Increase in trauma volume as compared to emergency department volume during the COVID-19 pandemic.

BACKGROUND: During the months between April through June 2020 when we experienced the largest number of COVID-19 patients in our hospital, the volume of patients in the Emergency Department (ED) was decreased by more than 30%. In contrast to most early reports we did not notice a decrease in trauma volume during this time period. MATERIALS AND METHODS: We compared trauma patients presenting to our Level III Trauma Center, between April 2019 through June 2019 to those presenting from April 2020 through June 2020, the initial surge in COVID-19 patients. We compared ground level falls (GLF), motor vehicle crashes (MVC), bicycle and skateboard crashes, assault, and other. RESULTS: There was a 13% increase in trauma patients presenting during the study period in 2020 as compared to 2019, and the total number of trauma patients as a percentage of total ED patients also increased 269/9235 (2.9%) to 308/6216 (5.0%), P < 0.0001. There was no significant difference in demographics or outcome data between the trauma patients presenting during the two time periods. Although traffic decreased by more than 40%, the number of MVC's was similar. CONCLUSION: The volume of patients presenting to our Trauma Center as compared to the total ED volume increased during the time period from April through June 2020 versus the year just prior to the COVID-19 pandemic. Despite the fact that the total traffic volume decreased more than 40 percent between these two time periods, the actual number of motor vehicle crashes remained similar.

A 22-year history of treating intentional falls from the Golden Gate Bridge at Marin Health Medical Center.

Background: The historical mortality rate after falling from the Golden Gate Bridge has been approximately 98%. We report on 14 recent survivors treated at Marin Health Medical Center. Methods: We retrospectively reviewed the 22-year experience of treating patients after Golden Gate Bridge falls. Patients with signs of life when recovered by the Coast Guard were included. Results: Marin General Hospital treated 26 patients with an average age of 28.2 years. The mortality rate was 46.2% with an increased survival over the past decade compared to the first 12 years, 61% vs 37%, P = not significant. The average injury severity score was 29.3 and was significantly lower over the past decade (43.9 vs 22.8, P = .004). The leading injuries were hemothorax/pneumothorax (73%), spine fractures (65%), lung contusions (50%), rib fractures (50%), and solid organ injury (46%). Patients with major cardiovascular injuries were significantly more likely to expire, 88% vs 28%, P = .009. Conclusion: The pattern of injury leading to death after an intentional fall from the Golden Gate Bridge has not changed significantly over the decades.

Helmet Usage Reduces Serious Head Injury Without Decreasing Concussion After Bicycle Riders Crash.

BACKGROUND: The importance of bicycle helmets in reducing injuries is unclear. Our center receives a disproportionate number of bicycle crash victims. We sought to evaluate the types of injuries observed and the role of helmets in reducing head injuries. MATERIALS AND METHODS: We evaluated demographic data and compared injuries between bicycle riders that crashed with and without helmets over a 9-year period. Categorical variables were compared using linear regression methods and nominal variables using ANOVA. Differences were considered significant for P ≤ 0.05. RESULTS: There were 906 patients evaluated, 701 with helmets (77%) and 205 (23%) without helmets. The mean Injury Severity Score was 9.3 ± 6.4. The most common injuries were concussion (n = 385), rib fractures (n = 154), clavicle fractures (n = 139), facial fractures (n = 102), and cervical spine fractures (n = 89). There was no significant difference in the number of patients with a concussion in riders with or without helmets, [299/701, 42.6% versus 86/205, 42.0%, respectively, (P = NS)]. In helmet versus no helmet riders, there were significantly fewer patients with facial fractures, [67/701, 9.5%, versus 35/205, 17.0%, respectively, (P = 0.003)], skull fractures [8/701, 1.1% versus 9/205, 4.4%, respectively, (P = 0.003)], and serious head injuries [6/701, 0.85% versus 8/205, 3.9%, respectively, (P = 0.002)]. CONCLUSIONS: Helmeted patients involved in bicycle crashes are less likely to sustain a serious head injury, a skull fracture, or facial fractures compared to riders without helmets. The most common injury in patients with a bicycle crash is a concussion. Helmets did not prevent concussion after bicycle rider's crash in our patient population.

Large bladder diverticulum presenting as an inguinal hernia.

We present the case of a 76-year-old man with a large bladder diverticulum presenting as an inguinal hernia with small bowel incarceration. Bladder herniation is extremely rare and when clinically suspected, computed tomography can be an important adjunct to diagnosis.

American Ginseng inhibits induced COX-2 and NFKB activation in breast cancer cells.

BACKGROUND: Epidemiologic evidence suggests reduced breast cancer mortality in users of American Ginseng (AG) (Panax quinquefolium). We hypothesized that AG extract decreases proliferation of human breast cancer cells via an anti-inflammatory effect applicable to the prevention of breast and other cancers. MATERIAL AND METHODS: A defined lyophilized aqueous extract of AG (LEAG) was dissolved in DMSO 1mg/mL, and serially diluted in saline. The cell lines MDA MB 231 and MCF7 were stimulated with the phorbol ester PDBu and treated with 100-500 mcg/mL LEAG. Proliferation was measured by MDA assay. Induced COX-2 expression was assayed by ELISA. Activation of NFkappaB by phosphorylation of the p65 subunit was quantified by CASE (cellular activation of signaling ELISA). RESULTS: Both cell lines had reduced proliferation when treated with LEAG. PDBu stimulation of MDA MB 231 increased expression of the COX-2 protein 20-fold at 48 hours (P<0.005). COX-2 protein expression remained at baseline concentrations in PDBu- treated MDA MB 231 cells exposed to 100 mcg/mL LEAG. The CASE assay showed a 4-fold increase in p65 activation 24 hours after PDBu treatment in normal medium, while phosphorylated p65 dropped below baseline in the cells treated with PDBu plus LEAG. CONCLUSION: In MDA MB 231, COX-2 was inducible with PDBu. This induced COX-2 expression was blocked by 100 microgram/mL LEAG in a time course consistent with the decline in the activated p65 subunit of NFkappaB. These results provide an anti-inflammatory mechanism for a possible anti-cancer effect of American Ginseng.