Trauma Monthly
Volume:22 Issue: 6, Nov-Dec2017

Trauma is currently the ninth cause of mortality in the elderly. Several factors may have an impact on the outcomes after trauma in the elderly including background disease, sex, trauma severity, and age. The aim of this study was to understand the sex differences about trauma in this growing population.

In a cross-sectional study, the records of all the traumatic injured people above 60 years of age who were admitted to a main center of trauma hospital in north of Iran in 2012 were studied. Demographic data, characteristics of road traffic incidents, and in-hospital medical profiles were derived. The analysis of data was done by using theχ 2 test and T test with SPSS Ver. 18 software. A P value of < 0.05 was considered statistically significant.

One thousand and eight-hundred thirty injured elderly patients were admitted during the study period. This amount accounted for 10.5% of the total injured. In this study 56.3% of victims were male with the mean age of 70.84±8.16 years in comparison to 71.65±8.59 years in women (P < 0.05). Sex differences were seen in Glasgow coma scale, place, mechanism of trauma, anatomical part injured, and in-hospital death rate (P < 0.05). Outdoor trauma was more prevalent in men and indoor trauma in women. The mechanisms causing trauma in both sexes were slipping and road traffic accidents, respectively. In men, head and neck were the most common anatomical sites injured, while most women suffered from injuries to the upper extremities.

It seems that elderly men are more at risk of severe injury with a higher mortality rate in comparison to elderly women

Chronic pain and disability after whiplash injury is common and causes considerable social and financial costs. Predicting the factors contributing to disability in whiplash injury can facilitate rapid intervention.

The aim of this study was to examine the effect of mental and behavioral factors on severity of whiplash injury disability two years after the primary insult.

In this analytic cross-sectional study, chronic complications of whiplash injury in patients were evaluated two years after the insult. Participants were categorized into three groups based on neck disability index scores at 2 years after the injury. Intergroup differences were analyzed and investigated with previous inconsistencies. P values less than 0.05 were considered statistically significant.

A total number of 81 patients were investigated in our study. Patients were categorized into the "recovered", "mild pain and disability" and "moderate/severe pain and disability" groups. There was no statistically significant relationship between three groups regarding the treatment method. Our results showed a statistically significant difference between the personality type and severity of disability (P = 0.031). The Beck depression score was not significantly different between the three disability groups.

Type B personality and primary presence of moderate stress symptoms after trauma can predict strongly the poor outcome at 2 years after injury. These factors should be evaluated in people with acute whiplash injury. Appropriate treatment based on these factors may help to reduce chronicity and related complications.

Upper extremity is exposed to injuries with physical, mental, social and economic consequences.

The aim of this research is to study the prevalence and types of personality disorders in patients with upper extremity trauma.

We included all patients with upper extremity trauma in a three-month period. The Millon Test was filled by all candidates with a clinical psychologist and psychometric supervision. Results were analyzed statistically.

202 male patients participated with age range of 14 to 70 years-old, amongst whom 41.4% had personality disorders. The prevalence of personality disorder in violence and self-injury groups was 72.7% and 39.3% respectively in the group of industrial accidents, which showed a significant difference (P = 0.003). Avoidant personality disorders (P = 001), narcissistic (P = 0.003), antisocial (P = 0.002), borderline (P = 0.001) passive aggressive (P = 0.002) were significantly more common in violence and self-injury groups.

The present study revealed that the prevalence of personality disorder in patients with upper extremity injuries is more than that in the society. Due to the high rate of personality disorder in hand trauma victims, routine psychological evaluation of these patients is warranted.

Subdural hematoma (CSD), the accumulation of blood below the inner layer of the dura, stems from bleeding of bridging veins or cortical arteries damaged normally by traumas. Chronic subdural hematomas (cSDH) are well documented in infants where it is frequently observed as a single entity.

Albeit cSDH is rare amongst children older than one year, the current report presents a case of a nine-year-old male with no trauma history developing spontaneous chronic subdural hematoma. Surgical management was performed, and there was a satisfactory resolution.

In spite of the lower incidence of cSDH in children, leading to misdiagnosis, early diagnosis and treatment with craniotomy and drainage suggests excellent prognosis.

The objective of the present study was to compare the use of Hirudoid immediately after surgery with its use 6 hours post-operatively when probable thrombosis was formed but tissue damage was still reversible.

After preparing 3 × 11 cm dorsal flap in all rats, one group of 8 rats received Hirudoid topically immediately after surgery during 9 post-operative days. Another group received it 6 h after surgery during 9 post-operative days. The control group received Vaseline immediately after surgery on a daily basis during 9 post-operative days.

The mean area of flap survival in the control group was 8.75 ± 3.32 cm2 (mean ± SD) and it was 12.38±1.93 cm2 and 14.36 ± 3.51 cm2 in Hirudoid immediately after surgery and 6 hours after surgery groups, respectively.

It was found that Hirudoid can be effective in improving flap viability; although its effect was not statistically significant when used immediately after surgery (P > 0.05), it significantly increased flap survival when used 6 h after surgery (P = 0.003).

Chronic neck pain (CNP) is a common disorder associated with substantial morbidity. Different methods of rehabilitation are used to manage chronic myofascial neck pain.

The present study aims to assess the effects of dry needling (DN), manual therapy (MT) and Kinesio Taping® (KT) methods on the treatment of patients with chronic myofascial neck pain.

Thirty-nine individuals (mean ± standard deviation (SD): Age 35 ± 10.1 years; height 178.6 ± 7.5 cm; body mass 86.9 ± 7.7 kg) out of 57 patients (age range: 18 - 55 years) were included in the current single-blinded randomized clinical trial. The subjects were assigned into 3 groups (N = 13 subjects in each group) including DN, MT, and KT. Pain intensity, pain catastrophizing scale (PCS), neck disability index (NDI), and cervical spine range of motion (CROM) in different directions were evaluated by self-reported questionnaires and cervical goniometer at baseline and following 5 treatment sessions. Following the evaluation of the normal distribution of variables by Shapiro-Wilk test, the paired-samples t-test and one-way analysis of variance (ANOVA) were used to analyze the data.

Pain intensity and catasrophizing, neck disability, and CROM in all directions significantly improved following the 3 interventions (P < 0.05). The score changes in CROM for rotation to right and left in MT group were significantly greater than those of the other 2 groups (P < 0.001). Comparisons of changes in scores of other variables between the 3 groups revealed no significant differences (P > 0.05).

It is assumed that DN, MT, and KT can improve pain and neck disability and increase CROM in patients with myofascial CNP. The MT techniques are more effective in increasing CROM for rotation compared to the other 2 methods.

Almost 25% of the world population suffer from early death due to preventable events. Trauma and sudden cardiac death are known as common causes of death. The arrival time to help the patient is known as a very important factor in enhancing survival and reducing side effects.

The aim of the present study was to identify the factors relating to the efficacy of prehospital emergency service (timerelated performance). In addition, it was intended to describe time indices of prehospital services among patients who had internal medical and trauma related problems.

In the present cross-sectional study, all the calls to the emergency medical service (EMS) were monitored. The reasons of these calls were internal medical problems and trauma (March 2009 to March 2013). The frequency of calls were derived from the information bank of EMS in Isfahan, Iran. Demographic features, type of events, time indices of EMS and the outcomes of registered patients were collected and the data were analyzed using descriptive and analytical statistics. Descriptive statistics included frequency, percentage, mean, median, and standard deviation and inferential statistics included t-test, ANOVA, multiple regression and chi-square test.

From a total of 299956 cases who had sought help, 61.9% were men. Also, 48.5% of the cases had internal medical and 51.5% had traumatic injuries. In 61.5% of the cases, the injured persons were transferred to the hospital and 3.2% of the cases resulted in death. The men had a morality rate of 1.6 more than women (P < 0.001). Response times were significantly higher than the standard of 8 minutes (P < 0.001). In 50.6% of the cases, the mean response time was less than 8 minutes.

Considering the increasing trend of traumatic events, especially in active groups of society (age groups of less than 45), equipping and updating ambulances and providing the EMS personnel with better training can help the injured people in reducing aftermath consequences. On the other hand, increasing neurologic problems in these age groups is an alarm for health managers and health workers, so that they can improve public health through revising health guidelines. Increase in the response time in prehospital emergency missions is also an alarm for the managers who must revise the methods of conducting emergency missions

Maxillofacial trauma is one of the most common traumas with many complications and disabilities. Recognition of the trauma-related mechanisms is the key to early diagnosis and treatment.

The current study was aimed at assessing maxillofacial trauma in emergency department.

The current cross sectional study was performed on 406 patients with maxillofacial trauma recruited from the emergency department (ED) of Shariati and Imam Khomeini hospitals from January 2014 to March 2015. Demographic data, etiology and mechanism of trauma as well as the type of maxillofacial fractures were recorded by the emergency medicine (EM) residents. Maxillofacial fractures, diagnosed by the computed tomography (CT) scan, were reported by the ED attending radiologist.

The current study evaluated 406 patients, 106 females (26.1%) and 300 males (73.9%), with maxillofacial trauma and the mean age of 29.95 ± 15.82 years. The leading causes of maxillofacial trauma were the road traffic accidents (RTA) (50.2%), followed by falling (20.0%) and assault (17.3%). Maxillofacial fractures were detected in 137 patients (33.7%) and mandibular fractures were the most common site (71.5%). The mean age of males was significantly higher than that of females. Some causes of maxillofacial trauma, such as assault and occupational accidents, were significantly common in males than females. The risk of maxillofacial fractures was significantly higher in the traumas caused by pedestrian-car accidents followed by falling and assault.

In the current study population, the patterns of underlying causes of maxillofacial traumas were similar to other types of traumas mainly affected by socioeconomic status of the society. RTA was the main cause of maxillofacial trauma and males were affected more than females. Most of the current study patients were in the 3rd and 4th decades of life. Mandible was the site mostly involved in MF fractures.

Use of autologous fascia, harvested from the thigh fascia lata, has been shown to be effective in the treatment of unilateral vocal fold paralysis (UVFP). However, advantages of this material have been less examined in the clinical setting. The present study aimed to assess the beneficial effects of medialization thyroplasty type I with cadaveric fascia lata on the vocal function of patients with UVFP.

This prospective interventional case series was performed on 10 patients with UVFP, who were candidates for medialization thyroplasty. All the patients were assessed using video stereoscopy to determine the gap and closure of glottis. Voice analysis was also performed. The voice handicap index (VHI) was completed for all the patients. The level of satisfaction with voice quality was also assessed, using the visual analogue scale (VAS).

The mean VHI scores significantly decreased at 1, 3, and 6 months after surgery. The mean VAS scores (for voice quality) significantly increased within 1 month after surgery, whereas they gradually decreased at 5 months after surgery. The mean values of minimum and maximum pitch indices were comparable before and after surgery. The mean jitter score decreased at 1 month after surgery, while it remained constant at 6 months after surgery. The mean shimmer score gradually reduced within 3 months after surgery. On the other hand, the mean harmonic/noise ratio (HN/R) significantly increased at 6 months after surgery. The findings showed a significant decline in the frequency of anterior and posterior glottis gaps at all postoperative intervals.

Short-term improvement of vocal quality and glottic efficiency, along with reduced glottis gap, is expected following medialization thyroplasty type I with cadaveric fascia lata.

Hydrogels based on natural ingredients, such as alginate, are considered promising wound dressings. Alginic acid, a polysaccharide polymer, is a structural component of the cell walls of brown algae. The important features of alginates used in biological dressings include non-toxicity, biocompatibility, biodegradability, hydrophilicity, and excellent swelling behavior.

In this study, the effects of alginate hydrogels and commercial alginate dressings were studied with regard to wound recovery in a rat model.

Fifteen Wistar rats were divided into three groups of five. One wound measuring 1 × 1 cm square was made on each rat using a template. One rat in each group was euthanized on the 4th, 7th, 14th, and 21st days, and skin samples were taken for histopathological analysis.

The findings showed that the average total time of wound healing in the synthetic alginate dressing group was similar to that of the commercial dressing group. In this study, we found that synthetic alginate hydrogels were much more convenient for wound dressings and for the treatment of surface wounds.

The treatment outcomes showed that our synthetic alginate hydrogel dressing was highly promising as an alternative wound-healing system, opening a new path toward future research and development.

Remarkably, one of the main causes of years of life lost due to premature death (YLL) is due to road traffic injuries (RTIs), which usually occurs at an earlier age in life.

This study aimed to determine the trend of YLL due to road traffic injuries in Kermanshah Province during the years 2009 - 2014.

This study relied on census data from forensic medicine reports. YLL related to RTIs were calculated according to the global burden of disease (GBD) 2010 guidelines, and the age and sex demographics of the population were obtained from the Governor General’s Office records for 2009 - 2014. The external causes of death were determined using the international classification of diseases (ICD-10) codes. To assess the YLL trend and its significance, negative binomial regression through the use of Stata 11 was implemented.

The mean age of the 3,231 subjects studied was 39.83 ± 21.27 years. A total of 78.4% of the subjects were males. The average number of fatal RTIs in the six-year period was 27.8 per 100,000 persons. The YLL rate was 149,995 (76.5 per 1000) including both sexes. The YLL rates due to premature mortality were 118,393 (119.8 per 1000) for males, and 31,602 for females (32.5 per 1000). The highest YLL rates for both sexes were in the age group of 15 - 44 years. The six-year trend of YLL due to premature mortality was therefore descending; with respect to the incremental period of one year, the YLL decreased by 7% on average (β = - 0.07; CI: - 0.09, - 0.05).

Despite the decrease in the mortality and YLL rates due to TRIs in recent years, these figures are higher global numbers; therefore, there needs to be more serious intervention.

Today, trauma is considered as a major cause of temporary or permanent disabilities for millions of people. Any loss of ability has considerable effects on the quality of life. One of the most important causes of disability is limb trauma. However, the quality of life with limb trauma is relatively unexplored.

The objective of this study was to explore the quality of life following limb trauma.

In this qualitative study a thematic analysis and purposive sample method was used to recruit 11 patients with a disability in the upper or lower limbs and a history of hospitalization caused by a traffic accident 6 months to 2 years earlier. Data were collected through semi-structured interviews continued until reaching saturation. The data analysis approach in this study was thematic analysis, which consists of a vigorous process of data familiarization, data coding, and theme development and revision. The trustworthiness of the results was ensured through constant comparisons, triangulation, member checks, and peer review.

Based on the participants’ experiences, three themes were conceptualized: existing with limitations, empowerment approaches in encountering disabilities, and seeking support.

The experience of living with limb disability was a limiting experience, and other person’s activities and relations could aid participants in achieving empowerment through strengthening and seeking compensatory mechanisms. More attention to the problems of patients, and more research is recommended.

Wound healing includes processes such as cell migration, extracellular matrix deposition, remodeling, and angiogenesis. In addition, antioxidative and anti-inflammatory reactions play key roles in the process of wound healing. Previous studies showed that Linum usitatissimum (LU) had anti-inflammatory, antimicrobial, and antioxidant activities. LU also stimulates fibroblast proliferation in the skin tissue.

Herein, we studied the effects of topical LU on the wound healing process in rat models, according to histomorphometrical and stereological parameters.

In this experimental study, 48 male rats (Wistar; 200 ± 20 grams) were randomly separated into four groups (n = 12): 5% LU gel-treated (E1), 10% LU gel-treated (E2), gel base-treated (C2), and the control group (C1), which received no treatment. A full thickness circular wound was created on the neck in each rat. At the end, the stereological evaluations, including wound closure rate, collagen, vascular and hair follicle density estimation, fibroblast proliferation, vascular length density, and mean diameter were performed. The data was analyzed, and P < 0.05 was considered statistically significant.

The average of the wound areas, collagen bundle synthesis, vascularization, and hair follicles in the LU-treated groups were significantly higher than the control group (P < 0.05). According to the estimated parameters, the contrast between E1 and E2 was insignificant.

Overall, topical LU showed the potential to enhance the wound healing process and tissue regeneration. However, more studies, particularly clinical trials, are highly recommended on LU and its mixture with other healing agents to find more potent treatments.

Despite observed post Sulfur Mustard (SM) exposure hemolysis, serum bilirubin concentration does not significantly increase in SM-exposed casualties. The concentration of serum bilirubin can be related to serum levels of inflammatory cytokines.

In this study, the relationship between the serum levels of Interleukin (IL)-1α, IL-1β, IL-1Ra, Tumor Necrotizing Factor (TNF)-α and IL-6 with serum bilirubin concentration was investigated.

Overall, 368 individuals, who were exposed to SM in 1986, and 127 non-exposed control participants were studied in the context of hematological factors, serum bilirubin and inflammatory cytokines. Total serum bilirubin and direct bilirubin were analyzed using an enzymatic method, while the inflammatory cytokines were evaluated by enzyme linked immunosorbent assay (ELISA).

The concentration of inflammatory cytokines in the exposed group was significantly different compared to the control group, however the serum concentrations of total and direct bilirubin did not differ between the two groups. Among cytokines, other than the relationship between the IL-6 concentrations and bilirubin level, there were no significant correlations between the levels of other cytokines with direct and total bilirubin.

Considering the lack of correlation between bilirubin concentrations and levels of inflammatory cytokines other than IL-6, we should identify other confounding factors for lack of increase in bilirubin in SM casualties, despite the observed hemolysis

High-pressure water jet injuries to the abdomen are extremely rare, but can cause serious damages to intraperitoneal organs. A case of 53-year-old man was injured on the right-side of the abdomen by a high-pressure water jet from sprinkler truck. On laparotomy, ischemic change of the terminal ileum and ascending colon, hemoperitoneum with mesenteric tearing, and inferior vena cava injury were noted.