Characteristics of skin injuries caused by power drill.

Skin injuries caused by power drills have been rarely reported. A case is described of a 51-year-old woman who was found dead on a motorway after committing suicide by jumping from a bridge. The body showed a total of nine circular/oval penetrating injuries of the chest and abdomen with very regular, smooth margins, and particular features due to the presence of "skin islands" inside the lesion and "short radial linear abrasions" around the margins. These injuries were caused by a power drill, which was later found in the woman's apartment. For comparison, experimental tests were carried out with the same drill and different bits on pig skin, whose appearance resembled those found on the body. Especially skin islands were also reproduced in the experimental tests. The presented case shows the possibility of this rare method of suicide (or suicide attempt) and the typical characteristics of such peculiar skin lesions that pose problems of differential diagnosis with other injuries such as gunshot injuries.

Evaluation of the Wheat Germ Oil Topical Formulations for Wound Healing Activity in Rats.

Wheat Germ Oil (WGO), the flour-milling by-product of wheat has essential constituents for skin health care as vitamin E, B-complex, squalene and unsaturated fatty acids. Incorporate WGO into polymers of the cream and ointment bases and evaluate the wound healing potential of these WGO formulations in the rat-animal model. <b>Materials and Methods:</b> WGO creams and ointments were prepared in two concentrations, 10 and 20% and evaluated for storage stability, homogeneity and compatibility using Fourier Transform Infrared (FT-IR) spectrometry. An amount of 0.5 g of the WGO formulations was applied daily to the injured area of the rats back. Wounds were observed for any clinical changes and healing compared to the control animal group. <b>Results:</b> The WGO was compatible with the cream and ointment bases and physically stables over 60 days of storage. The formulations of WGO have induced dose-dependent wound healing properties however the ointment formulations were demonstrating wound healing activity significantly better than the creams at all the intervals of the treatment. Within three weeks, 20% WGO ointment has induced a 90%reduction in the wound size diameter. Also, wounds recovered by 50% in 10 and 14 days of treatment with 20% WGO ointment and cream, respectively. <b>Conclusion:</b> The results revealed that WGO is a potential wound-healing agent from the scope that WGO is a common cosmetic ingredient and available at affordable prices.

Wound healing potential of licorice extract in rat model: Antioxidants, histopathological, immunohistochemical and gene expression evidences.

Wound healing is a public health concern. Licorice gained a great attention for its antioxidant and anti-inflammatory properties which expand its valuable effects as a herbal medicine. In this study, we pointed out to the wound healing potential and the mechanism by which licorice alcoholic extract can modulate cutaneous wound healing through immune, antioxidant, histopathological, immunohistochemical (IHC) and molecular studies. 24 Wister rats were assigned into 3 groups (n = 8 each); control group, topical and oral supplied groups. Licorice extract administration significantly increased total and differential leucocyte counts, phagocytic activity of neutrophils, antioxidant biomarkers as superoxide dismutase (SOD), glutathione peroxidase activities (GPx) and reduced glutathione (GSH) content with a notable reduction in oxidative stress marker malondialdehyde (MDA). Moreover, histopathological findings detected complete re-epithelialization with increasing collagen synthesis while IHC results revealed a significant enhancement in the expression of α-SMA, PDGFR-α, FGFR1 and Cytokeratin 14 in licorice treated groups compared with the control group. Licorice extract supplementation accelerated wound healing by increasing angiogenesis and collagen deposition through up-regulation of bFGF, VEGF and TGF-ß gene expression levels compared with the control group. UPLC-PDA-MS/MS aided to authenticate the studied Glycyrrihza species and recognized 101 potential constituents that may be responsible for licorice-exhibited potentials. Based on our observations we concluded that licorice enhanced cutaneous wound healing via its free radical-scavenging potential, potent antioxidant activities, and anti-inflammatory actions. Therefore, licorice could be used as a potential alternative therapy for wound injury which could overcome the associated limitations of modern therapeutic products.

The impact of infection complications after trauma differs according to trauma severity.

The impact of infection on the prognosis of trauma patients according to severity remains unclear. We assessed the impact of infection complications on in-hospital mortality among patients with trauma according to severity. This retrospective cohort study used a nationwide registry of trauma patients. Patients aged ≥ 18 years with blunt or penetrating trauma who were admitted to intensive care units or general wards between 2004 and 2017 were included. We compared the baseline characteristics and outcomes between patients with and without infection and conducted a multivariable logistic regression analysis to investigate the impact of infection on in-hospital mortality according to trauma severity, which was classified as mild [Injury Severity Score (ISS) < 15], moderate (ISS 15-29), or severe (ISS ≥ 30). Among the 150,948 patients in this study, 10,338 (6.8%) developed infections. Patients with infection had greater in-hospital mortality than patients without infection [1085 (10.5%) vs. 2898 (2.1%), p < 0.01]. After adjusting for clinical characteristics, in-hospital mortality differed between trauma patients with and without infection according to trauma severity [17.1% (95% CI 15.2-18.9%) vs. 2.9% (95% CI 2.7-3.1%), p < 0.01, in patients with mild trauma; 14.8% (95% CI 13.3-16.3%) vs. 8.4% (95% CI 7.9-8.8%), p < 0.01, in patients with moderate trauma; and 13.5% (95% CI 11.2-15.7%) vs. 13.7% (95% CI 12.4-14.9%), p = 0.86, in patients with severe trauma]. In conclusion, the effect of infection complications in patients with trauma on in-hospital mortality differs by trauma severity.

A pen as an intermediate target becomes a secondary projectile.

Firearm projectiles striking intermediate targets have the potential to create secondary projectiles, which can produce identifiable patterns of injury. We present a case in which a father, manipulating a handgun, was demonstrating how the firing pin worked to his adolescent son. He placed a pen inside the barrel of the gun for demonstration but did not recognize that a bullet was loaded into the firing chamber. The weapon was discharged causing fatal injury to the son. The pen, as an intermediate target, created identifiable injuries on the decedent, which were consistent with typical patterns of injury seen with secondary projectiles including a discrepant number of skin defects to number of counted projectiles and pseudo-stippling. Recognition of these identifiable patterns of injury in intermediate target involved gunshot wound cases can help support other autopsy findings and scene investigation.

Factors Associated with Serious Injuries among Adolescents in Ghana: Findings from 2012 Global School Health Survey.

INTRODUCTION: Injuries are of public health concern and the leading cause of residual disability and death among teenagers, especially in low- and middle-income countries (LMICs). In Ghana, the burden of injury among adolescents is under-reported. Hence, the study sought to determine the prevalence of serious injuries (SI) and the potential factors influencing these injuries among school children in Ghana. METHODS: This study was conducted in Ghana among Junior High School (JHS) and senior high school students (SHS) using the 2012 Global School-Based Student Health Survey (GSHS) data. The GSHS employed two-stage cluster sampling method. Serious injuries (SI) and independent factors were measured via self-administered questionnaires. Pearson chi-square test between each explanatory variable and serious injuries was conducted and the level of statistical significance was set at 5%. The significant variables from the chi-square test were selected for multiple logistic regression analysis. Multiple logistic regression was performed to estimate the adjusted odds ratio (AOR) at 95% confidence interval (CI). RESULTS: The prevalence of SI in the past 12 months was 66% [CI=61.8-70.2] . The most common cause of SI was fall, 36%. The common types of injuries were cut/stab wounds and broken/dislocated bone. In the multiple logistic regression analysis, after controlling for other variables, educational level (AOR = 0.64, CI = 0.44-0.90, p < 0.015), suicidal ideation (AOR = 1.58, CI = 1.00-2.48, p < 0.002), suicidal attempt (AOR = 1.88, CI = 1.29-2.72, p < 0.001), having at least one close friend (AOR = 1.49, CI = 1.17-1.89, p < 0.002), school truancy (AOR = 1.66, CI = 1.31-2.09, p < 0.000), smoking marijuana (AOR = 2.64, CI = 1.22-5.69), and amphetamine use (AOR = 2.95, CI = 1.46-5.69) were independently associated with SI. CONCLUSION: The findings of the study established a high prevalence of SI among adolescents in Ghana, with cut/stab wound and broken/dislocated bone being the most reported type of injuries. This study also revealed that factors such as educational level, suicidal ideation, suicidal attempt, at least one close friend, school truancy, smoking marijuana, and amphetamine use are associated with SI among the adolescents. Therefore, pragmatic interventional programs should be targeted at these factors to curb the rate of SI among junior and senior school students.

A multicenter trial of current trends in the diagnosis and management of high-grade pancreatic injuries.

BACKGROUND: Outcomes following pancreatic trauma have not improved significantly over the past two decades. A 2013 Western Trauma Association algorithm highlighted emerging data that might improve the diagnosis and management of high-grade pancreatic injuries (HGPIs; grades III-V). We hypothesized that the use of magnetic resonance cholangiopancreatography, pancreatic duct stenting, operative drainage versus resection, and nonoperative management of HGPIs increased over time. METHODS: Multicenter retrospective review of diagnosis, management, and outcomes of adult pancreatic injuries from 2010 to 2018 was performed. Data were analyzed by grade and time period (PRE, 2010-2013; POST, 2014-2018) using various statistical tests where appropriate. RESULTS: Thirty-two centers reported data on 515 HGPI patients. A total of 270 (53%) had penetrating trauma, and 58% went directly to the operating room without imaging. Eighty-nine (17%) died within 24 hours. Management and outcomes of 426 24-hour survivors were evaluated. Agreement between computed tomography and operating room grading was 38%. Magnetic resonance cholangiopancreatography use doubled in grade IV/V injuries over time but was still low.Overall HGPI treatment and outcomes did not change over time. Resection was performed in 78% of grade III injuries and remained stable over time, while resection of grade IV/V injuries trended downward (56% to 39%, p = 0.11). Pancreas-related complications (PRCs) occurred more frequently in grade IV/V injuries managed with drainage versus resection (61% vs. 32%, p = 0.0051), but there was no difference in PRCs for grade III injuries between resection and drainage.Pancreatectomy closure had no impact on PRCs. Pancreatic duct stenting increased over time in grade IV/V injuries, with 76% used to treat PRCs. CONCLUSION: Intraoperative and computed tomography grading are different in the majority of HGPI cases. Resection is still used for most patients with grade III injuries; however, drainage may be a noninferior alternative. Drainage trended upward for grade IV/V injuries, but the higher rate of PRCs calls for caution in this practice. LEVEL OF EVIDENCE: Retrospective diagnostic/therapeutic study, level III.

Glass table tops: An unusual source of lethal domestic injury.

A 42-year-old woman who fell through a glass tabletop had her lower back pierced by a long shard of glass. She rapidly exsanguinated. At autopsy, a single penetrating wound was present in her left lower back, with complete transection of her left kidney and a 3.5 L haematoperitoneum. Death was due to exsanguination following accidental transection of the left kidney by a penetrating glass injury of the lower back. Glass-topped tables are a well-recognised source of injury in a domestic setting There are far more non-lethal than lethal injuries, many of which involve children. Quite long shards may remain undetected in wounds for considerable amounts of time. Non-tempered glass is a particular risk for breakage. Glass-topped tables should not be used as substitutes for chairs, particularly in overweight or obese individuals.

Electrospun PLGA/SF/artemisinin composite nanofibrous membranes for wound dressing.

Combining biodegradable materials with natural plant components for wound dressing has been receiving significant attention. ART is a sesquiterpene lactone compound extracted from Artemisia annua L., possessing multiple pharmacological effects including antibacterial activity and anti-inflammatory property. Herein, the blended polylactic acid glycolic acid (PLGA)/silk fibroin (SF) membranes loaded with artemisinin (ART) are fabricated through electrospinning. With aid of SF, the fabricated membranes have a good sustained-release effect, and the accumulated ART release can reach 69% after three weeks. PLGA/SF/ART membranes exhibit favorable anti-inflammatory and cell compatibility in vitro evaluations. The in vivo experiment indicates that PLGA/SF/ART2 membranes can shorten the inflammation period and enhance skin regeneration in a full-thickness wound model through down-regulating the expressions of pro-inflammatory cytokines IL-1ß and TNF-α. To sum up, the fabricated PLGA/SF/ART2 composite membranes with anti-inflammatory properties can be a proposal wound dressing for chronic wound healing.

In-vivo wound healing activity of a novel composite sponge loaded with mucilage and lipoidal matter of Hibiscus species.

Many researches have been undergone to hasten the natural wound healing process. In this study, several Hibiscus species (leaves) were extracted with petroleum ether, methanol, and their mucilage was separated. All the tested species extracts were assessed for their viability percentage using the water-soluble tetrazolium. H.syriacus was the plant of choice to be incorporated in a new drug delivery system and evaluated for its wound healing activity. H.syriacus petroleum ether extract (PEE) showed a high percentage of palmitic and oleic acids while its mucilage demonstrated high glucosamine and galacturonic acid. It was selected to be formulated and pharmaceutically evaluated into three different composite sponges using chitosan in various ratios. Fourier-transformed infrared spectroscopy investigated the chemical interaction between the utilized sponges' ingredients. Morphological characteristics were evaluated using scanning electron microscopy. H.syriacus composite sponge of mucilage: chitosan (1:5) was loaded with three different concentrations of PEE. Medicated formulations were assessed in rat model of excision wound model. The wound healing ability was clearly proved by the clinical acceleration, histopathological examination, and modulation of correlated inflammatory parameters as tumor necrosis factor in addition to vascular endothelial growth factor suggesting a promising valuable candidate that supports the management of excision wounds using single-dose preparation.

Bull horn injuries. A 40-year retrospective study with 572 patients.

BACKGROUND: Although bullfighting festivals were traditionally attributed to the cultural idiosyncrasies of the Ibero-American people, they also exist world-wide. METHODS: A retrospective study was conducted, reviewing the medical records of patients treated on our service for bull horn injuries between January 1978 and December 2019. RESULTS: There were 572 admissions due to bull horn injuries. 54 of these patients had multiple injuries. The average annual admission was 13.6 patients. The most frequent injuries were located in the lower extremities, perineum, and abdomen. Forty-seven laparotomies were performed, revealing intra-abdominal visceral impairment on 39 occasions. The most frequently injured organs were the intestine and liver. The most frequent complications were skin devitalisation, infection and post-operative eventration. The recorded mortality was 0.87%. CONCLUSION: We wish to highlight the importance of injuries caused by bull horns worldwide. These are high-impact injuries with specific intrinsic characteristics that require regulated medical and surgical care.

Through fire and flames: post-burning survival and detection of dismemberment-related toolmarks in cremated cadavers.

During a homicide investigation in which fire has been used to reduce the size of the cadaver and conceal the evidence of injuries, the identification of perimortem trauma presents a challenge, in particular in cases when the perpetrator has dismembered the body followed by burning the remains. It is therefore important to understand the effects which heat causes on fresh bone. The aim of this paper is to perform a pilot study on the survival ratio of toolmarks in different anatomical regions associated with dismemberment, and a descriptive analysis of the variables that may potentially influence the post-burning survival and detection. To achieve this, three donated embalmed cadavers were used to simulate a case in which an attempted dismemberment and burning had occurred. Fifty-five pre-burning injuries were manually induced: 30 using a machete to inflict chopping trauma, and 25 with a serrated bread knife to inflict sharp force trauma, on the thigh, knee, ankle and wrist. The cadavers were cremated in a furnace at Madrid's Cementerio Sur and the burnt remains were analysed at the Laboratorio de Antropología y Odontología Forense of the Universidad Complutense de Madrid. Not all pre-burning injuries inflicted were visible after the cremation process; only 13% were detected in this experiment. Toolmarks can be masked, modified, destroyed or overlooked from the outset of the procedure due to several factors which influence the post-burning survival and detection of toolmarks and contribute to conceal the evidence of trauma. Additional research should be done to study further variables which affect the post-burning visibility of sharp force trauma.

Advantages in Wound Healing Process in Female Mice Require Upregulation A2A-Mediated Angiogenesis under the Stimulation of 17ß-Estradiol.

Estrogenic steroids and adenosine A2A receptors promote the wound healing and angiogenesis processes. However, so far, it is unclear whether estrogen may regulate the expression and pro-angiogenic activity of A2A receptors. Using in vivo analyses, we showed that female wild type (WT) mice have a more rapid wound healing process than female or male A2A-deficient mice (A2AKO) mice. We also found that pulmonary endothelial cells (mPEC) isolated from female WT mice showed higher expression of A2A receptor than mPEC from male WT mice. mPEC from female WT mice were more sensitive to A2A-mediated pro-angiogenic response, suggesting an ER and A2A crosstalk, which was confirmed using cells isolated from A2AKO. In those female cells, 17ß-estradiol potentiated A2A-mediated cell proliferation, an effect that was inhibited by selective antagonists of estrogen receptors (ER), ERα, and ERß. Therefore, estrogen regulates the expression and/or pro-angiogenic activity of A2A adenosine receptors, likely involving activation of ERα and ERß receptors. Sexual dimorphism in wound healing observed in the A2AKO mice process reinforces the functional crosstalk between ER and A2A receptors.

Drupin, a cysteine protease from Ficus drupacea latex accelerates excision wound healing in mice.

Wound healing is a tightly regulated physiological process that restores tissue integrity after injury. Plant latex proteases (PLPs) are considered an integral part in herbal wound care as it interferes at different phases of the wound healing process. Although many studies have reported the involvement of PLPs in healing process, an in-depth investigation is required to understand the molecular mechanism. Hence, the effect of PLPs with fibrinolytic activity on wound healing was investigated systematically using mouse excision wound model. Among 29 latices from Ficus genus tested, Ficus drupacea exhibited potent fibrinolytic activity. Cysteine protease responsible for fibrinolysis was purified from the F. drupacea latex named it as drupin, tested for its wound healing efficacy. The accelerated wound healing was mediated by downregulation of matrix metalloprotease (MMP)-9 without altering MMP-8 expression. Besides, drupin enhanced the rate of collagen synthesis at the wound site by increasing arginase 1 activity. And also, drupin increased the expression of arginase 1 in macrophages and involved in cell proliferation, and migration via MAP kinase and PI3K/Akt pathways. Overall, the present study highlights the interference of drupin in wound healing by increased arginase 1 activity and collagen synthesis, and cell proliferation and migration.

A Brief Review of Scanning Electron Microscopy With Energy-Dispersive X-ray Use in Forensic Medicine.

Scanning electron microscopy with energy-dispersive x-ray (SEM/EDX) analysis is an investigation whose potential has become increasingly important in the field of forensic research and diagnosis. We present the procedure to perform a well-carried-out SEM/EDX analysis on corpses affected by different types of injuries, such as blunt force trauma, ligature strangulation, electrocution, sharp force trauma, gunshot wounds, and intoxication. After the areas of forensic interest have been macroscopically identified, the sampling can be performed in 2 different ways: apposition of the double-sided graphite tape on the damaged area or performing the excision of a biological sample. In both cases, a proper negative control sample is required. In all cases, SEM/EDX analysis can detect exogenous microtraces consistent with the types of injuries involved. In blunt force trauma, microparticles of different nature deriving from the contact of the blunt instrument with the victim may be observed; in sharp force trauma, metal microtraces (Fe, Cr, Al, Ti) can be identified. In ligature strangulation, exogenous microtraces may be found in the cutaneous furrow. In electrocution, it allows to identify the pathognomonic metal pattern (Cu, Zn, Fe) of the "electric mark." In gunshot wounds, the main applications regards the detection of metal particles (Pb, Ba, Sb) of gunshot residues. Finally, in the analysis of intoxicants, it may identify traces of toxic substances. Thus, the authors conclude that SEM/EDX analysis can provide essential information to assist in the medicolegal investigation of death.

A Case of Crossbow Homicide With Review of Crossbow Injuries and Manner of Death Considerations.

Crossbow fatalities are a rare occurrence, but crossbow use is on the rise. The manner of death in crossbow fatalities is overwhelmingly opined accident or suicide, not homicide. Despite their increasing use and reports of at least 14 crossbow-related homicides in the media for the last 5 years, crossbow homicides are rarely reported in the medical literature; only 10 articles that discussed 20 crossbow homicides were identified in the PubMed database. Here, we describe a case of a 20-year-old man who was found dead in his driveway after being shot in the abdomen with a crossbow by another person. The crossbow bolt had a mechanical 2-blade broadhead that transected the descending aorta and lodged in his vertebra. When completing a medicolegal death investigation and postmortem examination on suspected crossbow-related deaths, knowledge of crossbow components, its utility as a weapon, wound patterns, and how it can cause death are important. This case serves to build on the limited medical literature of crossbow homicides, educate forensic pathologists about the features of crossbow deaths, and highlight manner of death considerations.

Complex Tissue Regeneration in Mammals Is Associated With Reduced Inflammatory Cytokines and an Influx of T Cells.

While mammals tend to repair injuries, other adult vertebrates like salamanders and fish regenerate damaged tissue. One prominent hypothesis offered to explain an inability to regenerate complex tissue in mammals is a bias during healing toward strong adaptive immunity and inflammatory responses. Here we directly test this hypothesis by characterizing part of the immune response during regeneration in spiny mice (Acomys cahirinus and Acomys percivali) vs. fibrotic repair in Mus musculus. By directly quantifying cytokines during tissue healing, we found that fibrotic repair was associated with a greater release of pro-inflammatory cytokines (i.e., IL-6, CCL2, and CXCL1) during acute inflammation in the wound microenvironment. However, reducing inflammation via COX-2 inhibition was not sufficient to reduce fibrosis or induce a regenerative response, suggesting that inflammatory strength does not control how an injury heals. Although regeneration was associated with lower concentrations of many inflammatory markers, we measured a comparatively larger influx of T cells into regenerating ear tissue and detected a local increase in the T cell associated cytokines IL-12 and IL-17 during the proliferative phase of regeneration. Taken together, our data demonstrate that a strong adaptive immune response is not antagonistic to regeneration and that other mechanisms likely explain the distribution of regenerative ability in vertebrates.

An autopsy case: Unusual characteristics of stab wounds inflicted by a survival knife.

A woman was stabbed 10 times and killed. The suspect confessed that he had used a thick (0.7 cm), single-edged survival knife with a serrated spine. However, the bilateral ends of the stab wounds appeared sharp. To address this discrepancy, we used pig skin to examine whether the knife could have been used to make the thin stab wounds observed. The widths of the pig skin wounds were approximately half the width of the knife and the ends of some wounds appeared sharp, particularly when the knife was held at a right angle. It was concluded that the suspect could have killed the victim using the survival knife. Similar pig skin experiments could be useful for forensic pathologists to determine whether a weapon of interest might have been used to inflict certain injuries.

Fatal craniofacial circular-saw-related injury: a rare case of accidental death.

Fatal injuries caused by circular saws are rare and mainly self-inflicted. To the best of our knowledge this is the first recorded case of accidental death of a woman caused by an injury to the head region inflicted by a saw blade. The autopsy showed a 35 cm long wound, stretching from the right half of the jaw along the right side of the face and the right temporal region up to the parietal region. The cut went through the right hemisphere of the brain in the temporal and parietal lobe regions, damaging the sagittal sinus. Air embolism was considered to be the cause of death. Fatalities involving power tools, such as a circular saw, warrant a high degree of suspicion of criminal activity and require a comprehensive medicolegal investigation. Placing guards over the blade and around the driving system, i.e. the motor, belt, arbor, is of great importance for the prevention of potentially fatal injuries.

Current opinion in the assessment and management of ballistic trauma to the craniomaxillofacial region.

PURPOSE OF REVIEW: Ballistic trauma represents a small proportion of injuries to the craniomaxillofacial (CMF) region, even in societies where the availability of firearms is more prevalent. The aim of this article is to review current opinion in the assessment and management of ballistic injuries sequentially from primary survey to definitive reconstruction. RECENT FINDINGS: For mandibular fractures because of ballistic trauma, load-bearing fixation remains the mainstay in the treatment. The use of load sharing fixation is rarely advised, even if the fracture pattern radiologically appears to fulfil the traditional indications for its use. Clinicians must be aware of specific situations in early internal fixation is contraindicated, particularly in those unstable patients requiring short damage control surgical procedures, avulsive soft and hard tissue defects and those injuries at increased risk of infection. SUMMARY: Staged surgery for complex injuries is increasingly becoming accepted, by which injuries are temporarily stabilized by means of maxillary--mandibular fixation (MMF) or an external fixation. Patients are subsequently repeat CT-scanned, and definitive internal fixation performed a few days later. Increased access to virtual surgical planning (VSP) and three-dimensional plates has revolutionized fracture reconstruction.