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1.
N Z Med J ; 134(1531): 50-58, 2021 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-33767476

RESUMO

AIM: To assess the effects of the community lockdown phases on trauma-related admissions to Midland region hospitals over the period 15 February to 10 July 2020, and to compare volume variation with the same period in the previous three years. METHODS: A retrospective, descriptive study of prospectively collected data from the Midland Trauma Registry in New Zealand. RESULTS: There was a 36.7% (p<.00001) reduction in injury admissions during Alert Level 4 ('Lockdown') compared with the same period in 2017, 2018 and 2019. This was in the context of volume increases during the pre-lockdown period (17.8%, p<.00001) and a 'rebound' as restrictions eased. There was an increase in injuries occurring at home (28.3%, p<.00001) and on footpaths (37.9%, p=0.00076), while there was a decline in events on roads (33.0%, p=0.017), at schools (75.0%, p<.00001) and in sports areas (79.7%, p<.00001). Falls remained the dominant mechanism of injury in 2020, contributing 39.9% of all hospitalisations. CONCLUSIONS: The reduction in hospital admissions during alert levels 4 and 3 was short lived, with a rebound evident when restrictions eased. Hospital resources have been strained because this rebound coincided with a planned 'catch up' on healthcare that was delayed during the higher community restriction levels.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Controle de Doenças Transmissíveis/métodos , Hospitalização/estatística & dados numéricos , Quarentena/estatística & dados numéricos , Ferimentos e Lesões , Adulto , /prevenção & controle , Criança , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Nova Zelândia/epidemiologia , Estudos Retrospectivos , Índices de Gravidade do Trauma , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/terapia
2.
N Z Med J ; 134(1531): 14-21, 2021 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-33767473

RESUMO

AIM: To re-investigate prescribing behaviours for tranexamic acid (TXA) use in the early management of severe trauma, and to compare against the standards considered to be best practice and the same study conducted at this centre two years prior. METHODS: We undertook a retrospective analysis of trauma patients requiring massive transfusion protocol (MTP) activation across a 26-month period. Physical and electronic inpatient records and ambulance documentation were reviewed to determine dose and timing of TXA administration. RESULTS: During the period studied, 53 trauma patients requiring activation of the MTP were identified. Of those for whom TXA was indicated, 90.9% received at least an initial dose of TXA and 50.0% received both doses. In total, 16.7% of patients received a dose within one hour of injury, 73.8% between one and three hours and 9.52% outside three hours. CONCLUSIONS: Compared with the previous study, the utilisation of TXA is now more consistent with what is considered best practice. Delayed administration beyond the three-hour therapeutic window was less than the 26.3% figure previously reported, and comparable to that of major trauma centres internationally. Persistent issues include the under-utilisation of the second dose and the potential for much earlier use, as has been achieved at centres where pre-hospital administration is the norm.


Assuntos
Transfusão de Sangue , Padrões de Prática Médica , Ácido Tranexâmico/administração & dosagem , Ferimentos e Lesões/tratamento farmacológico , Ferimentos e Lesões/etiologia , Adulto , Antifibrinolíticos/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Centros de Traumatologia
3.
N Z Med J ; 134(1530): 21-29, 2021 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-33651774

RESUMO

AIM: E-scooters were introduced to New Zealand in 2018 as a means of city transport. Since their introduction, their use has resulted in high injury rates. No studies have directly compared e-scooters to other forms of transport. METHOD: The Auckland City Hospital trauma registry was retrospectively searched for patients admitted with an e-scooter injury. A comparison group of patients admitted with an injury secondary to cycling during the same period was collected. RESULTS: 178 patients were identified: 69 with e-scooter injuries and 109 with injuries sustained while cycling. The hospitalisation rate for e-scooter injuries was 326 hospitalisations per million hours. There was a significant difference found in blood ethanol levels (18.6 vs 6.4% positive, p-value=0.01), mechanism of injury (isolated falls: 87 vs 60.6%), time of injury (55.1 vs 40.4% between 5pm-8am) and protective gear use (worn in 10.1 vs 78.9%). No differences were found in injury severity, ICU admissions, length of stay or mortality. CONCLUSION: This study demonstrates a concerningly high e-scooter-related hospitalisation rate and suggests e-scooters are currently not as safe as cycling. Strategies to improve e-scooter safety are needed and could include zero tolerance for alcohol, mandatory protective gear, restricted operating times and changes in road laws.


Assuntos
Veículos Off-Road/estatística & dados numéricos , Jogos e Brinquedos/lesões , Ferimentos e Lesões/epidemiologia , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Feminino , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Sistema de Registros , Estudos Retrospectivos , Ferimentos e Lesões/etiologia , Adulto Jovem
4.
Injury ; 52(3): 395-401, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33627252

RESUMO

PURPOSE: The aim of this study was to evaluate changes in both mechanism and diagnoses of injuries presenting to the orthopaedic department during this lockdown period, as well as to observe any changes in operative case-mix during this time. METHODS: A study period of twelve weeks following the introduction of the nationwide "lockdown period", March 23rd - June 14th, 2020 was identified and compared to the same time period in 2019 as a "baseline period". A retrospective analysis of all emergency orthopaedic referrals and surgical procedures performed during these time frames was undertaken. All data was collected and screened using the 'eTrauma' management platform (Open Medical, UK). The study included data from a five NHS Foundation Trusts within North West London. A total of 6695 referrals were included for analysis. RESULTS: The total number of referrals received during the lockdown period fell by 35.3% (n=2631) compared to the same period in 2019 (n=4064). Falls remained proportionally the most common mechanism of injury across all age groups in both time periods. The proportion sports related injuries compared to the overall number of injuries fell significantly during the lockdown period (p<0.001), however, the proportion of pushbike related accidents increased significantly (p<0.001). The total number of operations performed during the lockdown period fell by 38.8% (n=1046) during lockdown (n=1732). The proportion of patients undergoing operative intervention for Neck of Femur (NOF) and ankle fractures remained similar during both study periods. A more non-operative approach was seen in the management of wrist fractures, with 41.4% of injuries undergoing an operation during the lockdown period compared to 58.6% at baseline (p<0.001). CONCLUSION: In conclusion, the nationwide lockdown has led to a decrease in emergency orthopaedic referrals and procedure numbers. There has been a change in mechanism of injuries, with fewer sporting injuries, conversely, there has been an increase in the number of pushbike or scooter related injuries during the lockdown period. NOF fractures remained at similar levels to the previous year. There was a change in strategy for managing distal radius fractures with more fractures being treated non-operatively.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/tendências , Ciclismo/lesões , Procedimentos Ortopédicos/tendências , Encaminhamento e Consulta/tendências , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Idoso , Traumatismos do Braço/epidemiologia , Traumatismos do Braço/etiologia , Traumatismos do Braço/terapia , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/terapia , Criança , Pré-Escolar , Grupos Diagnósticos Relacionados , Feminino , Fraturas do Colo Femoral/epidemiologia , Fraturas do Colo Femoral/cirurgia , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Fraturas Ósseas/terapia , Fraturas Expostas/epidemiologia , Fraturas Expostas/etiologia , Fraturas Expostas/terapia , Humanos , Lactente , Recém-Nascido , Traumatismos da Perna/epidemiologia , Traumatismos da Perna/etiologia , Traumatismos da Perna/terapia , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Centros de Traumatologia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/terapia , Traumatismos do Punho/epidemiologia , Traumatismos do Punho/etiologia , Traumatismos do Punho/terapia , Adulto Jovem
5.
Artigo em Inglês | MEDLINE | ID: mdl-33573157

RESUMO

The purpose of this study was to identify the risk factors of serious fall-related injuries by analyzing the differences between two fall groups: one with serious fall-related injuries and one without such injuries. Applying a retrospective, descriptive investigation study design, we analyzed the degree of fall-related injury and the risk factors related to serious falls by conducting a complete survey of the medical records of fall patients reported throughout one full year, 2017, at a tertiary hospital in Seoul, Korea. Among the patients with reported falls, 188 sustained no injury (63.1%), 72 sustained minor injury (24.2%), and 38 patients sustained serious injury (12.8%). The serious fall-related injuries included eight lacerations requiring suture (2.7%), 23 fractures (7.7%), five brain injuries (1.7%), and two deaths (0.7%). Analysis results indicated that taking anticoagulants/antiplatelet drugs (p = 0.016) and having a fall history (p = 0.038) were statistically significant in the differences between the group with serious injury related to falls and the group without serious injury. Logistic regression revealed that taking anticoagulant/antiplatelet drugs was the factor most significantly correlated with serious injuries related to falls (OR = 2.299, p = 0.022). Results show that it is necessary to develop a patient-tailored fall prevention activity program.


Assuntos
Acidentes por Quedas , Ferimentos e Lesões , Adulto , Estudos Transversais , Humanos , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Seul , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia
6.
Mil Med Res ; 8(1): 12, 2021 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-33597038

RESUMO

Microwave radiation has been widely used in various fields, such as communication, industry, medical treatment, and military applications. Microwave radiation may cause injuries to both the structures and functions of various organs, such as the brain, heart, reproductive organs, and endocrine organs, which endanger human health. Therefore, it is both theoretically and clinically important to conduct studies on the biological effects induced by microwave radiation. The successful establishment of injury models is of great importance to the reliability and reproducibility of these studies. In this article, we review the microwave exposure conditions, subjects used to establish injury models, the methods used for the assessment of the injuries, and the indicators implemented to evaluate the success of injury model establishment in studies on biological effects induced by microwave radiation.


Assuntos
Micro-Ondas/efeitos adversos , Lesões por Radiação/complicações , Ferimentos e Lesões/etiologia , Animais , Modelos Animais de Doenças , Haplorrinos , Humanos , Camundongos , Coelhos , Ratos , Ferimentos e Lesões/fisiopatologia , Ferimentos e Lesões/veterinária
7.
Medicine (Baltimore) ; 100(6): e24642, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578587

RESUMO

ABSTRACT: Personal mobility devices (PMDs) have emerged as new factors in motor vehicle accidents, and related injuries are increasing. We aimed to describe the characteristics of PMD-related injuries presented to emergency departments (EDs) through a cross-sectional study for 7 years.This study is a multicenter cross-sectional study using the Emergency Department-based Injury In-Depth Surveillance database in South Korea. We identified all PMD-related injuries from 2011 to 2017 based on text searching. We categorized them into 3 groups based on their distinguishable characteristics: electric standing scooter (E-scooter), electric self-balancing wheel (E-wheel), and electronic board (E-board).A total of 448 PMD-related injuries were observed during the observation period. E-scooter-, E-wheel-, and E-board-related injuries occurred in 284, 138, and 26 cases, respectively. Most patients were between the ages of 19 and 59 years (69.2%), men (66.3%), and injured because of leisure activity (61.2%). The mechanism of injury was mostly traffic accidents (75.2%), but regarding injuries involving E-wheel and E-board, 25.4% and 30.8% of patients slipped from the device. The most commonly injured body part was the head, which accounted for 58.1% of E-scooter injuries, 38.4% of E-wheel injuries, and 53.9% of E-board injuries. Only 6 of all patients wore a helmet at the time of accident.PMD users and PMD-sharing programs are increasing, and more accidents are expected in the future. As PMDs are convenient to move and more people are willing to use them, proper riding and safety rules based on the type of PMD are needed to reduce the risk of injury. The results of this study can be used as basic data for developing safety policies.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Veículos Off-Road , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Fatores Etários , Criança , Estudos Transversais , Feminino , Dispositivos de Proteção da Cabeça , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Ferimentos e Lesões/etiologia , Adulto Jovem
8.
BMC Surg ; 21(1): 16, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407367

RESUMO

BACKGROUND: The treatment of hepatic injury can be complex. Medical clinical centers are often the first line hospitals for the diagnosis and treatment of hepatic trauma in China. The aim of the study is to summarize the experience in the diagnosis and treatment of hepatic trauma in one medical clinical center in China. METHODS: This retrospective study included patients with hepatic trauma admitted between January 2002 and December 2019 at the Xishan People's Hospital of Wuxi. The outcomes were cure rate and death within 14 days post-discharge. RESULTS: Among the 318 patients with hepatic trauma, 146 patients underwent surgical treatment, and 172 received conservative treatment; three patients were transferred to other hospitals for further treatment; 283 patients were cured, and 35 died. Severe hepatic trauma occurred in 74 patients, with a mortality rate of 31.1% and accounting for 65.7% of total mortality. American Association for the Surgery of Trauma (AAST) grading ≥ III (OR = 3.51, 95%CI: 1.32-9.37, P = 0.012) and multiple organ injury (OR = 7.51, 95%CI: 2.51-22.46, P < 0.001) were independently associated with death. Among patients with AAST grading ≥ III, surgery was an independent protective factor for death (OR = 0.08, 95%CI: 0.01-0.45, P = 0.004). Among patients with ASST ≥ III and who underwent surgery, age (OR = 5.29, 95%CI: 1.37-20.33, P = 0.015) and peri-hepatic packing (PHP) (OR = 5.54, 95%CI: 1.43-21.487, P = 0.013) were independently associated with death. CONCLUSIONS: AAST grading ≥ III and multiple organ injury were independently associated with death. Among patients with AAST grading ≥ III, surgery was an independent protective factor for death. Among patients with ASST ≥ III and who underwent surgery, age and PHP were independently associated with death.


Assuntos
Acidentes , Fígado , Ferimentos e Lesões , China , Estudos Transversais , Feminino , Hospitais , Humanos , Fígado/lesões , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Traumatologia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/terapia
11.
Chin J Traumatol ; 24(1): 1-4, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33323318

RESUMO

The year 2020 is an extremely unusual year. The world lost more than one million lives due to the attack of COVID-19. Economic production has been greatly reduced, and daily activities are largely restricted. Luckily the work of Chinese Journal of Traumatology (CJTEE) has not been adversely affected. 2020 is a harvest year for the journal, which (1) was included in the high-quality academic journals by China Association for Science and Technology; (2) cover of each issue is newly designed; (3) submission increased by about 60% with more countries and regions covered; (4) usage in the ScienceDirect database exceeded a million; (5) the CiteScore rises to more than 2.0 the first time. This study reviewed the articles published in the year 2020 by CJTEE.


Assuntos
Publicações Periódicas como Assunto , Ciência/organização & administração , Sociedades Científicas/organização & administração , Tecnologia/organização & administração , Traumatologia/organização & administração , Ferimentos e Lesões , China , Humanos , Fatores de Tempo , Ferimentos e Lesões/etiologia
12.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 13: 276-281, jan.-dez. 2021. ilus
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1150698

RESUMO

Objetivo: analisar os benefícios e os malefícios que Manobra de Kristeller apresenta na prática obstétrica para a mulher e o concepto. Método: trata-se de uma revisão integrativa realizada nas bases de dados LILACS, BDENF, IBECS e MEDLINE. Interpretou-se os resultados sintetizando-os de forma crítica e descritiva. Resultados: a amostra foi composta por nove estudos publicados entre 2007 a 2017. Estas publicações evidenciaram que esta manobra não possui benefício, em contrapartida, pode trazer vários malefícios à mulher como disfunções no sistema urinário, dispaurenia, dor perineal, incontinência anal, além do aumento do número de episotomias. Em relação ao concepto, foram encontrados registros de cefalohematomas, aumento do ritmo cardíaco fetal, hemorragia epidural e Caput sucedaneum. Conclusão: as publicações referem que esta manobra trará uma história reprodutiva marcada por traumas, além de reforçar o não uso desta técnica


Objective: to analyze the benefits and harms that the Kristeller Maneuver presents in obstetric practice for women and the concept. Method: this is an integrative review carried out in LILACS, BDENF, IBECS e MEDLINE. The results were interpreted by synthesizing them in a critical and descriptive way. Results: the sample was made by nine studies launched in 2007 to 2017. These subjects showed that this is not a benefit option, in contrast, it can bring several harm to the woman such as dysfunctions in the urinary system, dyspaurenia, perineal pain, anal incontinence, in addition to an increase in the number of episiotomies. Regarding the concept, the records of cephalhematomas, increased cardiac rhythm, epidural hemorrhage and Caput substudum were found. Conclusions: The publications referenced this maneuver to a reproductive culture marked by traumas, besides promoting the non-use of this technique


Objetivo: analizar los beneficios y los maleficios que la Manobra de Kristeller presenta en la práctica obstétrica para la mujer y el concepto. Método: se trata de una revisión integrativa realizada en las bases de datos LILACS, BDENF, IBECS e MEDLINE. Se interpretó los resultados sintetizándolos de forma crítica y descriptiva. Resultados: la muestra fue hecha por nueve estudios lanzados en 2007 a 2017. Estas materias evidenciaron que ésta no es una opción de beneficio, en contrapartida, puede traer varios maleficios a la mujer como disfunciones en el sistema urinario, dispaurenia, dolor perineal, incontinencia anal, además del aumento del número de episotomías. En relación al concepto, se encontraron los registros de cefalhematomas, aumento del ritmo cardíaco, hemorragia epidural y Caput sucedaneum. Conclusión: Las publicaciones referenciaron esta maniobra a una cultura reproductiva marcada por traumas, además de promover el no uso de esta técnica


Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Lacerações/etiologia , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Ferimentos e Lesões/etiologia , Trabalho de Parto , Episiotomia , Prática Clínica Baseada em Evidências/métodos , Saúde Materna/classificação
13.
Int J Mol Sci ; 21(24)2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33352826

RESUMO

Wound management remains a challenge worldwide, although there are several developed wound dressing materials for the management of acute and chronic wounds. The wound dressings that are currently used include hydrogels, films, wafers, nanofibers, foams, topical formulations, transdermal patches, sponges, and bandages. Hydrogels exhibit unique features which make them suitable wound dressings such as providing a moist environment for wound healing, exhibiting high moisture content, or creating a barrier against bacterial infections, and are suitable for the management of exuding and granulating wounds. Biopolymers have been utilized for their development due to their non-toxic, biodegradable, and biocompatible properties. Hydrogels have been prepared from biopolymers such as cellulose and chitosan by crosslinking with selected synthetic polymers resulting in improved mechanical, biological, and physicochemical properties. They were useful by accelerating wound re-epithelialization and also mimic skin structure, inducing skin regeneration. Loading antibacterial agents into them prevented bacterial invasion of wounds. This review article is focused on hydrogels formulated from two biopolymers-chitosan and cellulose-for improved wound management.


Assuntos
Celulose/química , Quitosana/química , Hidrogéis/química , Cicatrização , Animais , Biopolímeros/química , Queimaduras/etiologia , Queimaduras/terapia , Ensaios Clínicos como Assunto , Complicações do Diabetes , Humanos , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/terapia
14.
Am Surg ; 86(9): 1106-1112, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32967437

RESUMO

INTRODUCTION: Preinjury alcohol use and older age have independently been associated with poor outcomes. This study examined whether higher levels of blood alcohol concentration (BAC) correlated with an increased likelihood of poor outcomes in older trauma patients. METHODS: This was a retrospective cohort study of injured patients ≥65 years with BAC testing presenting to a Level 1 trauma center between 2015 and 2018. Patients were stratified by BAC at 4 thresholds of intoxication: BAC ≧10 mg/dL, BAC ≧80 mg/dL, BAC ≧150 mg/dL, and BAC ≧200 mg/dL. Propensity score matching using inverse probability of treatment weighting was used to estimate outcomes. Logistic and Poisson regression models were performed for each threshold of the BAC level with the matched cohort to assess clinical outcomes. RESULTS: Of all older patients (n = 3112), 32.5% (n = 1012) had BAC testing. In the matched cohort of 883 patients (76.7 ± 8.2 years; 48.1% female), 111 (12.5%) had BAC ≧10 mg/dL, 83 (74.8%) had BAC ≧80 mg/dL, 60 (54.1%) had BAC ≧150 mg/dL, and 37 (33.3%) had BAC ≧200 mg/dL. Falls (60.5%) and motor vehicle crashes (28.9%) were the most common mechanisms of injury. Median (IQR) of Injury Severity Score (ISS) was 5 (1-10). The risk of severe injury (ISS ≧15) was similar between alcohol-positive and alcohol-negative patients (9.9% vs 15.0%, P = .151). BAC ≧10 g/dL was not associated with length of stay, intensive care unit admission, or in-hospital complication, nor was any of the other 3 analyzed BAC thresholds. CONCLUSION: Overall, any detectable BAC along and increasing thresholds of BAC was not associated with poor in-hospital outcomes of older patients after trauma. Alcohol screening was low in this population, and intoxication may bias injury assessment, leading to mistriage of older trauma patients.


Assuntos
Intoxicação Alcoólica/sangue , Concentração Alcoólica no Sangue , Medição de Risco/métodos , Centros de Traumatologia , Ferimentos e Lesões/sangue , Idoso , Intoxicação Alcoólica/complicações , Feminino , Seguimentos , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , North Carolina/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/prevenção & controle
15.
PLoS One ; 15(9): e0238728, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32903278

RESUMO

OBJECTIVE: Road traffic injuries (RTIs) are recognized as one of the most important causes of morbidity and mortality throughout the world, especially in developing countries. Human behavior is reportedly one of the critical factors in the occurrence of such injuries. The purpose of this study is to evaluate the correlation of abnormal driving behaviors with the frequency and severity of RTIs among drivers in Hamadan, west of Iran. METHODS: The present cross-sectional study was conducted on 800 people driving, who were selected by multistage cluster sampling technique. Data were collected using a three-part self-administered questionnaire including demographic, social and driving characteristics; the Manchester driver behavior questionnaire (DBQ); as well as information on a history of the occurrence of the injuries caused by the crashes and the severity of them. Data were statistically analyzed using numerical indices, linear regression analysis, Pearson correlation, ordinal logistic regression model and multinomial logistic regression. RESULTS: The highest and lowest mean percentages of abnormal driving behavior were related to unintentional violations (19.13) and Lapses (16.44), respectively. "Changing radio stations and listening to music while driving", "overtaking a driver who drives slowly", and "unintentionally exceeding the speed limit" were the three highest behaviors associated with road traffic injuries, with the mean and standard deviation of (1.93 ± 1.4), (1.90±1.4), (1.58±1.3), respectively. Age, gender, educational level, driving experience and driving hours during the day were significantly associated with DBQ dimensions and severity of road traffic injuries. CONCLUSIONS: The results of this study showed that socio-demographic characteristics were significantly correlated with driving behavior. In addition, driving behaviors were correlated with traffic crashes and the resulting injuries. The findings of this study can be utilized to develop driving behavior interventions among the drivers.


Assuntos
Condução de Veículo/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Acidentes de Trânsito/estatística & dados numéricos , Adulto , Comportamento , Estudos Transversais , Feminino , Humanos , Masculino , Inquéritos e Questionários
16.
Khirurgiia (Mosk) ; (8): 17-22, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869610

RESUMO

OBJECTIVE: To evaluate the effectiveness of surgical treatment of post-burn defects of face and cranial vault. MATERIAL AND METHODS: There were 65 patients with post-burn defects of face and cranial vault. Mean age of patients was 38.5 years (min 17 years, max 67 years). Soft tissue reconstruction was performed by using of local tissues, combined plasty, balloon dermotension aand free flaps on microvascular anastomoses. Osteoectomy and sequestrectomy were carried out if it was necessary. Implants were used to eliminate through skull defects. RESULTS: Balloon dermotension with expanders and plasty with local tissues ensure skull reconstruction in the vast majority of patients. Through bone defects required reconstruction of the cranial vault with various implants. CONCLUSION: The proposed surgical approach ensures correction of severe functional and cosmetic disorders caused by post-burn skull defects, elimination of bone damage, restoration of normal skin of the face and cranial vault.


Assuntos
Queimaduras/cirurgia , Traumatismos Craniocerebrais/cirurgia , Face/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Crânio/cirurgia , Adolescente , Adulto , Idoso , Queimaduras/complicações , Traumatismos Craniocerebrais/etiologia , Traumatismos Faciais/etiologia , Traumatismos Faciais/cirurgia , Retalhos de Tecido Biológico , Humanos , Microcirurgia , Pessoa de Meia-Idade , Implantação de Prótese , Estudos Retrospectivos , Crânio/lesões , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/cirurgia , Expansão de Tecido , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/cirurgia , Adulto Jovem
17.
BMC Public Health ; 20(1): 1186, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32727594

RESUMO

BACKGROUND: Fall-related injuries are important public health problem worldwide. We aimed to describe the epidemiological and clinical characteristics of fall-related injuries in a level 1 trauma center. METHOD: A retrospective analysis of Qatar Trauma Registry data was conducted on patients admitted for fall-related injuries between 2010 and 2017. Comparative analyses of data by gender, age-groups and height of falls were performed to describe the epidemiological and clinical characteristics of patients, and in-hospital outcomes. RESULTS: A total of 4040 patients with fall-related injuries were identified in the study duration which corresponds to the rate of 2.34 per 10,000 population. Although the rate of fall-related injuries decreased over the years, the average number of patients per year remained high accounting for 32% of the hospitalized patients with moderate to severe injuries. Most of the injuries affected the head (36%) followed by spines (29%) and chest (23%). Males were predominant (89%), more likely to fall at workplace, fall from a greater height and have polytrauma than females. The working age-group (20-59 years) constituted the majority of injured (73%) and were more likely to fall at workplace, and to fall from higher heights compared to the older adults who sustained more fall at home. Overall in-hospital mortality was 3%. Outcomes including longer hospital length of stay and mortality were generally correlated with the height of fall except for the fall at home. CONCLUSION: Fall-related injuries remain as significant burden even in a level 1 trauma center. Variations in the pattern of injuries by age, gender and height of fall provide important information for targeted preventive measures.


Assuntos
Acidentes por Quedas , Hospitalização , Escala de Gravidade do Ferimento , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Acidentes por Quedas/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/etiologia , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo , Catar/epidemiologia , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/etiologia , Traumatismos Torácicos/epidemiologia , Traumatismos Torácicos/etiologia , Adulto Jovem
18.
Nat Commun ; 11(1): 3737, 2020 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-32719355

RESUMO

Glucocorticoids (GC) are a controversial yet commonly used intervention in the clinical management of acute inflammatory conditions, including sepsis or traumatic injury. In the context of major trauma such as surgery, concerns have been raised regarding adverse effects from GC, thereby necessitating a better understanding of how GCs modulate the immune response. Here we report the results of a randomized controlled trial (NCT02542592) in which we employ a high-dimensional mass cytometry approach to characterize innate and adaptive cell signaling dynamics after a major surgery (primary outcome) in patients treated with placebo or methylprednisolone (MP). A robust, unsupervised bootstrap clustering of immune cell subsets coupled with random forest analysis shows profound (AUC = 0.92, p-value = 3.16E-8) MP-induced alterations of immune cell signaling trajectories, particularly in the adaptive compartments. By contrast, key innate signaling responses previously associated with pain and functional recovery after surgery, including STAT3 and CREB phosphorylation, are not affected by MP. These results imply cell-specific and pathway-specific effects of GCs, and also prompt future studies to examine GCs' effects on clinical outcomes likely dependent on functional adaptive immune responses.


Assuntos
Imunidade Adaptativa/efeitos dos fármacos , Artroplastia de Quadril/efeitos adversos , Glucocorticoides/farmacologia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/imunologia , Doença Aguda , Idoso , Estudos de Casos e Controles , Método Duplo-Cego , Fadiga/tratamento farmacológico , Feminino , Humanos , Masculino , Metilprednisolona/farmacologia , Metilprednisolona/uso terapêutico , Inibidor de NF-kappaB alfa/metabolismo , Dor/tratamento farmacológico , Fenótipo , Fosforilação , Fator de Transcrição STAT3/metabolismo , Resultado do Tratamento
19.
J Trauma Acute Care Surg ; 89(4): 821-828, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32618967
20.
J Surg Res ; 254: 398-407, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32540507

RESUMO

BACKGROUND: Bicycle injuries continue to cause significant morbidity in the United States. How insurance status affects outcomes in children with bicycle injuries has not been defined. We hypothesized that payer status would not impact injury patterns or outcomes in pediatric bicycle-related accidents. METHODS: The National Trauma Data Bank was used to identify pediatric (≤18 y) patients involved in bicycle-related crashes admitted in year 2016. Patients with private insurance were compared with all others (uninsured, Medicaid, and Medicare). RESULTS: There were 5619 patients that met study criteria. Of these, 2500 (44%) had private insurance. Privately insured were older (12 y versus 11, P < 0.001), more likely to be white (77% versus 56%, P < 0.001), and more likely to wear a helmet (26% versus 9%, P < 0.001). On multivariate analysis, factors associated with traumatic brain injury included age (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.06-1.08; P < 0.001) and helmet use (OR, 0.64; 95% CI, 0.55-0.74; P < 0.001). Patients without private insurance were significantly less likely to wear a helmet (OR, 0.52; 95% CI, 0.44-0.63; P < 0.001). Uninsured patients had significantly higher odds of a fatal injury (OR, 4.43; 95% CI, 1.52-12.92; P = 0.006). CONCLUSIONS: Uninsured children that present to a trauma center after a bicycle accident are more likely to die. Although helmet use reduced the odds of traumatic brain injury, minorities and children without private insurance were less likely to be helmeted. Public health interventions should increase helmet access to children without private insurance, especially uninsured children.


Assuntos
Ciclismo/lesões , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Sistema de Registros , Ferimentos e Lesões/mortalidade , Adolescente , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Centros de Traumatologia/estatística & dados numéricos , Estados Unidos/epidemiologia , Ferimentos e Lesões/economia , Ferimentos e Lesões/etiologia
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