A postmortem study of demographics and severity of thoracoabdominal injuries among patients attending a teaching hospital in northeast India.

Introduction: The global estimate reflects 4.4 million injury-related deaths every year and the thoracoabdominal region is frequently injured since it is a wide area. Methods: An autopsy-based cross-sectional study was conducted using a convenient sampling technique for three years. A Chi-square test was conducted for categorical variables. A P value of less than 0.01 was considered statistically significant. Results: Out of 80 cadavers, the male:female ratio was 1:0.31. The commonest age group was 20-29 years. Victims of road traffic accidents were 54 (67.5%) followed by falls from height 10 (12.5%). External thoracic injuries were commoner than internal and vice versa in abdominal injuries. Liver injuries were major in number. Combined thoracic-abdominal and associated injuries were observed in 67 (83.75%) victims. The commonest cause of death was craniocerebral injury combined with hemorrhagic shock (36.25%). Eighteen (22.5%) victims died on the spot having an Injury Severity Score (ISS) of 73.37 followed by a survival time of 1-7 days in 17 (21.25%) cases. A significant correlation was found between ISS and survival period. Conclusion: All thoracic and abdominal injuries represent a possible increase in morbidity and mortality; hence, working toward their prevention and timely intervention is necessary.

The association between road traffic accidents and visual functions: A systematic review and meta-analysis.

BACKGROUND:  Poor visual functions have been reported to be related to the occurrence of road traffic accidents. AIM:  To review the association between visual function and road traffic accidents (RTAs) from published relevant empirical studies. SETTING:  Worldwide. METHODS:  A random effects (RE) model meta-analysis was conducted using STATA 18. Statistical tests conducted include meta-summary statistics, RE meta-analysis (forest plot), meta-regression (relationship between mean age and effect sizes), funnel plots, Egger's and Begg's tests for publication bias and small study effects. RESULTS:  A total of 17 relevant studies, which were either cross-sectional or observational by design, were included in the meta-analysis. Reported effect sizes were within computed confidence intervals (CI) at 95%. The computed Q test of homogeneity was 61.94. The overall mean effect size of 1.43 (95% CI of 0.985-1.883) was statistically significant at a 5% level (Z = 6.26; p  0.001). The I-squared = 62.17% (p = 0.00) confirmed moderate heterogeneity and the Q-value of 61.94 (p = 0.00) rejected the null hypothesis that the effect size was the same in all the studies. The funnel plot showed that the remaining majority of 13 studies were within the funnel plot on the right-hand side of the line of no effect. CONCLUSION:  These results provide evidence of associations between visual functions and RTAs, and highlight the need for targeted interventions and further research to address the challenges associated with impaired visual functions and road safety.Contributions: The study contributes to the understanding of the implications of visual functions for road safety.

Household cost of road traffic accident-related injuries: A case study of St. Joseph Hospital, Koforidua in Ghana.

Road traffic accidents (RTAs) are a prominent contributor to both mortality and morbidity, particularly affecting individuals aged 5-29 years. Road traffic Injuries impose substantial physical and economic burden on individuals, households, and governments, particularly in African nations. Thus, our study focuses on assessing the economic cost of road traffic accidents within the context of St. Joseph Hospital, Koforidua. A cross-sectional survey was conducted at the Emergency Unit of the St. Joseph Hospital with a sample size of 291 patients. A patient perspective was used in costing the management of RTAs. Data was descriptively analyzed with Microsoft Excel with means and standard deviations estimated for direct, indirect, and intangible costs to the patient. Total direct and indirect cost of road traffic accidents were approximately GHS1,973,801.28 (US$164,483.44) and GHS520,309.46 (US$43,359.12) respectively which represents 79.1 % and 20.9 % of the total cost. The annual average economic cost for all cases was GHS8,570.83 (US$714.24). Intangible costs were also found to be high, with 54.2 % patients rating their RTA burden to be between mild to moderate, 10.8 % as moderate to severe and 1.4 % as severe. RTA cost burden is huge for all households. Uninsured patients bear significantly higher costs than insured patients. Intangible costs were also high, prompting the need to provide psychological care to RTA victims and their families. Concerted efforts should be directed at strict enforcement, training, improvement of road infrastructure and legislation to reduce or curb road traffic accidents in LMICs.

Management of Congenital Radioulnar Synostosis Fracture Following Road Traffic Accident: A Rare Case Report.

Introduction: Congenital radioulnar synostosis (CRUS) is a rare condition characterized by the fusion of the radius and ulna bones in the forearm, resulting in limited forearm rotational movement. Case Report: We present a unique case of a 26-year-old male who suffered a forearm injury following a road traffic accident. Initial evaluation revealed a malformed proximal radius and distal radioulnar joint, and the presence of radioulnar synostosis, along with a fracture at the junction of the radius and ulna. Open reduction internal fixation was performed, followed by structured rehabilitation. At 6-month follow-up, significant improvement in forearm motion was observed, enabling the patient to perform daily activities independently. Conclusion: This case underscores the importance of comprehensive evaluation in traumatic injuries and understanding the anatomy and function of the forearm complex. It also highlights the efficacy of surgical intervention and rehabilitation in restoring function and quality of life for patients with this rare condition. This report contributes to the limited literature on managing fractures in the context of CRUS and emphasizes the need for further research in this area.

Near miss road traffic accidents and associated factors among truck drivers in Gamo zone, southern Ethiopia by using a contributory factors interaction model.

Background: Road traffic accidents (RTAs) are among the leading causes of injuries, fatalities, and the resulting increase in financial burdens worldwide. Every year, RTAs cause numerous serious injuries and fatalities in Ethiopia. it is important to understand how prevalent near-miss crash accidents are, and which by definition could have injured the victim but did not result in an actual accident. The determinants of these near-misses are essential in road crash accident reduction strategies. In spite of the fact that near-miss accidents are much more common than actual losses or injuries, very little research has been conducted on them. Thus, this study was intended to assess the near-miss accidents and associated factors among truckers in Gamo zone, southern Ethiopia. Methodology: The community-based cross-sectional study was employed from May 12 to July 10,2022, using a structured interviewer-administered questionnaire. A simple random sampling technique was used to select participants. The data were analyzed using the statistical package for social sciences. A binary and multivariate logistic regression model was used to identify the determinants of near-miss accidents. A statistical significance level was set at p < 0.05. Results: About 72.5% of truckers had experienced near-miss road traffic accidents. The majority of the near-miss accidents were caused by speeding, followed by driving on the wrong side of the road and skidding, 65 (22.6%), 39 (13.5%), and 38 (13.2%), respectively. Driving frequency per week, location of accidents, condition of the road, sleeping status, and weather conditions were significantly associated with near-miss accidents. Conclusion: The prevalence of near-miss accidents is high in the Gamo zone. Being a younger and less educated driver, high driving frequency per week, driving on major roads and junctions, foggy weather, and inadequate sleep all contribute to the occurrence of accidents. Road safety measures that could address these identified factors are required to mitigate potential RTAs.

Epidemiology of Oral and Maxillofacial Traumatic Injuries Among the Patients Reporting to the Dental Institute of Western Maharashtra Region, India.

Objective: To analyze the distribution, etiology, and patterns of oral and maxillofacial trauma among the subjects reporting to a dental institute in the Western Maharashtra region of India. Methods: This retrospective study was conducted by manually collecting data from the medical records of subjects who reported to the dental institute with a history of trauma from 1st January 2018 to 31st December 2022. All the injured subjects with complete clinical and radiographical records of maxillofacial injuries were included. The demographic data, etiology & site of trauma, and associated injuries were analyzed. Data were tabulated into four age groups (< 20 years, 21-40 years, 41-60 years, and > 60 years). Five etiological factors, i.e. road traffic accidents (RTA), stumble & falls, violence, animal attack, and strike by an object, were further evaluated based on age and gender. Maxillofacial injuries were classified into seven types: maxillary fractures (subcategorized), mandibular fractures (subcategorized), zygomaticomaxillary complex (ZMC) fractures, nasal, frontal, orbital, and naso-orbito-ethmoidal fractures. Data were tabulated and analyzed. Results: A total of 437 subjects were included, consisting of 84.2% males and 15.8% females, with the highest incidence of trauma between 21-40 years. Road traffic accident was the main reason for maxillofacial injuries (50.3%), followed by falls (26.5%), and violence (19.9%). ZMC fractures accounted for 55.4% (242 fractures), followed by mandibular fractures (42.3%). Conclusion: RTA is the main factor responsible for maxillofacial injuries in this part of Maharashtra among subjects of both genders. Education and motivation regarding road safety measures are the two factors that need to be focused on to reduce the incidence of maxillofacial injuries.

Comparative Study of Computerized Tomography Imaging of Facial Trauma Using 2D and 3D Reconstruction Scans.

Background The article intends to compare the efficacy of detecting fractures of facial bones in terms of the number of fractures detected, single or multiple involvement, displaced or undisplaced, segmental involvement, and comminuted or non-comminuted using 2D computerized tomography (CT) versus 3DCT for planning optimum treatment. Methodology One hundred patients with suspected facial bone fractures sustained either by assault, road traffic accident, or self-fall on arrival to casualty were examined clinically. Subsequently, palpation was done to detect facial bone fractures. On suspicion, they were subjected to a CT scan of the face in both coronal and axial views. The results were interpreted in the form of bones involved and detection of fractures of the same on both 2D and 3D scans. The acquired images of fractures obtained by 2D scan were reconstructed using software to obtain virtual images of the same by 3D scan to help further delineate which fractures or combination of them are better appreciated on both scans.  Result Out of 100 patients, 52 had maxilla fractures, which were better delineated by 3D scans. The detection of zygomatic arch fractures was almost equal on both scans. Mandibular and orbital fractures were better delineated by 3D scans. Conclusion To conclude, we believe that in maxillofacial trauma, 3DCT provides better information than 2DCT, especially with regard to the delineation of fractures and the involvement of single or multiple bones, as it gives a real-time picture of the same. This helps in planning the management of patients, whether surgical intervention is required or can be managed conservatively.

Early Tracheostomy versus Late Tracheostomy in Patients with Moderate-to-Severe Traumatic Brain Injury.

Objective The aim of this article was to study the impact of early versus late tracheostomy on clinical outcomes of moderate-to-severe traumatic brain injury (TBI). Materials and Methods A retrospective cross-sectional study was conducted in the Neurosurgery Department, Mayo Hospital, Lahore, in which a sample size of 50 cases was calculated over a period of 6 months from January 1, 2022, to June 30, 2022. The included cases were patients who suffered from moderate-to-severe TBI, isolated TBI, needed elective ventilation, required intensive care unit (ICU) admission during their hospital stay, and were between the ages of 18 and 65 years. All the rest were excluded. A structured proforma was used by the physician to collect data after the informed consent of the patient. The results were computed and analyzed statistically using Statistical Package for Social Sciences , version 26. Results The median age of patients was 40 (interquartile [IQ] range 34) years and were predominantly male (72%). The most common mode of injury was road traffic accidents (58%). The median Glasgow Coma Scale (GCS) score at arrival was 8 (IQ range 6) and the most common pupillary light reflex at presentation was bilaterally equally responsive to light (68%). Neurologic deficits were mostly absent or cannot be assessed on presentation (86%) and in 38% of the cases multiple findings were noted on computed tomography (CT) scan while among single findings seen on CT scan, subdural hematoma was the most common (22%). Multiple regression analysis was done through two separate models using age, gender, mode of injury, presenting GCS score, number of CT-scan findings, number of days after endotracheal intubation after which tracheostomy was done, and the timing of tracheostomy (early vs. late) as predictors, and a significant relationship was noted between the timing of tracheostomy (early vs. late) and GCS at discharge ( p = 0.001) as well as extended Glasgow Outcome Score (GOS) at discharge ( p = 0.013). Conclusion This study suggests that moderate-to-severe TBIs are most common in middle-aged males and mostly involve road traffic accidents. In most cases, multiple CT-scan findings are seen as compared with a single predominant finding. In such patients, early tracheostomy is superior to late tracheostomy as it results in significantly better GCS and GOS scores at discharge as well as a decreased duration of mechanical ventilation and ICU stay.

Refractive error and abnormal stereopsis association with road traffic accidents in Saudi Arabian truck drivers.

PURPOSE: To investigate the visual functions of truck drivers of the Kingdom of Saudi Arabia (KSA) in the region of Qassim and Dammam and to see if is there any association between these visual functions and self-reported road traffic accidents (RTA). METHODS: It is a cross-sectional, descriptive study. LogMAR visual acuity, refractive error, color vision, stereopsis, and confrontation visual fields were measured in 300 truck drivers in the Qassim and Dammam regions of KSA. Driving-related history and incidence of RTA from the past 3 years, systemic history, and general eye compliance history were collected through a self-reporting questionnaire. RESULTS: Among 300 truck drivers examined, 54 (18.4%) subjects have a refractive error, 14 (4.7%) subjects have color vision deficiency, 37 (12.2%) subjects have abnormal stereo acuity, and none of them have confrontation visual field defect. RTA was reported in 25 (8.3%) subjects. The current study has found RTA is significantly associated with refractive error (P = 0.01) and abnormal stereopsis (P < 0.01). Systemic history revealed that 11% of the subjects had diabetes mellitus. CONCLUSION: The current study is the first to report on the visual functions of KSA truck drivers. Hence, the current study has found a significant association between visual functions and RTA among truck drivers, we recommend a comprehensive examination need to be part of issuing driver's licenses in KSA. More studies with larger samples from different regions of KSA are needed to extrapolate these findings.

Lost years, mortality burden: the impact of COVID-19 pandemic on premature death due to road traffic accidents in a northern state in Malaysia.

BACKGROUND: This study addresses the persistent global burden of road traffic fatalities, particularly in middle-income countries like Malaysia, by exploring the impact of the COVID-19 pandemic on Road Traffic Accident (RTA) fatalities in Perak state, Malaysia, with a secondary focus on applying Years of Life Lost (YLL) to understand the implications of these premature deaths. METHODOLOGY: The cross-sectional study retrospectively reviewed certified RTA fatalities from 2018 to 2021, individually counting fatalities in accidents and excluding cases with incomplete death profiles. Data were collected from all Forensic Departments in the government hospitals in Perak. RTA fatalities were confirmed by medical officers/physicians following established procedures during routine procedures. A total of 2517 fatal accident and victim profiles were transcribed into data collection form after reviewing death registration records and post-mortem reports. Inferential analyses were used for comparison between pre- and during COVID-19 pandemic. The standard expected YLL was calculated by comparing the age of death to the external standard life expectancy curve taking into consideration of age and gender in Malaysia. RESULTS: This study included 2207 (87.7%) of the RTA fatalities in Perak State. The analysis revealed a decreasing trend in RTA deaths from 2018 to 2021, with a remarkable Annual Percent Change (APC) of -25.1% in 2020 compared to the pre-pandemic year in 2019 and remained stable with lower APC in 2021. Comparison between pre-pandemic (2018-2019) and pandemic years (2020-2021) revealed a difference in the fatality distribution with a median age rise during the pandemic (37.7 (IQR: 22.96, 58.08) vs. 41.0 (IQR: 25.08, 61.00), p = 0.002). Vehicle profiles remained consistent, yet changes were observed in the involvement of various road users, where more motorcycle riders and pedestrian were killed during pandemic (p = 0.049). During pandemic, there was a decline in vehicle collisions, but slight increase of the non-collision accidents and incidents involving pedestrians/animals (p = 0.015). A shift in accident from noon till midnight were also notable during the pandemic (p = 0.028). YLL revealed differences by age and gender, indicating a higher YLL for females aged 30-34 during the pandemic. CONCLUSION: The decline in RTA fatalities during COVID-19 pandemic underscores the influence of pandemic-induced restrictions and reduced traffic. However, demographic shifts, increased accident severity due to risky behaviors and gender-specific impacts on YLL, stress the necessity for improved safety interventions amidst evolving dynamics.

Time to wound closure in facial soft tissue injuries following road traffic accidents.

The 6-hour (6-h) time to wound closure was a controversial issue as studies have shown that time was not a substantial factor. Wounds in the face are often considered to have a lower infection risk. Despite this, the cause of injury was not extensively discussed in relation to this context. The primary objective was to investigate the association between the 6-h time to wound closure and wound complications following emergency management of facial soft tissue injuries (STIs). Additionally, the secondary objective was to explore other factors contributing to wound complications. A retrospective record review was conducted in our hospital in Kuala Lumpur, Malaysia, from 1 January 2017 to 31 December 2021. Medical records of patients with facial STIs due to road traffic accidents were included. Simple random sampling was used to select records meeting inclusion criteria. Data on demographic, injury, and treatment characteristics were collected using a standardized proforma. Descriptive, univariate and multivariate analyses were performed, including chi-square tests and binary logistic regression. A total of 295 patient records were included, with most patients being males (77.3%) and of Malay ethnicity (54.9%). The median age was 31.0 years. Majority of patients were treated within 6 h of injury (93.9%). Complications were documented in 6.1% of cases, including wound dehiscence and infection. Multivariate analysis revealed a significant association between 6-h time to closure and wound complications (OR: 7.53, 95% CI: 1.90-29.81, p = 0.004). Grade of surgeon on duty (OR: 4.61, 95% CI: 1.25-16.95, p = 0.02) and diabetes mellitus (OR: 6.12, 95% CI: 1.23-30.38, p = 0.03) were also shown to have a statistically significant association with wound complications. A 6-h time to wound closure, grade of surgeon on duty and diabetes mellitus were three major factors involved in facial wound complications following road traffic accidents.

Factors affecting severity and prognosis of traumatic brain injury among Bangladeshi patients: An institution based cross-sectional study.

OBJECTIVE: Traumatic brain injury (TBI) proves to be an obstacle for Bangladeshi patients due to the lack of facilities and specialist doctors in regional sections of the country. This study aimed to record different attributes of Bangladeshi TBI patients over a year i.e., their injury characteristics, treatments received and understand their impacts on the severity of TBI. METHOD: This cross-sectional study was carried out among 280 TBI patients treated in a tertiary care hospital in Dhaka. The physicians determined TBI's severity and prognosis as per the Glasgow Coma Scale (GCS) and Glasgow Outcome Score (GOS) respectively. RESULTS: Most TBI patients were male (76.1%) and aged between 18 and 50 years (52.2%), as in previous studies in South Asian countries. However, the prevalence of TBI due to road traffic accidents (RTAs) was much higher (67.9%) than in the earlier studies in South Asia. Additionally, more patients suffered from severe TBI (29.3%) and moderate TBI (35.7%), and a higher percentage of patients went through surgery (56.8%) compared to previous studies. A significant association of demographic (residence) and clinical characteristics (consciousness after injury, CT scan findings and treatment type) with the severity of TBI was found in bivariate analysis. It also revealed the significant dependence of clinical characteristics (TBI etiology, post-injury consciousness, treatment type and TBI severity) on TBI prognosis. Multivariate analysis showed that patients who were unconscious after TBI and with evident brain injury observed in CT scans have a substantially higher risk of having moderate or severe TBI than mild TBI. Moreover, patients with TBI due to RTAs or falls, evident brain injury in CT scans, post-surgical seizure, and moderate or severe TBI have a significantly higher risk of getting a more unfavorable TBI prognosis than moderate disability. CONCLUSIONS: In this study, RTAs were found to be the major cause of TBI. Additionally, some variables were identified as possible determinants of TBI severity and prognosis among Bangladeshi patients. The correlation of these variables with TBI should be further studied with the hopes that steps will be taken to reduce TBI incidents and improve its management to reduce the overall burden.

Frequency of concomitant injuries in maxillofacial trauma in a tertiary health care centre in India: A 5-year retrospective study.

PURPOSE: Road traffic accidents (RTA), assaults, falls, and sports-related injuries are the leading causes of maxillofacial trauma. Due to quite different geographical environment and fast urbanization, the use of various protective equipment is restricted in India. Thus, compared to other countries, there might be a significant difference in the pattern and frequency of associated injuries among subjects with maxillofacial trauma. The present study was conducted to identify the causes and pattern of various maxillofacial fractures and the frequency of other related injuries among subjects with maxillofacial trauma. METHODS: This is a cross-sectional retrospective study recording 2617 subjects with maxillofacial trauma. The patient demographics, causes of trauma, types of maxillofacial injury, and associated soft and hard tissue injuries were recorded. The types of maxillofacial and associated injuries were diagnosed from details of clinical examinations and the interpretation of various radiographs available in the file. The associated injuries were divided into head injury, other bony injuries, and soft tissue and vital structure injuries. Descriptive statistics and the test of proportion were used. A p value < 0.05 was considered as a level of significance. RESULTS: The maxillofacial injuries were significantly common in patients aged 16 - 45 years (66.7%) than in patients aged ≤ 15 and > 46 years (33.3%) (p < 0.001). The RTA was the most common cause of maxillofacial injury (n = 2139, 81.7%), followed by fall (n = 206, 7.9%), other causes of injury (n = 178, 6.8%), and assaults (n = 94, 3.6%). The maxillofacial injury by 2-wheel vehicle accidents was significantly higher than that by 4-wheel vehicle and other vehicle accidents (p < 0.001). There was a significant correlation between alcohol and RTA (p < 0.001). The head injury (n = 931, 61.1%) was the most common associated injury, followed by soft tissue and vital structures injuries (n = 328, 21.5%) and other bone injuries (n = 264, 17.3%). DISCUSSION: Head injury was the most common associated injury followed by soft tissue and vital structures and bone injuries among subjects with maxillofacial trauma. Clavicle fracture and injury to the lower extremities were the most common hard and soft tissue-associated injuries.

Treatment Gap in Mental Health Care for Victims of Road Traffic Accidents.

Road traffic accidents (RTAs) are among the most frequent negative life-events. About one in five RTA survivors is susceptible to posttraumatic stress disorder (PTSD). Knowledge about needs for, and usage of, mental health services (MHSs) may improve options for care for RTA victims. The current study aimed to assess rates of victims using different MHSs, including psychotherapy, pharmacotherapy and support groups, and to explore correlates of needs for and use of these MHSs. Further, we aimed to estimate the treatment gap in post-RTA care, defined as including people with probable PTSD who did not use MHSs and people wanting but not getting help from MHSs. Dutch victims of nonlethal RTAs (N = 259) completed self-report measures on needs for and use of MHSs and PTSD. Results showed that 26% of participants had utilized care from psychotherapy, pharmacotherapy or support groups. Among people with probable PTSD, this was 56%. Increased posttraumatic stress was the strongest correlate of MHS use. Forty-eight participants (17.8%) had an unmet care need and represented the treatment gap. Commonly reported reasons and barriers preventing MHS use were perceptions that problems were limited or would disappear without care and financial worries. Regarding possible future care, participants reported a preference for face-to-face (over online) help from a psychologist (over other professionals). The treatment gap for Dutch RTA victims may be limited. However, a significant number of RTA victims need care but do not obtain this care. Care options may be improved by reducing practical barriers to MHSs and increasing mental health literacy and acceptability of different forms of care (besides face-to-face care).

Risk factors and predictive model of cerebral edema after road traffic accidents-related traumatic brain injury.

PURPOSE: Cerebral edema (CE) is the main secondary injury following traumatic brain injury (TBI) caused by road traffic accidents (RTAs). It is challenging to be predicted timely. In this study, we aimed to develop a prediction model for CE by identifying its risk factors and comparing the timing of edema occurrence in TBI patients with varying levels of injuries. METHODS: This case-control study included 218 patients with TBI caused by RTAs. The cohort was divided into CE and non-CE groups, according to CT results within 7 days. Demographic data, imaging data, and clinical data were collected and analyzed. Quantitative variables that follow normal distribution were presented as mean ± standard deviation, those that do not follow normal distribution were presented as median (Q1, Q3). Categorical variables were expressed as percentages. The Chi-square test and logistic regression analysis were used to identify risk factors for CE. Logistic curve fitting was performed to predict the time to secondary CE in TBI patients with different levels of injuries. The efficacy of the model was evaluated using the receiver operator characteristic curve. RESULTS: According to the study, almost half (47.3%) of the patients were found to have CE. The risk factors associated with CE were bilateral frontal lobe contusion, unilateral frontal lobe contusion, cerebral contusion, subarachnoid hemorrhage, and abbreviated injury scale (AIS). The odds ratio values for these factors were 7.27 (95% confidence interval (CI): 2.08 - 25.42, p = 0.002), 2.85 (95% CI: 1.11 - 7.31, p = 0.030), 2.62 (95% CI: 1.12 - 6.13, p = 0.027), 2.44 (95% CI: 1.25 - 4.76, p = 0.009), and 1.5 (95% CI: 1.10 - 2.04, p = 0.009), respectively. We also observed that patients with mild/moderate TBI (AIS ≤ 3) had a 50% probability of developing CE 19.7 h after injury (χ2 = 13.82, adjusted R2 = 0.51), while patients with severe TBI (AIS > 3) developed CE after 12.5 h (χ2 = 18.48, adjusted R2 = 0.54). Finally, we conducted a receiver operator characteristic curve analysis of CE time, which showed an area under the curve of 0.744 and 0.672 for severe and mild/moderate TBI, respectively. CONCLUSION: Our study found that the onset of CE in individuals with TBI resulting from RTAs was correlated with the severity of the injury. Specifically, those with more severe injuries experienced an earlier onset of CE. These findings suggest that there is a critical time window for clinical intervention in cases of CE secondary to TBI.

Closed Degloving Injury of the Foot Caused by a High Impact Force: A Case Report.

An 18-year-old male subject was referred to our MRI scanning center, by an orthopedic surgeon, for a swelling over the plantar region of the foot. He had been in a motor vehicle accident a few weeks back, with no evidence of fracture at the time of injury. In subsequent weeks, he developed a swelling over his foot. MRI showed the presence of a fluid intensity lesion in the subdermal and dermal layers of his foot. Unguarded motor vehicle accidents often tend to cause severe injuries. Sometimes, they even need operative management since a motor vehicle collision is a high-impact accident. One of the pathologies caused by a high impact force is the Morel-Lavallée lesion or a closed type of degloving injury. A Morel-Lavallee lesion also needs operative intervention if major vascular channels are involved in the degloving. However, if the major vessels supplying the region of degloving are intact, open surgery may not be needed. In such cases, incision and drainage along with serial wound dressing may be attempted. The primary risk in closed degloving is recurrent or subsequent tissue necrosis. Close and watchful monitoring is needed to anticipate and prevent these. Closed degloving injuries or Morel-Lavallée lesions have been commonly described in the thigh and pelvis region. Here, we describe a case that developed in the dermal and fascial layers of the foot and was managed conservatively. The epidermal layer showed regeneration, and the patient did not need subsequent amputation.

Identification and analysis of accident black spots using Geographic Information System (GIS): A study on Kushtia-Jhenaidah national highway (N704), Bangladesh.

Road accidents, mostly on national highways, pose a significant public health and economic burden in Bangladesh, requiring in-depth analysis for road safety measures. This study comprehensively analyzes accident trends, characteristics, causes, and consequences by identifying the accident black spots on the Kushtia-Jhenaidah National Highway (N704). Accident records from 2017 to 2021 were collected from nearby police stations. Additionally, using a cluster random sampling approach, a questionnaire survey with 100 respondents (50% drivers and 50% general road users) was also conducted to capture diverse perceptions and behaviors. The study utilizes descriptive methods, such as trends analysis and frequency distributions, alongside spatial analysis techniques, including severity index, Kernel Density Estimation, and hotspot analysis. Findings indicate a decrease in accidents from 2018 to 2021, yet a concerning rise in fatalities in 2021. Trucks (47.9%) emerge as the primary contributor among 169 vehicles involved in accidents. Head-on collisions (36%) are prevalent, attributed to both human and environmental factors, including driver inexperience (56%), mobile phone use while driving (78%), lack of proper training (12%), overspeeding (28.3%), and nighttime driving (54%) influenced by seasons and land use. Mostly, victims aged from 20 to 40, where men are more affected by fatalities (70.7%) and women by injuries (86.3%). Out of 35 identified accident spots, including Battail, Bittipara Bazar, Laxmipur Bazar, Modhupur Bazar, IU Main Gate, Sheikhpara Bazar, and DM College Front, are designated as blackspot zones based on the frequency of accidents, deaths, and injuries. The study concludes by recommending targeted interventions, driver training, infrastructure improvements, regulatory measures, and victim assistance in collaboration with local and national agencies to enhance road safety and mitigate accident risks.

Ascending colon injury and ileal perforation due to blunt abdominal trauma: A case report.

A rare case of an ascending colon injury and ileal perforation in a 34-year-old male patient due to blunt abdominal trauma caused by a road traffic accident is reported in this study. This paper reports the clinical and imaging findings of seat belt syndrome. The seat belt syndrome primarily involves soft tissue injury; however, lacerations of the colon, small intestine, and mesentery have rarely been reported in the literature. However intestinal injuries, including bowel perforation and mesenteric injuries due to seat belt syndrome, must not be underestimated because they usually require emergency laparotomy because of accompanying peritonitis and hemorrhaging, and can be lethal if left untreated. Therefore, when an ascending mesocolon hematoma and free gas in the peritoneal cavity are present, gastrointestinal perforation due to seat belt syndrome should be suspected. In this case, gastrointestinal perforation was suspected based on the computed tomography findings, and emergency surgery was performed; the patient's course was uneventful without any postoperative complications. Early diagnosis and management are essential to prevent associated morbidity and mortality.

Assessing the Behavioral and Personality Changes in Alcohol Dependence Syndrome in Wardha, Central India.

Background Alcohol dependence syndrome occurs when the consumption of alcohol is uncontrollable. Most of the alcohol drinkers are usually males. There is a rise in the incidence of road traffic accidents under the influence of alcohol due to locomotor and cerebral dysfunction. Alcohol is a significant cause and contributing factor for domestic violence, family disharmony, and displeasure in families. Research studies have shown that after the lockdown of COVID-19, the consumption of alcohol decreased in India. This study was conducted to assess the behavioral and personality changes in alcohol dependence syndrome. Methods This study was conducted at a rural tertiary care hospital in Wardha, Maharashtra, Central India. Sixty-two males participated in the study. Out of which, 56 were included in the study. There were urban and rural participants in the study. The study was conducted for a period of six months. The participants who were being treated for alcohol withdrawal and alcohol dependence syndrome were included in the study. The individuals unwilling to participate in the research and those admitted to the intensive care unit were excluded from this study. The primary outcome measure of the study was to assess the behavioral and personality changes in alcohol dependence syndrome. Participants were screened using the Cut-Down, Annoyed, Guilty, and Eye-Opener (CAGE) and the Alcohol Use Disorders Identification Test (AUDIT) questionnaires. The diagnosis of alcohol dependence syndrome was made according to the International Classification of Diseases, Tenth Revision, (ICD-10) criteria. The participants were assessed using a self-report questionnaire. The parameters of assessment were aggressive behavior, domestic violence, workplace violence, verbal abuse, and variables including the forensic aspects of alcohol consumption, such as road traffic accidents, etc. Previous research and similar studies on factors related to alcohol dependence syndrome were compared to establish a conclusion for the study. Results Participants reported to have decreased psychomotor function upon alcohol consumption compared to the time they were not under the influence of alcohol. Aggressive behavior associated with irritability and agitation was observed in 89.28% (50 out of 56) participants. A total of 76.78% (43 out of 56) had road traffic accidents at least once under the influence of alcohol. Of the sample, 85.71% (48 out of 56) committed verbal abuse at the workplace and home as a result of aggression under the influence of alcohol. And 69.64% (39 out of 56) of the sample had memory loss after consumption of alcohol. Conclusion There are several behavioral changes in individuals who are alcohol dependent, which may affect their day-to-day activities and cause poor performance in the workplace. Participants in the study showed a notable positive relation between alcohol dependence syndrome and aggressive behavior, verbal aggression, domestic violence, memory loss, and road traffic accidents under the influence of alcohol. Alcohol dependence syndrome can be linked with decreased quality of life due to problems faced in daily activities like psychomotor functions, sleeping, etc. During the treatment of alcohol dependence or withdrawal from alcohol, individuals experience socio-behavioral changes. Cognitive behavior therapy, including cognitive neuroscience, can help in managing these behavior and personality changes in alcohol dependence syndrome.

Time series based road traffic accidents forecasting via SARIMA and Facebook Prophet model with potential changepoints.

Road traffic accident (RTA) is a critical global public health concern, particularly in developing countries. Analyzing past fatalities and predicting future trends is vital for the development of road safety policies and regulations. The main objective of this study is to assess the effectiveness of univariate Seasonal Autoregressive Integrated Moving Average (SARIMA) and Facebook (FB) Prophet models, with potential change points, in handling time-series road accident data involving seasonal patterns in contrast to other statistical methods employed by key governmental agencies such as Ghana's Motor Transport and Traffic Unit (MTTU). The aforementioned models underwent training with monthly RTA data spanning from 2013 to 2018. Their predictive accuracies were then evaluated using the test set, comprising monthly RTA data from 2019. The study employed the Box-Jenkins method on the training set, yielding the development of various tentative time series models to effectively capture the patterns in the monthly RTA data. SARIMA(0,1,1)×(1,0,0)12 was found to be the suitable model for forecasting RTAs with a log-likelihood value of -266.28, AIC value of 538.56, AICc value of 538.92, BIC value of 545.35. The findings disclosed that the SARIMA(0,1,1)×(1,0,0)12 model developed outperforms FB-Prophet with a forecast accuracy of 93.1025% as clearly depicted by the model's MAPE of 6.8975% and a Theil U1 statistic of 0.0376 compared to the FB-Prophet model's respective forecasted accuracy and Theil U1 statistic of 84.3569% and 0.1071. A Ljung-Box test on the residuals of the estimated SARIMA(0,1,1)×(1,0,0)12 model revealed that they are independent and free from auto/serial correlation. A Box-Pierce test for larger lags also revealed that the proposed model is adequate for forecasting. Due to the high forecast accuracy of the proposed SARIMA model, the study recommends the use of the proposed SARIMA model in the analysis of road traffic accidents in Ghana.