Attempted suicide with a crossbow.

INTRODUCTION: Airway management and control of bleeding are essential aspects of the management of attempted suicide involving the head and neck. Attempted suicide using a crossbow is exceptional. The patient's respiratory status, the position of the crossbow bolt in the head and neck, the type of bolt and its exit wound required airway management that has not been previously reported in the literature. CASE REPORT: This conscious patient had attempted suicide by shooting a crossbow bolt to the head. The radiological assessment (contrast-enhanced CT scan) did not reveal any vascular, ophthalmological or neurological lesions. The submental entry wound of the bolt avoided any damage to the lingual and ethmoidal arteries, lamina papyracea, or frontal lobe. The bolt induced mechanical trismus and its position limited access to the base of the neck, preventing orotracheal intubation. Nasotracheal intubation and primary tracheotomy were also difficult in this situation. It was therefore decided to remove the bolt while the patient was still conscious, rapidly followed by intubation, with no complications. CONCLUSION: In attempted suicide by crossbow involving the head and neck, airway management depends on the possibility of exposure of the glottis, the bolt exit wound and safe access to the anterior neck.

Impact of projected sea surface temperature biases on tropical cyclones projections in the South Pacific.

Climate model projections generally indicate fewer but more intense tropical cyclones (TCs) in response to increasing anthropogenic emissions. However these simulations suffer from long-standing biases in their Sea Surface Temperature (SST). While most studies investigating future changes in TC activity using high-resolution atmospheric models correct for the present-day SST bias, they do not consider the reliability of the projected SST changes from global climate models. The present study illustrates that future South Pacific TC activity changes are strongly sensitive to correcting the projected SST changes using an emergent constraint method. This additional correction indeed leads to a strong reduction of the cyclogenesis (-55%) over the South Pacific basin, while no statistically significant change arises in the uncorrected simulations. Cyclogenesis indices suggest that this strong reduction in the corrected experiment is caused by stronger vertical wind shear in response to a South Pacific Convergence Zone equatorward shift. We thus find that uncertainty in the projected SST patterns could strongly hamper the reliability of South Pacific TC projections. The strong sensitivity found in the current study will need to be investigated with other models, observational constraint methods and in other TC basins in order to assess the reliability of regional TC projections.

Screening for retinopathy of prematurity by telemedicine in a tertiary level neonatal intensive care unit in France: Review of a six-year period.

PURPOSE: To analyze the prevalence and risk factors for retinopathy of prematurity (ROP) and severe (treatment-requiring) ROP. METHODS: A retrospective study was conducted in a level III neonatal unit in Bordeaux, France, from 2009 to 2015. Four hundred and nineteen preterm infants who were screened for ROP exclusively by RetCam were included. RESULTS: ROP of any degree was diagnosed in 27.68% of infants. Stages 1, 2, 3 and 4 ROP was found in 44%, 46%, 9% and 1% of subjects, respectively. No stage 5 ROP was observed. 28/419 infants (6.6%) were treated exclusively with laser photocoagulation. No intravitreal anti-VEGF injections or surgical treatments were performed. No infants born at>31 weeks or with BW>1110g required ROP treatment. On multivariate analysis, risk factors for ROP development were low birth weight, low gestational age at birth, high duration of invasive mechanical ventilation, shock or use of vasopressors. On multivariate analysis, risk factors for severe, treatment-requiring ROP were male gender, gestational age≤27 weeks and Apgar score at 5minutes≤7. CONCLUSION: In our 6-year series, ROP was successfully identified on screening exclusively by telemedicine, and no surgical treatment was required. This study identifies known ROP risk factors, but the Apgar score at 5minutes as a risk factor for severe ROP requires further studies in order to be confirmed.

Impact of new prostheses on the oral health related quality of life of edentulous patients.

OBJECTIVE: A study was conducted to evaluate the impact of the placement of complete dentures by using the Global Oral Health Assessment Index (GOHAI). BACKGROUND: Oral health quality of life indicators can be used to evaluate the effects of dental treatments. MATERIAL AND METHODS: The 26 participants were treated in a French University Clinic during 2002. They were randomly divided into two groups. Each group received new prostheses, but evaluation of the quality of life was made at different periods [baseline, denture placement (group 1), 6 and 12 weeks (group 2) after placement]. A questionnaire was used to collect information on patient's satisfaction with the previous and new prostheses. Nonparametric tests were used to test the relationships between patients' satisfaction or baseline data and GOHAI variations with time as well as to compare mean values of GOHAI within each group. RESULTS: At baseline, the impact of oral health problems was apparent; the mean GOHAI-Add score was 45.8 (10.2). Six weeks after placement of the new denture, there was no difference in GOHAI scores compared with the initial assessment. An improvement in GOHAI score was observed 12 weeks after the participants received their new dentures (p < 0.05). Change in GOHAI-Add scores was negatively correlated with the initial GOHAI-Add score. Patients who preferred the new prosthesis enjoyed a positive change in GOHAI scores (p < 0.001). There was a relationship between participants' satisfaction with the new dentures and change in GOHAI scores (p < 0.05). CONCLUSION: The GOHAI can be used to evaluate needs for and effect of the making of new complete dentures.