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1.
Sud Med Ekspert ; 63(1): 15-19, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32040082

RESUMO

Aim of this study is to determine the influence of the basic conditions of the traumatic interaction of cutting and chopping objects with 'barrier' tissues of the scalp on the formation of morphological signs of damage. It was suggested to perform the comparative analysis of the morphological signs of incised and chopped scalp tissue wounds obtained by changing one given parameter in experimental damage modeling. The influence of the basic conditions of the traumatic interaction of cutting and chopping objects with the 'barrier' tissues of the scalp on the formation of morphological signs of the resulting damage was determined. The effectiveness of the proposed comparative analysis of morphological signs of incised and chopped lesions was confirmed.


Assuntos
Traumatismos Craniocerebrais , Ferimentos Perfurantes , Medicina Legal , Humanos , Microscopia
2.
JAMA ; 323(5): 444-454, 2020 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-32016308

RESUMO

Importance: Neurological disorders have been linked to suicide, but the risk across a broad spectrum of neurological disorders remains to be assessed. Objectives: To examine whether people with neurological disorders die by suicide more often than other people and to assess for temporal associations. Design, Setting, and Participants: Nationwide, retrospective cohort study on all persons 15 years or older living in Denmark, from 1980 through 2016 (N = 7 300 395). Exposures: Medical contact for head injury, stroke, epilepsy, polyneuropathy, diseases of myoneural junction, Parkinson disease, multiple sclerosis, central nervous system infections, meningitis, encephalitis, amyotrophic lateral sclerosis, Huntington disease, dementia, intellectual disability, and other brain diseases from 1977 through 2016 (n = 1 248 252). Main Outcomes and Measures: Death by suicide during 1980-2016. Adjusted incidence rate ratio (IRRs) were estimated using Poisson regressions, adjusted for sociodemographics, comorbidity, psychiatric diagnoses, and self-harm. Results: Of the more than 7.3 million individuals observed over 161 935 233 person-years (49.1% males), 35 483 died by suicide (median duration of follow-up, 23.6 years; interquartile range, 10.0-37.0 years; mean age, 51.9 years; SD, 17.9 years). Of those, 77.4% were males, and 14.7% (n = 5141) were diagnosed with a neurological disorder, equivalent to a suicide rate of 44.0 per 100 000 person-years compared with 20.1 per 100 000 person-years among individuals not diagnosed with a neurological disorder. People diagnosed with a neurological disorder had an adjusted IRR of 1.8 (95% CI, 1.7-1.8) compared with those not diagnosed. The excess adjusted IRRs were 4.9 (95% CI, 3.5-6.9) for amyotrophic lateral sclerosis, 4.9 (95% CI, 3.1-7.7) for Huntington disease, 2.2 (95% CI, 1.9-2.6) for multiple sclerosis, 1.7 (95% CI, 1.6-1.7) for head injury, 1.3 (95% CI, 1.2-1.3) for stroke, and 1.7 (95% CI, 1.6-1.8) for epilepsy. The association varied according to time since diagnosis with an adjusted IRR for 1 to 3 months of 3.1 (95% CI, 2.7-3.6) and for 10 or more years, 1.5 (95% CI, 1.4 to 1.6, P < .001). Compared with those who were not diagnosed with a neurological disorder, those with dementia had a lower overall adjusted IRR of 0.8 (95% CI, 0.7-0.9), which was elevated during the first month after diagnosis to 3.0 (95% CI, 1.9-4.6; P < .001). The absolute risk of suicide for people with Huntington disease was 1.6% (95% CI, 1.0%-2.5%). Conclusions and Relevance: In Denmark from 1980 through 2016, there was a significantly higher rate of suicide among those with a diagnosed neurological disorder than persons not diagnosed with a neurological disorder. However, the absolute risk difference was small.


Assuntos
Doenças do Sistema Nervoso/psicologia , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Esclerose Amiotrófica Lateral/psicologia , Traumatismos Craniocerebrais/psicologia , Dinamarca/epidemiologia , Feminino , Humanos , Doença de Huntington/psicologia , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/psicologia , Suicídio/psicologia , Adulto Jovem
3.
Am J Forensic Med Pathol ; 41(1): 78-80, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32022760

RESUMO

Investigation of a complex suicide is a challenging task, particularly when the combination of modalities adopted is rare and unplanned. There is often a significant likelihood of labeling the case as a homicide. We present an interesting case of unplanned complex suicide with self-stabbing and head injury resulting from intentionally being struck by a train. There were also hesitation cuts evident over the neck and left wrist. This case highlights the importance of studying the nature and characterization of the wounds, examination of clothes, and examination of the scene to safely conclude the cause and the manner of death.


Assuntos
Traumatismos Craniocerebrais/patologia , Ferrovias , Ferimentos Perfurantes/patologia , Traumatismos Abdominais/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos do Punho/patologia
4.
Medicine (Baltimore) ; 99(1): e18567, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895799

RESUMO

We investigated the epidemiological and clinical characteristics deaths from road traffic injury (RTI) in Beijing, and provided evidence useful for the prevention of fatal traffic trauma and for the treatment of traffic-related injuries.We retrospectively reviewed death cases provided by the Beijing Red Cross Emergency Center on road traffic injury deaths from 2008 to 2017. We analyzed population characteristics, time distribution, distribution of transportation modes, intervals to death, locations and injured body parts.From 2008 to 2017, there were 3327 deaths from RTI recorded by the Beijing Red Cross Emergency Center, with mainly males among these deaths. The average age at death was 46.19 ±â€Š17.43 years old (46.19, 0.43-100.24). In accidents with more detail recorded, pedestrians and people using nonmotorized transportation modes suffered the most fatalities (664/968, 68.60%). The most commonly injured body parts were the head (2569/3327, 77.22%), followed by the chest (180/3327, 5.41%), abdomen (130/3327, 3.91%), lower extremities (68/3327, 2.04%), pelvis (67/3327, 2.01%), spinal cord (31/3327, 0.93%), and upper extremities (26/3327, 0.78%). Burns accounted for 0.96% (32/3327), and unknown body parts were affected in 11.28% (365/3327). The average time interval from injury to death was 36.90 ±â€Š89.57 h (36.90, 0-720); 46.7% (1554/3327) died within 10 minutes after injury; 9.02% (300/3327) died between 10 min and 1 hour; 30.33% (1009/3327) died between 1 hour and 3 days; 13.95% (464/3327) died between 3 and 30 days.In Beijing, RTI is a significant cause of preventable death, particularly among pedestrians and users of non-motorized vehicles. Head trauma was the most lethal cause of RTI deaths. Our findings suggested that interventions to prevent collisions and reduce injuries, and improved trauma treatment process and trauma rescue system could address a certain proportion of avoidable RTI deaths.


Assuntos
Acidentes de Trânsito/mortalidade , Traumatismos Craniocerebrais/mortalidade , Pedestres/estatística & dados numéricos , Ferimentos e Lesões/mortalidade , Adulto , Idoso , Pequim/epidemiologia , Traumatismos Craniocerebrais/etiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/etiologia
5.
Curr Sports Med Rep ; 19(1): 24-28, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31913920

RESUMO

Soft tissue injuries to the head and neck are a common occurrence in sports. These anatomical regions are somewhat predisposed because of the "athletic stance" that is utilized in many close-contact sports. Although appropriate use of protective equipment, including mouth guards, helmets, and face shields, has reduced the incidence and severity of these injuries, they still occur regularly. To provide appropriate medical care, one must possess adequate knowledge of the superficial and deep anatomical structures, fundamental knowledge and skill in regard to wound care, and awareness of potential poor outcomes related to lacerations of unique structures, such as the mouth, eye, or ear.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Faciais/diagnóstico , Lacerações/diagnóstico , Lesões do Pescoço/diagnóstico , Traumatismos em Atletas/terapia , Traumatismos Craniocerebrais/terapia , Traumatismos Faciais/terapia , Humanos , Lacerações/terapia , Lesões do Pescoço/terapia , Volta ao Esporte
6.
Anthropol Anz ; 77(1): 75-82, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-31939989

RESUMO

In the course of a scientific cooperation between the German Mummy Project at the Reiss-Engelhorn-Museen, Mannheim (Germany) and the Musée National d'Histoire et d'Art Luxembourg (Luxembourg), an ancient Egyptian mummy head was analyzed using a multidisciplinary approach including radiocarbon dating, ultra-high resolution computed tomography, physical anthropology, forensic medicine and Egyptology. Dated to the Roman Period, the mummy head belonged to an upper-class woman between 25 and 35 years of age. Computed tomography revealed a lethal blunt force trauma affecting the dorsal parts of the parietal bones, below the intact overlaying soft tissue. Moreover, ancient medical treatment was evidenced through localized shaving of the hair on the affected area, which indicates that efforts have been made to keep the woman alive. This astonishing example of homicide demonstrates the enormous scientific benefit brought by the multidisciplinary investigation of mummified bodies and body parts, and sheds light on life, death and medical care of a woman from Roman Period Egypt.


Assuntos
Traumatismos Craniocerebrais , Múmias , Ferimentos não Penetrantes , Adulto , Antigo Egito , Feminino , Cabeça , História Antiga , Humanos
7.
Internist (Berl) ; 61(1): 91-95, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31673730

RESUMO

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


Assuntos
Traumatismos Craniocerebrais/complicações , Hiponatremia/etiologia , Síndrome de Secreção Inadequada de HAD/diagnóstico , Esqui/lesões , Acidentes , Adulto , Feminino , Humanos
8.
World Neurosurg ; 133: 127-134, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568909

RESUMO

Aulus Cornelius Celsus lived in Rome during the reigns of Augustus and Tiberius. He developed the scientific Latin, and his work De Medicina was the first medical textbook to be written in Latin, and subsequently the first medical treatise to be printed. He perhaps was a simple medical writer rather than a real physician, but his contributions to medical knowledge are outstanding. He described the tetrad of inflammation (dolor, rubor, calor, tumor), coined the term cancer, and reported several revolutionary surgical techniques. His eighth book, almost entirely dedicated to dislocations and fractures, provides an extensive description of head injuries such as extradural hematomas, lesions distant from the impact point, and intracranial damage in cases with no overlying fractures. He also provided the first description of brain swelling exceeding the level of the skull, described several surgical indications and craniotomy techniques, recommended treatment for depressed fractures (which had been previously considered untreatable), and detailed the surgical instruments employed. De Medicina was based on the previous Greek medical knowledge, but Celsus also provided original innovations, personal observations, and even comments and criticisms. Despite the fact that he was almost forgotten during the Middle Age, most of his concepts and surgical advices remained in the medical background of the following 2 millennia.


Assuntos
Traumatismos Craniocerebrais/cirurgia , Neurocirurgia/história , História Antiga , Humanos
9.
Dent Traumatol ; 36(1): 19-24, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31162805

RESUMO

BACKGROUND/AIMS: Ketamine sedation has not been reported to be widely used as a pharmacological behavioural management strategy to facilitate the treatment of acute paediatric oro-dental trauma. The aim of this study was to investigate the safety and effectiveness of intramuscular ketamine sedation for managing paediatric oro-dental trauma in a paediatric Emergency Department (ED). METHODS: The database of all paediatric procedural sedations performed in the hospital ED from 01 January 2014 to 31 December 2016 was reviewed to identify cases where intramuscular ketamine sedation was administered for dentists' treatment of oro-dental trauma. Patient demographics and epidemiological data, the type and number of sedation-related adverse events, and interventions performed were extracted from the database. Clinical notes were reviewed to verify the dental diagnoses and dental treatment performed. Adverse events were further risk stratified using the World SIVA adverse event reporting tool. RESULTS: In the study period, 167 intramuscular ketamine sedations were administered by ED doctors for dental treatment of oro-dental trauma. The patients' median age was 3.6 years (range 1.1 to 12 years). All dental procedures were successfully completed. Nineteen adverse events were reported (11.4%, n = 19) with the most common being emesis (9.0%) followed by transient desaturation (1.8%) and hypersalivation (0.6%). The lowest oxygen saturation level was 90%. None of the patients aspirated, and none required assisted ventilation or chest compression. The most common dental diagnosis was primary tooth luxation (49.1%). The most common dental treatment was primary teeth extraction (70.7%). When adverse events were stratified using the World SIVA tool, there were only 17 (10.2%) minor risk outcomes. CONCLUSIONS: The data support the safety and effectiveness of intramuscular ketamine sedation administered by trained ED doctors to facilitate the management of paediatric oro-dental trauma emergencies.


Assuntos
Analgésicos , Anestesia , Sedação Consciente , Traumatismos Craniocerebrais , Ketamina , Traumatismos Dentários , Analgésicos/administração & dosagem , Criança , Pré-Escolar , Sedação Consciente/métodos , Serviço Hospitalar de Emergência , Humanos , Lactente , Ketamina/administração & dosagem , Boca/lesões
10.
Accid Anal Prev ; 134: 105297, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31683233

RESUMO

The motorcyclist is exposed to the risk of falling and impacting ground head-first at a wide range of travelling speeds - from a speed limit of less than 50 km/h on the urban road to the race circuit where speed can reach well above 200 km/h. However, motorcycle helmets today are tested at a single and much lower impact speed, i.e. 30 km/h. There is a knowledge gap in understanding the dynamics and head impact responses at high travelling speeds due to the limitation of existing laboratory rigs. This study used a finite element head model coupled with a motorcycle helmet model to simulate head-first falls at travelling speed (or tangential velocity at impact) from 0 to 216 km/h. The effect of different falling heights (1.6 m and 0.25 m) and coefficient of frictions (0.20 and 0.45) between the helmet outer shell and ground were also examined. The simulation results were analysed together with the analytical model to better comprehend rolling and/or sliding phenomena that are often observed in helmet oblique impacts. Three types of helmet-to-ground interactions are found when the helmet impacts ground from low to high tangential velocities: (1) helmet rolling without slipping; (2) a combination of sliding and rolling; and (3) continuous sliding. The tangential impulse transmitted to the head-helmet system, peak angular head kinematics and brain strain increase almost linearly with the tangential velocity when the helmet rolls but plateaus when the helmet slides. The critical tangential velocity at which the motion transit from the rolling regime to the sliding regime depends on both the falling height and friction coefficient. Typically, for a fall height of 1.63 m and a friction coefficient of 0.45, the rolling/sliding transition occurs at a tangential velocity of 10.8 m/s (38.9 km/h). Low sliding resistance in helmet design, i.e. by the means of a lower friction coefficient between the helmet outer shell and ground, has shown a higher reduction of brain tissue strain in the sliding regime than in the rolling regime. This study uncovers the underlying dynamics of rolling and sliding phenomena in high-speed oblique impacts, which largely affect head impact biomechanics. Besides, the study highlights the importance of testing helmets at speeds covering both the rolling and sliding regime since potential designs for improved head protection at high-speed impacts can be more distinguishable in the sliding regime than in the rolling regime.


Assuntos
Fricção , Dispositivos de Proteção da Cabeça , Motocicletas/estatística & dados numéricos , Aceleração , Acidentes de Trânsito/classificação , Fenômenos Biomecânicos/fisiologia , Traumatismos Craniocerebrais/etiologia , Traumatismos Craniocerebrais/prevenção & controle , Humanos , Fatores de Risco
11.
J Surg Res ; 245: 426-433, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31442746

RESUMO

BACKGROUND: The Pediatric Emergency Care Applied Research Network (PECARN) decision rule demonstrates high sensitivity for identifying children at low risk for clinically important traumatic brain injury (ciTBI). As with the PECARN rule, the Israeli Decision Algorithm for Identifying TBI in Children (IDITBIC) recommends proceeding directly to computed tomography (CT) in children with Glasgow Coma Score (GCS) <15. The aim was to assess the diagnostic accuracy of two clinical rules that assign children with GCS <15 at presentation directly to CT. MATERIALS AND METHODS: Accuracy analysis for detecting ciTBI was performed on a multicenter cohort of children used in the Australasian Pediatric Head Injury Rules Study. RESULTS: The external cohort included 18,913 children; 1691 (8.9%) had CT scan, 160 had ciTBI, and 24 (0.13%) had neurosurgery. Applying IDITBIC and PECARN rules would have missed 11 and 1 ciTBI patients; respectively. All patients with missed injuries were classified as such based on a hospital stay of >2 d. None of these patients died, needed neurosurgery, or required ventilatory support. In children aged <2 y, sensitivity, specificity, positive predictive value and negative predictive value of IDITBIC and PECARN rule were 95.2%, 79.5%, 3.8%, and 99.9% and 100.0%, 59.1%, 2.0%, and 100.0%, respectively. In children ≥2 y, sensitivity, specificity, positive predictive value and negative predictive value of IDITBIC and PECARN rule were 92.4%, 75.3%, 3.1%, and 99.9% and 99.2%, 52.9%, 1.7%, and 100.0%, respectively. CONCLUSIONS: The two decision rules demonstrated high accuracy in identifying ciTBI. As a screening tool, the PECARN rule outperformed IDITBIC. The findings suggest that clinicians should strongly consider directing children with GCS <15 at presentation to CT scan.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico , Adolescente , Algoritmos , Criança , Pré-Escolar , Estudos de Coortes , Traumatismos Craniocerebrais , Humanos , Lactente , Tomografia Computadorizada por Raios X
13.
Acta Neurochir Suppl ; 127: 185-190, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407083

RESUMO

The purpose was to determine the status of the cerebral arterial compliance (cAC) in a concomitant head injury and cerebral vasospasm (CVS) with and without the development of intracranial hematomas (ICH). In Materials and Methods, we examined 80 polytrauma patients with severe TBI and CVS. During or immediately after dynamic helical computed tomography angiography (DHCTA), the monitoring of the transcranial Doppler of the MCA was recorded bilaterally with 2-MHz probes. The cerebral blood volumes were calculated from the DHCTA data with complex mathematical procedures using the "direct flow model" algorithm. In Results, CAC was significantly decreased (p < 0.001) in both the first and second group TBI and CVS (with or without ICH) in comparison with normal data (p < 0.001) and TBI without CVS. The cAC was significantly decreased on the side of the former hematoma with CVS than on the contralateral side with CVS (р = 0.003). In Conclusion, the cAC in TBI and CVS gets significantly lower as compared to the normal condition (p < 0.001). After removal of the ICH and development of CVS, the compliance in the perifocal zone remains much lower (р = 0.003) as compared to compliance of the other brain hemisphere.


Assuntos
Artérias Cerebrais , Cérebro , Traumatismos Craniocerebrais , Hemorragia Subaracnóidea , Rigidez Vascular , Vasoespasmo Intracraniano , Artérias Cerebrais/fisiopatologia , Humanos , Ultrassonografia Doppler Transcraniana
14.
Acta Neurochir Suppl ; 127: 191-194, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407084

RESUMO

The aim of the study was to assess the time constant of cerebral arterial bed in TBI patients with cerebral vasospasm (CVS) with and without intracranial hematomas (ICH).We examined 84 patients with severe TBI (mean 35 ± 15 years, 53 men and 31 women). The first group included 41 patients without ICH and the second group included 43 patients with epidural (7) and subdural (36) hematomas.Perfusion computed tomography (PCT) was performed in 1-12 days after TBI in the first group and in 2-8 days after craniotomy in the second group. Arteriovenous amplitude of regional cerebral blood volume oscillation was calculated as the difference of arterial and venous blood volume in the "region of interest." Mean arterial pressure was measured and the flow rate of middle cerebral artery was recorded with Transcranial Doppler after PCT. Time constant was calculated by the formula modificated by M. Kasprowicz. Results and Conclusion: The τ was shorter (p < 0.005) in both first and second group in comparison with normal values. The τ in the second group on ipsilateral side former hematoma with CVS was shorter than in the first group and in the second group on contralateral side former hematoma without CVS (р = 0.024).


Assuntos
Traumatismos Craniocerebrais , Vasoespasmo Intracraniano , Traumatismos Craniocerebrais/complicações , Feminino , Hematoma , Humanos , Masculino , Artéria Cerebral Média , Ultrassonografia Doppler Transcraniana , Vasoespasmo Intracraniano/etiologia
16.
No Shinkei Geka ; 47(12): 1255-1259, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-31874946

RESUMO

Most cases of the primary brainstem injuries(PBSI)are fatal, and disturbance of consciousness is often prolonged even if lifesaving is obtained. The mechanisms of PBSI are as follows: diffuse axonal injury from acceleration/deceleration, shear strain at the midbrain, direct injury of neurovascular structures by tentorial margin, and lower brainstem injury by hyperextension of the cervical vertebrae. Though we can use both CT and MRI to diagnose, MRI is more helpful than CT in detecting, localizing, and characterizing PBSI. When the location of PBSI is limited in the ventral side of pons, it may occasionally result in locked in syndrome(LIS). Generally it is difficult to diagnose LIS with severe trauma due to the rarity of this syndrome caused by head injury. Here, we report a case of an elderly man with traumatic brainstem hemorrhage, who transiently presented LIS and finally improved.


Assuntos
Traumatismos Craniocerebrais , Tronco Encefálico , Humanos , Imagem por Ressonância Magnética , Masculino , Ponte
17.
Pan Afr Med J ; 33: 215, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692769

RESUMO

Introduction: Pediatric traumatic injury is a major public health concern that is poorly documented in lower and middle-income countries. This study analyzed data on pediatric injuries from a unique hospital trauma registry in Abuja, Nigeria. Methods: Data were analyzed on 220 traumatically injured patients aged 21 years/less to describe injury characteristics and to determine the association between mechanism of injury and pediatric head injuries in Abuja, Nigeria, between 2014 and 2015. Bivariate analysis using Pearson's chi-square and adjusted logistic regression were conducted to characterize the population and identify risk factors for head injury. P-values<0.05 were considered statistically significant. All statistical analyses were performed using STATA v.15.1. Results: The majority of patients were male (60.9%) with a mean age (SD) of 12.5±6.9 years. Head injuries were most common (49.6%), followed by chest (14.1%), abdomen (12.3%) and back (7.7%). The mechanism of injury was statistically significantly associated with head injury (p=0.027) with 63% of children in a motor vehicle accident sustaining a head injury. After adjusting for covariates, the odds of head injury were 3.8 times higher for children injured in a motor vehicle accidents (MVA) compared to those with falls (95%CI 1.40-10.40). Conclusion: This analysis reveals that motor vehicle accident is a risk factor for traumatic head injury among children in Nigeria. Therefore, efforts should be made to address motor vehicle accidents involving children. These data will help to inform age-related prevention and treatment strategies. The results of this study highlight the importance of collecting pediatric trauma data in developing countries.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Traumatismos Craniocerebrais/epidemiologia , Ferimentos e Lesões/epidemiologia , Adolescente , Criança , Pré-Escolar , Traumatismos Craniocerebrais/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Nigéria/epidemiologia , Sistema de Registros , Fatores de Risco , Ferimentos e Lesões/etiologia , Adulto Jovem
18.
Ulus Travma Acil Cerrahi Derg ; 25(6): 622-627, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31701501

RESUMO

BACKGROUND: In our study, we have tried to find out how necessary whole-body computed tomography (WBCT) is to detect other body injuries that may accompany the patients, evaluating head trauma cases with WBCT. METHODS: In our study, we included 198 patients, who were referred to our hospital's emergency service after head trauma, had brain lesions detected in brain tomography (BT), had no additional examination findings and who underwent WBCT. In this retrospective study, patients' age, gender, type of lesion in brain CT, Glasgow Coma Scale (GCS) values and WBCT findings were examined. RESULTS: In this study, 85.4% of the patients were male and the average age was 25.7 years. The most common cranial CT findings were fracture, followed by parenchymal bleeding. 67% of the patients' GCS were below 8. Additional trauma was detected in 78 of the patients (39.4%). The most common additional lesion was the thoracic contusion. The mean age of the patients with cervical injuries determined in CT was significantly high (p<0.05). Statistical significance was determined between cranial fracture, foreign body incidence and thoracic injuries (p<0.05). The incidence of cervical injuries was significantly higher in patients with brain contusion detected in CT (p<0.05). Fracture frequency and presence of additional lesions in WBCT were significantly high (p<0.05). There was no correlation between other cranial lesions and additional injury areas (p>0.05). CONCLUSION: The number of studies evaluating WBCT is high in the literature. However, our study is important concerning that to our knowledge this study is the first study to evaluate the WBCT findings in the head trauma cases without the additional lesions on their bodies. WBCT scan should be recommended in patients whose clinical evaluation could not be completed. WBCT is an important diagnostic tool for the diagnosis of many pathologies, especially for intrathoracic lesions.


Assuntos
Traumatismos Craniocerebrais , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Imagem Corporal Total/estatística & dados numéricos , Adulto , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/epidemiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismo Múltiplo/epidemiologia , Guias de Prática Clínica como Assunto , Traumatismos Torácicos/complicações , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/epidemiologia
19.
Curr Sports Med Rep ; 18(11): 394-400, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702721

RESUMO

Participation in skiing, and especially snowboarding, continues to rise. As participation and level of competition in these winter sports increases, the number of injuries increases as well. Upper-extremity injuries are more common in snowboarding, whereas lower-extremity injuries are more common in skiing. Head injuries, particularly concussions, are common in both sports. Special consideration in these sports should be given to environmental conditions, such as high altitude and ultraviolet radiation. The purpose of this review is to discuss the most common musculoskeletal injuries seen in skiing and snowboarding, as well as considerations for initial assessment of these injuries and triage to the appropriate level of care. It is important for sports medicine physicians covering these sports to understand initial assessment and treatment of these injuries. Due to the potential for severe injuries in these sports, it is important to be able to quickly recognize an injury that needs to be assessed and treated urgently or emergently. With the increased participation and number of injuries in these sports, it also is important to consider prevention strategies that may minimize risk of injury.


Assuntos
Traumatismos em Atletas/classificação , Esqui/lesões , Altitude , Traumatismos em Atletas/epidemiologia , Traumatismos Craniocerebrais , Humanos , Medicina Esportiva , Raios Ultravioleta
20.
Georgian Med News ; (294): 10-16, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687941

RESUMO

Aim - to evaluate pathogens and their susceptibility to antibiotic therapy (ABT) in combat-related penetrating craniocerebral gunshot wound (PCGW) patients and develop recommendations for treatment of post-traumatic meningoencephalitis. We conducted a prospective analysis of examination and treatment results of 121 patients who were admitted to the Public Institution, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine, from 25 May 2014, to 31 December 2017, and were successively enrolled in the study. Intracranial purulent-septic complications were diagnosed in 14 (11.6%) patients including eight cases of isolated meningoencephalitis, three cases of meningoencephalitis combined with ventriculitis, two cases of meningoencephalitis combined with ventriculitis and subdural empyema and one case of multiple brain abscesses. In most cases of combat-related craniocerebral wounds, infections are considered nosocomial and typically related to medical procedures and devices. In most cases, the effectiveness of first-line antibiotics was low, and it was often necessary to prescribe broad-spectrum ABT, including those related to second-line antibiotics and reserve drugs, according to the World Health Organisation classification. The use of initial de-escalation of empiric ABT with the broadest-spectrum drugs, mainly as a part of combination therapy for expected gram-positive and gram-negative aerobic and anaerobic infection pathogens, is recommended.


Assuntos
Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Infecções Bacterianas/complicações , Abscesso Encefálico/tratamento farmacológico , Traumatismos Craniocerebrais/complicações , Infecção da Ferida Cirúrgica/complicações , Infecção dos Ferimentos/tratamento farmacológico , Ferimentos Penetrantes/complicações , Adulto , Bactérias/classificação , Bactérias/isolamento & purificação , Abscesso Encefálico/epidemiologia , Abscesso Encefálico/microbiologia , Traumatismos Craniocerebrais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/microbiologia , Ucrânia/epidemiologia , Infecção dos Ferimentos/diagnóstico , Infecção dos Ferimentos/epidemiologia , Infecção dos Ferimentos/microbiologia
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