e traumatismo social sob a ótica da Psicanálise das Configurações Vinculares / Memory, denial and social traumatism from a Psychoanalysis of Binding Configurations perspective / Memoria, desmentida y trauma social desde la perspectiva del Psicoanálisis de las Configuraciones Vinculares / Mémoire, négationnisme et traumatisme social dans la perspective de la Psychanalyse des Configurations de Liaison

O discurso negacionista e a minimização dos efeitos nefastos da ditadura civil-militar por figuras do alto escalão do governo são exemplos emblemáticos da desmentida de histórias de sofrimento social. Este estudo teórico aborda os processos psicológicos de apagamento de memórias sociais traumáticas e seus efeitos na transmissão psíquica, da perspectiva da Psicanálise das Configurações Vinculares, à luz de Puget e Berenstein. Mobilizando os conceitos de memória social, desmentida, trauma e traumatismo social, argumentamos que a denegação de fatos traumáticos gera uma dupla violência: por um lado, produz lacunas na história e um não-trabalho vincular que favorece transmissões psíquicas transgeracionais e, por outro, atenta contra o pertencimento social e a constituição narcísica dos sujeitos. À vista disso, concluímos pela necessidade de criar um dispositivo de escuta dos traumatismos sociais na contramão da desmentida, garantindo o direito assegurado pela Declaração Universal dos Direitos Humanos do acesso do povo à própria história

Denialist discourses and the downplayed harmful effects of the civil-military dictatorship by high-ranking Brazilian government officials are emblematic examples of negationist attitudes towards narratives of social suffering. This theoretical study addresses the psychological processes of erasing traumatic social memories and their effects on psychic transmission based on psychoanalysis of linking configurations according to Puget and Berenstein. By mobilizing the concepts of social memory, denial, trauma and social trauma, we argue that negating traumatic facts generates a double violence: on the one hand, it produces gaps in history and a non-work linking that favors transgenerational psychic transmissions; on the other, it attacks the individuals' social belonging and narcissistic constitution. We thus conclude by pointing out the need to create a listening device for social trauma that opposes denial, ensuring the right guaranteed by the Universal Declaration of Human Rights of people's access to their own history

El discurso negacionista y la minimización de los efectos nocivos de la dictadura civil-militar por parte de altas figuras gubernamentales son ejemplos emblemáticos de la desmentida de las historias de sufrimiento social. Este estudio teórico aborda los procesos psicológicos de borrado de las memorias sociales traumáticas y sus efectos en la transmisión psíquica, desde la perspectiva del Psicoanálisis de las Configuraciones Vinculares, a la luz de Puget y Berenstein. Movilizando los conceptos de memoria social, desmentida, trauma y trauma social, argumentamos que la negación de los hechos traumáticos genera una doble violencia: por un lado, produce vacíos en la historia y un no-trabajo vinculante que favorece las transmisiones psíquicas transgeneracionales y, por otro lado, ataca la pertenencia social y la constitución narcisista de los sujetos. En vista de ello, concluimos con la necesidad de crear un dispositivo de escucha de los traumas sociales en la dirección opuesta a la negación, garantizando el derecho garantizado por la Declaración Universal de los Derechos Humanos del acceso de los pueblos a su propia historia

Le discours négationniste et la minimisation des effets néfastes de la dictature civilo-militaire par des personnalités gouvernementales de haut rang sont des exemples emblématiques du déni des histoires de souffrance sociale. Cette étude théorique s'intéresse aux processus psychologiques d'effacement des souvenirs sociaux traumatisants et leurs effets sur la transmission psychique basée sur la perspective de la psychanalyse des liens proposée par Puget et Berenstein. En mobilisant les concepts de mémoire sociale, négationnisme, traumatisme et traumatisme social, nous soutenons que le déni des faits traumatiques engendre une double violence: d'une part, il produit des lacunes dans l'histoire et un non-travail contraignant qui favorise les transmissions psychiques transgénérationnelles ; d'autre part, il attaque l'appartenance sociale et la constitution narcissique des sujets. Nous concluons sur la nécessité de créer un dispositif d'écoute du traumatisme social opposé au négationnisme, en assurant le droit garanti par la Déclaration Universelle des Droits de l'Homme d'accès des peuples à leur propre histoire

Traumatismo e violência: a criança em meio à guerra urbana brasileira / Trauma y violencia: el niño en medio de la guerra urbana brasileña / Traumatism and violence: the child in the middle of the Brazilian urban combat / Traumatisme et violence: l'enfant dans milieu de la guerre urbaine brésilienne

O cotidiano de muitas crianças no Brasil tem sido atravessado por situações violentas extremas, evidenciando um estado de abandono social. Sendo assim, o presente artigo visa compreender, a partir da história de Sandro Barbosa do Nascimento e da psicanálise, a natureza do traumatismo e sua relação ao trauma na experiência da criança que vivencia cenas violentas em seu cotidiano. Compreendemos que o traumatismo se constitui na dimensão singular de cada criança, a partir do modo como lidam com o encontro com o trauma que as cenas violentas comportam, bem como com o gozo que irrompe da proximidade do Outro totalitário. Estes modos podem se constituir do recurso simbólico de cada sujeito, mas também da experiência com o não-sentido

La vida cotidiana de muchos niños en Brasil ha estado atravesada por situaciones de extrema violencia, evidenciando un estado de abandono social. Así, este artículo pretende comprender, a partir del relato de Sandro Barbosa do Nascimento y del psicoanálisis, la naturaleza del traumatismo y su relación con el trauma en la experiencia de los niños que viven escenas violentas en su vida cotidiana. Entendemos que el traumatismo se constituye en la dimensión singular de cada niño, a partir de la forma en que se enfrenta al encuentro con el trauma que suponen las escenas violentas, así como con el goce que brota de la proximidad del Otro totalitario. Estos modos pueden constituirse a partir del recurso simbólico de cada sujeto, pero también de la experiencia con el sinsentido

The daily life of many children in Brazil has been crossed by extreme violent situations, evidencing a state of social abandonment. Thus, this article aims to understand, from the story of Sandro Barbosa do Nascimento and of psychoanalysis, the nature of traumatism and its relation to trauma in the experience of children who experience violent scenes in their daily lives. We understand that traumatism is constituted in the singular dimension of each child, from the way they deal with the encounter with the trauma that can be found at violent scenes, as well as with the jouissance that erupts from the proximity of the totalitarian Other. These ways may be constituted from the symbolic resource of each subject, but also from the experience with non-sense

La vie quotidienne de nombreux enfants au Brésil est traversée par des situations de violence extrême, et témoigne d'un état d'abandon social. Cet article vise à comprendre, à partir de l'histoire de Sandro Barbosa do Nascimento et de la psychanalyse, la nature du traumatisme et sa relation au trauma dans l'expérience des enfants qui vivent des scènes de violence dans leur vie quotidienne. Nous comprenons que le traumatisme se constitue dans la dimension singulière de chaque enfant, à partir de la manière dont il gère la rencontre avec le trauma qu'impliquent les scènes de violence, ainsi qu'avec la jouissance qui jaillit de la proximité avec l'Autre totalitaire. Ces voies peuvent se constituer à partir de la ressource symbolique de chaque sujet, mais aussi à partir de l'expérience du non-sens

Gozo, segregação e trauma na civilização neoliberal / Enjoyment, segregation, and trauma in the neoliberal civilization / Jouissance, ségrégation et traumatisme dans la civilisation néolibérale

O real, em Lacan, aparece como um resto que escapa inevitavelmente à ordem simbólica e tem um efeito traumático. O sintoma responde ao traumático preservando algo dele, mas ao mesmo tempo o disfarçando. Para isso, ele alia-se à fantasia, na qual o gozo que assinala a irrupção do traumático é projetado no Outro. Na sociedade repressiva da época de Freud, sintoma e fantasia forneciam ao sujeito uma válvula de escape que velava o trauma estrutural. Na sociedade neoliberal contemporânea, o imperativo do gozo torna isso mais difícil e o trauma estrutural mostra-se de maneira mais evidente. Além disso, a segregação em termos de tipo de gozo ou de possibilidade de acesso ao gozo reforça o elemento traumático. O establishment psiquiátrico, contudo, tende a desresponsabilizar o sujeito (e a sociedade na qual ele vive) pelo trauma.

The real, in Lacan, appears as a rest that inevitably escapes the symbolic order and has a traumatic effect. The symptom responds to the trauma by preserving something from it while disguising it. For that, it articulates itself to fantasy, in which the enjoyment that marks the irruption of the trauma is projected onto the Other. In the repressive society of the times of Freud, symptom and fantasy provided the subject with an escape valve that veiled the structural trauma. In contemporary neoliberal society, the imperative of enjoyment hinders this mechanism, thus the structural trauma appears more evidently. Moreover, segregation in terms of the type of enjoyment or the possibility of access to enjoyment reinforces the traumatic element. The psychiatric establishment, however, tends to exempt the subject (and the society where he lives) from responsibility for the trauma.

Le réel, chez Lacan, apparaît comme un reste qui échappe inévitablement à l'ordre symbolique et a un effet traumatique. Le symptôme répond au traumatisme en en préservant quelque chose, mais en le masquant en même temps. Pour cela, il s'allie au fantasme, dans lequel la jouissance qui marque l'irruption du traumatique est projetée sur l'Autre. Dans la société répressive du temps de Freud, le symptôme et le fantasme fournissaient au sujet un exutoire qui voilait le traumatisme structurel. Dans la société néolibérale contemporaine, l'impératif de jouissance rend cela plus difficile et le traumatisme structurel apparaît plus clairement. De plus, la ségrégation en termes de type de jouissance ou de possibilité d'accès à la jouissance renforce l'élément traumatique. L'établissement psychiatrique a cependant la tendance à exonérer le sujet (et la société dans laquelle il vit) de la responsabilité du traumatisme.

Trauma, subjetivação e governabilidade na pandemia do Coronavírus / Trauma, subjectivation and governability in the Coronavirus pandemic / Traumatisme, subjectivation et gouvernabilité dans la pandémie de coronavirus

A intenção deste ensaio é a de problematizar os efeitos sobre as singularidades da pandemia do Coronavírus no registro eminentemente psíquico, articulando a experiência traumática com formas de subjetivação e da governabilidade, respectivamente. Com isso, o trauma pode ser interpretado como uma produção singular e coletiva ao mesmo tempo.

Trauma, subjectivation and governability in the Coronavirus pandemic. The intention of this essay is to problematize the effects on the singularities of the Coronavirus pandemic in the eminently psychic register, articulating the traumatic experience with forms of subjectivation and governability, respectively. With this, trauma can be interpreted as a singular and collective production at the same time.

Traumatisme, subjectivation et gouvernabilité dans la pandémie de coronavirus. L'intention de cet essai est de problématiser les effets sur les singularités de la pandémie de coronavirus dans le registre éminemment psychique, en articulant l'expérience traumatique avec des formes de subjectivation et de gouvernabilité, respectivement. Avec cela, le traumatisme peut être interprété comme une production singulière et collective à la fois.

Flexor digitorum profundus tendon infiltration by post-traumatic hemangioma. A pediatric case.

Pediatric cases of post-traumatic hemangioma of the palm are rare. Clinical evaluation and imaging are sometimes ambiguous and surgical exploration may show more conclusive results. This case report discusses the diagnosis and treatment of a teenager with post-traumatic hemangioma infiltrating the flexor digitorum profundus tendon of the index finger. Pathologic examination revealed a lobular capillary hemangioma known as pyogenic granuloma.

Brave spaces: Indigenous children in Canada plan for a different tomorrow.

When considering the impacts of historical trauma and colonization on the lived realities of Indigenous young people within Canada, it is essential that research uses strength-based, capacity-building approaches to ensure that the voices are heard and that their perspectives and advice can be actioned. A series of participatory workshops with adults and children were conducted within urban geographies to explore health-seeking behaviours, health knowledge, and community resiliency. Research took place in Manitoba, Canada (2015-2016, n = 36 girls and 24 adults) with First Nations and Métis community members and British Columbia, Canada (2017, n = 11 children and 15 adults) with Métis community members. Children participated in community transect walks, photo elicitation activities, discussion circles (with adult participant contribution), and projected community mapping exercises where they drew their ideal, imagined community. Community consensus processes were used for member checking as well as initial evaluation of research findings, including the establishment of key themes. Field notes, discussion transcripts, and images were analyzed for similarities and differences between ages, genders, cultural identifiers, and geographies. A key finding was the need for safe spaces that can also be brave spaces, or moments when the community can be free to push for change without reprimand. Children were particularly concerned with sustainable, appropriate housing, safe methods of transportation, access to green spaces, and environmental stewardship within their day-to-day lives. Novelty: Brave spaces are essential for achieving/maintaining wellness within Indigenous communities. This article responds to a need to shift to a determinants of life focus.

The post-traumatic reconstruction of nail bed defects using a homodigital dorsal adipofascial reverse flap.

Nail bed defects (NBDs) of the distal phalanx, are common and remain challenging to reconstruct. This study aimed to evaluate the clinical outcome of these post-traumatic injuries treated using a homodigital dorsal adipofascial reverse flap (HDARF). Sixteen patients, averaging 43-years-old, were retrospectively reviewed, who underwent the aforementioned procedure from February 2018 to December 2019. Range of motion of the distal interphalangeal (DIP) joint, static Weber's 2-point discrimination sensibility of the pulp, the percentage of nail adherence, complications, patient's satisfaction, subsequent nail regrowth, and flap survival were evaluated upon follow-up. At 26 months average follow-up, the percentage of flap survival was 100%. Complete regrowth of the nail was reported in 11 cases (69%), on average 4.7 months after surgery. A total absence of ungual regrowth was noted in 5 cases (31%). The mean static Weber's 2-point discrimination value of injured finger was 4.25 mm, reconstructed fingers' mean range of motion for the DIP joint was 75 degrees. Patient satisfaction was graded as very satisfying in 11 cases (69%), satisfying in 4 cases (25%), and disappointing in 1 case (6%). The HDARF is a good alternative for the management of NBDs of fingers and thumb. It yielded functionally and aesthetically acceptable results with low donor site morbidity. LEVEL OF EVIDENCE: IV.

Surgical management of persistent post-traumatic trans-tentorial brain hernia.

INTRODUCTION: Temporal engagement may persist after etiologic surgical treatment of acute subdural hematoma (ASH) without clinical improvement despite normalized intracranial pressure (ICP). The aim of this study was to assess the feasibility of secondary direct temporal lobe disengagement (DTLD) after surgery for supratentorial ASH and to evaluate clinical outcome. MATERIALS AND METHODS: This was a retrospective analysis of 4 patients undergoing secondary DTLD. Patient data were recorded at admission, pre- and postoperatively and at 6months' follow-up (FU): age, gender, Rotterdam score, Glasgow Coma Scale (GCS), neurological deficits, oculomotor nerve palsy (ONP), ICP, midline shift, complications and Extended Glasgow Outcome Scale (GOS-E). RESULTS: At postoperative evaluation 48h after DTLD, we observed a significant improvement in GCS score (initial 6±3, preoperative 7±3, postoperative 14±1; P=0.02), midline shift (initial 16±3mm, preoperative 13±5mm, postoperative 9±2mm; P=0.049) and ONP (P=0.01). In all cases, early postoperative imaging documented visualization of a patent ipsilateral peri-mesencephalic cistern. At 6-month FU, GOS-E showed 75% good recovery and 25% disability. Complete ONP recovery was observed in 75% of patients (P=0.01). Neurological deficits were present at FU in 25% of patients. No surgery-related complications or mortality were recorded. CONCLUSIONS: In traumatic brain injury, secondary DTLD may allow simple, effective and safe management of trans-tentorial uncal herniation, avoiding more challenging procedures. Clinical results are promising, as this technique seems to favorably influence neurological outcome in this selected subgroup of patients with persistent clinical and radiological signs of temporal engagement after etiological treatment with normal ICP values.

Facial fractures in post-revolution Tunisia as violence indicator: About 476 cases.

INTRODUCTION: On January 2011, Tunisia had known a revolution. To move from dictatorship to democraty project, the country suddenly fell into political instability, which was accompanied by a wave of social violence. Traumatology, and, particularly, maxilla-facial traumatology, is usually a reliable indicator of the degree of violence. AIM: The aim of this study was to establish the epidemiological profile of facial fractures during the various phases of political transition through which Tunisia has passed since revolution (2012-2016). PATIENTS AND METHODS: A retrospective cross-sectional study was conducted among all patients with facial fractures admitted to the department of Oral and Maxillo facial Surgery of University Hospital of Sahloul during five years (2012-2016). Fractures diagnosed late at the sequelae stage were excluded. Data of patients were recorded according to medical files, including cause of injury, age and gender, injury mechanisms and type of facial fracture. RESULTS: During the period of the study, a total of 476 patients were identified, with a sex-ratio of 7.2 to 1, patients ranged in age from 1 year to 76-years-old with a mean age of 27 years. Assaults were the most common cause of injury (39.1%). Mandible was fractured in 257 cases (54.2%) followed by zygoma (116 cases, 24.4%), nasal bone (99 cases, 20.8%) and Orbital walls (98 cases, 20.6%). DISCUSSION: The epidemiological profile of facial fractures in Tunisia has been changed since 2011. Facial fractures occur mainly after assaults, which are an indicator of increased social violence accompanying political instability present in our country.

Passive leg cycling increases activity of the cardiorespiratory system in people with tetraplegia.

Individuals with cervical spinal cord injury (SCI) are at an increased risk for cardiovascular disease. Exercise is well-established for preventing cardiovascular disease; however, there are limited straightforward and safe exercise approaches for increasing the activity of the cardiorespiratory system after cervical SCI. The objective of this study was to investigate the cardiorespiratory response to passive leg cycling in people with cervical SCI. Beat-by-beat blood pressure, heart rate, and cerebral blood flow were measured before and throughout 10 minutes of cycling in 11 people with SCI. Femoral artery flow-mediated dilation was also assessed before and immediately after passive cycling. Safety was monitored throughout all study visits. Passive cycling elevated systolic blood pressure (5 ± 2 mm Hg), mean arterial pressure (5 ± 3 mm Hg), stroke volume (2.4 ± 0.8 mL), heart rate (2 ± 1 beats/min) and cardiac output (0.3 ± 0.07 L/min; all p < 0.05). Minute ventilation (0.67 ± 0.23 L/min), tidal volume (70 ± 30 mL) and end-tidal PO2 (2.6 ± 1.23 mm Hg) also increased (all p < 0.05). Endothelial function was improved immediately after exercise (1.62 ± 0.13%, p < 0.01). Passive cycling resulted in an incidence of autonomic dysreflexia. Therefore, passive leg cycling increased the activity of the cardiorespiratory system and improved endothelial function, indicating it may be a beneficial exercise intervention for the cardiovascular and respiratory systems in people with cervical SCI. Novelty: Passive leg cycling increases the activity of the cardiorespiratory system and improves markers of cardiovascular health in cervical SCI. Passive leg cycling exercise is an effective, low-cost, practical, alternative exercise modality for people with cervical SCI.