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1.
West Afr J Med ; 37(2): 131-137, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32150631

RESUMEN

BACKGROUND: Trauma in developing countries has assumed an epidemic proportion and is now a public health problem. This is largely due to the rising incidence of road traffic crashes (RTC), increasing urbanization, industrialization and armed conflicts including terrorism fuelled by political, ethnic and religious factors in most developing countries. Unfortunately, this public health menace has not gotten the attention it deserves from the governments of the low-income countries, global non-governmental organisations and the mass media compared to the infectious diseases. METHODS: This was a 2-year retrospective cohort study of trauma patients who presented to our emergency department and died within 72 hours of admission. RESULTS: Within the period, a total of 6,858 patients, consisting of 2,228 trauma patients were admitted into our emergency department. Out of the trauma admissions, 256 patients died; giving a mortality rate of 11.5%. However, only 237 of the dead patients' case files could be reviewed. There were 195 (82.3%) males and 42 (17.7%) females. Majority of the deaths were in the age group 31 years - 45 years, with a mean age of 33.6 years. Road traffic crash was the most common cause of trauma deaths, 194 (81.9%); followed by flame burn, 15 (6.3%). Traumatic brain injury with or without other associated lesser injuries was the predominant diagnosis at presentation, 157 (66.2%). Most of the patients presented within 4 hours of their injuries, 136 (57.4%). Majority of the patients were brought to hospital by other road users, 133 (56.1%); and commercial bus was the commonest mode of transportation of the patients to the hospital, 102 (43.1%). CONCLUSION: The trauma mortality rate in our emergency department calls for urgent intervention measures. Critical amongst them is the need for establishment of a trauma system with an efficient pre-hospital emergency medical service component in our region.


Asunto(s)
Accidentes de Tránsito/mortalidad , Accidentes/mortalidad , Urgencias Médicas/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Mortalidad Hospitalaria , Heridas y Traumatismos/epidemiología , Accidentes de Tránsito/estadística & datos numéricos , Adulto , Causas de Muerte , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Centros de Atención Terciaria
2.
J Emerg Manag ; 18(2): 105-111, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32181866

RESUMEN

A new approach is proposed for assessing the integrated indicator of the technogenic risk of accidents on the city territory. The indicator is determined by the values of the individual indicators: potential danger, security, and vulner-ability of the territory. This approach allows us to assess the technogenic risk qualitatively and quantitatively and to take into account the complex of important factors affecting the safety of the city territory.


Asunto(s)
Accidentes , Planificación en Desastres/organización & administración , Medición de Riesgo , Ciudades , Humanos
3.
Sud Med Ekspert ; 63(1): 4-8, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32040080

RESUMEN

The objective of the work was to discuss theoretical and practical aspects related to commissioning of expert studies and performance of a multidisciplinary water-technical and forensic medical expertise, when violation of water transport safety rules is investigated. The studied practice of water transport accident investigations demonstrates that predominately forensic medical examination and water-technical examination are assigned separately. In this connection, there is a need to widen knowledge on transport-technical and forensic medical examinations. A multidisciplinary expertise including forensic medical, transport-trace, and water-technical examinations should be developed, because according to the authors' opinion, it is not properly elaborated for the time being, as evidenced by small quantity of scientific publications, as well as by the absence of a definition and description of a water-transport injury in the corresponding normative act regulating the performance of forensic medical expertise.


Asunto(s)
Medicina Legal , Contaminación del Agua , Accidentes , Agua
4.
J Forensic Leg Med ; 69: 101888, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32056805

RESUMEN

Firearms injuries have a legal and medico-legal importance, and are especially lethal when they reach the craniofacial regions of the victim. The present study aims to identify the characteristics of craniofacial lesions resulting from firearm projectiles, to register the most affected craniofacial regions by this type of injury and to verify the demographic profile of the victims. A retrospective study was carried out on the autopsy records produced in the first semester of 2015, in five Institutes of Legal Medicine in Porto Velho, situated in the cities of João Pessoa, Vitória, Porto Alegre and Brasília. Data extracted included sex, skin color and age of the victim, craniofacial region reached, shooting distance, shape and size of the injuries and manner of death (homicide, suicide or accident). Based on the 868 reports analyzed, it was possible to observe 1700 entrance lesions of firearm projectiles in craniofacial regions. Among cases of known manner of death, homicides were the most frequent (97.0%). It was observed a higher frequency of male victims (93.3%), mixed race (62.0%), between the ages of 12 and 29 years (59.4%). In all cases considered as suicide or accident there was only one entrance wound, but in 82.8% of the homicides there were multiple gunshot wounds. The craniofacial most affected regions were temporal (25.2%) and occipital (19.8%). The most common sites of projectiles exit were the temporal (25.3%) and parietal (16.1%). All cases of suicide were related to contact shot (69.2%) or close-range shot (30.8%), and among the homicides the distant range shots were more frequent (54.0%). The shape of entrance wounds was mostly circular (56.8%) and oval (31.3%), and among the exit injuries, the lesions were irregular (43.3%) and starry (24.1%). The entrance wounds showed smaller sizes than the exit lesions (p < 0.0001). The data obtained are useful for guiding research that takes into account craniofacial trauma caused by firearm projectiles, makes it possible to compare this data with those of other countries and can base investigative conclusions based on the analyzes discussed in the present work.


Asunto(s)
Traumatismos Faciales/mortalidad , Traumatismos Penetrantes de la Cabeza/mortalidad , Heridas por Arma de Fuego/mortalidad , Accidentes/mortalidad , Adolescente , Adulto , Distribución por Edad , Brasil/epidemiología , Niño , Grupos de Población Continentales/estadística & datos numéricos , Víctimas de Crimen/estadística & datos numéricos , Femenino , Homicidio/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Distribución por Sexo , Suicidio Completo/estadística & datos numéricos , Adulto Joven
5.
J Forensic Leg Med ; 69: 101889, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32056806

RESUMEN

Studies on firearm fatalities in some parts of Ghana have been reported. However, the incidence and pattern of firearm fatalities in the Northern sector of Ghana have fled the spotlight. This study aimed at reporting the incidence and pattern of gunshot fatalities autopsied within 2008 and 2013 year. There were 82(91.1%) male and 8(8.9%) female victims of gunshot deaths during the study period with an average of 15 cases annually. Where 60(66.7%) of the victims aged within 21-40; years resembling the pattern observed in several parts of the world. A significant number 28(31.1%) of the victims died of multiple shots or dispersed pellets affecting several parts of the body, followed by a single shot to the chest 18(20.0%), abdomen 17(18.9%), head 14(15.6%). Collectively, entry sites like the neck and upper limb among others accounted for 13(14.4%). Robbery accounted for 44(48.9%) followed by homicides 14(15.6%) cases. Recovered pellets, nature and legal status of firearm involved were also examined, and like in several developing countries, country-made guns played a substantial role in the firearm fatalities with calls to strengthen laws governing gun acquisition and use in the country.


Asunto(s)
Heridas por Arma de Fuego/mortalidad , Accidentes/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Niño , Crimen/estadística & datos numéricos , Víctimas de Crimen/estadística & datos numéricos , Femenino , Ghana/epidemiología , Homicidio/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Distribución por Sexo , Adulto Joven
6.
Medicine (Baltimore) ; 99(8): e19343, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080155

RESUMEN

RATIONALE: Foreign body (FB) ingestion is a relatively common clinical situation in the emergency department. However, multiple sharply pointed foreign bodies located in different organs are rare conditions and no definite treatment guidelines has been established. PATIENT CONCERNS: A 31-year-old amateur magician visited the outpatient clinic with a chief complaint of epigastric discomfort. He might have accidentally swallowed some needles while practicing a magic trick 2 days before. DIAGNOSIS: Imaging tests revealed 1 needle was stuck in the left liver lobe through the stomach wall, 1 was in the third portion of the duodenum, 3 were in the ascending colon, and 2 were in the transverse colon. INTERVENTIONS: A needle in the duodenum and 5 in the colon were removed by endoscopy. The needle stuck in the liver from the stomach was not visible inside the stomach and was successfully removed by laparoscopy a few days later. OUTCOMES: The patient was able to tolerate an oral diet and was discharged on postoperative day 4 without any complications. LESSONS: Developing a treatment plan in cases of multiple sharp FB may be difficult. A multidisciplinary team of endoscopists and surgeons is needed to determine the best possible treatment plan. This experience illustrates the importance of the planning of the sequence and method of removal of multiple foreign bodies from the gastrointestinal tract.


Asunto(s)
Endoscopía del Sistema Digestivo , Cuerpos Extraños/cirugía , Laparoscopía , Agujas , Accidentes , Adulto , Colon/diagnóstico por imagen , Colon/cirugía , Duodeno/diagnóstico por imagen , Duodeno/cirugía , Humanos , Hígado/diagnóstico por imagen , Hígado/cirugía , Magia , Masculino , Radiografía , Estómago/diagnóstico por imagen , Estómago/cirugía
7.
Med Oral Patol Oral Cir Bucal ; 25(3): e353-e358, 2020 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-32040466

RESUMEN

BACKGROUND: Intubation is necessary during critical situations to reduce the risk of death. In Brazil, a need exists to determine the prevalence of tooth avulsions in emergency and urgent care. The objective of this study was to identify the causes of orotracheal intubation (OTI), the number of tooth avulsions, and the avulsed teeth that result from urgent and emergency intubation. MATERIAL AND METHODS: The sample consisted of 116 patients (total group) in intensive care units (ICUs) distributed across Group 1 (G1), which was composed of 71 patients from an urgent-care hospital, and Group 2 (G2), which was composed of 45 patients from an emergency hospital. Clinical examinations showed dental alveolus with signs of recent exodontia in the upper and lower anterior regions. Sociodemographic data and the reason for intubation were evaluated. The Shapiro-Wilk normality test, chi-square test, Fisher's exact test, Mann-Whitney U test, and univariate logistic regression were performed with a significance level of 5%. RESULTS: The avulsion prevalence was 4.3%, with more cases receiving emergency intubation (n=4). All avulsions occurred in adults, and a significant difference (p=0.011) was observed with regard to the elderly. A 1-year reduction in age increased the chance of tooth avulsion during intubation by 1.09 times; being female increased the chance by 2.88 times. CONCLUSION: Pulmonary problems were the major causes of intubation, with the highest tooth avulsion prevalence observed during emergency intubation. The avulsed teeth were 11, 12, 13, 22, 32, and 33 across all cases.


Asunto(s)
Avulsión de Diente , Accidentes , Adulto , Anciano , Brasil , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Intubación Intratraqueal , Encuestas y Cuestionarios , Reimplante Dental
8.
Environ Sci Pollut Res Int ; 27(8): 8535-8547, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31907815

RESUMEN

The working conditions of underground mining are complex and variable, and roof fall and rib spalling are one of the main types of accidents that can occur. Building an integrated model to evaluate the risk of roof fall and rib spalling is the foundation of mine safety. On the basis of the inherent attributes of event risk, the fuzzy evaluation set and probability of basic events are obtained by using the fuzzy fault tree analysis method based on the sample's fuzzy information. Subsequently, the likelihood of roof fall and rib spalling is determined. Consequence severity data are obtained by using the dynamic fuzzy logic method, and the consequence severity grade of roof fall and rib spalling is evaluated via the dynamic fuzzy comprehensive evaluation method. The event risk level is determined by the risk matrix method. Roof fall and rib spalling in a non-coal mine is analyzed and evaluated by using fuzzy fault tree analysis and dynamic fuzzy comprehensive evaluation. The weak links in the operation of an underground mine are identified by fuzzy fault tree analysis as "mining process, roof management, support and reinforcement." Then, the risk development trend is determined by the dynamic fuzzy comprehensive evaluation method. The risk matrix method is integrated to determine whether the risk level of the mine is "high risk, unacceptable" and expected to deteriorate in the future. The results show the validity and feasibility of the risk analysis and prediction model for roof fall and rib spalling.


Asunto(s)
Lógica Difusa , Minería , Accidentes/estadística & datos numéricos , Minería/métodos , Probabilidad
10.
Am J Forensic Med Pathol ; 41(1): 27-31, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31895098

RESUMEN

BACKGROUND: The incidence of taking selfies and sharing them on social media as well as selfie-related dangerous behaviors is increasing, particularly among young people, also leading to selfie-related trauma and death. This study was performed to obtain epidemiological characteristics of selfie-related mortality in Italy. METHODS: Scientific literature and Italian media were reviewed. RESULTS: Twelve victims from 11 events, from 2014 to 2018, were analyzed (sex, age, accident types, the nationality, the Italian region where the incident took place, if the person involved was indigenous or a tourist, the dynamics and the causa mortis, if other people have been involved in the selfie, and if other people were deceased). The majority of selfie victims were male teenagers, the average age was 23.6 years, the most preferred site of taking selfies was the natural environment followed by the railway one, the most frequently reported event or accident type was falling from a height, and the most frequent causes of selfie-related deaths were multitrauma and drowning. CONCLUSIONS: Selfie-related deaths in Italy appear to be an issue and appear to be increasing. Particularly, male teenagers and young adults are at high risk for selfie-related deaths. Measures should be taken to reduce their incidence.


Asunto(s)
Accidentes/mortalidad , Fotograbar , Medios de Comunicación Sociales , Adolescente , Adulto , Distribución por Edad , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Distribución por Sexo , Adulto Joven
12.
Medicine (Baltimore) ; 99(4): e18789, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31977870

RESUMEN

Clinical features of extremity fractures (EFs) in patients presenting with traumatic spinal fractures (TSFs) and spinal cord injury (SCI) have not been investigated. To investigate the clinical features and risk factors for EFs in patients presenting with TSFs and SCI.Data from 1392 patients presenting with TSFs and SCI in our hospitals between 2001 and 2010 were retrospectively reviewed, among which 165 patients (129 males and 36 females, 37.5 ±â€Š10.6 years old) presented with EFs. The clinical features of EFs have been investigated.The frequencies of upper limb fractures were significantly higher in the motor vehicle collisions (MVCs) group than in the high-fall group (P = .012) and the struck-by-object group (P = .002). The frequencies of lower limb fractures were significantly higher in the struck-by-object group (P = .019) and the high-fall group (P = .011) than the MVCs group. Univariate logistic regression analysis show that being in the 19 to 39 age group (P = .001), having a lumbar spinal fracture (P < .001) and experiencing a high fall (P < .001) were risk factors for EFs. Multivariate logistic regression analysis showed that we should focus on the factors that having a lumbar spinal fracture and experiencing a high fall.High fall and MVCs were the most common aetiologies for EFs. Having a lumbar spinal fracture and experiencing a high fall were significant risk factors for EFs. We should make early diagnoses and initiate timely treatment according to different patterns of extremity fractures in patients with TSFs and SCI.


Asunto(s)
Fracturas Óseas/epidemiología , Extremidad Inferior/lesiones , Fracturas de la Columna Vertebral/epidemiología , Extremidad Superior/lesiones , Accidentes/estadística & datos numéricos , Adulto , Factores de Edad , Femenino , Fracturas Óseas/etiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Fracturas de la Columna Vertebral/etiología
13.
Forensic Sci Int ; 306: 110050, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31790892

RESUMEN

In 1995, the historical shipwreck of La Belle was discovered off the coast of Texas. One partial human skeleton was recovered from alongside cargo in the rear portion of the ship; a second (complete) skeleton was found atop coiled anchor rope in the bow. In late 2015, comprehensive forensic genetic testing began on multiple samplings from each set of remains. For the partial skeleton recovered from the ship's rear cargo area, results were obtained for 26/27 Y-STRs using traditional CE; with MPS technology, results were obtained for 18/24 Y-STRs, 56/56 ancestry-informative SNPs (aiSNPs), 22/22 phenotype-informative SNPs (piSNPs), 22/27 autosomal STRs, 4/7 X-STRs, and 94/94 identity-informative SNPs (iiSNPs). For the complete skeleton of the second individual, results were obtained for 7/17 Y-STRs using traditional CE; with MPS technology, results were obtained for 5/24 Y-STRs, 49/56 aiSNPs, 18/22 piSNPs, 15/27 autosomal STRs, 1/7 X-STRs, and 66/94 iiSNPs. Biogeographic ancestry for each set of skeletal remains was predicted using the ancestry feature and metapopulation tool of the Y-STR Haplotype Reference Database (YHRD), Haplogroup Predictor, and the Forensic Research/Reference on Genetics knowledge base (FROG-kb). Phenotype prediction was performed using piSNP data and the HIrisplex eye color and hair color DNA phenotyping webtool. mtDNA whole genome sequencing also was performed successfully. This study highlights the sensitivity of current forensic laboratory methods in recovering DNA from historical and archaeological human remains. Using advanced sequencing technology provided by MiSeq™ FGx (Verogen) and Ion S5™ (Thermo Fisher Scientific) instrumentation, degraded skeletal remains can be characterized using a panel of diverse and highly informative markers, producing data which can be useful in both forensic and genealogical investigations.


Asunto(s)
Restos Mortales , Dermatoglifia del ADN , Genética Forense , Fenotipo , Navíos/historia , Accidentes/historia , Cromosomas Humanos Y , Grupos de Población Continentales/genética , ADN Mitocondrial/genética , Electroforesis Capilar , Francia , Haplotipos , Secuenciación de Nucleótidos de Alto Rendimiento , Historia del Siglo XVII , Humanos , Masculino , Repeticiones de Microsatélite , Reacción en Cadena de la Polimerasa , Polimorfismo de Nucleótido Simple , Análisis de Secuencia de ADN , Texas , Secuenciación Completa del Genoma
14.
Internist (Berl) ; 61(1): 91-95, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31673730

RESUMEN

This article reports the case of a 43-year-old woman who presented to the emergency room with headache and paresthesia after a fall on the head while skiing. She had clinical signs of volume depletion and blood test showed severe hyponatremia. Cerebral imaging was unremarkable. The diagnosis of cerebral salt-wasting syndrome (CSWS) was made, which is defined by the presence of extracellular volume depletion due to a tubular defect in renal sodium transport in patients with normal adrenal and thyroid function. The disease is mostly secondary to a neurological disease or head trauma. The patient rapidly improved after volume therapy and treatment with mineralocorticoids. The differentiation of CSWS from the syndrome of inappropriate antidiuretic hormone (SIADH) secretion can be challenging but the distinction is important because treatment options are very different.


Asunto(s)
Traumatismos Craneocerebrales/complicaciones , Hiponatremia/etiología , Síndrome de Secreción Inadecuada de ADH/diagnóstico , Esquí/lesiones , Accidentes , Adulto , Femenino , Humanos
16.
Forensic Sci Int ; 307: 110101, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31865266

RESUMEN

Flualprazolam is a novel designer benzodiazepine, structurally related to alprazolam, flubromazolam and triazolam. In the last couple of years, it has been frequently detected in seizures and in forensic cases in Sweden and Finland. However, there is a lack of published blood concentrations for the drug, which presents difficulties when assessing its relevance for the cause of death. A quantitative method for the determination of flualprazolam in post-mortem blood was developed and validated, and subsequently used to analyse samples from 33 deaths previously screened as testing positive for flualprazolam in Sweden and Finland. Most of the cases in the study were accidental deaths (61 %) or suicides (18 %). The median (range) flualprazolam concentration was 18.0 (3.0-68) ng/g. The majority of the deceased were male (82 %) and the median age was 30 years. The median age in the Swedish cases was significantly higher (35 years) than in the Finnish cases (23 years) (p< 0.05). Poly-drug use and particularly the concomitant use of flualprazolam and opioids were very common in the study population. Most of the cases that were positive for flualprazolam were fatal poisonings by a drug (N=23), and in 13 cases, flualprazolam was implicated in the cause of death. Combining the resources of two countries in which all post-mortem toxicology is centralised provided a more comprehensive insight into the toxicology of flualprazolam. Research on novel psychoactive substances, such as flualprazolam, is required in order to be able to provide scientific evidence on the risks of these new substances for drug administration and potential users.


Asunto(s)
Benzodiazepinas/sangre , Drogas de Diseño/análisis , Psicotrópicos/sangre , Triazolam/sangre , Accidentes/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Benzodiazepinas/envenenamiento , Drogas de Diseño/química , Drogas de Diseño/envenenamiento , Femenino , Finlandia/epidemiología , Toxicología Forense , Cromatografía de Gases y Espectrometría de Masas , Humanos , Masculino , Persona de Mediana Edad , Estructura Molecular , Psicotrópicos/química , Psicotrópicos/envenenamiento , Distribución por Sexo , Trastornos Relacionados con Sustancias/mortalidad , Suicidio/estadística & datos numéricos , Suecia/epidemiología , Triazolam/envenenamiento , Adulto Joven
18.
J Environ Manage ; 253: 109748, 2020 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-31678687

RESUMEN

On November 2015, the Fundão Tailings Dam, located at Mariana municipality in Brazil, failed. Besides the deaths and injuries, economic losses, pollution and health problems associated to heavy metals in the water, Brazilian municipalities near the accident experienced an increase in the incidence of dengue. Since dengue fever is an insect-borne disease and the mosquito develops where there is stored water, there must be a relationship between the dam accident and the incidence of the disease. The purpose of this study is to test whether there is a causal relationship between the dam accident in Mariana and the number of dengue cases, number of hospitalizations due to dengue, and dengue outbreak in the municipalities affected by the accident. We find evidence that the accident had a positive and statistically significant impact on dengue indicators (for example, the probability of a dengue outbreak increased in 19%), what makes us call attention to another negative externality of tailings dam accidents.


Asunto(s)
Dengue , Accidentes , Animales , Brasil , Ciudades , Incidencia
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