The Dangers of Sneezing: A Review of Injuries

Background Sneezing is an almost universal daily phenomenon as a reflex to evacuate irritants from the nasal cavities. An autonomic-controlled buildup of intrathoracic pressure against a closed glottis followed by sudden release results in a burst of 1 kPa of air through the upper airway. Active intervention to limit a sneeze can be deleterious. Closure of the airway during a sneeze can result in over 20 times the airway pressures resulting in a variety of untoward events. This review summarizes all reported injuries that occurred as the result of a sneeze. Objective The objective of this review is to summarize the risks of closed-airway sneezing and determine if there are any trends which can help understand such injuries. Methods A comprehensive literature review was performed from 1948 to 2018 to identify all reports of sneeze-related injuries. Information was compiled from reports to gain insights into comorbidities and risk factors for sneeze injuries. Results There were 52 unique reports of sneeze-related injuries in the literature that were categorized into 6 areas of injury: intrathoracic, laryngeal/pharyngeal, ocular/orbital, intracranial/neurological, otologic, and other. The mean age of subjects who suffered a sneeze injury was 40 years old (range: 15–84 years), with 81% being male gender. Thirty percent had a risk factor for injury of prior trauma (5) or respiratory compromise (5). Conclusion A variety of injuries can occur during a sneeze, especially when a closed-airway sneeze is attempted, and high Valsalva pressure is transmitted to the other systems. Men are more at risk for these injuries with the majority occurring in patients with no known risk factor. When triggered, a sneeze should be allowed to proceed without intervention to prevent associated injuries.

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Temporary hemiepiphysiodesis using an eight‐plate implant for coronal angular deformity around the knee in children aged less than 10 years: efficacy, complications, occurrence of rebound and risk factors

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03915-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Zhen-Zhen Dai ◽

Zhen-Peng Liang ◽

Hao Li ◽

Jing Ding ◽

Zhen-Kai Wu ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Deformity Correction ◽

Genu Valgum ◽

Angular Deformity ◽

Screw Loosening ◽

Logistic Regression Models ◽

The Mean ◽

Low Incidence ◽

Angular Deformities

Abstract Background Temporary hemiepiphysiodesis (TH) using an eight-Plate implant is one of the most common surgeries used for the correction of coronal angular deformities around the knee in adolescents. However, few studies have focused on children aged less than 10 years treated with TH using an eight-Plate implant. The purpose of this study was to investigate the efficacy, correction velocity, and complications of TH with an eight-Plate implant as well as the occurrence of rebound and risk factors in this population. Methods This retrospective study included a total of 135 physes (101 knees) from 66 children (mean age of 4.69 years old, range from 1 to 10 years old) who underwent TH with an eight-Plate implant to correct coronal genu angular deformities in our hospital. Related clinical factors were recorded and analysed by multivariable linear and logistic regression models. Results The mean deformity correction period was 13.26 months, and the mean follow-up after eight-Plate removal was 12.71 months. In all, 94.06% (95/101 knees) of the genu angular deformities were completely corrected. Non-idiopathic genu angular deformity was found to be an independent risk factor for deformity correction failure (odds ratio (OR) = 2.47). The femoral correction velocity was significantly higher than the tibial correction velocity (1.28° vs. 0.83° per month, p < 0.001). After adjustment for other factors, younger children had higher correction velocities in the distal femur; however, genu valgum and idiopathic deformities were associated with higher correction velocities in the proximal tibia. In addition, we found three (3/101, 2.97%) knees with genu valgum that experienced rebound after removal of the eight-Plate, while five (5/101, 4.95%) knees with non-idiopathic genu angular deformity experienced screw loosening. No other complications were found, and non-idiopathic deformity was the only risk factor for complications (OR = 3.96). No risk factor was found for rebound in our study. Conclusions TH using an eight-Plate implant is an effective procedure for coronal genu angular deformities with a low incidence of complications and rebound in patients younger than 10 years old. For this population, TH using an eight-Plate should be considered as soon as the deformity stops responding to conservative treatments. The parents of children younger than 10 years of age with non-idiopathic deformities should be informed preoperatively that the deformity may be prone to correction failure or screw loosening after eight-Plate implantation.

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Does Presurgical Nasoalveolar Molding Have a Long-Term Effect on Nasal and Upper Airway Dimensions?

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620980234 ◽

2020 ◽

pp. 105566562098023

Author(s):

Ashwina S. Banari ◽

Sanjeev Datana ◽

Shiv Shankar Agarwal ◽

Sujit Kumar Bhandari

Keyword(s):

Upper Airway ◽

P Value ◽

Airway Patency ◽

The Mean ◽

Group 2 ◽

Acoustic Pharyngometry ◽

Nasoalveolar Molding ◽

Area And Volume ◽

Group 1

Objectives: To compare nasal and upper airway dimensions in patients with cleft lip and palate (CLP) who underwent nasoalveolar molding (NAM) with those without NAM during infancy using acoustic pharyngometry and rhinometry. Materials and Methods: Eccovision acoustic pharyngometry and rhinometry (Sleep Group Solutions) was used for assessment of mean area and volume of nasal and upper airway in patients with complete unilateral CLP (age range 16-21 years) treated with NAM (group 1, n = 19) versus without NAM (group 2, n = 22). Results: The mean nasal cross-sectional areas and volume were higher in group 1 compared to group 2 on both cleft ( P value <.001) and noncleft side ( P value >.05). The mean area and volume of upper airway were also significantly higher in group 1 compared to group 2 ( P value <.05). Conclusions: Nasoalveolar molding being one of the first interventions in chronology of treatment of patients with CLP, its long-term outcome on nasal and upper airway patency needs to be ascertained. The results of the present study show that the patients with CLP who have undergone NAM during infancy have better improvement in nasal and upper airway patency compared with those who had not undergone NAM procedure. The basic advantages of being noninvasive, nonionizing and providing dynamic assessment of nasal and upper airway patency make acoustic pharyngometry and rhinometry a diagnostic tool of choice to be used in patients with CLP.

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Lethal mechanisms in cases of inverted suspension from the lap component of seat belts

Medicine Science and the Law ◽

10.1177/0025802421993990 ◽

2021 ◽

pp. 002580242199399

Author(s):

Siobhan O’Donovan ◽

Neil EI Langlois ◽

Corinna van den Heuvel ◽

Roger W Byard

Keyword(s):

Motor Vehicle ◽

Seat Belt ◽

South Australia ◽

Upper Airway ◽

Motor Vehicle Crashes ◽

Blood Alcohol ◽

Neck Flexion ◽

Seat Belts ◽

Respiratory Compromise ◽

Positional Asphyxia

A retrospective review of autopsy files at Forensic Science South Australia in Adelaide, Australia, was undertaken over a five-year period from January 2014 to December 2018 for all motor vehicle crashes with rollovers ending with the vehicle inverted and the occupants suspended by the lap component of their seat belts. There were five cases, all male drivers (aged 18–67 years; Mage = 32 years). Acute neck flexion or head wedging was noted in four cases, with facial petechiae in four and facial congestion in one. Deaths were due to positional asphyxia in four cases, with the combined effects of positional asphyxia and head trauma accounting for the remaining case. Although all drivers had evidence of head impact which may have caused incapacitation, in only one case was this considered severe enough to have contributed to death. A blood alcohol level above the legal limit for driving was detected in two cases, but no other drugs were detected. This series demonstrates another subset of cases of seat belt–associated deaths where suspension upside down by the lap component of a seat belt had occurred after vehicle rollovers. Predisposing factors include incapacitation of the victim and delay in rescue. The postulated lethal mechanism involved respiratory compromise from the weight of abdominal viscera on the diaphragm, as well as upper airway compromise due to kinking of the neck and wedging of the head.

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Marriage, monogamy and HIV: a profile of HIV-infected women in south India

International Journal of STD & AIDS ◽

10.1258/0956462001915796 ◽

2000 ◽

Vol 11 (4) ◽

pp. 250-253 ◽

Cited By ~ 124

Author(s):

S Newmann ◽

P Sarin ◽

N Kumarasamy ◽

E Amalraj ◽

M Rogers ◽

...

Keyword(s):

Risk Factor ◽

Hiv Risk ◽

South India ◽

Reproductive Age ◽

Indian Women ◽

Clinical Presentations ◽

Vertical Transmission Of Hiv ◽

History Of ◽

The Mean ◽

Heterosexual Sex

A retrospective study was conducted on 134 HIV-infected females evaluated at an HIV/AIDS centre in south India to characterize their socio-demographics, HIV risk factors and initial clinical presentations. The mean age was 29 years; 81% were housewives; 95% were currently or previously married; 89% reported heterosexual sex as their only HIV risk factor; and 88% reported a history of monogamy. The majority were of reproductive age, thus the potential for vertical transmission of HIV and devastating impacts on families is alarming. Nearly half of these women initially presented asymptomatically implying that partner recruitment can enable early HIV detection. Single partner heterosexual sex with their husband was the only HIV risk factor for the majority of women. HIV prevention and intervention strategies need to focus on married, monogamous Indian women whose self-perception of HIV risk may be low, but whose risk is inextricably linked to the behaviour of their husbands.

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Abstract WMP14: Association of Systolic Blood Pressure, LDL Cholesterol, and Hgb A1c With White Matter Hyperintensity on MRI in the ACCORDION MIND Study

Stroke ◽

10.1161/str.51.suppl_1.wmp14 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Adam H de Havenon ◽

Tanya Turan ◽

Rebecca Gottesman ◽

Sharon Yeatts ◽

Shyam Prabhakaran ◽

...

Keyword(s):

Blood Pressure ◽

Risk Factor ◽

Regression Models ◽

Ldl Cholesterol ◽

Vascular Risk Factor ◽

White Matter Hyperintensity ◽

Vascular Risk ◽

Linear Regression Models ◽

Risk Factor Profile ◽

The Mean

Introduction: While retrospective studies have shown that poor control of vascular risk factors is associated with progression of white matter hyperintensity (WMH), it has not been studied prospectively. Hypothesis: We hypothesize that higher systolic blood pressure (SBP) mean, LDL cholesterol, and Hgb A1c will be correlated with WMH progression in diabetics. Methods: This is a secondary analysis of the Memory in Diabetes (MIND) substudy of the Action to Control Cardiovascular Risk in Diabetes Follow-on Study (ACCORDION). The primary outcome was WMH progression, evaluated by fitting linear regression models to the WMH volume on the month 80 MRI and adjusting for the WMH volume on the baseline MRI. The primary predictors were the mean values of SBP, LDL, and A1c from baseline to month 80. We defined a good vascular risk factor profile as mean SBP <120 mm Hg and mean LDL <120 mg/dL. Results: We included 292 patients, with a mean (SD) age of 62.6 (5.3) years and 55.8% male. The mean number of SBP, LDL, and A1c measurements per patient was 17, 5, and 12. We identified 86 (29.4%) patients with good vascular risk factor profile. In the linear regression models, mean SBP and LDL were associated with WMH progression and in a second fully adjusted model they both remained associated with WMH progression (Table). Those with a good vascular risk factor profile had less WMH progression (β Coefficient -0.80, 95% CI -1.42, -0.18, p=0.012). Conclusions: Our data reinforce prior research showing that higher SBP and LDL is associated with progression of WMH in diabetics, likely secondary to chronic microvascular ischemia, and suggest that control of these factors may have protective effects. This study has unique strengths, including prospective serial measurement of the exposures, validated algorithmic measurement methodology for WMH, and rigorous adjudication of study data. Clinical trials are needed to investigate the effect of vascular risk factor reduction on WMH progression.

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MO765CENTRAL VEIN STENOSES IN HD PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab103.003 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Aleksei Zulkarnaev ◽

Andrey Vatazin ◽

Vadim Stepanov ◽

Ekaterina Parshina ◽

Mariya Novoseltseva

Keyword(s):

Risk Factor ◽

Vascular Access ◽

Dwell Time ◽

Clinical Symptoms ◽

Clinical Signs ◽

Cox Proportional Hazards ◽

Important Risk Factor ◽

Central Vein ◽

Increased Risk ◽

The Mean

Abstract Background and Aims The prevalence of central vein stenosis (CVS) in patients on hemodialysis (HD) is difficult to be assessed directly. This is mainly caused by the variety of clinical signs and the high frequency of asymptomatic CVS. Aim: to assess the frequency of occurrence of various CVS forms in HD patients. Method The retrospective observational study is based on the results of treatment of 1865 HD patients who underwent diagnostic and therapeutic procedures on vascular access in our center. In case of vascular access dysfunction, patients were examined according to a local protocol: ultrasound of the peripheral (to exclude lesion of peripheral AVF segments) and central veins (over the available length), followed with CT-angiography or percutaneous angiography, if necessary. Results AVF/AVG dysfunction was observed in 29.4% of patients (549 of 1865). 211 patients were diagnosed with CVS. The prevalence of CVS was 11.3% (211 of 1865) among all HD patients and 38.4% (211 of 549) in patients with AVF dysfunction. Among patients with CVS, 37% (78 of 211) had vein lesions without clinical symptoms or with minimal manifestations (a tendency to decrease KT/V). The prevalence of asymptomatic CVS was 4.2% (78 of 1865) in the general population of HD patients and 14.2% (78 of 549) in patients with AVF dysfunction. In case of asymptomatic CVS it was detected by an ultrasound examination during CVC implantation (N=38), during unsuccessful attempts to implant CVC (N=29), in the case of recurrent AVF thrombosis without underlying peripheral segments lesion (N=9) or during echocardiography (N=2). The prevalence of asymptomatic CVS among patients without AVF dysfunction was 5.9% (78 of 1316). True prevalence of subclinical CVS among HD patients without obvious signs of AVF dysfunction may vary widely. A total of 48.8% (103 of 211) of all CVS cases were treated. At the same time, in 10.7% (11 of 103) of cases, patients did not present symptoms of CVS, and surgery was performed due to recurrent AVF thrombosis without damage of the peripheral parts of AVF. Patients with clinically manifest CVS who received endovascular interventions had a significantly higher risk of AVF loss compared to patients with asymptomatic CVS: HR=2.566 [95% CI 1.706; 3.86], log rank p<0.0001. However, patients with an asymptomatic CVS had a higher risk of AVF function loss compared to the general HD population (HR=2,051 [95% CI 1,243; 3,384], log rank p= 0.0004) – fig. 1. The use of CVC is a known risk factor of CVS development. We analyzed the relationship of CVS risk with multiply CVC placements and catheter dwell time using the Cox proportional hazards regression model (fig. 2). In the univariate model, a greater No of CVCs as well as longer time in place increased the risk of CVS. In the multivariate model (χ2=105.516, df=2, p<0.0001), catheter dwell time was no longer associated with an increased risk of CVC, while the mean number of inserted catheters remained an important risk factor. Conclusion The prevalence of both symptomatic and asymptomatic forms of CVS in HD patients is high. Patients with vascular access dysfunction should be carefully examined to identify the asymptomatic CVS. The mean No of catheterizations is a more important risk factor of CVS than longer catheter dwell time.

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Effect of ageing on plasma lipoprotein(a) levels

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1258/0004563021901937 ◽

2002 ◽

Vol 39 (3) ◽

pp. 237-240 ◽

Cited By ~ 11

Author(s):

Harukuni Akita ◽

Miyao Matsubara ◽

Hitoshi Shibuya ◽

Hirotoshi Fuda ◽

Hitoshi Chiba

Keyword(s):

Molecular Weight ◽

Coronary Heart Disease ◽

Risk Factor ◽

Heart Disease ◽

The Elderly ◽

Low Molecular Weight ◽

Lipoprotein A ◽

Significant Difference ◽

The Mean ◽

Japanese Subjects

Background Lipoprotein(a) [Lp(a)] is a risk factor for atherosclerosis and increases with age. The purpose of this study was to determine the effect of ageing on Lp(a) for three different apo(a) phenotypes. Methods We measured plasma Lp(a) concentrations in 551 unrelated Japanese subjects (20-88 years of age). We performed statistical analyses separately for three apo(a) phenotypes: the low-molecular-weight (LMW) phenotype with the F, B or S1 isoform, the intermediate-molecular-weight (IMW) phenotype with the S2 isoform and the high-molecular-weight (HMW) phenotype with the S3 or S4 isoform. Results For each phenotype, the mean plasma Lp(a) concentration and the frequency of Lp(a) concentrations ≥ 250 mg/L increased with age. Further, a statistically significant difference was always found between the younger subjects (20-39 years of age) and the elderly (over 60 years). The frequency of coronary heart disease increased with age, particularly for the LMW and IMW phenotypes. Conclusions We conclude that ageing elevates plasma Lp(a) concentrations, which may have a role in the prevalence of coronary heart disease in the elderly, especially those with the LMW or IMW phenotypes.

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Measurement of pharyngeal segments in Obstructive Sleep Apnea

Brazilian Dental Science ◽

10.14295/bds.2018.v21i1.1486 ◽

2018 ◽

Vol 21 (1) ◽

pp. 64

Author(s):

Marcos Marques Rodrigues ◽

Lucas Borin Moura ◽

Ariane De Souza Oliveira ◽

Marisa Aparecida Cabrini Gabrielli ◽

Valfrido Antonio Pereira Filho ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cone Beam Ct ◽

Sleep Apnea Syndrome ◽

Upper Airway ◽

Cone Beam ◽

Obstructive Sleep ◽

Intimate Relation ◽

The Mean ◽

Cephalometric Measurements

Objective: Obstructive Sleep Apnea (OSA) occurs by recurrent collapse of the upper airway during sleep. It results in complete (apnea) or partial (hypopnea) reduction of airflow and has intimate relation with the upper airway anatomy. Cephalometric analysis has been used to quantify airway dimensions. The aim of this study is evaluate the correlation between the anteroposterior dimension of the upper airway and the severity of obstructive sleep apnea. Material and Methods: A retrospective analysis was performed reviewing polysomnographic data (AHI) and anteroposterior cephalometric measurements of pharynx subregions: nasopharynx, oropharynx, hypopharynx. Results: The sample consisted of 30 patients. The mean body mass index was 29.60 kg/m2 and the average age was 46.8 years. Nine patients presented severe OSA, seven had moderate OSA , seven had mild OSA, and seven were healthy. The Pearson's correlation index between the anteroposterior dimension of the nasopharynx, oropharynx and hypopharynx and AHI was respectively -0.128 (p=0.517), -0.272 (p=0.162) and -0.129 (p=0.513). Conclusion: The correlation between anteroposterior linear dimension of the airway and OSA severity, assessed by AHI, was not positive. As an isolated parameter it did not correlate to the severity of the obstrucive sleep apnea syndrome and should be evaluated in conjunction with other factors. KeywordsUpper Airway; Obstructive sleep apnea; Cone beam CT.

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Differences in Risk Factors for Retinopathy of Prematurity Development in Paired Twins: A Chinese Population Study

The Scientific World JOURNAL ◽

10.1155/2014/212183 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Gordon S. K. Yau ◽

Jacky W. Y. Lee ◽

Victor T. Y. Tam ◽

Stan Yip ◽

Edith Cheng ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Retinopathy Of Prematurity ◽

Very Low Birth Weight ◽

Significant Risk ◽

The Mean ◽

Record Review ◽

Chinese Twins ◽

Retrospective Medical Record Review

Purpose.To determine the differences in risk factors for retinopathy of prematurity (ROP) in paired twins.Methods.A retrospective medical record review was performed for all paired twins screened for ROP between 2007 and 2012. Screening was offered to very low birth weight (≤1500 grams) and preterm (≤32 weeks) neonates. Twins 1 and 2 were categorized based on the order of delivery. Maternal and neonatal covariates were analyzed using univariate and multivariate regression analyses for both ROP and Type 1 ROP.Results.In 34 pairs of Chinese twins, the mean gestational age (GA) was 30.2 ± 2.0 weeks. In Twin 1, smaller GA (OR = 0.44,P=0.02), higher mean oxygen concentration (OR = 1.34,P=0.03), presence of thrombocytopenia (OR = 1429.60,P<0.0001), and intraventricular hemorrhage (OR = 18.67,P=0.03) were significant risk factors for ROP. For Twin 2, a smaller GA (OR = 0.45,P=0.03) was the only risk factor. There were no significant risk factors for ROP in Twin 1 or Twin 2 on multivariate analysis.Conclusion.In Chinese twin pairs, smaller GA was the only common risk factor for ROP while Twin 1 was more susceptible to the postnatal risks for ROP.

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Sleep apnoea: definition, prevalence, and role in cardiovascular diseases

ESC CardioMed ◽

10.1093/med/9780198784906.003.0256 ◽

2018 ◽

pp. 1058-1062

Author(s):

Olaf Oldenburg

Keyword(s):

Heart Failure ◽

Cardiovascular Disease ◽

Coronary Artery Disease ◽

Risk Factor ◽

Coronary Artery ◽

Negative Impact ◽

Intrathoracic Pressure ◽

Sleep Apnoea ◽

Stroke Severity ◽

Artery Disease

The two main forms of sleep apnoea are obstructive (OSA) and central (CSA) sleep apnoea. In the presence of cardiovascular disease, CSA can manifest as Cheyne–Stokes respiration. OSA and CSA both can cause substantial oxygen desaturations, alterations in sympathovagal balance, neurohumoral activation, and endothelial dysfunction; OSA also causes marked negative intrathoracic pressure swings, which have a number of undesirable cardiovascular consequences (e.g. increased cardiac transmural pressure gradients, sympathetic activation). OSA is the most common type of sleep apnoea in the general population, but rates are higher in cardiovascular disease. CSA is particularly prevalent in patients with underlying cardiac, neurological, or renal disease. Typical OSA risk factors include obesity, male gender, smoking, and age, while the severity of heart failure is predictive of the prevalence and severity of CSA. Recognition and diagnosis of sleep apnoea can be difficult because patients often do not present with typical symptoms. Sleep apnoea is an important co-morbidity in cardiovascular disease because of links with a number of conditions. OSA is an independent risk factor for the development of hypertension and heart failure, and has a negative impact on the effectiveness of treatments for atrial fibrillation. OSA has also been linked with the development of coronary artery disease, worse outcomes after acute myocardial infarction, and higher event rates in patients with coronary artery disease. CSA with Cheyne–Stokes respiration has important links with heart failure and is a risk factor for poor outcome even when other therapies are optimized. Cheyne–Stokes respiration has also been documented in stroke patients, increasing stroke severity and worsening prognosis.

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