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Journal of Wound Care Mar 2024
Topics: Animals; Skin Transplantation; Wound Healing; Plastic Surgery Procedures; Blast Injuries; Acellular Dermis
PubMed: 38457300
DOI: 10.12968/jowc.2024.33.Sup3.S11 -
European Journal of Case Reports in... 2024Until now, only a few cases of Valsalva-induced barotraumas (pneumothorax, pneumomediastinum and subcutaneous emphysema) have been described, and none of them among...
BACKGROUND
Until now, only a few cases of Valsalva-induced barotraumas (pneumothorax, pneumomediastinum and subcutaneous emphysema) have been described, and none of them among COVID-19 patients.
CASE DESCRIPTION
A man in his 50s was admitted for SARS-CoV-2-related acute respiratory distress syndrome (ARDS). Initial evolution was favourable with non-invasive ventilatory support, high-flow oxygen nasal cannula and the best supportive drugs available at the time. During the Valsalva manoeuvre while defecating, the patient reported sudden chest pain and showed a new acute hypoxemic respiratory failure due to a pneumothorax. It led to multiple complications (pulmonary embolism, haemoptysis, and cardiac arrest), and despite the best supportive care, led to the patient's death.
DISCUSSION
The Valsalva manoeuvre can be an overlooked cause of pneumothorax in patients with COVID-19. Predisposition to barotrauma in COVID-19 patients could be explained by several factors, including the extensive use of non-invasive and invasive ventilation during the pandemic, and the histological changes observed in the lungs of those infected with COVID-19.
CONCLUSION
We report the first description of a Valsalva-induced barotrauma in a COVID-19 infection. We emphasise the importance of treating constipation particularly in severe COVID-19 cases, to prevent complications such as barotrauma.
LEARNING POINTS
Pneumothorax is a common complication of severe COVID-19 infection, but Valsalva manoeuvre-induced pneumothorax in COVID-19 patients has never been reported previously.Particular care should be taken to prevent and treat constipation in hospitalised patients as it may cause a wide range of complications, including barotraumatism.The extensive use of non-invasive and invasive ventilation may play a role in barotrauma, but causal association has not been proven.
PubMed: 38455690
DOI: 10.12890/2024_004217 -
Radiology Case Reports May 2024Crack is the most potent form of cocaine. It directly affects lungs if inhaled and the damage may include barotrauma, acute pulmonary edema, alveolar hemorrhage,...
Crack is the most potent form of cocaine. It directly affects lungs if inhaled and the damage may include barotrauma, acute pulmonary edema, alveolar hemorrhage, bronchiolitis obliterans with organizing pneumonia, or vasculitis. The diagnosis of cocaine-related lung damage is based on clinical symptoms and radiological findings. When young individuals develop respiratory symptoms, investigation into cocaine use is necessary. We report the case of a young man with a history of cocaine use who presented for respiratory and neurological symptoms revealing crack lung and toxic cerebral vasculitis.
PubMed: 38444596
DOI: 10.1016/j.radcr.2024.02.015 -
World Neurosurgery May 2024In large-scale naval battles during World War II, sailors sometimes sustained serious lower limb injuries when explosion blast of sea mines was transmitted from...
Contemporary History of Spine Fractures Following Deck-Slap Injury: From Deck Blast During World War II Naval Battles to Axial Trauma During Touristic Speedboat Sea Cruise in 21st Century.
In large-scale naval battles during World War II, sailors sometimes sustained serious lower limb injuries when explosion blast of sea mines was transmitted from underneath through the metal deck of the ships. Some of these sailors were thrown in the air due to the blast and sustained axial trauma of the spine when they landed on the hard deck, which was thus called a deck slap by Captain Joseph Barr in 1946, among others. Nowadays, this peculiar mechanism has shifted to the civilian setting. Tourists unaware of the danger may sustain spine compression fractures when they sit at the bow of speed boats while underway on a calm sea. When the craft unexpectedly crosses the wake of another ship, tourists are thrown a few feet in the air before suffering a hard landing on their buttocks. This historical vignette is presented as a preventive message to help to reduce this poorly known yet avoidable "summer wave of vertebral fractures."
Topics: Humans; Blast Injuries; History, 20th Century; History, 21st Century; Military Personnel; Ships; Spinal Fractures; Travel; World War II
PubMed: 38437981
DOI: 10.1016/j.wneu.2024.02.140 -
Methods in Molecular Biology (Clifton,... 2024Traumatic brain injury (TBI) is one of the foremost causes of disability and death globally. Prerequisites for successful therapy of disabilities associated with TBI...
Traumatic brain injury (TBI) is one of the foremost causes of disability and death globally. Prerequisites for successful therapy of disabilities associated with TBI involved improved knowledge of the neurobiology of TBI, measurement of quantitative changes in recovery dynamics brought about by therapy, and the translation of quantitative methodologies and techniques that were successful in tracking recovery in preclinical models to human TBI. Frequently used animal models of TBI in research and development include controlled cortical impact, fluid percussion injury, blast injury, penetrating blast brain injury, and weight-drop impact acceleration models. Preclinical models of TBI benefit from controlled injury settings and the best prospects for biometric quantification of injury and therapy-induced gradual recovery from disabilities. Impact acceleration closed head TBI paradigm causes diffuse TBI (DTBI) without substantial focal brain lesions in rats. DTBI is linked to a significant rate of death, morbidity, and long-term disability. DTBI is difficult to diagnose at the time of hospitalization with imaging techniques making it challenging to take prompt therapeutic action. The weight-drop method without craniotomy is an impact acceleration closed head DTBI model that is used to induce mild/moderate diffuse brain injuries in rodents. Additionally, we have characterized neuropathological and neurobehavioral outcomes of the weight-drop model without craniotomy for inducing closed head DTBI of graded severity with a range of mass of weights (50-450 gm). This chapter also discusses techniques and protocols for measuring numerous functional disabilities and pathological changes in the brain brought on by DTBI.
Topics: Humans; Rats; Animals; Disease Models, Animal; Brain Injuries, Traumatic; Brain Injuries; Blast Injuries; Craniotomy
PubMed: 38427262
DOI: 10.1007/978-1-0716-3662-6_38 -
Herzschrittmachertherapie &... Mar 2024In 1930, Wolff, Parkinson and White described the syndrome that bears their names. The mechanisms of supraventricular tachycardias were analyzed by brilliant... (Review)
Review
In 1930, Wolff, Parkinson and White described the syndrome that bears their names. The mechanisms of supraventricular tachycardias were analyzed by brilliant electrocardiography interpretation by Pick and Langendorf. Wellens and Durrer using electrophysiologic studies analyzed the tachycardia mechanism invasively. In Germany the group by Seipel and Breithardt as well as Neuss and Schlepper studied the tachycardia mechanisms and response to antiarrhythmic drugs invasively by electrophysiological studies. Following the first successful interruption of an accessory pathway by Sealy in 1967, surgeons and electrophysiologists cooperated in Germany. Two centers, Hannover and Düsseldorf were established. Direct current (DC) ablation of accessory pathways was introduced by Morady and Scheinman. Because of side effects induced by barotrauma of DC, alternative strategies were studied. In 1987, radiofrequency ablation was introduced and thereafter established as curative therapy of accessory pathways in all locations.
Topics: Humans; Wolff-Parkinson-White Syndrome; Pre-Excitation Syndromes; Tachycardia, Supraventricular; Tachycardia; Accessory Atrioventricular Bundle; Catheter Ablation; Electrocardiography
PubMed: 38427036
DOI: 10.1007/s00399-024-01000-6 -
Journal of Applied Physiology... Apr 2024Decompression sickness (DCS) is caused by gaseous nitrogen dissolved in tissues forming bubbles during decompression. To date, no method exists to identify nitrogen...
Decompression sickness (DCS) is caused by gaseous nitrogen dissolved in tissues forming bubbles during decompression. To date, no method exists to identify nitrogen within tissues, but with advances in positron-emission tomography (PET) technology, it may be possible to track gaseous radionuclides into tissues. We aimed to develop a method to track nitrogen movement in vivo and under hyperbaric pressure that could then be used to further our understanding of DCS using nitrogen-13 (N). A single anesthetized female Sprague-Dawley rat was exposed to 625 kPa, composed of air, isoflurane, and N for 10 min. The PET scanner recorded N during the hyperbaric exposure with energy windows of 250-750 keV. The PET showed an increase in N concentration in the lung, heart, and abdominal regions, which all reached a plateau after ∼4 min. This showed that it is possible to gain noninvasive in vivo measurements of nitrogen kinetics through the body while at hyperbaric pressures. Tissue samples showed radioactivity above background levels in the blood, brain, liver, femur, and thigh muscle when assessed using a γ counter. The method can be used to evaluate an array of challenges to our understanding of decompression physiology by quantifying nitrogen load through γ counts of N, and signal intensity of the PET. Further development of the method will improve the specificity of the measured outcomes, and enable it to be used with larger mammals, including humans. This article describes a method for the in vivo quantification and tracking of nitrogen through the mammalian body whilst exposed to hyperbaric pressure. The method has the potential to further our understanding of decompression sickness, and quantitatively evaluate the effectiveness of both the treatment and prevention of decompression sickness.
Topics: Humans; Rats; Animals; Female; Nitrogen; Decompression Sickness; Diving; Rats, Sprague-Dawley; Decompression; Gases; Hyperbaric Oxygenation; Positron-Emission Tomography; Mammals; Nitrogen Radioisotopes
PubMed: 38420678
DOI: 10.1152/japplphysiol.00859.2023 -
Frontiers in Physiology 2024Intrapulmonary air-filled cavities, e.g., bullae, blebs, and cysts, are believed to contribute topulmonary barotrauma (PBT) and arterial gas embolism (AGE) in divers....
Intrapulmonary air-filled cavities, e.g., bullae, blebs, and cysts, are believed to contribute topulmonary barotrauma (PBT) and arterial gas embolism (AGE) in divers. However, literature is unclear about the prevalence of bullae in healthy adults, ranging from 2.3-33.8%. While this could in part be explained due to increasing quality of radiologic imaging, such as computed tomography (CT) scans, other methodological factors may also affect these findings. This study aims to ascertain the prevalence of bullae in young and healthy adults. This single-center cross-sectional observational study re-assessed the CT scans of adults (aged 18-40) performed for a clinical suspicion for pulmonary embolism, from 1 January 2016 to 1 March 2020. Presence of bullae was recorded in an electronic database. Chi-square and Fisher exact tests were used for statistical analyses. Additionally, a multivariate logistic regression analysis was performed to study the independent predictive value of identified risk factors. A total of 1,014 cases were identified, of which 836 could be included. Distribution amongst age groups (18-25, 26-30, 31-35, and 36-40) was almost equally, however, 75% of the population was female. Of the male proportion, 41% smoked, compared to 27% in females. In 7.2% (95% CI 5.6-9.1) bullae were identified. The prevalence increased with increasing age ( < 0.001), with odd ratios up to 5.347 (95% CI 2.164-13.213, < 0.001) in the oldest age group. Males and smokers had higher odds ratios for bullae of 2.460 (95% CI 1.144-4.208; = 0.001) and 3.406 (95% CI 1.878-6.157, < 0.001), respectively. Similar results were seen in the multivariate logistic regression analysis, where age, male sex and smoking were all statistically significant independent risk factors for bullae. Bullae were seen in 7.2% of a healthy population up to 40 years old. Increasing age, smoking, and being male were identified as statistically significant risk factors, both in independent and in multivariate logistic regression analyses. Our observations may warrant a re-evaluation of the contribution of bullae to PBT and AGE, as the latter two occur very rarely and bullae appear to be more frequently present than earlier assumed.
PubMed: 38420621
DOI: 10.3389/fphys.2024.1349229 -
JNMA; Journal of the Nepal Medical... Feb 2024Fireworks can cause severe ocular injuries which can be prevented if used with proper precautions. It causes not only mechanical injuries but also thermal and chemical...
INTRODUCTION
Fireworks can cause severe ocular injuries which can be prevented if used with proper precautions. It causes not only mechanical injuries but also thermal and chemical injuries. This study aimed to find out the prevalence of ocular firework injuries among patients presented to the emergency department during festival season in a tertiary eye hospital.
METHODS
This is a descriptive cross-sectional study done among patients presenting in the emergency department of a tertiary eye hospital after obtaining ethical approval from the Institutional Review Committee. Data of patients from medical records between 26 October 2021 to 28 November 2021 and 15 October 2022 to 17 November 2022 was collected. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.
RESULTS
Among 132 patients, the prevalence of ocular firework injuries was seen in 73 (55.30%) (46.82-63.78, 95% Confidence Interval). Closed globe injury was mostly observed in 56 (76.71%) patients with ocular injuries. The most common age group affected was those less than 30 years old 54 (73.97%).
CONCLUSIONS
The prevalence of ocular firework injuries was found to be lower than other studies done in similar settings. Protective measures should be used to prevent ocular injuries. A public awareness program needs to be launched before such festivals.
KEYWORDS
festivals; injuries; prevalence.
Topics: Humans; Adult; Holidays; Blast Injuries; Seasons; Cross-Sectional Studies; Incidence; Eye Injuries; Emergency Service, Hospital; Hospitals; Tertiary Care Centers
PubMed: 38409985
DOI: 10.31729/jnma.8433 -
Journal of Clinical Medicine Feb 2024The use of neuromuscular blocking agents (NMBAs) is common in the intensive care unit (ICU). NMBAs have been used in critically ill patients with lung diseases to... (Review)
Review
The use of neuromuscular blocking agents (NMBAs) is common in the intensive care unit (ICU). NMBAs have been used in critically ill patients with lung diseases to optimize mechanical ventilation, prevent spontaneous respiratory efforts, reduce the work of breathing and oxygen consumption, and avoid patient-ventilator asynchrony. In patients with acute respiratory distress syndrome (ARDS), NMBAs reduce the risk of barotrauma and improve oxygenation. Nevertheless, current guidelines and evidence are contrasting regarding the routine use of NMBAs. In status asthmaticus and acute exacerbation of chronic obstructive pulmonary disease, NMBAs are used in specific conditions to ameliorate patient-ventilator synchronism and oxygenation, although their routine use is controversial. Indeed, the use of NMBAs has decreased over the last decade due to potential adverse effects, such as immobilization, venous thrombosis, patient awareness during paralysis, development of critical illness myopathy, autonomic interactions, ICU-acquired weakness, and residual paralysis after cessation of NMBAs use. The aim of this review is to highlight current knowledge and synthesize the evidence for the effects of NMBAs for critically ill patients with lung diseases, focusing on patient-ventilator asynchrony, ARDS, status asthmaticus, and chronic obstructive pulmonary disease.
PubMed: 38398494
DOI: 10.3390/jcm13041182