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International Journal of Surgery Case... Jun 2024The surgical removal of unexploded mortar shells is rarely documented in the literature. Since most cases occur within war or conflict regions, reporting such instances...
INTRODUCTION AND SIGNIFICANCE
The surgical removal of unexploded mortar shells is rarely documented in the literature. Since most cases occur within war or conflict regions, reporting such instances is vital for optimizing and enhancing surgical practices, particularly in low-resource settings.
CASE PRESENTATION
We report the case of a 35-year-old man who sustained an injury from a 60 mm unexploded mortar shell, penetrating the patient's right posterior chest in the right paravertebral region of the 4th thoracic vertebra, causing intrathoracic injuries, multiple rib fractures, and a right pneumothorax. The patient was immediately resuscitated and transferred to the operating room. The projectile was removed without direct contact with metal instruments. A right chest tube was then inserted and the injured area was repaired, resulting in an uneventful postoperative recovery.
CLINICAL DISCUSSION
Unexploded mortar shell injuries are infrequently documented in the literature. These injuries are seen within war and conflict regions, that have limited accessibility or availability of experienced explosive ordnance disposal (EOD) teams, transporting personnel, and equipped and separated operating theaters.
CONCLUSION
Unexploded ordnance and munitions represent an underrecognized and underreported health risk to patients, healthcare providers, and healthcare facilities. These injuries are commonly encountered within regions that lack experienced transport and EOD staff. The need for the establishment of such experienced teams along with providing adequate training for healthcare providers is necessary.
PubMed: 38943933
DOI: 10.1016/j.ijscr.2024.109967 -
Journal of the Endocrine Society May 2024The association of obesity with bone fragility fractures is complex and non-linear. Despite good efficacy on weight loss, bariatric surgery (BS) is also associated with...
CONTEXT
The association of obesity with bone fragility fractures is complex and non-linear. Despite good efficacy on weight loss, bariatric surgery (BS) is also associated with bone loss. However, we lack information on risk factors of the long-term deleterious effects of BS on the skeleton.
OBJECTIVE
We aimed to assess the factors associated with low bone mineral density (BMD) performed a long time after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG).
METHODS
This cross-sectional study involved patients at a long distance from their BS that underwent dual-energy x-ray absorptiometry (DXA) with biological factors (vitamins, micronutrients, bone and inflammation biomarkers). Simple and multiple linear models (stepwise and parsimony approach) were developed.
RESULTS
A total of 131 patients (91 RYGB, 40 SG) underwent DXA (51.8 ± 11.08 years, 87.8% women). At a mean of 6.8 ± 3.7 years after surgery, the mean weight loss was -28.6 ± 9.6%, and only 6 patients (5.7%) had a -score less than or equal to -2.5. On univariate analysis, BMD was lower in the RYGB than in the SG group ( < .001) at all sites, despite similar fat and fat-free mass and weight loss. Serum parathyroid hormone and phosphate levels were higher in RYGB than SG patients. A total of 10.1% of patients showed vascular calcifications. On multivariable analysis, BMD remained different between surgery groups after adjustment for age, body mass index, ethnicity, and sex. The model-adjusted values were 0.451 for the total hip; 0.462 the femoral neck, and 0.191 the lumbar spine for the inflammation model; 0.458, 0.462, and 0.254, respectively, for the bone marker model; and 0.372, 0.396, and 0.142 for the vitamin model. Serum zinc, ferritin, and uric acid levels were the markers associated with BMD to a low extent.
CONCLUSION
BMD differed depending on the BS procedure. A few biological markers may be associated weakly with BMD well after the surgery.
PubMed: 38939832
DOI: 10.1210/jendso/bvae111 -
BMC Musculoskeletal Disorders Jun 2024Jaffe-Campanacci syndrome is a rare syndrome, characterized by multiple non-ossifying fibromas (NOF) and cafe-au-lait patches. The name was coined in 1982 by Mirra after... (Review)
Review
BACKGROUND
Jaffe-Campanacci syndrome is a rare syndrome, characterized by multiple non-ossifying fibromas (NOF) and cafe-au-lait patches. The name was coined in 1982 by Mirra after Jaffe who first described the case in 1958. Although it's suggested there is a relation with Neurofibromatosis type 1, there is still no consensus on whether Jaffe-Campanacci syndrome is a subtype or variant of neurofibromatosis-1(NF-1).
CASE PRESENTATION
In this article, we present a case series of 2 patients. The first case is a 13-year-old male with Jaffe-Campanacci syndrome who presented with a distal femur fracture. His father had positive features of both Jaffe-Campanacci syndrome and NF-1, while his sister only had features of NF-1, so we presented both.
CONCLUSION
Jaffe-Campanacci has a clear relationship with type 1 neurofibromatosis, which still has to be genetically established. Due to the presence of several large non-ossifying fibromas of the long bones, it is linked to a significant risk of pathological fractures. We concur with previous authors, that an osseous screening program should be performed for all patients with newly diagnosed type 1 neurofibromatosis, to identify non-ossifying fibromas and assess the potential for pathological fracture. Moreover, siblings of patients with NF-1 should be screened for multiple NOFs that may carry a high risk of pathological fractures.
Topics: Humans; Male; Adolescent; Neurofibromatosis 1; Cafe-au-Lait Spots; Female; Fibroma; Femoral Fractures
PubMed: 38937801
DOI: 10.1186/s12891-024-07581-0 -
Cureus May 2024Clozapine is an atypical antipsychotic that acts by blocking mainly dopamine 4 receptors. It is usually prescribed for treatment-resistant schizophrenia as well as...
Clozapine is an atypical antipsychotic that acts by blocking mainly dopamine 4 receptors. It is usually prescribed for treatment-resistant schizophrenia as well as treatment-resistant bipolar disorder. Clozapine has a wide profile of side effects that result from blocking different receptors all over the body. A 42-year-old Middle Eastern female is known to have suffered from schizoaffective disorder for many years and had frequent relapses despite compliance with treatment. She was commenced on Clozapine; the patient started complaining of an electric shock sensation throughout her body that resulted in recurrent falls with bilateral leg fractures. She was started on sodium valproate to exclude the possibility of seizure activity but the electric shock sensation did not subside. The decision was made to switch her to aripiprazole and gradually taper down and stop Clozapine which improved her symptoms. Careful monitoring of patients who receive Clozapine is recommended especially during the tapering phase due to the risky adverse events it can bring about. It is essential to understand the side effects in order to tackle them as soon as they arise.
PubMed: 38933635
DOI: 10.7759/cureus.61143 -
Acta Ortopedica Brasileira 2024Assess complications and risks in staged femoral shaft fracture treatment using external fixation and intramedullary nailing (DCO).
OBJECTIVE
Assess complications and risks in staged femoral shaft fracture treatment using external fixation and intramedullary nailing (DCO).
METHODS
Analysis involved 37 patients with 40 fractures, mostly male (87.5%), average age 32.9 years. Data included ASA score, AO/OTA and Gustilo classifications, Glasgow Coma Score, Injury Severity Score, times to external fixation and conversion, ICU duration, nail type, and reaming status. Complications tracked were mortality, deep infection, and non-union.
RESULTS
Predominant fracture type was AO/OTA A (45%), with 40% open (Gustilo A, 93.8%). Average ISS was 21; GCS was 12.7. Median ICU stay was 3 days; average time to conversion was 10.2 days. Retrograde nails were used in 50% of cases, with reaming in 67.5%. Complications included deep infections in 5% and non-union in 2.5%.
CONCLUSION
DCO strategy resulted in low infection and non-union rates, associated with lower GCS and longer ICU stays.
PubMed: 38933352
DOI: 10.1590/1413-785220243202e278586 -
Sensors (Basel, Switzerland) Jun 2024Low-frequency distributed acoustic sensing (LF-DAS) is a diagnostic tool for hydraulic fracture propagation with far-field monitoring using fiber optic sensors. LF-DAS...
Low-frequency distributed acoustic sensing (LF-DAS) is a diagnostic tool for hydraulic fracture propagation with far-field monitoring using fiber optic sensors. LF-DAS senses strain rate variation caused by stress field change due to fracture propagation. Fiber optic sensors are installed in the monitoring wells in the vicinity of a fractured well. From the strain responses, fracture propagation can be evaluated. To understand subsurface conditions with multiple propagating fractures, a laboratory-scale hydraulic fracture experiment was performed simulating the LF-DAS response to fracture propagation with embedded distributed optical fiber strain sensors under these conditions. The experiment was performed using a transparent cube of epoxy with two parallel radial initial flaws centered in the cube. Fluid was injected into the sample to generate fractures along the initial flaws. The experiment used distributed high-definition fiber optic strain sensors with tight spatial resolutions. The sensors were embedded at two different locations on opposite sides of the initial flaws, serving as observation/monitoring locations. We also employed finite element modeling to numerically solve the linear elastic equations of equilibrium continuity and stress-strain relationships. The measured strains from the experiment were compared to simulation results from the finite element model. The experimentally derived strain and strain-rate waterfall plots from this study show the responses to both fractures propagating, while the fracture at the lower position took most of the fluid during the experiment. Interestingly, a fracture first began propagating from the upper flaw of the two flaws, but once the lower fracture was initiated, it grew much faster than the upper fracture. Both fibers were intercepted by the lower fracture, further verifying the strain signature as a fracture is approaching and intersecting an offset fiber.
PubMed: 38931664
DOI: 10.3390/s24123880 -
Materials (Basel, Switzerland) Jun 2024The deep drawing process, a pivotal technique in sheet metal forming, frequently encounters challenges such as anisotropy-induced defects. This study comprehensively...
The deep drawing process, a pivotal technique in sheet metal forming, frequently encounters challenges such as anisotropy-induced defects. This study comprehensively investigates the influence of various yield criteria on the anisotropic behavior and fracture prediction in SECC steel cylindrical cups. It integrates Hill'48R, Hill'48S, and von Mises yield criteria in conjunction with Swift's hardening law to evaluate material behavior under complex stress states. Experimental and numerical simulations assess the anisotropy effects across multiple orientations (0°, 45°, and 90°), revealing intricate relationships between stress criteria and material response. The findings indicate significant discrepancies between isotropic and anisotropic models in predicting fracture heights, emphasizing the importance of selecting appropriate yield criteria. Notably, the von Mises criterion results in lower fracture heights, suggesting higher susceptibility to fractures, while the Hill'48R model aligns closely with experimental data, validated through variations in punch corner radius and blank holder force parameters, with a maximum deviation of 3.23%. Hill'48S displays moderate plastic deformation characteristics.
PubMed: 38930241
DOI: 10.3390/ma17122872 -
Materials (Basel, Switzerland) Jun 2024To investigate the influence of water content on the rockburst phenomena in tunnels with horizontal joints, experiments were conducted on simulated rock specimens...
To investigate the influence of water content on the rockburst phenomena in tunnels with horizontal joints, experiments were conducted on simulated rock specimens exhibiting five distinct levels of water absorption. Real-time monitoring of the entire blasting process was facilitated through a high-speed camera system, while the microscopic structure of the rockburst debris was analyzed using scanning electron microscopy (SEM) and a particle size analyzer. The experimental findings revealed that under varying degrees of water absorption, the specimens experienced three stages: debris ejection; rockburst; and debris spalling. As water content increased gradually, the intensity of rockburst in the specimens was mitigated. This was substantiated by a decline in peak stress intensity, a decrease in elastic modulus, delayed manifestation of pre-peak stress drop, enhanced amplitude, diminished elastic potential energy, and augmented dissipation energy, resulting in an expanded angle of rockburst debris ejection. With increasing water content, the bond strength between micro-particles was attenuated, resulting in the disintegration of the bonding material. Deformation failure was defined by the expansion of minuscule pores, gradual propagation of micro-cracks, augmentation of fluffy fine particles, exacerbation of structural surface damage akin to a honeycomb structure, diminishment of particle diameter, and a notable increase in quantity. Furthermore, the augmentation of secondary cracks and shear cracks, coupled with the enlargement of spalling areas, signified the escalation of deformation failure. Simultaneously, the total mass of rockburst debris gradually diminished, accompanied by a corresponding decrease in the proportion of micro and fine particles within the debris.
PubMed: 38930188
DOI: 10.3390/ma17122818 -
Journal of Personalized Medicine Jun 2024In the U.S., diagnostic errors are common across various healthcare settings due to factors like complex procedures and multiple healthcare providers, often exacerbated...
In the U.S., diagnostic errors are common across various healthcare settings due to factors like complex procedures and multiple healthcare providers, often exacerbated by inadequate initial evaluations. This study explores the role of Large Language Models (LLMs), specifically OpenAI's ChatGPT-4 and Google Gemini, in improving emergency decision-making in plastic and reconstructive surgery by evaluating their effectiveness both with and without physical examination data. Thirty medical vignettes covering emergency conditions such as fractures and nerve injuries were used to assess the diagnostic and management responses of the models. These responses were evaluated by medical professionals against established clinical guidelines, using statistical analyses including the Wilcoxon rank-sum test. Results showed that ChatGPT-4 consistently outperformed Gemini in both diagnosis and management, irrespective of the presence of physical examination data, though no significant differences were noted within each model's performance across different data scenarios. Conclusively, while ChatGPT-4 demonstrates superior accuracy and management capabilities, the addition of physical examination data, though enhancing response detail, did not significantly surpass traditional medical resources. This underscores the utility of AI in supporting clinical decision-making, particularly in scenarios with limited data, suggesting its role as a complement to, rather than a replacement for, comprehensive clinical evaluation and expertise.
PubMed: 38929832
DOI: 10.3390/jpm14060612 -
Journal of Personalized Medicine May 2024Pain perception, far from being a pathological mechanism, is a crucial protective stimulus to prevent additional injuries. Any disturbance in this complex system poses... (Review)
Review
INTRODUCTION
Pain perception, far from being a pathological mechanism, is a crucial protective stimulus to prevent additional injuries. Any disturbance in this complex system poses significant risks to individuals, affecting their quality of life and even their survival.
OBJECTIVE
This review aims to explore congenital insensitivity to pain, an extremely rare genetic disorder with an autosomal recessive pattern that results in the inability to perceive pain. We will focus on the well-known subtype, congenital insensitivity to pain with anhidrosis (CIPA). Our research seeks to update existing knowledge through a comprehensive literature review.
METHODOLOGY
The review employs a systematic literature review, analyzing various sources and scientific documents, primarily emphasizing CIPA. The review follows the PROSPERO protocol, registered under CRD42023394489. The literature search was performed on the Scopus, PubMed, and Cinahl databases.
RESULTS
Our review reveals secondary complications associated with CIPA, such as recurrent bone fractures, temperature insensitivity, self-mutilation, and, occasionally, intellectual disabilities. The limited available information underscores the need for expanding our knowledge.
CONCLUSIONS
In summary, CIPA, particularly, presents a significant medical challenge with adverse impacts on quality of life. Early diagnosis, education for families and healthcare professionals, and appropriate nursing care are essential for effective management. This review highlights the necessity of further research and awareness to enhance support for those affected.
PubMed: 38929791
DOI: 10.3390/jpm14060570