Background: Coronavirus disease 2019 (COVID-19) pandemic affected the psychological stability of people around the world and sparked various mental distresses, one of which is fear. Syrians are experiencing brutal war, economic devastation, and a pandemic crisis. This research identifies the factors associated with high fear of COVID-19 scores among the Syrian population. Methods: A cross-sectional online survey was distributed between May 5 and May 20 of 2020. A total of 3989 met the inclusion criteria. The questionnaire contained socio-demographic questions, the fear of COVID-19 questionnaire, the patient health 9-item questionnaire, and the generalized anxiety disorder 7-item questionnaire. One way analysis of variance tests was used to compare the distribution of fear of COVID-19 scores between the studied variables. Multiple linear regression models identified factors associated with high mean fear of COVID-19 scores. Results: Most participants were female 2935 (73.5%), single 3096 (77.6%), student 2397 (60.1%), and residing in Damascus 1412 (35.4%). Multiple linear regression analysis correlated higher mean fear of COVID-19 scores with female gender (B=0.825, p<0.001); being in a relationship or other marital status (B=1.633, p<0.001); poor and moderate economic status (B=0.805, p<0.001); education of secondary school or lower (B=0.879, p=0.003); and living with over 5 household members (B=0.408, p=0.037). Conclusion: Individuals prone to fear of COVID-19 should be targeted through targeted awareness campaigns and support groups. Mental health providers, researchers, and policymakers must plan a strategic approach to limit the exacerbation of mental health problems such as COVID-19 fear.
Falls into wells are a traumatic event that represents a major public health problem worldwide. These falls are often fatal in contrast to some falls from heights, given the depth of the well that has to be deep enough to reach the water aquifer. Despite the severity of the consequent injuries, falls into wells have not been documented enough in the medical literature. The purpose of this work was to study the characteristics of falls into wells referring to the literature to serve as a basis for proposing appropriate preventive measures to prevent such falls. The majority of the collected cases comprised suicide cases that died as a result of drowning or severe polytrauma. The pattern that emerged was similar to falls from heights with a predominance of head and skull fractures. Fractures of ribs and spine vertebrae were common, unlike long bone fractures. Several factors were involved in the pattern of damages such as body weight, speed, nature of the impacted surface, the orientation of the body at the time of impact, and the body part that hit the ground first.
Fractures of distal radius are very commoninjuries, accounting for about 15% workload of anorthopedic trauma unit. While cast treatment is universalfor stable fractures, unstable fractures with comminutionand intra-articular involvement are a different injury and aretreated mainly by ligamentotaxis with proper restoration of anatomy.
Duodenal injuries constitute around 5% of all abdominal traumas duodenal injuries associated with the highest mortality and morbidity rate because of their complex anatomy. Duodenal injuries managed surgically with adjuncts like pyloric exclusion and triple tube diversion, though primary repair still an option for low- grade injuries. In our case, where a 14-year-old boy with grade 3 duodenal injury has been managed with direct repair with duodeno-gastrostomy and without postoperative complications D2 Gastrostomy is a good option in high-grade D1 and Proximal D2 injuries. Even if the procedure fails, you will remains have more options for reconstruction. Though there is insufficient data available to recommend the treatment of choice, hemodynamic stability and rich vascular supply remains the mainstay of guiding management in these patients.
Background: Acute care surgery (ACS) patients represent a population at high risk to develop urinary tract infections (UTIs) and these are associated with significant morbidity and mortality. Lack of substantial data exists regarding the differences in incidence and outcomes of UTIs between trauma and emergency general surgery (EGS) patients. Methods: A prospectively maintained ACS database was queried for EGS and Trauma patients with a diagnosis of UTI using ICD 9 and 10 codes. Demographics, microbiology data and outcomes were abstracted. Student’s T-test and Chi- square were used to evaluate continuous and categorical variables. Binary logistic regression was used to determine the impact of UTI on EGS and Trauma patients’ outcomes. Results: Out of 15,475 EGS and 37,293 Trauma patients, the incidence of UTIs was similar between them (7.6% vs. 7.2% respectively p=0.248). Females in the EGS group had a significantly higher UTI rate (13.66% vs. 9.84% p=<.001). Trauma patients were significantly older (70 ± 20.16 vs. 57.83 ± 18.57 p=<.001) and had a higher Charlson comorbidity index (4.76 ± 2.95 vs. 4.39 ± 3.16 p=0.004). E. coli, Enterococcus sp., Klebsiella sp., and Candida sp. represented the most common organisms associated with UTIs. EGS patients had significantly more Foley catheter days (4.86 ± 9.13 vs. 3.43 ± 8.15 p=<0.001), longer hospital length of stay (hLOS) (12.11 ± 13.45 vs. 9.81 ± 12.59 p= <0.001) and higher mortality (6.30 % vs. 4.36% p=0.01) than trauma patients. On binary logistic regression with mortality as outcome, UTI was an independent predictor of increased mortality in EGS patients but not in the trauma group (EGS OR 1.72, p=0.0001 vs. trauma OR 0.55, p=<.0001). Conclusion: There is a high incidence of UTIs in EGS and trauma patients. Gram- negative rods are the most common organisms associated with these infections. EGS patients that develop a UTI are at increased risk of mortality as compared to trauma patient. Interventions to reduce the number of UTIs in ACS patients, including early Foley catheter removal, should be implemented routinely.
Sepsis is one of the leading causes of death for patients in the Intensive Care Unit (ICU). In the case of suspected or proven infection, sepsis is defined with increasing severity as (uncomplicated) sepsis, severe sepsis and septic shock. The present review aimed to present and discuss the literature about the prognostic value for survival or death of clinical and laboratory parameters in septic patients on ICU admission. Among laboratory parameters special attention was paid for the various disorders of the blood coagulation system and the immune and inflammatory response (i.e., levels of pro- and anti-inflammatory cytokines and other biomarkers of sepsis). We concluded that in patients admitted to the ICU with a suspected or confirmed diagnosis of infection and sepsis, the various clinico- laboratory scores and measurements [i.e., Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, Lung Injury Score (LIS), and PaO2/FiO2) seem to have a significant predictive value in terms of survival or death in almost all three groups of septic patients. Ant thrombin III and Protein C activity, as well as lactate level, have prognostic value in patients with severe sepsis or septic shock. Coagulation factors’ activity, as well as cytokine, procalcitonin and thrombopoietin levels have some predictive value only in distinct groups of septic patients.
Mind-Wandering (MW) is traditionally characterized as an attention shift from externally oriented task-related thoughts to internally task-unrelated thoughts. Although this is recognized as a natural phenomenon of mind, excessive MW has been related to several adverse outcomes in some executive domains. In this short communication it was discussed about the phenomenology of MW, an important tool for clinical practice.
Damage Control Surgery (DCS) is a concept of abbreviated laparotomy, designed to prioritize short-term physiological recovery over anatomical reconstruction in the seriously injured and compromised patient. Over the last 10 years, a new addition to the damage control paradigm has emerged, referred to as Damage Control Resuscitation (DCR). This focuses on initial hypotensive resuscitation and early use of blood products to prevent the lethal triad of acidosis, coagulopathy, and hypothermia. This review aims to present the evidence behind DCR and its current application, and also to present a strategy of overall damage control to include DCR and DCS in conjunction. The use of DCR and DCS have been associated with improved outcomes for the severely injured and wider adoption of these principles where appropriate may allow this trend of improved survival to continue. In particular, DCR may allow borderline patients, who would previously have required DCS, to undergo early definitive surgery as their physiological derangement is corrected earlier.
In keeping with its epistemic derivation from Greek, theOxford English Dictionarydefines trauma as “A wound, orexternal bodily injury in general.” That definition hasexpanded and even shifted toward a more mentalunderstanding of trauma, and correlatively toward“managing” those who are trauma-afflicted or teachingthem to “cope” with what has happened, whether a matterof shock, for example, on hearing of the death of a lovedone or being in a car accident, or a matter of stress in termsof an overwhelming work load.
Hallervorden-Spatz disease is a rare autosomal recessive disorder that can be present in a paediatric age group. The disease is classified based on the onset of symptoms, such and classic and atypical. Early symptoms onset is generally appearing in the first decade of life manifesting cognitive impairment and neurodegeneration. However, a child can be present with psychiatric disorders and speech disorders after the first decade of life. The mainstay diagnosis is made based on T2 weighted MRI, exhibit an eye-of-tiger sign, typically due to the accumulation of iron in globus pallidus, basal ganglia, or substantia nigra. A typical classified Hallervorden-Spatz presented at our hospital, the child was diagnosed based on disease traits and confirmed by radio imaging.
Background: The patients with severe trauma traumatic brain injury (STBI) should be intubated as early as possible, and most of the intubation was performed by anesthesiologists. With the construction of trauma centers in China, more and more trauma surgeons have mastered endotracheal intubation skills after standardized training, more and more trauma patients were intubated by trauma surgeons. We undertook a prospective observational cohort study of endotracheal intubation in emergency resuscitation room to study the effect of endotracheal intubation respectively performed by trauma surgeons and anesthesiologists on patients with STBI. Methods: We collected data of all intubated patients with STBI between January 2018 and March 2020. Patients were divided into trauma surgeons, intubation (TI) group and anesthesiologists, intubation (AI) group according to intubation performer. We recorded age, gender, GCS, ISS, admission RR, admission HR, admission SpO2, admission PO2, admission PCO2, admission SBP, mechanism of injury, type of intracranial lesion, endotracheal intubation time, 1-min success rate of intubation, intubation related complications, the time from arrival at hospital to intubation, incidence of aspiration pneumonia, mechanical ventilation time, 30-day mortality. Comparison was made between the two groups. Results: Among 356 STBI patients, 219 patients met the inclusion criteria (TI group N=142, AI group N=77). There were no significant statistical differences between the groups in age, gender, GCS, ISS, admission RR, admission HR, admission SpO2, admission PO2, admission PCO2, admission SBP, mechanism of injury, type of intracranial lesion. There were also no significant statistical differences between the groups in endotracheal intubation time, 1-min success rate of intubation and intubation related complications. The time from arrival at hospital to intubation in the TI group significantly lower than the AI group (p<0.01). Compared with the AI group, the incidence of aspiration pneumonia and the mechanical ventilation time were decrease (p<0.05). 30-day mortality had no significant statistical difference between the groups. Conclusion: The trauma surgeons can master endotracheal intubation skills through standardized training, and the intubation effect is not significantly different from that of anesthesiologists. Moreover, endotracheal intubation by trauma surgeons allow the patients with STBI to be intubated earlier and reduce the incidence of aspiration pneumonia and the mechanical ventilation time. So early intubation is beneficial for the patients with STBI, and trauma surgeons should be encouraged to master endotracheal intubation skills.
The incidence of pancreatic injury is low among trauma cases, and no clear treatment protocol has been established. Pancreatic injury, accompanied by injury to the main pancreatic duct (grades 3, 4 or 5 pancreatic injury) is generally thought to require surgery. Various surgical procedures are proposed for such cases, considering factors such as the patient’s general condition. In recent years, however, several reports have been published indicating that conservative treatment was possible, despite injury of the main pancreatic duct. We treated two cases of pancreatic trauma accompanied by injury to the pancreatic head and main pancreatic duct, and obtained good outcomes with drainage-based treatment. Therefore, we report on these cases along with a review of the literature.
The three levels of awareness in human consciousness which are divided by Freud: the conscious, preconscious, and unconscious. Each of them interferes with Freud’s ideas of the id, ego, and superego. Our Study which is cross sectional study conducted as an interview survey for one month, involved 167 participants from 21 countries. We used self - structured questionnaire which was tested for validity and Reliability All the participants were well informed about the purpose of our study and what we are testing for before we gained their consent. We found that 62% feel that they need to do this work and they will not do it again, but 38% do not feel that, while 59.9% follow their feelings to do the wrong thing and convince themselves not to do it again but 40.1% do not. There is a significant difference between people who feel guilty on a work and the people who feel that they need to do the wrong thing and they will never do it again. There is a significant difference too between people who feel that they need to do the wrong thing because they need it and the people who follow that feeling. The feeling of the need to do any work and it will not occur again is not under the control of the three levels of consciousness described by Sigmoid Freud, so the need to develop a new level of consciousness which we called it (Post consciousness) is necessary to explain these feelings in psychology. Biography: Hashim Talib Hashim is a fourth year medical student in Baghdad medical college. He is a researcher and he presented many researches in medicine in many conferences and published in many journals. He is the owner of the postconsciousness theory and the owner of Genes' communication theory.
Sisu (both noun and verb) is a Finnish word that loosely translates to having perseverance,integrity, and tenacity when faced with life’s most significant challenges with an emphasis on short termemphasis, action mindset, and a concept that is emerging in the field of positive psychology. Literature inconcussion/mTBI therapy including John Leddy’s April 2019 study regarding concussion and submaximalexercise crossed with the Emilia Lahti’s research on sisu provides the basis of this unique cultural-basedself help plan. The polarity of pre-brain injury capacity and post-brain injury capacity provides a basis forchange.The inspiring elements of this plan are: Sisurequiresconfrontingyourchallenges. Sisuisfindingenjoymentindiscomfort. Sisudemonstratesexercise/trainingismedicine. Sisuinvolvestheroleofreflection. Sisuislearningandreasoninformed. Sisuismakingconnectionsandstrengtheningrelationships(includingaskingforhelp.) Sisuisfindingbalanceandpurpose, visioning,anddoing. Biography: Kelly Thune, B.S. Biology, M.A.T Science Education., C.A.S. Education Leadership, Syracuse Universitybrings expertise in the area of school leadership, developing collaborative cultures for change,STEAM/STEM initiatives, designing optimal learning environments, personal and professionaltransformation, and yoga for brain injury. In her role as a school leader, she was credited â??2013 ESSAANYS Zone 5 Administrator of the Year, 2013 NYSSBA Be The Change for Kids Innovation Award,2013 PEB STEM Program of the Year Award and 2010 NYS ASCD Educating the Whole Child forthe 21st Century Award.â?? In 2017, she suffered a second and significant brain injury that was the impetusof learning and advocating for brain injury. She is an advocate and presenter for the New York State BrainInjury Association. She has written a book â??Sisu To A New Youâ?? that is currently in the edit phase of publishing. sisutoanewyou.com.
Introduction: Good Surgical Practice Guidelines 2014 (Royal College of Surgeons) state that 'surgeons must ensure that accurate, comprehensive legible and contemporaneous records are maintained of all their interactions with patients'. In June 2019, a retrospective study was performed at Broomfield Hospital (United Kingdom), assessing the quality of Post-Take Ward Round documentation in Trauma and Orthopaedic patients in a two week period. We aimed to evaluate the impact of a new Post-Take Ward Round (PTWR) proforma on Trauma and Orthopaedic documentation and the opinions of Allied Health Professionals (AHPs). Methods: By assessing notes of emergency patients and their adherence to the national Good Surgical Practice Guidelines 2014 (Royal College of Surgeons), areas for improvement were identified and a proforma created and implemented. Audit variables included documentation of the following: patient identifiers, date and time, consultant on-take, presenting complaint, discussion with patient/relatives, management plan and documenting clinician. After three months, this was re-audited with data collected from all admissions within a two week period alongside spot questionnaires completed by AHPs. Results: There was an improvement in recording the responsible clinician (48% to 100%) and documenting clinician (49% to 63%), history and examination (58% to 73%), initial diagnosis (68% to 92%) and management plan (35% to 98%). However, documentation of patient identifiers dropped (60% to 30%) alongside date and time (73% to 30%). 42% of AHPs agreed that documentation had improved since introduction of the proforma, whilst none of the respondents said that documentation had worsened. Conclusion: The proforma has led to improvements in both adherence to national guidelines and satisfaction amongst the AHPs thereby providing swift communication between the multidisciplinary team.
BACKGROUND AND OBJECTIVES: Venous thromboembolism is a major national health concern and a major contributor to morbidity and mortality. The aim of this study is to assess the effectiveness of adding the previous pharmacological deep-vein thrombosis medication of brain injury patients in the preadmission screen to aid the medication reconciliation process. INTERVENTION: The medications stated on the discharge summary and the Medication Reconciliation (MedRec) are continued. Adding the proper medication and the dosage the patient received in the Acute Hospital will aid the accepting physician with Medication Reconciliation and prevent delays in care. Rate of Medical DVT prophylaxis would be compared before and after the intervention. METHOD: A total of 924 cases were reviewed retrospectively. The cohort included patients admitted to the inpatient rehabilitation facility between April 2018 and December 2019 with a diagnosis of stoke or traumatic brain injury. Children were excluded from the sample. The improvement strategy was put in place on June 2019, therefore pre improvement group includes data from April 2018- May 2019 and post improve data includes records from June 2019- December 2019. RESULTS: There is significant improvement of DVT prophylaxis compliance after the DVT prophylaxis regiment at the acute hospital has been stated on the preadmission screen in addition to the Medication Reconciliation sent with the patient. CONCLUSION AND DISCUSSION: This study showed the effectiveness of adding the previous pharmacological deep-vein thrombosis medication in the preadmission screen to aid the Medication reconciliation process, this will significant improve the compliance of DVT prophylaxis regiment. Biography: Dr. Zhang is a board-certified physiatrist, and Director of Brain Injury Rehabilitation at St. Charles Hospital. He is also a Clinical Associate Professor at the State University of New York at Stony Brook. Dr. Zhang received his medical degree from Shanghai Medical University. He completed residency training in Physical Medicine and Rehabilitation at Montefiore Medical Center, New York, followed by a fellowship in Stroke Rehabilitation at the Kessler Rehabilitation Institute in New Jersey. Dr. Zhang's contributions to the field include numerous journal articles and presentations at national medical conferences.
Traumatic brain injury (TBI) is a worldwide public health problem typically caused by contact and inertial forces acting on the brain. Recent attention has also focused on the mechanisms of injury associated with exposure to blast events or explosions. Advances in the understanding of the neuropathophysiology of TBI suggest that these forces initiate an elaborate and complex array of cellular and subcellular events related to alterations in Ca++ homeostasis and signaling. Furthermore, there is a fairly predictable profile of brain regions that are impacted by neurotrauma and the related events. This profile of brain damage accurately predicts the acute and chronic sequelae that TBI survivors suffer from, although there is enough variation to suggest that individual differences such as genetic polymorphisms and factors governing resiliency play a role in modulating outcome. This paper reviews our current understanding of the neuropathophysiology of TBI and how this relates to the common clinical presentation of neurobehavioral difficulties seen after an injury. Biography: Prof. Dr. Anil Batta is presently professor & Head with senior consultant in Govt. Medical College, Amritsar. He did his M.B.B.S. and M.D. in Medical Biochemistry from Govt. Medical College, Patiala in 1984 and 1991, respectively. His research interest is mainly in clinical application especially cancer and drug de-addiction. He has supervised more than 25 M.D., M.Sc. and Doctorate researches and published more than 130 international research papers. He is the chief editor of America’s Journal of Biochemistry. He is also working as advisor to the editorial board of International Journal of Biological and Medical Research. He has been deputed member Editorial Board of numerous International & National Medical Journals of Biochemistry. He has also been attached as technical advisor to various national and international conferences in Biochemistry. He has been attached as hi-tech endocrinal, genetics and automated labs of Baba Farid Univ. of Health Sciences, Faridkot. He has chaired various sessions in the Biochemistry meets. He has been designated as member Editorial Board of various in US and other European Courtiers. He is also involved in various research projects at Govt. Medical, Amritsar. He has done superspecialisation in Drug-de-addiction from PGIMER, Chandigarh.
Background: Alcohol contributes to morbidity and mortality in trauma patients. Alcohol abuse is a leading risk factor for preventable death. This project aims to determine if a relationship exists between trauma outcomes and higher blood alcohol content (BAC) in patients. Methods: This retrospective cohort study included adult patients seen at Natividad Medical Center via trauma activation between 2015 and 2017 who had BAC screening performed. Metrics included injury severity score (ISS), Glasgow Coma Scale (GCS), mortality, length of stay and blood transfusion requirements. The cohort was stratified by BAC and age. The groups were analyzed for differences outcomes. Data formatting was performed using Microsoft Excel. SPSS statistical software version 25 was used to perform ANOVA, followed by post-hoc analysis Results and conclusion: 2,698 patients were included in the study. Patients with BAC>0.16 g/dL were found to have significantly longer hospital lengths of stay (3.69 days, p value 0.046) and significantly longer ICU lengths of stay (1.63 days, p value 0.047). An age-stratified analysis showed no significant difference in ISS, overall hospital LOS, blood requirements, mortality or major trauma. The one-way ANOVA showed that there were significant differences in the BAC groups for the following variables at the p<0.05 level: age (p=0.00), systolic blood pressure (p=0.00), hospital length of stay (p=0.00), heart rate (p=0.00) and GCS (p=0.00).Researchers have still not clearly elicited the role of alcohol and outcomes in trauma patients once they arrive to the hospital. More research is needed on the effects of alcohol on trauma patient outcomes.
