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1.
BMJ Case Rep ; 14(5)2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059533

RESUMO

A 65-year-old patient with background of alcohol excess and previous gunshot wounds was admitted with significant weight loss, leg cramps, dizziness and lethargy for the last 3 months. He was diagnosed with type 2 diabetes mellitus in July 2020 and was started on Metformin and Gliclazide by his in July; he was later commenced on alogliptin and empaglaflozin by diabetes specialist nurse in early August. He also had generalised muscle wasting, dorsal guttering in both hands and was cachectic when he presented to hospital. His haemoglobin A1c (HbA1c) was 124 mmol/mol in July 2020 and was 63 mmol/mol in September 2020. The patient had negative autoimmune and TB screen. CT abdomen/pelvis and CT lumbosacral spine that showed mild diverticular disease and bilateral L5 spondylolysis with L5-S1 spondylotic changes. Electrophysiological studies confirmed sensory motor peripheral neuropathy. Patient was diagnosed with diabetic neuropathic cachexia secondary to poorly controlled diabetes and was commenced on 30 units two times per day of NovoMix 30 insulin; this was adjusted to 24 units two times per day in endocrine clinic 3 months later, after gaining 10 kg in weight. Good glycaemic control is key to the management of such cases and, therefore, we recommend early referral to diabetes specialist input for consideration of insulin therapy.


Assuntos
Diabetes Mellitus Tipo 2 , Neuropatias Diabéticas , Ferimentos por Arma de Fogo , Idoso , Caquexia/etiologia , Diabetes Mellitus Tipo 2/complicações , Neuropatias Diabéticas/complicações , Hemoglobina A Glicada , Humanos , Masculino
2.
Isr Med Assoc J ; 23(5): 279-285, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34024043

RESUMO

BACKGROUND: The collapse of the Syrian healthcare system during the civil war led numerous citizens to cross the Syrian-Israeli border to seek medical care. OBJECTIVES: To describe the epidemiology of peripheral nerve injuries (PNIs) sustained in war, their management, and short-term outcomes. METHODS: A retrospective case series study was conducted on 45 consecutive patients aged 25.7 ± 9.3 years. These patients were referred to the hand surgery unit of the department of orthopedic surgery and traumatology at Galilee Medical Center between December 2014 and June 2018. Median time between injury and presentation was 60 days. Injury pattern, additional injuries, surgical findings and management, complications, and length of hospital stay were extracted from medical records. RESULTS: Most injuries were blast (55.6%) followed by gunshot injuries (37.8%). There were 9 brachial plexus injuries, 9 sciatic nerve injuries, and 38 PNIs distal to the plexus: specifically 20 ulnar, 11 median, and 7 radial nerve injuries. In the latter group, neurotmesis or axonotmesis was found in 29 nerves. Coaptation was possible in 21 nerves necessitating cable grafting in 19. A tendon transfer was performed for 13 peripheral nerves, occasionally supplementing the nerve repair. The patients returned to their country after discharge, average follow-up was 53.6 ± 49.6 days. CONCLUSIONS: For nerve injuries sustained in war, early surgical treatment and providing adequate soft tissue conditions is recommended. Tendon transfers are useful to regain early function.


Assuntos
Traumatismos por Explosões/cirurgia , Procedimentos Neurocirúrgicos/métodos , Traumatismos dos Nervos Periféricos/cirurgia , Lesões Relacionadas à Guerra/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Adolescente , Adulto , Traumatismos por Explosões/etiologia , Criança , Feminino , Hospitais , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/etiologia , Socorro em Desastres , Estudos Retrospectivos , Síria/etnologia , Transferência Tendinosa/métodos , Ferimentos por Arma de Fogo/etiologia , Adulto Jovem
3.
Adv Exp Med Biol ; 1317: 35-51, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33945131

RESUMO

Human remains have been displayed in museums in Europe since many centuries for historical, cultural, and educational reasons. Of particular interest are skeletal remains and body parts that have suffered violent deaths and such remains often feature in Criminology Museums. Despite the well-acknowledged value of human remains in medical education, bioarchaeology, and research, the display of human remains still raises ethical considerations ranging in severity depending on the cultural substrate and legal framework of each country. Recent developments in medical imaging and visualisation are offering an alternative way. Taking into account the emerging issues regarding exhibition and handling of human remains, this research project aims to use virtual methods to reconstruct the circumstances of the death of a nineteenth-century outlaw comprising one of the human exhibits at the Criminology Museum of Athens in Greece.For the purpose of the project, the severed head of the outlaw Stavrou was CT scanned, and the data were used to reconstruct and to evaluate the ballistic trauma sustained at the time of his death. From the scans, it was possible to determine the minimum number of shots, entrance and exit wounds, approximate calibre of the bullets, approximate distance from which they were fired, and general velocity of the round.Shots are fired from the lateral left and backside of the head and bullets exited from the right frontal and temporal area causing extensive damage to the right craniofacial region. The direction of the shots coming from the back and left suggests that Stavrou was more likely ambushed by gendarmerie squads and not shot in a fair fight which would have caused entry wounds in the anterior surface of the body. This is in agreement with historical evidence that placed him in gunfire with his fellow gang member Karapanos against a government squad. On the other hand, the possibility of being captured alive and executed cannot be rejected based only on wound ballistics.This work would be excellent supplementary material to the actual human exhibit for the accurate presentation of Stavrou's history at the Criminology Museum. In addition, it would allow the virtual exhibition of the material for historical and teaching purposes to museums and universities anywhere in Greece and along the globe, thus overcoming the obstacles of moving the actual remains.


Assuntos
Ferimentos por Arma de Fogo , Europa (Continente) , Balística Forense , Grécia , Humanos , Masculino , Radiografia
4.
Sud Med Ekspert ; 64(3): 41-44, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34013694

RESUMO

The purpose of our work was to assess the capabilities of the SEM in the framework of expert studies of gunshot injuries of targets made of cotton fabric. In the study of experimental injuries resulting from shots fired from the KO-M1-98 carbine with 8x57JS cartridges at various distances (from the stop to 3.5 m), the presence of features of the soot morphology was established, by which it is possible to judge the distance of the shot. Thus, by examining fragments of target tissue from the central and peripheral zones of soot deposition, electron microscopy revealed a change in the ratio, intensity, and topography of soot particles. The energy-dispersion analysis revealed that with increasing distance, the number of chemical elements that make up the capsule decreases, with the exception of tin, which has an unstable inversely proportional bond.


Assuntos
Armas de Fogo , Ferimentos por Arma de Fogo , Balística Forense , Humanos , Microscopia Eletrônica de Varredura , Fuligem
5.
Khirurgiia (Mosk) ; (6): 91-95, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34029041

RESUMO

Gunshot head injuries make up 35% of all injuries. Brain injuries are diagnosed in 42.2% of cases, maxillofacial region - 35.7%, eye - 13.9%, outer and inner ear - 3.2%. These damages account 14.8%, 12.5%, 4.9% and 2.9% of the total number of injuries, respectively. In our opinion, primary surgical treatment of gunshot wounds should be carried out in a strict system of multiple-stage surgical management in accordance with the principles of treating wounds from high-speed weapons.


Assuntos
Ferimentos por Arma de Fogo , Humanos , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/diagnóstico , Ferimentos por Arma de Fogo/cirurgia
8.
Cesk Patol ; 57(1): 11-16, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33910353

RESUMO

On 8 June 1972, the Czechoslovak OK DNN aircraft carrier L410 Turbolet was delivered to the regular line Marianske Lazne - Prague to the Federal Republic of Germany. About 8 minutes after the launch from Marianske Lazne Airport, the likely head of the group of kidnappers threw the captain of the plane. During the fight with one of the passenger, the head of the group of kidnappers killed the captain of the aircraft by a shot from 7.65 mm pistol. Other members of the hijackers group attacked other passengers. After the aircraft captains death, the second pilot took command and landed at the sports club at Weiden. After the landing, the kidnappers were detained by the police. Ten kidnappers stayed in the Federal Republic of Germany. An airplane with other passengers and coffin of a shot captain landed in Prague Ruzyne the following day. On June 12, 1972, the re-autopsy of the captain of the aircraft was performed at the Central Military Hospital in Prague. Post-autopsy status was detected. In this re-autopsy, it was possible to reconstruct the fire channel only incompletely, because during the previous autopsy performed in Federal Republic of Germany was excised the shot wound left on the neck. The fire channel began with a hole in the skin 10 cm above the right breast nipple, continued to the left and slightly upward through the subcutaneous tissue, passed through the 2nd rib at the right at a distance of 4.5 cm from the sternum, continued the lower and inner sides of the right collarbone, flowing on the front the ring cartilage and the first ring of the trachea, and on the underside of the left lobes of the thyroid gland, passed on the front of the left common carotid and continued into the area of the left SCM. The exid shot hole was on the left half of the neck. The direction of the shotway canal from right side to left side was detectable only by the fragment of the 2nd rib, which was broken out to the left and inside. The cause of the captains death was a traumatic shock. The injury was caused by a short firearm of small stance. Additional factors of firing were not found on the skin, as well as no signs of gas pressure. At the request of the experts performing the autopsy, a copy of the autopsy protocol from Germany was sent to them by an autopsied doctor. Among other things, it was reported that a 6.5 cm under the lower end of the left ear was a transversely oval, 2.5 cm long and 1.2 cm wide, red-black dried place of the upper skin, from which center run out a little red blood. At the conclusion of the autopsy protocol, it was found that there was a shotgun injury at the left side of the neck and the right side of the chest. The entrance wound according to the sent copy of the autopsy protocol, lay on the left side of the neck, the bullet penetrated the neck muscles, broke the inner branch of the cervical artery, passed through the trachea, penetrated the collarbone, split the 2nd rib to the right about 2 cm next to the sternum and the right chest 10 cm above the breast the nipple stepped out of the body. The direction of the penetration of the projectile through the body therefore had the opposite orientation compared to the re- autopsy. On the basis of this finding, the expert opinion from the re-autopsy was supplemented in the sense that there is no evidence in the autopsy protocol from Germany for the conclusion of the shot on the left side of the neck. Both autopsy experts examined the space of the aircraft cabin. The inspection showed that from the left, that is to the neck, the captain of the aircraft could be hit only if the attacker held the pistol in his left hand in a completely unnatural position so that his forearm was pulled upward over the left shoulder of the captain just to the left of the cabin and a hand bent in the wrist at a steep angle down to the right. The position of the shooters hand would be more natural if the captain of the aircraft turned backward over his left shoulder and turned the hull to the left. But this would be completely useless because of the situation, as he would look into the left cabin wall. More natural would be turning right over his right shoulder. In that case, he could be hit on the right side of the chest. The shooting kidnapper committed suicide in a cell overnight from 12 to 13 January 1973. It is not possible, based on the information available, to decide exactly how the gunshot has been going on. Czech experts did not have clothing of the captain or conclusions about their examination, and the hole on the left side of the neck was cut out by the German expert and was not provided to the Czech party through the request. It may be considered strange that the autopsy in Germany was performed in this relatively serious case outside the renowned forensic medicine department.


Assuntos
Suicídio , Ferimentos por Arma de Fogo , Aeronaves , Autopsia , Medicina Legal , Humanos , Masculino
10.
J Spec Oper Med ; 21(1): 71-76, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33721310

RESUMO

BACKGROUND: Uncontrolled external hemorrhage is a common cause of preventable death. The Hartford Consensus recommendations presented the concept of a continuum of care, in which police officers should be considered an integral component of the emergency medical response to active shooter incidents. Recent publications have reported individual cases of tourniquet application by police officers. This report analyzed all documented cases of hemorrhage control using tourniquets applied by police officers in a single large metropolitan police department. METHODS: A retrospective computerized search of all public safety communications center reports and police officer documentation for cases of tourniquet application was conducted by searching for the word "tourniquet." Each case was evaluated for indication and appropriateness using Stop The Bleed criteria for tourniquet placement. In addition, police response time was compared to emergency medical services (EMS) response time in an effort to determine if there was a time difference in response to the bleeding patient that could potentially impact patient outcomes. RESULTS: Forty- three cases were identified over the 6-year period ending in December 2019. The majority of cases involved gunshot wounds and most were civilian victims. Injured police officers accounted for two cases (gunshot wound and dog bite). Review of the officers' narratives indicated that most applications appeared justified using the Stop The Bleed criteria (two cases were questionable if a tourniquet was necessary and one may have been placed in an incorrect location). On average, police arrived 4 minutes sooner than EMS did. CONCLUSION: Several reports in the literature document the success of police officer application of tourniquets to control limb hemorrhage. Most of the reports involved a small number of case reports. This is the largest case series to date from a single urban police department.


Assuntos
Serviços Médicos de Emergência , Ferimentos por Arma de Fogo , Colorado , Humanos , Polícia , Estudos Retrospectivos , Torniquetes , Ferimentos por Arma de Fogo/terapia
11.
BMC Public Health ; 21(1): 366, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33641667

RESUMO

BACKGROUND: Alcohol and firearms are commonly involved in suicide in the United States. State alcohol and firearm policies may impact alcohol and firearm related suicide, yet little is known about these relationships. This study examines relationships between state alcohol and firearm policies and suicides involving alcohol, guns, or both, and explores interactive policy associations. METHODS: Alcohol policies were assessed with the Alcohol Policy Scale. Firearm policies were assessed using the Gun Law Scorecard from Giffords Law Center. Suicide data from the National Violent Death Reporting System in 2015 covered 22 states. State- and individual-level GEE Poisson and logistic regression models assessed relationships between policies and firearm- and/or alcohol-involved suicides with a 1-year lag. RESULTS: In 2015, there were 8996 suicide deaths with blood alcohol concentration test results in the 22 included states. Of those deaths, alcohol and/or firearms were involved in 5749 or 63.9%. Higher alcohol and gun law scores were associated with reduced incidence rates and odds of suicides involving either alcohol or firearms (adjusted incidence rate ratios [IRR] 0.72 (95% CI 0.63, 0.83) for alcohol policies, 0.86 (95% CI 0.82, 0.90) for firearm policies). Relationships were similar for suicides involving both alcohol and firearms, and there was an interactive effect, such that states with restrictive policies for both had the lowest rates of suicides involving alcohol or guns. CONCLUSIONS: More restrictive alcohol and firearm policies are associated with lower rates and odds of suicides involving alcohol or firearms, and alcohol and firearms, and may be a promising means by which to reduce suicide.


Assuntos
Armas de Fogo , Suicídio , Ferimentos por Arma de Fogo , Concentração Alcoólica no Sangue , Estudos Transversais , Homicídio , Humanos , Suicídio/prevenção & controle , Estados Unidos/epidemiologia , Ferimentos por Arma de Fogo/epidemiologia
12.
Rev Col Bras Cir ; 48: e20202784, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33787764

RESUMO

OBJECTIVE: the aim of this study was to identify associated factors with the increased length of hospital stay for patients undergoing surgical treatment for liver trauma, and predictors of mortality as well as the epidemiology of this trauma. METHODS: retrospective study of 191 patients admitted to the Cajuru University Hospital, a reference in the treatment of multiple trauma patients, between 2010 and 2017, with epidemiological, clinicopathological and therapeutic variables analyzed using the STATA version 15.0 program. RESULTS: most of the included patients were men with a mean age of 29 years. Firearm injury represents the most common trauma mechanism. The right hepatic lobe was injured in 51.2% of the cases, and hepatorraphy was the most commonly used surgical correction. The length of hospital stay was an average of 11 (0-78) days and the length of stay in the intensive care unit was 5 (0-52) days. Predictors for longer hospital stay were the mechanisms of trauma, hemodynamic instability at admission, number of associated injuries, degree of liver damage and affected lobe, used surgical technique, presence of complications, need for reoperation and other surgical procedures. Mortality rate was 22.7%. CONCLUSIONS: the study corroborated the epidemiology reported by the literature. Greater severity of liver trauma and associated injuries characterize patients undergoing surgical treatment, who have increased hospital stay due to the penetrating trauma, hemodynamic instability, hepatic packaging, complications and reoperations.


Assuntos
Armas de Fogo , Ferimentos por Arma de Fogo , Adulto , Hospitalização , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação , Fígado/lesões , Fígado/cirurgia , Masculino , Estudos Retrospectivos , Centros de Traumatologia
13.
Clin Plast Surg ; 48(2): 349-361, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33674056

RESUMO

Evolution in extremity injury treatment often occurs during major conflicts, with lessons learned applied and translated among military and civilian settings. In recent periods of war, improvements in protective equipment, in-theater damage control resuscitation/surgery, delivery of antibiotics locally/systemically, and rapid evacuation to higher levels of medical care capabilities have greatly improved combat casualty survivability rates. Additionally, widespread application of lower extremity tourniquets also has prevented casualties from exsanguination, thus reducing hemorrhagic-related deaths. Secondary to these, a high number of combat casualties suffering lower extremity traumatic injuries have presented for functional limb reconstruction and restoration as well as residual limb care.


Assuntos
Traumatismos da Perna/cirurgia , Extremidade Inferior/cirurgia , Medicina Militar , Procedimentos Cirúrgicos Reconstrutivos/métodos , Amputação Traumática/cirurgia , Conflitos Armados , Traumatismos por Explosões/cirurgia , Humanos , Salvamento de Membro , Extremidade Inferior/lesões , Militares , Ressuscitação , Procedimentos Cirúrgicos Vasculares/métodos , Ferimentos por Arma de Fogo/cirurgia
14.
Neurology ; 96(20): e2558-e2560, 2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-33692167

RESUMO

Patients with traumatic brain injury may be dependent on the decision-making of their families. Restrictive visitation policies implemented during the coronavirus disease 2019 (COVID-19) pandemic disproportionately affect these patients and their families. This narrative aims to illustrate this phenomenon and catalyze discussions regarding the need for careful evaluation of restrictive family visitation policies and exceptions that may be required for patients with brain injuries.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Cuidados Críticos , Tomada de Decisão Compartilhada , Traumatismos Cranianos Penetrantes/terapia , Visitas a Pacientes , Ferimentos por Arma de Fogo/terapia , Adulto , Cuidados Críticos/legislação & jurisprudência , Cuidados Críticos/psicologia , Cuidados Críticos/normas , Escala de Coma de Glasgow , Humanos , Internato e Residência , Masculino , Neurocirurgiões , Cuidados Paliativos , Visitas a Pacientes/legislação & jurisprudência , Visitas a Pacientes/psicologia
15.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541979

RESUMO

A 35-year-old man presented with a gunshot wound to his abdomen via his lower chest. Initial laparotomy did not identify any perforation or contamination. On day 3, a laparotomy under the hepatobiliary service discovered a gastric perforation, two lateral duodenal perforations and a complete transection of the common bile duct, presumably delayed perforation from the shockwave injury produced by the bullet. Contamination and haemodynamic instability precluded immediate reconstruction, and abdominal drains and external biliary drainage were established. High-volume duodenal fistula was managed with slow withdrawal of drains, and inadvertent dislodgement of the biliary drain in an outpatient setting resulted in spontaneous fistulisation of the bile duct to the lateral duodenal wall, with creation of a neo-bile duct. The patient remains well more than 1 year later, without external drainage despite no surgical reconstruction.


Assuntos
Ducto Colédoco/lesões , Drenagem , Duodeno , Fístula Intestinal , Ferimentos por Arma de Fogo/complicações , Traumatismos Abdominais , Adulto , Humanos , Laparotomia , Masculino , Tomografia Computadorizada por Raios X
16.
JAMA Netw Open ; 4(2): e2034208, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33538822

RESUMO

Importance: Preventing firearm violence requires understanding its antecedents. Yet no comprehensive longitudinal study has examined how involvement with firearms during adolescence-use, access, and victimization (defined as threatened with a weapon or gunshot injury)-is associated with the perpetration of firearm violence in adulthood. Objective: To examine the association between firearm involvement during adolescence and subsequent firearm perpetration and ownership in adulthood among youth involved in the juvenile justice system. Design, Setting, and Participants: This cohort study analyzed interview responses of 1829 randomly selected participants as part of the Northwestern Juvenile Project, a longitudinal study of health needs and outcomes of youth sampled from a temporary juvenile detention center in a large US city. Youth aged 10 to 18 years were interviewed in detention from November 1995 through June 1998. Participants were reinterviewed up to 13 times over 16 years through February 2015, for a total of 17 776 interviews. The sample was stratified by sex, race/ethnicity, age, and legal status (juvenile or adult court). Data were analyzed from April 2017, when data preparation began, through November 2020. Exposures: Firearm involvement during adolescence: use (ie, threaten, shoot), access (ownership, ease of access, firearm in household, membership in gang that carries firearms), and victimization (gunshot injury, threatened with a weapon). Main Outcomes and Measures: Firearm involvement during adulthood: perpetration of firearm violence (ie, threatening with or using a firearm) and firearm ownership. Results: Among the 1829 participants, 1388 had a 16-year follow-up interview: 860 males, 528 females; 809 were African American, 203 were non-Hispanic White; 374 were Hispanic; and 2 were other race/ethnicity; median (interquartile range) age of 32 (30-32) years. Eighty-five percent of males and 63.2% of females were involved with firearms as adolescents. Compared with females, males had significantly higher odds of every type of involvement except having a firearm in the home. In adulthood, 41.3% of males and 10.5% of females perpetrated firearm violence. Adolescents who had been threatened with a weapon or injured by firearms had 3.1 (95% CI, 2.0-4.9) and 2.4 (95% CI, 1.2-4.9) times the odds of perpetrating violence during adulthood. Similar associations were found for firearm ownership. Conclusions and Relevance: Involvement with firearms during adolescence-including victimization-is a significant risk factor for firearm perpetration and ownership during adulthood.


Assuntos
Vítimas de Crime/estatística & dados numéricos , Crime/estatística & dados numéricos , Armas de Fogo/estatística & dados numéricos , Violência com Arma de Fogo/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos , Criança , Direito Penal , Grupo com Ancestrais do Continente Europeu , Feminino , Violência com Arma de Fogo/prevenção & controle , Hispano-Americanos , Humanos , Estudos Longitudinais , Masculino , Propriedade , Fatores de Risco , Ferimentos por Arma de Fogo/epidemiologia , Adulto Jovem
20.
A A Pract ; 15(2): e01382, 2021 02 23.
Artigo em Inglês | MEDLINE | ID: mdl-33625119
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