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Annals of Ibadan Postgraduate Medicine Apr 2024The white cerebellum sign (WCS) is a classical but rare radiological finding usually associated with irreversible diffuse hypoxic-ischemic cerebral injury. Very few...
INTRODUCTION
The white cerebellum sign (WCS) is a classical but rare radiological finding usually associated with irreversible diffuse hypoxic-ischemic cerebral injury. Very few cases exist in the literature globally, especially from the West African region, as a potential hallmark of poor prognostic outcome. We describe the white cerebellum sign in a Nigerian pediatric patient, managed for severe head injury.
CASE PRESENTATION
A fourteen-year old boy presented to our emergency department with loss of consciousness following a pedestrian road traffic accident. Physical examination revealed a critically ill boy with fever, hypotension, tachycardia, gasping respiration, GCS 3, bilateral dilated unreactive pupils, absent corneal, gag and oculocephalic reflexes. He was thus diagnosed of severe traumatic brain injury and brainstem dysfunction. He had endotracheal intubation, ventilatory and inotropic support. Cranial computerized tomography scan of the patient showed radiological features in keeping with the WCS. His clinical status remained poor until he suffered a cardiac arrest about twelve hours after admission.
CONCLUSION
WCS has been reported in relation to child abuse, anoxic-ischemic brain injury, inflammatory and metabolic brain disorders and trauma. It is a classical radiological description of diffuse cerebral edema alongside relatively normal cerebellar hemispheres and brainstem. Management of this pathology is symptomatic, and aims to ameliorate the associated raised intracranial pressure, control seizures and prevent cerebral infarction. The index patient, who presented 24 hours after severe head injury with associated early post-traumatic seizures, respiratory failure and brainstem dysfunction, had an unfavourable outcome consistent with previous reports of WCS. We have reported the rare but classical white cerebellum sign. It remains a grave prognosticator of cerebral injury and should be sought for in the neuroimaging of patients with acute brain insults.
PubMed: 38939880
DOI: No ID Found -
Acta Medica Philippina 2024Tibial plateau fractures are due to high energy trauma brought about by axial compression forces and associated varus or valgus component.
INTRODUCTION
Tibial plateau fractures are due to high energy trauma brought about by axial compression forces and associated varus or valgus component.
OBJECTIVE
Patients diagnosed with tibial plateau fractures from January to December 2018 treated with internal vs external fixation will be described according to their Schatzker classification. The study further aims to compare the functional outcomes between the two groups in terms of surgery done.
METHODS
A chart review determined the distribution of demographics. The Modified Rasmussen Score (MRS) was used to determine the clinical and radiographic parameters after taking a new knee radiograph and assessment from the rehabilitation department. The MRS determined the functional outcomes of the said patients. Ethical considerations and proper informed consent were upheld after being reviewed by the hospital's research committee.
RESULTS
Out of 48 patients, 35 underwent internal fixation via open reduction using plates and/or screws, while 13 underwent external fixation using hybrid external fixator. The demographic profile showed mostly males between ages 20 to 49 years old. Most cases were due to vehicular accidents affecting the left lower extremity. In terms of Schatzker classification, the most common was type VI. The computed mean MRS of the internal fixation group was 30.43 while the external fixation group was 30.00, generally showing no significant difference.
CONCLUSION
Surgical intervention of tibial plateau fractures aims for anatomic reduction using internal or external fixation. There was no significant difference on the functional outcome of the two groups despite classifying the respondents according to Schatzker type, hence we can conclude that external fixation be chosen as the treatment of choice for tibial plateau fractures when properly indicated.
PubMed: 38939854
DOI: 10.47895/amp.vi0.6181 -
JACC. Advances Dec 2023Altered coagulation is a striking feature of COVID-19. Adult patients with congenital heart disease (ACHD) are prone to thromboembolic (TE) and bleeding complications.
BACKGROUND
Altered coagulation is a striking feature of COVID-19. Adult patients with congenital heart disease (ACHD) are prone to thromboembolic (TE) and bleeding complications.
OBJECTIVES
The purpose of this study was to investigate the prevalence and risk factors for COVID-19 TE/bleeding complications in ACHD patients.
METHODS
COVID-19-positive ACHD patients were included between May 2020 and November 2021. TE events included ischemic cerebrovascular accident, systemic and pulmonary embolism, deep venous thrombosis, myocardial infarction, and intracardiac thrombosis. Major bleeding included cases with hemoglobin drop >2 g/dl, involvement of critical sites, or fatal bleeding. Severe infection was defined as need for intensive care unit, endotracheal intubation, renal replacement therapy, extracorporeal membrane oxygenation, or death. Patients with TE/bleeding were compared to those without events. Factors associated with TE/bleeding were determined using logistic regression.
RESULTS
Of 1,988 patients (age 32 [IQR: 25-42] years, 47% male, 59 ACHD centers), 30 (1.5%) had significant TE/bleeding: 12 TE events, 12 major bleeds, and 6 with both TE and bleeding. Patients with TE/bleeding had higher in-hospital mortality compared to the remainder cohort (33% vs 1.7%; < 0.0001) and were in more advanced physiological stage ( = 0.032) and NYHA functional class ( = 0.01), had lower baseline oxygen saturation ( = 0.0001), and more frequently had a history of atrial arrhythmia ( < 0.0001), previous hospitalization for heart failure ( < 0.0007), and were more likely hospitalized for COVID-19 ( < 0.0001). By multivariable logistic regression, prior anticoagulation (OR: 4.92; 95% CI: 2-11.76; = 0.0003), cardiac injury (OR: 5.34; 95% CI: 1.98-14.76; = 0.0009), and severe COVID-19 (OR: 17.39; 95% CI: 6.67-45.32; < 0.0001) were independently associated with increased risk of TE/bleeding complications.
CONCLUSIONS
ACHD patients with TE/bleeding during COVID-19 infection have a higher in-hospital mortality from the illness. Risk of coagulation disorders is related to severe COVID-19, cardiac injury during infection, and use of anticoagulants.
PubMed: 38938489
DOI: 10.1016/j.jacadv.2023.100701 -
Trauma Case Reports Aug 2024In this case report, we discuss a rare incident of avulsion-type renal injury in a 24-year-old male with no significant medical history. The injury occurred during a...
In this case report, we discuss a rare incident of avulsion-type renal injury in a 24-year-old male with no significant medical history. The injury occurred during a traffic accident, where he was involved in a direct impact collision between a motorcycle and a vehicle, leading to altered corticomedullary differentiation in the right kidney, a retroperitoneal hematoma, and free fluid in the cavity. The patient underwent successful emergency abdominal surgery, which involved the removal of the damaged kidney due to the severity of the injury. During his postoperative recovery in the ICU, he received extensive care, including sedation, mechanical ventilation, and vasopressor support. Ultimately, he made a successful recovery and was discharged after rehabilitation. This case highlights the complexities involved in managing patients with renal injuries resulting from high-energy impact accidents. It emphasizes the importance of a multidisciplinary approach in treatment, the challenges associated with deciding on surgical intervention, and the significance of rehabilitation in patient recovery. The uniqueness of this case, characterized by its distinct mechanism of injury and the severity of the trauma, contributes to our broader understanding of renal trauma management in the field of trauma medicine. It underscores the need for personalized patient care strategies and emphasizes the effectiveness of surgical interventions in severe cases of renal trauma.
PubMed: 38938411
DOI: 10.1016/j.tcr.2024.101055 -
PLOS Global Public Health 2024Road traffic accidents account for 1.35 million deaths and up to 50 million injuries each year globally, mostly among persons aged 5-29 years. The existing road safety...
Road traffic accidents account for 1.35 million deaths and up to 50 million injuries each year globally, mostly among persons aged 5-29 years. The existing road safety measures in Ghana are grossly inadequate, leading to occurrence of unprecedented Road Traffic Accidents (RTA). This study sought to document the epidemiological indices and determine the public health implications of Road Traffic Accidents and the socio-economic effect on lives of RTA victims in Ho and Hohoe Municipalities of the Volta Region in Ghana. A cross-sectional study was carried out among 198 road traffic accident victims who reported to three health facilities in the Volta Region of Ghana. The victims were interviewed using a structured questionnaire. Principal component analysis was done to categorize RTA victims into various economic status. The results show that out of the 198 road traffic accident victims who were interviewed, 50% were breadwinners of their families. Approximately 40% of the accident cases happened between 12 mid-day and 6 o'clock in the evening. Among the RTA cases recorded, 35% involved four-wheeler vehicles. Majority (88%) of those with injuries resulting from motorcycle accidents sustained a head injury; 70% of the respondents who sustained a disability from RTA were unable to perform activity of daily living (i.e. bathing, oral care, and toileting). The average cost of care on RTA victims from formal and informal health care facilities, at the time of this study, was GHC 902 (US$150) and GHC 724 (US$120) respectively. In conclusion, the increase in usage of motorcycles as a means of transport has contributed significantly to the incidence of RTAs in the Ho and Hohoe municipalities posing a public health concern. Majority of RTAs resulted in head injuries and other disabilities which affected their ability to perform activities of daily living and posed significant economic cost to victims and their families who are mostly already in lower wealth quintiles.
PubMed: 38935786
DOI: 10.1371/journal.pgph.0003238 -
International Journal of Qualitative... Dec 2024The study aims to describe Swedish RNs' experiences of acute assessments at home. More patients with complex nursing needs are cared for at home due to an ageing...
PURPOSE
The study aims to describe Swedish RNs' experiences of acute assessments at home. More patients with complex nursing needs are cared for at home due to an ageing population. Registered nurses (RNs) who work with home healthcare need a broad medical competence and clinical experience alongside adapted decision support systems for maintaining patient safety in acute assessments within home healthcare.
METHODS
A content analysis of qualitative survey data from RNs ( = 19) working within home healthcare in Sweden.
RESULTS
There were challenges in the acute assessments at home due to a lack of competence since several of the RNs did not have much experience working as an RN in home healthcare. Important information was missing about the patients, such as access to medical records due to organizational challenges and limited access to equipment and materials. The RNs needed support in the form of cooperation with a physician, support from colleagues, and a decision support system.
CONCLUSION
To increase the possibility of patient-safe assessments at home, skills development, collegial support, and an adapted decision support system are needed. Collaboration with primary healthcare, on-call physicians, and nursing staff, and having the opportunity to consult with someone also provide security in acute assessments.
Topics: Humans; Sweden; Home Care Services; Female; Nurses; Male; Adult; Middle Aged; Surveys and Questionnaires; Qualitative Research; Clinical Competence; Attitude of Health Personnel; Patient Safety; Nursing Assessment
PubMed: 38934804
DOI: 10.1080/17482631.2024.2373541 -
Indian Journal of Dental Research :... Jan 2024During orthodontic treatment, temporary anchoring devices (TADs) are used to restrain tooth movement. They are a relatively recent addition to the dental toolkit.
INTRODUCTION
During orthodontic treatment, temporary anchoring devices (TADs) are used to restrain tooth movement. They are a relatively recent addition to the dental toolkit.
AIM
As TADs have limitations, Dr. Eric Lieu of Taiwan developed Infra Zygomatic Crest (IZC) screws which are placed between the maxillary second premolar at the bony crest.
TREATMENT PLANNING
The goal of this case study is to emphasize the value of anatomy, site selection, and IZC retrieval in the event of an accident. Cone beam computed tomography was used as a diagnostic tool for the precise location of the displaced IZC and immediate surgical retrieval was done under local anesthesia from the infratemporal space to prevent further complications.
TAKEAWAY LESSONS
Orthodontists knowledge of soft tissue and hard tissue anatomy and precise positioning is crucial for successful TAD implantation.
Topics: Humans; Orthodontic Anchorage Procedures; Cone-Beam Computed Tomography; Zygoma; Bone Screws; Male; Female; Bicuspid; Maxilla; Tooth Movement Techniques
PubMed: 38934757
DOI: 10.4103/ijdr.ijdr_143_23 -
Archivio Italiano Di Urologia,... Jun 2024The retention of foreign bodies inside the body during ludic/sexual procedures or for traumatism represents one of the causes of visits to accident and emergency...
BACKGROUND
The retention of foreign bodies inside the body during ludic/sexual procedures or for traumatism represents one of the causes of visits to accident and emergency departments that often requires surgical removal of the foreign body. However, there are cases where the discovery of such foreign bodies takes place after many years, as in patients that are slightly compromised from a neuro-sociological point of view.
CASE PRESENTATION
A 76-year-old male presented to an outpatient urological examination due to an increase in scrotal volume. At the ultrasound check, an acoustic interference from a solid object was detected, for which computed tomography was requested. The computed tomography scan revealed the presence of an elongated metal body in the perineum. The removal of the foreign body in the operating theatre was then scheduled. A 10 cm long stainless-steel nail located within an abscessed foreign body granuloma was identified and removed via a scrotal access. Four days later, a new surgical toilet was performed due to minimal necrosis of the skin flaps. The patient then performed three more dressings in the operating theatre during the following week. Healing took place by secondary intention until a perfect healing of the surgical wound was obtained.
CONCLUSIONS
Removal of foreign bodies from the perineum in case of infection can be challenging. Careful attention and postoperative dressings are crucial for the success of the case.
Topics: Humans; Male; Aged; Foreign Bodies; Scrotum; Stainless Steel; Nails; Tomography, X-Ray Computed
PubMed: 38934526
DOI: 10.4081/aiua.2024.12363 -
Cardiorenal Medicine Jun 2024Studies exploring the effectiveness and safety of percutaneous left atrial appendage occlusion (pLAAO) in patients with chronic kidney disease (CKD) are limited.
BACKGROUND
Studies exploring the effectiveness and safety of percutaneous left atrial appendage occlusion (pLAAO) in patients with chronic kidney disease (CKD) are limited.
OBJECTIVES
We aimed to analyze trends and outcomes following pLAAO in patients with CKD.
METHODS
We utilized the National Inpatient Sample (NIS) to identify hospitalizations for pLAAO from 2016-2020 and further identified cases with concomitant CKD. The primary outcome was mortality, and secondary outcomes were cerebrovascular accidents, major bleeding, vasopressor requirements, percutaneous coronary intervention, cardiac arrest, acute respiratory failure, transfusion, length of stay (LOS), and total hospital charges. Multivariable logistic regression was performed to further adjust for covariates.
RESULTS
A total of 89,309 pLAAO procedures from 2016 to 2020 were identified, of which 21,559 (24.1%) reported concomitant CKD, with males comprising the majority (62.2%). An increasing trend in pLAAO procedures was seen from 2.24 to 13.9 per 10,000 patients from 2016 to 2020. Despite patients with CKD having a higher rate of most comorbidities, there was no difference in mortality (non-CKD vs. CKD, 0.07% vs. 0.42%; aOR: 1.3, 95% CI: 0.4 - 4.4, p=0.686) and complications for CKD and non-CKD patients, while CKD patients had longer LOS and higher total hospital charge. No significant sex differences in outcomes among CKD patients were observed except for a longer LOS in females.
CONCLUSION
Despite generally having more comorbidities, outcomes of patients with CKD following pLAAO are similar to those without CKD, suggesting that pLAAO can be offered as a safe option for the treatment of AF in eligible patients with CKD.
PubMed: 38934134
DOI: 10.1159/000539953 -
Heliyon Jun 2024Ergonomic risk factors are a prominent cause of fatality and severe injuries in building constructions. Hence, this study applies a Structural Equation Modeling (SEM)...
Structural equation modeling approach for the analysis of ergonomics risk factors and occupational injuries among building construction workers in Bahir Dar City-Ethiopia.
Ergonomic risk factors are a prominent cause of fatality and severe injuries in building constructions. Hence, this study applies a Structural Equation Modeling (SEM) approach to analyze ergonomics risk factors and occupational injuries among building construction workers in Bahir Dar City, Ethiopia. The results indicate significant relationships between ergonomics risk factors and the prevalence of occupational injuries. This study's findings contribute to the understanding of occupational health and safety in the construction industry, highlighting the need for targeted interventions. A cross-sectional study has been carried out, where data was collected through direct observations and standardized pretested questionnaires. The study recruited 220 participants in the construction industry. The data was analyzed using AMOS to study the direct and indirect effects of the identified variable. SEM has shown that the magnitude of the prevalence of occupational injury was 65.2 %. The results also revealed that the mostly affected body parts were lower arm, lower leg, hand, toe, and knee. Carpenter & roofers, plasterer and daily labors & other helpers were highly injury subjected occupations in respective order. The six leading significant risk factors were, do not tie belt at scaffold, falling stairways & ladders, exposure hazardous substances, tools & machinery, electricity (electric power accidents), repetitive tasks, the layout didn't consider health & safety aspects in the site, and do not provide safety orientation for new workers engaging the job. Employees are mostly affected on their lower body parts which needs more focus to prevent it, especially carpenter & roofers, plasterer and daily labors. Also the findings show that 50 % of respondents agree that the higher priority for safety and health management practices should be given to finishing part of the construction followed by excavation and earth work, masonry, and electrical installations. Therefore, it is recommended that the contractors must focus more on the finishing phase.
PubMed: 38933936
DOI: 10.1016/j.heliyon.2024.e32234